bluuebunny/crossref_metadata_2025 huggingface dataset:
Building Researchers' Capacity for Embracing the Engagement of Older Adults in Research
Authors: Berman Rebecca , Lessem Rachel , Danilovich Margaret
Published: December 2021

The Sage Resource Project aimed to broaden the pool of researchers who include the voice of older adults using long-term services and supports (LTSS) in research processes. We developed training to build researcher capacity to engage older adults through the development of Sage Model research advisory boards. Methods included training strategies for learning mode, design, duration, and emphasis of content that were informed by results of a researcher needs assessment and input from 2 older adult research advisory boards. Over 100 researchers registered for a 4-webinar series. All respondents to webinar evaluations (22) reported learning about topics that aligned with webinar objectives and had interest in engaging older adult stakeholders and/or developing an older adult research advisory board in the future. Representatives from five universities expressed interest attending online interactive workshops to build advisory boards. Lessons learned identify directions for research on best practices for developing older adult advisory groups.
Vision, Cognitive Impairment, and Dementia in the Aging, Demographics, and Memory Study
Authors: Ehrlich Joshua , Swenor Bonnielin , Zhou Yunshu , Langa Kenneth
Published: December 2021

Vision impairment (VI) is common in late-life and may be a modifiable risk factor for cognitive decline and dementia. In this study, using data from the population-based Aging, Demographics and Memory Study (ADAMS), we analyzed the association of VI with cognitive impairment no dementia (CIND) and dementia. We found that VI (binocular presenting acuity <20/40) was significantly associated with incident CIND (OR=3.5, 95% CI=1.4-8.9, p=0.008) and dementia (OR=1.8, 95% CI=1.0-3.1, p=0.040) after adjusting for age. However, among those with CIND, VI was not associated with dementia (OR=0.9, 95% CI=0.4-1.8, p=0.733). The association between VI and CIND remained significant in models fully adjusted for demographic and health factors (OR=2.7, 95% CI=1.0-7.5, p=0.049). We conclude that VI is associated with development of CIND but not with subsequent onset of dementia. These findings suggest that the association between VI and dementia is driven by the elevated risk of dementia among those with CIND.
Retinal Vascular Density on OCT-A and Age-Related Central and Peripheral Hearing Loss in an Italian Older Population
Authors: Sardone Rodolfo , Bortone Ilaria , Panza Francesco , Sborgia Giancarlo , Giuliani Gianluigi , Pastore Valentina , Boscia Francesco , Quaranta Nicola
Published: December 2021

Age-related hearing loss (ARHL) and retinal vessel changes have both been associated to neurodegeneration/dementia, suggesting a possible link between these two conditions in older age. We analyzed data on 886 older participants (65 years+, age range: 65-92 years) in the cross-sectional population-based Salus in Apulia Study. OCT-A scan was used to measure SVD and DVD of the capillary plexi of the macula in different retinal quadrants. Peripheral ARHL was defined as >40 dB HL of PTA (0.5,1,2, and 4KHz) in the worst ear, and age-related CAPD as <50% at the SSI-ICM test in at least one ear. DVD at the whole retina and at the parafoveal quadrant were inversely associated only with age-related CAPD [OR:0.93; 95%CI: 0.88-0.96 and OR:0.94; 95 CI:0.90-0.99, respectively]. The association of retinal vascular density with age-related CAPD may bring us a further step forward in understanding the biological mechanisms underlying the links between neurodegeneration/dementia and ARHL.
Implications of Disability for Functional Trajectory, Service Use, and Expenditures
Authors: Anderson Wayne , Alkema Gretchen
Published: December 2021

People with disabilities face a diverse array of health care and support needs. These needs can vary by disability type, degree, and timing of the advent of functional limitations. These differences have implications for needed health care service use and related expenditures. The symposium will open with a Centers for Disease Control and Prevention-sponsored analysis of adult disability-associated health care expenditures, both nationally and by U.S. state, in total, by per adult, by per adult with disability, and by payer, to illustrate the contribution and variation of these expenditures to individual states and the health care system. We will next present a U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Planning and Evaluation effort to identify onset and patterns of reduced functional ability at end of life for older adults with and without dementia as related to other comorbidities. The last paper will present a Commonwealth Foundation study on older adults with functional disabilities and multiple chronic conditions, comparing those with high health care needs versus the subset of those people who are also high cost. Patterns of utilization differed between these two groups, and by state. These findings have implications for the development of care models that might best meet people’s needs. Our discussant will respond to the studies’ findings and discuss the important role that efforts to understand the nature of disability and functional status and the scale and scope of service use and costs have for people with disabilities.
Association Between Dual-Task Gait and Cognitive Function in Older Adults
Authors: Suri Anisha , VanSwearingen Jessie , Redfern Mark , Sejdic Ervin , Rosso Andrea
Published: December 2021

Community mobility involves walking with physical and cognitive challenges. In older adults (N=116; results here from initial analyses: N=29, Age=75±5 years, 51% females), we assessed gait speed and smoothness (harmonic-ratio) while walking on even and uneven surfaces, with or without an alternate alphabeting dual-task (ABC). ANOVA assessed surface and dual-task effects; Pearson correlations compared gait with global cognition and executive function composite z-scores. The four conditions (even, uneven, even-ABC and uneven-ABC) affected speed(m/s) (0.97±0.14 vs 0.90±0.15 vs 0.83±0.17 vs 0.79±0.16). Smoothness (2.19±0.48 vs 1.89±0.38 vs 1.92±0.53 vs 1.7±0.43) was affected by only surface (controlled for speed). Greater speed was associated with better global cognition(ρ=0.47 to 0.49, p<0.05) for all conditions and with better executive function for even-ABC(ρ=0.39, p=0.04) and uneven-ABC(ρ=0.40, p=0.03). Executive function was associated with smoothness during even(ρp=-0.42, p=0.03) and uneven(ρp=-0.39, p=0.04) walking. Type of walking challenge differentially affects gait quality and associations with cognitive function.
Pain Assessment in Impaired Cognition (PAIC15) Instrument: Cutoffs Against Three Standards
Authors: van der Steen Jenny , de Waal Margot , Achterberg Wilco
Published: December 2021

Observational pain scales can help identify pain in persons with impaired cognition including dementia who may have difficulty expressing pain verbally. The Pain Assessment in Impaired Cognition-15 (PAIC15) observational pain scale covers 15 important items that are indicative of pain, but it is unclear how likely pain is for persons with each summed score (theoretical range 0-45). The goal of our study was to determine sensitivity and specificity of cut offs for probable pain on the PAIC15 against three possible standards. We determined cut offs against (1) self report when able, (2) the established Pain Assessment in Advanced Dementia (PAINAD) cut off of 2, and (3) observer’s overall estimate based on a series of systematic observations. We used data of 238 nursing home residents with dementia who were observed by their physician in training or nursing staff in the context of an evidence-based medicine (EBM) training study, with 137 residents assessed twice. The area under the ROC curve was excellent against the PAINAD cut off (□0.8) at both assessments, but acceptable or less than acceptable for the other two standards. Across standards and criteria for optimal sensitivity and specificity, cut offs at the PAIC15 could be 3 or 4. Guided by self report we recommend PAIC15 scores of 3 and higher to represent probable pain with sensitivity and specificity in the 0.5 to 0.7 range.
Relationships of Pain Treatment With Dementia and Functional Outcome in Medicare Home Health Care
Authors: Wang Jinjiao , Cato Kenrick , Conwell Yeates , Heffner Kathi , Yu Fang , Caprio Thomas , Li Yue
Published: December 2021

Adequate pain management is important to post-acute care functional recovery, yet persons with Alzheimer’s disease and related dementias (ADRD) are often under-treated for pain. The objectives of this study were to examine in Medicare post-acute home health (HH) recipients with daily interfering pain 1) if analgesic use at home is related to functional outcome, and 2) if ADRD is related to the likelihood of analgesic use at home. We analyzed data from the Outcome and Assessment Information Set, Medicare claims, and electronic medical records of 6,039 Medicare beneficiaries ≥ 65 years who received care from a large HH agency in New York in 2019 and reported daily interfering pain. Analgesic use was identified in medication reconciliation of HH visits and categorized into any analgesics or opioid(s). ADRD was identified from ICD-10 codes and significant cognitive impairment. Functional outcome was measured as change in the composite score of Activity of Daily Living (ADL) limitations from HH admission to HH discharge. Use of any analgesics at home was associated with greater ADL improvement from HH admission to HH discharge (β= -0.20 [greater improvement by 0.2 ADLs], 95% Confidence Interval [CI]: -0.37, -0.04; p=0.017). Compared with patients without ADRD, those with ADRD were less likely to use any analgesics (Odds Ratio [OR] = 0.66, 95% CI: 0.49, 0.90, p=0.008) or opioids (OR=0.53, 95% CI: 0.47, 0.62, p<0.001) at home. Adequate pain management is essential to functional improvement in post-acute HH care. Patients with ADRD may be under-treated for pain in post-acute HH care.
The Relationship Between Knee Pain and Heart Failure in Older Black and Latino Women
Authors: Kheirbek Raya , Siaton Bernadette , Beamer Brock , Blumenthal Jacob , Katzel Les , Sorkin John , Hogans Beth
Published: December 2021

Background: Knee pain is the second-most prevalent and disabling common pain condition globally, having deleterious effects on daily function including mobility and exercise capacity; chronic knee pain is especially prevalent in older adults. There is substantial evidence to indicate that physically inactive individuals have higher rates of cardiovascular disease. Nonetheless, studies investigating cardiovascular risks with osteoarthritis have had mixed results. Objective: This study explores the relationship between knee pain and heart failure especially examining the factors of age, gender, race in U.S. older adults. Methods: Retrospective secondary analysis of Medicare claims data for 1.478 million adults over age 65. The standard analytical file for 2017 was segmented according to the presence of any of several ICD-10 codes for heart failure (HF). Medicare beneficiaries with and without HF diagnoses were evaluated for knee pain and other common pain-associated conditions; pain condition data was stratified by age, gender and race codes. Results: Knee pain was markedly increased in women with HF in the 65-70- and 70–75-year-old age-cohorts and relatively less increased in older age-cohorts and males. Knee pain in women was especially elevated in those with Medicare race codes indicating Black and Hispanic status. Conclusion: in a large cohort of Medicare beneficiaries, knee pain was noted to be markedly increased in younger cohorts of older women with HF, and more prevalent in Black and Hispanic women. Further studies should evaluate lifestyle, biomechanics, and inflammatory factors that may be contributing to this relationship.
Hearing Loss and Preventable Hospitalizations
Authors: Reed Nicholas , Morales Emmanuel Garcia
Published: December 2021

Nearly half of all adults over the age of 60 years have hearing loss. Recent research suggests adults with hearing loss experience increased health care expenditures and hospitalization. However, little is known about whether these are preventable hospitalizations which may indicate poorer healthcare system engagement. In this cross-sectional analysis, we examined data from combined 2016-2018 Medicare Current Beneficiary Survey (MCBS) datasets. Participants are asked to describe their self-perceived trouble hearing. Preventable hospitalizations were defined and generated from administrative claims files based on the Agency for Healthcare Research and Quality identified conditions that should be manageable in ambulatory care settings. Multivariate regression models adjusted for demographic/socioeconomic characteristics and general health determinants were used to explore the association between trouble hearing and outcomes. The combined 2016-2018 MCBS administrative claims files included 18,814 participant-years, 49.8% reported no trouble hearing, 43.4% reported a little trouble and 6.8% a lot of trouble hearing, respectively. A higher proportion of those with a lot of trouble hearing (6.8%) experienced at least one preventable hospitalization compared to those with a little trouble hearing (3.4%) and no trouble hearing (2.5%). In a fully adjusted logistic regression model, hearing loss was associated with 1.35 times the odds of experiencing at least one preventable hospitalization per year (OR=1.35; 95% CI=1.03-1.77). Medicare beneficiaries with hearing loss experience higher rates of preventable hospitalizations. This may be due to avoidance of care due to communication barriers. Further work is needed to understand underlying reasons and whether addressing hearing loss modifies the observed association.
Trends in Antiretroviral Regimen Complexity Among Medicare Beneficiaries With HIV, 2014-2018
Authors: Fleming Sean , Wastila Linda
Published: December 2021

Little is known about antiretroviral therapy (ART) patterns among Medicare beneficiaries with Human Immunodeficiency Virus (HIV). ART has significant implications for spending in Medicare Part D as use of single-tablet regimens (STR) grows, generic availability remains low, and price increases for branded therapies consistently exceed inflation. The objective of this study is to detail patterns of STR utilization among Medicare beneficiaries with HIV. We conducted a retrospective trend analysis using a 5% sample of Medicare Chronic Conditions Data Warehouse, 2014-2018. We included each person-month that fee-for-service beneficiaries with HIV had Parts A, B, and D coverage. Trends in annual prevalence of STR overall, by ART class, and by age, sex, and race subgroups were estimated. The study included 9,509 beneficiaries who contributed 345,708 person-months to the analysis. The prevalence of STR increased from 21.8% (95%CI, 21.5-22.1) in 2014 to 44.6% (95%CI, 44.3-45.0) in 2018 (p <0.0001), an increase of 104.6%. Integrase strand transfer inhibitors (INSTI) saw the largest increase in utilization between 2014 (4.4% [95%CI 4.2-4.5]) and 2018 (35.1% [95%CI 34.8-35.4]) (p<0.0001), a 701.8% increase. All sociodemographic subgroups experienced similar growth in STR use between 2014 and 2018. STR and INSTI utilization increased significantly over the study period, suggesting increased ART spending under Part D. Although increasing availability of generic multi-tablet ART regimens (MTR) may offer cost-savings, further research is needed comparing generic MTR to branded STR with regards to patient preferences, adherence, healthcare resource utilization, and total costs in the growing population of Medicare beneficiaries with HIV.
Older People With Dementia Running a Pop-Up Restaurant: How to Use Reality Shows to Reduce the Stigma of Dementia
Authors: Xu Wenqian
Published: December 2021

The present study focused on a Chinese reality show, Forget Me Not Café, which brought together five older people (aged 65 and older) living with dementia to run a pop-up restaurant and intended to reduce the stigma of dementia. The study aims to explore how the reality-show participants describe dementia in older people and how their views relate to the macrosocial context of dementia and older people. This study performed a thematic discourse analysis on the written and spoken content about dementia in older people (or later life) presented in the reality show. Four discursive themes were identified including: (1) age is a risk factor for dementia; (2) early signs and symptoms of dementia in older people deserve attention; (3) putting pressure on family caregivers of people with dementia; (4) expectations to maintain social engagement and slow down the development of dementia. This study also found that the views of the reality-show participants highlight the capability of older people with dementia to communicate effectively and live with the condition, their personal goals of sustaining a happy, meaningful and sociable life, as well as their actions to positively influence personal circumstances. The results of this study indicate that this reality show might help reduce the stigma of dementia and empower older people living with dementia, while it also tends to stress the responsibility for care on family carers and shift the responsibility of managing the dementia-related challenges to older people living with dementia.
Energy Decline May Predict Mild Parkinsonian Signs in Community-Dwelling Older Adults
Authors: Ehrenkranz Rebecca , Tian Qu , Rosso Andrea , Glynn Nancy W , Chahine Lana , Hengenius James , Zhu Xiaonan , Rosano Caterina
Published: December 2021

Mild Parkinsonian Signs (MPS) are common in older adults without overt neurological disease. MPS are often progressive and predict disability and dementia, yet little is known about predictors for MPS. Low self-reported energy is associated with mobility impairment, which is a hallmark of MPS. Yet whether self-reported energy relates to MPS is unknown. We explored the association of changes in self-reported energy with MPS in 293 participants (aged 83 ± 2.8 years, 58% women, 61% White) free of dementia and Parkinson’s Disease in the Health, Aging and Body Composition Study. Self-reported energy was assessed on a 0-10 scale annually between Year 2 and Year 10 (mean follow-up: 8 years) and its slope was estimated via linear mixed effects models. MPS were evaluated at Year 10 based on the Unified Parkinson Disease Rating Scale motor component. On average, self-reported energy declined 0.06 points per year. In a linear regression model adjusted for age, fatigue, and comorbidities, those with MPS had steeper SEL decline (β [Standard Error] = -0.358 [0.119]) in the prior eight years than those without MPS. Thus, declining self-reported energy may be a risk factor for MPS. Self-reported energy is easily evaluated in routine clinic visits, and may be a modifiable risk factor that can be targeted to reduce the incidence of MPS.
Patient Cognitive Impairment Associated With Greater Care Intensity During Medicare Home Health Care
Authors: Burgdorf Julia , Bowles Kathy
Published: December 2021

Medicare beneficiaries with cognitive impairment are more likely to access home health care than those without such impairment, and an estimated 1 in 3 Medicare home health patients has diagnosed dementia. However, recent changes to the Medicare home health payment system do not adjust for patients’ cognitive impairment. To the extent that cognitive impairment prompts higher intensity care, this could create a financial disincentive for providers serving this patient population. We draw on a nationally representative sample of 1,214 (weighted n=5,856,333) community-living Medicare beneficiaries who received home health care between 2011-2016. We measure care intensity by the number and type of visits received during an index home health care episode. We model care intensity as a function of patient cognitive impairment during the episode, measured via clinician reports in standardized patient assessment data. In propensity score adjusted, multivariable models holding all covariates at their means, home health patients with identified cognitive impairment received a significantly greater number of visits. During the index home health episode, cognitively impaired patients received an additional 2.82 total visits (95% CI: 1.32-4.31; p<0.001), 1.39 nursing visits (95% CI: 0.49-2.29; p=0.003), 0.72 physical therapy visits (95% CI: 0.06-1.39; p=0.03), and 0.60 occupational therapy visits (95% CI: 0.15-1.05; p=0.01). Findings suggest that recent changes to Medicare home health care reimbursement do not reflect the more intensive care needs of patients with cognitive impairment, and may threaten access to care for these individuals.
Deploying Implementation Strategies to Facilitate Professionals’ Use of the Home Care Frailty Scale
Authors: Juckett Lisa , Oliver Haley , Bunck Leah , Kurzen Crystal , Devier Andrea , Page Fannisha
Published: December 2021

Home- and community-based service (HCBS) organizations play an instrumental role in maximizing the independence of older adults, ages 60 and over. HCBS clients typically have multiple health complications, placing them at great risk of frailty—a complex condition associated with health decline and institutionalization. However, despite their frequent contact with older adults, HCBS professionals are not required to assess the frailty levels of their clients, creating a missed opportunity to monitor the needs of this at-risk population. The purpose of this quality improvement study was to test a package of five implementation strategies designed to support HCBS professionals’ use of the evidence-based Home Care Frailty Scale (i.e., Frailty Scale) with all new clients at one large HCBS organization. Implementation strategies included (a) selecting one professional to serve as the organization’s Frailty Scale “champion,” (b) holding three training sessions with 25 HCBS professionals, (c) modifying client charts to allow professionals to document Frailty Scale results, (d) pilot testing the Frailty Scale with a small group of clients, and (e) completing monthly chart audits to monitor rates of Frailty Scale implementation. During the first three months of Frailty Scale use, HCBS professionals administered the Frailty Scale to 414 out of 467 eligible clients (88.6%). For Month 1, 87.4% of eligible clients were administered the Frailty Scale, followed by 90.8% in Month 2, and 85.6% in Month 3. This quality improvement study suggests that a multifaceted package of implementation strategies can support professionals’ use of an evidence-based frailty instrument in the HCBS setting.
Decoding TikTok: Utilizing Social Media for Difficult Conversations About Ageism
Authors: Bouchard Lauren
Published: December 2021

Understanding ageism is a key aspect of gerontological curriculum. Media examples (e.g., television and movies) can be effective tools, and yet gerontological educators should stay updated on new media trends to encourage student interest. This presentation will explore a new social media application (i.e., TikTok) to help students recognize and dismantle their own ageist beliefs. The presenter will describe and explain the classroom activity, instructions for finding and downloading content, as well as the social media application itself. In this activity, students brainstorm their preconceived notion of older adults to catalyze open discussion regarding societal beliefs. Next, a few video examples, with both positive and negative portrayals of older adults are presented for discussion. Students may also bring other examples for participation credit to this class. This symposium presentation will include an interview activity guide, additional breakout group instructions, and other tips for creating impactful class discussion on ageism.
Memory Problems During COVID in Low-Income Older Adults
Authors: Zanjani Faika
Published: December 2021

Prevention, with widespread lifestyle risk reduction at the community-level, is considered an effective method to decrease Alzheimer’s disease (AD). Diverse low-income older adults in Virginia managing either diabetes/cardiovascular symptoms, were offered weekly lifestyle telephone-health coaching for 12-weeks, providing education, motivations, self-efficacy, and referral services for AD lifestyle risk. Participants provided positive anecdotal feedback and the need for continued health coaching during COVID-19. Thirty participants (predominantly African American/Black female) consented for continued health coaching during the pandemic with 47% reporting memory problems. Findings indicated poorer health status associated with reporting memory problems for poor physical health days, poor mental health days, total mental/physical health poor days, sad days, worried days, tired days, feelings of emptiness, feelings of rejection, feelings of failure, little interest/pleasure, and feeling down. This preliminary work creates the impetus for future large-scale AD prevention investigations to improve the lives of AD-risk, low-income, diverse older adults reporting memory problems.
Transparency, Documentation, and Open Science
Authors: Isaacowitz Derek
Published: December 2021

Some GSA journals are especially interested in promoting transparency and open science practices, reflecting how some subdisciplines in aging are moving toward open science practices faster than others. In this talk, I will consider the transparency and open science practices that seem most relevant to aging researchers, such as preregistration, open data, open materials and code, sample size justification and analytic tools for considering null effects. I will also discuss potential challenges to implementing these practices as well as reasons why it is important to do so despite these challenges. The focus will be on pragmatic suggestions for researchers planning and conducting studies now that they hope to publish later.
Oral Health, Cognitive Function, and Mortality: Findings From National Surveys
Authors: Wu Bei , Keepper Susie , Saunders Michele
Published: December 2021

Poor oral health, diabetes mellitus (DM), and cognitive impairment are common problems in older adults. Using national surveys, this symposium aims to present new findings regarding the impact of the co-occurrence of DM and poor oral health on cognitive function, cognitive decline, and mortality. This symposium will also cover the topic of dental care use among adult populations in the U.S. Using data from the Health and Retirement Study (HRS) (2006- 2018), the first study shows that adults with both DM and edentulism had the worst cognitive function, followed by those with edentulism alone, and those with DM alone. Using the same HRS data, the second study found that co-occurrence of DM and edentulism had a higher risk of more rapid cognitive decline with advancing age than the presence of each condition alone. The third study used data from the 2006-2016 HRS linked with mortality files, and revealed that the risk of diabetes and edentulism on mortality may vary across racial/ethnic groups. Using the Behavioral Risk Factor Surveillance System survey (2002-2018), the fourth study examined disparities of dental service utilization among racial/ethnic groups (Whites, Hispanics, Blacks, Asians, American Indians or Alaska Natives, and Native Hawaiian or other Pacific Islanders). Age differences in dental services were also compared between older adults and other younger and middle-aged populations. This symposium highlights the role of oral health in improving cognitive health. Policies and programs are needed to increase dental care access, a critical way to help maintain good oral health.
Longitudinal Association Between Perceived Fatigability and Brain Volumes in Community-Dwelling Older Adults
Authors: Schrack Jennifer , Liu Fangyu , An Yang , Wanigatunga Amal , Gross Alden , Simonsick Eleanor , Ferrucci Luigi , Resnick Susan
Published: December 2021

Perceived fatigability is linked to declining physical and cognitive performance, yet whether fatigability reflects early subclinical change in brain structure is unknown. Using mixed effects models, we assessed the longitudinal association of 3T MRI-derived brain volumes with perceived fatigability after a 5-min treadmill walk (0.67 m/s, 0% grade) using the Borg Rating of Perceived Exertion scale (range 6-20) in 802 BLSA participants (age 68.2+/-12.4 years, 45% men 66% White). In models adjusted for intracranial volume, demographics, chronic conditions, and CESD score, declining gray matter volumes in the frontal (β=-0.01) and temporal (β=-0.02) lobes, as well as the hippocampus (β=-0.25), precuneus (β=-0.10) and thalamus (β=-0.19) were associated with higher fatigability. Larger ventricular volumes were also associated with higher fatigability (β=0.02). Brain atrophy, particularly in gray matter and the hippocampal region, is longitudinally associated with increased fatigability in cognitively normal older adults, making it a potential marker of brain atrophy.
Monitoring the Effectiveness and Safety of ARNI vs. Angiotensin Receptor Blocker by Frailty Status
Authors: Kim Dae , Patorno Elisabetta , Gopalakrishnan Chandrasekar
Published: December 2021

Using Medicare data 2015-2017, we conducted 5 sequential 1-to-1 propensity score-matched analyses of ARNI initiators and angiotensin receptor blockers (ARB) initiators, mimicking the accrual of new data every 6 months. Primary effectiveness endpoint was a composite of heart failure hospitalization or all-cause mortality and primary safety endpoint was a composite of hospitalization or emergency department visits for hypotension, acute kidney injury, hyperkalemia, and angioedema. Among non-frail patients (n=5,014), the rates (per 100 person-years) for ARNI vs ARB were 12.7 and 9.2 (rate difference: 3.4, 95% CI: 0.8 to 6.1), respectively, for the effectiveness endpoint and 5.2 and 3.6 (rate difference: 1.5, 95% CI: -0.1 to 3.2), respectively, for the safety endpoint. Among frail patients (n=2,694), the corresponding rates were 19.8 and 21.6 (rate difference: -1.8, 95% CI: -7.0 to 3.4) for the effectiveness endpoint and 10.9 and 8.0 (rate difference: 2.9, 95% CI: -0.6 to 6.4) for the safety endpoint.
Life Course Stressors and Functional Limitations in Later Life Among White, Black, and Hispanic Adults
Authors: Sauerteig Madison , Ferraro Kenneth , Bauldry Shawn
Published: December 2021

Although striking racial and ethnic disparities in health are manifest during later life, they may be rooted in early-life exposures. Drawing from cumulative inequality theory, we investigate whether experiencing life course stressors increases the risk of later-life functional limitations and whether this relationship differs by race and ethnicity. This study utilizes longitudinal data from the Health and Retirement Study to test whether six indicators of child stressors and eleven indicators of adult stressors predict trajectories of the onset and severity of functional limitations in later life among a diverse sample of adults. We find that child and adult stressors are associated with earlier onset and greater severity of functional limitations during later life. Mediation analyses reveal the indirect influence of child stressors via adult stressors on onset and severity of functional limitations; however, the indirect effects are slightly stronger for Black and Hispanic adults than their White counterparts (i.e., moderated mediation). In sum, child stressors, in and of themselves, do not increase functional limitations among Black and Hispanic people but are associated with greater adult stress exposure, leading to more functional limitations in later life. Disparities in functional limitations are also partly due to lower education and less wealth among Black and Hispanic adults.
Uncovering Pet Issues: A Survey of Professionals Working With Older Adults and Care Partners
Authors: Bibbo Jessica , Johnson Justin , Drost Jennifer , Sanders Margaret
Published: December 2021

Pets can play an important role in older adults’ health behaviors and decisions. However, the degree to which these issues are encountered or addressed by professionals working with this population remains unknown. An interdisciplinary (e.g., healthcare, social services) sample of professionals (N=72, 93.05% female, Mage=48.82, SDage=12.57) completed an online survey focused on the pet ownership issues they have encountered while working with older adults, persons with dementia, and care partners. The professionals (n=66) estimated 42.86% of their clients had been pet owners, and 45.58% regularly asked their clients about pets. Issues raised to the professionals varied by type of client. Older adults most often brought up exercising the pet, routine veterinary care, and the financial aspect of ownership (all 37.50%). Persons with dementia most often discussed accessing pet care items (12.50%), exercising the pet (9.72%), and basic pet care (8.33%). Care partners brought up basic pet care (33.33%), planning for the pet due to their care recipients’ housing transition (26.38%), and exercising the pet (25.00%). Professionals reported talking to clients about planning for the pet due to housing transition, concerns about falling, and concerns about the pet’s behavior (all 31.94%). The professionals (n=69) were very favorable toward pet ownership in general (M=4.43, SD=0.78) (1=extremely unfavorable, 5=extremely favorable), less favorable about older adult pet ownership (M=4.15, SD=0.72, p=.002), and even less favorable about persons with dementia owning pets (M=3.51, SD=0.93, p<.001). The results provide evidence that pet ownership issues are likely encountered in geriatric service settings and may shape healthy aging.
Preferred Communication Channels Among Older Adults During COVID-19
Authors: Der Ananian Cheryl , Doebbeling Brad , Mejía G Mauricio , Wine Hallie , Houchins Michelle , Infurna Frank , Pishko Claire
Published: December 2021

Social distancing measures put in place during the COVID-19 pandemic limited in-person interactions and may have increased the risk for social isolation and loneliness in older adults. Purpose: The purpose of this study was to understand the communication channels used by older adults (age 50+) during the COVID-19 pandemic to mitigate social isolation and loneliness. Methods: Older adults (n=22) who were selected from a longitudinal study, ‘Aging in the time of COVID,’ and who had self-reported they successfully avoided loneliness, participated in a semi-structured online interview. Participants were asked to describe the communication techniques and efforts they used to stay connected to family and friends during the pandemic. All interviews were recorded and transcribed verbatim. A thematic analysis approach was used to identify common approaches. Results: Participants were primarily female and white (100%) with a mean age of 64.7 years. Preliminary findings (n=5) suggest older adults relied heavily on technology to facilitate communication with family and friends including texting, phone calls, email, video calls or conferences (e.g., Zoom), WhatsApp and social media, primarily Facebook. In-person communication strategies, including one-on-one and small group gatherings following social distancing guidelines, were preferred, but used less often than technology-based approaches. Living close to friends and family, and previous experience with technology were facilitators. Competing work and family demands, distance, and technology challenges limited communication. Conclusions: While older adults may adopt technology at a lower pace, they relied on digital communication technology to maintain social connections during COVID.
Learn, Engage, and Act to Advance Age Inclusivity in Higher Education
Authors: Montepare Joann
Published: December 2021

Shifting age demographics are reshaping our social structures with far-reaching implications for higher education. Aging populations mean more older adults are looking to higher education to meet their professional needs and personal interests, and the longevity economy is calling for a trained workforce to provide services to support the health and functioning of individuals as they age. As well, there is a need to improve students’ aging literacy, along with developing synergistic age-friendly campus-community partnerships to address aging issues. How can institutions explore, create, develop, and sustain more age-friendly programs, practices, and partnerships? This presentation will introduce the toolkit specially designed by the GSA-AGHE Workgroup for use by faculty, students, administrators, and other campus leaders, and will provide an overview of the Age-Friendly University (AFU) initiative and its 10 guiding principles for creating more age-inclusive campuses.
Positive Psychology and Disability Studies: Directions for Research on Aging With IDD
Authors: van Heumen Lieke , Heller Tamar
Published: December 2021

This presentation outlines future directions for research on aging with intellectual and developmental disabilities (IDD) informed by positive psychology and disability studies theory. Research on aging with IDD often focuses on losses in functioning that come with age and on ways to prevent such decline. When applying a positive psychology lens to the experience of aging with IDD the focus shifts to determinants of positive emotions and strength and on ways of increasing meaningfulness in life as one ages. A positive psychology lens also relies on the assumption that people can self-direct and organize their lives, which is essential for individuals aging with IDD who historically have lacked opportunities to exercise self-determination. Positive psychology as applied to disability aligns with disability studies perspectives that emphasize that different ways of being in the world can be ‘sources of knowledge, satisfaction, creativity, and happiness’ (Chivers, 2011 p.9).
Brief Alcohol Interventions With Older Adults: Results of a Systematic Review of Literature
Authors: Lemieux Catherine , Purser Gregory
Published: December 2021

Older persons are especially vulnerable to the negative effects of alcohol misuse. National reports show that the older-adult population is the least likely group to perceive a need for treatment and be screened for alcohol-related problems. Little research has examined the impact of brief interventions on different drinking outcomes in at-risk older adults. To address this gap, the current study sought to systematically review empirical literature examining the effectiveness of brief alcohol interventions (BAI) implemented with adults (≥50) engaged in at-risk drinking. The authors developed specific a priori inclusion criteria (e.g., alcohol-related outcome measures, randomized controlled trials, RCT) before beginning the search process. Key terms were entered into 9 databases to yield an initial pool of 5,909 articles, from which 5,572 were excluded. A total of 337 articles remained, from which an additional 89 were excluded. Next, the authors independently reviewed 248 full-text, empirical articles and subsequently excluded 237 that did not satisfy inclusion criteria. Thus, the current systematic review yielded 11 studies representing RCT or experimental designs that employed random assignment. Findings of the review indicated that 7 (63.6%) studies showed a positive effect, with only 1 showing no positive effect of the intervention. For the remaining 3 (27.2%), the positive effect of the intervention was not conclusively determined due to study design issues. Overall findings suggest that BAI are effective in reducing alcohol consumption in the older-adult population. Additional evidence is needed to further knowledge consistent with recent initiatives (e.g., Age-Friendly Health Systems, 4Ms) that promote healthy aging.
An Interdisciplinary Collaboration to Improve Hypertension Medication Adherence for Older Adults
Authors: Lee Jeannie , Rogers Wendy
Published: December 2021

Hypertension is highly prevalent in older adults (74.5% in ≥60 years) with dire consequences, and adherence to hypertension medications is low (approximately 50%). With increased smartphone use among older adults (81% for 60-69 years, 62% for ≥70 years), technology innovations can improve medication adherence. This symposium highlights the efforts of an innovative interdisciplinary team of experts (clinical, cognitive aging, human factors, health technology) to develop and implement the Medication Education, Decision Support, Reminding, and Monitoring (MEDSReM) system to improve hypertension medication adherence for older adults. MEDSReM is a theory-based, integrated mobile application (app) and companion web portal that educates, supports missed dose decisions, reminds, monitors adherence, and incorporates blood pressure feedback. In this symposium, we describe the interdisciplinary development efforts. Insel et al. will present the theory-based intervention, technology translation, and advancement of the MEDSReM system. Lee et al. will describe the interdisciplinary team and describe the work by the decision support subteam that created the medication formulary and generated an algorithm to guide missed-dose decisions based on pharmacology of aging. Rogers et al. will discuss the education subteam’s development of educational information about hypertension, medications, and adherence for the MEDSReM system. Mitzner et al. will illustrate the instructional support sub-team’s efforts to ensure older adults can interact with both the smartphone app and online portal. Lastly, Hale et al. will describe the user testing subteam’s usability processes including the integration of blood pressure self-monitoring. These efforts will provide insights for other interdisciplinary teams developing technology interventions for older adults.
Foundational Basis for the Development of MEDSReM
Authors: Insel Kathleen , Einstein Gilles , Morrow Daniel , Lee Jeannie , Rogers Wendy , Mitzner Tracy
Published: December 2021

Discovering a composite of measures of executive function/working memory predicted everyday medication adherence among older adults, led to the development of a behavioral intervention, the Multifaceted Prospective Memory Intervention (MPMI) to improve hypertension medication adherence. The intervention resulted in a 35% improvement in adherence compared to an active education and attention control condition. However, adherence slowly declined over an additional five months of adherence monitoring without the presence of interventionists in the home. We proposed that the use of technology might help individuals maintain the prospective memory strategies, resulting in sustained adherence. An interdisciplinary team was formed to translate the behavioral intervention to technology, resulting in the first version of the MEDSReM system. In this presentation we describe the evolution of the project, from the components of the successful MPMI to the design and initial testing of MEDSReM. These efforts provide general insights about translating interventions into technology tools.
Using O*NET Linkages to Advance Research: An Example Evaluating Cognitive Function and Work Transitions
Authors: Carr Dawn
Published: December 2021

The type of work older adults engage in has potential to play a key role in shaping health and wellbeing. In this presentation, using data drawn from an O*NET crosswalk linked with the Health and Retirement Study, I show how different types of transitions out of the workforce shapes cognitive function differently for individuals retiring from different types of occupations. Based on a factor analysis of 36 job-related abilities, activities, and contexts, this paper shows that retirement has a more significant consequence for cognitive function for those who retire from jobs with low levels of cognitive complexity, but no significant consequences for those who retire from jobs with high levels of cognitive complexity. I discuss these results in the context of the ways in which O*NET classifications of jobs can provide critical insights into the potential influence of changing retirement trajectories on wellbeing in later life.
Community-Based Participatory Research on Diet and Activity With an Indigenous Pueblo Community
Authors: Kopera-Frye Karen
Published: December 2021

Tribal Critical Race Theory (Brayboy, 2005) supports the use of decolonizing methodologies such as Community-Based Participatory Research when collaborating with Indigenous communities. This paper highlights the underlying processes in working with a Pueblo community on an intergenerational health project. Indigenous participants included 16 Piro Pueblo individuals who collaborated on a project examining healthy diets and activity in their community. The project involved providing information on the importance of activity and healthy eating of traditional foods to promote healthy living. Thematic analysis of open-ended questions exploring the role of culture in food and activity yielded important themes of gathering, resilience, history, honoring ancestors at mealtime, cultural ways, and activities such as dancing and drumming. The results suggest that projects addressing diet and activity collaborate to ensure cultural values, e.g., connectedness, cultural ways, e.g., gathering, dancing, and Indigenous knowledge are represented in the project and viewed through an Indigenous lens.
CPBR Process in Urban Settings and the Unique Challenges and Successes
Authors: Kim Steffi
Published: December 2021

CBPR is a framework that allows for the collaboration of researchers and communities as co-partners and is a supported approach for Indigenous communities. The community engagement and co-partnership in this study allowed for the researcher's flexibility to be responsive to culturally appropriate practices and priorities of the communities and participants. CBPR principles, including the Elder Advisory Committee (EAC), were utilized in this urban-based project. Challenges presented in many ways, including the processes of a) entering communities, b) relationship building, c) time involvement, and d) recruitment. Successes represented the unique opportunity to enter communities at an interpersonal level, b) close community engagement, c) gathering information beneficial for the research team and the community, and d) extended community engagement. While challenges exist, this approach's benefits are far-reaching promoting trust, support, and interest in future research endeavors. The presenter will discuss strategies and processes helpful in engagement, recruitment, and data collection.
The GSA NIA R13 Diversity Mentoring and Career Development Workshop: what did we learn after 3 years?
Authors: Heyn Patricia , D'Antonio Patricia , Whitfield Keith
Published: December 2021

The goal of the GSA NIA R13 Diversity Mentoring and Career Development Technical Assistance Workshop (GSA Diversity TAW) is to support, promote, and advance the training of diverse students in aging research. The program’s main aim is to increase the number of early career scientists who are historically underrepresented in gerontological research. Thus, from 2018 to 2020, more than 60 trainees and 16 faculty from diverse backgrounds participated in this unique gerontological training that included peer mentoring opportunities and engagements at the GSA Annual Meeting. The workshop curriculum included scientific presentations, networking, NIH grant preparation, career planning, and effective professional communication. Trainees and faculty were involved in the evaluation of the workshop, which included electronic surveys and focus groups that informed the design and curriculum of subsequent workshops. This paper will discuss the curricular design and objectives of the GSA Diversity TAW and present a summary of the trainees’ feedback results about the program and the iterative changes made based on that data.