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Generational Multimorbidity Disease Clusters for British Cohorts Born 1921 – 1960

Abstract The aim of this study is the first step in our understanding of the uniqueness and stability of multmorbdity disease patterns for different generations. The unique historical context that each generation has been exposed to is thought to have systemic health impacts and differences in epidemiological make-up (Clouston et al. 2021). Literature suggests that multimorbidity disease patterns, are similar across countries (Hernandez et al, 2021 – in press) and observational points, and that migration into complex disease clusters is more common as people age (Cassell et al, 2018, Kingston et al. 2018). Most commonly reported are Cardiovascular and Metabolic disease clusters which lead to lower quality of life, mortality and morbidity (Kudesia, 2021). We asked: Do multimorbidity disease patterns differ for unique generations? Using the ELSA, the disease clusters of three cohorts were examined; an older cohort, born 1921-1930, a middle cohort born 1931-1940 a younger cohort born 1941-1950 and the ”newest” cohort, born 1951-1960. Self-reported dementia and memory problems lead a specific cluster for the middle cohort, those born in 1931-1940, but not for the other cohorts. While disease patterns were different between sex for other clusters, the disease cluster of dementia and memory problems held similar disease patterns for males and females, with a prevalence of 3%. The dementia/memory problem cluster loaded with cardio/metabolic diseases. This suggests that complex multimorbidity for the British 1931-1940 cohort has had an impact related to dementia and memory problem diagnoses for this specific generation, for males and females alike.

COVID-19 has imposed challenges for older adults to access food, particularly in minority, lower income, and rural communities. However, the impact of COVID-19 on food access, diet quality, and nutrition of diverse older adult populations has not been systematically assessed. The objective of this study is to examine changes in food access, diet quality, and nutritional status among older adults during the COVID-19 pandemic and the potential differential impacts of the COVID-19 pandemic on these nutrition-related outcomes using the framework of the socio-ecological model. An electronic search was conducted using three databases (PubMed, CINAHL, and Web of Science) on March 7, 2021. Original, peer-reviewed English-language studies published 10/1/2019-3/1/2021 were considered for which the age of participants was 50 years and older (average age range 50-98). In order to be considered, studies must have examined food access, food security, or nutrition constructs as an outcome. The initial search yielded 13,628 results, of which 9,145 were duplicates. Of the remaining 4,483 articles, 13 articles were in scope and therefore selected in the final analysis, which can be characterized as descriptive (n=5), analytical (n=6), and correlational (n=2). Studies were conducted among community-dwelling older adult populations (n=7) as well as those temporarily residing in hospital settings (n=6) in 10 countries. More research is needed to examine the impact of COVID-19 on food access/security and the differential barriers experienced by older adult populations.

GENERATIONAL MULTIMORBIDITY DISEASE CLUSTERS FOR BRITISH COHORTS BORN 1921 -1960
Stacey Voll, 1 Graciela Muniz-Terrera, 2 and Scott Hofer, 1 1. University of Victoria,Victoria,British Columbia,Canada,2. University of Edinburgh,Edinburgh,Scotland,United Kingdom The aim of this study is the first step in our understanding of the uniqueness and stability of multmorbdity disease patterns for different generations. The unique historical context that each generation has been exposed to is thought to have systemic health impacts and differences in epidemiological make-up (Clouston et al. 2021). Literature suggests that multimorbidity disease patterns, are similar across countries (Hernandez et al, 2021 -in press) and observational points, and that migration into complex disease clusters is more common as people age (Cassell et al, 2018, Kingston et al. 2018. Most commonly reported are Cardiovascular and Metabolic disease clusters which lead to lower quality of life, mortality and morbidity (Kudesia, 2021). We asked: Do multimorbidity disease patterns differ for unique generations? Using the ELSA, the disease clusters of three cohorts were examined; an older cohort, born 1921-1930, a middle cohort born 1931-1940 a younger cohort born 1941-1950 and the "newest" cohort, born 1951-1960. Self-reported dementia and memory problems lead a specific cluster for the middle cohort, those born in 1931-1940, but not for the other cohorts. While disease patterns were different between sex for other clusters, the disease cluster of dementia and memory problems held similar disease patterns for males and females, with a prevalence of 3%. The dementia/memory problem cluster loaded with cardio/metabolic diseases. This suggests that complex multimorbidity for the British 1931-1940 cohort has had an impact related to dementia and memory problem diagnoses for this specific generation, for males and females alike.

HEALTH AND FINANCIAL RISK-TAKING PROPENSITY DURING THE COVID-19 PANDEMIC: DIFFERENCES BY AGE AND TIME Barış Sevi, and Natalie Shook, University of Connecticut, Storrs, Connecticut, United States
The COVID-19 pandemic has presented a global health threat of unprecedented magnitude and had a devastating impact on the world's economy. Accordingly, the riskiness of decisions related to health and finance may have increased. However, health and financial threats have differentially affected different age groups. For example, COVID-19 posed a greater health threat to older adults (65+ years) than younger or middle-aged adults, whereas financial threat due to the pandemic affected younger and middle-aged adults more than older adults. This study examined differences in the levels of health and financial risk-taking propensity by time of the pandemic and age group: young (18-39 years), middle-aged (40-64 years), and older adults (65+ years). A sample of 488 individuals residing in the US (245 Woman; Mage = 51.07, SD = 15.99) completed three waves of surveys in March, April, and May 2020. We found that risk-taking propensity for both health and financial decisions decreased over time. The risk-taking propensity was significantly lower in April and May than March, but risk-taking propensity in April and May did not significantly differ. The three age groups were all significantly different than each other in both health and financial risk-taking propensity at all three waves. Younger adults reported higher risk-taking propensity than older and middle-aged adults, and middle-aged adults reported higher risk-taking propensity than older adults. The findings indicate that the pandemic may have influenced all individuals to take less risks in the fields of health and finance regardless of their age. Although aging in the community promotes well-being in older adults, contextual factors (e.g., housing cost burden, neighborhood cohesion, neighborhood disorder) may impact this relationship. Identifying such risk factors represents a first step toward improving older adult well-being. NHATS data (Rounds 5-8) were used to answer two research questions (RQs). RQ1: "Is housing cost burden significantly associated with well-being?" RQ2: "Is this association further moderated by neighborhood cohesion and neighborhood disorder?" Participants were 18,311 adults ≥ 65 years old. Well-being was assessed by summing 11 commonly identified indicators. Two items were merged to assess housing cost burden (categories: "no burden," "no money for utilities," "no money for rent," and "no money for utilities or rent"). Neighborhood cohesion and disorder were combined (categories: "no cohesion, no disorder," "yes cohesion, no disorder," "no cohesion, yes disorder," and "yes cohesion, yes disorder"). Both RQs were assessed through a random coefficient model controlling for established covariates. RQ1 results revealed that, compared to "no burden," "no money for utilities or rent" (B = −1.22, p = .003) and "no money for rent" (B = −1.50, p = .007) were significantly associated with well-being. RQ2 results revealed that "no cohesion, no disorder" significantly moderated the association between "no money for utilities or rent" and well-being (B = −2.44, p = .011). These results indicate that increased housing cost burden is associated with decreased well-being, especially for those reporting no neighborhood cohesion. Future research should examine neighborhood-level protective factors promoting cohesion for older adults to support well-being.

HOW DO FAMILY CAREGIVERS' VALUES INFLUENCE PAIN MANAGEMENT FOR OLDER ADULTS WITH DEMENTIA?
Hui Zhao, 1 Pamela Kulbok, 2 Ishan Williams, 2 Carol Manning, 2 and Rafael Romo, 3 1. James Madison University,Harrisonburg,Virginia,United States,2. University of Virginia,Charlottesville,Virginia,United States,3. Dominican University of California,San Rafael,California,United States Professional caregivers rely on formal training when managing pain among patients with dementia, but family caregivers (FCGs) lack this foundation. Instead, FCGs use informal sources that may reflect a values-driven decision-making process. Few studies have examined how FGCs' personal values impact pain management for dementia patients. We sought to examine the influence of personal values on pain management among FCGs for community-dwelling older adults with dementia using qualitative descriptive methods. Twenty-five adult FCGs, aged from 29 to 95, were recruited in central Virginia. Participants were predominantly white, married, female, and high school graduates. We conducted semistructured interviews that were audio recorded and analyzed using constant comparative analysis. Four themes emerged: 1) Priority for pain management: when quality of life is valued over other factors (i.e., length of life), priorities focused on no pain, leading to better pain management; 2) Moral perspectives: negative views toward drugs, especially opioids, led to less use and greater report of pain; 3) Beliefs about alternative therapy: negative views led to less likely use of non-traditional approaches and reports of more pain, and 4) Personal experience of pain: past personal experiences of pain (negative or positive) influenced the priority placed on pain management and the FCG's ability to provide effective pain management. The diverse views held by FCGs demonstrate a value-based process and suggest a modifiable factor in pain management. Helping FCGs reflect biases while reinforcing values that improve pain management would lead to improve pain and quality of life for older adults with dementia.

HOW LONELY ARE OLDER AMERICANS ACT NATIONAL FAMILY CAREGIVER SUPPORT PROGRAM PARTICIPANTS?
Claire Pendergrast, 1 and Heather Menne, 2 1. Syracuse University, Syracuse, New York, United States, 2. RTI, RTI, District of Columbia, United States Innovation in Aging, 2021, Vol. 5, No. S1