Community-Residing Older Adults Research Articles

Reliability, validity and minimal detectable change of the Chinese Version of the Assessment of Physical Activity in Frail Older People (APAFOP-C)

BackgroundPhysical activity (PA) is essential in mitigating frailty syndrome, and it is necessary to measure PA in older adults with frailty. Assessment of Physical Activity in Frail Older People (APAFOP) is a suitable patient-reported outcome measure (PROM) for assessing PA among older adults with frailty. This study aimed to determine the reliability, validity and minimal detectable change of the Chinese version of the APAFOP (APAFOP-C).MethodsThis cross-sectional validation study was designed to measure the reliability and criterion validity of the APAFOP-C with 124 frail community-residing older adults. APAFOP-C was completed twice within an interval of 7–17 days to determine test-retest reliability. The investigator triangulation method was used to investigate inter-rater reliability, and a pedometer was used as the reference measurement to assess the criterion validity. Reliability and criterion validity were assessed using the intraclass correlation coefficient (ICC2,1), Pearson correlation coefficient for normally distributed variables, Spearman correlation coefficient, Wilcoxon signed-rank test for skewed variables, and the minimal detectable change at 95% level of confidence (MDC95). Agreement assessment was conducted using Bland-Altman plots for inter-rater reliability and criterion validity. Kendall’s W test assessed absolute agreement among three raters in inter-rater reliability. The Mann-Whitney U test was used to evaluate whether any particular day was more representative of certain daily activities.ResultsTotal PA on any arbitrarily chosen day illustrates daily activity (Z= -0.84, p = 0.40). The APAFOP-C exhibited strong-to-very strong test-retest reliability (ICC2,1=0.73–0.97; Spearman ρ = 0.67–0.89), and the total PA score demonstrated MDC95 < 10%. Inter-rater reliability was also strong-to-very strong (ICC2,1=0.96–0.98; Spearman ρ = 0.88–1.00), and moderate criterion validity when compared with total PA score on pedometer readings (Spearman ρ = 0.61). Limits of agreement among different raters regarding the APAFOP-C and the pedometer were narrow.ConclusionThe APAFOP-C was found to have limited but acceptable psychometric properties for measuring PA among community-dwelling older adults with frailty in China. It was a feasible comparative PROM for assessing PA worldwide. Practitioners can develop individualized exercise programs for frail older adults and efficiently track changes in PA utilizing the APAFOP-C.

Physical Performance, Body Composition, and Oral Health in Community-Residing Older Adults: A Cross-Sectional Study.

A group of active older adults was selected from a government-sponsored reunion center in Mexico City. OHRQoL was assessed using the General Oral Health Index (GOHAI), and nutritional status was assessed using the Mini Nutritional Assessment (MNA) tool. A short physical performance battery (SPPB) was applied, and, for body composition, DXA (dual X-ray absorptiometry) was conducted. Data were analyzed using logistic regression models, and marginal probabilities were obtained. This study involved 366 participants; their mean age was 73.9 (±6.2) years, and 24.9% had type 2 diabetes mellitus (T2DM). OHRQoL information revealed that pain or discomfort in the oral cavity was perceived by 63.9% of the older adults during the previous three months. The SPPB score was low in 159 (43.44%) participants. The logistic regression model revealed that age (OR = 1.13, p < 0.001), T2DM (OR = 2.10, p = 0.009), the risk of malnutrition/malnutrition (OR = 1.76, p = 0.047), high %BF (OR = 1.09, <0.001), and poor OHRQoL (OR = 1.96, p = 0.009) were associated with deteriorated physical performance. OHRQoL self-perception, excess body fat, and nutritional status impacted physical performance. Aging well requires a comprehensive approach.

Prevalence, country-specific prescribing patterns and determinants of benzodiazepine use in community-residing older adults in 7 European countries

BackgroundThe use of benzodiazepines (BZDs) in older population is often accompanied by drug-related complications. Inappropriate BZD use significantly alters older adults’ clinical and functional status. This study compares the prevalence, prescribing patterns and factors associated with BZD use in community-dwelling older patients in 7 European countries.MethodsInternational, cross-sectional study was conducted in community-dwelling older adults (65 +) in the Czech Republic, Serbia, Estonia, Bulgaria, Croatia, Turkey, and Spain between Feb2019 and Mar2020. Structured and standardized questionnaire based on interRAI assessment scales was applied. Logistic regression was used to evaluate factors associated with BZD use.ResultsOut of 2,865 older patients (mean age 73.2 years ± 6.8, 61.2% women) 14.9% were BZD users. The highest prevalence of BZD use was identified in Croatia (35.5%), Spain (33.5%) and Serbia (31.3%). The most frequently prescribed BZDs were diazepam (27.9% of 426 BZD users), alprazolam (23.7%), bromazepam (22.8%) and lorazepam (16.7%). Independent factors associated with BZD use were female gender (OR 1.58, 95%CI 1.19–2.10), hyperpolypharmacy (OR 1.97, 95%CI 1.22–3.16), anxiety (OR 4.26, 95%CI 2.86–6.38), sleeping problems (OR 4.47, 95%CI 3.38–5.92), depression (OR 1.95, 95%CI 1.29–2.95), repetitive anxious complaints (OR 1.77, 95%CI 1.29–2.42), problems with syncope (OR 1.78, 95%CI 1.03–3.06), and loss of appetite (OR 0.60, 95%CI 0.38–0.94). In comparison to Croatia, residing in other countries was associated with lower odds of BZD use (ORs varied from 0.49 (95%CI 0.32–0.75) in Spain to 0.01 (95%CI 0.00–0.03) in Turkey), excluding Serbia (OR 1.11, 95%CI 0.79–1.56).ConclusionsDespite well-known negative effects, BZDs are still frequently prescribed in older outpatient population in European countries. Principles of safer geriatric prescribing and effective deprescribing strategies should be individually applied in older BZD users.

Changes in instrumental activities daily living limitations and their associated factors according to gender in community-residing older adults: A longitudinal cohort study.

Increases in dependence among older adults cause increases in care needs and social care burden. Instrumental activities of daily living (IADL) are often used to assess the independence of older adults residing in communities. Various factors affect IADL limitations, but few studies confirm gender differences in IADL limitations in older adults. This study explored the changes in incidence of IADL limitations across 14 years and identified the factors associated with IADL limitations according to gender among older adults in Korea. This study uses secondary data analysis with 2006-2020 data from the Korean Longitudinal Study of Aging (KLoSA), a longitudinal cohort study. Among the total 10,254 participants, 1,230 adults aged 65 years and over who met the criteria were included in the final analysis. For each IADL item, a limitation was defined when the response was partial or complete dependence. Multivariate logistic regression was performed to identify the factors (in 2006) associated with IADL limitations in 2020. The mean age of the participants at baseline was 69.64 years (SD 3.93), and 61.0% of participants were female. Total scores for IADL limitations increased gradually across 14 years in all participants, and observed changes were statistically significant. The top three ranked items of IADL limitations differed according to gender in 2020: the top limitations in men were preparing meals, laundry, and using public transportation, and the top limitations in women were using public transportation, going out, and handling money. Factors associated with total IADL limitations were grip strength in men and age, dementia, fear of fall, and grip strength in women. Factors associated with the top three ranked items of IADL limitations differed according to gender. The incidence of IADL limitations gradually increased in all participants over a 14-year period. In older adults in Korea, gender differences were confirmed in the factors associated with IADL limitations, as well as in the main limited activities. To minimize IADL limitations in community-residing older adults, it is necessary to plan tailored interventions.

PET OWNERSHIP AND LONGITUDINAL CHANGE IN PSYCHOLOGICAL ADAPTATION – EVIDENCE FROM THE BLSA

Abstract Successful aging depends in part on maintaining psychological adaptation. Research examining the relationship of pet ownership (PO) or human-animal interaction (HAI) to human health supports contributions to psychological status, mostly in populations with diseases or disabilities. We examine the contributions of PO to maintaining psychological adaptation among generally healthy community-dwelling older participants in the Baltimore Longitudinal Study of Aging (BLSA). Participants (N=637, age M=68.3, SD=9.6 years, pet owners N=149) completed assessments of anxiety (Perceived Stress Scale-10), depression (Center for Epidemiological Studies Depression), happiness (1-10 rating) and psychological wellbeing (SF-12 Mental Component Score) every 1-4 years and a 10-year PO history. Linear mixed models with random intercepts were used to examine changes in psychological adaptation outcomes over up to 13 years (M=7.5, SD=3.6) according to time-varying PO. Overall anxiety decreased (b=-0.0360,se=0.0104,p=0.001) and depression increased (b=.099141, se=0.015837, p&amp;lt; 0.001) with aging. Psychological wellbeing (b=0.00055, se=0.00119, p=0.644) and happiness (b=-.00405,se=0.0206,p=0.844) did not change. PO moderated changes in anxiety (b=0.058452,se=0.024376,p=0.017), happiness (b=-0.101373,se=0.04779,p=0.034), and psychological wellbeing (b=-0.005541,se=0.002764,p=0.045), but not depression (b=-0.01134, se=.037065,p=0.769). Anxiety and happiness improved in pet owners and deteriorated in non-owners. Psychological wellbeing deteriorated faster for pet owners than non-owners. This study provides important longitudinal evidence that PO may promote some aspects of psychological adaptation among generally healthy community-dwelling older adults by moderating age-related declines in psychological adaptation later in life. It also highlights differences in psychological responses to animal assisted interventions in residents of care facilities from changes during the life-courses of generally healthy community-residing older adults.

OUTDOOR ACTIVITY ENGAGEMENT PRIOR TO AND DURING THE COVID-19 PANDEMIC IN SENIOR LIVING COMMUNITIES

Abstract There is growing evidence regarding the benefits of spending time outdoors. However, it is less understood if the COVID-19 pandemic has deterred or increased older adults’ outdoor leisure activities when they reside in senior living communities. This study aimed to discover how the pandemic affects senior living community-residing older adults’ outdoor activities. Older adults 65 and older were recruited through ResearchMatch and university partnerships. A qualitative descriptive approach was taken with semi-structured individual interviews conducted over Microsoft Teams, telephone, or in-person. A conventional content analysis was employed. Interviews were conducted in 2021-2022 with 4 females and 3 males from suburban Pennsylvania. While there were indoor restrictions and regulations (e.g., mask wearing when around others), the outdoor environments were less regulated and routine outdoor activities continued during the pandemic. Facilitators to outdoor activities were: 1) senior living campus features (e.g., paved walking paths, outdoor recreational sport areas), 2) structured outdoor activities (e.g., bocce ball and golfing tournaments facilitated by staff), and 3) access to transportation (e.g., to drive or visit other locations). A barrier to outdoor activities was: needing assistance from staff to exit buildings due to decreased mobility. This study illuminates that amenities and structured activities at senior living facilities promoted mobility in outdoor activities for those who preferred going outside. Findings inform design features that encourage mobility and outdoor activities among older adults. Policy implications include supporting senior living communities with less resources for maintaining campuses and neighborhoods, which could contribute to promoting outdoor activities and health equity.

SUPPORTING OLDER ADULTS WHO LIVE ALONE: UNDERSTANDING THEIR UNMET NEEDS USING NHATS SURVEY DATA

Abstract Research suggests that older adults living alone in the community are at higher risk for poor health-related outcomes due to lack of cohabitants to support their health needs. Using National Health and Aging Trends Study (NHATS) data, we identified community-residing older adults (≥65 years) with assistance needs for Instrumental Activities of Daily Living (IADLs), Activities of Daily Living (ADLs), or mobility. We used bivariate analyses to compare the unmet needs related to IADL, ADL, and mobility tasks between those living alone and those living with others. Of the 3,458 individuals identified, 28.9% (n=1001) lived alone. Those living alone were more likely to be women, unpartnered, and lacking informal caregivers. There was no difference in perceived overall health scores between the groups. Individuals living alone experienced more mobility and IADL-related unmet needs. In the month prior to survey completion, those living alone were more likely to forgo getting out of bed (p=0.031), grocery shopping (p&amp;lt; 0.001), cooking (p&amp;lt; 0.001), and paying bills (p=0.025) due to lack of available assistance. Our findings suggest that older adults living alone may need higher levels of formal assistance with IADLs to remain living in the community. Given the key role IADLs play in promoting quality of life and a person’s ability to remain independent and engaged in the community, it is important to consider IADLs in addition to ADLs when assessing formal care needs for those living alone. Policy makers should prioritize the specific needs of those living alone when developing national aging strategies.

BUILDING BRIDGES ACROSS AGE-FRIENDLY ELEMENTS GUIDED BY THE 4MS FRAMEWORK

Abstract The 4 Ms framework is a set of evidence-based elements of high-quality care delivered to older adults. These include What Matters, Mobility, Medication, and Mentation. By following these principles and practicing age-friendly older adults are more likely to experience good quality care that addresses their needs. This symposium aims to build bridges across age-friendly elements that focus on the 4 Ms framework by highlighting the research of four nurse scientists. Representing the “What Matters” element, advance care planning and palliative care interventions aim at understanding and aligning care with older adults’ care preferences. In the first presentation, Dr. Rahemi will present findings of health disparities across sociodemographic groups in advance care planning using data from the Health and Retirement Study. In the second presentation, Dr. Carpenter will report on findings from a pilot pragmatic clinical trial that examined the feasibility, acceptability, and preliminary effectiveness of a primary palliative care intervention among nursing home residents with serious illness. Under the element of “Mobility”, Dr. Sefcik will present findings from a qualitative descriptive study aimed at discovering how the COVID-19 pandemic affected the outdoor activities of senior living community-residing older adults. In the fourth presentation, Ms. Coates presentation examines the last two elements of the framework - Medication and Mentation. She will report on findings from a longitudinal case-control observational study using data from the National Health and Aging Trends Study examining differences in the frequency of unpleasant symptoms experienced by older adults with polypharmacy and/or dementia.

35 The Association Between Social Support and Cognition in Older Adults with Multiple Sclerosis

Objective:Research has shown that social support has protective effects against cognitive decline in older adults. No study to date has examined the relationship between social support and cognition in older adults with Multiple Sclerosis (MS). Advances in treatments for MS have resulted in a growing number of aging individuals with MS, making it imperative to identify modifiable risk factors that affect cognition, such as social support. Therefore, this study was designed to examine the association between social support and cognition in older adults with MS and healthy controls.Participants and Methods:Participants were older adults with MS (N = 70; M age = 64.71, SD + 3.86 years; 62.9% female) and community-residing older adults (N = 74; M age = 68.42, SD + 5.96 years; 58.1% female). Perceived social support was assessed using the Medical Outcomes Study Modified Social Support Survey (MSSS), which measures emotional/informational support, tangible support, affectionate support, and positive social interaction. Cognition was assessed with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), which measures immediate and delayed memory, attention, language, and visuospatial abilities. Linear regressions stratified by group status (MS vs. control) assessed the association between perceived social support and cognition.Results:Linear regressions controlling for age, gender, education, and medical comorbidities showed that higher total MSSS scores were related to higher RBANS scores in the MS group (β = 0.243, p = .046) and marginally in the control group (β = 0.239, p = .053). Examination of MSSS domains showed that emotional/informational support (β = 0.246, p = .044) and positive social interaction (β = 0.279, p = .023) were significant predictors of RBANS performance in the MS group. Positive social interaction (β = 0.262, p = .011) was a significant predictor of RBANS performance in the control group. Analyses that further adjusted for depression scores showed that positive social interaction remained a significant predictor of RBANS performance in the control group (β = 0.361, p = .005). In contrast, depression scores attenuated associations between all aspects of social support and RBANS performance in the MS group (p &gt; .05).Conclusions:Among older adults, the association between social support and cognition varied as a function of MS status. Overall perceived social support, emotional/informational support, and positive social interaction were significantly associated with cognition in the MS group. However, depressive symptoms attenuated these associations. In contrast, positive social interaction was the key driver of the association between social support and cognition among the healthy controls, and notably, this association remained significant even after adjusting for depressive symptoms.

43 Symptoms of Apathy in Older Adults with Multiple Sclerosis

Objective:Multiple sclerosis (MS) is a chronic neurodegenerative autoimmune disease of the central nervous system. Apathy is significantly higher in adults with MS compared to healthy populations. Apathy is a lack of motivation that can cause dysfunctions in each step of goal-directed behaviors. Apathy is associated with diminished ability to perform activities of daily living, tasks requiring normal executive function, and quality of life. Across various neurodegenerative disorders, apathy has been regarded as a predictor of poor cognition and functional outcomes. However, the severity of apathy and its association with cognitive function in older adults with MS have not been reported. This study's objective was to address this gap of knowledge. Hence, we evaluated: 1) the severity of apathy symptoms in older adults with MS compared to healthy older adults and, 2) the association of apathy symptoms and global cognitive functioning in older adults with MS compared to controls.Participants and Methods:Participants were community-residing older adults (age &gt;60ys) enrolled in a cohort study, “Brain Predictors of Mobility and Falls in Older Adults with Multiple Sclerosis.” Healthy controls (n=59; mean age=66.25± 3.37; %female=47.5) and persons with MS (n=69; mean age=64.58± 3.88; %female=62.3) were included in the analysis. Using McDonald criteria, MS diagnosis was physician-confirmed by medical record review, apathy symptoms were assessed through 4 apathy symptom questions on the 30-item Geriatric Depression Scale (GDS), and global cognitive functioning was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Covariates included age, gender, years of education, global health score (GHS), and depression (GDS w/out apathy questions). For the first objective, a linear regression model was used with a bi-level group status variable (MS vs controls) serving as a predictor of apathy symptoms. For the second objective, two linear regression models stratified by group status were run with apathy symptoms as a predictor of global cognitive functioning.Results:The presence of MS was significantly associated with worse apathy (β=.34, p &lt; .001) and it remained significant after adjusting for covariates (β=.19, p=.03). Additionally, apathy was negatively associated with global cognition in persons with MS (β=-.32, p =.01) and this association remained significant after adjusting for covariates (β=-.33, p =.01) except depression (β=-.27, p =.08). The association of apathy and global cognitive functioning was not significant in healthy controls (β=.01, p=.95).Conclusions:This study is the first to report worse apathy symptoms in older persons with MS compared to healthy controls. Additionally, worse apathy symptoms were associated lower global cognitive functioning in older adults with MS but not in healthy controls.

A - 82 Perceived Social Support Is Associated with Cognition but Not Physical Functioning in Older Adults with and without Multiple Sclerosis.

To examine the association between perceived social support, cognition, and physical functioning in older adults with and without Multiple Sclerosis (MS). Participants were dementia-free older adults with MS (N = 89; M age = 64.75, SD + 4.25years; 66.3% female) and community-residing older adults (N = 102; M age = 68.74, SD + 7.12years; 62.7% female). The medical outcomes study modified social support survey (MSSS), oral symbol digit modalities test (SDMT) and timed-25-foot-walk-test (T25FW) served as outcome measures. Linear regressions stratified by group status assessed the associations between PSS, cognition, and physical functioning. Higher total MSSS scores were associated with higher SDMT scores in the MS group (β= 0.24, p = 0.02) and in the control group (β= 0.26, p = 0.005). Positive social interaction (β= 0.27, p = 0.011) was associated with SDMT performance in the MS group. Emotional/informational support (β= 0.27, p = 0.003) and positive social interaction (β= 0.25, p = 0.007) were associated with SDMT performance in the control group. Depression scores attenuated associations between perceived social support and SDMT performance in the MS group (p > 0.05) but not the control group. In contrast, higher MSSS scores were not associated with higher T25FW scores in either group. Among older adults with and without MS, perceived social support was associated with cognition but not physical functioning. Depressive symptoms attenuated associations between perceived social support and cognition in the MS group only.

Pet ownership and maintenance of cognitive function in community-residing older adults: evidence from the Baltimore Longitudinal Study of Aging (BLSA)

Pet ownership has been associated with reduced deterioration in physical health as older adults age; little research focused on deterioration in cognitive function. We examine the relationship of pet, dog, cat ownership, and dog walking to changes in cognitive function among 637 generally healthy community-dwelling older adults (185 pet owners) aged 50–100 years (M = 68.3, SD = 9.6) within the BLSA. Cognitive assessments every 1–4 years over 1–13 years (M = 7.5, SD = 3.6) include the California Verbal Learning (Immediate, Short, Long Recall); Benton Visual Retention; Trail-Making (Trails A, B, B-A); Digit Span; Boston Naming (Naming); and Digit Symbol Substitution (Digit Symbol) Tests. In linear mixed models, deterioration in cognitive function with age was slower for pet owners than non-owners (Immediate, Short, Long Recall; Trails A,B,B-A; Naming; Digit Symbol); dog owners than non-owners (Immediate, Short Recall; Trails A,B; Naming; Digit Symbol); and cat owners than non-owners (Immediate, Short, Long Recall; Naming), controlling for age and comorbidities. Among dog owners (N = 73) walkers experienced slower deterioration than non-walkers (Trails B, B-A; Short Recall). All ps ≤ 0.05. We provide important longitudinal evidence that pet ownership and dog walking contribute to maintaining cognitive function with aging and the need to support pet ownership and dog walking in design of senior communities and services.

Presence and Persistence of Perceived Subjective Cognitive Complaints and Incident Mild Cognitive Impairments Among Community-Residing Older Adults

ObjectivesTo examine whether Subjective Cognitive Complaints (SCCs) predicted incident mild cognitive impairment (MCI). DesignProspective Study. SettingCentral Control of Mobility and Aging (CCMA), a cohort study of community-residing older adults. ParticipantsParticipants were dementia-free community-residing older adults. MeasurementsSCCs were assessed at the baseline and via bi-monthly structured phone interviews during the first year using the Ascertain Dementia 8 (AD8). Nonpersistent status required one or two SCCs endorsements and Persistent status required three or more SCCs endorsements. Outcome, presence of mild cognitive impairments (MCI) was determined by established case conference diagnostic procedures. Participants were followed annually. Generalized estimating equations (GEE), logistic model type, were used to determine the odds of developing MCI during follow-up. SCCs served as the three-level predictor (no/nonpersistent/persistent) and cognitive status (MCI versus normal) as the binary outcome. Analyses were adjusted for age, sex, education, race, health status, depressive symptoms, and global cognition. ResultsThe sample (n=454; mean age=75.67 ± 6.43; %female=55.3) included 245 participants who reported no SCCs, 156 who reported 1–2 SCCs, and 53 who reported 3 or more SCCs. Sixty-eight participants developed MCI during follow-up. Results showed that compared to no SCCs, persistent SCCs, and nonpersistent SCCs were significantly associated with increased odds of developing MCI during follow-up. ConclusionsThe presence of SCCs regardless of their persistence was associated with increased odds of developing MCI even when adjusting for objectively-assessed cognitive performance.

Determinants of access of frail, community-residing older adults to geriatricians in Ontario.

Little is known about determinants of access to community-based geriatricians. The Geriatric 5Ms™ describe geriatricians' core competencies and inform referrals to specialists for older adults with complex needs. We explored the association of the Geriatric 5Ms™ and other characteristics with outpatient access to geriatricians by home care (HC) clients. This was a population-based, retrospective cohort study of frail community-dwelling HC clients (≥60 years) with complex needs (n = 196,444). Health assessment information was linked to health services data in Ontario, Canada, 2012-2015. Multivariable generalized estimating equations were used to identify characteristics associated with geriatrician contact (≥1 visit in 90 days post-HC admission), including derived Geriatric 5Ms™ score, and predisposing, enabling, and need factors obtained from clinical assessments. Only 5.2% of the cohort had outpatient geriatrician contact in Ontario, Canada. Derived Geriatric 5Ms™ score was associated with higher odds of contact, but the model had modest discriminatory power (c-statistic = 0.67). In the broader multivariable model, based on empirically included factors and adjusted for regional differences, age, worsening of decision-making, dementia, hallucinations, Parkinsonism, osteoporosis, and caregiver distress/institutionalization risk were associated with higher odds of geriatrician contact. Female sex, difficulties accessing home, impaired locomotion, recovery potential, hemiplegia/hemiparesis, and cancer, were associated with lower odds of contact. This model had good discriminatory power (c-statistic = 0.77). Few frail, community-dwelling older adults receiving HC had any outpatient geriatrician contact. While the derived Geriatric 5Ms™ score was associated with contact, a broader empirical model performed better than the Geriatric 5Ms™ in predicting contact with an outpatient geriatrician. Contact was mainly driven by conditions common in older adults, but evidence suggests that geriatricians are not evaluating the most medically complex and unstable older adults in the community. These findings suggest a need to re-examine the referral process for geriatricians and the allocation of limited specialized resources.

Depressive Symptoms are Associated with Decline Over Time in Verbal Fluency Performance in Female but Not Male Community-Dwelling Older Adults

ABSTRACT Objective The current study was designed to examine associations between depressive symptoms and longitudinal declines in category and letter fluency performance in a gender-stratified sample of older adults. Method Participants were community-residing older adults (females: n = 289; males: n = 233) followed annually (2011–2018) as part of a cohort study conducted at Albert Einstein College of Medicine in New York. Depressive symptoms were assessed using the Geriatric Depression Scale (GDS). Standard forms assessed category and letter fluency performance. Participants were dementia-free during study enrollment. Results The presence of baseline depressive symptoms suggestive of subclinical depression was associated with a worse longitudinal decline in category fluency performance in female but not male participants. These associations remained significant when excluding participants with prevalent and incident mild cognitive impairment and incident dementia. Irrespective of gender, letter fluency performance did not decline over time and was not influenced by the presence of depressive symptoms. Discussion The present study’s results can aid in identification of older adults who may be at greater risk for cognitive decline, and add to the limited literature examining the influence of gender on longitudinal associations between depressive symptoms and verbal fluency performance.

LONG-TERM POSITIVE AND NEGATIVE CONSEQUENCES OF THE COVID-19 PANDEMIC AMONG OLDER ADULTS

Abstract Despite their greater physiological vulnerability, community-residing older adults have shown surprising psychological resilience, at least at the beginning of the COVID-19 pandemic. However, a handful of reports suggest that older adults’ well-being has decreased after a few months, although others have suggested a recovery after a year (Schlomann et al., 2021). The purpose of this study was to examine change in change from baseline (April-May, 2020) to a 13- month follow-up (June, 2021). We analyzed data from 162 older adults with complete data at both time points. Mean age at baseline was 72, SD = 7.6, range = 51-96; 71% were female, 13% were minorities; 74% were married, 71% retired, and most (85%) had at least a BA. Linear modelling showed that there were only marginal increases in the number of problems across time (B = .25, p = .08), but their severity did not increase. There were no significant changes in depression, anxiety, loneliness or physical symptoms over this time period. The modest increase in problems may have been offset by an end to being in lockdown and an increase in social contacts which doubled over this time period, B = 1.65, p &amp;lt;.001). More troubling was that self-reported resilience decreased, B = -.92, p &amp;lt; .01), as did the ability to perceive positives in this situation, B = -2.46, p &amp;lt; .01), and self-reported cognitive problems increased, B=.67, p &amp;lt; .01). Thus, the results showed decidedly mixed effects, suggesting individual differences in long-term adaptation to COVID.

Longitudinal relationship between living alone and health among Chinese older adults: the mediating role of activity engagement

ABSTRACT This study examined the longitudinal relationships between living arrangements and health and the mediation effect of social interaction and leisure activity among community-residing older adults in China. Data were retrieved from three waves of the China Health and Retirement Longitudinal Study (CHARLS 2011–2015). The sample included 5,927 respondents aged 60 or older at baseline. Multilevel generalised structural equation modelling (GSEM) was used. Results showed that living alone was associated with better self-rated health over time (B = .06, SE = .03, p < .05) relative to living with others. Social interaction and leisure activity significantly mediated the effect of living alone, accounting for nine per cent of the total effect on self-rated health. Living alone has direct and indirect effects on self-rated health through activity engagement. Practice and policy efforts are needed to help older adults, especially those living alone, remain socially engaged in a supportive environment.

Cognitive reserve and risk of mobility impairment in older adults.

Cognitive reserve (CR) protects against cognitive decline and dementia but its relation to mobility impairment has not been established. To address this important gap in the literature, we conducted a longitudinal investigation to test the hypothesis that higher baseline CR was associated with a lower risk of developing mobility impairment in older adults. Participants were dementia-free older adults who received brain magnetic resonance imaging and had gait speed assessments during follow-up. Using the residuals approach, CR was computed as the variance in the Modified Mini-Mental Status Examination total score, that was left after accounting for structural brain integrity, education, and race. Mobility impairment was defined using a validated cutoff score in gait speed of 0.8 m/s. Logistic regression models using general estimating equations were utilized to examine longitudinal associations between baseline CR and the risk of developing mobility impairment across repeated assessments. Of the participants (n=237; mean age=82 years; %female=56%) who were free of mobility impairment at baseline, 103 developed mobility impairment during follow-up (mean=3.1 years). Higher CR at baseline was associated with a lower risk of developing incident mobility impairment-odds ratio (OR)=0.819, 0.67-0.98, p=0.038 (unadjusted); OR=0.815, 0.67-0.99, p=0.04 (adjusted for socio-demographic variables and depression); OR=0.819, 0.68-0.88, p=0.035 (adjusted for illness history); OR=0.824, 0.68-0.99, p=0.045 (adjusted for white matter hyperintensities); OR=0.795, 0.65-0.95, p=0.016 (adjusted for falls history). Higher CR at baseline was protective against developing incident mobility impairment during follow-up among community-residing older adults.

A-106 Diagnostic Predictive Utility of Perceived Subjective Cognitive Complaints Measured by Ascertain Dementia 8 (AD8)

Abstract Objective: Literature regarding the association between the presence and persistence of subjective cognitive complaints (SCCs) and cognitive impairments is inconsistent. Therefore, we examined whether SCCs status (no/non-persistent/persistent SCCs), predicted the risk of developing incident Mild Cognitive Impairment (MCI). Methods: Participants were dementia-free community-residing older adults. We assessed SCCs at the baseline visit and via bi-monthly structured phone interviews during the first study year using the Ascertain Dementia 8 (AD8). Non-persistent status required one SCCs endorsement and Persistent status required two or more SCCs endorsements. Cognitive status was determined by established case conference diagnostic procedures. Participants were followed annually up to 5 years. Generalized Estimating Equations (GEE), logistic model type, were used to determine the odds of developing MCI during follow-up. The presence and persistence of SCCs served as the three-level predictor. Analyses adjusted for age, sex, education, ethnicity, and health status. Results: The sample (n = 454; mean age = 75.67 ± 6.43; %female = 55.3) included 245 participants who reported no SCCs, 105 who reported 1 SCCs and 104 who reported 2 or more SCCs. 59 participants developed MCI during follow-up. GEE results showed that compared to no SCCs, persistent SCCs (OR = 3.004, 95% CI = 1.503–6.003, p = 0.002), and non-persistent endorsements of SCCs (OR = 3.760, 95%CI = 1.946–7.265, p &amp;lt; 0.001) were significantly associated with increased odds of developing MCI during follow-up. Conclusions: The presence of SCCs regardless of its persistence was associated with increased odds of developing MCI among older adults.

Depression/anxiety symptoms and self-reported difficulty managing medication regimen among community-dwelling older adults

ObjectiveTo examine the associations between depression/anxiety severity and changes in severity and self-reported difficulty managing medications among a representative sample of community-residing US Medicare beneficiaries without a reported dementia diagnosis. MethodWe used the 2018 and 2019 National Health and Aging Trend Study (analysis sample N = 3198, 98% age 70+). Depression/anxiety was measured with the PHQ-4, and difficulty managing medication was self-reported. Following descriptive statistics, we fit a multinomial logistic regression model to examine the associations between depression/anxiety symptoms in 2018 and changes in severity between 2018 and 2019 and self-reported level of difficulty managing medication in 2019. ResultsOf past-month prescription medication users in 2019, 85.2%, 10.7%, and 4.1% reported no difficulty, a little/some difficulty, and a lot of difficulty or partial/full reliance on other's help for health/functioning reasons, respectively. Both mild and moderate/severe levels of depression/anxiety in 2018 were associated with significantly higher risks of a little/some difficulty and a lot of difficulty/other's help in 2019. Compared to no change in depression/anxiety symptoms between 2018 and 2019, decreased symptoms were associated with lower risk (RRR = 0.47, 95% CI = 0.28–0.78) and increased symptoms were associated with higher risk (RRR = 1.73, 95% CI = 1.12–2.67) of a little/some difficulty managing one's medication. ConclusionsDecrease and increase in depression/anxiety are associated with decreased and increased risk, respectively, of medication self-management difficulty among community-residing older adults. Healthcare providers should more carefully assess for medication management problems in their older adults with depression and anxiety symptoms and provide individually tailored interventions for those with great difficulty self-managing medication.