Are Anatomical Gift Donors Demographically Representative of the American Aging Patient Population?

Abstract Body donation for medical education is voluntary and open to all; however, it is undetermined if the donors studied at UMass Medical School (UMMS) are demographically representative of the national patient population. If not, medical students are missing the opportunity of experiencing normal variation within the population, which may promote bias in their clinical years. This cross-sectional study compared data from the UMMS Anatomical Gift Program (AGP) with the Health and Retirement Study (HRS) population data. This study examined sex, race, ethnicity, veteran status, and sexual orientation. 5 years (n=540) of AGP data and 3 waves (n=5,037) of HRS data were examined. The results demonstrate that sex differences between the AGP and HRS populations (55% for females vs. 45% for males; p=.10) are NOT significant. A significant racial difference between populations is noted (p=.000), with 98.3% of the AGP vs. 72.7% of the HRS identifying as white. Veterans are overrepresented in the AGP (22.6% AGP vs. 9.6% HRS; p=.000). 12.3% of HRS participants report Hispanic ethnicity compared to 0% in the AGP. In 2016, HRS included sexual orientation, with 92.7% of respondents identifying as heterosexual, 2.6% gay or lesbian, 1.0% bisexual and 1.3% other. No data were collected by the AGP pertaining to sexual orientation and neither database ask about gender identity. Aging populations are not represented in the anatomy labs at UMMS and likely nationally. Efforts are needed to improve this and enhance the education of the medical professionals, while expanding the end-of-life options for all community members.

recommended in older adult.Combined analysis of data from two novel decision support programs yielded complementary findings that together address both medical and social determinants of health.These have the potential to reduce medication-induced harm, costly re-hospitalization and/or emergency room visits and support the further evaluation of this combined approach in other vulnerable populations such as the seriously mentally ill, frail, those confined to home, opioid-dependent or otherwise impaired.

AFRICAN-AMERICAN RACE PREDICTS 1-YEAR COGNITIVE DECLINE AMONG ADULTS WITHOUT MODERATE DEMENTIA
Niser Babiker, 1 Alan Gonzalez, 1 Jovany Soto, 2 Chengjian Shi, 3 Andrey Rzhetsky, 4 and Megan Huisingh-Scheetz, 1 1.University of Chicago,Chicago,Illinois,United States,2. Illinois Institute of Technology,Orland Park,Illinois,United States,3. University of Chicago,chicago,Illinois,United States,4. University of Chicacgo,Chicago,Illinois,United States Previous literature shows conflicting conclusions about the association between race and cognitive decline, particularly in early impairment.In this study, we aimed to test whether race predicted 1-year change in Montreal Cognitive Assessment (MoCA) score among older adults without moderate-severe dementia.We secondarily explored whether multimorbidity, polypharmacy, depressed mood, antidepressant use, body composition, or frailty changed the association.We analyzed data (n=122) from predominantly African American (AfA, 78.7%) community-dwelling older adults from the south side of Chicago.Participants underwent baseline and 1-year MoCA testing.Age, gender, race, education, monthly income, co-morbidities (Charlson Comorbidity Index), medication use (<5 vs ≥5), depression (PHQ-2), proportion lean mass (DEXA), and the frailty phenotype (range 0-5) were collected at baseline.In a multivariate linear model, we regressed 1-year MoCA score on baseline MoCA score, race, and demographics and then evaluated the impact of each covariate added separately to the model on the race-cognition relationship.The mean MoCA score at baseline was 25.2+/-0.2(range 18-30) and 41.0% of participants experienced ≥1 point MoCA decline at 1 year.After adjusting for demographics, AfAs experienced a greater 1-year MoCA decline (β= -1.3, p=0.04) compared to other races.The effect size was unchanged after adjusting for multimorbidity and polypharmacy (β= -1.3, p=0.04), attenuated slightly after adjusting for frailty (β= -1.2, p=0.06), depressed mood (β= -1.2, p=0.05), lean mass (β= -1.2, p=0.04), and attenuated notably after adjusting for antidepressant use (β= -1.0, p=0.11).Findings support the need to further explore racial differences in cognitive decline and potentially related anti-depressant underuse.

ARE ANATOMICAL GIFT DONORS DEMOGRAPHICALLY REPRESENTATIVE OF THE AMERICAN AGING PATIENT POPULATION?
Amanda Collins, 1 and Yasmin Carter, 2 1.University of Massachusetts Boston, Boston, Massachusetts, United States, 2. University of Massachusetts Medical School, Worcester, Massachusetts, United States Body donation for medical education is voluntary and open to all; however, it is undetermined if the donors studied at UMass Medical School (UMMS) are demographically representative of the national patient population.If not, medical students are missing the opportunity of experiencing normal variation within the population, which may promote bias in their clinical years.This cross-sectional study compared data from the UMMS Anatomical Gift Program (AGP) with the Health and Retirement Study (HRS) population data.This study examined sex, race, ethnicity, veteran status, and sexual orientation.5 years (n=540) of AGP data and 3 waves (n=5,037) of HRS data were examined.The results demonstrate that sex differences between the AGP and HRS populations (55% for females vs. 45% for males; p=.10) are NOT significant.A significant racial difference between populations is noted (p=.000), with 98.3% of the AGP vs. 72.7% of the HRS identifying as white.Veterans are overrepresented in the AGP (22.6% AGP vs. 9.6% HRS; p=.000).12.3% of HRS participants report Hispanic ethnicity compared to 0% in the AGP.In 2016, HRS included sexual orientation, with 92.7% of respondents identifying as heterosexual, 2.6% gay or lesbian, 1.0% bisexual and 1.3% other.No data were collected by the AGP pertaining to sexual orientation and neither database ask about gender identity.Aging populations are not represented in the anatomy labs at UMMS and likely nationally.Efforts are needed to improve this and enhance the education of the medical professionals, while expanding the end-of-life options for all community members.

ASSOCIATION BETWEEN LONELINESS AND DISEASES SELF-MANAGEMENT IN OLDER ADULTS: SYSTEMATIC REVIEW
Emma Cho, 1 Alexandra Garcia, 2 Ya-Ching Huang, 3  Purpose: Older adults with chronic diseases are more at risk for loneliness, and loneliness has a negative impact on health behaviors, which are key to managing chronic diseases.However, little is known about the association between loneliness and self-management behaviors in older adults with chronic diseases.As societies worldwide experience the growth of aging populations who are at higher risk of having chronic diseases as they age, clinicians and researchers should assess and address loneliness of older adults with chronic diseases.Methods: This systematic review synthesizes research found in PubMed, MEDLINE, PsychINFO, CINAHL, and SocINDEX.Findings: fourteen studies were conducted in four countries and represented n= 128,610.Loneliness was measured by three different instruments.Reports of loneliness were frequent and ranged from 7.7% (in a report of severe loneliness) to 43.2% (moderate loneliness) of older adults.Older adults who experienced loneliness were less likely to be physically active, eat a healthy diet, or cope in positive ways and more likely to be female and seek healthcare.Conclusions: This systematic review found that loneliness was moderately prevalent, and that loneliness was associated with negative disease self-management behaviors in older adults with chronic diseases.Gaps in the research include a need for studies guided by theoretical pathways, using a consistent, theoretically-based measure of loneliness, and conducted on among people with specific chronic diseases.

ASSOCIATION OF SOCIAL DETERMINANTS, MULTIMORBIDITY, AND FUNCTIONAL STATUS WITH MORTALITY AFTER PNEUMONIA
Chan Mi Park, 1 Hye Chang Rhim, 2 Eun Sik Lee, 3 Wonsock Kim, 4 Jong Hun Kim, 5 and Dae Kim, 6 1. Harvard T.H.Chan School of Public Health ,Brookline,United States,2. Harvard University,Orlando,Florida,United States,3. Korea University Anam Hospital,Korea University Anam Hospital,Republic of Korea,4. Eulji Medical Center,Eulji Medical Center,Republic of Korea,5. CHA Bundang Medical Center,CHA Bundang Medical Center,Republic of Korea,6. Hebrew SeniorLife,Boston,Massachusetts,United States Social support, multimorbidity, and functional status are important determinants of health in older adults, but their prognostic implications remain unclear after an acute illness.We conducted a prospective cohort study of 201 patients 65 years or older who were hospitalized for pneumonia at a university hospital in Korea in 2019-2020.K-means cluster analysis was performed using social deprivation score (range: 0-5), activities of daily living (range: 0-7), instrumental activities of daily living (range: 0-7), physical limitation score (range: 0-7), and Gagne comorbidity index (range: 0-24) (higher scores indicate higher risk).Four groups were identified: 1) Group A: physically limited and non-disabled group with limited social support; 2) Group B: multimorbid but functional group with social support; 3) Group C: multimorbid and disabled group with social support; 4) Group D: multimorbid and disabled group with limited social support.For Groups A through D, the Kaplan-Meir estimates for 6-month mortality were 10.0%, 18.0%, 34.2%, and 43.6%, respectively, and the 6-month mean survival times were 166.4 days (95% CI: 156.1-176.6),156.9 days (95% CI: 140.8-173.1),145.2 days (95% CI: 126.6-163.8),and 125.9 days (95% CI: 107.7-144.1),respectively.After adjusting for sex, age, and pneumonia severity score, the hazard ratios for Groups B through D versus Group A were 2.07 (95% CI: 0.70-6.13),3.14 (95% CI: 1.17-8.42),and 4.38 (95% CI: 1.73-11.04),respectively.Our results suggest that multimorbidity and disabilities were implicated in higher risk of 6-month mortality after pneumonia, and social support may mitigate this risk among those with multimorbidity and disability.

CHRONIC DISEASES AND SELF-REPORTED HEALTH STATUS AMONG AMERICAN INDIAN/ALASKA NATIVE OLDER ADULTS
Ramona Danielson, 1 Collette Adamsen, 2 and Agnieszka Mason, 1 1.North Dakota State University,Fargo,North Dakota,United States,2. University of North Dakota,Grand Forks,North Dakota,United States Background: In the 1800s and 1900s, U.S. federal "Indian" policy (e.g., boarding schools, relocation) created historical trauma with impacts that reverberate today, such as the significant health challenges experienced among American Indian/ Alaska Native (AI/AN) populations.Our study seeks to better understand the burden of chronic disease, and also resilience, among AI/AN older adults.Methods: Data came from Cycle VII (2018-2020) of the National Resource Center on Native American Aging's "Identifying Our Needs: A Survey of Elders" survey of AI/AN adults ages 55+ from primarily rural tribal survey sites (N=20,642).Analysis explored self-assessed health