bluuebunny/crossref_metadata_2025_split huggingface dataset:
EVERYDAY DISCRIMINATION AND RACIAL/ETHNIC DISPARITIES IN COGNITIVE FUNCTIONING
Authors: Lai Wen-Hua “Zoey” 
Published: December 2023

Abstract
Alzheimer’s disease and related dementias are expected to triple from 5 million to 13.7 million by 2050 in the U.S. Black, and Latinx older adults experience poorer cognitive health and a 1.5 to 2 times higher rate of dementia than their white counterparts. Due to the structural racism in the U.S., chronic exposure to everyday discrimination may contribute to cognitive health inequalities, yet limited empirical research examines this association. This study uses parallel linear growth curve modeling to assess the impact of long-term exposure to everyday discrimination on the initial level of cognition (i.e., latent intercept) and change in cognition (i.e., latent slope) among older adults and examines whether such association varies among Black, U.S.-born Latinx, foreign-born Latinx, and white older adults. Using data from the 2006-2012 Health and Retirement Study (N=8,195), these findings show that racial/ethnic minority older adults, especially Blacks, experience greater everyday discrimination and poorer cognitive health than their white peers. Greater exposure to everyday discrimination was associated with lower initial levels of cognitive function and a faster decline in cognitive function. Results from multiple groups analysis further indicate that everyday discrimination shaped cognitive trajectories only for white and Black older adults but not for U.S. -born and foreign-born Latinx older adults. These findings suggest that white and Blacks older adults who experience a higher level of everyday discrimination may be vulnerable to cognitive decline. This study discusses the implication of these unexpected findings and future research directions.
BIODEMOGRAPHY OF AGING: INSIGHTS FROM TWINS AND THE OLDEST-OLD IN DENMARK
Authors: Christensen Kaare 
Published: December 2023

Abstract
The Danish Twin Registry holds health information from surveys and registers on more than 180,000 twins born in Denmark since 1870. Life course studies of the oldest twin cohorts show moderate heritability of lifespan but a substantial genetic influence on physical and cognitive functioning throughout life, i.e., twins are growing old but not growing apart, in terms of health phenotypes. Twins experience substantial growth restriction in the last intrauterine trimester. The generalizability of aging studies of twins hinges on whether this early life exposure has long-lasting health consequences. Generally, after the infant period, twin-singleton health differences are small, and during the 20th century, they have vanished. In the older twin cohorts, sex differences in the association between number of offspring and oral health late in life provided support for the proverb known in many countries: “A tooth per child”. Twin studies of biomarkers of aging revealed that perceived age estimated by lay assessors based on photos is a strong biomarker of aging. The 1895, 1905, 1910 and 1915 Danish Birth Cohort Studies of the oldest old were established to study secular trends in the health and functioning of the very old. Among the main findings of the studies are: Exceptional longevity does not lead to exceptional levels of disability; summed over cohorts, more people are living to the highest ages and are functioning better – and this progress is seen across the spectrum of health and functioning – offering hope for continued progress in health and survival among the oldest in society.
AGING IN THE RIGHT PLACE: HOUSING AND SOCIAL SUPPORTS FOR OLDER ADULTS EXPERIENCING HOMELESSNESS
Authors: Traver Anthony , Dabelko-Schoeny Holly 
Published: December 2023

Abstract
The Aging in the Right Place (AIRP) framework recognizes that secure housing for older adults should support one’s unique vulnerabilities and lifestyles. Applying the AIRP framework to older people experiencing homelessness (OPEH) reveals limited access to the types of living environments and supportive services that promote dignity, health, and inclusion in later life. This symposium aims to use the AIRP framework to examine the places, meanings, and opportunities experienced by diverse groups of OPEH striving to secure housing and promote their well-being. The first paper uses photovoice interviews and thematic analysis to broaden the current conceptualization of AIRP by exploring how feelings, actions, and place inform the meaning of AIRP for older adult residents of one temporary housing program in Vancouver, CA. The second examines the housing and support needs of older adult veterans in Calgary, CA residing in temporary congregate housing through a multi-methods approach involving document reviews, environmental audits, and in-depth interviews. The third paper uses interviews with OPEH and service providers in Columbus, OH to look across the continuum of housing occupied by older adults before, during, and after an episode of late-life homelessness and to investigate the mechanisms that allow OPEH to identify and access the housing they consider optimal. Finally, the discussion positions AIRP for OPEH within the broad context of Age-Friendly ecosystems to highlight the role of coordination between housing providers, government leaders, health services, university researchers, and residents to ensure that AIRP is achievable for precariously housed older persons.
MEANINGS OF AGING IN THE RIGHT PLACE FOR HOUSING INSECURE OLDER ADULTS IN TEMPORARY HOUSING
Authors: Mahmood Atiya , Canham Sarah , Weldrick Rachel , Patille Rachelle , Erisman Morgan 
Published: December 2023

Abstract
The concept of aging in place (AIP) is widely acknowledged as the preference of older adults. However, AIP without consideration of the intersections of diversity in later life is critiqued as lacking an equity lens. This gave rise to the exploration of what is needed to age in the right place (AIRP). Building on existing research, we examined the meaning of AIRP to older adults (aged 55+ years) who have experienced homelessness. We conducted photovoice interviews with 11 residents of a temporary housing program in Metro Vancouver (Canada). Using thematic analysis, we investigated the meanings of AIRP based on 1) How one feels, 2) What one does, and 3) Where one lives. Findings demonstrate that meanings of AIRP follow a similar pattern as Maslow’s Hierarchy of Needs. That is, when basic needs of shelter are met, participants’ considerations of the ‘right’ place to live extends beyond affordable housing to include having access to meaningful activities – in urban districts and nature-scapes – enabled by affordable transportation. This consideration includes higher-order factors such as opportunities for meaningful engagement and looking forward to a stable life, being at peace, feeling safe and comfortable in one’s home and neighborhood. Our examination of what AIRP means to this group of older adults broadens current conceptualizations. Given the increase of older adults who are homeless it is imperative that policymakers and practitioners be cognizant of meanings of AIRP to enable diverse groups of older adults to thrive in housing that is more than a shelter.
POTENTIAL MECHANISMS THROUGH WHICH INDUCING HEART RATE OSCILLATIONS AFFECTS PLASMA AMYLOID BETA LEVELS
Authors: Min Jungwon , Rouanet Jeremy , Cole Steve , Nashiro Kaoru , Yoo Hyun Joo , Cho Christine , Head Elizabeth , Mather Mara 
Published: December 2023

Abstract
Alzheimer’s disease-related protein amyloid beta (Aβ) plasma levels increase with age, and Aβ40 levels are associated with greater mortality. Most plasma Aβ40 is produced via platelets. Platelet activity is regulated by endothelial cells, which are stimulated by blood flow. Slow paced breathing with a 10-second cycle maximizes heart rate oscillations, which may stimulate endothelial-platelet interactions that affect Aβ production. We investigated this idea by randomizing healthy adults (54 younger and 54 older adults) into two groups with the opposite goals: increasing (Osc+) or decreasing (Osc-) heart rate oscillations. Four weeks of daily practice (20-40 min) resulted in large changes in plasma Aβ40 and Aβ42 levels. We also found that changes in Aβ were not associated with changes in resting-state physiology including heart rate variability. But the Aβ changes were associated with a frequency measure of heart rate oscillations induced during practice, suggesting that the Aβ changes were more driven by blood flow changes during practice. P-selectin is an indicator of endothelial activity. We found a significant intervention effect where the Osc+ intervention increased p-selectin and the Osc- intervention decreased p-selectin in older adults. Changes in p-selectin also showed strong negative correlations with changes in Aβ40 and Aβ42 in older adults. The results suggest that blood flow oscillations caused by high amplitude heart rate oscillations stimulated endothelial cells, which suppressed platelet activity and consequently reduced the production of Aβ in older adults. In follow-up research, we are investigating relationships between plasma Ab changes and changes in brain and cognition.
THE EMOTION PARADOX IN THE AGING BODY AND BRAIN
Authors: Mather Mara 
Published: December 2023

Abstract
With age, parasympathetic activity decreases while sympathetic activity increases. Thus, the typical older adult has low heart rate variability (HRV) and high noradrenergic activity. Younger adults with this physiological profile tend to be chronically unhappy and stressed. Yet, with age, emotional experience tends to improve. Why doesn’t older adults’ emotional well-being suffer as their HRV decreases? To address this apparent paradox, I present the autonomic compensation model. In this model, failing organs and initial phases of Alzheimer’s pathology trigger noradrenergic hyperactivity in older adults. Older brains attempt to compensate by increasing autonomic regulatory processes in ventromedial prefrontal (vmPFC) cortex. Age-related declines in nerve conduction reduce the ability of these compensatory attempts to reduce hyperactive noradrenergic activity and increase peripheral HRV. However, despite their muted effects on peripheral autonomic activity, these autonomic compensation attempts bias brain processing in favor of stimuli that tend to increase parasympathetic activity and against stimuli that tend to increase sympathetic activity. The autonomic compensation model can account for the “age-related positivity effect” in which, compared with younger adults, older adults show attentional and memory biases favoring positive over negative stimuli. Consistent with the autonomic compensation model, the age-related positivity effect is associated with vmPFC activity and functional connectivity and is evident even in early attention processes resistant to goal-directed processing. The autonomic compensation model posits that the aging brain responds to sympathetic hyperactivity in ways that amplify on-going automatic emotion regulation processes and so help maintain emotional well-being.
PROTECTING COGNITION AND INCREASING EQUITY THROUGH “COGNITIVE IMPACT ASSESSMENTS”
Authors: Leist Anja , Bertogg Ariane , Zanaj Skerdi 
Published: December 2023

Abstract
Today’s societies are characterized by increasing complexity, in which unimpaired cognitive performance is vital to navigate and participate, as well as to retain independence at older ages. Addressing the challenge of improving population brain health has mostly been considered from a dementia risk reduction perspective as identified by the Lancet Commission on dementia. However, risk factors with immediate harm to cognitive functioning, such as shift work or insufficient sleep are currently not explicitly accounted for. As exposure to these risk factors accumulates across the life course, we can expect substantial consequences for later-life brain health. We argue that, in policy and practice, systematic measures should be introduced to protect individuals from harms to their everyday cognitive functioning, and enable them to optimize cognitive performance throughout the life course. On behalf of the international multidisciplinary BRAINHEALTH-POLICY group, we explore the concept of a ‘cognitive footprint’ of policies with exemplars from current legislation and policy that either implicitly affect cognition, or explicitly address effects on individuals’ cognition. We suggest recommendations for systematic pre-intervention ‘cognitive impact assessments’ in fields such as medicine, where drug trials should include cognition as important secondary endpoint, and work, where labour laws should explicitly account for possibly harmful effects of certain work conditions to cognition. Besides immediate protective effects, we expect ‘cognitive impact assessments’ to have potential for long-term cognitive benefits on a population level as well as improve brain health equity by enabling individuals to reach optimum cognitive performance, with associated wider health benefits.
HOSPICE USE AND END-OF-LIFE EXPERIENCE BY RACE AND GEOGRAPHY: A LATENT CLASS ANALYSIS
Authors: Decker Autumn , Weaver Raven 
Published: December 2023

Abstract
Long existing inequalities near the end-of-life (EOL), including the death experience, have been uncovered because of increased attention during the COVID-19 pandemic. Hospice may be an avenue to equalize EOL experiences. This study aimed to 1) understand the profiles of hospice use and EOL experience in a national representative sample of decedents and 2) uncover how race and/or geographic location predict class membership. We conducted a latent class analysis with covariates using Waves 9-11 (n=1050) from the last month of life interview in the National Health and Aging Trends Study. Based on fit statistics, response probabilities, class separation, interpretability, and fit with theory, a four-class model was ultimately selected. The four latent classes were: well-rounded hospice care; no hospice, goal concordant care; no hospice, poor overall care; and complex hospice care. We found that geographic location was not a significant predictor of latent class membership but being non-White was significantly associated (p &lt; .001) with 8.79 times higher odds of being in the no hospice, poor overall care group and 1.85 times higher odds of being in the no hospice, complex care group compared to the reference class (well-rounded hospice care). The current study’s findings paint a complex picture of hospice use and EOL experience in a nationally representative sample. Hospice use alone does not make a “good death” experience, particularly for people of color. Rather, there are unique profiles of hospice use and experiences at EOL. Future research should explore the impact of geographic location on the death experience.
THE IMPACT OF HOME HEALTH CARE UTILIZATION ON SUBSEQUENT HOSPICE USE AMONG MEDICARE BENEFICIARIES
Authors: Jarrín Olga , Zafar Anum , Duberstein Paul , Wu Bei , Lin Haiqun , Kim Hyosin , Lopez Maria , Harvey S Marie 
Published: December 2023

Abstract
Home health care may increase the use of hospice among Medicare beneficiaries by providing improved access to care, enhanced care coordination, and earlier identification of the need for hospice. This study evaluated home health care use during the last three years of life as a predictor of death in the care of hospice for a cohort of 2,169,496 Medicare beneficiaries who died in 2019. The cohort included beneficiaries continuously enrolled in Medicare for 5 or more years, aged 40 and older, and living in the U.S. fifty states, District of Columbia, U.S. Virgin Islands, or Puerto Rico at death. Co-variates included acute hospitalizations during the look-back period, age at death, sex, race/ethnicity, comorbidities, insurance, rural/urban area, and state of residence. Overall, 46% of beneficiaries used home health care during the lookback period, and 62% died at home. Among beneficiaries who used home health care, 59% died in the care of hospice, compared to 45% who never used home health care. Beneficiaries who received home health care at any point during the lookback period were more likely to later die at home (OR 1.10) or in the care of hospice (OR 1.07) compared to their counterparts without a history of using home health care. Additionally, persons with dementia had greater odds of home death (OR 1.21) and death with hospice (OR 1.68) compared to their counterparts without dementia. This study provides strong evidence of the value of home health care as a strategy to improve end-of-life care quality for Medicare beneficiaries.
THE IMPACT OF STROKE ON TRAJECTORIES OF LONELINESS
Authors: Rule Payton , Willroth Emily , Graham Eileen , Nicholas Marjorie , Hattori Robin , Thompson Tess , Connor Lisa 
Published: December 2023

Abstract
While prior research has identified loneliness as a risk factor for stroke, less is known about whether stroke may increase the risk of loneliness. We examined this question using three large representative panel studies of middle-aged to older adults in the U.S., Europe, and Israel. Specifically, we used harmonized data from the Health and Retirement Study (n=23,834, 10.3% stroke survivors), the English Longitudinal Study of Aging (n=15,779, 5.1% stroke survivors), and the Survey of Health, Aging and Retirement in Europe (n=106,480, 3.6% stroke survivors). Multilevel modeling was used to examine trajectories of loneliness across middle and older adulthood and the impact of stroke on trajectories of loneliness. Across all three samples, loneliness followed a quadratic trajectory, decreasing or remaining stable prior to age 60 and then increasing throughout older adulthood. In individuals who experienced stroke, loneliness increased more sharply after stroke onset. In follow-up analyses conducted within the subsample of stroke survivors, loneliness was higher post-stroke compared to pre-stroke. Moreover, the effect size suggests that the impact of stroke on loneliness trajectories is greater than the impact of normative developmental processes. In this talk we will discuss these results as well as the implications of this work. Specifically, these results highlight the need for loneliness prevention efforts in stroke survivors. Interventions targeting stroke survivors’ social participation and autonomy may help prevent or decrease loneliness post-stroke. Additionally, programs aimed at educating stroke survivors’ social network on ways to provide effective support may also help promote social connection in this population.
CHALLENGES IN THE COMMUNITY-DRIVEN RECRUITMENT OF BLACK OLDER ADULTS TO A HEALTH RESEARCH REGISTRY
Authors: Perry Tam , Key Kent , Flores Elena , Rorai Vanessa , Mitchell Jamie 
Published: December 2023

Abstract
Black older adults are underrepresented in health research. Community members representing diverse aging-focused organizations in Flint, Michigan desired more accessible health discoveries, and formed a Community Advisory Board (CAB) in partnership with three local universities. With a grant from the National Institute on Aging (NIH), the CAB sought to promote research engagement through free community health programming and launching a Participant Research Pool (PRP) to connect Black older adults with non-invasive IRB-approved health research at participating universities. Despite extensive recruitment efforts by this academic-community partnership, including monthly virtual health seminars, a new website, tailored print and video promotional materials, a minority aging newsletter, and a community research symposium, the PRP remains severely under-enrolled after a year. An evaluation of recruitment strategies revealed a need for more frequent in-person programming, leveraging the social and professional networks of CAB members, increased intentionality in community partnerships, and more intensive and traditional modes of advertising to reach and recruit the target population. Lessons indicate that Black older adults in the community trust this research endeavor but require tailored and consistent outreach to engage with the participant research pool.
FORWARD STEPS AND MISSTEPS: WHAT WE’VE LEARNED THROUGH THE PROCESS OF COMMUNITY-ENGAGED RESEARCH
Authors: Lewis Jordan 
Published: December 2023

Abstract
Historically, research with Indigenous populations has disregarded community input, creating mistrust among tribal communities toward researchers, and resulting in communities limiting their involvement in research projects. Today, Indigenous communities are becoming more engaged in the research process, including developing their own tribal review boards, partnering with researchers throughout entire research process, as well as exercising their tribal sovereignty and housing their own data. These efforts have resulted in the development of rigorous Indigenous approval processes, increased engagement of Indigenous people and communities in research, and studies that have direct impacts on those engaged, as well as future generations, as well as protect both the Indigenous communities and the researchers. As a researcher trained to conduct culturally respectful and culturally safe research with Indigenous communities in Alaska, my team and I have gained first-hand experience with tribal research protocols, research processes, and the iterative process of developing relationships, navigating research ethics, as well as ensuring that findings are reflective of the community, its individual members, and the region. Despite our best efforts, research does not go as written in our grant proposals. This presentation will outline the complexities of navigating tribal approval processes in Alaska, highlight some of the challenges we have faced while conducting community-engaged research in Alaska; our lessons learned by doing it incorrectly. We will also share recommendations for researchers interested in working with Indigenous communities and how to work collaboratively with to avoid pitfalls, but also how to get back on track and develop lasting relationships.
THE ACHIEVE RANDOMIZED TRIAL: EFFECT OF HEARING LOSS INTERVENTION ON COGNITIVE DECLINE IN OLDER ADULTS
Authors: Deal Jennifer 
Published: December 2023

Abstract
Hearing loss in older adults is linked to accelerated cognitive decline and incident dementia in population-based observational studies; whether intervention can reduce cognitive decline is unknown. The multi-center NIH-funded ACHIEVE randomized controlled trial is testing efficacy of a best-practices hearing intervention (amplification and rehabilitation) versus a successful aging health education control intervention, on 3-year cognitive decline in 977 dementia-free adults aged 70-84 years with untreated mild-to-moderate hearing loss. This presentation will describe results for the primary outcome of 3-year cognitive decline, measured using a 10-item neurocognitive battery summarized using latent variable methods. Secondary outcomes include (1) domain-specific cognitive declines in memory, language and executive function and (2) time until cognitive impairment defined as a composite of adjudicated dementia or mild cognitive impairment diagnosis, a 3-point drop in the 30-item Mini-Mental State Exam (MMSE) administered in-person, or a 3-point drop in a factor score derived from the 10-item MMSE orientation subscale and 11-item Blessed scale administered over the phone and rescaled to be equivalent to the 30-item MMSE. The trial is ongoing with data closeout March/April 2023; data will be analyzed per the ACHIEVE Coordinating Center statistical analysis plan, approved by the NIA and ACHIEVE DSMB. Although preliminary results are not possible to include here to protect trial integrity, results will be available to present for GSA. ACHIEVE is the first large-scale randomized study to determine if hearing loss intervention reduces cognitive decline. Whether findings are positive or null, this study will have substantial clinical and public health impact.