bluuebunny/crossref_metadata_2025 huggingface dataset:
OPTIMIZING VOLUNTARY WORK DESIGN FOR HEALTHY AGING: RETHINKING VOLUNTEER ENGAGEMENT
Authors: Lu Shiyu
Published: January 2025

While existing research primarily focuses on the health benefits of volunteering in terms of quantity (e.g., participation or volunteer hours), the psychosocial aspects of role engagement in volunteering and its impact on healthy aging remain underexplored. Additionally, insights on establishing a supportive volunteering environment at the organizational level to facilitate healthy aging are lacking. This innovative study connected voluntary work design, role engagement in volunteering, and subjective well-being (SWB) among older adults. In an ongoing cross-sectional study involving 258 volunteers aged 60 and above in Hong Kong, the research revealed that the role engagement of volunteers (β = 0.08, p = 0.014) significantly correlated with SWB, while no significant association was observed between volunteer hours in the past 12 months and SWB (β = 0.001, p = 0.297), after adjusting for factors like age, gender, and cognitive function. Introducing elements of voluntary work design, such as task significance, organizational support, and autonomy, into the model unveiled a direct link between organizational support and improved SWB (β = 0.15, p = 0.003). Task significance (0.32, p =0.028) and organizational support (β = 0.04, p = 0.016) were further found to influence SWB through the role engagement of volunteering. The study underscores both theoretical and practical implications concerning the creation of a supportive volunteering environment conducive to healthy aging.
PSYCHIATRIC DISORDERS IN EARLY-ONSET VS. LATE-ONSET DEMENTIA: AN ANALYSIS OF THE ALL OF US RESEARCH PROGRAM
Authors: Qi Xiang , Vranceanu Ana-Maria , Wu Bei
Published: January 2025

Early-onset dementia (EOD), defined as being diagnosed with dementia before age 65, affects approximately 200,000 Americans. While EOD is characterized by an earlier and more severe onset, late-onset dementia (LOD) patients have longer exposure to potential risk factors for psychiatric disorders. This study investigates the relationship between EOD and psychiatric disorders, comparing it to LOD and individuals without dementia. We conducted a retrospective cohort study using electronic health records of 286,826 participants from the NIH All of Us Research Program. This diverse cohort included 59.7% women (mean age 52.3). Using multivariable logistic regression models, we found that compared to LOD, individuals with EOD showed increased risks of depression (OR 1.47, 95% CI 1.23-1.76), anxiety (OR 1.47, 95% CI 1.23-1.75), bipolar disorder (OR 2.63, 95% CI 2.04-3.38), schizophrenia (OR 2.76, 95% CI 1.96-3.88), and substance use and addiction (OR 1.86, 95% CI 1.96-3.88). The differences were more pronounced when comparing EOD to the no dementia group, with notably higher odds for depression (OR 4.82, 95% CI 4.37-5.33), anxiety (OR 3.79, 95% CI 3.30-4.36), bipolar disorder (OR 3.42, 95% CI 2.90-4.03), schizophrenia (OR 3.48, 95% CI 3.03-4.00), and substance use and addiction (OR 2.92, 95% CI 2.64-3.22). These findings persisted after controlling for sociodemographic characteristics, lifestyle factors, functional ability, and chronic conditions. Our results highlight the need for comprehensive mental health screening and targeted interventions for individuals with EOD. This study emphasizes the importance of early detection and specialized care for this vulnerable population, potentially informing healthcare policies and improving patient outcomes.
SOCIAL NETWORK BRIDGING AND COGNITIVE RESERVE IN SPECIFIC DOMAINS: BENCHMARKING TO EDUCATIONAL ATTAINMENT
Authors: Sun Haosen , Perry Brea
Published: January 2025

Cognitive reserve helps delay and slow cognitive decline despite neuropathology, with diverse social networks that have rich bridging potential enhancing this reserve. However, the benefits to different cognitive domains from such networks and the relative impact compared to other known resiliency factors are unclear. This study aims to identify which domain-specific cognitive reserve benefits most from social networks with higher bridging capital, with a comparison with education. Data from 217 participants in the Social Networks in Alzheimer’s Disease (SNAD) project were analyzed. Cognitive reserve was assessed using the residual approach, comparing cognitive domain performance against brain structure metrics from MRI. Social network bridging capital was measured through network characteristics such as structural holes, diversity, weak ties, and network size. Linear regressions examined the association between bridging capital and cognitive reserve across cognitive domains, comparing the effect size to educational attainment. Network bridging capital was significantly associated with general cognitive reserve and cognitive domains such as executive function, visuospatial skills, language, and episodic memory. The impact of bridging capital was comparable to or greater than that of educational attainment in these domains. However, it did not significantly enhance cognitive reserve in attention and processing speed, where education had a stronger influence. Overall, social networks with high bridging potential are particularly beneficial for enhancing cognitive reserve in certain domains. Interventions aimed at slowing cognitive decline in these areas could leverage diverse networks, especially early in disease trajectories, constituting a late-life modifiable protective factor.
WORK TOLL: AN INTERSECTIONAL ANALYSIS ON ABSENTEEISM AND PRESENTEEISM AMONG FAMILY CAREGIVERS FOR PLWD
Authors: Milnamow Mary
Published: January 2025

Working family caregivers for PLwD experience higher rates of work productivity loss—absenteeism and presenteeism—compared to their non-caregiving counterparts. Accessible workplace supports remain out of reach for many caregivers making them vulnerable for compensation loss. Only recently has an intersectionality approach been used in quantitative research to address persistent inequalities across disciplines. This cross-sectional study examined 1) relationship between caregivers’ intersecting social identities and access to flexible hours; and 2) extent caregivers’ intersecting social identities impact experiences of absenteeism and presenteeism. Dyads (n=891) from 2017 wave of National Health and Aging Trends Study (NHATS) and National Survey of Caregivers (NSOC) were analyzed using the validated WPAI-CG measure. Mixed-effect logistic regression models and generalized linear models were conducted. Findings suggest caregivers with one full-time job were less likely to have flexible hours compared to caregivers with part-time or multiple jobs (p<.05). Black female caregivers were more likely to have flexible hours compared to Black male caregivers (OR=9.3, p=.024), but the opposite relationship was found for White caregivers (OR=0.19, p=.002). Caregivers who were female, post-HS education, with flexible hours, and multiple health conditions had greater presenteeism (p<.05). Caring for someone with dementia was associated with greater presenteeism (p<.05). Caregiving situations vary drastically. Flexible hours are popular but may not adequately address work productivity loss; furthermore, findings suggest disparate access to them. As the number of PLwD is expected to rise over the next 25 years, policies and workplaces need to consider inclusive solutions to meet the needs of working family caregivers.
CMS AND ASTP: FEDERAL PARTNERSHIPS FORGED TO SUPPORT THE DEVELOPMENT OF INTEROPERABLE E-CARE PLANS
Authors: Hall Elizabeth Palena , Wittie Michael
Published: January 2025

Across the United States, more than 25% of Americans have multiple chronic conditions that often impact quality of life, mortality, complexity of care and cost. The need for seamless interdisciplinary communication and data driven decision-making continues to grow, however, health care often remains fragmented, poorly coordinated and inefficient. A comprehensive, shared, interoperable e-care plan has the potential to improve patient outcomes, satisfaction, and quality of care by making comprehensive health data available across providers and settings when and where it is needed most. At the Federal level, the Centers for Medicare & Medicaid Services (CMS) and the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health IT (ASTP) are engaged in efforts to improve interoperable e-care plans. This session will describe the current state of e-care plans and challenges, promising practices from the field, and opportunities for advancement. This presentation will discuss how ASTP programs interact with CMS’ work to support an e-care plan environment where patients’ care plan information is securely and readily available to support patient outcomes. The session will include an overview of updates and proposals to ASTP’s Health IT Certification Program, a description of how the United States Core Data for Interoperability (USCDI) and USCDI+ Program can support the collection and exchange of e-care plans with the care team and patients, support quality measurement and quality reporting programs, and highlight how interested parties can engage in ongoing standards and policy development.
ENHANCING HEALTHCARE VALUE THROUGH INTEROPERABLE E-CARE PLANS: A FRAMEWORK FOR QUALITY IMPROVEMENT
Authors: Bierman Arlene , Ling Shari , Nebeker Johanthan
Published: January 2025

Patient-centered data is critical for providing high-value care and assessing quality including functional and cognitive status, goals, and outcomes that matter most to people; these are often missing in Electronic Health Records (EHRs). Furthermore, lack of interoperability makes it challenging to share and aggregate data across clinicians and care settings, leading to fragmented and/or duplicative care. E-care plans (eCP) and data standards that focus on goal setting and outcome management are in development, and hold promise to support person- centered care planning across sites and settings of care. E-Care Plans support care coordination and quality improvement and inform future healthcare value-focused policies—such as those related to equitable coverage, quality improvement, measurement, payment, and innovation model planning. Interoperable eCPs could be integrated into clinical care and across the healthcare ecosystem. This integration will enhance care coordination and facilitate seamless information exchange. In this session, Federal officials from the CMS, VA, and AHRQ will explore the benefits of eCPs and discuss the work underway to support the implementation of these plans in clinical care. This presentation will also discuss efforts to develop value sets and FHIR mappings to enable bidirectional information exchange and the concurrent pilot testing of applications with patient data. E-care plans have the potential improve patient safety, reduce burden, support the efficient exchange of patient data such as cognitive function, physical function, and individual goals to support improving person-centered outcomes, advancing health equity, conducting economic analysis, and tailored program development.
SCAMMED BY LOVE: THE ROLE OF LONELINESS, TRUST, AND AGE IN FINANCIAL LOSSES FROM U.S. ONLINE ROMANCE SCAMS
Authors: Cole Rebecca
Published: January 2025

Online romance scam (ORS) victims are popularly characterized as lonely, overly trusting older adults targeted by scammers seeking gifts and money through fake romantic relationships. However, research focuses on middle-aged women, overlooking risks to older adults using social networking, online dating and Internet technologies. The present exploratory research aims to identify these risks by examining the associations among age, feelings of loneliness and trust, and ORS money loss from data collected in a nationwide online survey about U.S. ORS victimization. Male (n = 4) and female (n = 27) participants who were victimized in an ORS and lost any amount of money were identified through community partners and social media. Most participants reported their race as White (n = 17) or Black or African American (n = 10) and had a college degree (n = 22). Their average age was 52 years. The mean reported money lost to the ORS was $133,647. Pearson’s product-moment correlation was used to identify the variables’ associations, and Cohen’s D was used to determine the effect size of the relationships. The only statistically significant result identified a medium-strength relationship between age and ORS money loss r(28) =.584, p <.01. This finding contributes to the limited knowledge in the U.S. of ORS by giving some foundational insight into the role of age and ORS victimization. Technology continues to be a constant in most adults’ lives, and more support is needed to create a safe online Internet experience for all adults.
“SURVIVING AGING” - LOW-INCOME OLDER ADULTS AND THEIR PERSPECTIVES ON THE MEANING OF LIFE: A QUALITATIVE ANALYSIS
Authors: David Daniel , Hadson Kim , Brody Abraham
Published: January 2025

Introduction

Low-income older adults often face challenging life circumstances, making it essential to explore how they derive meaning in life. This study examines the perspectives of residents in Medicaid-supported assisted living facilities on what gives their lives meaning, shedding light on their psychosocial needs and well-being.

Methods

Qualitative interviews were conducted with 60 residents across three Medicaid-supported assisted living facilities in New York City. Participants responded to the question, “What gives your life meaning?” The sample was diverse, including individuals navigating aging, illness, and limited resources. Data were analyzed using content analysis to identify common themes.

Results

Five key themes emerged: 1) Overcoming Challenges, 2) Seeking Meaningful Relationships with Family and Aides, 3) Focusing on and Accepting the Present, 4) Personal Growth and Community Contribution, and 5) Maintaining Autonomy. A subset expressed an existential view, stating, “There is no meaning.” Despite numerous challenges, most residents sought meaning late in life by focusing on strengths rather than barriers.

Discussion

The findings highlight the complexity of meaning-making in later life, particularly among low-income older adults in under-resourced settings. While challenges are significant, the ability to find meaning through relationships, personal growth, and autonomy suggests critical avenues for intervention. Existential concerns raised by some participants indicate a need to address these perspectives within psychosocial support frameworks.

Conclusion

This study offers insights into how low-income older adults in assisted living derive meaning. Emphasizing strengths over barriers underscores the importance of targeted interventions to support their psychosocial needs and enhance their quality of life.
THE HEALTH TRAJECTORY OF OLDER IMMIGRANTS IN CANADA: FINDINGS FROM THE CANADIAN LONGITUDINAL STUDY ON AGING
Authors: Li Lun , Wister Andrew , Lee Yeonjung
Published: January 2025

In Canada, older immigrants constitute about one-third of aging Canadians, and the population size of older immigrants is projected to keep growing. The health and wellbeing of older immigrants are critical to Canada’s healthcare and social services systems. This study intends to examine the health trajectory of older immigrants in Canada over ten years (2011 to 2021) using three waves of data from the Canadian Longitudinal Study on Aging based on Linear Mixed Models. The data analysis unit contains a total of 21,480 older adults (aged 65 years and older), including 4,248 immigrants and 17,232 Canada-born. The results indicate that older immigrants report better physical health (fewer chronic diseases and better physical capability) than Canada-born older adults but experience a greater decline in physical health over ten years. When it comes to mental health, older immigrants and Canada-born older adults report similar levels of depression and loneliness, and the change of mental health is parallel over time. In addition, older immigrants report significantly lower levels of social wellbeing (e.g., social support and social participation), and a greater decline in perceived social support and social participation. The findings from this study enrich the “healthy immigrant effect” with older immigrants’ health situation in Canada over ten years. The findings also emphasize the need to support older immigrants in Canada to maintain social wellbeing and enhance the positive impacts of social determinants of health during the aging process.
A SENIOR CENTER-BASED MULTILEVEL LIFESTYLE INTERVENTION IN OLDER ADULTS WITH TYPE 2 DIABETES
Authors: Du Yan , Song Lixin , Volpi Elena , Hazuda Helen , Yin Zenong , Finley Erin , Jaen Carlos , Mireles Josh
Published: January 2025

Approximately 30% of adults aged 65 and over in the U.S. have Type 2 diabetes (T2D), leading to impaired physical function and reduced quality of life. This ongoing pilot project aims to assess the feasibility and acceptability of a multilevel lifestyle intervention at a day-activity senior center, examine preliminary effects, and explore implementation strategies. The study employs a 6-month, single-arm, pre- and post- test design (3 and 6 months). In collaboration with key stakeholders, including senior center staff and individuals with T2D, we are adapting the Diabetes Prevention Program curriculum and the Look AHEAD lifestyle intervention into a multilevel lifestyle intervention, targeting individual, interpersonal, and organizational levels. Nineteen older adults (mean age=68.5±5.5, Latinos/Hispanics=94.7%, female=89.5%) were enrolled. Fourteen digital lessons, facilitated by trained community health workers, are being provided separately in English and Spanish in a group format. Semi-structured interviews with key stakeholders will be conducted at 6 months to explore study acceptability and intervention adoption, implementation and sustainability. Baseline data showed that 83.3% of participants were obese, with 42.1% meeting physical activity recommendations. Self-efficacy scores for physical activity and diabetes management were 63.4±11.9 and 54.6±21.0. The mean HbA1c, extended short physical performance battery, and quality of life was 6.5±0.8, 15.7±3.8, and 40.8±7.8, respectively. The baseline data reveal significant challenges, such as high obesity rates and low self-efficacy in physical activity and diabetes management. We are leveraging these insights to tailor the multilevel lifestyle intervention to improve diabetes management, physical function, and quality of life in older adults with T2D.
AGREEMENT OF MEDICARE PART D VS. MINIMUM DATA SET REPORTED MENTAL HEALTH DRUGS USE IN NURSING HOMES
Authors: Huan Tianwen , Intrator Orna , Simning Adam , Boockvar Kenneth , Grabowski David C , Cai Shubing
Published: January 2025

Researchers have often used the nursing home Minimum Data Set (MDS) data to measure the rate of medication use, but little evidence exists on the accuracy of the MDS-based medication items. We compared quarterly rates of antipsychotic, antidepressant, and hypnotic use between the MDS and Part D Event file (PDE) in 2018 among long-stay nursing home residents enrolled in Medicare Part D who were ≥ 65 years old with psychiatric disorders or dementia identified in the MDS data. We used Cohen kappa to assess agreement in the share of residents using mental health medications during the quarter and used PDE data as a reference to calculate validity parameters. A total of 34.0%/73.4% of study participants were identified using antipsychotic/antidepressant medications in MDS assessments vs 34.3%/71.3% identified in PDE records (kappa value: 0.90/0.83). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MDS data compared to PDE were 96.7%/84.5%, 92.8% /96.7%, 96.3%/91.1%, and 93.6%/94.0%. Only 3.7% of study participants identified in the MDS data, vs 32.6% PDE-based users (kappa value: 0.1), used hypnotics. By combining anxiety medications with hypnotics, the rates of MDS hypnotic or anxiety users increased to 35.0% (kappa value: 0.74). The sensitivity, specificity, PPV, and NPV were 89.5%, 85.6%, 92.8%, and 79.8%, respectively. Agreement between the MDS and PDE in antipsychotic and antidepressant use was high, suggesting that the MDS is a valid tool to measure antipsychotic and antidepressant use. Additional work is needed to understand the disagreements between MDS and PDE in hypnotic use.
DNA METHYLATION AGE ACCELERATION MEDIATES THE ASSOCIATIONS BETWEEN EARLY-LIFE CIRCUMSTANCES AND DEMENTIA RISK
Authors: Pu Fan , Lin Zhuoer , Yu Jiao , Liu Zuyun , Chen Xi
Published: January 2025

Dementia represents critical public health challenges and exerts an immense economic burden. While mounting evidence has linked early-life circumstances to dementia risk, prior research mainly focused on single factors, failing to capture the complex interplay of comprehensive early-life circumstances and the underlying biological pathways. This study aims to fill the gap by exploring how multidimensional early-life circumstances, spanning family education, relationships, financial status, regional context, and school experiences, contribute to dementia risk in later life. Particularly, we investigate the role of DNA methylation age acceleration (DNAmAgeAccel) as a strong mediator of the associations. Using data from 4,018 American adults aged 50 and older from the Health and Retirement Study, we assessed dementia using the Langa-Weir Classification of Cognitive Function and DNAmAgeAccel through the residuals of 11 DNAm clocks. Our multivariate regression analyses demonstrated significant associations between early-life circumstances and dementia risk. Notably, adverse family education environments, such as mother’s low educational attainment and absence of time/attention from mother, along with poor family relationships, were associated with an increased risk of dementia. In contrast, positive school experiences, like engagement in creative arts in high school, were protective. Importantly, DNAmAgeAccel showed significant mediation effects, especially in education-related factors. For instance, DNAmAgeAccel mediated 15.1% to 32.8% of the association between maternal education and dementia risk. These findings highlight the enduring impact of multidimensional early-life circumstances on late-life cognitive health and suggest DNAmAgeAccel as a key biological pathway linking early adversity to dementia risk.
EMPOWERING COLLABORATION: ENHANCING GERIATRIC CARE WITH AGE-FRIENDLY CNA TRAINING BY LTC OMBUDSMEN
Authors: Sivers-Teixeira Theresa , Thayer Erin , Chang E-Shien , Chen Stella , Cherry Debra , Tate Rachel , Olsen Bonnie
Published: January 2025

Long-Term Care (LTC) Certified Nursing Assistants (CNAs) who provide direct care to residents often face significant challenges in supporting daily activities and the well-being of residents with functional decline. Frequent difficult behaviors can lead to negative experiences, reducing residents’ quality of life and diminishing CNAs’ job satisfaction. LTC Ombudsmen (LTCO) assist residents with issues related to day-to-day care, health, safety, personal preferences, rights violations, poor quality of care, and elder abuse. The USC Geriatric Workforce Enhancement Program (GWEP) developed an innovative program to train LTCO to deliver the Age-Friendly (AF) Nursing Home curriculum to improve CNAs’ geriatric competencies. A four-lesson curriculum, developed collaboratively by the Los Angeles LTCO Program administered by WISE & Healthy Aging, Alzheimer’s Los Angeles, Dr. Shien Chang, and the USC GWEP team, addresses: 1) AF principles of nursing home care, 2) evidence-based strategies for managing behavior issues related to dementia, and 3) strategies for increasing culturally appropriate communication with patients and caregivers. Using a train-the-trainer model, 5 LTCOmbudsmen were trained and delivered the curriculum to 133 CNAs in eight local nursing homes. A pre-post training survey administered to CNA participants showed a statistically significant increase in confidence in applying the training topics. Focus groups with LTCO trainers revealed a positive bidirectional impact on ombudsmen and CNAs. This training model introduced AF care strategies and strengthened the shared purpose between LTCO and CNAs. The study provides a foundation for ongoing collaboration and dissemination of this scalable and sustainable model to improve care for older adult LTC residents.
EXPLORING AI FOR DEMENTIA CARE SUPPORT IN NORTHERN ONTARIO: A LITERATURE REVIEW
Authors: Shrestha Hom , Shrestha Lucy
Published: January 2025

Dementia is the seventh leading cause of death globally, significantly impairs cognitive abilities and memory loss. Artificial intelligence (AI) has the potential to revolutionize dementia care by assisting healthcare professionals in diagnosing, managing, and treating dementia worldwide. We conducted literature review using Google Scholar, PubMed, and Laurentian libraries (OMNI), focusing on key terms such as “dementia,” “Alzheimer’s disease,” “artificial intelligence,” and “healthcare.” This review covered peer-reviewed publications from 2014 to 2023, aiming to fill gaps in this research area. The search yielded five relevant articles, identifying three core themes: AI’s impact on Alzheimer’s disease and related dementias (ADRD), early detection and diagnosis of ADRD, and AI’s role in supporting healthcare professionals, caregivers, and patients. Zhang et al. (2023) emphasized AI’s role in diagnosing Alzheimer’s disease using MRI, PET scans, biomarkers, and advanced machine learning applications. Hane et al. (2020) highlighted the use of machine learning models for assessing ADRD risk by analyzing clinical notes to prevent nursing home admissions and reduce care costs. Xie et al. (2020) explored the use of assistive AI devices by caregivers to manage ADRD, reducing patient dependence. Li et al. (2020) focused on voice-activated AI tools that help caregivers manage nutrition and reduce their workload. Gustavsson, Svanberg, and Mullersdorf (2015) examined the benefits of the interactive robotic “Justo Cat” in enhancing communication in dementia care. This review suggests conducting ethnographic participatory focused-groups with thematic analysis to inform policymakers in developing specialized educational programs, integrating advanced AI, expanding digital health and telemedicine, and launching community-driven initiatives.
“[CERVICAL CANCER], NOT AT THIS AGE…”: TREATMENT EXPERIENCES OF OLDER WOMEN WITH ADVANCED CERVICAL CANCER
Authors: Chidebe Runcie , Okoye Ifeoma
Published: January 2025

Background

Cervical cancer (CC) is 90% preventable with the HPV vaccine against sub-types 16 and 18, yet an estimated 21 women die every day from CC, and 7,968 die annually in Nigeria. Most of the women diagnosed with CC are older women, yet the gerontological aspect of CC among this population is largely scarce. Older women living with CC are at risk of undertreatment and are most likely to report the worst prognosis. This phenomenological study is aimed at understanding the treatment experiences of older women living with stage IV CC and their meaning-making of this incurable disease.

Method

Using interpretive phenomenological analysis (IPA), 16 older women (50 – 85 years) with advanced CC were recruited. Data was collected through semi-structured interviews, and the six steps of IPA were used for analysis.

Results

Four identified themes: “[cervical cancer], not at this age, not at any age anyway but at this age to me is even worse”, “He [the doctor] talked about surgery but because of my age, surgery was moved out”, “There is a need for support and to be loved” and “When someone’s [cancer] is palliative, take it as palliative, when it is critical treat it as such. Don’t treat palliative and leave critical aside”.

Conclusion

This study provided a gerontological insight into the lived experiences of these older women. As the world is working to eliminate cervical cancer with the human papillomavirus vaccine, older women who already have advanced cervical cancer should not be forgotten.
EXPERIENCES WITH PARATRANSIT USE AMONG OLDER ADULTS LIVING WITH DISABILITY
Authors: Fique Morgan , Mathis Lindsey , Castilo Andrea Melgar , Twardzik Erica , Falvey Jason , Cooper-Williams Jasmine
Published: January 2025

Public transportation agencies are required to offer paratransit services to individuals near fixed routes, but structural barriers to use (e.g., delays in rides) may disproportionately impact older adults. This is important, as nearly 10% of urban-dwelling older adults use public transportation, many to get medical care. However, how older users interact with, benefit from, or experience barriers related to paratransit services is unclear. We completed 12 semi-structured interviews with paratransit users aged 55 and older in the Baltimore area and analyzed the transcripts using inductive thematic analysis. Two independent researchers coded each transcript. Six main themes emerged: 1) Paratransit services help older adults maintain independence and reduce social isolation by improving access to healthcare and social engagement; 2) Ableist interactions with paratransit staff and access to working equipment (e.g., wheelchair lifts) were negative determinants of paratransit use experiences; 3) Inefficiency of the service, eligibility process, and recertification process place high burdens on older riders; 4) Paratransit frequently fails to meet needs of older disabled riders who experience cognitive impairment, sensory impairment, and/or mobility device use; 5) Built and social environment factors such as sidewalk quality, weather, and crime exposure increase the burden on older riders; and 6) Formal and informal social supports are critical for older adult paratransit use. The themes identified revealed critical gaps in current paratransit systems. These findings are crucial for guiding efforts to reshape policies and practices. By addressing these barriers, we can work towards improving service inefficiencies, eliminating ableism, and better supporting older disabled riders.
SUPPORTING AGING THROUGH HOUSING CHOICE: A DISCUSSION TOOL FOR COLLABORATION TOWARD LOCAL SOLUTIONS
Authors: Berlinger Nancy
Published: January 2025

This abstract concerns applied research and new open-access publications that will include piloting data from late September 2024, hence its submission as late-breaking research. This paper will present a discussion tool to support local discussion and collaboration to meet the housing needs of moderate-income older Americans. It has been informed by insights from national and regional aging and policy audiences and reflects findings from a mixed-methods study presented at GSA in 2022 concerning pandemic-era innovations that held promise for policy and practice concerning housing equity for older adults. Research shows that the vast “missing middle” population of older adults who do not qualify for housing subsidies and cannot afford market solutions geared to wealthy individuals struggles to pay for both housing and care. Within the national shortage of affordable housing, there is a shortage of housing that meets the needs of this population: housing that is affordable, accessible or adaptable, and a good fit for an aging person’s needs. This paper will share a slide-deck format tool and other resources that offer ways to explain housing needs, clarify realistic options, anticipate challenges, analyze and share success stories, and encourage productive collaboration among local policymakers, community members, housing developers, service providers, and other participants.
THE GROWING DEMAND FOR AGE-FRIENDLY CARE AND UNDERSERVED OLDER ADULTS IN THE HEALTH CARE SYSTEM
Authors: Terveer Katy
Published: January 2025

This session will present on the challenges and opportunities to re-think our health care system based on the latest findings from “Meeting the Growing Demand for Age-Friendly Care: Health Care at a Crossroads,” a study released by Age Wave and The John A. Hartford Foundation. We will explore the experiences and pain points of older adults, particularly those underserved, in today’s health care system based on a recently conducted survey with over 2,500 older adults ages 65+. We will identify key findings for those who are the least satisfied with their health care, namely, those with low financial resources, women, rural older adults, and Black and Hispanic older adults. We’ll summarize the key recommendations from the report for transforming health care systems to support longer healthspans and greater well-being as we age.
IMPLEMENTATION STUDY OF THE USE OF A BLOOD BIOMARKER TEST IN ALZHEIMER’S DISEASE: CLINICIAN SURVEY FROM QUIP II STUDY
Authors: Monane Mark , Carlile Robert , Johnson Kim , Gitelman Darren , VandeVrede Lawren , Jacobs Leslie , Braunstein Joel
Published: January 2025

Recent studies have shown that commercially available, high-performing blood biomarkers (BBMs) for Alzheimer’s disease (AD) pathology represent accurate, accessible, acceptable, and equitable tools to aid health care providers (HCPs) in the evaluation of their patients with signs or symptoms of mild cognitive impairment (MCI) or dementia. However, implementation of AD BBM tests into the clinical care pathway has not been extensively evaluated. The objective of this study was to assess the incorporation of the multi-analyte blood biomarker PrecivityAD2™ test (C2N Diagnostics, LLC, St. Louis, MO) into the clinical workflow of specialty clinics. A total of 203 patients (average age 74 years) evaluated by 12 HCPs (neurologists, geriatricians, geriatric psychiatrists, and others) representing 8 outpatient sites were included as part of the real-world QUIP II Study (NCT06025877). A five-item, end-of-study survey was developed and conducted using The Technology Acceptance Model (David, 1989) and included two constructs: perceived usefulness and perceived ease of use of this BBM test. HCP-reported acceptance scores averaged 9.6 (median 10, range 7-10): contribution to clinical decision-making and ease of understanding test results received the highest ratings. The net promoter score was 75, above the benchmark of 50 associated with excellent customer satisfaction (Qualtrics, 2024). Given recent guidelines and workshop recommendations highlighting the use of AD BBM tests in clinical care, we believe these survey data provide evidence of robust usefulness and acceptance of this BBM test, supporting its incorporation into the clinical care pathway to help HCPs rule in and rule out AD in cognitively symptomatic patients.
IMPROVING CARE THROUGH IMPROV: RESULTS OF A PILOT TEST WITH FAMILY AND FRIENDS OF PERSONS LIVING WITH DEMENTIA
Authors: Kemp Candace , Morgan Jennifer , Anglin Emerald , Greene Celeste , Williams Crystal , Williams Amanda
Published: January 2025

Evidence suggests that the use of improvisational (improv) theatre techniques in the dementia care context can have positive outcomes for care partners, persons living with dementia, and care relationships. We refined and pilot tested the feasibility, acceptability, and preliminary efficacy of the training program, “Improving Care through Improv,” which incorporates improv fundamentals with practical dementia care knowledge, among family and friends of persons living with moderate dementia. We used multiple methods to assess the program, including a no-control pre-post design trial involving surveys and focus groups. Participants received in-person training co-designed and co-led by an improv educator and a gerontologist during weekly 2-hour group sessions held over a 4-week period. We assessed the primary outcome (caregiver mastery) and exploratory outcomes (perceived stress, anxiety, caregiver burden, perceived ability to manage behaviors, and care recipient’s quality of life) at baseline; upon program completion, and 3 months post baseline. Forty care partners participated in the intervention, completed all three surveys, and participated in focus groups. Recruitment, enrollment, and completion rates alongside quantitative and qualitative findings indicate high levels of feasibility and acceptability. Dependent sample t-tests between times 1 and 3 showed significant improvement in caregiver mastery and significant reductions in perceived stress and depression. Participants characterized the program as “needed” and “very helpful.” Three months post baseline, 100% reported using the skills taught, with most saying that they used them “frequently” or “nearly always.” Findings demonstrate improv’s promise for improving dementia care experiences, illuminate areas for refinement and application, and support further testing.
LIVE AND DIE WITH DIGNITY: ALASKA NATIVE PERSPECTIVES AND EXPERIENCES ON DEMENTIA CAREGIVING AND FAMILY STIGMA
Authors: Kim Steffi , Lewis Jordan , Rebadulla Hannah , Thompson Lena , Demir Murat , Alejo Prince Iverson , Hilderbrand Zoey
Published: January 2025

Family stigma (FS), referring to experiences of stigma by association, is the consequence of stigmatizing beliefs and attitudes. This study assessed FS among Alaska Native (AN) Alzheimer’s disease and related dementias (ADRD) caregivers spanning three domains: caregiver, layperson, and structural stigma. Stigma can prevent caregivers from seeking a diagnosis, treatment, or support services. Caregivers report limited knowledge of the disease, little engagement with support and resources, and social isolation. This pilot study used a mixed methods approach to outline ADRD-related stigma and its impact AN caregivers’ quality of life. Semi-structured 60-90-minute interviews guided by the adapted Family Stigma – Alzheimer’s Disease scale were conducted with thirteen female AN ADRD caregivers across Alaska. The caregiver’s mean age was 62, with an average of seven years of caregiving. Descriptive statistics were used to report the quantity and frequency of reported experiences of stigma. Qualitative inquiries allowed for the exploration of in-depth cultural context. Interviews were analyzed using deductive and inductive content analysis. Caregivers identified several sources of FS. Layperson and structural stigma items were endorsed most often. Caregiver stigma detailed that limited support results in high levels of distress and experiences of depression. Cultural values such as caring for the Elders were protective and led to family and community involvement in giving care. Stigma reduced AN ADRD caregiver’s quality of life in the areas of family cohesion, limited participation in social events, and impacted professional engagement negatively. This study can inform future work to decrease the stigma associated with AN ADRD.
DISCRIMINATION ACROSS THE LIFE COURSE OF OLDER LONG-TERM RESIDENTS IN KOREA
Authors: Kim Jasmyn , Heo Jinmoo
Published: January 2025

Despite being one of the world’s most homogenous nations, South Korea’s (hereafter Korea) international population has grown significantly over the past few decades. As of 2022, approximately 2.5 million foreign citizens reside in Korea, comprising 5% of the total population and contributing to its evolving identity as a multicultural society. This demographic shift parallels Korea’s rapid socio-economic growth. However, foreign residents often encounter substantial challenges due to the persistent notion of a unified racial, ethnic, and cultural identity in Korean society, which can lead to cultural differences, social exclusion, stereotypes, and discrimination against those considered ‘others.’ The current qualitative case study explores the experiences of older long-term foreign residents from Western countries, focusing on discrimination across the life course. In-depth interviews were conducted with older international adults (mean age: 64.5) who had resided in Korea for over 3 years. Key findings revealed that despite experiencing alienation and exclusion from mainstream society, participants highlighted the importance of establishing social connections within both expatriate and local communities and reported a sense of belonging fostered through intercultural exchange, personal relationships and professional achievements. Although there is a growing emphasis on multiculturalism, prevailing cultural norms often hinder the complete integration of foreign residents into Korean society. This research sheds light on the complex power dynamics of ethnicity, social status, and discrimination, highlighting the need for more inclusive policies to better incorporate foreign residents in an increasingly globalized society.
LGBTQ-RELATED NEGATIVE LIFE EVENTS AND COGNITION: THE ROLE OF SLEEP, MENTAL DISTRESS AND UNSUPPORTIVE FAMILY
Authors: McKay Tara , Prasad Anyah
Published: January 2025

LGBTQ+ older adults are at increased risk of poor cognition. Using data from the LGBTQ+ Social Networks, Aging and Policy Study (QSNAPS, N=1,202), a unique panel study of 50-76 year old LGBTQ+ adults, and employing Structural Equation Modelling (SEM), we examine the association of LGBTQ-related negative life events (NLEs) with cognitive difficulty. We test whether the effect of NLEs on cognition is mediated by sleep quality or mental distress and whether it is exacerbated by the presence of unsupportive family members. About 20% of respondents report past year experiences of discrimination, harassment and/or violence and 40% report any cognitive difficulty. The association of NLEs with cognitive difficulty (e.g., trouble remembering names) is fully mediated by trouble falling asleep and mental distress (OR=1.21); NLEs increased trouble falling asleep (OR=1.96, p< 0.000), poorer sleep increased the likelihood of severe mental distress (OR=1.32, p< 0.000) and cognitive difficulty (OR=1.09, p<.001), and mental distress increased the odds of cognitive difficulty (OR=2.06, p< 0.001). The presence of unsupportive family members moderates the effect of NLEs on mental distress (main effect: OR=1.15, p=0.67; interaction effect: OR=2.86, p=0.009). The mediation effect of mental distress for the association between NLEs and cognitive difficulty for those with unsupportive family (OR=2.36) is greater than for those with no unsupportive family (OR=1.11). LGBTQ+ adults, especially those with unsupportive family, are at increased risk of cognitive impairment in later life. Interventions to support mental wellbeing, sleep hygiene, and affirmation of LGBTQ+ family members across the life course are critical to achieving health equity in aging.
THE INFLUENCE OF DISCRIMINATION ON GAY AND LESBIAN SPOUSAL DEMENTIA CAREGIVERS
Authors: Calasanti Toni , de Vries Brian
Published: January 2025

Most research has speculated that discrimination would influence the experiences of gay and lesbian spousal caregivers (e.g., Fredriksen-Goldsen, et al, 2016), but to date little research has revealed the actual impacts of discrimination and where and how it matters. The present study of 13 gay and 16 lesbian spousal dementia caregivers finds that both past experiences and present discrimination influence how they give care. On the one hand, past experiences of discrimination have taught these caregivers to be cautious, even when they have been out for many years and even when they live in what are typically considered to be supportive areas. Further, and even though many respondents reported no accounts of discrimination presently, some reported discriminatory experiences with social service or medical providers; and one gay husband had experienced violence in a care setting. At the same time, and what is less documented, are the ways that our respondents feel that what they learned to do to respond to discrimination prepared them for the challenges of spousal dementia care. This included all that lesbians and gay men faced during the HIV/AIDs epidemic. Having been “othered,” they feel they are more empathetic and sensitive to the stigma that comes with cognitive decline; they have greater self-reliance borne of the struggle with HIV/AIDs or in the face of estrangement from families or broader society; and they rely upon the resources provided by their communities. These results highlight areas both for subsequent novel research and interventions to support same-sex spousal dementia caregivers.
INVESTIGATING HEALTHCARE ACCESS DISPARITIES IN MINNESOTA THROUGH GIS ANALYSIS
Authors: Jang Woo , Krull Drew , Lee Seonhwa , Silverstein Merril
Published: January 2025

According to the 2020 report on population projections from the Minnesota State Demographic Center, older residents aged 85 and above are expected to more than double within the next 35 years. The report also highlights that in 2033, 32% of rural counties will experience a higher proportion of residents aged 65 years and older than 19% for urban counties. With the expected increase in the older population, the demand for healthcare services in rural areas will substantially rise. However, healthcare facilities are more dispersed in rural areas. Despite several accounts pointing to healthcare-deprived areas or the differential geographic presence of healthcare resources in recent years, GIS-based analysis in this area remains limited. To address this gap, our study utilizes data from the 2020 Census to assess various socio-demographic and economic factors shaping healthcare access inequalities for individuals aged 65 years and older in Minnesota. Employing GIS techniques, we identify unique spatial patterns and associated social factors contributing to healthcare access disparities. Our results visualize detailed maps highlighting areas facing challenges in accessing healthcare services and low-access populations across Minnesota. This study provides insights into understanding the spatial and social determinants of healthcare disparities, which assist policymakers and healthcare professionals to allocate resources more efficiently and address the unique needs of the target group.
MARITAL STATUS AND VASCULAR EVENTS IN A DIVERSE NORTHERN MANHATTAN COHORT
Authors: Gao Courtney , Roberts Jackson , Rundek Tatjana , Elkind Mitchell , Gardener Hannah , Gutierrez Jose
Published: January 2025

Background

Studies have shown that marital status is related to vascular outcomes but with potential variation by race/ethnicity. It remains unclear whether these associations occur in predominantly Hispanic populations.

Methods

In the Northern Manhattan Study prospective cohort, we assessed participants ≥40 years and stroke-free at baseline. We categorized participants as married or unmarried, a group subdivided into divorced/separated, widowed, or single. We used adjusted hazard models to relate marital status to myocardial infarction (MI), stroke, vascular death, and all-cause death.

Results

Of 2865 participants (53% Hispanic, mean 69 ±10 years), 32% were married, 16% were single, 28% were widowed, and 25% were divorced/separated. During a mean follow-up time of 15 years (IQR 3-28),14% had a stroke, 8% had an MI, and 68% died. Unmarried participants had a higher risk of any vascular event (aHR, 1.20 [95% CI, 1.04-1.39]) and all-cause death (aHR, 1.14 [95% CI, 1.02-1.28]) compared to married participants. The direction of the hazard ratios for stroke (aHR, 1.06 [95% CI, 0.83-1.35]) and MI (aHR, 1.11 [95% CI, 0.81-1.51]) was consistent with an increased risk. Divorced/separated participants had a higher risk of vascular events (aHR, 1.35 [95% CI, 1.14-1.61], vascular death (aHR, 1.29 [95% CI, 1.05-1.59]), and all-cause death (aHR, 1.21 [1.06-1.39]) compared to married participants.

Conclusion

In a predominantly Hispanic cohort, unmarried participants had a higher risk of vascular events and all-cause death. Future studies should explore the impact of risk stratification of patients based on marital status and provision of support to patients undergoing marital transition.