bluuebunny/crossref_metadata_2025 huggingface dataset:
CANCER PREVALENCE AND THE ROLE OF MULTIMORBIDITY AMONG OLDER ADULTS: USING NHANES 2011-2016
Authors: Tang Fei , Vasquez Elizabeth
Published: November 2019

Cancer risk increases as age, understanding the potential risk factors of cancer is essential for cancer prevention. Biological and epidemiologic studies suggest relationships between individual chronic conditions and increased cancer risk. However, limited researches have analyzed the association between multimorbidity (simultaneous presentation of two or more chronic diseases) and cancer. The current study is aimed to evaluate whether having multimorbidity is associated with increased all-site and site-specific cancer prevalence among older adults. Data of 5,200 older adults aged 55 years and older who participated in the 2011-2016 National Health and Nutrition Examination Survey (NHANES) were included in the study. Single and multiple logistic regression models were used to evaluate the associations between multimorbidity and cancer. 3,623 (70%) individuals in our study were identified as having multimorbidity and 992 (19%) individuals were diagnosed with cancer. After adjusting for demographic covariates and smoking status, having multimorbidity was significantly associated with having all-site cancer (AOR: 1.57; 95% CI: 1.25 – 1.98) and lung cancer (AOR: 8.91; 95% CI: 1.51 - 52.73). Multimorbidity was associated with increased odds of having cancers among older adults. Our findings add to the evidence suggesting the potential relationships between multimorbidity and cancer. Future longitudinal studies are needed to examine the biological mechanisms and temporality of the association. If the association between multimorbidity and cancer is affirmed, it could have substantial implications in public health, as management of multiple chronic conditions could also advantage cancer prevention among older adults.
LONG-LIVED INDIVIDUALS PRESENTING WITH LARGE BREAST AND COLON TUMORS HAVE A LOWER RISK OF CONCURRENT METASTASIS
Authors: Sweigart Benjamin , Johnson Michelle R , Voisine Michael , Song Zeyuan , Bertrand Kimberly , Andersen Stacy L , Sebastiani Paola , Perls Thomas T
Published: November 2019

We hypothesized large tumors (stage T3 or T4) are less likely to metastasize in centenarians compared to younger patients. We analyzed 2004 to 2015 Surveillance, Epidemiology, and End Results (SEER) data for the most common cancer types (breast, colon, lung, and prostate) among patients with T3 or T4 tumors and compared rates of M1 (presence of metastases) at time of diagnosis according to ages 30-110 years. Among 44,066 breast cancer patients, metastasis rates fell after age 80 for T3 and after age 74 for T4 tumors. The relative risk of metastasis [RR] for T3 patients ages 90-110 years compared to ages 50-89 years was 0.73, 95% CI 0.57;0.94, and the RR for T4 patients was 0.48, 95% CI 0.42;0.55. Among 296,041 colon cancer patients, metastasis rates for T3 and T4 tumors steadily declined after age 60; RR for T3 patients was 0.66, 95% CI 0.62;0.71 and for T4 was 0.73, 95% CI 0.69;0.78 for the older and younger age groups. No difference in metastasis rates at diagnosis was observed for ages 90-110 with small cell and non-small cell lung cancers. Among 52,738 men presenting with stage T3 prostate cancer, the rate of metastasis steadily increased after age 70 (RR = 6.00, 95% CI 4.72;7.63) while there was no substantial difference in metastasis rate according to age for T4 patients. More work is needed to determine whether these findings are related to differences in screening and detection among those at older ages or whether they have a greater resilience to metastasis.
CHARACTERIZING CONCURRENT ALZHEIMER’S DISEASE AND CANCER IN U.S. ADULTS OVER 65
Authors: Schiaffino Melody K , Murphy James
Published: November 2019

Cancer (CA) care delivery fragmentation persists for patients across the cancer continuum. Racial and ethnic disparities are one of the primary factors attributable for variation in treatment outcomes, in addition to language and patient-provider communication barriers. Latino and African-American communities also bear a greater burden of Alzheimer’s Disease (AD) risk than White making patients experiencing AD+CA at risk for poor quality and treatment disparities. This study aims to characterize AD+CA in a population-based sample. Using 2004-2013 SEER-Medicare data we identified multiple cancers and the prevalence of concurrent AD+CA in the database (N=273,349). Patients selected for a first primary, histologically confirmed, any stage, not diagnosed in death certificate or autopsy and had at least 24 months of data prior to diagnosis to calculate a comorbidity index. All analyses were conducted in SAS 9.4 (Cary, N.C.). Across lung (LC), colorectal, head and neck (HNC), prostate (PC), and cervical cancer (CC) we found 5890 cases of AD+CA or 2.15%. While lung represented the largest sample, colorectal (CRC) cancer was responsible for the largest proportion of concurrent AD+CA cases at 3.52% of all CRC. Black and Latino CRC, HNC patients had higher than overall prevalence of AD+CC. Black CRC patients had 6.13% AD+CA vs White 3.27 and Latino HNC patients reported 5.06% vs 3.25 White. Earlier stage patients had higher AD+CA vs later stages for CRC, HNC, and CC. The opposite was true for LC. Finally, women had slightly higher prevalence of AD+LC but significantly higher AD+CRC and AD+HNC compared to men.
GREATER HYPOGLYCEMIA UNAWARENESS IN OLDER COMPARED TO YOUNGER RURAL VETERANS WITH TYPE 2 DIABETES
Authors: Valencia Willy Marcos , Wang Kaicheng , Muralidhar Kiranmayee , Dang Stuti
Published: November 2019

Hypoglycemia is of great concern in older patients, especially when complicated with multimorbidity and geriatric syndromes. We implemented a telemedicine model to address hypoglycemia knowledge, risk factors, incidence and comanagement with their primary care teams (PCT). We identified 166 consecutive rural veterans with high hypoglycemia risk, based on a local medication database (sulfonylureas and insulin), age, and recent glycated hemoglobin A1c (HbA1c). We conducted a telephone medication reconciliation and survey assessing glucose self-monitoring (GSM), hypoglycemia knowledge and symptoms. Variables were tested using chi-square, Fisher’s, and one-way ANOVA. Multivariable logistic regression model was built to assess the association of hypoglycemia and age group, adjusted with treatment, HbA1c%, self-monitoring, and knowledge. There were 54 veterans aged <65 (younger), and 112 veterans aged ≥65 years (older). Average HbA1c was higher in younger than older (8.20±1.96 vs 7.43±1.34%, p=.003). There was no difference in treatment regimens, but the older had greater GSM (p=.028) and lower hypoglycemia symptom knowledge (p=.026). Symptomatic hypoglycemia was greater in younger versus older (50.0% vs 30.4%, p=0.014). Recent (past-2-weeks) hypoglycemic events were more frequent in younger than older (24.1 vs 1.79%, p<.001). Regression analyses showed that younger veterans were more likely to have hypoglycemia (OD=2.37, 95% CI 1.11-5.04). Our results indicate a great need to evaluate older adults with high hypoglycemia risk, in whom we observed less reports of hypoglycemia albeit with similar regimens and lower HbA1c. We suspect greater hypoglycemia unawareness, thus we are implementing a project using continuous glucose monitoring in this high-risk population.
DESIGN AND EVALUATION OF AN ECOLOGICAL MOMENTARY ASSESSMENT TOOL FOR ASSESSING DEPRESSION IN DEMENTIA
Authors: Niculescu Iulia , Iaboni Andrea
Published: November 2019

Background. Assessing depression in people with dementia is challenging due to limitations of retrospectivity. Mobile Ecological Momentary Assessment (EMA) provides a novel approach in assessing depressive symptoms by collecting informant measures in intervals throughout the day, decreasing recall bias and increasing representativeness. Objective. The objective of this study is to design an EMA application for assessing depression in individuals with dementia. Methods. A literature review was conducted to determine commonly used and validated assessments for depression in dementia. Assessments were analyzed for common items, where items less commonly used (<50% of assessments sharing the item) or not relevant to be collected using EMA were excluded. Wording of items were also analyzed to develop the specific structure of questions for the EMA assessment. Results: Six assessments were found and demonstrated adequate performance outcomes. Items fell into either mood-related, dementia-related, vegetative, psychotic or positive mood symptom groups. The mood-related group was analyzed separately for prominent items, which were sadness, anxiety, pessimism, loss of interest and irritability. Wording of items were modified to be consistent with being collected throughout the day, rather than retrospectively. These items were incorporated as core observational domains in the application to be tested. Sadness and anxiety were additionally included as self-report items as studies have shown these to be most discordant between individuals with dementia and informants. Conclusions: This research is a first step towards an innovative approach to assessing depression in dementia. Next steps involve evaluation of the application’s feasibility and reliability for assessing depression in dementia.
DECIDE, DISCOVER, AND DO: AN INTERVENTION FOR COMMUNITY-DWELLING INDIVIDUALS WITH DEMENTIA
Authors: Gorzelle Gregg , Skrajner Michael , Zeisel John , Best Cassie , Walker Drew
Published: November 2019

Decide, Discover, and Do!TM (D3) is a mobile application being developed and evaluated in an NIA-funded Phase 1 SBIR project. The goal of D3 is to enhance the quality of life and care for community-dwelling individuals with dementia (IWD) whose primary care partners (CPs) are their family members. D3 consists of (1) video-based, interactive training for family CPs on best practices in dementia care and (2) evidence-based activities for CPs to facilitate with their loved ones. The study examines the impact of D3 training modules on knowledge transfer and the effects of D3 activities on engagement/affect. The activities are unique in that they create an overarching narrative for daily activities that creates a consistent routine, thereby capitalizing on procedural memory. The activities build upon one another, starting with the IWD choosing a topic (e.g., nature) early in the day, followed by the dyad engaging in a tablet-based activity related to the topic (e.g., reading an article about rainforests), and culminating in an experiential activity (e.g., tasting various foods found in rainforests ). In pilot work, when training was implemented with homecare workers, there was a significant increase in knowledge from pre- to post-test (+21.0, p<.01). In addition, similar activities were shown to be highly engaging, with IWD exhibiting significantly higher levels of constructive engagement (+0.40, p<.01), and significant lower levels of other engagement (-0.13, p<.05), when compared to standard programming. This Phase 1 study will be complete by the conference; outcome data will be presented.
OLDER ADULTS’ PERSPECTIVES OF COGNITIVE HEALTH PROMOTION AND ACTIVITIES TO AMELIORATE COGNITIVE DECLINE
Authors: Bacsu Juanita R , Johnson Shanthi , Viger Marc
Published: November 2019

There is a paucity of research on cognitive health promotion from the perspective of older adults, especially within a rural context. However, dementia and cognitive impairment are more prevalent among rural older adults than urban older adults. This presentation has two objectives: to examine cognitive health promotion from the perspective of rural older adults; and 2) to identify key activities associated with ameliorating cognitive decline in rural communities. Drawing on a community-based participatory research approach, data was collected through two waves of semi-structured interviews with the same group of 42 older adults in rural Saskatchewan, Canada. Guided by lay theory and cultural schema theory, data was coded using thematic analysis. In describing cognitive health promotion, four key areas emerged including emotional health, intellectual health, social health, and functional health. In discussing activities to support cognitive health promotion, participants emphasized the importance of thinking positively, keeping your brain active, mingling with others, and managing your daily affairs. Focusing on older adults’ perceptions of cognitive health promotion provides valuable information to advance knowledge of key strategies and activities to support cognitive health. In developing effective strategies to promote cognitive health, it is essential to engage in collaborative research and partnerships with older adults.
PREDICTORS OF ATTRITION IN THE MULTI-ETHNIC 1FLORIDA ADRC CLINICAL CORE
Authors: Burke Shanna L , Barker Warren , Rosselli Monica , Rodriguez Miriam , Robayo Carolina , Chirinos Cesar L , Behar Raquel , Greig-Custo Maria T
Published: November 2019

Understanding predictors of attrition can position researchers to increase retention efforts and focus on preventing attrition. Attrition, or dropout of participants during a study prior to completion, can threaten the internal and external validity of a study’s findings. Data from the 1FloridaADRC Clinical Core was analyzed, and included 271 participants within a two-year follow-up window, of which 216 (79.7%) were retained. T-tests and chi-square analyses were used to determine if a number of demographic, clinical, acculturation, and neuroimaging predictors were associated with attrition. The participant cohort included: 85% with cognitive impairment; 60% Hispanic; 42% over the age of 75; and 62% female. Predictors of greater attrition included: age over 75 years (p< .003); cognitive diagnosis of MCI or dementia (p< .01); and lower scores on the Mini-Mental Status Exam (p<.04), the Hopkins Verbal Learning Test (HVLT) immediate (p< .02), and delayed (p<.002) Higher total score on the Neuropsychiatric Inventory Questionnaire (p<.06), endorsement of night time behaviors (p<.05) and greater hippocampal atrophy (p<.02) were also predictive of attrition. Hispanic ethnicity was not a predictor of attrition, as retention was 81% for Hispanics versus 79% for non-Hispanics. However, among Hispanic participants, English acculturation measured by the Bidimensional Acculturation Scale for Hispanics was lower for those who dropped out (t=2.8; p=.006).
PREDICTORS OF DEMENTIA IN OLDER ADULTS: VARIATION BY NATIVITY STATUS AND RACE-ETHNICITY
Authors: Moon Heehyul , Badana Adrian , Hwang So-Yeon , Sears Jeanelle , Haley William E
Published: November 2019

Among many possible factors that are associated with increased risk for dementia, one important topic is the role of race and ethnicity. However, previous studies did not examine rates separately by racial/ethnic groups and by nativity status, and little of this research comes from nationally representative data. The current study investigated different predictors of dementia by race/ethnicity and nativity status using Round 1 of the National Health and Aging Trends Study (NHATS, N=7,473). Our stratified log-binominal regression analyses by race/ethnicity (Non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic, and Other) show that the relationship of nativity status to dementia (Probable dementia vs Possible and no dementia) is likely determined by multiple factors (e.g., education, # of cardiovascular conditions/risk factors, # in household) that may vary across race and ethnicity. The relative risks of Probable dementia were higher among immigrants in the Hispanic, and other groups, but lower among immigrants in NHBs, although the relative risk of dementia among NHBs was marginally significant. Gender was not a significant factor of Probable dementia across the four groups after adjustment for other variables including nativity status. Older age was significantly associated with the higher prevalence of Probable dementia across the four groups. However, other risk factors for dementia varied considerably between the four racial/ethnic groups after controlling for nativity status. Healthcare providers systems must be prepared to deliver culturally competent supports and services to diverse groups of older Americans and their family members.
THE EARLY BIRD GETS THE WORM, NOT ANXIETY OR DEPRESSION: HOW INSOMNIA SYMPTOMS PREDICT ANXIETY AND DEPRESSION
Authors: Bolstad Courtney J , Thomas Anisha L , Nadorff Michael R
Published: November 2019

Symptoms of insomnia are associated with symptoms of depression and anxiety in older adults, yet less is known about the impact of specific forms of insomnia (i.e. onset, maintenance, and terminal insomnia). We explored how insomnia type predicted symptoms of anxiety and depression in older adults (n = 133; mean age 69, range 65-89). We hypothesized that onset and maintenance insomnia would have stronger relations to depression and anxiety than terminal insomnia. Regression analyses indicated that onset insomnia was the only significant predictor of anxiety symptoms, and maintenance was the only significant predictor of depressive symptoms. Thus, our findings suggest that despite overlap between depression and anxiety, insomnia may have different mechanisms of affecting each disorder. Implications for the treatment of anxiety and depressive symptoms by addressing insomnia problems will be discussed.
DEVELOPMENT, RELIABILITY, AND VALIDITY OF THE CAREGIVER MEALTIME ENGAGEMENT SCALE IN NURSING HOMES
Authors: Liu Wen , Bachelar-Murphy Melissa , Williams Kristine N
Published: November 2019

Persons with dementia commonly experience mealtime challenging behaviors resulting in negative outcomes. Appropriate caregiver engagement is critical in engaging residents in eating. Current caregiver behavior measures are neither validated nor specific for mealtime care. A feasible and reliable measure to evaluate caregiver engagement during mealtimes is needed. Our team developed the Caregiver Mealtime Engagement Scale (CMES), a 29-item observational measure with good content validity (Content Validity Index = 1.00). The CMES includes 24 positive behaviors (e.g., position resident upright) and 5 negative behaviors (e.g., interrupt resident). Each item is scored by frequency on a 0 (never) – 3 (always) scale. Total score ranges from 0-87; higher score indicates better engagement. This study aimed to test the CMES’ reliability and validity through a secondary analysis of 87 mealtime video-recorded observations from a hand feeding trial (P30). The sample included 7 residents and 25 staff from 2 nursing homes. The CMES has good internal consistency (Cronbach’s α =.775). Inter-rater reliability was good (r = .861, p<.001) based on ratings of 20 videos by two independent trained coders. Intra-rater reliability was excellent (r = .905, p<.001) based on ratings of 20 videos by one trained coder at two times (2-3 weeks apart). The CMES demonstrated good convergent validity based on association with the Relational Behavior Scale (r = .822, p<.001) and Mealtime Relational Care Checklist (r = .324, p=.002). Findings support the CMES’ reliability and validity. Future research is needed to test CMES among a larger diverse sample of caregivers in different settings.
FOSTERING COMPASSIONATE CARE FOR PERSONS WITH ALZHEIMER’S DISEASE AND RELATED DEMENTIAS
Authors: Cotton Samantha G , Faul Anna , D’Ambrosio Joe , Yankeelov and Pamela
Published: November 2019

The aim of this study was to examine the impact of the implementation of a new Compassionate Care (CC) curriculum, designed by social workers, on the quality of care provided by Certified Nursing Assistants (CNAs) to residents with Alzheimer’s disease (AD). Additionally, the purpose was to create a collaborative network of CNAs that supported each other. The sample included residents and CNAs from an experimental nursing facility and a control nursing facility. At baseline and 12-weeks, data were collected on AD knowledge, self-efficacy, caregiving satisfaction, and affiliate stigma. CNA changes in terms of their knowledge of AD, self-efficacy, caregiving satisfaction and affiliate stigma were analyzed using a two-way mixed method MANOVA. The stress levels of the residents, specifically agitation and salivary cortisol levels, was examined by testing a hybrid multilevel growth model. The final models were able to show how the changes in the CNAs specifically affected these positive outcomes. CNA knowledge and self-efficacy had the most impact on changing agitation levels, and CNA knowledge and agitation levels had the most impact on salivary cortisol levels. The results of this study showed that integrating a compassionate care curriculum into the work that CNAs perform can lead to positive outcomes on knowledge, self-efficacy, caregiving satisfaction, affiliate stigma and a reduction of agitation and cortisol levels in persons with AD.
PERSONHOOD-BASED KNOWLEDGE: A NEW CONSTRUCT PREDICTING PERSONAL DEMENTIA FEAR
Authors: Ebert Alexandria R , McFadden Susan , Kulibert Danica
Published: November 2019

Perhaps because the public is not well-versed on the biological and medical facts of dementia (biomedical knowledge; BK), or the life experiences and capabilities of persons living with dementia (personhood-based knowledge; PBK), dementia is one the most feared and stigmatized terminal illnesses (Alzheimer’s Society, 2007), typically resulting in social isolation (George, 2010). Similar to personal dementia fear (fear of developing dementia; PDF), dementia worry has been associated with suicide ideation (Cui et al., under review), which is a predictor of accepting attitudes toward physician-assisted suicide (Wolfgag, 2017). Findings from the development and testing of a conceptual model of social comfort indicated that people with higher levels of PBK had higher levels of social comfort towards persons with dementia (Ebert, Kulibert, & McFadden, 2019). The present study is a secondary analysis of data obtained from Wisconsin residents through an online platform and community outreach efforts (Ebert, Kulibert, and McFadden, 2019; N = 645) to examine whether individuals with higher levels of PBK have lower levels of PDF. A hierarchical linear regression revealed that PBK and BK were significant predictors of PDF (β = -.13, p < .05; β = .108, p < .05, respectively). However, when controlling for age (β = .14, p < .01) and knowing a friend or family member with dementia (β = -.19, p < .001), only PBK remained a significant predictor (β = -.16, p < .01). Results suggest that enhancing PBK through interactions with people living as well as possible with dementia could reduce PDF.
THE RELATIONSHIP BETWEEN HAIR CORTISOL, CHRONIC STRESS, AND WELL-BEING AMONG OLDER ADULTS WITH DEMENTIA
Authors: Kim Eunsaem , Bolkan Cory , Crespi Erica , Madigan Jennifer
Published: November 2019

Hair cortisol concentration (HCC) is a new method of measuring chronic stress by analyzing a small sample of hair. Given the strong relationship between chronic stress and quality of life (QOL) in people with dementia, HCC may enhance our understanding of their well-being. Our primary goal was to establish feasibility of HCC testing in people with dementia as a biomarker of chronic stress. To do so, we examined the HCC levels of chronic stress during the transition to memory care. Newly admitted memory care residents (N = 13, mean age = 82) were followed over nine months. Residents’ hair samples and health information were collected at three-month intervals. HCC in individuals with dementia (16.29 pg/mg) were considerably lower than older adults without dementia (30.48-57.8 pg/mg). Transition to memory care was associated with significantly decreased HCC levels (β = -.70, p < .001). Depression (β = -.32, p < .05) and psychotropic medication use (β = -.20, p < .01) facilitated the rate of HCC decline. Additionally, greater fluctuations in HCC over time were associated with higher HCC levels (β = .048, p < .05). Elevated HCC levels were related to poor functional capabilities (β = 8.31, p < .05), low social engagement (β = -6.01, p < 05), and poor overall QOL (β = -3.61, p < .01). These results underscore the significance of positive care environments to minimize chronic stress in individuals with dementia and indicate that HCC may be a useful stress measure in this population.
LINKING VISUAL-SOMATOSENSORY INTEGRATION TO COGNITIVE AND MOTOR OUTCOMES IN AGING
Authors: Mahoney Jeannette R
Published: November 2019

Ability to successfully integrate simultaneous information relayed across multiple sensory systems is an integral aspect of daily functioning. Unisensory impairments have been individually linked to slower gait, functional decline, and increased risks for falls in aging. Yet, research investigating age-related changes in multisensory integration (MSI) processes still remains relatively scarce. To date, there has been converging evidence for larger behavioral multisensory effects in older compared to younger adults; however, the question of whether larger effects are actually beneficial remains largely unanswered. Findings from our studies provide support for differential multisensory processing in aging, where decreased magnitude of visual-somatosensory integration was associated with worse balance, increased falls, and slower gait. Furthermore, we established a link between visual-somatosensory integration and cognition in aging. That is, magnitude of visual-somatosensory integration was largest in older adults with normal cognitive functioning, and presence of MCI/dementia significantly decreased magnitude of visual-somatosensory integration which in turn adversely impacted balance and gait performance. While the effect of MSI has been attributed to basic degenerative changes in neuronal architecture during the aging process, this speculative interpretation has yet to be formally tested. Future studies are clearly needed to establish the structural and functional correlates of MSI in aging, specifically visual-somatosensory integration, in order to further establish the link between differential multisensory effects with other important age-related clinical outcomes. Nevertheless, these studies stress the importance of successful MSI in aging, and highlight the need for multisensory based interventions that could potentially ameliorate disability.
RISK FACTORS FOR FALLS IN OLDER ADULTS WITH TYPE 2 DIABETES
Authors: Vieira Edgar R , Fontes Fabieli , Filho Bartolomeu , Cavalcanti Fabricia , Gazzola Juliana
Published: November 2019

The objective of this study was to evaluate the probability of the risk of falls in the older adults with type 2 diabetes. One-hundred and eleven older adults (age: 69±7 years) with type 2 diabetes participated in this cross-sectional observational study. The participants sociodemographics, physical function, cognitive status (Mini Mental State Exam – MEEM and Geriatric Depression Scale – GDS), balance (Mini BEST test), functional performance (WHODAS 2.0) and falls risk (Quick Screen Clinical Falls Risk Assessment – QuickScreen) were evaluated. The data was analyzed using the Kruskall-Wallis, Chi-square, and Fisher’s exact tests (p<0.05). Thirty percent of the participants had fallen during the previous 12 months, and 80% of the participants reported fear of falling. The average number of falls risks was 3.5±2. Increased number of falls risks were associated with lower educational level (p=0.005), poorer general health (p=0.001), vision impairment (p=0.017), higher number of diseases (p<0.0001), higher number of medications (p<0.0001), longer diabetes duration (p<0.0001), lower limb pain (p<0.0001), depression (p<0.001), worse functional performance (p<0.0001), and worse balance (p<0.0001). Older adults with type 2 diabetes with lower education, worse health and vision, greater number of diseases and medications, longer diagnosis of diabetes, lower limb pain, depressive symptoms, worse functional performance and balance presented more risks for falls.
FALLS AND NUTRITIONAL RISK AMONG RURAL STATE RESIDENTS
Authors: Wingood Mariana , Gell Nancy M , Tarleton Emily
Published: November 2019

Vermont continues to have one of the nation’s highest fall rates and its rurality may be a contributing factor. The purpose of our study was to compare fall history and nutritional risk (a fall risk factor also associated with rurality) in participants from rural and metropolitan areas. We collected data at statewide community-based fall risk screenings. During the events, nutritional data was collected using the DETERMINE Your Nutritional Health Screening Tool Questionnaire. We used descriptive statistics (chi2) to examine the relationship between fall history, nutritional risk, and rurality. From 123 subjects, 67% were classified as rural residents. There was no relationship between fall history and nutritional risk (p=0.6). Compared to rural residents, a significantly higher percentage of those living in metropolitan areas reported falls (54% versus 35% p=0.05). However, metropolitan residents were not at higher nutritional risk (49% versus 54%, p=0.61). National nutritional risk rates are lacking, but food insecurity is associated with nutritional risk. Our overall reported high nutritional risk (20%) is higher than the prevalence of food insecurity, both nationally (11%) and in Vermont (9%). In conclusion, we did not identify a relationship between fall history and nutritional risk. We did find a higher percentage of metropolitan residents reporting falls. Furthermore, we identified that DETERMINE is a feasible nutritional screening tool to use at fall risk screenings. It can be used to identify community-dwelling older adults at nutritional risk, but it may not have the sensitivity to identify an association between nutritional risk and falls.
INDOOR AND REAL-LIFE OUTDOOR GAIT SPEED AND ITS ASSOCIATION ON GEOGRAPHIC LIFE-SPACE AND OUTDOOR MOBILITY
Authors: Wong Chek Hooi , Tan Pey June , Chong Mei Sian , Mallya Jagadish U , Ginting Mimaika L , Ng Isabel H , Ho Soon Hoe , Yuen Belinda
Published: November 2019

Independent outdoor mobility is important to community-dwelling older adults as it enables reach and access to resources for everyday activities, but this becomes increasingly challenging with the progressive decline in physical performance in ageing. We aim to understand the relationship between Indoor (IGS) and Real-Life Outdoor Gait Speed (OGS) with objectively-measured geographic life-space extent and outdoor mobility among community-ambulant older adults in Singapore. Thirty-three participants aged ≥55 years living in three neighbourhoods wore hybrid mobility trackers continuously for 7 days. Baseline 6-metre IGS was measured with a stopwatch, while OGS was from outdoor accelerometer data. Nodes were defined as significant places visited for ≥5 minutes. Multiple linear regressions examined each association between IGS and OGS on geographic life-space extent and outdoor mobility measures adjusting for confounders. Participants’ mean age was 69.2±7.1 years with mean IGS and OGS of 1.11m/s and 0.85m/s respectively. They spent on average 4.7 hours/day out-of-home with the majority (57%) of nodes located within 500m from home. There were no significant associations between gait speeds and geographic life-space measures. Higher OGS was associated with higher total number of nodes/week while higher IGS was significantly associated with lower percentage of nodes within 500m from home. Our findings highlighted the complexity and multi-dimensionality of independent outdoor mobility as both gait speed performances were not significantly associated with geographic life-space extent, but rather with spatiotemporal interaction and opportunities to access locations for older adults’ daily activities.
COGNITIVE APPRAISAL AND KNOWLEDGE AS RISK FACTORS FOR HIGH FEAR OF FALLING IN OLDER AND MIDDLE-AGED ADULTS IN SINGAPORE
Authors: Tan Pey June , Ng Reuben , Chan Angelique , Mallya Jagadish U , Ismail Noor Hafizah , Wong Chek Hooi , Tay Peter K
Published: November 2019

Fear-of-falling (FOF) can be adaptive or maladaptive depending on one’s appraisal of knowledge and beliefs, but few have elucidated this cognitive process in older adults surrounding falls. We aim to identify risk factors for high FOF amongst community-dwelling older adults (OA) and middle-aged adults (MA) in Singapore. This was a cross-sectional survey of a nationally-representative sample of OA (≥60 years) and MA (40-59 years) identified by stratified random sampling. Primary outcome was high FOF measured by a single-item (4-point scale). Independent variables were history-of-falls, quality-of-life, fall-related cognitive appraisal (balance problems, importance to restrict activities to prevent falls) and knowledge indicators (knowledge of other OA who fell, ability to identify out of 13 fall risk factors). MA were also asked if they’re caregivers. Multiple logistic regressions identified risk factors for high FOF separately by age-groups, adjusting for socio-demographics and comorbidities. The final analysis included 549 OA (70.6±6.88 years) and 309 MA (49.7±5.89 years). No differences in high FOF was found among OA and MA (37% vs. 38%, p=0.305), but there were more falls among OA (19% vs 12%, p=0.010). Higher knowledge of fall risk factors and self-reported balance problems were significant risk factors for high FOF among OA only, while a history-of-falls and being a caregiver were significant among MA only. Perceived importance to restrict activities was associated with high FOF in both age-groups. Although findings suggest differences in the mechanism of high FOF between OA and MA, both age-groups have maladaptive appraisal tendencies related to restrict activities to prevent falls.
FRESH AND LEAN BEEF INTAKE IN RELATION TO FUNCTIONAL LIMITATIONS AMONG U.S. OLDER ADULTS, 2005-2016
Authors: An Ruopeng , Nickols-Richardson Sharon , Alston Reginald , Shen Sa , Clarke Caitlin
Published: November 2019

Beef is a key component in the American diet. This study assessed fresh and fresh lean beef intake in relation to functional limitations among U.S. older adults 65 years and older. Logistic regressions were performed on individual-level 24-hour dietary recall and health indicator data (N=6,135) retrieved from 2005–2016 National Health and Nutrition Examination Survey. Approximately 51%, 14%, and 9% of older adults consumed beef, fresh beef, and fresh lean beef, respectively. Daily increase in fresh beef consumption by 1 ounce-equivalent was associated with a reduction in the odds of lower extremity mobility limitation (LEM) by 16% (95% confidence interval=4%–27%), general physical activities limitation by 13% (1%–24%), and any functional limitation by 14% (2%–24%). Daily increase in fresh lean beef consumption by 1 ounce-equivalent was associated with a reduction in the odds of LEM by 22% (7%–34%) and any functional limitation by 15% (1%–28%). No association with activities of daily living, instrumental activities of daily living, or leisure and social activities limitations was identified. In conclusion, preliminary evidence links fresh and fresh lean beef consumption to reduced functional limitation risk. Older beef consumers are encouraged to modestly increase their intakes of fresh and lean beef, rather than total beef, to maximize attributes of functional health associated with beef consumption while concurrently avoiding additional saturated fat and sodium intake. Limitations of this study include measurement errors and cross-sectional study design. Future studies with longitudinal/experimental design are warranted to examine the influence of fresh/lean beef consumption on functional limitations among older adults.
PATTERNS OF DISABILITY ACCORDING TO ENROLLMENT TO HEALTH INSTITUTIONS AMONG ADULTS AGE 50 AND OLDER IN MEXICO
Authors: Castro Eduardo Cabrero
Published: November 2019

The aim is to describe and analyze the progression of the limitation in the Basic Activities of Daily Living (ADL) in the period 2012 - 2015, in adults over 50, grouped by their enrollment to public health services and private health institutions in Mexico (6 groups). The sociodemographic and health characteristics of each set of adults are included in this study. Disability is measured using the ADL scale. Data come from the longitudinal Mexican Health and Aging Study in the years 2012 and 2015. Multinomial logistic regressions and multi-state life tables were carried out for the analysis. Between 35% and 50% of the participants with disabilities at the beginning of the study, recovered their functionality regardless of which health institution they were enrolled to. Those individuals enrolled in two or more institutions are .33 times more likely to have no disability, compared to those who are not enrolled in any institution. Transition probabilities from active life to ADL disability rise sharply with age until 86 years old (21%), from which it begins to descend. Conditional life expectancy estimates for those initially healthy at the age 60 is 30.07 years. Of the above, 4.74 years are lived with disabilities. The disability process follows different trajectories in each group of enrollees. These trajectories were associated with socioeconomic and health factors (age, sex, diabetes and cognition). Being enrolled in 2 or more institutions is related to the prevention of disability. This is probably due to the increased access to health services.
FACILITATORS AND BARRIERS FOR ELDER ABUSE VICTIMS SEEKING HELP: FINDINGS FROM THE NATIONAL ELDER MISTREATMENT STUDY
Authors: Burnes David , Acierno Ron , Hernandez-Tejada Melba
Published: November 2019

Understanding help-seeking among victims of elder abuse is a critical challenge in the field. The vast majority of elder abuse victims remain hidden from formal support/protective response systems, such as adult protective services, legal/justice, law enforcement, or other agencies responsible for addressing this issue in the community. Guided by the Behavioral Model of Health Services Use, this study examined factors that facilitate or impede formal help-seeking among victims of elder emotional, physical and sexual abuse, represented by a call for help in the form of a report to police or other authorities. Data came from a national, population-based elder abuse study in the U.S. with a representative sample (n=304) of victims reporting abuse in the past year. Gold-standard measurement strategies were used to assess each elder abuse subtype. Multivariable logistic regression was conducted to identify help-seeking facilitators/barriers. Help-seeking through reporting to police or other authorities occurred among only 15.4% of elder abuse victims nationwide. Help-seeking was predicted by factors attached to the victim (abuse type, poly-victimization), perpetrator (prior police trouble, social network size), and victim-perpetrator relationship (victim dependence on perpetrator). This study highlights the extremely hidden nature of elder abuse in our society, as well as the need to develop strategies that incorporate victim, perpetrator, and victim-perpetrator relationship factors to promote greater help-seeking among victims.
ABUSE, NEGLECT, AND EXPLOITATION IN ASSISTED LIVING: AN EXAMINATION OF LONG-TERM CARE OMBUDSMAN COMPLAINT DATA
Authors: Magruder Karen , Xu Ling , Fields Noelle L
Published: November 2019

Adult Protective Services (APS) has seen cases of elder abuse increase recently and older adults living in long-term care facilities are subject to abuse, neglect and exploitation (ANE) at higher rates than community-dwelling seniors. However, there is scant empirical literature about ANE in assisted living (AL) settings and skilled nursing facilities (SNFs). The purpose of this study is to examine ANE complaints in AL and SNFs as recorded by Long-term Care Ombudsman Programs (LTCOPs) utilizing secondary data from a statewide database as well as an agency database used by staff ombudsmen who work in a large Metropolitan city in Texas. The sample included 140,497 complaints made at 1,940 licensed ALs with approximately 45,107 residents and 1,231 SNFs with 93,932 residents in Texas from 2010-2017. The percent of total complaints coded as ANE was higher in AL (2.01%) than in SNFs (1.46%) (p < .001). However, after controlling for number of residents, the rate of total ANE complaints per resident was higher (0.019) in SNF compared to AL (0.007) (z = -17.221, p <. 001). The incidence of financial exploitation was significantly higher in AL (23.46%) than in SNF (11.90%) (z = 5.582, p < .001). The percentage of verbal/psychological abuse in SNF (34.78%) was significantly higher than that in AL (23.4%) (z = -2.238, p < .05). Study findings contribute to the knowledge about the prevalence and nature of ANE in long-term care communities and bolster support for increased AL ombudsman presence, staff training, resident-centered care models, and AL oversight.
POLICIES AND PREVENTION OF U.S. WOMEN’S VIOLENT DEATH ACROSS AGES
Authors: Salari Sonia L , Sillito Carrie
Published: November 2019

U.S. violent death rates (homicide and suicide) are the highest in the developed world. Of all female murders (femicide), the majority are male perpetrated, intimate partner violence (IPV- 55-63%). Men are more often killed and by other male acquaintances, with only 2.8% IPV. Proportionally, older women (50+) have the top homicide victim rate (26%) among women. The baby boom cohort has been suicidal and aging has exacerbated the problem. Women are less likely to kill themselves, and the methods differ. We ask are mid and later life women’s lethal victimization similar to younger women? What are policy implications for prevention? Our research uses national level data from news surveillance of 728 intimate partner homicide suicide (IPHS) events and the State Firearm Law Database (SFLD) to improve our understanding of violent cause mortality by sex, age, method and location. IPHS patterns show 90% of events used firearm and 90% were male perpetrated. Results of multivariate analyses show young women had greater awareness and fear before IPHS. Evidence finds older men sometimes decided to kill their IP as part of their own suicide, without a history of known domestic violence. Older women have disproportionately low use of shelters, police and protective orders. SFLD shows population adjusted states with more DV firearms laws have significantly fewer IPHS events. Firearm culture has restricted research, blocked law enforcement and has done little to reduce gun access in households with vulnerable populations (e.g., suicidal husbands). Lethality Assessment Protocols could be modified for elder women’s unique situation.
ADVANCING AN INTERDISCIPLINARY SCIENCE OF AGING THROUGH A PRACTICE-BASED DATA SCIENCE APPROACH
Authors: Lucero Robert , Bjarnadottir Ragnhildur
Published: November 2019

Two hundred and fifty thousand older adults die annually in United States hospitals because of iatrogenic conditions (ICs). Clinicians, aging experts, patient advocates and federal policy makers agree that there is a need to enhance the safety of hospitalized older adults through improved identification and prevention of ICs. To this end, we are building a research program with the goal of enhancing the safety of hospitalized older adults by reducing ICs through an effective learning health system. Leveraging unique electronic data and healthcare system and human resources at the University of Florida, we are applying a state-of-the-art practice-based data science approach to identify risk factors of ICs (e.g., falls) from structured (i.e., nursing, clinical, administrative) and unstructured or text (i.e., registered nurse’s progress notes) data. Our interdisciplinary academic-clinical partnership includes scientific and clinical experts in patient safety, care quality, health outcomes, nursing and health informatics, natural language processing, data science, aging, standardized terminology, clinical decision support, statistics, machine learning, and hospital operations. Results to date have uncovered previously unknown fall risk factors within nursing (i.e., physical therapy initiation), clinical (i.e., number of fall risk increasing drugs, hemoglobin level), and administrative (i.e., Charlson Comorbidity Index, nurse skill mix, and registered nurse staffing ratio) structured data as well as patient cognitive, environmental, workflow, and communication factors in text data. The application of data science methods (i.e., machine learning and text-mining) and findings from this research will be used to develop text-mining pipelines to support sustained data-driven interdisciplinary aging studies to reduce ICs.
OSTEOSARCOPENIC OBESITY AND VITAMIN D IN U.S. ADULTS AGES 50 AND OLDER: A CROSS-SECTIONAL STUDY
Authors: Saltzman Barbara S , Kenney Kevin C
Published: November 2019

Osteosarcopenic Obesity (OSO) is the concurrent presence of obesity (excess body fat), sarcopenia (low muscle mass) and osteoporosis (low bone mineral density). Low levels of serum vitamin D (vitD) have been associated with each disease and their simultaneous presence. We examined this association in adults aged ≥50 years from the 2001-2006 survey cycles of the National Health and Nutrition Examination Survey (NHANES) (N=3791). SAS v9.4 complex survey procedures were used. Demographics and vitD status were compared across OSO components (0,1,2,3) by chi-squared tests and ANOVAs. Odds ratios and 95% confidence intervals for the association between vitD status and increasing number of OSO components were calculated using multinomial logistic regression (alpha=0.05). The mean age was 65.0 years (30% were older adults ≥ 65), 45.6% were female, and prevalences for obesity, osteoporosis, sarcopenia and OSO were 84.7%, 8.0%, 16.3%, and 1.8%, respectively. Additionally, 30.9% of the sample was vitD deficient. After adjusting for supplement use, and race, women with 1 or 2, and men with 1,2 or 3 OSO components were more likely to be vitD deficient than sufficient, compared to those with none [women: 2.8(1.4-5.7), 2.1(1.4-6.8), and men: 2.3 (1.5-3.6), 3.5(2.1-5.9) and 6.3(1.0-38.5), respectively]. Vitamin D status was associated with having one or two OSO components in women, and OSO and components in men, after adjusting for supplement use, sex, and race. These results suggest it is important to consider obesity, osteoporosis, and sarcopenia jointly with respect to vitamin D status in the chronic disease management of aging and older adults.
PARADOXICAL ASSOCIATION OF ADIPONECTIN WITH MORTALITY AMONG LONG-LIVED INDIVIDUALS AND THEIR OFFSPRING
Authors: Miljkovic Iva , Boudreau Robert M , An Ping , Thyagarajan Bharat , Christensen Kaare , Schupf Nicole , Kulminski Alexander , Zmuda Joseph M
Published: November 2019

Adiponectin is an adipokine with well-recognized roles as an insulin-sensitizing, anti-inflammatory, and cardioprotective factor. Despite these biological properties, higher circulating adiponectin levels have recently emerged as a potential risk factor for mortality among older adults. We evaluated the relationship between adiponectin and all-cause mortality further using data collected on 3525 men and women who were participants in the Long Life Family Study (LLFS), a multicenter cohort study of two-generation families with a clustering of healthy aging and exceptional survival. Fasting serum adiponectin levels were measured at study entry. Date of death was abstracted from death certificates and proxy. Cox proportional hazards models were used to estimate the risk of mortality per one SD increase in adiponectin. We adjusted for age, sex, field center, education, lifestyle factors, BMI, comorbid conditions (diabetes, hypertension, lung diseases, heart disease, stroke, and cancer) and intra-familial correlation structure. The mean age of participants at study entry was 71.7 ± 16.3 years (range, 32-110 years; 44.4% male). A total of 1147 deaths occurred during an average 11 years of follow-up (25295 person-years). Higher serum adiponectin was associated with increased mortality even after adjusting for several potential confounding factors (Hazard ratio [95% CI]: 1.19 [1.12, 1.27]; P<0.0001). Consistent with prior studies and contrary to its beneficial metabolic properties, higher adiponectin level was associated with greater all-cause mortality among long-lived individuals and their offspring. Further studies are needed to assess the potential mechanisms underlying this paradoxical association.