bluuebunny/crossref_metadata_2025 huggingface dataset:
DIRECT AND INDIRECT CAUSAL EFFECTS OF AIR POLLUTANTS ON ALZHEIMER’S DISEASE RISK AND DISPARITIES
Authors: Akushevich Igor , Yashkin Arseniy , Bona Vito Di , Kravchenko Julia
Published: December 2023

Ambient air contaminants have been associated with higher risk of Alzheimer’s disease (AD), related dementia, and cognitive impairment; however, mechanisms that underlay these effects remain unclear. Pre-existing arterial hypertension, diabetes mellitus, cerebrovascular disease, and renal disease have a strong impact on AD risk and disparities. These diseases, in turn, are associated with exposure to air contaminants, including particulate matter (PM2.5). We applied causal mediation analysis in the formulation of VanderWeele which provides causal estimates of the direct and indirect (through the effects on pre-existing diseases) effects of PM2.5 exposure on the risk of AD. We used Administrative Health Insurance Claims from 5%-Medicare (N=6,042,239; 1991-2020) to identify the date of onset for AD and risk related diseases such as arterial hypertension, diabetes, cerebrovascular, and kidney diseases that were considered mediators in these analyses. Information on ambient PM2.5 at the zip code level were derived from the Socioeconomic Data and Applications Center (SEDAC) that incorporates air monitoring data, satellite aerosol optical depth, meteorological conditions, chemical transport model simulations, and land-use variables. The estimates supported the hypotheses on the linear dependence of the dose-response function with higher effects for Males vs. Females, White vs. Black subpopulations, and stroke-belt states vs. other U.S. regions. We found that the contributions of indirect effects were stronger for younger older adults and reached up to 13% for cerebrovascular disease, 10% for arterial hypertension, 5% for diabetes, and 4% for chronic kidney disease. Analysis in subpopulations demonstrated health disparities in the effects of PM2.5 on AD risk.
EARLY DETECTION IN ALZHEIMER’S DISEASE AT ADVENTHEALTH: A DAVOS ALZHEIMER’S COLLABORATIVE FLAGSHIP SITE
Authors: Smith Steven , Pratley Richard , Baldivieso Valeria , Baksh Magda , Shepherd Gayle , Lopez Janice , Selzler Katherine , Murray James
Published: December 2023

Background

The emergence of new therapeutics highlights the need for more efficient and equitable early identification of people at risk of developing Alzheimer’s disease. The Davos Alzheimer’s Collaborative flagship program was designed to test feasibility, acceptability, and implementation of a digital cognitive assessment (DCA) followed by a blood-based biomarker (BBM) as part of primary care workflows.

Methods

Patients ≥65 years were contacted via their AdventHealth primary care provider or through social media to complete the Cogstate Brief Battery (CBB) DCA virtually. The CBB assesses four cognitive domains: processing speed, attention, visual learning, and working memory. Patients with an abnormal or borderline composite score were offered the PrecivityAD® blood test from C2N Diagnostics, an Alzheimer’s disease screening tool.

Results

Approximately 2387 patients expressed interest to participate and 1077 e-consented: 96% social media, 4 % PCP. Of those, 742 patients completed the DCA. 28% were positive, 15% were borderline, and 56% were negative for cognitive issues. Additionally, 192 patients received the blood test results where, 17.7% had high likelihood, 67.7% low likelihood, and 14.6% could not distinguish presence or absence of amyloid plaques. Utilization of digital tools varied across race and ethnicity.

Conclusion

Both PCP referrals and social media approaches demonstrated opportunities and challenges for early detection of Alzheimer’s. Implementation of both the CBB cognitive assessment and PrecivityAD® blood test was successful. Both DCAs and BBMs have value in early detection for cognitive impairment and a first step in identifying patients who could benefit from disease-modifying treatments.
INFLAMMATORY CYTOKINE, SOCIAL SUPPORT, AND HEALTH DISPARITIES IN PERSONS WITH COGNITIVE IMPAIRMENT AND DEMENTIA
Authors: Malatyali Ayse , Cidav Tom , Xie Rui , Thiamwong Ladda
Published: December 2023

The protective role of social support on cognitive functioning is extensively documented. A pro-inflammatory cytokine, Tumor necrosis factor-alpha (Tnf-alpha), might have a role in the connection between social support and dementia as a marker of systemic inflammation. This study describes the influence of lack of friends’ support and Tnf-alpha on cognitive functioning. We conducted a cross-sectional study on Health and Retirement Study participants aged 65 and above, using datasets from the 2016 interviews. Of the 9,262 participants, 72.4% had normal cognition. 21.3% had cognitive impairment, and 6.3% had dementia. Our regression model controlled with depression scores revealed that participants with a lack of friends’ support were 51% more likely to have cognitive impairment and 54% more likely to have dementia. The effect of Tnf-alpha was comparably higher on participants with dementia and cognitive impairment than on participants with normal cognition. Compared to quartile-1 (lowest Tnf-alpha levels), Quartile-4 (highest Tnf-alpha levels) was significantly associated with cognitive impairment (OR=1.60) and dementia (OR=2.37). Quartile-3 was only a significant predictor of dementia (OR=2.08). The effect of Tnf-alpha was insignificant in quartile-2 for both groups. Hispanics were 65% more, and African Americans were 67% more likely to have cognitive impairment than non-Hispanic whites. The likelihood of having dementia was even higher in racial/ethnic minorities: Hispanics were 3.3 times more, and African Americans were 2.3 times more likely to have dementia than non-Hispanic whites. Future research can focus on racial and ethnic variations in pro-inflammatory cytokines and social support among people with dementia.
ONLINE COGNITIVE MONITORING IN A SIMULATED ANTI-AMYLOID TRIAL: ADHERENCE AND COGNITIVE CHANGE
Authors: Kaye Jeffrey , Mattek Nora , Marcoe Jennifer , Mar Amanda , Shang Yanan , Pierce Aimee , Duff Kevin , Hughes Adriana
Published: December 2023

Remote assessment of cognitive function is increasingly of interest for monitoring cognitive decline. Additional advantages of remote monitoring are more frequent assessments and the examination of change over time, which may yield more sensitive indicators of cognitive status. This concept was tested in DETECT-AD (Digital Evaluations and Technologies Enabling Clinical Translation for Alzheimer’s Disease), an ongoing simulated anti-amyloid trial using digital biomarkers as outcome measures. Adherence to testing, relationships to age, global cognition, and SUVR, and trajectories of change were analyzed in the SMART (Survey for Memory, Attention and Reaction Time) test, a brief measure of visual-grid memory and executive function (Trails A/B, Stroop Color-Word), self-administered online every four weeks. To date (02/28/2023), 46/100 have been enrolled with mean(SD): follow-up=31.0(7.9) weeks (no dropout); age=78(6.6); 63% women; MoCABaseline=25.5(2.3); PET SUVR=1.09 (0.20; range=0.850-2.07). SMART surveys (n=184) completed online used a desktop (26%), laptop (48%), tablet (20%), or smartphone (7%). A mean of 4(2.0; range=1-8) SMART surveys/participant were completed with 96% completed tests. Older age significantly correlated with longer overall completion times (p=0.02), Trails-B (p< 0.01) and Stroop (p=0.02) times, and more click counts on Trails-B (p=0.03). MoCA total score significantly correlated with shorter completion times on overall SMART (p=0.02), Trails-A (p< 0.01), and Trails-B (p=0.03). There were no relationships between SUVR and SMART. Total SMART completion time decreased over multiple administrations (p=0.03), driven by shorter Trails-B time (p=0.01). Monthly online screening of cognitive function in a clinical trial setting is well maintained yielding novel information over time.
PROMOTING PARTICIPATION IN OCCUPATIONS AMONG OLDER ADULTS LIVING WITH NEUROCOGNITIVE DISORDERS AND CAREGIVERS
Authors: Belchior Patricia , Levasseur Melanie , Filiatrault Johanne , Ramachandran Meena , Bier Nathalie
Published: December 2023

Participation in meaningful occupations promotes self-confidence, self-esteem, overall health, and healthier life transitions. Due to significant life changes brought by neurocognitive disorders older adults living with neurocognitive disorders as well as caregivers may undergo some disruption in their occupational participation. Few interventions have focused on their ability to engage in meaningful occupations independently and together to successfully orchestrate their life to meet their own occupational needs. The goal of this study was to document the priority needs of older adults living with neurocognitive disorders and caregivers to promote occupational participation, to guide us in the development of an intervention. To this end, a rapid literature review was conducted. Three databases (Medline, PsycInfo and CINAHL) were searched. Studies were included if they used qualitative methods, included community-based individuals and were available in English or French. A total of 20 studies met the inclusion criteria. Two needs were prioritized in the literature by both older adults living with neurocognitive disorders and caregivers: 1) to continue participating in daily activities and social roles (e.g., maintain the connection with the community, use everyday technology), 2) to educate the public about the disease (e.g., bring awareness, knowledge, and understanding of dementia among the community at large). In the presentation we will discuss how the results will inform the development of an occupational-based intervention to promote meaningful occupations.
QUALITY OF LIFE ASSOCIATED WITH HOSPITAL DEATH AMONG PERSONS LIVING WITH DEMENTIA
Authors: Sullivan Suzanne , Li Chin-Shang , Chang Yu-Ping
Published: December 2023

Dementia is a progressive, terminal health condition impacting quality-of-life. Hospice programs supporting family caregivers in managing end-of-life care for persons living with dementia (PLWD) and preventing non-beneficial hospitalizations are underutilized. This univariable logistic regression of the National Health and Aging Trends Study rounds 1-9 (n=719) aimed to identify associations between quality-of-life of PLWD and hospital death (yes/no). Results indicate that PLWD going outside most days (OR=3.34, p=0.0004) were more likely to die in a hospital compared to those never going outside. Those whose health did not prevent them from enjoying life (OR=2.5, p< 0.0001) were more likely to die in a hospital. PLWD needing >30 minutes to fall asleep (OR=2.43, p=0.002) compared to those never needing >30 minutes to fall asleep, PLWD without problems speaking (OR=1.69, p=0.007), not needing help to eat (OR=1.82, p=0.001), without problems chewing or swallowing (OR=1.54, p=0.039), and having possible dementia (OR=2.35, p< 0.0001) were more likely to die in the hospital. African Americans (OR=1.80, p=0.003) were more likely to die in the hospital compared to Whites, PLWD who received gas energy assistance (OR=1.95, p=0.048), and those living in the Pacific West compared to the Midwest or Northeast (OR=2.57, p=0.004) were more likely to die in the hospital. These findings suggest that quality-of-life, availability of support, financial and psychosocial well-being, and social disparities were associated with higher risk of hospital death among PLWD. Quality-of-life and psycho-social demographic features may serve as mechanistic targets for interventions supporting hospice transitions and prevention of non-beneficial end-of-life hospitalizations.
USABILITY TESTING OF THE PACE APP TO SUPPORT FAMILY CAREGIVERS IN MANAGING PAIN FOR PEOPLE WITH DEMENTIA
Authors: Chi Nai-Ching , Shanahan Angela , Nguyen Kristy , Demir Ibrahim , Fu Ying-Kai , Herr Keela
Published: December 2023

Pain is a common symptom in older adults with Alzheimer’s Disease and Related Dementias (ADRD). It is difficult to assess and is often undertreated in people with ADRD. The PACE-app (Pain Control Enhancement application, was developed to enhance self-efficacy of family caregivers when controlling the pain of their care partner. The objective of this study was to test the usability of the PACE-app with family caregivers and clinicians. We evaluated the usability of the PACE-app. Participants (17 family caregivers, 6 clinicians) took part in a mixed-methods study that included a one-time recorded zoom meeting with standardized semi-structured guided review, interview, and a survey specific to their role. The Post-Study System Usability Questionnaire (PSSUQ) was used to measure usability. The overall PSSUQ score we found was 1.9. The range of scores can be between 1 and 7 with the lower numbers meaning favorable usability. The qualitative interviews showed a favorable user experience with 75% of all participants feeling the overall design was effective; 48% felt the tailored pain management strategies were useful; 24% suggested improving the app by having direct coaching information for the family caregiver. This study demonstrated favorable usability with those who tested the PACE-app. Suggestions for improvement were given and using the interview results in conjunction with the PSSUQ scores, we are able to make changes to the app interface to impact the overall design to enhance user experience.
A COMPREHENSIVE COMPOSITE FOR ALLOSTATIC LOAD SCORING AND RISK CATEGORIZATION FOR PREDICTIVE COMPARISONS
Authors: Buller-Peralta Ingrid , Gregory Sarah , Wells Katie , Ntailianis Georgios , O’Brien John , Ritchie Craig , Muniz-Terrera Graciela
Published: December 2023

Introduced three decades ago, the concept of Allostatic Load (AL) describes the wear and tear of the physiological response to chronic stress, and how sustained demand overloads the systems involved, deplete their resources, and leads them to fail. Current evidence shows positive relationship between AL and risk of developing conditions such as depression, fibromyalgia, cardiovascular disease, diabetes, cancer, early cognitive decline, and dementia. However, there is only partial consensus regarding which biomarkers can compose an AL index or how to accurately score them. Current proposals debate between purely statistical cut-off points, inclusion of gender and ethnicity differences, use of clinical reference values, and scoring ongoing medication. The result is a considerable heterogeneity of methods for AL calculation and a lack of universally agreed values, leaving researchers to subjectively choose which framework suits better to their aims. Using data from the PREVENT-Dementia study (cognitively normal mid-life participants, n=700), we developed a comprehensive composite for AL scoring to generate a more accurate and biologically relevant index, that considers both previous and recent clinical evidence. By including gender and age differences, high quartile approach, and up-to-date clinical reference values, individuals were categorized as no-risk, at-risk and high-risk of AL, which will be associated with MRI brain volume measurements. Comparison to serum Thyroid-stimulating hormone (TSH) levels will serve as proxy of the neuroendocrine biomarkers originally proposed as AL primary mediators, due to its association to increased cortisol. Additional stress-related biomarkers, such as sleep quality and the neutrophil-to-lymphocyte ratio will also be assessed for associations.
EPIGENETIC DIFFERENCE BETWEEN INSOMNIA GROUP AND NONINSOMNIA GROUP IN PARTICIPANTS WITH KNEE PAIN
Authors: Goicolea Soamy Montesino , Meng Lingsong , Huo Zhiguang , Foster Thomas C , Goodin Burel R , III Joseph L Riley , Fillingim Roger , Cruz-Almeida Yenisel
Published: December 2023

Chronic knee pain is a common condition that often co-occurs with insomnia. Epigenetic modifications, such as DNA methylation, may play a role in the sleep-pain relationship. In this study, we aimed to identify differentially methylated CpGs/regions and enriched genomic pathways associated with insomnia in participants with knee pain (KP). We recruited 140 cognitively healthy middle to older-aged adults with self-reported KP and extracted DNA from peripheral blood. MethylationEPIC arrays were used for methylation data quantification, R package minfi was used for data preprocessing and quality control, and Ingenuity Pathway Analysis (IPA) was used to explore functional implications of differential methylation in pathways related to insomnia. Annotated genes within ±5kb of the putative differentially methylated regions (DMRs, p< 0.05) were subjected to the IPA analysis. There were no significant differences in sex or race between the two groups (p>0.05). We observed an over-representation of younger participants in the insomnia group (p=0.005) and also from the University of Florida (p=0.008). At raw p < 0.05 cutoff, we identified a total of 20,006 CpG probes, including 12,674 hypermethylated, and 7,332 hypomethylated CpG probes. Pathway analysis using IPA identified multiple immune-related pathways enriched with insomnia-related differentially methylated regions (DMRs), including the antigen presentation pathway (p=3.39E-08). Verapamil was identified as the most significant upstream regulator (p=8.8E-07). Our findings suggest the importance of epigenetic regulation of the immune system in the sleep-pain relationship and highlight the need for further research to understand the epigenetic contributions to sleep disorders in individuals with chronic pain.
THE RELATIONSHIP BETWEEN CROSS-TISSUE AND INTRA-TISSUE MEASURES OF AGING BIOLOGY IN OLDER ADULTS
Authors: Waziry Reem
Published: December 2023

The present study included individuals (N=2406) aged 50 and older who had complete data for saliva-based telomere length and blood-based biological aging measures in the Health and Retirement Venous blood and Telomere length studies. Average telomere length was assayed using quantitative PCR (qPCR). DNA methylation clocks included: Horvath (353 CpG sites), Hannum (71 CpG sites), Levine (referred to as phenoAge, (513 CpG sites)), GrimAge, (epigenetic surrogate markers for select plasma proteins), Horvath Skin and Blood (391 CpG sites), Lin (99 CpG sites), Weidner (3 CpG sites), and VidalBralo (8 CpG sites). Physiology measures included albumin, creatinine, glucose, [log] C-reactive protein, lymphocyte percent, mean cell volume, red blood cell distribution width, alkaline phosphatase, and white blood cell count. Relationships between aging biology measures in blood and saliva and variations according to gender were assessed. Blood-based measures showed an inverse relationship with saliva-based telomere length. Increase in saliva-based telomere length was associated with 1 to 4 years slower biological aging based on blood-based measures with the highest magnitude being Weidner (Coefficient= -3.97, P = 0.005), GrimAge (-3.33, P < 0.001), and Lin (-3.45, P = 0.008). Variations in DNA methylation and physiology measures of aging biology with changes in telomere length provide new avenues for integration of these measures in clinical care of vulnerable and clinically difficult to reach individuals.
TRANSITIONS BETWEEN SARCOPENIA STATES AND ITS DETERMINANTS IN COMMUNITY-DWELLING OLDER ADULTS
Authors: Kim Miji , Shin Hyung Eun , Won Chang Won
Published: December 2023

Sarcopenia is characterized by an age-related progressive reduction in muscle mass and function. Few observational studies have characterized the dynamic nature of sarcopenia, which is potentially reversible. However, little is known about the determinants of sarcopenia reversal among community-dwelling older adults. We aimed to explore transitions in sarcopenia status and identify factors associated with the reversibility of sarcopenia over a 2-year follow-up period. We conducted prospective analyses (n=1,992) among participants (mean age, 76.3±3.9 years; 47.6% men) who underwent measurement of sarcopenia status at baseline and 2-year follow-up from the Korean Frailty and Aging Cohort Study. Sarcopenia status was diagnosed using the criteria of the 2019 Asian Working Group for Sarcopenia. After 2 years of follow-up, 224 (11.2%) individuals developed sarcopenia, 176 (8.8%) had reversed their sarcopenia, 276 (13.9%) remained in a sarcopenic state, and 1,317 (66.1%) had maintained a non-sarcopenic state. For men, moderate to high levels of physical activity (odds ratio [OR]=2.50 [95% confidence interval (CI)]: 1.31–4.56), resistance training more than 2–3 times per week (OR=2.03, 95% CI: 1.04–3.97), and lower body mass index (OR=0.67, 95% CI: 0.55–0.82) were associated with greater odds reversing sarcopenia. For women, cognitive function (OR=1.12, 95% CI: 1.05–1.26 per 1-point increase in the Mini-Mental State Examination) was associated with higher rates of reversing sarcopenia. To conclude, our results support the dynamic nature of sarcopenia and potentially reversible factors such as higher levels of physical activity and cognitive function, which could be beneficial in the treatment of community-dwelling older adults with sarcopenia.
IMPROVING HAND FUNCTION AMONG OLDER ADULTS THROUGH AN INTERGENERATIONAL SERVICE-LEARNING PROGRAM
Authors: Cook Rachel Logue , Schwartz Anna , Vanderlaan Courtney , Brown Susan
Published: December 2023

Adequate hand function is essential for performing daily activities such as eating and dressing, but declines with age. Homebound older adults in particular are at greater risk for losing hand function necessary to remain independent. However, hand function in this population remains largely understudied. The purpose of this study is to determine whether Hands and Health at Home, an intergenerational upper limb-based intervention, improves hand function among homebound Meals on Wheels (MOW) clients. In this program, pre-health college students are trained to deliver a variety of hand strength, dexterity, and sensory exercises to a MOW client twice a week for 8 weeks. In addition, clients are instructed to complete exercises twice a week on their own. Measures of strength, dexterity, and sensation, as well as self-reported hand function are measured before and after the intervention. Preliminary results indicate MOW clients improved their grip strength an average of 42% in the dominant hand and 26% in the nondominant. Approximately 50% of clients improved dexterity (measured via the Purdue Pegboard) in their nondominant hand, and over 65% self-reported increased upper limb mobility. All clients and students valued this hands-on experience with several requesting continued involvement in the program. Results from Hands and Health at Home suggest this intergenerational approach to delivering hand therapy is an effective and mutually beneficial way to serve the needs of homebound older adults in the community and promote student interest in aging careers.
SOCIAL ISOLATION AS A RISK FACTOR FOR GRIP STRENGTH DECLINE: FINDINGS FROM THE NHATS STUDY
Authors: Taani Murad , Ellis Julie , Lee Yura , Cho Chi , Hammouri Ammar , Schlueter Amy
Published: December 2023

Low grip strength is associated with negative health outcomes among older adults, including poor physical performance, sarcopenia, and all-cause mortality. Social isolation has been also linked with decreased physical function and mortality. Limited studies examined whether social isolation is a risk factor for grip strength decline among older adults and whether race differences exist in this association using population-based longitudinal data. The aim of this study was to evaluate the relationship between social isolation and grip strength among older adults and whether the relationship varies by race and over time. We analyzed National Health and Aging Trends Study (NHATS) data (2015 - 2018) and the sample included 4877 adults > 65 years old. Grip strength was measured using a digital hand dynamometer. Social isolation was measured using six NHATS items from the literature and the composite score ranged from 0 to 6, with a higher score indicating more isolation. The sample mean age was 75 (SD = 22; 68 - 110 years). Repeated-measures analysis of variance showed significant differences in grip strength across social isolation scores (p = .001) indicating that socially isolated older adults have significantly lower grip strength. We also found that grip strength significantly decreased by 2.046 kg over the four-year period (p = < .001). The findings showed no significant difference in grip strength across race and change in grip strength across time did not differ by race and social isolation. Interventions to improve muscle strength and reduce social isolation among older adults are needed.
COGNITIVE TRAJECTORIES IN MIDDLE-AGED AMERICANS, 1995–2018
Authors: Brown Rebecca , Zuo Xi , McMillan Corey , Stites Shana , Elo Irma , Langa Kenneth , Karlawish Jason , Xie Dawei
Published: December 2023

Given evidence that Alzheimer’s disease and related dementias (ADRD) develop over decades, middle age is increasingly recognized as a key life course period to target modifiable risk factors for cognitive decline and ADRD. Epidemiological trends show that the prevalence of chronic conditions that are risk factors for ADRD has increased in middle-aged adults over the past several decades, but it is unknown if cognitive trajectories have worsened in middle-aged people over this time period. We conducted a retrospective cohort study using data from 19,660 adults ages 50-64 enrolled from 1995-2018 in the longitudinal nationally representative Health and Retirement Study, followed through 2018. We fit group trajectory models to describe changes in cognition over time based on Telephone Interview for Cognitive Status scores and used mixed effects models to investigate change in slope adjusted for key risk factors (age, gender, race/ethnicity, education, net worth, chronic medical conditions, body mass index, age cohort). We identified four distinct groups of participants with differing start points in their cognitive trajectories. In adjusted analyses, trajectories of cognitive decline were steeper among racial/ethnic minorities, persons with lower education, lower net worth, history of stroke, and earlier age cohort. The effect of age cohort on the rate of decline was similar across racial/ethnic groups but differed across education and net worth groups. These findings suggest that cognitive trajectories among middle-aged adults have improved since the mid-1990s. However, disparities in cognitive trajectories persist among racial/ethnic minorities and those with lower education and net worth.
DETERMINING THE ASSOCIATION BETWEEN THE 24 HOUR COMPOSITION OF WAKING BEHAVIORS AND SLEEP WITH RECURRENT FALLS
Authors: Roe Lauren , Strotmeyer Elsa , Cawthon Peggy , Glynn Nancy , Ensrud Kristine , Stone Katie , Gabriel Kelley Pettee , Cauley Jane
Published: December 2023

Physical activity (PA), sleep, and sedentary behavior are individually associated with falls, but analyses examining one activity omit information about all other activities. We examined the combination of PA, sedentary behavior, and sleep on recurrent fall risk (2+ falls/year in any year) in older men using compositional data analysis. Data were from 2,705 men aged 79.0±5.1 years in the Osteoporotic Fractures in Men Study (MrOS). Twenty-four-hour accelerometer-measured time sedentary (< 1.5 METs), physically active (PA; >1.5 METs), and sleeping were used to calculate isometric logratios (ILR). ILRs were predictors in logistic regression models estimating the proportion of time in one activity relative to time in all other activities simultaneously, associated with recurrent falls. A total of 1,025 (37.9%) men experienced recurrent falls after four years of follow-up. In minimally adjusted models (age, race, clinic site, season of accelerometer wear), more PA relative to sedentary behaviors and sleep equated to lower odds of recurrent falls (OR: 0.70, 95%CI: 0.60, 0.79). More sedentary behavior relative to PA and sleep resulted in higher odds of recurrent falls (OR: 1.54, 95%CI: 1.14, 2.09). Associations were substantially attenuated after adjustment for height, weight, diabetes, health and smoking status, comorbidities, and instrumental activities of daily living impairments (MVPA vs. sedentary and sleep – OR: 0.88, 95%CI: 0.75, 1.02; sedentary vs. PA and sleep – OR: 1.33, 95%CI: 0.97, 1.82) and not significant. More PA and less sedentary behavior relative to other behaviors were associated with recurrent falls, with associations explained by poor health and comorbidities.
ASSESSMENT OF THE LINK BETWEEN FRAILTY AND DEMENTIA IN THE OLDEST-OLDS USING JOINT MODELS
Authors: Massa Franklin , Marroig Alejandra , Muniz-Terrera Graciela , Johansson Boo
Published: December 2023

Frailty and dementia affect many older adults worldwide. As the world’s population ages, the number of people experiencing frailty and dementia is increasing, posing significant challenges for individuals, health care systems and caregivers. Here, we aim to assess the link between the evolution of frailty and the time to dementia diagnosis in the oldest-old. We derived the frailty index (FI) using data from 5 waves of the OCTO-Twin Study: Origins of Variance in the old-old, and fitted joint longitudinal-survival models to repeat measures of the index and time to dementia diagnosis to understand the association between the trajectory of the FI and time to diagnosis. We accounted for possible effects of sex, education and the presence of the APOE e4 gene. A nonlinear trajectory of the frailty index (p < 0.001) and an effect of education attenuating the levels of the frailty index (p = 0.032) were observed. Additionally, the results agree with the literature regarding the effect of the APOE e4 as a greater risk for dementia (HR = 2.034, p < 0.001). Moreover, an increasing frailty trajectory is associated with an earlier time to diagnosis of dementia (HR = 1.096, p < 0.001). Our findings advance our understanding of the relation between frailty and dementia in the oldest old. Our approach accounts for the non-linearity of the trajectory of frailty and deliver a dynamic tool that updates dementia prognosis when a new measurement of frailty is available.
EVALUATING A TRANSITIONAL CARE PROGRAM FOR OLDER ADULTS WITH FRAILTY BETWEEN HOSPITAL AND HOME
Authors: Lee Ji Yeon , Cho Eunhee , Kim Sue , Kim Gwang Suk , Lee Kyung Hee , Kim Chang Oh
Published: December 2023

Older adults with frailty experience numerous health problems even after hospital discharge, highlighting the necessity of continued intervention until their recovery and return to daily routines. This mixed methods research (i.e., quantitative and qualitative studies) aimed to evaluate the effectiveness of a transitional care program developed for older adults with frailty during the transition from hospital to home and how it was helpful. From June to December 2021, 32 older adults with frailty were enrolled in a randomized controlled trial at a university-affiliated hospital in Korea. They were allocated to either an intervention group (n=16) or a control group (n=16) according to a random number sequence. The intervention group received a 12-week transitional care program that included inpatient care, structured discharge, and follow-up interventions (e.g., home visits and phone follow-ups); the control group received usual care only. At 12 weeks, program participants (eight frail older adults and eight family caregivers) had interviews for the qualitative research. The results showed that the intervention group had a higher score in knowledge readiness (p=.046) at discharge, empowerment (p=.032), and connectedness at four weeks (p=.037); community resource utilization (p <.001) and emergency room visit rate (p=.049) at 12 weeks; and improvement in depression (p <.001), family interaction (p=.045), and subjective health status (p=.002) over time. Participants described the program as a supportive, connected, timely, and personalized intervention. Overall, the study demonstrated that the transitional care program effectively improved the health outcomes of older adults with frailty and facilitated a safe transition between hospital and home.
EXAMINING FRAILTY SUBDOMAINS (PHYSICAL, PSYCHOLOGICAL, COGNITIVE, SOCIAL) IN COMMUNITY-LIVING ADULTS 45–85
Authors: Griffith Lauren , Muniz-Terrera Graciela , van den Heuvel Edwin , Khattar Jayati , Hogan David , O’Connell Megan , Levasseur Melanie , Raina Parminder
Published: December 2023

Frailty prevalence estimates vary considerably (4.0% to 59.1% in one review). Understanding these differences and what drives frailty among individuals could lead to more focused interventions. Breaking frailty into subdomains and exploring their relationships is one approach to this. A 127-item overall Frailty Index (FI) based on data collected on Canadian Longitudinal Study on Aging (CLSA) Comprehensive Cohort participants (n = 30,097 community-living adults aged 45-85 at baseline) was used to create physical, psychological, cognitive, and social subdomain-specific FIs. Each FI was divided into quintiles with the highest 20% (Q5) considered the frailest. We assessed subdomain FI quintile concordance (Goodman and Kruskal’s gamma), described the joint distribution of those most frail (Q5), and estimated the association between sex and age with Q5 subdomain FIs membership (logistic regression). The concordance among FI subdomain quartiles was low. The highest gammas (0.25-0.36) were between the physical/psychological and psychological/cognition subdomains. Concordance was generally higher in females who had higher odds of Q5 membership for overall (1.5), physical (1.7), psychological (1.6) and social frailty (1.1), and lower odds for cognitive frailty (0.7). The odds of Q5 membership increased with age for overall frailty and all subdomains except psychological frailty, which decreased with age. Our results suggest low concordance among frailty subdomains and the relationship between Q5 membership with sex and age differed by subdomain. These data may help to better target frailty interventions, but longitudinal data are needed to explore both the time course and interrelationships across subdomains.
FACTORS RELATED TO THE FRAILTY OF OLDER PEOPLE WITH STROKE IN TEHRAN
Authors: Kakhki Ali Darvishpoor , Aghaali Elham
Published: December 2023

Older people are the fastest growing segment of the population particularly in developing countries such as Iran. Older people encounter not only decreasing physical function but also diseases such as stroke which can lead to their frailty. This study was conducted to describe factors related to frailty of older people with stroke in Tehran. This descriptive, correlational study was conducted on a sample of 170 older people with stroke above age 60 in ten educational hospitals in 2020. A socio-demographic questionnaire, the Zarit Scale of Caregiver Burden, and the Frailty Index for Elders were used for data collection. Content validity and Cronbach’s alpha were used for evaluating the validity and reliability of questionnaires. Data were analyzed with SPSS 25. 55.9% of participants were female and 54.1% lived with their spouse; mean age was 77.18 (± 8.57). 92.4% were at risk for severe frailty, and 7.6% were at risk of frailty. The scores of frailty were associated significantly with increasing family caregiver burden and hospital admission rates, not having treatment insurance, and not having a reliable income source. The best predictors of frailty were family caregiver burden, hospital admission rates, and treatment insurance. The study showed that frailty is very common in older people with stroke and is related to a number of factors. Reducing family caregiver burden and admission rates to hospital, and having treatment insurance, will help prevent or reduce frailty in older people with stroke.
GERIATRIC MEASURES OF PHYSICAL FUNCTION HAVE THEIR ROOTS IN EARLY CHILDHOOD BRAIN HEALTH
Authors: Xie J Kathy , Winslow Lauren , Caspi Avshalom , Moffitt Terrie
Published: December 2023

Midlife is a pivotal period in the life course in terms of investing resources to mitigate challenges that can come in older age. It is important to understand the relationship between childhood and midlife health, as it could have predictive properties for aging. We investigated the association between early childhood brain health and midlife physical function in the Dunedin Study, a longitudinal birth cohort (n=1,037). Brain health was measured when Study members were age 3 using a neurological examination, tests of cognitive functioning, and temperament rating. Physical function was measured at age 45 using gait speed, step-in-place, chair stands, balance, and grip strength tests. Children with worse brain health had significantly worse physical function as adults (β, 0.23; 95% CI, 0.16 to 0.30; P < .001), after controlling for sex and childhood socioeconomic status. This relationship supports a link between cognitive and physical function in the aging and development process, the reconceptualization of aging and development on the same ontological path, and the utility of physical function tests – which can be used in many clinical settings – as reflections of lifelong, integrated health in addition to indicators of musculoskeletal integrity in older adults.
THE RELATIONSHIP OF SELF-MONITORING OF LIFESTYLES WITH PHYSICAL FUNCTION AND METABOLITES IN DIABETIC OLDER ADULTS
Authors: Du Yan , Song Lixin , Gonzales Mitzi , Espinoza Sara , Jaen Carlos , Wang Jing , Sharma Kumar
Published: December 2023

Type 2 diabetes (T2D) is a major risk factor for functional decline in older adults. Mobile/wearable devices are evidenced to improve lifestyles for diabetes management and improve functionality. This study assessed the associations of technology tracked lifestyle and self-monitoring behaviors with glycemic control, physical function and mitochondrial function related metabolites in older adults with T2D. Fitbit fitness trackers were used to track physical activity and food intake over 12-week in 15 older adults with T2D (age=70.5±4.8). Physical function was assessed by Short Physical Performance Battery (SPPB) and grip strength. First void urine was used to assess metabolites. The associations of percentage of days with tracked steps (PDWTS), percentage of days with food log (PDWFL), and 7-day mean steps with HbA1c, SPPB, grip strength and metabolites were examined using Pearson Correlation analysis. At week 12, PDWTS was negatively associated with 3-Hydroxyisovaleric acid and Hydroxyhippuric acid (P< 0.05). PDWFL was negatively associated with HbA1c, Hydroxyisovaleric acid, Hydroxyhippuric acid, and Hydroxybutyric acid (p< 0.05); SPPB was not related to any self-monitoring and lifestyle behaviors, but was negatively related to Hydroxyisovaleric acid, Glycolic acid and Hydroxyisobutyric acid (p< 0.05). In older adults with T2D, self-monitoring might improve glycemic control. Self-monitoring and SPPB were related to several urine metabolites, but the underlying mechanisms is unclear in this study with small sample size. Future research with sufficient power is needed to investigate the underlying mechanisms of self-monitoring and lifestyle behaviors on these metabolites, and how these metabolites might be applied to improve physical function in older adults with T2D.
CO-PRESCRIPTION OF OPIOIDS AND BENZODIAZEPINES AND 30 DAY HOSPITAL RETURNS IN OLDER ADULTS
Authors: Park JuYoung , Engstrom Gabriella , Ouslander Joseph
Published: December 2023

With the current opioid epidemic, greater attention has been focused on polypharmacy, in particular use of benzodiazepine (BZD). This study compared prescription of opioids or BZD, co-prescription of both, and prescription of neither at discharge with returns to the hospital within 30 days of discharge of older patients (75+ years). This is a secondary analysis of a quality improvement database developed during implementation of a care transition intervention for hospitalized patients age 75+. The database includes all non-ICU admissions over a 2-year period (24,784 admission cases). Returns to the hospital included Emergency Department visits, inpatient hospital stays, and observation admissions. Among the 24,262 discharges that had medication data, 1,594 (6.6%) were prescribed opioids only, 3,594 (15.0%) BZD only, 544 (2 %) opioids and BZD together, and 18,530 (76.4%) neither opioid or BZD. Each of the four prescription groups had a > 20% return rate within 30 days of discharge: 22.1% opioids only, 23.8% BZDs only, 23.7% opioids and BZDs, and 20.2% neither. Opioids were not associated with a significantly higher incidence of hospital returns. The data highlight the importance of educating healthcare providers about appropriate use of BZD and opioids in hospitalized and post-discharge older patients. Individualized care by interdisciplinary team members and support for family caregivers, as well as careful use of opioids for pain that cannot be managed by other modalities, may reduce hospital return rates and their associated morbidity and costs in the older population.
THE INTERSECTION OF INSOMNIA AND CENTRALIZED PAIN IN OLDER ADULTS
Authors: Smith Michael , Dean Meagan , Irwin Madison
Published: December 2023

The intersection of insomnia and pain with age has been broadly studied but has not been evaluated specifically in centralized pain. The objective of this study was to estimate the effect of age on rates of centralized pain and insomnia in older adults. This was a single center, retrospective, observational cohort study consisting of older adults (≥55 years old) with a diagnosis of centralized pain, insomnia, or both seen at University of Michigan Health from January 1, 2016 – January 1, 2022. The primary outcome was the proportion of older adults with both insomnia and centralized pain, defined as least one centralized pain diagnosis coded in the subject’s electronic health record within one year of insomnia diagnosis. A total of 26,804 patients were included in the analysis. Mean age was 66.84 years (SD 8.79); 66% of patients (n=17,687) were female. Overall, 92.1% of patients (n=24,683) carried ≥1 centralized pain diagnosis, 5.6% of patients (n=1,505) carried a diagnosis of insomnia, and 2.3% (n=616) had both [95% CI 2.1,2.5]. Of older adults with insomnia, 29% (95% CI 27, 31) also carried a centralized pain diagnosis. Of older adults with centralized pain, 2.4% (95% CI 2.3, 2.6) also carried an insomnia diagnosis. Compared to older adults with insomnia alone, those with both insomnia and centralized pain were more likely to be female (p=< 0.001) and older (p=0.014). Insomnia and centralized pain are highly prevalent in older adults and co-occur frequently in those with insomnia. Older adults with insomnia should be screened for centralized pain.
ACCEPTABILITY OF PODCASTS TO ENHANCE WELLNESS SKILLS AMONG OLDER ADULTS IN AN UNDERSERVED COMMUNITY
Authors: Janevic Mary , Lindsay Rebecca , Brewer Robin , Hill-Ashford Yolanda , Guzman Rebeca , Robinson-Lane Sheria , Hassett Afton , Murphy Susan
Published: December 2023

Podcasts convey information in an accessible, engaging, and memorable way, yet are seldom incorporated into behavioral interventions for older adults. We developed a podcast series as a component of the RESET intervention (Re-Engaging in Self-care, Enjoying Today), the subject of an ongoing NIH-funded randomized controlled trial in Detroit, Michigan. In RESET, community health workers teach self-management and resilience-building skills to small groups of primarily African American older adults, to address challenges to well-being and functioning caused by the COVID-19 pandemic. Participants listen to six podcast episodes, accessible by website, app, or IVR/dial-in, which feature an older-adult host from the community interviewing other community members and topic experts. Each episode is then discussed in the corresponding intervention session. The goal of the current study was to evaluate the first three podcast episodes (Power of Positivity, Eating for Well-being, and Stability in Strength) in a convenience sample of 8 older adults and agency staff from our trial’s Community Advisory Board. Using 5-point Likert scales, all respondents strongly agreed or agreed that the episodes were enjoyable, relevant, and effectively taught key wellness skills. Podcast strengths identified by respondents included: warm interactions between host and guests, motivational tone, and compelling personal stories. Areas for improvement included the need to represent additional perspectives. These data suggest that podcasts are an acceptable way to provide health information to older adults. The ongoing RESET trial will allow us to determine the extent to which podcasts can help bring about behavior change and functional improvement.
EARLY DEVELOPMENT OF BIO-EXPERIENTIAL TECHNOLOGY TO SUPPORT PERSONS WITH DEMENTIA AND CARE PARTNERS AT HOME
Authors: Rochon Elizabeth , Sy Maimouna , Phillips Mirelle , Anderson Erik , Plys Evan , Ritchie Christine , Vranceanu Ana-Maria
Published: December 2023

Bio-experiential approaches offer an interactive, multisensory, immersive environmental experience using technology and physical design to promote mind-body wellness. These designs have the potential to provide an in-home solution to help persons living with dementia and their care-partners manage challenges including agitation, conflict, stress, and difficult emotions (e.g., grief). This presentation discusses a partnership between an interdisciplinary academic team and a creative design and technology studio that has pioneered bio-experiential designs. This partnership’s mission is to develop a free interactive, immersive bio-experiential platform that offers a positive and engaging experience for both persons living with dementia and their care-partner(s). Our team iteratively developed an initial prototype using multiple strategies rooted in user-centered design, including a literature review, design thinking workshop with the full team, and two focus groups with clinicians (N=10; neurologists, geriatric psychiatrists, geriatricians, neuropsychologists, social workers, occupational therapists). Early development emphasized safety to minimize risk of increased agitation or other neuropsychiatric symptoms (e.g., hallucinations, sleep impairments). Key recommendations to enhance safety and usability included simple calming visuals and sounds, personalized experiences, familiar stimuli, and multisensory engagement (e.g., music, tactile stimuli). Increasing accessibility was also discussed related to ease of use and availability of platforms (e.g., laptop, television). We are now preparing for “live” iterative usability testing of our prototype (i.e., beta testing) with a diverse group of persons living with dementia and care-partner(s) before efficacy testing. The larger goal is implementation and wide dissemination as well as adaptations for other neurodegenerative conditions. *Dr. Vranceanu and Ritchie are co-senior authors.