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Objectives Life-span perspectives have long acknowledged that individual functioning is shaped by historical and sociocultural contexts. Secular increases favoring recent cohorts are widely documented. However, little is known about secular trends in day-to-day activities and whether historical changes have occurred in younger and older adults alike. Methods We compared data from 2 independent cohort samples of the daily diary portion of the Midlife in the United States Study obtained 18 years apart (1995/1996 cohort: n = 1,499 vs 2013/2014 cohort: n = 782) and identified case-matched cohorts (n = 757 per cohort) based on age, gender, education, and race. An activity diversity score was calculated based on 7 common daily activities, using Shannon’s entropy method. We additionally examined the roles of age and other sociodemographic and health characteristics in cohort differences in activity diversity. Results Results revealed that the 2013/2014 cohort experienced lower daily activity diversity than the 1995/1996 cohort. Age was positively associated with activity diversity in the 1995/1996 cohort, whereas age was negatively associated with activity diversity in the 2013/2014 cohort. These associations were significant for those who were older than age 55. Cohorts also differed in the types of most dominant activities and average time spent on those activities. Discussion Findings show changes in the lifestyles and daily activities of U.S. adults across 2 decades. Contrasting to the common belief that today’s adults may be healthier and more active, they seem engaging in less diverse daily activities, which can be a risk for future health outcomes.

Identifying factors associated with COVID-19 vaccination acceptance among vulnerable groups, including autistic individuals, can increase vaccination rates and support public health. The purpose of this study was to determine differences among autistic adults who reported COVID-19 vaccination acceptance from those who did not. In this study we describe COVID-19 vaccination status and self-reported preferences among autistic adults and identify related factors. Vaccine accepters were more likely to report increased loneliness during COVID-19, lived in more populous counties (p = 0.02), and lived in counties won by President Biden in the 2020 US presidential election (p 0.001). Positive correlations were found between desire to protect others, concern about contracting COVID-19, and trusting vaccine safety (p 0.001). Concern about vaccine safety was common among the vaccine hesitant, while lack of concern about COVID-19 overall was not. Identifying health promotion strategies based on self-reported, lived experiences about COVID-19 among vulnerable groups is key for public health impact.

OBJECTIVE: Aging is theoretically accompanied by emotional gains, but physiological self-regulatory losses. Emotional and physiological regulation can be operationalized as the extent of increase in negative affect and blood pressure upon experiencing a stressor (i.e., reactivity). The direction of age-based changes in negative affect reactivity to stressors is uncertain. Additionally, evidence for age-based increases in blood pressure reactivity to stressors is based largely on age-based differences observed in cross-sectional and lab-based studies. The present study is the first to examine long-term longitudinal changes in stress-related reactivity for both blood pressure and negative affect in the natural environment. METHODS: 375 healthy adults aged 50-70 years completed six days of hourly ambulatory blood pressure assessment and electronic diary reports of social conflict and task demand and control. 255 participants repeated three days of assessment in a six-year follow-up. With reactivity operationalized as the change in an outcome in association with momentary social conflict, task strain, or task demand (i.e., a model derived slope parameter), multilevel models were used to assess aging-based change in blood pressure and negative affect reactivity over the course of the six-year follow-up. RESULTS: Aging is associated with increased diastolic blood pressure reactivity to social conflict and task demand (β(social_conflict)= 0.48, p=.007; β(task_demand) =0.19, p=.005), increases in negative affect reactivity to social conflict and task strain (β(social_conflict)=0.10, p

OBJECTIVE. Socially integrated individuals are at lower risk of cardiovascular disease morbidity and mortality compared to their more isolated counterparts. This association may be due, in part, to the effect of social integration on nocturnal blood pressure (BP) decline or “dipping,” a physiological process associated with decreased disease risk. However, the pathways linking social integration with nocturnal BP dipping are unknown. We sought to replicate the association between social integration and BP dipping, and to test whether sleep characteristics (duration, regularity, continuity) and/or daily social interactions (frequency, valence) helped to explain the association. METHODS. 391 healthy midlife adults completed an actigraphy assessment protocol that measured sleep. During four actigraphy assessment days, participants also completed ambulatory BP monitoring and ecological momentary assessment protocols that measured BP and social interactions at regular intervals throughout the day. Social integration was assessed via questionnaire. RESULTS. Linear regression controlling for age, sex, race, education, and body mass index indicated that higher levels of social integration were associated with greater nocturnal BP dipping, as indicated by a smaller ratio of night/day mean arterial pressure (β=−.11, p=.031). Analyses of indirect effects suggested that this association was explained, in part, by greater sleep regularity among more integrated individuals. We did not find evidence for other hypothesized indirect effects. CONCLUSION. This was the first study to investigate sleep and social mechanisms underlying the link between social integration and nocturnal BP dipping. Because sleep regularity is modifiable, this pathway represents a potential intervention target to promote nocturnal BP dipping.

Objective To assess the use of Medicaid programs, including waivers, to address the needs of aging autistic individuals. Data sources We gathered data on Medicaid programs in place between 2004 and 2015 for 50 states and the District of Columbia from the Centers for Medicare and Medicaid Services website, by contacting state Medicaid administrators and advocacy groups, and by reviewing the Medicaid Analytic eXtract Waiver Crosswalk. Study design This retrospective analysis classified each Medicaid program and documented state changes over time in eligibility criteria: those serving autism spectrum disorder only, autism spectrum disorder or intellectual disability, and intellectual disability only. Data collection/extraction methods We captured age and diagnosis eligibility criteria for Medicaid programs serving any of the three target groups. Principal findings A total of 269 Medicaid programs met our criteria and most programs (51%) were 1915(c) waivers. The number of autism-specific 1915(c) waivers grew more than fivefold during the study period, outpacing increases in waivers serving individuals with intellectual disability. Conclusions States varied in their use of Medicaid to address the needs of the aging autism population. Further study of characteristics of states that changed their Medicaid programs, and of the health care use and outcomes associated with these changes, are needed to identify opportunities to replicate effective approaches to meeting the needs of this population.

This cohort study examines whether Medicaid waivers were associated with a reduced risk of Medicaid disenrollment among autistic adolescents who are transitioning to adulthood.

Self-perceptions of aging have important implications for health and well-being in later life. Early life experiences, cultural and societal notions about age, and one’s present health and situational context may contribute to one’s expectations and perceptions of their own aging (e.g., Levy, 2009; Diehl et al., 2014; 2021). However, self-perceptions of aging may also predict people's responses in the face of current or future challenges. This symposium takes a closer look at self-perceptions of aging in the context of different types of life challenges. Hu and Larkina discuss early life informal caregiving experiences as antecedents of negative self-perceptions of aging in later life. Koffer and Giasson discuss how ten-year longitudinal associations between subjective age and future loneliness differ among current caregivers and non-caregivers. Mejia and colleagues discuss the role of self-perceptions of aging in adaptation to life following a fall, highlighting potential protective effects of positive self-perceptions of aging and sense of control. Finally, Giasson and colleagues discuss positive self-perceptions of aging as predictors of preventive health behavior and resilience in the context of the COVID-19 pandemic. Dr. Jacqui Smith will conclude the session with an integration of common themes, practical implications, and future research directions that emerge from the four studies.

Different positions within social hierarchies receive unequal access to resources, leading to health disparities in later life (Agenor, 2020). Research addressing inequities must increasingly account for the many social categorizations (e.g., race, gender, socioeconomic status) that affect individuals‘ lived experiences. This symposium examines the role of intersecting social contexts on health and well-being across the life course. Surachman and colleagues use the U.S.-based National Growth and Health Study to examine the intersectionality between early life socioeconomic context and race on women’s metabolic syndrome severity. Their findings have implications for societal factors leading to accelerated aging across young adulthood and early midlife. Koffer and colleagues use the U.S.-based Study of Women’s Health Across the Nation to demonstrate differential midlife exposure to types and number of major life events across race/ethnicity and education. They subsequently find that major life events increase risk of cardiovascular disease events, indicating the importance of studying the life experiences of diverse women across midlife. Drewelies and colleagues use the Germany-based Berlin Aging Study II to look at the associations among multidomain identity and social background factors on physical, cognitive, and psychological aging. Implications from their work demonstrate the interplay of diversity on health and well-being in older adulthood. Conjointly, findings indicate that intersectional identities play an important role in shaping key outcomes of human functioning across adulthood and aging. Dr. Deborah Carr will critically discuss the three contributions from a life course perspective and provide considerations for future research and policy promoting equity for diverse older adults.

Cardiovascular disease (CVD) is the number one cause of death for women, and major life events across midlife may contribute to CVD risk. The present study aimed to test whether greater exposure to major life events across nearly two decades of longitudinal follow-up would be associated with higher risk of clinical cardiovascular disease events. 3,222 middle-aged women from the multi-ethnic Study of Women’s Health Across the Nation reported and provided up to 15 years of major life events, non-fatal incident CVD events, traditional biobehavioral and sociodemographic factors, and death certificates. Cox proportional hazards models were used to test the association between average annual life events and incident fatal and nonfatal CVD events. Each additional major life event was associated with a 1.16-fold (95% CI: 1.08-1.23) increase in CVD events. CVD risk will be discussed considering evidence of racial/ethnic disparities in exposure to major life events.

Experiences that make age salient can shape how old or young a person feels relative to their chronological age. Caregiving for a loved one may contribute to subjective age as well as the linkages between subjective age and well-being. We examined longitudinal associations between subjective age and future loneliness ten years later among 2,557 caregivers and non-caregivers (Baseline Mage=55) in the Midlife in the United States Study (2004-2014). Linear regression results indicated an interaction between caregiver status and subjective age (β = 0.60, 95% CI=[0.14, 1.06]), such that among non-caregivers, older subjective age predicted greater future loneliness, but among caregivers, younger subjective age predicted greater future loneliness. Associations hold after controlling for age, baseline loneliness, and caregiver status at follow-up. Future subjective aging research should examine the unique context of caregiving to further understand the meaning of subjective age and how it predicts important well-being outcomes among caregivers.

PURPOSE/OBJECTIVE(S) The PORTEC3 trial demonstrated a benefit for the use of adjuvant chemoradiation therapy (CRT) over whole pelvic radiotherapy (WPRT) in high risk endometrial cancer. While this trial included patients from Stage IB-III, unplanned subgroup analysis suggested the largest benefit in Stage III patients. This National Cancer Database (NCDB) analysis was performed to evaluate the staged-based differential benefit of CRT over WPRT across a broader number of patients with high-risk endometrial cancer. MATERIALS/METHODS Patients with endometrioid adenocarcinoma who underwent hysterectomy were identified in the NCDB from 2004 to 2017 who met enrollment criteria on the PORTEC3 trial: FIGO 2009 stage IA grade 3 with LVI, stage IB grade 3, stage II, stage IIIA, IIIB, or stage IIIC disease. Only patients receiving WPRT with or without chemotherapy were evaluated. Patients receiving chemotherapy alone or no adjuvant therapy were excluded. Chi-square analyses were performed to evaluate differences between patients receiving WPRT versus CRT. Kaplan-Meier survival analyses were performed and compared via log-rank analyses. RESULTS A total of 11,315 patients were analyzed, of which 7,334 (64.8%) patients received WPRT and 3,981 (35.2%) received WPRT and chemotherapy. Of patients receiving WPRT alone compared CRT, more patients were age 65 or greater (44.7% vs 36.0%, P < 0.001). Lymphovascular invasion (66.9% vs 52.8%, P < 0.001) and lymph node positivity were more common (58.7% vs 29.1%, P < 0.001) in patients receiving CRT versus WPRT alone. 5-year overall survival was improved in Stage III patients receiving CRT compared to those receiving radiation alone (76.2% vs 72.4%, P < 0.001). 5-year overall survival was not different in stage I-II patients receiving WPRT and chemotherapy versus WPRT alone (76.7% vs 77.7%, P = .91). CONCLUSION The addition of chemotherapy to WPRT improves overall survival in stage III patients or greater with endometrioid adenocarcinoma but not in patients with high-risk, stage I-II disease. AUTHOR DISCLOSURE E. Yu: None. T.A. DiPetrillo: Patent/License Fees/Copyright; Thomas DiPetrillo. P.P. Koffer: None. C.J. Miller: None.

Objective Stressful life events are associated with poorer physical, cognitive, and mental health. Examining life events trends across midlife illustrates normative experiences of stress in a critical life period for intervention and disease prevention. Further, there is a critical need for research with racially/ethnically diverse samples to identify differences in life event exposure, as they may relate to later health disparities. Method Annual life event reports were analyzed from 3,066 White, Black, Hispanic, Chinese, and Japanese women in the Study of Women’s Health Across the Nation. Across ages 43–65, longitudinal trajectories were fit to annual number of life events and 9 subcategories of life events (i.e., work problems, economic problems, partner unemployment, illness/accident of loved one, caregiving, bereavement, relationship problems, family legal/police problems, and violent events that happened to the self or family). Racial/ethnic differences were examined, controlling for education. Results Number of annual life events declined with age and plateaued in later midlife. This pattern was largely consistent across types of life events, though family health and bereavement-related life events increased in later midlife. Compared to White women, Black women experienced more life events, while Chinese, Hispanic, and Japanese women experienced fewer life events. Racial/ethnic differences were amplified in specific subtypes of life events. Discussion Racial/ethnic differences in exposure to life events across midlife may contribute to racial/ethnic health disparities in later life.

Purpose/Objective(s) Lobectomy followed by adjuvant chemotherapy is the standard of care for patients with clinically T1-T2N1 non-small cell lung cancer (NSCLC). However, the optimal treatment of patients who cannot undergo or refuse to undergo surgical resection is controversial. Currently, NCCN guidelines recommend concurrent chemoradiation; however, limited evidence exists to substantiate this recommendation for this particular patient population. Many groups advocate for radiation alone with standard or hypofractionated approaches. We hypothesized that concurrent chemoradiation would be associated with longer overall survival (OS) compared to hypofractionated or conventionally fractionated radiation. Materials/Methods We queried the National Cancer Database (NCDB) for patients with cT1-T2N1M0 NSCLC treated non-surgically with definitive radiation or concurrent chemoradiation between 2004 and 2016. We further restricted our cohort to patients receiving RT doses with an EQD2 ≥ 58.4 Gy and > 5 fractions. Patients were divided into four treatment groups: standard fractionated radiation (SFRT), hypofractionated radiation (HFRT), standard fractionated chemoradiation (SFRT+CT), and hypofractionated chemoradiation (HFRT+CT). Chemoradiation was defined as chemotherapy and radiation with start dates within 30 days. To address confounding by indication, inverse probability of treatment weights (IPTW) were constructed regressing sociodemographic, clinical, and facility characteristics on treatment group in a multinomial regression model. Weighted Cox proportional hazard regression models were then used to evaluate the relative hazard of death with SFRT set as the referent treatment group. Results A total of 2,534 patients met inclusion criteria and of these 2,200 patients (57,462.83 person-months) had complete data for all confounders and were included in the analytic sample. Of the 2,200 patients 26.6% received SFRT, 7% received HFRT, 62.1% received SFRT+CT, and 4.2% received HFRT+CT. The median EQD2 (IQR) were: SFRT 66 Gy (60-68), HFRT 66.7 Gy (62.5-71.9), SFRT+CT 65.5 Gy (60-66), and HFRT+CT 67.6 Gy (65.1-72.3). 27% of patients were still alive 36 months after the initiation of RT (17.3% of SFRT, 20.3% of HFRT, 33.2% of SFRT+CT, and 21.8% of HFRT+CT). After IPTW propensity weighting, the probability of death at 3 years was compared between the treatment groups and only SFRT+CT was associated with longer OS. Compared with SFRT, the hazard ratio for all-cause mortality for those treated with SFRT+CT was 0.67 (95% CI: 0.57-0.75), for HFRT was 0.86 (95% CI: 0.61-1.06), and for HFRT+CT was 0.81 (95% CI 0.61-1.06). Conclusion To our knowledge, this is the first large database propensity weighted analysis of patients with cT1-T2N1M0 NSCLC managed non-surgically with definitive radiation or chemoradiation. In this group, treatment with SFRT+CT is associated with longer OS relative to treatment with radiation alone.

PURPOSE/OBJECTIVE(S) The PACIFIC Trial established durvalumab consolidation after definitive chemo-radiation (CRT) as the standard of care for Stage III Non-small cell lung cancer (NSCLC) in those not undergoing surgery. The rate of G3+ pneumonitis risk in this trial was less than 5% in the durvalumab arm. However, there is limited data regarding radiotherapy (RT) lung dosimetry from the PACIFIC trial to determine whether it accurately reflect real-world patients with locally advanced NSCLC who often require high lung dose to obtain target coverage. It is unclear whether established constraints accurately predict pneumonitis risk in this population. We aim to report outcomes and pneumonitis risk in a real word population of patients treated with CRT and durvalumab and determine risk of pneumonitis based on RT lung dosimetry. MATERIALS/METHODS We identified patients treated with CRT and durvalumab at a single institution for NSCLC not undergoing surgical resection. Patients were excluded if RT dosimetry was not available. NCI CTCAE v5.0 was used for grading pneumonitis. Differentiation of radiation pneumonitis (RP) vs durvalumab pneumonitis (DP) was determined by a radiation oncologist. Kaplan-Meier method was used to analyze overall survival (OS), progression free survival (PFS), and pneumonitis incidence and were compared using log rank test. RESULTS 40 patients treated with CRT and consolidative durvalumab were identified with median follow-up of 19 months. 90% of patients were Stage IIIA or IIIB (IIA-IIIC). Median RT dose was 63 Gy (54-70 Gy). Median MLD was 16 Gy (7-21 Gy). Median lung V20 was 29.5% (10%-38%). OS and PFS at 2 years was 69.7% was 60.3% respectively. Grade 2+ and 3+ combined RP and DP for the overall cohort was 29.0% and 24.0% respectively. Median time to pneumonitis from completion date of RT was 129 days. 22.5% (9/40) of patients required steroids for treatment of pneumonitis. 15% (6/40) of patients had a new O2 requirement attributed to pneumonitis. Pneumonitis led to discontinuation of durvalumab in 20% (8/40) of patients. Of the 9 cases of pneumonitis, 7 (77.8%) were consider RP, and 2 (22.2%) DP. Grade 2+ pneumonitis risk was 64.5% in patients with lung V20 > 30% versus 8.3% in patients with lung V20 ≤ 30% (P > 0.001). Grade 2+ pneumonitis risk was 59.4% in patients with a MLD > 17 Gy versus 8.3% in those with MLD ≤ 17 Gy (P 30% versus 8.3% in patients with lung V20 ≤ 30% (P = 0.003). Grade 3+ pneumonitis risk was 47.0% in patients with a MLD > 17 Gy versus 8.3% in those with MLD ≤ 17 Gy (P 30% or MLD > 17 Gy. Larger series are needed to determine optimal dose constraints in this patient population in the era of durvalumab.

Objectives Age-related differences in daily experiences are often described using summaries of categorical repeated measures, including typologies of stressors, activities, social partners, and coping strategies. This paper illustrates how an intraindividual variability (IIV) framework can be used to extract additional meaning from categorical IIV data. Method Using 8-occasion categorical data on daily stressors from the National Study of Daily Experiences (N = 1,499, MAge = 46.74, SDAge= 12.91), we derive and compute six IIV metrics that invoke numeric and nominal measurement of the central tendency, dispersion, and asymmetry of individuals' stressor experiences and examine how these metrics, relative dominance, diversity, log-skew and mode, spread, order, are related to age and interindividual differences in negative affect. Results Results demonstrate the utility of the numeric and nominal categorical IIV metrics, with theoretically meaningful age gradients in the three numeric IIV stressor metrics and five of six IIV metrics mapping differences in negative affect. Discussion Findings highlight how the unique constructs measured by these six metrics of categorical IIV may be used to examine dynamic process, study interindividual and age-related differences, and expand the variety of developmental research questions that may be answered using categorical repeated measures data.

Background General and situational control beliefs have been examined separately as buffers of the effects of daily stressors on affective well-being. However, general (trait) control beliefs reflect perceived ability to adapt, change, and influence overall life circumstances, whereas situational (daily) control beliefs reflect perceived ability to manage current circumstances and achieve desired outcomes. Method Using 9 weeks of daily reports from 150 adults aged 18-89 years, we examined the extent that general and daily control beliefs buffer the between- and within-person associations involving stressors and negative and positive affect (i.e., daily stress processes) and whether/how the extent of buffering differs with age. Results Aligning with prior findings, both greater average stressor exposure and experiencing a daily stressor compromised daily affective well-being and both higher general and daily control beliefs facilitated daily affective well-being. Specific to the motivating hypotheses, both general and daily control beliefs buffered daily stressor-reactivity. Age was associated with individuals' daily stressor-buffering, such that stressor-reactivity was more effectively damped at older ages. Associations between general control beliefs and daily stress processes were age invariant. Discussion Mixed evidence of age differences across general and daily control beliefs highlights how within-person processes may differentially contribute to well-being as individuals accommodate age-related strengths and vulnerabilities.

Objectives As diary, panel, and experience sampling methods become easier to implement, studies of development and aging are adopting more and more intensive study designs. However, if too many measures are included in such designs, interruptions for measurement may constitute a significant burden for participants. We propose the use of feature selection-a data-driven machine learning process-in study design and selection of measures that show the most predictive power in pilot data. Method We introduce an analytical paradigm based on the feature importance estimation and recursive feature elimination with decision tree ensembles and illustrate its utility using empirical data from the German Socio-Economic Panel (SOEP). Results We identified a subset of 20 measures from the SOEP data set that maintain much of the ability of the original data set to predict life satisfaction and health across younger, middle, and older age groups. Discussion Feature selection techniques permit researchers to choose measures that are maximally predictive of relevant outcomes, even when there are interactions or nonlinearities. These techniques facilitate decisions about which measures may be dropped from a study while maintaining efficiency of prediction across groups and reducing costs to the researcher and burden on the participants.