bluuebunny/crossref_metadata_2025 huggingface dataset:
EFFECTS OF ADAPTIVE COMPUTER-BASED COGNITIVE TRAINING ON COMMUNITY-DWELLING ELDERS
Authors: Guo Guifang , Gongzhi Huijuan
Published: November 2019

This quasi-experimental designed study analyzed the effects of adaptive computer-based cognitive training among community-dwelling older adults. A 6-week (5 times/week) program was implemented with an intervention group (Difficulty Adaptive Training) and control group (Difficulty Fixed Training). General cognitive, memory, executive and attention functions were evaluated before (T1), completion (T2), and one month after intervention (T3). Sixty-one participants completed data collection. (1) General cognitive function: improved in both groups at T2, and T3, intervention group had better effect; (2) Memory function: improved in both groups in immediate, short and long-delayed recalls at T2 and T3, and recognition at T2. (3) Executive function: improved in both groups. Time of simple information processing was shortened at T2 and T3 in intervention group, at T3 in control group; TMT response inhibition was shortened at T2 and T3 in both groups. (4) Attention function: digit span forward was improved at T2 in intervention group.
LONGITUDINAL MENTAL HEALTH CONSEQUENCES OF PHYSICAL DISABILITIES: THE MEDIATING ROLE OF PERCEIVED DISCRIMINATION
Authors: Namkung Eun Ha , Carr Deborah
Published: November 2019

Individuals with disabilities have been historically mistreated by discrimination. The detrimental mental health effects of self-reported interpersonal discrimination are well established. However, little empirical attention has been given to the role of perceived discrimination in the adverse mental health outcomes of adults with physical disabilities. This study aims to examine whether daily interpersonal discrimination (i.e., microaggression) mediates the prospective association between having a functional impairment and subsequent changes in the individuals’ mental health outcomes over their midlife and old age. To address this question, this study used data from two waves of a population-based national study, the National Survey of Midlife Development in the United States, covering a 7- to 9-year period (n= 2,503; Mage at baseline = 57, SDage = 11). Physical disability or functional impairment was assessed with items adapted from the SF-36, capturing difficulty with nine activities of daily living. Having functional impairment at the baseline assessment was associated with increases in depressive symptoms and negative affect over the study period. Daily interpersonal discrimination partially mediated this longitudinal association, explaining 7.4% (for depressive symptoms) to 8.1% (for negative affect) of the total effects. Exposure to discrimination and its mental health consequences were also more pronounced at younger ages. Disability-related perceived discrimination is an under-recognized mechanism that is likely to contribute to mental health inequities in later life. Professionals in health and disability policy, research, and practice need to concentrate efforts on developing policy and programs that reduce discrimination experienced by US adults with disabilities.
RACIAL BIAS IN STAFF OPTIMISM ABOUT ADL IMPROVEMENT AMONG NURSING HOME RESIDENTS
Authors: Branco Kenneth J
Published: November 2019

Research on bias in health care has shown disparity in provision of care to and health outcomes of African Americans. Patient optimism was associated with improved physical and psychosocial outcomes, and nurse optimism was correlated with patient perceptions of care. We estimated effects of race using logistic regression, controlling for ADLs, cognitive impairment, and gender on both staff optimism and resident optimism about capacity for improvement in ADLs in a probability sample (n=2604) of nursing home residents who were evaluated with the resident assessment instrument (RAI). We found no difference between African American and White residents’ optimism about their own capacity for improvement. Staff findings were quite different. Staff were most optimistic about the potential of residents who needed ADL assistance OR=1.82; 95% CI [1.42-2.32] over those who were ADL dependent or those who only needed oversight. Most importantly, it was in the oversight category of ADL impairment where the greatest indication of racial prejudice occurred. Staff were much less likely to be optimistic about African American residents (16%) compared to White residents (30%). With all control variables entered, staff were still less willing to be optimistic about African American resident improvement (AOR=0.65; 95% CI [0.44-0.96]. The implications of these findings are troubling. It is unlikely that staff would expend energy on improving the functioning of the African American residents whom they believe cannot improve. Further research is needed on the extent to which prejudice in nursing homes is accompanied by discrimination and how the bias can be overcome.
HIGH-DEDUCTIBLE HEALTH PLANS AND COST OF HEARING AIDS AMONG ADULTS WITH HEARING LOSS: IMPLICATIONS FOR DISPARITIES
Authors: Mahmoudi Elham , Kamdar Neil
Published: November 2019

High-deductible health plans (HDHPs) have shown potential to curb rising healthcare costs. We examined use and cost of hearing aids (HAs), comparing HDHPs with non-HDHPs. Using the 2009-2016 Truven Marketscan claims, we identified adults aged 50-64 who were diagnosed with hearing loss (HL) and whether they used HAs or not (n=1,247,113). We applied multivariable generalized linear models, adjusting for age, gender, hierarchical condition categories (HCCs). To control for potential selection bias, we applied an inverse propensity score weighting. Our outcomes of interest included: (1) utilization and (2) total and out-of-pocket costs of HAs (inflation adjusted to 2016 dollars), comparing HDHPs with non-HDHPs. Number of enrollees in HDHPs increased by 343%, from 1,717 in 2009 to 7,615, in 2016. The percentage of patients who used HA increased from 9.5% (95% CI:0.09-0.10) to 15% (95% CI:0.14-0.15) within non-HDHPs and from 5% (95% CI:0.04-0.06) to 16% (95% CI:0.15-0.17) within HDHPs. The average adjusted cost sharing and total cost of HAs increased by 74% ($85 to $148) and 52% ($589 to $894), respectively, among non-HDHPs; they increased by 80% ($173 to $312) and 91% ($589 to $1,126), respectively, among HDHPs. Average out-of-pocket costs for HAs in HDHPs were twice as much as in non-HDHPs (p <0.0001). Total and out-of-pocket costs for hearing aids were substantially higher among HDHPs compared with non-HDHPs. Many employers have started offering only HDHPs, leaving their employees with no other health insurance option. Higher cost sharing may worsen the existing socioeconomic disparities in access to HAs.
OPPRESSIVE EXPERIENCES AMONG DEAF DIVERSE SENIOR CITIZENS
Authors: Frank Audrey K
Published: November 2019

None of the limited literature on deaf seniors focuses on their experiences of oppression. There is an article that demonstrates that not many mental health professionals have the skills to work with deaf seniors. Obstacles have been noted in the literature among deaf people in general terms of being oppressed with employment, doctors, education, family discrimination, stereotyping, stigmas and cultural conflicts because they are deaf. The obstacles facing deaf seniors had not been specifically explored before this research. The shift attention to deaf seniors is needed in order to make their experiences known and at the same time their lives, values, and strengths need to be understood and recognized. Ninety-one deaf seniors from five states aged between 50 years and 93 years were interviewed to describe their recent experience on oppression. They shared their common experiences on oppression such as lack of communication with their doctors, hearing co-workers, and family members, struggling to get promoted at work, and being left out in the neighborhood. According to the deaf seniors, the community did not acknowledge or accommodate the special needs they had as deaf seniors. Their detailed descriptions provide consistent evidence that supports the importance of cultural awareness for medical and mental health professionals. The professionals are to enhance better understanding of experiences among deaf seniors. This lack of awareness highlights the need for research about deaf seniors’ experiences of oppression and for research on what professionals should know about the special needs of this population.
SILVER FRIEND: A SMART SPEAKER PROJECT TO ASSIST LOW-INCOME OLDER ADULTS LIVING ALONE IN SOUTH KOREA
Authors: Kim Jongwoong
Published: November 2019

Ownership rate of smart speakers in the U.S. reaches 21 percent in late 2018, and the growth of the global market is predicted to explode in the coming years. With this trend, there is an increasing expectation that smart speakers can assist older adults to stay independently in their homes as they age. However, there still is a shortage of empirical studies and evidence that these devices can actually be effective in helping older adults age in place. This paper describes a pilot project, Silver Friend, in South Korea, which utilizes a smart speaker, NUGU, to help low income older adults who live alone remain their homes as actively and safely as possible. The Silver Friend project has largely two goals: 1) reducing the older adults’ loneliness and 2) improving emergency response via the NUGU’s voice recognition and data monitoring system. Initially, the project served 90 older adults who live alone in government-purchased rental housing. This project was a result of a public-private partnership led by a South Korean tech/telecom giant, SK Corporation, practicing its corporate social responsibility. In South Korea, 15 percent of the population is age 65 and older, and 20 percent of them (approximately 1.5 million older adults) are living alone and/or in need of financial assistance. With the ever-expanding global market for smart speakers, this paper focusing on a case in South Korea describes evidence and a potential policy model in utilizing a smart speaker to help achieve the goal of aging in place.
FINDINGS FROM THE ENTOURAGE NOORD PROJECT: CO-CREATING NEW HOUSING MODELS FOR OLDER ADULTS IN BRUSSELS
Authors: Smetcoren An-Sofie , De Donder Liesbeth
Published: November 2019

In response to the challenge of an ageing population and the housing crisis in Brussels, the practice-based project ‘Entour-Age Noord: Inspiring and innovative housing & work’ was launched. A main objective was to develop various innovative and small-scaled housing models for older adults. The new housing models were designed to reinforce quality of life of older people who are ageing in the neighbourhood whilst allowing them to choose the models best suited to their needs and wishes. Given the complexity and multidimensionality, participatory-action research was used and the project was divided into six different ‘work packages’ (WP’s). Within these WP’s, different stakeholders and end users (older people, informal caregivers, neighbourhood residents, Community Land Trust, etc.) were involved during various activities (service design methodology, architectural workshops, inspiring visits, focus groups etc.) in order to co-create the answers. First, based on the results, eight personas (=conceptual models of targeted groups) were developed. Second, stemming from the participants needs and wishes (e.g. desire for more social interaction), architectural and spatial design characteristics were detected (e.g. provide common/shared spaces that stimulate encounter). Based on these personas and spatial characteristics, two prototypes of new housing models were conceptually elaborated on paper and two were operationalized and prepared in practice. The spatial and architectural characteristics are not limited to old age but can be of interest of any age group. Future housing developments could take these suggestions into consideration. Furthermore, experiences, opportunities and pitfalls of a co-creative decision-making process with older adults will be discussed.
THE DUKE INTERAGENCY CARE TEAM: A BRIDGE TO GERIATRIC COMMUNITY RESOURCES
Authors: Kanne Geraldine E , Black Melissa , Disco Marilyn , Mack-Minniefield Rhonda , Halpern David , Upchurch Gina , White Heidi , Heflin Mitchell T
Published: November 2019

The Duke Geriatric Workforce Enhancement Program aims to improve linkages between primary care practices (PCP’s) and community-based organizations by developing an interdisciplinary, community-based team to consult with PCPs, identifying resources to help vulnerable older adults. The Inter-agency Care Team (ICT) includes a nurse practitioner, pharmacists, community resource specialists, geriatricians and geriatrics and advanced practice nursing fellows. PCP’s refer older adults with complex care needs through the EHR for virtual consultation by the ICT. Team members review medical records and call participants and caregivers to obtain permission for the consult, gather information on function, social factors, medical problems, and their perceived needs. The ICT meets to review each case and sends written recommendations to the PCP and patient. To date, the ICT performed consultations for 73 older adults with a mean age of 76 years. 69% were female. 71% were black and 26% white. Frequently identified needs included personal/home safety (74%), medication management (64.3%), food security (63.0%), cognition (49.3%), transportation (38.4%) and advance care planning (31.5%). In the 90 days before consultation, 32.9% of patients had ED visits and 21.9% were hospitalized. In the 90 days after, 24.7% had ED visits and 13.7% were hospitalized. (Differences were not statistically significant.) ICT provided virtual consultation for complex older adults with prevalent social needs and high rates of ED visits and hospitalization. The team worked with PCP’s to connect these patients more directly to community resources. Further study is needed to know rates of adherence with recommendations and true impact on health outcomes.
BUILDING SAFE ROUTES TO AGE IN PLACE THROUGH PARTNERSHIPS WITH AGE-FRIENDLY COMMUNITIES
Authors: Dabelko-Schoeny Holly , Fields Noelle L , Murphy Ian , White Katie , Sheldon Marisa , Ravi Kristen E
Published: November 2019

Participation in active transportation by older persons has been associated with higher quality of life and longevity. Efforts across the United States to increase active transportation (walking, biking and fixed route transportation) by older adults have lacked meaningful input by older adults, are non-theoretical and have had inconclusive results. This paper describes the findings from Phase 1 of the Safe Routes to Age in Place project, a collaboration between Age-Friendly Franklin County, The Ohio State University (OSU) and the University of Texas-Arlington (UT-A), funded by the Ohio Department of Transportation. The aim of the study is to increase the options and safe utilization of active transportation by older persons in three pilot neighborhoods in Franklin County, Ohio utilizing community-based participatory action research strategies with a customized data collection app, MyAmble. The purpose of Phase 1 was to engage city and regional planning students, government officials and older adults to identify “hot spots” in the three pilot neighborhoods. Heat mapping of community data including locations of densely-populated vulnerable older adults, fixed transportation routes, bus stop signage and benches, shared bike stations, bike routes, paratransit routes and pedestrian crash data was completed. Maps were used to identify areas of focus and discussions with municipal leaders and older adult residents further refined target areas to be used in the second phase of the study. Older residents completed walk audits using the MyAmble app and identified issues with sidewalks, crosswalk timers and bus stops. Implications related to age-friendly communities and active transportation are offered.
CHARACTERISTICS AND LIVING ARRANGEMENTS OF CHILDLESS ELDERLY AMERICANS
Authors: Xu Xiao , Liang Jersey , Kim BoRin , Ofstedal Mary Beth , Raymo James
Published: November 2019

Despite a growing number of Americans without children, information on characteristics of childless older adults and their living arrangements is sparse and often outdated. To address this knowledge gap, we examined data from the 2014 Health and Retirement Study (HRS) on childless Americans age ≥65 years (N=760) and compared with childless elders in 2004 HRS (N=830). All analyses accounted for complex sample design of HRS to generate nationally representative estimates. The proportion of elderly Americans without any living biological or step children increased from 8.1% in 2004 to 9.4% in 2014. Compared to childless elders in 2004, those in 2014 were younger (mean age=76.8 years versus 73.8 years, p<0.01) with a higher proportion completing college education (20.7% versus 37.5%, p<0.01) or were cognitively intact (64.6% versus 73.6%, p<0.01). However, childless elders in 2014 had more chronic conditions than those in 2004 (mean=2.5 versus 2.3, p<0.01). The proportion of childless elders living independently (alone or with a spouse) (81.6% in 2004 versus 82.6% in 2014) or living with others (10.0% in 2004 versus 13.5% in 2014) remained relatively stable, whereas the proportion living in nursing homes declined significantly from 8.4% in 2004 to 4.0% in 2014 (adjusted odds ratio [OR]=0.07, p<0.01). A sensitivity analysis limited to childless elders without biological children showed that they accounted for 9.9% of the elderly population in 2004 versus 11.9% in 2014, while other results were generally similar. These findings can help inform long term care needs of childless elders.
GERIATRIC CONDITIONS AND HEALTH CARE UTILIZATION AMONG OLDER ADULTS LIVING IN SUBSIDIZED HOUSING
Authors: Kler Sarah E , Jeon Sun Young , Patel Kanan , Ritchie Christine , Harrison Krista , Thomas Kali S , Brown Rebecca
Published: November 2019

In the US, 1.7 million low income older adults live in subsidized housing. Previous research suggests that subsidized housing residents have poorer health status than older adults in the general community. However, little is known about the prevalence of geriatric conditions. To understand these factors we conducted a retrospective cohort analysis of 11,558 Medicare enrollees ages 65+ who were enrolled in the National Health and Aging Trends Study in 2011 or 2015, including 507 living in subsidized housing and 11,051 in the general community. We compared subsidized housing residents to general community residents across measures of sociodemographics, functional limitations, and geriatric syndromes. We also compared the prevalence of hospitalization, move to a higher level of care, and death within five years. Results suggest that compared to general community residents, subsidized housing residents were more likely to be women (66% vs. 55%, p<0.01), racial/ethnic minorities (50% vs. 18%, p<0.01), and to lack a high school diploma (50% vs. 20%, p<0.01). They also had poorer health status, including higher rates of self-reported functional impairment (difficulty with 2 or more ADLs; 16% vs. 10%, p<0.01), probable dementia (15% vs. 8%, p<0.01), and frailty using the three-level Fried frailty index (55% vs 26%, p<0.01). Subsidized housing residents also had higher rates of hospitalization (29% vs. 22%, p<0.01), move to a higher level of care (4% vs. 3%, p<0.01), and death (10% vs. 7%, p<0.01) compared to community-residing peers. These findings will help inform targeted interventions to improve aging in place for this vulnerable population.
ANTI-AGING PROTEIN CD9 AFFECTS AGE-RELATED HEART FAILURE
Authors: Jonnakuti Sriya T , Ullah Mujib
Published: November 2019

The CD9 is transmembrane protein that plays a critical role in many cellular processes including aging associated cardiac pathologies. The heart function declines in the aged population. Ageing is strongly associated with many age-related conditions such as increased risk of heart failure. If aging can be prevented slowed down or even reversed, heart failure and other signs of aging could be controlled or even cured. It is unknown whether CD9 is cardioprotective. The objective of this study is to investigate whether a decline CD9 levels contributes to aging-related heart failure. Our data shows that CD9-deficient aged mice develop cardiac abnormalities and pathological cardiac hypertrophy, Cardioprotection by CD9 in old mice is followed by the downregulation of SIRT6 in the heart, and CD9 overexpressed exosomes ameliorates cardiac pathologies in treated mice and improves their long-term survival. Additionally, the serum level of CD9 decreased significantly in aged mice. CD9 overexpressed exosomes are cardioprotective and improve cardiac function in aged mice. These exosomes mediate their paracrine effects by attenuating, blood pressure, heart beat, reactive oxygen species and fibrosis. Remarkably, CD9 overexpression reversed fibrosis associated brain natriuretic peptide (BNP), Sirt6, and galectin 3 (Gal-3). These results provide a new perspective on the pathogenesis of cardiomyopathies and open new avenues for treatment of the disease.
SINGLE-CELL TRANSCRIPTOMICS OF AGING MOUSE ISLET REVEALS AGE-RELATED RECRUITMENT OF ISLET-RESIDENT MACROPHAGE
Authors: Nie Jia , Musi Nicolas
Published: November 2019

Type 2 diabetes (T2D) prevalence increases with age. The notion of inevitable progression of T2D has been challenged by reports of remission in some human T2D cases; however, this remission is dependent on islet function reserve. To elucidate the molecular mechanisms driving islet cell dysfunction, it is necessary to understand islet cell composition, diversity, and function throughout the lifespan. We generated a single-cell transcriptomic atlas of healthy islets isolated from young (5 weeks old), middle-aged (12 months old), and older-aged (25 months old) mice. Cell clustering identified 13 initial cell clusters that were further sub-clustered. This single-cell RNAseq profile showed that each cell type/group has different markers and functional characteristics and that age causes a remarkable shift in islet cell composition, diversity, and number. By comparing macrophages from young and old mice, we also found that aged islets contain a higher number of islet-resident macrophages. Overall, this single-cell islet atlas covers nearly all cells in the normal islet and allows a comprehensive exploration of all transcriptional states throughout the lifespan.
EATING THE PAIN AWAY: THE USE OF FOOD AS A COPING MECHANISM IN OLDER ADULTS EXPERIENCING CHRONIC PAIN
Authors: Felpeto Alexandra , Ramos Alexandra M , Hincapie Diana , Lenox Madison B , Reinhardt Rebecca
Published: November 2019

Individuals experiencing pain rely on impulse to make decisions, including choices regarding food consumption (Darbor, Lench, & Carter-Sowell, 2016). This study examined whether older adults experiencing chronic pain report higher instances of emotional eating in comparison to a population of older adults not experiencing chronic pain. Data stemmed from the Midlife in the United States study was analyzed to investigate whether individuals used food as a coping mechanism for chronic pain symptoms (Ryff et al., 2017). The sample consisted of Americans aged 60 to 74 years of age. Pain conditions included: has chronic pain (n=686) and does not have chronic pain (n=1036). Results of the Independent Samples T-Test indicated that participants were found to be engaging in emotional eating when experiencing chronic pain symptoms, as hypothesized. Participants in the has chronic pain condition reported relying on food as a coping mechanism more (M= 3.66, SD= 1.87) than participants in the does not have chronic pain condition (M= 3.42, SD= 1.71); t(1370)= 2.71, p= .007, d= 0.13. Results suggest that older adults experiencing chronic pain report utilizing food as a coping mechanism more than older adults that do not experience chronic pain. These findings have health implications given the rising obesity rates associated with persistent pain. Future directions may include studies on the negative health outcomes that result from high instances of emotional eating in older adults experiencing chronic pain. Additionally, investigating alternative coping mechanisms for chronic pain would be beneficial to diminish the harmful health effects of emotional eating.
EXPERIENCE OF STROKE RECOVERY FOR WOMEN 60 OR OLDER: USING AUTO-PHOTOGRAPHY TO ENHANCE THE NARRATIVE PROCESS
Authors: Johnson Iona
Published: November 2019

Stroke is a common health concern in the U.S. with 795,000 new strokes each year. Women dominate these numbers, with 55,000 more strokes per year than men, yet they are underrepresented in stroke research. Some research indicates that women have worse physiological and psychosocial outcomes after stroke than men, yet little is known about how they experience recovery. This study used a qualitative phenomenological approach to address the question: “What is the experience of stroke recovery for community dwelling women age 60 or older?” The participants were 10 women, ages 60 – 78, with times post-stroke ranging from 4 months to 15 years. They participated in 2 semi-structured interviews, with auto-photography used to enhance sharing of information. Between the two interviews, they were provided with a digital camera and asked to take pictures that helped to explain their lives before and after stroke. During the 2nd interview, participants described their pictures, and answered additional questions about their recovery. Interviews were transcribed verbatim, and the narratives were coded and analyzed thematically to describe how this sample of individuals experienced stroke recovery. Four overarching themes emerged from the data: 1) the stroke event, 2) a new chapter, 3) meaning and process of recovery, and 4) self-identity. In general, narratives revealed that recovery is described as a complex, individualized, and subjective experience that extends beyond overt physical abilities. Participants in this study experienced changes in self-identity and described a “new normal” after stroke. Implications and recommendations for rehabilitation, research, and policy are discussed.
HOW MULTIPLE CHRONIC DISEASE BURDEN INFLUENCES COMMUNITY-BASED BEHAVIORAL HEALTH PROGRAM PARTICIPANTS
Authors: Turner Keith W , Yin Cheng
Published: November 2019

Background: Studies have shown that participation in community-based self-management education programs can result in improved healthful behaviors (exercise, cognitive symptom management, coping, and communications with physicians), improved health status (self-reported health, fatigue, disability, social/role activities, and health distress), and decreased days in the hospital. Problem: One of the understudied factors thought to influence efficacy in community based self-management programs is the presence and impacts of multiple chronic conditions on participants within community based behavioral health program populations. Multiple chronic diseases when scaled collectively can be considered as a participant’s individual disease burden to be included in other analyses. Methodology: This investigation explores possible ways disease burden associates with such important constructs as participant personal characteristics and participant confidence in controlling impacts of their disease symptoms and participant preferences for use of various methods of coping with disease impacts. Outcomes: Results indicate a complex pattern of relationships between such factors as personal characteristics of program participants and their perceived mastery over the impacts of their disease symptoms, and their preferred mechanisms for coping. Implications: program designers and managers can better understand the differential influences of disease burden on participants analyzed with their personal characteristics and their preferential uses for coping mechanisms and their perceived ability to withstand the added burdens of multiple chronic diseases.
RURAL-URBAN DISPARITY IN BIOMARKER RISKS FOR CARDIOVASCULAR DISEASE AMONG CHINESE MIDDLE-AGED AND OLDER ADULTS
Authors: Wang Haowei , Stokes Jeffrey E
Published: November 2019

Cardiovascular disease (CVD) is a leading cause of adult mortality in China, accounting for 45% of deaths from noncommunicable disease. Moreover, Chinese health status and health services are disproportionately divided between urban and rural areas. This study examined rural-urban differences in age trajectories of CVD risk, measured by C-reactive protein (CRP), high-density lipoprotein (HDL) cholesterol, body mass index (BMI), and waist circumference. This study also investigated whether community factors, including recreational amenities, infrastructure availability, physical environment, public facilities, and health services, may explain such rural-urban disparities. We used data from the baseline data of the China Health and Retirement Longitudinal Study (2011), including 11, 528 respondents from 440 communities, who were aged 45 and older and participated in the biomarker survey. Multilevel models revealed that rural adults had a higher level of HDL and lower levels of CRP, BMI, and waist circumference compared to their urban counterparts. Rural adults also had slower age-related increases in trajectories for CRP, HDL and BMI. Associations of physical environment and public facilities with CVD risks were largely explained by rural-urban disparity. However, the availability of infrastructure explained both between- and within- rural-urban differences in BMI and waist circumference. Models were controlled for previously diagnosed CVD conditions, individual demographic characteristics, self-rated health, activities of daily living, depressive symptoms, physical activity, smoking and drinking behaviors. Findings contribute to the understanding of prevalence and disparities in biomarker risks for CVD among Chinese middle-aged and older adults. Intervention implications are discussed to address the emerging health disparities.
ASSOCIATION BETWEEN LEVEL OF PAIN AND DEPRESSION AMONG CHRONICALLY ILL OLDER ADULTS IN RURAL ALABAMA
Authors: Noh Hyunjin , Halli-Tierney Anne , Lee Lewis , Aladeokin Temilade
Published: November 2019

Pain and depression, two of the common symptoms among chronically ill older adults, have been found to be related in various populations; however, further knowledge is needed about their relationships and moderating factors among community-dwelling, chronically ill older adults, particularly in lower-income, rural areas with limited healthcare resources. Therefore, this study aimed to examine the association between pain level and depression among chronically ill older adults in rural areas. A total of 100 residents of a rural county in West Alabama, who are 55+ and have chronic illnesses and pain, were recruited from four community senior centers and were interviewed using a structured questionnaire. Pain levels were assessed by the Philadelphia Geriatric Center (PGC) Pain Scale, and depression by an abbreviated version of the Center for Epidemiologic Studies Depression Scale (CES-D). Bivariate correlation and multivariate analysis were conducted. The correlation between pain and depression was significantly positive (r = .35, p < .001). The results of the model indicated that pain scores and other control variables explained approximately 18 percent of the variance in depression. The multivariate analysis results confirmed that those who had higher pain scores were significantly likely to have increased depression scores (b = 4.97, SE = 1.52, p < .01). Education marginally significantly moderated the relationship between pain and depression (p = .059). The previously reported positive pain-depression relationship exists among chronically ill older adults in rural areas, calling for tailored interventions to reduce their pain and its impact on depression.
SELF-GLUCOSE MONITORING AND HYPOGLYCEMIA RISK IN OLDER RURAL VETERANS WITH TYPE 2 DIABETES
Authors: Valencia Willy Marcos , Wang Kaicheng , Muralidhar Kiranmayee , Dang Stuti
Published: November 2019

Hypoglycemia evaluation is expected in every encounter with diabetic patients. However, self-monitoring and self-management may not be complete at home, and limited by geriatric syndromes. Furthermore, hypoglycemia risk increases with age, and rurality may limit access to frequent monitoring. We identified 112 rural veterans with high hypoglycemia risk, using the local medication database (sulfonylureas and insulin), combined with age and glycated hemoglobin (HbA1c). Statistical analyses were conduct using SAS 9.4 (Cary, NC). We used Chi-square, Fisher’s, One-way ANOVA for baseline variables, and a multivariate logistic regression model to assess the association of hypoglycemia and risk factors, including age, HbA1c%, self-monitoring, and knowledge. Hypoglycemia was reported in 30.4% of cases, of whom the majority were younger than those not reporting hypoglycemia (72.0±4.3 vs 75.0±6.5 years, p=.015). Baseline HbA1c% was higher in cases with hypoglycemia compared to those without (7.7±1.6% versus 7.3±1.2%, not statistically significant). There were no significant differences between pharmacologic regimens, self-monitoring, and general knowledge. Veterans who knew hypoglycemia symptoms were 6 times more likely to reported hypoglycemia, compared with veterans who did not know any symptoms. We contacted primary care teams (PCT) for whom medications were adjusted. Hypoglycemia risk is high in the older population, and telemedicine programs can support primary care teams to improve management of their patients. Poor symptom knowledge needs to be addressed, while considering special attention for hypoglycemia unawareness in the oldest age group. We are implementing a project using continuous glucose monitoring in this high-risk population.
SLEEP APNEA ASSOCIATED COMORBIDITIES AND MORTALITY IN AN OLDER VETERAN POPULATION
Authors: Kresevic Denise M , pallaki muralidahar , Burant Christopher J , Gideon Clare , Schroeder Emily , Chen Peijun
Published: November 2019

Evidence continues to mount that sleep apnea (SA) occurs in 10-25% of Americans and is associated with significant morbidity and mortality (Schulman 2018). Among veterans, SA has been reported four times more often as compared to other non-veteran cohorts. (Wong 2015). The risk of developing dementia is increased in older individuals with OSA (Shastri, Bangar, & Holmes, 2015). The prevalence and characteristics of older adults with dementia and sleep apnea is not well known and long-term population-based studies on mortality have been lacking. Recent studies have reported overall mortality rates of 19%, in those individuals with SA, an increased rate of 1.5-3 times the mortality rate as compared to those individuals those without SA. Current recommendations support SA screening of high risk individuals including those with symptoms of snoring, fatigue, memory and concentration problems and mood changes. (Krist 2018). Despite a large number of older adults with suspected SA and comorbidities, the majority are not screened, referred, diagnosed and treated. In this VA pilot study of outpatient older male veterans with dementia and SA, N=195, mean age 75.83 years, SD=9.1, 51.3% were white, 37.5% were black. Frequently found comorbidities were: hypertension 88%, congestive heart failure 41%, Diabetes. 62% and, stroke 21%. Of note, among those who died, SA was significantly related to congested heart failure (r=.32, p<.001) and COPD (r=.40, p<.001). The overall mortality rate of 27% was higher than previous reports. Further investigation is needed to better understand the relationship between comorbidities, and SA, screening, treatment and mortality.
LIFITEGRAST 5% FOR DRY EYE DISEASE: COMBINED EFFICACY AND SAFETY FROM FIVE RANDOMIZED CONTROLLED TRIALS
Authors: Gonzalez Agustin L , Donnenfeld Eric , Baudouin Christophe , Holland Edward , Nichols Kelly , Karpecki Paul , Hamdani Mohamed , Shojaei Amir
Published: November 2019

Five randomized, double-masked, placebo-controlled trials were conducted in the US in adults with DED, an eye dryness score (EDS, visual analogue scale [VAS], 0–100) ≥40, and inferior corneal staining score ([ICSS], 0-4) ≥2.0 at study entry: four 84-day efficacy trials (phase 2, lifitegrast n=58, placebo, n=58; phase 3: OPUS-1, n=293, n=295; OPUS-2, n=358, n=360; OPUS-3, n=355, n=356) and a 1-year safety study (SONATA, lifitegrast n=220, placebo n=111). The pooled population had a mean age of 59.4 years, and 76% were females. Lifitegrast treatment, versus placebo, significantly improved EDS from baseline to day 84 in three of the four trials: OPUS-1 (treatment effect [TE] 4.7; P=0.0311), OPUS-2 (TE 12.3; P<0.0001), and OPUS-3 (TE 7.5; P=0.0003). Lifitegrast significantly improved ICSS in the phase 2 (TE 0.25; P=0.0498) and OPUS-1 (TE 0.23; P=0.0007) trials, and nominally in OPUS-3 (TE 0.17; nominal P=0.0135). The responder analyses from OPUS-2 and OPUS-3 assessed the proportion of subjects with an EDS reduction from baseline (≥10, ≥15, ≥20 points), and percentage change from baseline (≥30, ≥50, ≥70%), to days 14, 42 and 84. More subjects achieved ≥30% EDS reduction with lifitegrast versus placebo in Opus-2, and Opus 3 at days 14, 42, and 84 (all nominal P<0.0001). A similar trend was seen at other response thresholds. Pooled safety data (lifitegrast n=1287; placebo, n=1177) indicated Lifitegrast was well tolerated with no serious ocular adverse events. Lifitegrast significantly improved signs and symptoms of DED in adult subjects, with EDS improvements observed starting at day 14 after treatment.
INTRA-INDIVIDUAL PHYSICAL AND PSYCHOLOGICAL SYMPTOM VARIABILITY AND STRESS INFLUENCE ACTIVITIES OF DAILY LIVING
Authors: Moore Scott E , Wierenga Kelly , Hardin Heather K
Published: November 2019

Stress and symptomatology have been shown to have strong relationships to health outcomes in older adults. More specifically, perceived social stressors (PSS), whether related to disease, disability or demographics, is a contributor to health. Recently it was reported that intra-individual symptom variability (ISV) may predict poor health outcomes better than symptom severity in some chronic illnesses. Individual and combined influences of ISV and PSS on health behaviors are not fully described. Using a subset (n = 518, 46.5% men; mean age = 48.7) of MIDUS Refresher participants’ 8 day daily diary data, we sought to determine the influences of physical and psychological ISV and PSS on independent and basic activities of daily living (iADLs, bADLs). The ISVs represent an average of day-to-day variation across each of the 22 physical and 27 psychological symptoms for each participant. Psychological ISV, physical ISV, PSS, and total number of chronic conditions were entered into two structural equation models as predictors for each ADL outcome (p<.01). The models depicted both direct and indirect influences of psychological ISV on ADLs (iADLs: B=-.43, P < .001; B = .51, P < .001 [through PSS]; bADLs: B=-.45, P < .001; B = .51, P < .001 [through PSS]). However, the influence of physical ISV on ADLs was indirect (B = .22, P = .001 [through PSS]). Individual-level influences of ISV and PSS on ADLs may better aide healthcare providers’ identifying and intervening to disrupt poor health outcomes for those at risk.
SOCIAL TIES AND SUICIDAL IDEATION AMONG OLDER ADULTS REFERRED FOR A BEHAVIORAL HEALTH EVALUATION
Authors: Mavandadi Shahrzad , Ingram Erin , Klaus Johanna , Oslin David
Published: November 2019

The association between the quality and nature of social relationships and suicidal outcomes across the lifespan is well established. However, social ties are rarely assessed in primary care and other clinical settings where older adults at high risk for suicide-related outcomes are seen. This study examined the unique associations between three indices of social ties (i.e., perceived social support, frequency of negative social exchanges, and degree of social integration) and death/suicidal ideation among 3,261 older veterans (aged 65+) who completed a clinical mental health/substance use (MH/SU) assessment upon referral to a Primary Care-Mental Health Integration (PCMHI) program. Data on sociodemographics, MH/SU conditions (e.g., depression, anxiety, and substance use), perceived health, the three indices of social ties, and death/suicidal ideation were extracted from clinical interviews. Veterans were on average 70.8 years old (+6.5 years) and primarily male. Approximately half were married and 60.3% were non-Hispanic white. Forty percent reported death ideation or suicidal ideation, as measured by the Paykel Suicide Scale. Logistic regression analyses revealed that, adjusting for covariates, while perceived social support was associated with a greater risk of reporting death ideation relative to no ideation, both social support and frequency of negative exchanges were uniquely associated with greater risk of reporting suicidal ideation relative to no ideation. Social integration was unrelated to odds of death or suicidal ideation. Findings underscore the value of integrating assessments of multiple aspects of social ties into routine PCMHI practice, as doing so has the potential to enhance suicide screening and intervention efforts.
HepCare Europe: a service innovation project. HepCheck: enhancing HCV identification and linkage to care for vulnerable populations through intensified outreach screening. A prospective multisite feasibility study
Authors: Barror Suzanne , Avramovic Gordana , Oprea Cristiana , Surey Julian , Story Alistair , Macías Juan , Cullen Walter , Crowley Des , Horan Aidan , Naughton Anna Marie , Iglesias Maria , Ianache Irina , Lazar Stefan , Popa Ionut , McHugh Tina , Menezes Dee , Tinago Willard , Lambert John S
Published: November 2019

Objectives

Hepatitis C is one of the main causes of chronic liver diseases worldwide. One of the major barriers to effecting EU- and WHO-mandated HCV elimination by 2030 is underdiagnosis. Community-based screening strategies have been identified as important components of HCV models of care. HepCheck Europe is a large-scale intensified screening initiative aimed at enhancing identification of HCV infection among vulnerable populations and linkage to care.

Methods

Research teams across four European countries were engaged in the study and rolled out screening to high-risk populations in community addiction, homeless and prison services. Screening was offered to 2822 individuals and included a self-administered questionnaire, HCV antibody and RNA testing, liver fibrosis assessment and referral to specialist services.

Results

There was a 74% (n=2079) uptake of screening. The majority (85.8%, n=1783) were male. In total 44.6% (n=927) of the sample reported ever injecting drugs, 38.4% (n=799) reported ever being homeless and 27.9% (n=581) were prisoners. In total 397 (19%) active HCV infections were identified and 136 (7% of total sample and 34% of identified active infections) were new cases. Of those identified with active HCV infection, 80% were linked to care, which included liver fibrosis assessment and referral to specialist services.

Conclusions

HepCheck’s screening and linkage to care is a clear strategy for reaching high-risk populations, including those at highest risk of transmission who are not accessing any type of care in the community. Elimination of HCV in the EU will only be achieved by such innovative, patient-centred approaches.
Pooled genotyping strategies for the rapid construction of genomic reference populations1
Authors: Alexandre Pâmela A , Porto-Neto Laercio R , Karaman Emre , Lehnert Sigrid A , Reverter Antonio
Published: November 2019

The growing concern with the environment is making important for livestock producers to focus on selection for efficiency-related traits, which is a challenge for commercial cattle herds due to the lack of pedigree information. To explore a cost-effective opportunity for genomic evaluations of commercial herds, this study compared the accuracy of bulls’ genomic estimated breeding values (GEBV) using different pooled genotype strategies. We used ten replicates of previously simulated genomic and phenotypic data for one low (t1) and one moderate (t2) heritability trait of 200 sires and 2,200 progeny. Sire’s GEBV were calculated using a univariate mixed model, with a hybrid genomic relationship matrix (h-GRM) relating sires to: 1) 1,100 pools of 2 animals; 2) 440 pools of 5 animals; 3) 220 pools of 10 animals; 4) 110 pools of 20 animals; 5) 88 pools of 25 animals; 6) 44 pools of 50 animals; and 7) 22 pools of 100 animals. Pooling criteria were: at random, grouped sorting by t1, grouped sorting by t2, and grouped sorting by a combination of t1 and t2. The same criteria were used to select 110, 220, 440, and 1,100 individual genotypes for GEBV calculation to compare GEBV accuracy using the same number of individual genotypes and pools. Although the best accuracy was achieved for a given trait when pools were grouped based on that same trait (t1: 0.50–0.56, t2: 0.66–0.77), pooling by one trait impacted negatively on the accuracy of GEBV for the other trait (t1: 0.25–0.46, t2: 0.29–0.71). Therefore, the combined measure may be a feasible alternative to use the same pools to calculate GEBVs for both traits (t1: 0.45–0.57, t2: 0.62–0.76). Pools of 10 individuals were identified as representing a good compromise between loss of accuracy (~10%–15%) and cost savings (~90%) from genotype assays. In addition, we demonstrated that in more than 90% of the simulations, pools present higher sires’ GEBV accuracy than individual genotypes when the number of genotype assays is limited (i.e., 110 or 220) and animals are assigned to pools based on phenotype. Pools assigned at random presented the poorest results (t1: 0.07–0.45, t2: 0.14–0.70). In conclusion, pooling by phenotype is the best approach to implementing genomic evaluation using commercial herd data, particularly when pools of 10 individuals are evaluated. While combining phenotypes seems a promising strategy to allow more flexibility to the estimates made using pools, more studies are necessary in this regard.
A Mechanism-Based Forensic Investigation into the Postmortem Redistribution of Morphine
Authors: Gleba Jessica , Kim Jonghan
Published: November 2019

The interpretation of postmortem drug levels is complicated by the change in drug blood levels during the postmortem period, a phenomenon known as postmortem drug redistribution. We investigated the postmortem redistribution (PMR) of morphine, morphine-3-glucuronide and normorphine in the rat. Morphine (10 mg/kg) was intravenously injected into rats, followed by euthanasia 1 h post-injection. The carcasses were placed in a supine position at room temperature, and tissues including heart blood, femoral blood, liver, lung and brain were collected at different time points: 0, 8, 16 or 24 h postmortem. The samples were analyzed with a validated (following modified Scientific Working Group for Forensic Toxicology (SWGTOX) (20) guidelines) liquid chromatography–tandem mass spectrometry method. The use of a mechanism-based approach (involving the used set doses of drug with the study performed in controlled environment) to assess PMR using systematic and statistical analyses provides important information that has not previously been presented in PMR literature. While previous human studies focus on central to peripheral ratios as well as peripheral to tissue ratio, this work focused on the change in morphine and metabolite concentrations over the course of the postmortem interval in relation to each other in addition to the comparison to additional matrices at each postmortem interval. Postmortem redistribution was identified in several tissues across the postmortem interval; however, there was minimal statistical difference observed among each matrix at a given postmortem interval with the exception of normorphine and morphine-3-glucuronide. Combined, our study provides a valuable resource and reference information that can aide toxicologists, medical examiners or coroners when assessing postmortem drug concentrations of morphine and metabolites when they are making determinations of cause of death.