bluuebunny/crossref_metadata_2025 huggingface dataset:
LOW RESILIENCE FACTORS AND MINORITY RACE PREDICT QUALITY-OF-LIFE DEFICITS AMONG OLDER ADULTS WITH CHRONIC DISEASE
Authors: Nkwata Allan , Song Xiao , Zhang Ming , Ezeamama Amara
Published: December 2023

Resilience-promoting factors (RPF), minority race and their interaction, were evaluated as determinants of quality of life (QOL) decline in a nationally representative sample of US adults ≥50 years old (N=3932) with heart disease and/or type-2 diabetes from 2006-2014 as part of the Health and Retirement Study. RPF included personal mastery and positive social support (PSS). QOL was assessed by self-rated health (SRH) and defined as poor (fair/poor), good, or excellent (very good/ excellent). Repeated measures multinomial regression using generalized estimating equations (GEEs) related RPF, race, and their interaction to SRH declines over 8 years. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated with adjustment for time, sociodemographic and behavioral confounders. Low mastery, low PSS and minority race were each associated with higher odds of QOL declines over 8 years (mastery OR- 2.27, 95% CI: 1.83- 2.81; PSS OR- 1.35, 95% CI: 1.10-1.65; African American OR- 1.46, 95% CI: 1.25-1.70, and Other race OR- 1.43, 95% CI: 1.10-1.86). QOL declines related to PSS-friends varied by race and time (race x time x PSS-friends, p=0.093). Among older Caucasians, the association between PSS and QOL declines did not vary over time (p=0.676). However, among African Americans and Other race, low PSS was associated with increased odds of QOL declines over time (p=0.031 and p=0.034 respectively). RPF and minority race predicted QOL decline in older Americans with comorbid conditions. Policies/ interventions to enhance resiliency represent a viable strategy for mitigating racial disparities in overall wellbeing and improving health outcomes in aging Americans.
SOCIOECONOMIC DETERMINANTS OF FRAILTY TRAJECTORIES AMONG OLDER ADULTS IN SWITZERLAND (2004–2020)
Authors: Cheng Mengling
Published: December 2023

Frailty in old age is a major public health challenge. Frail older adults are at higher risk of adverse health outcomes and in greater needs for health services as compared to non-frail older adults. An emerging perspective views frailty as a dynamic process and older adults are likely to transition to improved frailty status. However, little is known about the socioeconomic determinants of frailty trajectories over the later life course. This study investigated how frailty evolves and transitions over time and how socioeconomic status impacts frailty trajectories. Data from the Survey of Health, Ageing and Retirement in Europe 2004-2020 (N=4,621 adults aged 50-105 in Switzerland) were analyzed. Fried’s phenotype was used to operationalize frailty. Changes in frailty status at a 2-year interval were used to identify frailty trajectories. Growth curve models were performed to investigate how age, sex, education, occupation, and income determined frailty trajectories over the later life course. This study had three findings. First, three frailty states were identified: non-frail, pre-frail, and frail. Second, five frailty trajectories were identified: stable frail, worsening, mixed, improving, and stable non-frail. Third, individuals aged 65 and above, women, and socioeconomically disadvantaged individuals had a higher risk of being stable frail and having a worsening frailty trajectory. Findings indicate that frailty intervention programs in Switzerland need to prioritize individuals in middle age and old age, women, and individuals with lower socioeconomic status to tackle the challenge of frailty.
ADVERSE CHILDHOOD EXPERIENCES AND DEPRESSIVE SYMPTOMS IN MIDDLE-AGED AND OLDER CHINESE ADULTS
Authors: Wei Wenxing , Townsend Aloen
Published: December 2023

Prior research has shown a significant effect from adverse childhood experiences (ACEs) to depressive symptoms in later adulthood, but there is very limited research on this relationship in China. This study examines the relationship between multiple childhood adversity indicators (childhood abuse, bullying victimization, and witnessing violence) and depressive symptoms in Chinese middle-aged and older adults by gender. The study was based on a nationally representative sample of 10,371 participants aged 45 and older collected through the China Health and Retirement Longitudinal Study (CHARLS). Childhood adversity indicators in the 2014 Life History Survey were merged with the harmonized 2018 CHARLS dataset. Structural equation modeling was conducted separately for males and females because the measurement model was not invariant by gender. Childhood abuse was not a significant predictor for either gender but bullying victimization and witnessing violence were significant. Witnessing violence was a stronger predictor for females (gamma = .15, p < .001) than for males (gamma = .08, p < .05). For both groups, childhood adversity variables together accounted for 6% variance in depressive symptoms. Experiences of being bullied in school and community and witnessing violence in the family were still influential in middle and late life. Figuring out what role ACEs are playing and how to deal with their effects are vital to providing more effective prevention and interventions. Further investigations are required, for example, regarding the mechanisms behind the significant relationships and why childhood abuse was not a significant predictor among this Chinese sample.
AN INTERNATIONAL PERSPECTIVE ON GOAL SETTING AND INTERDISCIPLINARY COLLABORATION WITHIN REABLEMENT PROGRAMS
Authors: Buma Lise , Tuntland Hanne , Zwakhalen Sandra , Metzelthin Silke
Published: December 2023

Over the last two decades, reablement has been studied and implemented in more than 16 countries. It is a person-centred approach aiming to enhance individuals’ (physical) functioning and increase or maintain their independence in meaningful activities. Goal setting and interdisciplinary collaboration are identified as important key elements of reablement. Due to limited intervention descriptions in the scientific literature, it is not clear how these two elements are applied in practice. This hinders the uptake of reablement services among healthcare care providers on national and international level. This study aimed to provide insight into: (1) goal setting; and (2) interdisciplinary collaboration within reablement programs. Therefore, a qualitative study in Norway and the Netherlands was conducted. In both countries, reablement staff (n=14) was interviewed. Data was analysed using both deductive and inductive content analysis. To increase rigor in terms of credibility, transferability, dependability and conformability; member checking, uniform data collection methods, note-taking, and direct quotations were used to analyse and present the data in this study. These focus groups resulted in, on the one hand, a clear overview of procedures regarding goal setting, treatment and evaluation methods, and on the other hand, valuable insights into staff experiences regarding interdisciplinary collaboration. In addition, facilitators and barriers for the implementation of goal setting and interdisciplinary collaboration in reablement programs were identified. This study resulted in valuable knowledge for healthcare providers to effectively implement reablement in practice.
HOW ELDERLY PEOPLE INTERACT AFTER THEIR RETIREMENT WITH THE COVID-19 ERA IN JAPAN
Authors: Yokota Fumihiko , Nishikitani Mariko , Tucker Gretchen , Bradley Dana
Published: December 2023

Amid the COVID-19 pandemic, little is still known about how older Japanese people socialize after retirement. This paper aims to describe the dynamics of social interactions in post-retirement older adults during the COVID-19 pandemic. From January to March 2021, we interviewed 17 Japanese elderly people in Fukuoka and Ehime who were over 65 and have already retired. Face-to-face Interviews were conducted using a semi-structured questionnaire. After the initial transcripts were translated from Japanese to English, we checked the transcripts for accuracy and coded for analysis. The participant’s mean age was 71 years old while their retirement’s mean age was 60 years old. Only one participant had full retirement while the rest were partial retired which they continued to work as part-time workers either with new employers or with the same employers. All participants reported that their social interaction became estranged after retirement, and disrupted during the COVID-19 pandemic. However, participants communicated online and/or interacted face-to-face with (1) neighboring people as a member of community association or volunteers, (2) ex-work colleagues, (3) old schoolmate, (4) their children and/or grand-children, (5) friends with the same hobbies. Following factors that may affect the interactive behavior of Japanese older people were identified; (1) Japan’s healthcare policy and pension system, (2) individual’s socio-economic status, (3) family structure and living arrangement, (4) community’s characteristics, (5) individual’s psychological, cognitive and health status, and (7) individual’s personality. Comparisons of social interactions between Japanese and US older adults will be important to find new knowledge for preventing social isolation.
LEVEL OF OBSTACLES BETWEEN WORK AND CARE PROVISION AND LIFE SATISFACTION AMONG JAPANESE WORKING FAMILY CAREGIVERS
Authors: Honda Ayumi , Liu Yin , Fauth Elizabeth , Honda Sumihisa
Published: December 2023

Objectives

This study aimed to examine whether facing obstacles between work and care provision (work/care obstacles) is a risk factor for life satisfaction and explore whether it moderates the association between care burden and life satisfaction among Japanese working family caregivers.

Methods

This cross-sectional study was conducted on 141 working family caregivers aged less than 65 years who were living with an older care recipient. We fit a multiple logistic regression model to examine the main and moderating effect of work/care obstacles on life satisfaction, in the context of care burdens.

Results

Facing work/care obstacles had a main effect on life satisfaction among employed family caregivers. Furthermore, work/care obstacles exacerbated the association between caregiver burden and life satisfaction. As for the family caregivers who did not experience work/care obstacles, the risk of poor life satisfaction did not differ regardless of number of caregiver burdens. In contrary, the family caregivers who experienced work/care obstacles and had 2 or more caregiver burdens had a poor life satisfaction (odds rations = 5.5, 95% confidence intervals = [1.97, 15.43]) compared with those who had 1 or less caregiver burden.

Conclusion

These findings suggest that obstacles between work and family was a risk factor for poor life satisfaction for employed individuals in Japan caring for an older relative. Mitigating such obstacles may be important for job retention, given the growing number of older adults in Japan. Key words Facing obstacles between work and care provision, family caregiver, life satisfaction, well-being, work–life adaptation
SOCIOECONOMIC GRADIENTS IN DEPRESSIVE SYMPTOMS AMONG OLDER ADULTS IN RURAL SOUTH AFRICA
Authors: Verma Mansi , Kobayashi Lindsay
Published: December 2023

Depression is one of the most common mental health disorders throughout the globe with an estimated 300 million people affected worldwide. Socioeconomic status may influence depression risk, due to its status as a critical influencing factor for health-related issues as well as serving as a barrier for healthy aging. The objective of this analysis was to examine the presence of socioeconomic gradients in depressive symptoms among older adults in Agincourt, a low-income rural region of South Africa. We conducted a cross-sectional analysis of baseline interview data from 2014/2015 for 5,059 participants aged ≥40 in the population-representative Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI). Household wealth was assessed as quintiles of an asset-based index, including ownership of assets such as housing materials, electricity, piped water, vehicles, and technological goods. Household per capita consumption on food, healthcare, leisure activities, and other goods was also assessed as quintiles. The presence of depressive symptoms was measured and categorized using the 8-item Center for Epidemiologic Studies Depression (CES-D) scale. We used multivariable adjusted logistic regression to examine the association between household wealth and household consumption quintiles and depression. In this study population, the prevalence of depressive symptoms was 17%. We observed no significant trends between household wealth, household consumption and depression (p=0.11 for both exposures). Depressive symptoms are not socioeconomically graded among older, rural South Africa adults. The high prevalence of depressive symptoms within the region should be considered as a public health concern.
THE ROLES OF COLATEC SOCIAL DANCING IN HEALTHY AGING AMONG KOREAN OLDER ADULTS
Authors: Lee Milae , Wu Xingxing , Payne Laura
Published: December 2023

Leisure activities can contribute to healthy aging (An et al., 2022). However, little research exists on leisure activities with soft stigma (Kraus, 2010). Yet, social dancing in Colatec (i.e., Korean daytime discos for older adults) is becoming more popular among older Koreans. Using qualitative methods, we examined how Colatec social dancing affects Korean older adults’ healthy aging. Thirteen participants aged 60 to 75 who regularly social dance at Colatecs voluntarily participated in an in-depth semi-structured interview that lasted between 45 to 75 minutes. The audiotaped interviews were transcribed verbatim, coded, and analyzed following interpretive phenomenological analysis (Smith & Osborn, 2003). Trustworthiness was assessed with member checking and researcher triangulation. Results revealed that although it is still culturally stigmatized, Colatec social dancing was essential for participants’ healthy aging. Participants perceived numerous benefits from social dancing that motivated their enduring engagement, despite the risks of the social stigma associated with Colatec dancing. Themes that emerged included: 1) Exercise from social dancing alleviated stress and depressive feelings associated with negative life events; 2) Colatec dancing boosted many participants’ self-esteem, enhancing their overall wellbeing; and 3) Meaningful social connections were developed among participants. Findings align with existing literature on how moderate physical activity contributes to older adults’ health (Bauman et al., 2016). Moreover, leisure serves as a social lubricant and enhances healthy aging (Mitas et al., 2011). Lastly, perceived by participants as a “playground”, Colatec affords older Koreans a space for engaging leisure activity which facilitated their healthy aging process (Heo et al., 2018).
TYPOLOGIES OF SOURCE OF CARE AMONG OLDER ADULTS: A COMPARATIVE STUDY OF CHINA AND THE UNITED STATES
Authors: Kong Dexia , Lu Peiyi
Published: December 2023

Background

We investigated typologies of source of care for older adults in China and the United States and applied Anderson Health Behavior model to examine associated significant determinants.

Methods

Cross-sectional data from 2014 Health and Retirement Study and 2013 China Health and Retirement Longitudinal Study were used. We included older respondents aged 65+ who had at least one limitation in activities of daily living (ADL) and instrumental ADL (IADL) (NChina=2,482, NUS=3,152). Respondents reported whether they received assistance with ADLs and IADLs from spouse, child/grandchild, relatives, other, and formal helpers, respectively. We employed latent class analysis to characterize the typologies of sources of care and multinomial logistic regression to examine the significant determinants of identified typologies.

Results

Four classes were identified in China: class 1 (59.91%) minimal care with IADL assistance from child/grandchild; class 2 (8.66%) child/grandchild-based care; class 3 (27.96%) spouse-based care; and class 4 (3.46%) spouse/child/grandchild-based care. Five classes were identified in the US: class 1 (51.97%) minimal care overall with limited spousal support; class 2 (20.88%) child/grandchild-based care; class 3 (8.44%) spouse-based care; class 4 (13.20%) formal care plus child/grandchild support; and class 5 (6.31%) various sources. In both countries, ADL and IADL were significant determinants.

Conclusion

In the US, sources of care were more diverse and included formal assistance. In contrast, older Chinese relied largely on their spouses and children/grandchildren for support. In both countries, physical circumstances are significant determinants. Policy efforts on supporting family-based care and expanding formal care are needed in both countries, particularly China.
AGING, MIGRATION, AND GRANDPARENTING IN POST–ONE CHILD POLICY CHINA
Authors: Zhang Nan
Published: December 2023

China’s rapid rural-urban migration and population ageing are posing significant challenges to traditional patterns of intergenerational familial support. To tackle population ageing, China’s one-child policy has been replaced by a two-child policy, subsequently a three-child policy. With limited institutional childcare facilities in place, ageing grandparents from rural areas often move to the cities where their adult migrant children settle to provide care for grandchildren. This group of older, rural people are largely marginalised and are invisible on the current research and policy agenda. This ongoing study, conducted in the Yangtze River delta urban area — one of the most developed, crowded, and the largest migrant-receiving urban regions in China — aims to uncover their experiences during the process of migration and adaptation, and establish the way in which this arrangement of grandparenting has impacted their everyday lives and well-being. Three compelling themes emerged at this stage: 1) intensified caring responsibilities imposed on older women largely owing to patriarchy; 2) intersection of old age, being women and exclusion of social welfare due to having a rural origin contribute to poor well-being; 3) the feeling of a lack of balance in terms of family exchange over the life course is not uncommon. It is possible that urbanisation will reinforce vulnerability and marginalisation of and exacerbate social exclusion of older women from rural origin. This project will form an important evidence base to tackle issues such as social exclusion of disadvantaged communities in China against the backdrop of rapid population ageing and urbanisation.
CONNECTING OLDER ADULTS AND DOCTOR OF PHYSICAL THERAPY STUDENTS THROUGH A COMMUNITY-BASED EXERCISE PROGRAM
Authors: Moriello Gabriele , Hamilton Alice , Bush Julie , Nunno-Evans Michelle , Schoellig Shannon , Hollins Nancy
Published: December 2023

The purpose of this qualitative study was to explore the perspectives of older adults regarding their experience participating in an intergenerational Integrated Clinical Experience (ICE) with Doctor of Physical Therapy (DPT) students. This ICE was designed as a community-based exercise program for older adults. DPT students designed individualized one-hour fitness plans for participants every week over the course of a semester. To obtain the perspectives of older adults, a descriptive phenomenological approach was chosen. A purposive sample of 16 older adults involved in the wellness program participated in 6 focus groups and one interview. Results of the thematic analysis revealed six themes; Blending of the Generations, It Motivated Me, I Can Do It Now, Mental and Social Boost, Program Tailored to Me, and Learn and Modify Habits. Participant interviews highlighted how older adults highly valued the relationships with students, and how the intergenerational environment of the program benefited their physical, social, and mental well-being. They also noted how students served as a source of motivation, leading to behavioral change and improvements in functional outcomes. These findings support existing literature on intergenerational programs, but this is one of the few studies that looked specifically at an intergenerational ICE. This ICE provided an innovative manner to meet the physical challenges faced by many older adults, and the intergenerational nature of the experience may have contributed to the well-being of all those involved. Future research using quantitative methods are needed to extend what was learned beyond the specific context of this study.
SOCIAL DETERMINANTS OF HEALTH RELATED TO GENREAL PHYSICIAN VISITS IN OLDER ADULTS LIVING WITH MULTIMORBIDITY
Authors: Benjasirisan Chitchanok , Lim Arum , Liu Xiaoyue , Ogungbe Oluwabunmi , Himmelfarb Cheryl Dennison , Davidson Patricia , Koirala Binu
Published: December 2023

Multimorbidity- the presence of two or more chronic conditions- is a global concern and is commonly associated with aging. Multimorbidity results in diminished physical function, higher healthcare utilization, and increased mortality rates. To understand healthcare challenges and increase prevention and continuity of care among older adults living with multimorbidity, the social determinants of health (SDoH) affecting general physician visits need to be explored. This study aimed to examine SDoH associated with general physician visits among 50 years and older adults living with multimorbidity using cross-sectional data from the 2010 to 2018 National Health Interview Survey. The SDoH, including marital status, race/ethnicity, education, poverty-income ratio, employment, health insurance, and having a usual place for medical care, were explored using logistic regression. The outcome was at least one visit to the general doctor’s office, a clinic, or elsewhere in the last 12 months. Among 25,108 participants (mean age ± SD was 68.1±10.16 years, 55.5% female, with 2.7±0.95 average number of self-reported morbidities) adjusted analysis controlling for age, sex, and categories of comorbidities found that Hispanic (OR=0.78, 95%CI=0.66-0.91), living below the poverty level (OR=0.79, 95%CI=0.68-0.92), and uninsured (OR=0.52, 95%CI=0.42-0.63) had lower odds of having one or more physician visits. Being unemployed (OR=1.26, 95%CI=1.11-1.42) and having a usual place for medical care (OR=7.94, 95%CI=6.39-9.86) had higher odds of having one or more physician visits. The result suggested that SDoH should be considered to navigate targeted health programs and policies to improve prevention and management of multimorbidity as well as to promote health equity.
A DIGITAL LIFE STORY BOOK ACTIVITY FOR OLDER ADULTS WITH MEMORY DIFFICULTIES: PROGRAM EVALUATION
Authors: Barbour Elizabeth , Lind Majse , Bluck Susan
Published: December 2023

Reminiscence activities are based on maintaining a core set of personal memories to aid self-continuity (Woods, 2012). Some interventions find limited effects (Charlesworth et al, 2016) but with participants reporting high satisfaction with the program. The aims of the current study were to: (i) demonstrate feasibility of intervention delivery to older individuals with memory difficulties, and (ii) provide analyses of program efficacy using a pre-posttest, control group design. Participants (N = 45; Mage = 76.12) were randomized to the Life Story Book intervention or Waitlist Control. A Life Story Book Interview was developed, using five evidence-based principles of autobiographical memory. Personalized multimedia books were created and reviewed by participants for fourteen days. To assess feasibility, participants in the intervention completed a memory quality questionnaire and feedback survey. Those who reviewed Life Story Books reported improved memory quality pre-post intervention, t(22) = -2.39, p = .026. Participants also positively rated their intervention experience at post-test, (M = 4.46/5). All participants completed self-related questionnaires (e.g., self-continuity, self-esteem) at pretest-posttest. No measure showed significant effects. Our results represent a conundrum for researchers. We provide evidence of feasibility of, and participant enthusiasm for, this reminiscence-based intervention. As seen in the literature, however, (Elfrink et al., 2021), sensitivity to detect pretest-postest change remains a challenge. The current study highlights participants positive reactions to reminiscence-based Life Story Books. Findings are discussed in terms of methods for assessing intervention efficacy in individuals with memory decline.
CONSEQUENCES OF PERCEIVED STRESS ON COGNITIVE DECLINE AND BLOOD PRESSURE AS A MODERATOR IN OLDER BLACK AMERICANS
Authors: Byrd DeAnnah , Coon David , Thorpe Roland J , Whitfield Keith
Published: December 2023

Previous research suggests that perceptions of stress shape cognitive health outcomes. However, few studies have explored this association longitudinally. The aim of this study was to determine whether perceived stress is associated with cognitive changes over time and if blood pressure (BP) acts as a moderator in a sample of older Blacks 48 to 95 years of age, who were enrolled in the Baltimore Study of Black Aging—Patterns of Cognitive Aging and interviewed at two time points, approximately 3 years apart (N = 450). Cognition included 5 domains: working memory, processing speed, verbal memory, vocabulary, and inductive reasoning. Three readings of orthostatic BP were collected and mean systolic (range = 82-230.3 mmHg) and diastolic BP (range = 51-136.7 mmHg) values were calculated for each participant. Results from the linear regression model showed no direct effect of perceived stress on cognitive decline. Systolic (F(3,426)= 4.37, p= 0.0048) and diastolic (F(3,426) = 3.26 p=0.0215) BP modified the relationship between stress and inductive reasoning at follow-up but was not related to any other cognitive domains, adjusting for age, sex, education, depressive symptoms, comorbidities, and baseline cognition. These important findings demonstrate the joint effects of stress and BP on cognition, highlighting the need for more research documenting the underlying processes and risk factors for domain-specific cognitive decline. The potential benefits of this approach provide a basis for developing cognitive interventions for this population of Black Americans.
CAREGIVER IDENTITY IN EMERGING ADULTHOOD: HOW IDENTITY DISCREPANCY AND SALIENCE RELATE TO DISTRESS
Authors: Canell Anastasia , Caskie Grace
Published: December 2023

As the older adult (age 65+) population grows in the United States, the demographics of caregivers are expanding to include more emerging adults (ages 18-25) who are participating in caregiving tasks. Minimal research has focused on this subgroup of caregivers to older adults, especially with regards to understanding factors that may influence their levels of caregiver distress. Guided by caregiver identity theory, the current study examined 1) the relationship between caregiver identity and caregiver distress, 2) support service utilization as a mediator between caregiver identity and caregiver distress, and 3) the inclusion of ageist attitudes within caregiver identity models. A sample of 259 emerging adult caregivers were recruited through Amazon MTurk. Fit of the hypothesized structural equation model was acceptable and squared multiple correlations (R2) indicated that 73.1% of the variance in caregiver distress, 23.8% of the variance in support service utilization, and 22.7% of the variance in ageist attitudes was explained by this model. Higher caregiver identity salience was significantly related to lower caregiver distress. Support service utilization partially mediated the relationship between identity salience and distress through an inconsistent mediation. The findings of the current study support caregiver identity as a unique, multidimensional process consisting of both identity discrepancy and salience latent constructs. Results showed low-to-moderate caregiver identity discrepancy, possibly due to identity flexibility during this developmental period. High caregiver identity salience was protective against caregiver distress for emerging adults. Ageist attitudes warrant inclusion in future research on caregiving identity development. Implications for support services are discussed.
EXPERIENCES AND SUPPORTIVE CARE NEEDS OF LATINX MILLENNIAL CAREGIVERS
Authors: Welling Anna , Hebdon Megan Thomas , Dupree Galilea , Horner Sharon , Thomas Michael , Peterson Neil , Hernandez Janice , Cuevas Heather
Published: December 2023

Latinx millennial caregivers are the largest ethnic minority subgroup within the millennial caregiving cohort. Due to age and life stage, members of this understudied group must often manage the competing priorities of career, family, and caregiving. Layered with these challenges are the experiences of being part of a minority group in the United States, with systemic barriers impacting access to healthcare, insurance, a safe built environment, and educational opportunities. The purpose of this qualitative descriptive study was to explore the experiences and needs of Latinx millennial caregivers. Participants were recruited locally and nationally using recruitment flyers and social media advertising. Data were collected from 29 participants using five focus group interviews and one individual interview. Data analysis using interpretive thematic analysis and inductive coding occurred. Twenty female and nine male Latinx millennial caregivers participated in the focus groups. Two meta-themes threaded throughout the analysis included the Latinx experience (immigrant background, Latinx culture, and navigating barriers as a minoritized individual) and being a super-caregiver. Main themes were identified: family well-being, occupational and financial well-being, social support dynamics, challenges and rewards of family caregiving, and coping strategies. Family and community were emphasized in all main themes. In this study, the importance of family and community relationships motivated caregiving and were areas where support was needed for Latinx millennial caregivers. Interventions and clinical support for these caregivers is needed that addresses their cultural background, the value of family and community, and the barriers they experience to accessing care and support.
PREPAREDNESS AND NEEDS AMONG YOUNG, MIDDLE-AGED, AND OLDER ADULT LATINX CAREGIVERS
Authors: Kopera-Frye Karen , Srejon Refat
Published: December 2023

Taking care of one’s family is a primary obligation among Latinx communities. According to CDC’s Behavioral Risk Factor Surveillance System, 22.9% of New Mexican adults reported providing care to a friend or family member in the past 30 days; 10.4 % provided care to an individual with dementia. The southern Border region of New Mexico is remote and desert, with high rates of poverty and inaccessibility to health care and services. Caregivers may feel unprepared for caregiving, lack the knowledge and skills required to provide care, but struggle through because of the importance of La Familia. Adverse physical and psychological consequences have been found; yet those who report greater preparedness exhibit lower levels of strain. Seventy-six primarily female and healthy Latinx caregivers (age range 20-76 years, 30% young, 40% middle-aged, and 30% older adults) were surveyed on caregiving they provide, administered the Preparedness for Caregiving Scale, and asked what types of services are needed in their role. Results indicated the top three provided aspects of caregiving were (in descending order): Food, emotional support, and transportation. Caregivers reported a high degree of preparedness in taking care of the recipient’s physical needs, handling emergencies, and proving overall care. Needed resources included emotional support, financial assistance, and respite. Greater caregiving provision was significantly associated with better health (r =. 53, p = .09) and greater resource needs (r = .35, p <.01). Thus, level of preparedness is an important caregiving dimension to address, especially with culturally diverse communities having strong cultural caregiving norms.
A LEAP! FORWARD?: DOES PERSONALIZED EXERCISE HELP MAINTAIN COGNITIVE FUNCTION IN OLDER ADULTS?
Authors: Medina Valerie , Burns Jeffrey M , Vacek James L , Mahnken Jonathan , Clutton Jonathan , VanSciver Angela , Watts Amber
Published: December 2023

Maintaining cognitive function is important to health in older adulthood. Physical activity can decrease the risk of cognitive decline in older individuals. We tested whether LEAP! Rx, a personalized exercise, and lifestyle education program would improve cognition in older adults. We randomized 220 participants (Mean age (SD) = 72 (4.83)), into the program or a control group. We used the NIH Toolbox Cognitive Battery to assess cognition. We analyzed change in cognitive performance from baseline to week 12 using repeated measures ANCOVA to compare the intervention and control groups, adjusting for age, gender, and education. Referral source (self- vs. physician-referred), treatment group (intervention vs. control), and measurement time (baseline vs. week 12) had a significant three-way interaction F(8, 212) = 4.57, p< 0.05. That is, clinician-referred participants in the intervention group improved more (vs. the clinician-referred control group), whereas self-referred control group participants improved more (vs. the self-referred intervention group). Older age, male gender, and lower education predicted poorer verbal learning F(1,218 = 18.79, p< 0.05; F(1, 218) = 28.67, p< 0.05; F(1, 219) = 4.13. Overall, cognitive scores improved more over 12 weeks in the intervention group compared to the control group. Thus, we conclude that personalized exercise programs may enhance or maintain cognitive function in older adults. The differences we observed in physician-referred versus self-referred participants has implications for implementation and scalability of health behavior change interventions, as well as implications for recruitment methods and representation in clinical trials research broadly.
IMPACT OF CAREGIVING HOURS ON COGNITIVE OUTCOMES ACROSS ADULTHOOD
Authors: Bhattacharyya Kallol Kumar , Molinari Victor , Liu Yin , Fauth Elizabeth
Published: December 2023

Being a caregiver has been associated with poorer physical health and well-being. The current study expands prior work by comparing cognitive functioning among individuals who were caregivers versus non-caregivers, and further examined varying caregiving hours and cognitive functioning among caregivers. Data were from waves 2 (2003-04) and 3 (2013-14) of the Midlife in the United States (MIDUS) study. A total of 2,075 individuals aged 35-86 years (Mage=55±11) were included from wave 2. We identified individuals who served as a caregiver in the past 12 months (N=264) at wave 2. Cognitive functioning was assessed by composite scores for both executive function (inductive reasoning, category verbal fluency, working memory span, processing speed, and attention switching and inhibitory control) and episodic memory (immediate and delayed free recall of 15 words). We used multiple linear regression models to examine associations between wave 2 caregiving versus non-caregiving status on wave 3 cognitive functioning (Model 1); and, among caregivers at wave 2, varying caregiving hours and wave 3 cognitive functioning (Model 2). After controlling for covariates on sociodemographic factors, and health and functional status at baseline in Model 1, caregiving was associated with better performance in episodic memory (b=.13, p<.05), but not executive function (b=-.06, p=.09). Model 2 revealed no significant association for either episodic memory or executive function. The findings supported the healthy caregiver rather than the stress process hypothesis, and that former caregiving may be associated with better memory functioning over time among middle-aged and older adults.
SEDENTARY BEHAVIORS AND COGNITION: DOES THE TYPE OF BEHAVIOR MATTER?
Authors: Wingood Mariana , Bouldin Erin , Gell Nancy
Published: December 2023

Older adults spend 80% of their waking hours performing sedentary behaviors (SBs) that are either mentally active (e.g., using computers, socializing, and completing hobbies) or passive (e.g., television viewing and resting). Cross-sectional studies report an association between passive SB participation and cognitive impairments. However, longitudinal impact of baseline SB participation on cognition is unclear. We addressed this gap by using the National Health and Aging Trends Study (NHATS) dataset to run competing risks proportional hazards models. In our models, participants were identified as having an event (i.e., outcome) if their cognition scores dropped ≤ 1.5 standard deviations (SD) below the mean during follow-up (rounds 7-11, years 2017-2021). Competing risks included moving to long-term care facilities or dying. Our analyses included 1,574 community-dwelling older adults (mean age 84, SD = 7.1) who completed the sedentary module included in round 6 (year 2016) and had intact orientation, recall, and executive function at baseline. The majority of participants were female (55%) and non-Hispanic white (78%), and reported good or excellent health (80%). We identified that participating in active SBs had a protective effect on orientation, recall, and executive function (subdistribution hazard ratios [SHR]= 0.28-0.46, p< 0.001-0.02). Activities that had significant protective effects across all models included using computers (SHR =0.15-0.46, p=< 0.001-0.001) and socializing (SHR=0.27-0.52, p= < 0.001-0.05). Passive SBs did not have significant SHRs. Our identified protective effects highlight the potential of preventing cognitive impairments through active SB programs. Intervention studies are needed to develop program protocols and identify effectiveness of active SB programs.
STRESSOR VARIETY, SEVERITY, AND IRREGULARITY AND THEIR ASSOCIATIONS WITH DAILY MEMORY LAPSES
Authors: Calfee Kristin , Lee Soomi
Published: December 2023

Long-term negative impacts of chronic stress on memory has been well established; however day-to-day associations between stressors and memory have not been fully examined, with lack of understanding on specific manifestations of stressors that may degrade daily memory. This study conceptualized three patterns of daily stressors: variety, severity, and irregularity. Data came from 1,132 adults who participated in an 8-day diary study as part of the Midlife in the United States study. Participants reported 7 types of stressors (e.g., work-related, home-related, discrimination) they encountered, which was summed daily (variety). On days when a stressor was encountered, they reported how stressful it was (severity). Individual standard deviation of stressor severity across the week (irregularity) was also calculated. Memory lapses were reported with 9 items each day. Results from multi-level modeling revealed that, at the within-person level, participants reported more memory lapses on days when they had greater variety (B= 0.126, SE=0.014, p<.001) or higher severity (B=0.071, SE=0.014, p<.001) of stressors. At the between-person level, participants with greater variety (B=0.717, SE=0.052, p<.001), higher severity (B= 0.168, SE= 0.031, p<.001), or greater irregularity (B= 0.141, SE= 0.047, p=.003) of stressors reported more memory lapses on average. These results were found after controlling for sociodemographic and health covariates. These findings highlight that even short-term stress, particularly severe or inconsistent stress may have a negative impact on day-to-day memory. Potential differences between older (age 65+) and younger (below age 65) adults in the relationship between these daily stressors and memory lapses are currently being explored.
THE DYNAMIC AND RECIPROCAL RELATIONSHIP BETWEEN PERCEIVED DISCRIMINATION AND COGNITIVE FUNCTION IN LATER LIFE
Authors: Amano Takashi , Jia Yuane , Redding-Raines Audrey
Published: December 2023

Studies have suggested that perceived discrimination is a potentially modifiable risk factor for cognitive health in later life. However, there is a lack of focus in the literature on the changes and directionality of the relationship between these two constructs. This study, based on socioemotional selectivity theory, investigates the dynamic and reciprocal relationship between perceived discrimination and cognitive function in later life. Data were drawn from four waves of the Health and Retirement Study (HRS; 2006, 2010, 2014, and 2018). We utilized a subsample of respondents who completed the psychosocial and lifestyle questionnaire in at least three waves. A total of 4,101 people who were 51 and older were included. Cognitive function was measured by the abbreviated version of the telephone interview for cognitive status (TICS-27). Perceived discrimination was measured using scores of the perceived everyday discrimination scale. Random intercept cross-lagged panel model (RI-CLPM) was utilized. Age was associated with lower perceived discrimination (b=-0.224, p<.0001). While lower cognitive function was cross-sectionally associated with higher perceived discrimination in all racial/ethnic groups, higher everyday discrimination predicted subsequent lower cognitive function only among White respondents. The model fit statistics were favorable: CFI=0.968; SRMR=0.045. Results suggested that a decline in cognitive function may exacerbate perceived discrimination which may result in further reduction of cognitive function in general. Lifetime experience of discrimination was discussed as a possible source of the racial/ethnic variations in the relationship. Further study is needed to examine whether this relationship holds among people with cognitive impairment or dementia.
DISPARITIES AND TRENDS IN COMPREHENSIVE PAIN MANAGEMENT AMONG THE ADULT POPULATION IN THE POST-OPIOID EPIDEMIC
Authors: Spataro Sebastián , Candon Molly
Published: December 2023

Introduction

Chronic pain is an epidemic, but there are various therapies that are effective at treating it. Disparities in access to chronic back pain management are well documented. However, studies have largely focused on the gap in utilization between Black and White patients, and on the use opioid therapies. The extent of disparities in utilization for other groups and how disparities by demographics interact with socioeconomic characteristics, are unclear.

Methods

Using insurance claims from Optum Data, we identified patients who had chronic low back pain between 2010- 2020. We measured trends in pharmacological and nonpharmacological therapies, disaggregating measures by sex, age, race/ethnicity, educational attainment, income, and parenthood. We estimated linear probability models to understand which demographic and socioeconomic characteristics were most predictive of utilization.

Results

There were large differences in the utilization of pharmacological and nonpharmacological pain care, with surprising findings. First, we found that Black patients were the most likely to be prescribed opioids, as well gabapentin, muscle relaxers, and NSAIDs, followed by White patients, Hispanics; Asians were the least likely to engage in pharmacological therapy. Linear probability models indicated that the largest predictor of pharmacological and nonpharmacological pain management was education and income.

Discussion

We document disparities in pain management, which point to important policy implications. Preferences of pain management warrant further attention, as our findings suggest that income and education are the largest driver. It could be that the time and out-of-pocket costs associated with nonpharmacological pain management reduce the likelihood that patients opt for these therapies.
FUNCTIONAL MRI TO PREDICT RECOVERY FROM DISORDERS OF CONSCIOUSNESS AFTER BRAIN INJURY
Authors: Rodriguez Bianca , Boivin Christopher , Fischer David
Published: December 2023

Disorders of consciousness (DoC) following brain injury are challenging for families, who often decide about end-of-life care without a clear understanding of a patient’s recovery. This has special significance for older and geriatric populations, as they often rely on caregivers, proxies, and family members in making health and life decisions, and now face the added severity of decisions surrounding continuing treatment. In improving neuroprognostication, we hope to decrease this burden in aging-related decision-making. Functional magnetic resonance imaging (fMRI) has proved helpful in identifying brain activity in DoC with implications for recovery of consciousness, function, and quality of life. This project seeks to develop and implement a standardized fMRI protocol to best induce signals of consciousness in participants and predict the likelihood of neurologic recovery. From there, we will measure how the protocol contributes to an accurate outcome prediction following a DoC as compared to standard methods. The study will be conducted in the intensive care unit(s) of the Hospital of the University of Pennsylvania; we anticipate having an initial analysis of results by Fall of 2023. The study will be enrolling and conducting fMRI’s with the device over one year under a randomized control trial. This study emphasizes improvements in the practice of neuroprognostication after stroke, anoxic brain injury following cardiac arrest, and other related conditions. The literature on these particular forms of traumatic brain injury and neuroprognostication remains limited, which is of disservice to older and geriatric populations who suffer these events at higher rates.
SUBJECTIVE COGNITIVE CONCERNS AND 5-YEAR NEUROPSYCHOLOGICAL TRAJECTORIES IN PARKINSON’S DISEASE
Authors: Luu Britney , Garcia Mary Ellen , Bangen Katherine , Galasko Douglas , Thomas Kelsey
Published: December 2023

Subjective cognitive concerns (SCC) are often associated with Alzheimer’s disease (AD)-related cognitive declines in cognitively unimpaired (CU) individuals. However, it is unknown whether the same is true for CU individuals with Parkinson’s disease (PD). Therefore, this study examined relationships between SCC and 5-year neuropsychological trajectories in CU individuals with newly-diagnosed PD (mean age=60.45 years; 35.2% female) in the Parkinson’s Progression Markers Initiative (PPMI) cohort. Participants were classified as having SCC (n=52) or no SCC (n=204) based on participant or caregiver report for item 1 on the Unified Parkinson’s Disease Rating Scale, part 1. First, baseline cerebrospinal fluid (CSF) biomarkers were examined by SCC group. Next, linear mixed effects models, adjusting for age, education, sex/gender, APOE genotype, psychiatric factors, and motor symptoms examined 5-year trajectories of individual neuropsychological measures by SCC status. Relative to participants without SCC, those with SCC had worse levels of CSF tau (p=.011), p-tau (p=.016), and p-tau/amyloid ratio (p=.003), but not amyloid or alpha synuclein. SCC was associated with faster rates of decline in learning (β=-.059, p=.018), memory (β=-.050, p=.035), and processing speed (β=-.052, p=.031), but not in semantic fluency, visuoperceptual abilities, working memory, or on a global cognition screening measure. Overall, SCC was associated with learning/memory and processing speed declines, but not other measures that may be more PD-specific (e.g., working memory, visuoperceptual). Given the elevated AD biomarkers, SCC may be particularly related to early changes due to co-occurring AD and PD pathology. Future work should investigate longitudinal AD and PD-related biomarker trajectories by SCC status.