Diverse Older Adults Research Articles

THE ADULT DAY CENTER: UNTAPPED TERRITORY FOR AGING RESEARCH

Abstract Adult day service centers (ADCs) in the United States are a vital, but overlooked source of community-based long-term care for diverse older adults with multiple chronic conditions, including dementia. The National Institute on Aging has called for more research on ADCs. In this interdisciplinary symposium, we present challenges and opportunities in conducting research in these congregate settings. First, we look at the operating status of ADCs nationally in the aftermath of the COVID-19 pandemic and disparities in access to care using longitudinal data from the National Post-acute and Long-term Care Study. Then we examine the lack of electronic health record utilization and clinical data capture in 4,035 ADCs nationally and discuss strategies to modernize technology in these settings to facilitate data collection. We subsequently present a new database, developed vis a vis an academic/community partnership between the National Adult Day Services Association and researchers, that centralizes and makes data collection feasible in ADCs with limited resources. We will also explore factors supporting intervention research that are unique to ADCs. Finally, we present a protocol adapted for the ADC setting, to test a mobile application that facilitates data collection and enables communication between ADCs, caregivers, and healthcare providers. Our findings show that, while research in ADCs has been limited historically, academic, government, and community partners are working together to spur pragmatic innovations that modernize these settings and better resource them to elevate standards of care.

VIOLENCE, IDENTITY, BEHAVIORS, AND ACCESS: MECHANISMS ACCOUNTING FOR CHANGES IN HEALTH OVER TIME OF LGBTQ OLDER ADULTS

Abstract As the population of older adults is growing in complexity and diversity, research has established health disparities by sexual and gender identity among older adults. While most research to date has been cross-sectional, this paper utilizes four-wave longitudinal data from Aging with Pride: National Health, Aging and Sexuality/Gender Study (NHAS) to understand the health and quality of life (QOL) of LGBTQ and sexual and gender diverse older adults over time. Mixed models were run to examine: (1) linear changes over time in health and QOL, controlling for background characteristics, (2) effects of key risk and protective factors on these changes, and (3) gender and age group interactions. Increases in violence, discrimination, identity stigma, adverse health behaviors and experiences (e.g., low physical activity, insufficient nutrition, and suicidal ideation), and decreased access to health and care services were related to poorer health, more cognitive and functional impairment, and lower QOL. Men (vs. women) and the Pride (vs. Silenced and Invisible) Generation were impacted to a greater degree by violence and discrimination, and the impacts of insufficient nutrition and suicidal ideation were also greater in the Pride Generation. Cognitive health of men and gender diverse individuals benefited more strongly from healthcare access. This longitudinal study provides important new findings regarding the mechanisms accounting for the accelerated decline in health and QOL over time in these diverse populations. This information is needed to develop tailored interventions that address these mechanisms as well as are responsive to variations among diverse ages, genders, and sexualities.

COGNITIVE ASPECTS OF MANAGING STRESS AND UNWANTED EMOTION SUCCESSFULLY IN OLD AGE

Abstract The ability to cope with stressors and manage unwanted emotion is central to health-related outcomes across adulthood. Prominent models of adult development suggest there may be age-related shifts in motivational strivings and accumulated knowledge that help support emotional well-being in old age. At the same time, older adults have cognitive and physical vulnerabilities that may offset some of these strengths. This session will showcase new work leveraging experimental and experiencing sampling methods to examine how people of varying ages and resource levels manage their emotions. These studies provide new insights into how older adults respond to stressors and adverse stimuli in controlled settings and daily life contexts. The first talk centers on how individuals are negatively impacted by cognitive stressors regardless of age, but older adults show more resilience than younger adults after stressor exposure. The second talk focuses on how a cognitive process known as affective labeling (or naming one’s emotions) can create emotion regulation difficulties, especially in old age. The third talk examines emotion regulation success and the benefits of instructional support for cognitively normal older adults compared to those with mild cognitive impairment (MCI). The fourth talk extends this work by tracking emotion regulation motives in daily life, showing that cognitively diverse older adults report fewer attempts to manage their emotions, but similar reasons for doing so, compared to relatively younger adults. Together these presentations delineate age-related similarity and differences in emotion regulation, highlighting avenues through which coping capacity may be maintained and improve in late life.

CHALLENGES AND OPPORTUNITIES IN RECRUITING DIVERSE OLDER ADULTS WHO ARE FRAIL FROM THE MAPS-B STUDY

Abstract Including diverse individuals at the research and participant levels are essential to improve the effectiveness of real-world interventions; however, there are challenges when including such individuals. Our study purpose was to report the challenges of recruiting diverse older adults for the Mapping Sedentary Behaviour study. Our methods were guided by Step 1 (“Establish Partnerships”) in the Knowledge-to-Action-Ethics Framework. We assembled a diverse team of eleven researchers, clinicians, and patient partners. To recruit a broad group of participants, we partnered with City Housing Hamilton, which provides subsidized housing for older adults. We met with the organization’s partnership development advisor who organized two recruitment orientations; 80 potential participants and returning attendees were present for both sessions. The organization provided coffee and donuts. Most attendees were from visible minorities and had visible disabilities (i.e., used a walker or cane). To build rapport, we met with attendees in groups of 5 to 6 to introduce the research team and explain the study. We recruited 13 participants (seven female, one transgender man; Morley FRAIL score≥3). Before their scheduled study visit, twelve participants dropped out citing medical mistrust (i.e., fearing unintentional medical tracking). The last participant dropped out after the initial study visit due to their family’s skepticism in research. Additionally, some individuals may have enrolled for financial incentives as they were interested in receiving immediate monetary compensation. We faced challenges when recruiting frail older adults from diverse backgrounds. Future studies should focus on developing methods to target medical mistrust with older adults and their families.

ADVANCE CARE PLANNING ACROSS SOCIODEMOGRAPHIC CHARACTERISTICS AND COGNITION LEVELS

Abstract Older adults from underrepresented and minority groups have higher rates of chronic disease and cognitive impairment and lower rates of advance care planning and comfort care at the end of life. This study examined advance care planning in U.S. older adults across different sociodemographic characteristics and cognition levels. Secondary data analyses were conducted using the 2014 Health and Retirement Study. Logistic regression models were run with each outcome variable (having living will, durable power of attorney for healthcare [DPOAH], and both the living will and DPOAH) stratified by cognition (dementia/impaired cognition versus normal cognition). Prediction variables included race, ethnicity, rurality, marital status, gender, education, age, everyday discrimination, social support, and loneliness. Of the 17,698 respondents, 77.8% had normal cognition and 22.2% had a diagnosis of dementia or impaired cognition. Black and Hispanic participants and younger individuals with lower levels of education were less likely to have a living will or both DPOAH and living will in place. Race and ethnicity were significant predictors of DPOAH among the normal cognition group but not in the dementia group. Rurality significantly predicted having a living will and both DPOAH/living will for the normal cognition group but not the dementia/impaired cognition group. This study provides evidence of the need to understand advance care planning disparities among older adults with multiple marginalized identities and different cognition levels. The findings are important for examining advance care planning regarding what matters to diverse older adults as they age and confront health and cognition decline.

OLDER ADULTS WITH MULTIPLE CHRONIC CONDITIONS FROM VULNERABLE POPULATIONS: THE SUCCESS OF PATIENT PRIORITIES CARE

Abstract As older adults in the USA grow more diverse, equitable translation of knowledge and best practices to vulnerable groups is essential. Older adults with multiple chronic conditions (MCC) benefit from care focused on the health priorities of individuals. Health priorities include: 1) core values that provide meaning to life; 2) specific, actionable, and realistic health goals that reflect these values; and 3) care preferences that include what individuals are able and willing to do (or not) to achieve their goals. For vulnerable older adults, adverse life experiences provide context to their values. A diverse panel will review the Patient Priorities Care (PPC) approach and describe how PPC has been successfully adapted at different institutions. The first presentation will describe PPC and the importance of identifying values, goals, and health preferences for older adults with MCC. The presenter will show that PPC improves outcomes among older adults, their families, and healthcare providers. The second presentation will describe the implementation of PPC in the VA system. The presenter will describe the impact of PPC and efforts to disseminate it. The third and fourth presentations will describe the cultural adaptation of PPC for older African Americans and older Hispanics respectively. The presenters will describe the adaptation process and discuss the barriers they faced, and the lessons learned from each population group. The panel will conclude by providing suggestions on how to disseminate and increase the adoption of PPC to identify what matters most for diverse older adults.

USER-CENTERED DESIGN FOR SOCIALLY ASSISTIVE ROBOTIC ACTIVITIES WITH OLDER ADULTS IN LONG TERM CARE

Abstract Apathy is common among older adults (OAs) in long term care (LTC) and associated with adverse outcomes. Engaging residents in socially interactive multimodal activities is resource intensive. Socially assistive robots (SARs) may supplement LTC staff resources. However, few studies have involved OAs in the design of SAR activity. We conducted a multi-step user-centered design process to design and evaluate SAR activities that a) used different robots (humanoid, puppy), b) a virtual reality interface, and c) required dyadic interaction between residents. Phase 1 (system design) focused on prototype development with input from literature and an advisory panel of LTC adults and staff. Phase 2 focused on determining usability measures. Phase 3 (iterative testing) focused on field testing at two LTC sites. Multiple sessions were conducted that required looping back to earlier stages of prototype development for refinement and improvement of both the activity and the system until end users deemed them usable. Results: 12 residents (ages 72-92, 9 women) and 5 LTC staff participated in the design of four SAR activities (music, fishing, painting, and spelling). Perceived comfort and confidence improved from baseline (d=0.708). Interaction between pairs increased from 0.16/min to 1.14/min. LTC staff were able to administer the system. Conclusion: Older LTC adults are pivotal in informing technology development and capable of providing essential information in use and acceptance of technology. Next steps include large scale feasibility and effectiveness testing in a clinical trial among diverse older adults residing in LTC facilities.

THE ROLE OF MILD COGNITIVE IMPAIRMENT AND MARITAL STATUS ON LONELINESS AND INTRUSIVE THOUGHTS IN DAILY LIFE

Abstract Loneliness is associated with maladaptive cognitions (e.g., rumination and intrusive thoughts) among young adults, but less is known about this association among older adults. Experiencing loneliness and intrusive thoughts throughout daily life may disrupt emotion regulation and increase risk for cognitive decline during later life. Moreover, social and cognitive factors, including marital status and mild cognitive impairment (MCI), may be protective or exacerbating factors that moderate these associations. For example, having close relationships (e.g., being married) is associated with better mental health and overall well-being for older adults and intrusive thoughts have been associated with poorer cognitive performance. We used multilevel modeling to examine the association between momentary loneliness and intrusive thoughts among older adults and whether MCI and marital status moderated this association. Participants were 316 diverse older adults without dementia (40% Black; 13% Hispanic, mean age = 77.45 years, 67% women) living in the Bronx, NY who completed ecological momentary assessments 5 times daily for 14 consecutive days. There was a significant three-way interaction (β = -0.175, p < 0.05) such that the association between momentary loneliness and intrusive thoughts was strongest for those with MCI who were not married and weakest for those with MCI who were married. Covariates included race/ethnicity, years of education, age, and gender. These findings suggest that for those who have MCI, being married may be a protective factor against moments of loneliness and intrusive thoughts. For those who are not married, tailoring interventions to accommodate MCI status may be worthwhile.

Testing the ‘Faith Moves Mountains model’ to increase Alzheimer’s disease awareness, detection, and diagnosis among rural, racially, and ethnically diverse older adults

Objectives Racially and ethnically diverse populations have recently contributed to the majority of rural and small-town growth. Consequently, the disproportionately high risk and prevalence of Alzheimer’s disease and related dementias (ADRD) among rural and minoritized older residents will likely increase. To address this threat, we tested the hypotheses that (1) a faith-based, resident-led approach would increase basic ADRD knowledge and diagnosis, and (2) older age, female gender, lower educational levels, and more years lived rural would predict number of referrals, new dementia diagnoses, and treatment. Methods An adaptation of Schoenberg’s Faith Moves Mountains model, previously successful in detection and management of other chronic illnesses in rural settings, guided this community-based participatory research. Local faith community members were trained as research assistants to recruit, administer surveys, conduct brief memory assessments, teach brain health strategies, and follow-up with residents. Outreaches were offered virtually during the pandemic, then in-person monthly at rotating church sites, and repeated ∼1 year later. Results This rural sample was racially and ethnically diverse (74.5% non-White), with 28% reporting eight or less years of formal education. Findings included that referrals and years lived rural were significant and positive predictors of new ADRD treatments [(b = 3.74, χ 2(1, n = 235) = 13.01, p < 0.001); (b = 0.02, χ 2(1, n = 235 = 3.93, p = 0.048)], respectively, regardless of participant characteristics. Conclusion Resident-led action research in rural, diverse, faith communities is a successful approach to increasing ADRD disease knowledge, detection, diagnosis, and treatment.

Cluster‐Derived Psychosocial Phenotypes, Cognitive Outcomes, and AD Plasma Biomarkers of Black and Hispanic/Latino Older Adults Enrolled in HABS‐HD

AbstractBackgroundAlthough Black and Hispanic/Latino older adults are at increased risk for Alzheimer’s disease (AD), there is considerable within‐group heterogeneity in psychosocial factors of risk and resiliency amongst these community members. The present study (1) used cluster analysis on measures of economic/social resources and psychiatric distress to identify distinct subgroups and (2) compared cognitive and AD biomarker outcomes of these groups in an effort to understand pathologic aging among racially/ethnically diverse older adults.MethodBaseline data from 816 Black and Hispanic/Latino participants without dementia enrolled in HABS‐HD were included. Variables in the cluster analysis included: annual income, state area deprivation index, social support, occupational complexity, chronic stress, and symptoms of depression and anxiety. A discriminate function analysis (DFA) tested the extent to which the individual variables predicted cluster‐group membership. ANOVAs and chi‐squared tests compared the groups on demographics. ANCOVAs controlling for age, education, sex, and race/ethnicity examined group differences in subjective cognitive concerns, objective memory and executive functioning composite scores, and plasma AD biomarkers (AB42/40, t‐tau, NfL).ResultThe cluster analysis identified 3 distinct groups: Group 1 was low resource/high distress (n = 215); Group 2 was high resource/low distress (n = 248); and Group 3 was low resource/low distress (n = 353; Figure 1). The DFA correctly classified 95.3% of participants. Results revealed significant group differences in education and the proportion of women and Black adults across the groups (see Table 1). ANCOVAs revealed significant group differences in subjective memory concerns, executive functioning composite, and plasma AD biomarkers; Group 1 consistently displayed poorer cognitive outcomes and more severe AD biomarker patterns relative to Groups 2 and 3, but there no differences in outcomes between Groups 2 and 3. No group differences on the memory composite were observed.ConclusionRisk for AD among racially/ethnically diverse older adults may differ as a function of current levels of resources and psychiatric distress. Group 1 represents individuals with low resources and high levels of distress that may be at increased risk for poor outcomes in late life. Future work should further clarify precise mechanisms of resiliency, such as social support, in Group 3 and explore longitudinal trajectories of cognitive decline across the groups.

Depression and the relationship between neurocognition and functional status and decline within ethnoculturally diverse middle and older adults

AbstractBackgroundEthnoculturally diverse (e.g., non‐Latinx Black (NLB), Latinx) older adults are up to twice as likely as non‐Latinx White (NLW) older adults to experience depressive symptoms. While the relationship between neurocognition (NC) and functional status (e.g., everyday functioning) in older adults is well‐established, the impact of depression remains unclear in diverse populations. We assessed the influence of depression on the relationship between NC and functional status in a sample of Latinx, NLB, and NLW middle‐aged/older adults.MethodThis cross‐sectional study included 50 NLB, 45 Latinx, and 38 NLW (N = 133) adults (59% female; 39% with HIV; M age = 65.3, SD = 6.69; M ed = 13.9, SD = 3.22) who completed the Beck Depression Inventory‐II (BDI‐II), Activities of Daily Living (ADL) scale, and a comprehensive NC battery. Demographically‐corrected T‐scores were used to compute global NC and domain average T‐scores (global cognition, executive function, learning, memory, verbal fluency). The BDI‐II Total Score (BDI‐tot), Cognitive‐Affective Subscale (BDI‐cog), Functional‐Somatic Subscale (BDI‐som), current functional status (ADL‐tot), and decline over time (ADL‐dec) were computed. A series of hierarchical linear regressions (HLRs; Step 1: BDI‐tot; Step 2: NC global/domain NP T‐scores) were computed to predict ADL‐dec in each ethnocultural group. To assess age effects in this relationship, additional HLRs (Step 1: BDI‐tot, age, BDI‐tot×age and Step 2: NC global T‐score) were computed.ResultBDI‐tot, BDI‐cog, and BDI‐som were significantly correlated with ADL‐dec (r s = .58‐.64, ps&lt;.01) in NLW adults. However, in NLB adults, only BDI‐cog was correlated with ADL‐dec (r = .51, p&lt;.01), while in Latinx adults, both BDI‐tot and BDI‐som were significantly related to ADL‐dec (r s = .38, ps &lt;.05). Within NLB adults, BDI‐tot accounted for 15‐16% of the variance in ADL‐dec (ps&lt;.05), but NC scores did not uniquely contribute to the model/s (ΔR 2 = 0‐.11, ps&gt;.05). Across ethnocultural groups, BDI‐tot×age did not significantly predict ADL‐dec. However, in the NLW group BDI‐tot×age was a significant predictor of ADL‐tot (ΔR 2 = .53, p&lt;.05).ConclusionDepressive symptoms are associated with functional decline, particularly in NLB middle/older adults. Cognitive‐affective symptoms may better predict functional status in middle/older NLB adults, while somatic‐functional symptoms are associated with functional decline in Latinx middle/older adults. Future studies should examine the longitudinal impact of depression on functional status/NC within ethnoculturally diverse older adults.

Social Networks and MRI measures of Brain Injury in Racially and Ethnically Diverse Populations

AbstractBackgroundSocial networks may influence late‐life cognition directly via affecting brain structures or indirectly through enhancing cognitive resilience – i.e., the ability to maintain cognitive function in the presence of neurodegeneration. This study assesses the associations of social networks with markers of neurodegeneration, and determines whether social networks modify the associations between these markers and cognitive function.MethodWe pooled data from three harmonized cohorts of Kaiser Permanente Northern California members: the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE)study, the Study of Healthy Aging in African Americans (STAR), and the LifeAfter90 (LA90) Study. Social network sizes were calculated by summing the number of living children, spouse, and close relatives and friends. Neuroimaging markers included total brain volume (TBV), hippocampal volume (HCV), and white matter hyperintensity volume (WMH). Volumetric measures were normalized using a residual approach, which regressed intracranial volume (ICV) on volumetric measures to predict the ICV‐adjusted volume. Executive function and verbal episodic memory were measured by the Spanish and English Neuropsychological Assessment Scales and were z‐standardized. Linear regression models estimated the associations between social network size and each neuroimaging marker, adjusting for age, sex, race and ethnicity, education, cohort, and Activities of Daily Living (ADLs). We included an interaction term between social networks and neuroimaging markers to evaluate whether the relationships between imaging markers and cognitive function differed by social networks.ResultThe pooled sample’s average age was 76 (SD 11) years (59% female; 47% Black) (Table 1). In the fully adjusted models, the mean differences in injury markers did not differ by social network size (Figure 1). However, the associations of HCV and WMH with executive function (βsocial network*WMH = 0.09, 95% CI 0.01,0.18; βsocial network*HCV = ‐0.08, 95% CI ‐0.15, ‐0.01) were stronger among participants with smaller social networks (Figure 2).ConclusionIn this cross‐sectional study of racially and ethnically diverse older adults, larger social networks attenuated the associations between neurodegeneration markers and executive function. These findings suggest that larger social networks may promote cognitive resilience.

Strategies to inform public policies while studying diverse older adults living alone with cognitive impairment in the United States

AbstractBackgroundBridging research and policy allows research findings to have a lasting impact in the wellbeing of vulnerable population such as the estimated 4.3 million older adults living alone with cognitive impairment in the United States. For example, a lasting impact comes from healthcare and social services provided by Medicare and Medicaid tailored to address unmet needs of these populations identified via rigorous research. Despite the importance of bridging research with policy, researchers seldom collaborate with policy makers, thus missing the opportunity of influencing policies. Reasons for these limited collaborations include limited knowledge on methods for researchers to collaborate with policy makers. This session will draw from the expertise gained by the research team of the 5‐year Living Alone with Cognitive Impairment Project to involve policy experts in the design of their mixed‐method study.MethodAt the very start of the 5‐year project (2020) we convened a Policy Advisory Group and then conducted 17 one‐on‐one interviews and 4 plenary meetings with its 17 members which include diverse policy experts at national and federal level.ResultRegular interactions between the research team and the Policy Advisory Group led to: 1) a mixed‐method design aligned with policy priorities; 2) a report highlighting the priorities of PAG members with regard to policies to enhance the wellbeing of older adults living alone in the US; 3) a series of policy briefs highlighting key findings and related policy recommendations.ConclusionThe oversight, and regular engagement, of a Policy Advisory Group has allowed the Living Alone with Cognitive Impairment Project to focus research activities that are most likely to be translated into policy solutions, thus likely to mostly benefit older adults living alone with cognitive impairment, with emphasis on communities of color. These practices can be easily replicated by researchers in studies supporting underserved populations.

Feasibility of the CART In‐Home Technology Platform in a Pilot Study of Hispanic Older Adults Residing in South Texas

AbstractBackgroundAs Alzheimer’s disease (AD) prevalence rises, the development of effective screening tools is necessary to aid in earlier AD diagnosis. In the USA, Hispanic and Non‐Hispanic Black adults are at a disproportionately higher risk of developing dementia than non‐Hispanic whites but are poorly represented in AD research. A digital assessment system ‐ the Collaborative Aging Research using Technology (CART) platform, has been developed to remotely and continuously detect early declines in cognition by analyzing changes in everyday activity levels. Although the platform is promising, installing digital technology in a home can cause concerns over privacy and user friendliness, especially in older adults. In our CART pilot study at UTHSCSA, we sought to determine the feasibility of deploying the CART platform in an underrepresented, mostly Hispanic population and to gain insight from their experiences.MethodSeven cognitively intact participants were enrolled in our year‐long pilot study. The CART platform consisted of a watch‐actigraph, digital scale, electronic pillbox, bed mat (measuring sleep), and wall‐mounted motion sensors. Participants completed weekly online surveys including mood assessments, the UDS3 neuropsychological battery at baseline and one‐year follow‐up, and an end‐of‐study user experiences survey. Wilcoxon signed rank exact tests were used to determine significance.ResultOur cohort consisted of five Hispanic, one non‐Hispanic Black, and one non‐Hispanic white participant, ages 65‐80. There were no significant changes in cognition, daily steps, sleep, weight, or heart and respiratory rate measured during sleep over the course of the study (p&gt;0.05). Self‐reported depressive symptoms decreased (p = 0.034) (Figure 1J). Weekly survey results supported this finding because self‐reported feelings of loneliness and “blue mood” also decreased. Responses to the user experience survey demonstrated that participants found the technology installation satisfactory (43%) or very satisfactory (57%) and thought that their privacy concerns were addressed satisfactorily (43%) or very satisfactorily (57%) (Figure 2).ConclusionOur results suggest that the CART platform was widely accepted by our mostly Hispanic older adult participants and that they were comfortable with the study devices. The findings support the feasibility of increasing representation of diverse older adults in dementia prevention research using digital devices.

Recruitment and Engagement of LGBTQIA+ Older Adults for The Stonewall Generations Study

AbstractBackgroundAccording to the Alzheimer’s Association, approximately 350,000 LGBTQIA+ older adults in the U.S. currently have Alzheimer’s disease and related disorders (ADRD), increasing to over a million by 2030. Our recent research suggests that 1 in 7 LGBTQIA+ older adults report problems with their memory and thinking (subjective cognitive decline), which was much higher than their cisgender (not transgender), heterosexual counterparts. However, very few studies have assessed the cognitive function of LGBTQIA+ older adults.MethodsWe are utilizing tailored recruitment and engagement strategies to recruit a racial/ethnically diverse sample of at least 250 LGBTQIA+ and 250 non‐LGBTQIA+ older adults aged 50+ from the U.S. with a range of cognitive function from healthy to mildly impaired. Our recruitment and engagement approaches are guided by community‐based participatory research approaches that focus on building trust, collaboration, cultural humility, and giving back to the community.ResultsWe have been utilizing novel methods to recruit and engage LGBTQIA+ older adults and community organizations across the U.S. into The Stonewall Generations Study. Our current efforts involve a diverse recruitment plan that relies on recruitment via social media (e.g., Facebook, Twitter), referrals from community organizations, local outreach (tabling at community resource fairs, attending Pride and other LGBTQIA+ focused events), presenting to LGBTQIA+ aging service organizations, and developing unique social and educational engagement events.ConclusionsOur current efforts to recruit and engage LGBTQIA+ older adults are important because they can help to identify ways to improve representation of diverse communities in Alzheimer’s disease and aging research. There is a need for tailoring research and recruiting and engaging diverse older adults, especially LGBTQIA+, into research and finding ways to address the health and Alzheimer’s disease risk of underserved populations. The Stonewall Generations Study aims to increase knowledge of culturally‐relevant recruitment and engagement strategies and identify targets for preventative interventions to decrease ADRD risk among LGBTQIA+ older adults.

The copenhagen cross-linguistic naming test (C-CLNT): Development and validation in a multicultural memory clinic population.

Despite recent advances in cross-cultural neuropsychological test development, suitable tests for cross-linguistic assessment of language functions are not widely available. The aims of this study were to develop and validate a brief naming test, the Copenhagen Cross-Linguistic Naming Test (C-CLNT), for the assessment of culturally, linguistically, and educationally diverse older adult populations in Europe. The C-CLNT was based on a set of standardized color drawings. Items for the C-CLNT were selected by considering name agreement and frequency across five European and two non-European languages. Ambiguities in some of the selected items and scoring criteria were resolved after pilot testing in 10 memory clinic patients. The final 30-item C-CLNT was validated by verifying its psychometric properties in 24 controls and 162 diverse memory clinic patients with affective disorder, mild cognitive impairment, and with dementia. The C-CLNT had acceptable scale reliability (coefficient alpha = .67) and good construct validity, with moderate to strong correlations with traditional language tests (r = .42- .75). Diagnostic accuracy for dementia was good and significantly better than that of the Boston Naming Test (areas under the curve of .80 vs .64, p < .001), but was poor for mild cognitive impairment. Only 3% of the variance in C-CLNT test scores was explained by immigrant background, while 6% was explained by age and years of education. In comparison, these proportions were 34 and 22% for the BNT. The C-CLNT has promising clinical utility for cross-linguistic assessment of naming impairment in culturally, linguistically, and educationally diverse older adults.

Multisectoral Collaborations to Increase Recruitment and Retention of Diverse Older Adults in Biomedical Research.

Older adults, especially minoritized racial-ethnic groups, are historically underrepresented in biomedical research. This study summarizes the development and assesses the impact of a review board involving a multisectoral group of stakeholders with the goal of increasing the diversity of older adults in biomedical research. A 25-member board of community members, caregivers, researchers, and clinicians from Upstate New York reviewed 3 projects presented by researchers, clinician-scientists, and a pharmaceutical company between January and December 2022. For each biomedical research project, the reviews provided guidance to increase the recruitment and retention of diverse older adults engaged in the study. Review board members and presenters completed surveys to provide feedback on their experience in this collaboration. There was consistent positive feedback from all members and presenters. From member surveys, feedback trended positive in meetings throughout the year. Community members and caregivers initially indicated discomfort in expressing their views; however, these concerns subsided over time. Presenters had a very positive experience in the review board's impact on their recruitment strategy and study design, and therefore very likely to use this service again. Recommendations were made to adjust membership criteria, presentation format, and funding to sustain this effort. Lack of diversity for older adults represented in biomedical research contributes to ethical and generalizability ramifications. The positive feedback from all stakeholders in our multisectoral board of community members, caregivers, researchers, and clinicians offers a promising structure for developing similar strategies to increase diversity within and beyond biomedical aging research in other communities.

5 The Association of Neighborhood Socioeconomic Deprivation with Neurocognition in a Diverse Cohort of Middle- and Older-Aged Persons Living with and Without HIV

Objective:Due to decades of structural and institutional racism, minoritized individuals in the US are more likely to live in low socioeconomic neighborhoods, which may underlie the observed greater risk for neurocognitive impairment as they age. However, these relationships have not been examined among people aging with HIV. To investigate neurocognitive disparities among middle- and older-aged Latino and non-Latino White people living with HIV (PWH), and whether neighborhood socioeconomic deprivation may partially mediate these relationships.Participants and Methods:Participants were 372 adults ages 40-85 living in southern California, including 186 Latinos (94 PWH, 92 without HIV) and 186 non-Latino (NL) Whites (94 PWH, 92 without HIV) age-matched to the Latino group (for the overall cohort: Age M=57.0, SD=9.1, Education: M=12.7, SD=3.9, 38% female; for the group of PWH: 66% AIDS, 88% on antiretroviral therapy [ART]; 98% undetectable plasma RNA [among those on ART]). Participants completed psychiatric and neuromedical evaluations and neuropsychological tests of verbal fluency, learning and memory in person or remotely. Neuropsychological results were converted to demographically-unadjusted global scaled scores for our primary outcome. A neighborhood socioeconomic deprivation variable (SESDep) was generated for census tracts in San Diego County using American Community Survey 2013-2017 data. Principal components analysis was used to create one measure using nine variables comprising educational (% with high school diploma), occupational (% unemployed), economic (rent to income ratio, % in poverty, (% female-headed households with dependent children, % with no car, % on public assistance), and housing (% rented housing, % crowded rooms) factors. Census tract SESDep values were averaged for a 1km radius buffer around participants’ home addresses.Results:Univariable analyses (independent samples t-tests and Chi-square tests) indicated Latinos were more likely to be female and had fewer years of formal education than NL-Whites (ps&lt;.05). Latino PWH had higher nadir CD4 than White PWH (p=.02). Separate multivariable regression models in the overall sample, controlling for demographics and HIV status, showed Latinos had significantly lower global scaled scores than Whites (b=-0.59; 95%CI-1.13, -0.06; p=.03) and lived in more deprived neighborhoods (b=0.62; 95%CI=0.36, 0.88; p&lt;.001). More SES deprivation was significant associated with worse global neurocognition in an unadjusted linear regression (b=-0.55; 95%CI=-0.82, -0.28; p&lt;.001), but similar analyses controlling for demographics and HIV status, showed SESDep was not significantly related to global scaled scores (b=-0.11; 95%CI= -0.36, 0.14; p=.40). Exploratory analyses examined primary language (i.e., English vs Spanish) as a marker of Hispanic heterogeneity and its association with neurocognition and SESDep. Controlling for demographics and HIV status, both English-speaking (b=0.33; 95%CI=0.01. 0.64; p=.04) and Spanish-speaking Latinos (b=0.88; 95%CI=0.58, 1.18; p&lt;.001) lived in significantly greater SESDep neighborhoods than Whites, with SESDep greater for Spanish-speakers than English-speakers (p&lt;.001). However, only English-speaking Latinos had significantly lower neurocognition than Whites (b=-0.91; 95%CI=0-1.57, -0.26; p&lt;.01; Spanish-speakers: b=-0.27; 95%CI=-0.93, 0.38; p=.41).Conclusions:Among our sample of diverse older adults living with and without HIV, English-speaking Latinos showed worse neurocognition than Whites. Though SES neighborhood deprivation was worse among Latinos (particularly Spanish-speakers) it was not associated with neurocognitive scores after adjusting for demographics. Further studies investigating other neighborhood characteristics and more nuanced markers of Hispanic heterogeneity (e.g., acculturation) are warranted to understand factors underlying aging and HIV-related neurocognitive disparities among diverse older adults.

84 Utilizing the DSM-5 Cross Cutting Measure to Characterize the Neuropsychiatric Correlates of Subjective and Objective Cognition

Objective:Historically, psychiatric conditions and neurodegenerative diseases have been considered differential diagnoses in older adults with cognitive impairment. However, recent evidence has shown that neuropsychiatric symptoms may be prodromal for neurodegenerative disease. Subjective Cognitive Decline (SCD) is a potential marker for pre-clinical Alzheimer’s Disease (AD) that is frequently related to mood disturbances. Delineating the relationship between neuropsychiatric symptoms, SCD, and cognitive impairment will help to define both the independent and combined utility of SCD and neuropsychiatric symptoms as markers of preclinical AD. This abstract uses the DSM-5 Cross-Cutting Measure (DSM-5 CC), a novel comprehensive screening tool for psychiatric symptoms, to examine the relationship between objective and subjective measures of cognition as they relate to neuropsychiatric symptoms.Participants and Methods:27 community dwelling, cognitively diverse older adults (78% female, mean age 71.9 ± 7) were enrolled in the Concerns about Memory Problems (CAMP) study. Inclusion criteria included the expressed concern about memory functioning by participants on a 5-item screener, while exclusion criteria were defined as previous diagnosis of neurodegenerative diseases and/or major stroke. All participants completed neuropsychological testing and study surveys including the DSM-5 CC. Participants completed Level 1 and all Level 2 (L2) forms of the DSM-5 CC. Spearman two-tailed non-parametric correlations and independent samples t-tests were conducted to examine the relationship between the DSM-5 CC and the 5-item subjective cognition screener, as well as the DSM-5 CC and objective cognition results.Results:Subjective measures of cognition, as measured by answers to the 5-item screening measure, were significantly associated with DSM-5 CC measures. Question 1 on the SCD screener which asks, “Compared to others your age, do you have difficulty with memory or thinking abilities?” was associated with anger (p=.033) and depression (p=.018) L2 forms. Question 3, “Do any difficulties with memory or thinking abilities make it difficult for you to do things in daily life?)” was associated with the L2 forms for somatic symptoms (p=.016) and repetitive thoughts and behaviors (p&lt;.001). Objective measures of cognition from neuropsychological testing also correlated with DSM-5 CC sub-scores. Digits Backwards Length (DBL) correlated with DSM-5 CC Level 1 Sum (r= -.57, p=.002). DBL (r=-.59 p=.001) and Digits Backwards Total Correct (DBTC) (r=-.47, p=.013) associated with somatic symptoms L2 and sleep L2 (DBL: r=,-.45 p=.019; DBTC: r=-.39, p=.044). Category Naming (animals) was also associated with anxiety L2 (r=-.42, p=.030).Conclusions:Subjective and objective measures of cognition were each related to sub-scores of the DSM-5 CC. Interestingly, the associations were largely non-overlapping. These results highlight the importance of considering a wide range of neuropsychiatric symptoms in the assessment of SCD and cognitive impairment. Findings contribute to the growing body of literature suggesting that neuropsychiatric symptoms should be studied in conjunction with cognitive symptoms among older adults as co-occurring phenomena. Future directions will need to include longitudinal studies that can examine the prodromal nature of SCD and neuropsychiatric symptoms for Alzheimer’s and other neurodegenerative disorders.

36 Disparities in General Mental Status Between Lower and Higher SES Ethnically Diverse Older Adults

Objective:To investigate differences in performance on a widely used cognitive screener between community-dwelling older adults from two disparate socioeconomic groups.Participants and Methods:Participants were part of a larger study of cognitive screening in healthy older adults. The total sample (N=79, 69.6% female, 19% White/Caucasian, 12.7% Asian, 43% Latino/a, 25.3% Black/African-American) consisted of community-dwelling adults (Mage=73.1 years [SD=7.2] and Meducation=14.3 years [SD=2.6]) who were initially recruited via social media, flyers, and general community announcements. A lack of ethnic minority participants resulted in a two-year commitment to reach communities of color via visits and provision of health literacy to local religious and community programs. Continuous contact with leaders/gatekeepers helped establish research study credibility and forge a stronger sense of trust among ethnically diverse participants in the greater Houston, TX, area. Testing was initially conducted at the clinical study site. Due to low participation rates among people of color, greater effort was placed on tailored strategies to overcome economic and time constraints (i.e., schedule/time conflicts, lack of transportation, inability to pay for parking). To fit the priorities and needs of the participants, testing was also conducted at their homes (25.3%) and nearby religious and community centers (22.8%). Participants identifying as Latino/a or Black were predominantly recruited and tested at their local community center (as requested by gatekeepers/participants) to increase access to the study, in contrast to Caucasian participants. Median income estimates were used to stratify participants by socioeconomic status (SES) based on zip codes into low SES (L-SES) or high SES (H-SES) groups.Results:Participants from the L-SES group had significantly lower total scores on the MoCA than their H-SES counterparts, t(77J=2.837, p=0.003, g=0.696. The average MoCA total score for participants from the L-SES group was 2.64 points lower. The observed differences in MoCA total score when stratifying by ethnicity may be attributable to differences in education level and SES, which are known risk factors for cognitive impairment and will be further examined upon recruitment completion.Conclusions:Studies have found that ethnically diverse older adults not only encounter more barriers to accessing quality health care but also experience disparities in brain health research. Communities of color comprise a sizeable portion of our older adults but have been traditionally underrepresented in clinical research, limiting the generalizability of research findings to clinical treatment. Socioeconomic deprivation has been identified as one of several barriers to research engagement for people of color, placing ethnic communities at increased risk for under- or misdiagnosis and limited access to medical intervention. Preliminary findings have implications for the recruitment of ethnically diverse groups in clinical research. Given the growing racial and ethnic diversity among the United States population, we must do our due diligence to increase understanding of participation and recruitment barriers for racial/ethnic individuals. Tailored community outreach and engagement strategies may be effective in improving the inclusion of ethnically diverse populations and facilitating recruitment and retention in clinical research studies.