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Objectives The prevalence of dementia varies geographically in the United States. However, the extent to which this variation reflects contemporary place-based experiences versus embodied exposures from earlier in the life course remains unclear, and little is known regarding the intersection of place and subpopulation. This study, therefore, evaluates whether and how risk for assessed dementia varies by place of residence and birth, overall and by race/ethnicity and education. Methods We pool data from the 2000 to 2016 waves of the Health and Retirement Study, a nationally representative panel survey of older U.S. adults (n = 96,848 observations). We estimate the standardized prevalence of dementia by Census division of residence and birth. We then fit logistic regression models of dementia on region of residence and birth, adjusting for sociodemographic characteristics, and examine interactions between region and subpopulation. Results The standardized prevalence of dementia ranges from 7.1% to 13.6% by division of residence and from 6.6% to 14.7% by division of birth, with rates highest throughout the South and lowest in the Northeast and Midwest. In models accounting for region of residence, region of birth, and sociodemographic covariates, Southern birth remains significantly associated with dementia. Adverse relationships between Southern residence or birth and dementia are generally largest for Black and less-educated older adults. As a result, sociodemographic disparities in predicted probabilities of dementia are largest for those residing or born in the South. Discussion The sociospatial patterning of dementia suggests its development is a lifelong process involving cumulated and heterogeneous lived experiences embedded in place.

To promote the financial capabilities of student loan borrowers, practitioners must understand the experiences and needs of borrowers across the life course. A national survey ( n = 1,874) conducted by MIT AgeLab explored perceived loan-related effects across the life course and sources of advice for borrowers. Across age groups, repaying student loans had most regularly imposed negative perceived effects on multiple domains of borrowers’ financial well-being. Younger borrowers reported more negative perceived effects of loans across domains, whereas older borrowers reported fewer negative perceived effects. Few participants had sought professional advice about student loan repayment, although younger borrowers were more likely to have sought loan-related advice in general; perceived levels of helpfulness of advice and comfort consulting with contacts were mixed. Financial social work is uniquely situated to act as a resource for multiple generations of student loan borrowers and their families.

Financial self-efficacy is associated with positive financial behaviors. This study investigated factors associated with financial self-efficacy among student loan borrowers based on original data collected through an online national survey of student loan borrowers between age 25 and 75. Results revealed that perceived student loan literacy prior to accruing higher education debt was significantly associated with current financial self-efficacy, while general financial literacy during repayment did not appear to be correlated with financial self-efficacy. This study draws on social cognitive theory to suggest that student loan literacy prior to accruing debt may act as a mastery experience, improving financial self-efficacy when the repayment period arrives. Given the increasing prevalence of student loans across all generations, this study underscores the need for early education and mentoring from financial professionals about student loan borrowing.

As college costs rise in the United States, many parents are forced to make difficult decisions about how to pay for their children’s higher education. Stress and conflict accompany financial issues and play a role in the financial picture for many families. Using Hill’s (Hill, Social casework 39:139–150, 1958) ABC-X model of family stress as a framework, this study describes results of a national survey of parents contributing to student loan payments for their child’s education and explores how this experience may play a role in familial conflict. Findings suggest marked gender differences in the relationship between contribution reason and the experience of conflict. Results also carry implications for financial professionals, suggesting a need for family-focused and gender-conscious financial education both before and during the student loan repayment process.

With student loan borrowing becoming an increasingly common experience in U.S. households, it is crucial to understand the interpersonal manifestation of education debt within family systems. This study sought to understand how accruing and repaying student loan debt for one’s own higher education relates to family dynamics and communication within families. Leveraging Family Communication Patterns Theory, this study asked: How do student loan borrowers describe loan-related family communication patterns prior to loan accrual and during the repayment period? Utilizing qualitative and quantitative data collected through a concurrent nested mixed methods study design, findings from this study profile family communication typologies leading up to, and during, student loan repayment. Study findings suggest that the ways in which families communicate about student loans prior to loan accrual and during repayment (a) relate to family financial socialization processes and (b) play at least a partial role in how they experience student loans as part of their overall family dynamics. This study proposes a model of loan-related family communication dynamics and offers implications for future scholarship and practice.

Adults with severe mental ill health may have specific attitudes toward physical activity. To inform intervention development, we conducted a survey to assess the physical activity patterns, preferences, barriers, and motivations of adults with severe mental ill health living in the community. Data were summarised using descriptive statistics, and logistic regressions were used to explore relationships between physical activity status and participant characteristics. Five-hundred and twenty-nine participants (58% male, mean age 49.3 years) completed the survey. Large numbers were insufficiently active and excessively sedentary. Self-reported levels of physical activity below that recommended in national guidelines were associated with professional inactivity, consumption of fewer than five portions of fruit and vegetables per day, older age, and poor mental health. Participants indicated a preference for low-intensity activities and physical activity that they can do on their own, at their own time and pace, and close to home. The most commonly endorsed source of support was social support from family and friends. Common motivations included improving mental health, physical fitness, and energy levels. However, poor mental and physical health and being too tired were also common barriers. These findings can inform the development of physical activity interventions for this group of people.

Objectives: To explore the effects of membership in a fitness program for older adults on social isolation, loneliness, and health. Method: Using survey responses from SilverSneakers members and matched nonmembers, regression path analysis was used to examine the influence of SilverSneakers membership on physical activity, social isolation, loneliness, and health, and the interrelationships among these concepts. Results: SilverSneakers membership directly increased physical activity and self-rated health, directly decreased social isolation, and indirectly decreased loneliness. Decreased social isolation and loneliness were associated with better self-rated health: social isolation and loneliness had independent direct effects on health, while social isolation also had an indirect effect on health mediated through loneliness. Discussion: Members of SilverSneakers experienced better health through increased physical activity, reduced social isolation, and reduced loneliness. Future research should explore independent effects of social isolation and loneliness on health and the mechanisms by which membership reduces social isolation and loneliness.

A correction to this paper has been published: https://doi.org/10.1007/s10834-021-09772-6

Currently, approximately 44 million people in the United States carry the weight of over 1.4 trillion dollars of student loan debt. As the cost of education continues to rise, the decision of taking on student loans is increasingly a family decision rather than an individual one. While the majority of research focuses on younger borrowers, little research has been done to understand the experiences of parents and grandparents taking on student loans for a loved one. In order to financially and emotionally manage this burden, borrowers may benefit from support from their social networks, including family and friends. For many, navigating these difficult conversations presents a challenge of its own. This presentation will spotlight an MIT AgeLab mixed methods study about how student loan borrowers between the ages of 51 and 75 experience and manage their student loans within family systems and how these loans may impact family dynamics. Data were collected through focus groups and a national survey. Preliminary findings suggest that older borrowers demonstrate several distinct communication typologies within their families in regards to finances, particularly regarding student loan accrual and repayment. Each of the four primary communication styles regarding loans impact borrowers’ financial and emotional wellbeing throughout the life course, as well as perceived relationship dynamics. Moreover, older borrowers are more likely to report family conflict if student loans are less frequently discussed with family members. Findings also suggest strategies to help parents and grandparents facilitate conversations abound student loans based on their unique family communication styles.

Central vascular access device (CVAD)-related sheaths, sometimes described as ‘fibrin sheaths’, may result in minor or significant sequelae, from persistent withdrawal occlusion (PWO) to infective sheaths associated with increased morbidity and mortality. The authors studied 179 patients who underwent isotope scans, where isotope was infused via the CVAD. Isotope was found to bind to the sheaths around the catheters of some patients. The amount of uptake was taken to be an extent to which a sheath had developed around the CVAD. The degree of uptake of isotope was categorised into three groups: low uptake, moderate uptake and high uptake. Patients were then followed up from the date the CVAD was inserted to 12 months after the date of the isotope scan, until the device was removed or to the date the patient died, to identify incidence of infection, thrombosis and PWO. PWO incidence in all levels of uptake was around 5–7%. Bloodstream infection (BSI) incidence for low uptake was 7% (9/130), moderate uptake 10% (3/30) and for patients with significant uptake 16% (3/19). Thrombosis for no uptake was less than 1% (1/130), moderate uptake 7% (2/30), and significant uptake had no incidence of thrombosis. Total complications: no uptake 15%, moderate uptake 23% and significant uptake 21%. This single-centre study showed that patients with isotope-highlighted sheaths experienced higher incidence of infective, thrombotic and total complications.

DHX9/RNA helicase A (RHA) is a host RNA helicase that participates in many critical steps of the HIV-1 life cycle. It co-assembles with the viral RNA genome into the capsid core. Virions deficient in RHA are less infectious as a result of reduced reverse transcription efficiency, demonstrating that the virion-associated RHA promotes reverse transcription before the virion gains access to the new host's RHA. Here, we quantified reverse-transcription intermediates in HIV-1–infected T cells to clarify the mechanism by which RHA enhances HIV-1 reverse transcription efficiency. Consistently, purified recombinant human RHA promoted reverse transcription efficiency under in vitro conditions that mimic the early reverse transcription steps prior to capsid core uncoating. We did not observe RHA-mediated structural remodeling of the tRNA(Lys3)–viral RNA-annealed complex. RHA did not enhance the DNA synthesis rate until incorporation of the first few nucleotides, suggesting that RHA participates primarily in the elongation phase of reverse transcription. Pre–steady-state and steady-state kinetic studies revealed that RHA has little impact on the kinetics of single-nucleotide incorporation. Primer extension assays performed in the presence of trap dsDNA disclosed that RHA enhances the processivity of HIV-1 reverse transcriptase (RT). The biochemical assays used here effectively reflected and explained the low RT activity in HIV-1 virions produced from RHA-depleted cells. Moreover, RT activity in our assays indicated that RHA in HIV-1 virions is required for the efficient catalysis of (−)cDNA synthesis during viral infection before capsid uncoating. Our study identifies RHA as a processivity factor of HIV-1 RT.

This presentation will discuss the role of social connections, activities and rituals in creating meaning for older adults throughout the lifespan and in times of transition. The MIT AgeLab Lifestyle Leaders are a well-educated and active group that knows how to combat loneliness by being actively involved in the community and finding activities and peers with whom to socialize. Researchers will present findings from three panel studies related to romantic relationships and friendships among the Lifestyle Leaders as well as different activities that bring meaning, structure and a sense of identity to their lives. Communication technologies are indispensable to them as ways to remain connected to their loved ones. Learning and helping others was among the most mentioned current sources of meaning and purpose, while “doing what you love” grew as a prioritized source of meaning as participants have aged.

Physical well-being is crucial for older adults to maintain their independence and age successfully. This presentation will share results on several dimensions of physical well-being among the MIT AgeLab Lifestyle Leaders. First, the presentation will discuss behaviors related to, perceived benefits of, and barriers to exercise and physical fitness for the oldest old and will explore how their exercise behaviors have changed over time. While most believed physical activity provides extensive benefits and self-identified as regular exercisers, they also identified many barriers. Potential solutions identified by the Lifestyle Leaders, including wearable technology, will be discussed. Second, the presentation will examine changes in vision and hearing the Lifestyle Leaders have experienced, how these changes have affected them, and their reactions to technologies that might mitigate losses in vision and hearing. Changes in vision primarily affected mobility-related activities and functional abilities, whereas changes in hearing affected interpersonal communication and sense of belonging.

Previous research demonstrates that student loan debt disproportionately affects women and is being repaid increasingly by older adults. Utilizing data collected through a mixed methods study at the MIT AgeLab (involving focus groups and a large national survey), we examine the impacts of repaying student loans on older women’s financial wellbeing. Findings focus on multiple areas, including the timing in which older women repaying student loans were able to pay down other debts, change jobs, get married, and pursue further education. Analysis also revealed that student loans impacted the amount that 63% of older women in the study were able to contribute to their retirement savings. Findings from this study suggest that repaying student loan debt for oneself and/or a family member can compromise older women’s near-term and longer-term financial being. Policy reforms are needed to support older women repaying student loans.

The repercussions of novel coronavirus (COVID-19) within the United States and across the globe are vast. Researchers at the MIT AgeLab conducted a national online survey (N=1200) related to COVID-19 in March 2020 with the goal of exploring participants’ COVID-19-related attitudes, hygiene and consumer behaviors, and their use of technology to work, make purchases, stay informed, and stay socially connected. In this presentation, AgeLab researchers will describe findings among a sub-population of study participants deemed to be at highest health risks for the virus: adults ages 60 and over. Findings demonstrate that the largest group of participants stayed informed about COVID-19 primarily through online sources. As a result of the virus, most had made changes to their health and hygiene practices, including implementing social distancing measures, and the majority had changed at least one of their purchasing behaviors, most often buying more products than usual online. Second only to participants’ physical health concerns related to COVID-19 were their financial health concerns, both related to near-term finances and longer-term financial goals. From this study, policy and practice implications emerge across public, private, and non-profit sectors that, taken together, can prepare older adults and their loved ones to survive and thrive during global emergencies.

Saving for retirement and the ability to provide care for a loved one can be dramatically affected by student loan debt. Currently, approximately 44 million people of all ages in the United States carry the weight of over 1.4 trillion dollars of student loan debt. Student loan borrowers of all ages may experience lower financial preparedness for retirement as well as decreased ability to provide care for family members, including aging parents. While older adults hold a relatively small proportion of student loans, they are the fastest growing subset of student loan borrowers and have disproportionately high rates of student loan defaults. As a result of their defaults, the Social Security retirement benefits of Americans ages 65 and older experienced a 500% increase in offsets over the last decade. This presentation will spotlight an MIT AgeLab mixed methods study about how student loan borrowers between the ages of 51 and 75 experience student loans within family systems and perceive and prioritize longevity planning in light of their student loans. Data collected for this study include focus groups and a large national survey. Preliminary findings suggest that for older borrowers, student loans are generally one of several financial constraints that can inform spending and saving decisions. For most, student loan payments are regarded as stunting overall retirement savings while the minority regard the two separately. Older borrowers also tend to have increased financial and familial responsibilities, including caring for aging parents, that compete for borrowers’ limited financial and temporal resources.

As people live longer than ever before, the chances of experiencing age-related sensory losses in vision and hearing are equally unprecedented. Changes in vision and hearing have demonstrated effects on older adults' physical, cognitive, and socioemotional wellbeing, particularly in regards to social isolation. Despite what is already known about the age-related impacts of vision and hearing changes, there is a relative lack of knowledge about repercussions for the "oldest old," those who are ages 85 and older. In this study, a panel of 25 adults ages 85 and older was surveyed and convened for small discussion groups about changes in vision and hearing and ways in which "the oldest old" perceive and utilize technologies that mitigate these changes. Changes in vision appeared to primarily drive independent activities and functional abilities whereas changes in hearing primarily affected ease of interpersonal communication and sense of connection and belonging. To adapt to age-related changes in vision and hearing, our findings suggest that adults ages 85 and older adopt a variety of protective mechanisms, including formal and informal assistance, assistive technologies, and attitudes that ultimately reflect an internal locus of control. Findings suggest a new avenue of research to focus on very old adults as "hackers" and creators of spaces and technologies that serve their evolving sensory needs.

The 3′-end of the genomic RNA of the hepatitis C virus (HCV) embeds conserved elements that regulate viral RNA synthesis and protein translation by mechanisms that have yet to be elucidated. Previous studies with oligo-RNA fragments have led to multiple, mutually exclusive secondary structure predictions, indicating that HCV RNA structure may be context-dependent. Here we employed a nuclear magnetic resonance (NMR) approach that involves long-range adenosine interaction detection, coupled with site-specific 2H labeling, to probe the structure of the intact 3′-end of the HCV genome (385 nucleotides). Our data reveal that the 3′-end exists as an equilibrium mixture of two conformations: an open conformation in which the 98 nucleotides of the 3′-tail (3′X) form a two-stem–loop structure with the kissing-loop residues sequestered and a closed conformation in which the 3′X rearranges its structure and forms a long-range kissing-loop interaction with an upstream cis-acting element 5BSL3.2. The long-range kissing species is favored under high-Mg2+ conditions, and the intervening sequences do not affect the equilibrium as their secondary structures remain unchanged. The open and closed conformations are consistent with the reported function regulation of viral RNA synthesis and protein translation, respectively. Our NMR detection of these RNA conformations and the structural equilibrium in the 3′-end of the HCV genome support its roles in coordinating various steps of HCV replication.

The paradigm protein synthesis rate is regulated by structural complexity of the 5′untranslated region (UTR) derives from bacterial and other riboswitches. In-solution, HIV-1 5′UTR forms two interchangeable long-range nucleotide (nt) -pairings, one sequesters the gag start codon promoting dimerization while the other sequesters the dimer initiation signal preventing dimerization. While the effect of these nt-pairings on dimerization and packaging has been documented their effect on authentic HIV translation in cellulo has remained elusive until now. HIVNL4-3 5′UTR substitutions were designed to individually stabilize the dimer-prone or monomer-prone conformations, validated in-solution, and introduced to molecular clones. The effect of 5′UTR conformation on ribosome loading to HIV unspliced RNA and rate of Gag polypeptide synthesis was quantified in cellulo. Monomer- and dimer-prone 5′UTRs displayed equivalent, basal rate of translation. Gain-of-function substitution U103, in conjunction with previously defined nt-pairings that reorient AUG to flexible nt-pairing, significantly activated the translation rate, indicating the basal translation rate is under positive selection. The observed translation up-mutation focuses attention to nt-pairings at the junction of R and U5, a poorly characterized structure upstream of the characterized HIV riboswitch and demonstrates the basal translation rate of authentic HIV RNA is regulated independently of monomer:dimer equilibrium of the 5′UTR.

Family caregivers often assist their care recipients with a wide variety of activities ranging from basic personal care to transportation, medication management, finances and more. Furthermore, many caregivers live apart from the loved ones that they provide care to, and have responsibilities outside of caregiving including work and family. Use of technologies and services designed to make life easier for the general population can also be leveraged to reduce the burden and stress related with caregiving. In this study, 30 family caregivers were surveyed in depth to learn about their experiences with various technologies and services. Questions covered caregivers’ use of technologies and services, perceived usefulness and ease of use, reasons for use and non-use, and ideas for new and improved tools. Many caregivers were currently using a technology or service for caregiving, but most of the technologies and services presented in the questionnaire were only used by a limited number of participants. While usage was limited, those that currently used technologies and services generally found them helpful for making caregiving duties easier. Responses showed that technologies and services were not being widely used mainly due to limited awareness and availability, and less because of lack of interest.

This presentation will explore the transportation and housing adaptations the MIT AgeLab Lifestyle Leaders have made to continue aging successfully. The first portion will focus on transportation and mobility, which are essential to access healthcare and provide opportunities for social interaction. We will present an overview of transportation issues faced by the 85+, including giving up the keys and adapting to new modes of transportation, and how changes in mobility have affected their abilities to stay healthy, safe and engaged. Participants expressed friction, frustration and fatigue related to the lack of choice and control over transportation options. The second portion of the presentation will discuss choice of residence, moving and downsizing in later life. Approximately half of the Lifestyle leaders have moved within the past ten years to receive care for their spouse, live in a place better suited for their lifestyle, be closer to family, or save money.