VISION IMPAIRMENT AND SOCIAL ISOLATION IN OLDER AFRICAN AMERICANS: THE IMPACT ON COGNITIVE DECLINE

Abstract Evidence suggests a consistent correlation between vision impairments, social isolation, and cognitive decline. The National Eye Institute reports that African Americans have an increased risk of developing certain vision impairments such as cataracts, glaucoma, and diabetic retinopathy. At the same time, older African Americans often receive care from family members and this family care may act as a buffer against social isolation and resulting cognitive decline. Using data from 737 African Americans that participated in waves 5, 6, and 7 of the National Health and Aging Trends Study (NHATS), we explored associations between vision impairment, social isolation, and cognitive functioning. Results showed that vision impairment at round 5 was related to increased social isolation, and higher social isolation at round 5 was related to decreased delayed word recall scores at the same wave. No significant longitudinal associations were found between these constructs. Findings suggest that concurrent associations exist between sensory impairments, social isolation, and cognitive functioning, but that these relationships are not robust across time. Despite support provided by unpaid family caregivers, African American older adults with vision impairment are at an increased risk for concurrent social and cognitive challenges. It may be that family support of those with sensory impairments helps so that these impairments aren’t related to social isolation or cognitive functioning across time. Researchers and clinicians could benefit older African Americans with sensory impairments by providing and encouraging support during early stages of vision loss.

days and provided saliva samples, from which cortisol was assayed. The number of negative GR experiences reported related to poorer daily well-being (negative and positive affect, physical symptoms, stress severity, and cortisol daily peakto-nadir ratio), whereas, the number of positive GR experiences was only related to lower severity of daily stressors (β=-0.03, p=.03). Examining specific GR experiences revealed that individuals who reported bad housing experience during the GR reported higher daily levels of negative affect (β=0.14, p<.001), physical symptoms (β=0.90, p<.001), and frequency of stressor days (β=0.01, p<.001), and lower daily levels of positive affect (β=-0.19, p=.02). Bad financial experience was related to more physical symptoms (β=0.62, p<.001) and greater severity of daily stressors (β=0.14, p=.03). Conversely, positive financial experiences were related to greater cortisol daily peak-to-nadir ratio (β=1.98, p=.03), but also greater frequency of stressor days (β=0.05, p=.01). Results highlight the potential influence of major economic strains on our ongoing daily experiences. This work has implications for policy and interventions around supporting midlife and older adults facing economic strains, in order to improve daily well-being.

PROFILES OF PERSONAL DETERMINANTS OF HEALTH AND ASSOCIATED HEALTH OUTCOMES IN OLDER ADULTS: A LATENT CLASS ANALYSIS
Melanie Serrao Hill 1 , Timothy Barnes 1 , Lizi Wu 1 , Rifky Tkatch 1 , Sandra Kraemer 2 , James Schaeffer 1 , and Charlotte Yeh 3 , 1. Optum Labs,Minnetonka,Minnesota,United States,2. UnitedHealthcare,Minnetonka,Minnesota,United States,3. ASI,Inc.,Washington,District of Columbia,United States Personal Determinants of Health (PDOH) are considered personal resources that contribute to successful aging. Positive PDOH factors have been associated with better health outcomes in older adults; however, research in this area is still limited. Using survey and claims data among adults age 65+ (N=2,866), profiles were identified based on five key PDOH factors (resilience, purpose in life, optimism, self-perception of aging, and social connection via loneliness) utilizing Latent Class Analysis (LCA). Differences in socio-demographics and healthcare outcomes were then explored utilizing multivariate regression models. Outcomes included emergency room (ER) visits, inpatient (IP) admissions, total medical cost, and quality of life (physical and mental health component scores). LCA models yielded three main classes within our sample: high PDOH (56%, n=1,150), moderate PDOH (40%, n=1,611), and low PDOH (4%, n=125). Those within the high PDOH class were significantly younger (Mage=75.6) compared to those within the moderate (Mage=78.2) and low (Mage=78.9) PDOH classes. In addition, the high PDOH class was significantly less likely to have an ER visit (OR=1.81, 95% CI:1.23-2.66) and had 28% better physical health and 52% better mental health components scores as compared to the low PDOH class. Results demonstrate support for the PDOH model as a potential successful aging model. Combinations used to create classes using resilience, purpose in life, optimism, selfperception of aging, and social connection via loneliness indicates that those who are positive in all five aspects show the most promising health outcomes. Future implications include targeting interventions at improving these variables for at-risk older adults.

RURAL-URBAN DISPARITIES IN COMORBIDITY BETWEEN OBESITY AND DIABETES AMONG OLDER ADULTS Youngjoon Bae, University of Massachusetts Amherst, Amherst, Massachusetts, United States
Obesity and diabetes are common among older Americans. While obesity is a risk factor for diabetes, research on ruralurban health disparities among older adults has reported paradoxical results. That is, living in rural areas is a risk marker of obesity, whereas rural residency is inversely associated with diabetes. This study utilized multiple national data resources to diagnose the inconsistency, including the 2006-2016 RAND HRS Longitudinal data, biomarker data, the 2010 US Census, and the USDA food access information. HRS survey participants 65 to 97 years of age comprised the study sample (N=6,476). General generalized estimating equation models with survey weights were used to estimate associations with measured obesity and diabetes. Age, race, Hispanic status, foreign-born status, education, marital status, working status, wealth, physical activity, smoking, drinking, ADL, IADL, loneliness, depression, cholesterol, HDL, CRP, and Cystatin C were included as control variables. Findings suggest that rurality is associated with a higher likelihood of obesity and a lower likelihood of diabetes, particularly for older women. However, by adjusting for confounders, these relationships disappeared. Instead, social isolation indicated significant associations with a lower likelihood of obesity and a higher likelihood of diabetes among older women. Contrary to prior research, the food desert and food insecurity measures did not correlate with both outcome variables. Further investigation on food consumption and dietary behavior among socially isolated older women is needed.

VISION IMPAIRMENT AND SOCIAL ISOLATION IN OLDER AFRICAN AMERICANS: THE IMPACT ON COGNITIVE DECLINE
Emily Hayes 1 , Avalon White 2 , Corinna Trujillo Tanner 2 , and Jeremy Yorgason 2 , 1. Brigham Young Provo,Utah,United States,2. Brigham Young University,Provo,Utah,United States Evidence suggests a consistent correlation between vision impairments, social isolation, and cognitive decline. The National Eye Institute reports that African Americans have an increased risk of developing certain vision impairments such as cataracts, glaucoma, and diabetic retinopathy. At the same time, older African Americans often receive care from family members and this family care may act as a buffer against social isolation and resulting cognitive decline. Using data from 737 African Americans that participated in waves 5, 6, and 7 of the National Health and Aging Trends Study (NHATS), we explored associations between vision impairment, social isolation, and cognitive functioning. Results showed that vision impairment at round 5 was related to increased social isolation, and higher social isolation at round 5 was related to decreased delayed word recall scores at the same wave. No significant longitudinal associations were found between these constructs. Findings suggest that concurrent associations exist between sensory impairments, social isolation, and cognitive functioning, but that these relationships are not robust across time. Despite support provided by unpaid family caregivers, African American older adults with vision impairment are at an increased risk for concurrent social and cognitive challenges. It may be that family support of those with sensory impairments helps so that these impairments aren't related to social isolation or cognitive functioning across time. Researchers and clinicians could benefit older African Americans with sensory impairments by providing and encouraging support during early stages of vision loss. Although childhood maltreatment can have lasting effects into later life, positive outcomes have also been observed, including an increased tendency towards prosocial behavior. However, little is known about the link between childhood maltreatment and later life prosocial behavior. Therefore, this study aimed to explore older adult's experiences of childhood maltreatment and identify mechanisms linked to prosocial behavior in later life. The individual level, but also broader cultural and contextual mechanisms, were considered by comparing two adversity contexts and applying conceptual frameworks (socio-interpersonal framework model of trauma and recovery, motivational process model of altruism born of suffering). Semi-structured interviews (60-120 minutes) were conducted with 29 Irish (older) adult survivors of childhood maltreatment: 17 institutional (welfare care) abuse survivors (mean age: 61 years, range: 50-77), 12 familial abuse survivors (mean age: 58 years, range: 51-72). Interviews were analyzed using Framework Analysis. In both groups at the individual level, enhanced empathy, amelioration, and identity-related mechanisms were linked to prosocial behavior, with connections to caring roles and coping strategies from childhood. On a social contexts level, the limited resources or opportunities for help in childhood, and the social norms and beliefs of that time, influenced participants' motivation to help others in later life. Group-specific mechanisms were also observed, such as compassion fatigue in the familial sample; and denouncing detrimental societal values in the institutional sample. The identification of individual, adversity-context, and culturespecific mechanisms linked to later-life prosocial behavior can promote a greater understanding of resilience and adaptability in older adult survivors of childhood maltreatment.

USING AGILE METHODOLOGY AND NUDGE STRATEGIES TO IMPROVE ENROLLMENT IN CLINICAL TRIALS
Peggy Bylund 1 , Jade Mehta 2 , Nandini Mathavan 3 , Kimberly Trowbridge 1 , Britain Taylor 4 , Husam El Sharu 5 , and Noll Campbell 6 , 1. Regenstrief Institute,Inc.,Indianapolis,Indiana,United States,2. Indiana University School of Medicine,Indianapolis,Indiana,United States,3. Indiana University School of Medicine/Center for Health Innovation and Implementation Science,Indianapolis,Indiana,United States,4. Indiana University Bloomington,Bloomington,Indiana,United States,5. Indiana University,Indianapoilis,Indiana,United States,6. Purdue University,Indianapolis,Indiana,United States The enrollment of human subjects is crucial for the success of clinical trials. In the ongoing "Reducing the Risk of Dementia through Deprescribing" trial, the initial approach for enrolling subjects did not meet expected goals in the first 6 months, creating the need for innovative nudge strategies. We used an Agile methodology as the framework to understand the problem, then find and implement a solution.
Our study aimed to examine the effectiveness of utilizing a texting nudge to enhance post-agreement recruitment of subjects with cognitive impairments. Prior to enrollment, eligible potential participants were contacted using a texting nudge. Potential participants received a second contact call to remind subjects of the enrollment appointment, introduce the person and the phone number that would call them, and the option of confirming or rescheduling. During the 1-week text-message experiment, 8 out of 9 subjects who agreed to participate in the study and received the text message enrolled, yielding an 89% post-agreement enrollment rate compared to a baseline rate of 44% prior to introducing this nudge. After implementing into the standard operating procedures, the 6-month average rate of enrollment among those that agreed rose to 80%, nearly doubling the rate from the first 6 months of the study and quadrupling the number enrolled each month. Inadequate recruitment has necessitated the use of innovative recruitment methods. Using the Agile problem-solving mindset, the texting nudge was developed to leverage the behavioral influences of the messenger, social commitments, priming and affect to increase subject enrollment.

DISSOCIATING RETEST EFFECTS FROM DEVELOPMENTAL CHANGE FOR PREDICTING COGNITIVE STATUS
Nicholas Tamburri 1 , Cynthia McDowell 2 , and Stuart MacDonald 2 , 1. University of Victoria, Montreal,Quebec,Canada,2. University of Victoria,Victoria,British Columbia,Canada In longitudinal designs, unadjusted retest effects can confound developmental change estimates. This study utilized a measurement burst design and three-level multilevel modeling to a) independently parameterize short-term retest and long-term developmental change and b) employ these estimates as predictors of cognitive status at long-term follow-ups. Using data from Project MIND , participants (N=304; aged 64-92 years) were assessed across biweekly sessions nested within annual bursts (spanning up to 17 total assessments over four years). Cognitive impairment no dementia (CIND) status was classified at Years 4 (the final burst assessment) and 8 (the study end date). Response time inconsistencies (RTI) were computed to index intraindividual variability across RT trials of a one-back response time (BRT) task. Three-level multilevel models simultaneously yet independently estimated BRT RTI