bluuebunny/crossref_metadata_2025 huggingface dataset:
SHARED EXPERIENCES OF MANAGING HEART FAILURE AND MULTIMORBIDITY: A QUALITATIVE ANALYSIS
Authors: Nelson Katie , Benjasirisan Chitchanok , Lim Arum , DeGroot Lyndsay , Badawi Sarah , Himmelfarb Cheryl Dennison , Davidson Patricia , Koirala Binu
Published: December 2023

Heart failure affects more than 6 million people nationally; most are older adults who have multimorbidity. Navigating symptom management and self-care maintenance can be challenging given heart failure’s non-linear trajectory. Therefore, identifying shared priorities is important for guiding steps to enhance care provision. Our study aimed to elicit experiences and perspectives regarding heart failure and multimorbidity management among patients, caregivers, and healthcare workers via semi-structured interviews. We used purposive and convenience sampling to recruit patients 50 years and older living with heart failure and comorbidities, family caregivers, and interdisciplinary healthcare workers from an academic medical center in the Mid-Atlantic region of the U.S. Participants were asked about disease trajectory, recognizing/treating symptoms, and service utilization. We used inductive thematic analysis and presented key findings at virtual co-design events, whereby participants ranked priorities to determine next steps. Forty-six interviews were conducted: 24 patients (mean ± SD: 70.1 ± 9.16 years; 46% female), 7 family caregivers (63.6 ± 14.18 years; 57% female), and 15 healthcare workers (35.6 ± 10.04 years; 80% female). Four themes were emphasized across groups: 1) clear communication, 2) health education for patients and caregivers, 3) care coordination and follow-up post-discharge, and 4) provision of mental and emotional support. Patients, caregivers, and healthcare workers uniquely contribute to heart failure and multimorbidity management. All groups share priorities surrounding clear communication, health education and comprehensive support. These factors can be significant barriers or facilitators in terms of optimizing patients’ symptoms and quality of life.
SEX DIFFERENCES IN THE ROLE OF SLEEP ON EXECUTIVE FUNCTION IN OLDER ADULTS
Authors: Wiranto Yumiko , Thangwaritorn Pilar , Meyer Kayla , Watts Amber
Published: December 2023

Advancing age is associated with a decline in sleep quality and cognitive performance. Previous work has shown that women report a higher number of sleep complaints, possibly due to hormonal and physiologic developmental changes across the lifespan. However, whether the effects of sleep quality on cognitive performance differ between sexes in older populations remains unclear. To address this gap, we analyzed data from 117 cognitively normal participants (44 men and 73 women) aged 60 and older (M = 74.82, SD = 6.52) to compare the effects of objectively measured sleep on executive function. Total sleep time was recorded with the GT9X Link Actigraph worn for seven consecutive days. The composite score of executive function was derived from a confirmatory factor analysis consisting of four separate tests (Verbal Fluency, Trail Making Test Part B, Digit Symbol Substitution Test, and Stroop Interference). We used hierarchical multiple regression to investigate sex differences in the effects of total sleep time on executive function. A quadratic model of total sleep time was a significant predictor of executive function in women (β = -.251, p = .034), but not in men adjusting for age and education. Longer sleep duration predicted improved executive function, but the performance decreased with oversleeping. These findings imply that interventions aimed at optimizing sleep duration may be beneficial for executive function in older women. Further research is necessary to identify sex-specific sleep requirements, which can inform the development of personalized interventions for older adults.
AN AGENTIC PERSPECTIVE ON AGING PREPARATION
Authors: Kim-Knauss Yaeji , Lang Frieder
Published: December 2023

When imagining one’s future life in old age individuals may respond to an uncertain future with proactive and preparatory activity aiming to maximize possible rewards and minimize risks or costs. The current research applies an agentic perspective on aging preparation that emphasizes the role of individuals’ beliefs and attitudes in determining their engagement in actions. The present research aims to investigate the associations between action-related beliefs (perceived utility/risk) and situational cues (experience/appraisals of aging-related life challenges) with individuals’ engagement in aging preparation. Data comes from the “Ageing as Future” project, which includes multicultural (i.e., Germany, US, Hong Kong, Taiwan, Czechia), longitudinal (i.e., five measurement points spanning from 2012 to 2020), and lifespan data (i.e., aged 18 to 98). Results from a series of analyses indicate that perceiving more utilities, having experience in caregiving, and having health-related worries at the peak of the COVID-19 pandemic were associated with engagement in aging preparation. However, the magnitude of these associations varied depending on the time perspective and cultural context. Findings suggest that individuals engage in aging preparation to attain desirable or to avoid undesirable outcomes in the future based on personal values and belief systems. The dynamic interplay of personal belief systems with temporal and cultural contexts was also highlighted that differently shapes individual’s agentic engagement in aging preparation.
THE ROLE OF HEALTH LITERACY IN HEALTH CARE UTILIZATION AMONG TAIWANESE OLDER ADULTS
Authors: Liao Zih-Yong , Liao Pei-Chun , Kuo Fang-Lin
Published: December 2023

Health literacy is one of important capabilities links to health-related behaviours. The extant study provides limited information about the healthcare access of older adults. This study investigated factors determining the healthcare utilisation of 2423 community-dwelling older adults from the Taiwan Longitudinal Study on Ageing between 2011 and 2015. We used linear mixed-effects regression models and cumulative logit models to examine whether personal characteristics are associated with healthcare utilisation. A significant association was found between the level of difficulties in health literacy and healthcare utilisation after controlling for age, comorbidity, depression, mobility and accessibilities. The higher the older adults scored in the difficulty of health literacy, the lower frequencies of clinics (p = .03), inpatient (p = .02) and dentist visits (p = .02). Individuals who access health-related information more easily have a better chance to receive inpatient services when they feel unwell (p = .0004). Better perceived health is less likely to use clinics (p < .0001), emergency (p < .0001) and inpatient services (p = .0007) but not include visits to pharmacy and traditional medicine. People engaging in workouts are less likely to purchase in a pharmacy (p = .02) but visit traditional medicine (p = .02) more often. It echoes that health literacy is an intermediate attribute to self-efficacy in managing personal health matters and suggests a perspective that older adults consider taking traditional medicine as a self-care instead of healthcare treatment. Future intervention programmes can address health literacy promotion as an initiating step to facilitate participants’ engagement.
NETWORK ANALYSIS OF ANXIETY AND DEPRESSIVE SYMPTOMS AMONG OLDER ADULTS WITH DIFFERENTIAL MENTAL HEALTH RISKS
Authors: Liu Tianyin , Zhang Wen , Wong Gloria Hoi-Yan , Lum Terry
Published: December 2023

Anxiety and depressive symptoms are common in older people, and network analysis may provide deeper characterization of symptom-symptom interactions to inform personalized care. The aim of this study was to elucidate characteristics of anxiety and depressive symptom networks of older adults with differential risks for depression and anxiety. A total of 4184 older adults (mean age = 77.3±8.8 years, 3245 women) were recruited from the community. Their anxiety and depressive symptom were measured using the Generalized Anxiety Disorder Scale 7-item (GAD-7) and Patient Health Questionnaire 9-item (PHQ-9), respectively. A cut-off score of 5 was used for both scales to differentiate people with mild or above anxiety/depressive symptoms; by this criterion, 1067 (25.5%) of the sample had no anxiety/depressive symptoms, 1690 (40.4%) had symptoms in one domain, and 1427 (34.1%) had symptoms in both domains. Central symptoms and bridge symptoms were identified via centrality indices and bridge centrality indices, respectively. Network stability was examined using the case-dropping procedure. Overall, Restlessness (GAD-7 item 5), Depressed mood (PHQ-9 item 2), and Fear (GAD-7 item 7) had the highest centrality values; two bridge symptoms, Restlessness and Psychomotor disturbances (PHQ-9 item 8), were also identified. Higher risks for depression and/or anxiety were positively associated with global strength; Restlessness and Depressed mood remained to be central symptoms, but in those with both depression and anxiety risks, Restlessness and Guilt/Self-blame (PHQ-9 item 6) bridged the two domains. Interventions designed to target central symptoms and bridge symptoms may be effective in alleviating co-occurring experiences of anxiety and depression.
COMPREHENSIVE MOBILITY FRAMEWORK VERIFICATION USING CANADIAN LONGITUDINAL STUDY ON AGING DATA
Authors: Webber Sandra , Liu Yixiu , Barclay Ruth , Jiang Depeng , Ripat Jacquie , Nowicki Scott , Tate Robert
Published: December 2023

Mobility within and between life spaces (one’s room, home, local community, and further destinations) positively influences quality of life and health in older adults. Understanding factors that impact mobility is relevant in many contexts (e.g., in clinical and research environments, for city-planning and social programming). The purpose of this study was to verify a comprehensive theoretical framework for mobility (Webber et al., 2010) with structural equation modelling using data from the Canadian Longitudinal Study on Aging (CLSA). We estimated associations between latent factors consisting of physical, psychosocial, environmental, financial, and cognitive attributes, and life space mobility for participants 65-85 years of age (n=11,667, mean age 73 ± 6 years) with age, sex and education as covariates. The model demonstrated good fit (CFI = 0.90, RMSEA (90% CI) = 0.025 (0.024, 0.026)). Physical, psychosocial, and cognitive health were positively associated with life space mobility. Being less afraid to walk after dark (environmental variable) was also associated with greater mobility. Financial status influenced mobility through positive associations with psychosocial health and physical health. Higher education was related to better cognitive function and better financial status. Age was indirectly associated with life space mobility through its negative associations with financial status, cognition, and physical health. The same model can be used for males and females. The comprehensive mobility framework was verified with the large population-based CLSA dataset. Continued use of the framework is supported as it accurately portrays the complexity of factors that influence older adults’ life space mobility.
RETIREMENT AND COGNITION: EXAMINING THE MENTAL RETIREMENT CONCEPT
Authors: Veal Britney , Meng Hongdao , Andel Ross
Published: December 2023

The concept of “mental retirement” posits that those approaching retirement experience less incentives to continue to engage with work, which is expressed as the so called “on-the-job” retirement effect, leading to negative changes in cognition. To test this notion, we set out to examine if participants who were about to voluntarily retire would have worse cognitive performance compared to those who continued working. We used members of the Health and Retirement Study who reported voluntarily retirement (n=333) in 2008 compared to those who continued working (n=2424). Cognition was assessed at four and two years prior to 2008 and in 2008. Analyses of covariance (ANCOVAs) were conducted with sociodemographic characteristics, chronic conditions, and baseline (2002) cognition as the covariates. Those who retired in 2008 and those who continued working varied on average age, 62.1±6.1 years vs. 60.7±6.1 years, p<.001, sex, 39% men vs. 45% men, p=.04, and average years of education, 13.3±2.6 years vs. 13.6±2.6, p=.04. ANCOVA results showed no significant between-group differences four years before retirement, F(1, 2669) = 0.00, p=.96, significantly worse cognitive scores among those who were planning to retire in two years compared to those who remained in the workforce, F(1, 2645) = 4.75, p=.03, and smaller, non-significant group differences in 2008, F(1, 2730) = 1.69, p=.19. These results support the existence of the “on-the-job” retirement effect, whereby the expectation of retired is accompanied by reduction in cognitive functioning, although it remains unclear whether this effect carries into retirement and/or under what circumstances.
A KNOWLEDGE-DRIVEN BIO-BEHAVIORAL NETWORK MODEL OF THE INFLAMMASOME AND CALORIC RESTRICTION
Authors: Chacko Thomas , Broderick Gordon , Moore Nadia , Parker Daniel , Kraus William , Huffman Kim
Published: December 2023

Healthy dynamic equilibrium between immune and endocrine function can be altered not only by illness but by changes in lifestyle including caloric intake. The Comprehensive Assessment of the Long-term Effects of Reducing Intake of Energy Study (CALERIE™) is a large multi-year longitudinal study funded by the National Institute on Aging investigating what metabolic adaptations would result from a 25% caloric restriction sustained for 2 years and how these might positively affect primary aging and inform on aging biomarkers and chronic diseases of aging. A broad range of behavioral and physiological markers were measured at different levels of biology, making comprehensive integration and interpretation of data challenging. Here we propose a knowledge-based framework for integrating data that fully applies our current understanding of biobehavioral regulatory biology. Leveraging the Elsevier Knowledge Graph and the MedScan Natural Language Processing (NLP) engine we extracted from peer-reviewed literature 816 documented regulatory relationships linking a subset of 85 data elements readily available, including ~ 15 immune inflammatory and 12 endocrine markers. With a connection density of ~11%, this network was supported by > 23,000 citations or a median of 7 citations per regulatory interaction. A structural analysis of connectivity patterns identified inflammatory marker CCL2, insulin and testosterone as key mediators of large-scale coordinated response to caloric restriction. Ongoing analysis will identify immune and endocrine decisional logic that drives network dynamics, providing candidate intervention targets potentiating caloric restriction that remain explainable in the context of established pathway biology.
A SIGNAL FOR HEALTH EQUITY: DIFFERENCES IN WHOLE HEALTH AND SOCIAL NEEDS AMONG MEDICARE ADVANTAGE SUBPOPULATIONS
Authors: McNamara Kelsey , Rudy Ellen
Published: December 2023

CMS’ 2024 Medicare Advantage (MA) Final Rule introduced the health equity index (HEI) to encourage plans to advance equity and improve outcomes for enrollees with social risk factors. Enrollees of focus include those receiving a low-income subsidy, dually eligible for Medicare and Medicaid, and/or having a disability. These populations historically have higher unmet social needs and poorer health outcomes. The purpose of this epidemiological study was to compare self-reported whole health and social needs among MA subpopulations. Analysis included 28,588 MA members who were screened for a companion care program (January–June 2023). Questionnaire included a social needs screener, UCLA-3 Loneliness Scale, and CDC’s Healthy Days Measure. To compare across metrics/domains (mental health, physical health, whole health, social support, loneliness), data was normalized 0 to 100 where higher scores represent better outcomes. Among the cohort, average age was 72, 31% male, and 37 states represented. Subpopulations included 70% traditional MA (TMA), 13% dual-eligible (DE), 17% people with disabilities (PWD), < 1% veterans (V). Average outcomes reported by subpopulations were (TMA; DE; PWD; V): number of unmet social needs (1.6; 2.3; 2.6; 1.4); social support score (63; 54; 53; 70); mental health score (74; 63; 59; 73); physical health score (57; 50; 48; 52); whole health score (65; 56; 53; 65). People with disabilities reported the lowest scores and indicate an important subpopulation in need. Meeting the HEI, and ultimately improving outcomes for some of the most historically marginalized members, will require an individualized and holistic approach to health and social care.
CHANGES IN MULTIMORBIDITY AMONG HOSPITALIZED ADULTS IN THE US
Authors: Picken Lauren , Zhang Yue , Loyd Christine
Published: December 2023

Having multiple chronic health conditions, or multimorbidity, is common among adult inpatients and is associated with risk of death, disability, and reduced quality of life. This investigation examines prevalence trends of multimorbidity over time among inpatients based on age, sex, and race and assesses hospitalization rates for individual diseases over time. Retrospective cross-sectional analysis of 2012-2018 US National Inpatient Sample datasets was completed. Participants were hospitalized patients ≥55y from community hospitals. ICD-9 and 10 codes for admitting diagnoses were used to calculate disease burden using the Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI). Unweighted mean index scores and admission rates for diseases were compared. Mean age for the sample was 72y, and inpatients were mostly female (53%) and White (77%). The mean comorbidity scores increased across the sample: mean CCI increased from 1.69 to 1.97 and mean ECI increased from 3.66 to 4.14. Comorbidity scores were higher over time with increasing age until about age 80-84 (for CCI) and age 85-89 (for ECI) and increased similarly among males and females. Black and Native American inpatients had the largest increase in mean CCI and ECI scores. Comorbidities with increased hospitalization rates included congestive heart failure (+5%), dementia (+6%), complicated diabetes (+14%), complicated hypertension (+17%), renal disease/failure (+5%), and obesity (+5%). Growing disease burden among inpatients supports the continued need for programs aiming to prevent and treat chronic diseases and multimorbidity, especially among underrepresented populations including Black and Native American communities.
DIFFERENCES BETWEEN TRAINEE AND SUPERVISOR PERSPECTIVES ON THE IMPACT OF COVID-19 ON GEROPSYCHOLOGY TRAINING
Authors: Luskey Valerie , Jacobs M Lindsey , Mlinac Michelle , Bashian Hannah , Reel Candice , Boyle Julia
Published: December 2023

The COVID-19 pandemic majorly impacted geriatric specialty training. To better understand this impact, a survey study was conducted to examine the pandemic’s unique impact on geropsychology training. Participants (N=62) included psychology trainees specializing in geropsychology and psychologists providing geropsychology training. The majority of participants identified as white (90.3%), female (87.1%), and 30-39 years old. Using a 5-point Likert scale ranging from “not at all impactful” to “extremely impactful”, participants rated their subjective experience on how the pandemic positively and negatively affected geropsychology training in three functional competency areas (assessment, intervention, and consultation) consistent with the Pikes Peak Model for Geropsychology Training. A 2x3 mixed design repeated measures ANOVA was conducted to examine similarities and differences in trainees’ and supervisors’ perceptions of the pandemic’s impact on the competency domains. Results indicate that supervisors’ and trainees’ perception of the pandemic’s negative impacts aligned, F(1,43)=.01, p=.931. Results were consistent across all competency domains, F(2,86)=1.39, p=.26; however, perceptions of the positive impacts significantly differed, F(2,84)=6.459, p=.002. Overall, both trainees and supervisors perceived more positive impacts on intervention and consultation compared to assessment, t(43)=3.54, p≤.001. However, trainees (M=1.8, SD=.112) reported more positive impacts overall compared to supervisors (M=1.3, SD=.09), F(1,42)=9.08, p=.004. These findings have significant implications for the level of competence in emerging geropsychologists’, particularly in the areas of cognitive and capacity assessments. Recommendations for additional assessment training and supervision will be provided.
EARLY LIFE LEARNING DISABILITY, PREMATURE PARENTAL DEATH PREDICTS LATE LIFE COGNITIVE IMPAIRMENT
Authors: Nkwata Allan , Smith Jacqui
Published: December 2023

Recent studies have increasingly identified links between early learning difficulties and later life cognitive impairment. Additionally, the death of a parent adversely affects various outcomes across the life course, particularly when the death occurs earlier than expected. This study evaluated the impact of early learning problems and death of a parent on change in cognitive function over 10 years among older Americans enrolled in the Health and Retirement Study. Data were from respondents’ early educational experiences collected in the 2015 and 2017 Life History Mail Survey and childhood stress measures were from the aggregated childhood histories (N = 10,775). Cognitive impairment was assessed per Langa-Weir’s classification, which includes normal, cognitively impaired but not demented (CIND) and demented groups. Generalized Estimating Equations (GEE) regressions estimated odds ratios (ORs) and 95% confidence intervals (CI) with adjustment for socio-demographic and lifestyle factors. Having at least one early learning problem, and death of a parent before the age of 16 were each associated with increased risk of later life cognitive impairment over time (OR 1.60, 95% CI 1.45-1.76 and OR 2.02, 95%CI 1.83-2.24 respectively). However, learning problem-related differences in risk of cognitive impairment varied by parental death status over time (learning problems x death x time, p=0.05). The risk was highest, amongst those that reported both experiencing early learning problems and parental death relative to those without learning problems. Policies and interventions that enhance diagnosis of early learning problems and improve childhood social contexts are needed to promote healthy cognitive aging amongst older Americans.
FAITH-BASED COMMUNITY OUTREACH TO INCREASE ALZHEIMER’S CLINICAL RESEARCH PARTICIPATION IN THE BLACK COMMUNITY
Authors: Gibson Ethlyn , Niknejad Bahar , Okhravi Hamid , Andrews Ebony , Brown-Hughes Travonia
Published: December 2023

Issues: Despite the fact that African Americans are twice more likely to develop Alzheimer’s disease (AD) compared to non-Hispanic whites, they are under-represented in AD clinical research. Lower representation exists in the AHEAD Study as well, which is an AD prevention clinical trial evaluating the efficacy and safety of Lecanemab in 1400 study participants. We sought to raise awareness about AD and increase clinical research participation of African Americans in the AHEAD Study, through a community-based education and recruitment program (CERP). Description: Our diverse team from Eastern Virginia Medical School and Hampton University, a Historically Black College University (HBCU), established a Community Advisory Board and Ministerial Alliance with representation from faith-based, long-standing civic and fraternal organizations within the Greater Hampton Roads Black community. The alliance guided us to identify prioritization areas for addressing sociocultural barriers and increasing clinical research awareness and participation in traditional African American events, key historic community sites, and non-traditional community centers (i.e., YMCA, independent-living, assisted-living centers, Annual Juneteenth Celebration, Black fraternity, and sorority events.) Community health workers, embedded within the community, of the same cultural background and ethnicity, drove our CERP. Lessons Learned: As of July 2023, we offered our program at 45 community events, including community health fairs, civics events, and Purple Sunday luncheons and talks at Black churches in urban and localities in Hampton Roads, in partnership with fraternal and civic community organizations. Out of over 1700 participants, 177 community members have been prescreened for the AHEAD Study.
HEAVY DRINKING, MENTAL HEALTH PROBLEMS AND RECOVERY IN OLDER ADULTS: EXPLORING SUPPORT NEEDS
Authors: John Deepti , Bareham Bethany , O’Donnell Amy , Liddle Jennifer , Chew-Graham Carolyn , Kaner Eileen , Hanratty Barbara
Published: December 2023

Many older adults who consume alcohol at harmful levels experience mental health problems. Common life events such as retirement, bereavement, and declining health, can contribute to anxiety and depression, with alcohol consumption being used as a coping mechanism. Tailored support is crucial to address the unique needs of older adults facing both alcohol misuse and mental health problems. These patients often fall into gaps between services (family practice/alcohol/mental health), which are unable to meet their complex support needs. This qualitative study aimed to understand the lived experiences of older adults with co-occurring heavy drinking and mental health problems, support received and unmet needs. We conducted semi-structured interviews with 14 older adults living in the North of England (completed Summer 2023). Thematic analysis and constant comparison were employed in data analysis. Findings highlighted the importance of age-tailored initiatives such as access to mental health support while actively drinking, supervised detoxification, increased peer support and services that are age inclusive and friendly. Risk factors such as grief, loneliness, financial problems and undiagnosed trauma in older adults contributed to development of these conditions. Older adults need services to work together, integrated around patient needs and addressing heavy drinking and mental health concerns at the same time. Future research should focus on improving mental health literacy and, developing holistic and preventive interventions to address risk factors for co-occurring alcohol and mental health problems in older adults.
MALNUTRITION IN COVID-19 SURVIVORS: PREVALENCE AND RISK FACTORS
Authors: Tosato Matteo , Calvani Riccardo , Landi Francesco
Published: December 2023

Nutritional status is a critical factor throughout COVID-19 disease course. Malnutrition is associated with poor outcomes in hospitalized COVID-19 patients. The aim of our study is to assess the prevalence of malnutrition and identify its risk factors in COVID-19 survivors. Study cohort included 1230 COVID-19 survivors aged 18-86 attending a post-COVID-19 outpatient service. Data on clinical parameters, anthropometry, acute COVID-19 symptoms, lifestyle habits were collected through a comprehensive medical assessment. Malnutrition was assessed according to Global Leadership Initiative on Malnutrition (GLIM) criteria. Our results showed that the prevalence of malnutrition was 22% at 4-5 months after acute disease. Participants who were not hospitalized during acute COVID-19 showed a higher rate of malnutrition compared to those who needed hospitalization (26% versus 19%, p< 0.01). Malnutrition was diagnosed in 25% COVID-19 survivors over 65 years of age compared to 21% younger participants (p< 0.01). After multivariable adjustment, the likelihood of being malnourished increased progressively and independently with advancing age (Odds ratio [OR] 1.02; 95% CI 1.01–1.03) and in male participants (OR 5.56; 95% CI 3.53–8.74). Malnutrition was associated with loss of appetite (OR 2.50; 95% CI 1.73–3.62), and dysgeusia (OR 4.05; 95% CI 2.30–7.21) during acute COVID-19. In the present investigation we showed that malnutrition was highly prevalent in a large cohort of COVID-19 survivors at 4-5 months from acute illness. Our findings highlight the need to implement comprehensive nutritional assessment and therapy as an integral part of care for COVID-19 patients
NAVIGATING THE DIGITAL DIVIDE: FACTORS INFLUENCING PATIENT PORTAL ADOPTION BY OLDER ADULTS DURING THE PANDEMIC
Authors: Jeong Chung Hyeon , Kim BoRin
Published: December 2023

The pandemic rapidly accelerated the adoption of digital healthcare technologies, including patient portals. The patient portals enhance patient-provider communication, streamline medical records management, and provides tailored education materials. Nevertheless, older patients, known as heavy healthcare users, often encounter challenges when adopting patient portals. This digital divide could lead to worsening health and healthcare disparities. Guided by the Senior Technology Acceptance and Adoption Model (STAM), this study explored the factors influencing the adoption of patient portals by older adults during the pandemic. We conducted semi-structured virtual interviews in 2021 with 31 older adults aged 60 or older with healthcare needs. Interviews were thematically coded and analyzed using constant comparative methods. The STAM proposes an orderly phase of technology acceptance among older adults, comprising three phases: 1) objectification, 2) incorporation, and 3) conversion. Our findings showed that some older patients felt compelled to use patient portals during the pandemic, bypassing the objectification phase, which is crucial for building an intention to use the new technology. Older patients who lack a strong intention to use patient portals tended to report challenges in the incorporation phase, rather than focusing on the usefulness of patient portals. From the interviews, we identified three overarching themes: 1) perceived concerns or limited benefits, 2) aging-related and system-related barriers, and 3) limited training opportunities. These themes could pose obstacles to the adoption of patient portals during the conversion phase. The findings of this study suggest areas for improvement to increase the adoption of patient portals among older patients.
ONE MINUTE TO RECOGNITION: THE AGITATION IN ALZHEIMER’S SCREENER FOR CAREGIVERS (AASC™)
Authors: Clevenger Carolyn , Brubaker Malaak , Patel Mehul , Cummings Jeffrey , Jackson W Clay , Stroud Jared , Pechin Sue , Grossberg George
Published: December 2023

Agitation is a common neuropsychiatric symptom of Alzheimer’s dementia (AD) and both a complex and burdensome aspect of patient care. Caregivers are often first to encounter agitation-associated behaviors and play a pivotal role in communicating these symptoms to healthcare providers (HCPs). However, most caregivers do not identify the breadth of signs/symptoms of agitation and are hesitant to discuss these behaviors with HCPs. There is, therefore, an unmet need for an easy, pragmatic screener to facilitate caregiver recognition of agitation associated with AD (AAD) and HCP discussions. Here, we report on the development of the Agitation in Alzheimer’s Screener for Caregivers (AASC™), a brief screening tool based on the International Psychogeriatric Association (IPA) consensus definition for agitation in cognitive disorders, designed to assist caregivers in recognizing agitation-associated behaviors in patients with AD. Initial draft development involved identification of specific behaviors that were discriminative for AD with/without agitation and representative of the full range of IPA-defined agitation behaviors (i.e., excessive motor activity, verbal aggression, physical aggression) based on current literature and input from 6 opinion leaders. An initial draft was then refined across 2 rounds of cognitive debriefing with caregivers (n=12; mean age=62 years) who described the screening tool as comprehensive yet easy to complete, and perceived it to be valuable, relevant, and easily understood. The AASC™ is a brief, easy-to-use tool supporting the identification and assessment of impact of agitation-associated behaviors. The screener can be completed by a caregiver in < 1 minute at home or in an HCP’s office setting.
PATHOGEN APATHY RESULTING FROM SKN-1 ACTIVATION: A MARK OF RESILIENCE OR A RATTLED GUT FEELING?
Authors: Nair Tripti , Weathers Brandy , Stuhr Nicole , Nhan James , Gorla Vandita , Curran Sean
Published: December 2023

Innate immunity is a key driver in promoting survival against xenobiotic stressors and hostile environments and an appropriate immune response is essential to organismal health across lifespan. Caenorhabditis elegans encounter pathogens in their natural environment and initiate cytoprotective and immune responses that can have long-lasting effects on health, even after the pathogen has been neutralized. Pseudomonas aeruginosa (PA14) is an opportunistic pathogen that is lethal to C. elegans with prolonged exposure. C. elegans employ multiple defense mechanisms to ensure survival upon exposure to pathogens to defend against the current infection and to avoid continued exposure, including activation of the key cytoprotective transcription factor SKN-1 (mammalian homologue Nrf2). Although wild type C. elegans quickly learn to avoid pathogens, our current work documents a peculiar apathy to pathogen in animals with constitutive activation of SKN-1. The outcome is surprising as the role of SKN-1 is to protect an animal from intracellular and environmental insults. This behavior is mediated by tissue specific actions of SKN-1 that initiate cell non-autonomous responses for pathogen avoidance, survival, and metabolic adaptation. Based on transcriptional signature of animals with SKN-1 activation upon exposure to PA14 we observed that the apathy behavior is independent of somatic lipid depletion, thus uncoupling these two exceptional physiological responses. Further, we define the role of neurosignalling molecules in the gut-brain axis that drive the apathy response to pathogens. Our work reveals new insights into how animals perceive pathogens in the environment and subsequently alter behavior and cellular programs to promote survival.
RACIAL AND ETHNIC DISPARITIES IN SOCIAL ISOLATION AND 11-YEAR DEMENTIA RISK AMONG OLDER ADULTS IN THE UNITED STATES
Authors: Grullon Jason , Soong Daniel , Wong Roger
Published: December 2023

Social isolation has been linked to cognitive impairment. Research on this relationship, however, remains limited because validated social isolation measures have been underutilized when examining dementia risk, while also considering differences among racial-ethnic groups. To address this gap, we analyzed 11 years of data (2011–2021) from the National Health and Aging Trends Study to examine the interplay between social isolation, race-ethnicity, and dementia. We constructed a longitudinal score using a validated social isolation variable for our sample of 6,155 community-dwelling U.S. adults aged 65 years and older. After applying sampling weights and imputing missing data, our analysis revealed a higher average longitudinal frequency of social isolation among Black (27.6%), Hispanic (26.6%), and Asian (21.0%) older adults compared to non-Hispanic White (19.1%) respondents during the 11-year period (t=-7.35, p<.001). Cox regression models indicated higher frequency of social isolation was significantly associated with a 45% increased dementia risk after adjusting for sociodemographic covariates (adjusted Hazard Ratio [aHR]=1.45, 95% CI=1.14-1.84, p<.01), but this association was non-significant after further adjusting for health covariates (aHR=1.16, 95% CI=0.92-1.46, p=.20). Race-ethnicity was also not a significant moderator in the association between social isolation and dementia. Our results suggest older adults of color experience higher longitudinal frequency of social isolation. Despite the elevated dementia risk we observed among older adults with higher social isolation, race-ethnicity did not moderate this relationship. Future research is needed to investigate the underlying mechanisms contributing to racial-ethnic disparities for social isolation, and develop targeted interventions to mitigate the associated risk for dementia.
THE RELATIONSHIP BETWEEN SEDENTARY BEHAVIOR AND COGNITIVE DOMAINS AMONG PEOPLE LIVING WITH DEMENTIA
Authors: Patel Charmi , Lewis Stevie , Jehu Deborah
Published: December 2023

Greater sedentary behavior negatively impacts cognition among older adults without dementia; however, the relationship between sedentary behavior and cognitive domains among people living with dementia (PWD) is unclear. Our aim was to explore the association between sedentary behavior and cognitive domains in PWD in residential care facilities. The testing took place at one nursing home (n=15/23), one memory care unit (n=4/23), and one assisted living facility (n=4/23). Participants completed a battery of cognitive tests (global cognition: Montreal Cognitive Assessment; executive function: Trail Making test, Digit Span Backwards Test; perception and orientation: Benton Judgment of Line Orientation Test; language: Boston Naming Test; learning and memory: Rey Auditory Verbal Learning Test; complex attention: Digit Symbol Substitution Test). We used the Morse Fall Scale to measure fall risk. Participants wore an actigraphy monitor on their wrist over seven days to measure sedentary behavior. Most participants were male (74%), white (87%), and had unspecified dementia (48%). Participants were sedentary for 8.0±2.7 hours/day. The regression model for sedentary behavior was significant (R2=0.82, F(10, 12)=5.39, RMSE=92.47, p< 0.05). Greater sedentary behavior was associated with poorer language function (β=-0.82, p=0.02), poorer learning and memory (β=-0.82, p=0.002), and greater fall risk (β=-0.43, p=0.03). Sedentary behavior was not associated with the other cognitive domains. Greater sedentary behavior may indicate a decline in language function, learning and memory, and increase fall risk in PWD. Sedentary behavior should be considered in routine assessments, as it may play an important role in monitoring cognitive decline in PWD in residential care facilities.
THE RELEVANCE OF COGNITIVE ABILITIES IN FRAUD DETECTION
Authors: Zhang Shenghao , Charness Neil , Boot Walter
Published: December 2023

Some previous studies suggest that cognitive decline might be responsible for older adults being susceptible to phishing attempts and frauds, but results are not consistent. The current study utilized a structural equation modeling approach to examine the role of different cognitive abilities in fraud detection. We used data from the baseline of the Intervention Comparative Effectiveness for Adult Cognitive Training (ICE-ACT, NCT03141281) Trial. The sample included 230 cognitively normal community-dwelling older adults (Mean age = 72). Reasoning was measured by Raven’s Advanced Progressive Matrices and letter sets. Memory was measured by Hopkins Verbal Learning Test and Rey Auditory Verbal Learning Test. Processing speed was measured by Digit Symbol Substitution Test and Useful Field of View. Fraud detection was represented by d-prime score calculated from rating of fraudulence in 10 vignettes describing fraud and non-fraud scenarios. Latent factors were created for reasoning, memory, and processing speed. Results showed that reasoning, memory, and processing speed explained 14% of variance in fraud detection, however, none of those cognitive factors uniquely predicted fraud detection. A higher-order general cognitive factor indicated by the reasoning, memory, and processing speed factors significantly predicted fraud detection and explained 13 % of variance. These results showed that general cognitive abilities have a medium effect in fraud detection in cognitively normal community-dwelling older adults. Discussion will focus on implications of those results on training and interventions aiming to prevent fraud in older adults.
THE USABILITY AND ACCEPTABILITY OF THE AUGMENTED REALITY HOME ASSESSMENT TOOL (ARHAT)
Authors: Fields Beth , Skrove Zachary , Tredinnick Ross , Sprecher Bryce , Lee Jenny , Shields Rachael , Ponto Kevin , Shin Jung-hye
Published: December 2023

Gaining access to reliable home assessments for aging in place can be challenging and expensive for urban residents and particularly those living in rural areas. Evidence has shown that there is a substantial increase in the number of older adults nationally and globally, making the availability of home assessments scarce. As individuals continue to age and become more susceptible to disabilities it is important that they have a home that allows them to age in place and is compliant with housing standards. Technology has the potential to make home assessments more accessible to older adults who want to age in place. The aim of this study was to determine the usability and acceptability of a mobile-based app, the Augmented Reality Home Assessment Tool (ARHAT), across different groups interested in home assessment (occupational therapists (OTs), older adults/family caregivers, and housing professionals) (N=16). Participants were mailed an iPhone with the ARHAT installed. After participants reviewed the ARHAT, they were emailed an electronic survey with closed and open-ended demographic, usability and acceptability questions. The majority of participants were White (94%), female (75%), from the Midwest (63%), and had a Bachelor’s degree or higher (81%). Participants reported that the ARHAT is easy to use and acceptable for measuring features of the home environment and can support aging in place. Future research should test the impact of the ARHAT on improving health service utilization (e.g., delaying institutionalization, reducing emergency department visits) rates among older adults.
VOICES OF LOW-INCOME LATINO OLDER ADULTS: WHAT ARE THEIR PERCEIVED LEARNING IMPEDIMENTS?
Authors: Rodriguez Tania , Wu Rachel
Published: December 2023

Cognitive and functional health disparities between Latino and White older adults show that Latinos have a higher risk for developing Alzheimer’s and related dementias (ADRD) in the United States. Such risk compromises Latino’s likelihood of becoming healthy agers, which is of high concern as they are one of the largest and fastest-growing minoritized groups in the United States. Nonetheless, there is a lack of research aiming to understand how to increase their cognitive and functional abilities. One way of stimulating cognitive and functional growth is through learning of new skills. However, learning is a privilege, and this population may face unique barriers to learning that other racial/ethnic groups may not, especially if they have a low income. This qualitative study focused on identifying the barriers to novel skill learning engagement of low-income Latino older adults. A total of 20 low-income, Latino older adults were interviewed in Spanish over the phone utilizing a semi-structured interview protocol. Themes were derived from the data using a thematic analysis approach. Our results showed that the following barriers were most common among our participants: health problems (80%), lack of money (75%), lack of awareness/knowledge of learning opportunities (75%), lack of technology access/literacy (75%), lack of proficiency in the English language (65%), lack of reliable transportation (55%), and lack of motivation due to being “old” (50%). These findings help inform learning program leaders, policymakers, and future learning interventions on the barriers that should be addressed for minoritized populations.
INTEROCEPTIVE ACCURACY ENHANCES DECEPTION DETECTION WITH GREATER AGE
Authors: Ebner Natalie , Heemskerk Amber , Lin Tian
Published: December 2023

Financial exploitation of older adults is a growing concern, with millions of seniors scammed annually, costing billions, and resulting in devastating consequences for health, independence, and well-being. Exploitation risk is exacerbated in Alzheimer’s disease and related dementias (AD/ADRD). Detecting deception is challenging, especially for older adults who tend to believe others are truthful. Understanding the neurobiological mechanisms underlying this susceptibility is essential to design effective intervention toward reducing exploitation in aging. In this research we demonstrate the importance of interoceptive awareness─the ability to interpret body signals─in deception detection in older adults. Seventy-six young (18-34 years) and 74 older (53-82 years) adults completed a heartbeat counting task to assess their interoceptive awareness. They also engaged in deception detection paradigms across two distinct, ecologically valid tasks: i) a lie detection task in which they made veracity judgments of genuine and deceptive individuals, and ii) a phishing email detection task to capture accuracy in online deception detection. Greater interoceptive awareness was associated with greater lie detection accuracy. Furthermore, with greater chronological age among older adults, greater interoceptive awareness was associated with better accuracy in both detecting deceptive individuals and phishing emails. These findings support interoceptive awareness as a relevant factor for interventions aimed at enhancing deception detection abilities in aging. Project results will advance insight into the neurobiology of deception detection to inform effective translation into intervention in mitigating exploitation risk in aging and eventually ADRD.
OLDER LGBTQ+ PEOPLE’S PERSPECTIVES ON DISCRIMINATION AND AGEING IN THE UK: EMERGING FINDINGS FROM A TIMELINE STUDY
Authors: Thomas Michael , Prescott Amy , Victor Christina
Published: December 2023

This paper presents emerging findings from a United Kingdom study of socially inclusive ageing, reporting on timeline interviews with a sample of 25 LGBTQ+ people aged forty years and above, carried out during summer and fall of 2023. The research interrogates older LGBTQ+ people’s understanding of the impact of minority sexuality and gender identity on their lived experience and the ways in which this impacts their approach to challenges and opportunities linked to ageing. We draw on an innovative methodological approach, adapting Adriansen’s (2012) timeline interview method to fit the needs of older participants. Timeline interviews provide an approach to life-story research that structures a conversation around a written timeline, produced on paper during unstructured qualitative interviews. During the paper presentation we share anonymised timeline and narrative data highlighting milestones in individual biographies. We focus on moments and periods where sexuality and gender identity may have been a positive factor in individual life stories (romantic relationships, community membership) or have been seen as more problematic (discrimination, stigma and marginalisation). The timelines and associated interview data also provide opportunities to ground the biographies of older LGBTQ+ people in the context of social, cultural, political and policy contexts. The timelines reveal compelling data about ageing and identity, belonging and exclusion. Our emerging findings reflect C. Wright Mills’s concept of the sociological imagination, placing personal troubles and histories in the context of public issues. We gratefully acknowledge the funding this study has received from the United Kingdom Economic and Social Research Council.