bluuebunny/crossref_metadata_2025 huggingface dataset:
STABILITY AND CHANGE IN SOCIAL ISOLATION PROFILES OVER TIME AMONG OLDER ADULTS
Authors: Sung Pildoo , Chan Angelique
Published: December 2023

This study examined transitions in social isolation profiles over time and factors associated with them, using longitudinal data from 1,305 older adults in Singapore. While prior studies have investigated social isolation profiles that combine objective measures of social disconnectedness and subjective feelings of loneliness, less is known about the stability and change in these profiles over time. We utilized random-intercept latent transition analysis to identify social isolation profiles and their transition patterns over time. Multivariable regression then examined whether health and sociodemographic characteristics were associated with specific transitions of interest. The empirical analyses yielded three key findings. First, at baseline, about 10% of older adults were “disconnected and lonely,” while 30% were “disconnected but less lonely.” The remaining respondents were “connected and less lonely.” Second, at follow-up, 44% retained their baseline profiles, while 56% transitioned into different profiles. Third, older adults with lower socioeconomic status were more likely to transition from the “connected and less lonely” profiles to the disconnected and less lonely profile. Older adults with declining mental health were more likely to remain in or transition into the “disconnected and lonely” profile. In summary, approximately half of the older Singaporeans were socially disconnected, and one in five of them perceived loneliness occasionally or more often. Socioeconomically disadvantaged older adults were more likely to experience social disconnectedness over time, but this does not necessarily accompany loneliness. Rather, it is declining mental health that leads to both social isolation and loneliness, which calls for tailored interventions.
EFFECTS OF ENGAGEMENT IN PHYSICAL ACTIVITY BY INFORMAL CAREGIVERS ON THEIR QUALITY OF LIFE
Authors: A’Azman Shamirah , Sung Pildoo , Malhotra Rahul
Published: December 2023

Informal caregivers are more likely to have poorer health and wellbeing than non-caregivers. Studies have shown the health benefits of engagement in physical activity (PA) among caregivers. However, little is known about whether and how caregiver engagement in PA promotes or protects caregiver wellbeing. We examined (1) the association of caregiver engagement in PA with caregiver quality of life (QoL) and (2) the moderating effect of caregiver engagement in PA on the relationship between caregiving stressors and QoL. We used data on 278 care-recipient/caregiver dyads from the baseline interview of a longitudinal study of caregivers of older adults in Singapore. Multivariable regression first examined whether caregiver engagement in PA (assessed by number of days in a week with at least 30 minutes of PA, self-reported) was associated with physical, psychological, social, and environmental domains of QoL. Subsequently, interaction terms between caregiving stressors (care-recipient physical, memory, behavioral, and mood impairments) and caregiver engagement in PA were introduced and tested. We found that caregiver engagement in PA had a positive association with psychological, social, and environmental domains of QoL. Furthermore, caregiver engagement in PA mitigated the negative association between care-recipient mood impairment and caregiver QoL in the physical and social domains. Our findings suggest that QoL of informal caregivers of older adults may be improved or protected by their regular engagement in PA, especially if their care-recipients have mood impairments. Providers serving caregivers should encourage caregivers to engage in PA and equip them with the necessary support to do so.
HIGHER STRESS AMONG ETHNIC MINORITY ADULT-CHILD CAREGIVERS COMPARED TO SPOUSAL CAREGIVERS IN DEMENTIA CARE
Authors: Lee Jung-Ah , Ju Eunae , Kim Julie , Sabino-Laughlin Eilleen , Hong Seunghye
Published: December 2023

Ethnic minority family caregivers of persons with dementia (PWD) suffer from negative health conditions resulting from continuous care responsibility for PWD. While adult-child caregivers have additional family care and job responsibilities, cultural and linguistic needs in ethnic minority families further compound caregiving challenges. Little research examines ethnic minority caregivers’ health statuses. This study aimed to understand the emotional health status and dementia care experiences of minority caregivers, between spouses and adult-children. The study collected cross-sectional survey data on perceived stress and utilizations of caregiving resources: Alzheimer’s agencies, state-funded in-home supportive service, adult-day service, support groups, and caregiving education. Recruitment focused on diverse communities with special emphasis on minority caregivers who speak Spanish, Vietnamese, or Korean in California. Seventy-six caregivers participated in surveys in their respective language; 42% Korean, 38% Vietnamese, 20% Spanish; 49% spouses/partners vs 51% adult-children/grandchildren; 78% females; 55% PWD with Medicaid; Mean English Proficiency (EP) of 3/5(1.3). Sixty-four percent of adult-child caregivers were employed (full-time or part-time) compared to 5% of spousal caregivers (P<.05). Adult-child caregivers showed higher stress compared to spousal caregivers (P<.05) despite no differences in PWD’s activities of daily living (ADL) scores and instrumental ADL scores. Although EP of adult-child caregivers was higher than spousal caregivers (P<.05), both caregivers underutilized care resources and showed little awareness of Alzheimer’s agencies. Findings demonstrated higher caregiving stress of adult-child caregivers compared to spousal caregivers of PWD among minority groups. Tailored interventions with appropriate language and cultural aspects should consider the caregiver’s relationship to the PWD.
RURAL–URBAN DIFFERENCES IN INFORMAL CAREGIVER RESOURCES, CAREGIVING INTENSITY, AND HEALTH-RELATED QUALITY OF LIFE
Authors: Cohen Steven , Ahmed Neelam , Greaney Mary
Published: December 2023

Rural-urban health disparities are pervasive among older adults and their caregivers. Rural areas in the US have a disproportionately high population of older adults, have reduced access to services, and are more reliant on family and friends for care. Research examining rural-urban disparities for informal caregivers is limited. There is a critical need to understand how caregiving intensity, access to resources, and caregiver health-related quality of life (HRQoL) differ by rural-urban status. Study objectives were to explore rural-urban differences in caregiving resources, intensity, and HRQoL. Data were abstracted from Waves 1 and 5 of the National Study of Caregiving. Rural-urban status was based on Rural Urban Continuum Codes. Generalized linear models, accounting for complex sampling, were used to explore associations between rural-urban status and caregiver resource utilization, caregiving intensity, and HRQoL. Compared to urban caregivers, rural caregivers were significantly more likely to be female (OR 1.19, 95%CI 1.12-1.26), older (beta=1.13 years, 95%CI 0.70-1.55), have obesity (OR 1.25, 95%CI 1.17-1.32), report poor/fair health (OR 1.08, 95%CI 1.01-1.16), and higher numbers of comorbidities (beta=0.18, 95%CI 0.13-0.22). Compared to urban caregivers, rural caregivers were significantly less likely to attend support groups (OR 0.55, 95% CI 0.46-0.65), but more likely to have caregiver training (OR 1.46, 95%CI 1.33-1.62). They assisted with fewer instrumental activities of daily living (beta=0.54, 95%CI 0.44-0.65), although there was not a significant difference for activities of daily living. Findings can facilitate the translation and adaption of policies, programs, and interventions to support and address the unique needs of rural caregivers.
UNPAID CAREGIVERS’ PROCESS OF COLLABORATING DURING OLDER ADULT HOSPITAL TO HOME TRANSITIONS
Authors: Liebzeit Daniel , Geiger Olivia , Jaboob Saida , Bjornson Samantha
Published: December 2023

Unpaid/family caregivers often provide support critical to older adult hospital to home transitions, but commonly lack time and preparation for their role. There is limited evidence regarding important collaboration and resources for caregivers during the transition. The objective of this grounded theory study was to examine caregivers’ process of collaborating with others during older adult hospital to home transitions. Interviews were conducted with unpaid caregivers of adults aged 60 and older and recently discharged from a medical/surgical unit at a large Midwestern teaching hospital, were audio-recorded, and transcribed verbatim. Data were analyzed using open, axial, and selective coding. Caregiver participants (N = 16) included spouses (n = 8), friends (n = 4), children (n = 3), and siblings (n = 1) of an older adult transitioning from hospital to home, were mostly female (n=14), and all were white, non-Hispanic. A conceptual model was developed which illustrates participants’ process of collaborating with a caregiving team, providers, networks, and other resources to support themselves and their older person. The process began with the participants taking on and identifying their role, and ultimately led to either supporting their older person’s progress towards independence or providing long-term caregiver support. Conditions, including finances, caregiver health, expectations, proximity, and availability, impacted the collaborative process. Consequences varied based on participants’ approach to caregiving, such a team versus individual approach. Implications include opportunities to promote active engagement of caregivers in the transition process and facilitation of a team-based approach to supporting the older person and caregivers.
THE DEVELOPMENT OF RELOAD-C, A WEB-BASED PLATFORM TO REDUCE LONELINESS IN CAREGIVERS OF PERSONS WITH ADRD
Authors: Marziliano Allison , Applebaum Allison , Burns Edith , Gieniusz Marzena , Mongelli Jessica , Patel Priya , Babar Huma , Diefenbach Michael
Published: December 2023

There is a need for effective evidence-based interventions to reduce loneliness in caregivers of persons with Alzheimer’s Disease and Related Dementias (ADRD). Interventions to reduce loneliness may be strengthened by incorporating concepts from Meaning-Centered Psychotherapy (MCP), effective in increasing meaning in life in patients with advanced cancer and their caregivers. Our central hypothesis is that concepts from MCP can be adapted for caregivers of persons with ADRD to reduce their loneliness through increasing their sense of meaning and purpose in life. Our purpose is to describe the development of RELOAD-C (REducing LOneliness in Alzeheimer’s Disease-Caregivers), a web-based platform that delivers MCP concepts, adapted for ADRD caregivers, via 6 brief videos, 7 virtual peer group meetings, and written content. The development of RELOAD-C occurred in 3 stages: 1) Preparatory Work/Adaptation of scripts from 6 existing MCP videos. 2) Stakeholder Involvement. N=15 AD/ADRD caregivers underwent individual interviews to provide expert feedback on the scripts. 3) Development of RELOAD-C. In collaboration with web specialists, RELOAD-C is created by integrating adapted MCP videos, links to virtual peer groups to discuss MCP concepts, and written MCP content. Input from stakeholders indicated: 1) preference for terminology (e.g., “caregiver” over “care partner”); 2) removing MCP content that urges caregivers to engage in complex conversations with the care recipient; 3) providing an explanation of ambiguous concepts (e.g., “unfinished business”); and 4) re-ordering the delivery of the MCP concepts. RELOAD-C is the product of multiple rounds of review by a multidisciplinary team and ADRD caregivers as expert stakeholders.
NOBODY CAN DRAG ME DOWN: AGING AS A DRAG PERFORMER
Authors: Donorfio Laura , Henneberry Kathleen , Chapman Brian
Published: December 2023

This presentation will detail the findings of an exploratory, qualitative research study examining the intersection of aging and drag performance. Even though drag queens have achieved significant levels of visibility in mainstream entertainment and have become increasingly present topics of discussion in news outlets, modern media, and even political landscapes, they are an understudied and underrepresented population (Knutson et al., 2020; O’Brien, 2018). Older drag queens have yet to be studied in the social science literature (Henneberry et al., 2022). “Drag Queens possess unique characteristics as a subpopulation of the lesbian, gay, bisexual, and transgender (LGBT) community that warrant exploration” (Knutson, Koch, Sneed, & Lee, 2018). This research aims to understand and represent the relatively understudied population of drag queens in academic literature while drawing attention to the specific sub-population of older adults in the profession. A semi-structured interview protocol and thematic analysis was utilized to understand the unique perspectives of self identified drag performers over the age of 50 (n=15; ages 54-94). Examining drag artistry and expression through the lens of aging has revealed themes of drag as a form of armor, ageism within the community, and shifts in social perceptions of drag performers. This presentation will introduce the term “dragism” in an attempt to explain the discrimination against drag queens within the LGBTQ+ community, as well as the interplay of both dragism and ageism for the participants of this study (Donorfio et al., 2022).
AGE AND STRESSOR-RELATED NEGATIVE AFFECT IN OLDER ADULTS: CROSS-SECTIONAL AND LONGITUDINAL EVIDENCE
Authors: Ferguson Giselle , Zavala Daisy , Corley Samantha , Scott Stacey
Published: December 2023

Most daily stress studies show stressor-related increases in Negative affect (NA), but older adults may show smaller increases due to emotion-regulation skills. However, most of this work is based upon single burst diary or ecological momentary assessment (EMA) studies which are functionally cross-sectional age comparisons; longitudinal analyses are needed to reveal whether individuals change as they age. In this secondary analysis of data from a measurement burst study of older adults in Bronx, NY (N=305; Mage=76.98), we examined how age interacted cross-sectionally and longitudinally with the effect of stressors on NA. Between 2017- (pre-pandemic) 2020, participants completed up to three 14-day EMA bursts. Five times daily, they reported current NA and whether a stressor had occurred since the last assessment. In a 4-level multilevel model accounting for demographics, Neuroticism, and stressors, NA was significantly higher with reports of stressors, including at the moment-level, day-level, and person-level. Regarding aging’s role in average NA for non-stressor moments, there were not significant cross-sectional age differences, but longitudinally across three bursts, NA increased significantly within-persons. We did not find evidence for cross-sectional age differences nor longitudinal change in the stressor-NA slope. Although neither cross-sectional age differences nor longitudinal change was found in the stressor-NA slope, we found significant longitudinal increases in non-stressor NA as individuals aged. Our results illustrate the value of measurement burst designs for disentangling differences between cross-sectional and longitudinal effects in daily processes. Further research on aging-related differences in affect and stress would benefit from these approaches.
DAILY EMOTION REGULATION AND AFFECT ACROSS WORK AND FAMILY CONTEXTS IN MID LIFE
Authors: Nichols Madeline , Chandler Kelly
Published: December 2023

Emotion regulation is an important skill for adults to use in interpersonal situations; however, limited research has examined whether emotion regulation strategies vary by context or the potential influences these strategies have on daily affect. We examined the frequency of emotion regulation strategies used in work and family contexts and the extent to which these strategies predicted daily positive and negative affect (PA; NA). Middle-aged adults (N=27, Mage=60.15, SD=3.77; Female=91.67%) completed 7 daily diary surveys. In both contexts, adults most often reported modifying situations to be more positive and using situational approaches. At work, adults also frequently expressed their emotions; at home, they reported modifying situations to be less negative. Preliminary multilevel model results indicated that NA was significantly higher on days when individuals reported distracting themselves from work situations (Est.=7.36, p<.01), suppressing emotions at work (Est.=3.29, p<.01), or expressing emotions around family (Est.=4.41, p<.01) compared to days when they did not use these strategies; conversely, on days when individuals distracted themselves from family situations, they reported lower NA (Est. =-2.80, p=.03) than on days they did not. On average, people who modify family situations to be more positive report higher PA (Est.=6.73, p<.01) than those who do not. Our results suggest that there is daily variability in emotion regulation strategy use and consequential impacts on affectual wellbeing by context. Understanding which emotion regulation strategies yield the most benefit in different contexts may inform interventions targeting emotion regulation as a modifiable behavior to promote health and wellbeing in later life.
SELF-RATINGS OF HEALTH BY AGE AND BIRTH COHORT: FOR WHOM DO THEY PREDICT MORTALITY?
Authors: Idler Ellen , Dore Emily
Published: December 2023

Global self-rated health as a predictor of mortality has become one of the most reliable outcomes in population-based follow-up studies. However, few studies focus on age or birth cohort differences in the mortality predictiveness of self-ratings of health. Personal knowledge of health accumulates throughout the life course, leading to the hypothesis that self-rated health would be most predictive in old age or in earlier birth cohorts. However, the pronounced effect of self-rated health on mortality means that those with the higher mortality risk of poor self-rated health in earlier adulthood would be less likely to survive to old age, potentially diminishing the effect through selective survival. In this paper we test for potential variations in the effects of age and birth cohort on the association between self-rated health and mortality in a large sample of adults aged 25-101 in the Panel Study of Income Dynamics (N=6437) followed from 1999-2019. We ask if self-rated health -- net of sociodemographic factors, physical and mental health conditions, and health risk behaviors – is equally predictive of mortality in three age groups spanning young, middle, and late adulthood, and in four birth cohorts. Fully adjusted models show that self-rated health was the most predictive for the group aged 41-64, and for those born 1946-1980, and that there were nearly null effects for those aged 25-40 or born 1981-1994. Thus, the effects of self-rated health on mortality vary by age and cohort, in ways that support both knowledge-based and selective survival interpretations of the association.
DEMYSTIFYING IMPACTS OF NEIGHBORHOOD ENVIRONMENT ON HEALTH OF OLDER CHINESE AMERICANS
Authors: Jiang Yanping , Tang Fengyan
Published: December 2023

Residential segregation is a key social determinant of health that disproportionately affects racial/ethnic minority and immigrant populations. The health impact of residential segregation and subjective neighborhood environment, however, is poorly understood among older Asian Americans. Findings from the limited existing studies on this topic exclusively relied on cross-sectional data and/or masked distinctive differences across Asian subgroups due to the usage of aggregated data. The purpose of this symposium is to provide a better understanding of health impacts of residential segregation and subjective neighborhood environment among older Chinese Americans, the largest Asian subgroup in the U.S. Findings presented in this symposium were from the Population Study of Chinese Elderly in Chicago (PINE) study, a longitudinal study of community-dwelling older Chinese immigrants living in greater Chicago. Session 1 describes key characteristics of neighborhood, sociodemographic, and health behaviors of older Chinese immigrants living in segregated neighborhoods. Session 2 moves beyond to determine unique and joint effects of residential segregation and neighborhood socioeconomic status on 8-year change in cognitive functioning. Session 3 focuses on mental health by investigating main and indirect effects of residential segregation on depression via social processes. Session 4 tests the interactive effects of social support with residential segregation on cognitive functioning and depression. Lastly, Session 5 demonstrates how subjective neighborhood environment, directly and indirectly, affects depression via coping. In sum, findings provide innovative and important evidence to facilitate a better understanding of health implications of living in segregated neighborhoods among older Chinese Americans.
PATIENT PRIORITIES CARE: THE PAST, THE PRESENT, AND THE FUTURE
Authors: Naik Aanand
Published: December 2023

Healthcare based on patient goals can improve the care of older adults, particularly those with MCC. Prior studies have identified five healthcare values that guide how patients establish healthcare goals and make medical decisions: 1) Self-sufficiency, 2) Enjoyment, 3) Connection, 4) Balancing quality and length of life, 5) Engagement in care. The Patient Priorities Care (PPC) approach is an evidence-based approach that allows patients to identify their healthcare values, or what matters most to them, and identify one thing, the most important goal they want to address based on their healthcare preferences. We have demonstrated that PPC is feasible and results in less burdensome care, including fewer medications and referrals to specialists. In the VA system, we have also shown that PPC helps clinicians recommend home and community services that are aligned with the patient’s priorities. To enhance its relevance for Veterans, African Americans, and Hispanics, a deliberate effort to adapt PPC has been used at different institutions. We believe that evidence-based interventions like PPC can help address health disparities by: 1) improving communication between healthcare providers and patients with different beliefs, race, ethnicity, and culture; and 2) aligning prevention and timely treatment with the health priorities of older adults with MCC. We will review what we have learned from PPC thus far. We will then describe current efforts to implement PPC in a more effective and sustainable manner and disseminate it in diverse healthcare systems. Finally, we will share our vision moving forward and opportunities for collaboration and growth.
FORMATIVE EVALUATION TRIAL OF THE “MY HEALTH PRIORITIES” PROGRAM IN SOUTHERN OLDER AFRICAN AMERICANS: THE BHIP STUDY
Authors: Ejem Deborah
Published: December 2023

Older African Americans (AA) with multiple chronic conditions (MCCs) living in the Deep South are less likely to have access to early palliative care (PC) despite experiencing higher symptom burden and healthcare use, and poorer communication around goals of care. This disparity in PC use may partly be due to a lack of culturally-responsive care practices that effectively activate AAs with MCCs to identify their own values and priorities for end-of-life care. We conducted a formative evaluation of the web-based, self-directed “My Health Priorities” Identification Program to determine cultural acceptability and feasibility of use among AAs with MCCs in a primary care setting. We are now recruiting 20 AA patient with MCC and caregiver dyads from UAB Kirklin Primary Care Clinic. Recruited dyads will complete the “My Health Priorities” program and participate in semi-structured acceptability interviews. Patients and caregivers will also complete pre- and post-test measures of perception of care, treatment burden, shared decision-making, and communication exchange. Preliminary findings from six dyads suggest that the current program lacks spirituality-specific content. Dyads also expressed that the exemplar character included in the program was not relatable or representative. Overall, participants stated that the program was useful in helping them to think about and articulate their healthcare values and priorities. The findings from the research will directly inform a small-scale pilot grant that will assess the acceptability, feasibility, and potential efficacy of a values solicitation and operationalization intervention for AAs with MCCs and caregivers.
COMPARATIVE TRANSCRIPTOMICS AND PROTEOMICS ACROSS SPECIES
Authors: Gorbunova Vera
Published: December 2023

Mammals differ more than 100-fold in maximum lifespan. Here, we conducted comparative transcriptomics on 26 species with diverse lifespans. We identified thousands of genes with expression levels negatively or positively correlated with a species’ maximum lifespan (Neg- or Pos-MLS genes). Neg-MLS genes are pri- marily involved in energy metabolism and inflammation. Pos-MLS genes show enrichment in DNA repair, microtubule organization, and RNA transport. Expression of Neg- and Pos-MLS genes is modulated by interventions, including mTOR and PI3K inhibition. Regulatory networks analysis showed that Neg-MLS genes are under circadian regulation possibly to avoid persistent high expression, whereas Pos-MLS genes are tar- gets of master pluripotency regulators OCT4 and NANOG and are upregulated during somatic cell reprogramming. Pos-MLS genes are highly expressed during embryogenesis but significantly downregulated after birth. This work provides targets for anti-aging interventions by defining pathways correlating with longevity across mammals and uncovering circadian and pluripotency networks as central regulators of longevity. I will also discuss integrating this transcriptome and proteome data.
STRATEGIES OF LIFESPAN REGULATION WITHIN AND ACROSS SPECIES
Authors: Gladyshev Vadim
Published: December 2023

Lifespan varies within and across species, but the general principles of its control remain unclear. We conducted multi-tissue RNA-seq analyses across mammalian species, identifying longevity signatures and examining their relationship with transcriptomic biomarkers of aging and established lifespan-extending interventions. Signatures of long-lived species were positively correlated with age-related changes and enriched for evolutionarily ancient essential genes. Conversely, lifespan-extending interventions counteracted aging patterns and affected younger, mutable genes enriched for energy metabolism. The identified biomarkers revealed new longevity interventions. We further developed a transcriptomic clock that quantifies progression through lifespan and reports the effects of longevity interventions. Overall, this work uncovers universal and distinct strategies of lifespan regulation within and across species and provides tools for quantifying aging and discovering longevity interventions.
IMMUNE AGING AT SINGLE-CELL RESOLUTION
Authors: Artyomov Maxim
Published: December 2023

I will discuss how single-cell resolution approaches reveal aspects of immune aging in tissues and in circulation. We will discuss comparison of immune aging in mouse tissues, accumulation of GZMK+ CD8 T cells and their human counterparts that accumulate in blood. We will discuss analysis of scRNA-seq profiling of PBMC along the healthy aging (317 samples from 25 to 85yo) and emerging subpopulation and antigen receptor changes during aging.
ATLAS-SCALE SINGLE-CELL DATA SCIENCE REVEALS SIGNATURES OF AGING AND REJUVENATION
Authors: Palovics Robert
Published: December 2023

The use of recent high-throughput transcriptomics technologies allows us for the first time to study aging at an unprecedented granularity and temporal resolution. This talk aims to provide insights into aging and heterochronic parabiosis, a model for systemic rejuvenation, by studying an atlas-scale single-cell dataset encompassing >100k cells across 20 organs and 50 cell types in young and aged mice as well as in parabionts. We will explore the age mimicking and age reversing effects of parabiosis within each cell type, identify parabiosis mediated rejuvenation signatures that appear throughout the whole body, and present a structural overview of aging and parabiosis across different organs.
LIVING WELL WITH MILD TO MODERATE DEMENTIA. FINDINGS FROM THE IDEAL PROGRAM: A BRITISH COHORT STUDY
Authors: Clare Linda , Victor Christina
Published: December 2023

IDEAL (Improving the Experience of Dementia and Enhancing Active Life) is a British-based cohort study that commenced in 2014 and recruited 1545 people with dementia and 1277 carers, following them for 3 waves at yearly intervals. IDEAL-2 continued to follow those who remained in the study for a further 3 waves and incorporated 205 additional participants as part of an enrichment cohort. A key research and policy goal is to understand the factors that promote or inhibit ‘living well’ for people with dementia and their carers, defined as the best achievable state of physical, mental and social health. In this symposium we examine how living well outcomes vary longitudinally and with social (minority ethnic status) factors. Two papers focus on quality of life of people with dementia longitudinally. Our first paper shows that for most study participants quality of life scores remained stable. For those with declining quality of life key associated factors include demographic characteristics, cognition, and psychological health including depression. Our second paper has a clinical dimension and demonstrates that, beyond the point of diagnosis, quality of life does not vary according to dementia subtype. Our third paper focuses on social health using social isolation as our measure. Isolation increased over time and was higher in carers than people with dementia. Our final paper demonstrates that, compared with their white British counterparts, minority ethnic carers report higher stress and role captivity and lower relationship quality while people with dementia have lower quality of life and higher loneliness.
DEMENTIA SUBTYPES AND LIVING WELL IN PEOPLE WITH MILD TO MODERATE DEMENTIA. LONGITUDINAL FINDINGS OVER SIX YEARS
Authors: Clare Linda , Martyr Anthony , Gamble Laura , Matthews Fiona
Published: December 2023

The heterogeneity of symptoms across dementia subtypes has important implications for clinical practice and dementia research. Variations in subtypes and associated symptoms may influence capability to ‘live well’ for people with dementia. In this paper we investigate the potential impact of dementia subtypes on the quality of life of people with dementia. We used longitudinal data from 1749 individuals with mild-to-moderate dementia participating in the IDEAL and IDEAL-2 studies. Assessments took place on entry and were followed up at 12, 24, 48, 72 and 96 months. We examined change in quality of life post diagnosis and associations with dementia subtypes using mixed effects models. Slightly more than half of participants , 52.4%, had a diagnosis of Alzheimer’s disease, 10.2% vascular dementia and 19.8% mixed Alzheimer’s and vascular dementia. Rarer subtypes of dementia, frontotemporal, Parkinson’s type, Lewy bodies accounted for 17.6% of participants . Dementia subtype had the greatest associations with quality of life at the time of diagnosis. Compared to individuals with Alzheimer’s disease, those with Parkinson’s disease dementia (-4.89, 95% CI: -6.60 to -3.417) and dementia with Lewy bodies (-4.90, 95% CI: -6.38 to -3.42) had relatively poorer quality of life at baseline. The difference in quality of life for people with vascular dementia (-1.70, 95% CI: -3.55 to -1. 35) and mixed Alzheimer’s and vascular dementia (-1.70 95% CI:-2.47 to -0.92) was less marked. There was little change in quality of life longitudinally and no difference in quality-of-life trajectories by dementia subtype
BRIDGE GERIATRIC WORKFORCE EDUCATION CURRICULUM BETWEEN 4M COMPETENCIES AND INTERDISCIPLINARY EDUCATION
Authors: Yoo Ji , Shen Jay , choe Ian , Tabrizi maryam , Ioanitoaia-Chaudhry Iulia
Published: December 2023

In a provider shortage area, education priority strategy is more practical rather than structure investment priority strategy. In aims of establishing Age-Friendly Community in this state where primary care provider number per capita ranks 50th state, 4Ms (What Matters, Mobility, Medication, Mentation) based interdisciplinary education across medicine, dental, pharmacy, nursing, social work, physical therapy were developed and implemented. We evaluated the impact of 4Ms application on healthcare providers education by measuring served patient outcomes (1) CMS defined Merit Incentive Payment System, patient satisfaction, and healthcare cost and (2) education outcomes of healthcare providers using 4M education competencies. We adopted STEPPS interprofessional communication skill toolkit and applied simulation training with standardized patients.
EVALUATE THE IMPACT OF INTERDISCIPLINARY EDUCATION AND TELEHEALTH PRIMARY CARE: QUALITY AND EFFICIENCY
Authors: Shen Jay , Yoo Ji , Kim Pearl
Published: December 2023

In a provider shortage area, an Interprofessional Education and Telehealth Primary Care (IPETC) for geriatrics workforce was developed in 2020. To analyze the impact of IPETC on quality and efficiency of care, we measured quality outcomes defined by the CMS defined quality measures - dementia caregiver education/referral and advance care plan, and efficiency outcomes by estimating healthcare cost savings from reducing hospitalization. Fifty eight community-dwelling adults aged 67 to 94 with mild to moderate dementia were selected in an urban safety-net primary care clinic. Propensity - demographics and level of physical impairment was matched. Main outcomes were (A) hospitalization-related healthcare cost estimates from the State Inpatient Dataset using the ICD-10 codes of principal diagnosis and hospital length of stay between January-December 2021. Twenty nine patients were cared by primary care providers who received the IPETC;29 patients were by those who did not have the IPETC; (2) CMS quality measures were compared between 2019 (baseline) and 2021. An average cost-saving of $22,135 per patient was observed among those treated by the healthcare providers who received the IPE/telehealth curriculum training than those treated by the providers without the training. CMS quality measures improved from 15.6% to 51.0% in dementia caregiver education/referral; 10.8% to 42.8% in documented advance care plans. Innovative interdisciplinary education and telehealth primary care has shown improvement of quality and efficiency of dementia care in a provider shortage area.
TECHNOLOGY-ASSISTED CARE PLANNING IN PRIMARY CARE OF A PROVIDER SHORTAGE AREA
Authors: Kang Mingon , Kim Laurie , Yoo Ji
Published: December 2023

We applied faireness algorithm to identify and mitigate bias in healthcare system. We also developed DeepPlan soft that can assist primary care providers, patients and caregivers with providing real-time risk prediction system, for example, discussing nursing home placement and designation of power of attorney. Our DeepPlan was built using cloud database system than can be exchangeable in secure way between patients and primary care providers. We linked DeepPlan use to workforce education and now we are ready for presenting education and patient clinical outcomes of using DeepPlan in primary care in a provider shortage area.
EPIDEMIOLOGIC GEROSCIENCE INNOVATIONS AT THE NEXUS OF REPRODUCTIVE AGING AND WOMEN’S HEALTH
Authors: Shardell Michelle
Published: December 2023

Signs of reproductive aging in women usually begin in women’s 30s and co-occur with declining circulating estrogen concentrations and irregular menstrual cycle onset. Menopause, defined by cessation in menstruation for ≥1 year, occurs on average at age 51 years, but about 1% experience menopause before age 40. Menopause and reproductive aging contribute to multiple health conditions such as certain cancers; however, a less studied condition is the genitourinary syndrome of menopause (GSM). GSM signs and symptoms include vulvovaginal atrophy, vaginal dryness, urinary tract infections, and more. Additionally, menopause leads to increased risk of osteoporosis, dementia, and other aging-related conditions. Given the multifactorial implications of reproductive aging in women’s health, an interdisciplinary geroscience-guided framework for epidemiology of aging is needed to identify biological contributors and consequences of reproductive aging to develop healthspan-enhancing interventions. In this symposium, we present five new developments across multiple stages of reproductive aging, consistent with meeting theme “Building Bridges. Catalyzing Research. Empowering All Ages”. Among women aged 35-60 years, we assess the role of cervical “inflamm-aging” in GSM; diabetes and vaginal dysbiosis associations with GSM; and vaginal microbial and metabolic signatures of urinary conditions/dysfunction. Among women aged ≥65 years, we examine associations of post-hip fracture sex hormones with physical recovery and links between age and type of menopause with Alzheimer’s disease. Building on the 2021 Journals of Gerontology Series A special issue on intersections of reproductive and aging biology, we discuss opportunities to advance reproductive aging and women’s health research by combining molecular assessment with rigorous epidemiology. This is a collaborative symposium between the Epidemiology of Aging, Geroscience, and Women’s Issues Interest Groups.
ASSOCIATIONS OF URINARY CONDITIONS WITH VAGINAL MICROBIOTA AND METABOLITES ACROSS REPRODUCTIVE STAGES
Authors: Shardell Michelle , Robbins Sarah , Borgogna Joanna-Lynn , Stennett Christina , Yeoman Carl , Burke Anne , Ravel Jacques , Brotman Rebecca
Published: December 2023

The genitourinary syndrome of menopause describes signs/symptoms of the female genitourinary tract, including urinary symptoms/conditions, resulting from declining estrogen in menopause. Menopause is also associated with declining abundance of Lactobacillus spp. in the vagina. Vaginal and urinary microbiota are highly concordant, where low abundance of certain Lactobacillus spp. have demonstrated associations with urinary symptoms/conditions. The vaginal microenvironment also includes microbially- and host-produced metabolites that may impact genitourinary health. Thus, we aimed to identify vaginal microbial and metabolic signatures of urinary conditions. In a two-year cohort study comprising 476 participants aged 35-60 years who contributed 1,153 semiannual person-visits, 15.2% (27/178) postmenopausal and 10.4% (31/298) non-postmenopausal participants self-reported a history of urinary conditions (overactive bladder, recurrent urinary tract infection[UTI], or cystitis). Among postmenopausal participants, history of urinary conditions was associated with higher covariate-adjusted odds of L. gasseri-dominated (OR[Odds Ratio]=4.29, 95% Confidence Interval[CI]=1.31-14.88) versus L. crispatus-dominated communities. Significant metabolites were enriched for the lipids sphingomyelins and metabolites involved in glycolysis (P<.05). Urinary conditions were associated with joint microbiota-metabolite profiles characterized by higher sphingomyelins, pyruvate, and genera Varibaculum and Escherichia; and lower dihydroxyacetone phosphate, nicotinamide, Gardnerella vaginalis, and genus Fusobacterium (P<.001). In contrast, among non-postmenopausal participants, urinary conditions did not significantly relate to microbial community (P>.10); however, sphingomyelins remained significantly enriched (P<.05). Signatures among postmenopausal participants include known UTI pathogen E. coli and metabolites that may facilitate and fuel its growth. Among non-postmenopausal participants, urinary conditions more strongly related to metabolic profiles than microbiota. Investigation of these signatures in incident/recurrent urinary conditions is needed.
HEALTH BEYOND DISEASE IN OLD AGE: RELATIONSHIP OF INTRINSIC CAPACITY WITH HEALTH CARE UTILIZATION
Authors: Si Yafei
Published: December 2023

In contrast to the traditional disease-centered approach, intrinsic capacity (IC) is a fine-grained and comprehensive measure of overall health. It plays an essential role in the healthy aging model proposed by the World Health Organization. However, how IC contributes to healthcare utilization and medical expenditures beyond the presence of chronic conditions in old age is not well understood. Data were from the China Health and Retirement Longitudinal Study. We used a validated, multidimensional tool (locomotor, cognitive, psychological capacity, sensory capacity, and vitality) for assessing IC at baseline (Wave 2011). Outcomes include outpatient and inpatient use, and their expenditure measured in Wave 2013. We used logistic and linear regression models to identify the association of IC with healthcare utilization, adjusting for demographics, lifestyles, and multi-morbidity (the presence 2+ out of 14 chronic conditions). We included 14,887 participants, and equally categorized them into three groups (low, intermediate, and high IC). Compared with those with a low IC, older adults with an intermediate level or high level of IC had a significant reduction of outpatient use (OR=0.80, 95% CI=0.72-0.90; OR=0.61, 95% CI=0.53-0.69) and inpatient use (OR=0.69, 95% CI=0.58-0.81; OR=0.58, 95% CI=0.49-0.70), after adjusting for demographics, lifestyles, and multi-morbidity. We did not find a significant association between IC and healthcare expenditure. Assessment of IC for older adults provides valuable information for healthcare use beyond chronic conditions. Assessment of IC in routine clinics may help screen for older adults with high healthcare utilization, which could optimize the allocation of healthcare resources and improve patient-centered care.
ENHANCING CARE FOR OLDER VETERANS WITH COMPLEX PHYSICAL, COGNITIVE, AND PSYCHOLOGICAL COMORBIDITIES
Authors: Gregg Jeffrey , Gould Christine , Karel Michele
Published: December 2023

Older veterans present in healthcare settings with more diagnoses than younger veterans and non-veteran older adults. Older veterans are also more likely to present with co-occurring physical, cognitive, and psychological conditions that are difficult to assess and treat. This is further complicated by the fact that many older veterans reside in rural areas without easy access to specialty care and, even in non-rural settings, there is a dire shortage of providers with geriatric expertise both within and outside of the Veterans Health Administration (VHA) system. The current symposium highlights promising findings from a variety of VHA programs aimed at enhancing the quality and reach of care provided to older veterans with complex needs. First, Dr. Bamonti will present mixed-methods results from her work in the development of Step-Cognitive Behavioral Therapy, a novel virtual intervention for older veterans with COPD. Second, Ms. Carlson will describe program evaluation outcomes from a project aimed at expanding geriatric mental health services via telehealth to older veterans with complex needs residing in rural areas. Third, Dr. Peeples will discuss factors affecting the implementation of the VA Behavioral Recovery Outreach Team model, which is aimed at facilitating successful discharge from inpatient settings and preventing rehospitalization for older veterans. Finally, Dr. Gregg will describe qualitative findings examining a component of the Geriatric Scholars Program for Psychologists, a national post-licensure training program for psychologists treating older rural veterans with complex needs. Dr. Karel, National Director of VHA Geriatric Mental Health, will close with discussion and highlight future directions.
BUILDING COMMUNITY RELATIONSHIPS FOR MORE MEANINGFUL ENGAGEMENT WITH OLDER BLACK ADULTS
Authors: Fuller Patrice , Fennell Charles , Lindauer Allison , Croff Raina
Published: December 2023

Black people are grossly underrepresented in clinical trials, especially in Oregon, where only 2% of the population is Black. The Oregon Alzheimer’s Disease Research Center’s (OADRC) Outreach, Recruitment, and Engagement (ORE) Core aims to correct this disparity by promoting research participation, fostering retention, and supporting quality experiences for Black Oregonians. Essential to this goal has been having an ORE Core that is 50% Black, leaders experienced in Black-centered cognitive health research, and a team that demonstrates commitment to community partnerships. The ORE Core engages a Community Outreach Specialist (COS) whose efforts reflect our Core’s value of “service before sign-up.” The COS differs from a traditional “recruiter” in that the focus is on community relationship-building, rather than recruitment. This can only be supported by first serving the community (e.g., joining community boards, volunteering) before asking community members to sign-up for research. The OADRC promotes research participation by supporting studies that focus exclusively on older Black health. The African American Dementia and Aging Project, supported by a valuable community health partnership, aims to understand lifestyle factors affecting cognitive health. The Sharing History through Active Reminiscence and Photo-imagery Study (SHARP) aims to improve brain health through a culturally celebratory framework centering the Black experience. As a result, SHARP has sustained high retention rates and increased Black participation in Center research. We discuss the role of ORE Cores, the role, values, and reflections of our COS, and examine how Center studies foster sustained community relationships, ultimately for more meaningful engagement within the Black community.
FROM CELLS TO SYSTEMS
Authors: Kheirbek Raya , Latham-Mintus Kenzie
Published: December 2023

Individuals who have been incarcerated may experience chronic pain due to various reasons, such as physical injuries sustained during their time in prison, untreated chronic medical conditions, or addiction to prescription medications. The pain may persist into late life, resulting in reduced quality of life, increased healthcare costs, and limited access to end of life care and hospice services. This issue requires collaboration among experts in pain management, geriatrics, and palliative care to develop effective interventions that address the unique needs of this population. Suicide among veterans is another pressing issue that requires an interdisciplinary approach. Incarcerated veterans may face numerous challenges upon release, including limited access to healthcare and social support, economic instability, and the stigma associated with a criminal record. These factors may contribute to increased risk of suicide. Addressing this issue requires a collaborative effort among experts in mental health, social work, and criminal justice to develop comprehensive programs that provide support for veterans transitioning from incarceration to civilian life. Being imprisoned can have lasting negative health consequences that persist throughout a person’s lifetime. Incarcerated individuals may face limited access to quality end-of-life care and hospice services, resulting in increased suffering during their final days. The experience of incarceration can also lead to social isolation and stigma, exacerbating mental health issues and further decreasing the quality of life at the end of life. Effective interventions are needed to address the unique healthcare needs of incarcerated individuals, particularly as they approach the end of life