bluuebunny/crossref_metadata_2025 huggingface dataset:
EXPERIENCES OF CHALLENGES AND DISCRIMINATION AMONG ASIAN AND ASIAN AMERICAN OLDER ADULTS
Authors: Vang Cindy , Lee Yeonjung , Her-Xiong Youhung
Published: January 2025

Asian Americans are one of the fastest-growing racial and ethnic minority older adult populations, with projections of up to 7.8 million in 2060. Despite the expected increase in this population, Asian Americans are often sidelined in discourses focused on discrimination and health disparities. The disparate discrimination and challenges for Asian and Asian American (AAA) older adults are not new; however, COVID-19 has exacerbated existing and emerging vulnerabilities and difficulties. The purpose of this study was to explore AAA older adults’ understanding and experiences of overcoming challenges and discrimination during the COVID-19 pandemic using a grounded theory methodology. Participants (N=30) identified as 50 years and older, resided in the United States, and had origins from Asia were recruited through convenience and snowball sampling methods. These older adults participated in a one-time open-ended interview about their experiences and how they overcame challenges and discrimination during the pandemic. The results of our study describe the process of overcoming COVID-19 challenges and discrimination through causal conditions, contextual factors, and intervening conditions, which influenced the central phenomenon of maintaining vigilance for COVID-19 and discrimination, participants’ resilience, and mental, emotional, and social consequences. Results imply further research to deepen knowledge of AAA older adults’ experiences with discrimination and resilience and policies to support interventions to enhance these older adults’ well-being.
AD/ADRD AND SOCIAL SUPPORT ADVOCACY FOR BLACK NURSING HOME RESIDENTS
Authors: Bailey Dionne , Bucy Taylor , Skarphol Tricia , Shippee Tetyana
Published: January 2025

Black older adults represent 24% of all nursing home (NH) residents in the U.S., 20.2% of whom have Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD). Despite consuming a disproportionate share of NH services, when compared to their white counterparts, Black older adults experience worse health outcomes and are more likely to reside in lower-quality facilities, a direct byproduct of systemic racism. To cope with the stress of inadequate care delivery, many Black residents rely on external social support networks. Little research to date has explored how external social support is or can be, leveraged by Black residents for improved care delivery. Drawing on the Minority Stress Model, we applied thematic analysis to three focus group transcripts (n=22) conducted with AD/ADRD caregivers in Minnesota. We found that resident social support networks overwhelmingly adopted a “support through advocacy” mentality. Although these efforts are grounded in the care of their friends or family, advocacy behaviors often had to be extended to additional residents because they identified themselves as lacking social support. Given the disproportionate share of Black residents with AD/ADRD living in institutional-based settings, understanding both formal and informal care delivery practices, especially the role of Black resilience, is essential to creating high-quality care settings.
WHAT FACTORS ARE ASSOCIATED WITH SELF-PERCEPTION OF INTENSE FAMILY CAREGIVING?
Authors: Hassell Susan , Campione Joanne
Published: January 2025

The stress and anxiety associated with family caregiving can contribute to the caregiver’s own health and well-being and can also be linked to less effective caregiving. As part of the 2023 National Survey of Older Americans Act (OAA) Participants, the following item was asked among 1,187 clients of the National Family Caregiver Support Program (NFCSP): “On a scale of 1 to 5, where 5 is very intense, how intense is the care you provide?” Fifty-one percent responded that the care is intense or very intense. Of the remaining caregivers, 15% responded that the care was not intense and 34% felt neutral. We first tested 62 survey variables for bivariate significant differences between “intense care” vs. “not intense care” and then used stepwise multivariable logistic regression. Variables included caregiver demographics, caregiving situational factors, caregiver nutrition, caregiver well-being, care receiver (CR) demographics and health conditions, and the number of activities of daily living (ADL) difficulties experienced by the CR. From the final logistic regression model (c-statistic = 0.74), the factors associated with a significant increase (p < 0.01) in the likelihood of self-reported intense care were: 1) CR’s number of ADL difficulties, 2) caregiver food insecurity score, 3) CR has Alzheimer’s or other memory-related disease, 4) caregiver provides all or almost all the care, and 5) the caregiver has no time for self. These findings provide a deeper understanding of the type of caregivers that may need more support from the NFCSP and from the OAA’s case management and home-delivered meals programs.
THE ROLE OF CARDIOVASCULAR MORTALITY IN LIFE EXPECTANCY GAPS AFTER AGE 50 BETWEEN US AND OTHER HIGH-INCOME COUNTRIES
Authors: Bramajo Octavio , Mehta Neil
Published: January 2025

Compared to other high-income countries, the United States underperforms in life expectancy. One key driver of this differential is cardiovascular disease (CVD) mortality, a cause of which the US has had worse trends since around 2008. The differential in CVD mortality has been previously described, however, its contribution to the widening of the US life expectancy lag relative to other high-income countries is unknown. We measured the contribution of CVD mortality to the post-2010 life expectancy divergence between the US and other ten high-income countries. Data and

methods

Using life table methods and WHO cause-specific mortality data, we computed life expectancy at age 50 (LE50) by sex and by two counterfactual scenarios to establish the contribution of CVD mortality in the growth LE50 gap between 2008 and 2019: first in a cause-deleted approach, removing CVD deaths, and by replacing the age-specific CVD mortality rates of the high-income countries in 2019 with the corresponding US CVD mortality improvement rate. The US had a lower LE50 compared to the average of other high-income countries in 2008), and the LE50 gap with those countries increased in 2019 by 0.4 years for females and 0.8 years for males. Either removing or replacing CVD mortality resulted in narrowing the overall LE50 gap between the US and the high-income countries in 2008 and 2019, and in most cases doing so was able to close it entirely by themselves, especially for females, with CVD explaining entirely the growth of the gap
CHARACTERIZING MEDICARE ADVANTAGE APPROACHES TO PROVIDING POSTACUTE HOME HEALTH
Authors: Gadbois Emily , Daus Marguerite , Jones Christine , Smith Jamie , Thomas Kali
Published: January 2025

Medicare Advantage (MA) is a major payer of post-acute home health care, but little is known about how MA approaches home health benefit design and provision. In-depth, semi-structured interviews were conducted with 18 leaders from MA plans and care management companies and transcribed; content analysis was used to characterize underlying themes. Across interviews, participants agreed that as long as clinically appropriate, home was the preferred setting for post-acute care. Participants described the role of MA plans and care management companies in the provision of home health care, with most taking a hands-off approach to selecting the setting of post-acute care, instead deferring to patients’ choices and citing CMS regulations restricting involvement. Other organizations had more involvement in the selection of post-acute setting, with participants saying that while they don’t “steer” or “direct” setting of care, hospital discharge planners often engaged with their staff for help with difficult to place patients. In the initiation of post-acute home health, participants reported a variety of strategies for service authorization and utilization management. Plans described various approaches to care management to complement post-acute home health services, which in some cases included engaging with care management companies to deliver this aspect of care. In discussing MA approaches to post-acute home health, participants also highlighted substantial challenges facing the home health industry, particularly staffing concerns, and especially in rural areas. Insights from this work can help policymakers understand how MA plans cover home health services and coordinate with providers.
THE 4MS OF BEHAVIORAL HEALTH IN AN AGE-FRIENDLY HEALTH SYSTEM: TESTING AN EDUCATIONAL FRAMEWORK
Authors: Emery-Tiburcio Erin , Porter Laura , Wang Siqi
Published: January 2025

The 4Ms framework of an Age-Friendly Health System (What Matters, Medication, Mentation, Mobility) was originally developed for hospital and ambulatory care settings. As many behavioral health providers did not clearly see a role for themselves in all 4Ms, the framework was adapted for use by behavioral health providers in order to improve the quality of care provided to older adults. The 4Ms-Behavioral Health (4Ms-BH) training program was designed and implemented to assess the impact of training on knowledge and clinical behavior change among mental health clinicians with little to no geriatric training. A secondary goal was to fine-tune the pilot training program for widespread implementation. Fifteen mental health clinicians from Community Mental Health Centers in three states completed eight hours of live webinar training over six months: one three-hour introduction followed by five monthly one-hour application webinars. Clinicians completed knowledge and clinical behavior measures before, during, and after training, along with an assessment of follow-up sustainability needs. The 4Ms-Behavioral Health framework was very well received by participants, who demonstrated significant knowledge gains and clinical behavior change. Participant knowledge increased for each of the 4Ms, with Medication and Mobility showing greatest improvement at 17% and 15%, respectively. Effect sizes for practice behavior change from pre-training to post-training were large (Cohen’s d range =.82 – 1.66, p≤.01) in each of the 4Ms assessment and action activities. Implications of the pilot training program for teaching students and licensed professionals will be discussed.
UTILIZATION OF 4MS TRAINING MODEL IN PRIMARY CARE SETTINGS WITH SOCIAL WORK LEARNERS
Authors: Faul Anna , Cotton Samantha , Yankeelov Pamela
Published: January 2025

The UofL GWEP used our FlourishCare curriculum (FCC) to train 52 social work (SW) learners on the 4Ms of age-friendly care. The FCC provides a variety of learning experiences, eg. online modules, workshops, interprofessional case management experiences, case conceptualization meetings, and Project ECHO’s. The FCC was delivered during the two-semester SW internship. The experiential part of the FCC allowed learners to work with small caseloads of patients incorporating the 4Ms in assessment, engagement and care navigation. Learners received weekly supervision from clinical SWers trained in the 4M model. The Kirkpatrick model of evaluation was used to evaluate the FCC, focusing on learner satisfaction, knowledge gain, self-efficacy to practice the 4M model, and patient outcomes. Evaluation data shows 95% of learners were satisfied/very satisfied with the learning experience. Learners showed a significant gain in knowledge related to the 4Ms of age-friendly care (Pre-M=65, SD=7.2; Post-M=76, SD=8.1). Learners significantly improved in in their self-efficacy to perform 4M age-friendly care (Pre-M=5.2, SD=1.3; Post-M=8.3,SD=1.9). Patient outcomes data, as measured by our biopsychosocial FlourishCare Index assessment showed that patients served by these learners significantly improved in their overall Index scores (Pre-M=50,SD=7.9; Post-M=59,SD=6.2), their psychological health (Pre-M=52,SD=5.4;Post-M=67,SD=6.1), and their health behaviors (Pre-M=49,SD=7.6; Post-M=58,SD=6.5). These results show the effectiveness of the FCC to develop a future SW workforce who has the ability to provide 4M age-friendly care.
AGE-FRIENDLY HEALTH SYSTEM “4MS STOP-AND-WATCH” PROGRAM: A CNA EDUCATION INITIATIVE IN LONG-TERM CARE
Authors: Elliott Susan
Published: January 2025

The valuable contributions of Certified Nursing Assistants (CNAs) working in the longterm care setting are often overlooked, particularly in the implementation of Age-Friendly Health System (AFHS) practices. The “4Ms Stop-and-Watch” initiative was developed to integrate CNAs into the AFHS transformation of a post-acute longterm care facility. With support of the facility administration, our team created didactic and experiential learning opportunities in which all facility CNA staff were invited to participate. CNAs first attended a presentation on the AFHS concepts and the 4Ms framework with a description of the “Stop-and-Watch” program provided. Participants were directed to use a paper form to identify and address at least one 4M during each shift. The information was then entered into an online questionnaire before the end of their shift. The CNA identified which of the 4Ms was addressed and the action taken (e.g., inform nursing supervisor). Survey results were compiled and analyzed to determine effectiveness of education, grasp of 4Ms assessment and intervention, and trends in resident encounters. Feedback was provided to CNAs and facility administration. The presentation will provide detailed information to enable facilities to develop a “4Ms Stop-and-Watch” program to optimize the competency and contributions of the direct care staff.
A NOVEL APPLICATION OF BOLCK-CROON-HAGENAARS METHOD WITH MIXED-EFFECT LATENT CLASS ANALYSIS OF AGING TRAJECTORIES
Authors: Xia Weiyi , Zafar Anum , Jarrín Olga , Setoguchi Soko , Roy Jason , Lin Haiqun
Published: January 2025

This work assesses the association between longitudinal trajectory classes and risk factors. The longitudinal trajectory classes are derived from the latent class analysis of longitudinal variables of interest such as repeated cognitive status and days in a quarter in a care setting during last years of life. This work aims to apply the Bolck–Croon–Hagenaars (BCH) method to the mixed effect group-based trajectory model to account for the individual heterogeneous effects. First, we fit a group-based trajectory model with random intercepts. The inclusion of the random effects poses a computational challenge that we address in this work. Next, each individual would be assigned a class membership with the highest posterior probability (modal assignment). Proportional assignments can be used as well. BCH weights are obtained based on the product of assigned class membership probabilities and the inverse of the matrix for misclassification errors. Finally, we reweight the data to assess the relationship between latent class memberships and risk factors. We test the performance of the bias-corrected BCH approach with simulated data. The simulation results reveal much smaller bias with BCH and larger bias with the naive three-step approach. We then apply the BCH method to assess the association between the aging trajectories, such as cognitive function trajectories or care setting trajectories in last years of life, and socio-demographic and clinical factors among Medicare beneficiary decedents. The application of the BCH method on the mixed-effect group-based trajectory modeling provides a rigorous assessment of the association between aging trajectories and risk factors.
MULTIDOMAIN INTERVENTION TO IMPROVE COGNITION IN OLDER ADULTS: NEW RESULTS AND FUTURE CHALLENGES
Authors: Bherer Louis
Published: January 2025

Decades of research have supported the notion that physical exercise and cognitive training can both help enhance cognitive performances in older adults. More recent studies have investigated whether these two domains of intervention could have synergistic effects, however results are equivocal. Moreover, there is an important heterogeneity among studies with regards to intervention modality within domain (e.g., memory or attention training as cognitive intervention; aerobic, resistance or combined physical exercise) and studied population (MCI vs. healthy aging). This symposium will discuss recent findings from innovative interventions ranging from within-domain attention training to multi-domain interventions that combine cognitive training or cognitive stimulation with or without physical exercise components. Issue of interindividual differences and the need to better individualized intervention as well as diversity in targeted population will also be discussed. Presentations will also address future challenges in combined intervention studies.
EFFECTS OF HOME-BASED COGNITIVE AND PHYSICAL EXERCISE TRAINING ON COGNITION IN OLDER ADULTS: THE COVEPIC TRIAL
Authors: Bherer Louis , Blanchette Caroll-Ann , Besnier Florent , Gayda Mathieu , Gagnon Christine , Vincent Thomas , Vrinceanu Tudor , Dupuy Emma
Published: January 2025

Background

Studies suggest that cognitive training and physical exercise can independently help improve cognition in older adults. This randomized clinical trial (COVEPIC study) aimed to compare the effects of 6 months of home-based physical exercise alone and combined with cognitive training on the cognition of older adults.

Methods

127 adults (50 years and older) were randomly assigned to one of the two following intervention arms (1:1): 1/ home-based physical exercise alone or 2/ combined home-based physical exercise and cognitive training. Participants completed videoconference neuropsychological assessments targeting episodic and working memory, processing speed and executive functions, prior to the intervention (T0), mid-intervention (T1) (3 months), and post-intervention (T2) (6 months). Clinicaltrials.gov (NCT04635462).

Results

Participation in the combined intervention showed a larger improvement than the exercise alone group on the MoCA from T0 to T1, and a change in executive functions which was not observed in the physical exercise only group. Effects of exercise dose were also observed, as participants who went through a higher dose of exercise showed larger improvement in episodic and working memory.

Discussion

Results suggest that a home-based intervention combining cognitive and physical training can help improve cognition in older adults.
EFFECTS OF A ONE-YEAR PIANO PRACTICE INTERVENTION ON COGNITIVE FLEXIBILITY IN HEALTHY OLDER ADULTS
Authors: Mack Melanie , Marie Damien , Worschech Florian , Krueger Tillmann , Sinke Christopher , Altenmueller Eckart , James Clara , Kliegel Matthias
Published: January 2025

We analyzed data of a randomized controlled trial to examine the effects of piano practice on cognitive flexibility in healthy older adults. Participants (N = 153, 69.5 ± 3.5 years of age, 57.5% females) were randomly assigned to a piano practice group (PP) or a control group engaged in active music listening (MC). Both groups underwent a year-long intervention with weekly 60-minute lessons and daily homework. We assessed switch and mixing costs in terms of speed (mean RTs) and variability (standard deviation of RTs) with a number switch and a perceptual switch task. We employed MIDI-based Scale Analysis to assess pianistic performance. Tests were conducted at baseline, after 6 months, post-intervention (12 months), and at follow-up (18 months). Results revealed more pronounced improvements in pianistic performance in the PP compared to the MC group over the course of the intervention. Both groups exhibited gains in several cognitive flexibility outcomes, which originated primarily in the latter half of the intervention. For mixing costs, the PP group showed partly greater improvements compared to the MC group. Additionally, the findings indicated a compensation account in both groups, which was partially more pronounced in the PP group. This study suggests that both piano practice and active music listening – with piano practice to a slightly higher degree - enhance cognitive flexibility, particularly in sustained control mechanisms linked to mixing costs. Both interventions potentially require longer than 6 months to induce behavioral transfer effects and are especially beneficial for individuals with lower cognitive flexibility levels.
INTERSECTING IDENTITIES AND HEALTH-RELATED QUALITY OF LIFE AMONG LGBTQ+ OLDER ADULTS
Authors: Kim Hyun-Jun , Jung Hailey , Oswald Austin , Fredriksen-Goldsen Karen
Published: January 2025

LGBTQ+ older adults remain understudied in terms of the intersectionality of their identities and its impact on health. It is unclear how certain aspects of identity are perceived as central and how the intersection of multiple identities influences experiences of discrimination. This study identifies intersectional profiles of identity centrality and attributions for day-to-day discrimination, focusing on gender, sexual and gender identity, age, and race/ethnicity among LGBTQ+ older adults. It also examines the associations between profile membership, key psychological and social factors, and physical and mental health-related quality of life (HRQOL). Utilizing data from the National Health, Aging, and Sexuality/Gender Study, the first national longitudinal study of 2,450 LGBTQ+ older adults, we unveiled five latent profiles using Latent Class Analysis, which depict heterogeneous patterns in individuals’ perception of their identities in terms of centrality and as the basis of their discrimination experiences. The most prevalent was the moderate centrality and discrimination profile (C1; 31%), followed by high centrality and discrimination (C2; 26%), low centrality and discrimination (C3; 17%), high centrality and low discrimination (C4; 15%), and low centrality and high discrimination (C5; 11%). C2 and C5 exhibited lower physical and mental HRQOL compared to other profiles, suggesting that multiple discrimination attributes may contribute to compromised health, regardless of identity centrality. C2 and C4 showed high identity centrality across all identities, which was linked to greater critical awareness and activism. This study highlights the significance of incorporating an intersectional lens to better understand the distinct needs and strengths within LGBTQ+ aging communities.
PAIN DURING MIDLIFE: A CROSS-NATIONAL ANALYSIS OF COHORT DIFFERENCES IN PAIN IN THE US, EUROPE, SOUTH KOREA, AND MEXICO
Authors: Infurna Frank , Syed Orchee , Cruz-Carrillo Yesenia , Dey Nutifafa , Wettstein Markus , Grimm Kevin , Lachman Margie , Gerstorf Denis
Published: January 2025

Over the past several decades, middle-aged Americans have exhibited troubling trends of declining mental and physical health over successive cohorts. However, this trend has not been consistently observed in peer nations. It is an open question whether pain shows similar national disparities. We thus examine how self-reports of pain have historically changed in the U.S. during midlife, and how this compares to peer nations. We used harmonized data on pain from nationally representative longitudinal panel surveys from the U.S., 13 European nations, South Korea, and Mexico to directly quantify national similarities and differences in historical change in midlife pain. Our results corroborate earlier reports that midlife pain is higher amongst later-born cohorts in the U.S. Of note is that these historical increases emerged at earlier stages of midlife for later-born cohorts. A similar pattern of historical increases in pain was observed in Continental and Nordic Europe. In contrast, historical declines in pain were observed in England, Mediterranean Europe, South Korea, and Mexico. These results suggest there could be aspects of American midlife today that are exacerbating feelings of pain, and these aspects may be shared in some European nations but absent or less influential in other peer nations. Our discussion focuses on potential explanations for this pattern, such as population level discrepancies in health, differential use of health care services, and the inter/intrapersonal costs of westernization, as well as how pain is conceptualized across nations.
TRAJECTORIES OF EPISODIC MEMORY IN MIDLIFE: HISTORICAL CHANGE FROM A CROSS-COUNTRY PERSPECTIVE
Authors: Wettstein Markus , Infurna Frank , Dey Nutifafa , Cruz-Carrillo Yesenia , Grimm Kevin , Lachman Margie , Gerstorf Denis
Published: January 2025

According to the Flynn effect, cognitive abilities have improved across the past decades. However, we know little about whether such historical improvements generalize to middle-aged adults and differ across nations. In this study, we used harmonized data on episodic memory from nationally representative longitudinal panel surveys including the U.S., Europe, Mexico, and China to compare historical change in age-related trajectories of episodic memory among middle-aged adults. Our sample included 89,775 participants aged 45 to 65 years who provided 272,876 observations over up to 20 years. Longitudinal multilevel regression models revealed that today’s middle-aged adults in the U.S. perform worse on episodic memory tests than their age peers in the past. In contrast, today’s middle-aged adults in most other countries perform better than did their peers in the past. At the same time, later-born cohorts of U.S. middle-aged adults exhibited a more favorable episodic memory trajectory than earlier-born cohorts, whereas this trend was not observed in most other countries. Cohort trends remained significant when controlling for socio-demographic indicators (gender, education) and health measures (grip strength, number of chronic diseases). Women and individuals with higher levels of education, higher grip strength and fewer chronic diseases exhibited better episodic memory performance, and the association of grip strength with episodic memory was stronger in later-born cohorts. Our findings suggest that countries differ in the extent and direction of historical change in episodic memory scores and trajectories. More research is needed to better understand why the Flynn effect in the U.S. seems to be reversed.
TRAINING CAREGIVERS TO BE INFECTION PREVENTION SUPERHEROES WITH PROJECT FIRSTLINE
Authors: Ham Carolyn , Schuh Madyson , Rogers Megan , Ellis Erica
Published: January 2025

Facility-acquired infections in long-term care facilities (LTCF) significantly affect resident’s safety and quality of life. Caregiving staff in LTCF are uniquely positioned to prevent infections by completing infection prevention and control (IPC) activities, including hand hygiene and using personal protective equipment. An IPC Needs Assessment (NA) survey was conducted in 2021 by the Washington State Department of Health (DOH) and University of Washington (UW) with 3,308 frontline healthcare respondents. Respondents from LTCF caregivers indicated a preference for self-paced, asynchronous learning experiences and ranked COVID-19 as the most interesting IPC topic. DOH partnered with UW and the Centers for Disease Control and Prevention to develop six Project Firstline Modules (PFM) on IPC topics. Drawing on adult learning theory principles, training content was developed with a focus on the needs and lived experience of caregivers. Each module was offered in English and Spanish and incorporated an instructional video, interactive scenario, job aid, and evaluation. Between February and December 2023, 589 LTCF caregivers completed modules, comprising 62.93% of all users, with the majority (97.3%) reporting that the information was easily understandable and 88.2% reporting they would be able to apply what they learned to their job. PFM completers reported the highest satisfaction for the module on respiratory droplets, consistent with the NA results. The delivery of PFM successfully provided actionable and accessible IPC training for LTCF caregivers. Future efforts to educate caregivers on IPC should consider their preferences in training modes and topics, and further explore public health and academic partnerships.
CONTEXT MATTERS: THE IMPACT OF ENVIRONMENT, MOOD, AND FATIGUE ON MOBILE COGNITIVE ASSESSMENTS
Authors: Wilks Hannah , Welhaf Matthew , Aschenbrenner Andrew , Morris John , Hassenstab Jason
Published: January 2025

To better understand the aging process and the subtle cognitive changes that occur in preclinical Alzheimer disease (AD), researchers are using technology to remotely measure cognition. We examined how concurrent environmental context, mood, and fatigue are associated with cognition in older adults at risk for AD. Participants (N = 288) were recruited from the Knight Alzheimer Disease Research Center (Mage = 75, RangeAge= 61-97). Cognition (e.g., associate memory and processing speed), context (e.g., with whom, where, activities prior to assessment), and current affect (e.g., mood, and fatigue) were measured contemporaneously on a smartphone-based application up to 28 times over a week in naturalistic environments. Clinical status was determined using the Clinical Dementia Rating □ (CDR□). Cognition at each assessment was predicted by contextual- and affect-related factors, and their interaction with CDR, while controlling for age, gender, education, and time in study. Associate memory and processing speed were worse in the presence of others, when assessed in locations other than home, and after engaging in sedentary behavior. Affective states were not associated with cognition. These effects were magnified in participants with very mild dementia symptoms, particularly for processing speed. Environmental and affective factors can influence memory and processing speed in older adults at risk for AD. Distracting environments were particularly problematic for individuals currently experiencing mild dementia symptoms. Studies of AD risk that rely on remote, unsupervised cognitive assessments should carefully assess and consider concurrent contextual factors when examining cognition.
UNREPRESENTED TO FLUSH-WITH-FAMILY: THE ROLE OF FAMILY STRUCTURE ON DEMENTIA CARE BY RURALITY
Authors: Utz Rebecca , Iacob Eli , Hollingshaus Mike , Bouldin Erin , Cudjoe Thomas , Miller Katherine , Farrell Tim , Ornstein Katherine
Published: January 2025

U.S. policy and clinical practice increasingly recognize the value and essential role that family caregivers play in planning and delivering long-term care, especially in the context of dementia where cognitive decline leads to practical and legal needs to rely on others (most often family) to serve as caregivers and surrogate decision makers. Given the preference of older adults to age-in-place and that younger generations commonly move away from rural areas, access to family support may characteristically differ across those living in urban versus rural areas. This study uses the Utah Caregiving Population Study (C-PopS), a unique population-based data resource that links administrative and health records with genealogical data, to describe the size and structure of first-degree family (FDF) members (spouse, child, sibling) associated with a cohort of persons aged 65+ who died with dementia in Utah, stratified by rural (n=11,105) vs. urban (n=38,099) geographic small-areas. Compared to those in urban areas, persons with dementia in rural settings were more likely to be married (39.3% versus 35.2%), but less likely to have adult children in the state (61.9% versus 67.9%). About one in five rural older adults with dementia (20.1%) were unrepresented (defined as no FDF present in the state), compared to about 17% of those in urban areas. Understanding rural-urban differences in how family structure characteristics are associated with distinct patterns of dementia care, including use of hospice and care transitions at end-of-life, will help inform health policy and future interventions targeting the unique needs of this vulnerable population.
LATE-LIFE SINGLEHOOD AND WELL-BEING: THE ROLE OF MARITAL STATUS AND SOCIAL RESOURCES
Authors: Ghose Urmimala , Park Rinseo , Smith Jacqui , Ram Nilam , Gerstorf Denis
Published: January 2025

Singlehood has long been identified as a potential risk factor for undermining well-being across adulthood, particularly in older ages. However, it is an open question what role other social resources may play. In the current study, we examine whether and how older adults experiencing marital transitions through divorce and spousal bereavement differ from their never married and continuously married peers in their well-being trajectories and in the roles that social support and strain play. We used six waves (2008 – 2018) of longitudinal data from 7,670 participants (Mage = 66 years, 56% women, 75% White) of the Health and Retirement Study (HRS). We also employed synthetic cohort matching to equate the groups on relevant background factors. First results of multi-level models revealed that bereavement trajectories were characterized by a steeper transition-related rise in depressive symptoms than the divorce trajectories, but also by a sharper drop in subsequent years. Both transition groups showed declines in depressive symptoms in the years after the event, yet those who had experienced divorce reached average levels of their continuously married peers after about three years, whereas the bereaved group continued to lag behind even after six years post-spousal loss. Overall, we found little evidence that the relevance of social resources for well-being trajectories differs across marital status groups. As one exception, we found that the predictive effects of strain from family and friends for elevated depressive symptoms was particularly pronounced among those who had experienced spousal loss.
STRATEGIES AND TOOLS TO MAKE THE INVISIBLE VISIBLE IN HOSPITAL CARE
Authors: Golden Blair , Fields Beth , Berian Julia
Published: January 2025

Family caregivers (relatives, partners, or other support persons) provide critical support during hospitalization events for older adults, ranging from providing companionship and emotional support to coordinating discharge planning. Despite their essential role in hospital care delivery, family caregivers often feel invisible and poorly integrated into hospital care teams. Recognizing this gap, the 2022 National Strategy to Support Family Caregivers was created by federally mandated advisory councils with public input. Goal 2 of this National Strategy consists of advancing partnership and engagement with family caregivers, including recognition of family caregivers as essential care team partners and inclusion of family caregivers within care plans. In response to Goal 2, this symposium will present innovative strategies and tools to advance partnerships and engagement with family caregivers within hospital-based care. Dr. Vick will present findings from a qualitative systematic review of family caregiver involvement during hospitalizations of older adults, leading to development of a conceptual model of family caregiver roles within hospital settings to guide future interventions. Ms. Hoel will discuss findings from a qualitative study identifying organizational barriers to family caregiver inclusion in the hospital care of people living with dementia. Dr. Scheunemann will discuss development of the ICU Family Workbook (a publicly available resource for family caregivers navigating critical illness), including results from content validity and user testing. Dr. Golden will present research findings on current practices and gaps with regards to caregiver and patient discharge education about delirium, a common condition affecting hospitalized adults.
REDUCING SERIOUS FALL INJURIES IN OLDER ADULTS: RESULTS OF A MULTICENTER WEARABLE TECHNOLOGY STUDY
Authors: Kinosian Bruce , Stefanacci Richard
Published: January 2025

Falls remain an immense public health concern for our growing aging population, causing over 3 million ER visits annually. With falls that result in hip fractures having devastating consequences for older adult health and independence, new solutions are urgently needed. This study evaluated the real-world effectiveness of the Tango® Belt, an innovative wearable device aimed at preventing serious fall injuries. In this six-month, comparative, adaptive study with historical controls conducted across 10 communities located in PA and CA, older adults used sensor-embedded belts alongside standard fall mitigation protocols. When worn during a potentially harmful fall, the belt deploys an airbag to cushion impact. We compared fall outcomes in the belt users (N=134) to propensity score matched historical controls (N=264). Analysis of fall events between the matched groups demonstrated similar rates of falls (p=0.081), but a significant reduction in the proportion of major hip injuries in the intervention versus the control group (1.1% vs 12.1% p=0.004) demonstrating a protective effect of 90.9% against hip fractures/dislocations due to serious hip-impacting falls. Further analysis reveals that the proportion of hospitalizations (8.2% vs 18.9% p=0.004) and ED visits (6.0% vs 17.8% p=0.0001) were also significantly reduced in the intervention vs control group. With compliance recorded at 67% across subjects and no serious AE’s noted related to the device, such “smart garments” address known compliance barriers with passive hip protectors. With serious fall injuries expected to exponentially rise with population aging, the study provides promising evidence for future use of disruptive innovations like Tango Belt.
CHARACTERIZING MUSIC PARTICIPATION FOR ADULTS WITH DOWN SYNDROME
Authors: Dorris Jennifer
Published: January 2025

Adults with Down syndrome (Ds) are living longer and have high risk of experiencing cognitive decline as they age. Unfortunately, few services are available to support aging adults with Ds and their care partners. Music is a safe, engaging intervention modality that has shown promising results for older adults experiencing cognitive decline. This study reported on adults with Ds’ frequency and type of music participation and described support provided by care partners. Additionally, the study explored associations of age, race, or level of intellectual disability associated with music participation. Care partners of adults with Ds (n =27) completed a survey that measured “listening” and “playing music” using the Guernsey Community Participation and Leisure Assessment. 92.6% of adults with Ds listened to music weekly or daily. 74.1% of care partners listened to music as an unaccompanied activity. 33.3% of adults with Ds played music either weekly or daily, and 48.2% of care partners described playing music as an unaccompanied activity. A significant association was found between race and playing music, but there were no significant associations between age, intellectual disability level, and music participation for adults with Ds. Knowing that racially minoritized adults with Ds had a higher frequency in playing music, those developing services and supports could consider utilizing music as a meaningful activity. Additionally, due to the lack of associations between age and intellectual disability, music programs could be developed equitably for changes in age and intellectual disability level, creating inclusive activities for this growing population of older adults.
IDENTIFYING PHENOTYPES OF OLDER ADULTS PLANNING FOR ALZHEIMER’S DISEASE SUPPORT
Authors: Miller-Winder Amber , Ramirez-Zohfeld Vanessa , Relerford Raven , Schierer Allison , Olvera Charlie , Murawski Alaine , Lindquist Lee
Published: January 2025

Older adults (OAs) with Alzheimer’s Disease (AD) often need additional support (e.g. in-home caregivers) but are unprepared. We modeled the types of plans OAs make surrounding long-term care (LTC)/ home support in the event of AD to describe different planning phenotypes. The Plan Your Lifespan (PYL) study examines OAs’ decision-making process about LTC/home support in the event of AD. Subjects are surveyed every 6 months about cognitive, social, functional, environmental factors; including living/support preferences. We employed mixed analytic methods (qualitative coding and GLMM). 293 subjects enrolled (mean age 73.5 yrs,72.7% female, 40.4% URM). Almost half (47.4%, n=139) experienced cognition decline with 10.3% identifying worsening memory loss. We identified four planning phenotypes: Deniers overlook the possibility of developing AD. Subjects with no measured cognitive impairment were 35% less likely to plan; Do-gooders plan to avoid burdening family and often complete an Advanced Directive (OR 1.75 [p < 0.05, 1.20-2.54]) or Living Will (OR 1.56 [p < 0.05, 1.08-2.25]; Defeaters do not plan due to external limitations; a below average Consumer Health Activation score (OR 0.65 [p < 0.05, 0.43-0.98]) signaled 35% less likely to plan; and Dumpers leave planning to their family; displaying sufficient social support (OR 2.4 [p < 0.05, 1.39-4.15]) and limited health literacy (OR 1.99, [p < 0.05, 1.24-3.2]). Helping OAs consider their support needs through identification of different phenotypes may allow providers to intervene early. Phenotypes depend on health literacy, social support, self-efficacy, and finances. Further research will examine how planning phenotypes change over time and how plans are implemented to best care for OAs with AD.
SUBJECTIVE COGNITIVE DECLINE IN OLDER ADULTS: THE ROLE OF Α-SYNUCLEIN AND AMYLOID PATHOLOGIES
Authors: Thomas Kelsey , Bangen Katherine , Rotblatt Lindsay , Tosun Duygu , Galasko Douglas
Published: January 2025

Some studies show subjective cognitive decline (SCD) to be an early marker associated with Alzheimer’s pathology. However, until recently, it has been impossible to measure Lewy body pathology in vivo, so its association with SCD is unknown. Participants without dementia (451 CN; 476 MCI) from the Alzheimer’s Disease Neuroimaging initiative were classified as positive or negative for amyloid (A+ or A-) using cerebrospinal fluid (CSF) Aβ42 and for α-synuclein (α-syn+ or α-syn-) using the CSF Seed Amplification Assay (441 A-/α-syn-, 80 A-/α-syn+, 331 A+/α-syn-, and 75 A+/α-syn+). Both participant- and study partner-reported SCD were measured using the Everyday Cognition (ECog) total and domain scores. Per self-report, after adjusting for age, education, sex/gender, race/ethnicity, APOE ε4+, and cognitive group, the A+/α-syn+ group had the greatest SCD relative to the other three pathology groups. The A-/α-syn+ group did not differ from the A-/α-syn- group on any ECog scores. None of these associations were moderated by cognitive status. Per study partner report, a similar pattern of results was observed, but the A+/α-syn- and A+/α-syn+ groups only significantly differed on the planning subscale despite A+/α-syn+ consistently having higher SCD. These results were moderated by cognitive group for the ECog total, memory, language, visuospatial, and divided attention scores such that associations were largely driven by the MCI group. In older adults without dementia, α-syn+ alone did not contribute to greater SCD; however, A+/α-syn+ had the greatest SCD as rated by both participant and study partner, highlighting the importance of measuring co-pathologies to understand SCD etiologies.
ASSOCIATION BETWEEN POLYPHARMACY AND Α-KLOTHO IN US OLDER ADULTS: THE MEDIATION ROLE OF INFLAMMATORY MARKERS
Authors: Wei Kai , Chen Chun , Yang Yanping , Wang Libin , Sun Shuimei
Published: January 2025

Introduction

Polypharmacy may lead to adverse health outcomes in older adults, but the relationship between polypharmacy and accelerated aging is not well understood. This study aims to investigate the association between polypharmacy and α-klotho, a blood anti-aging protein, using large population-based data.

Methods

The study selected 3569 participants aged 65-79 years with serum α-klotho test data and prescription information from the National Health and Nutrition Examination Survey (2007-2016). Participants taking 5 or more medications simultaneously were classified as having polypharmacy. Weighted linear regression analyses were conducted to evaluate the association between polypharmacy and α-klotho. Mediation analysis was conducted to investigate the impact of inflammatory biomarkers, including the systemic immune-inflammation index, systemic inflammation response index, and neutrophil-to-lymphocyte ratio, on the relationship between polypharmacy and α-klotho levels.

Results

The polypharmacy group consisted of 1,591 participants (weighted percentages 42.7%). The median level of α-klotho in the polypharmacy group was 733.16[594.47, 911.63] pg/mL, which was significantly lower than that in the non-polypharmacy group. After adjusting for multiple variables, polypharmacy remained significantly negatively associated with α-klotho (β-coefficient -0.0506, 95% CI -0.0855 to -0.0157), and this significant association were observed in men and women, respectively. Further mediation analyses revealed that the association between polypharmacy and α-klotho was mediated by inflammatory biomarkers, with the proportion of mediation ranging from 6.11% to 11.82% (all P < 0.01).

Conclusion

These findings suggest that polypharmacy is closely linked to circulating α-klotho levels, which may be partly mediated by inflammation.
INFLAMM-AGING IS NOT A UNIVERSAL AGING MECHANISM ACROSS DIVERSE HUMAN POPULATIONS
Authors: Franck Maximilien , Tanner Kamaryn , Ferrucci Luigi , Gurven Michael , Mehrjerd Ameneh , Yeong Joe , Hertel Johannes , Cohen Alan A
Published: January 2025

Inflamm-aging, defined by age-associated increases in inflammatory cytokines, is thought to be a universal mammalian aging mechanism associated with higher chronic disease risk, as observed in industrialized populations like the InCHIANTI cohort (Italy). However, consensus regarding its precise nature and a measurement framework is lacking. Its relevance and measurement applicability across diverse human populations, especially in non-industrialized societies with high infection burdens, remain unclear. We aimed to characterize inflamm-aging across four populations, examining its relation to age and chronic diseases. Through principal components and factor analysis, we studied immune variation within the InCHIANTI, Singapore Longitudinal Ageing Study (SLAS), Study of Health in Pomerania (SHIP), and Tsimane Health and Life History Project (THLHP) cohorts—Amerindian forager-horticulturalists from the Bolivian Amazon. We compared immune axes’ relationships with age and chronic diseases across cohorts. We observed major differences in the structure of inflammatory and immune variation across populations. Notably, the primary immune axis in the THLHP cohort diverged significantly from those in the InCHIANTI, SLAS and SHIP cohorts, with the latter two aligning more closely with the inflamm-aging phenomenon—albeit with variations in their manifestations. Furthermore, these axes did not consistently correlate with age across cohorts and exhibited differential impacts on chronic diseases, with the primary axes identified in InCHIANTI and SLAS showing stronger associations with chronic diseases. Our findings suggest inflamm-aging is not universal. There appear to be significant environmental and lifestyle impacts on inflammatory and immune variation leading to differences in how inflammation drives disease susceptibility across populations.