Using Assistive Health Technology to Assess Fall Risk Appraisal, Body Composition, and Physical Activity

Abstract One-third of older adults have a discrepancy between perceived and physiological fall risks or maladaptive fall risk appraisal (FRA). Older adults who report high fear of falling and overestimate their physiological fall risk are less likely to participate in physical activity (PA). Limited data suggest the interrelation between fall risk appraisal, body composition, and objective measured PA. This cross-sectional study examines the feasibility of recruitment and acceptability of Assistive Health Technology (AHT), including the BTrackS Balance System (BBS), Bioelectrical Impedance Analysis (InBody s10), and ActiGraph GT9X Link wireless activity monitor. This study demonstrates the benefits of using AHT to study the associations among FRA, body composition, and PA in older adults. We hypothesize that rational FRA is associated with higher levels of PA and skeletal muscle mass and lower levels of percent of body fat and body mass index. Topics presentation included research protocol and preliminary results.

Assistive Health Technology (AHT), including the BTrackS Balance System (BBS), Bioelectrical Impedance Analysis (InBody s10), and ActiGraph GT9X Link wireless activity monitor. This study demonstrates the benefits of using AHT to study the associations among FRA, body composition, and PA in older adults. We hypothesize that rational FRA is associated with higher levels of PA and skeletal muscle mass and lower levels of percent of body fat and body mass index. Topics presentation included research protocol and preliminary results.

NEW ISSUES IN LIFE COURSE RESEARCH: WHICH EARLY-LIFE FACTORS MATTER FOR LATE-LIFE OUTCOMES?
Chair: Jacqui Smith Discussant: Katrina Walsemann The increased availability of retrospective information about the lives of participants in population panel studies has expanded the range of precursors to include in life course research. However, this also challenges researchers to select among many potential precursors to a late-life outcome and to determine the relative role of factors from different periods in the life course. Each paper in this symposium uses life course information from the Health and Retirement Study (HRS) to examine different late-life outcomes. Speakers will discuss what guided the particular selection of factors and outcome to examine in their study. Sonnega, Helppie-McFall, and Lee focus on indicators of childhood financial and social adversity as potential predictors of early retirement due to poor health. Park, Larkina, and Smith ask if decisions taken in early adulthood about how to balance work-and family-life by individuals and their partners are related to the categories of important life accomplishments older adults report in their life review. Two papers examine precursors of late-life health outcomes. Williams-Farrelly and Smith identified different profiles of physical activity in early-and mid-adulthood. They discuss associations between these profiles and cognitive aging. Whereas social losses, relocation, and multimorbidity are well-documented precursors of Major Depression in old age, Bergmans and Smith asked if poor health in childhood played a distal role. The session concludes with an integrative discussion of issues by Walsemann. The relationship between life adversity and physical and mental health is well documented. The present research investigates life course adversity and early retirement due to poor health. Data are from the Health and Retirement Study, including the Life History Mail Survey (LHMS), HRS core surveys, and HRS Psychosocial Leave-Behind surveys. We create measures of childhood financial and social adversity and young-mid adulthood financial and social adversity. Early retirement is defined as self-report of "full" retirement between age 50 and 62. We use a Cox proportional hazards model competing risk framework comparing early retirement when poor health is a major reason for retirement with early retirement for any other reason. Models include covariates for age, gender, marital status, cohort, log household income, and log household wealth. Childhood financial adversity and homelessness in youngmid adulthood increases the instantaneous hazard of early retirement due to poor health.  = 3), what was reported, and whether early-life decisions about balancing family and work are associated with the reports. Women, whites, and people with at least high school education and normal cognitive status were more likely to report accomplishments (67%). We categorized reports as family-related (39%), personal (19%), combined family/personal (25%) or other (16%). Multinominal logistic regression models revealed that participants who themselves favored family over work in early life or whose spouse decided for family, were more likely to report family-related accomplishments.

DO LIFE COURSE PHYSICAL ACTIVITY PROFILES REDUCE THE EFFECTS OF CHILDHOOD EXPOSURES ON COGNITION? Monica Williams-Farrelly, and Jacqui Smith, University of Michigan, University of Michigan, Michigan, United States
Although physical activity throughout life is one of the most reliable predictors of healthy aging, can less consistent or favorable trajectories also improve cognition trajectories among older adults? Drawing from accumulation theories, we use longitudinal data from the Health and Retirement Study and Life History Mail Survey (N=9,309) to examine the early antecedents of cognitive decline and the extent to which different life course physical activity profiles can slow such a decline. Results from latent class analysis reveal seven distinct profiles: consistently low, consistently high, consistently average (reference), improvers, decliners, midlife motivators, and previously athletic "couch potatoes." Growth curve modeling analyses show that membership in the consistently high class and midlife motivators were associated with better cognition initially and over time, with no difference between the two classes. Additionally, though poor health and learning problems in childhood were associated with worse initial cognition, physical activity does not mediate the relationship.

ASSOCIATIONS OF MENTAL HEALTH AND CHRONIC PHYSICAL ILLNESS DURING CHILDHOOD WITH MAJOR DEPRESSION IN LATER LIFE Rachel Bergmans, and Jacqui Smith, University of Michigan, University of Michigan, Michigan, United States
While poor health in childhood has implications for mental health years later, less is known regarding its long-term impact. We determined whether childhood chronic physical illness burden was associated with major depression (MD) in later life (i.e., >50 years), and tested mediation by childhood mental health status using path analysis. Data came from the 2016 U.S. Health and Retirement Study (n=18,047). One standard deviation increase in childhood chronic physical illness burden was associated with 1.21 (95% CI = 1.12, 1.30) times higher odds of MD in later life. Childhood mental health status explained 57.8% (95% CI: 35.2, 80.4) of this association. Results indicated that the relationship of chronic physical illness burden in childhood with MD in later life was mediated by childhood mental health status. Whether greater screening for psychiatricrelated symptoms in childhood or review of health histories in later life can reduce the burden of MD requires further study.

OPTIMIZING THE GERIATRIC MENTAL HEALTH WORKFORCE THROUGH INNOVATIVE APPROACHES
Chair: Ana Jessica Alfaro Co-Chair: Rachel Rodriguez Discussant: Michele Karel The drastic demand for geriatrics-trained providers in medical and mental healthcare persists years after the Institute of Medicine first highlighted this need (2008; 2012). New innovative approaches must instead optimize the current workforce through leveraging existing geriatric experts' knowledge and skills related to working aging adults. This symposium will highlight four approaches spanning post-licensure education to using technology to deliver specialized services and training. First, Dr. Gregg will discuss the evaluation of an advanced topics workshop in Geropsychology which has significantly enhanced depth of Geropsychology competencies for psychologists working in primarily rural areas. Next, Dr. Asghar-Ali will describe the multi-modal interactive geriatric educational opportunities for interprofessional staff developed by the South East Texas Geriatric Workforce Enhancement Program (SETx GWEP). He will discuss how these training opportunities have been tailored to address the impact of COVID-19 and healthcare disparities among older adults. Third, Dr. Filips will present an evaluation of a consultation model in which a geriatric psychiatrist provides teleconsultation in a 5-state region to rural aging Veterans with complex medical and behavioral comorbidities. Finally, Dr. Beaudreau will describe adaptations to a national VA Problem Solving Training program for mental health clinicians of older Veterans with complex comorbidities. Dr. Karel, VA National Geriatric Mental Health Director, will serve as discussant and comment on the ways in which these novel approaches are meeting the ever-growing need for competent geriatric mental health providers.