bluuebunny/crossref_metadata_2025 huggingface dataset:
The Moderating Role of Age on Cognition Among Old Cancer Survivors: Comparison With Older Adults Without Cancer
Authors: Wang Kun , Lee Hee Yun , Neese Jessica
Published: December 2020

Considering that 64% of cancer survivors are older adults, it is plausible that the overlap of cancer and old age may worsen older cancer survivors’ cognitive functioning. The current study aimed to test the effect of cancer history on cognition in comparison with older adults without cancer history and examine how age groups moderated the association between cancer and cognition. A subsample of 9197 participants drawn from the Health and Retirement Study (HRS) Wave13 were included in this cross-sectional study. Total word recall (score range: 0-20), mental status (0-15), and total cognition (0-35) were the three continuous dependent variables. Multilinear regressions were conducted with and without the interaction term (cancer history * age group). Findings showed cancer survivors tended to be older, Non-Hispanic white males, and higher educational attainment. Cancer history (B= .14, p< .05) was significant only for mental status. Cancer survivors had higher mental status scores than older adults without cancer history. The moderation effects of age groups on total word recall (p< .05), mental status (p< .01) and total cognition (p< .01) were significant only in the 85+ group. After adjusting for other variables, cancer survivors in the 85+ age group had significantly higher mental status and total cognition scores than their non-cancer counterparts. Posttraumatic growth can potentially explain the surprising result that older cancer survivors had higher cognition scores. Another possible explanation is that high cognitive functioning lengthened survival, and not cancer increased cognition. More experimental studies are needed to explore the current study’s findings further.
Effect of Family Caregiver Need for Training on Medicare Home Health Care
Authors: Burgdorf Julia , Stuart Elizabeth , Wolff Jennifer
Published: December 2020

Medicare home health providers are required to offer family caregiver training; however, there is little information regarding the impact of family caregiver training on home health care intensity. A better understanding of this relationship is necessary to inform development and prioritization of caregiver training interventions in this setting. This research assesses whether and how family caregiver need for training affects care intensity during Medicare home health. We examine 1,217 (weighted n=5,870,905) fee-for-service Medicare beneficiaries who participated in the National Health and Aging Trends Study (NHATS) between 2011-2015 and received Medicare-funded home health care within one year of survey. Using propensity score adjusted, multivariable logistic and negative binomial regression, we model the relationship between family caregiver need for activity-specific training and the number/type of visits received during Medicare home health. We found that older adults whose family caregiver required training on self-care tasks had greater odds of receiving any therapy visits (aOR: 1.70; 95% CI: 1.01, 2.86), aide visits (aOR: 2.12; 95% CI: 1.11, 4.05), or training visits (aOR: 1.49; 95% CI:1.01, 2.21). Older adults whose family caregiver required training on medication management had greater odds of receiving any nursing visits (aOR: 3.03; 95% CI: 1.06, 8.68) and incurred 1.06 (95% CI: 0.11, 2.01) additional nursing visits. Findings support the importance of connecting family caregivers to training resources. Additionally, findings suggest that home health providers should consider prioritizing training interventions which focus on caregiving activities most closely tied to resource utilization: self-care and medication management.
An Ecological Model of Care for Older Adults With Cognitive Impairment
Authors: Rhodus Elizabeth , Rowles Graham , Bardach Shani , Hunter Elizabeth , Jicha Gregory
Published: December 2020

Living with dementia causes increasing dependence on the surrounding physical and social environment. There is limited information on environmental interactions of persons with cognitive impairment. Based on participant observation and repeated interviews with both members of nine dyads (primary care partner and person with cognitive impairment) in situ in their homes, a theoretical model depicting environmental interaction was developed. The model illustrates parallel and interwoven environmental experiences of each member of the dyad as they negotiate progressive cognitive impairment. Evolution of the dyad is situated within nested layers of the physical and contextual environment including physical structures, social norms, and political environments. Experiential elements for each member of the dyad are described. Elements include cognitive status, trial and error associated with care provision, adverse behavior linked with onset of caregiver burden, onset of a significant event leading to altered living situations, and maximum dependence on environmental factors prior to end of life. Evidence collected suggests that both persons of the dyad become increasingly susceptible to environmental influences with progression of the disorder. Implication of these findings offer a theoretical framework describing dyadic experiences of environmental interactions when living with dementia. This theoretical model provides a basis for clinical and social intervention to enhance the well-being of both members of the dyad. Interventions associated with environmental interactions may slow socially discordant behavioral manifestations associated with dementia and significantly improve quality of life for both members of the dyad.
Cognitive Impairment and Self-Care Among Congestive Heart Failure Patients in an Outpatient Clinic
Authors: Liu Chelsea , Williams Nicole L , Chandra Nisha , Rouf Rosanne , Gaddis Andrew , Gomez Yessenia , Simmons Tanya , Gottesman Rebecca
Published: December 2020

The burden of congestive heart failure (CHF) is the greatest among older adults. Cognition is important for carrying out self-care tasks such as monitoring sodium intake, but little is known about how cognition affects self-care in acutely ill CHF patients. We aimed to assess the association between cognition and self-care in CHF patients from an outpatient diuresis clinic. Cognitive function was measured using the Mini-Mental State Exam (MMSE) and other tests representing 5 cognitive domains. The Self-Care of Heart Failure Index (SCHFI), given to a subset of participants, consisted of 22 questions each scored on an ordinal scale of 1-4 with a total score ranging from 22-88; higher scores indicated better self-care. SCHFI questions were further categorized into maintenance, management and confidence sub-scores. Multiple linear regressions were used to analyze the association between neuropsychological test scores and SCHFI scores. A total of 68 CHF patients had complete SCHFI data, with a mean age of 65.6 years and a mean total SCHFI score of 70.9 points. Nine (13.2%) patients were cognitively impaired (MMSE<24). Older age, lower education and history of stroke were associated with cognitive impairment. After adjusting for age, education, diabetes, and depressive symptoms, no associations were observed between the other neuropsychological test scores and any of the SCHFI scores. Though findings suggest that cognition is not associated with self-care, the analysis may have been underpowered. Further evaluation of a greater number of CHF patients is needed to understand the implications of cognition on self-care and provide guidance for interventions.
Evaluation of Intervention Acceptability in Community Studies With Individuals and Dyads Affected by Dementia
Authors: Harris Melissa , Titler Marita
Published: December 2020

Multiple non-pharmacologic interventions for symptom management in community dwelling individuals with dementia have demonstrated effectiveness, but have had limited uptake in practice. Prior reviews have evaluated acceptability of interventions for caregivers, but none have evaluated interventions for care recipients with dementia and dyads. This review synthesized the evidence about intervention acceptability for dyads (individuals with dementia and informal caregivers) and individuals with dementia residing at home. Four databases were searched (PubMed, CINAHL, AgeLine, PsycINFO) using inclusion criteria of: intervention studies, community dwelling individuals with dementia or dyads of care recipients and informal caregivers, non-pharmacologic intervention, evaluation of intervention acceptability. Gray literature and non-English articles were excluded. 173 citations were screened by title and abstract, 38 were reviewed by full text, and 19 studies were included. 18 studies focused on dyads, and 13 different non-pharmacologic intervention types were evaluated across studies. Qualitative (n=3), quantitative (n=8) and mixed methods (n=8) were used to evaluate acceptability. Approaches and measures of acceptability included field notes, behavioral checklists, focus groups, semi-structured interviews, questionnaires, and completion rates of intervention sessions and outcome measures. Although participants’ benefit and satisfaction with the interventions were high across studies, variability in definitions of acceptability, the methods and measures used constrain the interpretation and generalizability of findings. Psychometric properties of quantitative questionnaires were not addressed even as the most basic level of face or content validity. To enhance the applicability of non-pharmacologic treatments for this population, future research should emphasize the evaluation of intervention acceptability, as well as effectiveness.
Outcomes of Primary Care for People With Dementia: What’s Important?
Authors: Wray Laura , Vest Bonnie , Brady Laura , Vair Christina , Beehler Gregory , McCarten John
Published: December 2020

People with dementia (PWD) typically receive most of their healthcare in primary care (PC), but neurocognitive disorders can be challenging to recognize, assess, and manage in that setting. As a result, cognitive impairment in older adults is often missed or not addressed until later stages. The result is poor management of comorbid health conditions, increased healthcare utilization, and negative outcomes for the patient and family. Further, strategies for improvement and barriers to high quality PC for PWD have received limited attention. To improve PC for PWD, it is essential to understand what care outcomes should be targeted. To address this gap, we used a qualitative approach to examine potential outcomes of PC from the perspectives of older adults, family caregivers, primary care teams, and geriatrics specialists (n=79) from two Veterans Health Administration healthcare systems. Participants were interviewed individually or in focus groups. A directed content analysis based on the adapted Donabedian model was employed and expanded to fully capture transcript content. Three main categories of outcomes were identified: Personhood (i.e., independence), Physical Health and Safety, and Quality of Life. Regardless of participant type, respondents focused on similar desired outcomes and, notably, identified outcomes as important for both patients and their broader social context (i.e., caregivers, family). Discussion will: show how findings align with work conducted in specialty and residential care; describe how challenges to attaining these outcomes in PC can be overcome; and, challenge cognitive screening recommendations for PC that are based primarily on risk/benefit analysis of medication-focused outcomes.
Polysomnographic Sleep Parameters: Novel Digital Biomarkers for Developing Dementia
Authors: Razjouyan Javad , Nowakowski Sara , Sharafkhaneh Amir , Kunik Mark , Naik Aanand
Published: December 2020

Neuroprotection, early diagnosis, and behavioral intervention are priorities for dementia research. Sleep is emerging as an important potential remediable risk factor. Polysomnography using various digital parameters, qualitatively and quantitively, evaluates sleep. In this study, we examined whether sleep parameters derived from attended overnight polysomnography (PSG) studies are associated with developing dementia. We retrieved 61,165 free-text PSG reports from the VA national electronic health records from 2000 to 2019. Patients with dementia diagnosis up to one-year after PSG were excluded. Patients who developed dementia >1 year after PSG (Dem) were classified using all-cause dementia ICD-9/10 codes documented on two separate visits starting a year after the PSG until the end of 2019 in a 1-year sliding period. Patients with no ICD-9/10 dementia codes (NDem) were propensity matched 1:1 for age, gender, race, ethnicity, BMI, and Charlston comorbidity index to the Dem group (n=1,534). We used natural language processing to identify sleep onset latency (SOL), total sleep time (TST), and apnea-hypopnea index (AHI). Univariate analysis was used to compare the groups. TST (254 v 266m, p=0.001) were significantly shorter and SOL (28 v 31m, p=0.047) were significantly prolonged in Dem compared to NDem. The odds ratio of individuals with an AHI ≥ 15 was significantly higher in Dem compared to NDem group (1.18, 95%CI: 1.04-1.35). Patients with incipient dementia exhibited longer SOL, shorter TST, and a greater proportion had moderate-to-severe apnea compared to patients without dementia. These objective sleep parameters may serve as potential biomarkers for patients at risk for developing dementia.
Development of a Claims-Based Algorithm to Identify Patients With Agitation in Alzheimer’s Dementia
Authors: Hwang Steve , Teigland Christie , Pulungan Zulkarnain , Parente Alexis , DePalma RoseAnn
Published: December 2020

Agitation is common in patients with Alzheimer’s dementia. Lack of a consensus definition has limited our understanding of the prevalence, patient profile, and added healthcare burden of agitation in Alzheimer’s dementia (AAD). We developed an algorithm to identify AAD patients using 100% of Medicare Fee-For-Service administrative claims from 2011-2017. We adapted the International Psychogeriatric Association (IPA) 2015 definition, which had not been tested using real-world data. Patients were required to have 2+ claims ≥30 days apart for Alzheimer’s disease and dementia, and continuous enrollment with medical/pharmacy coverage for 6-months pre- and 12-months post-index diagnosis. The AAD cohort included patients with 2+ claims ≥14 days apart with ICD-9-CM/ICD-10-CM codes selected based on the IPA definition (e.g., dementia with behavioral disturbance, irritability/anger, restlessness/agitation, violent behavior, impulsiveness, wandering). Patients with severe psychiatric disorders were excluded. The final population included 255,669 patients with (34.6%) and 482,710 patients without agitation (65.4%). The mean age in both populations was 82 years. Although the majority of patients in both groups was female, the proportion of males was slightly larger in the AAD group (31.2% vs 29.7%). Patients in the AAD group were also more likely to be low-income (dual-eligible: 44.0% vs 39.6%), disabled (10.4% vs 9.3%), and using antipsychotic and antidepressant medications. The 2 populations had similar comorbidity rates. AAD prevalence may be underestimated using claims data, given imprecise and under-coding. These findings suggest AAD patients can be identified using a claims-based algorithm to support early interventions that can potentially improve outcomes and reduce costs of care.
Sleep Quality Among Older Women and Men in the United States by Sexual Orientation
Authors: Galinsky Adena , Goldsen Karen Fredriksen , Dahlhamer James , Norris Tina
Published: December 2020

Sleep problems may increase the risk for, and result from, other health problems and negatively impact quality of life. Lesbian, gay, and bisexual older adults report more sleep problems compared to their straight counterparts when such problems are measured in the aggregate (e.g. “one or more of four specific sleep problems”). However, scant national research has examined if specific types of sleep problems vary by sexual orientation among older adults. Using 2015-2018 National Health Interview Survey (NHIS) data, we used logistic regression to separately model five sleep problems among women 50+ and men 50+ (lesbian/gay women: n=377, bisexual women: n=142, straight women: n=33,216; gay men: n=508, bisexual men: n=115, straight men: n=25,998) as functions of sexual orientation, controlling for age, race, education, and income. Sexual minority older adults were more likely than their straight counterparts to have taken sleep medication in the past week (women AOR=2.04, 95% CI:1.55, 2.67; men AOR=1.81, 95% CI:1.36, 2.40). The only other difference by sexual orientation found for men was bisexual older men’s greater likelihood, compared to straight men, of having difficulty falling asleep (AOR=2.02, 95% CI: 1.08, 3.79). Older women did not differ by sexual orientation in difficulty falling asleep, difficulty staying asleep, or waking up not feeling rested for four or more days in the past week, or meeting National Sleep Foundation recommendations for hours of sleep per night, whether lesbian/gay and bisexual women were examined together or disaggregated. Future research may examine why sleep quality only sometimes varies by sexual orientation.
Empty Beds in Nursing Homes Filled by Younger Individuals Following ACA Medicaid Eligibility Expansion
Authors: Ritter Ashley , Coe Norma , Freed Salama
Published: December 2020

National decline in nursing home occupancy rates coupled with expansion of Medicaid insurance eligibility under the Affordable Care Act (ACA) potentially create an opportunity for younger, low-income individuals to enter nursing homes following a hospitalization. Changes in the population of individuals using nursing homes could result in downstream consequences on facility payor mix, case severity index, and ultimately patient outcomes. This study measures the effect of ACA Medicaid eligibility expansion on the patient population using nursing homes, accounting for the nursing homes’ occupancy rate. Data were obtained from the publicly available national dataset, LTCfocus (2009-2016). Difference in differences estimation with time and state fixed effects was utilized to examine the effect of ACA Medicaid eligibility expansion on two outcomes, 1) average age in years of residents as of April 1 and 2) the proportion of individuals covered by Medicaid insurance at the facility level. Results show facilities with pre-ACA occupancy rates between 40% and 50% demonstrated the largest decrease in average age by year three, 1.32 years [95% CI: -2.257, -0.385]. Facilities with a pre-ACA occupancy rate of 60-70% demonstrated the largest increase in the proportion of individuals covered by Medicaid in year one, a 5.5 percentage point increase [95% CI: 0.009, 0.102]. In summary, Medicaid expansion under the ACA resulted in an increase in younger individuals and individuals covered by Medicaid using nursing homes, varying across pre-ACA occupancy rates. It remains to be studied if increased utilization of this high cost setting provides superior patient outcomes for these populations.
Barriers to Development of an App for Improving Staff-Family Communication at Israeli Geriatric Facilities
Authors: Cohen Rinat , Maydan Gal , Brill Shai , Cohen-Mansfield Jiska
Published: December 2020

Family caregivers (FCs) of institutionalized noncommunicative older persons reported multiple unmet communication needs focusing on the need to receive reliable and regular updates on the patient’s condition. We have developed a mobile app for improving communication between FCs and healthcare professionals (HPs), based on 152 interviews with FCs and 13 discussion groups with HPs from four Israeli geriatric facilities. Both parties participated in app planning, tailoring it to their needs and abilities. App use implementation encountered major obstacles including the bureaucratic process concerning signing contracts between the university and software development firms, which hindered the process for a full year; data security department required disproportionate security levels that interfered with user experience and delayed the development process; the study’s definition varied across different ethics/Helsinki committees (Institutional Review Boards; IRBs), which led to different demands, e.g., insurance for medical clinical trials although no drugs or medical device were involved; lack of cooperation by mid-level staff members despite the institutional adoption of the app project; low utilization by HPs resulted in FCs not receiving timely responses. Despite these and other obstacles, we tested app use for 15 months in one facility in a pre-post-design with intervention and control groups, and we have since begun testing it in another facility. FCs who had used the app had positive feedback and wished to continue using it. App use optimization requires implementation planning, assimilating changes in each facility’s work procedures and HP’s engagement and motivation and thus depends on institutional procedures and politics.
Usable and Privacy-Enhanced Telepresence Robots for Older Adults Aging in Place
Authors: Wu Xian , Beer Jenay
Published: December 2020

Aging population is growing rapidly in the United States and people are living longer. Maintaining health and wellness while aging-in-place is crucial for older adults. Telepresence technology is beneficial for this target population to stay socially connected, as well as utilize telehealth and telemedicine services. However, such technology was not specifically designed for older adults. For older users to adopt telepresence, it is important to ensure that they do not experience adoption barriers, such as issues with usability and privacy. This research used a user-centered evaluation to design, develop, and test telepresence user interfaces (UI). Thirty older adults (aged 60+) participated in a within-subjects evaluation of two telepresence UIs: 1) the controlled condition - a generic UI, called Presence, based on currently available telepresence systems; and 2) the experiment condition - an enhanced custom telepresence UI that was designed follow human factors and design principles for older adults, named InTouch. Participants tested both UIs in a virtual home environment developed in Unity. Qualitative and quantitative results suggest that older adults perceived the experiment condition – InTouch, to be more usable and private – and our older users provided insight on which usability and privacy features were critical for them. By investigating the design of telepresence for older users, and applying those findings to design recommendations, we aim to improve the ease of use and privacy level of telepresence– not only for our target users but for all users who wish to enhance social connectedness and utilize telehealth.
Use of GPS Tracking Technology to Measure Mobility in Older Adults: A Systematic Review
Authors: Chung Jane , Sargent Lana , Brown Roy
Published: December 2020

Global positioning system (GPS) tracking technology is increasingly used in aging research to objectively measure the spatial and temporal aspects of mobility in older adults. The review aims to systematically synthesize the literature to identify GPS-driven mobility measures and potential determinants of mobility limitation for community-dwelling older adults. A systematic search of six electronic databases was conducted. A total of 4897 articles were found with 2578 left to review after deduplication. Twenty-five studies met inclusion criteria: 24 cross-sectional studies and one follow-up study that measured mobility changes over time. Various types of GPS devices were used, including smartphones, GPS watches, or portable data logging kits. The GPS tracking period ranged from 1 to 30 days. The daily device wear time varied from 10 to 24 hours. Commonly reported GPS-based mobility measures included time out of home, distance moved, the number of out-of-home trips or walking tracts, the number of visited places, life-space area, and walking speed. Twenty-one studies reported some aspects of demographic, physical, psychosocial, or environmental factors related to the levels of GPS-based mobility. GPS tracking technology can continuously record individuals’ activities and functional abilities within their life space. We found that there was heterogeneity in ways of applying GPS technology and defining and measuring mobility in community-dwelling older adults. Given the lack of consistency in GPS-based mobility assessment, a clear definition of mobility and standardization of GPS data collection and analysis are required for comparison across studies and better understanding determinants of mobility limitation in community-dwelling older adults.
Reframing Aging: Penn’s Village Members Thrive While Aging in Place
Authors: Evans Lois , Eleey Jane , Saperstein Avalie
Published: December 2020

Villages help older neighbors age-in-place as they manage their environments, take advantage of opportunities for social and civic engagement, and improve or maintain health and well-being. National surveys repeatedly indicate that older adults prefer community living as long as possible. But communities change, and post-retirement living may require rebuilding social connections with old and new neighbors. Fortunately, today’s retirees bring a wealth of knowledge and skills to later life which they are happy to share. Drawing on the talents and career experiences of older adults in Center City, Philadelphia, Penn’s Village (PV) was created in 2007 to address the needs and wishes of neighbors wanting to stay in their own homes as they aged. A member of the Village-to-Village Network, PV (a 501c3) has itself matured through board development, strategic planning, and member engagement. In reframing aging in Center City, PV currently offers its over 300 members and volunteers an array of educational and recreational programs (e.g., talks, affinity groups, social events and outings); services (including transportation, home repairs, IT support, companionship, accompaniment to medical appointments), and opportunities to use their personal knowledge and skills to help their neighbors-- as drivers, companions, volunteer staff and co-chairs/members of committees (e.g., Board of Directors, Program, Welcoming, Marketing & Communications, Finance, Fundraising). In FY2019, volunteers provided nearly 1200 services to PV members. Our most recent survey responses indicate that 82% of volunteers found their work highly meaningful and 79% of those who received services believed their quality of life was greatly improved.
Patient-Reported Factors Alleviating Pain Among Persons With Cancer
Authors: Fullwood Dottington , Fillingim Roger , Wilkie Diana
Published: December 2020

Pain impacts wellbeing and is among the most common symptoms of cancer. Factors that decrease pain severity have been understudied despite their importance for high-quality cancer care. The study purpose was to describe pain alleviating factors and their association with type of cancer. This secondary comparative analysis included 579 participants from studies of inpatients and outpatients with cancer (mean age=58.7±12.3; 27.3% female; 85.5% White, 5.7% Black, 7.6% Other). They completed the McGill Pain Questionnaire on paper or a tablet computer. To determine factors that alleviated pain, we focused on the open-ended question: 1) What kinds of things relieve your pain? We coded text responses into six outcome categories: 1) Activity level, 2) Cognitive, 3) Environmental, 4) Medical, 5) Physical, and 6) Sedentary behavior. We counted the number of activities/factors in each category and conducted multivariable regression analysis adjusting for sociodemographic constructs. Adjusted models revealed that activity (ρ=0.02), cognition (ρ<0.001) and medication (ρ<0.001) were more often endorsed as alleviating factors among individuals living with lung cancer compared to head and neck cancer participants. Those diagnosed with lung cancer (ρ=0.02) and males (ρ=0.02) utilized significantly less physical alleviating factors than head and neck cancer individuals and females. This is the first study to examine pain-alleviating factors among individuals living with cancer. These findings contribute new information regarding activities that alleviate pain among cancer survivors. These findings could inform interventions to promote safe, personalized care designed to alleviate cancer-pain.
Evaluation of a Collaborative Care Management Program for Community-Dwelling Older Adults on High-Dose Opiates
Authors: Mavandadi Shahrzad , Foust-Montague Kristin , Grecco Elizabeth , Oslin David , Streim Joel
Published: December 2020

Treating pain in later life is complex, and there are significant safety risks associated with the use of analgesics, particularly opioids. This study examined preliminary results from a pilot study of a telephone-delivered collaborative care service designed for community-dwelling older adults with chronic pain receiving prescriptions for high doses of opioids (i.e., >120 mg morphine-equivalent dose). Eighty-two older adults referred by the Pennsylvania Department of Aging’s pharmaceutical assistance program for low-income seniors (PACE/PACENET) were eligible and enrolled in the program (i.e., the University of Pennsylvania/PACE Behavioral Health Laboratory). Patients were on average 73.5 (+/-6.1) years old, and the majority were white (91%) and female (70%). Patients completed a comprehensive baseline clinical assessment capturing their mental health, cognition, pain and functional status, as well as self-reported daily opioid dose and biopsychosocial needs. Patients were considered engaged in the program if they completed 2+ additional follow-up contacts with a care manager. During these contacts, care managers offered individualized treatment planning, with the goal of opioid dose reduction to safer levels. Of the 82 patients completing the baseline, 53 (65%) engaged in the program. At their last clinical contact, 91% of engaged patients achieved dose reductions (with 66% achieving dose reductions of >20% and 30% reporting doses <120 mg morphine-equivalent dose). Engaged patients also reported significant reductions in pain severity (p=0.05) and depressive symptoms (p=0.003) at the last contact relative to baseline. Findings support the feasibility of a community-based, collaborative care model for pain management and suggest the potential for positive treatment outcomes.
Polypharmacy and Potentially Inappropriate Medications in Patients With Dementia
Authors: Nonaka Ryo , Kanno Atsuhiro , Ohara Takahiro , Sumitomo Kazuhiro , Sato Shigeru , Miyazawa Isabelle , Koinuma Nobuo , Furukawa Katsutoshi
Published: December 2020

INTRODUCTION: The use of polypharmacy and potentially inappropriate medication (PIM) is a critical issue in geriatrics. Furthermore, the number of patients with dementia is dramatically increasing worldwide. In this study, we investigated: (1) if the states of polypharmacy and PIM differed in patients with and without dementia; (2) the types of medicine that were commonly prescribed; (3) the types of dementia that resulted in the prescription of multiple medicines; (4) if there was a correlation between the number of medicines and the number of medical institutions (hospitals and clinics) that the patients attended. METHODS: In total, 216 patients who were 65 years of age and older were analyzed. The number of medicines prescribed and the medical institutions they attended were counted through the electronic medical charts of Tohoku Medical and Pharmaceutical University Hospital. We employed the Beers 2019 criteria for the definition of PIM. RESULTS: (1) The number of prescribed medicines was not significantly different between patients with dementia and those without dementia. (2) Anti-hypertensives and gastro-intestinal medicines were the most commonly prescribed medicines in patients with and without dementia. (3) Patients with “dementia with Lewy bodies” and “mixed dementia” were prescribed the highest number of medicines. (4) The number of medicines and PIM use were significantly and positively correlated with the number of medical institutions. CONCLUSIONS: The number of medical institutions strongly affected the number of medicines prescribed and PIM use. Efforts should be made to organize and reduce the number of medical institutions that a patient attends.
Examining Ankle Foot Orthosis Wear Time in Patients With Peripheral Artery Disease
Authors: Myers Sara , Dinkel Danae , Hassan Mahdi , Despiegelaere Holly , Johanning Jason , Pipinos Iraklis
Published: December 2020

Peripheral artery disease (PAD) impacts over 8.5 million Americans and the prevalence of PAD increases with age. PAD restricts blood flow to the leg and its most common manifestation is claudication, a severe impairment of walking produced by ischemia-related, leg pain during exercise. An ankle foot orthosis (AFO) could improve these symptoms. To understand the potential impact of AFO usage, it is critical to determine wearability of the device in patients with PAD. The purpose of this study was to monitor wear time of an AFO and explore perceptions of the device. Participants (n=14) with PAD and claudication wore an AFO for three months. An accelerometer was placed directly on the AFO for 7 days and participants completed semi-structured interviews at midpoint (1.5 months) and post intervention (3 months). Based on accelerometer data at midpoint participants wore the AFO for an average of 4.9±2.3 out of 7 days and for an average of 7.5±4.2 hours each day. At post, participants wore the AFO for an average of 4.8±2.2 days for an average of 7.4±4.6 hours per day. In the interviews, almost all participants noted multiple barriers to wearing the AFO such as difficulty putting the AFO on and off, using stairs, walking on uneven ground, and driving. Our study found that participants wore the AFO ~7 hours/day but experienced barriers which may have limited their wear outside of these monitoring periods suggesting patients would wear an assistive device if design could be improved to address barriers.
Investigation of Roll-Over Characteristics in Healthy Old Individuals and Patients With Peripheral Artery Disease
Authors: Myers Sara , Bapat Ganesh , Johanning Jason , Pipinos Iraklis
Published: December 2020

Atherosclerotic blockages in the leg arteries, cause leg pain with ambulation (called claudication), impair gait and substantially reduce the walking ability of patients with peripheral artery disease (PAD). Ankle-foot orthoses are being developed and applied so patients can walk more and with less pain. Roll-over shape (ROS) is a potential design objective for such assistive devices. In the proposed work, we study roll-over characteristics in patients with PAD and healthy older subjects. Gait data of ten healthy older individuals (Age: 72.8 ± 5.5 years) and twenty patients with PAD (Age: 64.1 ± 6.6 years) were collected at self-selected walking speed. In patients with PAD, gait data were collected before the onset of pain and after claudication pain was induced. To generate ROS, the center of pressure data was transformed to the shank-based coordinate system and circular arcs were fit using an optimization program in MATLAB. Independent t-tests with Bonferroni corrections were used to separately compare roll-over radius differences (p<0.05) between healthy older to both walking conditions in patients with PAD. The mean roll-over radius was not significantly different between healthy older vs PAD pain-free (p=0.468) or PAD pain-induced (p=0.289) walking conditions. Our results indicate invariance of ROS radius in patients with PAD, which is consistent with previous literature showing general invariance of ROS in healthy young individuals. Previous biomechanical studies show gait kinematics and kinetics are more affected by PAD than by age. Future studies should focus on the potential adaptive mechanisms in patients with PAD achieving invariant ROS.
Variation in the Association of Body Types to Decreased High-Density Lipoprotein in Older Adults (NHANES 2005-2014)
Authors: Chukwurah Queendaleen
Published: December 2020

General obesity and central obesity represent cardiovascular disease risk factors and are known to be related to dyslipidemia. I examine the variation in the association of combined body mass index/waist circumference classification to decreased high-density lipoprotein cholesterol (HDL-C). Body mass index /waist circumference (WC) cut off values were used to create six body types: normal weight with normal WC (NWT-NWC), overweight with normal WC (OWT-NWC), obese with normal WC (O-NWC), normal weight with high WC (NWT-HWC), overweight with high WC (OWT-HWC), and obese with high WC (O-HWC). HDL-C was defined as decreased if < 40 mg/dl for men or < 50 mg/dl for women and normal if ≥ 40 mg/dL for men or ≥ 50 mg/dL for women. Sample population included 5,772 participants of the National Health and Nutrition Examination Survey (NHANES 2005-2014) aged 50 years and older. The mean (SD) age was 61.8 (0.2), and 50.5% were females, while 10% were minority. The prevalence of decreased HDL-C was 29.1%. Analysis involved weighted multivariable logistic regression adjusted for age, race-ethnicity, gender, education, poverty-income-ratio, smoking, and alcohol intake. Regression reveals a higher likelihood of decreased HDL-C for OWT-NWC (aOR 2.12 95% CI 1.43,3.15 ), NWT-HWC (aOR 2.57 95% CI 1.59,4.16 ), OWT-HWC(aOR 3.09 95% CI 2.29,4.15 ), and O-HWC (aOR 5.30 95% CI 4.01,6.86 ) when compared to NWT-NWC. These associations are important to public health practice and policies as it demonstrates the implications of the parallel use of anthropometric measures for all body weights in health-risk assessments of older adults.
Geriatric Fast Facts: Four Years of Growth and Reach
Authors: Duthie Edmund , Denson Kathryn , Simpson Deborah , Denson Steven , Malone Michael
Published: December 2020

Clinical teachers are increasingly challenged to find the time to provide point of care education for learners. To meet this challenge, an interprofessional team from competing health care systems created and sustained Geriatric Fast Facts (GFF): easily accessible, concise 1-2 page topic summaries for clinical teachers to use (in lieu of the mini-lecture) with learners at the point of care. Designed by geriatrics educators in consultation with IT experts, we launched a mobile enabled website that is indexed and searchable by free text or topic, organ system, ACGME competency, disease, and the “underlying science” for the disease/illness. GFF topics are authored by subject matter experts with peer review by senior geriatricians. Brief quizzes test learners’ knowledge with score reports. Our 4-year results reveal that: 1) “Geriatric Fast Facts” appear in the top Google 10 listing; 2) Search engines account for 39% of site traffic; 3) 60% of unique users (N=29,000) are via direct link; 4) 19% via referral from another site. Our “bounce rate” (55%) is ideal as users quickly gain the information sought - affirmed by our session duration which averages < 2 minutes. Our Google Analytics results reflect steady growth and international reach: 73% of sessions are from the U.S., 5% from Canada, 22% international and growing! In summary with our population continuing to age and time for teaching being limited, GFFs are quick, accessible, evidence-based resources for point of care teaching.
Learner Attitudes on Interprofessional Education Through Formal Interprofessional Case Discussions
Authors: Halli-Tierney Anne , Carroll Dana , McKinney Robert , Allen Rebecca
Published: December 2020

Interprofessional education case sessions allow learners to apply discipline-specific knowledge to real-life scenarios through facilitated discussion of a patient case. Our interprofessional case discussion was implemented for learners to develop care plans for complex geriatric patients; learners have intentional time to learn with, from and about each other’s roles in geriatric patient care. Cases were de-identified from actual complex patients seen in geriatrics clinic. All learners receive the case and work through it from their discipline’s perspective, then join a facilitated group discussion to develop collaborative care plans. At session end participants are surveyed using the ICCAS and qualitative comments about perceptions on interprofessional case learning. Thirty-five learners (47%) completed the feedback survey. Disciplines represented were medicine, pharmacy, psychology and social work. Thirty learners (85%) indicated the case discussion session was very educational (n=22, 62%) to educational (n=8, 23%). Themes used most frequently regarding what was most educational were: “different professional approaches”, “professional roles”, “collaboration” and “problem solving”. Typically, learners were unable to identify “least educational” components to the activity, but some learners found the pace of information presentation too rapid or felt other professionals did not provide enough context for the suggestions they made for the case. Suggestions to improve the interprofessional case discussion activity included increased “time for discussion and consensus building”, more session structure, and addition of other professionals (e.g., nutrition, law). The majority of interprofessional learners participating in interprofessional case sessions have found them to be educational. Feedback from learners aligns with goals of interprofessional education.
Does the Coexistence of Food Insecurity and Obesity in Older Adults Explain Variations in Glycated Hemoglobin?
Authors: Chukwurah Queendaleen
Published: December 2020

Obesity and food insecurity are known public health concerns for older adults, and both are independent predictors of glycated hemoglobin (HbA1c). I examined the impact of the co-existence of food insecurity and obesity on HbA1c using the National Health and Nutrition Examination Survey (NHANES), 2005-2014. Body mass index /waist circumference (WC) cut- off values were used to create six body types: normal weight with normal WC, overweight with normal WC, obese with normal WC, normal weight with high WC, overweight with high WC, and obese with high WC. HbA1c was defined as normal < 5.7% and abnormal >5.7%. Food security status (FSS) was defined following USDA protocols (food secure-FS, food insecure-FI). The sample population included 5,772 participants 50 years and older with mean (SD) age of 61.8 (0.2). A weighted multivariable logistic regression controlling for age, gender, race/ethnicity, education, and poverty-to-income ratio was run for this analysis. The proportion of older adults with both FI and obesity with high WC (51.1%, p<0.0001) was significantly higher than those FS (37.5%). Logistic regression model with body types and FSS had a maximum-rescaled R-square (MRRS) of 0.147 vs. 0.093 and 0.144 for FSS and body types alone. An increase in MRRS in the model with both body types and FSS compared to the models containing only body types or FSS demonstrates an improved model for fitting abnormal HbA1c levels. The knowledge of this effect may benefit health risk assessment and management in this population.
Predicting Perceived Health of Older Adults: The Role of Health, Personality, and Resilience
Authors: Arieli Rotem , Kim Joseph , Martin Peter
Published: December 2020

Past research has not addressed how domain-specific “health” personality traits are associated with resilience and well-being. The purpose of this study was to determine pathways from health personality to perceived health, mediated by resilience. Data included 3,907 participants, 65 and older, collected by a large provider of Medicare Supplemental Health Insurance. The Health Personality Assessment (health neuroticism, health extraversion, health openness, health agreeableness, and health conscientiousness), Brief Resilience Scale, and perceived health were measured. Structural equation modeling and bootstrap mediation were conducted in Mplus. The hypothesized model resulted in a marginal fit, so direct paths from health openness and health conscientiousness to perceived health were added, resulting in an improved fit, χ2(192)=1660.96, RMSEA=.04, CFI=.95; χ2∆(2)=403.99, p<.001. Health neuroticism and health extraversion negatively predicted perceived health, fully mediated by resilience, β=-.11, p<.001, and β=-.01, p<.05, suggesting that people anxious about their health or that talk about their health had significantly lower levels of resilience. Resilience positively predicted perceived health, indicating that more resilient people reported better health. Higher levels of health openness predicted significantly lower levels of perceived health, β=-.19, p<.001. Greater levels of health conscientiousness predicted better perceived health, β=.20, p<.001, and resilience in-turn positively related to perceived health, β=.08, p<.001. Health personality and resilience explained 25.3% of variance in perceived health. This study exemplifies the importance of health personality and resilience in predicting perceived health for older adults. Future research should examine interventions focused on health personality increasing resilience, as older adults with higher resilience reported significantly better health.
Clinical Screening for Lower Limb Muscle Weakness in Community-Dwelling Older Women
Authors: Abreu Daniela , Porto Jaqueline
Published: December 2020

The objective of the present study was to evaluate the ability of the five times sit to stand test (5TSST), grip strength (GS) and step test (ST) to detect older women with reduced lower-limb muscle strength (LLMS), and to investigate the clinical usefulness of the combination of such tests. One hundred and nineteen older women were submitted to the 5TSST, GS, ST and lower limb peak torque by an isokinetic dynamometer. The capacity of the clinical tests to detect older women with reduced LLMS was measured using the ROC curve, followed by calculation of posttest probability (PoTP). The results show that a ST score of 0.24 cm per cm of participant’s height shows the best PoTP for a positive test (72%). However, the combination of the ST and 5TSST enhances the accuracy from 48% (prevalence of weakness in the population) to 82.6% if both tests are positive, and decreases the PoTP from 48% to 11.4% if both tests are negative. The inclusion of GS provided additional benefits of small magnitude. In conclusion, the ST performed alone or in combination with 5TSST could be an alternative for clinical screening of LLMS reduction in older women. The early identification of impairment of lower-limb muscle strength in independent older adults may favor early intervention and prevention of negative outcomes such as falls and functional limitations.