bluuebunny/crossref_metadata_2025 huggingface dataset:
GENETIC VARIANTS ASSOCIATED WITH BLOOD PRESSURE PHENOTYPES IN OLDER ADULTS
Authors: Sargent Lana , Dixon Dave , Mackiewicz Marissa , Price Elvin
Published: December 2023

African Americans (AAs) suffer from higher rates of uncontrolled HTN even when receiving commonly prescribed classes of antihypertensive medications. Variation in blood pressure (BP) in older adults is known to be associated with a variety of cardiovascular endpoints, yet our understanding of underlying mechanisms is limited. This study aimed to determine if HTN genetic variants influence blood pressure variation within a population of AA older adults taking antihypertensives. Community-dwelling older adults from the Translational Approaches to Personalized Health (TAPH) cohort were recruited to enroll in a 24-hour ambulatory BP monitoring (ABPM) phenotyping study. The Quant Studio 12-K Flex system was used for genotyping participants for three previously established CACNA1C and CACNB2 genetic risk alleles (rs758173, rs2228645, and rs2357790). 69 participants had ABPM data that passed the minimum 80% successful readings threshold: age=68□6, Female=50.3%, Black=73%, White=21%, and Other=6%. ABPM revealed 50.7% controlled HTN, 27.5% Sustained uncontrolled HTN, 14.5 % White coat uncontrolled HTN and 7.2% Masked uncontrolled HTN. ANOVA and Linear regression models found that the CACNB2 genetic risk allele rs2228645 broadly impacts ABPM Phenotypes (C/C SBP= 120.8+/-12.9 mmHg, C/T SBP= 125.73+/-13.5, and T/T SBP= 140+/-34.8 mmHg, p=0.011), mean awake 24-hour SBP (C/C SBP= 124+/-12.7 mmHg, C/T SBP= 133.5+/-14.8, and T/T SBP= 143.7+/-25.6 mmHg, p=0.012), and mean sleep SBP (C/C SBP= 114+/-16 mmHg, C/T SBP= 125.4+/-15, and T/T SBP= 136+/-50 mmHg, p=0.024). CACNA1C and CACNB2 genetic variants influence blood pressure phenotypes in older AAs. Determining genetic variants that affect antihypertensive effectiveness could lead to improved antihypertensive therapy for individuals with HTN/CVD.
GERIATRICS IN HEALTH PROFESSIONS EDUCATION: A BIBLIOMETRIC ANALYSIS OF 70 YEARS OF RESEARCH
Authors: Pajuelo-Vasquez Renzo , Gutierrez-Baca Wendy , Flores-Cohaila Javier , Runzer-Colmenares Fernando M
Published: December 2023

To move forward in the field of Geriatrics in Health professions education (HPE), we must understand its conception and recognize current trends and future directions. Therefore, we conducted a bibliometric and network analysis of all studies indexed in the Scopus Database related to Geriatrics and HPE from 1953 to 2022. We retrieved 2940 studies comprising 7344 authors and 618 journals; these were imported to bibliometrics (RStudio) and Vos Viewer. To understand the intellectual structure, we employed a co-citation analysis; we identified 5 clusters that described fundamentals in geriatrics, nursing education, needs assessment, and interprofessional education (IPE). Furthermore, six topics were placed in the keyword co-occurrence, ranging from medical, nursing, dental, social workers, and interprofessional education. Consequently, we identified geriatrics education for medical students and interprofessional education between 2004 and 2016; furthermore, clinical competence was the most recent trending topic, accompanied by end-of-life care and geriatric psychiatry. In the evolution map, three topics emerged in the last ten years: IPE, online learning, and geriatric dentistry. These findings were confirmed in the bibliographic coupling analysis. Four major themes emerged among 13 clusters: IPE, Attitudes and career orientation to geriatrics, innovative educational methods such as gamification, and geriatric undergraduate education. Although we identified several studies, this barely represents the 1% of production in HPE. Furthermore, we identified a trend toward IPE, undergraduate medical education, career orientation, and innovative education. However, there is a lack of themes such as simulation and entrustable professional activities, with an underrepresentation of the developing world.
HEALTH RELATED SOCIAL NEEDS AND TREATMENT PREFERENCES OF OLDER ADULTS WITH SERIOUS ILLNESS
Authors: Jackson Amy , Carpenter Joan
Published: December 2023

The Centers for Medicare & Medicaid Services’ (CMS) health related social needs (HRSNs) include housing instability, food insecurity, transportation, utility difficulties, and interpersonal violence. HRSNs shape the experiences and outcomes of seriously ill older adults, influencing their access and ability to choose preferred treatments —from the time of diagnosis until the end of life. Little research has explored disparities in healthcare experiences related to unmet HRSNs and treatment choices, including palliative and end of life care. The purpose of this integrative review is to explore the literature regarding unmet HRSNs and provide research, practice, and policy considerations for investigators, clinicians, and payers regarding HRSNs and their impact on palliative and end of life treatment decisions. We searched PubMed, Embase, CINAHL, PsychINFO, Scopus, and Google Scholar using keywords related to HRSNs and palliative and end of life care. We identified 38 articles between 1998 and 2023 within the United States. Of the 38 articles, housing instability was the most often addressed (n=36), followed by transportation (n=1) and interpersonal violence (n=1). None of the articles explored food insecurity and utility difficulties related to serious illness and treatment preferences. Many of the articles describe the perspectives of people experiencing homelessness at the end of life (n =16). The current literature does not comprehensively address unmet HRSNs in relation to palliative and end of life care treatment choices. Future work must address HRSNs of seriously ill older adults to ensure equitable access to compassionate and person-centered palliative and end of life care.
HISTORICAL CHANGES IN COLLEGE EDUCATION AND EMPLOYMENT: GENDER EFFECTS ON LATE-LIFE COGNITIVE STATUS
Authors: Larkina Marina , Smith Jacqui
Published: December 2023

Early-life education and gender are well-known predictors of cognitive status in old age but multiple mechanisms underlie these associations. Recent US research on late-life cognition and dementia prevalence has highlighted the roles of age-cohort and racial/ethnic differences K-12 education. Less attention has been given to historical increases since the 1970s in the completion of college degrees by women and their subsequent employment histories. We examined new data for two cohorts (N = 9926; 50% born before 1948 vs. Baby Boomers, born 1948-1959) in the Health and Retirement Study (HRS) about the quantity (years, degree types) and content (field of study) of their college degrees. College information and employment histories were collected in a Life History Mail Survey (2015-2017). Cognitive status based on the Langa-Weir algorithm was defined as normal, cognitive impairment not dementia or dementia (CIND/D). Compared to men, women were less likely to have post-high school education (p < .002) or to have worked after their education. Cognitive status was predicted by degree type and work history. Gender by degree and gender by work interactions (for Baby Boomers only) revealed that having a BA/BS degree provided more protection against cognitive impairment for women than for men with the same degree, and women who worked had lower odds ratio of having CIND/D (0.36 [CI 0.17-0.77], p < .01). College majors were gendered and significantly accounted for variance in late-life cognitive status among the college educated. These findings provide new insight into the gendered life histories related to late-life cognition.
IMPACT OF DUAL-TASKING AND DEMENTIA DISEASE SEVERITY ON POSTURE, GAIT, AND FUNCTIONAL MOBILITY IN RESIDENTIAL CARE
Authors: Jehu Deborah , Langston Ryan , Sams Richard , Young Lufei , Hamrick Mark , Zhu Haidong , Dong Yanbin
Published: December 2023

Dual-tasking may be a useful tool for fall-risk screening among people living with dementia (PWD), but more evidence is needed. Our aims were to compare single- and dual-task posture, gait and functional mobility; and examine the relationship between dementia severity and dual-task interference among PWD. Thirty PWD (Age:81.8±7.3years; 35% Female; Montreal Cognitive Assessment:10.5±6.1points) from two residential care facilities wore six APDM inertial sensors and completed two trials of single- (feet apart) and dual-task posture (feet apart while counting backwards by 1’s), single- (walk 4m) and dual-task gait (walk 4m while naming words), and single- (timed-up-and-go (TUG)); and dual-task functional mobility (TUG while completing a category task). Results revealed that greater frequency, jerk, and area were observed during dual- than single-task posture (ps< 0.05), with no differences in velocity. Slower gait speed, greater double limb support, shorter stride length, and reduced elevation at mid-swing were detected during dual- relative to single-task gait (ps< 0.05), with no differences in medial-lateral trunk sway. Dual-tasking resulted in a longer duration, reduced turn angle, and slower turn velocity than single-tasking for the TUG (ps< 0.05), with no differences in sit-to-stand lean angle. Dual-task interference (greater jerk, faster gait speed) was related to moderate-to-severe compared to mild dementia (ps< 0.05). Dual-tasking was more sensitive to detect impairments in posture, gait, and functional mobility than single-tasking. Moderate to severe PWD had poorer dynamic stability and a reduced ability to appropriately select cautious gait during dual-tasking than those with mild dementia, which should be considered in fall-risk screening.
INCREASED HIPPOCAMPAL ATROPHY IN HIGH INTENSITY INTERVAL TRAINING GROUP 4 YEARS AFTER 5-YEAR EXERCISE INTERVENTION
Authors: Håberg Asta , Reitlo Line , Pani Jasmine , Stenvold Dorthe
Published: December 2023

The Generation 100 Study is a randomized controlled trial (NCT01666340) investigating the effects of a 5-year exercise intervention on several health outcomes, including brain volumes from MRI. Participants (born 1936-42) were living independently at inclusion. They were randomized (1-1-2) to supervised exercising with either high intensity interval (HIIT) or moderate continuous training (MICT) twice a week, or to a control group adhering to the national guidelines of ≥30 min of moderate to vigorous physical activity at least 5 days a week. The intervention lasted for 5 years, during which participants underwent physical and clinical examinations at baseline, 1-, 3-, 5-years. 105 participants (n: HIIT=33, MICT=24, Cont=48) also underwent brain MRI at 3T. Linear mixed models were used and the interaction between group and time on brain volumes was the main outcome. We have previously reported that the HIIT group had significantly greater hippocampal atrophy rate compared to the control group during the intervention. Participants were invited back 4 years after end of intervention and underwent the same examinations including brain MRI . A total 73 participants (n: HIIT24=, MICT=19, Cont=30) took part. The HIIT group trained at a higher intensity than the other groups. There were no associations between objective VO2 or any self-reported exercise measurements and hippocampal volume/atrophy rate at any timepoint. Still, the hippocampal atrophy rate remained greater in the HIIT group than in the controls 4 years after end of the exercise intervention.
PACE AND FFS MEDICARE OUTCOMES BEFORE AND DURING COVID-19: A PROPENSITY SCORE MATCHED ANALYSIS
Authors: Perry Morgan , Obbin Samuel , McCall Stephen , Dorris Joseph , Nardone Michael , Turner Ani , Stanik Christine
Published: December 2023

We compared outcomes of Program of All-Inclusive Care for the Elderly (PACE) participants and fee-for-service (FFS) Medicare, dually eligible individuals using a retrospective cohort study with propensity score matching on demographic, socioeconomic, and participant-specific acuity level variables. PACE participants in 132 PACE centers nationwide who were dually eligible, enrolled during the study period, and did not have end-stage renal disease were included. Over 80% of eligible PACE participants were matched with FFS beneficiaries during each period, bringing many covariates closer between groups. We assessed differences during each period using Wilcoxon signed rank test and over time using differences-in-differences analyses. PACE participants spent significantly more time in the community and less time in nursing homes and hospitals (all p< 0.01). PACE participants had fewer COVID-19 diagnoses and hospitalizations per member per month (all p< 0.01). Due to the blinding of data, we could not determine definitively which performed better in limiting severe pressure ulcers. However, the results indicate PACE performed better when the mean assumption for blinded data is used. For all-cause mortality, PACE participants continued to perform better than FFS both before and during the pandemic (all p< 0.01), but the rates were closer during the pandemic periods. The flexibility in the PACE model and its person-centered care delivery approach may have contributed to the positive outcomes compared to FFS before and during the pandemic. We should consider how best to leverage the PACE model of care to support older adults to remain in their homes and avoid institutional settings.
RACIAL/ETHNIC DIFFERENCES IN SUBJECTIVE COGNITIVE DECLINE (SCD) AND SCD-INDUCED OUTCOMES
Authors: Jacobs Moyosoreoluwa , Lichtenberg Peter , Tarraf Wassim
Published: December 2023

Alzheimer’s disease and related dementias (ADRD) prevalence will double by 2060, with significant racial/ethnic (R/E) differences in rates. Understanding R/E differences in risk factors of subjective cognitive decline (SCD)—a precursor to ADRD—is critical for timely premorbid interventions to modify ADRD onset. We used 2015 CDC Behavioral Risk Factor Surveillance System data from non-Hispanic White (NHW), Black (NHB), and Hispanic individuals aged ≥45 years (n=142,657) to examine R/E differences in SCD Status and five SCD-induced functional limitations and healthcare outcomes (e.g., health provider communication). We used generalized linear modeling to assess the contributions of predisposing (e.g., age), enabling (e.g., insurance), and health need (e.g., chronic disease) factors to explaining R/E differences. NHWs were generally older and healthier, with higher educational attainment than NHBs and Hispanics. NHBs (13.5%) were slightly more likely to endorse SCD (11.5% overall). NHBs and Hispanics endorsing SCD were significantly more likely than NHWs to report SCD-induced functional limitations. R/E differences were minimally attenuated after adjusting for the above-mentioned factors. We found no R/E differences in getting access to help, or in communicating with healthcare providers. NHBs and Hispanics (vs. NHWs) endorsing SCD are more likely to also endorse functional limitations despite reporting equivalent access to help and communication with healthcare providers. Clinical cognitive impairment depends on functional status and as such NHBs and Hispanics are potentially more vulnerable to cognitive disease (e.g., ADRD) onset. More research is required to understand gaps in care and how interventions can help mitigate this differential risk.
OLDER ADULT MISUSE OF OVER-THE-COUNTER MEDICATIONS: BENEFITS OF A NOVEL PHARMACY-BASED INTERVENTION
Authors: Chladek Jason , Gilson Aaron , Stone Jamie , Lehnbom Elin , Hoffins Emily , Berbakov Maria , Moon Jukrin , Chui Michelle
Published: December 2023

Older adults’ inappropriate use of over-the-counter medications (OTCs) is prevalent and comprises: (1) Drug-Age misuse – medication risks due to advanced age, (2) Drug-Drug misuse – medication interactions, (3) Drug-Disease misuse – contraindications with health conditions, and (4) Drug-Label misuse – deviations from label instructions. Since pharmacies are ubiquitous sources of OTC accessibility and medication safety expertise, a structural redesign of pharmacy aisles (Senior SafeTM) was conceived to mitigate older adult OTC misuse. A central feature of Senior Safe is the use of Stop Signs for high-risk OTCs and Behind-the-Counter Signs (BTC) for particularly high-risk OTCs. Given the signage’s practical importance, this study’ principal aim was to determine whether Senior Safe reduced misuse of Stop Sign/BTC OTCs. Twenty pharmacies from a mid-Western healthcare system were matched and randomly allocated to either control or intervention groups, from which 288 older adults were recruited (ages 65-91). Participants’ reported OTC use for a symptom scenario (pain, sleep, cough/cold/allergy) was evaluated to determine whether it fulfilled the four misuse types. Misuse occurrences between intervention/control sites were compared using multivariate modeling. Drug-Age and Drug-Drug misuse frequencies were significantly lower in intervention sites (Coef.=-1.012, p=.004; Coef.=-1.702, p=.004, respectively), while Drug-Disease and Drug-Label misuse had too few occurrences in intervention sites for statistical comparisons. Also, adults aged 85+ had the greatest likelihood of all misuse types. Senior Safe shows substantial benefit reducing high-risk OTC misuse, which is important particularly for vulnerable adults ages 85-91. Future research should document intervention mechanisms contributing to lower older adult OTC misuse.
SARCOPENIA AND POST-HOSPITAL OUTCOMES FOR OLDER PATIENTS IN AN EMERGENCY DEPARTMENT
Authors: Ho Tai-Hung , Huang Hsien-Hao
Published: December 2023

Introduction

Sarcopenia, an important condition in older adults, is associated with increased adverse outcomes, including falls, functional decline, frailty, and mortality. Sarcopenia is often not diagnosed in emergency department (ED) settings. Therefore, this study aimed to determine the prevalence, risk factors, and clinical outcomes of sarcopenia patients admitted to the ED.

Methods

This observational study included patients aged ≥ 65 years admitted to the ED of Taipei Veterans General Hospital from September 2019 to November 2021. The patients were divided into two groups according to the definition of the Asian Working Group for Sarcopenia: sarcopenia and non-sarcopenia.

Results

Among 867 enrolled, 447 (51.6%) were categorized into non-sarcopenia and 420 (48.4%) into sarcopenia groups. Sarcopenia patients were significantly older, shorter, weighed less, and had significantly lower values of body mass index, skeletal muscle mass, skeletal muscle index, and handgrip strength. The sarcopenia group had significantly fewer daily living and instrumental activities. The independent risk factors for sarcopenia were age (odds ratio [OR] 1.07, P < 0.001), malnutrition (OR 3.83, P < 0.001), and frailty (OR 1.91, P = 0.001). Sarcopenia patients had significantly higher admission (66.7% vs. 59.1%, P = 0.021) and 1-month mortality rates (P = 0.002).

Conclusion

Sarcopenia patients are at risk of functional decline, hospital admission, and 1-month mortality. The independent risk factors for sarcopenia include age, malnutrition, and frailty. The recognition of sarcopenia as a medical condition in an ED may prompt targeted nutritional interventions, tailored discharge plans, and referrals to reduce disability, admission, and mortality.
SUBSIDIZED SENIOR HOUSING IN THE U.S.: A SCOPING REVIEW
Authors: Park Sojung , Park Soobin , Ryu Byeongju , Baek Jihye , Amano Takashi , Kim BoRin
Published: December 2023

Although Subsidized Senior Housing (SSH) has been considered an important model to promote healthy aging among vulnerable subgroups of older adults, progress in developing, expanding, and improving SSH has been limited compared to other housing models. A comprehensive review of the recent knowledge base is a critical step toward developing and expanding policies and programs for senior housing for low-income older adults. This scoping review used a five-stage scoping review methodology to answer two research questions: 1) What are the trends in SSH empirical studies? 2) What are the main topics in the existing literature on SSH in the US? This review explores the social, physical, and service environments related to SSH in older adults in the US. Personal and environmental factors were key in examining study outcomes or main focus. We reviewed a total of 61 articles and found several notable trends, including a focus on racial and ethnic minorities, cognitive impairment among SSH residents, and Collaborative partnerships between housing operators and healthcare providers. More than half of the studies (54%) were quantitative, while the rest were qualitative (38%) or mixed-methods (8%). The lack of longitudinal or causal design research reflects the limited empirical knowledge of SSH. Four themes emerged: health and well-being (52.5%), healthcare use and health behaviors (31.1%), social relations (8.2%), and housing relocation (8.2%). We discussed implications for future research and program development efforts in SSH. Future research should explore the fit between individual characteristics and the multiple-factor environmental context.
TEAM BASED LEARNING, AN OPPORTUNITY TO PROMOTE INTERPROFESSIONALISM IN GERIATRICS EDUCATION: A SYSTEMATIC REVIEW
Authors: Pajuelo-Vasquez Renzo , Gutierrez-Baca Wendy , Flores-Cohaila Javier , Runzer-Colmenares Fernando M
Published: December 2023

Geriatric care is complex and requires high coordination between healthcare providers. Thus, interprofessional education remains a priority, and innovative teaching methods are needed. Team-Based Learning (TBL) - “an active learning and small group instructional strategy that focuses on higher-cognitive abilities through a sequence of activities including individual work, teamwork and immediate feedback through significant problems.” – appears as one of the most valuable solutions. Following BEME recommendations, this systematic review examined the current evidence on TBL in health professions education (HPE). PubMed, EMBASE, WoS, and Scopus were searched from inception till August 2023 using key terms/subject headings related to TBL and Geriatrics. Four studies published between 2013 and 2022 met our inclusion criteria. Two studies included solely nurses and the remaining two – students from different disciplines. One study was quasi-experimental, while others were cross-sectional. Studies involved undergraduate (n=4) and graduate (n=2) students. Geriatric care was the curriculum’s focus in two studies, while it was a component in the remaining two (covered in one or two modules). All studies followed the sequence of a TBL session. Although TBL was not preferred over traditional lectures for students (n=1), there was a gain in knowledge and skills in most of the studies (n=3). To analyze the quality of studies, the MERSQI was employed (Mean = 9.87, SD =1.31), but there was a lack of validity in assessment instruments and zero patient-reported outcomes. TBL is an opportunity to promote interprofessional education. However, further studies using better assessment methods and higher-level outcomes are needed.
THE HEALTHY AGING INITIATIVE: LONGITUDINAL RESEARCH EMPOWERING OLDER ADULTS TO LIVE THEIR BEST LIVES
Authors: Andrews Heather , Gilfix Talia , Stein Benjamin , Cappon Davide , Syme Maggie , Pascual-Leone Alvaro
Published: December 2023

The World Health Organization (WHO) has designated this the decade of Healthy Ageing--focused on developing and maintaining functional ability that enables well-being in older age. We developed the Healthy Aging Initiative (HAI), a prospective cohort study of adults 55+ measuring functional ability, going beyond a disease-focused model of population ageing to holistic intrinsic capacity (physical, cognitive, emotional, behavioral, cultural health) and environmental context. A multidisciplinary team of geroscientists developed a protocol of subjective and objective assessments evaluating several known modifiable risk factors for disability and dementia, mobility, strength, functional status, and mental wellness. By tracking these domains annually, we influence participant health trajectories with timely, actionable feedback and gain insight into causal factors that impact functional ability, creating a blueprint for translational clinical research in healthy ageing. A feasibility pilot (N=37; 80.8 avg. age, 67-93 age range; 92% White) was conducted within two affiliated older adult living communities. The revision process included evaluating specificity, sensitivity, and utility of all assessments (results to be presented), and accounting for participant suggestions (results to be presented). The majority of pilot participants perceived benefit from the assessment (81%) and would participate again (86%), despite 43% reporting the length as challenging. Results were used to revise the protocol content and process, including reducing assessment time from 2+ hours to 40 minutes, and completing surveys over the phone. We have begun the full roll out (HAI 2.0) into all affiliated older adult living communities (2023), and will have second annual assessments in the upcoming months.
THE IMPACT OF WORKPLACE DEMANDS AND RESOURCES ON THE JOB SATISFACTION OF MINORITY AND IMMIGRANT CNAS
Authors: Hawes Frances , Wang Shuangshuang
Published: December 2023

This study examines the association between occupational stress (job resources and demands) and job satisfaction among nursing assistants (NAs) in the long-term care (LTC) sector, considering differences based on race/ethnicity and immigration status. Data from 2,763 NAs were retrieved from the National Nursing Assistant Survey (NNAS). Guided by the JD-R model, our findings indicate that higher job resources, including organizational support, personal development opportunities, benefits, and peer support, are associated with greater job satisfaction among NAs. Conversely, higher job demands, such as structural, physical, and emotional demands, are linked to lower job satisfaction. Importantly, significant differences in occupational stress were observed based on race/ethnicity and immigration status. Hispanic NAs reported the lowest benefits, Black NAs reported the lowest levels of residents’ respect, and White NAs reported the lowest peer support. Naturalized NAs experienced higher job satisfaction with greater job resources, while resident NAs had lower satisfaction associated with higher job demands. These findings highlight the need for tailored support mechanisms to address disparities in job rewards and recognition among different racial/ethnic and immigration groups.
THE MEDIATION EFFECT OF SOCIAL SUPPORT BETWEEN DEPRESSIVE SYMPTOMS AND LONELINESS IN OLDER ADULTS WITH DIABETES
Authors: Cho Emma
Published: December 2023

The purpose of this study was to examine the relationship between depressive symptoms and loneliness in older adults with diabetes, and to explore the mediating role of social support in this association. This study was developed as a secondary data analysis using data from the National Social Life, Health, and Aging Project in the USA. The sample consisted of 407 older adults aged 50 to 93 years (mean = 64.76, SD=9.03; 50.9% male; 60% married and white). A multi-item survey questionnaire was used to assess loneliness, social support, and depressive symptoms. Spearman correlation analysis was used to examine the relationship between depressive symptoms, social support, and loneliness; the macro PROCESS on SPSS was used to examine the mediating effects of social support on the association between depressive symptoms and loneliness. Despite the significant correlation between depressive symptoms and social support, social support and loneliness, and depressive symptoms and loneliness, social support did not mediate the influence of depressive symptoms on loneliness. The results of this study support the need for increased awareness of depressive symptoms in older adults with diabetes. Depressive symptoms should be treated to alleviate loneliness, and more research is needed to explore how other social factors influence the relationship between depressive symptoms and loneliness, thereby preventing a synergistic effect of depressive symptoms and loneliness.
THE ROLE OF SELF-EFFICACY IN ADVANCE CARE PLANNING: DOES RACE AND ETHNICITY AFFECT THIS RELATIONSHIP?
Authors: Yauk Jessica , Dobbs Debra
Published: December 2023

Advance care planning (ACP) has been identified as essential in improving end-of-life patient satisfaction and goal-concordant care. Despite the benefits of ACP, rates remain particularly low among marginalized populations. Marginalized populations are also at an increased risk of receiving care incongruent with their wishes and reporting low-quality end-of-life care. ACP is a complex process where individuals must decide to plan and implement those plans. Because the ACP process is complex, an individual’s self-efficacy- or belief that they can perform a particular task, may be an important component when predicting ACP completion. Using data from the 2018 wave of the Health and Retirement Study (HRS), the current study aimed to understand how two facets of self-efficacy- mastery and constraint-, related to varying levels of ACP completion (living will, durable power of attorney for healthcare, and advance care planning discussions (DPAHC)). Furthermore, we looked at the possible moderating effects of race/ethnicity between self-efficacy and ACP. Results indicated that Black and Hispanic older adults are significantly less likely to complete all types of ACP. Furthermore, higher self-reported constraint- was significantly related to lower completion of ACP discussions (OR = 0.9, p= .05). Neither mastery or constraint were related to completion of a living will or DPAHC. Race/ethnicity was not found to moderate the relationship between self-efficacy and any level of ACP. Individual variables may be less important than community level variables or life-long discrimination when assessing completion of ACP among marginalized populations.
UNDERSTANDING AGE-RELATED DISPARITIES AND ENVIRONMENTAL BARRIERS IN OLDER ADULTS WITH MULTIPLE SCLEROSIS
Authors: Lee Kyungmi , Plow Matthew
Published: December 2023

Given the increasing life expectancy of individuals with multiple sclerosis (MS), the challenges faced by older adults with MS in terms of health changes and decreased physical function contribute to a potentially diminished quality of life. Despite this, our understanding of how this condition manifests in the context of aging remains limited. This study aims to examine age-related variations in fatigue, anxiety, depression, community engagement, and environmental barriers in older adults with MS, as well as to explore health disparities among older adults with MS. This secondary analysis involved 288 individuals with MS, divided into two age groups: below 60 years and 60 years and above. Aim 1 used T-tests and Aim 2 employed ANCOVA with disability adjustment. The results show that older adults with MS had higher levels of community engagement, disability, and behavioral-cognitive fatigue, reporting lower levels of anxiety, cognitive-motor fatigue, fatigue severity, and participation barriers than younger adults with MS. Noteworthy health disparities emerge, characterized by reduced community integration/participation (F=10.622, p=.001) and heightened environmental barriers (F=4.323, p=.039), even when adjusting for disability levels. The study highlights environmental barriers impeding social participation among older adults with MS, emphasizing the need to address these obstacles to enhance their quality of life. This underscores the imperative for customized interventions targeting reduced community disengagement and heightened environmental barriers faced by older adults with MS.
WITHIN TWIN PAIR DIFFERENCES INDICATE GENETIC EFFECTS OF SES INDICATORS ON LONGITUDINAL CHANGES IN PHYSICAL AGING
Authors: Finkel Deborah , Ericsson Malin , Gatz Margaret
Published: December 2023

Socioeconomic status (SES) predicts change in health status over age, even after accounting for measured confounders such as environmental and biological risk factors. Nonetheless, the source of SES-health associations continues to be heavily debated. Twin studies offer a method for testing causal hypotheses by incorporating within and between twin pair differences in longitudinal latent growth curve models (LGCM) of physical aging on both level of functioning and rate of change with age. Three longitudinal twin studies of aging from the Swedish Twin Registry (N = 2059) included up to 27 years of follow-up on a Functional Aging Index (FAI) consisting of lung function, grip strength, walking speed, and self-report sensory functioning. SES indicators included education, financial strain, and occupation. Pair means (between family effect) and within pair differences (within family effect) were included as covariates of both intercept and slopes in a two-slope LGCM (intercept at age 75); models were corrected for sex and parental SES. LGCM results were compared across full sample, monozygotic twins, and dizygotic twins. For the FAI intercept, MZ within pair effects in all SES variables were strongly attenuated, indicating genetic confounding. For slope 1, only MZ within pair effect for education was attenuated, and no SES indicators were related to rate of change in FAI after age 75. Thus, results suggest shared genetic factors explain the association between education and change in physical aging in early aging processes. In other words, genes that impact educational achievement may also influence health behaviors and physical aging.
EFFECT OF EARLY-LIFE DISCRIMINATION IN PARENTING ON THE PHYSICAL AND MENTAL HEALTH OF MIDDLE-AGED AND OLDER ADULTS
Authors: Guo Chao , Liu Lan , Liu Jie
Published: December 2023

This study aimed to explore the early-life discrimination in parenting on the physical and mental well-being of middle-aged and older adults, while also exploring the potential mediating role of early-life health. By combined data from the China Health and Retirement Longitudinal Study (CHARLS) in 2018 and related life history survey in 2014, 8204 females and 7305 males aged 45-84 were analyzed in this study. Logistic regression was employed to analyze the association between early-life discrimination in parenting and the incidence of chronic diseases as well as depression in middle-aged and older individuals. The KHB method was used to assess the mediating effect of early-life health in these connections. Regarding gender-based discrimination in parenting, parental preference for sons during early life was found escalated the probability of chronic diseases by 18% (OR=1.18, 95%CI: 1.01-1.38) and increased depression risk by 16% (OR=1.16, 95%CI: 1.03-1.31) among middle-aged and older females. In terms of sibling-related discrimination, parental inclination towards specific siblings heightened the likelihood of depression during middle and older years among females (OR=1.17, 95%CI: 1.03-1.34). However, these effects were not significant in males. The study further identified that early-life health partially mediated the influence of gender-based parental preferences on the mental well-being of middle-aged and older females, accounting for 8.603% of the overall effect. These findings underscored the potential for early-life discrimination within parenting to impact both the physical and mental health of middle-aged and older females by shaping their early-life health status, consequently resonating throughout their mental well-being in later life.
COGNITIVE FRAILTY: PREVALENCE, RISK FACTORS, AND THE RISK OF MORTALITY IN CHINESE MIDDLE-AGED AND OLDER ADULTS
Authors: Ning Hongting , Feng Hui , LI Junxin
Published: December 2023

To examine the age-specific prevalence, risk factors, and magnitude of the association between cognitive frailty and all-cause mortality in Chinese middle-aged and older adults. We used baseline (2011) and follow-up waves (2013, 2015, and 2018) data from the China Health and Retirement Longitudinal Study (CHARLS). The age group was categorized as middle-aged, old, and very old. Factors associated with cognitive frailty and the associations between cognitive frailty statuses and mortality were examined using multinomial logistic regression and Cox proportional hazards models, respectively. Totally 7947 participants were included in this study, and the overall prevalence of cognitive frailty was 12% (middle-aged, 11%; old, 10%; very old, 26%; P< 0.0001). Cognitive frailty was independently associated with rural residential status, long sleep duration, lack of social participation, depressive symptoms, and multimorbidity among all the age groups. Over the 7-year follow-up, participants with cognitive frailty were at a higher risk for all-cause mortality than the robust group (HR 1.70, 95%CI 1.12-2.57 for the middle-aged group, HR 1.70, 95%CI 1.02-2.84 for the old group, and HR 2.06, 95%CI 1.17-3.65 for the very old group). Pre-cognitive frailty was associated with a higher mortality risk in the middle-aged group only (HR 1.34, 95%CI 1.01-1.79). The prevalence of cognitive frailty in middle-aged adults was comparable with that in the old group. Cognitive frailty, a significant risk factor for mortality, was associated with multiple factors in middle-aged and older adults, calling for integrated cognitive frailty prevention strategies. Noticeably, pre-cognitive frailty in middle-aged people increases mortality risk and requires special attention.
DAILY ENGAGEMENT IN MEANINGFUL ACTIVITY FOR HOME CARE PATIENTS WITH SUBJECTIVE COGNITIVE DECLINE AND CAREGIVERS
Authors: Lu Yvonne , Ellis Jennifer , Perkins Susan , Hickman Susan , Chang Pei-Shiun , Haase Joan , Otis Laurie , Winton Rebecca
Published: December 2023

Patients with subject cognitive decline (SCD) often lose sense of control, disengage from meaningful activities, and have less confidence in their ability to manage daily challenges. The objectives of pragmatic pilot phase study were to evaluate the feasibility and benefits of a Daily Engagement in Meaningful Activity Professional (DEMA-Pro) for patients with SCD; and explore nurses’ experience of DEMA-Pro implementation. Forty-nine patients at four home healthcare sites received six weekly DEMA-Pro telephone sessions. The Outcome and Assessment Information Set-D were collected at starting date (pre-intervention) and discharge date (post-intervention). Quantitative surveys and qualitative focus group methods were used to explore the DEMA-Pro nurses (n = 3) experiences. The consent rate was 67.1%, the completed intervention rate 36.7%, and the partial completed intervention rate 25.5%. For 36 subjects with discharge data available, both IADLs and self-care scores improved (d = 3.11 and d = 2.66, respectively). Specifically, those that completed all DEMA-Pro sessions (n=14), partial completers (n=12), and non-completers (n=10), had improved scores on IADLs (d = 4.0, 4.2, and 2.5, respectively) and Self-Care (d = 3.7, 3.1 and 2.0, respectively). Completers had greater improvement than non-Completers for both outcomes and greater improvement on IADLs than partial completers (all p-values < 0.03). Nurses reported high satisfaction with their training, and high confidence that the implementation of the intervention met patient and caregiver needs. The DEMA-Pro has shown benefits and feasibility that will need further testing in a large pragmatic trial in homecare settings.
A PILOT FEASIBILITY STUDY INVESTIGATING BALANCE DELIVERY TO OLDER ADULTS WITH CHRONIC CONDITIONS IN REHAB SETTINGS
Authors: Choma Elizabeth , Peckenpaugh Jackson , Treat-Jaconson Diane , Martin Lauren , Wolfson Julian , Keller-Ross Manda , McMahon Siobhan
Published: December 2023

Little is known about the integration of balance exercise delivery into physical rehabilitation settings for older individuals with chronic conditions and fall risk. We assessed the feasibility, acceptability and limited efficacy of delivering evidence-based balance exercises to older adults with fall risk enrolled in cardiac rehabilitation (CR) for peripheral artery and/or cardiovascular disease through an explanatory sequential mixed methods pilot study. Phase one included a two-arm randomized trial comparing feasibility, acceptability and functional balance among 10 participants receiving an 8-week balance program delivered adjacent to CR and 10 participants receiving CR only. Phase two included semi-structured interviews to elicit perceived barriers/facilitators of program receipt. Data was analyzed using descriptive statistics to summarize feasibility and acceptability indicators and one-way ANCOVA to test balance effects (Short Physical Performance Battery [SPPB], Mini-BESTest). Qualitative data was analyzed through content analysis. Participants had a mean age of 72.3 (7.3). On average, treatment group participants attended 7.2 (1.8) out of 8 meetings and self-reported completion of 4.5 (1.8) exercise sessions/week. Adjusting for baseline values, the treatment group exhibited greater changes in the SPPB than the usual care group after 8 weeks (10.71±0.36 vs. 9.59±0.36; adjusted difference=1.13 [95% CI, 0.3,2.2]; p=0.045). Mini-BESTest scores were not significantly different (p=0.061). Participants expressed satisfaction with program duration and frequency, quality of instructional materials, challenge level, ease of home exercise completion, convenient delivery location, and improved balance self-awareness/skills. These findings could inform the design of future efficacy trials investigating balance integration within CR settings to improve reach of fall prevention efforts.
LINKING HEALTH ATTRIBUTES TO ACUTE-CARE USAGE IN SOUTH FLORIDA VETERANS, A PILOT SURVEY STUDY
Authors: Munoz Richard , Bursac Zoran , Gomez Carlos , Hansen Jared , Garcia Sandra , Ruiz Diana , Desir Marianne , Dang Stuti
Published: December 2023

“High-Need, High-Risk” (HNHR) Veteran patients are identified quarterly by the Department of Veterans Affairs (VA) as having the top 5% predicted probability of hospitalization or mortality. We fielded a pilot survey to 2,543 older “HNHR” Veterans receiving care at the Miami VA Medical Center between October 2017 and September 2018, where 634 replied; mean age 70.61, standard deviation, 8.98, racially/ethnically White (403, 61.24%), Black (240, 36.47%), Hispanic (537, 81.61%) and nineteen women (3%). The survey contained 42 self-reported questions covering physical, mental, and social determinants of health, and access/use of healthcare resources. Two measured prior 6-month acute-care utilization outcomes: emergency room visits (ERV) and inpatient hospital admissions (IHA). Logistic regression was used to find health attributes associated with both outcomes, and latent class analysis was used to group Veterans into clinically relevant latent classes, analyzing health attributes endorsed by each. We found that transportation access issues to receiving healthcare were associated with both outcomes (OR = 2.980, p = 0.014), underscoring the role of social determinants of health. Self-perceptions of general health (OR = 0.806, p = 0.04), and a Veteran attending the Miami VA frailty clinic (OR = 0.435, p < 0.001), were associated with ERV and IHA, respectively. We identified four latent classes distinctly grouping patients by endorsing 1) depression; 2) not having a caregiver and being unmarried; 3) functional issues, and 4) being homebound and receiving home healthcare. These latent classes will help better inform clinical recommendations and program development to better meet needs for “HNHR” Veterans.
Trading Repaired and Refurbished Goods: How Sustainable is EU Exhaustion of Trade Marks?
Authors: Geiregat Simon
Published: December 2023

Analysing EU, Benelux and German case law, this article examines whether the exhaustion doctrine in trade mark law contributes to a more sustainable economy. It considers that ecological motives seem not to have played a role either in the policy choice against international exhaustion, or in the Court of Justice of the European Union (CJEU) case law on legitimate reasons and the repackaging of medication.

Although exhaustion could, theoretically, incentivise traders to give new life to goods that were legitimately marketed before, the analysis shows that this is a risky business because of the thin and blurry line between lawful renewal activities and creating a false impression of affiliation. As such, it is unclear to what extent de-branding, re-branding, and co-branding can prevent liability for infringement, although co-branding renewed products is probably often the only way to do so. As an alternative to buy–renew–resell, traders could consider providing renewal services. On closer analysis, however, offering services puts them in an even less favourable position, and this seems hard to justify.

In addition to trade mark rights, copyright and/or design rights will often cumulatively apply to mark-bearing products. Although the latter rights are also subject to a principle of exhaustion, the effects of exhaustion can de facto be overruled by the exception for legitimate reasons proper to trade mark law. Moreover, it is argued that repair exceptions in copyright and design legislation have limited effect and that announced legislative reforms are unlikely to change that.

The unattractiveness of renewal businesses is further aggravated by the recurrent use of open norms and references to common practices. It is concluded that IP laws often leave it to the discretion of rightholders whether to offer sustainable post-sale solutions. Besides having clearer guidance on what is allowed, this paper suggests that exhaustion case law should take sustainability arguments into account, for instance by considering what would happen to goods if they were not renewed by the trader. To a large extent, the judiciary already has tools at its disposal to incorporate these kinds of elements.
The Disease Severity Index for Inflammatory Bowel Disease Is a Valid Instrument that Predicts Complicated Disease
Authors: Swaminathan Akhilesh , Fulforth James M , Frampton Chris M , Borichevsky Grace M , Mules Thomas C , Kilpatrick Kate , Choukour Myriam , Fields Peter , Ramkissoon Resham , Helms Emily , Hanauer Stephen B , Leong Rupert W , Peyrin-Biroulet Laurent , Siegel Corey A , Gearry Richard B
Published: December 2023

Background

The disease severity index (DSI) for inflammatory bowel disease (IBD) combines measures of disease phenotype, inflammatory activity, and patient-reported outcomes. We aimed to validate the DSI and assess its utility in predicting a complicated IBD course.

Methods

A multicenter cohort of adults with IBD was recruited. Intraclass correlation coefficients (ICCs) and weighted Kappa assessed inter-rater reliability. Cronbach’s alpha measured internal consistency of DSI items. Spearman’s rank correlations compared the DSI with endoscopic indices, symptom indices, quality of life, and disability. A subgroup was followed for 24 months to assess for a complicated IBD course. Area under the receiver operating characteristics curve (AUROC) and multivariable logistic regression assessed the utility of the DSI in predicting disease progression.

Results

Three hundred and sixty-nine participants were included (Crohn’s disease [CD], n = 230; female, n = 194; mean age, 46 years [SD, 15]; median disease duration, 11 years [interquartile range, 5-21]), of which 171 (CD, n = 99; ulcerative colitis [UC], n = 72) were followed prospectively. The DSI showed inter-rater reliability for CD (ICC 0.93, n = 65) and UC (ICC 0.97, n = 33). The DSI items demonstrated inter-rater agreement (Kappa > 0.4) and internal consistency (CD, α > 0.59; UC, α > 0.75). The DSI was significantly associated with endoscopic activity (CDn=141, r = 0.65, P < .001; UCn=105, r = 0.80, P < .001), symptoms (CDn=159, r = 0.69, P < .001; UCn=132, r = 0.58, P < .001), quality of life (CDn=198, r = −0.59, P < .001; UCn=128, r = −0.68, P < .001), and disability (CDn=83, r = −0.67, P < .001; UCn=52, r = −0.74, P < .001). A DSI of 23 best predicted a complicated IBD course (AUROC = 0.82, P < .001) and was associated with this end point on multivariable analyses (aOR, 9.20; 95% confidence interval, 3.32-25.49).

Conclusions

The DSI reliably encapsulates factors contributing to disease severity and accurately prognosticates the longitudinal IBD course.