bluuebunny/crossref_metadata_2025 huggingface dataset:
OXR1 STABILIZES THE RETROMER TO EXTEND LIFESPAN AND NEURONAL HEALTH BY DIETARY RESTRICTION
Authors: Wilson Kenneth , Bar Sudipta , Dammer Eric , Schilling Birgit , Seyfried Nicholas , Bellen Hugo , Ellerby Lisa , Kapahi Pankaj
Published: December 2022

Dietary restriction (DR) delays aging and neurodegeneration, but the mechanisms behind this remain unclear. We reared over 150 fully sequenced fly strains from the Drosophila Genetic Reference Panel under ad libitum feeding or diet-restricted conditions and measured lifespan as well as healthspan to identify new targets for DR-mediated longevity. Through genome-wide association study, we identified genetic variants associated with influencing these traits under each dietary condition. A variant in mustard (mtd, called Oxidation resistance 1, OXR1, in humans), significantly associated with DR-specific lifespan. We demonstrate that mtd/OXR1 in neurons is necessary for DR-mediated lifespan extension. Neuronal knockdown of mtd also accelerates sensory decline, arguing for a specific role of mtd/OXR1 in neuroprotection. We show that mtd is essential for stabilizing the retromer complex, which is necessary for trafficking transmembrane proteins and lipids for reuse. As a result of OXR1 deficiency, the retromer destabilizes and lysosomes become overused. Overexpression of retromer proteins or supplementation with chaperone compound R55 rescues the lifespan defects and neurodegeneration seen in mtd-deficient flies, and R55 is capable of rescuing lysosomal aggregation and OXR1-retromer co-localization in cells from humans with OXR1 deficiency. We further show through multi-omic analyses in flies and humans that mtd/OXR1 associates with accelerated transcriptomic aging and proteins involved in neurodegenerative diseases, including Alzheimer's disease (AD). Overexpression of OXR1 and retromer proteins rescued AD-associated phenotypes in a fly model of AD. Thus, mtd/OXR1 enhances protein recycling in response to DR through the retromer, improving neuronal health and lifespan through mechanisms conserved across species.
REGENERATION OF AGING LUNG TISSUE: A NOVEL WAY OF REOPENING THE PLASTICITY WINDOW OF POSTNATAL ALVEOLAR TYPE II CELLS
Authors: Hausman Hannah , Golding Hannah , Sawhney Amitoj , Brownfield Douglas
Published: December 2022

Prevalence of chronic lung diseases, such as pulmonary fibrosis and chronic obstructive pulmonary disease, have been found to increase with age. Pulmonary disease can occur from failure to maintain alveolar type (AT) 1 and alveolar type 2 cells located in the epithelium of the lung. It is currently known that AT2 cells are the facultative stem cells of the lung, and can transform into AT1 cells which make up the structure of the alveoli. This process happens throughout embryonic development, but AT2 cells can also replenish AT1 cell populations post lung injury. This research investigates whether this process that normally occurs during development can also occur in mature AT2 cells, and studies this question using genetically engineered mouse models at a postnatal stage. Using a double inhibition mechanism, we attempted to increase cellular proliferation by administering an agonist and conducted cellular lineage tracing with an SpcCreER lox system via tamoxifen-induced GFP expression. Through lineage labeling, we saw AT1 cells arising from AT2 cells that became plastic, mirroring the plasticity observed in development. Further research is needed to determine if this agonist can be used to epigenetically unlock mature AT2 cells. This result would provide a mechanism to temporarily induce plasticity in a patient’s own AT2 cells in an attempt to regenerate their lungs in disease.
USABILITY AND ACCEPTABILITY OF A PEER-DELIVERED TECHNOLOGY BASED MENTAL HEALTH INTERVENTION FOR FAMILY CAREGIVERS
Authors: Collins-Pisano Caroline , Leggett Amanda , Fortuna Karen
Published: December 2022

Family caregivers of people with dementia are critical to the quality of life of care recipients and the sustainability of healthcare systems but face increased risk of emotional distress and negative health outcomes. The purpose of this study was to examine the usability, acceptability, and preliminary effectiveness of a technology-based and caregiver-delivered peer support program, “Caregiver Remote Education and Support” (CARES) smartphone application and to identify barriers and facilitators to the ethical use of former caregivers as technology-based interventionists. Nine family caregivers of people with dementia received the CARES intervention and three former family caregivers of people with dementia were trained to deliver the CARES system. Quantitative data were collected at baseline and at the end of the two-week field usability study. Qualitative data were also collected at the end of the two-week field usability study. The pilot study demonstrated that a two-week, peer- delivered and technology supported mental health intervention designed to improve burden, stress, and strain levels was experienced by former and current family caregivers as usable, acceptable, and ethical. CARES was associated with non-statistically significant improvements in burden, stress, and strain levels. This pre/post field usability study demonstrated it is possible to train former family caregivers of people with dementia to use technology to deliver a mental health intervention to current caregivers. Future studies would benefit from a longer trial, a larger sample size, a randomized controlled design, and a control of covariables such as stages of dementia, years providing care, and the severity of dementia symptoms.
BRAIN ACTIVITY DURING DUAL-TASK STANDING IN OLDER ADULTS WITH MILD COGNITIVE IMPAIRMENT
Authors: Kahya Melike , Gouskova Natalia , Lo On-Yee , Zhou Junhong , Cappon Davide , Pascual-Leone Alvaro , Lipsitz Lewis , Manor Brad
Published: December 2022

Performance of a cognitive task while standing disrupts balance in older adults. This disruption is exaggerated in those with mild cognitive impairment (MCI). Moreover, older adults with MCI who exhibit greater dual-task ‘cost’ are more likely to develop falls and dementia. EEG studies suggest that cognitive-motor dual-tasking is associated with brain activity fluctuations originating from central brain regions at specific frequencies, particularly in the alpha-band (8–13 Hz). We hypothesized that older adults with MCI would demonstrate decreased EEG alpha power during dual-task standing compared to healthy controls, and that decreased alpha power would be associated with elevated dual-task cost. We recorded postural sway and EEG in 14 participants with MCI [Montreal Cognitive Assessment (MoCA) < 25] and 16 healthy older adults [MoCA>25] as they completed trials of standing with and without serial subtractions. Postural sway metrics were derived, and from EEG we calculated absolute alpha-, theta-, and beta-band powers within a-priori defined regions-of-interest: the left and right anterior, central, and posterior regions. Repeated Measures ANOVA demonstrated that participants with MCI exhibited decreased alpha power in the central regions during dual-task standing compared to healthy controls (p= 0.01). No significant difference was observed for theta and beta-band powers between participants with MCI and healthy controls. In those with MCI, lower alpha power during dual-task standing correlated with increased dual-task cost to postural sway path (worse balance) (r=-0.4, p=0.03). These results provide preliminary evidence that specific patterns of brain activity during dual-tasking are disrupted in MCI and this is associated with elevated dual-task costs.
UNMET TRANSITIONAL CARE NEEDS OF OLDER ADULTS DISCHARGED FROM HOME HEALTH CARE: A QUALITATIVE NEEDS ASSESSMENT
Authors: Bankole Ayomide , Girdwood Tyra , Leeman Jennifer , Womack Jennifer , Toles Mark
Published: December 2022

Transitional care is widely recognized as a set of time-limited services to support older adults during transfers between settings and providers of care; however, little is known about services that prepare older adults and their caregivers for transitions from Home Health Care (HHC) to independent self-care at home. The objective of this study was to describe HHC patients and clinician perceptions of unmet needs after HHC discharge and recommendations to address them in future research. A multiple case-study design was used in a single large HHC organization in North Carolina. Data were collected using chart reviews of HHC records and semi-structured interviews with paired patients (or caregivers as proxy) and HHC clinicians (Nf17 pairs). A transitional care intervention model was used as a conceptual framework to guide framework analysis of interview transcripts. Most patients were White (65%) and female (53%) with mean age of 83 years. Clinicians were Registered nurses and Physical therapists. Across cases, 17 patient and clinicians pairs described three unmet needs: (1)skills for symptom management; (2)community-based support for transportation, food, social engagement, and health services; (3)in-home support to assist with safety, and activities of daily living. HHC patients recommended new services while clinicians emphasized the need for resources to improve their capacity to prepare patients for discharge. These findings will inform an innovative adaptation of transitional care and other supports to prepare older adults and caregivers for transitions from HHC to independent self-care at home. Future research should explore adding transitional care services to address these needs.
CAN MONITORING OLDER ADULTS’ TECHNOLOGY USE PATTERNS HELP DETECT COGNITIVE DECLINE?
Authors: Cotten Shelia , Anarsky Reza Ghaiumy , Schuster Amy
Published: December 2022

Approximately six million U.S. older adults are diagnosed with Alzheimer’s Disease (AD), and this number is expected to more than double by mid-century. Monitoring older adults’ cognitive functioning is essential for the early detection of cognitive diseases, such as AD, which can increase treatment efficacy and slow AD’s progression. Cognitive functioning tests, however, have limitations as administrating them can be costly and time-consuming. This study aimed to determine whether technology use patterns could be used as an indicator of cognitive functioning. We utilized six waves (from 2015 to 2020) of data from the National Health and Aging Trends Study to assess whether stopping the use of different types of technology (using the Internet, computers or tablets, or sending texts and emails) are associated with cognitive functioning (memory, orientation, and executive functioning). We controlled for age, gender, marital status, race, education, activities of daily living, and overall health. Our analyses showed that stopping the use of going online, computers, tablets, and sending texts and emails were related to cognitive decline. These results suggest that practitioners should incorporate assessments of their patient’s online activity and use as it may be an innovative approach that is economical and efficient to identify individuals at risk of cognitive decline.
UNDERSTANDING MOTIVATIONS FOR PARTICIPATING IN EVIDENCE-BASED FALL PREVENTION PROGRAMS ON ZOOM
Authors: Rapoport Andy , Danilovich Margaret
Published: December 2022

The pivot to remote delivery of NCOA evidence-based programs has increased participant reach due to eliminating geographic or transportation barriers. Despite the convenience of participation in one’s own home, challenges for helping patients adhere to behavior change remain. This paper will present data from one community-based organization’s NCOA evidence-based falls prevention program implementation of Bingocize, Tai Chi, Otago, and SAIL on Zoom. Across all programs, only 36% of people who registered for workshops attended the first session. Participants, on average, only attended 27% of the sessions in a given workshop. To explore the barriers and facilitators to attendance in order to encourage patients to change health behavior, we used a mixed-methods approach to evaluate reasons for suboptimal adherence among n=735 participants across the 4 programs. We performed sub-group analysis to examine barriers and facilitators by the self-reported attendance rate. We conducted semi-structured interviews with n=14 participants, focusing on those who had less than 50% attendance for the workshop they registered for, and also received n=234 survey responses. For participants who attended >50% of workshop sessions, class enjoyment was the most cited facilitator of attendance. However, for those who attended < 50% of workshop sessions, email reminders were the most cited attendance facilitator. Results from this project provide critical information about specific barriers that different sub-groups of older adults face regarding participation in NCOA evidence-based programs to develop strategies to help motivate patients for health behavior change.
THE IMPACTS OF LIFESTYLE ON DEPRESSION AND LIFE SATISFACTION AMONG CHINESE OLDER ADULTS: A 7-YEAR FOLLOW-UP STUDY
Authors: Peng Man-Man
Published: December 2022

This study aims to explore the long-term effects of lifestyle-related factors and physical health on life satisfaction among older adults by transitions in mental health conditions. Using data derived from the China Health and Retirement Longitudinal Study (CHARLS), the analytic sample included 643 older adults. Linear regression analyses were used to examine the cross-sectional and longitudinal associations of lifestyle-related factors and physical health with depression risk and life satisfaction in older adults. In this study, sleep duration and multimorbidity was found to be significantly related to baseline and follow-up depressive symptoms in older adults. Compared to non-drinkers, current drinkers reported more severe depressive symptoms. More depressive symptoms were associated with worse impairment in physical function or Activities of Daily Living (IADLs). Among older adults remaining no depressive symptoms at baseline and follow-up, current drinkers tended to have lower life satisfaction than non-drinker. Shorter sleep duration showed a longitudinal correlation with lower life satisfaction. In the subgroups of emerging depression, past drinkers tended to have lower life satisfaction than non-drinkers, and baseline multimorbidity significantly predicted lower subsequent life satisfaction. In conclusion, our findings identified drinking and shorter sleep duration as the lifestyle-related detrimental factors of late-life depression and life satisfaction in Chinese community-dwelling older adults. Other physical-health-related risk factors of depression included worse impairment in physical function or IADLs, and multimorbidity. Our findings have implications for future psychosocial interventions targeted at alleviating depressive symptoms and promoting life satisfaction of the older adults based on their long-term mental and physical health conditions.
A THEORETICAL EXAMINATION INTO THE CONNECTIONS BETWEEN LINKED LIVES AND LATER LIFE DISABILITIES
Authors: Gyimah Akwasi Adjei , Van Vleet Samuel
Published: December 2022

As people age, they find themselves living similar lives to those around them. This concept is often referred to as linked lives. Linked lives explains that individual lives are often interdependent. This is due to various elements such as social and historical influences. These influences can imprint networks of shared relationships. Researchers have found that the first point of socialization as humans are social relationships with family and friends. However, while the connections of linked lives are often attributed to early life course trajectories, little research has evaluated the interdependency that is created with disabilities in later life. Life course disability research is a key factor of gerontology because a majority of older adults encounter disabilities within later life. This attributed disability can often forge bound and interdependence within people and their own social networks. This paper theoretically examines different perspectives of disabilities research and how it relates to the fundamental principles of linked lives. This paper highlights the gap in the current gerontological understanding of the later life links among older adults with disabilities. This theory paper provides the needed information for gerontologist focusing on older people with disabilities to be able to evaluate allocations needed for providing adequate social support and services tailored towards the needs of these interdependent lives.
COMPARING SUCCESSFUL AGING OF NEAR-CENTENARIANS AND CENTENARIANS: FINDINGS FROM 2011 AND 2021/22
Authors: Shum Eric Ngai Yin , Lau Bobo Hi Po , Cheung Karen Siu Lan , Chan Grace Man Yee , Kwan Joseph Shiu Kwong , Luk James Ka Hay , Martin Peter , Chan Cecilia Lai Wan
Published: December 2022

Successful aging (SA) was proposed by Robert J Havighurst in 1961 to capture how older adults add “lives onto (their) years.” While there is a consensus regarding the multidimensionality of the concept, the set of criteria that should be applied to older adults of advanced age remain controversial. Notwithstanding their inevitable decline in physical health, adults of advanced age may still enjoy good psychosocial well-being. In this light, we compared the proportion of “successful agers” in two cohorts of adults aged 95 or above who lived with their families in 2011 (Nf77) and 2021/22 (Nf120) in Hong Kong using two models – Model A: i: Good subjective health, ii: more well-off than average, iii: as happy as young (Cho et al., 2012) and Model B: i: Weekly social activities, ii: absence of dementia, iii: intact sight and hearing ability, iv: intact mobility (Nosraty et al, 2012). Both models have been applied in adults aged 90 or above. In the 2011 cohort, 13.0% and 16.9% of our sample fulfilled the SA criteria of Model A & B respectively. The percentages fell to 1.7% and 13.7% respectively in the 2021/22 cohort. The decrease is due to less participants fulfilling the financial criterion of Model A, as well as the criteria on intact sight and hearing ability and the absence of dementia of Model B. COVID presents multidimensional challenges for adults of advanced age. Examining the dimensions that are most impacted will help orient recovery works along the direction of SA.
A CLINICAL TRIAL USING METHYLATION AGE TO EVALUATE CURRENT ANTIAGING PRACTICES
Authors: Mitteldorf Josh
Published: December 2022

Recent advances in the technology of ‘‘aging clocks’’ based on DNA methylation suggest that it may be possible to measure changes in the rate of human aging over periods as short as a year or two. To the extent that methylation (and other biomarkers) are valid surrogates for biological age, the testing of antiaging interventions has thus become radically cheaper, faster, and more practical. Together with colleagues at McGill University, I have initiated a clinical trial to evaluate some of the most popular antiaging strategies currently deployed by ‘‘early adopters’’ in the lay community of personal health activists. We are recruiting 5000 subjects, age 45–65, and interviewing them in detail about their diet, drugs and supplements, exercise, social, and other practices that plausibly contribute to modulate the rate of aging. They agree to submit saliva samples for analysis of methylation age at the beginning and end of a 2-year test period. Primary endpoint is the difference in methylation age over the course of 2 years. Results will be viewed as an exploratory study to identify synergistic combinations of age-retarding treatments. All data (redacted for privacy) will be open sourced, available to the scientific community and to the public.
PLASMA HIGH DENSITY LIPOPROTEIN CHOLESTEROL AND RISK OF FRACTURES IN OLDER ADULTS
Authors: Hussain Sultana Monira , Ebeling Peter , Barker Anna , Beilin Lawrence , Tonkin Andrew , McNeil John
Published: December 2022

The ASPirin in Reducing Events in the Elderly trial participants (ASPREE, aged >70-years Australians), for whom high-density lipoprotein cholesterol (HDL-C) levels were measured were included. Fractures included were confirmed by medical imaging and included both traumatic and pathological fractures. Fractures were confirmed by an expert review panel. Cox proportional hazards regression was used to calculate hazard ratio (HR) and 95% confidence interval (CI) for associations with fractures. Of the 16262 participants who had a plasma HDL-C measurement at baseline 1,659 experienced at least one episode of fracture over a median of 3.98 years (interquartile range, 0.02, 7.0 years). In the fully adjusted model, each mmol/L increment in HDL-C was associated with a 34% (HR 1.34, 95% CI 1.20–1.50) higher risk of fractures. The results remained similar when these analyses were stratified by sex. Sensitivity analyses demonstrated that these associations persisted when the analyses were repeated including only: 1) nontraumatic fractures, 2) participants not on osteoporotic medications, 3) participants who were never-smokers and reported that they did not drink alcohol, and 4) participants who walked outside less than 30 minutes and reported no participation in moderate/vigorous physical activity. No association was observed between non-HDL-C and fractures. This prospective observational study suggests that higher levels of HDL-C are associated with higher fracture risk. This association was independent of the common risk factors of fractures.
THE RELATION OF AGE TO OUTCOMES IN THE DIABETES LIFESTYLE CHANGE PROGRAM CONDUCTED BY VIRGINIA COOPERATIVE EXTENSION
Authors: Pourkhalili Azin , Rafie Carlin , Sarshar Arash , Margheim Lynn
Published: December 2022

The National Diabetes Prevention Program established by the Centers for Disease Control and Prevention promotes the implementation of an evidence-based lifestyle change program (LCP) to prevent or delay the onset of diabetes. The LCP is a 12-month program with 26 lessons covering topics on healthy diets, increasing physical activity, managing stress, and coping with triggers, among others. It includes weekly goal setting, food, and physical activity tracking, and group support. The goals of the program are 5–7% sustained weight loss and 150 minutes of physical activity weekly. Little is known about the real-world effectiveness of the LCP in different age groups, particularly in older adults. The aim of this study was to evaluate the effects of age on LCP outcomes (weight loss, average physical activity, program attendance) conducted by Virginia Cooperative Extension from 2017 - 2022. Among 191 participants enrolled in the LCP, 141 (73%) completed eight or more sessions and 56% were above 60 years of age. Results show there was a significant direct relationship (coefficient=0.05, p=0.001) between age and weight loss percentage. Participants older than 60 had significantly (p=0.03) higher average physical activity (215 min per week) compared to those under 60 years old (161 min per week). In addition, participants above 60 had significantly (p=0.03) higher attendance (22 sessions) compared to those under 60 years of age (19 sessions). These findings suggest that targeting different age groups and intervention delivery methods can improve program outcomes.
BUILDING OUR LARGEST DEMENTIA (BOLD) INFRASTRUCTURE FOR ALZHEIMER'S ACT: CENTERS OF EXCELLENCE
Authors: McGuire Lisa
Published: December 2022

While public health experts cannot yet say how to prevent Alzheimer’s disease and related dementias (ADRD), emerging science indicates that ADRD may be slowed through the implementation of risk reduction strategies, early diagnosis, and better education and training of front-line health care professionals. The Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer's Act was introduced into the Senate (S. 2076) on November 6, 2017 and signed into law on December 31, 2018 (P.L. 115-406) amending the Public Health Service Act (Section 398A; 42 U.S.C. 280c-3-4). CDC's Alzheimer's Disease and Healthy Aging Program (AD+HAP) was authorized to implement the activities outlined in BOLD which were designed to create a uniform national public health infrastructure. This presentation will provide an overview of BOLD and the demonstrate how BOLD Program and Public Health Centers of Excellence recipients are working together to build a uniform national public health infrastructure.
AN AGE-FRIENDLY COURSE ADOPTING THE 4M GERIATRIC MODEL IN A PRIMARY CARE NURSE PRACTITIONER PROGRAM
Authors: Empleo-Frazier Ophelia , Marshall Ami , Doyle Margaret , Rink Andrea , Gallant Noelle , Wu Barry , Marottoli Richard
Published: December 2022

Training nurse practitioners to assume an expanded role in management of geriatric patients is key to addressing the care needs of a growing older adult population. To that end, the Yale School of Nursing revised geriatric coursework required of family nurse practitioner (FNP) and adult geriatric nurse practitioners (AGNP) to ensure the curriculum was sufficiently in-depth, engaging, and inclusive. Revisions included a new course, “Advanced Primary Care of the Older Adult” which focuses on the role of the nurse practitioner in the assessment, diagnosis, and management of primary geriatric syndromes. The 4M model (Medications, Mentation, Mobility, and what Matters most) provided the framework. Additionally, faculty added expert speakers, interactive dementia animated videos, book and movie discussions and a geriatric telehealth simulation component. Content was guided by training needs data collected from prior nurse practitioner students. At the end of each course, students were surveyed to assess attitudes towards geriatric care and satisfaction with the course. We compared survey responses pre (academic year 2019–2020, Nf18, response rate=53%) and post (academic years 2020–2021 and 2021–2022, Nf28, response rate=44%) rollout. In multivariate regression analyses adjusted for differences in age, gender, race, program (AGNP and FNP) and previous geriatric experience, we found significant improvement in measures of both confidence in providing geriatric care and satisfaction with course content. Analysis of qualitative data confirmed student satisfaction with the new course. Future work will include expansion and more rigorous evaluation of the program, including measures of student knowledge of best practices and increasing survey participation rates.
YES, AND...ENHANCING DEMENTIA CARE COMPETENCY THROUGH IMPROVISATIONAL THEATRE TECHNIQUES
Authors: Kemp Candace , Morgan Jennifer Craft , Hill Andrea , Pullon Emerald , Burgess Elisabeth , Perkins Molly , Bender Alexis
Published: December 2022

As the number of persons living with dementia escalates globally, innovations in clinical practice are needed to promote care interactions that lead to positive outcomes for care recipients and their care partners, including family, friends, direct care workers, and other care providers. Our ongoing NIH-funded study, focused on meaningful engagement and quality of life, points to the potential benefits of training care partners to use improvisational (improv) theatre skills in the context of dementia care. We present analysis of data derived from two one-year-long waves of qualitative data collection involving persons with dementia (n=59), their formal and informal care partners (n=165), and participant observation (over 12,000 hours) in six diverse assisted living communities. We identified a minority of care partners who, relative to others, had greater success engaging residents and eliciting positive responses. They also experienced less frustration during care encounters. In interactions with persons with dementia, these individuals routinely extended and accepted invitations to communicate and demonstrated an ability to be in the moment and meet people where they were. They accepted uncertainty about interactions and recognized the need to be flexible. These approaches parallel key improv tenets, which are teachable. We argue that improv training for care partners would enhance care competency and led to positive outcomes for care recipients and providers. Findings contribute to a small, but growing innovative body of literature from a variety of disciplines, including health care, that demonstrates the benefits of improv training in a myriad scenarios and settings, including in dementia care.
PREVALENCE, BURDEN, AND LOCATION OF CEREBRAL MICROINFARCTS AND THEIR ASSOCIATION WITH LATE-LIFE BLOOD PRESSURE
Authors: Sin Mo-Kyung , Cheng Yan , Ahmed Ali , Roseman Jeffrey , Zamrini Edward
Published: December 2022

Little is known about the relationship of late-life blood pressure (BP) profiles (level, trend and variability) with the presence, number and regional distribution (cortical vs subcortical) of cerebral microinfarcts. We examined these associations in older adults (age ≥65) using the Adult Changes in Thought (ACT) data. 551 participants (94.6% ≥80 years, 58.6% women, 94.2% white) had complete data on microinfarcts and 4 BP measures. Late-life BP, defined by the four BP values before death (2 year-time gap between measures), was treated using 3 different approaches: (1) categories (based on mean of 4 values); (2) trend (based on the difference between values 1 and 4); and (3) variability (based on standard deviation of the mean of the changes in 4 BP values from 1 to 4). Multivariable-adjusted logistic regression models were used to examine the associations of the late-life BP with microinfarcts, adjusting for relevant covariates. Each of the 5 systolic BP categories between 120 and 169 mmHg (reference: 110–119 mmHg) had significant twice higher odds (4 times for SBP ≥170) of presence and number of microinfarcts, which was only significant for subcortical region. Similar higher odds were observed for systolic BP trend (increase/decrease/no change), which was significant for both cortical and subcortical microinfarcts. Systolic BP variability had no significant association with microinfarcts. Similar associations were observed with diastolic BP. In conclusion, the presence (especially for subcortical regions) and number of microinfarcts were more likely to be in those with higher mean BP and those whose BP changed over the study.
CARDIOVASCULAR DISEASES PREDICT ALZHEIMER’S DISEASE ONSET IN NON-DEPRESSED ADULTS
Authors: Natale Ginny , Clouston Sean
Published: December 2022

We examined the mediating or moderating effect of stroke on the effect of cardiovascular disease (CVD) and the onset of Alzheimer’s disease (AD) in a nationally-representative sample of older Americans with and without clinical depression. Diagnosis of CVD was adjudicated with the established Health and Retirement Study (1992–2016) methodology and included self-reported coronary heart disease, angina, heart failure, myocardial infarction, or other heart conditions. Probable-AD and probable-Stroke were identified inferentially using a validated pattern recognition algorithm. Analyses were stratified by a validated cutoff of the Center for Epidemiologic Studies Depression Scale (CES-D.) Participants (Nf17,154) were observed an average of 8 times over the span of 20 years (Obs=138,510). 12% of all AD cases are preventable by eliminating CVD in older adults in the US, compared to the 31% of all AD cases are preventable by eliminating stroke in the population. In non-depressed adults, risks for accelerated AD onset included: CVD, stroke, age, diabetes, and current smoking. Non-depressed females had delayed AD onset than males. The interaction of CVD x Stroke accelerated AD onset by 1.79 times (95%C.I. =1.63–1.97) in non-depressed adults. CVD was not a significant risk of AD onset in depressed adults. We conclude that 1)reducing the incidence of CVD and strokes in the US would drastically reduce the number of new cases of AD; and 2) stroke compounds the CVD hazards of accelerated AD onset; and 3) clinical depression is a key modulator of the effect of the risk factors of accelerated AD onset.
A QUALITY INITIATIVE TO INCREASE HOSPICE REFERRALS FOR STARS PATIENTS DURING THE SECOND COVID SURGE
Authors: El Shanawany Perihan , Nouryan Chris , Choi Chris , Flynn Ann , Burns Edith
Published: December 2022

Background

CMS uses the Overall Hospital Quality Star Rating program to stratify hospitals based on specific quality criteria (e.g., 30-day readmissions of older adults with pneumonia). “STARS patients” experience more readmissions, longer LOS and often have more complex discharge plans. During the second surge of COVID we implemented a program to increase hospice referrals through early identification and implementation of goals of care (GOC) conversations.

Methods

Electronic Medical Records reviewed for STARS patients from pre- (1/2019-7/2020) and post (3/2021–2/2022) program implementation. Location: 2 community-based hospitals. Data collected: demographics, hospital outcomes, discharge disposition. Data compared with Student’s t tests and Chi square.

Results

459 patients, 177 pre-program and 282 post-program were included. Groups were similar in age (83.0 vs 83.6), LACE score (13.0 vs 12.8), principal diagnoses (PNA: 41.5% vs 46.0%, HF/COPD/AMI: 58.5% vs 54.0%), and mortality (3.5 vs. 4.0%). LOS increased 4.9 days vs. 6.1 days (p < 0.01), readmission rates unchanged: 12.6% vs 13.0% (p=0.90). GOC conversations increased, 48.6% to 75.0% (p < 0.01), DNR from 24% to 44% (p < 0.01), and comfort measures from 0.5% to 5% (p < 0.01). Hospice referrals increased from 0.5% to 11.2% (p < 0.01). Discussion: Early identification of STARS patients increased GOC conversations, DNR, comfort measures and hospice referral. Patients across time periods were similar in age, LACE and admitting diagnoses. LOS increased by a day, likely reflecting time needed to arrange discharge disposition. Increased hospice at end-of-life is associated with better quality care and patient/family satisfaction. This program may be adapted to larger, academic medical centers within the health system.
GLOBAL ELDER ABUSE: A MEGA-MAP OF SYSTEMATIC REVIEWS
Authors: Estenson Lilly , Marnfeldt Kelly , Yon Yongjie , Mikton Christopher , Wilber Kathleen
Published: December 2022

Elder abuse is an increasingly prevalent public health problem that requires a global political and evidence-based response. To make global evidence on elder abuse easier to locate and analyze, we constructed a mega-map – an interactive map that systematically identifies and overviews existing systematic reviews – on elder abuse prevalence, consequences, risk and protective factors, and interventions. Following Campbell Collaboration methodological guidelines, we conducted a comprehensive database and grey literature search of the global elder abuse literature (n=2,776) to identify systematic reviews that examine one or more of these four abuse domains among adults age 60+ (n=111). We then coded the reviews to identify key characteristics, including the types of abuse, settings, World Health Organization (WHO) geographic regions, and demographic subgroups represented in each review, that can be filtered in the mega-map. We also adapted the Joanna Briggs Institute Critical Appraisal Checklist for Systematic Review and Research Syntheses to appraise the quality of each review. We found that the focus of existing evidence syntheses is most commonly interventions (n=59), followed by prevalence (n=52), risk factors (n=51), consequences (n=31), and protective factors (n=16). The majority of published elder abuse studies have been conducted in the European, Western Pacific, and Region of the Americas WHO geographic regions. Few reviews examine systemic abuse and system-level interventions. Future studies on elder abuse should address these gaps in research on protective factors and systemic aspects of elder abuse, and build evidence about elder abuse in the African, South-East Asian, and Eastern Mediterranean WHO geographic regions.
PERSONALITY PROFILE OF RURAL-DWELLING OLDER ADULTS IN AN ONGOING HOARDING TREATMENT STUDY
Authors: Nix Caitlyn , Dozier Mary
Published: December 2022

Symptoms of hoarding disorder, such as significant household clutter, difficulty discarding, and excessive acquisition tend to increase in later life. With many challenges involved in aging in place, older adults may be particularly vulnerable to adverse events occurring while living with excessive clutter (e.g., fall risk, sanitation issues). Therefore, understanding what factors predict hoarding symptom severity is an essential step towards increasing older adults’ ability to age in place while experiencing hoarding symptoms. Personality traits have been demonstrated to predict hoarding symptoms in a wide range of ages. However, a sample of older adults in this clinical population has not been evaluated. The IPIP-NEO-60 is a shortened version of a widely used open-source personality measure that utilizes the five-factor model of personality (Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness). We used this measure to evaluate the personality profiles of rural-dwelling older adults (age 50 and up, M = 63) enrolled in an ongoing treatment study for hoarding disorder (n = 14). Compared to normative data from 910 adults aged 50 and up and matched for gender, most participants scored in the average range for Neuroticism, Extraversion, and Openness, with a nearly even split between high, low, and average scores for Agreeableness. Half of participants scored in the low range for Conscientiousness. Given the considerable proportion of participants demonstrating low Conscientiousness in this sample, screening a larger sample for beyond-average facet scores within this factor (e.g., self-efficacy, cautiousness) may assist clinicians in selecting impactful treatment targets for hoarding disorder in older adults.
RISK FACTORS FOR HAZARDOUS DRINKING AMONG DEMENTIA FAMILY CAREGIVERS
Authors: Chilatra Jessica Hernandez , Browning Wesley , Wang Danny , Pickering Carolyn
Published: December 2022

Little is known about alcohol use disorder (AUD) among family caregivers of people living with dementia, even though it is suspected as a contributing cause for caregiving outcomes such as elder mistreatment. This study examines the frequency of and potential risk factors for hazardous drinking (one dimension of AUD, measured by the Alcohol Use Disorders Identification Test AUDIT-C) among a sample of dementia family caregivers (Nf165). We used data from the first wave of an ongoing longitudinal study on daily dementia caregiving experiences. We computed binary logistic regression models using SPSS version 28 to identify potential risk factors. Among our sample, 20% of caregivers identified as positive for hazardous drinking. Caregivers with greater difficulty regulating their emotions (OR= 1.046, P=0.005, [95%CI] = 1.014–1.079) had significantly greater odds for hazardous drinking, as well as those with a history of physical neglect in childhood (OR=1.176, P=0.01, [95%CI] =1.037–1.334) and those who seek social support as a coping mechanism (OR=1.119, P=0.01, [95%CI] = 1.027–1.220). Additionally, the higher number of ADLs their relative needs assistance with the lower the odds (OR=0.775, p=0.01, [95%CI] =0.64–0.94) of hazardous drinking. Demographic factors such as gender and age were not associated with hazardous drinking, though the sample was predominantly female (90%). Findings show that dementia family caregivers experience hazardous drinking at a rate higher than the general population (6–16%) suggesting family caregivers are at a uniquely higher risk for AUD. Furthermore, the potential risk factors could inform future screening efforts to identify family caregivers experiencing hazardous drinking.
A DEMENTIA IMMERSION SIMULATION EXPERIENCE AS A TRAINING TOOL FOR HEALTH CARE PROFESSIONALS
Authors: Sanchez-Reilly Sandra , Reilly Paula , Reilly Elizabeth , Silva Isabella , Arevalo Lyda , Zaragoza Gabriela
Published: December 2022

Background

Dementia, a progressive, devastating and incurable disease affects millions of older Americans and their caregivers. Effective dementia-training programs for caregivers and healthcare professionals (HP) can lead to improved patient outcomes. Simulation-educational experiences are innovative with long-lasting impact. Currently, there are no simulation hands-on experiences focused on dementia care to train HP or hired caregivers (HC). Objective: To evaluate the educational effectiveness of a Dementia Immersion Simulation Experience (DISE) intervention among HP and HC.

Methods

DISE is a face-to-face 2-hour intervention that includes virtual reality, hands-on simulation with multiple sensory experiences, group debriefing led by dementia-caregiving expert. Program evaluation and pre/post knowledge assessments were administered.

Results

Nf110. HP, Nf72; HC, Nf25. Pre/post mean score of knowledge assessment (scale 0–12) for all was 8.3/9.7 (p < 0.0001). Participants were also grouped by whether they were “well-informed” (achieving 10 or better on knowledge assessment) or had “knowledge gap” (9 or fewer). 25% were well-informed on dementia before DISE; 63% after DISE (p < 0.0001). DISE program evaluation showed 98% participants highly rated experience across all categories. Evaluation scores further support an effective program. Furthermore, number of clinical referrals seeking expertise from a dementia specialist/team increased by 50% two months post-intervention.

Conclusion

DISE is a successful tool to teach, support and empower HP and HC, effectively changing care provided to individuals with dementia by using hands-on simulation training. Further studies are needed to evaluate the effectiveness of DISE in improving behavioral symptoms, training family caregivers, and decreasing other dementia-related undesirable outcomes such as nursing home placement.
UNIQUE TRANSKINGDOM MICROBIOME SIGNATURES LINKED WITH COGNITIVE DECLINE IN OLDER ADULTS OF MIAGB CONSORTIUM COHORT
Authors: Chaudhari Diptaraj , Jain Shalini , Yadav Hariom , Masternak Michal , Holland Peter , Agronin Marc ,   MiaGB Consortium Team
Published: December 2022

The prevalence of age-related cognitive disorders is increasing. Effective prevention and treatment interventions are unavailable due to a poor understanding of aging biology. Multiple emerging evidence indicates that the gut microbiome is linked with age-related disorders; however, their clinical importance in differentiating and predicting the risk of cognitive decline or dementia is largely elusive. Utilizing samples and data of a large, multi-site clinical study across the state of Florida called Microbiome in aging Gut and Brain (MiaGB) Consortium, our whole genome microbiome sequencing revealed that the viral and archaeal population was significantly reduced in the gut of older adults with dementia (n=8) compared to those with mild cognitive impairment (MCI) (n=25) and normal cognition (n=59). Whereas the fungi were exclusively detected in the controls only. Alpha diversity of the participants with MCI and dementia was lower than the cognitively healthy controls. The abundance of Actinobacteria and Verrucomicrobia phyla was higher, and Firmicutes phylum was lower in the participants with dementia. Bacteriophages Lactobacillus prophage Lj771 and Microbacterium phage Min1 were exclusively detected in the gut of the participants with dementia. The study also identifies key metabolic pathways altered in the controls versus the cognitive impairment state. Our biomarker discovery analyses also revealed that these unique microbiome signatures and pathways might have predictive power for cognitive decline and dementia risk and offer new targets for future therapeutic interventions.
THE WHATMATTERS APP: CO-DESIGNING PERSON-CENTERED CARE FOR PEOPLE WITH DEMENTIA IN CARE SETTINGS
Authors: Hung Lillian , Guo Ellen , Sakamoto Mariko , Lok Karen , Wong Yi , Tran Candy , Mann Jim , Berndt Annette , Egeberg Eva
Published: December 2022

The purpose of our study is to provide comfort through digital resources (e.g., music and visual materials) for patients/residents with dementia in hospitals and long-term care. By working with users (patients/residents, families, and staff) and using a co-design approach, we have developed a mobile app prototype called “WhatMatters” to equip staff with a useful digital tool for delivering person-centered care in hospitals and long-term care homes. Using user experience co-design methods, we conducted a series of virtual co-design workshops with acute and long-term care staff (n=10), clinical experts (n=3), residents (n=3), and patient and family partners (n=7) to understand: (a) what “comfort” means, (b) how care needs are communicated and provided for, and (c) how a mobile app may be used to support psychosocial needs of people living with dementia in hospital and long-term care settings. Thematic analysis has identified three themes to inform the development of the mobile app WhatMatters: (a) familiarity brings comfort, (b) sharing of information between staff and families allows for continuity of care and person-centered care, and (c) accessible and curated content can evoke memories and create a comforting space. Our study conclusions are: It is feasible and necessary to work with users (including clinical staff, patient, and family partners) and relevant stakeholders to co-design a mobile app, a useful tool to support the delivery of person-centered care in care settings.
UNDERSTANDING THE ROLE OF A SOCIALLY ASSISTIVE ROBOT TO SUPPORT AGING IN PLACE
Authors: Mois George , Vergara Lizandra , Ali Afnaan Afsar , Trinh Mimi , Rogers Wendy
Published: December 2022

Communities may lack the infrastructure and required resources to support healthy aging and aging in place. Advancements in technology development such as socially assistive robots and artificial intelligence present new opportunities to support and meet the needs of older adults. For example, Misty is a socially assistive robot designed to allow customizability and adaptability to support and meet diverse user needs pertaining to tasks and activities. Our research aim is to understand if Misty can facilitate social interactions with older adults, control the home environment, and provide reminders. We are exploring older adults’ attitudes towards Misty through demonstrations of these activities. Through this research we provide insights pertaining to the facilitators and barriers in the acceptance and use of a socially assistive robot like Misty, to support healthy aging. Furthermore, our findings will provide guidance for design and implementation of artificial intelligence through socially assistive robots in a home environment.
LIGHT THERAPY FOR SLEEP DISTURBANCE OF NURSING FACILITY RESIDENTS WITH DEMENTIA: A SYSTEMATIC REVIEW
Authors: Bian Wenxin , Toles Mark , Xavier Rose Mary
Published: December 2022

Background

Bright light therapy has shown promise in addressing sleep problems in nursing facility residents with dementia. However, recent studies yielded conflicting outcomes and few studies focused on nursing facilities. The purpose of this systematic review was to describe effectiveness of light interventions in nursing facility residents with dementia. Method: We searched PubMed, CINAHL, EMBASE, PsychINFO, and Scopus using key terms “sleep”, “dementia” and “residential facilities”, and synthesized data with thematic analysis and vote-counting.

Results

Of eight studies that met inclusion criteria, six were randomized controlled trials and 2 were quasi-experimental. Sample size ranged from 11 to 77 residents. Studies tested 3 light therapies: timed bright light (n=6), timed regular light (n=1), and variable 24hour light (n=1). Light delivery method, light exposure, and adherence to therapy protocols were not consistently reported. All studies indicated light therapy improved some resident outcomes, such as sleep efficacy and total sleep time; however, 88% of studies did not report sampling strategies or a statistical power analysis and 22% had small sample size (n < 15).

Conclusion

Insufficient evidence is available to recommend light therapies for nursing facility residents with dementia. Adequately statistically powered studies that are rigorously designed with representative samples are needed for robust estimation of the effects of light therapy on sleep. Future studies must account for the unique characteristics of nursing facility residents with dementia that impact their adherence to light therapy.