bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring the Impact of Age-Related COVID-19 Messaging on Internalized Ageism in Older Adulthood
Authors: Sangrar Ruheena , Chesser Stephanie , Porter Michelle
Published: December 2020

Public health messages during the COVID-19 pandemic have indicated a higher risk for older people and/or those who have multiple health conditions. Subsequent societal discourse, however, has at times arguably protested the full protection and treatment of older people from COVID-19, potentially contributing to internalized ageism. To date, how older people interpret age-related pandemic messaging and discourse has not been explored. This study examined older adults’ perspectives of age-related COVID-19 messaging and societal discourse, as well as their perceptions of vulnerability, using a social constructionism framework. Adults age 65 to 89 years participated in semi-structured interviews about their thoughts and experiences with ongoing pandemic-related public messaging. Preliminary analysis suggests that participant perspectives of COVID-19 messaging are situated along a continuum of concern associated with contracting the virus. While some, for example, describe minimal concern, others express being fearful. Individual perceptions of safety appear to be informed, in part, by the presence or absence of an underlying health condition. Individual approaches to media criticism and consumption, personal risk-taking thresholds, financial stability, and social connectedness also appear to influence how the participants perceive pandemic-related messaging. Findings suggest the framing of COVID-19 and pandemic protocols, as well as the media’s sensationalization of age-related issues, can impact older peoples’ perceived vulnerability of contracting the virus. Future research is needed to understand the long-term implications of ongoing pandemic-related messaging on older adults’ experiences of aging, as well as the consequences such messaging could pose to for their health and social behaviors.
Facility Characteristics and Quality Deficiencies of Florida Nursing Homes With COVID-19 Cases and Deaths
Authors: Wang Xiaochuan , Wilson Courtney
Published: December 2020

The Coronavirus disease 2019 (COVID-19) has been disproportionately affecting nursing homes throughout the United States, resulting elevated risk for COVID-19 morbidity and mortality to nursing home residents. Given the high percentage of aging population, large number of nursing homes, and staggering surge of COVID-19 cases in Florida, it’s critical to understand factors that may affect Florida nursing homes’ vulnerability to the COVID-19 pandemic. Using Nursing Home COVID-19 Dataset as of July 26, 2020 obtained through Centers for Medicare and Medicaid Services (CMS), and Provider Info Dataset and Health Deficiencies Dataset available through CMS Nursing Home Compare data, we constructed a database of Florida nursing facilities with confirmed COVID-19 cases and deaths, with corresponding facility characteristics and quality deficiencies. We examined the facility characteristics (e.g. facility size, ownership state, chain affiliation, staffing level) and quality deficiencies (e.g. infection control deficiencies) of Florida nursing homes with and without publicly reported COVID-19 cases and deaths. Results indicated that, as of July 26, 2020, 73.3% and 40.8% of Florida nursing homes had resident COVID-19 cases and death, respectively (N=701). Findings also suggested that Florida nursing homes of large facility size, chain affiliated, and for profit, were significantly more likely to have documented resident COVID-19 cases (p<.05). Larger facility size (120 beds or more), staff shortage, and having prior infection control deficiency citation, were significantly related to the odds of having resident COVID-19 deaths (p<.05). Policy and practice implications and future research directions will be addressed to better protect the at-risk nursing home residents.
Factors Associated With Loneliness During the COVID-19 Pandemic Among Older Adults With Chronic Conditions
Authors: Polenick Courtney , Perbix Emily , Salwi Shreya , Maust Donovan , Birditt Kira , Brooks Jessica
Published: December 2020

Social distancing related to the COVID-19 pandemic may heighten loneliness among older adults, especially those with chronic conditions that increase risk for severe illness from the coronavirus. Little is known, however, about potential risk and protective factors linked to loneliness during the pandemic. In the present study, we examined factors associated with loneliness in a U.S. sample of adults aged 50 and older with at least one chronic condition. Participants included 701 adults aged 50 to 94 (M = 64.57 years, SD = 8.84) who were recruited over 8 consecutive weeks between May 14 and July 9, 2020 to complete an anonymous online survey. We estimated a series of multiple linear regressions to determine how sociodemographic characteristics, health characteristics, stress related to COVID-19, and social resources were independently associated with loneliness during the pandemic. Two-thirds of participants reported moderate to severe loneliness. The fully adjusted regression model showed that being a person of color, having a spouse or cohabiting partner, and reporting more emotional support were linked to lower levels of loneliness. Higher anxiety symptoms, more worry about being infected with COVID-19, and greater perceived financial strain because of COVID-19 were associated with higher levels of loneliness. These findings pinpoint potential targets for interventions to improve and maintain the well-being of a particularly vulnerable subgroup of older adults during the COVID-19 pandemic and in future public health crises.
Unsung Heroes: Caregiver Experiences During COVID 19
Authors: Mata Aaron , Mickens Melody , Dassel Kara , Utz Rebecca
Published: December 2020

Objectives: COVID-19 has spared no age group but is proving to be most dangerous to the elderly and individuals with more vulnerable immune systems. COVID-19 represents a unique challenge to caregivers above and beyond the ordinary stresses they experience and many informal caregivers currently providing care have not planned for the pandemic and its effect on access to health care services, respite resources, and support groups, etc. The purpose of our study is to assess COVID-19’s impact on the mental health and wellness of informal caregivers. Method: An interdisciplinary collaborative of caregiving scholars created a 47-item web-based anonymous survey with quantitative and qualitative questions to assess caregiving experiences during COVID-19. Participants were recruited through convenience sampling using social media and flyers distributed by local/national organizations. Results: Participants (N=96) reported an average age of 50 years old and were predominately adult children caring for parents (45%) with neurological (40%) and chronic medical conditions (25%). Only 4% cared for individuals diagnosed with COVID 19. Nearly all reported significant changes in caregiving that included increased time spent caregiving for care recipients and other family members, greater stress and worry, fewer breaks for self-care, increased isolation, and decreased access to social/emotional supports and respite services. Discussion: Unplanned changes to caregiving during COVID 19 have created an acute need for research, clinical care guidelines, and policy promoting virtual respite care, social support for caregivers, and more readily available community based resources that promote caregivers’ physical and emotional wellbeing without requiring them to leave their homes.
Virtual connection between older people with dementia and families during COVID-19 pandemic
Authors: Hung Lillian
Published: December 2020

People staying in hospitals need more support to cope with the lockdown and visitor restriction during the COVID-19 pandemic, especially for older people with cognitive or physical impairment. Everyday technology such as a touchscreen tablet has great potential to support person-centred care. We aimed to support the adoption of tablets for hospitalized people with dementia to connect with families and friends. A patient-oriented research approach was employed to co-produce the toolkit. We are a transdisciplinary team, including a medical student, physicians, nurses, patients, and family partners. We facilitated staff focus groups (n=3), and conducted stakeholders’ interviews (n=4) to gain a more comprehensive understanding of users’ needs. The sample included ten patients, ten family members, 40 staff members, nurses, care workers, physicians, and unit clerks (n=40). The Consolidated Framework for Implementation Research (CFIR) guided the research design and qualitative analysis. A toolkit was developed based on participants’ perspectives on what needs to be in place to support successful adoption. We developed a mobile tablet with one mechanical arm and one leg on wheels. Participants reported impacts: (a) it puts a smile on the patient’s face, (b) it alleviates anxiety and worries on both sides, and (c) it reduces responsive behaviors. The conceptual framework CFIR provides helpful guidance in identifying barriers to implementation. Working with users including patient and family partners to explore possible solutions was key to our success. Future research should engage patient and family partners to seek proactive strategies to address obstacles to advance the science of technology implementation.
Determining the Role of ApoE4 in Age-Related Cerebrovascular Decline
Authors: Foley Kate , Borchian Peter , Garceau Dylan , Kotredes Kevin , Territo Paul , Sasner Michael , Howell Gareth , Diemler Cory
Published: December 2020

Cerebrovascular decline occurs during aging and may be critical during prodromal phases of Alzheimer’s disease (AD). The E4 allele of apolipoprotein E (APOE4) is the greatest genetic risk factor for AD and decreased longevity and studies suggest APOE4 increases risk for age-dependent cerebrovascular damage. To study the relationship between APOE4 and age-related cerebrovascular decline, male and female C57BL/6J (B6) mice carrying combinations of APOE alleles including APOE4 (risk) and APOE3 (neutral), as well as B6 controls were assessed at a variety of ages from 4 to 24 mos for cognitive ability, biometrics and cerebrovascular health including i) PET/MRI using 64Cu-PTSM (perfusion) and 18F-FDG (metabolism), ii) transcriptional profiling and iii) immunofluorescence. Despite no cognitive decline, male APOE4 mice showed hypo-perfusion and hypo-metabolism by 12 mos, while female APOE4 mice showed an uncoupled hyper-perfusion and hypo-metabolism phenotype. Transcriptional profiling showed differential expression of genes involved in regulation of cerebral perfusion, glucose transportation and metabolism in APOE4 mice. An age-dependent blood brain barrier compromise was also apparent in the brains of female APOE4 mice. Physical activity reduces risk for human AD and our data shows exercise improves cerebrovascular health in mice. However, the effects to cerebrovascular health in individuals carrying genetic risk factors such as APOE4 are not known. To determine whether exercise can overcome APOE4-dependent cerebrovascular damage, APOE mice are being exercised from 2-4 and to 2-12 mos. Transcriptional profiling and immunofluorescence will determine whether the benefits of exercise to the cerebrovasculature are modulated by genetic risk factors such as APOE4.
Effects of CNS Demyelination and Myelin Recovery on Urinary Physiology
Authors: Ramasamy Ramalakshmi , Rosenberg Dawn , Hardy Cara , Crocker Stephen , Smith Phillip
Published: December 2020

Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system (CNS). Of note, over 80% of MS patients have urinary symptoms as one of their earliest symptoms. Since MS patients often live into older age, urinary incontinence and retention are significant problems for which few if any effective preventive or therapeutic options are available. The mechanisms by which MS contributes to urinary dysfunction are not well understood. We propose to elucidate the impact of demyelination on urinary performance using the cuprizone model, a model used to study the effects of CNS demyelination and spontaneous remyelination. We hypothesize that CNS demyelination in the cuprizone model will result in aberrant changes in urinary function, and that after remyelination occurs this dysfunction will be alleviated. C57Bl/6 mice were treated with cuprizone (0.2% w/w) for four weeks to induce demyelination. One group was allowed four additional weeks to recover from demyelination, while the other continued cuprizone treatment. Following this eight-week treatment, pressure/flow cystometry, electromyography, and molecular studies were performed to assess demyelination-induced differences in urinary performance. Cuprizone-recovery mice displayed improvements in cystometric function compared to their demyelinated littermates, as seen through improved volume sensitivity and voiding efficiency. Pharmacologic studies showed no significant changes in contractile responsiveness. Thus, we conclude that CNS demyelination results in aging-like phenotype and urinary dysfunction consistent with that observed in clinical disease. Therapeutics aimed at increasing the remyelination potential of the CNS neurons offer the possibility of alleviating urinary dysfunction associated with MS.
NMN Rescues Endothelial Function and Neurovascular Coupling, Improving Cognitive Function in Aged Mice
Authors: Tarantini Stefano , Yabluchanskiy Andriy , Ballabh Praveen , Farkas Eszter , Baur Joseph , Sinclair David , Csiszar Anna , Ungvari Zoltan
Published: December 2020

Adjustment of cerebral blood flow (CBF) to neuronal activity via neurovascular coupling (NVC) has an essential role in maintenance of healthy cognitive function. In aging increased oxidative stress and cerebromicrovascular endothelial dysfunction impair NVC, contributing to cognitive decline. There is increasing evidence showing that a decrease in NAD+ availability with age plays a critical role in a range of age-related cellular impairments but its role in impaired NVC responses remains unexplored. The present study was designed to test the hypothesis that restoring NAD+ concentration may exert beneficial effects on NVC responses in aging. To test this hypothesis 24-month-old C57BL/6 mice were treated with nicotinamide mononucleotide (NMN), a key NAD+ intermediate, for 2 weeks. NVC was assessed by measuring CBF responses (laser Doppler flowmetry) evoked by contralateral whisker stimulation. We found that NVC responses were significantly impaired in aged mice. NMN supplementation rescued NVC responses by increasing endothelial NO-mediated vasodilation, which was associated with significantly improved spatial working memory and gait coordination. These findings are paralleled by the sirtuin-dependent protective effects of NMN on mitochondrial production of reactive oxygen species and mitochondrial bioenergetics in cultured cerebromicrovascular endothelial cells derived from aged animals. Thus, a decrease in NAD+ availability contributes to age-related cerebromicrovascular dysfunction, exacerbating cognitive decline. The cerebromicrovascular protective effects of NMN highlight the preventive and therapeutic potential of NAD+ intermediates as effective interventions in patients at risk for vascular cognitive impairment (VCI).
Home Health Care Practices to Reduce Acute-Care Hospitalizations
Authors: Albright Bonnie , Pelenur Yael
Published: December 2020

Avoidable acute-care admissions are linked to negative health outcomes for patients and are costly to insurers. Home health care agencies (HHAs) are important players in preventing these admissions. Research on best practices to prevent acute-care admissions in the home health care context is limited. The purposes of this study were both to discover what practices HHAs are implementing in Medicare-certified home health care episodes to prevent acute-care admissions, and to learn what barriers HHAs face in implementing these practices. This study used mixed methods including qualitative and quantitative elements. Seven key informant interviews were used to develop a web survey that was emailed to all Medicare-certified HHAs in Massachusetts (response rate 12.43%, n=23). Using qualitative methods including thematic review, open-coding, and member-checking this study developed a four-categorization method. The categories are assessment, interventions, communication, and global practices. The study also developed a taxonomy for describing barriers to implementing practices. The distribution of responses for the new taxonomic categories were: patient-related (32.35%), staffing-related (29.41%), software-related (17.65%), physician/hospital-related (14.29%), and reimbursement/regulation-related (5.88%). This study fills a gap in research by describing the realities of home health care practice in the context of avoidable acute-care admissions. The categorization of best practices and the taxonomy of barriers developed in this study provide frameworks for understanding HHA practice. Further research is needed to effectively reduce avoidable acute-care admissions during and after Medicare-certified home health care episodes.
Measuring Caregiver Person-Centered Communication for Persons With Dementia via Video Observations
Authors: Jao Ying-Ling , Coleman Carissa , Williams Kristine , Berish Diane , Liu Wen , Berkley Amy , Liao Yo-Jen
Published: December 2020

Communication is fundamental for daily care activities in nursing homes (NHs). Second-by-second behavioral coding of video observations is an ideal approach to examine the interactive nature of communication but requires a reliable coding scheme. Recent studies have adapted the Peron-Centered Behavioral Inventory (PCBI) and Task-Centered Behavioral Inventory (TCBI) to analyze caregiver communication during mealtime interactions, but their use for coding general daily caregiving activities has not been widely evaluated. This pilot study adapted the PCBI and TCBI of video observations and determined their inter-rater reliability for measuring caregiver verbal communication with persons with dementia (PwD). We analyzed videos from a randomized controlled trial of an intervention to improve caregiver communication in NHs. We selected one 1-minute segment from 12 videos that included interactions of caregiver-resident dyads. One research assistant transcribed caregivers’ verbal communication and segmented the communication into utterances. Two other research assistants independently coded each utterance using the adapted PCBI and TCBI. The coding scheme was expanded by modifying the existing operational definitions, adding three new codes, and developing a coding decision guide. Residents were Caucasian (100%), mean age 86 years with dementia and resistive behaviors. The adapted PCBI and TCBI had an inter-rater reliability of Kappa=0.656 (p<.001) across the 12 videos. Overall, our adapted PCBI and TCBI showed substantial inter-rater reliability. The results support the use of our adapted PCBI and TCBI to distinguish between person-centered and task-centered communication in video observations, which, in turn, allows for sequential analysis to examine the impact of caregiver communication on PwD.
The Breaking Point: Family Dementia Caregivers’ Recognition of the Need to Intervene
Authors: Harrington Candace , Dean-Witt Cheryl , Hardin-Fanning Frances
Published: December 2020

Family dementia caregivers are an under-recognized and valuable geriatric workforce whose services have broad implications for health care systems. Family dementia caregivers may experience uncertainty, loss of role identity, involuntary role assumption, or undesirable life transitions. Subsequent unintentional mistreatment or abuse of their family care recipient may occur. Approximately 50% of caregivers admit to some form of mistreatment of their loved one who lives with dementia. Using Selder’s (1989) life transition theory, this qualitative study explored family members’ life transition process toward their new role identities as family dementia caregivers to better understand the personal and historical contexts of caregiving. Semi-structured interviews were conducted with 10 participants to answer the questions: How does one acquire the role of primary family dementia caregiver?” and “How do personal and historical contexts inform the family dementia caregiver role?” Richness of data drove our sample size. Epistemological integrity ensured trustworthiness and rigor. A modification of Colaizzi’s (1978) analytic method was used for interpretative phenomenological analysis. The emergent themes uncovered by participants’ statements included: “It’s my turn”, “the breaking point”, and “a fine line” with the subtheme “balancing dignity and safety”. Participants described their introspective journeys toward a changed reality as family dementia caregivers. Our findings suggested the need for early recognition and vigilance to prevent the exploitation and mistreatment of those with dementia. Rural agriculture-based family caregivers in our study described unique and challenging characteristics. Further research is needed to explore the implications of these contextual nuances for rural agriculture-based family dementia caregivers.
Anthropometric Measures of Obesity and Food Consumption Among U.S. Chinese Older Adults
Authors: Zheng Shenglin , Le Qun , Dong XinQi
Published: December 2020

Most research uses body mass index (BMI) alone to measure obesity. Combined with waist circumference (WC), BMI may better identify obesity-related health risk. And diet is a key component of obesity management. To better understand the relationship between obesity and diet, this study aims to examine two anthropometric measures of obesity and the food consumption among U.S. Chinese older adults. Data were drawn from the PINE study wave III (2015-2017), a prospective cohort study of community-dwelling Chinese older adults (N=3053). We categorized participants into 6 groups: normal BMI (18.5-24.9) with normal WC (women ≤ 88cm and men ≤102cm), normal BMI with high WC (women WC >88cm and men WC >102cm), overweight (BMI=25.0-29.9) with normal WC, overweight with high WC, obese (BMI >30) with normal WC, and obese with high WC. A forty-eight-item food frequency questionnaire was used to measure frequencies of vegetables, fruits, grains, protein foods, dairy, sweets, and alcohol intake. Almost 12% participants had normal BMI but high WC and 10% were overweight with high WC. Participants who were overweight with high WC reported the highest intake of vegetables among groups. Participants with higher WC had significantly higher fruit consumption, compared to those with normal WC, regardless of their BMI. Spearman correlation analysis showed that being overweight with a high WC was correlated with higher frequencies of vegetables and fruits intake and having normal BMI with normal WC was correlated with higher alcohol intake. The findings provide new insights for future research and interventions on obesity/chronic disease management.
Body Composition by CT vs. DXA: Long-Term Prediction of Mortality in the Health Health ABC Cohort
Authors: Farsijani Samaneh , Xue Lingshu , Boudreau Robert , Santanasto Adam , Kritchevsky Stephen , Newman Anne
Published: December 2020

Background: Early work in the Health ABC cohort found that strength, but not muscle size predicted mortality. Recent literature suggests that body composition by computerized tomography (CT) and magnetic resonance imaging (MRI) predicts adverse health outcomes in diverse populations, but has not been directly compared to dual-energy X-ray absorptiometry (DXA) for predicting mortality. Objective: With long term follow-up, we reexamined body composition and mortality in Health ABC, comparing DXA and CT measures of muscle and fat. Methods: The Health ABC study assessed body composition in 2911 older adults (age 73.6±2.9 years) in 1996-97. Mid-thigh CTs were read for muscle area, inter-muscular, subcutaneous-fat areas and muscle density (HU). DXAs were read for whole body fat mass and appendicular lean mass (ALM). Mortality was assessed every 6-months through 2014 (maximum 17.4 years). Cox proportional hazards models, adjusting for age, sex, race, height, weight, physical activity, smoking and comorbidities were used to assess mortality risk. Results: Strong correlations were observed between mid-thigh muscle and subcutaneous fat areas by CT and leg lean and fat mass by DXA (P<0.05). Lower mortality rates, per SD, were associated with higher CT muscle area (HR-men=0.76 [95%CI: 0.68-0.86]; HR-women=0.84 [0.75-0.94]), muscle density (HR-men=0.86 [0.79-0.93]; HR-women=0.89 [0.81-0.97]) and higher subcutaneous-fat (HR-men=0.90 [0.81-0.99]; HR-women=0.87 [0.77-0.98]), adjusting for covariates. Similarly for DXA, greater ALM (HR-men=0.56 [0.44-0.71]; HR-women=0.77 [0.59-1.01]) and higher total fat mass (HR-men=0.53 [0.40-0.72]; HR-women=0.58 [0.37-0.90]) were associated with lower risk of death. Conclusion: With long term follow-up, both CT and DXA assessments of body composition predicted all-cause mortality risk.
Quality of End-of-Life Care for Vietnam Veterans: Implications for Practice and Policy
Authors: Carpenter Joan , Smith Dawn , Griffin Hilary , Kinder Daniel , Thorpe Joshua , Ersek Mary , Kutney-Lee Ann
Published: December 2020

In federal response to the aging population of Vietnam-era Veterans, Congress directed the Department of Veterans Affairs (VA) to create a pilot program to identify and develop best practices for improving hospice care for this population. A first step in VA’s response was to identify whether the end-of-life (EOL) care needs and outcomes of Vietnam-era Veterans differed from previous generations. Using medical records and bereaved family surveys, we examined clinical characteristics, healthcare utilization, and EOL quality indicators for Vietnam-era Veterans who died in VA inpatient settings between 2013-17. Contemporaneous comparisons were made with World War II/Korean War-era Veterans. Compared to prior generations, higher percentages of Vietnam-era Veterans had mental health/substance use diagnoses and disability. Similar percentages of family members in both groups reported that overall EOL care was excellent; however, post-traumatic stress disorder management ratings by families of Vietnam-era Veterans were significantly lower. Although current VA EOL practices are largely meeting the needs of Vietnam-era Veterans, greater focus on mental health comorbidity, including post-traumatic stress disorder, Agent Orange-related conditions, and ensuring access to quality EOL care in the community is warranted. Policymakers and healthcare professionals should anticipate more physical and mental health comorbidities among Veterans at EOL as Vietnam-era Veterans continue to age. Findings are being used to inform the development of standardized EOL care protocols and training programs for non-VA healthcare providers that are tailored to the needs of this population.
Chemotherapy and Anesthesia in Colorectal Cancer Survivors and the Risk of Alzheimer’s Disease
Authors: Akushevich Igor , Yashkin Arseniy , Kravchenko Julia , Kertai Miklos
Published: December 2020

Exposures common in cancer patients––chemotherapy, surgical injury and/or anesthesia, alone or in combination with predisposing factors––have been suggested as potential risk factors for Alzheimer’s disease (AD). We explored the relationship between chemotherapy and cumulative anesthesia exposure, and development of AD in colorectal cancer survivors. We conducted a retrospective cohort study of individuals age 65 and older diagnosed with colorectal cancer between 1998 and 2013, drawing on SEER-Medicare data and employing a proportional hazards model. We found that exposure to chemotherapy in colorectal cancer survivors demonstrated a protective effect for AD HR=0.821 (0.784-0.860). The beneficial effect held in race-, sex-, cancer-stage-specific subgroups, across chemotherapy agents (e.g., Fluorouracil, Oxaliplatin, or Fluorouracil+Leucovorin), in multivariable analyses, and in propensity score-based pseudorandomization based on 70 demographic, socioeconomic, cancer-diagnosis-related, and comorbidity variables. The effect was diminished or absent when non-AD dementias were analyzed. Findings further demonstrated that the association between chemotherapy exposure and AD was not affected by competing risk of long-term mortality or possible correlation between choosing chemotherapy and higher cognitive score or use of alternative health insurance. The effect of anesthesia on AD was not significant (0.998 per hour, 0.992-1.005) and this effect held in all subgroups, multivariable analyses, and for pseudorandomized subpopulations. Harmful effect was detected for cerebral degeneration, excluding AD, cognitive deficits following cerebral hemorrhage, cognitive disorder due to injury, hepatic encephalopathy, and hepatolenticular degeneration. Sensitivity analyses focused on SEER-Registry-specific effects and possible misspecifications in anesthesia records with alternative models demonstrated stability of estimates.
Fear of Falling and Cognitive Decline in Healthy Aging Adults
Authors: Kraut Rebecca , Holtzer Roee
Published: December 2020

Fear of Falling (FOF) is common and associated with poor mobility in aging but whether persistence of FOF endorsement influences cognitive decline has not been reported. Here we determined the effect of FOF, measured dichotomously and after accounting for persistence, on decline in global cognitive function (GCF), memory, and attention/executive functions. Older adults with persistent FOF (n=81; mean age=77.63±6.67 yrs; %female=74.1), transient FOF (n=60; mean age=76.93±6.01 yrs; %female=61.7), and no FOF (n=286; mean age=75.77±6.42 yrs; %female=49.3) were included. FOF was assessed through yes/no responses to “do you have a fear of falling?” at baseline. GCF was assessed using RBANS; memory was assessed using a composite score comprising the immediate and delayed recall index scores from RBANS; attention/executive functions were assessed via a composite score comprising TMT A & B, letter and category fluency tasks, and digit symbol modalities. Cognitive measures were administered annually for up to six years. Linear mixed effects models revealed that persistent FOF was associated with a worse decline in GCF compared to both transient FOF (estimate=0.78, p=.022) and no FOF (estimate=0.75, p=.004). Persistent FOF was also associated with a worse decline in memory compared to those with transient FOF (estimate=0.08, p=.004) and those with no FOF (estimate=0.06, p=.006). Associations between FOF status and decline in attention/executive functions were not significant. These findings demonstrate that persistent FOF is a risk factor for cognitive decline in community-residing older adults.
Understanding Alzheimer’s Disease Knowledge in Low-Income, Racially Diverse Older Adults
Authors: Zanjani Faika , Wilkerson Taylor , Rhodes Annie , Inker Jennifer , Richardson Joann
Published: December 2020

Individuals demonstrate varying levels of Alzheimer’s disease (AD) knowledge, as well as commonly held misconceptions about the risk factors and nature of the disease. Older adults often demonstrate low scores on AD knowledge scales and African Americans are often specifically not aware of their higher AD risk status compared to other racial groups. We measured the Alzheimer’s knowledge in 60+ community-dwelling adults, as part of a larger study on AD health coaching. Participants (n=20) were recruited from low-income communities within the Richmond, Virginia area. The study sample was 85% African American (n=17) and 55% male (n=11). Participants completed a behavioral psychosocial test battery, including the Alzheimer’s Disease Knowledge Scale. Similar to previous research, this sample of older adults held common misconceptions about AD, including the ideas that mental exercise can prevent AD (80% answered incorrectly) and individuals with AD are incapable of making decisions about their care (70% answered incorrectly). In this sample, the majority of African American older adults were aware of the fact that they have the highest risk for developing AD (20% answered incorrectly) compared to other racial groups. Analyses found no significant relationship between AD knowledge and health outcomes, alcohol consumption, or education. In conclusion to reduce AD risk, addressing AD knowledge in minority low-income population is important and needed. This is especially relevant since African American older adults are more likely to live in communities rather than nursing or assisted living facilities, receiving less access to interventions and research innovation.
Uses of Reminiscence in Dementia Care
Authors: Khait Abdallah Abu , Shellman Juliette
Published: December 2020

Improving the quality of life for older adults diagnosed with dementia is a public health research priority. Reminiscence is one non-pharmacological technique used to address the behavioral and psychosocial problems associated with dementia. The uses of reminiscence in dementia care have not yet been integrated, synthesized, critically analyzed, or delineated in the literature. Whittemore and Knafl’s five-step method provided the framework for this integrative review. A comprehensive search of PubMed, CINAHL Plus, SCOPUS, and PsycINFO was undertaken. Articles published in English, focused on participants with a diagnosis of mild to moderate dementia, and with evidence of using reminiscence in dementia care were included. Twenty-six studies published between 2009 and 2019 that met the inclusion criteria were analyzed. Four themes emerged from the integrated findings: (a) recovery from the darkness of depressive symptoms; (b) enhancement of cognitive functions and filling the memory gap; (c) living a fulfilling life in late adulthood, and (d) fulfilling reminiscence functions. The critical appraisal process revealed mixed effectiveness of the use reminiscence on health outcomes in dementia care due to diverse types of reminiscence, different outcomes measures, different data collection toolkits, and a lack of a standardized reminiscence protocol among research studies. Results from this review provide a better understanding of the potential benefits of using reminiscence in dementia care. However, improving the methodological rigor of future studies is necessary to attain conclusive evidence of the effectiveness of using reminiscence in dementia care. Implications of these findings for gerontological education, practice, and research will be presented.
Racial and Ethnic Health Inequalities in Accelerated Transitions in Mild Cognitive Impairment and Dementia
Authors: Natale Ginny , Zhang Yun , Clouston Sean
Published: December 2020

Background: It is unclear how the expected risk of Mild Cognitive Impairment (MCI) and conversion to dementia in the United States differs by Race/ethnicity and gender in older adults. It is unclear whether expectations about racial disparities have changed in light of changing trends in obesity and diabetes. Method: We analyzed six waves of the National Health and Aging Trends Study (NHATS), a nationally representative prospective cohort study of U.S. residents aged 65 and older. Participants were classified into four clinically meaningful mutually-exclusive groups: unimpaired, MCI, probable dementia and death. We used multistate survival models to examine individuals’ cognitive transitions and reported predictors using hazards ratios. Results: Participants (n=6,078) were 77 years old, on average, and the majority were white, females and high school graduates. Increased age was associated with risk of MCI and death. Adjusted for obesity status and diabetes, Hispanics were had a net reduced risk of death from dementia (HR=0.60; 95% CI [0.38-0.96]) but lived longer with MCI and dementia before death. Cognitively normal Blacks faced significantly increased risk of developing MCI (HR=2.54 95% CI [1.81-3.53]) and dementia (HR=1.77 95% CI [1.34-2.35]). Obese and overweight elderly had reduced risk across transitions to MCI then to dementia, but similar risks of death compared to lower body mass indices (BMI). BMI and diabetes reveal a suppression effect and racial inequalities became more apparent. Discussion: Results showed persistent racial inequalities in MCI, probable dementia, and death, supporting the theory that racial/ethnic factors are important to expectations of aging Americans.
Association Between Chronic Illness, Masculinity, and Well-Being in Older Black Men
Authors: Young Hana , Li Jessalyn , Esiaka Darlingtina
Published: December 2020

Research suggests that living with a chronic illness has deleterious impacts on the well-being and quality of life of aging adults. Specifically, it opposes traditional masculine constructs in men and impacts their physical and mental health outcomes. In this study, we examined the lived experiences of Black men, aged 55 years and over, and diagnosed with chronic illness using life history narratives. Participants responded to open-ended questions such as “what aspects of living with illness do you find relatively difficult or easy?” and “what situations make you particularly aware of your illness?” Common themes that emerged from the participants’ responses were the performance of masculinity, fulfilling family duty and obligation, limited sexual encounters, and feelings of exclusion in one’s community. Additionally, participants stated that chronic illness impacts their mental well-being and triggers behavioral responses that exacerbate their ability to cope with the illness. Their responses highlight the conflict between traditional masculine expectations and the presence of chronic illness and illustrate the extent to which ‘manhood’ is a determinant of health even in older men. Our findings can inform the development of tools and interventions designed to improve the experience of well-being among Black men aging with chronic illness.
A state-of-the-art review of the current role of cardioprotective techniques in cardiac transplantation
Authors: Cullen Paul P , Tsui Steven S , Caplice Noel M , Hinchion John A
Published: December 2020

OBJECTIVES

The use of ‘extended criteria’ donor hearts and reconditioned hearts from donation after circulatory death has corresponded with an increase in primary graft dysfunction, with ischaemia–reperfusion injury being a major contributing factor in its pathogenesis. Limiting ischaemia–reperfusion injury through optimising donor heart preservation may significantly improve outcomes. We sought to review the literature to evaluate the evidence for this.

METHODS

A review of the published literature was performed to assess the potential impact of organ preservation optimisation on cardiac transplantation outcomes.

RESULTS

Ischaemia–reperfusion injury is a major factor in myocardial injury during transplantation with multiple potential therapeutic targets. Innate survival pathways have been identified, which can be mimicked with pharmacological conditioning. Although incompletely understood, discoveries in this domain have yielded extremely encouraging results with one of the most exciting prospects being the synergistic effect of selected agents. Ex situ heart perfusion is an additional promising adjunct.

CONCLUSIONS

Cardiac transplantation presents a unique opportunity to perfuse the whole heart before, or immediately after, the onset of ischaemia, thus maximising the potential for global cardioprotection while limiting possible systemic side effects. While clinical translation in the setting of myocardial infarction has often been disappointing, cardiac transplantation may afford the opportunity for cardioprotection to finally deliver on its preclinical promise.
Indefinite derivative for stability of time-varying nonlinear systems
Authors: Hadj Taieb Nizar
Published: December 2020

This paper is concerned with stability analysis of nonlinear time-varying systems by using Lyapunov function based approach. The classical Lyapunov stability theorems are generalized in the sense that the time-derivative of the Lyapunov functions are allowed to be indefinite. Then, under quite general assumptions, we first present a new converse stability theorem for a large class of time-varying systems which will be used to prove certain stability properties of nonlinear systems with perturbation. Therefore, a new Lyapunov function is presented that guarantees global asymptotic stability under some restrictions on the perturbed system. Furthermore, some illustrative examples are presented.
Development and Validation of an Analytical Method for Quantitation of Alpha-Pinene in Rodent Blood and Mammary Gland by Headspace GC--MS
Authors: Silinski Melanie A Rehder , Licause Joseph , Uenoyama Teruyo , Blake James C , Fernando Reshan A , Robinson Veronica G , Waidyanatha Suramya
Published: December 2020

Alpha-pinene (AP), produced by pine trees and other plants, is the main component of turpentine and is used as a fragrance and flavor ingredient. Exposure occurs via the use of personal care and household cleaning products and in the lumber industry. Despite widespread exposure, toxicity data for AP are limited. The objective of this work was to develop and validate a method to quantitate AP in rodent blood and mammary glands, in support of toxicokinetic and toxicology studies of AP. The method uses 100 µL of blood or $\sim$100 mg of mammary gland with analysis by headspace (HS) gas chromatography--mass spectrometry. The samples are diluted with internal standard (2H3-AP, IS) and sealed in HS vials; mammary glands are homogenized within the vial. The vials are equilibrated briefly at 60°C before a HS sample is analyzed. The method was validated in Sprague Dawley rat blood over the range 5–500 ng/mL and mammary gland over the range 100–5,000 ng/g. The method was linear (r ≥ 0.99), accurate (mean relative error (RE) ≤ ±13.4%) and precise (relative standard deviation (RSD) ≤ 7.1%) in both matrices. Recoveries incorporating IS were ≥88.7% at all concentrations in both tissues. Standards as high as 1,500 ng/mL in blood and 20,000 ng/g in mammary gland could be analyzed using lower injection volume or extrapolating the calibration curve beyond the upper limit of quantitation (mean %RE ≤ ±18.7; %RSD ≤ 2.2). Loss of AP occurred during overnight autosampler storage as well as frozen storage in as few as 15 days, but incorporation of IS prior to storage corrected for the loss such that calculated concentrations were within 84.7–117% of day 0 concentrations following frozen storage up to ≥32 days in both matrices. Matrix evaluation was performed in Hsd:Sprague Dawley®SD® rat and B6C3F1 mouse blood and mammary glands (mean %RE ≤ ±9.2; %RSD ≤ 4.3). These data demonstrate that the method is suitable for determination of AP in rodent blood and mammary glands.
The one that didn’t get away
Authors: Howard Jeremy
Published: December 2020

The sale of Holbein’s ‘Portrait of Christina, Duchess of Milan’ to Henry Clay Frick in 1909 – a painting that had been on long-term loan to the National Gallery in London from the Duke of Norfolk – and the painting’s eleventh-hour rescue, following a campaign by the National Art Collections Fund, became a national cause célèbre. Coming at a time of heightened sensitivities about the loss of Britain’s heritage and her declining importance as a world superpower, the threatened export of the painting provoked a huge outcry in the press, in which Frick, the Duke of Norfolk and the art dealers Colnaghi were cast in the role of villains in an Edwardian melodrama. However, new evidence presented in this article shows that the truth was considerably more complicated and prompts an examination of Edwardian debates about the protection of the national heritage.
Human Herpesvirus 6 Infection in Pediatric Liver Transplantation: Single-Center Study of Incidence, Outcomes, and Management
Authors: Mysore Krupa R , Phan Tuan L , Himes Ryan W , Schady Deborah , Eldin Karen W , Prusty Bhupesh K , Munoz Flor M
Published: December 2020

Background

Distinctions between HHV-6 primary infection in seronegative patients and HHV-6 reactivation in seropositive patients remains largely undescribed in pediatric liver transplant (LT) recipients.

Methods

We implemented pretransplant serology testing of HHV-6 in a large pediatric hospital and retrospectively assessed the incidence, manifestations and outcomes of HHV-6 infections over a 3-year period.

Results

Among 101 pediatric LT recipients, 96 had pretransplant HHV-6 serologies; 34 (35.4%) were seronegative and 62 (64.6%) seropositive. Posttransplantation, 8/25 (32%) seronegative patients had HHV-6 DNAemia (primary infection) compared to 2/48 (4%) seropositive patients (p=0.002). Compared to seropositive patients, seronegative patients with HHV-6 DNAemia were younger, and had symptoms of fever and/or elevated aminotransferases in association with higher viral loads, in the first month post-transplant. More than 90% of seronegative patients and 77.8% of seropositive patients had HHV-6 detected by PCR in liver biopsy obtained for concerns of allograft rejection, but most had no detectable concomitant DNAemia. Active replication of virus in the liver was confirmed by in situ hybridization in select cases. While HHV-6 infection occurred among patients on prophylaxis doses of antivirals for CMV, HHV-6 DNAemia and presenting symptoms resolved on treatment doses.

Conclusions

HHV-6 DNA-emia occurred more frequently in seronegative pediatric LT recipients, usually in the early posttransplant period, and was subsequently detected in allograft biopsies. HHV-6 cannot be ruled out as a cause of hepatitis in the absence of allograft tissue testing and specialized virological assays, as HHV-6 may disrupt local allograft immune homeostasis while evading traditional screening methods using blood or plasma. The assessment of pre-transplant HHV-6 serological status may be important for risk stratification and post-transplant management of pediatric LT recipients
Successful one-stage laparoscopic procedure for de Garengeot hernia: a totally extraperitoneal repair-first approach
Authors: Sakon Ryota , Hara Yoshiaki , Tomizawa Yuki , Ishiyama Yasuhiro , Ito Shingo , Oneyama Masataka , Amiki Manabu , Narita Kazuhiro , Tachimori Yuji , Goto Manabu
Published: December 2020

The de Garengeot hernia is a femoral hernia in which the appendix migrates into the hernia sac. It is usually diagnosed intraoperatively due to its rarity and lack of clinical presentation typical to acute appendicitis. Although most cases need emergency operation due to incarceration, no standard procedure exists. We report the case of a 49-year-old woman who was diagnosed with a de Garangeot hernia preoperatively by contrast-enhanced computed tomography. She underwent one-stage laparoscopic surgery via a totally extraperitoneal approach followed by laparoscopic appendectomy. She recovered uneventfully and was discharged on postoperative Day 3. Generally, hernioplasty and appendectomy are required for the de Garengeot hernia treatment. Avoiding a peritoneal incision around the herniation and performing a mesh repair prior to appendectomy is expected to carry a lower infectious risk than other laparoscopic procedures. With accurate diagnosis, this procedure could be a useful modality for de Garengeot hernia.