bluuebunny/crossref_metadata_2025 huggingface dataset:
Early-life Stress, Depressive Symptoms, and Inflammation: The Role of Social Factors
Authors: Nakamura Julia , Kim Eric , Rentscher Kelly , Kuhlman Kate
Published: December 2020

Early-life stress (ELS) is associated with elevated risk of adverse psychological (e.g., depression) and physical health outcomes (chronic diseases driven by inflammation) in older adulthood. We evaluated whether four social factors buffered the ELS-depressive symptoms and ELS-inflammation associations. Data were from 3,416 adults (58.28% female; Mage=68.41; SDage=10.24) who participated in the 2006 wave of the Health and Retirement Study, a nationally representative sample of older adults in the United States. We used hierarchical regression analyses to first test the main effects of ELS on depressive symptoms and inflammation (high-sensitivity C-reactive protein). We then assessed whether four social factors (perceived support, frequency of social contact, network size, and volunteer activity) moderated the ELS-depressive symptoms and ELS-inflammation relationships. We found a small positive association between ELS and depressive symptoms (B=0.17, SE=0.05, p=.002), which was moderated by social contact and perceived support. Specifically, ELS was only associated with elevated depressive symptoms for participants with limited social contact (B=0.24, SE=0.07, p<.001) and low perceived support (B=0.24, SE=0.07, p<.001). These associations remained after accounting for potential confounders (age, body-mass index, adulthood stress, and marital status). ELS was not associated with inflammation, and no social factors moderated the ELS-inflammation link. Increased social contact and perceived support may be protective for individuals at an elevated risk of developing depressive symptoms as a result of ELS. Future interventions may benefit from leveraging these social factors to improve quality of life in adults with ELS.
The Frailty Index, Missing Data, and Imputation
Authors: Pridham Glen , Rutenberg Andrew
Published: December 2020

The frailty index (FI) is a summary measure of health during aging that is defined by the average number of ‘things wrong’, i.e. health deficits, across a sundry of lab, clinical, and questionnaire measurements. Missing data are ubiquitous in aging studies. Although the FI appears to have robust predictive power—even when ignoring missing data, there has not been a systematic study of the consequences of imputation when used in the principle investigation. We investigated the standard imputation methodology, multiple imputation using chained equations (MICE), and other missing data methods, in terms of prediction of mortality and statistical power using the 2003/04 and 2005/06 NHANES datasets. When we masked known data completely at random, we observed that available case analysis incorrectly estimated the true variance of the FI leading to potential problems in hypothesis testing, whereas imputation helped mitigate this effect. We also observed that the default imputation methods from MICE showed a significant increase in FI relative to the ground truth together with a decrease in predictive power, hence we suggest other options when performing imputation with NHANES. The underlying missing mechanism in NHANES is not random and appears to be important, for example survival curve analysis showed that the top half of patients with the most missing data died significantly younger than the bottom half.
The Role of Communities of Residence on Older Mexican Adults’ Likelihood of High Depressive Symptoms
Authors: Downer Paige , Wong Rebeca
Published: December 2020

Exposure to population- and individual-level poverty, poor health, and negative life-events contributes to overall life adversity that may increase older adults risk of depression. We hypothesize that increased neighborhood-level multidimensional poverty and decreased proportions of within-neighborhood health promoting socio-demographic characteristics will be positively associated with depression among older Mexican adults. This study uses data from Wave 1 (2001) and Wave 3 (2012) of the Mexican Health and Aging Study (MHAS). Wave 1 will be used for information for socio-demographic characteristics, including gender, female-headed households, rural settings, and employment status. Wave 3 will be used for information on self-reported depressive symptoms. Information for neighborhood characteristics will come from the 2000 Mexican Census that has been linked with the 2001 MHAS wave. Older Mexican adult’s exposure to multidimensional poverty at the locality (city/town) level will be measured by the proportion of the population aged 15 and older with low education; the proportion of the population with low access to health care services; the percentage of homes with inferior construction materials; and the proportion of the population without sewage and running water. A multivariable logistic regression will be used to model the association between older Mexican adult’s neighborhood and community characteristics in 2001 on depression in 2012. The expected findings will inform government policies to increase access to affordable housing, the availability of health care services, educational and employment opportunities, and public infrastructures such as transportation, water, and sanitation services, and energy services to reduce mental health burden.
Simulating the Effects of Construction in NYC’s Chinatown on Fruit and Vegetable Consumption in Local Residents
Authors: Yi Stella , Li Yan , Imbruce Valerie , Tan Yi-Ling , Foster Victoria , Wang Vivian , Kwon Simona
Published: December 2020

In 2017, the mayor of New York City (NYC) unveiled a 10-year plan to close the city’s largest jail complex and to build four satellite detention centers – including one in Manhattan’s Chinatown. Chinatown is a destination for affordable produce and its retail produce sector is comprised of street vendors and small stores, a style of fresh fruit and vegetable (FV) marketing the city promotes to achieve its goal of equitable access to healthy foods. The objective of this study was to project the impact of the proposed construction activity on FV consumption among residents in Chinatown. We developed an agent-based model that accounts for individual and neighborhood-level factors (e.g., age, gender, education, food environment) to predict FV consumption at the neighborhood level in NYC. We assumed that long-term construction will lead to the closure/migration of fresh produce vendors and therefore a reduction of FV access. We simulated three scenarios in which the number of fresh produce vendors is reduced by 5%, 10%, and 15% due to construction. Results suggest that planned construction could decrease the consumption of FV by 2.1%, 4.4%, and 6.8% among residents in Chinatown if the construction would reduce the number of fresh produce vendors by 5%, 10%, and 15%, respectively. Preliminary sensitivity analyses demonstrate the negative impact of the construction on FV consumption could be greater among older (65+ years) vs. young adults. The planned construction of a detention center in Chinatown may decrease the consumption of FV among its residents, particularly older adults.
COVID-19 pandemic lockdown responses from an emotional perspective: Family function as a differential pattern
Authors: Lopez Javier , Perez-Rojo Gema , Noriega Cristina , Velasco Cristina , Carretero Isabel , López-Frutos Patricia , Galarraga Leyre
Published: December 2020

Family can be an essential resource at times of loss or vital crisis. Loneliness and isolation in older adults might have serious negative consequences for their mental health. For this reason, this research aims to analyze the role of family function in the anxiety and depression experienced by older adults during the COVID-19 crisis. Participants were 882 Spanish community-dwelling adults over 60 years of age. Sociodemographic characteristics, characteristics related to the coronavirus, self-perceived health, family function, avoidance, depression and anxiety were analyzed. Data suggest a buffering effect of family function on anxiety and depression during the pandemic. Furthermore, being unmarried or a female, greater fear of COVID-19, worse self-perceived health, greater avoidance, and worse family function were associated with higher levels of anxiety. Likewise, greater fear of COVID-19, poorer self-perceived health, greater avoidance, and poorer family function, were associated with greater depression. These results point out that family dysfunction is a predisposing factor for the development of the emotional problems of anxiety and depression in older people in potentially stressful and loss situations.
COVID-19 Social Distancing Measures and Loneliness among Older Adults
Authors: Choi Eun Young , Farina Matthew , Wu Qiao , Ailshire Jennifer
Published: December 2020

In response to the COVID-19 pandemic, older adults are advised to follow social distancing measures to prevent infection. However, such measures may increase the risk of loneliness. The current study aimed to investigate (1) whether social distancing measures, particularly limiting close social interactions, are associated with loneliness among older adults, and (2) whether the association between social distancing measures and loneliness is moderated by sociodemographic characteristics. Data were from the fourth wave (April 29 to May 26, 2020) of the nationally representative Understanding America Study (UAS) COVID-19 Survey. We used data on adults 50 years or older (N = 3,283). Multivariate logistic regression models of loneliness were examined to test the independent effects of social distancing measures and their interaction with sociodemographic characteristics on loneliness. Four indicators of social distancing measures were considered: (a) avoiding public spaces, gatherings, or crowds, (b) canceling or postponing social activities, (c) social visits, (d) close contact (within 6 feet) with others. Cancelling or postponing social activities and avoiding close contact with other people were associated with 36% and 41% greater odds of loneliness, respectively. Furthermore, males and non-Hispanic Whites who had no close contact with others had a significantly greater probability of reporting loneliness than those who had contact. Our findings emphasize the heterogeneous nature of COVID-19 related experiences across subpopulations of older adults and call special attention to vulnerable groups that may be more impacted by the challenge of COVID-19 social distancing.
The Family and Medical Leave Act: A Policy Analysis and Recommendations to Address Employed Caregiver Burden
Authors: Park Geunhye , Robinson Erin
Published: December 2020

Family caregiving plays a pivotal role in the long-term care system in the U.S, as there are over 40.4 million people providing unpaid care to individuals aged 65+ (U.S. Bureau of Labor Statistics, 2019). The majority are women providing supports to a parent/grandparent and provide an average of three hours of care each day. This places greater demands on family caregivers in balancing their dual caregiver/employment roles. The Family and Medical Leave Act (FMLA) of 1993 enables family caregivers to take unpaid leave to provide supports to immediate family. While FMLA was intended to provide flexibility to employed caregivers, many struggle with family-work conflicts and caregiver burden is high. Therefore, this conceptual paper offers a critical examination of FMLA and how family caregivers of older adults are impacted. Results of this analysis revealed three themes. First, FMLA is largely inadequate for employed caregivers, as only 60% of the workforce are eligible and unpaid leave restrictions create considerable financial hardship. Second, employer discrimination is high and family caregiving discrimination claims have dramatically increased since FMLA was enacted. And third, many employed caregivers are unaware of FMLA policies and eligibility requirements, which results in underutilization of benefits. Based upon these results, several policy and employer recommendations can be made, such as expanding FMLA coverage to include paid leave and non-immediate family caregivers. Additional recommendations will also be addressed. As it has been nearly 30 years since FMLA was enacted, updated policy is vital to continue supporting employed caregivers in their roles.
Nursing Home Social Workers Perceptions of Preparedness and Coping for COVID-19
Authors: Miller Vivian , Fields Noelle , Kusmaul Nancy , Anderson Keith , Maxwell Christy
Published: December 2020

Social work has a long history of responding to the needs of vulnerable populations during times of crisis and disaster. Social workers are working at the front lines responding to the current COVID-19 pandemic in a variety of health care practice settings, including nursing homes, however it is unclear how social workers perceive their preparedness during this time. This study employed a cross-sectional survey to nursing home social workers via social media on feelings of preparedness for COVID-19, what has been most professionally helpful for social workers during these times in their role in COVID-19, as well as demographic questions. Demographic data were analyzed using SPSS and qualitative data were analyzed using the rigorous and accelerated data reduction (RADaR) technique. Data are based on a sample of 63 (N=63) nursing home social workers. Findings revealed that while some social workers felt prepared for the coronavirus, many respondents stated that they were unprepared to meet the demands and challenges they were facing. Moreover, participants shared that professional support was critically important to get through COVID-19. These findings are important, as social workers are tasked with ensuring each resident attains their highest level of psychosocial well-being, which can be achieved only when nursing home staff are supported. Findings from the present study suggest that additional support for nursing home staff ought to include peer mentoring and mutual support. Additionally, improved leadership across health care settings is worth assessing.
Increased Blue Mood and Loneliness during COVID-19 Pandemic in a Veteran Cohort
Authors: Mattek Nora , Wall Rachel , Beattie Zachary , Wu Chao-Yi , Kaye Jeffrey , Dodge Hiroko , Silbert Lisa
Published: December 2020

Older Veterans are at especially high risk of depression and social isolation due to COVID-19 stay-at-home orders and necessary safety precautions. We aimed to objectively measure differences in mood reports before and after COVID-19 stay-at-home orders in rural older Veterans. Participants age > 62 were enrolled in the Collaborative Aging Research using Technology (CART) initiative, a NIH and VA HSRD funded multi-site study examining the feasibility of unobtrusive remote sensing and monitoring of physical, cognitive, and health-related activities. The VA CART site consists of Pacific Northwest Veteran volunteers and their cohabitants. Weekly online health forms including questions about blue mood and loneliness were collected January – July 2020. A COVID stay-at-home order was instituted March 13 2020. Generalized estimating equations (GEE) with logit link was used to investigate differences in mood reports pre- and post- stay-at-home orders. 100 older volunteers completed 2441 health reports (mean age 71.2 years, 41% female, 19% single). Thirty-five percent were urban, 34% large rural, and 31% small rural using rural-urban commuting area (RUCA) scores urban: 1-3; large rural 4-6; small rural 7-10. After adjusting for covariates, incidence of blue mood and loneliness reports were significantly higher after stay-at-home orders (OR=4.4, p<0.0001 and OR=7.2, p<0.0001 respectively). Results varied by rurality with large rural volunteers showing the largest increases. Real-world monitoring of weekly health reports may identify those at greatest risk for depression and social isolation in older Veterans and their cohabitants and is of particular relevance in rural settings, where access to specialty care is limited.
Co-Occurrence of Physical and Cognitive Decline in Vervet Monkeys (Chlorocebus aethiops sabaeus)
Authors: Frye Brett , Shively Carol , Craft Suzanne , Register Thomas , Jorgensen Matthew , Latimer Caitlin , Scott Christie , Register Hannah
Published: December 2020

Age-related neurodegeneration associated with Alzheimer’s (AD) disease begins in middle age, well before the onset of symptoms. Therefore, translational models to identify modifiable risk factors in middle-age are needed to understand etiology and identify therapeutic targets. Vervet monkeys (Chlorocebus aethiops sabaeus), like humans, naturally develop several risk factors for AD with age, including obesity, prediabetes, and hypertension. Furthermore, older vervets exhibit accumulation of amyloid and tauopathies, decreased brain volumes, and physical declines in gait speed, suggesting that these NHPs may be useful models of early AD-like neuropathology. Currently, we are investigating the extent to which cognitive and physical decline co-occur in 20 elder (mean age=23 years, ~equivalent to a human age of 80 years) and 10 middle-aged (mean age=11 years) females through assessments of physical performance, executive function, social cognition, and short-term memory. These measures are part of a larger study to integrate physical, social, and cognitive function with measures of body composition, metabolic profiles, CSF, blood, neuroimages, and neuropathology. While tests of social cognition and short-term memory are ongoing, assessments of executive function indicate that performance declines with age (N=26; p<0.05; R-squared=0.23). Furthermore, animals that exhibit slower gait speed also perform poorly on the executive function task (N=26, p<0.05; R-squared=0.25). These preliminary results suggest that accelerated aging co-occurs in multiple systems in vervets. This study will enable examination of temporal relationships between physical and cognitive declines. Ultimately, this comprehensive, integrative whole-body approach will help clarify the mechanisms underlying divergent aging trajectories and inspire interventions that promote multi-system healthy aging.
Increased Serum IL 6 Associated With Mortality and Cognitive Impairment in Elderly Brazilians
Authors: Caldeira Marcelo , Brunialti Milena , Salomão Reinaldo , Filho Clineu Almada , Cendoroglo Maysa
Published: December 2020

Immunological and inflammatory changes are gaining importance in aging as they are associated with functional limitations and mortality. Chronic inflammation associated with aging (Inflammaging) is a systemic and subclinical condition, characterized by changes in the levels of interleukins such as IL1, IL4, IL6, IL8, IL10 and TNF alpha, associated with genetic, physiological and environmental factors, whose importance is to be directly associated with morbidity and mortality in the elderly. Objective: To evaluate, through a longitudinal study, the relationship between chronic inflammation associated with aging and possible outcomes, such as cognitive changes and mortality in independent oldest old adults. Methods: were evaluated 201 elderly, aged 80 years or older, community residents, with preserved cognition, without acute diseases and with controlled chronic diseases. In a 02 years of interval, laboratory collections of inflammatory markers (IL 1, IL 4, IL6, IL10, TNF alpha and CRP) were performed and outcomes such as cognitive impairment and deaths were evaluated. Results: There was a correlation between increased serum IL6 and cognitive impairment, in the group of women (p-value = 0.008) and in the group All (p-value = 0.022). In the group of men, there was a significant difference between the increase in IL6 values ​​(p-value = 0.028) and CRP (p-value = 0.016) in relation to deaths. Conclusion: The results of this longitudinal study showed and confirmed the positive association between changes in inflammatory markers such as IL6 and outcomes such as cognitive impairment and mortality also in elderly Brazilians.
Odor Sensitivity as a Biomarker of Aging
Authors: Sarker Marjana , Leiser Scott
Published: December 2020

Recent studies support the deterioration of the sense of smell as an important biomarker for cognitive impairment diseases, including Alzheimer’s disease. The model organism C. elegans has a well-studied olfactory system, which provides an ideal platform to measure loss of smell with aging. The goal of our project is to use the short lifespan and olfactory changes observed in nematodes to identify mechanisms to slow aging and treat age-related diseases. Our approach is to utilize worms at various times of their healthy adult lifespan and to test for their sensitivity to known attractants such as benzaldehyde. These odorants are largely detected by the main AWC olfactory neurons. It is well documented that the responsiveness of AWC decreases with age. Our paradigm is to briefly fast worms to increase motivation before testing their ability to discriminate odors. Our results show that younger worms actively move toward the attractant and show preference for specific attractants. However, older worms frequently do not respond to attractive odors and remain near the point of origin, regardless of motility. These results indicate a decreased odor response with age. Our current work focuses on identifying genes and compounds that positively affect this odor response in older animals. The resulting data can then be tested for their efficacy to improve other aspects of healthspan and potentially longevity.
Nicotinamide and Sugar Metabolism Associated With Muscle Mass Loss During Calorie Restriction in Older Adults
Authors: Quillen Ellen , Lee Jingyun , Furdui Cristina , Beavers Daniel , Beavers Kristen
Published: December 2020

Weight loss among older adults remains controversial due to lean mass loss and potential exacerbation of disability risk. Using the Medifast for Seniors clinical trial (NCT02730988), which investigated high protein supplementation (≥1.0 g/kg/d) during caloric restriction to preserve lean mass among 96 older adults (>70 years, 74% women, 27% black) with obesity (BMI: 35 kg/m^2), we applied untargeted metabolomics to identify small molecules associated with the highly variable change in lean muscle mass during weight loss. Forty-seven participants were randomized to high protein weight loss, and 92% lost at least 5% body weight over 24 weeks. Across DXA-ascertained measures of lean body mass, gynoid lean mass exhibited the broadest range of change: +4% to -12%. For 38 participants, untargeted metabolomics data was generated from fasted serum samples collected before and after intervention. 121 serum metabolites were identified and change from baseline was tested for correlation with percent change in gynoid muscle mass. Increasing nicotinamide levels were associated with a greater loss of gynoid muscle mass (R^2=0.22, p=0.0027). Pathway analysis was applied to identify Kyoto Encyclopedia of Genes and Genomes (KEGG) biochemical pathways containing multiple nominally-associated metabolites. The amino sugar and nucleotide sugar metabolism pathway was significantly enriched (p=0.006), containing four sugar metabolites associated with shifts in lean muscle mass. This pathway is important in the glycosylation of polysaccharides, a ubiquitous and important regulator of energy metabolism, but has not previously been linked to muscle mass and should be further interrogated in preservation of lean muscle during weight loss.
Poor Mitochondrial Health and Systemic Inflammation? Testing of a Classical Hypothesis
Authors: Zampino Marta , Ferrucci Luigi , Spencer Richard , Fishbein Kenneth , Simonsick Eleanor , Kuo Pei-Lun
Published: December 2020

Chronic low-grade inflammation often occurs with aging and has been associated with negative health outcomes. Despite extensive research on the origins of “inflammaging”, the causative mechanisms remain unclear. However, a connection between poor mitochondrial health and chronic inflammation has been hypothesized, with decreasing mitochondrial function occurring with age and precipitating an increase in reactive oxygen species and other pro-inflammatory macromolecules such as mitochondrial DNA. We tested this hypothesis on a population of 619 subjects from the Baltimore Longitudinal Study of Aging, measuring muscle mitochondrial oxidative capacity in vivo by phosphorus magnetic resonance spectroscopy (P-MRS), and plasma interleukin (IL)-6, the most widely used biomarker of inflammaging. The P-MRS-derived post-exercise phosphocreatine recovery time constant tau-PCr, a measure of oxidative capacity, was expressed as a categorical variable through assignment to quintiles. Participants in the first quintile of tau-PCr (best mitochondrial function) were taken as reference and compared to the others using linear regression analysis adjusted for sex, age, lean and fat body mass, and physical activity. Those participants with the lowest oxidative capacity had significantly higher log(IL-6) levels as compared to the reference group. However, data from the other quintiles was not significantly different from the reference values. In conclusion, severe impairment of oxidative capacity is associated with increased inflammation. This study design does not provide conclusive evidence of whether increased inflammation and impaired bioenergetic recovery are both caused by underlying poor health status, or whether mitochondrial deficits lead directly to the observed inflammation; we anticipate addressing this important question with longitudinal studies.
Racial Differences in Glucose Handling and Function With Obesity Reduction: Preliminary Findings
Authors: Borack Michael , Miller Marshall , Rincker Jamie , McDonald Shelley , Starr Kathyrn , Bales Connie
Published: December 2020

Blacks have higher rates of obesity and are twice as likely to develop diabetes as non-Hispanic whites. Obesity reduction can improve metabolic health, but physical function and glucose handling may be threatened by concomitant loss of muscle mass. These preliminary findings from a 4-mo. randomized controlled trial assess the racial differences in glucose handling and physical function in obese, older adults with prediabetes (Fasting Plasma Glucose (FPG) ≥95<126 mg/dL or HbA1c 5.7-6.4%) following obesity reduction. At 4 mo. endpoint, participants (n = 31; age = 68.1±5.4 years, BMI =36.0±4.7 kg/m2) had reduced (p<0.05) body weight in both Blacks (5.1%) and Whites (4.1%); HbA1c levels were also reduced (Blacks = -0.3 ±0.3; Whites = -0.1±0.3) with no difference by race. However, FPG was reduced for Blacks compared to Whites (-7.9±9.5 vs. -2.8±6.2 mg/dL; p<0.05). Short Physical Performance Battery (SPPB) score was lower for Blacks than Whites at both baseline (9.8±1.5 vs 10.9±1.2; p<0.05) and 4 mo. (10.17±1.4 vs 11.21±1.3; p<0.05), respectively. A trend towards improvement (p=0.08) in meters walked in 6 minutes was present in both Blacks (13.3±60.8) and Whites (20.0±36.3) with no between-group difference. Interestingly, at baseline, 41% of participants said they modified their behaviors due to a fear of falling despite having a mean SPPB score of 10.3±1.5. Following the intervention, fear of falling was reduced, with 35% of the participants reporting this behavior. Our findings illustrate that modest weight loss improves glucose handling, physical function and perceived fall risk for both Black and White older adults with prediabetes.
Gender Differences in Caregiving of Older Adults: A Systematic Review of the Literature
Authors: Bueno Michael , Chase Jo-Ana
Published: December 2020

Caregivers of older adults with chronic illness provide essential care that benefits individuals and society. Many factors influence health outcomes related to the caregiving role. The purpose of this review is to explore how caregiver health outcomes may vary by gender. Data sources include CINAHL, Google Scholar, Google and PsychINFO. Eligible studies focused on gender-based differences in psychological and emotional outcomes of primary informal or familial caregivers (ie, spouses, children, grandchildren, nieces, nephews, neighbors, and friends) of an older adult with chronic illness. The Caregiver Identity Theory (CIT) guided this study. Twelve studies were eligible for this review. Consistent with the CIT, negative outcomes are associated with changing role identity throughout the care recipient’s disease progression, and these outcomes differ between genders. Women tended to experience higher overall burden, stress, anxiety, shame and role strain; however, some studies found that men may be affected more during the initial transition into the caregiver role. Methodological limitations of primary research in this area included the use of cross-sectional design, poor generalization to US populations since most studies were conducted outside of the US, and disproportionately fewer male participants across studies. Overall, gender differences in health outcomes among caregivers exist, and other variables relating to gender, such as kinship and age, may also be important factors. Findings suggest health professionals should create individualized engagement, communication, and training strategies with considerations for gender differences in design. Future studies including more male caregivers and more diverse participants is warranted.
Staff and Administrator Perceptions of Fall Risk Management in Home- and Community-Based Service Settings
Authors: Juckett Lisa , Poling Rachael
Published: December 2020

Older adults who receive home- and community-based services (HCBS), such as home-delivered meals and personal care assistance, are at particular risk for falls due to their extremely high prevalence of fall risk factors. HCBS organizations and their staff are well-positioned to implement fall risk screens with HCBS clients and then refer older adults to fall prevention services as needed; however, the extent to which HCBS organizations manage fall risk has yet to be systematically examined. The purpose of this qualitative study was to explore the barriers to and facilitators of implementing fall risk screens and fall prevention service referrals in HCBS organizations. A total of 26 HCBS staff members and administrators participated in semi-structured interviews and focus groups. Qualitative data were examined using directed content analysis guided by the Consolidated Framework for Implementation Research. HCBS staff expressed that strong rapport with clients allowed for them to address fall risk proactively but were concerned that their lack of fall prevention training precluded them from effective fall risk management. HCBS administrators perceived their organization to have reliable internal communication procedures which enhanced fall prevention care coordination but believed their limited connections with fall prevention service providers served as a barrier to referring at-risk clients to appropriate care. Accordingly, HCBS stakeholders are encouraged to develop strategies, such as providing fall prevention coaching and building a network of fall prevention service providers, that account for these barriers and facilitators in future efforts to support effective fall risk management with HCBS clients.
Dietary Protein and Transitions Between Frailty States and to Death in Advanced Age: LiLACS NZ
Authors: Teh Ruth , Kerse Ngaire , Mendonca Nuno , Menzies Oliver , Hill Tom , Jagger Carol
Published: December 2020

Modifiable factors delaying frailty progression are important in demographic ageing; health disparities for indigenous people require specific strategies. Does dietary protein intake impact transitions in frailty in Maori (indigenous) and non-Maori aged 80+ in New Zealand? LiLACS NZ is population based longitudinal cohorts of Maori aged 80-90 years and non-Maori aged 85 years, followed yearly to 5 years follow up. At 12 months follow up 459 participants contributed nutrient intakes from 24hr multiple pass recall dietary intake. Frailty states were derived from Fried frailty criteria. Mortality was established through National Health Index matching. Multistate modelling investigated the contribution of protein intake to transitions in frailty states and death using models of increasing complexity: 1)age, ethnicity; 2)sex; 3)disease counts; and 4)energy intake. Over 60% of the sample were prefrail throughout the study; disease burden differentiated frailty state. Of a total of 1269 transitions, 692 remained the same; the models used 549 transitions; 44% from robust to pre-frail or pre-frail to frail. Those recovering from pre-frail to robust had lower disease burden and higher nutritional intake. Those with higher protein intake were less likely to transition from robust to prefrail (model 4: per 1g/kg bodyweight/d: HR: 0.28, 95%CI: 0.08-0.91) and from pre-frail to robust (0.24 0.06-0.93). Increased protein intake was associated with increased transition from frailty to mortality but was moderated by energy intake. Greater protein intake in octogenarians in NZ was associated with both better and worse outcomes. Total energy intake tended to moderate negative outcomes.
Dietary Quality Predicts Short-Term Change in Mobility Limitations in Older U.S. Adults
Authors: Bishop Nicholas , Ullevig Sarah , Zuniga Krystle , Wang Kaipeng , Tucker Julia
Published: December 2020

Using a representative sample of older Americans, this project examines the association between dietary quality and short-term change in mobility limitations and whether this association differs for the food insecure or those receiving nutritional assistance. The sample was drawn from the 2012 Health and Retirement Study and 2013 Health Care and Nutrition Study and included 3,779 respondents representing a population of 37,217,566 adults aged 65 and older. Mobility limitations were operationalized as a log-transformed count of 11 indicators of limitation in physical mobility. Dietary quality was measured using the Alternative Healthy Eating Index-2010 (AHEI-2010) based on responses to a food frequency questionnaire. Food insecurity was a binary measure based on the USDA six-item short form. Nutritional assistance included receipt of supplemental food from sources such as food banks and/or reporting receipt of SNAP benefits (1=yes, 0=no). Autoregressive multiple regression was used to test whether AHEI-2010 predicted change in mobility limitations from 2012-2014 and whether food insecurity or receipt of supplemental food moderated this relationship. Around 10.7% of older adults were food insecure, and around 17.5% reported receipt of nutritional assistance. AHEI-2010 was associated with a slower decline in mobility limitations over the 2-year observational window (b=-0.014, SE=.003, p<.001), but food insecurity nor nutritional assistance were associated with changing mobility limitation, either directly or as moderators of the association between progressing limitations and AHEI-2010. These preliminary findings suggest dietary quality may be associated with disablement among older adults regardless of food environment.
Food Insecurity and Dental Caries in U.S. and South Korean Older Adults Ages 60+
Authors: Chi Donald , Kim Yujin , Scott JoAnna
Published: December 2020

There are no studies on the association between food insecurity and dental caries (tooth decay) in older adults. We analyzed nationally representative data from two countries – the U.S. and South Korea – to test the hypothesis that food insecurity would be positively associated with tooth decay in older adults ages 60+. The U.S. analyses focused on National Health and Nutrition Examination Survey data from three cycles (2011-12, 2013-14, and 2015-16) and the South Korean analyses focused on Korean National Health and Nutrition Examination Survey data from one cycle (2013-2015). Food insecurity was defined using the 18-item USDA Household Food Security Survey and a validated Korean version of the same survey. Tooth decay was defined as having at least one decayed tooth (no/yes). We ran logistic regression models to generate odds ratios and 95% confidence intervals (CI). The percentage of fully food secure older adults was 74.0% in the U.S. and 82.2% in South Korea. Twenty-three percent of U.S. older adults and 28% of South Korean older adults had at least one decayed tooth. Older adults in the U.S. with food insecurity were 2.03 times as likely to have untreated tooth decay (95% CI: 1.43, 2.87; P<0.0001). Findings were similar for South Korean older adults. Food insecurity is significantly associated with untreated tooth decay in both U.S. and South Korean older adults. Future research should identify the aspects of food insecurity that increase older adults’ risk for tooth decay, with an emphasis on those that are amenable to population-based interventions.
Challenges to Comorbidity Management for Older HIV-Positive Individuals
Authors: Baim-Lance Abigail , Kerr Christine , Addison Diane
Published: December 2020

70% of individuals with HIV in the United States are 50 years or older. These individuals’ HIV is often well-managed, but they have acquired several comorbidities, including cardiovascular disease, non-AIDS defining cancers, renal disease, osteoporosis, liver disease, and neurocognitive disorders. Existing literature provides little guidance on structuring services to meet this burgeoning population’s complex clinical and aging-related needs. To inform an approach, between April 2015 and June 2018, we conducted 13 exploratory qualitative group discussions with patients, providers and administrators receiving or providing HIV services in New York’s Hudson Valley. We also conducted a retrospective electronic medical record chart review (n=50) of individuals >50 years receiving HIV care in 2017 at a Hudson Valley federally qualified health center (FQHC) to describe subspecialty referrals. Analysis of discussion groups highlighted challenges with initial access, the quality of encounters, and consistent follow-up. Patients thought ‘ageism’ contributed to poorer care quality, though extensive experience navigating the system was an advantage. The EMR review revealed patients receiving two referrals on average to (most commonly) ophthalmology/optometry (14%), gastroenterology (12%), dental (9%), cardiology (9%), and orthopedics (8%). Only half (54%) of scheduled referral appointments were attended. Documented barriers included insurance/costs, transportation, patient refusal, and fear of HIV disclosure. Findings suggest there are HIV-specific and non-specific barriers for older individuals with HIV, including perceived perceptions of aging. We have initiated a pilot study to investigate multilevel barriers and enablers to optimal comorbidity management. Gerontological insights brought to this analysis will support developing aging-appropriate clinical practices for this population.
Effects of Medicare Drug Subsidies on Adherence for Diabetics: Evidence From a Regression Discontinuity Design
Authors: Glynn Alexandra , Hernandez Inmaculada , Roberts Eric
Published: December 2020

Out-of-pocket prescription drug costs are rapidly rising, particularly for insulin, which is a life-saving drug used by 3.1 million diabetics on Medicare. High out-of-pocket costs place an accentuated financial strain on older adults with diabetes, many of whom have low incomes, and may impede medication adherence, leading to poor health outcomes. The Medicare Part D Low-Income Subsidy (LIS) program limits drug co-pays to under $8.50 per prescription and caps out-of-pocket drug costs for lowest-income recipients (<135% Federal Poverty Level, FPL), resulting in pronounced differences in out-of-pocket costs for those with marginally different incomes. Using detailed income data from the Health and Retirement Study linked to Medicare claims (2008-2016), we employed a regression discontinuity (RD) design to isolate the effects of differences in out-of-pocket costs at eligibility thresholds for the LIS. Diabetic beneficiaries whose income exceeded the LIS eligibility threshold had lower Part D spending (-$945/year, p=0.03, n=2,367) and adherence to oral antidiabetic drugs (-8%, p=0.02). We conducted secondary analyses at the eligibility threshold for Medicaid, as individuals whose income exceeds the eligibility limit for Medicaid (100% of FPL in most states) are significantly less likely to receive the LIS. Above the Medicaid eligibility threshold (n=2,295), annual spending on insulin was $395 lower (p=0.002) and proportion of insulin use was 6% lower (p=0.04). These results suggest low-income Medicare beneficiaries who are not shielded from out-of-pocket costs via the LIS are particularly sensitive to drug costs. Policy proposals to limit out-of-pocket costs could improve medication adherence to high-cost drugs for vulnerable beneficiaries.
Type of Tea Consumption and Mild Cognition Impairment in Older Adults
Authors: Yao Yao , Chen Huashuai , Gu Danan , Zeng Yi
Published: December 2020

Existing studies have testified the neuroprotective qualities of tea. As there are several types of tea, question on which type of tea may exert substantial influence on cognitive health is intriguing and remains unknow. We aim to estimate the association between type of tea consumption and mild cognition impairment (MCI) using a nationally representative dataset of older population in China. Type of tea consumption was classified as three groups: Green, fermented (White, Oolong, Black, and Pu’eh), and flower tea. The Mini-Mental State Examination (MMSE) was adopted to assess cognitive function. We conducted multivariate logistic regressions to evaluate the association between type of tea drinking and cognition outcomes (MMSE score and MCI). Potential confounders including sociodemographic factors, health conditions, dietary patterns, lifestyles, activities of daily living, mental health, and living environments. A total of 10,923 participants (mean age: 85.4 yr; female: 53.5%) included in the study. The type of current tea consumption among the participants were: 2143 for green tea, 1302 for fermented tea, and 844 for flower tea. Compared to those who had no habit of tea consumption, the odds ratio of MCI in green tea drinkers was 0.80 (0.68-0.95), in fermented tea drinkers was 1.07 (0.89-1.30), and in flower tea drinkers were 0.85 (0.67-1.09). Our study showed green tea and flower tea consumption associated with lower odds of MCI, while the association was not found among fermented tea drinkers. Future experimental and longitudinal studies are warranted to illustrate the association between varied type of tea and cognitive health.
Trends in Disability Among Adults 55-64 in the United States and England From 2002 to 2016
Authors: Choi HwaJung , Schoeni Robert , Cho Tsai-Chin , Langa Kenneth
Published: December 2020

The paper’s goal is to assess whether and, if so, the extent to which prevalence in disability of adults near retirement ages in the US increased over time compared to their peers in England and examine income group differences in the relative trends. This study uses 2002-2016 Health and Retirement Study (HRS) and English Longitudinal Study of Ageing (ELSA) focusing on adults aged 55-64. Annual percent changes over the period of 2002-2016 for limitations in instrumental activities of daily living (IADL) and activities of daily living (ADL) are estimated for each survey (HRS and ELSA) using multivariable logistic regressions to adjust for individual-level characteristics While disability prevalence of adults ages 55-64 in England improved over the years of 2002-2016 (annual % change= -2.01 for IADL; - 2.53 for ADL), disability prevalence of US adults has not improved and in fact even worsened in terms of IADL (annual % change= +1.35). There are substantial variations in the IADL/ADL trends by income groups. In the US, the adverse trends in disability were more pronounced among the lowest income groups (annual % change in IADL=1.76 for bottom 20% vs. -2.08 for top 20%; annual % change in ADL=1.08 for bottom 20% vs. -2.08 for top 20%). In England, the disability status improved over time for all but the lowest income group. We will examine further to identify specific factors contributing to divergent/convergent trends in disability between the US and England.
Microtubule-associated protein 1B dysregulates microtubule dynamics and neuronal mitochondrial transport in spinal muscular atrophy
Authors: Bora Gamze , Hensel Niko , Rademacher Sebastian , Koyunoğlu Dila , Sunguroğlu Merve , Aksu-Mengeş Evrim , Balcı-Hayta Burcu , Claus Peter , Erdem-Yurter Hayat
Published: December 2020

Spinal muscular atrophy (SMA) is a devastating childhood disease primarily affecting lower motoneurons in the spinal cord. SMA is caused by the loss of functional survival of motoneuron (SMN) protein, leading to structural and functional alterations of the cytoskeleton in motoneurons and other cells. Loss of SMN results in impairments of microtubule architecture, but the underlying mechanisms are not completely understood. In this study, we mechanistically analyzed the effects of SMN deficiency on microtubules, demonstrating a reduced stability together with a reduction in alpha tubulin detyrosination. This was caused by increased levels of microtubule-associated protein 1B and tubulin tyrosine ligase, resulting in mitochondrial mislocalization in SMA. Our findings suggest that altered tubulin post-translational modifications and microtubule-associated proteins are involved in the pathomechanisms of SMA, such as an impaired axonal transport of mitochondria.
Effective antimicrobial combination in vivo treatment predicted with microcalorimetry screening
Authors: Kragh Kasper Nørskov , Gijón Desiree , Maruri Ainhize , Antonelli Alberto , Coppi Marco , Kolpen Mette , Crone Stephanie , Tellapragada Chaitanya , Hasan Badrul , Radmer Stine , de Vogel Corné , van Wamel Willem , Verbon Annelies , Giske Christian G , Rossolini Gian Maria , Cantón Rafael , Frimodt-Møller Niels
Published: December 2020

Objectives

The worldwide emergence of antibiotic resistance calls for effective exploitation of existing antibiotics. Antibiotic combinations with different modes of action can synergize for successful treatment. In the present study, we used microcalorimetry screening to identify synergistic combination treatments against clinical MDR isolates. The synergistic effects were validated in a murine infection model.

Methods

The synergy of meropenem combined with colistin, rifampicin or amikacin was tested on 12 isolates (1 Escherichia coli, 5 Klebsiella pneumoniae, 3 Pseudomonas aeruginosa and 3 Acinetobacter baumannii) in an isothermal microcalorimeter measuring metabolic activity. One A. baumannii strain was tested with two individual pairings of antibiotic combinations. The microcalorimetric data were used to predict in vivo efficacy in a murine peritonitis/sepsis model. NMRI mice were inoculated intraperitoneally and after 1 h treated with saline, drug X, drug Y or X+Y. Bacterial load was determined by cfu in peritoneal fluid and blood after 4 h.

Results

In vitro, of the 13 combinations tested on the 12 strains, 3 of them exhibited a synergistic reduction in MIC (23% n = 3/13), 5 showed an additive effect (38.5% n = 5/13) and 5 had indifferent or antagonistic effects (38.5% n = 5/13). There was a significant correlation (P = 0.024) between microcalorimetry-screening FIC index values and the log reduction in peritoneal fluid from mice that underwent combination treatment compared with the most effective mono treatment. No such correlation could be found between chequerboard and in vivo results (P = 0.16).

Conclusions

These data support microcalorimetic metabolic readout to predict additive or synergistic effects of combination treatment of MDR infections within hours.