bluuebunny/crossref_metadata_2025 huggingface dataset:
USE OF PRESCRIPTION MEDICATIONS WITH SOMNOLENCE AS A POTENTIAL ADVERSE EFFECT AMONG OLDER ADULTS IN THE UNITED STATES
Authors: Wilder Jocelyn
Published: December 2023

Over half of community-dwelling older adults experience sleep disorders, with approximately 40% reporting somnolence or/and excessive daytime sleepiness, associated with an increased risk for cognitive impairment and premature mortality. The use and concurrent use of prescription medication with somnolence as an adverse effect may be an overlooked contributor to this growing problem. This study aims to characterize the use or concurrent use of medications with somnolence as an adverse effect and to assess associations between their use and the prevalence of somnolence (excessive daytime sleepiness or sleep duration of ≥9 hours) using data from the National Social Life, Health, and Aging Project (NSHAP) 2010-2011 (N=3,338). Adjusted prevalence was estimated from multivariable logistic regression models adjusted for socio-demographic measures and the number of medications without somnolence as an adverse effect. The estimated prevalence of somnolence was 54% for those reporting use of 3 or more medications with somnolence as an adverse effect vs. 36.5% for those not using such medications. The use of prescription medications with somnolence as a potential adverse effect was prevalent. Concurrent use of medications with somnolence as an adverse effect was associated with a higher prevalence of somnolence. These findings demonstrate the need for more research to understand the impact of concurrent use of medications with similar adverse side effects on OAs’ health and well-being.
PREDICTING 10 YEAR MORTALITY WITH MACHINE LEARNING: EVIDENCE FROM NATIONAL SOCIAL LIFE, HEALTH, AND AGING PROJECT
Authors: Li Yiang
Published: December 2023

The current academic literature extensively used linear logistic models with social, behavioral, and psychological status to predict mortality. However, few address the interdependency of predictors and the imbalance of targets that adversely bias the results. Using the National Social Life Health and Aging Project (NSHAP), we developed two machine learning models predicting the 10-year mortality of older adults in the US. We first used tree-based algorithms of Decision Tree (DT) that account for the interdependency of the social features and decide the splitting nodes and thresholds using entropy gain conditional on the previous splitting predictor to discern disposition status. Second, we used the Fuzzy Support Vector Machine (FSVM) that regards every sample as a node in high-dimensional vector space and splits the nodes with an optimum plane by finding the best linear combination of features to get an optimum prediction accuracy. Additionally, FSVM addresses the target imbalance problem by conducting a more delicate classification of samples with close predicted probabilities of being alive and deceased. Compared to the accuracy rates achieved by the Logistic Regression, our algorithms perform better on the entire population and the population near the class boundary. We also discussed the social and demographic characteristics of the cases whose disposition statuses were either wrongly predicted as deceased or alive by our algorithms. The findings serve important purposes for public health practitioners in accurately understanding the risk and protective factors of mortality in aging.
EFFECTS OF DISCLOSING DIAGNOSES AND BIOMARKER RESULTS FOR ALZHEIMER’S DISEASE AND RELATED DISORDERS
Authors: Amano Takashi , Carpenter Brian
Published: December 2023

Early diagnosis of mild cognitive impairment (MCI) and Alzheimer’s disease and related dementias (ADRD) has been recognized as a key strategy to improve health-related outcomes. However, given that these conditions are highly stigmatized, receiving a diagnostic label or knowing about biomarkers related to MCI or ADRD may have a profound impact on the person’s life. As the impacts of disclosure of diagnostic information related to MCI and ADRD on the well-being of people living with these conditions are not well understood, this symposium attempts to address this knowledge gap. The first presenter will describe a study that examined racial/ethnic variations in the effects of diagnostic labeling of ADRD on social aspects of the person’s life. The second presenter will discuss findings from a systematic review of the effects of ADRD and cognitive impairment on social engagement. The third presenter will present the findings of the study on the effect of amyloid PET results disclosure on health-related behaviors of people with MCI. The fourth presenter will describe the results of an online vignette study on the outcomes of a preclinical Alzheimer disease diagnosis. The fifth presenter will discuss the use of blood biomarkers to aid in the diagnosis of ADRD in primary care (PC). At the end of the presentation, the discussant will highlight implications for future research and policy development to alleviate negative impacts and maximize the positive impacts of a diagnostic label of MCI and ADRD.
INFLUENCES OF HAVING COGNITIVE IMPAIRMENT OR DEMENTIA ON SOCIAL ENGAGEMENT AMONG OLDER ADULTS: A SYSTEMATIC REVIEW
Authors: Scher Clara , Amano Takashi , Reynolds Addam , Jia Yuane
Published: December 2023

Studies have suggested that promoting and maintaining social engagement are positively associated with various well-being outcomes in later life. One notable barrier to sustaining social engagement in later life is development of cognitive impairment (CI) and/or Alzheimer’s disease and related dementias (ADRD). This study aims to synthesize existing literature exploring the impact of CI and ADRD on social engagement among older adults. We conducted a search of studies written in English language in the following databases: PsychInfo, PubMed, MEDLINE, CINAHL, and The Cochrane Library. Inclusion criteria included: observational studies that were conducted outside of residential long-term care facilities, included social engagement as an outcome variable, and examined the impact of cognitive impairment and/or ADRD on social engagement. Eighteen studies were included for qualitative synthesis. The majority of studies used author-developed scales to measure social engagement. Three utilized formal clinical diagnosis to measure cognitive impairment and ADRD. Twenty unique social activities were included, such as volunteering, attending community groups, and religious services. Four primary themes emerged regarding the relationship between CI/ADRD and social engagement: decreased levels of social engagement, reduced variety of social activities, lowered motivation, and heterogeneity in social engagement. Results suggest that people with CI/ADRD have reduced social engagement, but the evidence is limited due to the inconsistent use of measures for social engagement and CI/ADRD. Future research is needed to develop valid and reliable measures of social engagement that can be used among individuals living with CI/ADRD.
COMMUNITY ADVISORY COUNCILS: AN ENGAGEMENT STRATEGY FOR PATIENT-CENTERED LEARNING
Authors: Severance Jennifer
Published: December 2023

Advisory councils provide a forum for patients and families to partner with health care systems and share experiences, perspectives, ideas, feedback, and recommendations that can improve both the patient experience and health care outcomes. Research shows that patient partnerships fostered through advisory councils can also positively impact health professions education and training by supporting patient-centered learning. With a goal to promote collaboration among community stakeholders in the delivery of geriatrics education and training, a Geriatric Workforce Enhancement Program formed a Community Advisory Council. A project team developed the council goals, structure, application and recruitment processes, and facilitation methods. Over two years, a total of 27 older adults, caregivers and community advocates participated in the advisory council both online and in-person. Council members completed an orientation session and met four times over a twelve-month period. At each meeting, faculty prepared two to four open-ended discussion questions regarding knowledge, skills, and attitudes relevant to the nursing home workforce, student education, continuing education, and community outreach. Responses were collected through paper surveys and online forms. Thematic analysis of qualitative responses identified common themes that were shared with education and clinical leadership to inform and improve learning experiences, health care processes, and council engagement. Presenters will describe the council’s structure and composition as well as recruitment, facilitation, and evaluation methods, and lessons learned. This project demonstrates a replicable model of evaluating education that involves older adults, families and community in co-creating quality learning and patient experiences.
THE ROLE OF CONTEXTUAL FACTORS IN ADULT DEVELOPMENT AND AGING
Authors: Hueluer Gizem , Nakagawa Takeshi , Wahl Hans-Werner
Published: December 2023

Individual development is embedded in multiple environmental systems, ranging from broader distal cultural and historical contexts to more proximal residential, family, and partnership contexts. The goal of this symposium is to showcase research studying the role of distal and proximal contextual factors in the development and aging of key domains, including health, cognitive function, social relationships, and emotional experiences. Nakagawa et al. examine cultural differences in the associations of positive affect and loneliness with longevity using data from prospective surveys in the United States (1986–2005) and Japan (1987–2006). Hülür et al. use 35-year longitudinal data (1977-2012) from 3,482 participants of the Seattle Longitudinal Study to examine associations between perceived residential neighborhood characteristics and trajectories of cognitive aging. Kobayashi et al. study cohort and gender differences in trajectories of social contact and social participation and the effects of being married and living with a child using data from the National Survey of the Japanese Elderly (1987-2021). Meier et al. will present data from a study on emotional co-regulation in younger and older couples’ daily lives focusing on situational factors (e.g., psychological availability) within romantic relationships that can shape daily emotional experiences and relationship quality. The discussion by Hans-Werner Wahl will focus on how these approaches contribute to our understanding of processes of context dynamics and how they can be utilized to promote the maintenance of health and function in aging.
DO POSITIVE AFFECT AND LONELINESS PREDICT LONGEVITY ACROSS CULTURES? FINDINGS FROM THE UNITED STATES AND JAPAN
Authors: Nakagawa Takeshi , Hueluer Gizem , Horn Andrea
Published: December 2023

Prior studies have revealed the beneficial effects of positive affect and the harmful effects of negative affect on health and longevity. The majority of the evidence comes from Western countries, but cross-cultural studies suggest that the relationship between affect and health varies by culture. In this preregistered secondary analysis (https://osf.io/ke5pr), we investigated variations in the links of positive affect and loneliness with longevity across cultures. Data were derived from comparable surveys in the United States (1986–2005) and Japan (1987–2006). We identified case-matched American and Japanese samples based on age and sex (n = 1,663 per country, mean age = 70 years). Positive affect (2 items), negative affect (2 items), and loneliness (1 item) were measured using five available items from the Center for Epidemiological Studies Depression Scale. The measurement model of positive and negative affect was invariant across cultures. The affect scores were standardized based on each sample. Cox proportional hazard models assessed the associations of positive affect and loneliness with mortality. We used multiple imputation for missing data. Greater positive affect was associated with reduced mortality risk across cultures (hazard ratio [95% confidence interval] = 0.955 [0.914–0.998]) after controlling for negative affect and demographic and health factors. Culture did not moderate the association. Additional adjustment for behavioral factors attenuated the hazard ratio to statistical non-significance. Loneliness and negative affect were not associated with mortality. Our findings suggest that the health benefits of positive affect are primarily similar across cultures.
DOES LIVING WITH A FAMILY AFFECT SOCIAL CONTACT/PARTICIPATION? VARIATIONS ACROSS BIRTH COHORTS AND GENDER IN JAPAN
Authors: Kobayashi Erika
Published: December 2023

Changing family structures and values might have affected social relationships outside the household in a different way for men and women. This study clarified birth cohort and gender differences among older Japanese in terms of (a) trajectories of social contact and participation and (b) effects of living with a family on them. Data were obtained from ten waves of the National Survey of the Japanese Elderly (1987-2021) for 5,855 individuals who commenced participation by 2012. Quadratic growth models were examined as a function of age at time t (≥63 years) for the frequency of contact with children living apart, with friends and neighbors, and participation in community groups, whose intercept and slope were predicted by gender and birth cohorts (C1:1902-13, C2:1914-25, C3:1926-37, C4:1938-49). Whether effects of being married and co-residing with a child would differ by gender and cohorts was also examined, controlling for socioeconomic and health status. The results showed that the level of contact/participation at age 75 increased in women in recent cohorts. The frequency for friends and groups declined with age after the mid-70s across cohorts. C4 showed a steeper decline in the child/friend contact, indicating the COVID-19 influence. Living with a family generally impeded social contact, except that married men contacted non-coresident children more frequently than their unmarried counterparts. The negative effect of living with a child was greater in women and the earliest birth cohort. Thus, social isolation could matter not only for older adults living alone, but also for those living with a family.
WIDOWHOOD AND COGNITIVE DECLINE: THE ROLES OF FRIENDS AND GENDER
Authors: Zhang Zhenmei , Liu Hui (Cathy) , Hsieh Ning
Published: December 2023

Widowhood has been identified as a risk factor for cognitive decline and dementia. Yet less is known about the protective and exacerbating factors of cognitive decline following widowhood. This study examines the roles of friendship characteristics in moderating the negative effect of spousal loss on cognition for older Americans. Drawing on data from the 2006-2018 Health and Retirement Study, we aim to answer two questions: 1) whether friendship network and quality moderate the association between spousal loss and cognitive decline in late life; 2) whether the moderating effect of friendship characteristics on cognition differ for men and women. Cognitive trajectories were assessed every other year from 2006 to 2018 (in total 7 waves). Friend characteristics were assessed in the 2006 psychosocial questionnaire and included the number of close friends, contact frequency, and support and strain from friends. The analytical sample comprised 3,636 respondents aged 50 and older who were married in 2006 and participated in the psychosocial questionnaire. Among the final sample, 370 lost spouses between 2006 and 2010, and 3,266 remained married throughout the observation period. Preliminary results from latent growth curve models showed that several characteristics of friendship including contact frequency and strain from friends are significantly associated with cognitive function at baseline. Furthermore, strain from friends interacted with widowhood status and gender to shape cognitive trajectories. Specifically, higher friendship strain was associated with a faster cognitive decline for the widowed but not for the married a pattern observed only among men but not women
FRIENDSHIP NETWORKS AND HEALTH AMONG BLACK AND WHITE DEMENTIA CAREGIVERS
Authors: Ng Yee To , Birditt Kira
Published: December 2023

Social networks and support protect against health risks associated with dementia caregiving. Yet, little is known about the unique role of friends in the dementia caregiving context, as most prior caregiving studies do not differentiate between family and friends when examining social networks and support. The experience of racism and stronger familial values among Black individuals may affect their friendship networks and the implications of friends for health. This study examines racial differences in the number of friends in close social networks, contact frequency and support from friends, and links with mental health among Black and White dementia caregivers. A total of 98 dementia caregivers (63% White Americans, 90% female, Meanage = 62.66) completed baseline interviews in which their social network and mental well-being were assessed. Findings revealed that White caregivers reported more friends in their close networks than Black caregivers. However, there were no racial differences in contact frequency with network friends, or the frequency of receiving practical and emotional help from friends in assisting patients with dementia. Furthermore, receiving emotional support from friends was linked to lower levels of anxiety and depression, and these effects were greater among White caregivers. Together, this study provides a better understanding of racial disparities in friendship networks among dementia caregivers and their implications for mental health.
RESEARCH ON SUPPORT FOR ELDER CARE IN DIFFERENT CULTURES AND SETTINGS
Authors: Jiang Lin , Zhang Ning
Published: December 2023

This cross-culture symposium consists of four studies that examined the interventions, patterns, technology, and challenges for elder care across settings in the U.S., China, and other countries. The first two papers focus on caregivers for patients with Alzheimer’s disease and related dementia (ADRD). The paper from the U.S. fills that gap by examining the information and communications technology utilization in relation to mental health among Mexican American informal caregivers for persons with ADRD. The findings suggest a need to explore further different types of ICT and their effects on Mexican American informal caregivers’ mental health. To help t reduce social isolation and loneliness, we may consider choosing an appropriate ICT based on their situation and culture. The paper from China highlights ADRD informal caregivers’ needs and struggles, which were ignored by the Chinese public. Also, the paper examined a model for healthcare professionals at inpatient and outpatient clinics to provide support to caregivers medically and emotionally. The third paper is a systematic review summarizing the latest evidence regarding the importance of using technology among people with dementia and their caregivers as an intervention. The fourth paper broadens our horizon by using a multinational comparison perspective to analyze research on pattern recognition and innovation of home-based care under the change of family structure in China. After individual presentations are done, one discussant will summarize shared themes in these papers and provide critical feedback.
VOICES FROM THE INSIDE: MEDICAL TREATMENT FURLOUGH IN THE LARGEST STATE PENITENTIARY IN US: LESSONS LEARNED
Authors: Harris Jolie
Published: December 2023

As part of the criminal justice reform to reduce prison population, the State of Louisiana undertook an initiative to explore a medical treatment furlough project. The plan was to transition long-term inmates from the prison to long-term care (LTC)). Angola, the largest maximum security prison in the U.S, had over 1000 prisoners 60 years or older. Eighty percent of the prison population is serving a life sentence. Prisoners with significant health and mobility issues were to be considered to be released to off-site facilities with parole supervision. We present lessons learned from exploring all aspects of a possible partnership between a Louisiana long-term care company and the correction department including: conducting site visits at Angola and the long-term care facility; gathering best practice data; exploring a referral process and acuity classification tool; exploring the role of the parole officer; and examining the prison population against the regulations for long-term care facilities from the perspective of the prisoners and current residents. Additional considerations were the impact on the local community and on-going support for services provided, along with staffing, staff training, and security and safety of the facility. After multiple discussions with representative from the Louisiana Department of Health we found the obstacles were too great to implement the program. Exposure to the challenges facing the corrections department and examining how to implement the Act as written was a lesson in the value of viewing an issue from multiple perspectives.
STRATEGIES FOR OLDER ADULT AND INFORMAL CAREGIVER INVOLVEMENT IN HEALTH POLICY DEVELOPMENT: STAKEHOLDERS’ VIEWS
Authors: Kolade Opeyemi , Porat-Dahlerbruch Joshua , Perlman Saritte , van Achterberg Theo , Ellen Moriah , Kolade Opeyemi , Porat-Dahlerbruch Joshua , Perlman Saritte , van Achterberg Theo , Ellen Moriah
Published: December 2023

Older adults and informal caregivers’ involvement in policy-making processes can enhance the creation of responsive policies and the provision of better health and well-being services. However, current involvement literature is more focused on involvement in research and healthcare decision-making. This research aims to explore stakeholders’ perspectives on approaches for the involvement of older adults and informal caregivers in health policy development. A qualitative study using semi-structured interviews was conducted within the European TRANS-SENIOR consortium and included policymakers, researchers, and advocacy organizations in nine countries. Participants were included if they had experience with older adult/informal caregiver involvement in health policy development. A total of eighteen interviews were conducted with nine representatives from older adult/informal caregiver advocacy organizations, five policymakers, and four researchers. Identified themes were: 1) diversity of involvement approaches, 2) impact of involving older adults and informal caregivers in health policy development, and 3) facilitators and barriers of involvement. Findings indicated that older adult and informal caregiver involvement vary in nature and intensity and that the actual effect of older adult and informal caregiver involvement in health policy development is difficult to assess. There is no one-size-fits-all approach for involving older adults and informal caregivers in health policy development; stakeholders can focus on exploring and implementing context-specific tailored strategies. Our study findings provide evidence that can be useful to decision-makers to involve older adults and informal caregivers in health policy development.
THE URBAN AGING RESIDENT’S COALITION: A CASE STUDY IN LATE-ADULTHOOD COMMUNITY ACTIVISM
Authors: Wright Kathy , Shields Pamela , Moss Karen , White Katie , Tate Judith , Rose Karen
Published: December 2023

The COVID-19 global pandemic, police brutality, and threats to voting rights retraumatized African American older adults, who lived during civil rights, causing feelings of powerlessness. Older adults can be equipped to regain agency and control through community activism. We provide a case study of an older African American activist’s (Ms. P) journey to create the Urban Aging Resident’s Coalition (UARC)—an affiliation of the National African American Men’s Wellness Agency. UARC was founded in 2019 to improve mental and physical health for urban older adults. Post-pandemic, Ms. P along with teenage volunteers, held monthly educational sessions that included interactions with local police and voting rights education. To facilitate a non-confrontational experience, Ms. P had the police bring Golden Retriever therapy dogs and a community support person. To increase relatability for voter education, Ms. P formed a panel of retired legislators, the first African American state senator who developed the Ohio Office of Minority Health, a younger state representative, and the former CEO of the Urban league to hold an open forum on voting rights and redistricting. Nearly 60 older adults attended the monthly educational sessions. The community activist addressed those traumas experienced by older adults in a safe and encouraging social environment. Participants reported feeling more comfortable interacting with the police. Older adults increased their awareness of the importance of voting to elect leaders that represent them and their ideas. This model, to engage minoritized groups to regain agency and power, can be a template for other communities.
EPIDEMIOLOGY OF THE INVERSE COMORBIDITY OF DEMENTIA AND CANCER: THE CHALLENGE OF SELECTIVE SURVIVAL BIAS
Authors: Shardell Michelle , Rathbun Alan , Gruber-Baldini Ann , Guralnik Jack , Golden Justine , Kapogiannis Dimitrios , Simonsick Eleanor
Published: December 2023

Observational studies have consistently found dementia to be inversely related to cancer, where presence of cancer predicts lower dementia risk, and presence of dementia predicts lower cancer risk. This “inverse comorbidity” relationship is of interest as an avenue to potentially identify novel intervention targets to develop for both conditions. However, it is unknown whether inverse comorbidity reflects underlying physiological mechanisms or is explained by selective survival bias. Specifically, persons with cancer are more likely to die before dementia onset than otherwise similar persons without cancer. Thus, we aimed to assess the robustness of inverse comorbidity between dementia and cancer to statistical methods that vary in how they address selective survival bias. Four discrete-time modeling methods were applied to data from the Health, Aging and Body Composition Study (n=3075; age: 70-79 years; 41.7% black; 51.5% women): (1) generalized estimating equations (GEE) assuming all missingness to be completely at random; (2) weighted independence estimating equations partly conditioned on being alive that only weight data missing for non-mortality reasons; (3) multiply-weighted GEE weighting data for all sources of missingness; and (4) marginal structural models that additionally adjust for covariates using inverse propensity score weights. Covariates included: demographics, APOEε, lifestyle characteristics, and health conditions. Methods (1)-(3) produced almost identical results: (1) Risk Ratio(RR)=0.81, 95% Confidence Interval(CI)=0.69-0.95; (2) RR=0.81, 95%CI=0.69-0.94; and (3) RR=0.81, 95%CI=0.69-0.94. Results for method (4) were slightly attenuated: RR=0.85, 95%CI=0.72-0.99. Inverse comorbidity was consistently observed and robust to statistical handling of missing data/mortality. Future research aims to identify mechanisms of inverse comorbidity.
THE U-SHAPED RELATIONSHIP BETWEEN DAILY ENERGY INTAKE AND ALL-CAUSE MORTALITY IN US ADULTS
Authors: Farsijani Samaneh , Mao Ziling , Newman Anne
Published: December 2023

The association between low energy intake and longevity observed in non-human studies has not been confirmed in large-scale human investigations. Therefore, we determined the associations between daily energy intake and all-cause mortality in US adults. We included 33,094 US adults (age>19 years) from the National Health and Nutrition Examination Survey (2003-2018). Total energy intake was obtained from 24-hour food recalls and mortality was determined through December 2019 using the National Death Index. Survey-weighted multivariable Cox proportional hazard models were used to calculate all-cause hazard ratios (HR) across categories of energy intake. HR models were stratified by age, sex, race, and BMI, while controlling for potential covariates. During a median follow-up of 96 months, 4,162 participants died. Low energy intake (< 1,000 kcal/day) was associated with higher mortality (HR=1.53 [95% CI 1.26-1.86]) vs. the reference category (2,000-2,500 kcal/d) independent of age, sex, race, BMI, and income. Similarly, low energy intake was associated with higher mortality risk (P< 0.05) in middle-aged (40-64y) and older (≥65y) adults, men, women, and Whites. We observed the same negative associations between energy intake and mortality in normal-weight (18.5-24.9 kg/m2), over-weight (25.0-29.9), and obese (≥30.0) individuals (P< 0.05). The only exception was in Blacks, where lower energy intake was associated with lower mortality (HR=0.75 [0.57-0.99]). Higher energy intake (≥4,000 kcal/d) was also associated with higher mortality, though HRs were not significant, except in young (20-39y), women, and normal weight adults. Our result showed a U-shaped relationship between total energy intake and mortality, like the observed relationship between BMI and mortality.
ACTIGRAPHIC MEASURES OF SLEEP AND METABOLIC SYNDROME AMONG OLDER ADULTS
Authors: Chen Diefei , Yue Yiwei , Hossain Sharmin , Rabinowitz Jill , Wanigatunga Amal , Ferrucci Luigi , Simonsick Eleanor , Spira Adam
Published: December 2023

Self-reported sleep disturbances are associated with obesity and diabetes, but little is known about links between objectively measured sleep and metabolic syndrome (MetS) in later life. We investigated associations between actigraphic sleep parameters and MetS in 406 participants (53.5% women, 20.9% Black) aged 72.8±10.1 years at baseline (range: 50-96) in the Baltimore Longitudinal Study of Aging. Participants completed wrist actigraphy (6.6±1.0 nights) and were classified as having MetS if they had ≥3 of the following: waist circumference ≥102 cm for men, ≥89 cm for women; high-density lipoproteins < 40 mg/dL in men, < 50 mg/dL in women; triglycerides >150 mg/dL; high blood pressure ≥130/85 mmHg; fasting blood glucose ≥100 mg/dL. Overall, 37 participants had MetS at baseline and 27 participants developed MetS over 2.3±2.2 years of follow-up. Cross-sectionally, compared to participants with total sleep time (TST) < 6 hours, those with 6-8 hours TST had lower odds of MetS (OR=0.28, 95%CI 0.13,0.61); higher sleep efficiency (SE) was associated with lower odds of MetS (OR=0.65, 95%CI 0.48,0.89) and longer wake bout length (WBL) was associated with higher odds of MetS (OR=1.47, 95%CI 1.07,2.01). Excluding 37 participants with MetS at baseline, TST >8 hours was associated with faster increases in the likelihood of developing MetS (OR=1.62, 95% CI 1.03, 2.55). Findings link intermediate TST and higher SE to lower odds of MetS, and longer WBL to higher odds of MetS in older adults cross-sectionally; TST >8 hours was associated with higher odds of incident MetS. Further studies are needed to understand mediators of sleep-MetS associations.
OBSTRUCTIVE SLEEP APNEA RISK AND LONGITUDINAL TRAJECTORY OF FUNCTIONAL HEARING LOSS OVER EIGHT YEARS OF FOLLOW-UP
Authors: Jiang Kening , Spira Adam , Reed Nicholas , Lin Frank , Deal Jennifer
Published: December 2023

Hearing loss prevention is important for physical, cognitive and psychosocial health among older adults. Obstructive sleep apnea (OSA) might cause functional hearing loss through ischemic damages to the cochlea or central auditory processing, but there is a lack of longitudinal evidence. The National Health and Aging Trends Study (NHATS) is a longitudinal panel survey of Medicare beneficiaries aged 65+ years. STOP-Bang is a validated screening tool for OSA risk and a subsample of NHATS round 3 participants responded to a modified version (age>50, male, high blood pressure, body mass index >35 kg/m2, snore loudly, observed apnea, tiredness; range 0-7, elevated risk if ≥3). Functional hearing loss at follow-up (rounds 3-11) was defined as self-reported deafness, hearing aid use, or inability to hear well enough to use the telephone or have conversations in a room with the television or radio on. We used generalized estimating equations logistic regression with inverse probability attrition weighting, adjusting for demographics and comorbidities. Among 1,433 participants, elevated OSA (58%) was associated with higher odds of hearing loss at baseline (odds ratio:1.50, 95% confidence interval[CI]:1.08, 2.10). Both OSA groups had significant annual increases in odds of functional hearing loss (Low:1.07, 95% CI:1.01, 1.13; Elevated:1.12, 95% CI:1.07, 1.18) during the first 4 years. Afterwards, the low OSA risk group continued to have significant increase in odds of functional hearing loss but not the elevated OSA risk group. OSA might be a novel risk factor for hearing loss. Screening and treating OSA might be important for hearing loss prevention.
WHAT CAN WE LEARN FROM THE LINK BETWEEN SLEEP AND GAIT ON THE AGING PROCESS?
Authors: Agmon Maayan , Tzemah-Shahar Roy , Shochat Tamar
Published: December 2023

Falls are a major problem among older adults; and older adults with sleep complaints are at a four-fold risk of falls compared with those without sleep complaints. Recent studies demonstrate comorbidity between gait and sleep, which are two essential, modifiable, and age-sensitive functions. Yet, most studies were conducted on older adults, whereas studies on midlife adults are lacking. Such studies can open a window to better understanding of the aging process. We aim to explore the link between sleep quality and gait among community-dwelling midlife adults. We recruited 103 midlife adults (age 59.3±7). Gait was evaluated with the cognitive Dual-Task (DT) paradigm. Gait speed and variability were assessed with the APDM mobility lab. Sleep quality was evaluated objectively using one-week actigraphy and subjectively using the Pittsburg Sleep Quality Index (PSQI). We found that age was significantly associated with earlier bedtime (p=0.007), lower sleep efficiency (p=0.01) and increased wake after sleep onset (p=0.01). Sex differences were found for objective and subjective sleep duration (actigraphy and PSQI, p=0.002 and p< 0.001, respectively), with women sleeping significantly more than men. No sex differences were found for sleep efficiency. A significant main effect was found for actigraphy-based sleep duration (short/intermediate/long) on gait speed, such that gait speed was slower in long compared to short and intermediate sleepers under DT only (p=0.018). To conclude, a negative association between sleep quality and gait speed under DT was found, showing adverse health outcomes for long versus short and intermediate sleepers in midlife.
DETERMINANTS OF INFORMAL CARE TRAJECTORIES IN ENGLAND
Authors: Gessa Giorgio Di , Deindl Christian
Published: December 2023

In the context of an ageing population, combined with long-standing challenges in the delivery of formal social care for older people, unpaid caregivers play a key role in promoting the quality of life of older people and their extended families and ensuring that needs for care and support are met. Although many studies have provided snapshots of informal care provision, few so far have examined longitudinal patterns of informal care provision among older people. This paper aims to describe caregiving trajectories in later life and to examine how socioeconomic, demographic, and health characteristics of older adults relate to these patterns (including needs and enabling factors). Using six waves of the English Longitudinal Study of Ageing, we conduct latent trajectory analysis to cluster people’s diverse trajectories into a finite number of groups. The intensity of informal care provision is also considered when identifying longitudinal trajectories. Preliminary results show five distinct trajectories of informal care provision (including those who never provide informal care, those who provide sporadic informal care, those with increasing and decreasing commitment to care provision, and those who care throughout). Gender, age, health, income, living arrangements, and family compositions all relate to long-term trajectories of informal care, with younger married women in good health more likely to provide informal care throughout. Support should be provided to this group of caregivers, given that engagement in long-term caregiving might be detrimental to mental health.
SUBJECTIVE AGE MODERATES THE RELATIONSHIP BETWEEN GLOBAL COGNITION AND SUSCEPTIBILITY TO SCAMS
Authors: Weissberger Gali , Lim Aaron , Mosqueda Laura , Nguyen Annie , Fenton Laura , Han Duke
Published: December 2023

Understanding factors that increase susceptibility to scams in old age is of critical importance. Cognitive functioning has been demonstrated to be an important factor in predicting financial exploitation and scam risk. There is also evidence that subjective age, or one’s perceived age relative to chronological age, may be associated with financial exploitation risk. This study examined the interactive effect of subjective age on the relationship between global cognition and susceptibility to scams. Sixty-five participants underwent an assessment of global cognition (Mini-Mental State Examination; MMSE), reported their subjective age, and responded to a self-report questionnaire on scam susceptibility. A main effect of global cognition on scam susceptibility was found (b = -0.029, ß = -0.280, p = 0.028); there was no main effect of subjective age on scam susceptibility (p = 0.819). An interaction between cognition and subjective age was found, such that the negative association between cognition and scam susceptibility increased as subjective age increased (b = -0.185, ß = -0.311, p = 0.016). Examination of conditional effects demonstrated that the relationship between cognition and scam susceptibility was not significant amongst those with subjective ages below one standard deviation (SD) of the mean, but was significant for those whose subjective ages fell around or above the mean (within 1SD, b = -0.03, SE = 0.01, p = 0.03; +1SD, b = -0.06, SE = 0.02, p = 0.001). Findings suggest that individuals with older subjective ages may be particularly vulnerable to the negative effects of lower cognition on scam susceptibility.
THE IMPACT OF COVID-19 ON RESIDENTS AND FAMILY/FRIEND CAREGIVERS IN ASSISTED LIVING HOMES
Authors: Hoben Matthias , Maxwell Colleen , Beeber Anna
Published: December 2023

Healthcare reforms have neglected assisted living (AL) and nursing homes (NHs) for decades, setting them up for the excessive rates of death and suffering during COVID-19. Research before and during the pandemic has primarily focused on NHs, largely overlooking AL. AL is rapidly expanding, caring for people with similar vulnerabilities as those in NHs, yet is less regulated, offers fewer services, has lower staffing/skill mix levels and requires significant family/friend involvement in care. This symposium presents a program of research (COVCARES, COVID-19 and the Care of Assisted living Residents), aiming to understand how the pandemic has impacted AL resident, family/friend, and facility outcomes, and how resident outcomes compare between NHs and AL. Our research started over a decade ago with the first population-based cohort study comparing AL and NHs in Canada. Our current research includes repeated surveys (10/2020–04/2021 and 07/2021–09/2021) with family/friend caregivers and AL facilities, and population-based clinical and health administrative data (2017-2021) from AL and NH residents in Western Canada. Five presentations will report on the design/methods/goals of COVCARES (#1), the impact of the pandemic on family/friend involvement in AL resident care (#2), impacted of the pandemic on psychotropic drug prescriptions in AL (#3), and the association of AL home preparedness for and response to the pandemic on resident pain (#4) and loneliness (#5). Our discussant (Anna Beeber) will highlight similarities and differences between AL and NHs, similarities and differences in both settings between the US and Canada, and how policymakers can account for these differences.
COVID-19 AND THE CARE OF ASSISTED LIVING RESIDENTS: THE COVCARES PROGRAM OF RESEARCH
Authors: Hoben Matthias , Maxwell Colleen
Published: December 2023

This presentation describes the goals, design and methods of the COVID-19 and the Care of Assisted living Residents (COVCARES) program of research. Our goals were to address critical knowledge gaps related to how COVID-19 impacted assisted living (AL) residents, family/friend caregivers, and homes, and to compare how outcomes differed between AL and nursing homes (NH). Partnering closely with provincial Alzheimer Societies, family caregiver advocates, and health policy decision makers, we conducted two interconnected studies: The first was a prospective cohort study, surveying family/friend caregivers of AL residents and directors of care of AL homes in the Canadian provinces of Alberta and British Columbia twice (10/2020–04/2021 and 07/2021–09/2021). 673 caregivers and 104 AL homes responded to our first survey. Of those, 386 caregivers and 78 AL homes submitted a second survey. The second was a population-based retrospective cohort study (01/2017–12/2021), using clinical and health administrative data of all AL and NH residents in Alberta. Data included Resident Assessment Instrument (RAI) records, acute care and emergency department admission data, prescription medications, data on COVID-19 infections, and vital statistics of 23,355 AL residents and 41,583 NH residents. Analyzing each of the aforementioned data sets individually, and linking family and facility surveys, as well as resident and facility survey data, we provide unique insights into the impacts of the COVID-19 pandemic on AL settings. The presentations in this symposium will share selected key findings from our program of research.
ASSOCIATION OF ASSISTED LIVING HOMES PREPAREDNESS AND RESPONSES TO THE COVID-19 PANDEMIC WITH RESIDENT LONELINESS
Authors: Devkota Rashmi , Maxwell Colleen , Dampf Hana , Shrestha Shovana , Hoben Matthias
Published: December 2023

Loneliness has been an ongoing problem among Assisted living (AL) residents and has worsened during the COVID-19 pandemic. Loneliness is associated with an increased risk of mental and physical illness, cognitive decline, suicidal behavior, and all-cause mortality. However, the impact of the pandemic on AL residents’ loneliness is poorly understood. We surveyed 42 AL homes in Alberta to understand whether resident characteristics and homes’ pandemic preparedness and response to the pandemic were associated with resident loneliness. The surveys reflected pandemic waves 1 (Mar-Jul 2020) and 2 (Nov 2020-Feb 2021) and were linked to Resident Assessment Instrument (RAI) records of residents who lived in these homes during these periods. Using generalized estimating equation models, we assessed whether resident characteristics, residents’ social relationships, and home preparedness for and responses to the pandemic were associated with resident loneliness (measured as present or absent based on RAI items). Our sample included 1,828 residents (wave 1: 890, wave 2: 938). Almost 13% of the residents reported loneliness (wave 1: 11.2%, wave 2: 14.2%). Depressive symptoms (odds ratio [OR]=2.73, 95% CI, 1.9-3.9) daily/excruciating pain (OR=1.97, 95% CI, 1.4-2.8), and cognitive impairment (OR=0.38, 95% CI, 0.2-0.6) were significantly associated with loneliness. Caregiver availability, hours of caregiver help, and home preparedness were not associated with loneliness, but more communication with caregivers (OR=2.19, 95% CI, 1.1-4.2) and same or improved staff morale (OR=0.61, 95% CI, 0.4-0.9) were. Improving staff morale and communication with caregivers is crucial in addressing resident loneliness.
“SMALL BITES” QUALITY IMPROVEMENT: A SLEEP INTERVENTION FOR RESIDENTS WITH DEMENTIA IN THE NURSING HOME “NEW NORMAL”
Authors: Snow A Lynn , McCullough Megan , Morgan Robert , Baier Rosa , McCreedy Ellen , Richards Kathy , Fry Liam , Hartmann Christine
Published: December 2023

Together with three nursing home (NH) corporations, we co-designed and adapted a “small bites” approach to pragmatic clinical trial (PCT) implementation that was successful even during the pandemic height. Our pilot PCT to improve sleep for nursing home residents with dementia began with the start of the pandemic, with its increased resident acuity and resident care burden, increased workforce shortages and instability, and need for increased leadership involvement. Using co-design principles, we reviewed all procedures with our first NH and identified ways to reduce staff burden by “bite-sizing” the as much implementation protocol as much as possible (e.g., serial 5-minute staff trainings). We implemented revised procedures in all three pilot NHs. To identify adaptations, we used a modified version of the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) to code meeting minutes, researcher fieldnotes about adaptations, and 35 group interview transcripts with the leadership/champion teams. We also coded for feasibility, acceptability, and sustainability. We used an iterative, rapid content analytic approach to qualitative analyses. Most adaptations occurred in the pre-implementation phase, although some occurred in the pilot implementation phase. Adaptations concerned reducing staff burden, such as moving from in-person visits to a fully virtual approach that used 30-minute once-a-week project meetings and streamlining how staff completed measures. The resulting intervention package worked in all corporations on all levels: feasibility, outcome, and sustainability. Necessity being the mother of invention, we landed on a better process than originally planned, one that may be valuable for the wider nursing home research community.
THE ROLE OF THE LTSS SCORECARD IN PROMOTING STATE ACCOUNTABILITY FOR CAREGIVER POLICY
Authors: Reinhard Susan
Published: December 2023

In 2011, the AARP produced its first LTSS Scorecard in “Raising Expectations: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers”. This presentation discusses the history, background, and goals of the Scorecard, which examines four key dimensions of state LTSS system performance: affordability and access; choice of setting and provider; quality of life and quality of care; and support for family caregivers. This presentation focuses on the extent to which support for family caregivers was a focus of that first report and how that focus has changed over time. In addition, the presentation will consider the extent to which the Scorecard has proved an effective policy tool in holding states accountable for progress in supporting family caregivers. Has the Scorecard achieved its stated goal to “to spark conversations, galvanize broad-based coalitions, and focus stakeholders’ attention on the factors that most directly impact consumers and their families”? What has AARP learned through its experience of developing and administering the Scorecard, and what changes are being considered with respect to the dimensions pertaining to family caregivers? The presentation will conclude by noting synergies with the work of the RAISE Family Caregiver Advisory Council and the priorities indicated in its National Strategy to Support Family Caregivers.