bluuebunny/crossref_metadata_2025 huggingface dataset:
CURIOSITY TOWARDS ROBOT: THE ROLE OF AGE AND PERSONAL RELEVANCE
Authors: Chu Li , Fung Helene H
Published: November 2019

Being curious has various physical, social and psychological benefits. However, theories like the socioemotional selectivity theory suggest that information seeking goals tend to be overshadowed by emotionally meaningful goals with age. Personality and social psychology research also found consistent decline of curiosity in later adulthood. In contrast, selective engagement theory propose that people simply become more selective on where they allocate their cognitive resources as they age. Particularly, older adults tend to invest in things that have personal relevance. Yet, few studies have explored the interaction between age and personal relevance in the context of information seeking tendencies. We conducted a pre-test-post-test experiment with 50 younger (age 19-34) and 50 older adults (age 60-78). Participants were invited to learn about a robot (Vector by Anki) and freely interact with the robot for about 30 minutes. Questionnaires were filled before and after the interaction. Our results confirmed previous findings that older adults showed lower level of trait curiosity than younger adults (F(1, 98)=21.94, p<.001, ΔR2=). However, older adults actually showed higher level of state curiosity towards robot than their younger counterparts (F(1, 96)=21.94, p<.001). Moreover, there was a marginally significant interaction effect of personal relevance (p = .06). Tukey’s post-hoc test revealed that older adults who perceived increased relevance (M=5.39) after the interaction were significantly more curious than younger adults who also perceived increased relevance (M=4.51, p=.02), but there was no significant age difference when they perceived decreased relevance. Present study offers insights on promoting curiosity among older adults.
BARRIERS TO ORAL HEALTH IN THE OLDER POPULATION
Authors: Sharma Kavita , Tepper Lynn , Kunzel Carol
Published: November 2019

A strong challenge is posed for patients and their caretakers by the growing need for promoting oral healthcare for this population, as research substantiates the connection between oral health and systemic health. This study identified the major barriers to providing optimal oral care to the older population. Fifty patients aged 60 and over visiting the Columbia University College of Dental Medicine Clinic were administered a questionnaire which reflected possible barriers to oral health care. Statistical analysis of data revealed that the top three barriers in order of relevance were the (1) cost of treatment, (2) anxiety, and (3) transportation. The youngest old (60-69) indicated that the lack of time and conflict with work schedules were additional barriers, while the older sample (70+) experienced obstacles due to disability and illness. When gender differences were analyzed, transportation was the most significant as a barrier among males, and fear/anxiety was most significant for females. Ethnically, non-Hispanics indicated that (1) shortage of time, (2) anxiety, and (3) lack of social/physical support were significant barriers. Findings indicated that even those with Medicaid insurance coverage believed that the cost of dental treatment and caregiving responsibilitieswere major barriers to seeking care. Conversely, even those without dental insurance indicated that disability and illness were barriers to seeking care. This pilot study highlighted various barriers to oral health care and highlighted the need for intervention to address barriers, such as social services, expanded Medicaid coverage, and transportation assistance, to ultimately improve access to optimal oral health care.
DISPARITIES IN DEPRESSION AMONG CHINESE OLDER ADULTS
Authors: Hao Zhichao , Li qingyi , Ruggiano Nicole
Published: November 2019

Depression has become one of the major health issues among older adults. In turn, various factors can facilitate or impede the occurrence of depression, socially, economically and culturally. Around 2050, China will have 487 million older adults or nearly 35 percent of the total population. Due to the different background of society, economy and culture, what explanations and knowledge can China provide based on present experiences and practices to help better understand depression among older adults from more comprehensive way? This study was conducted on the latest wave (2011-2014) of the Chinese Longitudinal Healthy Longevity Survey (CLHLS, 1998-2014). The sample included 7,107 Chinese older adults age from 65 to 117 years in China. A binomial hierarchical logistic regression was performed to examine the likelihood of having depression among older adults predicted by geographic characteristics, quality of life, chronic diseases, personal community services, social community services, and demographic variables including gender, age, and current marital status. Analysis indicated that approximately 10% of Chinese older adults in the sample reported depression. Compared to female and young-old adults (age 65-74), males (OR=.636, p<.001) and oldest-old adults (age 95+) (OR=.822, p<.001) were less likely to have depression. Older adults who lived in rural areas (OR=.681, p<.001) showed less likelihood of having depression. Older adults who had better life quality (OR=.553, p<.001) revealed less likely to have depression. Having social services in the community (OR=.908, p<.05) significantly lowered the likelihood of having depression among Chinese older adults. Implications for research, policy, and practice are discussed.
ASSOCIATION BETWEEN HOME HEALTH SERVICE USE AND FACILITY ADMISSION IN OLDER ADULTS WITH AND WITHOUT DEMENTIA
Authors: Wang Jinjiao , Caprio Thomas V , Simning Adam , Shang jingjing , Conwell Yeates , Yu Fang , Li Yue
Published: November 2019

This study is a secondary analysis of the Outcome and Assessment Information Set (OASIS) and administrative billing records of 6,153 adults ≥ 65 years old who received home health (HH) from a not-for-profit HH agency in upstate New York in CY 2017. We evaluated the association between the use of home health services (HH) with the hazard of unplanned facility admissions among Medicare patients with and without Alzheimer’s disease and related dementia (ADRD). Outcome was time from HH start of care to an unplanned facility admission of any type, including the hospital, nursing home, or rehabilitation facility. Independent variables included weekly intensity (visits/week, hours/week) of each discipline, including skilled nursing (SN), physical therapy (PT), occupational therapy (OT), social work (SW), and home health aide (HA), separately. ADRD was identified by diagnosis (ICD-10 codes) and cognitive impairment (M1700, M1710, M1740 [OASIS]). In multivariable Cox Proportional hazard models that adjusted for time-varying effects of HH intensity, receiving the highest intensity of SN (3.3 visits of 2.78 hours per week) and PT (2.5 visits of 2 hours per week) was related to up to a 54% and 86% decrease, respectively, in the hazard of unplanned facility admission among patients with ADRD (n=1,525), and decreases of 56% and 90% respectively among patients without ADRD (n=4,628). This is the first study in the United States showing that receiving a sufficient amount and appropriate mix of HH services was associated with substantially reduced risk of unplanned facility admission among patients with ADRD by up to 86%.
PERCEPTIONS, ACCEPTABILITY, EXPECTATIONS, AND CONCERNS OF SMART HOME TECHNOLOGIES AMONG OLDER ADULTS
Authors: Guan Amy , Dannewitz Hannah C , Stratton Lauren , Margrett Jennifer , Boot Walter R , Charness Neil H , Narasimhan Balaji
Published: November 2019

Optimal aging in place has become a common preference among older adults to maintain identity and independence, thus smart home technologies are increasingly utilized to achieve these goals. However, disconnect may exist between potential technological benefit and perceptions of acceptability and usability (Lee & Coughlin, 2015). We assessed perceptions of adults aged 50+ (range 50-90 years) to analyze their priorities and ultimate acceptability of smart home technology. Data were collected through surveys, focus groups, and case study interviews. Three major themes emerged regarding smart home utilization: benefits, concerns, and expectations. Participants endorsed smart home technologies (e.g., sensors, telehealth devices) and identified benefits, such as the promotion of optimal aging (e.g., maintaining independence, staying active, safety). However, responses also reflected concerns about privacy, ease of use, and amount of control. Expectations regarding smart homes included more mobility, efficiency, and safety within the home. One participant described technology as having “options [that] are exhausting, but also exciting.” Survey responses (n=30) were analyzed to understand participants’ familiarity with smart home technologies, including: nanotechnology (10.7%), smart showers (42.9%), home sensors (70.4%), telehealth (74.1%), smart appliances (71.4%), personal sensors (81.5%), and voice-activated devices (96.4%). Additionally, respondents indicated their willingness to implement these technologies to maintain and/or improve their daily functioning: nanotechnology (53.8%), smart showers (28.6%), home sensors (66.6%), telehealth (81.5%), smart appliances (40.0%), personal sensors (55.5%), voice-activated devices (64.3%). Discussion focuses on the priorities and needs older adults express regarding technology utilization and the implications for person-centered design and implementation of future smart home technologies.
VALIDATING THE CARE PREFERENCE ASSESSMENT OF SATISFACTION TOOL TO MEASURE QUALITY OF CARE IN NURSING HOMES
Authors: Madrigal Caroline , VanHaitsma Kimberly , Mogle Jacqueline , Fick Donna , Scanlon Dennis , Abbott Katherine M , Behrens Liza
Published: November 2019

The Institute for Healthcare Improvement’s Triple Aim calls for measures of the ‘patient care experience’ to understand and improve the quality of care delivery. But, quality measures in the nursing home (NH) historically lack the resident perspective. Measuring whether residents are satisfied with the fulfillment of their care preferences using the Care Preference Assessment of Satisfaction Tool (ComPASS) has been encouraged nationally by the Centers for Medicare and Medicaid (CMS); however, the ComPASS has not been validated as a measure of the resident care experience. The purpose of this study was to compare ComPASS to the Ohio NH Resident Satisfaction Survey (a widely accepted quality measure for reimbursement). We examined 196 resident responses from 28 NHs in Pennsylvania using multilevel modeling to account for dependencies in the data (residents in the same NH may respond similarly compared to residents from different NHs). Residents were 81.2 years old (SD= 11.1), female (70.4%), and white (80.1%). Residents with higher scores on the ComPASS reported significantly higher levels of satisfaction with care (B=2.94, SE B=0.59, p<0.000). Results from this study support the potential use of ComPASS to measure, track, and improve the quality of NH care. Using ComPASS aligns with CMS’s Section F of the Minimum Dataset, an assessment of residents’ preferences which promotes the delivery of more person-centered care. Ultimately, ComPASS can help benchmark the quality of the resident care experience across facilities which aids staff, facilities, policy-makers, and NH-shoppers in improving decision-making and care delivery.
YES, CHANGING HOW YOU TEACH DOES MAKE A DIFFERENCE
Authors: Duthie Edmund H , Denson Kathryn , Simpson Deborah , Denson Steven , Szymkowski Amanda
Published: November 2019

Perceptions of an educational experience’s value impact learning. “Hands-on” activities promote deeper learning and retention. Educators may jettison more poorly rated sessions, not having time for perceived content revisions based on evaluation data. We sought to determine if simply changing the sequence of a session’s activities, using the same content, improved learner evaluations. Using a session focused on application of resources for dementia patient caregivers, we provided two versions of the same content to 2 groups of clinicians. In session version #1 (V1), participants were asked about caregiver stresses and barriers and then viewed two video triggers of a dementia patient and a stressed family caregiver. Participants then identified the caregiver’s struggles and recommended resources. At the session’s end they were provided with a Geriatric Fast Fact (GFF) (www.geriatricfastfacts.com) that hyperlinked to a variety of evidence-based resources by topic. In session version #2 (V2), only the content was flipped. The GFF was presented prior to the video, with clinicians were then tasked to identify best resources using the GFF. The V2 cohort rated the session higher than V1 cohort on a 4-point scale (1= Excellent, 4= Poor). Overall quality of learning plan (V1 =1.4 ; V2 =1.3); Would you recommend the session to peers (V1 = 1.5; and V2 =1.2) and Overall course evaluation (V1 = 1.5; V2. = 1.4) all improved. Using learner evaluations to revise the sequence of the same content was an effective educational strategy. Don’t throw the baby out with the bathwater!
ASSESSING THE ADEQUACY OF SOCIAL SECURITY RETIREMENT BENEFITS ACROSS RACE-ETHNICITY, GENDER, AND AGE OF RETIREMENT
Authors: Kim Jin H
Published: November 2019

This research assessed the adequacy of Social Security retirement benefits across race-ethnicity, gender, and age of retirement, and in turn, whether the differing levels of benefit adequacy have any relation to mortality risk. Prior studies generally find that a replacement rate of between 70 to 80 percent of prior earnings would likely allow a worker to maintain his or her standard of living in retirement since various work-related expenses are reduced or eliminated at the point of transition. As such, the current study used panel data from the 1996 - 2016 waves of the Rand version of the Health and Retirement Study to 1) determine earnings replacement rates for non-Hispanic White, non-Hispanic Black, and Hispanic males and females in the first period of retirement, and 2) to examine whether earnings replacement rates are associated with mortality risk in a Cox regression model. The findings revealed that for those retiring at age 65 or later, Hispanic females and White males had the lowest earnings replacement rates at 39.3% and 40.7%, respectively. For those retiring before age 65, Hispanic males and White males had the lowest earnings replacement rates at 30.3% and 26.7%. Although replacement rates should indeed be lower for high earners due to Social Security’s progressive benefit formula, the low replacement rates determined for Hispanic males and females were unexpected. Moreover, mortality risk was found to be significantly associated with earnings replacement rates in the final model, but the combination of race-ethnicity and gender still showed a stronger relation.
HAND2 TRANSCRIPTION FACTOR ENHANCES NMJ ORGANIZATION AND FUNCTION IN OLD MICE
Authors: Rodrigues Anna Carolina Zaia , Bonilla Henry J , Messi Maria Laura , Wang Zhong-Min , Freeman Willard M , Delbono Osvaldo
Published: November 2019

Over time, declining muscle force and power leads to mobility disability and impaired quality of life. In aging rodents and humans, a denervation and reinnervation process is strongly implicated in sarcopenia: the progressive decline of skeletal muscle mass, composition, and function. We propose that the concomitant decline in expression of Hand2, a key transcription factor (TF) for sympathetic neuron maintenance, induces motor pre- and postsynaptic neuromuscular junction (NMJ) instability and disorganization. To counter the deleterious effect of sympathetic denervation, we developed a novel viral vector (AAV9-Hand2-eGFP, Hand2) carrying Hand2 expression exclusively to sympathetic neurons. Male and female, 16-month-old mice, were examined for signs of muscle denervation and sarcopenia 6 months after IV injection with either Hand2 or control empty virus (AAV9-eGFP, EV). We found that Hand2 increased preterminal synaptic vesicle release, neurofilament phosphorylation (Neurite length: Hand2: 3732±496 µm, EV: 2674±165 µm; P <0.01), NMJ pre/postterminal co-localization, hindlimb muscle mass (EDL: 25%, soleus: 14%, tibialis anterior: 17% and gastrocnemius: 25%; n = 6-8 muscles per treatment group; P < 0.01), myofiber cross-sectional area, and protein kinase-A RIIα/RIα ratio (EV, RIIα:1.05±0.03, RIα:0.93±0.04, ratio: 1.13; Hand2, RIIα:1.81±0.03, RIα:0.94±0.03, ratio: 1.94; P<0.001) which contributes to stability of the NMJ. We also examined Hand2 gene methylation, and RNA-sequencing, muscle metabolomics, and whole body and muscle function with aging in EV and Hand2 injected mice. Our data indicate that expression of Hand2 significantly enhances skeletal muscle adrenergic receptor signaling through the canonical pathway, and prevents in NMJ transmission, and muscle mass and function decline with aging.
THE RELATIONSHIP BETWEEN SUBJECTIVE AGE, CHRONOLOGICAL AGE, AND COGNITIVE FUNCTIONING IN OLDER ADULTS.
Authors: Morris Emily P , Zahodne Laura B
Published: November 2019

Prior longitudinal research suggests that younger subjective age (i.e., feeling younger than your chronological age) predicts better subsequent cognitive functioning and lower dementia incidence independent of chronological age. However, no research has investigated interactions between subjective age and chronological age. This study examined whether older adults with more youthful subjective age performed better on cognitive evaluations than those with older subjective age and whether associations differed as a function of chronological age. Data from 1,047 older adults aged 65 and older from the Health and Retirement Study’s 2016 Harmonized Cognitive Aging Project were analyzed. Separate linear regressions estimated associations between subjective age and factor scores corresponding to five cognitive domains: executive function, episodic memory, language, visuospatial functioning, and processing speed. Covariates included sociodemographic characteristics and chronic disease burden. Interaction terms tested whether chronological age modified associations between subjective age and cognition. In the whole sample, younger subjective age was associated with better language. Significant interactions for all five domains revealed that associations were stronger and statistically significant for participants at the oldest chronological ages. The predictive value of subjective age may be highest among the oldest adults. These cross-sectional findings suggest that the oldest adults are most vulnerable to the detrimental effects of feeling older than one’s chronological age, cognitive difficulties are more relevant for subjective age perceptions for the oldest adults, and/or subjective age better reflects consequential physiological deterioration in that group. Future longitudinal research is needed to elucidate these possibilities.
DETECTING PRE-FRAILTY STATUS: COMPARISON OF CLINICAL JUDGMENTS AND THE PAULSON LICHTENBERG FRAILTY INDEX.
Authors: Hu Yi-Ling , Fritz Heather A
Published: November 2019

Nearly 50% of U.S. elders are prefrail and at risk for frailty. Identifying prefrail elders and escalating care could attenuate frailty progression. Screening tools are seldom used in practice. Thus, clinical judgment may be a realistic way to ensure widespread frailty screening. No studies, however, have assessed the validity of clinicians’ judgment in identifying prefrail elders. This study explored the level of agreement between clinical judgments of frailty status and status categorizations made using the validated Paulson Lichtenberg Frailty Index (PLFI). Older Blacks (n = 202) recruited from a primary care clinic were first categorized as healthy, pre-frail, or frail using the PLFI. Next, geriatric physicians and nurses categorized participants into one of the same categories based on clinical judgment. Clinicians could use medical records to make determinations. We used Cohen’s Kappa to determine the level of agreement of both approaches. We used descriptive statistics to explore if any of the 5 PLFI indicators explained discordant categorizations. Of the 202 participants (mean age: 76.7 8.6), 52 (26%) were prefrail and 57 (28%) were frail based on the PLFI. Physicians’ judgments aligned with the PLFI in 43% of prefrail and 65.7% of frail cases. Nurse judgments aligned with the PLFI in 43.9% of prefrail and 17% of frail cases. There was slight to fair agreement between clinical judgments and PLFI (physicians Cohen’s κ = .23; Nurses Cohen’s κ = .59). No specific PLFI indicators independently explained discordant categorizations. Findings suggest that clinical judgments did not align well with PLFI categorizations.
SARCOPENIA ACCORDING TO BRAZILIAN AND EWGSOP 2 CUTOFFS: DATA FROM SARCOS
Authors: Menezes Julia M , Paes Angela T , Frisoli Alberto
Published: November 2019

Cutoff values for lean mass and muscle strength are still controversial in the diagnosis of sarcopenia. The use of European, American and Asian consensus outside these regions may lead to important diagnostic errors. We hypothesized that there are significant differences between the cutoff points from Brazil and Europe in older people. This is a cross-sectional analyses of 502 older adults from SARCOS study, conducted at São Paulo - Brazil. All subjects underwent DXA analyses of total body. Lean mass was obtained from appendicular lean mass by height2 and muscle strength by dynamometer of dominant hand. The Brazilian cutoff points were based on 25th percentile by gender. The European ones were from EWGSOP 2. Agreement was assessed by the Kappa coefficient. The mean age was 78.39 ± 7.08 years old and 277 (55.18%) individuals were women. Among the ethnic groups, 339 (67.53%) were caucasian, 145 (28.88%) afrodescendants and 18 (3.59%) asians. The Brazilian cutoffs for muscle strength were 26 kg for men and 16 kg for women (equivalent to EWGSOP2); while those for lean mass were significantly lower, 6.56 kg/m2 vs. 5.56 kg/m2, respectively. The prevalence by EWGSOP 2 was higher than that obtained by the Brazilian cutoff points (20.32% vs 14.14%, p <0.001), even though these criteria presented Kappa = 0.792; p <0.001. Considering these disparities, 6 out of 100 subjects are considered sarcopenic by European criteria and not by the Brazilian cutoffs. There are significant differences in sarcopenia cutoffs between Brazil and Europe, and this cause important diagnostic variations.
CONSCIENTIOUSNESS, ACTIVITY ENGAGEMENT AND MOMENTARY AFFECT IN OLDEST-OLD ADULTHOOD
Authors: Windsor Tim D , Curtis Rachel G , Hoppmann Christiane A , Luszcz Mary A
Published: November 2019

Participation in meaningful activities may be particularly important for late life well-being. We examined associations of moment to moment variability in meaningful activity engagement with positive and negative affect in the daily lives of oldest-old adults. Moderating effects of conscientiousness on meaning-affect associations were also examined considering recent theorising that late life declines in conscientiousness could reflect adaptive self-regulatory processes. Participants were 73 adults aged 84 and above from the Australian Longitudinal Study of Aging Daily Life Time-Sampling (ADuLTS) study, who provided self-report data on activity engagement (including ratings of meaning and degree of challenge associated with activities) and affect on five occasions per day over seven days. Within-person variability in meaningful activity engagement was associated with positive and negative affect; however, these associations were conditional upon the extent to which activities were rated as challenging. Specifically, positive affect tended to be lower on occasions when activities were rated as less meaningful, but also more challenging. Similarly, negative affect was rated as lower on occasions when activities were regarded as more meaningful, and at the same time less challenging. Participants who were higher in conscientiousness reported higher overall positive affect, and associations of higher conscientiousness with lower momentary negative affect were evident on occasions when activities were rated as more challenging. Engagement in meaningful activity is associated with higher positive, and lower negative affect in late life, with these associations dependent on the extent to which activities are challenging. Findings are discussed in the context of self-regulatory perspectives on adaptation.
FACTORS AFFECTING BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS IN OLDER ADULTS WITH DEMENTIA
Authors: Sinwoo Hwang , Cho Eunhee
Published: November 2019

The purpose of this study was to identify factors predicting behavioral and psychological symptoms of dementia(BPSD) in older adults with Dementia. This is a cross-sectional study, recruiting 157 participants from neurology general hospital as study subjects. Data collection was performed from June 2018 to May 2019. BPSD were classified using a modified version of the Cohen-Mansfield agitation inventory(CMAI), which are physically non-aggressive behaviors(PNAB), physically aggressive behaviors(PGAB), verbally non-aggressive behaviors(VNAB), verbally aggressive behaviors(VAGB). The Cornell scale for depression in dementia(CSDD), korea activity of daily living scale(K-ADL), korean mini-mental state examination(K-MMSE), activity and sleep time through using actigraphy for 2weeks, salivary melatonin and cortisol level at 4 times a day done after waking up, after breakfast, before and after dinner, and medication were measured as influencing factors. The generalized linear mixed model analyses indicated that VNAB and VAGB were associated with severe depression(p<0.01, respectively), low melatonin level at the after waking up (p<0.05, respectively), and high melatonin level before dinner(p<0.05, respectively). On the PNAB and PGAB, severe depression(p<0.05, respectively) and high activity(p<0.05, respectively) showed great influences. These findings suggest that developing of intervention of BPSD must be started with detecting depression, ADL. Considering the factors of each type of symptom, tailoring an individual approach is recommended. In addition, this study identified that the activity through actigraphy and salivary melatonin measurement are useful tools to examine BPSD. It can be helpful in the objective evaluation of BPSD.
MACHINE LEARNING ANALYSIS OF MOUSE FRAILTY FOR PREDICTION OF BIOLOGICAL AGE AND LIFE EXPECTANCY
Authors: Kane Alice , Schultz Michael B , Mitchell Sarah , MacArthur Michael , Mitchell James , Howlett Susan E , Bonkowski Michael S , Sinclair David
Published: November 2019

In mammals, the lack of accurate biomarkers for biological age is a current limitation to identifying novel aging interventions. Molecular biomarkers including DNA methylation hold promise but are invasive and currently expensive. The Frailty Index (FI) quantifies the accumulation of health-related deficits and is fast, cheap, and non-invasive. Studies have demonstrated that FI correlates with age and mortality risk in mice and humans. However, the FI has not been modelled to directly predict biological age or life expectancy. We tracked aging male C57BL/6 mice until their natural deaths, scoring them longitudinally with the FI. We find that FI score correlates with and is predictive of age and that some but not all parameters of the FI are individually well-correlated with age. To better predict chronological age, we performed an elastic net regression on the FI termed FRIGHT (Frailty Inferred Geriatric Health Timeline) Age. FRIGHT Age is a strong predictor of age (r2=0.73, median error=47.5 days), but is not superior to chronological age at predicting life expectancy. To better predict mortality, we built a random forest model termed the AFRAID (Analysis of Frailty and Death) score, which predicted survival at multiple ages (r2=0.375, median error = 46.4 days). The FRIGHT and AFRAID models were responsive to chronic treatment with enalapril (30mg/kg/day), an angiotensin converting enzyme inhibitor that extends healthspan, and methionine restriction, a dietary intervention that extends healthspan and lifespan. Our findings underscore the value of assessing non-invasive biomarkers for aging research and may help speed the identification of aging interventions.
ANTIBIOTIC EXPOSURE IN LONG-TERM CARE FACILITIES IS ASSOCIATED WITH URINARY MICROBIOME PERTURBATIONS
Authors: Schell Brent R , Ward Doyle V , Bradley Evan S , Dutta Protiva , Haran John P
Published: November 2019

The discovery of the human urinary microbiome, defined as the microbial communities which colonize the human urinary tract, has shed new light on the meaning and clinical significance of bacteriuria. The prevalence of asymptomatic bacteriuria has been reported to be as high as 50% in healthy older adults living in long term care facilities, yet the urinary microbiome of this population has not been reported. The aim of this pilot study was to describe the urinary microbiome of this population and explore the cross-sectional relationship with recent antibiotic exposure. Voided urine samples were obtained from healthy, institutionalized older adults (ages 79 to 95), including non-catheterized men and women without any urinary symptoms. The bacterial genomic content of each urine sample was assessed by 16S rRNA sequencing. Among the 77 genera found across 16 urine samples, there was no significant difference in the microbial diversity across age groups. When grouped by antibiotic exposure, those recently exposed had a significantly lower diversity (Shannon’s index of 2.16 vs. 2.61, p = 0.029), and lower evenness (Pielou’s evenness of 0.58 vs. 0.69, p= 0.017) relative to those who were not recently exposed. Enrichment analysis showed that recent antibiotic exposure was associated with an increased abundance of the genus Bacteroides and decreased abundance of the genus Streptococcus. To our knowledge, this is the first report describing the urinary microbiome of institutionalized older adults and suggests that recent antibiotic exposure should be accounted for in future studies of the urinary microbiome in this population.
PALLIATIVE CARE... WHAT’S THAT? : MEDICAID PATIENT-IDENTIFIED BARRIERS TO PALLIATIVE CARE
Authors: Hoe Deborah , Wang Yu-Hsuan , Meyers Kate , Enguidanos Susan
Published: November 2019

Multiple studies demonstrate most consumers do not know about palliative care. And, since January 2018, California’s Medi-Cal Managed Care patients have been eligible for palliative care services under Senate Bill 1004 (SB 1004). Yet, the uptake of palliative care services has been underwhelming. The purpose of this study is to explore patient-centered barriers to palliative care. We recruited 27 adult Medicaid patients suffering from advanced cancer, chronic obstructive pulmonary disease, congestive heart failure, or liver disease, from community-based sites in Los Angeles, and conducted semi-structured qualitative interviews. Each participant was asked questions to elicit their knowledge about, and perspectives on, palliative care as well as their preferred communication approaches for receiving a referral to palliative care. The interviews were audio-recorded and transcribed verbatim. We used a grounded theory approach to guide our analysis of primary themes. Our findings indicated that the barriers to palliative care referrals among this population included lack of knowledge about palliative care and available services; the reliance on, and trust in, primary care physicians for information; language and cultural barriers; and patient believing they are neither old enough nor sick enough to need palliative care. This population also preferred direct contact, with in-person consultations more favorable than telephone calls. These findings emphasize the critical role primary care physicians play in advocating for safety net patients and the necessity for culturally sensitive education about palliative care. Promoting knowledge and understanding of palliative care among both primary care physicians and consumers is vital to ensuring access to care.
CO-DESIGNING CANCER SCREENING INTERVENTIONS WITH PEOPLE OVER 55 YEARS OLD AT RISK FOR LUNG CANCER
Authors: Tuzzio Leah , Palazzo Lorella , Brush Sarah , Ehrlich Kelly , Anderson Melissa , Gao Hongyuan , Wernli Karen
Published: November 2019

In 2014, the US Preventive Task Force recommended annual lung cancer screening with low dose CT (LDCT) for adults aged 55 to 80 years old with significant smoking history. Although screening reduces lung cancer mortality, the leading cause of cancer mortality in the US, adherence to screening follow-up remains low. In a human-centered design qualitative study, health services researchers and eight adults over 55 years old from Kaiser Permanente Washington who had recently had an LDCT participated in two co-design sessions. We elicited barriers, facilitators and design principles to develop multilevel interventions that aim to improve adherence to ongoing LDCT. In the initial discussion, participants identified four key areas for improvements to adherence: a) reminders for scheduling and appointments, b) knowledge about tests and follow-up, c) convenience in location and scheduling, and d) financial and non-financial incentives. In a second session, participants referenced patient personas and sketched storyboards, a comic strip-like format showing steps in a journey, to describe different ways to help patients return for LDCTs. Through qualitative analysis, we identified ten elements to consider incorporating in multilevel interventions: versatility (e.g., multiple reminder options), social support (e.g., families, peers), individualization (e.g., tailoring to patient needs), feelings (e.g., fear, relief), knowledge (e.g., harms/benefits, expectations), responsibility (e.g., who is accountable for reminders), continuity (e.g., clear pathway to adherence), consistency (e.g., same messages), cadence (e.g., rhythm of messages), and acknowledgment (e.g., recognition of screening completion). Next steps are to incorporate feedback from clinical stakeholders and develop multilevel interventions for further testing.
PERSONAL SELF-MONITORING DEVICES TO IMPROVE SLEEP AMONG OLDER PEOPLE: A FEASIBILITY STUDY
Authors: LeBlanc Raeann G , Torossian Maral , Czarnecki Paige , Spencer Rebecca , Jacelon Cynthia , Marquard Jenna
Published: November 2019

Chronic sleep disturbances reduce physical and mental health and affect over 8 million people age 65 years and older in the United States. There is evidence that use of a wearable Personal Self-Monitoring Device (PSMD) may improve sleep self-management in young adult populations. Feasibility of PSMD use for older individuals has not been explored and was the goal of this study. Persons age 65 years and over with self-reported sleep disturbances were recruited in a local community and were asked to wear a commercial PSMD for a 4-week period. To assess whether such an intervention may be feasible, outcomes included consent rate, study completion rate, data download interpretation, identification of a sleep self-management goal, improved knowledge about sleep, and improved sleep. Twenty-six persons (12 males and 14 females) were recruited over 3 months, out of a total of 33 expressing interest. Mean age=72, SD=4.99. Ninety-two percent of participants completed the study and reported improved awareness of sleep patterns and identified a sleep goal. Total sleep time was M=7 hours 14 minutes, SD=40 minutes; total restful sleep time was M=4 hours 33 minutes, SD=1 hour 22 minutes. In conclusion, sleep self-management with the use of a PSMD is feasible and of interest among persons in the young-old age category (65-74 years). There is potential for the use of PSMD among older people with the goal of improved sleep self-management. Future studies for sleep health self-management and interventions using personal sleep monitoring are recommended.
LONG-TERM EFFECT OF A MULTICOMPONENT INTERVENTION ON PHYSICAL PERFORMANCE AND FRAILTY IN OLDER ADULTS
Authors: Oh Gahee , Jang Il-Young , Lee Heayon , Jung Hee-Won , Lee Eunju , Kim Dae Hyun
Published: November 2019

Multicomponent interventions improve physical function and frailty in older adults, but their long-term benefit remains uncertain. We report the 30-month outcomes of a 24-week multicomponent intervention versus usual care in community-dwelling older adults. This prospective non-randomized study was conducted in 383 older Koreans (mean age, 76.8 years; female 72.3%) living alone or receiving medical aid in rural communities. Of these, 187 received a 24-week multicomponent intervention that consisted of group exercise, nutritional supplements, depression management, deprescribing, and home hazard reduction. The remaining 196 individuals received usual care. After 1:1 propensity score matching, we compared the short physical performance battery (SPPB) score (0-12 points), frailty phenotype scale (0-5 points), and deficit-accumulation frailty index (0-1) at 6, 18, and 30 months. Restricted mean survival time was estimated for death and institutionalization-free survival time at 30 months. The intervention group had higher SPPB scores than the comparison group at 6 months (difference 3.2; 95% CI, 2.5-3.8), 18 months (1.2; 95% CI, 0.5-1.9), and 30 months (1.1; 95% CI, 0.5-1.8). They had lower frailty phenotype scale (-0.6; 95% CI -0.9 to -0.3) and frailty index (-0.04; -0.07 to -0.02) only at 6 months, but similar scores at 18 and 30 months. Death and institutionalization-free survival time over 30 months was 28.5 months (95% CI, 27.7-29.3) in the intervention group versus 24.2 months (95% CI, 22.3-26.1) in the comparison group (difference, 5.2 months; 95% CI, 3.0-7.3). The 24-week multicomponent intervention showed sustained improvement in physical function for 30 months, but only temporary reduction in frailty.
EXTERNAL HOME DISREPAIR ASSOCIATED WITH OBJECTIVE SLEEP DISTURBANCES IN LOW-INCOME OLDER ADULTS WITH DISABILITIES
Authors: Okoye Safiyyah M , Perrin Nancy , Szanton Sarah , Spira Adam P
Published: November 2019

Sleep disturbances are linked to poor health, loss of independence and mortality in older adults. Rates of poor sleep are higher among socioeconomically disadvantaged older adults. Understanding how environmental factors may affect sleep in this population could lead to interventions to improve sleep-related health outcomes. We determined cross-sectional associations of home and neighborhood conditions with sleep parameters, measured by wrist actigraphy, in 136 low-income, predominantly African-American older adults with disabilities. Primary predictors were third-party-rated objective indicators of disrepair or disorder based on: 1) inside-home conditions (e.g., evidence of pests, tripping hazards, clutter); 2) outside-home conditions (e.g., broken windows, crumbling foundation); and 3) neighborhood conditions (e.g., litter, graffiti, vacant buildings). Outcomes were actigraphic total sleep time (TST; total number of minutes in bed spent asleep), wake time after sleep onset (WASO; total number of minutes spent awake after initially falling asleep), and sleep efficiency (SE; % of time in bed spent asleep). Presence of one or more outside-home conditions indicating disrepair or disorder was associated with 36.3-minutes shorter TST, 18.1-minutes more WASO, and 4.7% lower SE (all p <0.05). Conditions inside the home and of the neighborhood were not associated with sleep. These preliminary findings suggest that among low-income older adults with disabilities, external-home disrepair is associated with objectively measured WASO, TST, and SE. External-home disrepair may affect sleep through physical, psychosocial and behavioral pathways. Further research should examine longitudinal associations between external-home conditions and objectively measured sleep in socioeconomically disadvantaged older adults.
PERIPHERAL ARTERIAL DISEASE AND SEDENTARY TIME IN OLDER ADULTS
Authors: Fullwood Dottington , McDermott Mary , Manini Todd M
Published: November 2019

Peripheral artery disease (PAD) is associated with increased rates of physical disability in older adults, yet few interventions exist to reduce this risk. Intermittent claudication, exertional calf symptoms that resolve within 10 minutes of rest, is the classic symptom for PAD, but many people with PAD are absent of these symptoms. Ankle brachial index (ABI) is a non-invasive measure that identifies the presence and severity of lower extremity arterial obstruction due to atherosclerosis. We studied whether abnormal ABI is associated with increased time spent in sedentary behavior in a large sample of community-dwelling older men and women (70-89 years) enrolled in the Lifestyle Interventions and Independence for Elders (LIFE) study. Older adults underwent an ABI test and then wore a tri-axial accelerometer on the hip for up to seven days. Total accumulated sedentary time and sedentary time spent in bout lengths of 10minutes or more, 30 minutes or more, and 60 minutes or more were calculated. ABI values, divided into PAD (<.90, n=156) and non-PAD (0.90 - 1.40, n=960), were evaluated in covariate-adjusted regression models adjusting for age, body mass index, comorbidity presence, gender and smoking. Older adults with PAD had significantly higher total accumulated time spent in sedentary behavior than those without PAD (13.1 minutes per day, p<0.02). No associations were found with longer bout lengths of sedentary time. These results suggest that older adults with PAD accumulate more time in shorter bouts of sedentary behavior. Future interventions may consider targeting short sedentary bout-lengths for reducing PAD symptoms.
HEAT KILLED LB. PARACASEI OR CELL WALL LIPOTEICHOIC ACID AMELIORATES AGE-RELATED LEAKY GUT AND INFLAMMATION
Authors: Wang Shaohua , Ahmadi Shokouh , Nagpal Ravinder , Jain Shalini , Mishra Sidharth , Kritchevsky Stephen , Kitzman Dalane , Yadav Hariom
Published: November 2019

Increased inflammation associated with leaky gut is a major risk factor for morbidity and mortality in older adults; however, successful preventive and therapeutic strategies are not available to ameliorate these conditions. In this study, we demonstrate that a human-origin Lactobacillus paracasei D3-5 strain (D3-5), even when dead, extended life span of C. elegans. In addition, feeding D3-5 to older mice (>79 weeks) prevented high fat diet (HFD)-induced metabolic dysfunction and decreased leaky gut and inflammation, which were associated with improved physical and cognitive function. D3-5 feeding significantly increased mucin production and proportionately, the abundance of mucin-degrading bacteria Akkermansia muciniphila was also increased. Mechanistically, we show that the cell wall of D3-5 contains lipoteichoic acid (LTA), which enhanced mucin (Muc2) expression via TLR-2/p38-MAPK pathway, which in turn reduced age-related leaky gut and inflammation. This study indicates that the D3-5 and its LTA can prevent/treat age-related leaky gut and inflammation.
MAPPING COLLABORATION RELATIONSHIPS IN AGE-FRIENDLY COMMUNITIES INITIATIVES
Authors: Pestine-Stevens Althea
Published: November 2019

Age-friendly initiatives (AFIs) convene stakeholders throughout a community to improve social and built environments for long lives. Despite rapid growth in AFIs worldwide, research on how AFIs operate, sustain, and impact their communities has been slow to develop. This poster presents a new social network analysis (SNA) survey instrument, which can be used to advance research on AFIs by identifying key relationships and activities that drive collaborative community change processes. The survey asks a representative from each organizational member of an AFI coalition to select “partner” organizations with whom they have worked on AFI goals. Respondents then select from a list of activities in which they engage with each partnering organization. The questions regarding collaboration activities were developed based on theories of inter-sectoral and community-wide collaboration, SNA studies of collaboration in health prevention networks, and qualitative interviews with leaders of an established AFI coalition in Upstate New York. This tool was administered with respondents from 18 organizations comprising the New York coalition. Administration of the pilot indicated that the questions were acceptable and feasible for participants to complete. Analysis of the data through SNA software (UCINET) yielded visual maps to understand dimensions of the AFI’s inter-organizational network. Local government offices and nonprofits emerged as central network nodes for connecting stakeholders. Findings also indicated denser networks around lower-intensity collaboration activities, such as sharing information, relative to higher-intensity activities, such as sharing financial resources. Implications of the tool for future research on the development of AFIs across diverse community contexts are discussed.
ABO GENE AND AGING-RELATED OUTCOMES IN OVER 379,000 EUROPEAN-DESCENT PARTICIPANTS OF UK BIOBANK
Authors: Kuo Chia-Ling , Pan Ziwei , Pilling Luke C , Kuchel George A , Melzer David
Published: November 2019

Genetic variants associated with multiple traits are potential targets to delay aging. Drugs supported by genetic evidence are twice as likely to succeed in human trials. Single nucleotide polymorphisms (SNPs) in the ABO gene were reported by genome-wide associations studies, associated with breast cancer, coronary artery disease, stroke, and type II diabetes. To evaluate the potential of ABO gene as a target for aging intervention, we conducted a phenome-wide association study (PheWAS) to associate the genotype-derived blood types (based on two SNPs in the ABO gene) with a wide range of aging-related outcomes. The genotype-derived blood type distribution (41% A, 9% B, 3% AB, and 47% O) is similar to that reported by the UK National Health Service (39% A, 10% B, 3% AB, and 48% O). The blood type was not associated with parental lifespan or extreme parental longevity. Non-O types had modestly lower risk of hypertension than O type but higher risk of type II diabetes and pancreatic cancer (e.g., OR= 1.37, 95% CI: 1.17 to 1.59 comparing A to O). Additionally, “A" type had modestly higher risk of breast cancer than other types. “A” allele (in A or AB type) was associated with lower heel bone mineral density, alkaline phosphatase (e.g., 0.41 standard deviation lower in A than that in O, 95% CI: -0.42 to -0.40), and hemoglobin concentration, but higher HbA1c, direct LDL, and cholesterol. Blood types with A allele(s) are less favored than other blood types, which however are adversely associated with some aging traits.
VERIFICATION OF PAIN MEDICATION ADHERENCE IN OLDER ADULTS USING INTERACTIVE VOICE REMINDERS
Authors: Shade Marcia , Rector Kyle , Kupzyk Kevin
Published: November 2019

Adherence to analgesics needs to be monitored to ensure optimal pain management and avert adverse events among older adults. mHealth reminders may encourage adherence behavior, but it is unclear if medication use ensues following the reminder. The purpose of this study was to trial the use of medication event monitoring to verify the initiation of scheduled pain medication after an mHealth reminder. Methods: N=15 adults 55 and older created Google Assistant reminders to take their scheduled pain medication and write in a pain diary. A sub sample of n= 5 participants used a Medication Event Monitoring System Cap with their scheduled pain medications over 4 weeks. Data were collected on demographics, pain severity, and medication adherence. Descriptive statistics were performed. Results: Five women with ages ranging from 56-80 years, reported pain in multiple body locations. Pain severity on average was rated at 4 and at its worst 7; with pain relief ranging from 50-90%. Adherence percentages ranged from 82% to 100%. The overall latency was M = 55 min, SD = 100 min. The average latencies varied among the 5 participants; the shortest average time was 17 minutes and the longest average time was 4.5 hours. Only 15% of pain medications were taken within 5 minutes and 64% within 30 minutes of the interactive voice assistant reminder. Conclusions: It is important to ensure a behavioral intervention promotes the desired outcome. Medication event monitoring systems may help to identify non adherent behaviors when using mHealth interventions to promote pain medication adherence.