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The Diverse Elders Coalition, in partnership with its six member organizations and the Benjamin Rose Institute on Aging, completed a national survey of 840 family and friend caregivers from diverse racial, ethnic, and sexual orientation communities to understand their unique caregiving issues and challenges. Data from a subsample of 404 caregivers identifying as Hispanic/Latino, Asian, Southeast Asian or from multiple ethnicities were examined to determine the relationship between difficulties performing culture-related care tasks (i.e., assisting with immigration issues and language barriers) and a variety of caregiver outcomes. Regression analysis controlling for background and context characteristics showed caregivers experiencing more culture-related task difficulties had significantly higher levels of several negative caregiving consequences, including health strain (B=.19, p=.001), relationship strain (B=.17, p=.005), work strain, (B=.24, p=.000) isolation (B=.17, p=.002), and symptoms of depression (B=.29, p=.000). Moreover, higher levels of strain and depression among caregivers who reported high levels of culture-related task difficulties ranged from 26%-54%. More difficulties with culture-related tasks also were significantly related to dissatisfaction with support resources, including lower ratings of the quality of care receivers’ healthcare (B=-.20, p=.001), and lower satisfaction with support they and their care receivers received from family and friends (B=-.17, p=.006 and B=-.16, p=.011, respectively). Results suggest caregivers from diverse communities struggling with culture-related tasks experience more negative consequences of caregiving and less helpful social support. Service providers working with caregivers from diverse communities should assess for culture-related task difficulties, recognizing these problems may be a window into a variety of adverse caregiving effects.

Osteoporotic fractures and their sequelae are a leading cause of morbidity and mortality in older adults. In the United States, nearly 50% of white women and 20% of black women and white men will suffer a fragility fracture in his or her lifetime. Osteoporosis medications reduce the risk of major fragility fracture by 31-62%, but numerous care gaps exist, including screening rates as low as 1-47% and treatment rates as low as 16-30% even after a fracture has already occurred. From January to August 2019, we conducted a multi-faceted quality improvement project at a university hospital-based geriatric primary care clinic, with a goal of improving our rates of osteoporosis screening and treatment. We designed and tested electronic health record-based registries of eligible patients, and developed patient outreach workflows and physician “inreach” workflows. We piloted a bone health clinic. While we did not meaningfully affect the rate of osteoporosis screening, our efforts resulted in an increase in treatment of osteoporosis from 49% to 53%. Documentation of osteoporosis decision making among eligible patients improved from 66% to 80%. In our clinic, ongoing barriers to evidence-based osteoporosis management include competition for time with other medical issues, patient mistrust of medications, and the complexity of decision making around osteoporosis in older adults with polypharmacy and limited life expectancy. Future work must balance the broad application of treatment guidelines via population health tools with the need to individualize treatment decisions for each patient’s overall health and goals of care.

Although recruiting persons with dementia into research is challenging enough, finding those who live-alone in the community is even more difficult. Consequently, live-alone persons with dementia are often overlooked and/or deliberately excluded from inquiry despite calls for more inclusive approaches to dementia research. Based on enrollment strategies from an interview-based protocol recruiting 120 live-alone persons with dementia, our National Institute on Aging- funded study identified five domains of gatekeepers imperative to gaining access to community-dwelling, live-alone persons with dementia: 1) housing (e.g., service coordinators), 2) data proprietors (e.g., regulatory specialists), 3) institutional (e.g., review boards), 4) kin (including fictive kin), 5) clinical (e.g., medical providers, clinician practices). In addition, gatekeeper domains are multilayered and serve distinct roles in both facilitating and hindering access to and enrollment of this under-researched vulnerable population. Analysis of our recruitment efforts contribute significant insights into how the dementia research community may engage the various domains of community gatekeepers, providing direction for current and future social science research.

With the limited advancements in medical treatment, there is a growing emphasis on supporting people with early-stage dementia adjusting to their diagnosis and improve their quality of life. This study aimed to evaluate the effects and experiences of people with early-stage dementia attending a 12-week Health Promotion, consisting of 2-hour sessions at weekly intervals focusing on understanding the progression of dementia, promoting physical activity, nutrition, coping, relationships, home- and travel safety, medication and communication with health care providers. Quantitative and qualitative assessments were conducted at baseline and follow-up 1-2 months post intervention, including cognition, self-rated health and depressive symptoms and individual short interviews. A total of 90 persons with dementia participated in this study. The results demonstrated a stable cognitive function, measured by Mini Mental State Examination, of people with dementia during the 4 month follow-up, and a significant improvement in self-rated health measured by EQ VAS (95% CI 0.2 to 7.6, p=0.037). Depressive symptoms measured by Cornell Scale for Depression in Dementia, demonstrated a decline by one point, which is an improvement in depressive symptoms, although not significant. 32 of the 90 qualitative interviews with participants and their carers were included and analyzed with systematic text condensation. The results demonstrated that the intervention was well received by the participants, learning about dementia, practical strategies and focusing on remaining resources was particularly highlighted as well as improved family communication. In conclusion, the intervention had beneficial effects on the cognitive function, self-rated health and depressive symptoms of people with dementia.

Grandparenting can be a rewarding and health-promoting experience for older adults. However, grandparent-caregivers often experience greater stress and poorer health relative to non-caregiving grandparents. Further, little is known about grandparents caring for a child with a rare, chronic illness. This study aimed to extend knowledge of the expectations, roles, and experiences of grandparents providing care to a child affected with an inherited metabolic condition. The sample included 23 grandparent-mother dyads from the Inherited Diseases, Caregiving, and Social Networks Study. The grandparent sub-sample ranged from 49 to 79 years of age (Mage = 64), the majority were female (83%) and married (74%), and almost half (48%) were retired. Social network assessments were analyzed to determine concordance between mother- and grandparent-reports of grandparents’ role in the child’s caregiving network. Fifteen mother-grandparent dyads (65%) agreed on grandparents’ role in the child’s network, with the majority of those (93%) considering the grandparent to be very close and important (versus less close or excluded from the caregiving network). Grandparents whose self-reports of their role in their child’s caregiving networks were consistent with mother-reports appeared more likely to report that they spend enough time caregiving than those whose reports were inconsistent. Content analysis of grandparents’ interviews provided supporting information about the joys and regrets of their grandparenting experience and perspectives on caregiving expectations. This research leverages multi-informant social network and qualitative data to illuminate grandparents’ role in the caregiving networks of chronically ill children and adaptation to non-normative grandparenting experiences.

Chemotherapy destroys cells indiscriminantly and releases proinflammatory factors into the bloodstream that can adhere to endothelial cells (ECs); resulting in phenotypical changes consistent with “accelerated vascular aging”. This pilot study examined associations between markers of EC integrity, vascular aging, and cognition in 15 female breast cancer survivors 12–18 months after chemotherapy (median age: 57 years) and 2 non-cancer controls (58/59 years). EC integrity was evaluated using frequency-dependent electrical impedance (Z4000Hz) and levels of apoptosis (caspase-3/7), inflammation (NFkB activation), and oxidative stress (NRF2 activation) in cultured human endothelial cells (EC) exposed to the subject’s serum. Vascular aging was characterized by low serum insulin growth factor ([IGF1a]

Older adults are an important demographic group in the tourism sector, particularly in Florida. This study assessed age-group differences in the characteristics and habits of 2019 Daytona Bike Week attendees, as evidence indicates the average age of bike week visitors is rising. Aging Studies and Hospitality undergraduate students at Bethune-Cookman University interviewed 335 participants using Google Forms on their mobile phones. Results from chi-square tests indicate that there were significant differences between younger (20-39 years), middle-aged (40-59 years) and older adults (60+ years) in terms of gender and income, expenditures on accommodations, type of accommodations, nights spent, and first-time attendance. A greater percentage of older bike week attendees were male and higher income, and were less likely to be first-time attendees. Older adults also tended to spend more on accommodation and stayed longer, and were more likely to stay in Air BnBs, rental homes or a second home/condo compared with younger and middle-aged adults, but were less likely to stay in a hotel/motel or with friends/family. No significant differences were found in expenditures on food, alcohol, gas, entertainment or shopping. Findings suggest that older bike week attendees are important contributors to bike week tourism, particularly with respect to accommodations.

Drawing from the lens of architecture, designing a research study for a controlled, simulated environment requires the consideration of three primary types of interaction involving people and infrastructure. These three types include the interface between and among the respondent(s) and the researcher(s), the interface between and among the people playing these roles and the infrastructure surrounding them (inclusive of self-report measures, sensing technology, furniture, etc.), and the interface between and among the various types of study infrastructure. The flow of a study across these interfaces becomes a form of choreography, with implications for protocol adherence, reproducibility, and data quality. Recently, a pilot study assessing an older adult population’s upper-body performance was our first iteration of research utilizing a simulated environment: the U-M HomeLab, an ADA-accommodating, one-bedroom apartment built within the basement of a large research facility. Nine participants, aged 61 to 72, with self-reported upper-body weakness completed a series of tasks resembling activities of daily living, such as lifting laundry baskets and vacuuming. By backtracking through our development of this pilot study, we illustrate how considerations of interface play a significant role across every stage of study design, incorporating aspects of wayfinding, dialogue, safety, acclimation, and visibility that are relevant to an older adult population. From these reflections, considerations of interface inform a “check-list” for simulation choreography, providing guiding questions for assessing these types of interactions while iterating through study design.

The number of older adults with Alzheimer’s Dementia is projected to increase by 28.6% in Florida by 2025. Cost-effective non-pharmacological interventions targeting both persons with dementia (PWD) and their family caregivers (FCs) are urgently needed. This small pilot study tested the feasibility of a music and mindfulness intervention in an assisted living community (ALC) in Tampa, FL. Methods: We used a mixed-methods single group pre-post study design. To date, a total of 5 PWD and 3 FCs were enrolled, and all completed the 4-week intervention (12 sessions for PWD and 4 sessions for FCs). Outcome measures include behavioral symptoms and sleep quality for PWD, and mindfulness, sleep quality and perceived stress for FCs. Outcome data were collected via survey questionnaires and focus group interviews (FCs and staff). Results: Preliminary analysis showed that the intervention is well-received by PWD, FCs, and ALC staff. PWD participants experienced a reduction in behavioral symptoms post-intervention (Cohen’s d=0.33). FC participants reported increased mindfulness and reduced stress. In focus group interviews, both FCs and staff corroborated the positive findings in residents’ mood and behaviors. Barriers to large scale implementation include intervention time commitment (ALC staff) and scheduling difficulties due to work (FCs). Both FCs and ALC staff recommended the continuation of the intervention and making it available to all memory care residents. Based on the initial results, additional testing of the intervention is currently in progress (10 PWD) and updated results will be reported. Implications for conducting community-based non-pharmacological interventions will be discussed.

Biological ages predicted by biochemical markers (biomarkers) outperform other measures in predicting a variety of aging outcomes. Several have been developed in recent studies, and there is evidence that each may independently predict mortality. While the included biomarkers are disease-associated, it is unclear what aspects of aging are captured. We aimed to understand and quantify genetic predisposition to accelerated biological ages, determined based on two measures, PhenoAge (9 biomarkers plus chronological age, Levine et al. 2018) and BioAge (7 biomarkers plus chronological age, Levine 2013). We performed genome-wide scans using the UK Biobank data (n=107,460 for PhenoAge, n=98,446 for BioAge). The SNP-based (single nucleotide polymorphism) heritability estimates were 14.45% and 12.39% for PhenoAge and BioAge, respectively. Both shared the strongest signal in the APOE region, with opposite associations with e2 and e4 alleles. e2 was associated with younger BioAge but older PhenoAge. e4 was associated with older BioAge but younger PhenoAge. BioAge was highly genetically correlated with its element of systolic blood pressure (rg=0.84) and the genetic correlation between PhenoAge and red blood cell distribution width was 0.65. Previous genome-wide association study findings of the top hits suggest that BioAge mostly captures cardiac aging but PhenoAge has more to do with inflammatory aging. The results are consistent with SNP clusters by associations with a broad range of aging traits, including an independent cluster with SNPs near the APOE. Genetic risk scores will be created to quantify the genetic predisposition and will be tested for associations with numerous aging traits.

Patients treated for head and neck cancer may experience impaired eating and talking that may affect their ability to undergo social activities. We conducted a secondary data analysis to explore: 1) prevalence of perceived social isolation, and 2) association between perceived social isolation and health-related quality of life (HRQoL) in patients with head and neck cancer. Data were collected during a clinical usefulness study of the Electronic Patient Visit Assessment (ePVA), a valid, reliable web-based patient-reported symptom measure for head and neck cancer. The study population consisted of 56 patients recruited during or after treatment for head and neck cancer. Perceived social isolation data were collected using the ePVA. HRQoL data were collected using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, a valid measure frequently used in the head and neck cancer population. Data analysis consisted of descriptive statistics and Student’s T-Test. The study population consisted primarily of persons > 60 years (mean age = 61.5 + 12), male (68%), White (77%), and receiving surgery, chemotherapy, radiation therapy or combination of these treatments (70%). Among participants, 36% reported that their current health situation negatively affected their social activities. Reasons for perceived social isolation included fatigue, feeling ill. Statistical analysis found that perceived social isolation was significantly associated with deceased HRQoL (t=5.3, p

Using the Stereotype Content Model as a framework for understanding ageism, our two objectives are (1) examining the predictive utility of benevolent ageism on well-being outcomes and (2) identifying conditional relationships between sex, perceived age, benevolent ageism, and well-being outcomes. In a snowball sample of 150 older adults who were 65 years old and older, we examined sex, perceived age, ageism, environmental mastery, and depression. Our benevolent ageism scale is an expanded version of the Ambivalent Ageism Scale that included additional items of accommodation created by us. Environmental mastery and depression were assessed by standard, internally valid, measures. Using regression analyses, we found that benevolent ageism predicted depression above and beyond hostile ageism. Additionally, benevolent ageism uniquely predicted environmental mastery for men, whereas hostile ageism uniquely predicted environmental mastery and depression for women. Finally, perceived age was a better predictor of well-being than chronological age. It is essential to consider how benevolent ageism relates to well-being due to the tenets of the Stereotype Content Model. Additionally, delineating the ways that sex and perceived age contribute to double jeopardy vs. crisis competence in the face of benevolence will lead to a more intricate understanding of the paths in which overaccommodative behaviors relate to well-being in older adulthood.

Chronic inflammation is associated with frailty and functional decline in older adults but the molecular mechanisms of this linkage are not well understood. We sought to examine metabolic and physiologic states associated with aging and frailty by analyzing the composition of metabolites in the blood of a population of community dwelling young, and older adults. Serum inflammatory cytokines and demographic and physiological covariates were collected in a set of community-dwelling adults age 20-97 (n=166). We then used LC/MS technology to profile 121 metabolites from five substance classes. Associations of the cytokines and metabolites with grip strength, walking speed, falls and outcomes were assessed in young, robust, pre-frail and frail participants. Age and frailty status positively correlated with IL6, TNFα, TNFαR1, IL1β (p

Social networks can directly influence the health and well-being of older adults. Some work has suggested that network growth is associated with increased well-being. However, little is known about how the quality of relationships with confidants may be associated with better psychological well-being over and above the number of confidants. We aimed to test the hypothesis that feeling closer to confidants would be associated with lower anxiety and fewer depressive symptoms above and beyond the influence of the number of confidants as well as the number of children and grandchildren. To test this hypothesis, we collected data during face-to-face interviews with 131 community-dwelling adults who were between the ages of 58 and 94. Participants’ gender, age, marital status, self-rated health, and cognitive function were included as covariates in the models. In line with predictions, regression analyses showed that average closeness with confidants predicted significantly lower reports of anxiety (p < .05) and depressive symptoms (p < .001). Additionally, the number of confidants was not significantly associated with anxiety or depressive symptoms. Interestingly, having a greater number of children and grandchildren was associated with increased anxiety symptoms. These results extend previous work by suggesting that the quality of the relationship with confidants is more important for psychological well-being than the number of confidants. Future work should test these associations longitudinally so that directionality can be inferred.

Frailty is a state of heightened vulnerability due to the cumulative declines across multiple physiological systems. Growing attention is given to identifying social environmental factors associated with the risk of frailty. It is not yet known how different aspects of social relationships (structure and quality) are linked to frailty, and whether the strength and directions of links may differ by relationship types. Current study aims to 1) to identify sub-populations that follows distinctive trajectory of frailty and 2) to examine the multidimensional social relationship predictors of frailty trajectory. Data came from six waves of the Health and Retirement Study (2006-2016). Sample was older adults aged over 65 (n = 8,892; Mage = 74, SD = 6.96). Frailty index was created using 32 items each wave. Network size, frequency of contact, support, and strain with each relationship type (spouse, children, family, friends) was measured at baseline. Growth mixture model identified three distinctive subpopulations of older adults who share similar frailty trajectory, namely the average, high, and steep increase frailty group. Multinomial logistic regression results showed that frequent contact with friends were associated with lesser frailty. Perceived strain with the spouse, children, and family members all had additive influence on the membership to the higher or steep increase frailty group, compared to the average frailty group. Total network size or perceived support from ties were not significant factors for frailty progression. Interventions can target friendships and stress with kin members as modifiable factors to reduce the risk of frailty progression.

No national data exist on drug shortages, missing medications, opioid diversion, and opioid diversion prevention in hospice. We conducted a national survey of hospices (administered June-September, 2018). We randomly selected 600 hospices to survey representatives about: (1) care for patients/families with substance use disorder (SUD) (2) drug shortages; (3) instances of drug diversion; and, (4) drug disposal practices. Surveys were conducted by phone and online. Sample weights were used to adjust for non-response. A total of 371 hospices completed surveys (response rate=62%), 63% of which were administered by phone. Half (50%) of agencies were mid-sized (26-100 patients) and non-profit. Two thirds (66%) of hospices reporting that medications either “never” or “rarely” go missing. On average, there were 0.80 reported cases of confirmed diversion per agency within the past 90 days. Although a majority of hospices (78%) screen patients for SUD, only 43% screen informal caregivers. Just under half (42%) of hospices reported drug shortages over the past year. A minority (8%) of hospices stopped prescribing certain medications altogether due to concerns about diversion. 52% of hospices reported that employees are not allowed to dispose of medications after a home death. Agency representatives estimated that, after a home death, unused opioids were left in the home 32% of the time. On average, hospices have nearly one case of opioid diversion per quarter. Hospices are experiencing medication shortages and restrictions on medication disposal. Changes are needed in policy and practice to address these challenges.

BACKGROUND: Sarcopenia contributes to frailty, disability, and dependence in older adults, and is accelerated by Type 2 Diabetes Mellitus (T2DM). In addition to its direct role in increasing muscle mass, progressive resistance exercise training (PRET) may also reduce sarcopenia by improving endothelial function and muscle perfusion. METHODS: Fifteen older adults with uncomplicated and well-controlled T2DM participated in a PRET program 3 times weekly for 3 months. Prior to and immediately following the intervention, flow-mediated dilation testing was performed to assess large vessel endothelial function via ultrasound and muscle perfusion via near-infrared spectroscopy (NIRS). RESULTS: Preliminary ultrasound data from 9 subjects show a significant increase (5.21% to 8.73%, p=0.0448) in percent flow mediated dilation (%FMD), suggesting a modest improvement in endothelial function after 3 months’ PRET. Preliminary NIRS data from 7 subjects showed no significant changes in oxygen saturation or reperfusion rates as a result of the intervention. CONCLUSION: Our preliminary data indicate that, in older adults with T2DM, 3 months’ PRET is associated with modestly improved endothelial function in large vessels (as demonstrated by a significant increase in %FMD), but does not appear to be associated with improvements in muscle perfusion

Montessori-based Activity Programming (MAP) was adapted for Veterans Affairs (VA) Community Living Centers (CLCs) and aims to increase independence and meaningful engagement in residents with cognitive impairment. The Montessori model prioritizes offering choice, knowing and harnessing a resident’s abilities, and enabling them to carry out purposeful roles and activities. Any perceived deficit in cognitive functioning is “circumvented” by preparing the environment to support maximum independence. The implementation of MAP-VA in VA Western NY CLC involved 3 lodges, 52 staff, 16 champions, and 65 CLC residents. Standardized implementation measures demonstrated improvements over six months in five domains assessing development of a resident-directed community. Hypothesized outcomes included improved national percentile quality improvement (QI) rankings related to psychological symptoms and medications (e.g., depressive symptoms and use of antipsychotic/antianxiety medications) and physical functioning (e.g., less falls and ability to move independently). Scores six months prior to the implementation of MAP-VA (April, 2018 to September, 2018) were compared with scores during six months of implementation post training (November, 2018 to March, 2019). Compared to pre-intervention QI measures related to psychological symptoms, a clinically meaningful trajectory of symptom decrease was observed with rankings during implementation (e.g., depressive symptoms, amount of antipsychotic medications). Likewise, compared to pre-intervention QI rankings regarding physical functioning, post-training rankings showed a trajectory of improvement (e.g., help with ADLs, ability to move independently). Implementation of the MAP-VA intervention demonstrates preliminary evidence for improvement in QI measures related to psychological symptoms and physical functioning. Implications for QI efforts in VA CLCs will be presented.

Benevolent ageism has recently been recognized as a form of patronizing treatment that older adults experience because of the kind and incompetent age stereotype proposed by the Stereotype Content Model. However, there is limited research that examines older adults’ experiences with patronizing treatment. The aim of this study was to conceptualize benevolent ageism based on older adults’ experiences with items from an existing measure of ageism, the Ambivalent Ageism Scale, and additional items created by us that expand the measurement of benevolent ageist behaviors. In an internet-based sample of older adults who were 65 years old and older (N =135), the benevolent subscale of the Ambivalent Ageism Scale with our additional 10 items demonstrated excellent reliability (α = .90). An exploratory factor analysis cleanly yielded a 4-factor solution that mirrored previous findings, (1) hostile ageism, (2) unwanted help, (3) cognitive assistance/protection, while introducing a new factor of (4) condescending endearment. The findings from this study have widened the scope with which ageism is viewed by examining older adults’ experiences with ageism and conceptualizing characteristics of benevolence that older adults may face due to the widespread belief that they are kind and incompetent. The validation of a scale measuring individuals’ experiences with ageism will provide insight as to whether older adults experience ageist behaviors that people report endorsing and if older adults receive unnecessary offers of help. A recipient’s perspective of ageism will aid in the understanding of the insidious and benevolent characteristics of ageism within society.

Early in PD, women may experience a more benign disease course than man. Limited research has examined differences between men and women with moderate, treated PD with a mean duration >5 y. Retrospective analyses were performed on data collected from studies, conducted 2011–2019, that assessed motor, cognitive and psychosocial function in 199 people with PD (women=72). We compared performance using univariate analyses, adjusting for age, housing type and education. Men and women patients were not different in PD stage (Stage Mdn= 2, IQR=.5), age (mean±SD; 69.1± 8.9 y), education (16.4 ± 2.3 y), number of medications (5.9±4.1), comorbidities (3.4±1.8), physical function, nor time with PD (6.6±4.6 y). Women were more likely to live in assisted living or senior residences (p=.005). Men gave more correct answers in subtraction, (8.8 ± 4.0 vs. 6.4±3.7; p

In order to develop genuine anti-aging interventions it is important to find the best estimate of the aging rate in humans, which is often measured as a slope parameter of the Gompertz law. The compensation effect of mortality (CEM), refers to mortality convergence, when higher values for the slope parameter are compensated by lower values of the intercept parameter (initial mortality) in different populations of a given species. The age of this convergence point is called the "species-specific life span". Due to CEM, factors associated with life span extension are usually accompanied by paradoxical increase in actuarial aging rate. We evaluated the stability of CEM by analyzing the United Nations abridged life tables for 241 countries and regions and estimating parameters of the Gompertz-Makeham model using method of non-linear regression in the age interval 30-80 years. We found that the species-specific lifespan is equal to 94.5 ± 0.5 years, which is the same as reported in the past for years before the 1960s: 95 ± 3 years (Gavrilov, Gavrilova, 1991). Thus, the convergence point of CEM is stable despite significant mortality decline over past 50 years and is not affected by factors decreasing mortality at younger ages. Populations deviating from CEM with apparently slow aging (with both slow actuarial aging rate and low intercept parameter) have been identified. The existence of CEM in mice (ITP data) allowed us to find interventions that are able to both extend lifespan and slow the actuarial aging rate giving promise for radical life extension.

This poster provides an overview of the aims, methods, and emergent findings from an ongoing five-year NIA-funded project (R01AG062310) examining meaningful engagement and quality of life among assisted living (AL) residents with dementia. The overall goal of this project is to determine how opportunities for meaningful engagement can best be recognized, created, and maintained for individuals with different dementia types and varying levels of functional ability. Guided by grounded theory, this qualitative study will involve 12 diverse AL communities in and around Atlanta, Georgia, USA. Presently, our interdisciplinary team is collecting data in four communities using ethnographic observations, semi-structured interviews, and resident record review. We are studying daily life in each community, following 30 resident participants, and actively recruiting and interviewing their formal and informal care partners. Based on ongoing analysis, we offer key emergent findings. First, meaningful engagement is highly individualized and dynamic. Differing personal interests, along with wide variations in cognitive and physical abilities, can present challenges for AL community staff and other care partners when trying to recognize what constitutes meaningful engagement for residents. Second, multiple complex factors interplay to shape the experience of meaningful engagement among persons living with dementia, such as personal characteristics, care partner background and training, AL community design and philosophy, and state/corporate regulations. Finally, flexibility and ‘meeting the resident where they are at’ appear to be critical to identifying and fostering meaningful engagement for persons living with dementia. We discuss the implications of these preliminary findings for translation, dissemination, and future research.

Understanding lifecourse determinants of older-age health outcomes is indispensable for resources planning and optimizing public health in light of continued gains in longevity in the US and worldwide. Data increasingly points to midlife health and modifiable risk factors as critical targets for improving older-age health outcomes and mitigating potential cognitive impairment and disease. We used 16-years of biennial data (1998-2014) from the Health and Retirement Study (unweighted-n=6,724), to examine how a comprehensive battery of midlife (age 50-64 years) health measures (disability, physical function, comorbid conditions, and self-reported health) affect cognitive status (using Langa-Weir criteria: Normal, Cognitively Impaired Not Dementia (CIND), and Dementia) and death 16-years later. Additionally, we test for racial/ethnic and gender modifications in the effects of these conditions on the outcomes of interest. We used survey multinomial logistic regression models adjusting for predisposing sociodemographic factors, health-enabling economic characteristics and health behaviors. Relative risk ratios (RRR) across all unadjusted models varied from 1.36-4.84 and 1.36-3.31 for those with dementia and who died in 2014 respectively, suggesting worse health outcomes in midlife are associated with higher dementia/mortality risk in later-life. After covariates-adjustment, comorbidities (RRR=1.15[1.04,1.27]) and Self-reported Health (RRR=1.36[1.22,1.52]) were associated with CIND, and attenuation was particularly pronounced for IADLS (RRR=3.15[2.25,4.43]) and Fine Motor Skills (RRR=1.94[1.46,2.57]) for individuals with dementia in 2014. Neither sex nor race/ethnicity modified these associations. Modifying the midlife health profile of US adults can yield important public health savings and reductions in structural and social health burdens through extenuating the prevalence of dementias and reducing excess mortality.

Despite the well-documented clinical and public health impacts of palliative care on older patients’ end of life experiences, racial and ethnic disparities in palliative care use still remain. However, empirical evidence on the sources of disparities is lacking, particularly for Asian Americans. Given the rapid growth and increasing cultural diversity of the older Asian population in the United States, a systematic review was conducted to provide a comprehensive overview of the best available evidence on the barriers to palliative care use among Asian Americans. Search was conducted using six electronic databases (PubMed, CINAHL, PsycINFO, EMBASE, Cochrane Library, and Google Scholar), and all procedures of the study have been guided by Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P). A total of 23 studies published in the U.S. since 1998 were included. Individual level barriers to palliative care service use among Asian Americans identified by the study included lack of palliative care knowledge, lack of insurance, cultural beliefs, language barrier, attitude toward death, family centered decision-making. Provider level barriers included lack of training and experience about palliative care, patient-provider discordance in language and culture, and absence of policy or guidance for providers. Although racial disparities in palliative care for Asian Americans were evident, Asian Americans were underrepresented in palliative research. Future research effort should be directed toward the development of culturally sensitive palliative care services and policies that reduce racial and ethnic specific barriers.

Osteoporosis is among the most debilitating disorders for aging men and women. Mechanisms underlying loss of bone mass and impaired fracture healing in aged population are not completely understood. Our lab and others reported increased levels of the oxidized tryptophan metabolite, kynurenine (Kyn), in bone marrow mesenchymal stem cells (BMSCs) and interstitial fluid. Here, we report that Kyn significantly inhibits osteogenic differentiation of BMSCs likely via activating aryl hydrocarbon receptor (AhR). KYN significantly downregulated mRNA levels of pro-osteogenic CXCL12 axis, including CXCL12, and its two main receptors CXCR4 and ACKR3. Secreted protein levels of CXCL12 were significantly reduced with KYN, and were rescued upon the use of AhR antagonist 3’,4’-dimethoxyflavone (DMF). Moreover, KYN upregulated levels of pro-aging and CXCL12-targeting miRNAs miR-29b-1-5p and miR-141-3p. Additionally, KYN significantly inhibited mRNA and protein levels of the epigenetic enzyme Hdac3 which is responsible for activating osteogenesis and inhibiting adipogenesis in BMSCs. Using mutagenesis and luciferase assays, we show evidence that miR-141-3p and miR-29b-1-5p directly target CXCL12 3’-UTR. We also show that miR-29b-1-5p directly targets Hdac3 explaining the significantly increased acetylation levels of H4 with KYN treatment. Finally, we show that mRNA levels of both KYN receptor AhR, and KYN-producing enzyme IDO-1 are regulated by CXCL12. We believe this data explains a novel mechanism of the bone aging phenotype and provides multiple potential clinical intervention targets for controlling osteoporosis.

Prior epidemiologic studies have established that high rates of comorbidity of diabetes and depression is common. The aim of this study is to examine prevalence and correlates of mental health conditions among older African Americans with chronic health conditions The sample (n=1,399) from the first round of the NHATS includes older African Americans living in their community: 60% women, 35% married, 39% less than HS, 57% from the South. A two-way MANCOVA was conducted to determine the effect of diabetes and high blood pressures on four DV (no interest, depressed, anxious, worry) while controlling for age. Data indicated that 37% are with diabetes and 80% with high blood pressure and showed that 10% no interest, 4.4% depressed, 3.6% anxious, and 6.4% constantly worry for nearly every day. The main effects of high blood pressure [Wilk’s Λ = .983, F= 2.322, p =.010, η 2 = .015)] and diabetes [Wilk’s Λ = .975, F= 3.526, p =.010, η² = .024] indicate significant effect on combined mental health DV. The covariate significantly influenced the combined MH DV [Wilks’ =.983, F = 3.697, p = .003]. Univariate ANOVA results showed that only anxiety and worry were significantly affected by diabetes and high blood pressure except “depressed” and “no interest” These results partially support that older African Americans with chronic illness are at high risk for general mental health. However, anxiety and worry were more prevalent than just ‘be depressed’. Greater attention should be paid to specific mental expressions of minority older patients.

Volunteering provides sense of meaning in life. The impact of volunteering on different dimensions of meaning in life and the mechanisms explaining the effects have been rarely researched. This study examined the effects and the mechanism of a formal volunteering program for mental health in older persons, including training, service provision, and supervision, on two dimensions of meaning in life — presence of meaning and searching for meaning — among senior volunteers. A mixed method study was conducted. 103 volunteers (average age=63.3±6.6) completed assessments at three time points: before and after the training, and one-year after service provision. They self-assessed Meaning in Life Questionnaire (MLQ) and reported time use in different tasks. 26 of them participated in focus groups discussing their experience in the program. Volunteers’ search for meaning differed between time points (F(1.87,173.81)=3.20, p

The media has become increasingly more agenda-driven and politically biased in recent years. This research explores whether the major news outlets fosters an environment of negative sentiment towards the older adult population over a 4-year-period from 2016-2019. The paper uses a content analysis approach. 199 news articles that include keywords such as "older adults", "seniors" or "elderly" are randomly selected among those published in the first week of March in 2016, 2017, 2018 and 2019 from the online archives. Main attitudes towards the older adults are extracted and categorized. In the 4-year span, regression analysis shows that negative attitudes are apolitical and are found in almost two-thirds (64%) of the 199 news articles in both liberal and conservative news outlets, suggesting that the current media creates a ubiquitously hostile environment for older adults. However, more liberal news outlets tend to produce more articles with positive messages about the older adults (p

Increased life expectancy and the diversity of family structure have resulted in a substantial rise in the number of families with grandparents as the main caregivers (e.g. custodial grandparents). The structures of these families affect the well-being of all family members. After middle age, psychological well-being is associated with marital relationship quality, and raising one’s grandchildren is a known source of strain to relationships. The current study examined adults aged 40 and older (M age = 57.6 yr, 53% female) using a nationwide sample from MIDUS to assess the extent to which custodial grandparenting status influences marital affectual solidarity, depressive symptoms, life satisfaction, and perceived stress. Measures included the Center for Epidemiological Studies Depression Index, Spousal Affectual Solidarity, Satisfaction with Life Scale, and Perceived Stress Scale. Marital affectual solidarity was significantly related to custodial status and psychological well-being, and there were significant differences in marital relationship quality and psychological well-being between custodial grandparents and non-custodial grandparents. However, custodial status failed to moderate the relation between marital affectual solidarity and mental health. Although other factors surrounding custodial grandparents likely affect their marital relationship and mental health, these results suggest that grandparents raising grandchildren are under particular strain in their marriages and are in need of targeted interventions to ameliorate stress and depressive symptoms. These findings will inform the need for more research and supportive educational programs on family relationships and the psychological health of custodial grandparents.

Since their discovery in 1970, flavin-containing monooxygenases (FMOs) have been studied as Phase 1 xenobiotic metabolizing enzymes that act on sulfur- and nitrogen-containing small molecules. In 2015, we demonstrated that C. elegans (worm) fmo-2 was not only necessary for hypoxic response and dietary restriction-mediated lifespan extension, but was also sufficient to extend lifespan when overexpressed. Consistenet with a conserved role for FMOs as longevity-promoting enzymes, mouse hepatic Fmo3 transcript is highly upregulated by numerous major lifespan extending interventions. A contrasting series of reports, however, have described mammalian Fmo3-mediated production of trimethylamine N-oxide (TMAO) as a risk factor for atherosclerosis and other major diseases. My thesis research aims to define the regulation and function of worm fmo-2 using genetic and biochemical approaches. My data thus far support the hypothesis that fmo-2 acts on sulfur amino acid pathway intermediates to promote longevity and healthspan.

More than one million older adults reside in assisted living (AL) communities in America. This figure is projected to double by the year 2030. It is typical for residents in these communities to have cognitive and physical impairments requiring differing levels of care. Due in part to these impairments, it is vital to the health and well-being of residents to participate in meaningful recreational activities. This secondary analysis of ethnographic observations totaling 818 hours and semi-structured interviews with 25 residents enrolled in an NIA-funded study (5R01AG047408) explores in depth barriers and facilitators to activity engagement in a large (90+ bed) moderate-income, all-African-American AL community located in a large urban city in the southern US. Residents range in age from 59 to 103 (mean = 85) and are predominantly female. We linked our findings from thematic analysis to six domains of quality palliative care identified by the 2018 National Consensus Project (NCP) Guidelines for Quality Palliative Care: cultural, physical, psychological, social, structures and processes, and spiritual aspects of care. Key barriers include limitations related to staffing (a low staff-to-resident ratio and high staff turnover) and activities that do not adequately address needs of residents with varying interests and abilities. A robust daily devotion and other activities that incorporate culturally relevant music are activities highly valued by most residents. Implications of these findings contribute to a larger effort to create positive change in the structures and processes of care in AL and can inform best practices for palliative care within these communities.

In spite of expert recommendations that written material should be provided at a level of health literacy that matches that of the person receiving it, there have been few studies of matching. In this study we evaluated the utility of a new strategy to assess patients’ preference for information at different difficulties and assessed the relation of their preference to measured health literacy and health locus of control (LOC). We measured health literacy in participants then asked them to choose between pairs of texts with the same content but at the 3rd, 6th, or 8th-grade levels. Statistical analyses assessed the relation of participants’ health literacy to their preference as well as personal characteristics. Participants (n = 155) were 84 women and 71 men aged from 40 to 82 years (mean=57; 136 African Americans and 19 whites). Participants had clear preferences: those with lower levels of health literacy preferred texts at the 3rd grade level and those with higher levels preferred more difficult texts. Preference was not related to age, gender or race but was to education and health literacy (p < 0.05). Persons who chose more difficult texts reported higher levels of internal health locus of control (t [144] = 2.68, p = 0.01). A predictive analytic model using education and preference resulted in 80% correct classification of participants. Using this model may be a simple way to match information presentation to patients’ level of health literacy. Further research on this strategy is needed.

This study aims to examine the relationship between religiosity and depressive symptoms in a large cohort of community-dwelling U.S. Chinese older adults living in the Greater Chicago area, which has received relatively little research attention. Cross-sectional self-report data was obtained from the Population Study of Chinese Elderly in Chicago between 2011 and 2013 (N=3,157). Depressive symptoms were measured by the nine-item Patient Health Questionnaire (PHQ-9). A score of 5 and above indicated the presence of clinically significant depressive symptoms. Logistic regression analyses were conducted to examine the association between religiosity and depressive symptoms. Out of 3,157 participants, 20.3% participants had a score of or above 5 on PHQ-9. 35.4% reported religiosity as being “important” (24.7%) and “very important” (10.7%); 16% reported attending organized religious services at least once a month (3.1% reported once a month; 12.3% reported once a week; 0.6% reported almost every day); 23% reported having religious services at home at least once a month (10.3% reported once a month; 3.2% reported once a week; 9.5% reported almost daily). Results showed that recognizing religiosity as important is significantly negatively associated with depressive symptoms (odds ratio [OR]=0.94, 95% confidence interval [CI]=0.89-0.99). However, no significant associations between depressive symptoms and religious activity attendance or religious service at home were observed. Findings suggest that senses of belonging and life meaning may help reduce depressive symptoms, rather than the religious activities per se. Future interventions could reduce depressive symptoms of U.S. Chinese older adults through religiosity.

Adult foster homes (AFHs) are small, residential settings providing older adults and persons with disabilities an alternative to nursing facilities and larger residential care settings. Some groups, including individuals with Alzheimer’s disease and related dementias, are well served by smaller settings. Although AFHs are common throughout the US, research on this setting is scant and dated. This study summarizes four years of qualitative data from Oregon AFH owners’ (N=726) responses to open-ended questions about the challenges and rewards of owning and operating an AFH. Content analysis of 924 comments indicate that providing resident care (42%), finding the work meaningful and “a life calling” (21%), developing a family-like connection with residents (15%), and working at home (8%) were the most commonly reported rewards. The most frequently described challenges included caring for residents with multiple chronic health conditions—including those with difficult behaviors (17%), difficulty hiring and retaining qualified caregivers (15%), low Medicaid reimbursement rates (14%), and adhering to administrative rules (14%). Results highlight AFH providers’ personal satisfaction with caring for and establishing connections with residents, and challenges associated with residents’ increasingly complex care needs, Medicaid reimbursement rates, and attitudes about state regulations. Although AFHs are licensed by states, they are subject to federal regulations, including the 2014 Centers for Medicare & Medicaid Services home and community-based services ruling. The new regulations, Oregon administrative rules, Medicaid reimbursement rates, and caregiver supply are presented to contextualize AFH owner comments and regulatory considerations.

Aging is a multifaceted process that challenges organisms with stresses resulting from the dysregulation of cellular processes. Unsurprisingly, given how tightly regulated it is under normal conditions, transcription is one of the key pathways disrupted during aging. Indeed, dysregulation of transcription contributes to the activation of transposable elements, the loss of cellular identity, and decreased stem cell potency with age. Our previous work identified intragenic cryptic transcription (CT) as a novel type of age-associated transcriptional dysregulation that limits the lifespan of yeast and worms. Continuing this work, we show for the first time that CT increases with age in mammalian stem cells. Increased CT is associated with disrupted chromatin structure, particularly with the reduction of H3K36me3, a histone modification known to inhibit CT throughout eukaryotes. We propose that an age-associated reduction in H3K36me3 in actively transcribed gene bodies drives disruption of chromatin structure in these regions, resulting in an open chromatin state. This open chromatin state is permissive for the entry of RNA Pol II, which can then initiate transcription from within the gene body. These aberrant cryptic transcripts may contribute to the pathological load of mammalian aging.

Introduction: By incorporating age-friendly technology into the care of older adults with high utilization, providers can address complex care needs more efficiently and urgently. Age-friendly technology has the potential to alleviate loneliness that occur with homebound older adults and affect healthcare outcomes. Specific Aims: 1) To evaluate the feasibility of integrating age-friendly telemedicine in a homebased primary care setting using. 2) To evaluate the effects of engaging older adults with age-friendly technology to address loneliness. Methods: UCSF Geriatric Medicine provided GrandPads to 21 patients ages 60 to 94 over a one year period. All research participants were community residing, predominantly low income, and homebound. There was no charge to the patients for the GrandPad. Providers who used the GrandPad with their patients were queried on their experiences. Patient questionnaires included a telemedicine readiness survey, satisfaction and UCLA 3-item loneliness scale. GrandPad tablets are commercially available and underwent an evaluation with the IT Security Risk Assessments team. Results: 100% of providers who used grandpad felt was easy to use and efficient. 83% felt the platform was easier than other platforms. 83% of patients felt the grandpad helped them connect to their providers and 82.5% felt the grandpad was easy to use and 78% felt more connected as a result of using grandpad. Conclusion: Patients and providers are satisfied with an older adults friendly tablet and it can easily be implemented in health care settings. Grandpads may also help older adults feel more connected.

The corpus callosum (CC) connects homologous cortical structures across hemispheres and is the largest white matter tract in the human brain. Post-mortem studies suggest that CC myelination begins in infancy, reaches a plateau in the middle age, and declines in the later years. The latter is accompanied by myelin disruption and reduction in fiber density and diameter, i.e. changes in intra-/extracellular water space. We used multi-echo T2 imaging to estimate, via multi-exponential T2 relaxation of water, the myelin water fraction (MWF), a direct proxy for myelin content, and geometric mean T2 (geomT2IEW) that reflects water in the intra-/extracellular space, to investigate age differences in five CC regions covering its anterior to posterior span in 395 healthy individuals (7-85 years; 161M+235F). The general linear model analysis of MWF showed main effects of age and age-squared conditioned on interactions by CC region. Univariate polynomial regressions on three age groups (7-29, 30-59, and 60-85 years) revealed the overall quadratic association between age and MWF as mainly driven by the positive linear relationship in the youngest group and minimal differences in the remainder of the lifespan, save for two weak negative linear associations in the anterior/middle CC body. With geomT2, a main linear effect of age, and significant interactions between age and age-squared by region were observed. The positive linear association was especially prominent in the regions with greater fiber density. The results are consistent with CC myelination into adulthood and decreased axonal density and diameter but not prominent myelin degeneration in elderly individuals.

In health care and senior housing and care, the challenge of meeting diverse regional workforce needs is increasingly important in higher education. Educators within gerontology are rising to this challenge using multiple platforms, including online education (Carter, Solberg, & Solberg, 2017; Nadash, Miller, Porell, Birchander, Glickman, & Burr, 2014). This poster presents the life cycle of a traditional face to face introductory level graduate gerontology course which was transitioned to a fully online course. This transition was achieved using a structured course development process based on nationally recognized online course quality standards by Quality Matters (QM). Utilizing a team approach, the process incorporated faculty (subject matter experts and course developers), instructional designers, and professional staff in distance education, faculty teaching support, and online learning specialists. QM standards serve to assure quality online instruction, with the goal of providing students with a positive and successful online learning experience. Analysis of this case highlights the role of Certified (QM) peer reviewers who have expertise in Gerontology and can serve as the connector of online gerontology courses offered within programs, between institutions, and globally. Recommendations are presented to improve the pedagogical quality of online courses to attract and retain students in gerontology and aging studies courses. The case for building an initial network of online course peer reviewers to strengthen online teaching and learning within the gerontology profession will be made.

The prevalence of diabetes among older adults has increased substantially and health complications resulting from diabetes have significant adverse effects on health status of older adults. While diabetes cannot be cured, it can be managed successfully with healthy lifestyle choices. The purpose of this study is to examine the disparities in health status, health behaviors, and preventive health services for older adults with diabetes. This study used data from the 2018 Behavioral Risk Factor Surveillance System. The sample included older adults 50 and over. Health behaviors included exercise, smoking, and heavy alcohol drinking. Preventive health services included dental visit, flu shot, and colorectal cancer screening. Chi-Square analysis and weighted multivariate logistic regression was performed. Not surprisingly, older adults with diabetes were significantly more likely to be in poor health than those without diabetes. Compared to non-diabetic group, older adults with diabetes were more likely to have had no exercise in the previous month. Interestingly, more older adults with diabetes reported having visited dentist, had flu shot and colonoscopy than those without diabetes. In both groups, older adults who presented health behaviors and received preventive health services were more likely to report good health compared to those who did not. The results suggest that further efforts are needed to address the health disparities for older adults with diabetes. Given the risk of comorbidities and its complications for older adults with diabetes, further research should be directed toward designing better health promotion programs and policies for older adults with diabetes.

Blood pressure and perfusion of the brain are central components of neurological health that are often influenced by heart failure. This retrospective case-control study analyzed blood pressure changes preceding the diagnosis of dementia in patients over the age of 60. Blood pressures were obtained from the date of dementia diagnosis, and then one year and five years before diagnosis. Study “controls” were age-matched patients without dementia, using the mean age of dementia diagnosis as the first data point. Over the five-year period preceding diagnosis, 67.2% with dementia showed decreasing systolic pressure compared to 46.6% of patients without dementia. Similarly, 62.7% with dementia showed a decreasing systolic pressure over the one-year period, compared to 50.0% of those without dementia. Additionally, there was a significant difference (p < 0.001) in the dementia rates between African American and Caucasian subgroups (55.0% African Americans vs. 31.0% Caucasians). Patients with dementia were more likely to have decreasing blood pressure trends than age-matched patients without dementia and appeared to have significantly lower blood pressures one year before the diagnosis. It is crucial that providers are cognizant of these trends and risk factors for dementia as they manage blood pressures in geriatric patients.

The characteristics of where older adults live have strong links with disability. Although lower income older adults experience disability at higher rates, less is known about the link between housing characteristics and functional health in this group. A within group comparison among this population is needed to understand how aspects of this vulnerable subgroup’s housing context are associated with health outcomes. The present study examines the association between housing and functional health among a U.S. nationally representative sample of independent living (i.e., not living in nursing homes or assisted living facilities) lower income adults age 65+. Using data from round one of the National Health and Aging Trends Study, a sub-sample of N=2,865 lower income (

Alzheimer’s disease and related dementias (ADRD) are challenging chronic health conditions that disproportionately impact African Americans. Caring for a family member with ADRD can be a taxing experience that impacts the mental, social, and physical realms of the caregiver’s life. Chronic fatigue and high levels of anxiety, depression, and agitation have all been associated with caregiving. The extant literature on caregivers is limited by being conducted primarily in settings with White participants, excluding the cultural attitudes and values that may impact caregiver experience. As part of a larger, mixed-methods team studying the impact of an innovative psychoeducational intervention, the researchers conducted a qualitative interpretive meta-synthesis (QIMS) to better understand the experiences and perceptions of African Americans who care for family members with ADRD. A QIMS was chosen as the methodology for this study because of its ability to create a more holistic understanding of the phenomenon, while maintaining the integrity of the original studies. An exhaustive literature search yielded 1,285 potentially relevant studies. Studies were compared across a priori inclusion criteria. Findings of this study indicate that overall knowledge of ADRD is relatively low among caregivers and participants are unsure of how to access educational materials. Synthesis of these studies also indicate a need for incorporating spiritual well-being into caregiving services. Results of this study may help social workers and other health care professionals to better understand cultural perceptions of the disease and how to better provide psychoeducational interventions related to the specific needs of African American caregivers.

Approximately 12-18% of family caregivers to older adults in the U.S. are 18-25 years old (i.e., emerging adulthood), yet minimal research has focused on this subgroup of caregivers (Levine, 2005; Smyth, Blaxland, & Cass, 2011). Individuals’ perceptions of an older adult’s social role relate to their attitudes toward older adults as a group (Hummert, 1999; Kite & Wagner, 2002). However, whether perceptions that emerging adult caregivers hold of older adults are specific to the social role of “care-recipient” has not been studied. A sample of 210 informal caregivers (ages 18-25) were surveyed to collect qualitative responses regarding perceptions of an older adult care-recipient (age 65+) and to assess quality of contact with the care-recipient and ageist attitudes. Participants were asked to provide five adjectives describing their older adult care-recipient. Approximately 43% provided a set of adjectives in which 80%-100% were coded as positive adjectives (e.g., “active”, “wise”); similarly, half of the sample’s adjective sets contained 0%-25% negative adjectives (e.g., “helpless”, “obnoxious”). The quality of contact with the care-recipient was significantly correlated (p

The purpose of this investigation was to examine associations between health personality and health activation as predictors of general health. Participants from the study included 3907 individuals 65 years of age and older from AARP® Medicare Supplement Plans insured by UnitedHealthcare Insurance Company. The participants completed a survey including the Health Personality Assessment, the Consumer Health Activation Index, and a single-item assessment of self-rated health. Structural equation modeling determined how health personality predicted health activation, and health activation in turn predicted general health. The hypothesized model fit without direct paths from health personality to general health was not optimal. In a second step, we added direct paths from health openness, health neuroticism, and health conscientiousness to general health. The final model fit was then excellent, x2 (df=2) = 18.26, p < .01, RMSEA = .05, CFI = .99. Health neuroticism and health openness were negatively related to health activation, which indicated participants with high health neuroticism and health openness scores were less health activated. Conversely, higher health agreeableness and conscientiousness were associated with more activation. Pathways from health personality via health activation to general health were tested for mediation. Health activation significantly mediated relationships between health neuroticism, health openness, health agreeableness and health conscientiousness to general health. These findings support health activation accounting for some of the associations between health personality and general health. Health neuroticism, health openness, health agreeableness, and health conscientiousness were more closely connected to health activation than health extraversion.

Transitioning across medical settings (e.g. from hospital to post-acute (PA) or PA to homecare (HC)) is a difficult time with numerous challenges, as critical information passes across sites, new systems are quickly established, and caretakers change. Older cardiac heart failure (CHF) patients, often with comorbidities and having fewer social supports, are especially vulnerable to rehospitalizations at that time. This study examines the impact of a Social Work Transitions (SWT) intervention, designed to ease older cardiac patients’ transition from a PA to HC setting, on rehospitalization rates. The SWT model for CHF patients was developed in a large healthcare system with a continuum of services for older adults including PA and HC. Once a patient enters PA from the hospital a transitions social worker (SW) remains the patient’s primary support and contact through PA discharge and the transition to HC. In HC, that same SW ensures needed services occur, conducts home visits, and provides additional follow-up via phone calls. Study 1: compared HC rehospitalization rates of CHF patients receiving SWT (N=28) with those not receiving SWT (N=26). This natural control group arose during the initial program months, as SW turnover occurred and some CHF patients were not accompanied by a transitions SW. SWT patients had half the rehospitalizations (25%) as controls (54%). Study 2 tracked 30 day rehospitalizations rates for the first 17 study months (N=257). Program rehospitalization rates (16.7%) were below the CMS benchmark (21%). These findings support using the SWT program to prevent unnecessary rehospitalizations in CHF patient.

Exceptional aging has heritable components. One genetic risk factor for cognitive aging may be Apolipoprotein E (APOE), but it is unclear to what extent APOE relates to cognitive aging versus risk of Alzheimer’s disease. Cognitive aging may also be influenced by leukocyte telomere length (LTL), posited to be a marker of “biological age”. We examine the relationship between APOE, LTL, and memory in aging. For APOE, effects of ε4 (ε3ε4/ε4ε4) and ε2 (ε2ε3/ε2ε2) versus the more common ε3ε3 referent genotype on episodic (EM) and working memory (WM) were examined, comparing longevous families to the general population. Participants belonged to a multi-generational, international cohort (Long Life Family Study) including relatives from long-lived families and spouse-controls. 3,654 participants with valid memory, APOE, and telomere data at baseline were included. Regression analyses were stratified by age group and relative status, adjusting for sex, education, and country. Among controls, ε2 was associated with better WM (p

Objectives: Research has consistently reported the importance of adult children’s filial piety in maintaining relationship quality with their older-adult parents, especially in Asian countries due in large part to the influence of Confucianism. However, less attention has been paid to its effects in their later relationship—oldest-old parents and older-adult children, and very few studies employed a dyadic approach. Methods: In the current study, we examined the effects of actor- and partner effects of the attitudes toward filial piety on intergenerational relationship quality. Data from 105 dyads of very old parents, 81 to 97 years old (M = 87.9, SD = 2.8) and their older-adult children, 65 to 72 years old (M = 65.9, SD = 1.2) were utilized for the analyses. Results: Results showed that children’s attitudes toward filial piety were positively related to the relationship quality reported by both old children (i.e., actor-effects, β = .64, p < .001) and oldest-old parents (i.e., partner-effects, β = .63, p = .001). The effect of actor’s and partner’s attitudes toward filial piety on relationship quality was not significant. Discussion: Findings suggest that children’s attitudes toward filial piety, as compared to parents, may play a more important role in the quality of relationships between oldest-old parents and their older-adult children in South Korea.

This study examined the efficacy of a series of 28 behaviors (e.g., comfort eating, attending worship services, getting a massage, etc.) in moderating the perception of stress among older adults. First, 28 individual behaviors were assessed to determine whether they buffered or exacerbated the impact of an objective stress measure (i.e., the count of stressful life events) on perceptions of stress (measured using Cohen’s Perceived Stress Scale [PSS]). A full sample analysis used data from 1,000 randomly selected U.S. adults age 40 and older, but subsequent analyses explored coping behaviors for two age groups—those age 40 to 59 and those 60 and older. In the full sample analysis, multiple moderating conditions were noted including stress-buffering for worship service attendance, recreational shopping, and getting a massage. Also among the full 40+ sample, stress-exacerbation was noted for social media use and coping by “overreacting to things.” Factor analysis (employing a polychoric correlation matrix) reduced the 28 individual behaviors into 9 clusters comprised of related behaviors and representing a general coping approach. Looking within the age groups, significant stress-buffering was limited to those age 60 and older for two coping approaches—a “Self-Care and Travel” approach and an Inspirational approach (e.g., praying, attending church, etc.). For both age subgroups there was no coping approach, not even the hedonistic “blowing off steam” approach, that was found to exacerbate the impact of stressful life events on the perception of stress.

This network schema is presented to aid in conceptualizing the many processes of aging, the causal chains of events, and the interactions among them, including feedback and vicious cycles. Contemplation of this network suggests promising intervention points for therapy development. This diagram is maintained on the Web as a reference for researchers and students. Content is updated as new information comes to light. www.LegendaryPharma.com/chartbg.html At first glance the network looks like a complicated web. However, as a conceptual summary, in one view, we can see how the many biogerontological processes relate to each other. Importantly, examination of these relationships allows us to pick out reasonably plausible causal chains of events. Within these chains, we can see age-related changes or accumulations that appear to be promising targets for future therapy development. Especially harmful is damage to the body's regeneration and repair systems, because they normally repair damage to other structures and systems. The many observable signs of human senescence have been hypothesized by various researchers to result from several primary causes. Inspection of the biochemical and physiological pathways associated with age-related changes and with the hypothesized causes reveals several parallel cascades of events that involve several important interactions and feedback loops. This network model includes both intracellular and extracellular processes. It ranges in scale from the molecular to the whole-body level. Effects due to externalities, lifestyle, environment, and proposed interventions are highlighted around the margins of the network.

Heart failure and dementia are common age-related conditions. Heart failure and associated comorbidities of hypertension and arrhythmias may impact cognition. Retrospective data of 311 patients averaging 98 (±3.2) years who received treatment at the University of Arkansas for Medical Sciences were analyzed for diagnoses, prescribed medications and health conditions relevant to heart failure, hypertension, arrhythmias and dementia. 74% of the subjects were white, non-Hispanic, 24% were African American, and 2% were of unknown ethnicity. 83% were women and 17% were men. Only 251 (81%) of the reviewed charts had blood pressures recorded, of whom 43% (n=114) had systolic pressures >140mmHg. Furthermore, 50% (n=156) of patients had heart failure, and 29% (n=89) had dementia. Of those with dementia, 35% had an arrhythmia. For those without a diagnosis of dementia or any treatment for dementia, 25% had an arrhythmia. Heart failure and arrhythmias have not been well studied as an etiological factor for dementias. In our cohort, the presence of heart failure diagnoses was not different in those with dementia versus those without dementia. However, more patients with dementia had arrhythmias versus those without dementia, suggesting that arrhythmias may contribute to cognitive decline, even in the oldest old. Approximately 70% of the arrhythmias were atrial fibrillation. We did not have data on the management of these arrhythmias and whether anticoagulants were being used appropriately, especially for atrial fibrillation. Nevertheless this highlights the importance of close management of arrhythmias for maintaining cognitive health in older adults.