bluuebunny/crossref_metadata_2025 huggingface dataset:
OLDER WOMEN AND HIV: THE IMPACT OF PROVIDER COMMUNICATION OF HIV/AIDS ON CONVERSATIONS WITH NEW SEXUAL PARTNERS
Authors: Robinson Erin , Park Geunhye , Nyang’au Getrude
Published: December 2023

Older adults account for 50% of people living with HIV and nearly 20% of new HIV infections in the U.S. Inadequate communication with a healthcare provider has been identified as a contributing factor, as stigma surrounding older adults, sex, and HIV/AIDS is persistent. Many older adults report having conversations with their healthcare providers about HIV prevention more routinely in their younger years. To date, however, little is known about provider communication of HIV with older patients. This cross-sectional study aims to help fill that gap. Survey participants (N=427) were asked about the frequency in which their primary healthcare providers talked with them about HIV/AIDS before they turned 50, as well as their future likelihood to discuss HIV/AIDS with a new sexual partner. Participants ranged in age from 50 to 84 years (M=58; SD=6.3), and were predominately white (94%) and female (73%). Regression analysis demonstrated that among women in the sample, provider communication about HIV/AIDS prior to them turning 50 year of age was associated with their future likelihood of talking with new sexual partners about HIV/AIDS (β=0.151, p<.05). Eighty-seven percent of the sample reported intentions to discuss condoms with a new sexual partner with a mean of 4.89 (SD=1.47, Range=1-6) indicating “Somewhat Agree” and “Agree”. These findings suggest that provider communication of HIV/AIDS is important for risk prevention. Those conversations help guide future decision making among women in particular, even into their later years.
IMMUNOMETABOLIC CHECKPOINTS OF INFLAMMAGING
Authors: Dixit Vishwa
Published: December 2023

Inflammation is a key hallmark and driver of age-related functional decline. Evidence that innate immune sensor NLRP3 inflammasome links aging to functional decline supports Metchnikoff’s original prediction that phagocytes or macrophages drive aging-associated degenerative diseases in an organism. Tissue resident macrophages are key to maintenance of homeostasis, a response that is compromised with age. It remains unclear whether negative energy balance in a host elicited by caloric restriction (CR) impacts mechanisms that control inflammation. The precise identity of factor(s) that link alterations in organismal metabolism to macrophage response are unclear. CR in rodents clearly elicits anti-inflammatory effects, but despite several years of research efforts, the endogenous drivers that couple energy balance to inflammatory cellular quiescence or activation is unknownThe RNA-sequencing analyses of adipose tissues from CALERIE-II study participants identified that CR in humans activates transcriptional programs implicated in mitochondrial metabolism, anti-inflammatory responses, and longevity. Our results show that macrophage derived protein PLA2G7, that is inhibited by CR in humans, reduces inflammaging, protects against thymic involution and protects against metabolic dysfunction. Furthermore, the CR in humans identifies unique regulators of inflammation including a CR-inhibited adipokine called SPARC that controls healthspan. Collectively, our studies establish that CR is relevant to human physiology and immunobiology and offers an important platform to harness immunometabolic checkpoints of inflammation and longevity.
SES DISPARITIES IN FUNCTIONAL IMPAIRMENT WITHIN OLDER ASIAN AMERICANS: COMPARISON OF FOUR RACIAL/ETHNIC GROUPS
Authors: Wang Katherine , Zhu Zheng , Qi Xiang
Published: December 2023

This study investigated to what extent socioeconomic status (SES) disparities associates with functional impairment within older Asians in comparison with other racial/ethnic groups. Data were from the National Health and Nutrition Examination Survey 2011-2018 that included 3,297 White, 1,755 Black, 1,708 Hispanic, and 730 Asians aged ≥60. Physical functioning was measured by activities of daily living (ADL) or instrumental activities of daily living (IADL). Memory was determined by CERAD-WL, and language fluency was measured by Animal Fluency Tests. We conducted multivariate logistic regressions to examine the association between SES and functioning impairment within racial/ethnic groups and performed seemingly unrelated regressions to compare the regression coefficients across subgroups. For the age- and sex-adjusted prevalence of functional impairment, Asians with ≤high school education had the highest prevalence of memory impairment among all races/ethnicities, and no difference was observed for all racial/ethnic groups with >high school education. After adjustment for key covariates, Blacks and Hispanics had higher odds of ADL/IADL disabilities and cognitive impairment relative to Whites. The odds of ADL/IADL disabilities did not differ with Asians and Whites, whereas Asians were more likely to have language fluency impairment than Whites. Education disparity for ADL disability (OR, 3.42; 95% CI, 2.21-5.29) and memory impairment (OR, 16.87; 95% CI, 8.57-33.21) were largest among Asians compared to Whites, Blacks, and Hispanics. Income disparity for function impairment did not significantly differ across four racial/ethnic groups (all P > 0.05). This study indicates that Asians fare worst in the burden of functional impairment due to education disparity.
FACTORS ASSOCIATED WITH DEPRESSIVE SYMPTOMS AMONG OLDER SOUTHEAST ASIAN AMERICANS
Authors: Wang Kaipeng , To My Ngoc , De Fries Carson , Wu Bei
Published: December 2023

Depressive symptoms are prevalent among older adults, particularly those from Southeast Asian American (SEAA) communities. Although SEAAs represent one of the fastest growing minority groups in the U.S, research has given little attention to understanding depression among older SEAAs. This study therefore aimed to examine the factors associated with depressive symptoms among older Southeast Asian Americans. We recruited a total of 251 adults aged 55 and above who identified as Vietnamese American, Filipino American, or Indonesian American via community organizations. Participants completed online or in-person questionnaires. Depressive symptoms were measured with the 10-item Center for Epidemiologic Studies Depression Scale. Items are rated on a 4-point Likert scale, with higher scores indicating more depressive symptoms. We used ordinary least squares (OLS) regression to examine the association between depressive symptoms and various health, psychological, social, demographic, and environmental factors. In general, Vietnamese Americans (mean=1.74, SD=0.65) had significantly more depressive symptoms than Indonesian (mean=1.56, SD=0.60) and Filipino (mean=1.47, SD=0.47) Americans. OLS regression results showed that resilience and age were negatively associated with depressive symptoms, while greater family conflict was significantly associated with more depressive symptoms. Participants who could not speak English fluently had significantly more depressive symptoms than those who could not. Those residing in urban or suburban areas had significantly more depressive symptoms than those living in rural areas. Results contribute to better understanding of the factors that contribute to depression among older SEAAs and inform the strategies for preventing and treating depression in this population.
ACCELEROMETER-DERIVED PHYSICAL ACTIVITY IN THE NATIONAL HEALTH AND AGING TRENDS STUDY
Authors: Schrack Jennifer , Zhang Talan , Wanigatunga Amal , Zipunnikov Vadim , Freedman Vicki
Published: December 2023

Physical activity (PA) is a modifiable risk factor for disability, chronic conditions, and functional outcomes with aging. Yet the amount of PA in which older adults engage is not well understood, as objective evidence is lacking, particularly among those aged ≥80 years. To address this gap, the National Health and Aging Trends Study (NHATS) implemented wrist-worn accelerometry (Actigraph Centrepoint Insight Watch) in a subset of Round 11 (2021) participants (N=747, 54% women, 40% aged≥80) using a seven-day 24-hour/day protocol. Mean daily PA (total activity counts/day) was examined in those with ≥3 valid wear days by health and demographic factors with analytic survey weights applied. Daily PA averaged 1.67M counts/day, was lower at older ages and varied widely across health and demographic factors, notably: women were more active than men (β=208K), married participants more active than unmarried (β=163K), those with impaired contrast vision were less active than those with normal vision (β=-231K), those with hearing loss were less active than those without hearing loss (β=-233K), and participants with possible or probable dementia were less active than those without dementia (β=-457K) (p<.001 for all). With regards to care and accommodations, those who reported getting help with mobility were less active than those who did not (β=-459K) and those residing in the community were more active than those in (non-nursing home) residential care (β=394K). These data present unique insights into factors that may shape daily PA in older adults. Future work should examine longitudinal trends and potential interaction with the disablement process.
SENSORIMOTOR IMPAIRMENTS AND DEMENTIA: A CROSS-SECTIONAL ANALYSIS OF NATIONAL HEALTH AND AGING TRENDS STUDY
Authors: Davoudi Anis , Agrawal Yuri , Gross Alden , Wanigatunga Amal , Reed Nicholas , Ehrlich Joshua , Schrack Jennifer
Published: December 2023

Sensory impairments in vision and hearing are linked to dementia in older adults. However, this association has not been investigated in conjunction with motor function performance. We examined cross-sectional sensory and motor function and dementia status data from 1,765 participants in the National Health and Aging Trends Study (NHATS R11, 2021) (32.7% aged ≥80 years; 55% women) who completed objective physical function and sensory testing. Motor function was defined using grip strength (kg), gait speed (m/s), standing balance, and chair stand speed (stands/sec). Sensory function was defined using hearing (pure tone average for better ear (BPTA) (dB)) and vision (contrast sensitivity (logCS)). Dementia was categorized as possible or probable using NHATS dementia classification. Survey-weighted logistic regression models estimated the likelihood of dementia by impairment in sensory and motor function, adjusted for demographic and medical conditions. 185 (10.5%) participants had possible or probable dementia. In models incorporating both motor and sensory impairments, impaired standing balance (<3 standing balance score in SPPB) and slow walking speed (<0.8m/s) were associated with higher odds of dementia (OR=1.75; 95%CI 1.10-2.79; and 2.39 95%CI 1.37-4.15, respectively), while hearing impairment (BPTA>25dB) and contrast sensitivity (<1.55logCS) were not associated with higher prevalence of dementia. In this nationally representative sample of older US adults, results suggest motor function is more strongly associated with dementia relative to sensory function among participants able to complete physical function testing. Future research is needed to understand how the associations of sensory and motor function with dementia change from mid-to-late life.
MUSCLE STRENGTH AND INCIDENT DEMENTIA IN THE NATIONAL HEALTH AND AGING TRENDS STUDY (NHATS)
Authors: Wanigatunga Amal , Lu Yidan , Marino Francesca , Davoudi Anis , Dougherty Ryan , Schrack Jennifer
Published: December 2023

Slower gait speed is linked to dementia risk, but the role muscle strength plays in this relationship is unclear. We examined whether muscle strength measured in the hands and legs is related to dementia risk beyond usual gait speed. We included 3,212 NHATS participants (mean age 75 years, 54% women) followed from 2011-2019 without dementia at baseline. Muscle strength was measured by maximal grip strength (kg) and repeated chair stands (seconds). Incident dementia combined possible and probable dementia defined by a validated NHATS algorithm. Cox regression models were used to estimate longitudinal associations between each baseline muscle strength and incident dementia. Models were adjusted for demographics and medical conditions, and additionally for usual paced gait speed (m/s). Over an average of 5 (SD=3) years, there were 946 (30%) first-time dementia events. For 1 kg higher in grip strength, there was a 2% decrease in incident dementia (HR:0.98; 95%CI: 0.97-0.99;p<0.001), which remained significant after adjustment for gait speed (p=0.005). More time to complete chair stands was positively associated with dementia incidence (HR:1.02; 95%CI:1.01-1.03;p<0.001) but results were attenuated after adjusting for gait speed (p>0.10). All results remained robust after removing events that occurred 1 year from baseline. These findings suggest that grip strength, after accounting for gait speed, is associated with dementia incidence. These results suggest the muscle morphology differences between the hands and legs capture different neuromuscular mechanisms linked to dementia. Replication of these findings and further investigation into potential biological mechanisms are needed.
TRANSCRANIAL DIRECT CURRENT STIMULATION MODULATES BRAIN ACTIVITY DURING DUAL-TASK STANDING IN OLDER ADULTS
Authors: Kahya Melike , Gouskova Natalia , Lo On-Yee , Zhou Junhong , Cappon Davide , Pascual-Leone Alvaro , Lipsitz Lewis , Manor Brad
Published: December 2023

In older adults, performing an attention-demanding cognitive task while standing comes with a ‘cost’ (i.e., decrement) to postural control. Transcranial direct current stimulation (tDCS) designed to facilitate the excitability of the left dorsal-lateral prefrontal cortex (L-DLPFC) and motor cortex (M1) mitigates this dual-task cost (DTC). The effects of tDCS on underlying brain activity measured by electroencephalography (EEG) during dual-tasking, however, is unknown. We hypothesized that tDCS would decrease the DTC of EEG-measured alpha and gamma power, as these frequencies have been linked to attentional processing and their attenuation is believed to reflect more efficient and/or effective postural control. Thirty participants received 20-minutes of tDCS targeting the L-DLPFC and M1, or sham (i.e., control) stimulation, in random order, on two separate visits. Before and immediately after each stimulation, EEG and postural sway area were recorded as participants completed trials of standing with and without verbalized serial subtractions. EEG alpha and gamma power were derived from channels corresponding to the L-DLPFC and M1 areas. The DTC (absolute change from single to dual-tasking) for both EEG and sway outcomes were calculated. tDCS, compared to sham, decreased the DTC to gamma power (p=0.04) and sway area (p=0.04). No pre-to-post stimulation changes were observed for alpha power (p=0.42). Participants who demonstrated a greater decrease in the DTC to gamma power after tDCS exhibited a greater reduction (improvement) in the DTC to sway area (r=0.66, p=0.002). The results suggest that the tDCS-induced changes in gamma-frequency activity were associated with improved dual-task standing balance in older adults.
PSYCHOMETRIC PROPERTIES OF THE CHANGING TALK ONLINE TRAINING PROGRAM EVALUATION SCALE FOR LONG-TERM CARE STAFF
Authors: Yang Frances , Coleman Carissa , Shaw Clarissa , Perkhounkova Yelena , Hein Maria , Williams Kristine
Published: December 2023

The Changing Talk (CHAT) intervention educates long-term care staff about elderspeak and person-centered communication strategies. The online version of CHAT training is a national trial to reduce behavioral symptoms in long-term care residents with Alzheimer’s Disease and other dementias. The development and validation of program evaluation scales are important for ensuring valid intervention evaluation. Using item response theory to assess the satisfaction of the CHATO program by staff, we tested for unidimensionality and local independence. Confirmatory factor analysis showed that there was redundancy between two items, based on the best fitting unidimensional model (Root Mean Square Error of Approximation=0.134, Comparative Fit Index=0.999). The IRT parameters showed that the highest discriminating item was the “The information in the course was clearly presented,” which also showed the highest range of difficulty parameters for the response choices. Other items in the scale were: “This course enhanced my knowledge of the subject matter,” “The information was a good refresher for me,” “I can use this training in my job,” “The resources listed in the course were useful for my job duties,” “The video clips were useful in helping me learn course materials,” “I would recommend this course to others,” “The learning activities were useful in helping me learn course materials,” and “I was satisfied with this course overall.” Differential item functioning due to race/ethnic, language, and educational achievement were examined to test for the presence of measurement noninvariance. This program evaluation scale may be utilized in other pragmatic trials as a valid measurement tool.
CANNABIS USE AMONG OLDER ADULT CANCER PATIENTS: PATTERNS OF USE AND PERCEIVED SYMPTOM MANAGEMENT
Authors: Fahey Margaret
Published: December 2023

Prevalence of cannabis use among U.S. older adults (>65 years) is increasing and is common among cancer survivors of all ages. This National Cancer Institute-funded supplement supported administration of a cross-sectional survey in a state with illegal access to cannabis. This study descriptively examined weighted estimates of cannabis rates (lifetime, post-diagnosis, current) among older patients (>65 years) (N=524; 51% of full sample) with a cancer diagnosis (< two years). Of those endorsing post-diagnosis use, weighted estimates examined patterns of use (timing relative to cancer treatment, reasons for use, primary mode of use) and self-reported impact of cannabis on symptoms (since diagnosis; 5-point Likert scale for 9 symptoms). Almost half (46.0%) of older patients used cannabis in their lifetime, with 18.2% using post diagnosis and 9.8% currently using. Of patients who used cannabis following diagnosis (N=107), approximately half used during cancer treatment (7.0% had not yet started) and most common mode of use was smoking (e.g., joint) followed by edible use. Most common reasons were for pain (44.3%), sleep (43.4%) and recreationally (38.1%). Most common symptoms patients endorsed improved quite a bit, included pain (27.7%), difficulty sleeping (27.3%), and stress, anxiety, depression (23.5%). Overall, few believed cannabis worsened symptoms, with most indicating either improvement or no change. Findings indicate older oncology patients commonly use cannabis to alleviate medical or health symptoms. Oncology care teams require evidence-based recommendations and guidance to inform conversations and shared decision making about cannabis with their older patients, even within a state without a legal cannabis marketplace.
THE LTSS STATE SCORECARD AND THE ROLE OF STATE POLICY
Authors: Tewarson Hemi
Published: December 2023

States play a crucial role in long-term services and supports. State agencies and legislatures have the power to make LTSS and family caregiver supports more (or less) accessible, affordable, and high-quality for the residents they serve. In addition, much of the policymaking during and after the peak of the COVID-19 pandemic took place at the state level. State agencies had the authority to grant providers, consumers, and family caregivers new flexibilities and options as it relates to LTSS, and states have and continue to decide where much of the federal COVID-19 funds (e.g., American Rescue Plan HCBS funding) will ultimately go. This portion of the symposium will present an overview of where states are today with LTSS and how the Scorecard can help both identify and drive system change.
PREDICTING CLIENT RETURN TO ADULT PROTECTIVE SERVICES: A SECONDARY ANALYSIS OF RECURRENCE USING NATIONAL APS DATA
Authors: Gaeta Raphael , Gassoumis Zach , Lovegrove Peter
Published: December 2023

APS programs are provided by state and local governments across the U.S. to serve older adults and adults with disabilities facing abuse, neglect, or exploitation (“maltreatment”). The purpose of this analysis was to identify predictors of recurrence, which occurs when clients return to APS for investigation/services after their cases have been closed. The analysis combined several data sources, including the National Adult Maltreatment Reporting System (NAMRS), the first comprehensive, national data reporting system for APS programs. This analysis represents the first study of this kind to use NAMRS data. The main analyses used Bayesian logistic regression with client, case, and state-level APS system characteristics to predict 12-month recurrence in a multi-state model and in separate single-state models. The sample included data on 1,211,360 APS episodes that closed from 2015-2019 in 19 states. These episodes contained information on 946,477 unique APS clients. About one in five clients in this analysis experienced at least one episode of recurrence. Multivariate results revealed several significant predictors of recurrence (e.g., gender, maltreatment type, maltreatment disposition, episode length, case closure reason), with the largest being age (85+ vs. ≤59 AOR=0.876) and self-neglect (AOR=1.132). The findings may be helpful for APS programs to better recognize and serve clients at high risk of returning to APS after their cases close. The findings also highlight the ambiguity surrounding the concept of recurrence in the APS field and the need for further research to determine the circumstances in which recurrence may be considered a negative or a positive outcome.
BIRTHPLACE AND COGNITION AMONG US OLDER ADULTS: EVIDENCE FROM THE HARMONIZED COGNITIVE ASSESSMENT PROTOCOL (HCAP)
Authors: Lin Zhuoer , Chen Xi
Published: December 2023

Growing evidence shows that place of birth and related circumstances may impose lasting and multiplicative impacts on a host of late-life outcomes; yet how it affects various domains of cognitive function in late-life is less understood. In this paper, we exploit the comprehensive cognitive assessments in the Health and Retirement Study (HRS) Harmonized Cognitive Assessment Protocol (HCAP) and HRS geographic data at birth to determine to what extent birth location measured at the state level is associated with cognitive status in later life for a representative sample of Americans over age 50 (N=3,324). We found that state of birth significantly influenced various cognitive domains later in life (including episodic memory, executive function, attention, visuospatial function, language fluency and orientation); and the regional rankings tended to be highly consistent across the cognitive assessments in each domain. Regression analysis demonstrated that the geographic disparities in cognition across birth states could be partly explained by the late-life differences in socioeconomic statuses. Nevertheless, Shapley decompositions demonstrated that, after accounting for mid-life to late-life factors, state of birth still contributed 20%-30% of the explained variations in cognitive outcomes. Particularly, foreign-born individuals and those born in the southern states tended to score the lowest on average on each of the cognitive tests/domains and can account for most of the explained differences in cognition. These findings suggest that place of birth may have lasting impacts on disparities in cognition later in life. Public policy should play pivotal roles in leveling the playing field in early life.
SOCIAL DETERMINANTS OF COGNITIVE HEALTH: A SCOPING REVIEW
Authors: Zhang Lingling , Zhang Yao
Published: December 2023

Population aging has caused a substantial increase in neurodegenerative disorders, such as Alzheimer’s disease (AD), the fifth leading cause of death for people aged 65 and older. It has posed tremendous challenges to families and society. The existing research shows that postponing AD onset by 5 years would reduce the disease prevalence by half. Therefore, to better understand the modifiable risk factors, including social determinants of health (SDOH) for cognitive health, will be helpful for early prevention and resource allocation. SDOH are classified into five domains (healthcare access and quality, education access and quality, social and community context, economic stability, and neighborhood and built environment). There are studies examining the relationship between one or more domains of SDOH and cognitive health, however, to our knowledge, there is no comprehensive review has been done to synthesize the evidence from all domains of SDOH. This literature review aims to map the existing evidences on social determinants of cognitive health to inform future programs and policies. Twenty-nine studies were included in the review through a systematic search of relevant literature published on peer-reviewed journals from four electronic databases (Pubmed, PsychInfo, CINAHL, and MEDLINE) during 2012-2022. The review summarized a broad range of empirical research on how SDOH affect cognition, as well as revealed the racial disparities in cognitive function, which is worth noting. The favorable SDOH conditions such as better healthcare access, education, social engagement, etc. were proved protective factors for cognitive impairment. Race and racial segregation were found to be the opposite.
PSYCHOSOCIAL FACTORS AND EARLY MID-LIFE BLACK WOMEN’S SLEEP QUALITY: A CONSIDERATION OF INTERSECTIONAL MEASURES
Authors: Erving Christy
Published: December 2023

Beyond an individual behavior, scholars are progressively conceptualizing sleep as embedded in social factors. Extant research establishes that sleep is influenced by experiences based on status characteristics such as gender or race along with psychosocial stressors such as discrimination. Moreover, sleep is important in the context of gender and racial disparities, as Black women experience relatively poorer sleep quality compared to their Black male and White counterparts. Given their relatively poor sleep quality, this presentation will center Black women by examining how psychosocial factors influence their subjective sleep quality in early mid-life, an important life course stage characterized by significant role obligations in personal and professional life domains. This presentation also takes an intersectional approach, examining the sleep implications of two recently developed measures that capture the unique intersectional oppression of Black women: Superwoman Schema and gendered racial microaggressions. To assess the association between these intersectional psychosocial factors and subjective sleep quality, data are drawn from Mechanisms Underlying Stress and Emotions (MUSE) in African-American Women’s Health Study, a cohort of 422 Black women (ages 30-46) in Atlanta, GA, USA. Preliminary findings suggest that both Superwoman Schema endorsement (e.g., feeling obligated to help others) and reports of gendered racial microaggressions (e.g., feeling marginalized and silenced in professional settings) are related to poor subjective sleep quality. Moreover, these associations remain even after adjusting for various factors including, but not limited to, depressive symptoms, anxiety symptoms, and social support. Study implications and future research directions will be discussed.
SOCIAL DETERMINANTS OF SMOKING CESSATION IN MIDDLE-AGED AND OLDER ADULTS WITH SERIOUS MENTAL ILLNESSES
Authors: Leutwyler Heather , Hubbard Erin , Bussell Theodore , Zahedikia Negin , Balestra Dennys , Wallhagen Margaret , Okoli Chizimuzo
Published: December 2023

People living with serious mental illnesses (SMI) continue to face a disproportionate burden of tobacco-related prevalence, morbidity, and mortality as compared to those without SMI. The risk of mortality related to cigarette smoking among those with SMI is six-times that for persons without SMI. Tobacco use undermines social determinants of health (SDoH) in general and the social determinants of mental health more specifically. Not only does tobacco use exacerbate mental health symptoms, it further impedes mental health recovery by reducing expendable income, sustaining poverty, hindering food security, and limiting job opportunities. Conversely, stopping tobacco use is associated with improved mental health and, possibly, substance use recovery outcomes. The purpose of this paper is to analyze the social determinants of tobacco smoking cessation as described by adults with SMI. We conducted semi-structured qualitative interviews with 17 middle aged and older adults (mean=52, sd=6.9) with SMI upon completion of a 12-week smoking cessation program. Grounded Theory methodology guided data collection and analysis. Participants described what contributed to their success with smoking cessation or reduction and pointed out how SDoH played a role in the process. Five broad categories of SDoH described were: 1. Support and sense of belonging; 2. Structure and meaningful activities; 3. Employment; 4. Role models; and 5. Access to green space. Our findings illustrate the importance of SDoH in health interventions and are a reminder to consider these SDoH as interventions are tailored to meet the unique needs of people living with SMI.
COGNITIVE BEHAVIORAL TREATMENT OF INSOMNIA SLOWS THE PACE OF BIOLOGICAL AGING: RESULTS FROM AN RCT IN OLDER ADULTS
Authors: Carroll Judith
Published: December 2023

Insomnia in late life has been linked to accelerated biological aging, presenting a behaviorally modifiable target to slow the pace of aging. We previously demonstrated that treatment of insomnia in older adults using cognitive behavioral therapy for insomnia (CBT-I) reduced the expression of the cellular senescence marker, p16INK4a, in peripheral blood mononuclear cells (PBMC). Next, we tested whether this treatment for insomnia would alter the biological pace of aging, estimated from the DNA methylation derived DunedinPACE, as compared to a sleep education therapy (SET), an active comparator condition. Participants 60+ years old with insomnia were enrolled in a randomized controlled trial and assigned to CBT-I (n=49) or SET (n=45). Epigenetic data were obtained from DNA extracted from blood collected prior to initiation of treatment (baseline) and again 18-24 months later. A mixed linear models adjusting for age, sex, BMI, and education revealed a significant treatment by time interaction (p=0.003). Receipt of CBT-I was associated with a decline in the epigenetic pace of aging, while those receiving SET had an increase in their pace of aging. Findings indicate that a behavioral intervention to improve insomnia was effective at slowing the pace of biological aging among older adults. Future research will be needed to replicate these findings in other age groups and specific populations with heightened risk for accelerated aging.
IMPROVING NURSING HOME DISASTER READINESS THROUGH IMPLEMENTATION SCIENCE
Authors: Bell Sue Anne , Inloes Jennifer , Wasserman Michael , Donnelly John , Wyte-Lake Tamar
Published: December 2023

The new investigation on the state of emergency preparedness in nursing homes from the Senate Finance and Aging Committee Chairs is a call to action. As large-scale disasters continue to become increasingly common worldwide, nursing homes, whose residents are more vulnerable to disaster-related health and psychosocial shocks, and their staff, are carrying progressively more responsibility for healthcare readiness practices. Implementation science is a research discipline that seeks to improve uptake of evidence-based practices, such as healthcare readiness planning, and thus has potential to improve nursing home care delivery during and after disasters. The purpose of this review was to describe the limited field of existing evidence-based strategies in the peer-reviewed literature that seek to advance healthcare readiness in the nursing home setting and illustrate how implementation science can better support healthcare readiness planning for nursing homes. We discuss three main themes: 1) implementation science frameworks can strengthen nursing home staff engagement around healthcare readiness; 2) implementation science can support tailoring of emergency preparedness plans to individual nursing homes’ unique needs; and 3) implementation science can advance the integration of nursing homes into local, state, and federal healthcare readiness planning initiatives. Finally, research is urgently needed to both generate and disseminate implementation strategies that increase uptake of evidence-based health care readiness practices in the nursing home setting.
COGNITIVE IMPAIRMENT AMONG OLDER ADULTS WITH INTERSECTING SEXUAL, GENDER, RACIAL, AND ETHNIC MINORITY IDENTITIES
Authors: Kim Hyun-Jun , Oswald Austin , Jung Hailey , Fredriksen-Goldsen Karen
Published: December 2023

Emerging research shows Lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults experience higher prevalence of cognitive impairment when compared to their heterosexual and cisgender peers of a similar age. The same is true for racial and ethnic minority older adults when compared to their White counterparts. Little is known about the cognitive health of older adults with intersecting sexual, gender, racial, and ethnic minority identities, highlighting a critical gap in gerontological research that requires further investigation. This study utilizes four time-point data from the first longitudinal study of a racially and ethnically diverse sample of LGBTQ older adults. Multilevel mixed models accounting for intersecting sexual, gender, racial, and ethnic identities were applied to examine subgroup differences in cognitive impairment as well as risk and protective factors after controlling for confounding factors. Black and Hispanic LGBTQ minority older adults (b=5.20, p<.01; b=4.05, p<.01) experience higher levels of cognitive impairment over time when compared to their White LGBTQ peers. Day-to-day discrimination targeting the confluence of sexual/gender and racial/ethnic minority status (b=2.78, p<.05) was positively associated with higher cognitive impairment. Community engagement (b=-.46, p<.05) was negatively associated with cognitive impairment regardless of race and ethnicity whereas network size was exclusively negatively associated with cognitive impairment for Black LGBTQ older adults. The overall findings demonstrate racial and ethnic differences in cognitive impairment among LGBTQ older adults and illuminate the importance of culturally tailored interventions that account for intersectionality, social connectivity, and discrimination to promote cognitive health for specific subgroups.
SEQUENCE ANALYSIS OF CARDIOMETABOLIC MULTIMORBIDITY AND ASSOCIATION WITH SUBSEQUENT DEMENTIA
Authors: Nagel Corey , Allore Heather , Botoseneanu Anda , Kaye Jeffrey , Newsom Jason , Bishop Nicholas , Quiñones Ana
Published: December 2023

Sequence analysis is used in the social sciences to examine patterns of events occurring across the life course, but there are few examples of its use in multimorbidity research among older adults. We used sequence analysis to identify longitudinal patterns of cardiometabolic multimorbidity over a five-year period among participants in the National Health and Aging Trends Study (N=5,218). Multimorbidity sequences were constructed using self-reported diagnosis of diabetes, heart disease, stroke, and myocardial infarction (MI) assessed annually. Death was included as an absorbing state, yielding a total of 281 distinct sequences. We calculated sequence dissimilarity using optimal matching then used hierarchical clustering to identify seven distinct sequence clusters. The largest cluster (46.2%) was characterized by no baseline cardiometabolic disease and minimal incident disease across the 5-year period. Three clusters were characterized by stable sequences: diabetes (13.1%), heart disease (7.5%), and MI or stroke (7.3%) across the 5-year period. Two clusters exhibited a high rate of incident cardiometabolic disease during the 5-year period, one among persons with no baseline disease (9.6%) and one with rapid accumulation of cardiometabolic multimorbidity (5.3%). Finally, one cluster largely contained persons who died during the study period (11.0%). Compared to those with no baseline and minimal incident cardiometabolic disease, the odds of subsequent dementia were significantly higher among the cluster without prior disease who developed incident cardiometabolic disease (OR= 1.61, 95% CI:1.07,2.43) and the cluster with high cardiometabolic multimorbidity (OR=2.77, 95% CI:1.84,4.18). These findings contribute to our understanding of the impact of cardiometabolic multimorbidity on cognitive health.
DRAWING AS A METHOD TO DETECT SOCIO-COGNITIVE PERCEPTIONS OF HUMAN LONGEVITY IN EARLY CHILDHOOD
Authors: Bishop Alexander , Callaway-Cole Larissa , Grimmett Hailey
Published: December 2023

The aim of this investigation was to understand how young children socially and cognitively perceive human longevity through drawing. Data for this study were collected from young children, ages 3 to 6, enrolled in Pre-K and Kindergarten classrooms through a university-supported early childhood education center. Investigators first conducted brief open-ended interviews to gauge participant understanding of the concept of being “old.” Participants were then asked to draw a self-portrait image of what might look like at 100 years of age. Finally, participants were asked to describe their picture as well as share a story regarding the self-portrait image they had crafted. Images were decoded and analyzed relative to depicted content, pattern and position, and color preferences. Findings highlight reliance on internal working models which appear to highlight socially emergent and learned attitudes, beliefs, and stereotypes about growing old. Further discussion relative to underlying indication of emotional development will be highlighted.
THE INTERSECTIONAL IMPACT OF RACE AND GENDER ON END OF LIFE
Authors: Suntai Zainab , Noh Hyunjin , Lee Lewis , Bell Gregg , Lippe Megan , Lee Hee Yun
Published: December 2023

Over the past few decades, research on quality of life at the end of life has proliferated, with an increased focus on issues of diversity. However, few studies have considered the impact of multiple disadvantaged identities, including the combination of race and gender. This study assessed the intersectional impact of race and gender on four end-of-life outcomes: pain, anxiety/depression, patient autonomy, and overall care quality. Data were derived from the combined 2012 to 2020 last-month-of-life interviews conducted by the National Health and Aging Trends, which is an annual longitudinal panel survey of Medicare beneficiaries aged 65 and older. Multivariate logistic regression models were used to test the association between the race/gender intersection and each of the four outcomes. Results showed that Black women were the most likely to be in pain, most likely to have a lack of autonomy in decision-making, and the least likely to have excellent or good care at the end of life. White women were the most likely to have had anxiety/depression, followed by Black women, Black men, and then White men. Across all four outcomes, White men were the most likely to have had favorable outcomes, confirming the theory of intersectionality. These results point to a significant disparity in quality end-of-life care for Black women, who have double-jeopardy as a result of their membership in two vulnerable groups. Thus, there is increased need for practice, policy, and research interventions to attain equitable end-of-life care for all individuals.
THE PUBLIC HEALTH IMPLICATIONS OF DEMENTIA CAREGIVING IN THE US: FINDINGS FROM THE 2021 BRFSS
Authors: Gaugler Joseph , Lamb Raza , Denno Ben , Baumgart Matthew , Yam Hawking , McGuire Lisa
Published: December 2023

To further elevate dementia caregiving as a public health imperative, representative data that highlights more local variations in dementia caregiving is essential, as such data can better target and tailor services as well as advance policy innovations at the state level. We empirically examined state variations in dementia caregiving in the U.S. by analyzing data from the Behavioral Risk Factor Surveillance System (BRFSS) among the 39 states that used the Caregiver Module in 2021. Prevalence of hypertension among dementia caregivers ranged from a low of 28.7% (CI 16.7-44.8) in South Dakota to a high of 53.6% (CI 43.9-63.1) in Arkansas. The mean hypertension prevalence rate in the 39 states for dementia caregivers was 42.0%, compared with a mean hypertension prevalence rate for non-dementia caregivers of 38.2%. Close to half (44.2%, CI 31.8-56.6) of dementia caregivers in Michigan provide care for 40 or more hours per week. In 35 of the 39 states, at least one-third of dementia caregivers provide care for 20 or more hours per week; in comparison, at least one-third of non-dementia caregivers provide care for 20 or more hours per week in only 7 of the 39 states. The findings illustrate how intensity and the health implications of dementia care vary across states in the U.S. and can help inform more localized programmatic and policy targets to address the public health implications of dementia care.
NIA DIVISION OF BEHAVIORAL AND SOCIAL RESEARCH
Authors: Nielsen Lisbeth
Published: December 2023

Dr. Nielsen will discuss research priorities for the NIA Division of Behavioral and Social Research. Dr. Nielsen will also be available for small group discussion.
SAFE AND SENSATIONAL: ASSESSING THE SECURE AND PRIVATE ONLINE DATING WORLD FOR OLDER ADULTS
Authors: Noah Naheem , Das Sanchari
Published: December 2023

Online dating applications have become a popular way for people worldwide to meet potential partners, including older adults aged 65 and above. However, using these applications involves revealing personally identifiable information (PII), which raises privacy and security concerns, particularly for older adults who are often the targets of cyberattacks. To address this issue, this paper conducted a literature review of 38 peer-reviewed publications on online dating security and privacy, with a focus on older adults. The review found that while 10 papers evaluated older adults’ cybersecurity issues, and two papers explored mobile security management with adults, no papers explicitly focused on older adults and dating applications. To fill this research gap, this paper conducted an application-level security and privacy analysis of ten popular online dating applications, including Tinder, Grindr, Match, Bumble, OkCupid, SilverSingles, Harmony, EliteSingles, Christian Mingles, and LDS Singles. The study revealed that these applications have concerning data security practices that may affect the privacy and security of users, especially older adults. The paper concludes by providing actionable recommendations for secure and privacy-preserving user experience. For instance, online dating applications should implement secure authentication mechanisms, such as two-factor authentication, and use end-to-end encryption to protect users’ data. Additionally, the applications should enable users to control their data and allow them to choose the information they want to share with others. Moreover, the dating apps should provide clear and concise privacy policies that are easy to understand and readily available to users.
INCARCERATION HISTORY AND ITS ASSOCIATION WITH COGNITION AND ISOLATION AMONG OLDER BLACK AMERICANS
Authors: Kahsay Eskira , Sneed Rodlescia , Zhong Chuwen , Mezuk Briana
Published: December 2023

Incarceration is a risk factor for adverse health and disproportionately affects Black Americans. Little is known about its implications for later life functioning. This study investigated the associations between incarceration and social isolation and cognition among older Black Americans. Sample included African American and Caribbean Black respondents aged 50+ from the National Survey of American Life, 2001-2003 (N=1,561; 12.6% with incarceration history). Lifetime incarceration history (yes/no) was defined as having been in jail, prison, or juvenile detention. Continuous cognitive score was measured using the WHO Disability Assessment Schedule-II, with higher scores indicating higher cognitive difficulty. Binary isolation was assessed by combining two indicators of frequency of contact and feelings of closeness, for friends and family, using a 4-point Likert scale. Multivariable weighted linear and logistic regressions were fit for the associations between cognitive score and social isolation, respectively. All models adjusted for age, sex, ethnicity, poverty, education, marital status, and drug use; model for cognition further adjusted for mental health and traumatic experiences and models for isolation further adjusted for discrimination. Moderation by nativity (U.S. versus foreign born) was assessed using interaction. History of incarceration was associated with worse cognition (β = 0.09, 95% CI: -1.48, 1.66) and higher odds of social isolation for frequency (AOR: 1.48 95% CI: 0.89, 2.46) and closeness (AOR: 1.05, 95% CI: 0.52, 2.15). Results not moderated by nativity. Findings suggest contexts surrounding incarceration, like social supports, may be important engagement points for successful transitions and promotion of psychological and cognitive health in this population.
PERCEIVED WORKPLACE AGEISM AND RACIAL/ETHNIC DISPARITIES IN COGNITIVE FUNCTIONING AMONG OLDER WORKERS
Authors: Sahin Duygu Basaran , Heiland Frank , Yin Na , Smith Ryan
Published: December 2023

Research suggests that discrimination contributes to racial/ethnic disparities in health, but little is known about the role of perceived workplace ageism in this phenomenon. Workplace discrimination threatens a person’s livelihood, self-esteem, and identity. Older workers from racial/ethnic minority groups may experience both race- and age-based discrimination. Using data from the Health and Retirement Study, we investigate whether workplace ageism is related to older workers’ cognition and whether the link differs by race/ethnicity. We find that workers who perceive ageism in their workplaces tend to do worse on standard cognition tests than those who do not. For example, the immediate and delayed word recall performance is 13-14% of one SD lower among individuals who report that co-workers pressure older workers to retire before age 65. The relationships are stronger (more negative) for Hispanic workers, but there is no evidence that they differ between Non-Hispanic Black and Non-Hispanic White workers.