bluuebunny/crossref_metadata_2025 huggingface dataset:
DEVELOPING A PROTOCOL TO ASSESS EXPOSURE TO ENVIRONMENTAL POLLUTANTS AMONG OLDER ADULT WOMEN IN SOUTHEAST MICHIGAN
Authors: Baker Jillian , Park Sung Kyun , Richards-McCullough Kerry , Hoover Andrew , Karvonen-Gutierrez Carrie
Published: December 2023

Environmental pollutants, including PFAS, phthalates, and parabens, contribute to the development of age-related diseases like cancer, cardiometabolic disease, and neurodegenerative diseases. Unfortunately, these chemicals are common in everyday exposures, including drinking water, personal care products (PCPs), non-stick cookware, and food packaging. Exposures to these pollutants may be high in communities that have encountered structural disadvantages; neighborhood disinvestment and decaying infrastructure can make exposures to these pollutants more likely, thus increasing the burden of age-related disease in these communities. Interventions that reduce exposures to these chemicals may prevent or delay the onset of age-related disease, especially in groups experiencing poorer health outcomes because of structural racism and discrimination. To explore the feasibility of a behavior change intervention for older adults that reduces exposure to harmful chemicals in PCPs, a protocol was developed to: 1) Assess attitudes, knowledge, and behaviors related to environmental pollutants via questionnaire; 2) Characterize individual-level ‘exposomes’, the unique mixture of chemicals a person encounters in their everyday lives, by wearing a silicone wristband; 3) Measure environmental exposures in serum. Data collection will begin in September 2023 among older adult women who have participated in the Study of Women’s Health Across the Nation (SWAN) at the Michigan site. Older adults have accrued environmental exposures across their lifetimes, likely in a way that reflects patterns of structural disadvantage. While structural solutions are necessary to address issues of health equity, behavior change efforts can work in tandem to reduce harmful environmental exposures to improve the health of older adults.
DEVELOPMENT OF A PHYSICAL PERFORMANCE SUMMARY SCORE IN MIDDLE AGE: FINDINGS FROM THE CARDIA FUNCTION ANCILLARY STUDY
Authors: Burrows Brett , Sloane Richard , Pieper Carl , Lewis Cora , Gabriel Kelley Pettee , Jacobs David , Bowling C Barrett
Published: December 2023

Recent evidence suggests that ~20% of middle-aged adults report mobility limitations, supporting the need for assessment strategies to detect early-onset limitations, appropriate for this population. Coronary Artery Risk Development in Young Adults (CARDIA) enrolled 5,115 Black and White men and women ages 18-30 years from four sites (Birmingham, AL; Oakland, CA; Minneapolis, MN; and Chicago, IL) in 1985-86. The CARDIA Function Study added self-reported function (PROMIS SF20a) and 5 physical performance measures (gait speed, single-leg balance, lower extremity strength, grip strength, and 6-minute walk test) to the Year 35 in-person follow-up exam conducted in 2020-22. The CARDIA Physical Performance (CAPP) score was developed by calculating sex-specific quartiles separately for each performance measure, assigning points based on these quartiles (0 for not attempted, 1-4 for each quartile), and summing points across all 5 performance measures (range 0-20, higher scores = greater performance). Among 2,021 CARDIA Function participants [mean age: 60.1 (±3.6) years; 57% female; 45% Black] the mean CAPP score was 12.3 (±4.1; range 0-20). Mean CAPP scores differed by age < 60 vs. ≥60 years old (12.7 vs.12.1, p< 0.05) and self-reported function above vs. below the median SF20a score (14.0 vs. 10.6, p< 0.001), but as expected, not sex (12.3 vs. 12.3, p=0.99). Among middle-aged adults, the newly developed CAPP score captured a wide range of physical performance. Lower CAPP score was associated with lower than median self-reported function suggesting that the CAPP score may be helpful assessment tool for detecting early-onset limitations to attenuate functional declines with aging.
DIFFERENCES IN FRAILTY BETWEEN TRADITIONAL MEDICARE AND MEDICARE ADVANTAGE BENEFICIARIES
Authors: Shi Sandra , Olivieri-Mui Brianne , McCarthy Ellen , Kim Dae Hyun
Published: December 2023

Medicare Advantage (MA) plans cover at a minimum the same services as fee-for-service Medicare (FFS), but may target patient populations that differ in health and frailty. Leveraging 2011 and 2015 National Health and Aging Trends Study (NHATS) linked to Medicare claims, we classified participants as FFS or MA beneficiaries based on 12 months of Medicare enrollment. We calculated a deficit accumulation-based frailty index (FI) and phenotypic frailty from the survey assessment. All analyses accounted for the complex sampling design and weighted to reflect national estimates. In 2011, MA beneficiaries were more likely to be female (MA vs FFS: 59.1% vs 55.6%), Black (9.6% vs 7.4%) or other race (9.8% vs 5.2%), and to have an estimated income <$25,000 (44.5% vs 39.4%). Although the mean FI was similar between MA and FFS (MA vs FFS: 0.25 vs 0.25), MA beneficiaries were more likely to have mild frailty by FI (20.1% vs 18.6%) but less likely to have severe frailty by FI (10.0% vs 11.7%) or phenotypic frailty (13.5% vs 14.0%). MA beneficiaries had a higher prevalence of some comorbidities, such as hypertension (MA vs FFS: 64.9% vs 63.3%) and diabetes (24.4% vs 23.3%), but a lower mean number of ADL disability (0.32 vs 0.39). In 2015 the results were similar, although MA beneficiaries had a higher prevalence of pre-frailty (MA 46.0% vs 43.3%). In conclusion, MA beneficiaries seem to have a lower level of deficit-accumulation frailty and phenotypic frailty. This difference is driven by comorbidities, but not functional disability.
DIFFERENT PATTERNS OF VACCINE HESITANCY AMONG OLDER ADULTS BY RACE/ETHNICITY, INCOME, AND EDUCATION
Authors: Kim BoRin , Jeon Jehoon , Jeong Chung Hyeon
Published: December 2023

Despite significant efforts to increase COVID-19 vaccination rates, a substantial number of people exhibit vaccine hesitancy. Vaccine hesitancy is considered as one of the greatest threats to global health but also poses substantial risks to individuals. Moreover, vaccine hesitancy patterns may reflect and perpetuate existing health disparities. This study aims to investigate if specific patterns of vaccine hesitancy exist among older adults across racial/ethnic and socioeconomic groups. Our sample included 4,656 respondents aged 65+ who participated in the 2021 Health and Retirement Study Perspectives on the Pandemic that focuses on the first-year pandemic experiences. Latent class analysis and multinomial regression was used to identify vaccine hesitancy patterns and examine the associated factors, adjusting for age, gender, marital status, and self-rated health. Four vaccine hesitancy patterns were identified: no hesitancy (56.7%), mild hesitancy-uncertainty (19.4%), strong hesitancy-personal concerns (12.0%), and strong hesitancy-lack of trust/conspiracy (11.9%). White (RRR=1.659, p<.01), higher income (RRR=1.005, p<.05) and higher education (RRR=1.078, p<.001) were positively associated with no hesitancy. Respondents with higher education (RRR=0.573, p<.05) were less likely to be in the group of mild hesitancy with uncertainty. Hispanics (RRR=0.583, p<.05) and higher education (RRR=0.332, p<.001) were negatively associated with strong hesitancy with personal concerns. African Americans (RRR=2.426, p<.001) and those with lower education (RRR=1.324, p<.001) were more likely to be in the group of strong hesitancy with lack of trust/conspiracy. Our findings show that vaccine hesitancy is not random, which is closely related to social stratification impacting health disparities in this society.
DISRUPTED SOCIAL LIFE MEDIATES ASSOCIATION BETWEEN PANDEMIC WORRIES AND RISK OF ELDER ABUSE
Authors: To Louis , Leung Lok Man , Wan Debby , Tsui Ronald , Yan Elsie
Published: December 2023

Social isolation is an important risk factor for elder abuse. This study investigated the mediating effects of pandemic-related disruptions of social life between worry about the pandemic and risk of elder abuse. A total of 1078 community dwelling older persons participated in this community survey. They provided information on their demographics, worry about the pandemic, pandemic related disruptions of social life, and risk of elder abuse as measured by a 10-item scale derived from Dong et al. (2015). Participants age ranged from 60 to 100 (mean= 76.2, SD=7.9), majority of them were female (81.6%), single, divorced or widowed (52.8%). Prevalence of risk of abuse was high (21.5%), with the most prevalent type being family conflicts at home (16.6%), followed by feeling uncomfortable with someone in the family (8.1%). Participants who were not in a marital relationship, of larger household, reported feeling worried about the pandemic and felt their social life disrupted were at greater risk of abuse. Logistic regression results show that pandemic related disruptions of social life partially mediated the association between worry about the pandemic and risk of abuse. In the final model, participants who reported feeling worry about the pandemic and those who reported that the pandemic has caused disruptions in their social life were at greater odds of reporting risk of abuse (OR=1.14 and 1.13 respectively, p<.05). The effects of the former diminished after the latter was entered into the model. This finding highlights the importance of social life in protecting older persons against abuse.
DO RELIGION, CULTURE, RACE, OR ETHNICITY PLAY A ROLE IN CHOOSING PEG TUBE AT THE END OF LIFE?
Authors: Park Isabella , Hernandez Guisela , Lambert Frederick , Loccisano Elisabeth , Nouryan Christian , Cho Catherine , Gajraj Asha , Burns Edith
Published: December 2023

Although there is substantial evidence that Percutaneous Endoscopic Gastrostomy (PEG) causes significant morbidity and does not change mortality for patients with advanced dementia it continues to be used. We describe a quality initiative of Palliative Care Consultation (PCC) in conjunction with any new PEG evaluation. EMR review and interview with patient (and/or proxy) being evaluated for first-time PEG in two community hospitals within large health system in demographically diverse major metropolitan area. PCC teams provided consistent, culturally/religiously, language-sensitive education regarding PEG, conducted interviews about subsequent decision. Post-initiative PEG placement dropped from >75% to 17.6%, 76 patients received PCC with PEG evaluation. Average age 83.5 (range: 56-108), 55% female. Religion: 54% Christian, 7% Muslim, 10% Jewish, 11% non-religious, 18% other; 46% White, 37% Black, 8% Asian, 8% Hispanic. Common evaluation reasons: difficulty swallowing (30%), low PO intake (30%). Majority of patients had dementia (71%), stroke (18%), Parkinson’s (8%). Most decision-makers (66%) hadn’t received prior counseling regarding alternate nutrition options. After PCC, 17.6% chose PEG, 79.7% careful hand feeding, 2.7% remained unsure. Those choosing PEG mostly desired “guaranteed” nutrition despite risks (10/13), and/or a trial seeking patient recovery (5/13). There were no apparent differences in race/ethnicity, age, sex, or religion that distinguished those electing PEG. PCC initiative to support patients and families “choosing wisely” around PEG placement for those with advanced illness has resulted in significant reduction. Decision-makers mostly cited wish to guarantee nutrition while some hoped for patient recovery. Religious affiliation and sex were not cited as reasons in this group.
DOES CRIMINAL VICTIMIZATION RAISE THE RISK OF IADL LIMITATIONS AMONG OLDER ADULTS?
Authors: Ren Jinnan , Sauerteig-Rolston Madison , Bell Mallory , Ferraro Kenneth
Published: December 2023

Many studies have analyzed the effect of victimization on children and young adults, but relatively few have explored its impact on older adults’ well-being. Drawing from cumulative inequality theory, this study analyzed a sample of 11,860 respondents aged 50 and older from the Health and Retirement Study (HRS) to examine whether victimization experiences, measured by physical attack/assault, robbery/home burglary, and fraud, raise the risk of limitations in performing instrumental activities of daily living (IADLs). The analysis, which used zero-inflated negative binomial models to examine the onset and severity of IADL limitations, revealed that criminal victimization was associated with a higher likelihood of IADL limitations (IRR=0.735, p< 0.01), even after adjusting for demographic and health-related factors. Additional analyses examining the influence of each type of victimization showed that the experiences of a physical attack and robbery were related to IADL limitations. These findings demonstrate that criminal victimization experiences are associated with compromised IADL function, especially when the encounter involves an intentional act of immediate harm. There is a need for (a) additional research on the consequences of criminal victimization on the health and well-being of older adults and (b) interventions to help older adults who experience a personal or property crime.
EGG CONSUMPTION AND INCIDENT CARDIOVASCULAR DISEASE: VARIATION BY DIETARY PATTERN
Authors: Kritz-Silverstein Donna , Anuskiewicz Blake Blake
Published: December 2023

Some studies link egg consumption with cardiovascular disease, but none considers modification by dietary pattern. This study examines effects of egg consumption on incident cardiovascular disease (CVD), and variations of associations within the context of dietary pattern. Participants were 4,930 men and women from the Rancho Bernardo Study without prevalent CVD in 1972-74, who were followed through 2021 via mailed surveys, follow-up visits, and death certificates. Dietary data from 1988-91 enabled calculation of the alternate Mediterranean diet (aMed) score for 1632 individuals. Comparisons showed those with incident CVD (N=2066, 49.1%)were older (p< 0.001), had higher BMI (p=0.004), cholesterol, triglycerides, systolic and diastolic blood pressures (p’s< 0.001) than those without incident CVD, but did not differ in egg consumption. Those consuming more eggs/week were older (p< 0.001) and had higher BMI (p=0.002). Men consumed more eggs/week than women (means=4.2 vs. 3.2, p< 0.001). Adjusted Cox proportional hazards models showed there were no significant associations of egg consumption with incident CVD in men or women (HR=1.00, 95%CI=0.98-1.02; HR=1.01, 95%CI=0.99-1.03, respectively). However,analyses by dietary patterns showed that in men, but not women, increased egg consumption was associated with a 7% reduced risk of incident CVD (HR=0.93; 95%CI=0.88-0.98) among those with high aMed scores, but a 6% increased risk (HR=1.06; 95%CI=1.01-1.11) among those with low aMed scores. In conclusion, for men, dietary pattern modified associations such that among those with a healthier dietary pattern, egg intake was associated with lower incident CVD. For women, egg intake was unassociated with incident CVD regardless of dietary pattern.
ELDERLY CARE POLICY IN CHINA: ITS EVOLUTIONARY PATH AND IMPLICATIONS ON GOVERNANCE
Authors: Wang Qingwei , Ma Yu , Chen Jiayu
Published: December 2023

Over the years, the Chinese elderly care policy has undergone significant changes, leading to the systematic development of a comprehensive elderly care service system. This study explores the pivotal policies formulated by central policy-making bodies and examines the historical and current state of the elderly care system in China. The findings demonstrate a consistent alignment between the system’s evolutionary trajectory, the practical expectations of the population, and the Communist Party of China’s (CPC) objective of fostering a unified and balanced society. The study also highlights inherent issues concerning governance mechanisms and role-position within the system. Notably, we highlight the successful protection of older adults during the COVID-19 pandemic as an exemplary care of care service provision and draw lessons from international experience.
ENGAGING WITH AGING: OLDER ADULTS’ ADAPTATIONS TO URINARY CONCERNS
Authors: Wu Kuan-Ching , Ge Shaoqing , Chien Shao-Yun , Jin Jessica , Park Suah , Belza Basia
Published: December 2023

Urinary concerns (UC) increase with age impacting health and quality of life. The aims of this study were to describe: 1) UC as an age-related change (ARC); 2) the challenges of UC; 3) adaptation strategies used to manage UC; and 4) the value of engaging with aging (EWA) as a framework to promote self-management of UC. Data was used from semi-structured interviews with 29 older adults (mean age 77 years). An iterative coding process was used. A codebook was developed based on a-priori themes derived from the EWA framework, our previous publication, and a line-by-line coding of one of the transcripts. As the analysis progressed, additional codes emerged, enriching the codebook. Six themes emerged: 1) the participants’ experiences of UC; 2) responses to UC, 3) adaptation and management strategies; 4) knowledge and understanding of UC; 5) available capacities and resources; and 6) the impact of the COVID-19 pandemic on UC. Participants tended to address their UC by adjusting routines, medication schedules, or diet patterns. They tried to secure restroom locations or use tools or reminders to resolve their UC. COVID-19 led to increased inconvenience for older adults to engage in outdoor activities due to the closure of public restrooms. Through a comprehensive qualitative study and in-depth analysis of older adults’ UC and adaptations, these participants developed personalized adjustments to address their needs and abilities to their UC. These findings offer insights into the individual aging experience, which will further enhance our understanding and advancement of person-centered care.
EPISTASIS ASSOCIATION STUDY TO IDENTIFY NETWORK HUB GENES IN ALZHEIMER’S DISEASE AND RELATED DEMENTIAS
Authors: Evans Luke , Reynolds Chandra , Hoeffer Charles
Published: December 2023

Despite recent advances in understanding ADRD genetic risk, the vast majority of the genetic variance of AD/ADRD risk remains unexplained by identified loci such as APOE or the polygenic signal. One unexplored reservoir of genetic effects is interactions among genes (epistasis), which could identify key and novel molecular pathways, networks, and specific cell types in which the ADRD genetic risk is manifest. We tested all pairwise gene-gene interactions using our recently-developed transcriptome-wide interaction study method on ADRD in the UKBiobank. While no individual epistatic association was genome-wide significant (p< 2.56e-10), several approached significance (p< 3e-8). More importantly, we identified three core genes with >10 suggestive epistatic interactions. These include genes with some limited, prior evidence of a role in ADRD etiology, but none that have been identified in single-locus GWAS. In follow-up enrichment analyses of neuronal annotations underlying the interaction associations, we found genes intolerant to protein truncating mutations (PI), and those expressed specifically in endothelial cells, excitatory neurons in the prefrontal cortex , neuronal stem cells, and PI excitatory dentate gyrus cells to be nominally enriched (p< 0.05) in interaction associations with ADRD using prefrontal cortex imputed expression. Together, these suggest that we can uncover novel aspects of AD biology through these interaction associations and identify genes that may play a key role in integrating signals of AD risk. We anticipate identifying additional core genes and pathways as we integrate other larger and more diverse datasets.
ETHICAL CONSIDERATION IN HOME MONITORING ASSISTIVE ROBOT FOR COGNITIVE IMPAIRMENT: A SCOPING REVIEW
Authors: Wang Jing , LaRoche Dain , Begum Momotaz , Choquette Cassidy , Tang Xueting , Arthanat Sajay
Published: December 2023

As the aging population continues to grow, the demand for innovative technologies to support individuals with cognitive impairment in their daily lives has risen significantly. Home monitoring assistive robots (HMAR) have emerged as a promising solution, offering assistance with tasks, scheduling and safety monitoring. This scoping review aims to explore and synthesize the ethical considerations surrounding the use of HMARs for persons with cognitive impairment. We adopted the Arksey and O’Malley framework, encompassing five stages: identifying the research question, identifying relevant studies, selecting studies, charting the data, and summarizing and reporting results. A comprehensive search strategy was employed across electronic databases, including PubMed, PsycINFO, Scopus, and CINAHL, using search terms derived from titles, abstracts, and keywords identified in key publications and previous reviews relevant to the scope of this review. The synthesis of the 25 included literature highlights several key ethical dimensions related to HMARs for individuals with cognitive impairment, including autonomy and decision-making, privacy and surveillance, family dynamics and dyadic relationships, human-robot trust, cultural considerations, and equitable access to technology. The review underscores the complexity of ethical dilemmas posed by HMARs, including issues of informed consent, data security, power differentiation between persons with cognitive impairment and their caregivers, and disparities in technology access. The findings of this scoping review contribute to the ongoing discourse on the ethical implications of utilizing HMARs for cognitive impairment and provide insights for the development of responsible and inclusive technological solutions.
EVALUATING STOCHASTIC EPIGENETIC MUTATIONS: RELIABILITY, SUBTYPES, AND AN ALTERNATIVE DETECTION APPROACH
Authors: Markov Yaroslav , Higgins-Chen Albert
Published: December 2023

Stochastic Epigenetic Mutations (SEMs) have emerged as promising biomarkers for aging and age-related disorders. Conceptually, a SEM is defined as an outlier in DNA methylation (DNAme) value at a specific genomic site, compared to a given population or cohort. These mutations are seldom shared among subjects, emphasizing their potential to capture the heterogeneity of age-associated DNAme changes, and their cumulative count in individuals rises with age. We hypothesized that the original statistical method for SEM detection is not well suited for DNAme data and demonstrated its reliability constraints at both the individual and aggregate levels, using technical replicates from whole blood samples. In response to these challenges, we explored the factors influencing individual SEM reliability and identified best practices for SEM detection. We also developed an alternative machine learning-based detection method. Importantly, our classifier demonstrated improvements in the proportion of shared SEM and ICC scores when tested in an independent dataset with technical replicates, maintaining the associations of higher SEM loads with age, mortality, and cardiovascular disorders in the FHS study cohort. To support the wider application of our findings and address the need for SEM analysis tools, we have introduced a novel R package, SEMdetectR. Leveraging parallel programming, this package offers rapid SEM identification using both the original and new methods, accompanied by robust downstream analysis features.
EVALUATION OF THE ILLINOIS PUBLIC HEALTH ASSOCIATION ALZHEIMER’S DISEASE EARLY DETECTION AND AWARENESS CAMPAIGN
Authors: Bobitt Julie , Zahir Zohaib , Roseberry Krissy
Published: December 2023

Of the 55.8 million adults aged 65 and over in the US, nearly 12% are at risk for or have subjective cognitive decline (SCD), yet more than half have not seen a healthcare provider about their SCD. Furthermore, studies show that fewer than 50% of individuals with Alzheimer’s or a related dementia (ADRD) have been diagnosed by a physician. Missed diagnoses of dementia are more common among Blacks/African Americans than Whites and both Black/African American and Latinx individuals with cognitive impairment are less likely than Whites to report that a physician has diagnosed them. To adequately address community needs for ADRD early detection and awareness, the Illinois Public Health Association (IPHA) established the Alzheimer’s Disease Early Detection and Awareness Campaign and partnered with community-based organizations (CBOs) and their community health workers to educate underserved populations about the risk for ADRD and the importance of early screening, and to assist clients in achieving referral to ADRD care services. To evaluate the campaign, IPHA partnered with the University of Illinois Chicago. We used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) implementation outcomes framework to guide the evaluation and share quantitative and qualitative results including the number of participants that reached our target audiences, effectiveness of the program on participant knowledge and behaviors, adoption of the campaign elements by the CBOs, implementation barriers and facilitators, and intentions for program maintenance. Results and lessons learned can be used to inform awareness and education efforts in other communities with special emphasis on reaching underserved populations.
EXAMINING THE ASSOCIATION BETWEEN HYDRATION STATUS AND OBESITY IN OLDER ADULTS
Authors: Lafontant Kworweinski , Thiamwong Ladda , Stout Jeffery , Park Joon-Hyuk , Xie Rui , Fukuda David
Published: December 2023

Adequate hydration is an important modifiable determinant of overall physical health within community-dwelling older adults. Research and clinical practice often use urine osmolarity and bioelectrical impedance analysis (BIA) to assess hydration status. Prior evidence links inadequate hydration to increased obesity, typically measured by body mass index (BMI). However, this association has not yet been evidenced in community-dwelling older adults, especially in low-income settings. This cross-sectional study assessed 103 older adults (16 men, 87 women; mean age 75.7 ± 7.19 years; BMI 26.8 ± 5.22 kg/m2). Total body water (TBW), intracellular water (ICW), fat mass (FM) and fat-free mass (FFM) were measured using multi-frequency BIA (InBody S10). Linear regression analysis examined continuous BMI. TBW/FFM and ICW/FFM as hydration indicators showed weak correlation with FM (TBW/FFM: r = 0.357, p < 0.001; ICW/FFM: r = -0.243, p = 0.013). However, only TBW/FFM significantly correlated with BMI (TBW/FFM: r = 0.236, p = 0.016; ICW/FFM: r = -0.143, p = 0.151). These results suggest TBW/FFM and ICW/FFM may not adequately indicate hydration status while maintaining sensitivity to body composition in adults aged 60-96 years. Further research should examine these findings using urine osmolarity as the hydration assessment.
EXAMINING THE ASSOCIATION OF HISTORICAL REDLINING WITH NURSING HOME QUALITY
Authors: Plummer Narcissa , Ratnayake Aneeka , Wong Chelsea , Olivieri-Mui Brianne
Published: December 2023

Aim

Redlining systemically relegated people of color to lower-resourced areas which are known to have had long-term effects on access to healthcare; however, it is not currently known if access to nursing home (NH) quality was impacted.

Methods

In this cross-sectional descriptive study, we created a Geographical Information Systems map of the distribution of Massachusetts NH in the year 2021, layered over a 1934 redlining map with neighborhood categories: Best, Still Desirable, Declining, and Hazardous. Our dataset included redlining categories, 2021 NH characteristics (e.g., bed size, 5-star quality rating), and change in median household income from 1930 – 2021 (proxy for resources, in 2021 dollars). Descriptive statistics estimated the association of each variable with NHs’ 5-star quality rating.

Results

The majority of NHs were in historically Declining (n=45,71%) or Hazardous (n=10,16%) neighborhoods. While 3% (n=2) were in Best neighborhoods. Both NHs in Best neighborhoods were 5-star, while 1 NH was 5-star in Hazardous neighborhoods. There were 63 NH included with a mean change in median household income of $47,684.06 (SD $37,844.01). The greatest increases in mean income were observed in hazardous neighborhoods containing 1-4-star NHs. The highest increase in mean income was $140,000 (n=1), occurring in a neighborhood with a 4-star NH.

Conclusion

Despite the growth of resources in hazardous neighborhoods, most NHs in these areas were less than 4-stars. Increasing resources may not benefit NH quality in historically redlined/hazardous areas. Future research should examine this phenomenon at a national level.
EXAMINING THE NON-LINEAR ASSOCIATION BETWEEN YEARS OF EDUCATION AND LATE-LIFE COGNITION
Authors: Robinson Sara , Salemi Jason , Meng Hongdao , Rijnhart Judith
Published: December 2023

Dementia, a rising health concern, is expected to impact 13 million adults in the United States by 2050. Low education is a well-established risk-factor for dementia. However, few studies have investigated possible non-linearity of the association between years of education and late-life cognition, nor have investigated gender differences in this association. This study aimed to investigate whether years of education is non-linearly associated with late-life cognition, and whether the size of this association differed across men and women. To address this aim, we used data from the U.S. representative Health and Retirement Study, encompassing a sample of 32,712 respondents with episodic memory data available between 1998 and 2018 and with complete data on self-reported education (median=12, interquartile range=12-15), gender (18,509 women, 14,203 men), and confounders (ethnicity, race, parental education, childhood immigration status, and birth year). Episodic memory was measured as immediate and delayed recall using a 10-word recall test. We used confounder-adjusted linear mixed-effects models to estimate the associations between years of education and immediate recall (model 1) and delayed recall (model 2). In both models, the estimated education-recall association was non-linear based on the statistically significant squared and cubic terms (p< 0.001). Generally, an increase in education was associated with an increase in immediate and delayed recall, and these associations were more pronounced for larger education values. There were no statistically significant gender differences in the education-recall associations in both models. These findings indicate the importance of assessing non-linearity of the association between years of education and late-life cognition.
EXPLORATION OF STRESS FLUCTUATIONS IN FAMILY CAREGIVERS OF OLDER PEOPLE WITH MILD COGNITIVE IMPAIRMENT
Authors: Kabaya Sonoko , Greiner Chieko , Nakamura Masahide , Yamaguchi Yuko , Ryuno Hirochika
Published: December 2023

Mild cognitive impairment (MCI) is common, affecting 10%-35% of people over 65, and around two-thirds overall develop dementia over their lifetime. Previous studies have reported that family caregivers (FCs) caring for older people with MCI experience considerable burden, which tends to cause various neuropsychiatric symptoms, such as depression, apathy, and irritability. However, it is not clear how FCs’ stress, which leads to increased burden, fluctuates within a day through their daily activities. The aim of this study was to explore the characteristics of stress variability in FCs. We recruited one dyad of an older adult with MCI over the age of 65 and a FC. Data collection was performed continuously for 7 consecutive days. We adopted smart watches (GARMIN vívosmart 4) to measure Heart Rate Variability (HRV)-based stress. Moreover, we asked a FC to talk with a Virtual Agent (VA) on a laptop freely to understand when and what kind of daily activities were done and the FC’s feelings. Detecting change points in time series data was performed using Python 3.9. Results showed that change points in the FC’s daily stress appeared when the FC starts specific activities such as preparing meals and confirming some medicine that an older adult with MCI should take and daily schedules. The FC also expressed anticipatory grief at the prospect of future dementia through the VA. This finding is beneficial for considering how to reduce FCs’ stress during daily activities.
EXPLORING PROPERTY TAX BURDENS AND AGING IN PLACE: A GEOSPATIAL INVESTIGATION IN PENNSYLVANIA
Authors: Kim Jongwoong
Published: December 2023

Utilizing Geographic Information System (GIS) techniques and a composite index, this project delves into the intricate geographic patterns of property tax burdens in Pennsylvania, with a specific focus on older residents contemplating aging in place amidst limited financial resources. The study scrutinizes various factors, including property tax rates, home values, income, demographics, and other housing-related variables, to comprehensively grasp their effects on the financial feasibility of aging in place. Pennsylvania displays notable disparities in property taxes, averaging approximately 1.5% of home value, across counties due to distinct assessment systems and varying assessed-to-market ratios (CLRs). Tax rates are also influenced and specified by smaller administrative and geographic entities, including municipalities and school districts. Despite alternatives (e.g., assisted living), aging in place remains the preferred choice for most older Americans. This accentuates the significance of assessing property tax affordability that facilitates potential aging in place, particularly for financially constrained but “healthy” seniors who may not qualify for tax rebates or local freezes. Moreover, escalating housing prices and assessed values further emphasize the urgency. Cartographic and tabular findings from the study unveil challenging situations for seniors in specific county clusters of Pennsylvania, encompassing not only “expensive” urban but also “typically affordable” rural settings. Additionally, areas with the highest tax rates are not always the most financially burdensome (and vice versa) with all other factors taken into account. This study offers practical insights that have the potential to inform adjustments in housing and tax policies aimed at benefiting older adults in Pennsylvania.
EXPLORING THE ASSOCIATION OF SLEEP WITH COGNITIVE DOMAINS AMONG PEOPLE LIVING WITH DEMENTIA
Authors: Lewis Stevie , Patel Charmi , Jehu Deborah
Published: December 2023

People living with dementia (PWD) commonly experience sleep disruptions, which impacts mental alertness, increases daytime sleepiness, and results in poorer quality of life. While sleep preserves cognitive function among PWD, the relationship between sleep and different cognitive domains is unclear. Our objective was to explore the association between sleep and cognition domains among PWD. Twenty-three PWD completed a battery of cognitive tests (global cognition: Montreal Cognitive Assessment; executive function: Trail-Making Test (TMT), Digit Span Forward Test; perception and orientation: Benton Judgement of Line Orientation Test (BJLO); language: Boston Naming Test; learning and memory: Rey Auditory Verbal Learning Test; complex attention: Digit Symbol Substitution Test) at two residential care facilities. Participants wore a motion watch on their wrist for 7 days to monitor sleep. Participants were primarily male (74%), white (87%), and 48% had unspecified dementia. The average number of hours of sleep per night was 4.6±1.2 hours. The overall regression model for sleep was significant (R2=0.80, F(10,12)=4.68, RMSE=42.32, p< 0.05). More sleep was associated with better perception and orientation (BJLO:β=0.57, p=0.03), greater sleep efficiency (β=0.93, p=0.01), longer wake after sleep onset (β=1.19, p 0.002), and there was a trend for better executive function (TMT:β=-0.34, p=0.09). PWD have inadequate sleep. Greater amounts of sleep seem to preserve perception and orientation and may play a protective role for executive function, but more evidence is needed. Regularly assessing sleep may be useful in screening and monitoring cognitive changes among PWD in residential care facilities.
EXPLORING THE EFFICACY OF ARTIFICIAL INTELLIGENCE IN DELIVERING HOSPICE INFORMATION
Authors: Ross Jeanette , Dentchev Alexander , Reilly Elizabeth , Sanchez-Reilly Sandra
Published: December 2023

Background

Artificial Intelligence Chatbots (AIC) are swiftly gaining popularity due to their language model capability to address user queries by analyzing extensive amounts of available data and generating human-like responses. Objective: To analyze the accuracy of AIC in responding to inquiries related to hospice services and benefits. Additionally, the goal is to assess the user-friendliness of AIC in comparison to traditional web search engines.

Methods

AICs, namely ChatGPT and Bard, were subjected to testing through a series of questions and scenarios pertinent to hospice services (such as its definition, eligibility criteria, types of provided services, and specific care scenarios). Recorded responses from the AICs were subsequently evaluated for accuracy and quality by experts in geriatric palliative care.

Results

Both ChatGPT and Bard provided mostly accurate responses to fundamental questions and uncomplicated scenarios regarding hospice. These encompassed explanations about prognosis, interdisciplinary teams, and basic services offered. While ChatGPT did not furnish articles or source references, it did offer occasional medical advice. On the other hand, Bard issued medical information warnings and occasionally included visual aids like pictures, diagrams, and website links. When faced with the same set of questions, conventional web search engines often supplied links to webpages that did not invariably contain specific answers to the queries.

Conclusions

The AICs can deliver predominantly accurate, generic information about hospice in a conversational and comprehensible manner. Future research could delve into how AICs would respond to more personalized and specific inquiries that could be posed by patients or caregivers.
EXPLORING THE SOCIO-SPIRITUAL MEANING AND COPING STRATEGIES OF OLDER ADULTS LIVING WITH CANCER IN NIGERIA
Authors: Odo Obinna , Udeh Kingsly , Okolie Jonathan , Chidebe Runcie
Published: December 2023

The growing cancer mortality, poor access to palliative care, treatment hesitancy, poor survivorship, and limited oncology healthcare infrastructure have been investigated in Sub-Saharan Africa. In Nigeria, the orthodox treatment and management of cancer is still greatly influenced by superstitious belief and spiritual connotations. Yet, the socio-spiritual and culturally sensitive meanings attached to cancer and treatment are still lacking in the literature. This study explored the socio-spiritual strategies of older adults living with cancer in Nigeria. The study adopted a qualitative approach and data were collected through a semi-structured interview with 15 older adults from the Oncology unit, University of Nigeria Teaching Hospital (UNTH) Enugu State, Nigeria. The data were managed and inductively coded using NVivo 12 and analyzed thematically. The findings of our study show that cancer is traditionally conceptualized as the aftermath of a disconnection with supernatural/ancestral forces. By implication, such misconceptions affect the level of dispositions and steps taken toward diagnosis and treatment. To this end, our study argues that blending spiritual needs, social support, and culturally sensitive cancer education could improve the quality of life and coping capacity of older adults living with cancer. The study recommends the infusion of socio-spiritual interventions to cancer treatment for older adults in Nigeria.
FACTORS ASSOCIATED WITH THE INCIDENCE OF COGNITIVE IMPAIRMENT IN OLDER COSTA RICAN ADULTS
Authors: Méndez-Chacón Ericka , Camacho David
Published: December 2023

Cognitive impairment is a critical global public health problem that contributes to lower quality of life and greater medical costs. Despite the growing number of older adults in Costa Rica, few studies have examined cognitive impairment in this population. We drew data on participants (60 years+) with no cognitive impairment (Score of >=12 on MMSE) from wave 1 of the Costa Rican Longevity and Healthy Aging Study (CRELES; n=2,827). Guided by the diathesis-stress-model, we used logistic regression to determine social and health predictors of cognitive impairment incidence (Score < 12 of on MMSE) 2 years later (wave 2). Incidence of cognitive impairment was 5.8% (95% CI, 5.0-7.0). Formal school education (elementary: OR=0.32; 95% CI, 0.17-0.60; high school or more: OR=0.11; 95% CI, 0.02-0.60) and being married or living as married (OR=0.52; 95% CI, 0.28-0.96) were identified as protective against cognitive impairment. Greater age (OR=1.09; 95% CI, 1.06-1.13), consuming more than 400g of carbohydrates per day (OR=2.20; 95% CI, 1.22-3.91), and more challenges with Instrumental Activities of Daily Living (OR=1.70; 95% CI, 1.23-2.28) increased odds of developing cognitive impairment. Common predictors including biological sex, residential zone, smoking, income, bad health perception, depression, and cortisol (ug/dl) were not associated with the onset of cognitive impairment at wave 2. We consider that contextual (e.g., healthcare infrastructure), cultural factors (e.g., familism), as well as diet may help shape predictors and their effects on cognitive functioning. Researchers and practitioners should collaborate on implementation of culturally appropriate and contextually feasible interventions that address predictors of cognitive impairment.
FAILURE TO RECOVER FROM PROACTIVE INTERFERENCE & TRAJECTORY OF CLINICAL DEMENTIA RATING SUM OF BOXES IN AMNESTIC MCI
Authors: Zheng D Diane , Curiel Rosie , Ortega Alexandra , Crocco Elizabeth , Crenshaw Kiresten , Ramirez Sofia , Ortiz Juliana , Loewenstein David
Published: December 2023

Background

The Loewenstein-Acevedo Scale for Semantic Interferences and Learning (LASSI-L) has been shown to be sensitive to Alzheimer’s Disease (AD) pathology among those with preclinical AD, however, LASSI-L’s ability to predict longitudinal cognitive and functional decline of preclinical AD has not been examined.

Method

We evaluated 97 older adults aged 54-98 who were diagnosed with amnestic mild cognitive impairment (aMCI) at 1Florida Alzheimer’s Disease Research Center initial visit. The mean age was 71.9 yr, 51% male, average education 15.7 yr, and mean MMSE score was 28.0. Participants had 3 to 5 visits over a follow-up time as long as 76.7 months. We examined the association of LASSI-L measures on the growth curve trajectory of Clinical Dementia Rating sum of Box (CDRSOB).

Results

The growth curve model that best fit the CDR sum of box trajectory is a linear form and included the fixed and random effect of intercept and slope of time. After adjusting for age, gender, education, Hopkins Verbal Learning Test (HVLT) delayed recall and LASSI-L maximum storage capacity, worse performance on LASSI-L measures of vulnerability to proactive semantic interference (B2 cued recall, β=-0.093, se 0.004, p-0.004) and semantic intrusion (B2 cued intrusions, β=0.053, se 0.023, p=0.02) were statistically significant in predicting a steeper slope on the trajectory of decline in CDRSOB.

Conclusions

The LASSI-L measures reflecting failure to recover from proactive interference and associated intrusions predicted the rate of cognitive/functional decline over time in amnestic MCI and demonstrated the utility of LASSI-L’s longitudinal prediction of prodromal AD.
FRAILTY IN MIDLIFE AS A PREDICTOR OF CHANGES IN BODY COMPOSITION FROM MIDLIFE INTO OLD AGE
Authors: Kananen Laura , Haapanen Markus , Mikkola Tuija , Jylhävä Juulia , Wasenius Niko , Eriksson Johan , von Bonsdorff Mikaela
Published: December 2023

Few studies have investigated the association between frailty and subsequent body composition. We performed separate linear mixed model analyses in 996 adults (mean age at baseline[SD]: 61.5[2.9]) in a Finnish longitudinal birth cohort study to explore the relationships between changes in frailty status assessed by the Rockwood 41-item-frailty-index (FI) and changes in body mass index (BMI), lean mass index (LMI), fat mass index (FMI), and FMI to LMI-ratio values during 17 years of follow-up. With advancing age, LMI and BMI decreased, whereas FMI and FMI to LMI -ratio increased. Those who were frail (FI≥ 0.25) already at baseline, followed by those who became frail during the follow-up, experienced faster decreases in LMI and faster increases in FMI and FMI to LMI -ratio values relative to those who were ‘never frail’. Contrastingly, those in the highest third of absolute annual increase in FMI and FMI to LMI-ratio became frailer faster over time relative to those in the lowest third. We found evidence of an adverse health outcome of frailty where lean indices declined faster and fat indices and fat to lean -ratios increased faster from midlife into old age. The changes resembled those that occurred with aging, but at a faster pace. The relationship between body composition and frailty is likely bidirectional, where high or increasing levels of fat are associated with the risk of becoming frailer earlier, but where a longer duration of frailty may increase the risk of faster age-related changes to body composition.
GENDER DIFFERENCES IN COVID-19 EXPERIENCES OF OLDER FEMALE VETERANS USING THE PROSPECTIVE HERO CARE SURVEY DATA
Authors: Tyagi Pranjal , Garcia Sandra , Bouldin Erin , Trivedi Ranak , Intrator Orna , Pugh Mary Jo , Leykum Luci , Dang Stuti
Published: December 2023

Aging female Veterans faced unique experiences during the COVID-19 pandemic. We used self-reported experiences of older female Veterans during this time in comparison with male Veterans. We received responses for the HERO CARE survey from 2,080 (88 (4.2%) female, 1,992 (95.8%) male) community-dwelling Veterans from five geographically diverse Veterans Affairs Medical Centers. Veterans were prompted to self-report the impact of COVID-19 through an open-ended question asking to share anything they would like us to know about their experience. Open-ended responses were classified through inductive coding into emergent themes and chi-square tests. The most common emergent themes from female Veteran responses were social isolation (17.8%), negative effects on physical health (15.6%), and issues with accessing VA healthcare resources (15.6%). The most common emergent themes from male Veterans were social isolation (12.7%) and issues with accessing VA healthcare resources (8.2%). However, female Veterans were more likely to report experiencing a decline in their physical health compared to males (p< 0.01), more likely to report experiencing a negative change in their mental health (p< 0.01) and more likely to experience a decline in their general satisfaction with life (p< 0.002). They were also more likely to experience an issue with accessing VA healthcare resources (p< 0.02), and to experience financial problems (p< 0.0001). Female Veterans were more likely to report negative impacts of the COVID-19 pandemic to their mental and physical health, general satisfaction with life, and accessing VA healthcare resources. Routine assessment may be needed to adequately address their needs.