Background

Dementia and cognitive impairment (CI) affect over 10% of older adults, with an additional 15–22% experiencing mild cognitive impairment (MCI), which often progresses to dementia. Both conditions may have an adverse impact on quality of life. This study examines the association of dementia and CI on pain, sleep disturbances, and life satisfaction in older adults.

Methods

Using 2010 RAND Health and Retirement Study data, we analyzed 22,034 participants with 811 (3.7%) having dementia, 636 (16.5%) having MCI, and 17,587 (79.8%) without CI. We also conducted multivariate regression analyses to estimate the odds of pain, sleep disturbances, and life satisfaction while controlling for sociodemographic and health factors.

Results

The overall prevalence of CI was 20.2%. Pain was reported among 40.1% of participants with dementia, 41.3% with MCI, and 35.8% of those without CI. Sleep disturbances were more common among those with dementia (21.1%) and MCI (19.1%) than those without CI (13.8%). Individuals with MCI had higher odds of reporting pain (OR = 1.18, p=0.04) compared to those with dementia. Also, dementia was associated with higher odds of sleep disturbances (OR = 1.25, p=0.03) and life satisfaction (OR = 1.41, p<0.001) but lower odds of reporting pain (OR = 0.84, p=0.03) compared to those without CI.

Conclusion

Older adults with CI were more likely to experience sleep disturbances and life satisfaction compared to those without CIs. These findings highlight the need for targeted, evidence-based interventions to improve well-being in this population.

Background: Older adults with asthma experience a heightened frequency of emergency department (ED) visits for disease management when compared to younger adults, costing approximately five times more than comparable office visits. It remains important to assess variables related to ED use to inform interventions for older adults. Methods: The goal of this presentation will be to describe a retrospective study of electronic health records of adult patients between 1^st January 2023 to 31^st December 2023. Participants (N = 18,046) were adults aged 65 to 70 years. A multinomial logistic regression analysis was used to assess the relationship between predictors of health (asthma, prescribed systemic corticosteroids, prescribed biologic medications, body mass index, current diabetes, ever had pneumonia, chronic rhinitis, biological sex, race and ethnicity, access to MyChart, and health insurance type) and frequency of ED utilization for patients. Results: Patients with asthma who were prescribed systemic corticosteroids, had higher odds of visiting the ED compared to asthma patients who were not prescribed these medications. Asthma patients who had diabetes, a history of pneumonia, and those accessing the digital patient portal were visiting the ED more frequently. Lastly, patients who had Medicaid insurance were visiting the ED more than patients with other types of insurance coverage or no insurance. Conclusions: Given that care in ED carries a substantial financial burden, clinicians and health researchers must continue to explore ways to reach patients in primary care settings to reduce costly visits and return visits to the ED among older adults with asthma.

Background: High allostatic load (AL), a biological indicator of physiological dysregulation due to chronic stress, is associated with poor cognitive functioning. However, little is known on whether sociodemographic characteristics modifies this association.

Objectives: This study examines whether gender, race, and socioeconomic status modified the association between AL and poor cognitive functioning.

Methods: I used 2013-2014 NHANES data, a nationally representative survey of noninstitutionalized Americans. Data based on eight biomarkers (albumin, BMI, glycated hemoglobin, HDL cholesterol, total cholesterol, diastolic blood pressure, systolic blood pressure, and resting heart rate, were used to create an overall summary index of AL. I created a dichotomous indicator for each biomarker (high vs. lower risk) based on clinically accepted criteria. Participants with an AL score of 4 or more were characterized as having high AL. NHANES included standardized tests to evaluate cognitive functioning, including animal fluency, delayed recall, and digit symbols for participants 50+. I conducted a series of survey-weighted linear regression models to estimate associations.

Results: AL was associated with lower global and specific subtypes of cognitive functioning. However, only the association between AL and the digit span score remained statistically significant after adjusting for sociodemographic characteristics (beta= -0.21, 95% CI= -0.39, -0.03). Preliminary testing did not suggest associations differed by gender or race.

Conclusion: AL may be associated with specific types of cognitive functioning. More research is needed to identify the types of mental functioning that are most affected by chronic stress and whether this association differs across the US population.

Background: Obesity is a modifiable risk factor for multiple chronic diseases, but the association of obesity at different life stages with cognitive impairment and the link of body mass index (BMI) change from mid- to late-life with cognitive health remain unclear.

Methods: Data were obtained from National Health and Aging Trends Study, a longitudinal sample of U.S. Medicare beneficiaries aged 65+. Self-reported BMI at age 50 was categorized as normal (18.5-24.9), overweight (25-29.9), or obese (≥30). BMI change (%) from age 50 to baseline (i.e., 2011, mean age ~77) was calculated. Cognitive impairment from 2011-2022 was identified through a combination of self-reports, AD8 Screening responses, and cognitive tests. Logistic regressions estimated the association between mid-life BMI and baseline cognitive impairment, while Cox regression models assessed the relationships of mid-life BMI and BMI change with cognitive impairment during follow-up (2012-2022). All models were adjusted for demographics.

Results: Among 7,504 individuals, 1,990 (26.5%) were identified as having cognitive impairment at baseline, while 1,774 (23.6%) developed cognitive impairment during 2012-2022. Mid-life obesity was significantly associated with an increased odds of cognitive impairment at baseline [odds ratio=1.23, 95% confidence interval (CI)=1.04–1.47] and during follow-up [hazard ratio (HR)=1.16, 95% CI=1.00–1.34]. Additionally, a BMI decline >5%, considered clinically meaningful, was significantly associated with a higher risk of cognitive impairment during follow-up (HR=1.26, 95% CI=1.10–1.46).

Conclusions: Our findings confirmed mid-life obesity as a potentially modifiable risk factor and suggested substantial BMI decline from mid- to late-life might be a marker for cognitive impairment.

Background

A majority of people living with dementia (PLWD) rely heavily on the care of unpaid family members or friends, which oftentimes takes a physical, emotional and financial toll on the caregiver. Healthcare providers have an opportunity to couple dementia care with caregiver support, however, this opportunity is frequently missed. To better understand current practices among providers, a landscape analysis was conducted, consisting of an internet review of available dementia caregiver support tools, as well as key informant interviews (n=12), and an online survey (n=199) with dementia caregivers. Results indicate that caregivers often receive insufficient communication and support from providers.

Description

To address this issue, a toolkit was developed to offer providers strategies to better support dementia caregivers and promote their health. The toolkit contains 5 modules, covering dementia caregiving data, physical and emotional challenges, financial strain and how to provide a care team pathway for caregiver communication and referrals to services. Each module contains simple scripts for providers to follow to engage with caregivers and offer resources.

Lessons Learned

The landscape analysis revealed that there are a variety of available resources designed to help providers educate caregivers on caring for PLWD, however, there is a scarcity of tools aimed at helping providers support caregivers themselves. This toolkit fills that gap by offering providers practical resources for embedding caregiver support into dementia care.

Implications

This toolkit aims to enhance dementia care by building capacity among providers to support caregivers in caring for PLWD, as well as in caring for themselves.

Background: Deterioration of mental health due to experiences of chronic stress can result in individuals adopting maladaptive behaviors or approaches that cause harmful physiological effects such as heavy drinking and smoking. Previous studies have indicated mixed results pertaining to caregivers' maladaptive coping styles. Thus, the aim of the present study is to explore the coping mechanisms used by Texas caregivers with special focus on rural caregivers as it is commonly known that rural areas in Texas lack availability of mental health professionals.

Methods: We utilized the 2021 Texas subsample from the Texas Health and Human Services Department. All analyses were conducted in R in the package survey utilizing a sample of N = 1, 299 applying sampling weights. We explored multicollinearity for our dataset though we found no issues. Next, we performed a logistic regression utilizing the dependent variable “metropolitan area or not”, and the independent variables gender, poor mental health, diagnosed with depression, poor physical or mental health and the coping mechanisms of drinking (heavy, binge) and smoking.

Results: Consistent with the literature, a coping mechanism that was statistically significant at alpha = .05 when comparing the urban versus the rural areas among a sample of caregivers was current smoking status (OR = 1.22, 95% CI= 0.14 to 1.99).

Conclusions: When comparing rural to urban caregivers in the state of Texas we found smoking was the only maladaptive coping mechanism that was prevalent among these caregivers.

Background: Falls are the leading cause of hip fractures, traumatic brain injury, earlier admission to a nursing home, and injury related deaths for residents aged 65 years and older in the US. In 2020, falls among adults 65 and older caused over 36,000 deaths making it the leading cause of injury related death for that age group. Description: A Matter of Balance © is a national structured group intervention that utilizes a variety of activities to address physical, social and cognitive factors affecting fear of falling and to teach fall prevention strategies. In various community settings, two student nurse coaches present the program in 8 two-hour weekly sessions. Lessons Learned: With funding from SWCAA over the last 10 years, the Egan School has been able to provide more than 120 MOB programs to over 1000 older adults. Roughly 200 nursing students have been trained as coaches. All participants consistently report improved self-efficacy in program objectives (i.e. finding a way to get up from a fall, reducing fall risks, increasing physical strength, and becoming steadier on their feet). Implications: This program provides an evidence-based fall prevention educational program to older adults. MOB focuses on increasing an older person’s self-efficacy skills to help diminish fear of falling which can compromise social interaction and increase risk for social isolation, depression and anxiety. In addition, MOB coaches help participants to identify and initiate home safety measures to prevent falls. This contributes to empowering older adults to live in the community setting of their choice.

Background

With the global increase in the aging population, the importance of community-based care and Aging in Place (AIP) has been emphasized. The study aimed to investigate the role of home-based primary care in the association between perceived care sufficiency and depressive symptoms among older adults in South Korea.

Methods

We conducted a survey of the ‘Home-Based Primary Care Cohort (HBPC). One survey has been completed by March 2024, the second survey by September 2024 and the third survey by March 2025. Study population was community-dwelling older adults aged 65 years and older who were receiving long-term care services. Perceived care sufficiency was assessed based on participant’s self-reported. Depressive symptoms were measured using GDS. Additionally, this study examined how the frequency of HBPC services moderated the relationship between subjective care sufficiency and depressive symptoms. Multiple linear regression models were applied to calculate.

Results

Among older adults receiving HBPC services, 61.4% (N=202) reported that their caregiving hours were insufficient, and 82% (N=270) exhibited depressive symptoms. A significant association was found between perceived care sufficiency and depressive symptoms (β = 0.89, p = 0.011). However, as the frequency of HBPC service utilization increased, the relationship between perceived care sufficiency and depressive symptoms became nonsignificant.

Conclusions

These findings emphasize the importance of ensuring perceived care sufficiency within the community to reduce depression among older adults. HBPC can play a role in designing future community-based care systems. Furthermore, HBPC may serve as a key resource in establishing an integrated community care system.

Background

The Tennessee Department of Health has recognized healthy aging as a priority. With age different factors can increase risk of infection, a potential precursor to sepsis. Previous research has identified age and comorbidities as risk factors for sepsis.

Objective

This study aims to identify factors which increase the risk for hospitalization from sepsis for individuals aged 65 and older.

Methods

We analyzed 254,618 TN Hospital Discharge records for individuals 65 and older between 2017-2023 with principal sepsis (n = 162,361) and without (n = 92,257). Identification was based on an AHRQ report. Using logistic regression, we modeled principal sepsis diagnosis as a function of age group, sex, race, admission source, comorbidity presence (Hypertension, Diabetes, and COPD), and urogenital implant presence.

Results

Before and after adjusting, all predictors except race were significant. Compared with patients 65-74, patients 75-84 [OR:1.14, 95% CI:1.12-1.16] and patients 85+ [OR:1.31, 95% CI:1.28-1.34] had increased odds of a principal sepsis diagnosis. Female patients compared to male [OR:1.06, 95% CI:1.04-1.07], admission from a nursing or assisted living facility [OR: 2.34, 95% CI:2.19-2.49], healthcare facility [OR:1.70, 95% CI:1.56-1.85], hospital [OR:1.54, 95% CI:1.47-1.62], or non-healthcare facility [OR:1.87, 95% CI 1.79-1.95] compared to physician referral, and having at least one comorbidity [OR:1.25, 95% CI:1.23-1.28], had increased odds of principal sepsis diagnosis. Having a urogenital implant decreased odds of principal sepsis diagnosis [OR:0.56, 95% CI:0.46-0.68].

Conclusions

Multiple factors increase the risk for sepsis as primary reason for treatment in older adults. Preventative care and health maintenance may reduce sepsis admission.

Background

Alzheimer’s Disease and Related Dementias (ADRD) disproportionately impacts socioeconomically disadvantaged and racial/ethnic minority populations with disparities existing in exposure to risk factors, prevalence of disease, and treatment. Identifying harmful social and toxin exposures across the life course will allow for effective disease prevention and mitigation interventions.

Methods

Using geospatial analytics, we examined the geographic proximity of currently operational coal-fired power plants (CPP) and Alzheimer’s Disease Research Centers (ADRCs) in the United States. We created multiple buffers around the CPPs to define neighboring communities, mapped a 100-mile catchment area around the ADRCs, and characterized these communities’ area-based disadvantage (operationalized using the Area Disadvantage Index) and populations.

Results

Of the neighborhoods within 10 miles of a CPP, 99% (n=15,644) were in the 80% most disadvantaged deciles of neighborhood disadvantage; 40% of neighborhoods (n=6,221) were in the 20% most disadvantaged neighborhoods. Greater than 20% of the US population lives within 100 miles of an ADRC and 50 miles of a CPP.

Conclusions

CPP are ubiquitous and are disproportionately located in disadvantaged areas, leading to environmental justice concerns and health disparities. Among the individuals living in a 100-mile catchment area of an ADRC—individuals who are more likely to donate their brains to an ADRC—there is a high likelihood of exposure to toxic emissions from CPPs. Further studies examining the independent and interconnected associations between life-course exposure to disadvantage and toxic heavy metal emissions from CPPs is required to more deeply characterize the biological mechanisms underpinning the development of ADRD health disparities.