bluuebunny/crossref_metadata_2025 huggingface dataset:
PREDICTING FALLS IN PARKINSON'S DISEASE
Authors: Pretzer-Aboff Ingrid A , Elswick and Ronald K
Published: November 2019

People with Parkinson’s disease (PD) have a proclivity to falling. Early identification and treatment of PD patients with a high risk of falling is important to decrease morbidity, mortality, and improve quality of life. We compared functional performance tests and balance tests in people with PD to determine which tests predict fallers. Sixty participants were recruited, mean age 71.4 y.o. (range 55 – 89), 43 were male, and 34 were identified as fallers (defined as having fallen at least twice in the past year). A logistic regression model was built to determine which functional performance and balance tests would best predict fallers. Predictors in the model included Hoehn and Yahr stage of disease, Unified Parkinson Disease Rating Scale (UPDRS), Barthel Index, Timed Up and Go (TUG), Tinetti Balance Assessment, Berg Balance Scale, and results from a force plate that recorded sway in both static and dynamic conditions (open eyes and closed eyes). Correlations among predictor variables were assessed for multicollinearity and were less than 0.8. Using both a forward and backward stepwise approach, the best prediction model included Tinetti Balance Total score only. ROC analysis yielded an area under the curve of 74% with a cutoff of 13 which had a diagnostic accuracy of 68.8% with an 83% specificity and 56% sensitivity. Given that the cost of treatment for an injurious fall far exceeds preventative measures a clinician may opt to use a cut off of 14 when using the Tinetti Balance Assessment given an 70% specificity and 68% sensitivity.
ASSESSING PREFERENCES FOR COMMUNICATING WITH TECHNOLOGY: COMMUNITY-BASED PROVIDER PERSPECTIVES
Authors: Sillner Andrea Y , VanHaitsma Kimberly , Wion Rachel , Boltz Marie
Published: November 2019

Miscommunication during older adults’ care transitions from hospital to community-based settings (e.g. home health) can lead to adverse events. Effective use of technology assisted communication (TAC) may help to remedy miscommunication surrounding care transitions. Care providers in community-based settings are well-positioned to provide insight on the feasibility and current use of TAC. The purpose of this research was to determine contextual factors (i.e., intrapersonal, interpersonal, environmental) that influence the use of TAC in the home health setting from the perspective of community-based direct care providers and administrators. Focus groups were conducted with direct care providers and c administrators from two different settings – rural and urban/suburban. Content analysis was used to determine themes. Participants indicated that there are many barriers for older adults’ use of TAC such as low interest, fear of technology, knowledge gaps, and lack of access to technology. However, others embraced the use of TAC and technology in the community-based care. Additionally, certain forms of TAC, such as text and email, may be better for communicating with informal caregivers. Some direct care providers indicated they were not allowed or encouraged to use certain TAC with patients due to potential security concerns. The community-based care administrators highlighted the importance of TAC but did indicate that use can be limited due to liability and HIPAA concerns. These findings provide important insight for both determining how to best implement TAC for older adults in community-based care settings and aiding in the development of a tool for measuring preferences.
SUPPRESSION OF GHRELIN SIGNALING EXACERBATES ULCERATIVE COLITIS IN OLDER MICE
Authors: Wu Chia-Shan , Noh Jiyeon , Tuchaai Ellie , DeLuca Jennifer A , Allred Kimberly F , Allred Clinton D , Sun Yuxiang
Published: November 2019

The aging process is characterized by increased chronic low-grade inflammation, aka inflamm-aging, which offend is accompanied by ‘leaky gut’ syndrome. Inflamm-aging is a highly significant risk factor for both morbidity and mortality in the older adult population (>65 years of age). In addition, there is a growing prevalence of inflammatory bowel disease (IBD), a chronic inflammatory condition of the gastrointestinal tract in the older adult population. The pathogenesis of late-onset IBD is suggested to be more complex compared with younger IBD patients; the causes determining the age of IBD onset remain unexplained. Ghrelin is a 28-amino-acid peptide hormone mainly produced by X/A-like cells of the stomach, with well-characterized functions in growth hormone secretion, food intake, adiposity and insulin resistance. Ghrelin’s biological relevant receptor is Growth Hormone Secretagogue Receptor (GHS-R). Ghrelin and ghrelin mimetics have been considered viable candidates for treating cachexia, sarcopenia, and gastrointestinal disorders. As expected, we observed that the expression of tight junction proteins in colon mucosal layer decreases with age. When challenged with dextran sulfate sodium (DSS) to induce experimental ulcerative colitis, 18-months old male C57BL/6 mice exhibited exacerbated disease activity scores compared to young male mice (5-months), showing worsened pathology such as rectal bleeding and difficulty in defecation. DSS-induced colitis was exacerbated in both ghrelin-deficient (Ghrl-/-) and ghrelin receptor-deficient (Ghsr-/-) mice. Together, these data suggest endogenous ghrelin signaling contributes to susceptibility to colitis, and ghrelin signaling pathway may present a novel target for prevention and treatment of leaky gut syndrome in aging.
RELATIONSHIP BETWEEN CARE CHALLENGE TYPE AND PSYCHOSOCIAL OUTCOMES IN FAMILY CAREGIVERS OF PERSONS WITH DEMENTIA
Authors: Shaw Clarissa , Williams Kristine N , Hein Maria , Coleman Carissa , Perkhounkova Yelena
Published: November 2019

Enhancing dementia care is a public health priority and supporting family caregivers of persons living with dementia (PLWD) is a critical need. This poster reports the relationships between the types of care challenges reported by family caregivers and their scores on psychosocial measures. Family caregivers (N=83) participating in the FamTechCare clinical trial identified three top priority care challenges and completed a series of measures (i.e., burden, depression, sleep quality, and reaction to dementia behaviors) at baseline. Priority care challenges were classified using the 10-category Technology-supported Dementia Care Typology. Three of the categories (i.e., behavioral and psychological symptoms of dementia [BPSD], activities of daily living [ADL], and disease expectations [DE]) were reported by an adequate number of caregivers in order to test relationships with psychosocial measures using the Kruskal-Wallis Test. Caregivers reporting 2 or 3 BPSD challenges had higher burden (p=.007), more depression (p=.022) and worse sleep quality (p=.020) compared to those reporting 0 or 1 care challenges related to BPSD. In comparison, caregivers with 2 or 3 challenges related to DE (e.g., PLWD memory loss) had less burden (p=.008), less depression (p=.030), and better sleep quality (p=.042), compared to those reporting 0 or 1 challenge related to DE. Caregivers identifying 2 or 3 care challenges related to ADLs also reported higher levels of depression (p=.036). Dementia caregivers face vast caregiving responsibilities. Caregivers facing BPSD challenges report greater burden and depression. These results reinforce the need for tailored interventions to assist family caregivers in the managing varied care challenges.
IDENTIFYING SOCIAL MEDIA RESOURCES AVAILABLE TO CAREGIVERS OF ALS PATIENTS
Authors: Sanchez-Reilly Sandra , Vutukuri Sireesha , Reilly Paula , Ross Isabela S , Mejia Andrea , Ross Jeanette
Published: November 2019

Background: Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disorder that causes muscle weakness, disability, and death, with survival of 3-5 years and affecting all populations including Hispanics. ALS patients are mostly cared for by family caregivers (FCG) who experience burden, psychological distress and impaired quality-of-life. Thus, FCG may not leave their homes to access resources. Social media might be a way to accessing support, but little is known about quality/quantity of AL- FCG resources. Research Objectives: To identify and categorize types of bilingual resources available to ALS-FCG in Facebook. Methods: We used Facebook both groups (public and closed groups) and pages and collected numbers-of-likes, organization type and resource provided. Bilingual search terms (Spanish) included ALS/ALS-caregiver. Results: 24 pages/31 groups in English vs. 37 pages/29 groups in Spanish. English resources had more likes/members (3510/790 vs.410/95; p<0.001) and were more active (60+ posts in recent month). Community resources and provision of social support were similarly shared through groups in both languages; advocacy was more prominent among Spanish groups (69%vs.39%, p<0.001). English pages significantly provided more social support (96% vs.65%, p<0.001), more caregiver skills (67%vs.49%, p<0.001), inspirational roles (88% vs.59%, p<0.001). Spanish pages and groups were better in providing news/research to FCG (59%vs.16%, p<0.001). Implications for research, policy or practice: Facebook provides numerous useful bilingual resources to ALS-FCG. FCG may receive social support, inspiration, training, news/research and advocacy. Further interventions need to actively improve the role of social-media in supporting bilingual ALS FCG and use it as a platform of dissemination.
LOSS NEGATIVELY IMPACTS A HEALTHY LIFE IN US ADULTS: FINDINGS FROM THE HEALTH AND RETIREMENT STUDY
Authors: Ingels Justin B , Miles Toni
Published: November 2019

Previous research reports that the loss of a loved one increases the risk of mortality and physical and mental health problems. Using data from the 2004 to 2014 waves of the Health and Retirement Study, we estimate the years of healthy life (YHL) from 2004 to death for each respondent. YHL is based on the combination of years lived between 2004 and 2014, a projection of years beyond 2014, and self-rated health. Regression models stratified by age and gender were developed with the loss of a parent or spouse as the primary exposure and YHL as the dependent variable. Annual estimates of the total YHL lost associated with bereavement were based on these regression analyses and US Census data. Models reveal a strong dose-relationship between YHL lost and the number of losses. In total, the annual YHL lost associated with loss in US adults between 50 and 84 years of age is estimated at 2.0 and 1.6 million for men and women, respectively. Nearly three-fourths of the annual YHL lost are associated with adults younger than 65. Interaction analyses suggest that increasing physical activity has the greatest impact on reducing YHL lost in those with the greatest number of losses, one to two YHL per person. Understanding the full impact of loss on the lives of adults is an important step toward framing loss as a public health issue, especially for middle-aged adults. Results suggest that physical activity should be an important aspect of bereavement interventions.
GENOME-WIDE META-ANALYSIS SUPPORTS HETEROGENEITY IN POLYGENIC ARCHITECTURE OF DISABILITY
Authors: Kulminski Alexander , Kang Chansuk , Loika Yury , Stallard Eric , Culminskaya Irina
Published: November 2019

Disability and frailty increase steeply with age after midlife. They comprise broad, non-specific aging-related health/well-being declines. Understanding the molecular mechanisms of these declines could help in combating processes related to intrinsic aging. We performed genome-wide meta-analysis of disability using data on N=12,550 disabled individuals of Caucasian ancestry from five independent studies with N=24,068 genotyped participants. Disability was measured using the Activities of Daily Living (ADL) scale. A subject was considered disabled if he/she had at least one ADL impairment. All subjects in our study were aged 50+ years. The analysis followed a discovery-replication strategy using two studies as discovery samples and three others as replication samples. At the discovery stage, we selected SNPs at nominal significance (p<0.05) and evaluated their associations with disability in the replication samples. Meta-analysis across all studies identified 30 SNPs (24 loci) at p<10e-4. SNPs from four loci (chromosomes 2, 8, and 12) attained suggestive significances at p<10-5. We constructed two polygenic risk scores (PGRS) using these 30 SNPs whose minor alleles were positively (19 SNPs) and negatively (11 SNPs) associated with disability, PGRS_p and PGRS_n, respectively. Meta-analysis across all studies identified strong effects for PGRS_p (beta=0.436, p=1.18×10e-32) and PGRS_n (beta=-0.426, p=8.74×10e-19). The associations for the PGRSs observed in two discovery studies were replicated in three independent studies. The lack of genome-wide significant effects of individual SNPs combined with the highly significant effects of the PGRSs shows that, in line with the heterogeneous origin of disability, its genetic architecture is of highly heterogeneous polygenic origin.
DELIRIUM SEVERITY AND COGNITIVE OUTCOMES
Authors: Welch Sarah A , Ely E Wesley , Han Jin H
Published: November 2019

Delirium is heterogeneous and can vary by severity. The impact of its severity is unclear. This prospective cohort study enrolled emergency department (ED) patients who were > 65 years old and admitted to the hospital. Delirium severity was determined by the Confusion Assessment Method for the Intensive Care Unit Severity (CAM-ICU-S) Scale measured at enrollment. This scale ranges from 0 (no symptoms) to 7 (most severe). Premorbid and 6-month cognition were determined using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) which ranges from 1 to 5 (severe cognitive impairment). Multiple linear regression was performed to determine if delirium severity was associated with 6-month function and cognition adjusted for pre-illness IQCODE, baseline functional status, comorbidity burden, severity of illness, and central nervous system diagnosis. Two-factor interactions were incorporated to determine if pre-illness cognition modified the relationship between delirium severity as measured by the CAM-ICU-S and 6-month cognition. A total of 228 older patients were enrolled in the ED and of these, 105 were delirious. Median (interquartile range) CAM-ICU-S scores was 2 (0, 5). In patients with intact pre-illness cognition, a point increase in the CAM-ICU-S significantly increased the 6-month IQCODE by 0.06 (95%CI: 0.01 to 0.12) points. In patients with impaired pre-illness cognition, there was no significant association between the CAM-ICU-S and 6-month IQCODE. Thus delirium severity is associated with poorer 6-month cognition, but this association is more prominent in those with intact pre-illness cognition.
USING SOMATOSENSORY GAMES TO IMPROVE HEALTH AND SOCIAL ENGAGEMENT OF TAIWANESE OLDER ADULTS IN A COMMUNITY
Authors: Chen Duan-Rung , Chen Ya-Mei , Tseng Winston Tseng
Published: November 2019

Objective. Playing games has become a new way to enhance the physical activity, quality of life, social engagement of older adults. This study aims to conduct a 6-month somatosensory game program, inviting older adults to play Microsoft Xbox Kinect games and study whether games can bring benefits to them. Methods. A total of 70 community-dwelling older adults (35 as experimental group, 35 as controls) were recruited. The experiment group played somatosensory games twice per week in a local health center. These games contained three types of categories: 1) Tournament games (for upper limb and lower limb); 2) Single games (for aerobic exercise and muscle training);3) Puzzle games (for collaboration and group dynamics): Results. After 6 months, in the experiment group, the body mass index decreased from 23.45 to 23.29 (p<0.03). In muscular endurance category, 30 second chair rise jumped from 18 to 23.07 (p<0.0001). And 2 min leg lifting increased from 119.48 to 137.75 (p<0.001). In the flexibility category, back scratch test from right hand on top and left hand on top both improved (p<0.026; p<0.46, respectively). Trend analysis indicates that the improvements in 30 second chair rise (p<0.0001) and 2 min leg lifting (p<0.001) is linear. The intensity of social interactions increased noticeably in the experiment group. The SF8 health survey also revealed that experimental group perceived lower level of bodily pain. No significant improvement in the control group in all categories. Conclusion. Playing somatosensory games regularly may help older adults physically and socially.
MULTIMORBIDITY RESILIENCE IN COMMUNITY-RESIDING OLDER ADULTS: MEASUREMENT AND HEALTH OUTCOMES
Authors: Xu Yingzhi , McConnell Eleanor , Xue Tingzhong (Michelle) , Corazzini Kirsten
Published: November 2019

Multimorbidity is widespread, costly, and associated with a range of deleterious outcomes; it affects an estimated 67-80% of older adults. This study tests the validity of a multimorbidity resilience index developed in a Canadian sample of older adults by Wister et al., (2018), with a U.S.-based sample, using National Social Life, Health, and Aging Project (NSHAP) data, and draws upon the index to investigate the effects of resilience on outcomes over time. We mapped Wister et al.’s (2018) index to NSHAP measures, and assessed cross-sectional associations with health outcomes, using logistic regression. To assess the effects of resilience on health outcomes over time, we estimated mixed models of the relationships between resilience on outcomes over a 5-year interval. Total resilience was consistently associated with improved outcomes, including pain level (OR=.51, CI .41-.64); reduced utilization (OR=.45, CI .33-.60); improved mental health (OR=9.13, CI 6.20-13.44); self-rated physical health (OR=6.97, CI 4.76 10.19); and sleep quality (OR=3.66, CI 2.76-4.86). Longitudinal model results indicate change in multimorbidity resilience and number of chronic diseases predict (α=.001) pain level and self-rated physical health. Effects were moderated by socio-demographic factors. Our findings validate Wister et al.’s (2018) resilience index in a U.S. sample, supporting the importance of this measure to capture core components of older adults’ capacity to sustain well-being in the context of living with multiple, chronic conditions. Results from the longitudinal models provide beginning insights into the effects of resilience on symptom experience and perceived health over time, highlighting potential levers for change.
QUANTIFYING THE BURDEN OF HOSPITALIZED DAYS IN MEDICARE BENEFICIARIES WITH MULTIMORBIDITY
Authors: Wei Melissa Y , Tilton Nicholas , Mukamal Kenneth J
Published: November 2019

Multimorbidity predicts several health outcomes including physical and cognitive functioning and mortality. Multimorbidity also predicts healthcare burden, but this has not been studied using a patient-centered measure that weights conditions by their impact on physical functioning. Health and Retirement Study participants were continuously enrolled in Medicare Parts A/B 1-year before and after the 2012-2013 HRS interview. Medicare claims were used to compute ICD-coded multimorbidity-weighted index (MWI-ICD) by summing physical functioning-weighted conditions. Given excess observations of zero hospital days (78.1%), we used zero-inflated Poisson regression to examine the association between multimorbidity and hospitalized days. First, logit models predicted membership into the zero-coded “no hospitalizations” group. Second, Poisson models predicted hospital days for participants not in the zero-coded group. We converted adjusted regression coefficients to odds ratios to report odds of zero hospitalized days. To compare model fit between MWI-ICD and simple disease count we used AICs. The final sample N=5201 participants had mean age 77.6+/-11.6 years, MWI-ICD 16.5+/-11.6, and 1.9+/-6.0 (range 0-90) hospitalized days. Each 1-point increase in MWI-ICD was associated with 4.3% decreased odds of zero hospitalized days (OR=0.96, 95%CI: 0.95-0.96) and 2% increased number of expected hospitalized days (IRR=1.02, 95%CI: 1.01-1.03) over one year in adjusted models. MWI-ICD had a lower AIC than simple disease count. Multimorbidity measured with MWI-ICD was associated with a decreased odds of zero hospitalized days and an increased number of expected hospitalized days. Multimorbidity contributes greatly to patient burden through increased hospitalization and is better captured through an index weighting conditions to physical functioning.
FEASIBILITY OF ONLINE SYNCHRONOUS CAREGIVER DEMENTIA COACHING FOR REJECTION-OF-CARE BEHAVIORS
Authors: Jablonski Rita A , Vicki Winstead , Pilonieta Giovanna , Geldmacher David
Published: November 2019

Problem: Two-thirds of family caregivers of persons living with dementia have encountered rejection-of-care behavior, usually during assistance with activities of daily living. Purpose: To describe the feasibility of an online videoconferencing platform to help caregivers prevent and reduce ROC behavior. Design: Quasi-experimental. Sample: Twenty-six family caregivers: 54% female, 77% white, 62% spouses (31% wives, 31% husbands), mean age 65 years, and college-educated (92%). Their care recipients were 61% female, 77% white, mean age of 76 years, and college-educated (88%). Procedure: Family caregivers who endorsed problematic ROC behaviors in their care recipients participated in six online, individual, synchronous, sequential, and weekly 1-hour coaching sessions. We measured general burden (Zarit Burden Inventory) and the frequency, severity, and associated distress of responsive behaviors (Neuropsychiatric Inventory Questionnaire). Data collection intervals were before coaching (baseline), immediately after the final session (Time 1), and six weeks (Time 2) and 12 weeks (Time 3) after the final session, respectively. Results: Caregivers reported less overall distress scores at Time 2 compared to baseline: 13.58 (SD 6.44) versus 17.42 (SD 6.90), t=2.56, p=0.017). Distress scores returned to baseline by Time 3. Caregivers reported less severe ROC behavior at Time 2 which was not statistically significant. Burden remained unchanged throughout the 24 weeks. Conclusion: Online caregiver coaching that targets ROC behavior is feasible. Qualitative review of the encounters suggests that a longer period of intervention and an outcome measure more sensitive to ROC effects on activities of daily living may be needed in future studies.
β-GPA: AN AMPK ACTIVATOR WITH POTENTIAL EFFECTS ON HEALTHSPAN AND FUNCTION
Authors: Dorigatti Jonathan , Thyne Kevin , Liu Yuhong , Salmon Adam B
Published: November 2019

β-Guanidinopropionic acid (β-GPA) is a naturally occurring compound reported to activate AMP Activated Protein Kinase (AMPK) signaling in vivo. Acute administration of β-GPA in young animals has been reported to improve multiple functional measures including a switch to oxidative fatigue-resistant muscle fibers, improved glucose uptake, and increased mitochondrial biogenesis. However, it is unknown if β-GPA may promote healthy aging or prevent late-life functional decline. To address this knowledge gap, we tested the effects of β-GPA on mitochondrial energetics and cellular function in young and old genetically heterogenous mice (HET3). Both age groups were fed either 1% β-GPA or control chow for ~5 months and basic functional parameters including metabolism were assessed. β-GPA treatment decreased lean and fat mass in young males, but prevented late-life losses in these parameters in old animals. Notably, glycated hemoglobin (HbA1c) levels were lower in treated young and old males suggesting improved glucose homeostasis. Citrate synthase activity was also higher in old males fed β-GPA suggesting increased mitochondrial biogenesis. At the molecular level, mitochondrial Complex I expression decreased with β-GPA treatment in old males versus controls. High resolution respirometry revealed generally decreased respiration in old animals compared to young and decreased Complex 1 coupled respiration in soleus of β-GPA treated young but not old males. These findings indicate that the mitochondrial effects attributed to β-GPA may be mediated by its action on Complex I. While treatment outcomes varied in young and old males these results suggest β-GPA may prove beneficial in combating age-related declines in function.
SEX HORMONES AND ARTHRITIS IN A LONG-LIVED ANIMAL MODEL, THE ELEPHANT
Authors: Chusyd Daniella E , Brown Janine , Nagy Tim R , Griffin Timothy , Kraus Virginia , Huebner Janet , Allison David , Austad Steven N
Published: November 2019

Arthritis affects women more so than men, particularly after menopause. Sex hormones may play a role in arthritis development, yet this is still unclear. Elephants have a similar lifespan to humans and develop arthritis and joint issues (musculoskeletal impairments (MI)), but do not undergo menopause. Interestingly, many female zoo elephants do not exhibit normal ovarian cycles, closely resembling that in post-menopausal women. Objectives: 1) examine ovarian cyclicity status with MI (Asians: N=84; Africans: N=83); 2) determine whether gonadotropin and sex hormones are reduced in cycling elephants with MI (Asians: N=16; Africans: N=26); and 3) evaluate whether serum CTXI, a marker of type 1 collage degradation, is associated with MI in elephants (Asians: N=40; Africans: N=32). We used longitudinal serum and health data on ovarian cycling and non-cycling zoo African and Asian elephants with and without MI. Serum progestagen, leutinizing hormone, follicle stimulating hormone, and CTXI concentrations were measured. Cyclicity status was based on progestagen patterns. Zoo veterinarians classified the elephant with MI based on clinical exams and observations. In both Asian and African elephants, MI was significantly associated with cyclicity status (P=0.015, 0.032, respectively), but not independent of age (P=0.251, 0.091, respectively). There were no significant differences in any hormone concentration, during either the luteal or follicular phase, between elephants with or without MI (P>0.135). There were no significant differences in CTXI concentrations between age- and cycling-matched elephants with and without MI (P>0.957). Preliminary results do not provide compelling evidence that gonadotropin and sex hormones influence MI development in elephants.
NEUROPATHOLOGY AND GAIT SPEED DECLINE IN OLDER ADULTS: THE ATHEROSCLEROSIS RISK IN COMMUNITIES (ARIC) STUDY
Authors: Sullivan Kevin J , Griswold Michael , Hughes Timothy , Hugenschmidt Christina E , Lockhart Samuel , Mosley Thomas , Gottesman Rebecca , Windham Gwen
Published: November 2019

Neuropathological markers including amyloid-beta (Aβ) have been implicated in mobility decline in older adults, but no studies have examined the relationship between these markers and longitudinal change in gait speed in a racially diverse community-based sample. In the multi-site prospective ARIC study, a subsample of participants (n=1,978, mean age=76.3, 28.5% black) underwent brain MRI at Visit 5 (2011-13). Of these, 343 participants (mean age=75.9, 42.6% black) completed PET scans using the tracer florbetapir to estimate global brain Aβ. We investigated the relationship between four neuropathological markers [white matter hyperintensities (WMH; log2cm3), infarcts (present/absent), brain atrophy (log2cm3), and global Aβ (log2SUVR)] with cross-sectional usual pace gait speed (cm/s) over 4 meters, and change in gait speed through Visits 6 (2016-17) and 7 (2018-19). Linear regression models were adjusted for age, site, sex, education, BMI, intracranial volume, and all race interactions. Cross-sectionally, slower gait was associated with higher WMH volume (β=-2.16, 95%CI: -2.92, -1.39), infarcts (β=-5.81, 95%CI: -7.86, -3.76), and brain atrophy (β=-16.39, 95%CI: -21.07, -11.71). Longitudinally, only higher WMH volume was statistically associated with gait speed decline (β=-0.14, 95%CI: -0.28, -0.01). Global Aβ was not statistically associated with gait speed cross-sectionally (β=-.269, 95%CI: -8.11, 7.57) or longitudinally (β=-1.16, 95%CI: -2.94, 0.62). There were no significant interactions with race. Detrimental relations of cerebral small vessel disease to mobility and mobility decline were observed across race in this diverse sample. The magnitude of the Aβ association with gait speed decline was high, although not statistically significant in the smaller PET subsample.
LIVING WITH MULTIPLE MYELOMA: SELF-MANAGEMENT STRATEGIES
Authors: LeBlanc Matthew R , LeBlanc Thomas W , Ashley Bryant L , Pollak Kathryn I , Bailey Donald E , Smith Sophia K
Published: November 2019

Multiple myeloma (myeloma), is an incurable cancer of the plasma cells that affects many older adults. Over 30,000 new diagnoses and over 12,000 deaths are attributed to myeloma annually in the United States, where the median age of diagnosis is 69 years old. Dramatic improvements in survival over the past fifteen years have transformed myeloma into a chronic disease for many. The disease and its toxic, ongoing treatment lead to significant challenges for patients. In this study we explore the self-management strategies patients use to address the challenges of living with myeloma through semi-structured one-on-one interviews with myeloma patients and clinicians. Fifteen myeloma patients and ten myeloma clinicians were interviewed between September 2017 and September 2018. Self-management strategies emerged in five major categories; managing uncertainty, finding emotional strength, seeking support, medication management, and activity management. The care of MM patients has made great strides as new and more effective treatments have extended survival for many patients. Effective self-management strategies are critical in addressing the challenges of this increasingly chronic disease. Our study explores the ways myeloma patients address the many challenges they face due to their disease and its’ treatment. Findings from this study could inform the development of interventions to optimize and support patients living with myeloma self-management.
LAY YOUR BURDENS DOWN: DEFERRED RELIGIOUS COPING AS A MARITAL STRESS BUFFER FOR OLDER AFRICAN AMERICAN COUPLES
Authors: Skipper Antonius D
Published: November 2019

Although growing bodies of research explore the dynamics of minority families, few consider the African American family from a strengths-focused perspective. Stressors that threaten familial stability, such as financial strain, health disparities, and sporadic employment, disproportionately affect African American families and contribute to high rates of dissolution. In response, African American families often rely on religion as a source of coping and resilience. While existing literature adequately captures the frequency of religious-based responses to stress, opportunities to examine the nuances and underlying processes of religious coping for African American families exist. This study addresses the need to move beyond the broad measures of religiosity and religious coping, in exchange for a more in-depth exploration of how various forms of religious coping, specifically deferred coping, impact well-being. Deferred religious coping is characterized as a complete reliance on a higher power during a time of stress. Thirty-five older African American couples (N=70 individuals), representing 11 states in the U.S., were interviewed regarding the dynamics of deferred religious coping in the marital dyad. Following the digital recording and transcription of the narrative data, the interviews were analyzed with an open coding procedure consistent with grounded theory and Numeric Content Analysis (Marks, 2015). Analyses reveal that nearly 75% of the couples interviewed utilized deferred religious coping in response to stressors that could threaten marital stability. Further, salient themes include: (1) The Three-Party, Divine Triangle of Marriage, (2) Deferring Health Problems Reduces Worry, and (3) A Healthy Work-Family-Prayer Balance. Implications for practice are also discussed.
FAMILY DEMENTIA CAREGIVER RECRUITMENT STRATEGIES IN LONG-TERM CARE FACILITIES
Authors: Paun Olimpia , Inventor Ben R , Fogg Louis , Vondracek Hugh , Salinas Ilse
Published: November 2019

Recruitment of dementia caregivers whose family members reside in long-term care facilities (LTCFs) poses unique challenges as it traditionally relies on the assistance of facility administrators. The purpose of this presentation is to examine and evaluate new recruitment strategies to determine their effectiveness in an ongoing Stage I randomized clinical trial testing the effects of a Chronic Grief Management Intervention, Video-streamed (CGMI-V) on caregivers’ mental health (grief, depression, anxiety) and facility-related outcomes (conflict with staff, satisfaction with care). A total of 144 caregivers will be randomly assigned to the CGMI-V or to the minimal treatment conditions. The initial recruitment plan was to build on already-established relationships with more than 35 LTCFs that helped recruit in a previous study. The usual approach was to offer written materials and onsite presentations about the study to facility staff and to dementia family caregivers of facility residents. Within the first six months, recruitment efforts yielded less than a dozen participants, thus we had to refine our approach. Revised recruitment strategies included the adoption of resources from the National Institute on Aging’s ADORE (Alzheimer’s and Dementia Outreach, Recruitment, and Engagement) and ROAR (Recruiting Older Adults into Research) platforms. This new approach included online study advertising on NIH and Alzheimer’s Association research study repositories and advertising on parent institution’s on-hold messaging system. Adoption of these new strategies is yielding an increase in participant screening and enrollment. Results are pending.
UPDATING AND TESTING THE PASRR SCREEN IN KANSAS: REAL WORLD IMPLICATIONS
Authors: Wendel-Hummell Carrie L , Kang Hyun , Sullivan Darcy , O'Neal Alan , Swartzendruber Lora , Boyd Marion , LaPierre Tracey , Poggio John
Published: November 2019

Kansas is updating the PASRR (Preadmission Screen and Resident Review) Level 1 screen per new guidance from the PASRR Technical Assistance Committee (PTAC), via a partnership between the State and university researchers. PTAC has directed states to screen for undiagnosed serious and persistent mental illness (SPMI) and also recommends screening for substance related disorders. Stakeholders were engaged through advisory workgroups and a content validity expert panel. These activities led to the creation of a revised PASRR Level-1 screen, but stakeholders also raised several concerns. PASRR law does not require Level-1 assessors to have professional training in mental health diagnoses or treatment, yet new guidelines asks them to screen for undiagnosed SPMI. Further, there are apparent discrepancies between these new guidelines and PASRR Level-2 criteria. Finally, current information management systems are not equipped to handle the higher security protocols associated substance use disorders. The draft instrument was tested with a sample of 103 nursing facility applicants by trained PASRR assessors and inter-rater reliability (IRR) was tested via a standardized vignette with 14 trained PASRR assessors. Only 3% of actual NF applicants were identified as possibly having an undiagnosed SPMI and only 43% of assessors correctly identified symptoms of a suspected SPMI in the standardized vignette, indicating poor validity and reliability in assessing for undiagnosed SPMI during the Level-1 screen. New PASRR guidelines may better ensure that nursing facility residents receive appropriate care for SPMI, however, there are many challenges to ensuring an accurate screen and supporting successful implementation.
TRAUMA THROUGH THE LIFE CYCLE IN AN IMMIGRANT POPULATION
Authors: Dong Gabriella , Bergren Stephanie M
Published: November 2019

The majority of studies on traumatic events have focused on either children or younger adults, while traumatic events in older adults have not been sufficiently investigated. Older immigrants encountered a wide range of traumatic events across the life span, before and after immigration, in the origin and host countries. This study aims to provide a descriptive epidemiology of lifetime traumatic events in older Chinese Americans. The data were drawn from the Population Study of Chinese Elderly in Chicago (PINE) in 2017-2019, with a sample size of 3,126. Traumatic events were evaluated by natural disasters, personal and historical events. After examining the lifetime prevalence of natural disasters, we found typhoon (64.46%) has the highest prevalence, followed by earthquake (39.81%) and tornado (7.25%). In terms of personal events, death of a loved one (69.78%) was the most prevalent, followed by robbery (12.57%), physical assault (5.36%), fire (5.29%), divorce (5.16%), cancer (5.10%), falsely accused (2.15%), homeless (1.57%), sexual assault (0.99%), and imprisonment (0.74%). In addition, 18.91% of women experienced abortion and 11.25% of women experienced miscarriage,. With respect to historical events, most participants experienced the Cultural Revolution (73.27%), the Great Leap Forward (62.71%), and famine (60.01%). A small proportion experienced the Japanese invasion of China (27.14%), Tiananmen Square protests (7.86%), and the Vietnam war (4.78%). In our sample, women were more likely than men to encounter traumatic life events. Further studies could examine the influence of cumulative exposure to natural disasters, personal events and historical events on health outcomes of older immigrants.
WHOLE-BODY TAU-KNOCKOUT MICE DEVELOP AGE-ASSOCIATED METABOLIC DYSFUNCTION AND OBESITY
Authors: Baeuerle Eric , Zhang Ning , Musi Nicolas , Orr Miranda E
Published: November 2019

The microtubule associated tau protein (MAPT) is expressed in multiple tissues; however, the primary focus has been its role in neurodegenerative diseases such as Alzheimer’s disease. Few efforts have been made to investigate tau protein function outside of the nervous system. We previously noted that aged (20 mo.) Mapt-KO mice had significantly greater body mass than either age-matched wild-type mice or a Mapt-KO/rTg4510 mouse model of late stage neurodegeneration. We hypothesize that endogenous tau contributes to normal metabolic function and sought to characterize potential metabolic alterations in whole body Mapt-KO mice. In 2-3 month-old wild type (WT) and Mapt-KO mice fed ad lib chow diet, we observed no significant difference in glucose or insulin tolerance. However, in 16 month-old Mapt-KO mice fed ad lib chow, we observed glucose intolerance (p<0.05) and increased body mass (1.45-fold, p<0.001) compared to WT. In this aged cohort, we evaluated body composition by quantitative magnetic resonance, spontaneous activity and running, grip strength and Rotarod performance, nest building, and performed high resolution respirometry in hippocampus and soleus. Mapt-KO shows significant increases in lean and fat mass (1.18-fold, 2.97-fold, p<0.05) and nest building (Deacon Score, p <0.05), and reductions in ambulatory activity (p<0.01) and rotarod balancing (p<0.0001) despite an ability to learn the task. No significant changes were seen in grip strength, spontaneous running, or mitochondrial respiration, although there was a trend of reduced maximum uncoupled respiration in Mapt-KO hippocampus (p<0.1). This study concludes that Mapt plays an important role in glucose homeostasis and body weight regulation.
FACTORS ASSOCIATED WITH HEALTH-RELATED QUALITY OF LIFE IN KOREAN ELDERLY BY REGION
Authors: Yun Jungmi , Lee Yeongsuk , Lee Hyun-Ju
Published: November 2019

There have been inequalities in healthcare indices in the elderly by regions in Korea, and this gap is increasing. To improve their health-related quality of life (HRQoL), it is essential to identify the cause of the regional health gap and to work out solutions. This study aimed to analyze the factors associated with HRQoL in the Korean population aged over 65 years by region. Integrated raw data from the 2017 Korea Community Health Survey (n = 57,317), a cross-sectional study, were utilized. Based on the reduced Social-Ecological Model, the dependent variable was HRQoL and individual, interpersonal, and community factors were independent variables. Data were analyzed by complex-samples descriptive methods, and complex-samples general linear model (CSGLM). In both regions, individual factors (gender, age, household income, education level, drinking, BMI, sleep duration, the number of chronic illness, economic status, subjective health status, and physical activity), interpersonal factors (neighbor and friend contact frequency, religious activity, fellowship activity), and community factors (satisfaction with safety level, public transportation, and medical service) were commonly associated with HRQoL of elderly people (p < .05). In urban areas, household type and charity activity were associated with HRQoL, in contrast, neighboring help was associated with HRQoL in rural areas (p < .05). Based on the results of this study, multi-dimensional efforts considering personal, social, and environmental factors are necessary to improve HRQoL of the elderly. Furthermore, it implies that efforts should be made to ensure health equity through social support, or improvement of community factors considering regional characteristics.
CUMULATIVE ADVERSITY AND COGNITIVE FUNCTION AMONG OLDER ADULTS
Authors: Dong Gabriella , Li Mengting
Published: November 2019

The majority of studies on traumatic life events focus on posttraumatic stress disorder and depression, while less is known whether the cumulative exposure to traumatic events over the life course will deteriorate cognitive function. This study aims to investigate the association between lifetime traumatic events and cognitive function in an immigrant population. The data were drawn from the Population Study of Chinese Elderly in Chicago (PINE). Face-to-face interviews were conducted with a sample of 3,126 U.S. Chinese older adults in 2017-2019. Twelve types of traumatic events were assessed: physical assault, residential fires, sexual assault, miscarriage, abortion, imprisonment, being falsely accused, divorce, death of a loved one, being robbed, experiencing cancer, and being homeless. Cognitive function was measured through global cognition, episodic memory, working memory, processing speed, and Mini-Mental State Examination (MMSE). Linear regression was performed. In our sample, the maximum traumatic events experienced by one participant are eight types. Older adults who experienced one additional personal event were associated with higher global cognition (b=0.101, SE=0.012), episodic memory (b=0.130, SE=0.016), working memory (b=0.151, SE=0.034), processing speed (b=1.709, SE=0.178), and MMSE (b=0.124, SE=0.057), while controlling for age, gender, income, and education. In contrast with earlier studies, we identified the positive relationships between traumatic events and cognition. Older adults who had prior experience with stressful life events could demonstrate an advantage over those without such an experience. Further studies could investigate how individuals would respond to stressful life events, and how their resilience mechanism would promote cognitive function.
LOSS OF HYPOXIA SIGNALING LIMITS SKELETAL MUSCLE RESPONSE TO AEROBIC EXERCISE IN AGING
Authors: Endo Yori , Li Bin , Udeh Kodi , Panayi Adriana C , Neppl Ron , Sinha Indranil
Published: November 2019

Skeletal muscle function declines with aging. Physical activity improves muscle function, but may require upregulation of the hypoxia signalling pathway. In this study, we examine the effect of exercise on muscle function in young and old mice and explore the role of hypoxia pathway in mediating exercise-induced functional improvement. Young (3 months) and old (22-24 months) mice underwent either aerobic exercise training on a treadmill for 8 weeks (40 minutes per run, 3 times weekly, at 8 meters/min at a 15 degree inclination) or no exercise as a control. Maximum running speed and distance were measured pre- and post-exercise. Following training, there was a significant increase in both maximal speed (20%, p<0.05) and distance (2.5 fold) running in young mice which exercised versus young control (p<0.01). Old mice following exercise training did exhibit any improvement versus the old control group. Notably, protein levels of aryl hydrocarbon receptor nuclear translocator (ARNT), a critical regulator of hypoxia signalling, was 4.7-fold lower in the muscle of old mice after exercise as compared to young (p<0.01). To evaluate further whether loss of hypoxia signaling limits response to exercise, we developed a mouse with an inducible, skeletal muscle specific ARNT knockout (ARNT mKO). ARNT mKO mice exhibited no improvement in either maximal running speed or distance following exercise training. In contrast, littermate controls, with normal ARNT levels, exhibited improvement in both maximal speed and distance running following exercise. Our results suggest that an aging-associated decline ARNT and hypoxia signalling may limit aerobic exercise benefits.
LIFESPAN AGE-RELATED DIFFERENCES IN THE REGIONAL WHITE MATTER MICROSTRUCTURE OF THE HUMAN CORPUS CALLOSUM
Authors: Lynn John , Anand Chaitali , Arshad Muzamil , Khatib Dalal , Stanley Jeffrey , Raz Naftali
Published: November 2019

The corpus callosum (CC) connects homologous cortical structures across hemispheres and is the largest white matter tract in the human brain. Post-mortem studies suggest that CC myelination begins in infancy, reaches a plateau in the middle age, and declines in the later years. The latter is accompanied by myelin disruption and reduction in fiber density and diameter, i.e. changes in intra-/extracellular water space. We used multi-echo T2 imaging to estimate, via multi-exponential T2 relaxation of water, the myelin water fraction (MWF), a direct proxy for myelin content, and geometric mean T2 (geomT2IEW) that reflects water in the intra-/extracellular space, to investigate age differences in five CC regions covering its anterior to posterior span in 395 healthy individuals (7-85 years; 161M+235F). The general linear model analysis of MWF showed main effects of age and age-squared conditioned on interactions by CC region. Univariate polynomial regressions on three age groups (7-29, 30-59, and 60-85 years) revealed the overall quadratic association between age and MWF as mainly driven by the positive linear relationship in the youngest group and minimal differences in the remainder of the lifespan, save for two weak negative linear associations in the anterior/middle CC body. With geomT2, a main linear effect of age, and significant interactions between age and age-squared by region were observed. The positive linear association was especially prominent in the regions with greater fiber density. The results are consistent with CC myelination into adulthood and decreased axonal density and diameter but not prominent myelin degeneration in elderly individuals.