Silvia Sörensen

Background and Objectives: The prevalence of vision impairment continues to increase globally due to population growth and aging. Among older adults with vision impairment, loneliness is common. Prior studies assessing loneliness risk have relied on regression-based approaches, which may not capture complex, heterogeneous conditional pathways. We apply a theoretically guided machine learning approach to examine loneliness risk among older adults with age-related macular degeneration (AMD). Research Design and Methods: Using baseline data from 210 adults with AMD (Agemean = 80.1 years) enrolled in a randomized controlled trial, we applied a decision tree method using measures of legal blindness, emotional responses to vision loss, social life satisfaction, anxiety, depression, optimism, future planning, and sociodemographic factors to investigate heterogeneous pathways to loneliness. Results: Decision tree models demonstrated stable discrimination (AUCtrain = .88, AUCtest = .78, DeLong 95% confidence interval: 0.68–0.88) and robust classification performance across thresholds. Social life satisfaction emerged as the primary branching condition differentiating loneliness outcomes. Distinct pathways suggested that high social life satisfaction was strongly associated with lower loneliness; optimism served as a compensatory resource when social satisfaction was lower. Additional pathways highlighted the effects of vision loss severity, anxiety, and emotional responses to vision loss on loneliness. Depressive symptoms differentiated loneliness outcomes within a lower-anxiety branch, suggesting depression may overshadow protective factors. Discussion and Implications: These findings suggest that loneliness arises through heterogeneous psychological pathways rather than single risk factors. By identifying conditional configurations of psychosocial and health-related factors, interpretable decision-tree models may inform more targeted screening, evaluation, and intervention strategies.

Positive emotions can buffer stress‐related negative emotions; however, it remains unclear whether such protective benefits extend to middle‐aged and older adult caregivers of family members with dementia, a population particularly vulnerable to stress and its health consequences. This secondary analysis of laboratory data from a parent clinical trial (R01AG049764) examined the role of sustaining positive affect in buffering the effects of stress‐related emotional reactivity on subsequent negative mood. This study recruited 192 cognitively healthy, middle‐aged, and older adults who were dementia caregivers (mean age = 68.14) reported high stress and/or caregiver burden. During a laboratory session, emotional reactivity to an acute stressor (a math and working memory task) was assessed using changes in valence and arousal from the Self‐Assessment Manikin (SAM) before and after the stressor. Positive and Negative Affect Schedule (PANAS) was completed 10 min before and 40 min after stressor task. Hierarchical regression models tested whether the changes of positive affect across the session moderated associations between SAM valence/arousal reactivity to the stressor and later negative mood. As hypothesised, greater negative valence and arousal reactivity to acute stressor were each associated with higher negative mood later. Among caregivers with less decline in positive affect across session, associations between valence/arousal reactivity and later negative mood were weakened. Our findings support the undoing hypothesis, demonstrating that maintaining positive affect mitigates the impact of emotional reactivity on negative mood. This suggested that interventions fostering sustained positive emotions may be a promising strategy to enhance caregivers' stress adaptation and promote healthier ageing.

Background and Objectives: The chronic stress of caregiving for a family member with Alzheimer’s disease and related dementias (ADRD) is associated with a host of health risks, including accelerated cognitive aging and poor emotional well-being. Despite known links between cognitive and emotion regulatory pathways, cognitive training has not been tested in ADRD caregivers as a means to strengthen cognitive capacity and concomitant emotion regulation, domains undergirding stress adaptation. This study aimed to identify effects of computerized cognitive training on cognitive and emotion indicators of caregivers’ capacity for stress adaptation, a key mechanism for healthy aging. Research Design and Methods: ADRD family caregivers (N = 195; ages 55–85 years) enrolled in a 2-arm randomized controlled trial were assigned (1:1) to engage in a vision-based speed of processing and attention (VSOP/A) training or video education (VE). Processing speed and attention, working memory under stress, and emotion reactivity to laboratory and caregiving stressors were measured at baseline, following an 8-week intervention, and 6 months and 12 months postintervention. Intent-to-treat analyses using mixed models for repeated measures tested effects of VSOP/A training on these outcomes. Results: The VSOP/A group had significantly improved processing speed and attention performance compared to the VE group, and these differences persisted through 6 months postintervention. At 6 months postintervention only, working memory performance under stress was significantly better among the VSOP/A compared to VE group. At 12 months, caregivers in the VSOP/A group reported less negative emotion in response to ADRD-related behavioral symptoms of their care recipient. There were no group differences in acute emotion reactivity to the laboratory stressor at any time point. Discussion and Implications: Findings from this study suggest that targeted cognitive training should be further developed as an efficacious strategy to strengthen ADRD family caregivers’ stress adaptation capacity and healthy aging. Clinical Trials Registration Number: NCT03036423

As populations continue to age, the demand for future care is expected to increase. Future care preparation is a form of proactive coping that can prevent or offset potential stressors related to the changing needs of older adults. Acquisition and preservation of resources are essential for effective proactive coping. Integrating social convoy theory, intergenerational solidarity theory, and proactive coping theory, this study assessed the level of digital literacy, quality of intergenerational relationships, and future care preparation in son‐dominant, daughter‐dominant, and gender‐balanced families. The direct and indirect effects of digital literacy on future care preparation through intergenerational relationships were also examined. Data from 3,626 participants with at least one adult child were drawn from the Panel Study of Active Aging and Society conducted in 2022, which was designed to be a biennial study conducted with a representative sample of individuals aged 50 years and older in Hong Kong. Aging parents in son‐dominant families had the highest levels of digital literacy; those in daughter‐dominant families had the highest levels of intergenerational relationship quality and future care preparedness. Intergenerational relationship quality mediated the relationship between digital literacy and future care preparation in all three types of families, but the effect sizes differed. These findings suggest a need to enhance the digital literacy of aging adults and improve their intergenerational relationships, thereby assisting them to prepare in advance for their future care needs.

Background: In recent years, there has been growing concern about prejudice in crowdfunding; however, empirical research remains limited, particularly in the context of medical crowdfunding. This study addresses the pressing issue of racial disparities in medical crowdfunding, with a specific focus on cancer crowdfunding on the GoFundMe platform. Objective: This study aims to investigate racial disparities in cancer crowdfunding using average donation amount, number of donations, and success of the fundraising campaign as outcomes. Methods: Drawing from a substantial data set of 104,809 campaigns in the United States, we used DeepFace facial recognition technology to determine racial identities and used regression models to examine racial factors in crowdfunding performance. We also examined the moderating effect of the proportion of White residents on crowdfunding bias and used 2-tailed t tests to measure the influence of racial anonymity on crowdfunding success. Owing to the large sample size, we set the cutoff for significance at P<.001. Results: In the regression and supplementary analyses, the racial identity of the fundraiser significantly predicted average donations (P<.001), indicating that implicit bias may play a role in donor behavior. Gender (P=.04) and campaign description length (P=.62) did not significantly predict the average donation amounts. The race of the fundraiser was not significantly associated with the number of donations (P=.42). The success rate of cancer crowdfunding campaigns, although generally low (11.77%), showed a significant association with the race of the fundraiser (P<.001). After controlling for the covariates of the fundraiser gender, fundraiser age, local White proportion, length of campaign description, and fundraising goal, the average donation amount to White individuals was 17.68% higher than for Black individuals. Moreover, campaigns that did not disclose racial information demonstrated a marginally higher average donation amount (3.92%) than those identified as persons of color. Furthermore, the racial composition of the fundraiser’s county of residence was found to exert influence (P<.001); counties with a higher proportion of White residents exhibited reduced racial disparities in crowdfunding outcomes. Conclusions: This study contributes to a deeper understanding of racial disparities in cancer crowdfunding. It highlights the impact of racial identity, geographic context, and the potential for implicit bias in donor behavior. As web-based platforms evolve, addressing racial inequality and promoting fairness in health care financing remain critical goals. Insights from this research suggest strategies such as maintaining racial anonymity and ensuring that campaigns provide strong evidence of deservingness. Moreover, broader societal changes are necessary to eliminate the financial distress that drives individuals to seek crowdfunding support.

Background and Objectives: Latinos caring for a person with Alzheimer’s disease and related dementias (ADRD) have the highest prevalence of caregiving. Yet, they are less likely to benefit from evidence-based interventions given their continued underrepresentation in ADRD-related research. Community advisory boards (CABs) have the potential to address barriers to research for underrepresented communities; however, there are complexities to establishing and sustaining CABs. This article describes how our work addressed challenges in CABs related to unbalanced power relations, language barriers, the value of time, and low research knowledge and health literacy. Research Design and Methods: Nine Latino CAB members, including older Latino caregivers, were trained in a comprehensive program designed to increase knowledge about health research methods and ethics, cognitive health, and cultural adaptation methods. Members completed pre- and post-training measures of Alzheimer’s disease knowledge, attitudes, and beliefs toward research, and a satisfaction survey. Results: Results from the satisfaction questionnaire indicated that the program was well received. CAB members increased their knowledge regarding the management of behavioral and psychological symptoms of dementia and dementia-associated risk factors and treatment. Positive changes in members’ attitudes toward research included increased willingness to participate in trials and subject protection measures. Discussion and Implications: Formalized training in research conduct and ethics and health literacy is a promising strategy to reduce challenges in establishing and maintaining CABs and can also optimize CAB impact to address gaps in older Latino ADRD caregiving research.

BACKGROUND In recent years, there has been growing concern about prejudice in crowdfunding; however, empirical research remains limited, particularly in the context of medical crowdfunding. This study addresses the pressing issue of racial disparities in medical crowdfunding, with a specific focus on cancer crowdfunding on the GoFundMe platform. OBJECTIVE This study aims to investigate racial disparities in cancer crowdfunding using average donation amount, number of donations, and success of the fundraising campaign as outcomes. METHODS Drawing from a substantial data set of 104,809 campaigns in the United States, we used DeepFace facial recognition technology to determine racial identities and used regression models to examine racial factors in crowdfunding performance. We also examined the moderating effect of the proportion of White residents on crowdfunding bias and used 2-tailed t tests to measure the influence of racial anonymity on crowdfunding success. Owing to the large sample size, we set the cutoff for significance at P<.001. RESULTS In the regression and supplementary analyses, the racial identity of the fundraiser significantly predicted average donations (P<.001), indicating that implicit bias may play a role in donor behavior. Gender (P=.04) and campaign description length (P=.62) did not significantly predict the average donation amounts. The race of the fundraiser was not significantly associated with the number of donations (P=.42). The success rate of cancer crowdfunding campaigns, although generally low (11.77%), showed a significant association with the race of the fundraiser (P<.001). After controlling for the covariates of the fundraiser gender, fundraiser age, local White proportion, length of campaign description, and fundraising goal, the average donation amount to White individuals was 17.68% higher than for Black individuals. Moreover, campaigns that did not disclose racial information demonstrated a marginally higher average donation amount (3.92%) than those identified as persons of color. Furthermore, the racial composition of the fundraiser’s county of residence was found to exert influence (P<.001); counties with a higher proportion of White residents exhibited reduced racial disparities in crowdfunding outcomes. CONCLUSIONS This study contributes to a deeper understanding of racial disparities in cancer crowdfunding. It highlights the impact of racial identity, geographic context, and the potential for implicit bias in donor behavior. As web-based platforms evolve, addressing racial inequality and promoting fairness in health care financing remain critical goals. Insights from this research suggest strategies such as maintaining racial anonymity and ensuring that campaigns provide strong evidence of deservingness. Moreover, broader societal changes are necessary to eliminate the financial distress that drives individuals to seek crowdfunding support.

Background: Recent studies have analyzed the factors that contribute to variations in the success of crowdfunding campaigns for a specific cancer type; however, little is known about the influential factors among crowdfunding campaigns for multiple cancers. Objective: The purpose of this study was to examine the relationship between project features and the success of cancer crowdfunding campaigns and to determine whether text features affect campaign success for various cancers. Methods: Using cancer-related crowdfunding projects on the GoFundMe website, we transformed textual descriptions from the campaigns into structured data using natural language processing techniques. Next, we used penalized logistic regression and correlation analyses to examine the influence of project and text features on fundraising project outcomes. Finally, we examined the influence of campaign description sentiment on crowdfunding success using Linguistic Inquiry and Word Count software. Results: Campaigns were significantly more likely to be successful if they featured a lower target amount (Goal amount, β=−1.949, z score=−82.767, P<.001) for fundraising, a higher number of previous donations, agency (vs individual) organizers, project pages containing updates, and project pages containing comments from readers. The results revealed an inverted U-shaped relationship between the length of the text and the amount of funds raised. In addition, more spelling mistakes negatively affected the funds raised (Number of spelling errors, β=−1.068, z score=−38.79, P<.001). Conclusions: Difficult-to-treat cancers and high-mortality cancers tend to trigger empathy from potential donors, which increases the funds raised. Gender differences were observed in the effects of emotional words in the text on the amount of funds raised. For cancers that typically occur in women, links between emotional words used and the amount of funds raised were weaker than for cancers typically occurring among men.

Moral development during emerging adulthood is a topic of growing interest. Several different theories within the study of human development appear to converge on this point of inquiry, as the study of moral development during emerging adulthood recruits different areas of expertise. This paper explores different theoretical approaches to the study of moral development during emerging adulthood and demonstrates the need for interdisciplinary collaboration. The overall shape of the exploration is governed by broad philosophical considerations grounded in the ethics of Aristotle. First, Aristotle’s ideas are adapted to a developmental paradigm, providing an overarching theory of moral development. Second, the study of moral development during emerging adulthood is situated within the relational developmental system metatheory of human development. These first two theories provide a framework for “moral” and “development,” respectively. Additional conceptual and theoretical issues are addressed as they arise, including moral identity and the link between virtue and happiness.