bluuebunny/crossref_metadata_2025 huggingface dataset:
ENGAGED RESEARCH: HUMILITY, LISTENING, BETTER QUESTIONS, BETTER ANSWERS
Authors: Gilmore-Bykovskyi Andrea
Published: December 2022

The expansive field of aging science comprises diverse disciplines, perspectives, and approaches to address questions that extend from strengthening our understanding of biological aging to promoting wellbeing among diverse aging populations. Engaged research practices represent a cross-cutting series of diverse epistemological beliefs and pragmatic practices in the conduct of research with broad relevance to areas of inquiry across the translational aging research continuum. This presentation will describe experiences with the establishment, maintenance, and continual evolution of engaged research practices in an interdisciplinary program of health services research focused on Alzheimer’s disease and related dementias (AD/ADRD). Specifically, this presentation will discuss: a) conceptualizations of engagement and its relationship to equitable research, b) engagement as praxis for the conduct of equitable research, c) personal reflections on experiences with and the practice of humility, listening, and valuing stakeholders’ distinctive expertise, and d) practical recommendations for early career scholars approaching engaged research.
ASSOCIATIONS BETWEEN LONELINESS AND COGNITIVE RESILIENCE TO NEUROPATHY IN OLDER ADULTS
Authors: Jackson Kathryn , Wilroth Emily , Luo Jing , James Bryan , Ong Anthony , Bennett David , Mroczek Daniel , Graham Eileen
Published: December 2022

Loneliness in the aging population is a concern, as increased loneliness is associated with decreased cognitive function and increased neuropathology. Less is understood about the relationship between loneliness and cognitive resilience. Cognitive resilience is defined as the discordance between a person’s actual and expected cognition given their neuropathology and can be estimated by extracting residuals from a model regressing cognition on neuropathology. Using data from two longitudinal aging cohorts (MAP/MARS), we estimated cognitive resilience proximate to death and cognitive resilience over time to use as the key outcomes. We then regressed these two cognitive resilience indicators onto loneliness level and slope. Higher baseline loneliness and increasing loneliness over time were both associated with lower cognitive resilience. Our results suggest that loneliness should be included into resilience-based prevention models, and interventions aimed at optimizing cognitive function across older adulthood should include loneliness reduction as a potential area of focus.
IS NARCISSISTIC PERSONALITY ASSOCIATED WITH SUICIDE IDEATION IN MIDDLE-AGED AND OLDER MEN?
Authors: Heisel Marnin , Flett Gordon , Links Paul
Published: December 2022

Older adults have high rates of suicide, necessitating theory and research on factors that contribute to suicide risk and may be targets for intervention. Clark (1993) theorized that age-related losses and transitions can trigger narcissistic injury in older men, and lead to mood decline, substance misuse, loss of insight, and suicide ideation and behavior. We tested elements of Clark’s model in a secondary analysis of a geriatric depression clinic database (n=574), and reported a positive association between clinician-diagnosed Narcissistic Personality (NP) and suicide ideation and behavior, controlling for depression severity (Heisel et al., 2007). We sought to replicate and extend these findings in 82 community-residing men, 55 years and older (M=63.3, SD=4.6), who participated in a trial of Meaning-Centered Men’s Group (MCMG; Heisel et al., 2020) for those concerned about or struggling with the transition to retirement. Participants completed the Pathological Narcissism Inventory (Pincus et al., 2009), Geriatric Suicide Ideation Scale (Heisel & Flett, 2006), and Geriatric Depression Scale (Yesavage et al., 1983). Linear regression analyses indicated a significant association between PNI-Contingent Self-Esteem and GSIS totals (t=2.41, p=.019) and GSIS Loss of Personal Worth (t=2.10, p=.040) and Perceived Meaning in Life Subscales (t=2.80, p=.007), controlling for depressive symptom severity (Geriatric Depression Scale; Yesavage et al., 1983), suggesting an association between suicide ideation and self-esteem issues. These and other findings will be discussed in a broader thematic context regarding masculinity, loss, life transitions, and suicide prevention.
RETIREMENT TRANSITIONS AND COMPLETED SUICIDE DURING RECOVERY FROM THE GREAT RECESSION: EVIDENCE FROM THE NVDRS
Authors: Mezuk Briana , Ananthasubramaniam Aparna , Dang Linh , Jurgens David
Published: December 2022

One million older Americans retire annually. While these transitions are not generally associated with poor mental health, the broader macro-economic context in which retirement transitions take place may shape how they relate to mental health. The objective of this study was to use state-of-the-art natural language processing (NLP) to develop a model to identify retirement transitions from textual data in the National Violent Death Reporting System (NVDRS), and to use that model to examine how the number of suicides related to retirement transitions changed during the recovery from the Great Recession. Data come from the NVDRS (2003 - 2018, n=62,165), a state-based registry of suicide deaths. We used RoBERTa to train a NLP model to identify retirement transitions (e.g., recent retirement, anticipated retirement, unable to retire despite wanting to) from 1,291 annotated sentences from NVDRS text narratives of suicide decedents aged ≥55 (model performance: F1=0.92). Applying this model, 19.35 of every 1,000 suicides among decedents aged ≥55 years mentioned a retirement transition. Decedent characteristics associated with retirement transitions were younger age (< 75 years), having a college education and experiencing financial problems. The probability that a narrative referenced a retirement transition increased 1.495-fold during the Great Recession (2007 - 2009) and declined during recovery (2009-2016) before beginning to increase again. Findings illustrate the utility of NLP methods to identify workforce transitions from NVDRS narratives, and further understanding the impact of macro contextual events like the Great Recession on population mental health.
DIFFERENCES IN ADVANCE CARE PLANNING AMONG RACIAL AND ETHNIC MINORITIES AND PERSONS WITH ADRD
Authors: Yauk Jessica , Meng Hongdao , Dobbs Debra
Published: December 2022

Advance care planning (ACP) is an important process to enable individuals to make their preferences known in the event of dementia onset. Racial and ethnic minorities have an increased risk of developing dementia. Understanding more about ACP differences by race and dementia status will help improve ACP communication among minority populations. For the current study the 2018 wave of the Health and Retirement Study (N=8,663) to test the relationship between dementia status and ACP and if there were differences by race. Findings indicated that both African Americans and Hispanics are less likely to have completed ACP than non-Hispanic Whites. In unadjusted models, having a dementia diagnosis indicated a lower likelihood of completing ACP; dementia was not significant in the final model when controlling for predisposing and enabling factors. More research on the predisposing and enabling factors that influence ACP among minority and dementia populations is needed.
EXPERIENCES WITH APATHY AND MHEALTH PREFERENCES AMONG ADULTS WITH MILD COGNITIVE IMPAIRMENT
Authors: Ingle Pilar , Plys Evan , Kline Danielle , Stark Emma , Portz Jennifer Dickman
Published: December 2022

Apathy is common early in dementia, often increases in severity as illness progresses, and is one of the most pervasive neuropsychiatric symptoms associated with Alzheimer’s Disease and related dementias (ADRDs). This study explored experiences of apathy and preferences for dyadic-communication via mobile health (mHealth) among adults with mild cognitive impairment (MCI) and their care-partners. Semi-structured interviews were conducted with 10 ADRD-related health providers (5 behavioral neurologists, 2 nurse practitioners, 2 geriatricians, 1 nurse, 1 social worker), 9 patients with MCI (5 male, mean age = 73), and 6 of their care-partners. Participants expressed interest in the development of mHealth dyadic communication tools targeting apathy symptom monitoring, dyadic understanding of apathy, spiritual and religious coping, sharing ADRD health information, and resources for addressing burdensome behavioral symptoms of MCI. This research provides preliminary insight to the development of apathy specific mHealth communication strategies that may improve patient and care-partner quality of life.
MY LONG CLOSE FRIENDSHIP WITH HELEN KIVNICK
Authors: Wyatt-Brown Anne
Published: December 2022

Anne Wyatt-Brown will discuss meeting Dr. Kivnick at a conference at Case Western Reserve in the 1980s, organized by David Van Tassel, who was introducing academics to the field of Gerontology. Kivnick was invited to discuss her work with Erik Erikson. Wyatt-Brown will discuss her long friendship with Kivnick, which continued until Kivnick’s death at age 70. Wyatt-Brown will also discuss Kivnick’s chapter in their book The Big Move with Ruth Karpen and Margaret Gullette, where Kivnick comments with compassion and insight about the steps Wyatt-Brown took to become vitally involved in the eldercare community, where she lived with her seriously ill husband.
ANOCRITICAL READINGS OF THE INTERSECTIONS OF AGE AND GENDER IN AMERICAN LITERATURE: A FEMINIST CRITIQUE
Authors: Haring Nicole
Published: December 2022

Intergenerational relationships have been present features in texts from the American literary canon that often problematizes the intersections of age and gender. This paper investigates how representations of intergenerationality provide the opportunity to explore the concepts of relationality and intersectionality through a feminist lens. Maierhofer’s concept of anocriticism was used in in the analysis of Julia Alvarez’ In the Time of the Butterflies (1994) and Yaa Gyasi’s novel Homegoing (2016) to validate individual experiences of gendered ageing. This paper presents ways in which this particular intersection can be viewed as a potential site of resistance towards what it means to grow old as a woman. Placing literature in a cultural, social, and political context, traditional paradigms can be reconstructed and heteronormative assumptions of age and gender can be deconstructed by focusing on the individual narratives and their potential for resistance.
USING PHOTOVOICE TO EXPLORE THE STRUCTURED ENVIRONMENT AND ADVANCE POLICY IN MULTIPLE CONTEXTS
Authors: Hladek Melissa , Han Hae-Ra
Published: December 2022

Contextual factors, including social determinants of health, have gained recognition for greatly influencing aging trajectories and chronic disease progression. Although traditional qualitative research gives a rich understanding of the internal psychological experience, it is unable to assess socio-cultural and built environment aspects of life apart from the verbal descriptions from participants. This symposium examines the use of Photovoice as a tool to assess the socio-cultural and structural context surrounding the participant. This symposium will present a narrative review on the use of current Photovoice methodologies in dementia care; results from three studies using photovoice, one with participants with mild cognitive impairment and their caregivers to explore their perceptions of aging in their home, the second exploring the lived experience and structural barriers among older adults with pre-frailty or frailty awaiting kidney transplant, and the third exploring the older adult peer mentors’ experience providing community-delivered hearing care. The talks will also address practical aspects of using photovoice such as institutional review board tips, logistical challenges, interview preparation and coding approaches. The fifth talk will describe Photovoice result dissemination strategies, including photo exhibits and stakeholder meetings, used to engage the community and advance policy to improve disparities. Photovoice as a research tool originally aimed to reinforce empowerment for those marginalized in society to describe their lived environment. This important aim is augmented in this symposium by improving researchers’ understanding of context to design more impactful research.
NARRATIVE LITERATURE REVIEW OF PHOTOVOICE STUDIES TO EXPLORE METHODOLOGY, ANALYSIS, AND THE DEMENTIA EXPERIENCE
Authors: Jenkins Emerald , Thaitrong Phatt , Taylor Janiece , Reiff Jenni Seale , Huynh Grace , Hladek Melissa , Szanton Sarah
Published: December 2022

Dementia is a serious public health concern requiring effective interventions to address older adults’ unmet needs. Photovoice, an underutilized and effective communication method for persons with waning abilities, provides insight into lived experiences and diverse needs. The purpose of this study is to understand current methodologies, analysis, and participant insights from photovoice literature in persons with dementia. A narrative review was conducted through PubMed, CINAHL Plus, and PsycINFO. From eleven eligible studies, insights were categorized via the 5-level Hierarchy Model of Needs in Dementia incorporating the 3-level Blackfoot Native American belief. Synthesized findings suggest providing dyadic opportunities to: (1) spend time in the natural world, (2) link activities for healthy aging with a need for hard work, and (3) recognize the importance of social determinants of health/disease when focusing on brain health. This review fills the knowledge gap regarding the lived experience of persons with dementia using relevant photovoice methodology.
VISION IMPAIRMENT IN A GLOBAL LIFE COURSE MODEL OF POTENTIALLY MODIFIABLE DEMENTIA RISK FACTORS
Authors: Ehrlich Joshua , Goldstein Jenna , Swenor Bonnielin , Whitson Heather , Langa Kenneth , Veliz Phillip
Published: December 2022

Vision impairment (VI) is a risk factor for accelerated cognitive decline and incident dementia. An estimated 90% of VI is preventable. Nonetheless, VI has not been included in the dominant life-course models of dementia risk factors. We sought to strengthen existing models of potentially modifiable dementia risk factors through the inclusion of VI using cross-sectional survey data from the Gateway to Global Aging project (G2Aging) from 31 countries. Prevalence rates and communalities from the G2Aging will be used to estimate the population attributable fraction (PAF) of dementia due to VI. It is expected that the PAF for VI will range from 1.0%-2.0%, suggesting that >10,000,000 prevalent dementia cases globally may potentially have been prevented through healthy vision. Since a large majority of VI can be treated with cost-effective but underutilized interventions, this may represent a viable target for future interventional research that aims to slow cognitive decline and prevent dementia.
INFLUENCE OF POSTTRAUMATIC STRESS AND ABNORMAL SPIROMETRY ON COGNITIVE PERFORMANCE IN 9/11 WTC RESPONDERS
Authors: Zammit Andrea , Hall Charles , Clousten Sean , Luft Benjamin
Published: December 2022

Post-traumatic stress disorder (PTSD) and abnormal spirometry are highly prevalent mental and health conditions in World Trade Center (WTC) responders. We tested the hypothesis that PTSD symptomatology and abnormal spirometry are conjointly and synergistically associated with poorer cognitive performance. A total of 1,326 responders (mean age = 53.1, SD = 8.1, 92% males) from the WTC Health Program took part in the study. PTSD symptomatology was assessed using the PCL-IV, and we calculated the FEV1/FVC ratio to measure pulmonary function. Cogstate assessments measured cognitive performance. Linear regressions were employed to evaluate PTSD and pulmonary function on cognitive performance while adjusting for age, sex, education, smoking status, and comorbidity. Higher PTSD symptomatology and lower pulmonary function were independently and conjointly negatively associated with cognitive performance. Further, a significant synergistic effect was present in that higher severity of PTSD symptomatology in the presence of lower pulmonary function was associated with poorer cognitive performance (estimate = -0.096, SE = 0.03, p <0.001). Results suggested that chronic stress and lung damage might share underlying biological mechanisms, including inflammatory and oxidative stress pathways, which may also be affecting the brain. Early intervention efforts to mitigate preventable cognitive decline in high-risk populations should be studied.
CONTINUOUS WORK-BASED LEARNING IN THE NURSING HOME SETTING
Authors: Meijers Judith
Published: December 2022

Nursing homes face challenges caused by increasing numbers of older adults with frailty and multimorbidity, and complexity of care in combination with decades of under resourcing and severe workforce challenges. In most countries the vast majority of direct care in LTC homes is provided by a large unregulated workforce that is largely unregulated, female, racialized and poorly remunerated. The results are severe difficulties in recruiting and retaining staff at all levels and a tendency to substitute less qualified workers for more highly qualified and more highly remunerated. Less well reported are the significant pressures that critical LTC home managers face. However, they are equally under duress especially in the wake of a global pandemic. Developing a culture of continuous learning and integrating this into daily nursing practice is one promising way to attenuate these challenges, ensure a high quality of care and a better equipped nursing staff. However, insight into strategies and interventions that contribute to such a continuous work-based learning culture in nursing homes is still relatively limited. In this symposium we will focus on different approaches to increasing workplace learning in long term care.
SEXUAL AND MARITAL SATISFACTION IN OLDER ADULTHOOD: EFFECTS OF CHILDHOOD AND ADULTHOOD VIOLENCE EXPOSURE
Authors: Kong Jooyoung , Easton Scott , Zhang Yan
Published: December 2022

Objectives

Guided by Finkelhor and Browne’s traumagenic dynamics model, the current study examines: 1) the long-term effects of childhood sexual abuse (CSA) and other adverse childhood experiences (ACEs) on older adults’ sexual and marital satisfaction, 2) the mediating role of intimate partner violence (IPV) victimization in the association between childhood adversities and sexual and marital satisfaction, and 3) whether gender moderates the mediational association.

Research Design and Methods

Using the Wisconsin Longitudinal Study, we analyzed data from 4,239 older adults between the 2004/2005 (Wave 1, Mean age = 65 years) and 2011 (Wave 2, Mean age = 72 years) data collections. The structural modeling approach was employed where the independent variables were CSA and ACEs, the dependent variables were sexual and marital satisfaction in Wave 2, and the mediators were IPV victimization and sexual and marital satisfaction in Wave 1.

Results

Both CSA and ACEs were associated with lower levels of sexual satisfaction and marital satisfaction in late adulthood. IPV victimization mediated the association between ACEs and marital satisfaction. The hypothesized moderated mediation by gender was not supported. Discussion and Implications: Using a population-based sample, this is one of the first studies demonstrating that distal life events such as CSA and ACEs can undermine older adults’ sexual and marital health, and revictimization in adulthood may serve as a mechanism for the association. Timely intervention is needed to prevent persistent negative effects of childhood violence.
TRANSFORMING AN INTERGENERATIONAL SERVICE-LEARNING PROJECT DURING THE COVID-19 PANDEMIC
Authors: Zucchero Renee' , Delgado-Rodriguez Annaliet
Published: December 2022

The COVID-19 pandemic has required transformation in the delivery of higher education and pedagogy that is used. The Co-Mentoring Project links undergraduate Psychology of Aging students with older adult volunteers for an intergenerational service-learning experience. Prior to the pandemic, the Project was delivered via an in-person format. During the pandemic, the Project transitioned to a virtual format. Self-reported postproject evaluations from undergraduate students (n= 30) and older adults (n= 27) during the two academic years prior to the pandemic were compared to evaluations from students (n= 26) and older adults (n= 28) during two years of the pandemic. Mann-Whitney U Tests revealed no significant differences in older adult and student postproject evaluation outcomes between in-person and virtual formats. For example, there were no differences in older adult level of enjoyment between the in-person (Md= 5, n= 27) and virtual formats (Md= 5, n= 28), U = 405.00, z = .84, p = .40. Likewise, there no differences in student level of comfort interacting with older adults between in-person (Md= 5, n= 30) and virtual formats (Md= 5, n= 26), U = 389.00, z = -.02, p = .99. Qualitative information from the postproject evaluations indicated participants were glad to have had the opportunity to meet virtually during the pandemic, however they preferred an in-person format. These results support the conclusion that intergenerational service-learning can be successfully implemented virtually. This paper will describe the transformation of the Project from an in-person to virtual format, and advantages and disadvantages of both formats.
THE DAWN OF A SOCIETY OF DIVORCEES: CHANGING PATTERNS OF LATE LIFE CIVIL STATUS
Authors: Öberg Peter , Bildtgård Torbjörn
Published: December 2022

Half a century ago Lopata used the concept “society of widows” to describe the gendered reality of late life singlehood, where widowed women were excluded from coupled social life, depended on a community of other widows for social integration, and refrained from initiating new relationships due to “sanctification” of their former husbands. We use Swedish, American and EU census data 1970-2020 and a national survey to Swedes 60-90 years old (n=1225; response rate 42%) to illustrate a substantial change in the demographic landscape of late life civil status. More people enter later life as divorcees or become divorced at a high age. Among Swedes 60+ divorcees outnumber widowed people, and the incidence of late life divorce has more than doubled since the millennium in what has been called the “grey divorce revolution”. Many other Western countries follow the same demographic trend, posing important questions about the transformation of unmarried later life. We conclude by proposing the concept “society of divorcees” for this new demographic landscape of late life singlehood, argue that research is needed to capture this new reality, and discuss the implications of this change for access to social support later life.
NOVEL BEHAVIORAL INTERVENTIONS TARGETING COGNITIVE-MOTOR NEUROPLASTICITY IN OLDER ADULTS
Authors: Bhatt Tanvi , Hughes Susan , Hughes Susan
Published: December 2022

Comparatively little is known about the ability of physical activity to improve or maintain cognitive function in older adults. Our Midwest Roybal Center uses social/behavioral theory to promote engagement in physical activity in order to improve this outcome. In 2019, we received funding to establish a Multimodal Connectomics Core that enabled investigators to examine concurrent changes in cognitive function and brain connectivity by providing access to fMRI imaging. The Connectomics Core enabled investigators for the first time to examine cognitive function and changes in brain connectivity simultaneously by providing access to fMRI imaging as well as MRI data storage and data analysis. It enabled measuring of standardized participant outcomes selected from the NIH toolbox. This Symposium describes findings from the first three completed pilots and discusses their implications for the field. The first pilot by Bronas examined effect of a 6-month home-based walking program in people chronic kidney disease on cognitive function and intervention induced neuroplasticity compared to usual care. The second pilot by Marquez adapted the Fit & Strong! program to test the combined impact of physical activity and interactive health education for managing mood on cognitive function among older adults with depression. The third pilot by Bhatt examined the effectiveness of 4 weeks of exergaming combined explicit cognitive training on behavioral measures of fall-risk (physical and cognitive) and their associations with brain integrity measures. The discussant will initiate discussion based on outcomes of these pilots and future directions for developing them into larger studies or clinical translation.
ENHANCING WELL-BEING THROUGH EXERCISE DURING OLDER AGE
Authors: Marquez David
Published: December 2022

Dr. Marquez’s Roybal pilot Enhancing Well-Being Through Exercise During Older Age piloted an adaptation of a group exercise evidence-based program for people with arthritis symptoms, Fit & Strong!, that included education on emotional wellbeing and mental health. The pilot used a waitlist design to test the 8-week program among Black residents reporting depressive symptoms living in a senior housing facility. A battery of physical, emotional, and cognitive outcomes were collected pre and post intervention and a subset of participants (n=11) received MRIs pre and post. The sample included 28 participants (n=13 intervention, n=15 waitlist) who had a mean age of 69.8, were 89% female, reported a mean of 3.6 chronic conditions, and an average WOMAC pain score of 5.7 (moderate pain). Though under-powered, analyses show greater improvements in key physical activity and cognitive domains among the intervention group compared to the waitlist group.
DOES FIVE-STAR QUALITY RATING MATTER FOR NURSING HOME QUALITY DURING THE COVID-19 PANDEMIC?
Authors: Yu Lei , Qiu Xiao , Sun Na
Published: December 2022

Objectives Nursing homes (NH) confronted tremendous difficulties considering confirmed residents Covid-19 cases and deaths in the U.S. The Centers for Medicare & Medicaid Services (CMS) applies the Five-Star Quality Rating (FSQR) to indicate the quality of care in nursing homes based on health inspection surveys, staffing as well as care process and resident outcomes during the COVID-19 pandemic. This study aims to examine whether FSQR was related to the total number of NH resident Covid-19 cases and deaths.Design This study analyzed 6,978 nursing homes across the country with data from CMS Nursing Home Compare, CMS COVID-19 Nursing Home Public File, Long-term Care Focus, Payroll Based Journal, Rural-Urban Commuting Area. Negative binomial regressions were used to investigate associations between FSQR and NH COIVD-19 outcomes controlling for state fixed effects and clustering of nursing homes within counties. The characteristics of facility, residents, payer-mix, nursing staff, and geographic location were also controlled. ResultsComparing to NH with 1-star in Health Inspection, Staffing, or Overall ratings, NH with better performance have lower risk of having increased number of COVID cases and deaths among residents. Further, nursing home Quality Measures rating is not significantly associated with residents’ COVID-19 deaths. ConclusionOverall, the FSQR is a useful measure of quality in part when investigating NH’s performance during the COVID-19 pandemic. Future policymakers should pay special attention to providers performing poorly in FSQR when improving the quality of nursing homes, particularly regarding infection control.
NORTH CAROLINA NURSING HOME AND PUBLIC HEALTH RESILIENCE DURING 2021 OF THE COVID-19 PANDEMIC
Authors: Lane Sandi , Spaulding Trent , Hege Adam , Sugg Maggie , Iyer Lakshmi
Published: December 2022

Since the onset of the COVID-19 pandemic many healthcare organizations have operated in a climate of uncertainty. Building resilience is one method used to survive and thrive during periods of uncertainty. Measuring an organization’s resilience (ability to prepare for, respond and adapt during time of change) allows the organization to identify its vulnerabilities and set priorities to avert negative outcomes during an untoward event. Through collaboration with four long-term care professional associations, the Benchmark Resilience Tool (BRT-13) resilience survey was disseminated to North Carolina long-term care leaders in April 2021. The BRT-13 survey was also sent to North Carolina public health officials via email during the same timeframe. The BRT-13 contains 13 resilience (RES) items divided into two factors of adaptive capacity (AC) and planning (PL) on a five-point Likert scale of strongly disagree (1) to strongly agree (5). Organizational factors surveyed included type of facility, rural-urban classification area designation, ownership type, level of debt, level of profitability, and employee satisfaction. A total of 142 completed surveys were received, 101 (71%) from long-term care leaders and 41 (28.9%) from Public Health officials. Overall average resilience scores ranged from 3.96 for public health respondents to 4.46 for continuing care retirement communities (CCRC) respondents. Analysis of Variance (ANOVA) was employed to compare the three factors (AC, PL, and RES) to the organizational factors. Resilience was significantly associated with one factor, employee satisfaction. Our findings indicate that organizations can build resilience through processes that contribute to staff satisfaction.
IDENTIFYING THE FRAILTY COMPONENTS THAT ARE MOST IMPORTANT IN PREDICTING POSTSURGICAL OUTCOMES
Authors: Mardini Mamoun , Smail Emily , Tighe Patrick , Price Catherine , Kaufmann Christopher , Manini Todd
Published: December 2022

Presurgical frailty among patients is strongly associated with poor postsurgical outcomes. In the prior presentations of this symposium, we assessed the associations between each individual frailty syndromic component and three postsurgical outcomes. However, it remains unclear whether individual relationships remain after accounting for presence of the other components. In regression models that included all frailty components, demographic information, and medical history, results showed that weight loss and slow walking speed were significantly associated with length of stay and 30-day mortality, respectively. Of note, the odds of mortality in patients with slow walking speed was over three times higher than patients with normal walking speed. Lastly, weaker grip strength was strongly associated with discharge to more intensive care (vs. to home). These findings suggest that frailty screening should be universally applied before surgical procedures for better risk stratification.
PRESURGICAL GRIP STRENGTH PREDICTS POSTSURGICAL OUTCOMES IN OLDER ADULTS
Authors: Manini Todd , Mardini Mamoun , Smail Emily , Tighe Patrick , Price Catherine , Kaufmann Christopher
Published: December 2022

Muscle weakness is a strong predictor of a myriad of health outcomes among older adults. However, measures of muscle strength are not incorporated in healthcare settings which is partly due to a lack of established clinical applicability. Maximal grip strength was measured in 11,668 older patients (73.2+/-6.0 yrs, 50.3% female) during a standard presurgical consultation. Each kilogram of maximal grip strength was associated with approximately 1-hour shorter length of stay. Patients categorized as having weak muscle strength according to sex-based norms had a higher 30-day post-surgery mortality than their non-weak counterparts (Odds Ratio: 2.5, p=0.002 after statistical adjustment of age, sex, race and disease history). Additionally, patients with weak muscle strength were less likely to be discharged home than patients without weakness (68.8% vs. 83.9% returning home, p<0.01). Grip strength is a consistent predictor of post-surgical outcomes that might be used to improve care management.
PRECLINICAL DEMENTIA CARE AND PREVENTION IN CONTEXT: FROM INSIGHTS TO ACTION
Authors: Gan Daniel Rong Yao , Heyn Patricia , Greenfield Emily
Published: December 2022

Dementia affects people with lower socioeconomic statuses disproportionately. People with undiagnosed Alzheimer’s disease may or may not express dementia symptoms depending on their brain reserve, cognitive reserve, and their ability to compensate for brain pathology. Much of these depend on their childhood education, but late-life social engagement may also play a role. As lifespan increases globally, preclinical dementia care and prevention in community settings will be increasingly important. The characteristics of everyday environments that are kind to various changes amid declining cognition may enhance the quality of life of older adults with and without dementia. Such environments may be available or unavailable in diverse communities of varying socioeconomic statuses. This collaborative symposium between the ADRD and CEnR interest groups brings together multidisciplinary scholars to imagine psychosocial interventions that could mitigate place-based disparities in cognitive health. The first presentation frames the importance of relational perspectives in a biopsychosocial-ecological model of care amid cognitive decline. The second presentation shows the cognitive impact of networks among kinless older adults across Europe. The third presentation explores community perspectives on preventive brain health programs in various neighborhoods. The fourth presentation centers the voice and action of people with dementia to improve their neighborhood social environments. The final presentation identifies policy implications for community-based care and prevention from network perspectives. Discussions will distil the significance of community for persons living with and without dementia diagnosis to generate place-based interventions that may better support care and prevention in diverse settings, and identify structural barriers to these efforts.
SOCIAL NETWORKS AND COGNITIVE FUNCTION: POLICY IMPLICATIONS FROM RECENT RESEARCH
Authors: McConnell William , Haggar Katherine , Manchella Mohit , Roth Adam , Perry Brea
Published: December 2022

This presentation will describe a series of research projects using Social Network Analysis (SNA) to measure the personal social networks of community-dwelling older adults at-risk for or currently experiencing dementia. The first part of the presentation will provide a brief overview of SNA methods, including advantages of SNA compared to more traditional social activity scales. The second part of the presentation will present evidence from multiple studies to identify distinct pathways linking upstream social network characteristics to downstream pathophysiological processes in the aging brain. In particular, we will distinguish between cognitive stimulation experienced in expansive social networks and neuroendocrine benefits derived from cohesive social networks. The third part of the presentation will present implications for psychosocial interventions to reduce health disparities in dementia care and prevention. We recommend leveraging the multidimensional functionality of social networks across the lifecourse to influence multiple cognitive health pathways simultaneously.
MICROLEVEL COMMUNICATION BETWEEN FAMILY CAREGIVERS AND PERSONS LIVING WITH DEMENTIA
Authors: Kim Sohyun , Liu Wen
Published: December 2022

Little is known about the relationship between family caregivers and persons living with dementia communication at micro-level (smallest verbal and nonverbal behavior unit). Micro-level communication was assessed second-by-second using 75 in-home video recordings from 19 caregiver-care recipient dyads. Each care recipient (N = 38) and caregiver (N = 42) behavior unit was paired and compared using Spearman’s partial correlation. Two-hundred twenty care recipient-caregiver behavior unit pairs were correlated (n = 148 verbal, n = 72 nonverbal pairs, rs range = .456 - .990, all p < .05). Ninety-one caregiver facilitative-care recipient engaging behavior unit pairs (e.g., comfort/empathetic touch, using humor) were positively correlated (rs range = .460 - .990, all p < .05). Eighteen caregiver disabling-care recipient challenging behavior unit pairs (e.g., withdrawing) were positively correlated (rs range = .456 - .697, all p < .05). Individualized caregiver education for matching and adjusting communication is needed to facilitate meaningful interaction.
IMPLICATION OF PAIN ON MOBILITY, FALLS, AND PSYCHOLOGICAL OUTCOMES FOR PEOPLE LIVING WITH DEMENTIA
Authors: Na Annalisa , McClure Leslie , DiMaria-Ghalili Rose Ann , Gitlin Laura
Published: December 2022

Dementia and pain can challenge mobility, increase fall risk, and result in psychological consequences; however, the extent of these relationships among community-dwelling people living with dementia (PLWD) is unclear. Using the National Health and Aging Trends Study, we examined 9,974 community-dwelling older adults (female=57%, age>85yrs=18%) for pain prevalence, mobility (i.e., Short Physical Performance Battery [SPPB]), falls, and psychological outcomes (i.e., depression and anxiety) using four groups with and without dementia (+PLWD/-PLWD) and pain (+Pain/-Pain). Groups were compared at baseline with ANOVA and chi-square and over time with repeated-measures ANOVA models. Pain (+PLWD= 56.8%; -PLWD=49.8%) most commonly affected the low-back and knee. Group differences were significant for baseline mobility, falls, and psychosocial outcomes, p<0.01, but not SPPB over time. Therefore, pain is common, especially at low back and knee, and associated with health and function among PLWD, indicating a need for early and effective interventions that can preserve quality of life.
A NATIONWIDE EXAMINATION OF MEDICARE PART B UTILIZATION DURING HOSPICE ELECTION
Authors: Christian Thomas , Plotzke Michael
Published: December 2022

This research characterizes trends in two hospice-specific modifiers: (1) “GV” indicating services for the terminal/related conditions by an attending physician not an employee of the hospice and (2) “GW” indicating physician services unrelated to terminal/related conditions. We identified Part B (carrier/physician supplier) claims during hospice elections in Federal Fiscal Year (FY)2020, and replicated an Office of Inspector General (OIG) approach calculating potentially “questionable” Part B claims, where the physician and diagnosis codes match between the hospice and Part B claims (without a GW modifier listed). Using logistic regression, we calculated adjusted odds ratio (AOR) and 95% confidence intervals (CI) to characterize this billing. Overall, $372.8 million in physician services occurred during hospice elections in FY2020. Of this, two-thirds ($247.8 million) included a GW modifier, one-quarter ($86.5 million) a GV modifier, $2.2 million both modifiers, and $40.8 million neither modifier. Replicating the OIG methodology, we calculated $19.4 million (5.2%) as “questionable”. Beneficiaries electing hospice for 180+ days were three times more likely (95% CI 2.99-3.12) to have questionable billing as a beneficiary electing hospice 14-29 days, and facility residents were more likely to have questionable billing, relative to beneficiaries in their own homes. Questionable billing rates were also highest in the northeastern quadrant of the country. Lastly, we found ten percent of physicians accounted for almost three-quarters of all questionable billing. CMS should further monitor physician services during hospice to maintain the integrity of the benefit and ensure beneficiaries receive adequate care.
PERSPECTIVES OF THE EM-SART: INTERVIEWS WITH ADULT PROTECTIVE SERVICES CLIENTS
Authors: Burnett Jason , Haggerty Kristin Lees , Campetti Randi , Stoeckle Rebecca
Published: December 2022

Older adults who experience mistreatment are more likely to visit emergency departments (ED), yet screening and response protocols in these health care settings are sorely lacking. Protocols designed with the mistreated older adult’s perspective in mind are needed to maximize efficacy and effectiveness. In this study, 18 mistreated older adults completed semi-structured perspective interviews regarding the ED Elder Mistreatment Screening and Response Tool (EM-SART). The findings highlight the importance of training healthcare staff to ask elder mistreatment (EM) questions in a preset context and to ask EM questions with empathy, concern, privacy, and clarity. Participants also stressed the desire to be reported to Adult Protective Services, but to also be included in the safety planning. These findings have direct implications for training health care workers to screen and respond to EM in the ED.
A POLICY ANALYSIS OF ELDER ABUSE PREVENTION LEGISLATION: TRANSLATION OF NATIONAL INITIATIVES TO THE STATE LEVEL
Authors: Decker Autumn , Bruzios Kathryn , Weaver Raven , Bolkan Cory
Published: December 2022

Elder abuse (EA) is an under-recognized global public health threat in need of enhanced research and policy attention, with 1 in 6 older adults experiencing at least one form of abuse/neglect. Public policy changes, such as the federal 2017 Elder Abuse Prevention and Prosecution Act (EAPPA), aim to address EA, but little is known regarding translation and implementation of the initiatives to state-levels. Applying a thematic analytic approach, we identified four major themes from the EAPPA: criminal investigation support; abuse reporting; financial exploitation; and training/technical assistance. Then, we conducted a comparative policy analysis to evaluate each state’s EA statutes enacted since 2017 to determine whether statutes were updated to reflect the EAPPA’s goals. Preliminary findings from 10 states (i.e., states with the greatest proportion of older adults in each Health & Human Services region) showed that eight states had updated statutes relevant to an identified theme(s). Eight states updated statutes related to financial exploitation, highlighting the growing concern over this specific type of abuse. Four states updated statutes related to reporting, reflecting problems with identifying and detecting elder abuse. Two states updated statutes regarding investigation, demonstrating minimal emphasis on elder abuse investigation. No states updated statutes relevant to training/technical assistance. These findings indicate significant state-level variability in translation and implementation of recent legislation. More recognition, research, and policy attention to EA, in the U.S. and globally, is needed. We conclude with recommendations for innovation and prevention policy efforts coupled with multidisciplinary collaborations to strengthen implementation against EA at the state-level.
NEIGHBORHOOD ADVERSITY AND COGNITIVE HEALTH: THE MODIFYING ROLE OF SELF-PERCEPTIONS OF AGING
Authors: Choi Eunyoung , Zelinski Elizabeth , Ailshire Jennifer , Jang Yuri
Published: December 2022

Research has documented the increased risk of cognitive impairment among older adults living in socioeconomically disadvantaged neighborhoods. Much less is known about the factors that moderate this risk. We conceptualized self-perception of aging (SPA) as a potential moderator because it reflects core beliefs about the self at older ages but is also closely linked to late-life health. Guided by the diathesis-stress model that postulates the interactive roles of cognitive styles and stressors in shaping health outcomes, we hypothesized that more positive SPA would buffer the effects of neighborhood adversity on cognitive function. Using data from the Health and Retirement Study (2008–2016), the analytic sample consisted of adults aged 54 and older (N=5,902). Cognitive function was assessed by the Telephone Interview for Cognitive Status. The neighborhood indicators included 1) poverty rates at the census tract level, 2) perceived neighborhood social cohesion, and 3) perceived neighborhood disorder. Three-level growth curve models were separately estimated for each neighborhood indicator’s effect as well as its interaction with SPA on the 8-year cognitive function trajectories. Findings showed that higher poverty rates, more disorder, and less cohesion were associated with lower initial levels of cognitive function but slower rates of cognitive decline. SPA partially moderated the linkage between neighborhood adversity and the level of cognitive function. More positive SPA was associated with reduced negative effects of living in neighborhoods with higher poverty rates and more physical disorder. These findings highlight the intersection of an individual-level psychological factor and a contextual-level factor in shaping late-life cognition.
AGING-RELATED VEGF IMPAIRS MUSCLE REGENERATION
Authors: Endo Yori , Hwang Charles , Zhang Yuteng , Neppl Ronald , Argawal Shailesh , Sinah Indranil
Published: December 2022

Purpose

Aging is associated with frailty, a parameter that correlates with mortality and loss of muscle mass. The molecular mechanisms behind aging-associated impairment of muscle regeneration remain incompletely understood. We hypothesized VEGF-A with known role in angiogenesis and muscle progenitor differentiation to regulate regeneration in aged skeletal muscle.

Methods

Young C57BL/6 (10 weeks old) and old C57BL/6 mice (24 months old) were subjected to muscle cryoinjury to induce regeneration. Quantifications of cross-sectional area (CSA) of regenerating myofibers were performed. Tibialis anterior muscle lysates was used for quantifying VEGF-A. To evaluate the role of VEGF in muscle regeneration, a similar experiment was performed on VEGFlo mice with a 75% decrease in VEGF-A activity and littermate controls. ML228, a hypoxia signaling activator that increases VEGF-A levels, was injected into young and old mice as well as VEGFlo and littermate controls.

Results

Old mice exhibited marked reduction in the VEGF-A protein levels and regenerating myofiber CSA on DPI 10 (1250 vs. 833μm2, p<.001). Similarly, VEGFlo mice exhibited significantly smaller regenerating fiber CSA as compared to littermate controls on DPI 10 (541 vs. 238μm2, p=.0011). Pharmacological augmentation of VEGFA using ML228 increased muscle VEGF levels by 2 folds and skeletal muscle regeneration in both old mice (25% increase in regenerating fiber CSA, p<.01) and VEGFlo (20% increase in regenerating fiber CSA, p<.01) mice, but not young or littermate controls.

Conclusions

Muscle regeneration declines with aging in correlation with loss of VEGFA levels within skeletal muscle. Supplementation of VEGFA represents a therapeutic target for sarcopenia.
UNNECESSARY AND HARMFUL MEDICATION USE IN COMMUNITY DWELLING PERSONS WITH DEMENTIA
Authors: Deardorff W James , Jing Bocheng , Growdon Matthew , Yaffe Kristine , Boockvar Kenneth , Steinman Michael
Published: December 2022

Persons with dementia (PWD) often have multiple comorbidities which results in extensive medication use despite potentially limited benefit and increased risk of adverse events. Compared to the nursing home, little is known about medication overuse and misuse among the ~70% of PWD in the community. Therefore, we examined medication use from Medicare Part D prescriptions among 1,289 community-dwelling PWD aged ≥66 from the Health and Retirement Study. We classified medication overuse as over-aggressive treatment of chronic conditions (e.g., insulin/sulfonylurea use with hemoglobin A1c<7.5%) and medications inappropriate near the end of life. We classified medication misuse as medications that negatively affect cognition (strongly anticholinergics/sedative-hypnotics) and problematic medications (using Beers and STOPP criteria). We describe the prevalence and patterns of different types of medication overuse/misuse. Frequently problematic medications included antipsychotics (9%), benzodiazepines (12%), and gabapentinoids (13%). Our findings highlight the burden of unnecessary/harmful medications among PWD and inform future deprescribing interventions.