bluuebunny/crossref_metadata_2025 huggingface dataset:
INNOVATION CHARACTERISTICS AND STAKEHOLDER INCLUSION IN LTC HOMES DURING COVID-19
Authors: Santos Suzanne , Ginggeaw Sangduan , Melo Ruth , Rabello Gilciney Andrade , Zuniga Franziska , Cranley Lisa , Lepore Michael , Chu Charlene
Published: January 2025

The toll the COVID-19 pandemic has taken on the quality of life of those living and working in Long-Term Care (LTC) homes resulted in calls for innovation in the LTC sector. Results from the observational, experimental, qualitative and mixed-method studies (n=62) showed that 50% and 45.2% of the innovations were characterized as products and processes, respectively. Organizational innovations were reported in 4.8% of the studies. Regarding the settings, the majority (52.4%) of the studies were performed at the micro level, followed by meso (25.4%) and macro (20.6%) levels. The identified innovations were predominantly (35.5%) related to new tools for clinical care and staff education, such as online pain assessment training and the creation of virtual instruments for shared end-of-life care decisions, followed by telecommunications interventions (22.6%), generally aimed at improving connections between residents and their families. COVID-19 detection/prevention (11.3%) was the third most common innovation category in this scoping review. Participants of the studies included staff (71%), residents (56%), family members/caregivers (29%) and experts/researchers (11.3%). Only 9.7% of them included all stakeholders. The innovations implied active engagement (62.9%), where the interventions relied on stakeholder’s actions (e.g. video calls); passive engagement (22.6%), where no actions from stakeholders were needed (e.g. ambient monitoring systems) and co-designed interventions (14.5%), where participants contributed with all stages (planning, implementing, evaluating) of the innovation. Innovations in LTC homes during COVID-19 were mainly characterized as new products or processes aimed at the care of residents and staff training, which required the active involvement of stakeholders, mostly staff.
WAITING TO BENEFIT: AGE-BASED DISABILITY REGULATIONS AND PATHWAYS TO SUPPLEMENTAL SECURITY INCOME IN LATER LIFE
Authors: Freitag Callie
Published: January 2025

Supplemental Security Income (SSI) is an important resource for low-income older adults and people with disabilities, but it is notoriously difficult to be deemed eligible. Older SSI applicants may have an easier time getting approved. Starting at age 45, the Social Security Administration (SSA) relaxes the disability requirements for certain groups every five years until they are eliminated at age 65. If the age-based rules prevent otherwise-eligible people from receiving SSI benefits, then the consequences for this economically vulnerable group could be particularly dire. This paper has two aims. First, I estimate the SSI take-up rate by age and test whether discontinuities in SSI take-up exist when SSA disability determination rules are relaxed (at ages 45, 50, 55, and 60) and eliminated (at age 65). Second, I identify patterns of employment, homelessness, and public assistance use among SSI recipients in the five years prior to SSI take-up and examine how these patterns vary by age. I conduct these analyses with administrative microdata from multiple agencies in Washington state spanning from 2010 through 2017. I find strong evidence of discontinuous increases in SSI take-up when the disability rules are relaxed at age 55 and eliminated at age 65, suggesting the program rules may act as gatekeepers for otherwise eligible applicants. Adults face significant financial hardship in the five years prior to receiving SSI. People who took up SSI between the ages of 40 and 59 were more likely to have been homeless than employed prior to receiving SSI.
UNCOVERING THE DIMENSIONS OF WELL-BEING AMONG CAREGIVERS FOR OLDER AMERICANS IN THE NATIONAL STUDY OF CAREGIVING
Authors: Yang Frances , Roche-Dean Maria , Williams Kristine
Published: January 2025

Evaluating caregiver well-being is vital for healthcare providers, researchers and policymakers. There are various valid and reliable instruments for caregiver well-being with as many as 45 items in Tebb’s Caregiver Well-Being Scale. When conducting survey research it is imperative to avoid participant burden and fatigue by limiting the number of questions. The National Study of Caregiving (NSOC) is a survey about caregivers’ responsibilities, health, and well-being while caring for their older care recipients. This study focuses on identifying and reducing the complex dimensions of the 17 well-being questions to yield a streamlined, valid, and reliable caregiver well-being measure in 2022. Exploratory factor analysis (χ2=1332, df=43, p<.001; RMSEA=0.1; CFI=0.96) and confirmatory factor analysis (χ2=1027, df=51, p<.001; RMSEA=0.09; CFI=0.97) were conducted with 2,376 caregivers’ responses in Round 12. Twelve questions were identified with high reliability (Cronbach’s alpha (α)=0.97) to best fit a three dimensional model for caregiver well-being: 1) Positive affect (cheerful mood, calm and peaceful, full of life; α=0.94), 2) Isolation (bored, lonely, life has meaning, life is lonely because I have few close friends; α=0.93), and 3) Psychological distress (upset, felt little interest, felt down depressed, felt nervous, felt unable to stop or control worrying; α=0.93). Reducing the number of valid caregiver well-being questions by 29% has the potential to decrease survey fatigue for caregivers. The dimensions or themes identified for caregivers’ responses about their well-being allows for appropriate development of targeted interventions and policy recommendations to improve informal caregiver well-being who are caring for those aging in the US.
METHODS TO CONSTRUCT AND ANALYZE COGNITIVE FUNCTION TRAJECTORIES USING CLAIMS AND ASSESSMENT DATA
Authors: Jarrín Olga , Lin Haiqun
Published: January 2025

This symposium presents the methodology for construction and analysis of the cognitive function change over time during the last five years of life among Medicare beneficiaries. Understanding the changes in cognition is important in maintaining functional independence in last years of life. The first presentation explains the methodology to harmonize data from healthcare claims and clinical assessments across various post-acute and long-term care settings for Medicare beneficiaries who died in 2019, age 50 or older at death, with at least five years of continuous Medicare enrollment. Cognitive function data were harmonized to create a four-category variable: no impairment, memory loss, mild cognitive impairment (MCI), and dementia/severe cognitive impairment. The second presentation examines change in cognitive function over the last five years using the group-based trajectory model for ordered categorical outcomes, revealing ten cognitive function trajectory groups. Sociodemographic and clinical factors were assessed for their association with the trajectories and used to predict trajectory class clusters with machine learning algorithms. The third presentation presents a novel application of the three-step Bolck-Croon-Hagenaars (BCH) method with mixed-effects group-based trajectory model to account for the individual heterogeneous effects, and assess the association between the group membership and risk factors. The fourth presentation leverages the strengths of real-world data for nearly two million Medicare beneficiaries to unpack within-group racial/ethnic and sex differences in cognitive function trajectories and their predictors with discussion from a life-course perspective. Collectively, these methods and findings advance our understanding of differential late-life cognitive decline patterns, informing future etiological and intervention studies.
TESTING THE EFFECTS OF COGNITIVE TRAINING ON ALZHEIMER’S DISEASE AND RELATED DEMENTIAS: THE MODERATING ROLE OF SDOH
Authors: Rebok George , Clay Olivio , Wallace Gail , Ball Karlene , Thorpe, Jr. Roland , Marsiske Michael , Felix Cynthia , Willis Sherry
Published: January 2025

The Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study is the largest randomized clinical trial of the efficacy of cognitive training (memory, reasoning, processing speed) in improving both cognitive abilities and everyday functioning in normal older adults (N = 2,802; age M = 73.6, range 65-94 years; 76% female; 26% African American), with follow-ups extending through 10 years, and additional follow-ups on claims-based dementia diagnosis through 20 years post-intervention. This presentation considers not only training focus (cognition, exercise) but also a) subjects’ individual differences in social context variables like social determinants of health (SDoH) and b) Alzheimer’s Disease and Related Dementias (ADRD) as training outcome. Overall, we found fewer significant effects of SDoH as moderators of cognitive training effects on diagnosed dementia than we expected, indicating cognitive training was beneficial for individuals across the continuum for most domains of SDoH (e.g., education access, economic stability, neighborhood and built environment, health care access, social and community context). Participants obtained a greater degree of protection from ADRD through cognitive training when they had higher scores for domains associated with health care access (HRs.68 to.75) and more education (HRs.75 to.76). Higher scores on neighborhood and built environment were also associated with lower ADRD risk (HRs.69 to.70). Future work should continue to explore culturally tailored training interventions alone and in combination with physical exercise and environmental modifications such as improved healthcare access to reduce ADRD risk associated with SDoH that disproportionately affects racially diverse aging populations.
BEYOND THE MARGINS: INTIMATE PARTNER VIOLENCE AND TRANSGENDER OLDER ADULTS’ HEALTH AND WELL-BEING
Authors: Hoy-Ellis Charles , Jung Hailey , Cook-Daniels Loree , Kim Hyun-Jun , Fredriksen-Goldsen Karen
Published: January 2025

Transgender older adults experience disproportionate violence and abuse, increasing their risk for deteriorating physical health, disability, depressive symptoms, and elevated stress levels when compared with their non-transgender age-peers. Studies have shown that barriers like fear of seeking healthcare, insufficient physical activity, internalized stigma, experiences of victimization, and a lack of social support play indirect roles in negatively impacting the health of this group, which has historically faced marginalization and neglect. According to the Health Equity Promotion Model, stigma and victimization significantly impact the mental health of older transgender adults. This study seeks to explore the connections between intimate partner violence (IPV), victimization, social resources, and mental health outcomes within this population. By analyzing cross-sectional data from a national survey involving lesbian, gay, bisexual, and transgender adults aged 50 to 95 years (N = 2,560), we found that transgender respondents (n = 167) experienced IPV at over double the rate of their non-transgender lesbian, gay, and bisexual counterparts (16% vs. 7%). Among transgender individuals, IPV strongly correlates with increased victimization and internalized stigma. IPV significantly predicted mental health quality of life and depressive symptomatology, independent of lifetime discrimination and victimization. Additional significant predictors of mental health outcomes were social network and support. Given the recent and continuing policy shifts nationwide affecting the transgender community, initiatives aimed at stigma reduction, victimization prevention, and bolstering social support are crucial for improving the health and overall well-being of transgender older adults. Insights from this research can guide stakeholders in countering regressive policies and legislation.
PREDICTORS AND IMPLICATIONS OF GENERATIVITY AMONG LGBTQ+ OLDER ADULTS
Authors: Jung Hailey , Kim Hyun-Jun , Emlet Charles , Fredriksen-Goldsen Karen
Published: January 2025

Generativity is a concern, commitment, and action for others including the next generation, and has been shown positively associated with the health and well-being of older adults. Since LGBTQ+ older adults have experienced overt marginalization and often have limited contact with younger generations, generativity may resonate with unique implications in LGBTQ+ communities. Yet, to date research on generativity with this community is lacking. In this paper, we integrate Generativity Theory and Health Equity Promotional Model (HEPM) to examine the predictors of generativity among LGBTQ+ older adults and explore key psychological and social factors that moderate the relationship between stigma experiences and generativity. Using the 2016 data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study (N = 2,233), we regressed generativity in three blocks; first, social location and stigma variables, next, psychological resources, and lastly, social resources. The predictive power of the model significantly improved in each step. Psychological resources (i.e., mastery, resilience, and critical awareness) and social resources, (i.e., social participation, network size, social support, and LGBTQ+ community engagement) were all positively associated with generativity. In terms of moderating effects, day-to-day discrimination no longer had negative effects on generativity when experienced by older adults with higher levels of critical awareness. Interestingly, lifetime discrimination had positive effects on generativity for individuals with higher mastery levels. Findings suggest psychological and social mechanisms that may foster fortitude and stress-related growth among LGBTQ+ older adults. This research provides valuable insights to foster intergenerational relationships and cultivate strengths in the LGBTQ+ community.
BRIDGING ACCESS GAPS: EXAMINING USE OF DIGITAL HEALTH TECHNOLOGIES AMONG SEXUAL AND GENDER MINORITY OLDER ADULTS
Authors: Romanelli Meghan , Kim Hyun-Jun , Fredriksen-Goldsen Karen
Published: January 2025

LGBTQ older adults face distinct challenges accessing healthcare. Digital health solutions offer responsive approaches that broaden availability of health information and care, especially for those experiencing isolation, discrimination, and barriers to care. While some LGBTQ older adults prefer digital health technologies, others face difficulties with electronic literacy that prevent use. The current study examined the association of sexual and gender identity and health access factors (barriers to care; health literacy; help-seeking beliefs; healthcare discrimination) with past 12-month use of digital health technologies for communication, insurance matters, and health-information seeking. Data were analyzed from the 2015 healthcare access module of Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS) (N=2,322). Results indicated digital health use varied across LGBTQ older adult subgroups and access factors. Transgender older adults, compared to cisgender, were more likely to use each digital resource to manage their health and healthcare. Participants with experiences of healthcare discrimination more likely communicated with their providers online, while those with lower health literacy turned to the internet to find health information. Older cohorts (65-79; 80+), poverty-impacted, and Black and Hispanic participants were less likely to use digital resources. Digital health technologies may enhance healthcare access for LGBTQ older adults, potentially bridging gaps in service availability and acceptability. This is particularly evident for certain LGBTQ subpopulations such as transgender older adults and those facing greater barriers to care and discrimination. It remains imperative to create digital access and address literacy needs among older cohorts and LGBTQ communities with multiple marginalized identities.
A NOVEL TIME USE APPROACH ON SUCCESSFUL AGING: RACIAL AND GENDER DISPARITIES IN DAILY PRODUCTIVE ENGAGEMENT
Authors: Wong Jason , Lu Siyao , Lou Yifan , Zang Emma , Carr Deborah
Published: January 2025

Background and Objectives

Productive engagement (PE) represents a potential pathway toward successful aging (SA). Using time diary data, this study explored how U.S. older adults structure their daily lives in different productive roles, the impacts of these roles on one specific dimension of SA (self-rated health), and the extent to which these patterns differ by race and gender.

Research Design and Methods

We use data from the American Time Use Survey (n = 17,990) and sequence and cluster analyses to identify distinctive daily PE time-use patterns. Multivariable linear regression models were used to evaluate associations between these patterns and self-rated health, and the moderating roles of race and gender.

Results

Five PE clusters were identified: Low Degree of PE (29%), Moderate Unpaid Work & Light Social Participation (42%), Persistent Unpaid Work (12%), Persistent Paid Work (9%), and Persistent Social Participation (7%). White women were the most likely, while Black men were the least likely to have any PE. All PE clusters were positively associated with self-rated health, compared to “Low Degree of PE”. The strongest positive association was observed for “Persistent Paid Work,” especially for women. Racial differences were more prominent among women than men. The health benefits of PE were less pronounced among Black women than White women.

Discussion and Implications

The positive association between PE and self-rated health varies across race-gender groups. Future research should consider the persistent structural barriers that may prevent older adults with disadvantaged backgrounds, particularly Black women, from benefiting from PE and experiencing SA.
EXPLORING SERIOUS ILLNESS CARE EXPERIENCES AMONG BLACK CHICAGOANS’ CAREGIVERS: A QUALITATIVE INQUIRY
Authors: Wilder Jocelyn , Draw Kandis , Downing Kimberly
Published: January 2025

Palliative and hospice services have shown tangible evidence of enhancing the quality of life, decreasing the likelihood of depression, and extending survival for those receiving palliative care. Black individuals receive referrals later and are less likely to utilize palliative and hospice care; national data estimated that only 7.6% of hospice patients were Black. This qualitative study investigates the nuanced perspectives on serious illness care among Black Chicagoans through focus groups and in-depth interviews. Employing an inductive thematic approach, we explored the knowledge, attitudes, and beliefs to understand the intricate cultural, familial, and healthcare dynamics that influence serious illness care experiences among caregivers. Our findings reveal diverse and complex narratives surrounding end-of-life care, reflecting the intersection of race, familial expectations, and healthcare systems. Participants shared moving experiences with family and health care providers, shaping their attitudes towards hospice and palliative care. Discussions highlighted limited knowledge of available services regarding access to and utilization of end-of-life care resources. Thematic analysis identified several key domains, including quality of care, decision-making related to death and dying, and the role of race, highlighting the importance of culturally competent care. These findings underscore the need for healthcare providers to adopt culturally sensitive approaches. This research illuminates the diverse perspectives and experiences within Black communities and informs the development of culturally responsive end-of-life care strategies. Our study contributes to a deeper understanding of the unique challenges and opportunities in providing quality end-of-life care for Black individuals and families.
BEING BOLD: USING PUBLIC HEALTH AWARDS TO CHANGE STATE DEMENTIA POLICY
Authors: Rhodes Annie , Staton Ashley , Bluestein Daniel , Ivey Kimberly , Coney Rachel , Price Andrea , Sargent Lana , Miller Melicent
Published: January 2025

The BOLD Act (Building Our Largest Dementia Infrastructure) was passed by the United States Congress on December 31st, 2018, to support state health departments with dementia-friendly and healthy brain activities. In Virginia, the Virginia Department of Health (VDH) awarded the Virginia Center on Aging a BOLD sub-award to create an epidemiologic registry to catalog dementia, neurodegenerative disorders, and caregiving cases. Registries are a valuable but underused strategy for an equitable public health response to brain health promotion and to monitor trends in dementia and neurodegenerative disorders. The Virginia registry, known as the “Virginia Memory Project” (VMP), is only the 4th statewide dementia registry in the United States. In 2024, the Virginia State legislature unanimously voted to pass HB 1455, establishing the VMP into state law and codifying a dementia and caregiving registry in Virginia. A key outcome and sustainability strategy of launching the VMP was creating a framework to influence policy at the state level to infuse public policy with evidence-based resources, education, and impact for dementia, caregiving, and neurodegenerative disorders. The VMP is unique among epidemiologic dementia registries because it is a responsive registry that offers patients, caregivers, and persons with undiagnosed memory concerns linkage to information, services, and support. In this session, we will discuss the framework we used as an academic-public partnership to launch the VMP and how researchers can use grant funding as an advocacy mechanism to influence policy, ultimately supporting brain health and caregivers.
RESEARCH ADVANCES USING DIGITAL METHODS TO ASSESS COGNITION IN OLDER ADULTS
Authors: Britton Karysa , Hawks Zoe , Sliwinski Martin
Published: January 2025

This symposium highlights the use of digital methods to assess and contextualize cognition in older adults. Across five talks, we consider several digital cognitive assessment methods, including self-administered computerized tests and smartphone-based ecological momentary assessments (EMAs). First, Dr. Louisa Thompson reports findings on the utility and acceptability of using well-validated, reliable digital cognitive assessments to screen for cognitive decline among older adults in primary care settings. Second, Dr. Zoë Hawks uses EMA and passive data from wearable sensors to investigate links between glucose and cognition in relation to neuropsychiatric risk. Third, Hannah Wilks discusses the importance of assessing both environmental and affective influences when examining cognition via EMA in individuals with symptoms of dementia. Fourth, Dr. Karina Van Bogart uses multilevel modeling to examine associations between levels of loneliness and self-reported memory lapses among older adults. Finally, Dr. Emorie Beck examines psychosocial influences on diurnal cycles of cognitive variation. Together, Dr. Martin Sliwinski will draw connections between research showcasing how digital methods can be employed to promote routine screening for cognitive decline, elucidate contextual factors that contribute to cognitive variation in older adults, and assess unique influences of individual differences on cognitive performance.
DYNAMIC ASSOCIATIONS BETWEEN GLUCOSE AND ECOLOGICAL MOMENTARY COGNITION IN TYPE 1 DIABETES
Authors: Hawks Zoe , Beck Emorie , Jung Lanee , Fonseca Luciana , Sliwinski Martin , Chaytor Naomi , Germine Laura
Published: January 2025

Cognitive variability is associated with fall risk, cardiovascular mortality, and cognitive decline. Identifying factors that influence cognitive variability may inform evidence-based guidelines aimed at supporting cognitive and physical health across the lifespan. This goal is particularly salient in Type I Diabetes (T1D), an autoimmune condition characterized by large glucose fluctuations. T1D confers risk for neurodegeneration, and laboratory studies suggest that cognition is reduced when glucose is very low or very high. The present study leveraged advances in continuous glucose monitoring (CGM) and cognitive ecological momentary assessment (EMA) to clarify the impact of naturally-occurring glucose fluctuations on cognitive performance (sustained attention, processing speed) in 200 adults with T1D. Using hierarchical Bayesian modeling, we observed that large glucose fluctuations were associated with slower and less accurate processing speed. Glucose fluctuations were not related to sustained attention, and some individuals exhibited greater cognitive vulnerability to glucose fluctuations than others. Using data-driven lasso regression, we identified seven clinical characteristics that predicted individual differences in cognitive vulnerability to glucose fluctuations: age, time in hypoglycemia, lifetime severe hypoglycemic events, microvascular complications, glucose variability, fatigue, and characteristics (e.g. neck circumference) previously linked with weight and sleep apnea. These results establish the impact of glucose on processing speed in naturalistic environments and indicate that minimizing glucose fluctuations is important for optimizing processing speed. Beyond T1D, this work demonstrates how data from physiological sensors and EMA can be integrated to better understand individual differences in daily cognitive functioning and clinical risk.
INTERAGENCY COLLABORATION TO SUPPORT CAREGIVERS IN RURAL COMMUNITIES
Authors: Telonidis Jacqueline , Hernandez Christopher , Rupper Randall , Morgan Jennifer , Supiano Katherine , Edelman Linda S , Dassel Kara
Published: January 2025

The Utah Geriatric Education Consortium (UGEC) is a Health Resources and Services Administration (HRSA) Geriatrics Workforce Enhancement Program committed to providing age- and dementia-friendly education to primary care and geriatrics workforces and supporting caregivers of people with dementia. We partnered with three rural, multi-county Area Agencies on Aging (AAA) to design and implement hybrid dementia caregiver conferences. Other partners included the Utah Chapter of the Alzheimer’s Association, Utah Department of Health and Human Services, VA Salt Lake City Healthcare System Geriatric Research Education and Clinical Center, and Utah Department of Veterans and Military Affairs. Conference topics included: UGEC educational programs and resources; local AAA community-based programs and resources; dementia, depression, and delirium screening; understanding/responding to dementia-related behaviors; caregiver grief; VA healthcare enrollment and caregiver support programs. The conferences averaged 70.33 (range 54-92) in-person attendees and 12 (range 3-21) virtual attendees. Attendees reported positive levels of satisfaction on a 5-point scale, including that the conferences were engaging (X = 4.55) and effective (X = 4.62), provided examples useful to their education (X = 4.59), met stated goals (X = 4.53), and were better/a lot better compared to similar programs (X = 4.40). In-person attendees reported a sense of community amongst caregivers, and appreciation for the topics related to grief and caregiver support. Attendees suggested adding a caregiver panel, and more local long-term care services and support vendors. In conclusion, rural caregiver conferences which include in-person and virtual modalities meet the educational and flexibility needs of rural caregivers in Utah.
SOCIO-EMOTIONAL DEVELOPMENT ACROSS ADULTHOOD AND AGING
Authors: Ghose Urmimala , Gerstorf Denis , Heckhausen Jutta
Published: January 2025

Understanding how social relations evolve across adulthood, thereby shaping well-being in later life is a longstanding question in lifespan developmental research. The presented studies offer novel insights, utilizing innovative methodologies, diverse time scales, and varied samples. Chopik combined qualitative data from the Harvard Student Study Class of 1964 with machine learning techniques, reporting a larger and closer friends’ circle during freshman year to be associated with more positive life reflections, enhanced relationships, and reduced mental illness fifty years later. Chopik also explored historical changes in these associations using a novel cohort sequential design. Fiori et al. analyzed hierarchical network mapping and ecological momentary assessment data from the Stress and Well-being in Everyday Life study. Contrary to common theoretical expectations, they found that only interactions within the inner circle of social networks declined with age, and increased positivity in interactions extended beyond the inner circle. Hülür et al. conducted an event-contingent experience sampling study on older adults revealing that interactions with more close social partners were linked to higher well-being across communication modes. Digital text-based communication was identified as a compensatory mechanism for individuals with smaller social networks. Ghose et al. utilized a unique synthetic cohort matching method with Health and Retirement Study panel data, illustrating distinct well-being trajectories in older adults undergoing marital transitions compared to their never/continuously-married peers. Their results suggested more pronounced initial increase and subsequent decrease in depressive symptoms following spousal bereavement than divorce, with social strain identified as an additional risk factor in bereavement.
A NOVEL MRI-COMPATIBLE SYSTEM CHARACTERIZING THE EFFECTS OF AGING ON SUPRASPINAL SENSORIMOTOR CONTROL OF WALKING
Authors: Yue Hao , Shen Bin , Chen Yishu , Zhang Yufeng , Lü Jiaojiao , Manor Brad , Fu WeiJie , Zhou Junhong
Published: January 2025

As the only part in direct contact with the ground during walking, foot soles continuously perceive the somatosensory information (e.g., ground reaction forces). The activation of the supraspinal regions/networks in response to such somatosensory inputs is thus important for walking performance, which is oftentimes altered by aging and age-related conditions. It is challenging to characterize such supraspinal activations via traditional neuroimaging techniques (e.g., functional MRI, fMRI), since people are required to stay motionless during the MRI scan. We here thus developed a novel foot-sole stimulation system that simulates the pressure changes as experienced by each foot sole and the pace of foot switch during walking over the ground, and enables characterizing the walking-related activation of the supraspinal regions via fMRI. To examine its validity and reliability of simulation, 10 younger and 10 older adults completed two trials of 10-meter walking. The recorded temporal changes of pressure on foot soles of each step were recorded and used to program the motion of the system with high validity and reliability (r=0.90~0.95, p< 0.0001). The phantom imaging test showed that the signal-to-noise ratio of the MR image in system-working (29.84±4.32) was similar to that (29.78±3.76) in off-working condition (p=0.73), suggesting great MRI compatibility. The block-designed fMRI test showed that compared to resting, multiple supraspinal regions (e.g., postcentral and precuneus gyrus) (p< 0.005) were activated by the foot-sole stimulation. This novel MRI-compatible system provides a novel tool to characterize the effects of aging and age-related conditions on the supraspinal sensorimotor control of walking.
THE ASSOCIATION BETWEEN GRATITUDE AND MORTALITY AMONG OLDER US WOMEN
Authors: Chen Ying , Okereke Olivia , Kim Eric , Tiemeier Henning , Kubzansky Laura , VanderWeele Tyler
Published: January 2025

Gratitude, as a positive emotion, is a potentially modifiable psychological factor that may enhance healthy aging. However, the association between gratitude and mortality has not been studied. Using data from the Nurses’ Health Study (N=52,169 U.S. female nurses, mean age=79 years, 2016 questionnaire wave to December 2019), Cox proportional hazards regression models estimated the hazard ratio of deaths by self-reported levels of gratitude at baseline. Gratitude was assessed with the 6-item Gratitude Questionnaire, a validated measure of one’s general tendency to experience grateful affect. Deaths were identified from the National Death Index, state statistics records, reports by next of kin, and the postal system. Causes of death were ascertained by physicians through reviewing death certificates and medical records. Over 158,374 person-years of follow-up, 5,343 incident deaths were identified. Greater gratitude was associated with a substantially lower hazard of mortality. For instance, the highest vs. lowest tertile of gratitude was associated with a 10% lower hazard of all-cause deaths (95% confidence interval of hazard ratio: 0.82, 0.97), adjusting for baseline sociodemographic characteristics, social participation, religious involvement, physical health, lifestyle factors, and mental health. When considering cause-specific deaths, gratitude was inversely associated with each specific cause of death. This inverse association was strongest with deaths due to cardiovascular disease. This study provides the first empirical evidence suggesting that experiencing grateful affect is associated with a lower risk of mortality in later life. Interventions designed to increase the experience of grateful affect may provide a novel avenue for increasing longevity among older adults.
QUANTIFYING PACE OF AGING AMONG OLDER ADULTS: AN ANALYSIS WITH HEALTH AND RETIREMENT STUDY
Authors: Balachandran Arun , Pei Heming , Kothari Meeraj , Dominigue Benjamin , Furuya Alex , Belsky Dan
Published: January 2025

Rise in global population aging and age-related morbidities calls for measures that that can detect differences in aging trajectories in time to reduce and prevent disease burdens. Pace of Aging (PoA) measure captures longitudinal change in human physiology across multiple systems and captures within-individual changes. However, there has been no investigations of the measure around a sample of older adults to identify who are aging fast and who are most likely to gain from interventions. Using nine biomarkers representing three types of data (blood biomarkers, physical assessments, and functional tests) in the Health and Retirement Study (in 2006, 2008, 2010, 2012, 2014, and 2016), we studied PoA among 13,379 adults aged 40 or above at their first biomarker measurement. Our results extend analysis of PoA into later life and establish its associations with morbidity, disability, and mortality. Racial disparities in PoA represent opportunities for health intervention and prevention. Pace of Aging was more rapid in older as compared to younger participants. Independent of age, participants with faster Pace of Aging were at increased risk of cognitive impairment, incident chronic disease, disability, and death over follow-up compared to those with slower Pace of Aging (e.g. mortality HR=1.94 95%CI[1.82-2.08]). Population groups with shorter life expectancies exhibited faster Pace of Aging. Pace of Aging is a new tool for bio-social gerontology that can inform projections and evaluate trends in aging-related health changes in populations around the world.
AGE DIFFERENCES IN MILLING BEHAVIOR AND PERCEIVED STRESS DURING THE COVID-19 PANDEMIC
Authors: Burns Reilly , Piazza Jennifer , Rusmevichientong Pimbucha , Wood Michele
Published: January 2025

In a disaster, milling behavior refers to persistently seeking relevant information. It occurs most often when levels of emergency preparedness are low and the disaster is unexpected (Wood et al., 2012). Excessive milling can create a sense of vulnerability and lead to a decline in feelings of trust and readiness (Ejeta et al., 2015). One antidote to milling is effective communication and well-designed programs that increase levels of disaster preparedness. Unfortunately, such communication and programs are often ineffective for older adults (Brown & Haun, 2014). The current study examined age differences in knowledge and milling behavior during the COVID-19 pandemic. Participants included 425 individuals from Orange County, CA (18-87, mean age 47.02 years), who completed an online survey. Results from multiple regression analyses revealed that higher levels of milling were associated with higher levels of perceived stress, particularly among the older adults in the sample (B =.031, p =.026). Older adults also reported being less knowledgeable about what they can do to prepare for a pandemic (B = -.009, p =.044). Results remained significant after adjusting for education, race, and gender. Findings suggest that increasing older adults’ knowledge of a disaster through trusted sources may reduce milling behavior, which could decrease levels of stress in this population during a disaster.
MEMORY CHANGES IN COGNITIVELY HEALTHY OLDER ADULTS: AGE EFFECTS IN MEMORY-BASED INFERENCE
Authors: Charles Cara , Rockette Ra’Shida , Bowman Caitlin
Published: January 2025

Memory changes in older age are well documented, even among cognitively healthy older adults. Most prior research has focused on age-related declines in remembering details of individual experiences. However, memory-based inference is another important memory ability that allows us to make connections across separate experiences to make novel decisions. Little is known about the extent of age differences in inference abilities. In the present experiment, we administered an inference task to young and cognitively healthy older adults that asked them to both remember pairs of items that were presented directly (e.g., apple – truck, truck - clock) and that could be combined to form an indirect inference association that was not shown (e.g., apple-clock). Test results showed above-chance performance in older adults for both remembering direct pairs and making inferences. However, older adults performed worse than young adults overall, with a larger age deficit in inference compared to direct memory. We also tested for age differences in the ability to remember which context the associations were learned in (direct vs. indirect) because a loss of context memory can indicate separate experiences have been combined in memory. Successful inference was more likely to lead to a loss of context memory in older adults compared to young adults, but further analyses indicate that strategic responding in older adults could account for this difference. Overall, we found that older adults had an additional cost to forming inferences compared to remembering direct items, but the underlying mechanisms of that difference will require future investigation.
STRESS RESPONSE DURING COGNITIVE TASKS USING EEGS
Authors: Vergara Kristine , Khalil Mohammad , George Kiran
Published: January 2025

Abstract - Drawing upon literature indicating the potential positive effects of engaging in cognitive tasks, particularly memory games, on the mental well-being of older adults, this study aims to investigate the relationship between cognitive tasks and stress responses among the aging population. We hypothesize that older adult participants who engage in memory games will exhibit varied stress responses based on the difficulty levels of the tasks. In this preliminary investigation, we present initial findings from a subset of participants (N = 7) aged 65 and above, focusing on their EEG readings collected during memory game sessions using the g.Nautilus Research headset. Our preliminary analysis suggests a correlation between increased task difficulty and elevated theta and delta brain wave activity, indicating heightened stress responses during more challenging cognitive tasks. Ongoing data processing using MATLAB will allow for a more comprehensive comparison of EEG signals between individuals with and without significant health conditions, further elucidating the relationship between cognitive tasks and stress levels among older adults. These preliminary insights pave the way for a deeper understanding of the impact of cognitive activities on stress responses in this population, with implications for the development of targeted interventions within healthcare and mental wellness frameworks. Keywords: Aging, stress, cognitive tasks, Electroencephalography (EEG), MATLAB
ACCEPTABILITY OF THE RESOURCE CONNECTION FOR RURAL CAREGIVERS OF PEOPLE LIVING WITH DEMENTIA
Authors: Hoel Sydney , White Lillian , Zuraw Matthew , Hill Jordan , Elliot Christian , Pickett Andrew , Werner Nicole
Published: January 2025

Rural family caregivers of people living with Alzheimer’s disease and related dementias (ADRD) experience higher caregiver burden and lower social supports compared to urban ADRD caregivers. However, research regarding how to better connect rural ADRD caregivers to resources in the community is lacking. CareVirtue Resource Connection, a web-based platform designed with rural ADRD caregivers and rural community organizations, aims to provide rural ADRD caregivers with personalized and hyper-localized resources. We conducted a 30-day field test of Resource Connection with rural ADRD caregivers (N=15) followed by semi-structured interviews to explore participants’ perceptions of CareVirtue Resource Connection acceptability. The objective of this study was to identify barriers and facilitators to Resource Connection acceptability based on the post-use interviews. Interview transcripts were analyzed using deductive content analysis guided by the Technology Acceptance Model (i.e., ease of use and usefulness) using an iterative team-based coding process. ADRD caregivers were self-identified rural, aged Mean=70.1 years (59-81 years), 80.0% women (n=12), and 93.3% white (n=14). Facilitators to Resource Connection acceptability included having all resources provided in one space, resource recommendations based on need and location, notifications about new resources, connecting with other caregivers, emotional and mental health benefits, and the ability to share resource information with others. Acceptability barriers included limited time to connect with provided resources, mismatch of resources to ADRD stage, and a lack of local resources. Results suggest key areas for improving the design that will inform intervention refinement prior to large-scale effectiveness testing.
AMBIGUOUS LOSS AND RESILIENCE IN THE FAMILY CONTEXT OF DEMENTIA: A META-SYNTHESIS
Authors: Chan Athena Chung Yin , Perkins Cade , Garcia Lizbeth , Lyons Sophia , Hernandez Frank , Singer Jonathan
Published: January 2025

Having family members living with Alzheimer’s disease or related dementias (ADRDs) triggers high distress due to ambiguous loss. Ambiguous loss is an unclear loss with no resolution or closure to the physical presence and psychological absence of a loved family member. Resilience may buffer the distress from ambiguous loss in the family context of ADRDs. Existing reviews primarily focus on carer resilience. Little is known about the family processes navigating losses related to ADRDs. This meta-synthesis of qualitative studies aims to synthesize the family processes of ambiguous losses and resilience in the context of people with ADRDs. Peer-reviewed articles published after 1990 were identified in four electronic databases. A keyword search was performed associated with qualitative or mixed methods, dementia, and resilience or ambiguous loss. Seventy-two articles from 17 countries were included. Findings suggested the coexistence of resilience and ambiguous loss among persons with ADRDs and their family members. For individual-level and family-level resilience, three themes emerged, including belief systems (i.e., acceptance, gratitude, focusing on present and seeing positives in situations), organizational processes (i.e., finding support in friends and family, self-care and self-love), and communication / problem-solving (i.e., use of humor, working as a team). For intrapersonal and interpersonal ambiguous loss, two themes emerged including physical (i.e., loss of self-care, privacy and autonomy, current and expected future roles) and emotional (i.e., loss of identity, pride or dignity, sense of purpose, shame associated with memory loss, and home is no longer home). This meta-analysis calls for culturally-tailored family-based practice and policy.
COMING TOGETHER: HOW AFRICAN AMERICAN ADULT DAUGHTER ALZHEIMER’S CAREGIVERS ARE NAVIGATING FAMILY RELATIONSHIPS
Authors: Scott-Poe Deneisha , Dolbin-MacNab Megan
Published: January 2025

Alzheimer’s disease currently impacts around 5.8 million Americans, with African Americans being two to three times more likely to develop Alzheimer’s disease than their white counterparts. Most of these individuals are being cared for by their adult daughters. Previous research has explored African American women’s reports of less caregiver burden and strain, yet few studies have examined the impact of racial and gender oppression on how African American adult daughters approach caregiving. Guided by the theoretical perspective of intersectionality, the purpose of this qualitative study was to gain a deeper understanding of the family dynamics of 26 African American adult daughter caregivers and how the intersection of race, gender, and the history of care influences caregivers and their family relationships. To participate in the study, individuals had to at least be 18, be providing care for one year, and self-identify as African American and woman. Results of a constructivist grounded theory analysis revealed four major themes. The first was contextual stressors, which highlighted the unique sets of stressors that impacted caregiver mental health. The next theme was ideology about African American women and care, which emphasized the familial and personal beliefs about how women cared. The third theme, expectations placed on caregivers, highlighted the caregivers’ internalization of how women are supposed to care. The last theme, coming together, highlights how caregivers navigated their family relationships while providing care to their parents with Alzheimer’s disease. Implications for future research and systemic practice with African American adult daughter caregivers will be discussed.
DEVICE-MEASURED DAILY PHYSICAL ACTIVITY IN OLDER ADULTS WITH DEMENTIA: CROSS-SECTIONAL RESULTS FROM THE HUNT STUDY
Authors: Sverdrup Karen , Mork Paul Jarle , Strand Bjørn Heine , Ernstsen Linda , Tangen Gro Gujord
Published: January 2025

To provide accurate estimations of physical activity (PA) in epidemiological research and population studies, the use of accelerometers has skyrocketed over the past decade. However, implementation of accelerometers to accurately estimate PA in people with dementia is lagging. This population-based, cross-sectional study aimed to quantify daily PA in people with dementia categorised by sex and dementia subtype, using data from the ≥70 years cohort in the fourth wave of the Norwegian Trøndelag Health Study (HUNT4 70+). Clinical experts diagnosed dementia and subtypes according to DSM-5 criteria. PA was measured with two tri-axial accelerometers on the lower back and thigh for seven consecutive days. PA types and postures were classified using a validated machine learning model and analysed as mean minutes per day (min/d). Moderate-to-vigorous PA (MVPA) was defined as walking, running, and cycling, and analysed as mean minutes per week (min/w). Of the 1894 participants diagnosed with dementia, 577 participants had valid PA data. These participants spent 231 min/d in total PA, most of which was in standing (187 min/d). Mean time in MVPA was 50 min/w and only 4.3% met PA recommendations (≥150min/w). Men spent more time in MVPA than women (p< 0.001), whereas women spent more time standing (p=0.008). There were no differences between dementia subtypes in volume or intensity of PA. These results indicate that, in people with dementia, independent of dementia subtype and sex, there exists an enormous disadvantageous gap between performed PA and recommended levels of PA.