BACKGROUND:While short-term temperature increases (e.g., daily) have been linked to higher rates of mental health hospitalizations, associations between longer-term temperature (e.g., annual) and mental health, particularly depression, are underexplored. The objective of this study was to examine the association between annual average temperature and depression incidence in a United States cohort. METHODS:After excluding all participants in the Nurses' Health Study II who reported clinician-diagnosed depression or antidepressant use prior to 2001, we followed 39,339 participants across the study period between 2001 and 2019. We spatially linked 800 m2 annual average temperature estimates from the PRISM model to participants' biennially-updated residential addresses. We defined incident depression as self-report of clinician-diagnosed depression or antidepressant use. We used Cox proportional hazards models to estimate adjusted hazard ratios and 95% confidence intervals for the association between annual average temperature and incident depression. Models included demographic and lifestyle characteristics as covariates. We performed sensitivity analyses to assess the robustness of the observed association to changes in outcome definition. FINDINGS:In a fully adjusted model, the hazard ratio for the association between annual average temperature and incident depression was 1·06 (1·02, 1·08) per interquartile range (4·9) increase. While this estimate was mildly attenuated in sensitivity analyses considering alternative outcome definitions, the adverse association remained robust. INTERPRETATION AND FUNDING:Our results suggest that sustained exposure to higher temperatures is associated with chronic depression and other mental health outcomes. This work was supported by National Institutes of Health grants U01 CA176726, U01 HL145386, and P30 ES000002.

OBJECTIVES:Higher endogenous estrogen may be associated with better cognition, but associations with menopausal hormone therapy (MHT) have been inconsistent, possibly due to differences in the timing of use. This prospective cohort study aimed to evaluate the associations between reproductive span, as a proxy for endogenous estrogen history, MHT use, and cognitive function. METHODS:We assessed cognitive change (1995-2008) with four telephone interviews (primary outcome: global composite score average of six test z-scores) in 14,217 Nurses' Health Study participants (mean age 74.3 y) and examined associations with reproductive span ([age at menopause]-[age at menarche]), and MHT use duration, separately by 0-10 years, and 11+ years after menopause. RESULTS:A longer reproductive span was associated with better cognitive trajectories (mean annual rate of change difference [95% CI]41-46 vs. ≤33 y=0.008 [0.00005, 0.015]; P-trend=0.02). MHT use 0-10 years postmenopause was associated with faster decline (mean difference8-10 vs. 0 y=-0.007 [-0.016, 0.002]; P-trend=0.02); use during 11+ years postmenopause was not associated. CONCLUSIONS:Although MHT use was not inversely associated, a longer reproductive span was associated with better cognitive trajectories.

Depression is a leading cause of disease burden, disability, and distress for millions of older adults. Therefore, prevention of late-life depression (LLD) is a research and public health priority. Much of the research on depression prevention has been guided by the central framework of prevention of mental disorders that was developed by the National Academies of Medicine (NAM). This framework features three modes of prevention, centered on the group or people at risk: 1) indicated prevention, which focuses on those who have symptoms but are below the threshold of clinical disease; 2) selective prevention, which focuses on persons at higher risk to develop a disease because of having key risk factors; 3) universal prevention, which focuses on the population as a whole, regardless of risk factors or risk status. This perspective will provide illustrative examples of all three NAM modes of prevention, including one example from the author's work that simultaneously addressed indicated, selective, and universal prevention of late-life depression in the VITamin D and OmegA-3 TriaL-Depression Endpoint Prevention (VITAL-DEP) study. This paper will also discuss next steps in research to advance LLD prevention, with a view toward ensuring that all older adults can benefit from the increasing range of prevention options available.

BACKGROUND:Experimental models suggest that in utero photoperiod influences circadian regulation and systems tied to later-life anxiety, depression, and addiction. Whether in utero photoperiod is associated with mental health and substance use in adolescents and young adults remains unknown. METHODS:10,721 full term born children from the GUTS cohort contributed to these analyses. Total photoperiod was calculated by summing daily light hours across 280 gestational days using each offspring's exact birth date and state. We used multivariable adjusted generalized estimating equations, logistic regression, and linear regression to estimate odds ratios (ORs) and mean differences (MDs) for self-reported mental health and substance use outcomes across quintiles of in utero photoperiod. RESULTS:We observed no association between in utero photoperiod and mental health outcomes. Marijuana, opioids, stimulants, and alcohol use also did not differ by photoperiod. However, offspring in the top versus bottom photoperiod had lower odds of ever smoking [MV-ORQ5vsQ1, 0.89; 95% CI: 0.80,0.99; P = 0.08], smoked fewer cigarettes per day [MV-MDQ5vsQ1, -0,16; 95%CI: -0.29,-0.04; P = 0.02], and showed lower nicotine dependence [MV-MDQ5vsQ1, -0,46; 95%CI: -0.8,-0.12; P = 0.007]. No sex interactions were observed for mental health; for smoking and marijuana, males had lower odds of use. CONCLUSION:In utero photoperiod was not associated with mental health. Greater prenatal light exposure was linked to reduced smoking, but not alcohol or marijuana use, in offspring. Further research should examine cumulative prenatal and postnatal photoperiod effects on these outcomes.

BACKGROUND:Chronic pain (CP) and early cognitive decline (ECD) disproportionately impact older Black adults. Our team developed and adapted Active Brains, our evidence-based program that uses mindfulness-based cognitive therapy (MBCT), using cultural tailoring for older Black adults with CP-ECD comorbidity. This protocol paper describes Healthy Aging as Black Adults, In It Together (HABIT), a comparative-effectiveness trial of two evidence-based intervention programs - our culturally tailored adaptation of Active Brains, called MBCT with walking (MBCT+w), and Active Living Every Day (ALED). Our aim is to test which of the two comparators will be superior in improving health outcomes (physical, emotional, and cognitive function) among older Black adults with the CP-ECD comorbidity, and we will assess whether improvements are maintained over a 6-month follow-up. METHODS:We aim to recruit (N = 400) older, community-dwelling Black adults with CP-ECD comorbidity. Eligible participants are 50 years or older, with CP for 3 months or more, and meet screening criteria for early cognitive decline (ECD). Patients will be randomized to either culturally tailored MBCT+w or ALED, which are matched in intervention dosage, at 12 contact hours over 12 weeks (i.e., 720 min of group intervention), and delivered in person in group format. Data will be collected pre- and post-intervention and 6-months follow-up. We will conduct linear mixed effect models to estimate between-group differences for health outcomes over time. CONCLUSION:Findings will support the implementation of the superior program (MBCT+w or ALED) into community settings through a peer delivery modality to support older, community-dwelling Black adults with CP-ECD comorbidity. Clinical trial registration ClinicalTrials.gov Identifier #NCT06246929.

Introduction: Pet ownership is widespread, with many owners reporting emotional benefits, but evidence on its psychological and biological effects remains mixed. Prior research has linked strong pet attachment, particularly to dogs, to lower psychosocial distress, but underlying biological mechanisms are not well understood. We examined associations of pet ownership and attachment with a metabolite-based psychosocial distress score (MDS) and broader metabolic profiles, distinguishing between dogs and cats. Methods: We analyzed data from 213 participants (131 pet owners, 82 non-owners), using the Lexington Attachment to Pets Scale and a previously developed MDS reflecting psychosocial distress. Linear regression assessed associations between pet variables and MDS or individual metabolites, adjusting for demographic, lifestyle, and health factors. Metabolite set enrichment analysis identified associated metabolite classes. Results: Pet ownership and pet attachment were not associated with MDS overall. However, stronger pet attachment was associated with lower MDS (β(95%CI)=-0.58(-1.07,-0.08), p=0.02) among dog owners but not cat owners. Across all measured metabolites, N6,N6-dimethyllysine was significantly associated with pet attachment. Several metabolite classes were associated with pet ownership and attachment, with some in opposite directions. For example, triglycerides with than three double bonds were positively associated with ownership but inversely with attachment, particularly among cat owners. Conclusion: Although pet ownership and attachment were not associated with MDS overall, stronger attachment was associated with lower MDS among dog owners but not cat owners. Pet ownership and attachment showed distinct metabolomic patterns, with differences between dog and cat owners. Further studies are needed to replicate and expand on these findings. ### Competing Interest Statement The authors have declared no competing interest. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study protocol was approved by the Institutional Review Board of Brigham and Women's Hospital and the Committee on the Use of Human Subjects in Research of Harvard T.H. Chan School of Public Health (Boston, MA, USA). Voluntary return of questionnaires indicates informed consent. The study was conducted in accordance with all relevant ethical guidelines and regulations, including the Declaration of Helsinki. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Due to participant confidentiality and privacy concerns, data cannot be shared publicly and requests to access NHS/NHSII data must be submitted in writing. According to standard controlled access procedures, applications to use NHS/NHSII resources will be reviewed by our External Collaborations Committee to verify that the proposed use maintains the protection of the privacy of participants and the confidentiality of the data. Investigators wishing to use NHS/NHSII data are asked to submit a brief description of the proposed project. Please see https://www.nurseshealthstudy.org/researchers (contact email: nhsaccess{at}channing.harvard.edu) for details. National Institutes of Health, https://ror.org/01cwqze88, R01 HD101101, U01 HL145386, U01 CA176726, U01 CA167552

Attention-deficit/hyperactivity disorder (ADHD) is associated with social role dysfunction and loneliness. Household dogs and cats may facilitate social interactions and emotional support, but little is known about their associatons with social role function and loneliness among youth with ADHD. In this study, we addressed these associations in 1056 participants from the Growing Up Today Study (GUTS), a cohort of children from the Nurses’ Health Study (NHS)II. ADHD was determined using maternal reports and participants’ self-reports of diagnosis and/or treatment. Pet ownership was assessed during childhood and early adolescence in the 1999 questionnaire, with categories: (1) Dog and cat; (2) Dog but no cat; (3) Cat but no dog; (4) No dog or cat. Outcomes included overall social role functioning (assessed in 2013), quality of interpersonal relationships with mothers (2005) and romantic partners (2010), and loneliness (assessed repeatedly between 2007 and 2016). Overall social role functioning was analyzed using the chi-square test; quality of interpersonal relationships and loneliness were analyzed using generalized mixed models. No significant differences were observed in overall social role functioning across pet categories. Compared to those who had no dog or cat, dog and/or cat owners did not differ in their likelihood of reporting high-quality interpersonal relationships. Similarly, dog and/or cat ownership was not associated with lower likelihood of loneliness compared to those who had no dog or cat. Future studies could examine repeated measures of pet ownership and other aspects of pet ownership, such as emotional attachment, to clarify potential associations with social and psychological outcomes.

Endogenous estrogen history across the life course may be associated with better cognitive maintenance. Few large longitudinal studies have evaluated this prospectively, and results have been inconsistent. We assessed the association of reproductive span, an indicator of endogenous estrogen history, with cognitive change in older women. We followed 13,419 Nurses’ Health Study participants who were free of stroke, were ≥70 years old as of 1995-2001, reported natural menopause or bilateral oophorectomy and had information on ages at menarche and menopause. Reproductive span was defined as age at menopause minus age at menarche. Four telephone-based cognitive assessments were administered (at 1.5-2 year intervals). The primary outcome was the global composite score, averaging z-scores of 6 tests measuring general cognition (the Telephone Interview of Cognitive Status, TICS), verbal memory, category fluency, and attention. Linear mixed-effects models, adjusted for age, education, depression, menopausal hormone therapy (MHT) within 10 years of menopause, surgical menopause, and other lifestyle and health variables, were used to estimate the differences in annual rate of change over time by quintiles (Qs) of reproductive span. We examined interactions with menopause type, MHT duration and apolipoprotein E ( APOE ) e4 allele (among 5,434 women). The mean baseline age was 74.3 years, the mean follow-up was 6.6 years, and the mean reproductive span was 36.4 years (range = 7-46 years). Longer reproductive span was significantly associated with more favorable cognitive change: compared with women with the shortest reproductive span (Q1: ≤33 years), women with the longest reproductive span (Q5: ≥41 years) demonstrated better maintenance in global cognition (difference in annual rate of change Q5vs.Q1 = 0.007; 95% CI: 0.00001, 0.01; p-trend = 0.02); this difference was equivalent to that observed in women 1.4 years apart in age. We observed similar trends with TICS and verbal memory (p-trends≤0.04), but not category fluency (longer reproductive span was associated with better baseline performance, p≤0.01; but not differences in rates of decline) and attention (no associations found). We observed no interactions with surgical menopause, MHT, or APOE e4. Longer reproductive span, an indicator of greater endogenous estrogen history, was significantly associated with more favorable cognitive maintenance in older women.

Alzheimer's disease (AD) and AD-related dementias (AD/ADRD) have a substantial genetic basis, with APOE4 homozygotes increasingly recognized as a distinct genetic subtype. To identify genotype-specific metabolic pathways and modifiable risk factors, we integrated genetic, plasma metabolomic and dietary data from 4,215 women and 1,490 men in prospective cohorts. Here we show that the associations of 57 metabolites with dementia risk varied by APOE4 genotype or other AD/ADRD risk variants. For example, cholesteryl esters and sphingomyelins were most strongly associated with increased dementia risk in APOE4 homozygotes, whereas inverse associations with glycerides were specific to this genotype. Dimethylguanidino-valeric acid was more strongly associated with dementia risk among carriers of the rs2154481-C allele (APP). Adherence to the Mediterranean diet more effectively modulated dementia-related metabolites in APOE4 homozygotes, suggesting targeted prevention strategies. Incorporating metabolomic data modestly improved dementia risk prediction, particularly during early follow-up. Mendelian randomization analysis identified 19 putative causal relationships between metabolites and cognitive outcomes, including protective effects of 4-guanidinobutanoate, carotenoids and N6-carbamoylthreonyladenosine. These findings reveal genotype-dependent metabolic profiles of cognitive health and support precision nutrition approaches for ADRD prevention.

BACKGROUND AND OBJECTIVES:Subjective cognitive decline (SCD) is an early indicator of cognitive impairment and dementia risk, yet its clinical management remains inconsistent. Health care professionals play a critical role in identifying and addressing SCD, but their perspectives on barriers and facilitators to care are understudied. This study explored health care professionals' insights for improving SCD care. RESEARCH DESIGN AND METHODS:We conducted five qualitative focus groups (n = 26) with multidisciplinary health care professionals providing care for older adults with SCD. Participants were recruited from diverse clinical settings within an academic medical center. Transcripts were analyzed using a hybrid deductive-inductive thematic analysis. We proposed strategies to overcome barriers to SCD care using the Expert Recommendations for Implementing Change framework. RESULTS:Four major themes emerged: (a) Terminology, Identification, and Diagnosis-barriers related to inconsistent terminology, overlap with normal aging, and limited standardized guidelines; (b) Psychosocial Factors-stigma surrounding SCD, variability in patient motivation for interventions, and caregiver roles; (c) Access and Equity-disparities in culturally and linguistically concordant care, financial barriers, and exclusion from research; and (d) Health Care Systems-time constraints, referral delays, and clinic variability impacting the quality of care. DISCUSSION AND IMPLICATIONS:Findings highlight systemic and psychosocial barriers to SCD care, as well as potential facilitators, including interdisciplinary collaboration and patient-centered strategies. Addressing these challenges requires targeted interventions to standardize terminology, improve provider education, enhance access, and promote equitable care. Future research should evaluate implementation strategies to optimize SCD management and reduce disparities in early dementia prevention efforts.

1633 Background: While some clinical studies report greater cognitive difficulties in middle-aged women diagnosed with and treated for breast cancer over the short-term, observational studies of older persons, with longer follow-up, found that a history of cancer was associated with lower Alzheimer’s disease risk. We estimated the relation of breast cancer and treatment history with cognitive status and rate of decline among older women. We further divided breast cancer survivors by: (1) time since cancer diagnosis (assessing recency), (2) age of cancer onset (reflecting body aging at diagnosis), and (3) stage (capturing disease aggressiveness). To evaluate any overlap in shared or opposing genetic risk, we estimated cognitive status by breast cancer polygenic risk score (PRS). Methods: A cognitive sub-study was initiated in 1995-2001 in the Nurses’ Health Study, including 1,378 breast cancer survivors and 14,196 cancer-free women. Breast cancer diagnoses were self-reported and confirmed by medical records; treatment was self-reported. Cognitive function was assessed up to 4 times (over a mean of 6.6 years) and combined into 4 outcomes: global composite score, Telephone Interview for Cognitive Status (TICS), verbal memory, and working memory. We used linear models to assess breast cancer history and treatment with cognitive status (averaged across follow-ups). We used mixed-effects models to assess breast cancer history and treatment with rate of cognitive decline. We computed a breast cancer PRS and evaluated cognitive function across quartiles of PRS. Results: The mean age of breast cancer diagnosis was 65.4 years, and the mean time between cancer diagnosis and baseline cognitive assessment was 8.6 years. We observed similar distributions of key risk factors for AD between women with and without history of breast cancer, including age, education, depression, and physical activity. No significant differences in global cognitive status were noted comparing women with a history of breast cancer with those who were cancer-free. Associations did not differ by age of cancer onset ( < 65 vs. ≥65 years), time since diagnosis ( < 5 vs. ≥5 years), or stage. Genetically predicted breast cancer risk was not associated with the global cognitive status. Women with breast cancer and treated with hormone therapy, chemotherapy, and/or radiation therapy had similar global cognitive status compared to cancer-free women. No significant differences by breast cancer history were observed for TICS, verbal memory, or working memory. Over the modest follow-up time, we observed no significant differences in cognitive decline between women with a history of breast cancer and cancer-free women. Conclusions: We observed no association of history of breast cancer or breast cancer treatment with cognitive function status or rate of decline, suggesting there is neither harm nor benefit of breast cancer diagnosis on long-term cognition.

BACKGROUND:Greenspace exposure is associated with lower depression risk. However, most studies have measured greenspace exposure using satellite-based vegetation indices, leading to potential exposure misclassification and limited policy relevance. We examined the association of street-view greenspace measures with incident depression in a prospective cohort of US women. METHODS:We applied deep learning segmentation models to 350 million US street-view images nationwide (2007-2020) to derive ground-level greenspace metrics, including percentage of trees, grass, and other greenspace (plants/flowers/fields), and linked metrics to Nurses' Health Study II participants' residences (N = 33,490) within 500 m each year. Cox proportional hazards models estimated the relationship between street-view greenspace metrics and incident depression, assessed through self-report of clinician-diagnosed depression or regular antidepressant use and adjusted for individual- and area-level factors. FINDINGS:In adjusted models, higher percentages of street-view trees were inversely associated with incident depression (HR per IQR, 0.98; 95%CI: 0.94-1.01) and specifically clinician-diagnosed depression (HR per IQR, 0.94; 95%CI: 0.90-0.99). Higher percentages of street-view grass were also inversely associated with incident depression, but only in areas with low particulate matter (PM2.5) levels (HR per IQR, 0.79; 95%CI: 0.71-0.86). Results were consistent after adjusting for additional spatial and behavioral factors, and persisted after adjusting for traditional satellite-based vegetation indices. CONCLUSION AND RELEVANCE:We observed participants who lived in areas with more trees visible in street-view images had a lower risk of depression. Our findings suggest tree-planting interventions may reduce depression risk.

Alzheimer's disease and related dementias (ADRD) affect persons living with dementia (PLWD) and care partners, often disrupting emotional well-being and relationship dynamics. Despite growing evidence of dyadic interdependence in dementia care, most psychosocial interventions remain individually focused, missing an opportunity to improve relational and health outcomes. Dyadic dementia interventions (DDIs) aim to support both members of the dyad through shared communication, coping, and mutual support. The primary objective of this review is to introduce the guiding principles of the CONFIDE-ADRD Roybal Center at Massachusetts General Hospital, as these provide a useful roadmap for advancing scalable, theory driven, and person-centered DDIs. We explore the promise and challenges of DDIs, including inconsistent application of theory, measurement difficulties, and barriers to recruiting dyads from a broad range of populations with disparities. Drawing from chronic illness models and dementia-specific programs, we propose a roadmap for building scalable, theory-driven DDIs grounded in mechanistic science. We introduce CONFIDE-ADRD as a national initiative providing funding, training, and expert consultation to accelerate DDI development. The Center's 14 guiding principles support person-centered, context-sensitive intervention design that targets both individual and relational mechanisms of change. As dementia care becomes increasingly relational and dynamic, robust dyadic approaches are critical to reducing care burden, strengthening relationships, and improving outcomes for both PLWD and care partners. Readers are encouraged to engage with CONFIDE-ADRD's resources and contribute to the advancement of dyadic dementia care research.

The Circadian Imbalance Index (CII) integrates chronotype, sleep duration, neuroticism, caffeine intake, and vitamin D. In a genome wide association study (GWAS) of CII in 312,935 European ancestry UK Biobank participants, we identified 27 loci mapping to 72 genes, including circadian regulators CALCA, DHCR7, KDM5A, HAL, and CRX. Gene-overlap analyses demonstrated shared architecture with CII components, while EPHB1, SERPING1, C12orf74, PLEKHG7, and EEA1 were uniquely associated with CII. A CII polygenic score (CII-PRS) showed phenome-wide associations with type 2 diabetes (T2D), major depressive disorder, and obesity. Genetic correlations linked CII with insomnia, mood symptoms, body mass index (BMI), T2D, coronary artery disease (CAD), and myocardial infarction (MI). Mendelian randomization suggested causal effects of CII on T2D, mood swings, and MI, and reverse effects of CAD, mood, and MI on CII. This work shows that circadian imbalance is a polygenic trait connecting sleep-related biology to metabolic, cardiovascular and mood health outcomes.

Abnormalities of choroidal blood flow in the eye are associated with occurrence of age-related macular degeneration (AMD). Cocoa flavanols show beneficial effects on vascular risk factors in small and short-term trials and may help reduce AMD risk. To examine whether daily supplementation with cocoa extract, a source of flavanols, prevents the development or progression of AMD. This was a prespecified ancillary study of the COSMOS (COcoa Supplement and Multivitamins Outcomes Study) trial, a double-blind, placebo-controlled, 2 × 2 factorial randomized clinical trial of a cocoa extract supplement and a multivitamin supplement in the prevention of cardiovascular disease and cancer among 21 442 US adults, including 12 666 women aged 65 years and older and 8776 men aged 60 years and older. The intervention phase was performed from June 2015 through December 2020; data analysis was completed in August 2024. Cocoa extract supplement (500 mg/day cocoa flavanols, including 80 mg (−)-epicatechin) or placebo. The primary end point was a composite of incident cases of AMD plus cases of progression to advanced AMD (geographic atrophy, neovascular membrane, retinal pigment epithelium detachment, or disciform scar) among participants with AMD at baseline, based on self-report confirmed by medical record review. Mean (SD) participant age was 72.1 (6.6) years, and 12 666 participants (59.1%) were female. During a median (IQR) period of 3.6 (3.2-4.2) years of treatment and follow-up, 344 participants (1.6%) experienced a confirmed AMD event (316 incident AMD, 28 progression to advanced AMD). For the primary composite end point, there were 159 cases (1.5%) in the cocoa extract group and 185 cases (1.7%) in the placebo group (hazard ratio [HR], 0.87; 95% CI, 0.71-1.08; P = .21). Separate Cox models fitted because of evidence of nonproportional hazards (P = .048) indicated a 23% decreased risk in the cocoa extract group during the first 2 years of treatment (HR, 0.77; 95% CI, 0.59-1.01), with no added benefit for treatment beyond 2 years (HR, 1.06; 95% CI, 0.76-1.50). Similar time-dependent findings were observed for the secondary trial outcomes of incident visually significant AMD and advanced AMD. In this ancillary study of the COSMOS randomized clinical trial, cocoa extract supplementation for a median period of 3.6 years among older women and men had no effect overall on occurrence of AMD. However, a possible modest treatment effect early in the trial could not be ruled out, which warrants further investigation to clarify whether cocoa extract may help reduce AMD risk. ClinicalTrials.gov Identifier: NCT03205202

The efforts of an academic psychiatry department to embark on an antiracism strategic planning process are outlined, including the establishment of an antiracism task force charged with the development of an antiracism strategic plan. The initial process of the task force is described, recommendations are summarized, and future directions are outlined.

Abstract Home health aides (HHAs) provide support for homebound older adults with cognitive impairments, while lessening strain on familial caregivers. However, HHAs face structural challenges in work-related transportation. To address this gap, we began a pilot study of on-demand access to free Uber rides for HHAs who were recruited, trained and provided job placement in partnership with Community stakeholder-partner CCHERS (Center for Community Health Education Research Services). Through community engagement with CCHERS, and as informed by other community partners (e.g., Mothers for Justice & Equality, Mass HomeCare Alliance), we identified lack of affordable, accessible, reliable transportation as the most-cited structural barrier affecting HHAs and their delivery of homecare. Thus, this study provided access to free Uber rides for HHAs’ job training, home care assignments and other work-related travel, for the duration of study funding; all HHAs were offered access to free rides for as long as funding was available, and key metrics were measured among HHAs during periods with and without ride funding. Preliminary data show high prevalence of other social determinants of health among HHAs using rides (e.g., 50% reporting food and housing insecurity). Outcomes among HHAs (work satisfaction, work hours, visit completion) and patients (patients reached, patient diversity) will be presented regarding whether free, on-demand transportation support for HHAs via Uber will: 1) Improve metrics among HHAs (total visits, hours/week and days/week worked, missed visit/no-shows, work satisfaction); 2) Increase racial, ethnic, socioeconomic and geographic diversity of older adults with cognitive impairment/dementia receiving homecare.

BACKGROUND:Endogenous estrogen history across the life course may be associated with better cognitive maintenance. Few large longitudinal studies have evaluated this prospectively, and results have been inconsistent. We assessed the association of reproductive span, an indicator of endogenous estrogen history, with cognitive change in older women. METHOD:We followed 13,419 Nurses' Health Study participants who were free of stroke, were ≥70 years old as of 1995-2001, reported natural menopause or bilateral oophorectomy and had information on ages at menarche and menopause. Reproductive span was defined as age at menopause minus age at menarche. Four telephone-based cognitive assessments were administered (at 1.5-2 year intervals). The primary outcome was the global composite score, averaging z-scores of 6 tests measuring general cognition (the Telephone Interview of Cognitive Status, TICS), verbal memory, category fluency, and attention. Linear mixed-effects models, adjusted for age, education, depression, menopausal hormone therapy (MHT) within 10 years of menopause, surgical menopause, and other lifestyle and health variables, were used to estimate the differences in annual rate of change over time by quintiles (Qs) of reproductive span. We examined interactions with menopause type, MHT duration and apolipoprotein E (APOE) e4 allele (among 5,434 women). RESULT:The mean baseline age was 74.3 years, the mean follow-up was 6.6 years, and the mean reproductive span was 36.4 years (range = 7-46 years). Longer reproductive span was significantly associated with more favorable cognitive change: compared with women with the shortest reproductive span (Q1: ≤33 years), women with the longest reproductive span (Q5: ≥41 years) demonstrated better maintenance in global cognition (difference in annual rate of changeQ5vs.Q1 = 0.007; 95% CI: 0.00001, 0.01; p-trend = 0.02); this difference was equivalent to that observed in women 1.4 years apart in age. We observed similar trends with TICS and verbal memory (p-trends≤0.04), but not category fluency (longer reproductive span was associated with better baseline performance, p≤0.01; but not differences in rates of decline) and attention (no associations found). We observed no interactions with surgical menopause, MHT, or APOE e4. CONCLUSION:Longer reproductive span, an indicator of greater endogenous estrogen history, was significantly associated with more favorable cognitive maintenance in older women.