HEALTH BEHAVIORS AND PSYCHOLOGICAL WELL-BEING ALLEVIATE DIABETES-RELATED DISABILITY DETERIORATION

Abstract Diabetes is known to increase the risk of disability, which may be buffered by health behaviors and psychological factors. However, few existing studies examine how these factors affect disability in diabetic patients over time. The present study assessed the extent to which diabetes affected disability with age and how that effects differed by health behaviors and psychological well-being in older Taiwanese. The data of 5131 adults aged 50 and older were drawn from the 1996-2007 Taiwan Longitudinal Study on Aging. A cohort sequential multilevel modeling was employed to explore the effects of sociodemographic, comorbidities, lifestyle, and psychosocial factors in mediating and moderating the link between diabetes and disability. Disability was measured by mobility limitation in 1999, 2003, and 2007, while health behaviors and psychological factors were measured in 1996, 1999, and 2003 to be lagged time-varying covariates in random effect model analyses. Our results showed that adults with diabetes had more mobility limitation (β(diabetes) =3.031, P<.001) and progressed each year with ageing (β(diabetes*age) =0.061, P<.005). Exercising more than four times a week reduced the risk of disability by 51 % in diabetic patients (β(diabetes*exercise≥4 times) =-1.220, P<0.05). Social participation (β(social participation)=-0.631, P<.005), stress (β(stress)=0.651, P<.001) and depression (β(depression)=0.144, P<.001) had independent effects on the risk of disability in adults, but the interaction with diabetes was not significant. To conclude, exercise is the most powerful factor to alleviate the risk of disability in diabetic patients.

2.3%, and 3.9% of the primary caregiver was spouse, son/ daughter-in-law, daughter/son-in-law, grandchildren, and housekeeper.For widowed persons, 60.2%, 21.1%, 9.9%, and 5.9% of the primary caregiver was son/daughter-in-law, daughter/son-in-law, grandchildren, and housekeeper, respectively.Multivariable-adjusted model showed that, among married older adults, son/daughter-in-law and daughter/son-in-law as the primary caregiver was associated with 41% (95% confidence interval [CI]=6%-87%) and 67% (95%CI=10%-154%) higher mortality than spouse as the primary caregiver, respectively.For widowed persons, daughter/son-in-law and grandchildren as the primary caregiver was associated with 12% (95%CI=3%-20%) and 14% (95%CI=2%-24%) lower mortality than son/daughter-in-law as the primary caregiver, respectively.Majority of disabled older adults in China relied on their spouse and children to care for them.Type of primary caregiver was associated with death in both married and widowed persons.More resources need to be allocated to disabled Chinese older adults with poor survival outcomes.

COGNITIVE AND HEARING IMPAIRMENTS IN OLDER ADULTS: EVIDENCE FROM THE HEALTH AND RETIREMENT STUDY
Jessica S. West, 1 and Scott Lynch 1 , 1. Duke University, Durham, North Carolina, United States As the number of older adults increases, increased prevalence of cognitive and sensory impairments pose growing public health challenges.Research on the relationship between hearing impairment and cognition, however, is minimal and has yielded mixed results, with some studies finding that hearing impairment is associated with cognitive decline, and others reporting that the association is weak or non-existent.Most of this research has been conducted outside of the U.S., and the few U.S.-based longitudinal studies have relied mostly on small, non-representative samples involving short follow-up periods.Further, despite known gendered patterns in cognitive and hearing impairments, no studies to date have examined whether the relationship between the two varies by gender.Our study addresses these weaknesses in the literature by utilizing nine waves of the Health andRetirement Study (1998-2014;n=14,169), a large, nationally representative, longitudinal study that facilitates examination of long-term interrelationships between hearing and cognitive impairments.In this study, we use autoregressive latent trajectory (ALT) methods to model: 1) the relationship between hearing impairment and cognitive decline, and 2) sex differences in the relationship.ALT models enable us to determine whether hearing impairment and cognitive impairment are associated, net of their common tendency simply to co-trend with age.Results indicate that hearing and cognitive impairments are strongly interrelated processes that trend together over time.Moreover, hearing impairment has an increasing impact on cognitive impairment across age while the effect of cognitive impairment on hearing impairment levels out over time.Sex differences in these patterns are discussed.

DEPRESSION, FUNCTIONAL DISABILITY, AND ACCESSING HEALTH CARE AMONG OLDER MEN AND WOMEN IN GHANA AND SOUTH AFRICA
Candidus C. Nwakasi, 1 and J. Scott Brown 1 , 1. Miami University, Oxford, Ohio, United States Objectives.To inform a preventive approach to mild depression among older Ghanaians and South Africans, this study will investigate the association and possible variabilities between mild depression, functional disability, accessing health care, sociodemographic, and socioeconomic factors across genders in both countries.Methods.Cross-sectional wave 1 (2007)(2008)(2009)(2010) data from WHO's Study on Global Ageing and Adult Health (SAGE) are used, and a sample of 3871 for Ghana and 3076 for South Africa are analyzed.Binary multiple logistic regression is used to identify the association between mild depression, functional disability status, socioeconomic and sociodemographic factors, and health status.Results.The proportion of mild depression (MD) is 3.78% and 8.15% for older Ghanaian men and women, and 2.29% and 11.91% for South African older men and women, respectively.At 95% CI, increased severity (mild and high levels) of functional disability are associated with increased odds of MD in Ghanaian and South African older men and women.Apart from South African older men, older people in the study who do not receive healthcare when needed have increased odds of MD.Sociodemographic and socioeconomic factors are also associated with MD.
Discussion.An untreated, persistent MD may lead to worse conditions with fatal outcomes.Since, mental health care is lacking in both countries, this study recommends policies directed towards support for formal and informal long-term care, and healthcare access to reduce the risks of depression.Thus, this study's findings may provide relevant information for managing depression among older Ghanaians and South Africans.

HEALTH BEHAVIORS AND PSYCHOLOGICAL WELL-BEING ALLEVIATE DIABETES-RELATED DISABILITY DETERIORATION
Yi-Hsuan Tsai, 1 and Ching-Ju Chiu 1 , 1. Institute of Gerontology, National Cheng Kung University, Tainan, Taiwan Diabetes is known to increase the risk of disability, which may be buffered by health behaviors and psychological factors.However, few existing studies examine how these factors affect disability in diabetic patients over time.The present study assessed the extent to which diabetes affected disability with age and how that effects differed by health behaviors and psychological well-being in older Taiwanese.The data of 5131 adults aged 50 and older were drawn from the 1996-2007 Taiwan Longitudinal Study on Aging.A cohort sequential multilevel modeling was employed to explore the effects of sociodemographic, comorbidities, lifestyle, and psychosocial factors in mediating and moderating the link between diabetes and disability.Disability was measured by mobility limitation in 1999, 2003, and 2007, while health behaviors and psychological factors were measured in 1996, 1999, and 2003 to be lagged time-varying covariates in random effect model analyses.Our results showed that adults with diabetes had more mobility limitation (β(diabetes) =3.031, P<.001) and progressed each year with ageing (β(diabetes*age) =0.061, P<.005).Exercising more than four times a week reduced the risk of disability by 51 % in diabetic patients (β(diabetes*exercise≥4 times) =-1.220,P<0.05).Social participation (β(social participation)=-0.631,P<.005), stress (β(stress)=0.651,P<.001) and depression (β(depression)=0.144,P<.001) had independent effects on the risk of disability in adults, but the interaction with diabetes was not significant.To conclude, exercise is the most powerful factor to alleviate the risk of disability in diabetic patients.

PREDICTORS OF CONCOMITANT COGNITIVE AND PHYSICAL FUNCTION DECLINE: RESULTS FROM THE HEALTH ABC STUDY
Elizabeth Handing, 1 Iris Leng, 1 Kathleen Hayden, 1 Caterina Rosano, 2 and Stephen Kritchevsky 1 , 1. Wake Forest School of Medicine, Winston-Salem, North Carolina, United States, 2. University of Pittsburgh, PIttsburgh, Pennsylvania, United States Although many individual risk factors for cognitive and physical decline have been identified, less is known about factors that predict concomitant or "dual decline".Utilizing data from the Health ABC study (n=2,553), we examined trajectories of decline based on repeated measures of the Modified Mini-Mental State Exam (3MS) and Short Physical Performance Battery (SPPB) across 5 years.Next, we calculated four mutually exclusive trajectories of decline derived from the slope: no decline (change in slope ≥ 0, n= 1,190), cognitive decline (lowest quartile of slope in 3MS; n=445), physical decline (lowest quartile of slope in SPPB; n= 407), and dual decline (lowest quartile for both cognitive and physical decline; n= 211).Logistic regression tested the association of 23 baseline risk factors dual decline.Odds of dual decline where higher in relation with depression (CES-D >16) (Odds Ratio [OR]: OR:2.77, 95% Confidence Interval [95% CI] [1.25-6.15]),and lower for individuals with a better score on the Digit Symbol Substitution Test (DSST) (OR: 0.97 [0.95-0.98]),grip strength (OR: 0.97 [0.94-1.00]),and 400m gait speed (OR: 0.11 [0.03-0.40]).Among the predictors identified, depressive mood at baseline nearly tripled the odds of developing dual decline, but was not associated with decline in either the cognitive or physical domains.Depressive mood is uniquely associated with dual decline; future studies should focus on the overlap between mood states and function, as mood may be modifiable.

AGE FRIENDLY COMMUNITIES NEIGHBORHOOD AND HEALTH AMONG CHINESE ADULTS: BEYOND THE URBAN AND RURAL DICHOTOMY
Yuekang Li, 1 and Yi Wang 2 , 1. Washington University in St.Louis,St.Louis,Missouri,United States,2. The University of Iowa School of Social Work,Iowa City,Iowa,United States The associations between physical frailty and depressive symptoms among older individuals were established in existing literature.Taking the person-environment perspective, we argue that neighborhood environment could either buffer the stress derived from being physically vulnerable or worsen it by adding another layer of stressors in the environmental context when physical health declined.The objectives of this study are to explore 1) to what extent the neighborhood-level characteristics moderate the relationship between physical frailty and depressive symptoms, 2) if there were rural-urban differences in the moderation effects, and 3) whether some of the environmental factors worked beyond the contextual influences of the rural-urban scope.Using the China Health and Retirement Longitudinal Study 2011 wave, 6,246 individuals ages 60 years and older were included for analyses.Multilevel mixed-effects models were fitted to examine the moderating effects of urbanicity and neighborhood-level socio-economic status (SES) on the relationship between frailty and depressive symptoms among older adults, controlling for individual-level characteristics.Results showed a stronger relationship between deterioration in physical health and depressive symptoms in rural neighborhoods and neighborhoods with lower SES, after controlling for individual-level SES.Also, the moderating effects of the neighborhood-level socioeconomic factors remained after controlling for urbanicity, indicating that neighborhood SES works beyond the rural-urban contexts.Findings from this study demonstrate the important roles of neighborhood socioeconomic characteristics in reshaping and the need to redefining China's rural-urban dichotomy.The findings also identified neighborhoods with low SES as potential targets for policy and practice to reduce the stress associated with health decline.

LAYING THE GROUNDWORK FOR BECOMING AN AGE-FRIENDLY UNIVERSITY: A MULTI-PHASE STUDY
Melissa L. Cannon, 1 Renata Kerwood, 1 Mandie Kondash, 1 Samuel Rowley, 1 and Hannah Wehr 1 , 1.Western Oregon University, Monmouth, Oregon, United States As evidenced by the growing Age-Friendly University (AFU) global network, institutions of higher education are increasingly seeking ways to enhance the experiences of older adults who use them for reasons such as lifelong learning, career development, and intergenerational engagement.This multi-phase study explored the barriers and facilitators for older adults accessing a public university in a small Oregon town.The first phase of the study involved survey data collection from 46 members of the local senior center adjacent to the university campus.For the second phase, researchers recruited a sample from the survey respondents and used snowball sampling to conduct 12 interviews with senior center members, past and current senior center directors, and key contacts among university staff.The third phase of data collection paired student researchers with older adult research participants (N=14) in participatory action research to capture the unique perspectives of the research participants visiting the university campus using photovoice and a follow-up focus group.Quantitative data were analyzed using SPSS while qualitative data were analyzed using team coding and intensive group discussion to develop categories and themes.Findings revealed various opportunities to increase age-friendliness according to the principles outlined by the AFU initiative, such as developing a lifelong learning center on campus, strengthening the university-senior center partnership, and removing accessibility barriers in order to make the university campus friendlier for people of all ages and abilities.These findings are being used in a proposal to join the AFU network and to shape the university's AFU vision.