bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE SOCIAL DETERMINANTS OF BRAIN HEALTH: FROM THE SEARCH FOR MECHANISMS TO RECOMMENDATIONS TO INCREASE EQUITY
Authors: Leist Anja , Muniz-Terrera Graciela 
Published: December 2023

Abstract
Dementia risk has been established to be partly attributable to modifiable social and behavioral risk factors. However, the biological pathways behind these associations and the effects of intervening on present risk factors to reduce dementia risk have not been fully elucidated. The symposium will present latest research on the social determinants of brain health and dementia. We will explore proposed mechanisms between modifiable risk factors and risk of dementia, and present findings on the modifiability of dementia risk through addressing risk factors. Specifically, the first presentation reports analyses testing possible pathways from socioeconomic status, notably childhood and adulthood indicators such as (parental) education and occupation, to cognitive functioning in later mid-adulthood via indicators of brain damage and white matter connectivity with the Maastricht Study. The second presentation reports empirical analyses testing the possible mediating role of the gut microbiome in the relationships between social and modifiable risk factors and Mild Cognitive Impairment with data of the controls of the Luxembourg Parkinson’s Study. The third presentation reports on the associations between hearing loss as a modifiable risk factor and incident dementia in the UK Biobank and investigates the potential to modify hearing loss-associated dementia risk through the use of hearing aids. Lastly, the fourth presentation moves to recommendations for policy and government action. It gives an overview of various fields in which policy and legislation could implement cognitive impact assessments to protect individuals’ cognition, with the aim of improving population brain health and health equity. This is a Brain Interest Group Sponsored Symposium.
EDUCATION AS A RISK FACTOR OF MILD COGNITIVE IMPAIRMENT—THE ROLE OF THE GUT MICROBIOME
Authors: Klee Matthias , Aho Velma , May Patrick , Krueger Rejko , Wilmes Paul , Leist Anja 
Published: December 2023

Abstract

Background
Social determinants of health relate to an individual’s risk of MCI and dementia. However, pathways from identified modifiable risk factors such as education are not well understood, yet. While previous findings suggest distinct taxonomic signatures of the gut microbiome in dementia and MCI patients, and further education linked to its composition, we sought to test the possibly mediating role of the gut microbiome in the relationship between education and MCI. Method: Gut microbiome composition was ascertained with 16S rRNA gene amplicon sequencing. MCI classification was based on the Montreal Cognitive Assessment. Education in years was grouped (0-10, 10-16, 16+). Mediation analysis was conducted decomposing direct and indirect effects of education on MCI mediated by gut microbiome diversity (Chao1, Inverse Simpson, Shannon) or individual species at Genus level (ldm-med, permanova-med). Differential abundance analysis across education groups was conducted (ANCOM-BC, DESeq2). Result: After exclusion of participants with PD, below age 50, or with missing data, n=256 participants (n=58 with MCI) of the Luxembourg Parkinson’s Study were eligible for analysis (M[SD] Age=64.7[8.3] years). Education (16+ compared to 0-10 years of education) had a natural direct effect of NDE=0.36 (P&lt;.01) on MCI, Chao1 included as mediator. We did not find significant mediation by gut microbiome composition or individual species.

Conclusion
Our findings indicate direct effects of education not mediated by the gut microbiome. Taxonomic analysis suggests a signature linked to lower risk of dementia in higher educated individuals. Longitudinal research is needed to investigate associations over time.
LESS HOSPICE UTILIZATION AMONG CONNECTICUT MEDICAID DECEDENTS WITH NURSING HOME STAYS BEFORE DEATH
Authors: Dillon Ellis , Migneault Deborah , Shugrue Noreen , Wakefield Dorothy , Lee Chae Man , Charles Doreek , Richards Bradley , Robison Julie 
Published: December 2023

Abstract
Hospice use, and length of enrollment of over 7 days are both considered indicators of quality care at the end of life, but the potential impact of nursing home (NH) stays on these outcomes is not well understood. This study analyzes hospice use and short hospice enrollment (0-7 days) for decedents in Connecticut’s Medicaid program who died between 2017 and 2020 and had a hospice-appropriate diagnosis. We compare individuals who had a NH stay within 60 days of their death to those who did not. Among 26,264 decedents meeting inclusion criteria, 14,227 (54.2%) had a NH stay within 60 days of death. Overall, 12,368 (47.1%) of all decedents received hospice care prior to death. Patients with a NH stay within 60 days of death were less likely than those without one to use hospice (44.3% vs 50.4%, p&lt;0.01) (OR=0.78, (95% CI: 0.74, 0.82), p&lt;0.01). Among those receiving hospice care, 4911 (39.7%) had short hospice enrollment. Patients with a NH stay within 60 days of death were 2.4 times more likely to have short hospice enrollment (OR=2.41 (95% CI: 2.24, 2.60), p&lt;0.01) compared to those without. These findings suggest a need for further research into why individuals with NH stays are less likely to use hospice care and more likely to have shorter hospice enrollment. Comparing Medicaid decedents with NH stays prior to death to those living in the community may reveal disparities and areas that would benefit from interventions or policy change.
OVERCOMING TENSIONS IN CULTURALLY RESPONSIVE RESEARCH WITH LGBTQ+ OLDER ADULTS OF COLOR
Authors: Oswald Austin , Cooper Lujira , Guess Aundaray 
Published: December 2023

Abstract
Lesbian, gay, bisexual, transgender, and queer plus (LGBTQ+) older adults of color are underrepresented in gerontological scholarship due to structural factors that limit their research participation. This presentation applies critical reflexivity to weave together the narratives of a gerontological researcher, service provider, and older adult who co-constructed a research project committed to improving the visibility of LGBTQ+ older adults of color in gerontology scholarship. Through the lens of queer failure, we analyze personal narratives documenting our process designing and implementing a participatory action research project to uncover pivotal moments that shifted the course of the research in unexpected, yet critically important ways. Three themes emerged that illuminate key epistemic tensions associated with culturally responsive research with LGBTQ+ older adults of color, specifically navigating cross cultural tensions, intergenerational tensions, and pandemic related tensions. These findings highlight the limitations of traditional research methods which fail to account for historic and contemporary experiences that may shape perceptions of researchers and individuals’ willingness to participate in research. Working through these tensions in solidarity contributed to the revision and improvement of traditional methods by developing culturally responsive approaches to research with LGBTQ+ older adults of color. Embodying a participatory, reflexive, and collaborative approach to inquiry has the potential to challenge and transform hegemonic scientific discourse that marginalizes certain communities. This presentation ends by offering implications for research that may support the development of culturally responsive methods for underrepresented communities in which future studies can expand upon, so long as the community is in the lead.
LONELINESS, SOCIAL ISOLATION, AND HEALTH WITHIN THE CONTEXT OF A GLOBAL PANDEMIC
Authors: Graham Eileen , Neupert Shevaun , Antonucci Toni 
Published: December 2023

Abstract
Social connectivity is a crucial human experience. The objective experience of being disconnected (i.e., social isolation) and the subjective feeling of being disconnected (i.e., loneliness) are related but distinct experiences that have unique impacts on physical, mental, and cognitive health. The COVID-19 pandemic forced much of the global population into a prolonged state of isolation, and many older adults found themselves abruptly cut-off from important sources of social interaction. The lasting impacts of the pandemic are still unknown. This symposium brings together several projects addressing key questions about longitudinal processes of loneliness and social isolation among middle aged and older adults, both prior to and during the COVID-19 pandemic. Jackson will present results from a coordinated data analysis (CDA) showing the extent to which loneliness, social isolation, and social asymmetry are related to MCI, dementia, mortality, and life expectancy. Rule will discuss the impact of stroke on trajectories of loneliness in a CDA. Zhang and Fingerman will present findings that show how loneliness and social isolation vary among individuals with functional limitations. Zavala will present results from a CDA that explored daily patterns of loneliness during the early months of the COVID-19 pandemic. Lastly, Beck will discuss a CDA that examined trajectories of social asymmetry prior to and during the COVID-19 pandemic. Antonucci will synthesize and discuss each project within the context of broader implications for empowering older adults. In sum, this symposium presents novel evidence showing that loneliness and social isolation in older adulthood are impactful predictors of health.
A COORDINATED ANALYSIS OF THE ASSOCIATIONS BETWEEN LONELINESS, SOCIAL ISOLATION, AND THE COGNITIVE HEALTHSPAN
Authors: Jackson Kathryn , Yoneda Tomiko , Luo Jing , Mroczek Daniel , Ong Anthony , Steptoe Andrew , Graham Eileen 
Published: December 2023

Abstract
Insufficient social connection in older adulthood is a growing public health concern. Current research suggests that loneliness and social isolation are related to consequential health outcomes in later life. There is a large and growing literature suggesting that loneliness and social isolation are associated with increased risk of dementia and mortality, but these outcomes typically have been considered separately and without controlling for competing risk factors. Using multi-state survival models which permit simultaneous estimation of transitions between several states within one model, the current study examined the extent to which loneliness, social isolation, and social asymmetry (defined as the discordance between loneliness and isolation) are associated with transitions between cognitive status categories (non-impaired, mildly impaired, severely impaired) and death. We estimated near-identical models individually across 11 independent long-term longitudinal studies (i.e., ELSA, HILDA, HRS, LISS, OCTO-TWIN, SATSA, SHARE, SHP, SOEP, MAP, MARS) using the coordinated data analysis methodological framework, representing a total sample size of over 140,000, and meta-analysis to provide precise estimates of the effects of loneliness, isolation, and social asymmetry on cognitive healthspan transitions. Preliminary findings suggest that loneliness is associated with increased risk of transitioning from non-impaired to mildly impaired cognitive functioning. Higher loneliness is associated with shorter survival time and fewer years in a healthy cognitive state. Lastly, we found that lower social asymmetry (i.e., social resilience) is associated with longer cognitive health span (more years in NCI). These results provide promising evidence suggesting that poor social relationships are robustly associated with a diminished cognitive healthspan.
SOCIAL DETERMINANTS OF HEALTH AND DEMENTIA: PUBLIC HEALTH PERSPECTIVES
Authors: Gaugler Joseph , McGuire Lisa , Epps Fayron 
Published: December 2023

Abstract
The U.S. Department of Health and Human Services and its Office of Disease Prevention and Health Promotion define social determinants of health (SDOHs) as “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” Featuring presenters from the three national Building our Largest Dementia Infrastructure (BOLD) Public Health Centers of Excellence as well as other Centers of Disease Control and Prevention Healthy Brain Initiative programs, this symposium will examine how dementia influences, and is influenced by, SDOHs. Specifically, issues that require critical public health action, including prevention, early detection, and family caregiving will be examined within a SDOH framework. Transcending these concerns, this symposium will also feature a presentation that considers the complex associations between health equity, SDOHs, and dementia. We anticipate that this symposium and its presentations will facilitate and advance gerontology’s understanding of dementia as a public health imperative, and as importantly, begin to identify how public health at the local, tribal, state, and federal levels can mobilize to address the challenges and opportunities of dementia.
FEASIBILITY AND EFFICACY OF LIFE REVIEW DEPRESSION INTERVENTION BY VIDEO-TRAINED FAMILY CAREGIVERS
Authors: Miyawaki Christina , McClellan Angela , Bouldin Erin , Brohard Cheryl , Kunik Mark 
Published: December 2023

Abstract
Due to the high prevalence of depressive symptoms and dementia in older Americans, we developed a six-week virtual depression intervention, Caregiver-Provided Life Review (C-PLR) for care recipients (CRs) with early-stage dementia and mild depression and their family caregivers (CGs). We changed the length of CG training iteratively, trained CGs in interviewing and probing skills via video, and CGs delivered life reviews (LR) with CRs at home (N=25 dyads). The objective of the study was to examine the feasibility and efficacy of C-PLR on CRs who were community-dwellers and long-term care facility residents. We collected pre- and post-measures of CRs’ depression (primary outcome) and life satisfaction, CGs’ burden, positive aspects of caregiving, and CG-CR relationship quality (secondary outcomes) and compared them using paired t-tests. We evaluated if the effect differed by race/ethnicity, residential setting, or living arrangements. CGs were 52 years old (mean), working (64%), college-educated (72%), female (88%), and in good-excellent health (72%). CRs were 81 years old (mean), female (84%), and in poor-fair health (56%). CRs’ depression significantly improved following C-PLR (p&lt; 0.001), and this effect was found in CRs who were Asian (p=0.017), White (p=0.040), community-dwelling (p&lt; 0.001), lived alone (p=0.045), and lived with others (p=0.002). Secondary outcomes did not change. This study demonstrated that C-PLR can be successfully taught to CGs via video and effectively reduces CRs’ depressive symptoms without increasing CG burden. C-PLR could be implemented broadly to improve symptoms among CRs in community and residential settings, as well as among a diverse population of CRs.
FOOD INSECURITY AMONG OLDER ADULTS IN THE UNITED STATES DURING THE COVID-19 PANDEMIC
Authors: El-Abbadi Naglaa , Fan Zhongqi , Yang Amy , Ronan Ana , simpson Ryan , Nguyen Kimberly , Naumova Elena 
Published: December 2023

Abstract
The COVID-19 pandemic severely impacted food access and nutritional security across the United States, and exacerbated disparities in household food insecurity rates particularly among older adults due to potential for reduced food access, mental or physical health limitations, or fixed incomes. This study investigated food insecurity among older adults in the US throughout time periods of the pandemic, exploring differences among population groups for food insecurity risk factors. Data was from the US Census Bureau’s Household Pulse Survey, April 2020 through December 2022, weight-adjusted for a nationally representative sample (n=3,884,922). Logistic regression models were constructed to examine the association between older age and self-reported household food insecurity. Reasons given for food insecurity were examined as secondary outcomes. Covariates included demographics, socioeconomic status, household structure, food support programs, and mental health status. Findings showed risk of food insecurity among adults aged 60+ years more than doubled among minority racial groups compared to non-Hispanic White (p&lt;0.001) but was inversely associated with being female compared to male (OR 0.77, p&lt;0.001). Older adults who reported experiencing at least one mental health indicator (anxiety, depression, low interest, or worry) more than half of the week had over five times the odds of being food insecure (OR 5.68, p&lt;0.001). Overall, trends and factors associated with prevalence and reasons for food insecurity were found to vary across age groups, and at different points of the pandemic. Our findings can help elucidate factors to identify older adult groups at greater food insecurity risk.
USING NETWORK ANALYSIS TO EXPLORE DIFFERENCES IN DIETARY INTAKES ACROSS OLDER ADULTHOOD
Authors: Shea Kyla , Rogers Gail , Barger Kathryn 
Published: December 2023

Abstract
Federal nutrition guidance in the Unites States (US) is based on the premise that healthy diets can help delay the onset or progression of age-related disease and disability. Yet, little is known about if or how dietary intakes differ across the older adulthood age span. We used NHANES 2015-2016 and 2017-March 2020 data to examine the dietary intakes of 60-69 year old (n=2079), 70-79 year old (n=1181) and 80+ year old (n=644) adults in the US. Mutual information was used to infer network relationships among all possible pairs of fourteen What We Eat in America food group categories. Based on edge weights, we observed some similarities and some differences in the manner in which food groups were co-consumed across older adulthood. For example, fruit and dairy were co-consumed similarly in the three age groups. Among the 60-69 and 70-79 year olds, protein and vegetables were co-consumed, while fruits were consumed with grains and mixed dishes. However, in the 80+ year olds, vegetables were mostly consumed with fats and oils, but less so with protein, and grains were consumed with dairy, but less so with fruit. Based on a network science approach, the manner in which food groups are consumed appears to change throughout older adulthood. Future studies are needed to evaluate consumption patterns of specific foods among age-defined and other subgroups of older adults and explore potential associations with age-related health outcomes.
THE EFFECTS OF AGE AND SEX ON THE GUT MICROBIOME AND GUT HOMEOSTASIS IN MICE
Authors: Lee Jennifer , Wellenstein Kerry , Matuszek Gregory 
Published: December 2023

Abstract
Symbiotic interactions between the gut microbiome and intestinal epithelium are key contributors to regulating gut homeostasis and host metabolism in mice. However, the majority of studies measuring these outcomes have been reported in male and not female mice. Here, we find sex-specific differences in gut homeostasis and host metabolism in conventional C57BL6 chow-fed mice. Functional analyses of the gut metagenomes and metabolomes, gut barrier function, and colonic T-cell populations are different between young and old female and male mice. These data highlight the importance of considering sex as a biological variable in aging rodent studies, which may lead to optimized strategies to improve healthy aging for all.
PATIENT AND FAMILY PARTNER OUTCOMES OF THE FAM-FFC TRIAL
Authors: Boltz Marie , Mogle Jacqueline , Kuzmik Ashley 
Published: December 2023

Abstract
The Fam-FFC trial tested the hypotheses that patients who participated in Fam-FFC would have more return to baseline function, more physical activity, and less delirium, depressive symptoms, and behavioral symptoms of distress, and that care partners would demonstrate increased preparedness for caregiving (primary outcome) and less anxiety, strain, and burden, as compared to participants in the control arm. The likelihood of returning to baseline function across time for Fam-FFC participants was twice that of the control group by the end of 6 months (OR = 2.39, p =.011). Fam-FFC was also associated with fewer behavioral symptoms of distress at six-months (changeintervention = -1.973, SE = .396, p &lt; .0001, d = .467; changecontrol = -.859, SE = .389, p = .028, d = .203); moderate physical activity, depressive symptoms, and delirium severity did not differ by treatment arm. Preparedness for caregiving increased significantly more from 2 months to 6-months (changeintervention=2.4, SE=.439, d=.563; changecontrol=.893, SE=.450, d=.212, overall p = .02), and marginally increased from discharge to six months. (changeintervention= 2.783, SE= 0.44, d=.682; changecontrol=1.695, SE=0.44, d=0.415, overall p =0.08), in the intervention group, with no group differences in anxiety, strain, and burden. Fam-FFC may prevent some of the post-acute functional decline and behavioral symptoms in persons with dementia while increasing FCP preparedness. Future research should focus on sustainability of patient improvements and addressing the chronic stressors associated with the care partner role.
DEVELOPMENT OF A SENSOR-ENHANCED CARE COORDINATION APPROACH TO FACILITATE AGING IN PLACE
Authors: Popejoy Lori , Reeder Blaine , Robinson Erin , Proffitt Rachel , Vogelsmeier Amy , Lee Knoo 
Published: December 2023

Abstract
Older adults living in rural areas of the country face unique challenges in accessing health services and community-based supports to facilitate aging in place (AIP). This is especially true for those with health concerns that have required care at a nursing facility. Re-establishing independence after a permanent discharge from a long stay nursing home can be difficult and puts strain on informal care networks. To address this, our team developed a novel approach to help older and disabled adults who were discharged from the Show-Me Home project, which supports clients permanently discharged from the nursing home. The Age-friendly Sustainable Smart and Equitable Technologies for Aging in Place (ASSETs for AIP) is a demonstration project funded by the Department of Health and Human Services. We are an interdisciplinary team of researchers and clinicians who use a strengths-based and client-driven approach to empower older and disabled adults for self-management of their disability, conditions, health, and well-being. Our care coordination team consists of a registered nurse, occupational therapist, and social worker, who assess health-related conditions, set goals, empower change, and monitor progress. For individuals enrolled in ASSETS for AIP, we rely on open-source smart home technologies and consumer-grade wearable devices to monitor activity patterns to identify changes in activity and health. Our care coordination team uses these data as well as client assessments to engage with clients to help them maintain independence. This model shows great promise in addressing the needs of older and disabled adults, thus enabling them to age in place.