Background: Approximately 1 in 3 women 50 years or older are affected by osteoporosis and subsequent fractures, which result in increased hospitalizations, disability, and mortality. Clinical decision tools for osteoporosis screening play a key part in preventing fractures, but some still include inappropriate race-based adjustments, despite numerous critiques. This may lead to under-referral for minoritized populations. This investigation examines eligibility for osteoporosis screening by demographic groups when using the Osteoporosis Self-Assessment Tool (OST), a fracture risk tool that does not use race adjustment.

Methods: A retrospective chart review of patients seen in an ambulatory Endocrinology service line was conducted in 2024. Inclusion criteria included female post-menopausal patients, ages 50-64. Odds ratios were calculated for women identifying as White, Black, Hispanic/Latine, Asian and Other.

Results: A total of 114 patients from 692 charts reviewed met the screening eligibility cutoff using the OST. There were no statistically significant differences in the proportion of women for whom DXA screening was indicated by self-identified race (Black women OR=1.36 [95% CI, 0.74–2.50]; Hispanic/Latine women OR=1.18 [95% CI, 0.39–3.53]; Asian women OR=1.04 [95% CI, 0.66–1.63]; Other OR=1.42 [95% CI, 0.45–4.51]).

Conclusions: Lack of difference in the proportion of women eligible for DXA screening by self-identified race adds further evidence to the importance of using a risk tool that does not make inappropriate race-based adjustments. Replacing these tools will help ensure that fracture risk is not miscalculated for underrepresented populations, leading to potentially missed opportunities to prevent life-altering osteoporotic fractures.

Background: With permission from the Global Initiative of Obstructive Lung Disease (GOLD), the American Lung Association recreated their screening tool, Could it be COPD? as an online tool and integrated the questions into an over the phone option through the Lung HelpLine and Illinois Tobacco Quit Line (ITQl). Between February 2024 and September 2024, 1,939 people completed the tool online and 1,165 completed the tool through the HelpLine/ITQL. Description: From the online respondents, 1,448 people indicated they may be at risk of COPD and of these 365 answered the question, “yes” they will speak with their healthcare provider about the results. Of the respondents who completed the survey through the HelpLine/ ITQL, all the respondents who were at risk of COPD were recommended to speak with their healthcare provider. Lessons Learned: To understand if a person at risk of COPD spoke with their healthcare provider, the Lung Association created a one question survey that was emailed to 256 people between February 2024 and August 2024. In total, 12 people responded and 8 reported they spoke with their healthcare provider. Of the people who completed the tool via the Lung HelpLine/ ITQL, 60 of the 137 people reported speaking to their healthcare provider. Implications: Over the phone and email format can be utilized as methods to collect follow-up data. To increase consistency of responses, a timely, standardized email communication system should be utilized.

Background: Older adults with dementia face social, economic, and healthcare costs. Subjective cognitive decline (SCD), an early indicator of dementia, may delay healthcare engagement, hindering adoption of preventive behaviors. We examined the impact of SCD on adherence to routine health exams and cancer screenings.

Methods: Using 2022-2023 data from the CDC Behavioral Risk Factor Surveillance System, we analyzed the relationship between SCD and adherence to five preventive health behaviors among U.S. adults aged ≥45 years (n=200,584): flu shot, routine check-up, colonoscopy/sigmoidoscopy, mammogram, and prostate exam. We also examined how SCD-related factors (e.g., ability to work, conduct daily activities, have discussions with provider) influenced these behaviors. Logistic regressions controlled for healthcare access and participant characteristics, clustering by state/territory.

Results: Among participants with SCD, odds of having a flu shot and routine check-up were 10% and 12% higher (OR=1.10, SE=0.02; OR=1.12, SE=0.04), respectively. For those who discussed SCD with a provider, odds of adhering to flu shot, routine check-up, and mammogram recommendations were 30%, 129%, and 22% higher (OR=1.30, SE=0.04; OR=2.29, SE=0.17; OR=1.22, SE=0.12). For women whose SCD interfered with work or daily activities, mammogram adherence was 22% and 32% lower (OR=0.78, SE=0.06; OR=0.68, SE=0.07). Poor healthcare access was associated with lower adherence to all five health behaviors regardless of SCD status.

Conclusions: SCD was associated with higher adherence to flu shots and routine check-ups, likely due to increased interactions with providers. Maintaining healthcare access and provider relationships may promote better adherence to health behaviors and screenings in older adults with SCD.

Background: Osteoporosis is a common condition that affects more than 10 million Americans and significantly increases the risk of fracture, particularly among older adults, for whom such fractures can lead to severe morbidity. However, most individuals do not know they have osteoporosis as it is asymptomatic. Thus, screening is vital for diagnosis and to improve patient outcomes through the timely administration of preventative medications and lifestyle changes. This study aimed to identify provider-reported barriers and facilitators to osteoporosis screening within a large academic institution in an urban setting to better understand and improve screening uptake.

Methods: A qualitative study was conducted at a large urban medical system in NYC, involving semi-structured interviews with 10 physicians from various specialties. The Theoretical Domains Framework (TDF) guided the interview design, focusing on providers' experiences, perceptions, and practices related to osteoporosis screening. Interviews were conducted remotely, transcribed, and analyzed using inductive analysis to identify key themes and domains.

Results: The analysis revealed several provider-reported barriers to osteoporosis screening, including time constraints, competing clinical priorities, and the absence of electronic health record (EHR) prompts. Providers also noted patient-related barriers such as misconceptions about osteoporosis severity, fear of treatment side effects, and logistical challenges. Facilitators identified included the implementation of EHR reminders, increased provider training, culturally appropriate patient education, public awareness campaigns, and improved accessibility to screening services.

Conclusions: The study highlights critical barriers and potential facilitators to osteoporosis screening and offers insights for future interventions aimed at improving screening rates and ultimately bone health.

Introduction: While the protective benefits of physical activity are well known, the impact of lifelong physical activity on diabetes status remains underexplored. This study examines the relationship between participation in lifelong physical activity and self-reported status in adults aged 50 and older (N=7,240).

Methods: Participants were selected from the Health and Retirement Study (HRS) 2015-2017 Life History Mail Survey and 2020 biennial wave. Descriptive statistics (Chi-square tests and t-tests) assessed the associations and mean differences between physical activity levels across life stages (18-29, 30-30, 40-49 and 50+) by diabetes status. The study utilized logistic regression to examine the relationship between participation in physical activity and diabetes status, adjusting for sociodemographic, childhood and adulthood health factors and complex survey design.

Results: 2,064 (27.82%) reported diabetes and 5,356 (72.18%) reported no diabetes. In bivariate analysis, participation in moderate/vigorous activity from 18-50+ was associated with diabetes onset (p<.001). For each examined age group, moderate/vigorous physical activity was associated with lower odds of diabetes in later life. The association appears stronger with each successive age group, ranging from OR=0.79 (CI: 0.69, 0.92; p<0.01) in ages 18-29 to OR=0.65 (CI: 0.56, 0.76; p<.001) in the 50+ age group. Participation in high school sports was not associated with a subsequent diabetes diagnosis in later life (OR=0.91 [SE: 0.08]; p>.05).

Conclusion: Moderate to vigorous physical activity from ages 18 to 50+ was associated with reduced odds of diabetes, highlighting the need for public health initiatives that promote sustained physical activity throughout adulthood to mitigate diabetes risk.

Background: The Tennessee Dementia ECHO program addresses the urgent need for a skilled dementia care workforce in Tennessee. By 2050, the demand for geriatricians in Tennessee is expected to increase 29-fold, posing significant challenges, particularly in rural areas. Research shows that enhancing the primary care workforce, particularly through collaborative care models, can improve dementia health outcomes and reduce healthcare costs.

Description: Launched in September 2024, the Tennessee Dementia ECHO program is a repeating 12-week tele-mentoring initiative designed to enhance the knowledge, skills, and confidence of primary care clinicians and other healthcare professionals caring for patients with dementia. Each weekly one-hour session includes an expert didactic and interactive case discussion. Topics covered include medication management, behavioral concerns, and deprescribing.

Lessons Learned: The program has recruited over 230 healthcare learners. Surveys showed a 50% average increase in confidence, and 50% of responding learners reported implementing changes in their practice. Challenges to recruiting physicians to participate in the program highlight the need for tailored outreach strategies. Sustaining participation across multiple sessions requires personalized engagement strategies. Partnerships with local organizations, including medical associations and community health groups, have been critical in promoting engagement and broadening program reach.

Implications: The Tennessee Dementia ECHO program has the potential to show how collaborative care models can bridge workforce gaps, promote early dementia detection and management, and improve health outcomes. Expanding this initiative can make Tennessee a model for other regions facing similar challenges.

Background: Osteoporosis, a chronic, progressive bone disease affects approximately 54 million Americans, causing significant health and economic burdens. Low bone mineral density (BMD) is a key precursor to osteoporosis, making it essential to understand the factors associated with low BMD. This study used a nationally representative U.S. sample to estimate the national prevalence of low BMD and identify associated factors.

Methods: Cross-sectional data was drawn from the 2017-2020 National Health and Nutrition Examination Survey for older adults (≥ 50 years) with valid total femur (hip) BMD measurements obtained via dual-energy X-ray absorptiometry (N=1,600, weighted N= 46,038,585). BMD status was dichotomized as low BMD and normal BMD. Weighted bivariate and multivariable logistic regression models examined associations between BMD status and sociodemographic, biological, and behavioral factors.

Results: About 45.2% of U.S. adults aged 50 years and older reported low BMD of the total femur. The multivariable logistic regression model revealed that females, individuals aged 65 years and older, and non-Hispanic White, Asian, and Hispanic individuals were more likely to report low BMD. In contrast, overweight and obese individuals were less likely than normal weight individuals to report low BMD. Parental history of osteoporosis, physical activity, and vitamin D intake were associated with higher odds of low BMD in bivariate regression models. (all ps<0.05)

Conclusions: A significant prevalence of low BMD was observed, with notable disparities across gender, race/ethnicity, and certain lifestyle factors. Tailored interventions are needed to address modifiable factors, while also considering the impact of non-modifiable factors in osteoporosis prevention strategies.

The global population is aging with an expected 200% increase in older adults in Sub-Saharan Africa(SSA) between 2019 and 2050. Cardiovascular-kidney-metabolic syndrome(CKMS) is a group of interrelated metabolic risk factors that start early in life and have been found to be associated with morbidity and mortality. Unfortunately, little is known about the association between CKMS and health outcomes in SSA.

The aims of this analysis were to understand the association between CKMS and self-rated health and depression among middle-aged and older adults in SSA.

Data from the Health and Aging in Africa: Longitudinal Studies in South Africa (HAALSI)(2022) and HAALSI Tanzania(2018) for 7,358 adults aged 40 and older were used. Dependent variables were self-rated health (good vs poor) and continuous depressive symptoms Center for Epidemiological Studies Depression (CESD) score. Primary independent variables were CKMS (yes vs no) and continuous CKMS symptoms. Covariates included sociodemographics, behavior, social risk, and comorbidities. Unadjusted and fully adjusted logistic (self-rated health) and linear (CESD score) regression methods were used. Analyses were conducted using Stata v.17.0 and p<0.05 defined statistical significance.

In fully adjusted models, older adults with CKMS had 1.34 odds of poor self-rated health (95% CI: 1.19,1.50) compared to those without CKMS; and every additional CKMS symptom was associated with 23% increased odds of poor self-rated health (OR:1.23;95%CI:1.16,1.30). Similarly, older adults with CKMS had mean 1.11 increase in depressive symptoms (95%CI:0.62,1.59).

Comprehensive care strategies including non-communicable disease management and mental health care are recommended to optimize health outcomes and support healthy aging in SSA.

Background: Attributable to hypertension is approximately 8.5 million deaths. Regular physical activity (PA) attenuates age-related reductions in central arterial compliance and restores levels that may lower blood pressure (BP) and the risk for cardiovascular diseases (CVDs). More than one-in-five older adults live in rural U.S., have low PA and higher CVD-related risks and mortality compared to their urban counterparts. Yet a paucity of information exists on the relationship between PA and hypertension control in U.S. rural settings. We aim to examine the association between hypertension control and PA in a rural Midlands setting, South Carolina.

Methods: Medicare annual review data collected between July 2024-January 2025 from Abbeville County were examined. Uncontrolled hypertension was defined as a BP reading of 140/90 mmHg or higher, regardless of whether the person is taking medication for high BP. PA was self-reported. Binomial logistic regressions were used to examine the determinants of hypertension control.

Results: Responses from 800 Medicare population were analyzed (females: 55.6%; mean ±SD age, 73.2±8.48 years). Overall, the unadjusted prevalence (95% CI) of uncontrolled hypertension was 38.6% (95%CI: 35.3-42.0%). Compared to a healthy weight, being overweight (2.1; 95% CI: 1.3-3.3: p=0.002) or obesity (1.8; 95% CI: 1.1-2.8: p=0.010) was associated with higher odds of uncontrolled hypertension. Contrary to most previous findings, self-reported PA (1.57; 95% CI: 1.05-2.34: p=0.027) was associated with a higher likelihood of uncontrolled hypertension.

Conclusions: The contrary PA findings demonstrate the need to obtain objectively measured physical activity data to appropriately support behavioral interventions for patients with hypertension.