bluuebunny/crossref_metadata_2025 huggingface dataset:
SOCIAL INTELLIGENCE TRAINING AND CUSTODIAL GRANDFAMILIES: A QUALITATIVE ANALYSIS OF RELATIONSHIPS
Authors: Dolbin-MacNab Megan , Smith Gregory , Infurna Frank , Webster Britney , Castro Saul , Crowley D Max , Musil Carol
Published: December 2023

Custodial grandfamilies often experience relational challenges related to parenting and the grandparent-grandchild relationship that would benefit from intervention. Social intelligence training (SIT), which focuses on improving socio-emotional skills via online, self-guided modules, holds promise for helping grandfamilies address their relational challenges. The purpose of this qualitative study was to examine SIT skills that custodial grandmothers and grandchildren utilize in their interactions and the impact of SIT on their relationship. The sample consisted of 27 dyads of custodial grandmothers and adolescent (ages 11 to 18) grandchildren enrolled in an RCT examining the effectiveness of SIT. Dyads who completed the SIT were randomly selected and completed individual, open-ended interviews over the telephone, after post-test but prior to the 3-month follow-up. Results of a thematic analysis revealed several themes related to the SIT skills grandmothers and grandchildren were utilizing including taking and understanding the other’s perspective, attending to the nonverbal communication, engaging in active listening, reflecting on their treatment of each other, and slowing down communication to think before speaking. Analyses further revealed that grandmothers and grandchildren noted SIT-related improvements in their relationship, with themes reflecting improvements in the quality of communication, the frequency and intensity of conflict, understanding of each other, and sense of emotional connectedness. Those dyads that did not report relational improvements had a strong relationship prior to completing the SIT or the grandchild did not fully engage in the SIT. Directions for research and family-based interventions with grandfamilies will be discussed. [Funded by the National Institute on Aging (R01AG054571)]
THE PREVALENCE AND CHARACTERISTICS OF UNREPRESENTED ADULTS ADMITTED TO KOREAN HOSPITAL SETTINGS
Authors: Kim Hyejin , Choi Jiyeon , Lee Won , Lee Ilhak , Song Mi-Kyung
Published: December 2023

BACKGROUND

Unrepresented adults refer to persons who have lost their decision-making capacity and have neither available surrogates to make medical decisions for them nor the documentation of their treatment preferences. Recently, concerns about this population have been emerging in the hospital setting in South Korea. However, little is known about this population. Thus, this study aimed to identify the prevalence and demographic and clinical characteristics of unrepresented patients admitted to hospitals in South Korea.

METHODS

This qualitative descriptive study was conducted using semi-structured interviews with 37 physicians, nurses, social workers, and others from 22 hospitals and directed content analysis. RESULTS: The number of unrepresented patients seemed to be small in hospital settings, but higher in public hospitals than private ones. Participants reported that the reasons unrepresented patients lost their decision-making capacity included loss of consciousness, delirium or alcoholism-related mental change, dementia, and mental retardation. Surrogates were unavailable because no families were found through a rigorous search, or because families were inaccessible, refused to be decision-makers, or were unable to serve as surrogates as they were not a legally-bound immediate family. These patients were mostly in their 50s – 70s, predominantly male, and living alone, and had poor socioeconomic status and poor hygiene. Most of them had no medical records before admission. CONCLUSIONS: Unrepresented patients are recognizable even though the number is small. Based on the common characteristics of unrepresented adults, national and societal efforts are necessary to identify ‘at-risk’ people and prevent them from becoming unrepresented in healthcare settings.
CORRELATES OF SUBTLE COGNITIVE DYSFUNCTION IN A HIGHLY EDUCATED COHORT OF MID LIFE AND OLDER AFRICAN AMERICANS
Authors: Brown-Hughes Travonia , Gamaldo Alyssa , Pettigrew Corinne , Thorpe Roland J
Published: December 2023

Remote cognitive screening modalities can be an initial step in assessing cognitive health. This cross-sectional study examined how risk and protective factors relate to cognitive performance in non-demented African Americans aged 50 and older. Participants were part of the African American-United Memory and Aging Project (AA-UMAP), a geographically diverse cohort of college-educated adults recruited and evaluated via telephone and online. Demographic, health variables and activity engagement were self-reported through an online survey. Cognition (global cognition, memory, and psychomotor/attention) was measured remotely using the Telephone Interview for Cognitive Status (TICS-40; N = 143) and the CogState Brief Battery (CBB; N = 51). Health variables included a mental health composite (e.g., depression and/or anxiety) and a metabolic conditions composite (e.g., high cholesterol, hypertension, diabetes, and/or obesity). Activity engagement was assessed with self-reported physical, mental, and social lifestyle activities. Linear regression models indicated that older age was associated with slower psychomotor/attention performance (p < 0.01) and marginally lower learning/working memory accuracy (p = 0.08) even after adjusting for covariates (e.g., sex and education). Cognitive performance was unrelated to mental health, metabolic conditions, and lifestyle activity engagement. Neither health-related risk factors nor level of engagement activities were significantly associated with cognitive performance in this remotely screened sample of highly educated middle-aged and older African American adults. More studies of midlife and older African Americans are needed to obtain a more in-depth understanding of the degree to which biopsychosocial strengths and deficits in midlife may affect or alter later-life cognitive trajectories.
ESTIMATED ARTERIAL STIFFNESS, COGNITIVE DECLINE, AND DEMENTIA AMONG MIDDLE-AGED AND OLDER ADULTS
Authors: Heffernan Kevin , Wilmoth Janet , London Andrew
Published: December 2023

Prior research suggests arterial stiffness may be a useful vascular biomarker that predicts age-related cognitive decline. In this paper, we use the Health and Retirement Study (HRS) to examine the relationship between estimated pulse wave velocity (ePWV), which is an under-analyzed but readily available estimate of arterial stiffness, and cognitive decline. The HRS assesses cognitive function with the Telephone Interview for Cognitive Status (TICS). In this 27-point TICS measure, scores between 7 and 11 indicate cognitively impaired but no dementia (CIND) and scores between 0 and 6 indicate dementia. We modeled the relationship between ePVW and cognitive status change from 2006/2008 through 2018. The findings indicate ePWV increases the odds of having CIND and dementia relative to having no CIND or dementia. In addition, ePWV increases the odds of transitioning into CIND and dementia from a higher cognitive functioning state. The results are robust to controlling for: age, age squared, age cubed, systolic and diastolic blood pressure along with sociodemographic characteristics (gender, race, ethnicity, wealth, income, education), health status (history of cardiovascular disease (CVD,) diabetes, and stroke and related medication use), health behaviors (smoking, physical activity, body mass index), and CVD-related biomarkers (C-reactive protein, cystatin-C, hemoglobin A1c, total cholesterol, high-density lipoprotein (HDL) cholesterol). These findings suggest that ePWV is a simple screening tool and novel biomarker that can be used to monitor vascular cognitive aging and CIND progression in middle-aged and older adults.
RACIAL/ETHNIC DIFFERENCES IN NEUROCOGNITIVE PROFILES OF OLDER ADULTS WITH 6-YEAR INCIDENT DEMENTIA
Authors: Jacobs Moyosoreoluwa , Chek Carmen , Tarraf Wassim
Published: December 2023

Hispanic and non-Hispanic Black (NHB) older adults have higher dementia rates than non-Hispanic Whites (NHWs). Estimates of dementia prevalence and incidence in community-based cohorts are mostly based on threshold value performance on cognitive assessment batteries. We used longitudinal data from the HRS Harmonized Cognitive Assessment Protocol (HCAP) to (1) generate and compare, across race/ethnicity, neurocognitive profiles for older adults (>65 years) not meeting research criteria for dementia in 2010 and developing dementia by 2016 (using Langa-Weir’s dementia classification), (2) assess racial/ethnic differences in these profiles, and (3) test socio-demographic effects on dementia-specific differences in neurocognitive performance. Performance on all HCAP measures was highly sensitive to 6-year incident dementia classification. However, we found notable domain-specific differences in test sensitivity, whereby performance on general screeners (e.g., MMSE) and memory-based tests (e.g., CERAD word list recognition) were significantly lower (≤2 SDs from normed population means). Hispanics and NHBs generally performed lower than NHWs, with more pronounced group differences in general screeners and executive function tests. Sociodemographic characteristics significantly attenuated Hispanic differences, but less so for NHBs, relative to NHWs. Despite these group differences, NHWs with incident dementia had worse neurocognitive profiles than their NHB and Hispanic counterparts. Dementia classification algorithms (e.g., Langa-Weir) sensitively detect cognitive impairment. However, these algorithms more accurately identify higher severity cognitive impairment in NHWs compared to NHBs and Hispanics. Such methods can yield dementia estimates biased by sociocultural factors. Further research is needed to identify culturally appropriate neurocognitive tests that enhance precise dementia diagnosis, using population-level epidemiological data.
EXAMINING THE IMPACT OF BURNOUT ON RESEARCH PARTICIPATION IN CLINICIANS TREATING DEMENTIA
Authors: Rawoof Anam , Summerhayes Emily , Talwar Sonia , Hodgson Nancy
Published: December 2023

Clinicians treating people living with dementia (PLWD) are likely to face burnout due to 1) the significant emotional burden of the job and 2) the increasing number of patients requiring dementia care. While much research has been conducted on the impact of clinician burnout on patient care and outcomes, more research is needed on its effects on clinician participation in research studies. This study will analyze qualitative data to examine the effect of clinician burnout on participation and intervention uptake in a dementia care research study.
A MIXED METHODS APPROACH TO UNDERSTANDING SPOUSE AND CHILD CAREGIVERS’ EXPERIENCES OF LUCID EPISODES IN DEMENTIA
Authors: Kim Kyungmin , Bangerter Lauren , Finnie Dawne , Gaugler Joseph , Maria Lapid , Frangiosa Theresa , Griffin Joan
Published: December 2023

Lucid episodes (LE) in people living with late-stages of dementia (PLWD) have been reported anecdotally, but less is known about how this seemingly unexpected phenomenon is experienced by family members. This study aims to examine variability in family caregivers’ experiences with LE, focusing on the two most common groups of informal caregivers, spouses and children—whether they may exhibit differential appraisals of and responses to LEs. Using a sample of former and current family caregivers from UsAgainstAlzheimer’s A-LIST, we conducted an online survey to spouse and child caregivers (N = 387). Qualitative semi-structured interviews were also conducted with a subset of these caregivers who have witnessed an LE (n = 22). Survey results indicate that child caregivers were more likely to witness a LE. Among “former” caregivers who have witnessed a LE (n = 140), spouses were likely to appraise LEs more negatively and make changes in care decisions (i.e., end-of-life planning and financial decisions) after LE, compared to child caregivers. Among “current” caregivers who have witnessed a LE (n = 80), spouses were more likely to indicate no special circumstances prior to LE, whereas children were more likely to indicate LEs associated with visits from friends and family; there was no difference in positive and negative appraisals of LE between current spouse and child caregivers. Content analysis of qualitative interviews revealed that observed differences between spouses and children were related to their different caregiving contexts, such as relationship history, living arrangement, expectations/motivation, and care resources.
A SCOPING REVIEW OF PHYSICAL ACTIVITY IN ADULTS OVER 50 WITH AUTISM: MANY BARRIERS AND SPARSE DATA
Authors: Kartoz Connie , Jefferson Rebeca , Antonakakis Antigone , Eisenberg Chase
Published: December 2023

The population of older adults with autism is growing, yet the literature for this group is still relatively sparse (Mason et al., 2022). Adults with autism are reported to have multiple co-morbidities and a reduced life span (Hand et al., 2020). While physical activity (PA) is known to reduce chronic disease burden, extant research indicates young adults with autism do not engage in physical activity (PA) with the same frequency as neurotypical peers. Little is known about PA for older adults with autism. This scoping review aimed to explore research about PA for older adults with autism. Following the PRISMA-ScR guidelines, 5 databases were searched (2018 and later) with keywords ‘autism’, ‘older adults’, ‘PA’ and age group delimiters. Initially, no articles were found, and the search was expanded to include all adults. After eliminating duplicates, 121 studies were reviewed, with 31 meeting the criteria (PA, autism and no participants less than 18) and 9 having any participants over 50; in each of these 9 studies, the number of participants over 50 was less than 100. Only 2 studies focused on adults over 50. Level of evidence was low. The limited data suggests those aging with autism do not engage in recommended levels of PA, experience barriers to the same, but that interventions improve PA and possibly quality of life. Based on this review, there is a dire need to design interventional research regarding increasing PA in older adults with autism to improve equitable health outcomes for this at-risk group.
ACCULTURATION, ALCOHOL USE, AND SLEEP AMONG LATINX ADULTS AT RISK FOR ALZHEIMER’S DISEASE AND RELATED DEMENTIAS
Authors: Jimenez Daniel , Burke Shanna , Hayes Timothy , Grudzien Adrienne , Russell Accacia , Soto Gianinna Munoz , Peralta Eriana , Padden Eleni
Published: December 2023

Background

Excessive alcohol use can negatively impact sleep. In the U.S., Latinx people are most likely to engage in problematic drinking when compared to other racial/ethnic groups. Acculturation in U.S. society has been suggested as a contributing factor to problematic drinking. Excessive alcohol use and poor sleep are known risk factors for developing Alzheimer’s disease and related dementias (ADRD). Little is known about the interaction between acculturation and alcohol use on sleep outcomes in Latinx adults, especially among those at risk of ADRD. The current study explored whether acculturation to the U.S. moderated the relationship between alcohol use and sleep.

Methods

A secondary analysis of a community-based sample of 113 Latinx adults, ages 40-60, was conducted. Participants had a parent diagnosed with ADRD. Measures included surveys gauging alcohol use (WHO ASSIST V.30), acculturation (Bicultural Involvement Questionnaire), subjective sleep (Pittsburgh Sleep Quality Index), and objective sleep measures using actigraphy (ActiGraph). A multiple regression analysis was performed to evaluate whether acculturation moderated the relationship between alcohol use and sleep outcomes

Results

The sample was predominantly female (92%), people born outside the US (74%), with approximately 83% of participants reported lifetime alcohol use. Americanism acculturation (b= 0.30, SE= 0.21, p=0.007) and biculturalism (-b= 0.30, SE= 0.13, p=0.003) significantly moderated the relationship between alcohol use and sleep duration. Implications: Expanded, targeted research and intervention focused on sociocultural factors impacting alcohol use for Latinx people at risk of ADRD must be further explored to identify and intervene in sleep disparities occurring among this population.
ACTIVATING THE NEXT GENERATION OF GERONTOLOGY ENTHUSIASTS... ONE SEMESTER AT A TIME
Authors: Culligan Joanna , Schepisi Ila
Published: December 2023

At the Engagement Center for Creative Aging at Virginia Tech, we are activating the next generation of gerontology enthusiasts while breaking down stigmas associated with aging and cognitive change. Each semester, we have an opportunity to engage with the undergraduate and graduate student population here on campus through field work, volunteerism and student employment. Here, students engage with adults in our community through a wide range of programs to support aging from community clubs, caregiver wellness and our adult day services program. This paper focuses on Reframing Aging with students who engage in field work at our adult day services program through the Department of Human Development and Family Science at Virginia Tech through strategic application of active learning pedagogical techniques including lecture, class discussion, experiential activities and application exercises. In addition to classroom components, students participate in service delivery at our center. At the beginning of each semester, students are asked (using an anonymous online polling tool), “What words do you associate with older adults” and “… older adults with dementia.” The most common words that have appeared, semester after semester, are: stubborn, inflexible, angry, sad, decline, struggling, forgetful and confused. At the end of the semester, sixteen-weeks later, students are asked the same questions. The most common words associated with older adults and those experiencing dementia at the end of the semester are: interesting, unique, wise, lovely, welcoming, insightful, experienced, helpful, normal, honest and human. In one semester, we are helping to Reframe Aging with this approach.
ADVANCED CARE PLANNING SERVICES BILLING ENCOUNTERS AMONG MEDICARE BENEFICIARIES WHO DIED IN 2019
Authors: Kobylarz Fred , Kim Hyosin , Zafar Anum , Lin Haiqun , Lopez Maria , Jarrín Olga
Published: December 2023

In 2016, the Centers for Medicare & Medicaid Services (CMS) introduced advanced care planning (ACP) services Current Procedural Terminology [CPT] codes 99497 (first 30 minutes) and 99498 (additional 30 minutes). This enabled healthcare providers to seek reimbursement for discussing future medical care preferences when patients are unable to make decisions. In this study, we linked administrative, claims, and encounter files for the 2,238,611 Medicare beneficiaries who died in 2019. Of these, 17.7% (395,258) had a billing code for ACP services in 2018 or 2019. Among fee-for-service (FFS) beneficiaries, 18.8% had ACP services billed compared to 15.7% of Medicare Advantage (MA) beneficiaries. Most ACP encounters were for the first 30 minutes of services (91% FFS, 90% MA). Among FFS beneficiaries, most ACP encounters were attributed to internal medicine (30.8%), family medicine (12.6%), and nurse practitioners (29.9%); and took place in hospitals (47.6%), skilled nursing facilities (18.4%), and office (14.2%) settings. Location of ACP services was available for only 8% of MA encounters: hospitals (40.3%), skilled nursing facilities (18.2%), and office (20.1%). Additional findings will be presented regarding variation in ACP encounters by race/ethnicity and geographic region (state, rural/urban community, area deprivation index) that enhance our understanding of ACP service use at the end-of-life for Medicare fee-for-service and Medicare Advantage beneficiaries.
BETTER DIET QUALITY IS ASSOCIATED WITH REMAINING NON-FRAIL OVER TIME IN A DIVERSE COHORT
Authors: Kuczmarski Marie , Beydoun May , Georgescu Michael , Hooten Nicole Noren , Mode Nicolle , Evans Michele , Zonderman Alan B
Published: December 2023

Frailty is a major public health concern affecting the health and well-being of adults. Poor diet is among several modifiable risk factors for developing frailty. We examined associations of dietary quality assessed by the Healthy Eating Index with frailty status over mean 8.7y follow-up. The sample was comprised of African American (AA) and White participants enrolled in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study (44% male, 44% AA, mean baseline age of 48.5y). Only participants from the baseline study and first 2 follow-up visits with dietary data, 2 recall days per visit, and frailty data were included (n=2901). Frailty was prospectively determined by the modified FRAIL scale. Group-based trajectory modeling identified 3 diet quality groups (high: g3 [5.2% of sample, HEI(X±SD): 57.4±4.1], medium (g2: 48.2%, 46.1±3.7), low (g1: 46.5%, 38.2±2.9) and 2 frailty groups (remaining non-frail [20.2% sample] or being pre-frail or frail over time). Multiple logistic and Cox proportional hazards regressions found high and medium HEI trajectory groups, compared to the low HEI group, were associated with reduced risk of being pre-frail or frail, with a clear dose-response relationship (g2 vs. g1: HR=0.77, 95% CI: 0.64-0.92, p=0.004; g3 vs. g1: HR=0.29, 95% CI: 0.18-0.49, P< 0.001), even after adjusting for sociodemographic factors, smoking, drug use, and allostatic load. These findings were corroborated with Kaplan-Meier curves and log-rank tests, providing longitudinal evidence of the link between better diet quality with lower frailty risk, and the importance of diet in successful aging during middle age.
BIOMARKERS IN CNS-ORIGINATING EXTRACELLULAR VESICLES: A DIAGNOSTIC META-ANALYSIS FOR PARKINSONIAN DISORDERS
Authors: Taha Hash Brown , Bogoniewski Aleks
Published: December 2023

Parkinsonian disorders, including Parkinson’s disease (PD), multiple system atrophy (MSA), dementia with Lewy bodies (DLB), progressive supranuclear palsy (PSP), and corticobasal syndrome (CBS), present overlapping early symptoms, complicating accurate diagnosis. Predicting the conversion of prodromal conditions like REM behavior disorder (RBD) to PD, MSA, or DLB is also complex. Extracellular vesicles (EVs), small structures released by cells, carry cell-state-specific biomarkers that can cross the blood-brain barrier, providing a window into the brain’s biochemistry. Blood-isolated CNS-originating EVs have become a popular diagnostic tool. Yet, challenges remain in replicating and validating these findings. We conducted a PRISMA-guided systematic review and meta-analysis of 15 studies involving 1,455 persons with PD, 206 with MSA, 21 with DLB, 172 with PSP, 152 with CBS, 189 with RBD, and 1,045 healthy controls (HCs). Diagnostic accuracy for distinguishing persons with PD from HCs was moderate but showed high heterogeneity and significant publication bias. This indicates that studies with non-significant or lower effect sizes were less likely to be published. Differentiating persons with PD from those with PSP or CBS is limited due to the small number of involved studies. Our analyses suggest that biomarkers from CNS-originating EVs may not reliably differentiate persons with MSA or RBD from HCs due to variable accuracy and high heterogeneity. Our findings highlight the moderate diagnostic accuracy of EV biomarkers in differentiating Parkinsonian disorders, emphasizing substantial heterogeneity and significant publication bias. The need for larger, more standardized, and unbiased studies is underscored to validate the utility of EV biomarkers as diagnostic tools.
CAREGIVERS & COLONOSCOPIES: A QUANTITATIVE COMPARATIVE STUDY OF CAREGIVERS’ PREVENTATIVE HEALTH BEHAVIORS
Authors: Quinlan Claire , Brady Samantha , Ashebir Sophia , Balmuth Alexa , D’Ambrosio Lisa , Coughlin Joseph
Published: December 2023

That many caregivers experience some degree of burden is well-established, but little research has investigated the association of burden on caregiver preventative health behaviors. A lack of adherence to these behaviors, including to recommended colonoscopy and mammography screenings, routine vaccinations, annual clinic visits, and HIV testing, may portend worsening health outcomes for family caregivers if diseases are left undetected or untreated; such outcomes could also be caused by and contribute to the crisis of lack of care to meet demand. Survey questionnaires (N=326) were completed by 214 current caregivers and 112 former caregivers from the national MIT AgeLab Caregiver Panel. Respondents predominately identified as white (88%) and female (83%), with a median age of 40-49 years old. Questions assessed caregiving intensity, health status, reported caregiving burden, and adherence to preventative health screenings and vaccinations (per USPTF age- and gender-based recommendations). Among all caregivers, just 17% reported that they were up-to-date with appropriate preventative health screenings. Current caregivers were less likely than previous caregivers to be up-to-date. Controlling for age, income level, and health status, caregiving intensity (as measured by hours per week) was an independent predictor of adherence to preventative health screenings. These findings suggest that current caregivers who are providing high-intensity care are less likely to be engaging in preventative health behaviors for themselves. This finding is concerning for the future health of these caregivers as well as their care recipients and highlights the need for primary care preventative health initiatives specifically targeting family caregivers.
CAUSAL EFFECT OF ANTI-DEMENTIA DRUGS ON PATIENTS’ ECONOMIC BURDEN USING DOUBLE/DEBIASED MACHINE LEARNING APPROACH
Authors: Jiang Xiangxiang , Lv Gang , Li Minghui , Lu Kevin
Published: December 2023

Alzheimer’s disease and related dementia (ADRD) present a significant public health challenge and carry a substantial financial burden. Exploring avenues for treatment, the administration of anti-dementia drugs has emerged as a potential intervention for ADRD. However, prior research has been susceptible to omitted variable bias due to data limitations and struggled to establish causal relationships due to confounding by indication. Our study aims to uncover the causal impact of anti-dementia drug utilization on the economic burden among ADRD patients through Double/Debiased Machine Learning (DML) method. Leveraging data from the Medicare Current Beneficiary Survey (MCBS) spanning 2015 to 2017, we utilized a nationally representative survey linked to Medicare data, providing comprehensive insights. DML techniques, including Random Forest (RF) regression and Least Absolute Shrinkage and Selection Operator (LASSO) regression algorithms, were employed to investigate the causal effect. After exclusion and inclusion, a total of 218,237 ADRD patients used anti-dementia drugs, with an average total medical cost of $16,695.87; 95.51% (4,646,408 patients) of ADRD patients did not use anti-dementia drug, with an average total medical cost of $27,567.09. Results from generalized linear regression showed that anti-dementia drug use did not have a significant impact on total medial cost (β = -0.29, P = 0.10). However, results from DML demonstrated a significant true effect [RF regression (β = -0.85, P = 6.79×10-3), LASSO regression (β = -0.78, P = 9.95×10-3)]. To conclude, our analysis demonstrated the causal effect of anti-dementia drug utilization in reducing overall medical costs borne by ADRD patients.
CHOICE TO PROVIDE CARE AND KNOWLEDGE OF DEMENTIA SYMPTOMS: IMPACT ON CAREGIVERS’ EXPERIENCES
Authors: Zimami Sumiyyah , Darwish Hala , Marriott Deanna J
Published: December 2023

As the population ages, understanding the needs of people with dementia and their caregivers becomes increasingly crucial. Caregivers have various experiences related to the rewards and challenges of choosing to provide care. This project investigates how caregivers’ choice to provide care for someone with dementia and their knowledge of dementia symptoms influence their caregiving experiences. The study employed a secondary data analysis from the National Alliance for Caregiving and the American Association of Retired Persons. Caregiving experiences were gauged using a 5-point Likert scale ranging from ’completely negative’ to ’completely positive’. Statistical analyses were conducted using descriptive statistics, chi-square tests, and ordinal logistic regression adjusting for covariates such as dementia stage, caregiver relationship, mental health, and caregiving attitude. Relative risks and 95% confidence intervals were estimated for interpretation using Stata/SE 18.0 with an a-priori significance level of p< 0.05. The study involves 927 caregivers, predominantly women (66.13%) aged 50 – 74. Caregivers who chose to provide care and recognized dementia symptoms were significantly more likely to report positive experiences (ARR= 1.38, p=< 0.001; ARR= 2.27, p=0.03) respectively. Caregivers who felt fulfilled or optimistic had positive experiences (ARR= 1.92, p< 0.001; ARR= 2.21, p< 0.001). Contrastingly, caregivers dealing with emotional stress or caring for relatives with moderate dementia were more likely to have a negative experience (ARR= 2.80, p< 0.001; ARR= 1.39, p=0.006). These findings highlight the importance of developing tailored nursing interventions to support caregivers’ conscious decision to provide care and increase caregivers’ knowledge, potentially enhancing the quality of life for caregivers.
CO-DESIGNING A HIGH-ACCURACY HOME MONITORING SYSTEM FOR MANAGING FRAILTY IN OLDER ADULTS
Authors: Rincón Adriana Ríos , Chan Andrew , Figeys Mathieu , Koubasi Farnaz , Ahmed Yusuf , Gregson Geoffrey , Miguel-Cruz Antonio
Published: December 2023

Background

Frailty, a condition often affecting older adults, increases vulnerability and diminishes physical abilities across bodily systems. Current non-routine frailty screening in primary care or clinical settings fails to detect “hidden health vulnerabilities” in a timely manner. Smart home technologies offer an affordable and effective solution for continuous frailty tracking and prevention. However, existing home monitoring technologies typically require users to acquire new skills or are invasive, such as camera-based systems. Objective: Our goal is to create a high-accuracy home monitoring system coupled with Internet of Things devices to identify potential frailty indicators.

Methods

This qualitative description study involves 4 to 8 participants, including older adults with and without Mild Cognitive Impairments/frailty, caregivers, and clinicians, in a group interview. Using card sorting and task mapping, the interview seeks to identify and define the features and challenges of a smart home system to monitor frailty in older adults.

Results

The study is registered in clinical trials, with data collection commencing soon. At the conference, we will present the research protocol and the findings from the analysis of the interviews.

Conclusion

Through the early engagement of older adults and caregivers, we strive to design a valuable and meaningful system that (1) uses zero-effort technologies so frail older adults do not need to develop new skills in order to use the system; (2) is a non-camera-based tracking technology preserving autonomy and privacy; (3) generates the frailty data meaningful for older adults, caregivers and the health system.
COHORT PROFILE FOR THE TONGJI CARDIOVASCULAR HEALTH STUDY: A PROSPECTIVE MULTI-OMICS COHORT STUDY
Authors: Xu Ting , Lu Yueqi , Chen Bangwei , Deng Chenxin , Zhang Yucong , Ruan Lei , Li Tao , Zhang Cuntai
Published: December 2023

The Tongji Cardiovascular Health Study aimed to further explore the onset and progression mechanisms of cardiovascular disease (CVD) through the combination of traditional cohort study and multi-omics analysis including genomics, metabolomics and metagenomics. This study included participants aged 20-70 years old from Geriatric Health Management Center of Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology. After enrollment, each participant underwent a comprehensive series of traditional and novel cardiovascular risk factors assessments at baseline, including questionnaires, physical examinations, laboratory tests, cardiovascular health assessments, and biological samples collection for subsequent multi-omics analysis. A biennial follow-up will be performed for ten years to collect the information above and the outcome data. Totally, 2,601 participants were recruited in this study (73.4% men), with a mean age of 51.5±11.5 years. They were mostly highly educated (college and bachelor’s degree or above: 92.8%) and mostly had healthy lifestyle behaviors. A total of 50.5% and 14.9% of men and 23.1% and 3.4% of women were overweight and obese, respectively. The proportion of several comorbidities such as hypertension, diabetes mellitus, and hyperlipidemia increased with age, and the rapid increase in women around the age of 40-50. With the progress of the cohort follow-up work, it is expected to provide unique multidimensional and longitudinal data on cardiovascular health in China.
COMMUNITY ENGAGEMENT IN THE DEVELOPMENT OF SEE ME: THE STUDENT-ELDER* ENGAGED MENTORING EXPERIENCE
Authors: Oosterhouse Kimberly , Skemp Lisa , Williams Ginger , Lesperance Larry , Heid-Grubman Jeanne , Hill Caesar , Banks-Wright Hortense
Published: December 2023

Loneliness, isolation, and suicide have been exacerbated by COVID-19 and ongoing uncertainties for both older adult and college-age populations. The 2023 Surgeon General’s Advisory on loneliness and isolation advocates for the healing effects of social connection, but ageist attitudes and stereotypes hinder social connections across generations. Intergenerational programs aim to address ageism and social connectivity, however, transferability of programs to culturally diverse groups remain challenging. Additionally, nursing curricula tend to focus on frail older adults, emphasizing vulnerability rather than wellness and disconnection rather than connection, contributing to disinterest in gerontological nursing. Prior community engaged ethnographic research identified five diverse older adult subcommunities that prioritized the need to address isolation and loneliness. Collaborating with these community organizations and nursing students, we developed the nursing Student-Elder*-Engaged Mentoring Experience (SEE ME) with the purpose of creating a sustainable and transferable program to address these needs. We will describe the research-based partnership process and resulting program development that focused on mutual wellness through reciprocal social connectivity among older adults in the community and nursing students in a required gerontological nursing course. In partnership, we developed and refined culturally appropriate processes, forms, assignments, activities, schedules, overall course organization, and program evaluation materials. Animated video modules and “Let’s Talk” questions were developed to facilitate student - older adult discussion. Dissemination and access to the program materials will be discussed. *The term “elder” was selected by the older adult community partners as their preferred nomenclature.
DAYS AT DUNROVIN: ANALYSIS OF FIELD NOTES FROM AN ONLINE NATURE-BASED INTERVENTION FOR OLDER ADULTS
Authors: Westmore Megan , Tulloh Anna , Mauldin Rebecca , Anderson Keith , Hagedorn Aaron
Published: December 2023

Implementing novel interventions for older adults is often challenging, and understanding processes is as important as evaluating outcomes. Days at Dunrovin (D@D) is an online program providing virtual access to a Montana ranch. While originally designed as an individual activity, researchers converted D@D into a group activity for older adults. In this presentation, researchers present an analysis of field notes from 65 group sessions (n = 65) in an assisted living community. Results are organized using the first four elements of the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance). Reach (i.e., participation) depended on encouraging participation and transporting residents to activity areas – often time-consuming, and diminished by limited resources. Effectiveness (preliminary) was evidenced by participant engagement with the activity, and by staff and family observations of participants’ affect and behavior. Laugher, conversations, and reminiscence were consistently observed. Adoption, the level of facility acceptance, was mixed as some staff welcomed the new activity while others found it difficult to support while attending to regular work. Implementation depended on many factors, including the environment (e.g., room arrangement), time of day, fluctuations in participant well-being, and technological capacities such as broadband width. Most notable was a lightning strike on the D@D cameras that resulted in the temporary use of archival content rather than viewing livestreams. Results suggest the feasibility and potential effectiveness of using nature-based livestream broadcasts as a group activity in assisted living and reveal the invaluable role field notes play in understanding implementation and evaluating interventions in applied research.
DECISION-MAKING CAPACITY ASSESSMENTS FOR VULNERABLE ADULTS: LESSONS FOR SOCIAL WORK COMPETENCY
Authors: Navarro Adria , Leishman Eppie
Published: December 2023

Social work approaches to the assessment of decision-making capacity (DMC) assessment have largely been informed by literature from 25 years ago. Evidence-based practices include the ACED short version and the IDA-CA 3.0. When considering this specific practice by social workers there is the UK policy supporting competent practice through legislation, the Mental Capacity Act (2017) of England and Wales. Nine practitioners practicing through guidance presented by this policy were interviewed to learn what may support practices in the United States. Findings point to the importance of foundational values and efforts to optimize the vulnerable adult’s performance. Practical methods used in the assessment are gleaned, along with the training that has informed their work. Training advice included didactic, case review, and role-playing of increasingly complex cases. Experience working with diverse populations of vulnerable adults was also highlighted. This research strives to inform steps that enhance capacity within health and social care settings to adequately assess DMC. Understanding decision-making ability aids in preventing both paternalism and the insufficiency of support and/or protection.
DESIGNING COLLABORATIVE AUGMENTED REALITY ACTIVITIES WITH OLDER ADULTS IN LONG TERM CARE
Authors: Maxwell Cathy , Tauseef Mahruhk , Ullal Akshith , Watkins Alexandra , Tate Judith , Juckett Lisa , Mion Lorraine , Sarkar Nilanjan
Published: December 2023

Loneliness is common among older adults in long term care (LTC) settings. Interactive communication technologies hold great promise in reducing loneliness but require design and evaluation studies. As part of a larger study on use of head mounted display augmented reality (HMD-AR) to connect older LTC adults with family members, we conducted a participatory design study to a) identify and design HMD-AR multi-user activities and b) address barriers found with LTC residents when interacting with HMD-AR.

Results: Laboratory testing was conducted with 23 older adults with normal cognition (ages 65 to 93, 6 men) and field testing with iterative feedback cycles with 8 older adults with impaired mobility and cognition (ages 54 to 87, 2 men, 4 with stroke) that resulted in prototype development and testing of three activities: playing checkers, decorating a fireplace, and eating a meal. Challenges successfully addressed through technological innovations included: 1) enhancing perceptions and ease of interacting with photorealistic avatars, 2) providing various techniques to allow older adults to view and move AR objects despite cognitive and functional impairments (e.g., visual-perceptual impairments; limited dexterity), 3) using visual aids and voice commands, 4) developing visual adaptations for central vision and color detection impairments, and 5) creating tutorials and help guides for learnability and remembrance. Sessions lasted for 30 minutes and no adverse effects were noted with prolonged or repeated HMD-AR use. All enjoyed the HMD-AR activities.

Conclusion: HMD-AR can be successfully adapted for use by older adults with multiple cognitive and physical impairments.
DEVELOPMENT AND APPLICATION OF R1RHO DISPERSION IMAGING OF AGING MUSCLE IN AN ANIMAL MODEL
Authors: Adelnia Fatemeh , Wang Feng , Gore John
Published: December 2023

Compelling evidence from animal studies demonstrates that microvascular impairment contributes to the etiologies of several age-related chronic diseases, including sarcopenia. For example, capillary hemodynamic profiles are altered in old F344 rat spinotrapezius muscle compared with those of younger counterparts. However, a validated non-invasive measure of microvasculature geometry and structure has not yet been developed. Recently, it has been shown that R1ρ dispersion imaging at weak locking field frequencies (FSL) provides a unique way of characterizing microvessel size and density. Moreover, previous R1ρ images were acquired at strong FSL (≥500Hz) and used to measure the age-related differences linked to macromolecular deposition, such as collagen in the extracellular matrix. Here, we aimed to develop a non-invasive 3D volume R1ρ dispersion imaging method at weak FSLs (< 300Hz), to quantify microvasculature changes in skeletal muscle. We successfully implemented the protocol and applied it to the lower leg of five F334 female rats at age 15 mo. The whole lower leg of each rat was also imaged using conventional multislice T1-FLASH, Diffusion-weighted, and T2-MGE pulse sequences. We found that R1p value measured in calf muscles decreased from 46.92Hz to 41.63Hz by increasing FSL from 5Hz to 240Hz, which we suggest derives from the effects of rephasing some of the signal losses that arise from diffusion in intrinsic magnetic field gradients generated from microvessels. Future direction of this ongoing study will be to compare these results with data collected from young female rats at age 6 months and further validation using ex-vivo histology.
DEVELOPMENT OF AN EVIDENCE-BASED FRAMEWORK FOR INNOVATION READINESS OF LONG-TERM CARE ORGANIZATIONS
Authors: van den Hoed Monique , Backhaus Ramona , Beaulen Audrey , Hamers Jan , Daniels Ramon
Published: December 2023

Increasing innovation readiness of long-term care organizations is vital to ensure future provision and affordability of care delivery. Against this background, there is a need to obtain more insight into the factors that may lead to innovation readiness of long-term care organizations. Therefore, we conducted a scoping review and an interview study. The scoping review was based on the framework from Arksey and O’Malley and included 44 studies. The interview study was conducted with 16 stakeholders having a professional role in long-term care for older adults in the Netherlands: academics, (top)management, innovation managers and consultants. Based on the results of both studies, we propose a framework of factors contributing to innovation readiness. The framework consists of five main factors enabling innovation readiness of long-term care organizations for older adults: 1) strategic course for innovation 2) innovation journey 3) leadership for innovation 4) learning for innovation and 5) innovative organizational culture. The collective findings support the notion that for innovation readiness the interplay of main factors is vital and benefits from an approach at the individual, team, organizational and inter-organizational levels. Furthermore, our findings indicate that some factors might be more conditional and other factors might play a more supportive role. Research into innovation readiness of health care organizations is a rather new field. Further research directed toward a framework for innovation readiness might deliver a structured approach for managers of long-term care organizations to embed and assess innovation readiness.
DO PHYSICAL DISABILITY, FOOD INSECURITY, AND NEIGHBORHOOD COHESION MATTER IN DEPRESSION?
Authors: Jeong Jihyeong , Sacco Paul
Published: December 2023

Although previous studies have explained the association between food insecurity and depression, there has been a dearth of studies that have examined this relationship with older adults with physical disabilities and explored other variables that could have potentially impacted this relationship. Given the social capital theory, recognizing community-level factors provides broader contexts about the physical and social environments of communities where older adults with physical disabilities live. Thus, this study aimed to explain how physical disability and food insecurity are related to depression and examine the buffering effect of neighborhood cohesion on the relationship between food insecurity and depression. We analyzed 5,668 older adults aged 60 years or over from the Health and Retirement Study 2020 Core Final Release. This study conducted logistic regressions to examine the buffering effects of neighborhood cohesion on the association between food insecurity and depression, including covariates. The results showed that physical disability and food insecurity were statistically significantly associated with depression. Interestingly, the hypothesis of the buffering effects of neighborhood cohesion was not supported. This result can be explained by characteristics of mental health that different factors beyond food insecurity and neighborhood cohesion may influence. In other words, neighborhood cohesion alone may not be able to explain its buffering effects on the relationship between food insecurity and depression. While the results of this study may seem contrary to social capital theory, future studies need to consider various moderating variables to understand how community and stressors such as food insecurity interact with mental health.
DOES POSTOPERATIVE GABAPENTIN ANALGESIA ADD TO DELIRIUM IN OLDER COLORECTAL SURGERY PATIENTS?
Authors: Rajan Ashna , Monteiro Joao Filipe G , Mujahid Nadia , Vrees Matthew , Schechter Steven , McNicoll Lynn , Gravenstein Stefan , Singh Mriganka
Published: December 2023

Our health system adopted a frailty adjusted low-(100 mg) or high-dose(300 mg) gabapentin regimen for opioid sparing postoperative analgesia for older colorectal surgery (CRS) patients to hasten return of bowel function and discharge. But, was it also associated with delirium? 1,306 elective CRS patients ≥ 65 years admitted from 4/2015-6/2023 were retrospectively studied, after excluding those receiving critical care, or hospitalized >3 months. Delirium was defined by ICD coding or postoperative antipsychotic use. Delirium rates were compared using multivariate logistic regression between no- (NG), low- (LG) and high- (HG) dose gabapentin, controlling for age, gender, race, Charlson Comorbidity Index (CCI), depression, preoperative gabapentin use and length of hospital stay. Bivariate, chi-square and t-tests were also used for comparison, as appropriate. NG recipients were found to be older (75.8±7.5) than LG (74.3±6.6, p-value=0.0041) or HG (73.4±6.8, p-value=0.0040), but similar by CCI (mean CCI:6.5±3.9) and depression (17.5%). While overall delirium rates were similar between all three groups, preoperative exposure to gabapentin (as a home medication) was associated with a 3-fold increase in delirium in the HG vs LG (OR 2.76 95% CI [1.25-6.08]) as well as HG vs NG (3.02 [1.38-6.59]) groups. Without gabapentin exposure preoperatively, the NG group was 3 times more likely to develop delirium compared to HG (3.09 [1.36-6.98]). Gabapentin may contribute to postoperative delirium but the unexpected greater delirium incidence among the NG compared to LG may reflect unmeasured confounders of greater underlying delirium risk, or a LG delirium sparing effect.