bluuebunny/crossref_metadata_2025 huggingface dataset:
PERSPECTIVES ON MEASURING QUALITY DEMENTIA CARE: FINDINGS FROM A STUDY IN LOW-RESOURCE LONG-TERM CARE
Authors: Kusmaul Nancy , Rataj Alison , Lepore Michael , Corazzini Kirsten , Kim Yoon Chung , Wang Jing , Holmes Sarah , Davie Laura
Published: January 2025

The quality of long-term care for persons living with dementia includes elements of both quality of life and quality of care. However, which elements are most important for measuring quality is less clear and may vary based on different stakeholder perspectives. According to the National Academies of Science, Engineering, and Medicine (NASEM), quality measurement is important because it supports work towards improving quality of care, specifically making care more safe, timely, equitable, efficient, effective, and patient-centered (2022). This presentation will discuss perspectives on quality measurement among residents living with dementia, their families, staff, and administrators in low-resource long-term care settings in two states. Using a priori team coding of interviews with 59 participants, three themes emerged: (1) Quality care includes getting to know residents and communicating with them, (2) Measures of relational aspects of quality are difficult to implement, and (3) Good quality care results in better outcomes on existing clinical quality measures. During study interviews, participants readily discussed elements of quality in individual provision of care but had difficulty describing quality measurement at an organizational or systematic scale, supporting previous findings that direct observation may be an accurate indicator of quality of care, but is challenging to implement at scale. Additionally, participants conceptualized care provision from their unique perspective (i.e. staff, resident, family) suggesting that each may have different factors that constitute quality care. This study underscores the importance of quality measurement and the challenges of operationalizing quality, particularly for persons living with dementia.
ABUSE ACROSS THE LIFE COURSE: CONNECTIONS WITH ELDER ABUSE
Authors: Miller Julie , Mars Lori
Published: January 2025

Likely conservative estimates suggest that 1 in every 10 Americans aged 60+ have experienced some form of elder abuse. As theoretical understandings of abuse in general have evolved, so too have conceptualizations of abuse at different stages of the life course, including in older adulthood. Questions remain, however, about ways in which abuse experienced earlier in the life course connect with subsequent experiences with elder abuse. This symposium brings together leading researchers and practitioners to explore abuse across the life course and connections with elder abuse. The first and second presentations in the symposium center experiences of elder abuse victims, with one presentation exploring patterns of abuse victimization across the lifespan and connections with prospective health outcomes in older adulthood, and another presentation focusing on experiences of financial exploitation among Holocaust survivors. The third and fourth presentations shift the perspective to emphasize experiences of people involved in the lives of elder abuse victims, including dementia caregivers who may be at greater risk for experiencing or perpetrating abuse once caregiving obligations begin and, in another case, concerned persons in the lives of elder abuse victims. Taken together, the presentations surface new insights and questions that locate elder abuse within a life course framework and connect abuse across the life course with elder abuse in particular. The symposium will include discussions of implications for research, practice, and policy.
KEEPERS OF CONTEXT: CENTERING VOICES OF CONCERNED PERSONS IN THE LIVES OF OLDER ADULT VICTIMS
Authors: Rachmuth Lisa
Published: January 2025

Older adults who experience financial exploitation and other forms of abuse often experience this abuse in isolation. However, financial exploitation and other forms of abuse can also profoundly impact another group of individuals in the lives of older adults: non-abusing family members, friends, and neighbors, referred to as “Concerned Persons” (CPs). The Concerned Person in the life of the older adult is often one of the few persons that can help identify the abuse and find resources to help the older adult move out of the abuse. Concerned Persons in the lives of older adults are sometimes secondary victims of the abuse, isolating themselves from other support networks and at times putting themselves at risk in various ways. A series of focus group conducted in 2024 focused on factors that motivated Concerned Persons in the lives of the older adult to help, how Concerned Persons can help professionals understand the older adults’ experiences with abuse across the lifespan, and how they can affect change for the older adult. Focus groups were conducted in affiliation with the Elder Abuse Helpline for Concerned Persons (the Helpline), a program at Weill Cornell Medicine. Through the Helpline, CPs are able to receive supportive counseling for themselves and referrals to ongoing services for themselves and the Older Adults who are abused. Findings from this research surface new insights that connect Concerned Persons’ experiences and attitudes with the topic of abuse across the lifespan, pointing to implications for research, policy, and practice.
PRESIDENTIAL SYMPOSIUM: FUNDAMENTAL APPROACHES TO HEALTHY AGING
Authors: LeBrasseur Nathan
Published: January 2025

The major threats to a long and healthy lifespan in humans include heart disease, stroke, cancer, diabetes, and Alzheimer’s disease; conditions for which the risk rises exponentially with advancing age. Healthy lifestyle choices are currently the most effective strategies to delay if not prevent the onset and progression of each of these distinct conditions, which suggests that they counter the fundamental biology of aging. In this Presidential Symposium, thought leaders in nutrition (Dr. Peterson), exercise (Dr. Fielding), sleep (Dr. Carroll), and circadian rhythms (Dr. Panda) will share their insights into how lifestyle choices influence biological mechanisms and, in turn, the clinical manifestations of aging.
IMPACT OF EXERCISE/PHYSICAL ACTIVITY ON HEALTH SPAN: FROM MOLECULAR MECHANISMS TO FUNCTIONAL BENEFITS
Authors: Fielding Roger
Published: January 2025

Exercise/physical activity counters the onset and progression of chronic diseases (e.g., type 2 diabetes (T2D), cardiovascular disease (CVD), cognitive decline, and cancers), geriatric syndromes (e.g., frailty), and disability, even when introduced in later-life. Advancing chronological age is associated with well characterized declines in muscle size, performance, and physical functioning across multiple species. Underlying these age-related changes are declines in the force/power generating capacity of skeletal muscle that appear to be driven by changes in skeletal muscle contractile protein function, metabolic derangements, and alterations in neuromuscular activation. Age-associated changes in muscle gene transcription, epigenetic modifications, mitochondrial stability, and anabolic capacity, all suggest that fundamental changes in aging biology are responsible for these changes. Furthermore, many of these responses have been shown to be responsive to changes in regular physical activity suggesting a putative role for exercise/physical activity on health span with aging. In my presentation, I will review the underlying mechanisms of age-related changes in skeletal muscle mass and function and how changes in regular physical activity can attenuate or reverse the observed changes in mass and function that occur with advancing age with resultant improvements in health span.
PLEIOTROPIC HEALTH BENEFITS OF TIME-RESTRICTED FEEDING
Authors: Panda Satchidananda
Published: January 2025

The global epidemic of obesity is driving a rapid increase in metabolic syndrome, which in turn contributes to several chronic diseases, including type 2 diabetes, certain cancers, and dementia. To combat this diverse set of diseases, there is an urgent need for simple yet effective measures with widespread benefits across multiple organ systems that can be implemented at a population scale. Time-Restricted Feeding/Eating (TRF or TRE) is a circadian-based dietary intervention where daily energy intake is limited to a consistent 6-12 hour window without explicitly changing the quantity of food consumed. In laboratory animals, this approach sustains circadian expression of the majority of protein-coding genes in a tissue-specific manner. When fed an obesogenic diet, TRF can mitigate metabolic disorders such as adiposity, dyslipidemia, hypercholesterolemia, fatty liver disease, atherosclerosis, and gut dysbiosis. Research from various labs has also shown that this method can reduce the risk and impact of dementia and certain cancers. Genetic and multi-omics studies are beginning to uncover the extensive molecular pathways engaged during time-restricted feeding. This foundational research is likely to drive large clinical trials across diverse populations to assess the feasibility and sustainability of TRE as a population-level intervention to reduce the global burden of diseases.
CAPABLE TRANSPLANT: ADAPTATION OF CAPABLE FOR USE WITH OLDER ADULTS WITH INACTIVE STATUS AWAITING KIDNEY TRANSPLANT
Authors: Hladek Melissa , Curriero Samantha , Xue Qian-Li , Crews Deidra , DeMarco Mara McAdams , Wilson Deborah , Brennan Daniel , Szanton Sarah
Published: January 2025

Over 800,000 Americans live with end-stage kidney disease (ESKD), disproportionally affecting older adults. This group represents just 1% of Medicare’s Fee for Service (FFS) population, yet utilizes greater than 7% Medicare FFS resources. Rates of kidney transplantation (KT), the preferred treatment for ESKD, have risen 5-fold for older adults since 1990 but there is vast heterogeneity in access to KT. Older adults are more likely to be listed as inactive (on the waitlist but ineligible for KT) and, inactive status is associated with a 2.2 fold increased risk of waitlist mortality compared to those that remain active. Barriers to active status are multi-factorial but frequently modifiable and include symptoms such as fatigue, depression and stress, pain as well as loss of physical function, social isolation, and decreased health literacy. Using community participatory research and human centered design, we used photos, interviews, persona development, storyboarding and focus groups to identify three barriers unique to this population around the themes of: mental fortitude, support and communication. Our CAPABLE adaptation, called CAPABLE Transplant, incorporates greater motivational and communication strategies for the person and the home as well as a robust digital literacy component to address the needs of this population. An open-label pilot phase helped to solidify all aspects of the adaptation with resulting 30-person pilot randomized control trial on-going. This presentation will focus on the human centered design adaptation process and results thus far.
AFRICAN IMMIGRANT BELIEFS AND CAREGIVER BURDEN: WHAT IS THE EVIDENCE?
Authors: Nkimbeng Manka , Aswani Truphosa , Albers Elizabeth , Gaugler Joseph
Published: January 2025

Perceptions among African immigrants can impact caregiving for individuals with dementia and their caregivers. However, the specific beliefs and their effects on caregiving outcomes remain unclear. This study aims to investigate the relationship between African immigrants’ beliefs and caregiver burden. Logistic regressions were used to explore the relationship between various beliefs (including family homecare, secretiveness about health, fear of bad news and death, facility-level care being the last resort, and preference to send someone with dementia to Africa) with caregiver burden with 155 African immigrant caregivers. The average age of a caregiver was 34 years, 30% were born in Africa, and 12% of persons living with dementia were residing in Africa. After adjusting for age, sex, place of birth, and marital status, caregivers who believed that care should be provided at home, those who viewed facility-level care as a last resort, and those who preferred to send someone with dementia to Africa showed higher odds of caregiver burden, although these associations were not statistically significant (OR 1.19, 95% CI [0.42-3.4]; OR 1.16, 95% CI [0.42-3.18]; OR 1.09, 95% CI [0.37-3.24], respectively). Although these findings were not statistically significant, the trend reveals that these African immigrant beliefs may negatively influence the care partner. Thus, there is a need for interventions that target both beliefs and poor health outcomes in Africans, an understudied research population.
DAILY PSYCHOLOGICAL EXPERIENCES AND SLEEP HEALTH AMONG AFRICAN AMERICAN FAMILY CAREGIVERS
Authors: Irani Elliane , Griggs Stephanie , Chen Zhengyi , Hickman Ronald
Published: January 2025

Extensive research has been conducted on the reciprocal associations between daily psychological experiences and sleep health (i.e., sleep satisfaction, daytime alertness, sleep timing, efficiency, and duration) in the general population. However, little research has focused on whether these associations vary for African American family caregivers who experience unique stressors and report lower sleep satisfaction and shorter sleep duration than other groups. We investigated how daily psychological experiences, including positive and negative affect, general stress, caregiving stress, and positive experiences, impact same-night sleep in African American family caregivers, and how nightly sleep affects next-day experiences. African American family caregivers (n=31) wore a research-grade actigraphy device day/night and completed daily diaries at bedtime and waketime over 7 days. Multilevel models evaluated within-person associations between daily psychological experiences and sleep health adjusted for participants’ age, prior-day outcome, and weekend (vs. weekday). Participants in the study were mostly women (80.6%), with an average age of 58.3 years. Most participants were caring for a parent (77.4%). On days when participants reported higher-than-average prior night sleep satisfaction, they reported higher-than-average positive experiences and affect, and lower-than-average negative affect. Daytime alertness was linked to higher positive experiences and affect, and lower negative affect and general stress. Results for the reversed direction revealed that negative affect, general stress, and positive experiences predicted next-day daytime alertness. Findings support the psychological health benefits of sleep in the context of African American family caregivers’ daily life and suggest that interventions should focus on improving sleep health to enhance daily psychological experiences.
THE ROLE OF EDUCATION ON BRAIN PATHOLOGY AND COGNITIVE DECLINE ACROSS WOMEN AND MEN IN THE US
Authors: Kim Min Hee , Morin Brittany , Olvera Alice , Ying Gelan , Khadka Aayush , Choi Seo-Eun
Published: January 2025

Women have a higher risk of developing Alzheimer’s disease and related dementia (ADRD) than men. Education, as a key contributor to cognitive reserve, might protect the ADRD onset. While existing evidence suggests that increased educational attainment may attenuate the negative impact of neuropathology on cognitive function, these studies focused primarily on average cognitive function, and little is known about whether education similarly attenuates the relationship between neuropathology and cognitive decline among those with high or low levels of cognitive outcomes or sex/gender. Using the Alzheimer’s Disease Neuroimaging Initiative sample (772 male and 627 female participants, who were cognitively normal or had mild cognitive impairment at baseline), we investigated education attainment modified the association between anatomical reduction in the brain and cognitive decline in sex-stratified models. We applied quantile regression with a three-way interaction term (education x cortical thickness x years) against 10-year cognitive function, an established specification for testing the cognitive reserve mechanism. We included a robust set of biological and contextual confounders. Primary results showed that, among males, education had attenuated the relationship between brain pathology and cognitive decline at lower levels of cognitive function distribution. Among females, education attenuates brain pathology and cognitive decline in all levels of outcome distribution with large confidence intervals. We will discuss potential explanations for differential effect modification by education on the brain pathology-cognition relationship across sex/gender and expand its implications for future research and policy/practice intervention.
NEIGHBORHOOD DISADVANTAGE, FUNCTIONAL DISABILITY, AND COGNITIVE DECLINE AMONG OLDER MEXICAN AMERICANS
Authors: Qin Weidi , Cavanagh Lucia , Owens Joshua , Snih Soham Al , Vega Irving
Published: January 2025

This study aims to investigate the longitudinal association between disability and cognitive decline, and to determine the moderating effects of neighborhood disadvantage among older Mexican Americans. Data came from the Hispanic Established Population for the Epidemiologic Study of the Elderly (2004-2005 to 2012-2013) linked to 2010 National Neighborhood Data Archive. Older Mexican Americans without cognitive impairment at baseline were selected (n=1,189). Cognitive function was measured by the Mini-Mental State Examination (MMSE). Neighborhood disadvantage was created based on five census-tract indicators (e.g., % of households below poverty). Disability was indicated by a count of activities of daily living (ADL) and instrumental ADL (IADL) limitations. Multilevel mixed-effects regression models were performed to estimate cognitive change over time, accounting for socio-demographics and health conditions. There was an average decline of 0.91 and 0.32 in the MMSE score as a function of ADL and IADL disability, respectively (p<0.05). Significant interactions between ADL and IADL disability and neighborhood disadvantage were observed. Among older Mexican Americans who were exposed to higher levels of neighborhood disadvantage, ADL and IADL disability were significantly associated with faster cognitive decline. The study findings suggest that neighborhood disadvantage undermines cognitive health among older Mexican Americans who have functional disability.
CHILDHOOD ROOTS OF FRAILTY: MACHINE LEARNING INSIGHTS INTO HEALTH INEQUALITY IN LATER LIFE
Authors: Huo Shutong , Gill Thomas , Chen Xi , Feng Derek
Published: January 2025

This study investigates the impact of childhood circumstances on health inequality in later life, with a particular emphasis on frailty among older adults in the United States, highlighting the significance of early life historical and social factors. We employed data from the Health and Retirement Study (HRS), incorporating the 2012, 2014, 2016, and 2018 waves along with the 2015 Life History Mail Survey (LHMS). Using innovative conditional inference trees and forests, we evaluated 43 distinct childhood factors and their contribution to the Inequality of Opportunity (IOP) in health outcomes. The circumstances in both countries can be divided into seven domains: 1) war or economic crisis at birth; 2) regional and urban/rural status at birth; 3) family SES in childhood; 4) parental health status and health behaviors in childhood; 5) health and nutritional status in childhood; 6) relationship with parents in childhood; 7) friendship in childhood. We found that key early-life predictors identified include experiencing the Great Depression, adverse childhood events, socioeconomic status, and access to educational resources, all of which play critical roles in determining frailty in older adults. The machine learning models, particularly conditional inference forests, significantly outperform traditional analytical methods in predicting health inequality, with the best out-of-sample performance. The findings demonstrate the importance of early-life circumstances in shaping later health outcomes and stress the early-life interventions for health equity in aging societies.
CONTEXTUAL INFLUENCES ON THE MAINTENANCE OF SOCIAL INTEGRATION IN LATE LIFE
Authors: Huxhold Oliver
Published: January 2025

Being socially integrated is essential for maintaining health and well-being in late adulthood. Although life course sociology and lifespan psychology have emphasized the influence of contextual conditions on different aspects of social integration for a long time, the majority of studies on social relationships in late life have focused on differences at the individual level. To address this shortcoming, this symposium presents a number of complementary perspectives on macro- and meso-level influences on late-life social development. To this end, Webster presents an analysis that details how meso-level resources integrated into the individual’s social network enhance the individual’s likelihood of volunteering. Following this presentation, Brandt and colleagues report on societal differences across European countries in a comprehensive index of social integration and relate these differences to well-being in late adulthood. Considering short-term changes in societal conditions, Klasen and colleagues present a theoretical model that details concrete pathways by which societal crises may impact social relationships. Finally, Suanet and colleagues investigate long-term societal changes and report on cohort and socio-structural differences in age-related changes in positive and negative social exchanges. Overall, the symposium offers a comprehensive view of societal and socio-structural influences on social integration. The talks combine new theoretical perspectives with sophisticated analyses and provide new insights into contextual factors in late life that are relevant for the development of targeted social interventions.
THE LINK BETWEEN EDUCATION WITHIN SOCIAL NETWORKS AND VOLUNTEERING
Authors: Webster Noah
Published: January 2025

Volunteering serves as a critical source of social integration in later life and also is a well-known health promoting activity. It is therefore important to continue exploring unidentified barriers and facilitators of volunteering. Both higher education and social networks (e.g., decreasing network proximity) have been linked with volunteering. No research though has explored how educational resources embedded in older adults’ social networks may facilitate this activity. In this study, we examine the association between average social network education and odds of volunteering among older adults. Respondents age 60 and older who participated in Wave 3 (2015) of the longitudinal Social Relations Study based in Metro Detroit were selected for analysis (n=342). During interviews, when asked to identify social network members, respondents were also asked to report the education of up to the first 10. Forty-one percent of respondents reported volunteering in the past year. Controlling for respondents’ own education as well as other demographic characteristics (age, gender, marital status), higher average social network education was significantly associated with greater odds of volunteering. In a regression model without average social network education, individual education was significantly associated with greater odds of volunteering, but this effect was no longer significant after network education was added to the model. Findings highlight that educational resources, often viewed as an indicator of macro-level socio-economic status, when embedded in social networks plays a greater role in facilitating volunteering than at the individual-level. This suggests a potential new pathway for intervention to increase volunteering in later life.
THE INFLUENCE OF SOCIETAL CRISES ON SOCIAL INTEGRATION
Authors: Klasen Lisa , Buenning Mareike , Kelle Nadiya , Huxhold Oliver
Published: January 2025

Societal crises have profound effects on various life domains. So far, the literature has focused on the effects of crises on financial security or health. Effects on social integration, i.e., social relationships and social participation, have received little attention, despite of their relevance for physical and mental health. The COVID-19 pandemic brought this topic to the forefront of the scientific and societal debate. However, to date no theoretical framework has been developed that captures the breadth and long-term influence of societal crisis on social integration. This presentation introduces a new theoretical framework – the DIRe-Crises-Model – for analyzing the effects of social crises on social integration, building on the Differential Investment of Resources (DIRe) Model. According to the DIRe-Crises-Model, crises influence social integration via four pathways by: a) limiting the time and energy that can be invested in social relationships, b) restricting the social opportunity structure, c) influencing individual characteristics essential for resource investment, and d) influencing the effects of social relationships (e.g., changes in the experience of loneliness). Dynamic components in the model allow to derive hypotheses on the long-term development of the different effects pathways of crises on social integration. Moreover, social inequalities can moderate the effects of the different pathways of crisis on social integration. The DIRe-Crises-Model as a theoretical framework has the potential to guide empirical analysis on the effects of any given societal crisis on social integration. As such, the framework may help to manage future crises, for example, by stimulating targeted interventions.
“I KNOW EVERYTHING. STOP TELLING ME I’M FINE”: A DYAD STUDY ON DISCRIMINATION AGAINST OLDER PATIENTS
Authors: Tong Juncheng , Cao Jiawei
Published: January 2025

Despite the increasing societal attention and concern towards older patients with cancer, self-perceived social discrimination by patients, along with benevolent discrimination by their families, are often too subtle to be recognized. Since only a few studies have investigated such issues, this qualitative study aims to investigate the sources and causes of social discrimination in this group. Semi-structured interviews were conducted with 23 dyads of older patients with cancer and their primary caregivers (i.e., family members) about perceived self-discrimination and quality of life. Interview transcripts with dyads were audio recorded, transcribed verbatim, and analyzed line-by-line using thematic analysis. Two researchers independently coded transcripts and reviewed discrepancies until a consensus was reached. Four significant themes were uncovered from interviews with patients: 1) self-definition, 2) withholding information from primary caregivers, 3) socialization anxiety, and 4) stereotypes about aging and dying. Four themes emerged from interviews with primary caregivers: 1) avoiding provoking patients’ frustration and discomfort by withholding medical information, 2) being considerate but lack of communication, 3) exhaustion with repeated disappointment, and 4) family love and compromise. These findings suggest that such actions by the caregivers could result in feelings of discrimination, distrust, or even betrayal by the patients. This study provides guidance to both clinicians and caregivers to 1) identify unintended discrimination practices in healthcare, 2) strengthen dyad trust and communication, and 3) accept external support services (e.g., counseling and palliative care), which are essential for improving patients’ quality of life.
THE IMPACT OF SYNCHRONIZED DYADIC DANCE ON SOCIAL BONDING AND INTERGROUP CLOSENESS
Authors: Suberry Assaf , Bodner Ehud
Published: January 2025

Synchronization of bodies in time encourages positive social functions such as cooperation and compassion. This study examined the effect of synchronous dance movements on social bonding and perceived intergenerational closeness. 168 participants ranging in age from 20 to 45 (young adults) and 65+ (older adults) were randomly assigned to six dyad conditions, which included dancing synchronously or asynchronously with an in-age-group or with an out-age-group stranger for 11 minutes. Participants completed social bonding with the partner and perception of distance between social groups (in terms of religiosity, ethnographic origin, political stance, and age) questionnaires. We used generalized estimating equations (GEE) modeling to assess variation across both individual measurements and measurements within dyads. Social bonding significantly increased in the synchronized condition (b = 0.51, p =.014), with participants reporting higher bonding with the dancing partner compared to the asynchronous condition. Relative to older participants, younger participants demonstrated a greater enhancement in perceived closeness across diverse social groups, as well as a greater increase in perceived closeness between age groups following the intervention. Lastly, participants reported a greater sense of closeness across generations when dancing asynchronously with in-group members compared to out-group members. We explore the possibility that declining openness and a shift towards conservatism in older adults may influence social connectedness and attitudes. Intergenerational dance programs may promote intergenerational relations and social cohesion, particularly for young adults. Practitioners from various fields - welfare, nursing, sport, music education, and community therapy may benefit from intergenerational rhythmic activity.
EFFECTS OF HEARING INTERVENTION ON PHYSICAL ACTIVITY AND FUNCTION: FINDINGS OF THE ACHIEVE RANDOMIZED TRIAL
Authors: Huang Alison , Schrack Jennifer , Glynn Nancy
Published: January 2025

This session examines the long-term effect of hearing intervention on physical activity and function. The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) randomized controlled trial (2018-2022) is a multi-center randomized controlled trial of 977 adults aged 70-84 with untreated hearing loss and without substantial cognitive impairment (Clinicaltrials.gov Identifier: NCT03243422). The trial’s primary outcome was to determine efficacy of hearing intervention for reducing 3-year cognitive decline. Data on exploratory outcomes, such as physical activity and function were also gathered. Associations between hearing loss and lower physical activity and function have been consistently demonstrated across large epidemiologic studies. The mediating factors that may underlie these associations include changes in auditory awareness, communicative difficulty, cognitive decline, and/or reduced social connection. Hearing intervention (e.g., provision of hearing aids and related technologies, counseling, and education) may modify these mechanistic pathways and could potentially serve as an intervention for improving or maintaining physical activity and function among older adults with hearing loss, but has yet to be investigated in a randomized controlled trial. This session will describe the overall study design of the ACHIEVE trial and present results on the 3-year effect of the hearing intervention vs. health education control on four exploratory outcomes of physical activity and function: accelerometry-based and self-reported physical activity, fatigue, and physical performance.
EFFECT OF HEARING LOSS TREATMENT ON ACCELEROMETRY-MEASURED DAILY PHYSICAL ACTIVITY
Authors: Schrack Jennifer , Wanigatunga Amal
Published: January 2025

Hearing impairment is widespread in older adults and associated with lower physical activity, but whether hearing loss treatment reduces or attenuates age-related decline in physical activity as individuals become more aware of -and interactive with- their surroudings is unknown. This study tested the effect of a hearing intervention vs. successful aging health education control on quantities and patterns of wrist-worn, accelerometer-derived daily physical activity over 3-years among older adults with hearing loss, a pre-specified exploratory outcome in the Aging and Cognitive Health Evaluation in Elders Study. Two-level linear mixed effects models with an interaction term (intervention x time) were used to test if 3-year change in physical activity outcomes differed by intervention assignment. Function-on-scalar regression (FOSR) models were used to examine potential intervention time-of-day differences in physical activity. Participants were (mean±SD) aged 76±6 years, 89% White, 52% female, and 53% had a Bachelor’s degree or higher. At baseline, mean activity counts/day were 1.86x106±810,889, active minutes/day were 382.3±160.5, and activity fragmentation was 23.8%±8.2%. At year 3 of follow-up, activity counts/day and active minutes/day declined (β [95%CI]) (-49,584 [-61,873, -37,294] and -8.7 [-11.4, -6.1]), respectively, and activity fragmentation increased (0.18% [0.01, 0.35%]). Results did not differ by intervention assignment. FOSR models showed no difference in time-of-day activity by intervention assignment. Results suggest the hearing intervention did not attenuate 3-year declines in physical activity in older adults with hearing loss. Findings may have been attenuated by the content of the successful aging program (single-session on physical activity), or relatively short follow-up time.
EFFECTS OF HEARING INTERVENTION WITH HEARING AIDS ON PHYSICAL FUNCTION: FINDINGS FROM THE ACHIEVE STUDY
Authors: Zhang Wuyang , Deal Jennifer
Published: January 2025

Hearing loss is an underrecognized risk factor for physical function decline that may be amenable to rehabilitative intervention. Using data from the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study, a randomized controlled trial of best practices hearing intervention on cognitive decline (Clinicaltrials.gov Identifier: NCT03243422), we investigated the effect of hearing intervention versus health education control on 3-year changes in physical function, a pre-specified outcome for the trial. 977 participants were randomized 1:1. The primary outcomes for this analysis included the Short Physical Performance Battery (SPPB), rescaled according to published guidelines developed in the Health Aging and Body Composition study to address ceiling effects in high-functioning populations, and grip strength. At baseline, the study sample had an average SPPB score of 1.80±0.34, with a mean age of 76.8±4.0 years, 54% female, and 11% self-reported Black race. In linear mixed effects models adjusted for participants’ baseline socio-demographic characteristics, health status, and hearing status (and corresponding time interactions), 3-year changes (in SD units) were did not differ between treatment groups in SPPB scores (β=-0.001; 95%CI: -0.115, 0.113; p-value: 0.98) and grip strength (β=0.016; 95%CI: -0.054, 0.085; p-value: 0.66). In pre-specified sensitivity analysis, the strongest estimated effect of hearing intervention on SPPB performance was among those with worse cognitive test performance (β=0.237; 95%CI: -0.019, 0.493; p-value: 0.07). Given that physical function was not the primary outcome of the ACHIEVE trial, these results should be considered exploratory. Follow-up of ACHIEVE participants is ongoing to determine if intervention effects require longer follow-up time.
THE JOINT EFFECTS OF EXPOSURE TO AIR POLLUTION AND HEAT ON EPIGENETIC AGING IN THE HEALTH AND RETIREMENT STUDY
Authors: Dang Kristina , Choi Eunyoung , Finch Caleb , Crimmins Eileen , Ailshire Jennifer
Published: January 2025

Prior research shows independent associations of exposure to air pollution and heat on epigenetic alterations. However, less is known about the combined effects of long-term air pollution (PM2.5) and acute heat events. We examine joint effects of elevated PM and heat on DNA methylation (DNAm). Data from the 2016 Health and Retirement Study DNAm Sample (N=3,464) were merged at the census tract level to (1) annual ambient concentrations of PM2.5 from CACES and (2) daily heat index data averaged 7-days before blood collection from gridMET. Four categories of joint PM2.5 and heat were analyzed: (1=reference) low PM2.5 (< 9.2 𝜇g/m3) and low heat (< 80 on heat index); (2) low PM2.5 and high heat; (3) high PM2.5 and low heat; and (4) high PM2.5 and high heat. We used five epigenetic aging measures: Horvath, Hannum, PhenoAge, GrimAge, DunedinPACE. Linear models were adjusted for age, sex, cell type, race/ethnicity, education, and neighborhood poverty. Compared to the reference of low PM2.5 and heat, we found associations of short-term heat and low PM with accelerated DNAm aging for Hannum (𝛽=0.61 95%CI:0.05, 1.18) and PhenoAge 𝛽=0.90 95%CI:0.28, 1.52). High PM2.5 and low heat had weaker associations (Hannum 𝛽=0.41 95%CI:-0.28, 1.11; PhenoAge 𝛽=0.13 95%CI:-0.61, 0.89), as did joint effects of high PM2.5 and heat (Hannum 𝛽=0.21 95%CI:-0.61, 1.03; PhenoAge 𝛽=0.27 95%CI:-0.68, 1.22). Short-term heat may accelerate epigenetic aging, particularly in areas with low air pollution. These findings suggest underlying physiological responses to acute heat exposures may differ between residents in low and high air pollution environments.
EVIDENCE OF PSYCHOSOCIAL BEHAVIORAL AND COGNITIVE FORTITUDE TO AD IN RACIALLY/ETHNICALLY MINORITIZED OLDER ADULTS
Authors: Clark Alexandra
Published: January 2025

It is essential that emerging research focuses on characterizing important heterogeneity in risk and resiliency to Alzheimer’s disease (AD) within minoritized communities of color. Our previous work has used empirical methods to identify distinct psychosocial-behavioral and cognitive phenotypes within a large sample of community-dwelling Black and Latinx older adults enrolled in the Health and Aging Brain Study: Health Disparities (HABS:HD). This first part of this presentation will discuss the identification and characterization of unique psychosocial-behavioral phenotypes. We will highlight how these phenotypes displayed varied cognitive, neuroimaging, and AD biomarkers outcomes, with an emphasis on understanding mechanisms by which a “resilient” Low Resource/Low Distress group defies the odds of economic inequality and does not appear to be at increased risk for developing AD. This second part of this presentation will highlight data that provides a more nuanced understanding into why bilingualism has been linked to a later age of AD onset. We demonstrate that there is significant variability in the cognitive profiles of bilingual Latinx speakers that is partially attributable to language of testing, proficiency, dominance, and age of acquisition. Furthermore, we discuss the identification of a unique group of bilingual speakers with above average memory performance who are less likely to progress to the mild cognitive impairment phase. Collectively, this work illustrates the need to move beyond racial/ethnic group comparison studies to non-Latinx whites, highlights the importance of characterizing within-group heterogeneity, and further emphasizes potential points of prevention and intervention for optimizing aging outcomes in racially/ethnically minoritized older adults.
LIFECOURSE STRESS EXPOSURES, RESILIENCE, AND BIOBEHAVIORAL MECHANISMS UNDERLYING DISPARITIES IN COGNITIVE AGING
Authors: Chen Ruijia
Published: January 2025

Stress exposures across the lifespan, such as childhood adversities and financial strain, may contribute to social disparities in cognitive outcomes. Individuals from socially disadvantaged backgrounds tend to be exposed to more stressors than their advantaged counterparts. Prior research has indicated that psychosocial stressors are key determinants of physical and mental health as well as health disparities. However, their roles in Alzheimer’s Disease and Related Dementias (ADRD) risk have received considerably less attention. In addition to understanding and intervening directly on stressors, elucidating modifiable factors, such as social networks, further along these pathways may offer additional intervention avenues. Greater social networks have been consistently noted as predictors of lower ADRD risk, yet the structure and impact of social networks may vary across racial and ethnic groups, making it essential to assess the associations between social networks and ADRD risk in diverse racial and ethnic groups. Psychosocial stressors may lead to sleep disturbances (e.g., sleep apnea and insomnia), biobehavioral factors that disproportionately affect racial and ethnic minorities. With the availability of effective treatments for some types of sleep disturbances, evaluating how these disturbances contribute to ADRD risk across different racial and ethnic groups could identify novel targets for reducing disparities in ADRD. This presentation will cover a series of studies applying advanced epidemiologic methods, including causal inference, to investigate the roles of life course stress and resilience factors in contributing to disparities in cognitive aging.
IMPACT OF STRUCTURAL RACISM ON COGNITIVE DECLINE
Authors: Ali Talha , Cohen Joshua , Gilani Owais , Needham Belinda , Dokshina Darya
Published: January 2025

Black individuals are twice as likely as White individuals to develop cognitive impairment. However, little empirical research has investigated the sources underlying these racial disparities. We examine the effects of exposure to structural racism as a fundamental cause of racial disparities in the risk of subjective cognitive decline among older adults. Data on subjective cognitive decline from the 2015-2016 Behavioral Risk Factor Surveillance System (BRFSS) were analyzed among adults aged 45 years and older. We operationalized structural racism as an index of the number of racist vs. neutral vs. anti-discriminatory state-level policies. BRFSS participants were assigned structural racism exposure based on their state of residence at the time of the survey. The association between exposure to structural racism and the risk of subjective cognitive decline was examined using multilevel logistic regression models. Interaction terms were used to examine how this association was modified by individual-level race. American Indian Alaska Native, multiracial, and Hispanic individuals had the highest reports of experiencing subjective cognitive decline. Black individuals were the most likely to live in states with high levels of structural racism. Greater exposure to structural racism was associated with higher odds of reporting subjective cognitive decline. This association was modified by individual-level race and ethnicity, such that the risk of subjective cognitive decline decreased with increasing exposure to structural racism among Hispanic individuals. These findings warrant further research into exploring the social and emotional factors that offer resilience among Hispanic older adults.
NEIGHBORHOOD WALKABILITY AND SOCIOECONOMIC CORRELATES OF STEP ACTIVITY FOR NON-HISPANIC BLACK OLDER ADULTS
Authors: Moored Kyle , Desjardins Michael , Varma Vijay , Richards Emily , Ohgi Sayuri , Donahue Patrick , Carlson Michelle
Published: January 2025

Neighborhood socioeconomic resources and walkability (e.g., proximity of services/amenities) may promote health in later life by encouraging physical activity. Yet, structural racism (e.g., redlining) has caused Black Americans to disproportionately reside in more disadvantaged neighborhoods. We examined whether neighborhood socioeconomic disadvantage, both independently and jointly with neighborhood walkability, was cross-sectionally associated with objective step activity in non-Hispanic Black older residents of Baltimore City, MD. Participants were from the Baltimore Experience Corps Trial at baseline (n=168, mean age=67.0±5.5). Neighborhood measures included validated indices of Census tract-level walkability (e.g., transit access, street connectivity, service/commercial density) and socioeconomic disadvantage (e.g., poverty, unemployment). Individuals were further categorized into combined walkability/disadvantage groups using median splits of each index: low walkability/low disadvantage (40%), high walkability/low disadvantage (7%), high walkability/high disadvantage (46%), low walkability/high disadvantage (8%). Average daily step activity was measured using an ankle-worn monitor (mean=4.3 wear days). Linear regression was used to examine associations with step activity adjusted for age, gender, and education. Being in the highest (vs. lowest) tertile of disadvantage was associated with 1513 fewer average steps per day (95% CI: -2873,-153). While walkability was not independently associated with step activity (p>.05), the high walkability/high disadvantage group had an average 1381 more steps per day (95% CI: 204,2558) compared to the low walkability/high disadvantage group. Higher neighborhood socioeconomic disadvantage was linked with lower physical activity for non-Hispanic Black older residents of Baltimore City. Yet, positive neighborhood attributes like walkability may buffer against socioeconomic disadvantage, potentially by providing access to services/amenities that promote activity.
THE IMPACT OF CULTURE ON CIVIC ENGAGEMENT OF AGING ASIAN IMMIGRANTS: FINDINGS FROM A MIXED STUDY IN EDMONTON, CANADA
Authors: Tong Hongmei
Published: January 2025

As a well-known immigrant-receiving country, Asian immigrants constitute most immigrants in Canada. However, the understanding of cultural diversity and intra-cultural similarities and differences among aging immigrants’ civic activities is limited. A mixed-methods study was conducted to examine civic participation experienced by Filipinos, Indians, and Chinese, since they are the three largest ethnocultural communities in Edmonton. Thematic analysis related to research questions was used for data analysis. Findings show diversity in the understanding of civic engagement and willingness, and their understanding and engagement in civic activities are affected by culture-related factors such as country of origin, time since immigration, citizenship status, greater official language proficiency, and pre-migration participation in activities. Public policies, such as immigration and integration policies (e.g., multiculturalism, diversity, and social inclusion), also influence immigrants’ civic participation. The findings suggest that cultural diversity should be considered in promoting civic activities among aging immigrants.
EXPLORING THE RELATIONSHIP BETWEEN LONELINESS, RELIGION, AND SPIRITUALITY FOR OLDER ADULTS IN ENGLAND
Authors: Victor Christina
Published: January 2025

Although there is evidence linking the prevalence of loneliness with religion and/or spirituality in north America, this topic is rarely researched in the UK. This study explored the relationship between measures of religious affiliation, attendance, and practice with loneliness for older adults in England. We generated an analytic sample of 6225 adults aged 50+ who took part in wave 9 of the English Longitudinal Study of Ageing (ELSA). The exposure variables of religious affiliation, attendance and practice were measured by questions on religious identity; frequency of attendance at places of worship in the last year; and 4-point Likert scales of agreement or disagreement with religious importance, meaning and purpose, prayer and meditation, and activity. Loneliness outcome was measured using the three item University of California Los Angeles loneliness scale. The majority of our analytic sample were Christian (77%), 22% had no religion and 49% had not attended a place of worship in the last year. The prevalence of loneliness (score 6+ on UCLA scale) was 19%. Religious attendance was significantly associated with loneliness (OR =.73 CI.62-.85, p <.001), with attendance protective against feeling lonely. However, this relationship was not significant after adjustment. No relationship was observed between loneliness and religious affiliation or spirituality. Religious identity remains prevalent in older adults in England, but attendance and practice less so. Further studies in diverse populations, using validated measures of loneliness and religion, are necessary to investigate whether loneliness can be moderated or mediated by religion/spirituality alongside other determinants.