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To respect people's preference for aging in place and control costs, many state Medicaid programs have enacted policies to expand home and community-based services as an alternative to nursing facility care. However, little is known about the use of Medicaid long-term services and supports (LTSS) at a national level, particularly among dual-eligible beneficiaries with Alzheimer's disease and related dementias (ADRD).Using Medicare and Medicaid claims of 30 states from 2016, we focused on dual-eligible beneficiaries 65 years or older with ADRD and described their use of any form of LTSS and sub-types of LTSS (home-based, community-based, and nursing facility services) across states.We found that 80.5% of dual-eligible beneficiaries with ADRD received some form of Medicaid LTSS in 2016. The most common LTSS setting was nursing facility (46.7%), followed by home (31.5%) and community (12.2%). There was sizeable state variation in the percentage of dual-eligible beneficiaries with ADRD who used any form of LTSS (ranging from 61% in Maine to 96% in Montana). The type of LTSS used also varied widely across states. For example, home-based service use ranged from 9% in Maine, Arizona, and South Dakota to 62% in Oregon. Nursing facility services were the most common type of LTSS in most states. However, home-based service use exceeded nursing facility use in Oregon, Alaska, and California.Our findings suggest substantially different use of LTSS across states among dual-eligible beneficiaries with ADRD. Given the importance of LTSS for this population and their families, a deeper understanding of state LTSS policies and other factors that contribute to wide state variation in LTSS use will be necessary to improve access to LTSS across states.

Periventricular white matter hyperintensities (pvWMHs) are commonly observed on MRI in older individuals and are associated with cognitive and motor decline. The etiology of pvWMH remains unknown. Venous collagenosis has been implicated, which may also interfere with perivascular fluid flow leading to dilation of perivascular spaces (PVS). Here, we examine relationships between in vivo pvWMH volume and ex vivo morphological quantification of collagenosis and the PVS in veins and arteries.Brain tissue from 25 Oregon Alzheimer's Disease Research Center subjects was selected to cover the full range of WMH burden. Tissue from white matter abutting the ventricle was stained with Masson's trichrome and smooth muscle actin. An automated hue based algorithm identified and segmented vessel into collagenized vessel walls, lumen, and PVS. Multiple linear regressions with pvWMH volume as the dependent variable and either collagen thickness or PVS width were performed with covariates of vessel diameter, age at death, sex, and interval between MRI and death.PVS width and collagen thickness were significantly correlated in both arteries (r = 0.21, p = 0.001) and veins (r = 0.23, p = 0.001). Increased venous collagen (p = 0.017) was a significant predictor of higher pvWMH burden while arterial collagen was not (p = 0.128). Neither PVS width in arteries (p = 0.937) nor veins (p = 0.133) predicted pvWMH burden.These findings are consistent with a model in which venous collagenosis mediates the relationship between vascular risk factors and pvWMH. This study confirms the importance of changes to the venous system in contributing to MRI white matter lesions commonly observed with advanced age. ANN NEUROL 2022;92:992-1000.

We aimed to examine the impact of COVID-19 pandemic-related stay-at-home orders on weekly reports of mood and activity before and during COVID-19 in a sample of older Veterans and their cohabitants.Urban and rural Veterans and their cohabitants living in the Pacific Northwest ≥62 years old were enrolled as part of the Collaborative Aging Research Using Technology initiative (n = 100, age = 71.2 ± 6.5, 41% women). Participants reported frequency of social activities (e.g., travel away), physical illness, and mood (blue mood and loneliness) via weekly online health forms.A total of 2,441 weekly online health forms (OHFs) were collected from 100 participants. During the COVID-19 pandemic, blue mood (OR = 4.4,The current study established that blue mood and loneliness were significantly more prevalent in older Veterans following COVID-19 stay-at-home orders regardless of rurality.The COVID-19 pandemic associated health precautions, while necessary to curb acute health risks, have created a unique situation that places vulnerable populations at increased risk of low mood.

We assessed longitudinal associations between social networks and incidence of all-cause dementia, Alzheimer’s disease (AD) and vascular dementia in Kuakini Honolulu-Asia Aging Study participants over a 10-year follow-up period. Median split of Lubben Social Network Scale (LSNS) scores defined weak/strong social networks among 2636 men who were dementia-free at baseline (median age 77 years) and during the first 3 years. Kaplan-Meier curves showed that those with strong networks at baseline were less likely to develop all-cause dementia (p

Mobility features are important for health. In this study, we quantified in-home mobility and explored potential health and environmental correlates. Participants included community-dwelling older adults living alone (n=139). Two indoor mobility features were developed (frequency; interdaily stability) using passive, room-level (bathroom; bedroom; kitchen; living room) infrared motion sensors, and contact sensors attached to homes’ egress doors at entryways. Existing data on gait and cognition, weekly online surveys assessing mood (blueness; loneliness) and pain severity, and publicly available locality-based atmospheric (daylight hours) data were leveraged. On average, higher indoor mobility frequency was associated with faster gait speed (p=0.04), less time out-of-home (

Epidemiological studies suggest that social isolation is a risk factor of dementia although the underlying mechanisms are not well known. A core component of social isolation is a lack of conversational interactions. We recently completed a NIH-funded multi-center randomized controlled trial called Internet-Based Conversational Engagement Clinical Trial (I-CONECT, ClinicalTrials.gov: NCT02871921), which aimed to examine whether social engagement, specifically conversational interactions through webcam and internet, could improve cognitive function in socially isolated older adults with mild cognitive impairment (MCI) or normal cognition. The data was un-blinded in August, 2021. We found strong evidence of efficacy in the primary (global cognitive function, Cohen’s d = 0.73, p=0.03) and secondary (memory function, Cohen’s d=0.67, p=0.03) outcomes at Month 6 (high-dose post-trial endpoint) and Month 12 (maintenance-dose post-trial-endpoint), respectively, using the mixed model for repeated measures. We will present the background, COVID-19 pandemic related protocol modifications and the primary results of this intervention project.

This study aimed to simultaneously examine the associations between social activity and connectedness and depressive symptoms in older adult couples. Using SEM and data from 116 community-dwelling couples (age 76.18 ± 8.49), we found that engagement in social activities was associated with lower depressive symptoms in men (p = 0.014), whereas more close friendships were associated with lower depressive symptoms in women (p = 0.018), controlling for partner effects, age, education, and cognitive function (CFI: 1.00, TLI: 1.35, RMSEA: 0.00 [0.00, 0.08]). Unexpectedly, we also found better female physical health to be associated with greater depressive symptoms in males (p = 0.029). When examined as dyadic physical health, more incongruence between the physical health of partners was associated with greater depressive symptoms in men (p = 0.007). Discussion will focus on distinct influences of social activity and connectedness on mental health, and the context of gender, marriage, and dyadic health.

Socially isolated older adults with MCI are at greater risk of developing ADRD. This study compares the emotional status of older adults with MCI to their cognitively normal counterparts within a socially isolated sample. We used baseline data from the Internet-based Conversational Engagement Clinical Trial (NCT02871921). MCI status was determined according to clinical diagnosis. Three emotion domain scores were calculated: negative affect, social satisfaction, and psychological wellbeing. Linear regressions were conducted for all 17 Emotion Battery measures and 3 domain scores. The 127 participants' mean age was 81.1 (SD=4.6). About 54% were diagnosed with MCI. Older adults with MCI had more negative affect, yet no difference was observed in social satisfaction and psychological wellbeing. Individuals with MCI had higher levels of fear, perceived hostility, perceived stress, sadness, and lower self-efficacy. Better understanding the emotional status could inform the development of behavioral health interventions and early detection of MCI.

The Internet-Based Conversational Engagement Clinical Trial (I-CONECT, ClinicalTrials.gov: NCT02871921) is a multi-center randomized, 12-month efficacy study. There is converging evidence that social isolation is a risk factor of cognitive decline and dementia. We hypothesized that increasing social interaction in older adults with normal cognition or mild cognitive impairment (MCI) could improve or sustain cognitive function through internet-based conversational engagement. African Americans (AA) are at higher risk for developing dementia but their participation in clinical trials is low. Objectives: (1) discuss the effective outreach process to recruit urban AA older old adults (mean targeted age of 80+); (2) describe how we retained participants in a yearlong study using technology-based interventions. The most successful outreach and recruitment sources were the voter registration mass mailings and the Healthier Black Elders Research Center. Successful recruitment methods included: hiring diverse staff, compensating participants’ time, and adjusting research protocols for opting out of MRIs and genetic saliva samples. Technology intervention strategies included: providing user-friendly Chromebooks and free internet connections, simple instructions with pictures, vision and hearing correction, and in-home training with technology support backup. During the pandemic, we could assists participants in learning to use the laptop remotely. Over 12,000 subjects were contacted, which led to 39 randomized participants. Our retention rate thus far is over 75%. This demonstrates that AA older adults are reachable, willing to participate in research and able to use communication technology with appropriate supports for long-term sustainable interaction that may improve cognition and health equity.

Indoor room transition is an underexplored real-world activity outcome. We estimated the stability and variability of indoor room transitions and their associations with mild cognitive impairment (MCI) in older adults. Older adults living-alone (n=159, age=78.3±8.8 years, 14% MCI) from the Oregon Center for Aging & Technology (ORCATECH) and the Minority Aging Research Study (MARS) were included. Room transitions were detected using passive infrared motion sensors in bathroom, bedroom, kitchen, and living room. The hourly number of room transitions was used to calculate the interdaily stability and intradaily variability of room transitions. MCI was operationalized by the Clinical Dementia Rating equaled 0.5. Generalized estimating equations models adjusted for demographics, health, and environmental factors revealed that older adults with MCI had a lower interdaily stability of room transitions than cognitive healthy peers (z=-2.06,p=0.03). A pervasive-sensing system deployed in homes can obtrusively measure room transition activities to inform cognitive health in older adults.

Background: The COVID-19 pandemic has changed the health security of older adults. Few have examined how older US veterans have reacted and coped with the COVID-19 pandemic. We aimed to identify changes in physical health and their differential impact by rurality of older veterans. Method: Participants were veterans (aged ≥ 62 years) and their cohabitants, living in the Pacific Northwest, enrolled in the Collaborative Aging Research using Technology (CART) initiative. Daily step counts via actigraphy were collected from January 1st to July 8th, 2020. COVID-19 time periods were determined by stay-at-home orders issued on March 13th, 2020. Generalized estimating equation models were used to examine changes in physical activities associated with COVID-19 time periods and rurality indicated by the rural-urban commuting area score. Results: A total of 102 participants were included in the analysis (mean age = 71.0 years, 56% male, 32 living in urban areas). Daily average step counts were 2318 and 3012 before and after COVID-19 stay-at-home orders (t=4.85, p

BACKGROUND The current clinical trial assessment methodology relies on a combination of self-report measures, cognitive and physical function tests, and biomarkers. This methodology is limited by recall bias and recency effects in self-reporting and by assessments that are brief, episodic, and clinic based. Continuous monitoring of ecologically valid measures of cognition and daily functioning in the community may provide a more sensitive method to detect subtle, progressive changes in patients with cognitive impairment and dementia. OBJECTIVE This study aimed to present an alternative trial approach using a home-based sensing and computing system to detect changes related to common treatments employed in Alzheimer disease (AD). This paper introduces an ongoing study that aims to determine the feasibility of capturing sensor-based data at home and to compare the sensor-based outcomes with conventional outcomes. We describe the methodology used in the assessment protocol and present preliminary results of feasibility measures and examples of data related to medication-taking behavior, activity levels, and sleep. METHODS The EVALUATE-AD (Ecologically Valid, Ambient, Longitudinal and Unbiased Assessment of Treatment Efficacy in Alzheimer’s Disease) trial is a longitudinal naturalistic observational cohort study recruiting 30 patients and 30 spouse coresident care partners. Participants are monitored continuously using a home-based sensing and computing system for up to 24 months. Outcome measures of the automated system are compared with conventional clinical outcome measures in AD. Acceptance of the home system and protocol are assessed by rates of dropout and protocol adherence. After completion of the study monitoring period, a composite model using multiple functional outcome measures will be created that represents a behavioral-activity signature of initiating or discontinuing AD-related medications, such as cholinesterase inhibitors, memantine, or antidepressants. RESULTS The home-based sensing and computing system has been well accepted by individuals with cognitive impairment and their care partners. Participants showed good adherence to the completion of a weekly web-based health survey. Daily activity, medication adherence, and total time in bed could be derived from algorithms using data from the sensing and computing system. The mean monitoring time for current participants was 14.6 months. Medication adherence, as measured with an electronic pillbox, was 77% for participants taking AD-related medications. CONCLUSIONS Continuous, home-based assessment provides a novel approach to test the impact of new or existing dementia treatments generating objective, clinically meaningful measures related to cognition and everyday functioning. Combining this approach with the current clinical trial methodology may ultimately reduce trial durations, sample size needs, and reliance on a clinic-based assessment. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/17603

I-CONECT is a randomized controlled clinical trial to examine the impact of social interaction delivered via video-chat on cognitive function (clinicaltrials.gov number: NCT02871921, project website: www.I-CONECT.org ). We aimed to enroll 320 community-dwelling socially isolated older adults (age >=75 years). The recruitment of participants has started in 2018 and was ongoing when COVID-19 pandemic began. Video chat and telephone-based social interaction interventions did not change during COVID-19. However, new recruitment and cognitive assessments, which require in-person contact and deployment and retrieval of video chat devices in participant homes, were suspended due to the nature of our study population (i.e., older age, higher likelihood of comorbidities). Recently we were able to successfully switch to complete remote assessments including 1) telephone-based cognitive assessments using T-COG (Telephone Cognitive Assessment battery), and 2) contactless delivery of our study devices (Chrome books and electronic pill boxes) for subject self-installation. Our creative approach to self-installations includes color coded pictures and an easy-to-follow installation manual, accompanied by remote instruction and support via telephone. This poster introduces our remote assessment and installation protocol and participant and technical support team feedback regarding this new contactless protocol. This presentation provides useful guidance for future studies considering completely remote assessment and telemedicine approaches.

Despite the clear and compelling association between social connections and well-being, the underlying mechanisms that help stave off adverse health impacts are not well understood, particularly among older adults in disadvantaged groups. Social relationships in older age may be instrumental for exchanging and gaining knowledge that further influence health and help increase awareness about misconceptions and lifestyle behaviors known to delay or reduce cognitive decline. This study used cross-sectional survey data from 147(aged 58-90 years; 75% female) low-income African American homebound community dwellers to investigate heterogeneity in dementia literacy profiles and its association with social connectedness. Eleven items (false=0, true=1, don’t know=2) from a validated instrument were used to measure dementia literacy (DL). The Lubben’s social network scale was used for a social connectedness construct. We employed a 2-stage latent class modeling approach to examine heterogeneity in DL and estimate the regressions among the derived classes and the predictors (social connectedness, education level and age). A 3-class model produced a reasonable fit and classification (entropy=0.852) of “dementia literacy patterns” labeled as (high-literacy:37%), moderate-literacy:45.2%), low-literacy:17.8%)). Social connectedness was highly predictive of class membership. A high level of social relationships increased the probability of being in the “high-dementia-literacy” class compared to the “low-dementia-literacy” class (OR=2.189, p=0.016). For a unit increase in social connectedness, the odds of being in the “high-dementia-literacy” class compared to the “low-dementia-literacy” class increased by a factor of 2.2. Tailored and focused interventions to reduce social disconnectedness may also help increase dementia awareness and reduce barriers to early diagnosis.

Physical/functional limitations are known to lead to loneliness, but there is little research on protective factors that may mediate their adverse association, particularly in vulnerable populations. This study used cross-sectional survey data from 147 (aged 58-90 years; 75% females) predominantly low-income African American homebound community dwellers to investigate the role of resilience and social connectedness in mediating the effect of physical/functional limitations on loneliness. Items from validated instruments were used to measure four latent variables (physical/functional limitations, resilience, loneliness and social connectedness). Structural parallel mediator models estimated each path in the mediation analysis controlling for gender, education, and age. Confidence intervals for mediation effects were generated via bias-corrected bootstrapping with 10,000 replications. The total effect of physical/functional limitations on perceived loneliness was significant. Social connectedness and resilience fully and significantly mediated the relationship between physical/functional limitations and loneliness. The indirect effect (B =.143; 95% CI = .047, .280) for the physical/functional limitations-resilience-loneliness pathway indicated that the positive effect of physical/functional limitations on loneliness was approximately 0.143 points lower as mediated by higher resilience. The indirect path of physical/functional limitations on loneliness through the mediation of social connectedness (B =.077; 95% CI = .010, .168) yielded a reduction of .077 points. The total amount of variance in feelings of loneliness accounted for by the overall model, which included the proposed mediators and control variables, was 48.6%. Interventions to build resilience and social interactions may attenuate the effects of physical/functional disability and loneliness on health outcomes in individuals at risk.

Key activities and life events that impact quality of life and health may be gleaned from cross-sectional annual surveys or for medical data, derived intermittently from electronic health records. These methods cannot reflect the day-to-day and week-to-week changes that typically occur in domestic life. To assess the frequency and types of major life activities and events occurring at finer-grained temporal scale, we queried online, every week, three domains of activity and function (life events such as having an overnight visitor, travel away from home; health-related events such as medication changes, falls, ER/hospital visits, health limitations; and internal states such as pain, mood, or loneliness). Over a mean assessment period of 2.9 ± 1.2 years, 16,738 online surveys were completed by 129 community-residing volunteers with mean age 84 years. Overall the most frequent events reported were physical health limitations (14%), travel away from home (12%) and overnight visitors (9%). Needing new in-home assistance for medication management, bathing, dressing or grooming was rare (1%). Accidents were also rare (1%). Low mood, pain ratings (0-10 scale) and loneliness were infrequently reported; 4% low mood, 8% pain rated > 5, 3% reporting loneliness. Low mood and increased pain intensity were highly correlated with health changes (medication changes, ER/hospital visits, health limitations, falls; all p

A comparative statics model is utilized to examine mechanisms of gender inequality: gender distribution (skew), gender segregation (composition), occupational captivity, hierarchical ceilings, glass ceilings, and internal labor market (ILM) structure/network linkages. The analysis examines new linkages between sex segregation and glass ceilings; two elements of sex segregation–composition and captivity; and two elements of glass ceilings–pathways inside and outside one's original ILM. Gender‐specific career trajectories were constructed to analyze women's career opportunities in 22 occupational ILMs in the U.S. federal government for two periods between 1962 and 1989, demonstrating how to extract career implications from much shorter periods of time. There is a very large differential effect by gender when staying within one's occupational ILM; however, when pathways that include changing ILMs are considered, women's opportunities to enter the top tier become almost equivalent to those for men in the seco...

The authors sought to identify patterns and associations of prescription and over-the-counter sedative-hypnotic use in an older, rural, blue-collar, community-based cohort in southwestern Pennsylvania over 10 years.A group of 1,627 individuals age 65 and over were recruited and assessed during 1987-1989 and re-assessed during approximately biennial waves. Data included sleep medications, demographics, depressive symptoms, sleep complaints, and cognitive functioning (Mini-Mental State Exam [MMSE]).At Waves 1 through 5, the mean age of the cohort increased from 73.4 to 80.5 years. Use of prescription sedative-hypnotics (primarily benzodiazepines) increased from 1.8% to 3.1%, and over-the-counter sedative-hypnotic use (primarily diphenhydramine) increased from 0.4% to 7.6%. At Wave 5 (1996-1998), 8.17% of the sample reported using diphenhydramine as a sleep aid. After adjusting for age and sex, diphenhydramine use was associated with higher education and more depressive symptoms, the latter becoming nonsignificant after controlling for initial insomnia. MMSE became significantly associated with diphenhydramine use when 143 subjects with dementia were excluded from the analysis.As the cohort aged, prescription sedative-hypnotic use remained relatively stable, whereas over-the-counter sedative use, principally diphenhydramine, increased substantially. The association of this drug with cognitive impairment in persons without dementia highlights its potential for causing adverse reactions in older adults.