Aging & dementia in Asia: insights into risk & protective factors through demography & family studies

With the arrival of an aging society, cognitive health in older adults has become a global focal point. Cross-sectional studies have shown that internet use and physical activity may significantly affect cognitive function in older adults, but their longitudinal relationships and underlying mechanisms have not been fully explored. This study aims to explore the relationship between internet use, physical activity, and cognitive function, and examine the mediating role of physical activity. This study uses two rounds of longitudinal data from the China Health and Retirement Longitudinal Study (2018 and 2020), including a total of 2,383 individuals aged 60 and above. Cross-lagged regression analysis is used to test the bidirectional relationship between internet use and cognitive function, while a semi-longitudinal mediation model is used to examine the mediating role of physical activity. The results indicate that there is a bidirectional relationship between internet use, physical activity levels, and cognitive function. Higher levels of internet use are associated with better cognitive function, and physical activity levels mediate the longitudinal relationship between internet use and cognitive function in older adults. This study reveals the complex relationship between cognitive function, internet use, and physical activity in older adults, and provides new perspectives for interventions aimed at improving cognitive health in older adults. Future research should further explore the dynamic changes between these variables to develop more effective intervention strategies and improve cognitive health and well-being in older adults.

BackgroundWith the increase in life expectancy, age-related cognitive decline has become a prevalent concern. Physical activity (PA) is increasingly being recognized as a vital non-pharmacological strategy to counteract this decline. This review aimed to (i) critically evaluate and synthesize the impact of different PA and exercise modalities (aerobic, resistance, and concurrent training) on cognitive health and overall well-being in older adults, (ii) discuss the influence of exercise intensity on cognitive functions, and (iii) elucidate the potential mechanisms through which PA and exercise may enhance or mitigate cognitive performance among older adults.Main BodyAn exhaustive analysis of peer-reviewed studies pertaining to PA/exercise and cognitive health in older adults from January 1970 to February 2025 was conducted using PubMed, Scopus, Web of Science, PsycINFO, and MEDLINE. There is compelling evidence that aerobic and resistance training (RT) improve cognitive function and mental health in older adults, with benefits influenced by the type and intensity of exercise. Specifically, moderate-intensity aerobic exercise appears to bolster memory, executive functions, and mood regulation, potentially through increased cerebral blood flow, neurogenesis, and production of brain-derived neurotrophic factors in the hippocampus. Moderate-to-high-intensity RT acutely enhances visuospatial processing and executive functions, with chronic training promoting neurogenesis, possibly by stimulating insulin-like growth factor-1 and augmenting blood flow to the prefrontal cortex. Findings related to the effects of concurrent training on cognitive function and mental health are heterogeneous, with some studies reporting no significant impact and others revealing substantial improvements. However, emerging evidence indicates that the combination of concurrent training and cognitive tasks (i.e., dual tasks) is particularly effective, often outperforming aerobic exercise alone.ConclusionsRegular aerobic and RT performance is beneficial for older adults to mitigate cognitive decline and enhance their overall well-being. Specifically, engaging in moderate-intensity aerobic exercises and moderate-to-high-intensity RT is safe and effective in improving cognitive function and mental health in this demographic. These exercises, which can be conveniently incorporated into daily routines, effectively enhance mental agility, memory, executive function, and mood. The findings related to concurrent training are mixed, with emerging evidence indicating the effectiveness of combined concurrent and cognitive tasks on cognitive health and well-being in older adults.Key Points- Moderate-intensity aerobic exercise is associated with significant improvements in cognitive function, mood regulation, and overall well-being in older adults. These benefits are linked to structural and functional changes in the brain such as increased hippocampal volume and elevated levels of brain-derived neurotrophic factor.- Moderate-to-high-intensity resistance training, both in acute and chronic forms, enhances cognitive performance in older adults, particularly in executive functions and visuospatial processing. Cognitive benefits, including improvements in information-processing speed, attention, and memory, can be sustained through regular training.- The effects of concurrent resistance and aerobic training on cognitive function in older adults are mixed. However, combining concurrent training with cognitive tasks (i.e., dual-task training) is particularly effective and often outperforms aerobic exercise alone.- Cognitive and well-being improvements from aerobic and resistance training are mediated by mechanisms such as increased cerebral blood flow and oxygen delivery, enhanced neurogenesis, reduced oxidative stress and inflammation, and positive hormonal changes.- While the optimal exercise dosage for promoting cognitive health in older adults remains undetermined, empirical evidence indicates a positive correlation between increased exercise dosage and cognitive health improvements.

Background: As the population ages, cognitive impairment and dementia have become one of the greatest health threats in older adults. Prior studies suggest that exergaming could improve cognitive function in older adults. To date, few long-term exergames intervention studies on older adults during the COVID-19 epidemic exist. This study aimed to investigate the effects of exergame on cognitive function in Chinese older adults, and to examine whether exergame was more effective than aerobic dancing for executive function and working memory. Methods: 55 participants (mean age = 65.4 ± 3.7 years) were randomly assigned to an exergame training (ET) group, an aerobic dancing training (ADT) group, or a control (CON) group. The ET and ADT groups received 36 sessions (three 75-min training sessions per week, exercise intensity = 65 to 75% HRmax) during a 12-week period. The outcome measures for cognitive function included working memory measured by the N-back test, and executive function measured by the Stroop test. Results: The ET group showed a significantly positive effect in working memory, relative to the ADT (accuracy in 1-back test: ES = 0.76, p < 0.01), and CON group (accuracy in 1-back test: ES = 0.87, p = 0.02). Moreover, the performance in the Stroop test showed some improvements in executive function after intervention in the ET and ADT groups (Stroop intervention effect: ES = 0.38; p = 0.25). Conclusions: Exergame had a positive benefit in improving cognitive functions in older adults without cognitive impairment. Long-term exergame training could improve working memory in older adults. Exergame and aerobic dancing can efficiently improve inhibitory control of executive function in older adults. Maintaining an active lifestyle is protective of cognitive health in older adults.

BackgroundBy 2060, Latinos will represent nearly one‐third of Americans and the Latino elderly population over 65 will nearly quadruple. Over the next 40 years, Latinos are projected to have the largest increase in Alzheimer’s disease and related dementia (ADRD) cases. Despite the expected number of Latinos with ADRD, knowledge gaps are particularly large for Latinas living in regions typically underrepresented in ADRDs research, such as rural and/or agricultural regions. Therefore, the goal of this study is to assess knowledge, perceptions, and feelings associated with ADRD among a sample of middle‐age Latina women.MethodWe used qualitative methods involving semi‐structured interviews to examine the knowledge, perceptions, and feelings associated with ADRD among a subsample of the Center for Health Assessment of Mothers and Children of Salinas (CHAMACOS) study participants, who are Latina women residing in an underserved agricultural community entering mid‐life (mean = 47 years old). We conducted interviews with 20 Latina women and analyzed data with thematic content analysis.ResultsWith regard to knowledge and perceptions about ADRD, three themes emerged: 1) Women associate ADRD with loss of memory, getting lost, losing one’s humanity; 2) They are not familiar with protective and risk factors for ADRD, including cardiovascular risk factors; 3) They believe ADRD can be prevented and want to learn how to prevent it and recognize signs and symptoms. With regard to feelings associated with ADRD, three themes emerged: 1) Fear of developing ADRD, losing independence, and not being aware of reality or who they are; 2) Sadness about how people with ADRD are treated, including those living in a nursing home; 3) A sense of powerlessness to help people with ADRD or oneself once diagnosed with ADRD.ConclusionMiddle age represents a window of opportunity to reduce ADRD risk by raising awareness, prioritizing lifestyle changes, and create community conditions that support brain health. This study found that middle‐aged Latinas are concerned about ADRD and want to learn how to prevent ADRD and recognize signs and symptoms. More research is needed to study effective interventions to prevent ADRD among middle‐age Latinas, particularly from regions of the US often underrepresented in ADRDs research.

BackgroundMiddle age is increasingly acknowledged as a critical window for prevention of Alzheimer’s disease and related dementia (ADRD) since research has shown that AD develops in the course of 20–30 years (1) but we know very little about middle-aged individuals’ perspectives on ADRD. Knowledge gaps are particularly large for Latinas living in regions typically underrepresented in ADRD research, such as rural and/or agricultural regions. This is important given that over the next 40 years Latinos are projected to have the largest increase in ADRD cases in the U.S. Therefore, this study aims to assess knowledge, perceptions, and feelings associated with ADRD among a sample of middle-age, Spanish-speaking Latina women.MethodUsing qualitative methods involving semi-structured interviews, we examined knowledge, perceptions, and feelings associated with ADRD among a subsample of the Center for Health Assessment of Mothers and Children of Salinas (CHAMACOS) study. Participants are Latina women residing in an underserved agricultural community entering mid-life (mean = 46.5 years old). Interviews were conducted with 20 women and data was analyzed with inductive thematic content analysis.ResultsWe identified themes regarding perceptions, knowledge, and feelings. First, participants perceive ADRD as involving (1) Loss of memory, (2) Getting lost; (3) Losing the person they once were. With regard to knowledge about ADRD, participants reported: (1) Some knowledge about protective and risk factors for ADRD, (2) No awareness of the links between cardiovascular risk factors and ADRD; (3) A desire to learn prevention methods alongside signs and symptoms of ADRD. Themes related to feelings about ADRD were: (1) Fear of developing ADRD and not being aware of reality or who they are; (2) Worry about losing relationships with loved ones and caretaking if diagnosed with ADRD; (3) Sadness about forgetting one’s family and depending on others if diagnosed with ADRD.ConclusionThe knowledge gaps and negative feelings associated with ADRD highlighted in this study underscore the need for ADRD interventions to include CVD prevention, particularly for mid-life Latino populations residing in rural regions.

BackgroundIn the background of an aging population, the risk of cognitive impairment in the older population is prominent. Exposure to complex neighborhood built environments may be beneficial to the cognitive health of older adults, and the purpose of this study was to systematically review the scientific evidence on the effects of neighborhood built environments on cognitive function in older adults.MethodsKeywords and references were searched in Web of Science, Pubmed, PsycINFO, and MEDLINE. Studies examining the relationship between the built environment and cognitive function in older adults were included. The neighborhood built environment as an independent variable was classified according to seven aspects: density, design, diversity, destination accessibility, public transportation distance, blue/green space, and built environment quality. The cognitive function as the dependent variable was classified according to overall cognitive function, domain-specific cognitive function, and incidence of dementia. The quality of the included literature was assessed using the National Institutes of Health's Observational Cohort and Cross-Sectional Study Quality Assessment Tool.ResultsA total of 56 studies were included that met the inclusion criteria, including 31 cross-sectional studies, 23 longitudinal studies, 1 cross-sectional study design combined with a case-control design, and 1 longitudinal study design combined with a case-control design. Most of the studies reviewed indicate that the built environment factors that were positively associated with cognitive function in older adults were population density, street connectivity, walkability, number of public transportation stops around the residence, land use mix, neighborhood resources, green space, and quality of the neighborhood built environment. Built environment factors that were negatively associated with cognitive function in older adults were street integration, distance from residence to main road. The relationship between residential density, destination accessibility, and blue space with cognitive function in older adults needs to be further explored.ConclusionPreliminary evidence suggests an association between the neighborhood built environment and cognitive function in older adults. The causal relationship between the built environment and cognitive function can be further explored in the future using standardized and combined subjective and objective assessment methods, and longitudinal or quasi-experimental study designs. For public health interventions on the cognitive health of older adults, it is recommended that relevant authorities include the neighborhood built environment in their intervention programs.

With the increasing number of older adults, research on cognitive function has expanded. However, studies examining the mediating effect of depression on the association between complex factors and cognitive function in older adults are still insufficient. Additionally, there is a lack of studies that have investigated these relationships by integrating multiple factors related to the cognitive function of older adults. Therefore, our study investigated the association between the number of family members, self-rated health, depression, and cognitive function in community-dwelling older adults and highlighted the mediating role of depression in these relationships. We used data from 218 older adults aged over 65 collected in a previous study. The independent variables were the number of family members and self-rated health, and the dependent variable was cognitive function measured by the cognitive impairment screening test (CIST). The mediation variable was depression measured by the Patient Health Questionnaire-9 (PHQ-9). Structural equation modeling was used to examine the association between the independent, dependent, and mediation variable. The mean ages of the participants were 81.71 (standard deviation [SD] = 6.00) years, with 198 females (90.83%) and 20 males (9.17%). The structural equation model demonstrated a good model fit (chi-square value = 33.375; degrees of freedom = 24; p-value = 0.0964; RMSEA = 0.042; CFI = 0.970; TLI = 0.956; SRMR = 0.042). Self-rated health and the number of family members were not directly associated with cognitive function; however, depression had significant indirect effects (self-rated health to cognitive function: coefficient = -0.023, p-value = 0.017; number of family members and cognitive function: coefficient = 0.012, p-value = 0.030). Our findings indicated that depression plays a crucial mediating role between self-rated health, number of family members, and cognitive function. The results highlight the need for comprehensive strategies for mental health care to support cognitive health in older adults.

Comparative efficacy of exercise interventions for cognitive health in older adults: A network meta-analysis.

BackgroundNumerous studies have documented racial and ethnic differences in the prevalence and incidence of Alzheimer’s disease and related dementias (ADRD). Less is known, however, about racial and ethnic differences in health care expenditures among older adults at risk for ADRD (cognitive deficits without ADRD) or with ADRD. In particular, there is limited evidence that racial and ethnic differences in health care expenditures change over the trajectory of ADRD or differ by types of service.MethodsWe examined racial and ethnic patterns and differences in health care expenditures (total health care expenditures, out-of-pocket expenditures, and six service-specific expenditures) among Medicare beneficiaries without cognitive deficits, those with cognitive deficits without ADRD, and those with ADRD. Using the 1996–2017 Medical Expenditure Panel Survey, we performed multivariable regression models to estimate expenditure differences among racial and ethnic groups without cognitive deficits, those with cognitive deficits without ADRD, and those with ADRD. Models accounted for survey weights and adjusted for various demographic, socioeconomic, and health characteristics.ResultsBlack, Asians, and Latinos without cognitive deficits had lower total health care expenditures than whites without cognitive deficits ($10,236, $9497, $9597, and $11,541, respectively). There were no racial and ethnic differences in total health care expenditures among those with cognitive deficits without ADRD and those with ADRD. Across all three groups, however, Blacks, Asians, and Latinos consistently had lower out-of-pocket expenditures than whites (except for Asians with cognitive deficits without ADRD). Furthermore, service-specific health care expenditures varied by racial and ethnic groups.ConclusionsOur study did not find significant racial and ethnic differences in total health care expenditures among Medicare beneficiaries with cognitive deficits and/or ADRD. However, we documented significant differences in out-of-pocket expenditures and service-specific expenditures. We speculated that the differences may be attributable to racial and ethnic differences in access to care and/or preferences based on family structure and cultural/economic factors. Particularly, heterogeneous patterns of service-specific expenditures by racial and ethnic groups underscore the importance of future research in identifying determinants leading to variations in service-specific expenditures among racial and ethnic groups.

BackgroundAmerican Indian and Alaska Native (AI/AN) peoples face a rising burden of Alzheimer's disease and related dementia (ADRD). The 2024 Lancet Commission identified modifiable risk factors for dementia for the general population; however, a comprehensive understanding of risk factors associated with ADRD among AI/AN peoples is missing. This study utilizes a national database to estimate the prevalence of health conditions associated with ADRD and examine disparities between older AI/AN and White populations.MethodWe analyzed 2019 Medicare Master Beneficiary Summary File data for Medicare beneficiaries aged 68 and older, including all AI/AN beneficiaries and a 5% random sample of White beneficiaries. Two types of health conditions were examined: Lancet risk factors available in the Medicare data and other conditions that have been associated with ADRD (Table 1). Prevalence of ADRD and each condition was reported. Bivariate and multivariate logistic regressions assessed the associations between health conditions and ADRD.ResultAmong 112,280 AI/AN and 1,010,862 White beneficiaries, the former had higher age‐adjusted prevalence of ADRD (15.6 % vs. 13.3%), and substantially higher prevalence of 5 out of 9 Lancet risk factors, including diabetes, alcohol use disorder (AUD), tobacco use disorder, visual impairment, and hearing loss; similar prevalence of hypertension, depression, and traumatic brain injury (TBI); but a lower prevalence of hyperlipidemia (Table 1). Bivariate analyses revealed that all conditions were associated with higher ADRD odds in both populations, with TBI, depression, and AUD showing the strongest association with ADRD (Table 2). In multivariate regressions, the associations for TBI (odds ratio (OR) = 8.00), AUD (OR=3.30), visual impairment (OR=2.38), and hearing loss (OR = 1.34) were stronger in AI/AN beneficiaries, while depression, diabetes, and hypertension had stronger associations in Whites (Figure 1).ConclusionOlder AI/AN Medicare beneficiaries compared to their White counterparts, exhibit a higher prevalence of ADRD and 5 of the 9 Lancet risk factors. Furthermore, several conditions had stronger associations with ADRD among AI/AN beneficiaries, underscoring the importance of addressing disparities in ADRD risk factors to mitigate ADRD risk among AI/AN peoples. Further research using longitudinal data with social and behavioral determinants is essential to better understand and reduce these disparities.

INTRODUCTIONAlzheimer's disease and related dementias (ADRD) remain a leading cause of morbidity and mortality. Poor cardiorespiratory fitness (CRF) has been identified as a potential risk factor for ADRD. Since CRF is a modifiable risk factor, we evaluated the association between CRF changes over time and ADRD risk.METHODSOur cohort consisted of US Veterans (mean age 60.7±9.0 years; male, n = 128,749; and female, n = 5,421). All completed two standardized exercise treadmill tests (ETT) between 2000 and 2017, at least 1 year apart (mean 3.5±2.7 years), with no evidence of ADRD at the time of both ETTs. We assigned participants to one of three age‐ and gender‐specific CRF categories based on peak metabolic equivalents (METs) achieved during the initial ETT and five categories based on CRF changes at the final ETT. Cox proportional hazard models adjusted for age, comorbidities, and medications were used to evaluate ADRD risk across CRF categories.RESULTSDuring the up to 15.0 years of follow‐up (mean 7.2 years; interquartile range [IQR] 4.3–9.9 years), totaling 966,337 person‐years, 10,699 ADRD cases occurred (11.1 events/1000 person‐years). Compared to the Low‐fit group, ADRD risk decreased progressively with increased CRF and was 22% lower (hazard ratio [HR] 0.78; 95% confidence interval [CI]: 0.75‐0.81; p<0.0001) for Moderate‐fit individuals and 30% lower (HR 0.70, 95% CI: 0.67–0.73; p<0.0001) for High‐fit individuals. Compared to Low‐fit individuals with no CRF change, an increase of 0.1–<2.0 METs was associated with a 13% lower ADRD risk (HR 0.87, 95% CI 0.79–0.95; p<0.0001), while an increase of ≥2.0 METs was associated with a 24% lower risk (HR 0.76, 95% CI 0.70–0.83; p<0.0001).CONCLUSIONWe observed an inverse and independent association between CRF and ADRD risk. An improvement in CRF of approximately ≥1.0 MET led to a lower risk of ADRD in Low‐fit individuals. These findings may have considerable clinical and public health significance in reducing ADRD risk.HighlightsPoor cardiorespiratory fitness (CRF) has been identified as a potential risk factor for Alzheimer's disease and related dementias (ADRD). Thus, we assessed the potential impact of changes in CRF over time on ADRD risk.CRF changes reflected inverse and proportional changes in ADRD risk.Low‐fit individuals who improved their CRF by ≥0.1 metabolic equivalents (METs) had a 13%–24% lower ADRD risk. Conversely, a decline in CRF by ≥2.0 METs was associated with a 14% increased ADRD risk among Moderate‐fit and a 18% increase among High‐fit individuals.

BackgroundAlzheimer's disease and related dementias (ADRD) caregivers are a unique subgroup of adults in the US that may be at increased risk of ADRD themselves due to both unmodifiable (e.g., sex and age) and modifiable (e.g., health behaviors) risk factors. In 2024, the Lancet Commission on Dementia Prevention, Intervention and Care identified 14 potentially modifiable ADRD risk factors across the life course that contribute to a 45% reduction in population attributable risk. Our objective was to estimate and compare the prevalence of each modifiable risk factor for ADRD among ADRD caregivers, non‐ADRD caregivers, and non‐caregivers.MethodWe used 2021‐2023 Behavioral Risk Factor Surveillance System data. The sample comprised 6,959 family ADRD caregivers, 57,267 family caregivers of people with other health conditions (non‐ADRD), and 256,677 non‐caregivers. Modifiable risk factors evaluated were less than college education, hearing loss, high cholesterol, hypertension, alcohol use, obesity, smoking, depression, physical inactivity, diabetes, vision loss, and social isolation. Bivariate analysis using chi square tests was conducted.ResultADRD caregivers were significantly more likely to be 45‐64 years old (45%) and female (64%) compared to non‐ADRD caregivers (40% and 61%, respectively) and non‐caregivers (32% and 51%, respectively; p < .05). The prevalence of ADRD risk factors among ADRD caregivers ranged from 5% for vision loss to 60% for less than college education. ADRD caregivers were significantly more likely to have high cholesterol (45%) compared to non‐caregivers (40%) and non‐ADRD caregivers (43%). The prevalence of hypertension was significantly higher among ADRD caregivers (44%) than among non‐caregivers (40%). Conversely, ADRD caregivers had a significantly lower prevalence of less than college education (53%) and physical inactivity (21%) compared to non‐caregivers (60% and 25%, respectively) and non‐ADRD caregivers (60% and 15%, respectively; p < .05).ConclusionOur findings provide the first comprehensive look at the epidemiology of modifiable ADRD risk factors among ADRD caregivers whose health is often overlooked in the medical literature. ADRD caregivers had a high prevalence of several risk factors, while other risk factors were less common compared to non‐caregivers and non‐ADRD caregivers. Interventions and efforts to reduce risk factors for ADRD (e.g., hypertension) may be particularly beneficial for ADRD caregivers.

Older Adults with Mental Illness or Dementia Struggle with the Skilled Nursing Facility-to-Home Transition

Aging populations in low‐ and middle‐income countries (LMICs) are growing more rapidly than those in high income countries (HICs). Thus, globally, the burden of Alzheimer’s disease and related dementias (ADRD) profoundly impacts LMICs, with greater burden and risk for late‐life women than men. LMICs are unable to meet diagnostic challenges with underfunded healthcare infrastructure, low numbers of clinicians with training and expertise in ADRD, and a lack of culturally and linguistically sensitive screening assessments. Emerging social and societal factors that are important risk and protective factors for later life ADRD and are differentially experienced by gender/sex are relatively understudied, yet essential in LMICs. Typical samples in neuroscience studies have been small and highly selected. They have been biased toward Western, Educated, Industrialized, Rich, and Democratic (WEIRD) samples and do not apply well to target populations in LMICs. In addition, levels‐of‐analysis across social/societal and biological determinants of disease are not typically integrated, and social/societal factors such as sociocultural (e.g., culture, religion, gender norms, access to education, discrimination, social aspects of pandemics, disability), political (e.g., governments and policies; migrants and displaced persons; war and conflict; reproductive health, justice, and agency), environmental (e.g., climate change and pollution), and economic factors (e.g., poverty), and their co‐occurrence, have been minimally considered for their role and impact on ADRD. To better understand gender/sex differences in ADRD in LMICs, we review how these social and societal factors may be important to ADRD using an integrated Population Neuroscience and Syndemics framework. Population neuroscience considers the brain in context using multiple levels of analyses, a life course perspective, and tools to enhance internal and external validity, while Syndemics suggest that diseases and social conditions may cluster and interact in populations with syndemic risk factors—sociocultural, political, economic, and environmental factors which promote stress pathways. We lay out a model in which syndemic risk and protective factors contribute to or protect from stress and biological aging and ultimately ADRD risk, both directly and indirectly through physical and mental health conditions. We close with recommendations for future aging and ADRD research based on this integrated Population Neuroscience‐Syndemics of ADRD framework.

Background: Alzheimer’s disease and related dementias (ADRD) are highly prevalent among adults with heart failure (HF). HF is associated with disability among older adults, especially those with ADRD. This may impact aging in place after HF hospitalizations, which is concerning given this is an important outcome for patients recovering from serious illnesses. We aimed to examine the association between ADRD and aging in place among Medicare beneficiaries hospitalized for HF. Methods: We identified 80,694 fee-for-service beneficiaries hospitalized for HF between 2017 and 2019 in a 20% random sample of Medicare claims. HF hospitalization and ADRD were identified using ICD codes. The primary outcome was restricted home time, a patient-centered claims-based measure of successful aging in place defined as spending ≥ 10 days not at home (e.g., hospitalized, nursing home, inpatient facility) over 6 months post-discharge. Multivariable logistic regression was used to examine the association between ADRD and restricted home time adjusting for demographic and clinical characteristics; secondary analyses evaluated the likelihood of returning to pre-hospitalization days at home 6 months post-discharge. Results: Eighteen percent (n= 14,503/80,694) of adults hospitalized for HF had concurrent ADRD. HF patients with ADRD were older (83 vs 77 years), more likely to be female (56% vs 48%), and have dual Medicaid/Medicare eligibility (27% vs 21%), but had similar hospital length of stays and days at home preceding HF hospitalization compared to those without ADRD. Of HF patients with ADRD, 63% had restricted home time (vs. 51% without ADRD) and 52% failed to return to baseline days at home (vs. 42% without ADRD). In adjusted models, older adults with ADRD had 34% greater odds of experiencing restricted home time (OR=1.34, 1.30-1.40), and 20% lower odds of returning to baseline days at home (OR=0.80, 0.77-0.83) 6 months post- discharge than those without ADRD. Conclusions: HF hospitalizations impact the ability of older adults to successfully age in place, especially among those with ADRD. Tailored post-discharge care solutions are urgently needed to address the challenges faced by HF patients with ADRD.