bluuebunny/crossref_metadata_2025 huggingface dataset:
BUILDING CLINICAL JUDGMENT IN THE HEALTH CARE WORKFORCE BY ADDRESSING THE 4MS AND MULTICOMPLEXITY
Authors: Avallone Margaret , Perweiler Elyse , DeGennaro Jennifer , Mock Marilyn
Published: December 2023

Since 2019, NJGWEP, Rutgers School of Nursing-Camden and Fair Share Support Services, Inc. partnered in an affordable housing site in an underserved, disadvantaged community to support aging in place. Senior nursing students conduct Resident Health Risk Assessments (RHRAs) using the 4Ms framework to build assessment skills, sharpen clinical judgment, and address the Geriatric 5th M in a multi-complex resident population. Nursing students, working in teams with social service and community health workers, completed 92 RHRAs incorporating the 4Ms (What Matters, Mind, Medication, Mobility). On average, residents had > 3 risk factors related to the 4Ms (M=3.31); 25% +screen for depression, 25% +screen for cognitive impairment, 64% w/mobility deficits, 83% w/polypharmacy, and 80% on 1 or more high-risk medications. There were 53% w/diabetes, 65% w/hypertension and other biopsychosocial factors related to social determinants of health; 91% could be characterized as multi-complex (the Geriatric 5th M) and in need of services/supports to age in place. The 4Ms framework, with the addition of the 5th M, provides curricular structure for development of clinical judgment through focused assessment, analysis, flagging of key assessment data, prioritization of problems, and developing person-centered plans of care. Interprofessional (IP) case studies of increasing levels of difficulty experienced by affordable housing residents build cultural competence, foster development of critical thinking, clinical reasoning, and, when supplemented by weekly IP case reviews, facilitate shared decision-making and care planning. The process is further supported by a customized electronic database that permits monitoring person-centered recommendations and outcomes over time, gauging impact.
DEVELOPMENT OF A COMMUNITY-ENGAGED DEMENTIA EDUCATION PROGRAM FOR THE VIETNAMESE AMERICAN COMMUNITY
Authors: Miyawaki Christina , Nguyen Kim , McClellan Angela , Ho Tuong-Vi
Published: December 2023

Despite the life-threatening escape from Vietnam, Vietnamese refugees’ health data are scarce. To fill this knowledge gap, we developed the Vietnamese Aging and Care Survey (VACS) and examined the health of community-dwelling older Vietnamese (≥65 years) in Houston, Texas, the 2nd largest Vietnamese-populated metropolitan area in the U.S. The data revealed their adverse health conditions including a high prevalence of cognitive impairment. We proposed a Community-Engaged Dementia Education Program to improve the community’s dementia literacy based on the Cultural Exchange Model as a conceptual framework. Using Edwards’ 9-stage Community Readiness Model, 14 Vietnamese key informants assessed their current literacy level (Aim 1). To develop dementia educational materials (Aim 2), the informants formed focus-group discussions. We used thematic analysis to analyze the community’s understanding of dementia and developed educational materials. Key informants were aged 58 years (mean), Vietnam-born (93%), married (79%), college-educated (72%), women (86%), and full-time employees (79%). They lived in the U.S. for 39 years and in Houston for 30 years. Themes such as the Vietnamese community’s low dementia literacy, their perception of dementia as a normal part of aging, and suggestions for introducing dementia conversations to the community emerged. We considered a one-pager as appropriate educational material, and included culturally- and linguistically-appropriate content and its translation, a target population’s image, and dementia warning signs encouraging them to see their doctors for cognitive check-ups. Our next steps include utilizing local ethnic social media, disseminating the one-pager, and offering a “Brain Booth” at various Vietnamese health fairs.
ASSOCIATION OF SECOND GENERATION EPIGENETIC CLOCKS AND DISCRIMINATION WITH TRAJECTORIES OF CHRONIC HEALTH CONDITIONS
Authors: Mutambudzi Miriam , Brown Maria , Chen Nai-Wei
Published: December 2023

This study aimed to examine whether 2nd generation epigenetic clocks and perceived discrimination as measured by the Everyday Discrimination Scale are associated with differential classification into trajectories of chronic health conditions (CHCs). We used 2014-2020 data from the Health and Retirement Study (HRS) and biological clock data from the 2016 HRS Venous Blood Study (N=3,177). CHC trajectories were constructed using latent class growth models. Multinomial logistic regression analysis examined the association between PhenoAge and GrimAge epigenetic clocks respectively, perceived discrimination, and the constructed trajectories. Participants (≥ 50 years) were classified into 4 CHC trajectory classes, graded by risk of increasing mean CHCs, with trajectory class 1 indicating the lowest mean number of CHCs (most favorable) and class 4 the highest (worst), over 3 study waves. Approximately 35.5% Black, 24.9% Hispanic, and 25% White participants reported high discrimination (p< 0.01). Compared to Whites, Blacks had increased risk of classification into trajectory class 4 (RRR=1.91, p=0.02 GrimAge and RRR=2.31, p< 0.01 PhenoAge). PhenoAge was associated with increased risk of classification into trajectory class 4 for Hispanics (RRR=1.17, 95%CI=1.06-1.28), and modest increases in risk for Blacks (RRR=1.07, 95%CI=1.01-1.15) and Whites (RRR=1.06, 95%CI=1.03-1.09). GrimAge was associated with increased risk of classification into trajectory class 4 for Hispanics (RRR=1.21, 95%CI=1.06-1.38), Blacks (RRR=1.19, 95%CI=1.06-1.33) and Whites (RRR=1.14, 95%CI=1.08-1.20). Despite higher observed rates of discrimination in Blacks, experiences of discrimination increased risk of classification into trajectory class 4 for whites only (RRR=1.59, 95%CI=1.06-2.38). Discrimination findings should be interpreted with caution and future work should account for coping strategies.
PATHWAYS TO OR WITHIN SOCIAL EXCLUSION? AN INTERSECTIONAL LIFE COURSE PERSPECTIVE ON OLDER ROMANIAN ROMA
Authors: Tufă Laura , Precupetu Iuliana , Anghel Ionut , Aartsen Marja
Published: December 2023

Social exclusion is considered a dynamic process as people can move in and out of exclusion while also experiencing different types of exclusion over their life course. In this paper we set out to understand pathways to social exclusion of older Romanian Roma, a particular population that received little attention in the literature. We aim to understand the lived experiences of social exclusion of Roma with the use of life histories and events calendars and we employ an intersectional life course perspective by looking at the nexus of structural, individual, and relational factors that impacted the pathways of older Roma across their life course. The intersection between ethnicity, gender, education, work, residence/segregation and income is employed in order to understand how disadvantage unfolded across the life course and into late life. The data come from 15 biographical interviews with older Roma living in rural and urban Romania, collected in 2021. Results illustrate how specific structural processes like sedentarization of nomad communities, the fall of the communist regime in 1989 and the retrocession of gold unevenly affected Roma across the intersectional characteristics and transformed into turning points in their lives, while interposing to a little extent with their pathways to social exclusion. De-institutionalized life courses and fast transitions had an important bearing on the ways disadvantage unfolded for older Roma living in segregated communities. Finally, super-linked lives at family and community level, when deprived of outside support, contributed to deep exclusion in later life.
USING THE MOCA-SA WITH SPANISH-SPEAKING OLDER ADULTS: STRENGTHS, LIMITATIONS, AND CORRECTIONS
Authors: Piedra Lissette , Iveniuk James , Pudelek Kelly , Howe Melissa , Marquez David
Published: December 2023

Exploratory factor analyses using Round 2 and 3 data reveal discrepancies in the MoCA scores of English and Spanish speakers. In this paper, we describe the strengths and limitations of using NSHAP’s state-of-art MoCA measure with Spanish speakers and propose a solution to the discrepancies observed between the two linguistic groups. To arrive at our remedy, we calculated modification indexes of Spanish language MoCA items to identify items that remained consistent across ethnoracial language groups. From these items, we constructed an abbreviated MoCA-SAA (Spanish version) that compared favorably with the long form MoCA-SA across the different grouping and showed predicative validity with consequential outcomes associated with cognitive decline.
ASSESSING HOW AGE, GENDER, RACE, AND EDUCATION AFFECT THE RELATIONSHIPS BETWEEN COGNITIVE DOMAINS AND OLFACTION
Authors: Zhong Selena , Wroblewski Kristen , Laumann Edward , McClintock Martha , Pinto Jayant
Published: December 2023

The associations between cognitive domains and odor identification are well-established, but how sociodemographic variables affect these relationships is less clear; using the survey-adapted Montreal Cognitive Assessment instrument (MoCA-SA), we assess how age, gender, race, and education shape these relationships. First, we used two different methods, cluster analysis and multidimensional scaling, to empirically derive distinct cognitive domains from the MoCA-SA since it is unclear whether the MoCA-SA can be disaggregated into cognitive domains. We then used ordinal logistic regression to test whether these empirically derived cognitive domains were associated with odor identification and how sociodemographic variables modified these relationships. We identified five out of the six theoretical cognitive domains, with the language domain unable to be identified. We found that odor identification was associated with episodic memory, visuospatial ability, and executive function. Stratified analyses by sociodemographic variables reveal that the associations between some of the cognitive domains and odor identification varied by age, gender, or race, but not by education. These results suggest that 1) the MoCA-SA can be used to identify cognitive domains in survey research and 2) the performance of smell tests as a screener for cognitive decline may potentially be weaker in certain subpopulations.
CHALLENGES AND OPPORTUNITIES OF (RE)CONNECTING AFTER COVID-19
Authors: Rauer Amy , Fiori Katherine
Published: December 2023

Although social distancing and other COVID-19 precautions were designed to protect older adults, the resultant disruptions to social connections were considerable. As vaccines became widely available, however, older adults were able to reconnect and resume social activities, a process we refer to in this symposium as social reintegration. The following studies highlight the challenges and opportunities associated with this reintegration process. First, Fuller et al.’s longitudinal, mixed-methods study considers how older adults’ coping strategies changed over the course of the pandemic as social distancing precautions were lifted. Building off this paper, Rauer et al. explore how and with whom older adults stayed occupied while reintegrating, and how activity profiles changed across six months. Using the same dataset to investigate the nature of these social interactions and the role of personality, Fiori et al. examine how positive and negative social exchanges and optimism predict changes in older adults’ attitudes about how COVID-19 shaped their family life. The role of individual differences is underscored by So et al.’s study of the surprisingly dynamic links between older adults’ generativity and their mental health as they reintegrated over six months. The transitory nature of this reintegration period is further highlighted by Marini et al., who found that older adults anticipated a wide variety of stressors and rewards over this time that changed with the emergence of new COVID-19 variants. Together, these papers paint a compelling picture of how older adults navigate times of transition to reconnect to others and establish a “new normal”.
LIVING WITH DEMENTIA: EXPERIENCES OF LGBTQ PEOPLE WITH DEMENTIA AND SIGNIFICANT OTHERS
Authors: Siverskog Anna , Sandberg Linn
Published: December 2023

Dementia is commonly conceptualized in biomedical terms as a deterioration of brain function and a subsequent loss of self. However, dementia scholars have increasingly underscored how the self of the person with dementia may be maintained through social interactions in their everyday life. This may pose specific challenges for LGBTQ people who may not be out in care settings due to fear of discrimination and whose chosen family may not be recognized by formal care providers. This paper presents preliminary findings from a qualitative study conducted in Sweden with LGBT individuals living with dementia. The project builds on policy analysis as well as semi-structured interviews with LGBTQ people with dementia, people significant to them such as partners, family and friends, and interviews with frontline care staff and managers within dementia care. The thematic analysis illustrates how experiences of living with dementia as an LGBTQ person vary depending on the progression and type of dementia, the individuals’ social support network, how open one is with their sexual orientation or gender identity, living at home or in a dementia care facility, socioeconomics, and other factors. In line with how other ageing scholars have pointed to the potentiality of queer theory to move beyond framing dementia as pathology and decline, concepts of queer time and queer failure are used here to understand the results in ways that disrupt notions of self, temporalities, normativity, subjectivity and what it means to age successfully.
PARTICIPANTS’ PERSPECTIVES ON RECEIVING RESULTS USING FOUND POETRY: A MIXED-METHODS STUDY
Authors: Bybee Sara , Eaton Jacqueline , Wong Bob
Published: December 2023

Few researchers share study results with participants, often citing a lack of knowledge regarding how to do so. This study explored the dissemination preferences of study participants receiving results in the form of found poetry, developed from dyadic interviews with sexual and gender minority (SGM) and non-SGM couples’ regarding their experiences with cancer. Participants (N=24) completed demographic and health questionnaires, a pre-posttraumatic growth-inventory-expanded (PTGI-X), and were randomized to receive the found poem as text, text and audio, audio, or video formats. Participants completed a post-PTGI-X, reported dissemination preferences, and emotions experienced. Open-ended responses demonstrated that using found poetry to disseminate results communicated that participant experiences were understood, fostered introspection, and renewed appreciation for their partner. Only SGM participants (n=3) reported preferring a format other than the one to which they were randomized. The text-only and combined text and audio formats evoked the greatest number of emotions (n=13 each) followed by video (n=4), and audio-only (n=3). Across randomization groups, interest (n=11) was most frequently reported, followed by sadness (n=8), and joy (n=6). Quantitatively, there were no significant changes in participants’ PTG—a small sample size may have reduced statistical power—which might be seen as a failure. However, the open-ended responses indicate that innovative approaches to dissemination are acceptable and multiple options may increase accessibility. Only SGM participants preferred an alternate format, potentially reflecting a natural inclination to question the status quo. Including minority perspectives (positive/negative) illuminates the need to offer study participants choices in how and when they receive findings.
FROM FAILURE TO OPPORTUNITY IN QUEERING GERONTOLOGICAL CURRICULUM
Authors: Bouchard Lauren
Published: December 2023

Institutes of higher education vary tremendously in their support of LGBTQ students, which can contribute to unequal educational opportunities and outcomes. The presence of LGBTQ people in education can be inherently divisive, with some states and educational institutions prohibiting the inclusion of LGBTQ-related topics in the curriculum. LGBTQ students who experience discrimination in the classroom and heterosexism in the curriculum may be less motivated to complete program requirements, resulting in lower completion rates. Attrition of these marginalized students can lead to fewer qualified gerontologists who reflect the increasing diversity of the aging population. Additionally, the gerontological curriculum within and across programs may fail to capture nuanced and diverse narratives of resilience and lived experiences due to dominant, heteronormative educational contexts and frameworks. Through the lens of the queer art of failure, the presenter utilizes autoethnography (e.g., analysis of past writing and personal communications) as a queer person in a non-affirming gerontology graduate program. They will discuss how institutional failure lead to enthusiasm for curriculum development, student mentoring, and queer knowledge dissemination. Key findings include the significance of institutional clarity on academic freedom, the necessity of institutional support, and the solidarity of LGBTQ students, faculty, and older adults. The presenter will conclude with their future research directions and strategies to support students and early-career scholars to overcome political, institutional, and what are often felt as personal failures.
A GOLD MINE OF TEXT TEXT MINING VERSUS MANUAL CODING METHODS REGARDING QUALITY OF CARE IN LONG-TERM CARE FOR OLDER ADULTS
Authors: Hacking Coen , Verbeek Hilde , Hamers Jan , Aarts Sil
Published: December 2023

In long-term care for older adults, large amounts of text are collected that cover the quality of care, such as transcribed interviews, medical records, and text in electronic health records. Researchers currently analyze textual data manually to gain insights, which is a time-consuming process. Text mining (TM) could provide a solution, as this methodology can analyze large amounts of text automatically. Therefore, this study aims to compare TM to the gold standard of manual coding regarding sentiment analysis and thematic content analysis. Data was collected from interviews with residents (n=21), family (n=20) and care professionals (n=20). TM models were developed and compared to the manual approach. The results of the manual and TM approach were evaluated in three ways: accuracy, consistency and expert feedback. Accuracy showed how similar the approaches are. Consistency showed if an individual approach finds the same themes in similar text segments. Expert feedback was used to show the perceived correctness of the TM approach. The accuracy analysis showed that 81.8% of text segments receive the same sentiment code in both approaches and 83.7% of text segments receive the same thematic codes. Interviews coded by TM had a higher consistency compared to those coded manually. Expert feedback showed that the TM had a limited understanding of the context. However, it also showed certain inconsistencies of manual coding. The current study has shown that TM can be an effective tool for quickly and accurately identifying sentiment and thematic content in large amounts of textual data.
RELATIONSHIPS OF SOCIAL AND COGNITIVE ACTIVITY TO WELL-BEING AND COGNITIVE FUNCTIONING OVER TIME
Authors: Liao Hsiao-Wen , Chu Li , Carstensen Laura
Published: December 2023

Research on engaged lifestyles points to promising ways to age well. Findings are mixed, however, when different types of social and cognitive activity engagement are examined. The present study, juxtaposing core tenets of socioemotional selectivity theory and the engagement hypothesis, tested the relative importance of social engagement with close partners and engaging in cognitively stimulating activities for older adults’ psychological well-being and cognitive performance over time. Of particular interest was the comparison between individuals with high levels of interaction with close social partners yet low levels of cognitive activity engagement and those with low levels of social engagement but high levels of cognitive activity engagement. The sample (N = 1607) was drawn from participants in the Health and Retirement Study who participated in the 2008, 2012, 2016, and 2020 modules. Engagement profiles were created based on the frequency of contact with close social partners outside the household (i.e., children, family members, and friends) and engagement in cognitively stimulating activities (i.e., reading, writing, using computers, cooking, playing word games, and doing hobbies) at baseline. Results of growth curve modeling, controlling for demographic background and baseline performance, showed that, as predicted, older adults with high levels of social interactions and low levels of cognitive activity engagement had superior life satisfaction but poorer performance on delayed recall than their counterparts who had the opposite engagement profiles. We draw on the life-span principle that development involves gains and losses in interpreting the findings.
Late Breaking Biological Sciences Session
Authors: Rogina Blanka
Published: December 2023

This is a key element specific to the Biological Sciences Section within the Gerontological Society of America annual scientific meeting that allows for very new and unpublished findings to be presented. Due to the rapid advancement of our knowledge, four speakers in this symposium are selected from the submitted late breaking Abstracts. Special emphasis is given to selecting early career faculty, postdoctoral fellows and graduate students.
EXAMINING A RANDOMLY ASSIGNED MUSIC PROGRAM ON STRESS AND WELLNESS: CARE PARTNERS OF OLDER ADULTS LIVING WITH DEMENTIA
Authors: Tompkins Catherine , Ihara Emily , Layman Shannon , Inoue Megumi , Gimm Gilbert
Published: December 2023

OBJECTIVE

The Mason CARES study examined the effects of a randomly assigned personalized music intervention (Phase II) for care partners of older adults living with dementia after implementation of a 9-week virtual stress management program (Phase I) to reduce stress and increase well-being.

METHODS

A total of 99 care partners completed the 20-week study across three cohorts in 2022. Baseline data on care partner stress levels and well-being were collected before beginning a 9-week stress management program (Phase I). Care partners were randomly assigned to a 4-week music intervention treatment or control group before the next stage of the intervention (Phase II). Researchers assisted care partners with identifying their family member’s favorite music during early adulthood years. MP3 players loaded with the favorite music were mailed to treatment group members. Focus groups were conducted to explore the utilization of personalized music. RESULTS: Nearly half (49%) were spousal care partners, ranging from 35-85 years old with 80% having at least a 4-year college degree, and 62% having an income greater than $70,000. Using ANOVAs to analyze mean stress levels and well-being, no significant differences in stress and well-being were found between the treatment and control groups. CONCLUSION: Despite the lack of statistically significant findings, preliminary analysis of focus group interviews revealed that many care partners benefited from the personalized music intervention. Effectiveness may depend on other factors, such as familiarity with using the technology, past experiences with music, care partner’s baseline level of stress, and the older adult’s stage of dementia.
EXPLORING THE EVERYDAY EXPERIENCES OF FAMILY CAREGIVERS OF PEOPLE LIVING WITH DEMENTIA: A LONGITUDINAL DIARY STUDY
Authors: Seetharaman Kishore , Kervin Lucy , Basu Koushambhi , Baumbusch Jennifer
Published: December 2023

People living with dementia rely largely on the support of unpaid family caregivers to remain living at home in the community. The strain created by this dependence is evidenced by high rates of distress among caregivers of people living with dementia and underscores the importance of access to appropriate formal and informal supports for this group. Providing tailored and meaningful supports and services to families requires a good understanding of the multidimensional and dynamic nature of the caregiving experience. Our study employed longitudinal qualitative methodology to understand how caregivers of people living with dementia were experiencing progression of the disease and shifting support needs over a two year-period. Fourteen family caregivers in British Columbia, Canada, wrote monthly diaries reflecting on their experience of caregiving and navigating supports. Thematic analysis of 137 diary entries shed light on different facets of caregiving experience, including psychological and emotional challenges (e.g., feeling overwhelmed, lacking a sense of control, trouble maintaining sense of self) and difficulties navigating formal care and supports (e.g., lack of access to services and information, lack of flexibility in service delivery). However, accounts also reflected participants’ resilience, through a range of coping strategies adopted to resolve problems encountered in caregiving, drawing on emotional and practical support from family, friends, and community. The diaries offer critical perspectives on gaps and inadequacies in formal supports for family caregivers and opportunities to better support the health and wellness of caregivers and recipients through dementia care policy and practice.
LOSING PERSONHOOD: EXPERIENCES OF INDIVIDUALS CARING FOR A FAMILY MEMBER WITH DEMENTIA
Authors: Carter Rachel , Norton Sally , Moskow Marian , Bobry Melanie , Van Orden Kimberly , Heffner Kathi , Wittink Marsha
Published: December 2023

Over 11 million people in the United States are providing informal care for a person with dementia (PwD). When providing care, family caregivers for a PwD may find their own sense of personhood becomes lost, impacting their social connectedness. This qualitative study characterizes family caregivers’ social connection experiences, goals, barriers, and facilitators. We used a criterion-based purposeful sampling strategy to identify 30 family caregivers for PwD ages 50+ who were lonely (n=20) and not lonely (n=10) according to their UCLA loneliness scale short form scores (not lonely = < 5 and lonely = ≥ 6). We recruited selected participants through the Healthy Aging Research Program (HARP) population study. We then conducted individual, semi-structured interviews with each participant and performed a content analysis on all transcribed interviews, utilizing preset codes based on a theoretical frame and developing novel codes until key themes were identified. Participants reported connections between social connectedness—loneliness, disconnection, and feelings of isolation—and the loss or diminishment of their own personhood. When asked about their past and present social activities, the ones caregivers identified as important allowed them to feel connected to others and to themselves, offering either or both: 1) the opportunity to relate to others in ways they could not relate to the PwD; 2) social and emotional engagement that reinforced their sense of personhood. When social activities did not offer either of these, caregivers experienced disconnection. Results indicate potential ways to intervene to mitigate loss of personhood and promote social connectedness in family caregivers.
DAILY SOCIAL RELATIONSHIP QUALITY, DAILY STRESS, AND SUBJECTIVE COGNITIVE DECLINE AMONG OLDER ADULTS
Authors: Jang Heejung , Mogle Jacqueline
Published: December 2023

Although prior research has shown that social relationships are strongly associated with cognitive function, few studies have explored the link between the quality of daily relationships and subjective cognitive decline (SCD). The present study explores whether the quality of daily relationships is associated with daily stress and how daily stress mediates the relationship between the quality of daily relationships and SCD among older adults. This study uses data from 254 older adults aged 70 or older who completed the Einstein Aging Study. Multilevel mediation analyses were conducted to account for daily measurements nested within individuals. The cognitive change index was used to measure SCD. We tested the indirect effect of daily relationship quality on SCD through daily stress levels. There was a significant positive association between ambivalent (β=.148, p<.001; β=.324, p<.001) and neutral (β=.095, p<.001; β=.297, p<.001) relationships and daily stress levels at both the within- and between-person levels. Between-person daily stress was, in turn, associated with greater SCD (β= .169, p<.05). In particular, there was a significant indirect path from ambivalent relationships to SCD through daily stress. This study contributes to a more detailed understanding of how relationship quality can impact cognition through increased exposure to daily stress. The quality of daily social relationships may be crucial to preserving older adults’ cognitive function.
BARRIERS AND FACILITATORS TO INTEGRATED SUBSTANCE USE AND HIV CARE: ADMINISTRATOR AND PROVIDER PERSPECTIVES
Authors: Bender Alexis , Chan Kiera , Hunt Riley , Perkins Molly
Published: December 2023

Since the beginning of the HIV epidemic, HIV and substance use have been intricately connected. Substance use may cause additional damage to the brain, higher viral loads, low medication adherence, and higher AIDS-related deaths. A potential area to improve access to care and treatment for people aging with HIV and substance use is through integrated care. Yet little is known about the barriers and facilitators to integrated care, especially in practices serving vulnerable populations, such as older adults or PLWH in rural areas. We conducted in-depth interviews with 21 providers (e.g., Physicians, APPs, RNs) and 15 administrators (e.g., clinic managers, care coordinators) across Georgia between January 2021 and November 2022. Interviews explored perceptions about clinic integration and desire, or lack of desire, to increase integration. Data were analyzed using inductive and deductive thematic analysis guided by the Consolidated Framework for Implementation Research. Both groups perceived important benefits to integrated care, especially for older or more vulnerable populations, but the definitions varied across respondents. Providers and administrators agreed that integrated care provided greater access to care with less interruption to patients’ lives. Barriers to increasing integration included, but were not limited to, physical space, staffing and budgetary constraints, and limited opportunities for collaboration. Most providers, except those in practices with the highest levels of integration, experienced barriers to getting patients into adequate substance use treatment when needed. Integrated care is vital to treating older adults and vulnerable individuals living with HIV, especially those with co-occurring substance use disorders.
STRESS, STEM CELLS, AND THE GUT MICROBIOME—IMPLICATIONS FOR AGING
Authors: Rodriguez-Fernandez Imilce
Published: December 2023

Adult somatic stem cells have a crucial role in maintaining the regenerative capacity of tissues throughout the lifespan of the organism. With age comes a reduction in tissue renewal and repair upon injury. Understanding the mechanisms that maintain stem cell function could potentially lead to the development of therapeutic strategies to mitigate age-related tissue degeneration and improve healthspan. Of particular interest is understanding how stem cells deal with different types of stressors such as oxidative stress and bacterial stress. To study this, we use the Drosophila intestinal stem cells (ISCs) as a model system. ISCs are normally quiescent but during stress, they divide asymmetrically to give rise to one stem cell and one differentiated cell: an enteroblast (EB) that will become an Enterocyte (EC) or an enteroendocrine progenitor (EEp) cell that will later become a mature enteroendocrine (EE) cell. ECs have roles in digestion and immune response. EEs have roles in hormones and peptide secretion. ISCs have a crucial role in regenerating lost intestinal cells after bacterial infection, oxidative stress, or normal cell attrition. Thus, ISCs are always sensing the gut environment and respond to cues by activating or repressing proliferation. By studying the function of two important stress-sensing transcriptions namely Nrf2/CncC and HSF1 in ISCs, we have uncovered an unprecedented role of these genes in stem cell identity and the regulation of the gut microbiome. These findings could shed light on the mechanisms altered during aging that contribute to stem cell mis-differentiation and microbial dysbiosis.
THE EFFECTS OF WISDOM AND HEALTH ON NORTH AMERICAN SENIORS’ WELL-BEING SINCE COVID-19
Authors: Feng Zhe , Ferrari Michel , Saffaran Pouria , Munroe Melanie , Shamim Asma , Morris Stephanie
Published: December 2023

Public health restrictions necessitated by COVID-19 resulted in significantly reduced social contact for many older people, given their increased risks of infection and developing severe symptoms, even death. While reduced social contact can be a major cause of distress, our recent North American study (n=307) found 3 levels of resilience to the impact of COVID-19 – high (“well-adapted”), average (“getting-by”) and low (“struggling”) – associated with changes to wellbeing before (Time1), in summer 2020 (Time2), and about 18 months after (Time3). The present study investigates the wellbeing trajectory of 69 older individuals (Mage = 58.83, SDage = 7.21, max. = 77, min. = 50) within that larger sample who reported closely following local physical distancing recommendations. Specifically, it examines how their wellbeing was affected by their country of residence, and self-reported personal wisdom, self-transcendence, and health at Time2 and Time3. Simple logistic regression models suggest that, across Time2 and Time3, higher wisdom and better health were associated with higher likelihoods of being well-adapted vs. just getting-by. Higher self-transcendence at Time3 but not Time2 increases the likelihood of being well-adapted. Multiple logistic regressions with country, personal wisdom, self-transcendence, and health as predictors show that, controlling for all other variables in the model, higher wisdom and better health at Time2, as well as higher self-transcendence and better health at Time3, increase the likelihood of being well-adapted vs. just getting-by. Our findings demonstrate the protective values of personal wisdom, self-transcendence, and health during prolonged periods of isolation and stress for the older population.
HEALTH COACHING IMPROVES EVERYDAY COGNITION AMONG INDIVIDUALS AT RISK FOR ALZHEIMER’S DISEASE
Authors: Gray Michelle , Paulson Sally , Gills Joshua , Jones Megan , Campitelli Anthony , Urbina Ray , Bryk Kelsey , Glenn Jordan
Published: December 2023

Alzheimer’s disease (AD) is the 7th leading cause of death and 6th most burdensome disease among US older adults. With pharmacological treatments for AD being predominantly ill-effective, alternative, non-pharmacological prevention and treatment strategies warrant exploration. Personal health coaching provides individualized strategies designed to improve physical, social, and emotional health leading to positive behavior changes that may improve cognitive ability. The purpose of the present investigation was to examine the effects of a Health Coaching (HC) intervention on cognitive outcomes. Adults (n=182) over 45 years of age were randomly assigned to HC or control arm of a 12-month intervention. Participants (age = 61.9 + 8.4 years) had their cognition (ECog-12) tested at baseline, 16, and 52 weeks. Participants assigned to the HC intervention met with a health coach once per month to establish healthful goals and implementation strategies improving the health and well-being of the participants. The control group received bi-weekly emails including similar information presented during the health coaching sessions. Results revealed a main effect for time for improved ECog-12 scores (p=.04) with a 3.2% improvement in ECog-12 after 52 weeks. Upon further analysis, HC had a significant improvement in cognitive performance after both 16 and 52 weeks, while the control group remained unchanged. Improvement in self-reported cognition was 4.0% (p=.03) and 5.5% (p=.01) in the HC group after 16 and 52 weeks, respectively. These results suggest HC is an effective non-pharmacological prevention strategy for cognitive decline among a group of adults at-risk for developing AD.
JOINT ASSOCIATIONS OF PHYSICAL ACTIVITY AND SLEEP DURATION WITH COGNITIVE AGING
Authors: Bloomberg Mikaela , Brocklebank Laura , Hamer Mark , Steptoe Andrew
Published: December 2023

Given the paucity of dementia treatments, identifying contributors to cognitive decline from midlife is important to delay onset of symptoms. Low physical activity (PA) and nightly sleep duration outside 6-8 hours are key interrelated factors thought to contribute to cognitive decline and dementia; how PA and sleep combine to influence cognitive ageing is not well-explored. We used linear mixed models to examine independent and joint associations of PA (low, high) and sleep duration (short [< 6 hours], optimal [6-8], long [>8]) with 10-year cognitive trajectories in cognitively-healthy adults aged ≥50 years from the English Longitudinal Study of Ageing (N=8958). We found low PA (p< 0.001) and suboptimal sleep (p=0.01) were independently associated with worse cognitive performance; short sleep was also associated with faster cognitive decline (p=0.04). At baseline, high PA/optimal sleepers had higher cognitive scores than all sleep categories in the low PA category (e.g. difference high PA/optimal-low PA/short at age 50=0.14 [0.05, 0.24] standard deviations), with no difference in cognitive scores between sleep categories within the high PA category. Differences remained consistent over 10 years of follow-up, except high PA/short sleepers who declined faster than high PA/optimal sleepers, such that scores at 10 years were commensurate with low PA (difference high PA/optimal-high PA/short=0.20 [0.08, 0.33]; high PA/optimal-low PA/short=0.22 [0.11, 0.34]). Baseline cognitive benefits afforded by high PA were insufficient to ameliorate rapid cognitive decline associated with short sleep. While WHO identify PA as a key target for maintaining cognitive health, PA interventions may be ineffective without considering sleep habits.
COLLABORATING WITH LONG-TERM CARE PROVIDERS IN ELDER MISTREATMENT RESEARCH
Authors: Pillemer Karl , Meeador Rhoda , Schultz Leslie , Rorick Leann , Robson Karen , Teresi Jeanne
Published: December 2023

To study elder mistreatment in institutional settings, collaboration is needed with nursing home and assisted living providers. Studies show that common problems emerge in researcher-practitioner collaboration, including differences in the key areas of orientation, training, nature of evidence, time horizons, and uses of research. Barriers specific to collaboration with. LTC providers also present challenges, including reputational risk from participating in EM studies and demands on administrative and staff time that limit availability for research. We report on a successful model for collaboration with LTC providers, based on the implementation and evaluation of the “Improving Resident Relationships in Long-Term Care” program. This evidence-based program was implemented to prevent and treat resident-to-resident aggression in nursing homes (16 facilities) and assisted living (14 facilities), involving over 2000 residents. Findings revealed a set of replicable elements to obtain LTC provider collaboration on sensitive issues like resident-to-resident aggression: (1) Preparatory efforts to gain commitment of administrative personnel; (2) agreements regarding confidentiality and anonymity; (3) identification of one or more “facility champions,” who demonstrate enthusiasm and willingness to advocate for the program; (4) providing payment to participating facilities to cover expenses such as overtime needed to release staff to attend trainings; (5) gaining the support of trusted provider organizations; (6) demonstrating that the program helps meet regulatory requirements; and (7) a procedure to allow for pragmatic modifications to the intervention that allow greater fit with the provider’s workflow. Implications for elder mistreatment intervention research are discussed.
THE EMED TOOLKIT: COLLABORATION TO IMPROVE ELDER MISTREATMENT SCREENING AND RESPONSE
Authors: Haggerty Kristin Lees , Stoeckle Rebecca , Dash Kim , Epstein-Lubow Gary , Campetti Randi , Froberg Ruthann , Tambor Ellen
Published: December 2023

The National Collaboratory to Address Elder Mistreatment (The Collaboratory) is a group of elder mistreatment (EM) researchers, clinicians, and advocates who came together with the goal of improving elder mistreatment identification and response in hospital emergency departments (ED). Since its inception in 2017, the Collaboratory has prioritized working in close collaboration with health care and aging services providers as well as older adult survivors to develop, test, and disseminate the Elder Mistreatment Emergency Department Toolkit (EMED Toolkit). The EMED Toolkit is a set of streamlined tools designed to improve EM screening and response in hospital EDs and foster improved collaboration between the hospital and community-based services. The EMED Toolkit is comprised of four core components 1) an online staff survey to assess EM practice and drive system change 2) the evidence-based EM Screening and Response Tool designed to efficiently screen all older adult patients for potential mistreatment, 3) online training modules to educate ED staff on elder mistreatment identification and response, including use of the screening tool, and 4) a Community Connections Roadmap designed to help EDs identify and establish connections with community-based services that can support safe discharge and provide ongoing support to older adults experiencing and at risk for mistreatment. In this presentation we will summarize results from a feasibility study testing EMED Toolkit implementation at five hospitals in the US, describe the Collaboratory’s approach to disseminating the EMED Toolkit more widely through local, regional, and national systems change initiatives, and share lessons learned from our efforts.
FAMILY MATTERS: CROSS-CULTURAL DIFFERENCES IN FAMILISM AND CAREGIVING OUTCOMES
Authors: Falzarano Francesca , Moxley Jerad , Pillemer Karl , Czaja Sara
Published: December 2023

The increasing number of minority older adults and subsequent increase in minority individuals needed to provide care highlights the need to understand how the caregiving role is experienced and perceived among racial/ethnic minority groups. Familism, a cross-cultural collectivist value, has been examined as a driving mechanism influencing differential outcomes in family caregivers. However, research examining familism in caregiving has yielded mixed results. Guided by the Sociocultural Stress and Coping Model, the purpose of this study is to examine cross-cultural differences in familism and its influence on caregiving outcomes. Baseline data were collected from 243 family caregivers who participated in the Caring for the Caregiver Network randomized controlled trial, a culturally tailored technology-based psychosocial intervention. Results showed that familism was more highly endorsed by Hispanic and African American participants, when compared to Whites, which was subsequently associated with positive aspects of caregiving, depression, and burden. Exploratory analyses among the Hispanic subgroup were conducted to examine how acculturation, operationalized as number of years living in the US, influences familism and found that a longer length of time spent in the US was negatively associated with familism. When dividing our sample into U.S. natives versus non-natives, non-native Hispanic participants reported higher familism compared to natives. Findings indicate that cross-cultural differences in caregiving appraisals may operate as a function of cultural values, which influence one’s subjective evaluation of the caregiving role and contribute to more optimal outcomes – highlighting the need for culturally congruent interventions to promote positive caregiving outcomes particularly among racial/ethnic minorities.
EMPOWERING AND ADDRESSING AGE-RELATED CONCERNS AMONG OLDER WOMEN LIVING WITH HIV
Authors: Vu Thi , Quinn Marielle , Valeika Sarah , Monin Joan
Published: December 2023

There are currently over 100,000 older (ages 50+ years) women living with HIV/AIDs in the United States. Older women living with HIV (OWLH) face unique psychosocial challenges with HIV prevention and care, including intimate partner violence, gender discrimination, ageism, and caregiving responsibilities. These factors can impede self-care and contribute to increased mental, emotional, and physical burdens. Little is known about the resources OWLH draw upon to help manage psychosocial stressors and their perspectives of aging with HIV. This qualitative study identified sources of strength and self-care among OWLH, as well as their concerns about aging with HIV. We recruited participants through HIV clinics and community support groups. We conducted one-on-one, semi-structured in-depth phone interviews with OWLH. Interviews were recorded and transcribed verbatim. Following a Grounded Theory approach, two coders performed open coding then thematic coding. Participants (N = 23) were on average 60 years old (range 51 – 68) and had been living with HIV for an average of 23.7 years. We found that a desire to self-educate, community activism, and engagement with other OWLH reduced participants’ internalized stigma and were sources of empowerment. However, concerns about aging with HIV persists, including pervasive HIV stigma, comorbidities, shrinking caregiver networks, long-term effects of treatment, and lack of HIV research and programs focusing on older women. These findings suggest that while OWLH are empowered agents in their own HIV care journey, structural interventions (e.g., inclusion of older women in HIV trials) are still needed to address the unique concerns of this population.
CO-DESIGNING A CULTURALLY INFORMED DEMENTIA SYMPTOM SELF-MANAGEMENT MHEALTH APP WITH CARE PARTNERS
Authors: Durga Aditi , Lin Shih-Yin , David Daniel , Moss Karen , Turchioe Meghan Reading , Valdez Rupa , Brody Abraham
Published: December 2023

Over 16 million care partners (CPs) in the U.S. provide more than 17 billion hours of unpaid care for family and friends living with dementia. Yet, significant inequities and access issues exist in assisting CPs to receive high quality support. Thus, this study aimed to tailor our existing evidence-based Aliviado Dementia Care mHealth app for diverse CP users through a user-centered approach to empower CPs with culturally informed knowledge, structure and resources. Based on needs identified by CPs, wireframing was performed. CPs then reviewed the interactive wireframes, were asked to perform various tasks, and provide feedback on any pain points, confusion, usability, and new ideas (“Think aloud”). Eight CPs (3 Black, 1 Asian, 4 White, 1 Hispanic; 38% Female; 29-77 years) from 6 different US states participated in the user testing. CPs found the wireframes easy to navigate and intuitive. Based on CP feedback, changes were made to include inclusive language, reconstruct the dashboard, and add medication alerts and a summary care profile. CPs voiced pleasant surprise that the app was going to have such a substantial feature set, including guiding them through person-centered assessment and care planning of interventions to non-pharmacologically self-manage behavioral and psychological symptoms of dementia and caregiving stress. We thus successfully developed an initial set of wireframes using co-design principles with CPs. CPs appreciated the goal of self-management and activation to work with their primary care providers. Future work will seek to test a functional model with diverse CPs in diverse participants in the community.