bluuebunny/crossref_metadata_2025 huggingface dataset:
DEPICTION OF OLDER ADULTS IN AN INTERNATIONAL PACIFIC RING STUDENT COMPETITION ON OLDER ADULT CARE
Authors: Guillemot Jonathan , Yunus Raudah Mohd , Rueda Ordoñez Carlos Joaquin , Withers Mellissa , Xin Meiqi , Rozelle Mary , Kubasova Ksenia , Hairi Noran Naqiah
Published: December 2023

The Global Health Program of the Association of Pacific Rim Universities (APRU), a consortium of universities in countries surrounding the Pacific Ocean, organized a competition in 2020 named “2020 Case Competition Challenge “Improving Elderly Care in the Asia-Pacific””. It yielded proposals from 28 teams from nine countries in Asia and the Americas in the form of 10-minute videos. Our study aimed to analyze the depiction of older adults to identify patterns of portrayal of older adults among university students. We coded the videos according to a two-step process, whereby we first filtered the videos to identify extracts related to the portrayal of older adults and subsequently coded the dataset according to a list of 10 codes, which were elaborated iteratively during the first step of coding. We analyzed the coded data and identified patterns, which served as a basis for analytical axes. Across included economies, we identified strong patterns of discriminatory discourse and depiction. Older adults were often assumed to be systematically sick, disconnected from the social and technological realities as well as incapable of being active contributors to society. Teams often proposed solutions medicalizing socialization, whereby social interactions were represented as clinical interventions void of meaning. In this unusual approach to studying portrayal of older adults among university students, we found concerning patterns of bias, therefore calling for immediate action towards tackling discrimination at university levels. Considering the pace of global aging, such intervention would contribute the essential view that demographic aging, as such, is not a problem.
CHALLENGES AND OPPORTUNITIES IN RECRUITING DIVERSE OLDER ADULTS WHO ARE FRAIL FROM THE MAPS-B STUDY
Authors: Tariq Suleman , Kouroukis Alexa , Kennedy Courtney , Adachi Jonathan , Leckie Carolyn , Papaioannou Alexandra , Rodrigues Isabel
Published: December 2023

Including diverse individuals at the research and participant levels are essential to improve the effectiveness of real-world interventions; however, there are challenges when including such individuals. Our study purpose was to report the challenges of recruiting diverse older adults for the Mapping Sedentary Behaviour study. Our methods were guided by Step 1 (“Establish Partnerships”) in the Knowledge-to-Action-Ethics Framework. We assembled a diverse team of eleven researchers, clinicians, and patient partners. To recruit a broad group of participants, we partnered with City Housing Hamilton, which provides subsidized housing for older adults. We met with the organization’s partnership development advisor who organized two recruitment orientations; 80 potential participants and returning attendees were present for both sessions. The organization provided coffee and donuts. Most attendees were from visible minorities and had visible disabilities (i.e., used a walker or cane). To build rapport, we met with attendees in groups of 5 to 6 to introduce the research team and explain the study. We recruited 13 participants (seven female, one transgender man; Morley FRAIL score≥3). Before their scheduled study visit, twelve participants dropped out citing medical mistrust (i.e., fearing unintentional medical tracking). The last participant dropped out after the initial study visit due to their family’s skepticism in research. Additionally, some individuals may have enrolled for financial incentives as they were interested in receiving immediate monetary compensation. We faced challenges when recruiting frail older adults from diverse backgrounds. Future studies should focus on developing methods to target medical mistrust with older adults and their families.
“THE ONLY WAY FOR US TO STAY SAFE IS TO HIDE”: THE EXPERIENCES OF OLDER CHINESE IMMIGRANTS DURING COVID-19 IN NYC
Authors: Wu Yiyi , Brennan-Ing Mark , Finkelstein Ruth
Published: December 2023

The COVID-19 pandemic disproportionately affected older adults, who were at heightened risk for COVID-19 morbidity and mortality, as well as social isolation. Challenges to accessing health information and vaccine resources were amplified among older immigrants due to language barriers, lack of established social networks, and experiences of systemic discrimination. Considering the surge of anti-Asian violence across the country and the high-profile violent incidents targeting Asian older adults, our analysis focuses on the lived experiences of older Chinese immigrants during the pandemic in New York City (NYC). To describe the support needed during the pandemic to inform service delivery, we conducted in-depth interviews with 9 low-income Chinese adults over 65 about their experiences in coping with COVID-19. Interviews were transcribed and subjected to inductive thematic analysis. Results show that driven by the pro-vaccination and science norms in China, participants shared an overall positive attitude towards vaccines and exhibited extraordinary resilience to COVID-misinformation. However, COVID-19 and anti-Asian violence amplified each other. Fear of contracting COVID-19 due to perceived age-related vulnerability and fear of anti-Asian violence were prevalent, leading to self-protective withdrawal and deferred health care. Many expressed concerns about traveling to public places alone. Deeply frustrated with the government’s role in controlling violent crimes, some participants decided to stay home indefinitely to evade trouble. Mechanisms to draw out people who have socially withdrawn are needed. Senior service providers in NYC should initiate discussions about perceived safety and implement peer buddy systems to enhance post-pandemic quality of life for Asian older adults.
SOCIOECONOMIC DISPARITIES IN PHYSICAL AND OCCUPATIONAL THERAPY HOME HEALTH CARE VISITS FOR PEOPLE WITH DEMENTIA
Authors: Muruganand Ashwath , Lassell Rebecca , Lin Shih-Yin , Convery Kimberly , Fletcher Jason , Brody Abraham
Published: December 2023

People living with Dementia (PLWD) utilize Home Health Care (HHC) services such as Physical Therapy (PT) and Occupational Therapy (OT), but little is known about service utilization patterns among PLWD from different socioeconomic backgrounds. We aimed to identify disparities in service utilization in PLWD in a HHC setting across socioeconomic backgrounds using a measure of geographic socioeconomic deprivation, the Area Deprivation Index (ADI). ADI is a composite measure of census variables describing socioeconomic disadvantage, reported as national percentile rank. This secondary analysis utilized data collected February 2017–May 2022 in a dementia symptom management clinical trial at a large, urban, Medicare certified nonprofit HHC agency in New Jersey. Demographic and service utilization data from 153 dyads of PLWD and caregivers was collected. PLWD’s area codes were used to calculate ADI. ADI national percentile was divided into quartiles, and PT and OT utilization for the highest quartile was compared to the three lowest quartiles using Poisson regression, consistent with previous literature. The highest quartile group was defined as ADI above the 36.5th percentile. ADI varied from 2nd to 73rd percentile, with a median of 24th percentile. Analysis controlled for pre-existing comorbidities using pre-trial Charlson Comorbidity Index scores, classified as high (>5), medium (3-4), or low (1-2). High ADI classification was associated with a 50.2% decrease in OT utilization (IRR=.498, CI=.348-.713), and 39.4% decrease in PT utilization (IRR=.606, CI=.485-.759). Further investigation of disparities in PT and OT utilization in HHC is needed, given the disproportionate burden of disease on socioeconomically distinct populations.
HETEROGENOUS EFFECTS OF MEDICARE BENEFIT FOR ADVANCE CARE PLANNING CONVERSATION BY SOCIODEMOGRAPHIC FACTORS
Authors: Lou Yifan
Published: December 2023

Background

Although Medicare makes the option of physician-patient advance care planning (ACP) discussion available to everyone starting in 2016, older adults from disadvantaged backgrounds may be less likely to benefit from the policy. Motivated by Fundamental Cause Theory, this study examines the heterogenous policy effect, as a natural experiment, on older adults’ ACP uptake.

Methods

Data were from Health and Retirement Study 2012-2020 with 15,647 individuals. I used two quasi-experimental models – interrupted time series (ITS) analysis and difference-in-difference (DID) – to study ACP outcomes before and after the policy implementation between older adults who were Medicare-eligible and those who weren’t. I studied the heterogenous effects in stratified samples by race/ethnicity, immigration background, and socioeconomic status. I used coarsened exact matching to address the potential bias that the comparison group is not the ideal counterfactual control unit.

Results

DID reveals that, in the total population, Medicare expansion was associated with a significant increase (0.05 percentage point) in the proportion of older adults who completed advance directives, but not for having informal conversations. Furthermore, I find no evidence that the Medicare expansion was effective in improving the rates of ACP among Black, Hispanic, Asian or Native American, or non-US-born older adults. Lastly, based on ITS results, the policy only has significant immediate policy effects (level change) on ACP uptake, but not for sustained effects (slope change). Discussions: The current policy reproduced the disparities in ACP. I discuss health policy recommendations to improve the ACP rate among older adults with disadvantaged backgrounds.
DID COVID-19 CHANGE REPORTS OF LONELINESS AND SOCIAL ISOLATION AMONG OLDER AMERICANS ACT CLIENTS?
Authors: Menne Heather , Pendergrast Claire
Published: December 2023

COVID-19 raised immediate concern about the exacerbation of already high levels of loneliness and social isolation of older adults. Using the cross-sectional 2019 and 2021 National Survey of Older Americans Act Participants, we explored changes among selected populations of OAA clients – family caregivers (CGs), home-delivered meal clients (HDMs), and congregate meal clients (CMs). Descriptive statistics, t-tests, and review of 95% confidence intervals between years were conducted to understand rates of loneliness (UCLA 3-items) and social isolation (1-item). Results were not statistically significant but yield important findings. First, there were more cases of loneliness (48-70%) and social isolation (31-50%) than was known for the general older adult population before COVID-19. Second, the changes between 2019 and 2021 varied by service and gender. Among CGs, there was little difference in the cases of social isolation and loneliness from 2019 to 2021; however, male CGs reported a 20.3% increase in cases of social isolation. For HDMs there was a little difference over time in cases of social isolation and loneliness. There was a 23.3% increase in the number of CMs reporting social isolation and a small increase (9.3%) in CMs reporting loneliness; however, there was an 18.4% increase in cases of loneliness among male CMs. These results warrant further investigation to understand whether OAA services are a protective factor for social connections and further implementation of innovative approaches to lower overall rates of social isolation and loneliness among OAA clients.
ADVANCED CARE PLANNING: LEVERAGING PARTNERSHIPS TO IMPROVE STATE-WIDE DISSEMINATION
Authors: Bodenheimer Lisa , Rutberg Jennifer , Tadel Pat , DeGennaro Jennifer
Published: December 2023

Rowan-Virtua School of Osteopathic Medicine, The New Jersey Institute for Successful Aging (NJISA), in collaboration with the New Jersey Division of Aging Services (DoAS) and Respecting Choices, implemented a state-wide project training workforce professionals in Advanced Care Planning (ACP) conversations with older adults. The concept: proactively leverage the long-term care management relationships in community-based, high-touch programs. NJISA identified Respecting Choices, an evidenced-based program approved by the Administration for Community Living. Respecting Choices offers standardized certification for ACP facilitators and instructors, paving a pathway for workforce sustainability. To achieve state-wide penetration, NJISA partnered with NJ DoAS to target staff and professionals serving the state aging network. NJ DoAS provided access to county-level case managers serving the Jersey Assistance for Community Caregiving (JACC) program, Program of All-Inclusive Care for the Elderly (PACE) nurses and social workers, and NJ DoAS staff. Also included in training efforts were staff from select senior affordable housing sites. With funding support through the New Jersey Health Foundation, NJISA and Respecting Choices offered virtual, live training course for certification of First Steps ACP facilitators and instructors and Design and Implementation for state aging networks, and ACP Instructors. NJ DoAS modified the electronic documentation system utilized by JACC staff to capture on-going ACP conversations and outcomes. Despite barriers and mid-course corrections, training totals include (30) certified ACP Facilitators, (3) leaders for Design and Implementation, and (5) certified ACP Instructors. Response to curriculum was positive; participants indicating greater confidence navigating ACP conversations. Future plans to continue dissemination have been discussed.
EVALUATION OF DEMENTIA EDUCATION TRAINING IN GEORGIA NURSING HOMES
Authors: Chen Yun-Zih , Morgan Jennifer , Okwaro Lynnete
Published: December 2023

The increased use and misuse of antipsychotics and psychotropics in nursing homes have been well documented. Person-centered dementia care training that addresses skill development and practice change around communication strategies and non-pharmacologic approaches has the potential to impact the misuse of these drugs as chemical restraints. The goal of this study is to implement and evaluate an online team-based dementia education (Dementia Beyond Drugs: Changing the Culture of Care) program aimed at skill development and practice change. The program was delivered online over six weeks to teams of nursing home staff for a total of 12 hours of synchronous interactive learning. Teams were also assigned application exercises between meetings. Topics included “dementia, dementia beyond drugs, interpersonal approaches, and understanding personal expressions.” This study implemented the training with staff teams from 22 nursing homes in Georgia (N=97). Pre-post data analysis reveals a significant improvement in the nursing home environment and relationships as measured by the Kansas Culture Change Instrument, and increased attention to the use of antipsychotic drugs in staff meetings. This study indicates that team-based online learning has the potential to improve person-centered dementia care practices and attention to the use of non-pharmacological approaches to address behavioral expressions of residents living with dementia. Future research is needed to expand person-centered dementia care education programs to more nursing homes and evaluate their short and long-term effectiveness.
PERSON-CENTERED DEMENTIA CARE IN SOUTH KOREA: AN INTEGRATIVE REVIEW
Authors: Kong Eun-Hi , Park Hyunju , Shin Juh
Published: December 2023

Person-centered dementia care is a globally recognized best practice; however research on this practice is lacking. In Korea, the number of people living with dementia is rapidly increasing, expanding the need for person-centered care. Thus, we reviewed published studies regarding person-centered dementia care in Korea. We searched for studies in four databases (RISS, KISS, KoreaMED, and DBpia) and selected 14 primary studies published between 2007 and 2023. Two reviewers extracted data and three reviewers analyzed the data. Search keywords included person-centered care, person-centred care, person-centered dementia care, person-centred dementia care, dementia, demented, Alzheimer, or cognitive impairment. A total of 14 articles met inclusion criteria. The primary studies were published between 2007 and 2023, and most studies were conducted in long-term care settings and targeted formal care staff. The authors’ disciplines included nursing, social welfare, humanity, and human services. Many studies did not report theory or theoretical models. Research designs included non-experimental study (8), qualitative study (4), and experimental study (2), and randomized clinical trial (1). Many studies did not report on theory or theoretical models. Most quantitative studies included variables such as personhood in dementia, person-directed care, person-centered climate, dementia knowledge, or attitude toward dementia. Most quantitative studies reported that person-centered dementia care education programs enhanced personhood in dementia in long-term care settings. The qualitative studies explored the meaning of humanitude, readiness to adapt, effective communication, or education programs related to person-centered dementia care. Future scholars should conduct experimental studies or mixed-method studies to report on theory or theoretical models.
BLACK CAREGIVERS’ CULTURAL, RELIGIOUS, AND SYMPTOM MANAGEMENT EXPERIENCES WITH HOME HOSPICE CARE
Authors: Park Taeyoung , Sloan Danetta , Cruz-Oliver Dulce Maria , Reid M Cary , Czaja Sara , Adelman Ronald , Dignam Ritchell , Phongtankuel Veerawat
Published: December 2023

Informal Black or African American (Black/AA) caregivers are at high risk for caregiver burden due to both greater caregiving responsibilities and unmet needs. However, there has been minimal research on the challenges Black/AA caregivers face after hospice enrollment. This study seeks to address this knowledge gap by applying qualitative methods to understand Black/AA caregivers’ experiences around cultural, religious, and symptom management challenges during home hospice care. Data from semi-structured interviews with 11 bereaved Black/AA caregivers of patients who received home hospice care were qualitatively analyzed. Cultural needs (e.g., knowing their language, having familiarity with foods) were perceived as not on top of mind for many Black/AA caregivers. However, there was concern of stigma around mental health preventing care recipients from sharing their mental health concerns and seeking resources. Many caregivers relied on their personal religious networks rather than services provided by hospice chaplains. Regarding symptom management, caregivers struggled most with managing patients’ pain, lack of appetite, and decline near End of Life (EoL). Lastly, caregivers reported increased burden during this phase of caregiving but were satisfied with the overall hospice experience. Our results suggest that tailored approaches that target mental health stigma in the Black/AA community and reduce caregiver distress around EoL symptoms may improve hospice outcomes among Black/AA hospice caregivers. Hospice spiritual services should consider offering services complementary to caregivers’ existing religious networks. Larger quantitative studies are needed to examine the clinical implications of these results in terms of patient, caregiver and hospice outcomes.
EXPLORING THE BIOLOGICAL AGING DYNAMICS IN A RENAL DEVELOPMENT ORGANOID MODEL
Authors: Kasahara Tomoko , Zhang Bohan , Tyshkovskiy Alexander , Tongu Yoshiyasu , Abe Takaaki , Gladyshev Vadim
Published: December 2023

Aging clocks emerge have emerged as promising molecular estimators of biological age based on DNA methylation or transcriptomic profiles. Among other insights, they revealed “ground zero” of aging during mouse embryogenesis characterized by the lowest biological age. To model the biological age dynamics during human embryogenesis, we established a differentiation culture system that mimics embryonic kidney development from human iPSCs. We then applied multiple aging clocks to the samples from hiPSC to kidney organoid stages. This analyses revealed the lowest biological age around the intermediate mesoderm stage, indicating a potential rejuvenation event at an early stage of renal development. A principal component analysis suggested that development in this system may comprise two processes with distinct contributions to aging, with one process increasing monotonically during development, while the other increasing at primitive streak and decreasing after the mesoderm phase. We further examined the relationship between these two processes and our previously-established transcriptomic signatures of aging and reprogramming. Interestingly, the former process may represent mostly age-related genes, while the latter process reprogramming-related genes. These findings suggest the occurrence of “ground zero” in a cell culture model of early embryonic development and characterize it in the context of molecular pathways and transcriptomic signatures.
SEX DIFFERENCES IN THE LINK BETWEEN DNA METHYLATION–BASED BIOLOGICAL AGING AND HEALTH IN OLDER INDIVIDUALS
Authors: Phyo Aung Zaw Zaw , Fransquet Peter , Wrigglesworth Jo , Woods Robyn , Espinoza Sara , Ryan Joanne
Published: December 2023

It is well-established that women live longer than men, however, sex differences in biological aging have not been consistently reported, and may differ depending on the measure used. This study aimed to determine the correlation between DNA methylation (DNAm) age acceleration (AA) measures, with system-wide frailty-index (FI) aging and brain-predicted age difference (brain-PAD), in an initially healthy population of men and women aged ≥70 years. We additionally explored the extent to which these AA measures were associated with clinical measures, and chronic conditions, separately in men and women. DNAm age (Horvath, Hannum, PhenoAge, GrimAge, and DunedinPACE) were estimated in blood from 560 Australians (women, 50.7%) enrolled in the ASPREE study. FI was a deficit accumulation of 67 items including cognition and morbidities. Brain age was estimated from T1-weighted MRI. Clinical measurements, laboratory tests, and self-reports were used to identify chronic illnesses. FI had the strongest correlation with GrimAA and DunedinPACE (range r: 0.20 to 0.24 in both sexes) but was not associated with HorvathAA. Brain-PAD was not correlated with any biological aging measure. Correlations between AA and clinical measures were more commonly found in women than men and were the strongest for DunedinPACE and clinical measures including grip strength, gait speed, and self-rated health (r: -0.23 to 0.24). AA measures, especially GrimAA and DunedinPACE, were significantly associated with hypertension, diabetes, chronic kidney disease in men, and obesity and depression in women. Our findings highlight the importance of considering sex differences when investigating the link between biological age and clinical measures.
PATTERNS OF ALCOHOL USE OVER TIME AMONG OLDER COUPLES: IMPLICATIONS FOR SELF-RATED HEALTH
Authors: Turkelson Angela , Birditt Kira , Polenick Courtney , Cranford James , Blow Fred
Published: December 2023

Alcohol use in older adults is increasing which can have implications for health outcomes. Research has examined longitudinal patterns of drinking for individuals over time, but not couples. Couples often engage in concordant drinking behaviors but it is unknown if couples become more or less concordant or discordant in their drinking over time or how increased concordance or discordance influences health. The purpose of this study was to examine patterns of alcohol use over time among older couples and their links with self-reported health. A total of 8,570 husbands and wives completed the main interview of the Health and Retirement Study (HRS) for at least three consecutive biennial waves between 1996 and 2016. Latent class growth analysis revealed five trajectories of couple drinking: 1. Concordant - husband and wife light (n = 6398, 75%); 2. Concordant - husband and wife light/moderate (n = 781, 9%); 3. Concordant - husband and wife moderate (n = 296, 3.5%); 4. Discordant - husband heavy and wife light (n = 293, 3.5%); 5. Discordant - husband moderate and wife light (n = 802, 9%). Discordant couples and concordant light couples reported worse self-rated health over time compared with concordant light/moderate and concordant moderate couples. The most common pattern of drinking was concordant drinking with husbands showing light decreasing drinking and wives showing light stable drinking over time. Findings are consistent with literature and suggest that discordant drinking couples have poorer health.
VIEWS ON HELPFUL SUBSTANCE USE RECOVERY PATHWAYS: DO OLDER AMERICANS DIFFER FROM THEIR YOUNGER COUNTERPARTS?
Authors: Meier Naomi , Sharma Rachita , Garland Paula , Moore Ami
Published: December 2023

Recovery from substance use is generally a lifelong process with different pathways. This study used data from the Justice Community Opioid Innovation Network (JCOIN), 2021, a nationally representative survey of over 6,000 American adults, to examine factors that influence the views on most helpful pathways for recovery among older Americans (60 years and older) compared to their younger counterparts (less than 60 years old). Multiple linear regression was used to determine differences across age, political affiliation, cultural identity, and regional location. A factor analysis of 9 questions that asked respondents to rate the most helpful pathways for recovery generated three domains: 1. Medical services enabling environment (PCP, intensive inpatient program, and rehab program); 2. Direct conventional treatment (Prescription medication and therapist); and 3. Sociocultural factors/non-conventional treatment (Family/friends, spiritual/natural healer, self-help group, and faith-based organization). Older and younger Democrats, Independents, and residents of the Northeast and Midwest regions agreed that the medical services were helpful for recovery. While younger and older Democrats believed that direct conventional treatment was helpful, younger and older Republics as well as younger married people believed it to be less helpful. While older Democrats agreed that non-conventional treatments are most helpful, younger Democrats and Independents believed them to be less helpful. However, younger Republicans, Blacks and Hispanics believed that they are most helpful. Given the significant differences in the views of older and younger Americans on helpful pathways to recovery, policymakers and stakeholders are encouraged to be mindful of the several policy recommendations presented in the paper.
USE OF VIDEO-BASED DATA TO INFORM PSYCHOSOCIAL INTERVENTIONS FOR PEOPLE LIVING WITH DEMENTIA
Authors: Wong Gloria Hoi-Yan , Choy Jacky C P
Published: December 2023

The pandemic has accelerated technological developments in care services. Emerging evidence suggests feasibility of delivering evidence-based psychosocial interventions such as group cognitive stimulation therapy using information and communication technology (ICT) platforms. A unique opportunity offered by ICT is the more readily available data at session level to investigate nuanced, theoretically based outcome predictors, to improve efficacy of these complex interventions. Theoretically, the cognitive and wellbeing benefits of group cognitive stimulation therapy is related to the level of person-centred engagement. As part of an ongoing randomised controlled trial involving ICT-delivered group cognitive stimulation therapy, this study examines the use of big data analytics of session behavioural data to develop predictive algorithms of cognitive and wellbeing outcomes. In 78 people living with mild to moderate dementia from 26 groups, we create automatically estimated markers of facial expression and eye movement pattern, and hand-coded markers (using time-sampling method) of engagement level and speech/verbal production information, to autobiographical information presented in the session. These markers are used to predict changes in cognitive and wellbeing outcomes. Pilot analysis using hand-coded speech sample suggested strong correlation between time-sampled engagement level with cognitive benefits, and changes in information content and fluency with cognitive benefits after the group intervention (ranging from r=0.76 to 0.97, p< 0.001). The markers we develop in this study using video-based data from ICT-delivered therapy sessions, including deep learning-based emotion recognition and eye movement analysis with hidden Markov model, allow further application in understanding the mechanisms of action in different psychosocial interventions.
INVESTIGATING PSYCHOLOGICAL FACTORS AS A PREDICTOR OF FEAR OF FALLING AND FALL RISK IN OLDER ADULTS
Authors: Blount Amber , Thiamwong Ladda , Lighthall Nichole , Xie Rui , Park Joon-Hyuk , Loerzel Victoria , Stout Jeffrey
Published: December 2023

Psychological factors related to appetitive and avoidant motivation, perceptions of aging, and regulatory focus (promotion focus on gains versus a prevention focus on non-losses) are likely to play an important role in predicting one’s fear of falling (FOF) and resulting impact on physical activity engagement. This pilot study aimed to investigate the gap in current research related to these psychological factors as predictors of older adults’ Fear of Falling and Fall Risk Appraisal (FRA). The study assessed positive and negative perceptions about aging in regards to control and consequences of aging (Brief Aging Perceptions Questionnaire [B-APQ]), motivation (Behavioral Inhibition System/Behavioral Activation system [BIS/BAS]), regulatory focus in goal achievement (Regulatory Focus Questionnaire [RFQ]), FOF (Fall-Efficacy Scale-International [FES-I]), and static balance levels (BTracks Balance system [BBS]). Participants (n=48) were categorized into four FRA groups: rational (low FOF/normal balance), irrational (high FOF/normal balance), incongruent (low FOF/poor balance), and congruent (high FOF/poor balance). A Spearman Rho correlation found that FOF was positively correlated with two of the BAPQ sub-domains of Control-Positive (ρ = 0.46, p<.001) and Consequences and Control Negative (ρ = 0.43, p =.002),. A Kruskal-Wallis test found the relationship between BAPQ Control Positive and the Irrational and Rational FRA group baselines to be significant. The results suggest that among other psychological factors, perceptions about aging may be predictive of FOF and FRA in aging. These results highlight the importance of clinicians addressing not only the physiological factors of fall risk, but also the psychological factors underlying fall risk in older adults.
POTENTIAL PROTECTIVE EFFECTS OF INSTRUMENTAL ACTIVITIES OF DAILY LIVING ON ALZHEIMER’S DISEASE CHARACTERISTICS
Authors: McCray Rachel , Oruru Daisha , Locklear Clarence , Bubu Omonigho , Turner Arlener
Published: December 2023

Previous research has shown the significance of self-efficacy in improving cognitive trajectory. Additionally, it has been demonstrated that impaired cognitive functioning is a predictor for low functionality in both basic and instrumental activities of daily living (iADLs). However, little research has been done on potential protective effects of iADL functionality on markers of Alzheimer’s disease. To examine if iADL functionality (possibly through self-efficacy) has a protective effect on Alzheimer’s disease characteristics in older adults, we assessed the relationship between functionality and hippocampal atrophy. This study utilized data from the National Alzheimer’s Coordinating Center Uniform Dataset (NACC UDS) covering September 2005 to February 2021. Participants included in the analyses (N=2517, 65.7% women, 11.9% Black/African American, mean age 68.7, SD=9.15) were all cognitively normal. The analyses use baseline Functional Activities Questionnaire (FAQ) assessment, measures of independent living, and required assistance, in addition to presence or absence of Hippocampal Atrophy (measured ~5 years later) in two 2x2 contingency tables. While no relationship between baseline FAQ and later hippocampal atrophy emerged, a relationship between independent living status at baseline and hippocampal atrophy was demonstrated (X2{2,446}=11.38, p=0.003) with higher independence in iADL tasks associated with less atrophy. Though further research is needed, these preliminary results suggest living independently and having agency over iADL tasks may confer some neurocognitive protection and indicate the possibility of less hippocampal atrophy over time in individuals with higher levels of independence. Future studies should also explore the potential positive influence of iADLs on other characteristics of Alzheimer’s disease like cognition.
IDENTIFYING CONFLICTS EXPERIENCED BY OLDER ADULTS WHILE AGING IN PLACE
Authors: Murawski Alaine , Tschoe Marianne , Miller-Winder Amber , Schierer Allie , Relerford Raven , Ramirez-Zohfeld Vanessa , Lindquist Lee A
Published: December 2023

Older adults are faced with making decisions about aging-in-place as their health changes. These decisions create conflicts with others causing stress and frustration. We sought to characterize the conflicts older adults experience. As part of a larger study on decision making about aging-in-place (R01AG058777), we are longitudinally following a cohort of older adults with surveys every 6 months. Subjects are asked to describe conflicts that have occurred regarding their living situation. Responses were coded using constant comparative analysis examining type, content, and whether statements were interests, rights, or power-based. We enrolled 293 subjects (mean age 73.5 yrs, SD 5 yrs, 40.4% non-White; 94.5% retention rate) and 124 conflicts were reported over 18 months. Thematic analysis revealed three types of conflicts: Interpersonal (subcategories: spouse, intergeneration, other), task, and value-based. Content was coded into 6 themes: Location change, home maintenance issues (e.g., My son insisted I put in a new lower tub, and I didn’t want to), different ways of completing tasks (e.g., it is about my children and the way we do things), safety (e.g., Neighbor’s boyfriend kicked in the door and destroyed our property), financial, and health-related. Most statements were either interests or rights-based. Older adults experience a range of conflicts involving aging-in-place decision making. Most often older adults experience interpersonal conflicts with supporters about moving from their home or maintaining/adapting their home. Training in negotiation may help alleviate these conflicts between older adults and their care supporters.
INSOMNIA AND UNHEALTHY ALCOHOL USE DURING THE COVID-19 PANDEMIC AMONG WOMEN VETERANS AGE 50 YEARS AND OLDER
Authors: Tighe Caitlan , Quinn Deirdre , Atchison Karley , Bachrach Rachel
Published: December 2023

Older women Veterans have a high burden of comorbid medical and mental health conditions and may be particularly at risk for co-occurring insomnia and unhealthy alcohol use. Some research suggests rates of both increased during the COVID-19 pandemic; however, few studies extended beyond pandemic year one or examined administrative data. Using Department of Veterans Affairs (VA) electronic health record data, we examined rates of insomnia (diagnoses, prescription insomnia medications) and unhealthy alcohol use (diagnoses, positive alcohol screens) in a national sample of women Veterans aged 50 years and older (N=239,638) prior to and during the pandemic (March 2018-2022). During this timeframe, insomnia rates increased across age groups. Annual insomnia rates were highest among women ages 50-59 (12.8-14.9%) and lower for women age 60 and older (6.2-12.1%). The annual rate of unhealthy alcohol use was also highest among women ages 50-59 (13.9-15.3%) and lower for women age 60 and older (5.4-12.9%). For the youngest and oldest age groups, rates of unhealthy alcohol use decreased annually until 2021 and then increased; for women aged 60-79, rates increased except in 2020, when rates declined. The proportion of women with both conditions in a given year ranged from .5-2.9% and was highest at younger ages and lowest at older ages. Together, results indicate annual rates of insomnia and unhealthy alcohol use during COVID were highest in midlife women but increased over time across ages, signaling a potential need for intervention and prevention efforts aimed at addressing sleep health and alcohol use across mid-late adulthood.
METABOLOMIC SIGNATURES OF HEALTHY AGING AMONG COMMUNITY-DWELLING OLDER ADULTS
Authors: Yao Shanshan , Marron Megan , Newman Anne , Shah Ravi , Murthy Venkatesh
Published: December 2023

Metabolomic signatures of healthy aging were created by relating comprehensive mass-spectrometry-based metabolomic profiles with the Healthy Aging Index (HAI), a composite of cardiovascular, lung, cognitive, metabolic, and renal function, scored 0-10. Black and white older adults (N=2017, mean age 75 years; 35% Black) in the Health, Aging, and Body Composition Study were randomly divided into a training (70%) and test (30%) sample. In the training sample, metabolites associated with baseline HAI were identified. Penalized regression was used to generate a parsimonious metabolomic risk score for baseline HAI, which was entered into linear regression models for Year 10 HAI and Cox models for mortality adjusting for baseline age, race, gender, and study site. We identified 12 baseline HAI-related metabolites associated with Year 10 HAI after adjusting for baseline HAI. One standard deviation (SD) higher metabolomic risk score was associated with 0.25 [95%confidence interval: 0.10-0.40] higher Year 10 HAI (training adjusted beta: 0.25 [0.10-0.40]; test: 0.42 [0.15-0.68]). Baseline HAI was associated with mortality (training adjusted hazard ratio: 1.54 [1.43-1.66] per SD; test: 1.33 [1.18-1.50]). Adjusting additionally for metabolomic risk score attenuated the association between baseline HAI and mortality by 41% (training) and 67% (test). In this model, the metabolomic risk score was associated with higher mortality (training: 1.28 [1.18-1.40]; test: 1.42 [1.22-1.65]). Pathway analysis suggested that metabolic pathways of Aminoacyl-tRNA biosynthesis, Arginine biosynthesis, and Citrate cycle may contribute to healthy aging. Metabolomic signatures of baseline healthy aging are associated with long-term healthy aging and mortality independent of lifestyle and traditional risk factors.
HOUSING CONCERNS AND TRAJECTORIES OF KINLESS OLDER ADULTS WITH DEMENTIA
Authors: Perry Tam , Taylor Janelle , Mehmood Yasir
Published: December 2023

Housing preferences of older adults (e.g., to remain in residence, or relocate), housing options available, and housing needs related to changing physical and cognitive abilities are common concerns of aging. The challenges are possibly more complex for those living with dementia, who may have difficulty articulating housing preferences, and whose housing needs may include supportive care. For those with dementia who lack close kin, these challenges are likely significantly compounded. This paper focuses on the intersection of housing concerns for 64 participants in the Adult Changes in Thought (ACT) study who were kinless (no living spouse or children) when they developed dementia. All the ACT participants were 65+ when recruited. Everyone in this sample had received a research diagnosis, and their mean age at dementia onset (estimated at the midpoint between the research study that triggered the diagnostic evaluation, and the last research study before that -- usually one year before diagnosis) was 87 (Standard Deviation [SD] 7 years), with a median age of 86 and a range of 71-103.We present an analysis of their housing trajectories, as captured in chart notes from their medical records. We highlight multiple themes illustrating how housing intersects with health and social well-being and conclude by commenting on the potential of medical records for understanding and documenting issues related to housing.
PROJECTION OF MEDICAID SPENDING ON PEOPLE WITH ALZHEIMER’S DISEASE AND OTHER RELATED DEMENTIAS
Authors: Degenholtz Howard
Published: December 2023

As the US population is aging, the number of people with Alzheimer’s Disease and Other Related Dementias (ADRD) is increasing. People with ADRD have high expenditures on medical care and long-term services and supports (LTSS). Medicaid is the largest single payor for LTSS, however, the literature on the demographic trends and epidemiology of people with ADRD does not offer projections of Medicaid spending. The goal of this study was to develop an estimate for future Medicaid spending for people with ADRD for the state of Pennsylvania. The approach taken was to develop a demographic projection of the size of the older population, then estimate the fraction of people with ADRD who are eligible for Medicaid. Next, we used estimates of current spending trends to project future spending through 2025. Nearly all Medicaid participants with ADRD are dually eligible for both Medicaid and Medicare, however, Medicare managed care encounter data were not available for analysis. Thus, the prevalence of ADRD was constructed using Medicaid and Medicare fee-for-service (FFS) claims data. Two alternate estimates of the prevalence of ADRD among Medicare managed care enrollees were used (same as Medicare FFS, or slightly lower). Estimates were generated under several growth rates in per person spending on home and community-based services (HCBS). The results shows that growth in HCBS spending is the largest factor in predicting spending, leading to estimates ranging from $2.8 billion to $3.5 billion. Future research will extend the model to additional years.
FIT AND STRONG! IN ILLINOIS: LESSONS LEARNED
Authors: Hughes Susan , DeMott Andrew , Bobitt Julie
Published: December 2023

This session will describe lessons learned from a major effort to disseminate Fit & Strong! (F&S) statewide in Illinois, a state with both strong urban and rural counties. F&S is an evidence-based program for older adults who experience lower extremity mobility challenges. It is recommended for dissemination by the Administration on Community Living and the Centers for Disease Control and Prevention and is currently offered in 32 states. We received a substantial ARPA contract from the Illinois Department of Public Health (IDPH) to disseminate F&S sustainably throughout Illinois, between July 2022 and June 2023. We have convened Referral Network and Sustainability Workgroups to guide the work. Our goal is to identify 111 community-based organizations (CBOs) who can enroll 1,667 older adults into the program. We have developed an extensive number of collaborators including the aging network and a large number of healthcare systems and plans. We are also collaborating with the Illinois Extension Program to reach underserved rural areas of the state. This extensive collaborative effort has enabled us to enroll 70 CBOs that plan to offer the program. This collaboration between aging and healthcare networks that is co-sponsored by the Illinois Department on Aging and IDPH appears to be enabling us to reach a considerable number of providers who previously were not aware of or offering F&S. We are collecting pre/ post participant outcomes to evaluate program impact and examining state fall rates and uptake of lower extremity joint replacements. Lessons learned and preliminary findings will be discussed.
MEDICAID ADULT DAY SERVICE CENTERS STAFFING AND SERVICE DIFFERENCES BY PROFIT STATUS
Authors: Batista-Malat Eleanor , Wilber Kathleen
Published: December 2023

Adult day service centers (ADSC) encompass a broad range of services, yet few studies have examined staffing and service differences in for-profit and non-profit centers. Previous long-term services and supports (LTSS) research has found that for-profit nursing homes have lower levels of staffing, however, this research has not extended to ADSCs. Data from the 2018 wave of the National Post-Acute and Long-Term Care Study were used to examine differences in staff hours per patient day (HPPD) and services offered in ADSCs by profit status. Only ADSCs that accept Medicaid were included because the majority of the responding ADSCs accept Medicaid (76.8%) and Medicaid acceptance and profit status are significantly related (p<.001). Using t-tests, there was a significant difference (p=.002) in total HPPD with higher HPPD in non-profit ADSCs, with a difference of about 13 minutes. Additionally, there were significant differences in the number of transportation (p<.001) and medical (p<.001) services offered by profit status, with for-profit ADSCs offering a higher number of services, although there was no difference in the number of social/behavioral services (p=.122). These findings suggest that ADSCs that accept Medicaid may be subject to similar incentive structures that lead to lower levels of staffing in for-profit LTSS. The higher number of transportation and medical services in for-profit ADSCs that accept Medicaid also suggests different financial models for for-profit and non-profit ADSCs. Future research should more closely examine factors associated with ADSC staffing levels and service provision, and how these measures are associated with quality of care.
EXPERIENCES OF TECHNOLOGY USE BY OLDER ADULTS DURING COVID-19
Authors: Kilaberia Tina , Hu Yuanyuan , Ratner Edward , Bell Janice
Published: December 2023

Computer and communications technology use expanded during the COVID-19 pandemic, but little is known about how this affected older people. Using the Unified Theory of Acceptance and Use of Technology questionnaire and qualitative interviews, we examined 18 older adults’ technology use during COVID-19 across two subgroups of nine older adults each: those scoring above (“high”) and those scoring below (“low”) the median (4.09). Overall, older adults scored fairly high (mean 4.0; SD=0.5; range 3.1-4.8 across 16 items on a scale of 1 to 5). In each group of nine older adults, four (44%) described technology as being helpful during the pandemic. Among high scoring older adults, 100% utilized technology to order either groceries or household items and six (67%) used either telehealth or online health information system (i.e., MyChart) to communicate with health services providers, compared to three (33%) and four (44%) within the low scoring group. No one in the high scoring group described a degree of cognitive difficulty whereas four 44% in the low scoring group did. All but one (94%) older adults described needing some help with technology from family members, friends, and/or paid technology services. Two themes complement these findings by reflecting strengths (“lots of ways to do everything”) and challenges (“I just get through it”) of using technology. Greater technology mastery may positively influence the ability of older adults to meet their needs, but cognitive challenges may prevent full engagement with technology.
PREDICTORS OF FUNCTIONAL ABILITY VARY BY AGE
Authors: Pullen Carly , Patrick Julie Hicks
Published: December 2023

Across adulthood, chronic physical and emotional conditions can interfere with wellbeing. We examined the potential moderating effect of age on the process functional ability Using data from 401,958 adults who completed the 2020 Behavioral Risk Factor Surveillance System survey, we tested the associations among age, sex, race, chronic health conditions, poor mental health, and functional ability. The initial model was a poor fit to the data, χ 2 (DF = 24) = 592039, p > .001; RMSEA = .25. In order to examine whether this poor fit was related to age differences in the model, we removed age as a predictor and included it as a moderator. Thus, we tested the model among 122,005 younger adults, 140,122 midlife adults, and 139,831 older adults. The model fit improved, χ 2 (DF = 54) = 567119.79 p > .001; RMSEA = .25. Variance accounted for in functional ability differed, with 22% among younger adults, 33% at midlife, and 20.5% for older adults. Additional post hoc analyses were conducted and suggest alternate pathways to functional wellbeing across the lifespan. Our results are discussed the within the context of expanding investigations of functional wellbeing to include a set of predictors which captures both common and unique pathways across age.