SURVIVAL OF THE FITTEST OR FRAILEST? COMPARING THE HEALTH OF CENTENARIANS OVER A 10-YEAR PERIOD

Abstract The first centenarian study in Hong Kong was conducted in 2011 and examined the multidimensional health of adults aged 95 or older. The 2011 study found that, among a population of about 3,000 centenarians, a significant proportion enjoyed a high degree of autonomy in their daily functions in relatively good health. The study has been repeated in 2021/22 (i.e., born in 1926 or before) when the city had more than 11,000 centenarians. Comparison of the two samples (2011: Nf77; 2021/22: Nf120) who lived with their family shows a significant difference in functional health, but not as much for physical health, favouring the 2011 cohort. More than 75% of the 2011 cohort demonstrated autonomy in activities of daily living (Bathing: 77.9%, dressing: 85.7%, toileting: 90.9%, indoor transfer: 89.6%; continence:75.3% and feeding: 94.8%). Only about half of the 2021/22 cohort were autonomous in these areas (40.0%, 44.3%, 54.7%, 42.5%, 63.2%, 46.7%, respectively). The number of chronic illnesses between the two cohorts were comparable (Mean(SD): 2011: 2.7 (1.6); 2021: 3.26 (1.60), yet dementia and frailty were more prevalent in the 2021 cohort (dementia: 44%; frailty: 9.1%) then the 2011 cohort (41.0%; 23.4%). Our findings alert metropolitans worldwide to the fast-increasing population of adults of advanced age with significant personal care and health needs in the community. Existing care for older adults has to be reframed and overhauled to provide comprehensive home- and personal-care support which will be essential for realizing ageing-in-place for adults in advanced age, especially after social distancing policies in COVID-19.

implementation across health systems.We conducted a Type III hybrid implementation-effectiveness, stepped-wedge cluster randomized trial (SW-CRT) in 8 Veterans Affairs hospitals examining a hospital-based walking program known as STRIDE.Based on the SW-CRT design, hospitals were randomized to a sequence (timeline) for STRIDE, and additionally randomized 1:1 to receive implementation support according to the Replicating Effective Programs (REP) framework only or REP plus additional team-based communication training known as CONNECT.The study was powered to examine impact of STRIDE on discharge destination to home vs other (primary outcome); hospital length of stay (LOS) was a secondary outcome.Patient-hospitalizations in pre-STRIDE time periods (n=8167) were similar to post-STRIDE time periods (n=9070) (e.g., mean age 73, 97% male, 28-30% Black race).In adjusted models, odds of discharge to home were higher among eligible patients hospitalized in post-STRIDE time periods (OR 1.6; 95% CI 1.3-2) compared to pre-STRIDE.Findings were robust to 3 sets of sensitivity analyses.There was no difference in LOS (IRR 1.01; 95% CI 0.94,1.09).Hospitals randomized to CONNECT had higher program reach (mean 13% vs 3%) but lower daily fidelity (mean 25.7% vs 37.5%).Despite limited direct program reach, implementation of a hospital walking program was associated with higher odds of discharge to home.The first centenarian study in Hong Kong was conducted in 2011 and examined the multidimensional health of adults aged 95 or older.The 2011 study found that, among a population of about 3,000 centenarians, a significant proportion enjoyed a high degree of autonomy in their daily functions in relatively good health.The study has been repeated in 2021/22 (i.e., born in 1926 or before) when the city had more than 11,000 centenarians.Comparison of the two samples (2011: Nf77; 2021/22: Nf120) who lived with their family shows a significant difference in functional health, but not as much for physical health, favouring the 2011 cohort.More than 75% of the 2011 cohort demonstrated autonomy in activities of daily living (Bathing: 77.9%, dressing: 85.7%, toileting: 90.9%, indoor transfer: 89.6%; continence:75.3% and feeding: 94.8%).Only about half of the 2021/22 cohort were autonomous in these areas (40.0%, 44.3%, 54.7%, 42.5%, 63.2%, 46.7%, respectively).The number of chronic illnesses between the two cohorts were comparable (Mean(SD): 2011: 2.7 (1.6); 2021: 3.26 (1.60), yet dementia and frailty were more prevalent in the 2021 cohort (dementia: 44%; frailty: 9.1%) then the 2011 cohort (41.0%; 23.4%).Our findings alert metropolitans worldwide to the fast-increasing population of adults of advanced age with significant personal care and health needs in the community.Existing care for older adults has to be reframed and overhauled to provide comprehensive home-and personal-care support which will be essential for realizing ageing-in-place for adults in advanced age, especially after social distancing policies in COVID-19.

FRAILTY INDEX AT THE BEGINNING OF ELDERHOOD AND HEALTHCARE COSTS AND UTILIZATION OVER 10 YEARS
Jieun Jang and Dae Kim, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, United States Background: We assessed whether the frailty index measured at the beginning of elderhood can predict healthcare costs over 10 years in a nationwide Korean population.Methods: This retrospective cohort study included 215,887 individuals who underwent a standardized comprehensive geriatric assessment at the age of 66 years as part of the National Screening Program for Transitional Ages in 2007-2009 and participants were followed up until December 31, 2019, from the Korean National Health Insurance database.Frailty status was defined based on a 39-item frailty index: robust (< 0.15), pre-frail (0.15 to < 0.25), frail (≥0.25).Generalized linear model was used to examine any changes in healthcare cost among prefrail group, frail group following 10 years from the age of 66 years, relative to changes in healthcare cost of the robust group.This study constructed an interaction term between the frail group and age.Results: Frailty status at age 66 years was associated with an increased annual total healthcare cost per NHI beneficiary (robust * age vs frail * age: β = 89.5,SE = 4.0, P < .0001),annual inpatient healthcare cost per NHI beneficiary (robust * age vs frail * age: β = 70.3,SE = 4.1, P < .0001)over 10 years, but not significant in annual outpatient cost per NHI beneficiary after adjusting for frailty category, demographic factor, socioeconomic factor, and time fixed effect.Conclusions: The frailty index at the age of 66 years was associated with an accelerated increase in healthcare costs over 10 years.

A PSYCHOMETRICALLY ROBUST LONGITUDINAL RESEARCH MEASURE OF FRAILTY: FIVE DIMENSIONS ACROSS AGE AND TIME
Stacey Voll, 1 Graciela Muniz Terrera, 2 and Scott Hofer 1 , 1. University of Victoria,Victoria,British Columbia,Canada,2. Ohio University,Athens,Ohio,United States The research construct of frailty in aging requires a measure with sound psychometric properties, that is stable across longitudinal points of observation.Using Exploratory Factor Analysis and Longitudinal Mixed Methods, we developed a five-factor research measures of frailty that is robust across time.Standardized regression scores for each factor allow us to estimate the change in severity of dysfunction as individuals age.We propose a system for developing research tools for the concept of frailty in large longitudinal data sets, and present our findings of five factors of frailty for females and males from the English Longitudinal Study on Ageing.

DEVELOPING A NOVEL FRAILTY INDEX TO STUDY FRAILTY OF SEXUAL AND GENDER MINORITY OLDER ADULTS IN THE ALL OF US DATABASE
Chelsea Wong, 1 Michael Wilczek, 2 Jordon Bosse, 3 Louisa Smith, 3 Justin Manjourides, 3 Ariela Orkaby, 4 and Brianne Olivieri-Mui 3 , 1. Harvard Multicampus Geriatric Medicine Fellowship Program, Brookline, Massachusetts, United States, 2. Northeastern University, Gray, Maine, United States,3. Northeastern University,Boston,Massachusetts,United States,4. VA Boston,Boston,Massachusetts,United States Prevalence of frailty among older sexual and gender minority adults (OSGM) is unknown despite disparities in mental health, medical comorbidities, and physical function.The NIH-funded All of Us Program was launched May 2018 aiming to enroll 1 million US participants focusing on those underrepresented in biomedical research, including OSGM.Using validated methods, we developed an All of Us deficit accumulation frailty index (AoU-FI) consisting of 33-items using baseline survey responses of adults aged 50+.Deficit domains include comorbidities, physical functioning, mental health, cognition, and sensory impairment.AoU-FI was valid if ≤20% of items were missing and ≤70% were comorbidities.OSGM self-identified or had discordance between gender and sex responses.OSGM (n=5,678) and non-OSGM (n=66,325), were similar in age (mean (IQR) = 66.7 (60-73) vs 66.9 (60-74)) but were more diverse (White 78% vs 82%, Black 7.5% vs. 6.5%,Hispanic/Latino 6.9% vs. 5.9%).AoU-FI had an expected gamma distribution across groups.OSGM frailty had a narrower range (0-0.67 vs. 0-0.75)and higher mean of 0.19 (sd=0.11)vs 0.17 (sd=0.1)compared to non-OSGM.To our knowledge, this is the first study of frailty among OSGM.Findings suggest OSGM experience worse frailty, highlighting the need to understand disparities in frailty, identify interventions, and develop policies to support OSGM.Additionally, our novel AoU-FI creates opportunities to apply frailty to diverse participants and types of data from digital health to genomics within the All of Us database.

REFRAMING STUDENT EXPERIENCES AND ATTITUDES TOWARDS WORKING WITH OLDER ADULTS
Iveris Martinez, California State University, Long Beach, Long Beach, California, United States We are experiencing a shortage of trained health and social service providers to meet the needs of an aging society.However, few students have positive opportunities to work with older adults in their training.If they interact with older adults it is usually in end-of-life and nursing home care settings.We therefore need to find creative ways to motivate students in these fields to choose to work with older

SESSION 5084 (PAPER) LATE BREAKING: APPLYING REFRAMING AGING IN YOUR WORK IV SURVIVAL OF THE FITTEST OR FRAILEST? COMPARING THE HEALTH OF CENTENARIANS OVER A 10-YEAR PERIOD Lian Ying Chun Pat, 1 Bobo Hi Po Lau, 1 Karen Siu Lan Cheung, 2 Grace Man Yee Chan, 3 Joseph Shiu Kwong Kwan, 4 James Ka Hay Luk, 5 Peter Martin, 6 and Cecilia Lai Wan Chan 2 , 1. Hong
Implementation strategies like CONNECT that enhance teamwork and communication may improve patient access to clinical programs being implemented in new settings.