bluuebunny/crossref_metadata_2025 huggingface dataset:
FINANCIAL EXPLOITATION VULNERABILITY IN OLDER AGE: INTERPERSONAL AND BRAIN MECHANISMS
Authors: Han Duke
Published: January 2025

Financial exploitation vulnerability in older age can be viewed as an intersectional model of multiple potentially contributing features that can vary from individual predisposing characteristics to interpersonal dynamic factors. Here we present recent work from our lab focused on two mechanisms. In Study 1, thickness of the entorhinal cortex as measured by a 7-Tesla brain MRI scan was associated with a measure of perceived financial vulnerability in 97 older adults without any significant cognitive impairment in models adjusted for demographics and cognition (beta=-0.05, SE=0.02, p<0.05). The entorhinal cortex is well-known for its role as the first brain region to show signs of deterioration in preclinical Alzheimer’s Disease; therefore, findings suggest early age-associated pathological brain changes may underlie financial vulnerability. In Study 2, financial vulnerability was associated with depth of relationships, but not breadth of relationships, in 115 older adults without any significant cognitive impairment after covarying for demographics, depressive/anxious symptoms, and cognition (beta=-.08, SE=.03), p<.01). Findings argue for the importance of considering interpersonal relationship dynamics when assessing financial vulnerability. Together, these studies argue for the importance of considering multiple factors and different levels of analysis when considering financial exploitation vulnerability in older age.
IN SEARCH OF TIME: TIME PERSPECTIVE AND LIFE’S FINITUDE
Authors: Kim-Knauss Yaeji , de Couto Clara Paula , Ekerdt David
Published: January 2025

Human existence is inherently bounded by a finite timeline, and this reality shapes our perceptions, attitudes, and behaviors towards the time. This awareness of life’s finitude prompts individuals to prioritize meaningful pursuits or to adapt to the constraints of time, as elucidated in theories in gerontology, and validated through numerous empirical studies. Against this background, this symposium delves into the impact of time perspectives on psychological outcomes, as well as on individuals’ approaches to their own mortality. N. Fung and H. Fung will offer a comprehensive examination of how motivation changes as time left in life is perceived to decrease. Wirth et al. will present findings about the influences of different subsets of time perspective on life satisfaction using longitudinal data. Incorporating ideas from construal-level theory, de Paula Couto et al. will delve into age-specific factors associated with desired longevity under impairment conditions. Kim-Knauss et al. will discuss behaviors associated with perceived engagement in end-of-life planning and examine potential cultural differences by comparing the findings from Germany and South Korea. Selovin et al. will explore psychological and behavioral factors contributing to a sense of preparedness for death and dying among older adults. Finally, Ekerdt will discuss the findings from these presentations, offering comprehensive insights into the interplay between time perspective and human behavior in confronting mortality.
THE ROLE OF PSYCHOLOGICAL AND BEHAVIORAL FACTORS IN FEELING WELL-PREPARED FOR DEATH AND DYING
Authors: Selovin Fabio , Rupprecht Fiona , Nikitin Jana
Published: January 2025

In previous research, death preparation has usually been defined as the amount and type of formal death arrangements an individual has undertaken (e.g., having written a last will). In contrast to such formal preparation, our study focuses on the subjective feeling of being prepared for death and dying. Based on construal-level theory, we assume that different behavioral and psychological factors matter for this subjective feeling of preparedness depending on the subjective temporal distance to death. The sample consisted of 121 participants aged 51 to 95 years (M = 63, SD = 9; 48% female). Participants were asked how prepared they felt for death and dying and how extensive they experienced their remaining future. Furthermore, we assessed aspects of formal death preparation, informal death preparation (i.e., death communication with partner), generativity and death attitudes (i.e., fear of death, belief in an afterlife). Results showed that neither formal nor informal death preparation were predictive of the subjective feeling of being prepared. Instead, the fear of death emerged as the strongest (negative) predictor across the sample. Interaction analyses further showed that individuals who felt close to death, felt prepared when their generativity and opportunities for being generative were high. Findings are discussed using a life-span perspective, illuminating what being prepared for death and dying might mean for the individual.
PSYCHOSOCIAL AND IMMIGRATION DETERMINANTS OF SLEEP HEALTH AMONG OLDER CHINESE IMMIGRANTS
Authors: Jiang Yanping , Tang Fengyan
Published: January 2025

Good sleep is critical for maintaining physical and cognitive health among older adults. Few studies, however, have examined factors related to sleep among older Asian immigrants, who face unique challenges that may put them at elevated risk of experiencing poor sleep. This study aimed to examine the effect of various psychosocial and immigrant factors on sleep outcomes over 2 years in a large sample of older Chinese American immigrants. Data were drawn from a subsample (N = 2,228) from the Population Study of Chinese Elderly in Chicago. Participants self-reported multiple psychosocial and immigrant factors, including neighborhood cohesion, neighborhood disorder, social disconnectedness, loneliness, perceived racial discrimination, perceived social support, negative social interactions, acculturation, perceived stress, depression, length of living in the U.S., income, and education. Participants also completed questionnaires on sleep quality and insomnia. Multivariate regression analyses showed that of the psychosocial and immigrant factors, depressive symptoms significantly predicted poorer sleep quality and worse insomnia over 2 years, controlling for baseline sleep quality and insomnia. Also, neighborhood disorder predicted worse insomnia over 2 years but not sleep quality. In addition, exploratory analyses for subdomains of sleep quality showed that perceived stress and negative social interactions predicted lower sleep efficiency over time. Neighborhood disorder and depressive symptoms appear to be salient risk factors for poor sleep health among older Chinese immigrants. Interventions targeting neighborhood environment and mental health services may be critical in improving sleep health and promoting healthy aging of older Chinese immigrants.
END-OF-LIFE CARE DISPARITY FOR ASIAN AMERICAN PACIFIC ISLANDER AND WHITE AMERICANS WITH DEMENTIA
Authors: Kim Hyosin , Lin Haiqun , Zafar Anum , Wu Bei , Duberstein Paul , Jarrín Olga
Published: January 2025

Alzheimer’s disease and related dementias (ADRD) disproportionately affects Asian American and Pacific Islander (AAPI) older adults, similar to other minoritized groups. People living with ADRD have significant caregiving and end-of-life care needs. Little is known about racial disparities in end-of-life care for the AAPI Medicare beneficiaries with dementia. Using Medicare administrative, claims, and assessment from inpatient, hospice, and post-acute and long-term care settings for Medicare beneficiaries who died in 2019, differences in end-of-life care and place of death for AAPI (n= 20,301) and non-Hispanic White (n=762,443) Medicare beneficiaries with dementia and comparable levels of multimorbidity (median 6, IQR 5-8) were studied. Compared to White beneficiaries with dementia, AAPI beneficiaries with dementia were more likely to be dually enrolled in Medicare and Medicaid (60% vs. 32%), yet less likely to use home health care (52% vs. 55%) or nursing home care (54% vs. 64%) during the last 3 years of life; less likely to use hospice care during the last 6 months of life (52% vs. 65%); and more likely to die in an inpatient setting (34% vs. 26%) compared to their white counterparts. Differences were magnified among beneficiaries with high chronic disease burden (four or more comorbidities in addition to dementia). Underuse of hospice services and the high rates of Medicare-Medicaid dual enrollees among AAPI beneficiaries with dementia and multiple comorbidities warrant further attention, as the disease burden particularly increases with multiple chronic conditions.
RECONSTRUCTING CULTURAL IDENTITY: THE ORAL NARRATIVES OF CENTENARIAN DESCENDANTS OF INDIGENOUS ANCESTRY
Authors: Bishop Alex , Finchum Tonya , Heinz Melinda
Published: January 2025

This study examined storytelling narratives of indigenous centenarians from the Oklahoma 100 Year Life Project. Qualitative content analysis was conducted using oral history narratives of N = 16 centenarian descendants (n = 5 men; n = 11 women) of American Indian ancestry (n = 8 White/Caucasian; n = 4 African-American; n = 4 Indigenous). Of interest was identifying themes reflecting cultural influences. Analyses resulted in four thematic classifications. The first theme included “transmission of historical trauma,” and involved resettlement, slavery, and race relations. One centenarian man reflected, “That’s the reason they’re called sooners... that use to belong to the Cherokees, and they took all the land...” A second theme involved “mutual interdependence.” One centenarian woman remarked, “I never enjoyed anything if I had it and didn’t share with somebody else. That’s the way I’ve been all my life. I just love to share things with people” A third theme concerned “leisure and sporting.” One centenarian man recounted training with the varsity track team, “... everybody was blowing just like a steam engine except me...I had been running all summer long out there in the buffalo grass pastures.” The fourth theme entailed “lifelong learning.” One centenarian woman recalled, “I organized a club... we studied Indian customs... our families and traditions... we called ourselves ‘Tsa-la-gi,’ which means Indian ladies.” Results will further highlight differential influences of American Indian cultural heritage on socio-emotional well-being in human longevity.
LONG-TERM IMPACTS OF A LIFESTYLE INTERVENTION IN OLDER ADULTS WITH DIABETES AND OVERWEIGHT OR OBESITY: LOOK AHEAD
Authors: Huckfeldt Peter , Semelka Charles , Jakicic John
Published: January 2025

Mid-life weight loss and maintenance is often recommended as a means to improve health later in life, however its long-term benefits have not been rigorously established. The Action for Health in Diabetes (Look AHEAD) randomized controlled trial compared an intensive lifestyle intervention (ILI) designed to induce and maintain a 7% weight loss through caloric restriction and increased physical activity with a control condition of diabetes support and education (DSE) in 5,145 individuals aged 45-76 years with type 2 diabetes and overweight/obesity over up to 11 years of follow-up beginning in 2001. Although the ILI group had greater initial improvements in cardiovascular disease risk factors compared to DSE, there were no overall differences in the incidence of the trial’s primary and secondary cardiovascular outcomes between the ILI and DSE groups. However, ILI did have a positive impact on diabetes control and complications, depression, physical health–related quality of life, and health care use and costs. Subsequently, the Look AHEAD trial transitioned to an in-person observational study in 2012 to assess the long-term benefits and potential harms of an ILI, which continued for 10 years before transitioning to phone-only observational period in 2022 – the Look AHEAD Aging study. This symposium will describe the long-term impact of the lifestyle intervention and the effect of diabetes-related risk factors on self-reported vision and hearing (Espeland and colleagues), nutritional risk (Houston and colleagues), self-reported disability in basic activities of daily living, instrumental activities of daily living, and mobility (Semelka and colleagues), and multi-morbidity (Davis and colleagues).
LATE-LIFE DISABILITY FOLLOWING THE ACTION FOR HEALTH IN DIABETES (LOOK AHEAD) TRIAL
Authors: Semelka Charles , Neiberg Rebecca , Huckfeldt Peter , Hayden Kathleen , Chen Haiying , Wagenknecht Lynne , Espeland Mark , Houston Denise
Published: January 2025

The Look AHEAD trial intensive lifestyle intervention (ILI) was associated with better mobility in adults with type 2 diabetes and overweight/obesity. The objective of this study is to describe the post-intervention impact on disability in older adults. Disability was assessed using the Pepper Assessment Tool for Disability (PAT-D) at the first post-trial visit and three subsequent study visits during the observational phase. Disability was defined by self-reported responses ‘of a lot of difficulty’ or ‘unable to do’ on any item within the PAT-D subscales for Basic Activities of Daily Living (BADL), Instrumental Activities of Daily Living (IADL), and mobility. Regression models using generalized estimating equations were used to examine the association between intervention assignment and BMI across post-trial visits with disability prevalence, adjusting for age, sex, race/ethnicity, CVD history, and repeated measures. The mean±SD age and BMI of participants (n=1299) at the first post-trial visit was 68.7±5.6 years and 34.4±6.1 kg/m2, 61% were female, 69% were White, 8% had CVD history at baseline, and 51% were assigned to ILI. Over a median 9 years of post-trial follow-up, disability increased in BADLs from 3.1% to 12.6%, IADLs from 3.5% to 22.7%, and mobility from 21.9% to 46.7%. Participants with a higher BMI (35+ vs. <30 kg/m2) had increased odds of disability in IADLs (OR [95% CI]: 2.0 [1.5-2.8]) and mobility (2.2 [1.7-2.9]). There was no association between prior assignment to ILI and disability (p≥0.78). In conclusion, we found clinically relevant differences in late-life disability by post-trial BMI status.
LONG-TERM ASSOCIATION OF DIABETES CONTROL WITH SELF-REPORTED VISION AND HEARING
Authors: Espeland Mark , Walkup Michael , Wagenknecht Lynne , Hayden Kathleen , Semelka Charles , Wing Rena , Beckner Tara , Houston Denise
Published: January 2025

Older adults with type 2 diabetes are at increased risk for vision and hearing loss. We examined whether better control of glycosylated hemoglobin (HbA1c), blood pressure, and weight was associated with better self-reported vision and hearing acuity among older adults with type 2 diabetes and overweight or obesity. The Look AHEAD Aging study administered a standardized questionnaire to N=1,008 individuals, mean (SD) age 77.8 (5.7) years, who had been enrolled in the Look AHEAD trial of intensive lifestyle intervention (ILI). We examined how mean levels of HbA1c, systolic blood pressure (SBP), and body mass index (BMI) over the prior 10 years were associated with markers of vision and hearing acuity, controlling for age, gender, and diabetes duration. Hearing and vision deficits were assessed by self-report of fair, poor, or worse abilities. Multisensory deficits were defined as reported deficits for both vision and hearing. Relatively better 10-year control of HbA1c was associated with less prevalent vision deficits (OR=0.72 per IQR lower HbA1c, p=0.002) and with less prevalent multisensory deficits (OR=0.65 per IQR lower HbA1c, p=0.002). Better 10-year SBP control was also associated with less prevalent vision deficits (OR=0.72 per IQR lower SBP, p=0.005). Prior random assignment to ILI and 10-year BMI levels were not associated with self-reported vision. HbA1c, SBP, BMI, and intervention assignment were not significantly associated with hearing acuity. Long-term control of HbA1c and SBP are important to maintaining vision in older individuals with type 2 diabetes. HbA1c control may also reduce the prevalence of multisensory deficits.
LONG-TERM EFFECTS OF AN INTENSIVE LIFESTYLE INTERVENTION ON NUTRITIONAL RISK IN OLDER ADULTS WITH DIABETES
Authors: Houston Denise , Anderson Andrea , Semelka Charles , Hayden Kathleen , Huckfeldt Peter , Chen Haiying , Wagenknecht Lynne , Espeland Mark
Published: January 2025

Malnutrition is common in older adults and is associated with morbidity, mortality and decreased quality of life. We examined the post-intervention impact of the Look AHEAD intensive lifestyle intervention (ILI) on nutritional risk – the presence of risk factors such as food insecurity, poor appetite, and low food intake which can lead to malnutrition – in older adults with type 2 diabetes and overweight/obesity in the Look AHEAD Aging study (~9 years after the intervention was terminated). Nutritional risk scores (range 0-21) were calculated from the DETERMINE checklist, a 10-item questionnaire of factors linked to poor nutrition in older age, and categorized as low (0-2), moderate (3-5) and high (6+). Multinomial logistic regression was used to examine the association between intervention assignment, post-intervention weight change, unintentional weight loss, and current BMI with nutritional risk adjusted for current age, sex, race/ethnicity, and education in 1032 participants. Forty percent of participants were at high nutritional risk and 48% at moderate nutritional risk. There was no association between prior assignment to ILI (p=0.65) or post-intervention weight loss or gain of ≥5% (p=0.09) and nutritional risk. However, unintentional weight loss of ≥10 lbs over the past year was associated with high nutritional risk (OR [95% CI]: 2.18 [1.16-4.09]) and current BMI of ≥30 kg/m2 was similarly associated with both moderate (1.62 [1.01-2.60]) and high (1.68 [1.03-2.74]) nutritional risk. In conclusion, current BMI and recent unintentional weight loss, but not past assignment to ILI or post-intervention weight loss/gain, were associated with nutritional risk.
THE EFFECT OF SECONDARY JOBHOLDING ON INCOME MOBILITY OF DIRECT CARE WORKERS
Authors: Kim Jiyeon
Published: January 2025

Recent studies show that many direct care workers acquire secondary jobs because their primary employment does not offer sufficient wages or work hours. While prior research has emphasized how secondary jobs protect direct care workers from poverty, it is unclear how these jobs affect these workers’ subsequent employment outcomes. This paper analyzes longitudinal data to investigate whether secondary jobs can serve as a pathway for direct care workers to obtain a primary job that provides income above the poverty-line and test if some secondary occupations are more beneficial than others. I find that whereas a secondary job in a non-direct care occupation helps direct care workers later attain a primary job that pays above poverty-level, working in two direct care jobs restrains them from doing so. In addition, these effects vary by race and gender such that the benefits to holding a non-direct care secondary job are greater among men and whites, compared to their women and racial minority counterparts. These findings raise concerns about unequal opportunities for wage mobility among direct care workers and the implications this has for the retention of this workforce.
CHALLENGES AND FACILITATORS TO IMPLEMENTING A PILOT HOME HEALTH PROGRAM IN THE VETERANS HEALTH ADMINISTRATION
Authors: Walkner Tammy , Seaman Aaron , Good Mary , Benzel Heather , Roman Irene San , Davila Heather
Published: January 2025

The Veterans Health Administration (VA) provides access to skilled home health (e.g. rehabilitation therapy, nursing) and home health aide services to >200,000 Veterans annually to support aging in place. Historically, these services have been provided by community-based agencies contracted with VA. In 2021, the Iowa City VA implemented the VA’s first “VA Home Health” (VAHH) program. The goals were to increase Veterans’ access to home health and improve care coordination. Given early evidence of the program’s success, VAHH expanded in 2022 to three additional sites in Iowa and South Dakota. Our team conducted semi-structured interviews with VAHH leaders (n=13) and frontline staff (interviews in progress) at the 4 program sites about their implementation experiences. Implementation barriers include: a steep learning curve; the need to define roles and create operating procedures; recruiting and hiring sufficient staff to administer and deliver the program; and challenges obtaining space and vehicles for staff. Facilitators include: staff commitment to the program; existing relationships within and outside VA; and flexibility to tailor VAHH to meet site needs. Despite similarities across sites, there were also implementation differences, primarily related to recruiting staff, hiring processes, and needs of Veterans targeted for the program (e.g. social/medical complexity). Continued evaluation is part of the implementation process, and our team will be interviewing primary care staff next to gain their perspectives. Our findings provide insights into developing and implementing a promising home health program with lessons for VA sites that may also serve as a guide for other large healthcare organizations.
PHYSICAL AND MENTAL HEALTH NEEDS OF OLDER ADULTS EXPERIENCING HOMELESSNESS: CHALLENGES AND INNOVATIONS IN CARE
Authors: Souza Anita , Tsai Jenny
Published: January 2025

Adults over the age of 50 are the largest growing demographic of individuals experiencing homelessness. They enter a continuum of housing services with a myriad of chronic and acute health conditions that have often been unaddressed due to sporadic and episodic care utilization primarily within emergency services. The compounding health impacts of chronic homelessness accelerate aging within this demographic. Housing services offer an opportunity to address unmitigated health issues. Housing services are seeking research and programmatic interventions to meet this need. This symposium will explore the physical and mental health needs of older adults experiencing homelessness across the continuum of housing services from shelter entry to permanent supportive housing though a variety of research methodologies. The first presenter (Souza) will present results of a study applying latent class analysis to administrative shelter services data to identify unobservable subgroups within the population of older adults living in shelter. The second presenter (Berg) will discuss the implementation of shelter-based care services to older adults with complex medical needs in a low barrier, harm reduction focused hotel shelter. The third presenter (Robinson) will describe a qualitative investigation examining barriers to mental health care for older adults in permanent supportive housing. The discussant (Tsai) will lead symposium attendees in a discussion of future considerations for research, policy, and practice to meet the needs of this growing demographic of older adults.
PAIN AND MEMORY LANE: SEX-SPECIFIC INSIGHTS INTO STRESS REACTIVITY, PAIN, AND COGNITION IN MID- TO LATE LIFE
Authors: Curtis Ashley , Costa Amy , Stearns Melanie , McGovney Kevin , Miller Mary Beth , McCrae Christina
Published: January 2025

Pain and cognition are bidirectionally associated. Perceived stress reactivity is linked to pain and cognitive perception, but interactive relationships are unclear. Sex differences are established in all factors (pain/stress reactivity/cognition), but studies in aging and chronic pain populations are limited. This study examined sex differences in interactive associations of pain and stress reactivity on memory in middle-aged/older adults with chronic pain. Cognitively healthy aging adults (N=678; 52%-women; Mage=62.4±11.3) experiencing frequent pain in past 3 months completed assessments of pain intensity (average past week), stress reactivity (Perceived Stress Reactivity Scale), and memory (Everyday Memory Questionnaire). Multiple regressions evaluated interactions between sex, pain, and stress reactivity on memory, controlling for age, education, #medical conditions, sleep/pain medication, and depression. Sex interacted with pain in associations between stress reactivity and memory (R-squared=.005, p=.04). Greater stress reactivity was associated with worse memory for women with lowest pain (~22/100; B=.59±.24, p=.01), both women (B=.63±.18, p<.001) and men (B=.76±.20, p<.001) with intermediate pain (~48/100), and both women (B=.67±.23, p=.003) and men (B=1.30±.28, p<.001) with highest pain (~73/100). Findings suggest relatively consistent associations between stress reactivity and memory across pain levels in aging women. In aging men, stress reactivity impacts memory at moderate pain levels, but this is exacerbated (two-fold) as pain increases. Sex-specific tailoring of behavioral pain treatments is encouraged. Techniques to reduce stress reactivity (cognitive control, mindfulness) may benefit memory. Prospective studies and objective assessments of stress reactivity, pain, cognition, and circulating sex hormones are needed to understand sex-specific modifiable risk factors of cognitive decline.
THE IMPACT OF CHILDHOOD READING ENVIRONMENTS ON COGNITIVE HEALTH IN LATER LIFE AMONG OLDER EUROPEANS
Authors: Sun Haosen , Xi Yueming
Published: January 2025

While educational achievement helps to accumulate cognitive reserve and promote cognitive function in later life, the influence of the early living environment before completing formal education remains unclear. This study aims to investigate how childhood reading environments, alongside educational achievements, jointly contribute to cognitive health in older adulthood. Analyzing life history data from 123,199 older Europeans aged 50 and above, sourced from the Survey of Health, Ageing and Retirement in Europe, this research examines the interplay between childhood reading environments and educational achievement and their joint effect on cognitive health at older ages. Having more books in the household at age 10 is positively associated with higher cognitive functioning in later life, independent of educational achievements and other childhood socioeconomic status (SES) factors like household size and number of rooms. Additionally, access to books in childhood partially alleviates the cognitive disparities associated with educational achievement. These findings indicate that a rich reading environment at home in childhood offers enduring benefits for cognitive health, which is particularly valuable for individuals who ended up with lower educational achievements. This underscores the potential of interventions focused on enhancing early reading environments to promote long-term cognitive resilience.
CONFLICT MONITORING AND INHIBITORY CONTROL IN OLDER ADULTS WITH AGE-RELATED HEARING LOSS
Authors: Shende Shraddha , Mudar Raksha
Published: January 2025

Various processes of cognitive control, including conflict monitoring and inhibitory control, are critical for listening in complex environments (e.g., speech-in-noise [SiN] recognition). However, few have examined both conflict monitoring and inhibitory control in individuals with age-related hearing loss (ARHL) despite their known challenges in SiN recognition. In 16 individuals with mild ARHL and 23 normal-hearing controls, we examined conflict monitoring using two picture-word interference tasks, “Animals” and “Objects” tasks; inhibitory control in two Go/NoGo tasks, “Single-Car” and “Object-Animal” task; and SiN using QuickSiN test. The picture-word interference tasks consisted of pictures of animals/objects that were superimposed with labels that either matched (matched condition) or did not match the pictures (unmatched condition). Participants responded by pushing the “matched” or “unmatched” button. Reaction time and accuracy were recorded. The Go/NoGo tasks consisted of pictures of cars/dogs in the Single-Car task and objects/animals in the Object-Animal task. Participants responded by pushing a button to some trials, the Go trials (cars/objects), and withholding button push to others, NoGo trials (dog/animals). Reaction time for Go trials and accuracy for Go/NoGo trials were recorded. Relative to controls, ARHL group had worse accuracy on unmatched condition of “Objects” task (p =.006) and Go trials of “Object-Animal” task (p =.018). Partial correlations revealed that worse SiN recognition was associated with worse accuracy on Go trials of the “Object-Animal” task, and no other correlations were significant. Our findings reveal alterations in both conflict monitoring and inhibitory control in mild ARHL, with inhibitory control linked to SiN recognition.
RECRUITMENT OF OLDER ADULTS FOR CLINICAL RESEARCH: STRATEGIES, COSTS, AND REPRESENTATION
Authors: Nicklas Barbara , Coen Paul , Magaziner Jay
Published: January 2025

Clinical research is crucial for identifying new preventative strategies and treatments to address the diverse health care needs of older adults. A necessary component of conducting ethical and unbiased research is to successfully enroll enough study participants who represent the population being studied in a cost-effective and timely manner. Despite the NIH policy mandating that investigators include participants of all ages or specify an acceptable reason for excluding participants based on age, many studies still lack appropriate representation of older adults. Furthermore, an important objective of the NIA’s Strategic Directions for Research for 2020-2025 is to “Develop and implement strategies to increase inclusion of underrepresented populations in aging research”. To implement appropriate strategies for enhancing participation of historically excluded subpopulations, additional data are needed regarding the degree of underrepresentation of these individuals in the research being conducted and reasons for lack of inclusion. This symposium includes three presentations regarding recruitment of older adults for clinical research. These include a compiled analyses of studies conducted over the past 20 years at the Wake Forest OAIC, and data on recruiting older adults for the national Molecular Transducers of Physical Activity Consortium and the two-site observational Study of Muscle, Mobility and Aging. The data presented in the first two talks provide objective observations of the most effective strategies, and the costs, for recruiting older adults. The third presentation compares basic demographics of those enrolled to those who show interest and are screened for participation, and compared to the characteristics of the local population.
ARE UNDERSERVED GROUPS INCLUDED IN AGING RESEARCH? RESULTS ACROSS MANY CLINICAL RESEARCH STUDIES
Authors: Neiberg Rebecca , Leng Xiaoyan , Houston Denise , Miller Michael , Beavers Kristen , Rejeski W Jack , Kritchevsky Stephen , Nicklas Barbara
Published: January 2025

Research can be inherently biased when results cannot be generalized across different subsets of a population that differ from those enrolled in the study. Thus, it is critical to recruit a diverse range of individuals who represent the entire population and who represent the disease or health condition being studied. The purpose of this study was to examine the demographics of 3,454 individuals enrolled in 11 clinical studies conducted from 2002-2023 and supported by the Wake Forest Older Americans Independence Center. Studies included recruited >80 participants and had a minimum age eligibility of 55 years with no upper age exclusion. The total number of individuals phone screened for participation was 19,937. The characteristics of those enrolled were compared to those who were initially screened for participation to assess whether eligibility criteria enabled participants to approximately match the characteristics of those who inquired about participation. The demographics of the screened participants were: Age (mean±SD), 69.8±7.0 yrs; 69% female; 76.4% non-Hispanic white/23.6% black; and 79.3% with at least some college education. The enrolled participants were: Age, 69.8±6.6 yrs; 64% female; 76.1% non-Hispanic white/23.9% black; and 80.5% with some college education. The age distribution of those screened ranged from 23-98 years with 43.7% being >70 yrs, 19.9%> 75 yrs, and 6.8%> 80 yrs while the distribution of those enrolled ranged from 55-92 years with 45.2% being >70 yrs, 20.7%> 75 yrs, and 7.6%> 80 yrs. Further analyses will compare these demographics to those of the 5 counties surrounding the research center.
ADVOCATING FOR AN AGE-INCLUSIVE WORKFORCE AND WORKSPACES: THE COLORADO EXPERIENCE
Authors: Waterhouse Jodi
Published: January 2025

This session will focus on the advocacy work that is required at the state level to ensure that older adult worker rights are protected, both as they are looking for meaningful work with a livable wage or once in the workplace. We will describe a step-by-step process to advocate for and successfully implement policies to promote an age-inclusive workforce in Colorado – a state with one of the fastest-growing older adult populations and one of the most robust age-friendly community movements in the US. To help drive change within our state, we started by building community consortiums focused on education, advocacy, and sponsoring legislation to address identified workforce needs and opportunities. We will highlight the importance of a comprehensive needs assessment process in which community consortiums engaged as the basis for their advocacy work. Examples of consortiums, created by the Colorado Governor’s Office, will be shared as a model for symposium participants to create similar working groups to engage key constituents in their own states. We will also share our experience of crafting bills and seeing them through the legislative process, highlighting bills that we have sponsored and that have been passed in Colorado. Attendees will leave this session with more insights about how to work with their state’s elected officials to drive more support for an age-inclusive workforce and workplaces.
RESTORING GLUTATHIONE HAS BENEFITS FOR OLDER ADULTS AND MICE
Authors: Taffet George
Published: January 2025

The role and importance of mitochondrial function and glutathione is not well recognized by clinicians Glutathione is the most abundant intracellular anti-oxidant and is responsible for detoxifying many reactive, potentially harmful molecules and is most older adults are glutathione deficient because of low free Cysteine and especially Glycine. Supplementation with Glycine and N-Acetyl Cysteine is able to restore cellular glutathione. This symposium will fill these gaps by providing knowledge about glutathione, its role in defending anti-oxidant status, the deficient precursors, and the results when glutathione is restored by providing the precursors and the potential sex differences in these effects.
GLYNAC AND THE AGING MOUSE HEART: SEX-RELATED DIFFERENCES AND OUTCOMES
Authors: Cieslik Katarzyna , Angellini Aude , Marquez Grecia Garcia , Fiorotto Marta , Taffet George
Published: January 2025

Aging is associated with increased reactive oxygen species (ROS) resulting from an imbalance in antioxidant defenses and a rise in proinflammatory milieu. Glutathione (GSH) is a naturally occurring antioxidant which concentration is reduced in aging. Studying hearts of 21 month old male and female mice, we found that the enzymes of the GSH pathway synthesis were not downregulated however, supplementing a diet with GSH precursors (termed GlyNAC) for 3 months, improved cardiac diastolic function (measured longitudinally) and exercise performance in males. A much smaller GlyNAC effect on cardiac function and exercise was seen in females. Unbiased cardiac proteome mass spectrometry (MS) analysis validated by protein expression and functional assays demonstrated that a GlyNAC-supplemented diet led to an increase of Ndufb8 expression (a subunit of the mitochondrial respiratory chain complex), and higher enzymatic activities for CPT1b and CrAT, two carnitine acyltransferases, critical to cardiomyocyte fatty acid metabolism. Crosslinking and expression of fibrillar collagens is directly linked with extracellular matrix (ECM) stiffness, and although diastolic function was improved with GlyNAC, no significant change in fibrillar collagen was detected in the hearts of GlyNAC-fed old males. MS analysis determined that GlyNAC increased fibromodulin (Fmod) expression, which can inhibit collagen fibril formation. In summary, these data suggest that there are phenotypic sex-dimorphism differences in old mice and that these differences may affect the response to pharmacological and diet interventions, including GlyNAC. Furthermore, a simple diet intervention has been proven to ameliorate age-related cardiac diastolic dysfunction in old males.
FINANCIAL HORIZONS: EXAMINING RURAL AND URBAN NURSING HOME FINANCIAL PERFORMANCE
Authors: Orewa Gregory , Ghiasi Akbar , Gupta Shivani , Pradhan Rohit , Weech-Maldonado Robert
Published: January 2025

Rural nursing homes (NH) struggle with financial sustainability due to sparse populations, high costs, and scarce healthcare resources. Urban counterparts face increased operational costs and resource competition, despite larger populations and better infrastructure. Addressing these distinct challenges is essential for the sector’s financial health and strategic relevance. This study examines financial performance differences between rural and urban nursing homes. The study utilized secondary data from 2017 to 2022 from the Medicare Cost Report, LTC Focus, Care Compare, and Area Health Resource File. The data were modeled using hierarchical linear regression controlling for year and state fixed effects. The dependent variable was operating margin, and the independent variable was nursing home location (Rural vs. Urban). Two models were run, the first controlling for organizational factors (size, quality, ownership, occupancy rate, payer mix, and percent minorities) and the second for organizational and environmental factors (population 65 and older, competition, and Medicare Advantage) that may be associated with financial performance. Results suggest that urban nursing homes had significantly higher operating margins compared to rural facilities (β=1.95, p< 0.01) after controlling for organizational factors. After controlling for environmental factors, urban nursing homes still had higher operating margins (β=0.90, p< 0.01) than rural facilities, but to a lesser extent. As such, rural nursing homes have lower financial performance than urban, even after accounting for organizational and environmental differences. To the extent that lower financial performance may affect quality and access to long-term care, policymakers should explore reimbursement strategies to address these financial disparities.
A STATEWIDE PROGRAM FOR SCREENING FOR DEMENTIA IN MEDI-CAL PRIMARY CARE IN CALIFORNIA: DEMENTIA CARE AWARE
Authors: Chodos Anna
Published: January 2025

In California, the Department of Health Care Services (Medi-Cal) expanded benefits for older beneficiaries to include screening for dementia by trained primary providers starting in July 2022. In addition, they created a program to promote this screening and provide the training called Dementia Care Aware. The University of California, San Francisco was awarded the contract to realize this program through the end of September 2024 and brought together 4 other University of California campuses and statewide Alzheimer’s organizations to stand up the program. During the symposium, attendees will hear about the key accomplishments from creating and disseminating this program. These include: the development of the screening approach, called the cognitive health assessment, with state and national experts; the creation of interactive on-line learning and live trainings; success in dissemination to California’s 58 counties and overall uptake among providers and progress to the program’s goals of 4000 trained in two years; and lessons learned. Implementation of dementia screening based on the cognitive health assessment in two public health systems (in San Francisco and Los Angeles) provide evidence of how screening is possible in safety net primary care. Finally, a summary of key challenges will show how common barriers in primary care nationwide can be considered before implementing dementia screening programs.
HOSPITALIZATION-ASSOCIATED FUNCTIONAL DECLINE IN OLDER ADULTS: CLASSIFYING THE RISK USING THE “TIMED UP AND GO” TEST
Authors: Tzemah-Shahar Roy , Gatenio-Hefling Orly , Asraf Kfir , Dilian Omer , Gil Efrat , Agmon Maayan
Published: January 2025

Hospitalization Associated Functional Decline (HAFD) in older adults has been recognized as a major phenomenon with crucial consequences such as slower recovery increased morbidity, and higher mortality; it is linked with reduced mobility levels during hospitalization. To date, there is no objective test that can directly estimate personal risk for HAFD. The aim of this study was to examine the contribution of the Timed Up and Go (TUG) test in predicting HAFD among older adults. We used a cross-sectional study design; a total of 310 older adults (age≥65) hospitalized between December 2018 and August 2020 were included; the Modified Barthel Index was used to assess HAFD; it was administered at admission to evaluate patients’ independence in activities of daily living two weeks prior hospitalization, and at discharge. The TUG test was performed on admission; a cut-score of 12 seconds was used to predict functional decline, while accounting for demographics, length of hospitalization, comorbidity burden (Charlson’s comorbidity index), and Adult Lifestyles and Function Interview (ALFI-MMSE). Participants able to complete the TUG test in less than 12 seconds showed no significant change in the Modified Barthel Index; TUG test completion in 12 seconds and over or inability to complete it was associated with significant reduction in function, defined by a reduction of three points or more in the Modified Barthel Index (a reduction of 4 and 8.8 points respectively). The risk for HAFD is currently underestimated in clinical settings, the TUG test could be used to identify those at risk of HAFD.
MITO-MODULATORY MEDICATION USE AND SKELETAL MUSCLE BIOENERGETICS IN OLDER ADULTS
Authors: Phang Howard , Bergstrom Jaclyn , Atayee Rabia , Hart Laura , Cawthon Peggy , Cummings Steve , Molina Anthony
Published: January 2025

Drug-induced changes in mitochondrial function have been described for many medications, including those commonly prescribed for older adults such as statins, NSAIDs, and metformin; however, the clinical impact of “mito-modulatory medication” use remains unclear. Given the high rate of prescription medication use among older adults, it is imperative to understand the consequences of mito-modulatory medication use. Further, mitochondrial dysfunction in skeletal muscle has been linked to declining physical performance and fitness in older adults, highlighting the importance of understanding how drug-induced mitochondrial modulation impacts skeletal muscle. We sought to assess how mito-modulatory medication use is related to skeletal muscle bioenergetics in older adults using data from the Study of Muscle, Mobility and Aging (SOMMA). We hypothesized that mito-modulatory medication use would be associated with lower skeletal muscle ex vivo (MAX ETS) and in vivo (ATPMax) bioenergetic measures. In unadjusted models, MAX ETS was lower in mito-modulatory medication users (mean= 82.4 [77.7-87.0]) compared to non-users (mean= 92.7 [87.5-97.9]) for men (p=0.0021) but not for women (p>0.05). Similarly, ATP-Max was lower in mito-modulatory medication users (mean= 0.54 [0.50-0.57]) compared to non-users (mean= 0.62 [0.58-0.66]) for men (p=0.0004). Adjustments for potential confounders attenuated some, but not all, of the associations. These results suggest that mito-modulatory medication use is related to lower skeletal muscle bioenergetics in older men but not women. Further investigation will provide greater clarity for the apparent sex differences in the impact of mito-modulatory medication use on muscle bioenergetics.
EFFECT MODIFICATION OF AGE AND SEX BETWEEN AORTIC CALCIFICATION AND MORTALITY IN A COMMUNITY SAMPLE OF OLDER PATIENTS
Authors: Horbal Steven , Leis Aleda , Holcombe Sven , Karvonen-Gutierrez Carrie
Published: January 2025

Abdominal aortic calcification (AAC) is a useful cardiovascular risk assessor in opportunistic screening. As cardiovascular risk changes with increasing age, effective AAC use depends on understanding influential factors on AAC and mortality. This study evaluated modification of age and sex on the relationship between aortic calcification and mortality. This sample includes 6647 Michigan Medicine patients age ≥ 65 years, without cardiovascular disease, and who received an abdominal computed tomography scan between 1999-2022. AAC was elevated if calcification exceeded 19.26% of the aortic wall at the L3 vertebral level. Cox regression was used to assess AAC and mortality (adjusted for body mass index and Charlson Comorbidity Index) and stratified by age group (65-79, 80+ years) and sex. In the sample, 18.3% (n=1219) were 80+ years and the mortality rate was 38.0%. Those with elevated AAC had 99% higher mortality hazard than those with unelevated AAC [HR 1.99 (95% CI 1.66, 2.41)]. A statistically significant interaction was observed between age category, sex, and AAC status. Among patients 80+ years, elevated AAC was protective for mortality [HR 0.79 (95% CI 0.62, 0.98)]. Further, elevated AAC was associated with 35% lower mortality hazard in females age 80+ [HR 0.65 (95% CI 0.46, 0.92)] but was not significant in males age 80+. Important effect modification by age and sex exists on the relationship between AAC and mortality. This suggests the impact of AAC as a risk factor for mortality may decrease with age and be less important in 80+ year old females relative to males.
ADVANCING AFFORDABLE, ACCESSIBLE HEARING CARE FOR OLDER ADULTS: FINDINGS FROM THE HEARS RCT AND ASSOCIATED STUDIES
Authors: Nieman Carrie , Han Hae-Ra , Lin Frank
Published: January 2025

Age-related hearing loss is independently associated with adverse health outcomes, but the use of hearing aids by older adults is low and disparities exist. The incorporation of community health worker (CHW)-partnered models can reduce barriers and address disparities. The HEARS (Hearing health Equity through Accessible Research & Solutions) intervention is a hearing care intervention delivered by CHWs that incorporates a low-cost amplification device and education on age-related hearing loss. The efficacy of the HEARS intervention was assessed through a randomized controlled trial (RCT) (JAMA, 2022) that demonstrated the intervention significantly improved communication function. The RCT was the first of a CHW-delivered hearing care intervention designed for older adults that included provision of amplification. As a community-engaged trial, the trial was also one of the largest hearing-related trials in the U.S. of African American older adults and low-income older adults with hearing loss and provides a unique opportunity to advance understanding of hearing care among communities not traditionally represented within research. This symposium presents secondary analyses from the HEARS RCT that inform the continued expansion of hearing care, including among individuals with cognitive impairment and those with limited technology use. The symposium also shares findings from community-engaged hearing screening efforts (K-HEARS Screen) in partnership with Korean American ethnic churches and provides the first estimates of hearing health behaviors among older Korean Americans. Together, the symposium shares lessons in partnering with CHWs and community organizations to optimize the development and testing of interventions to advance hearing health equity across diverse communities.