bluuebunny/crossref_metadata_2025 huggingface dataset:
Exclusion of Medicare Advantage Enrollees From Medicare Health Outcomes Analyses: Potential for Bias
Authors: Yashkin Arseniy , Akushevich Igor , Yashin Anatoliy
Published: December 2020

The aim of this paper is to assess the extent of the potential bias introduced by the exclusion of the Medicare Advantage (MA) population– an increasingly sizeable (31% of all beneficiaries in 2017) subset of the Medicare population which does not provide claims data to the Centers for Medicare and Medicaid Services– from Medicare-based health outcomes and epidemiologic analyses. Using self-reported data from the Health and Retirement Study together with monthly information on Medicare enrollment, we compared MA enrollees with individuals enrolled in traditional Medicare (TM) on 42 variables representing demographic, socioeconomic, adverse health behavior and health status-related characteristics over the 1991-2015 period. We used both univariate analysis (t-tests and standardized differences) and multivariate logistic regression to compare the two groups. We found that apart from differences in economic (higher in TM group) and education status (lower in MA group) – which have been increasing in magnitude over the 1991-2015 period– the MA subset was highly comparable with the traditional Medicare (TM) population. Even though the TM population was characterized by slightly higher levels of morbidity, the resulting crude prevalence rates for common age-related diseases in the TM/MA groups were within each other’s 95% confidence intervals and did not represent a major source of bias. MA membership was not associated with increased mortality at any point over the 1991-2015 period. We conclude that exclusion of the MA population will not lead to notable bias in health outcome analyses apart from those for which income and education are important explanatory factors.
Identifying a Population Living With Alzheimer’s: Concordance Between Medicare Claims and Survey Reports
Authors: Akincigil Ayse , McKenzie Camille
Published: December 2020

Community-level estimates of Alzheimer’s disease and related dementias (ADRD) are necessary to assess health care needs and supports (to patients and family members), determine the burden of disease, conduct public health planning, improve access and care quality improvement, and to build a workforce with the necessary skills. Data from Medicare claims can provide efficient and timely estimates. However, earlier studies suggest that identifying ADRD populations solely from Medicare claims fails to capture many individuals that live with ADRD, with false-negative cases as high as 60%. We examined nationally representative data from the 2015-2017 Medicare Current Beneficiary Survey (MCBS) to assess the claims-based case ascertainment method, covering the transition to the International Classification of Diseases, Tenth Revision (ICD-10). The study population included community dwellers aged 65 or older, enrolled in traditional fee-for-service (n=12,409). Claims based method identified 1,325 cases (10.7% prevalence). However, there were 196 (1.6%) additional cases that self/proxy reported ADRD, but there was no ADRD diagnosis in any of their Medicare claims (hereafter referred to as self-report only). On average, the self-report only group reported higher numbers of limitations in activities, or instrumental activities of daily living, worse overall health, and more difficulty in concentrating or remembering, suggesting they are likely to be false negatives under claims-based case ascertainment method. In conclusion, claims based case ascertainment methods failed to capture some individuals with ADRD, but the magnitude of false-negative cases declined substantially in the era of ICD-10.
High Intensity Walking Reduces Frailty and Improves Physical Function Among Older Adults Living With HIV
Authors: Danilovich Margaret , Achenbach Chad , Yeh Chen , Balmert Lauren , Berzins Baiba
Published: December 2020

Walking is a preferred mode of exercise for older adults, yet limited evidence exists on the optimal intensity to promote health gains, particularly among those with the frailty syndrome. Older adults aging with HIV have physical function impairments and higher prevalence of frailty, yet there is a paucity of evidence on therapeutic options to help these individuals maintain or improve their physical functioning. The purpose of this study was to investigate the feasibility and efficacy of a high intensity walking training (HIWT) intervention for pre-frail and frail older adults living with HIV. We enrolled n=11 older adults (>50 years of age and pre-frail or frail on the SHARE-FI). Participants underwent 16 walking sessions 2x/week consisting of 5 minute intervals of stair climbing, fast walking, weighted walking, balance tasks, and steps ups for a total of 30 minutes of high intensity (>70% of HRmax or >15 Rating of Perceived Exertion) activity. All participants were able to achieve the targeted high intensity levels throughout the sessions. We used a t-test to compare pre-post test means on a variety of physical performance measures. We found statistically significant improvements in the frailty score on the SHARE-FI, PROMIS fatigue, self-selected gait speed, Short Physical Performance Battery (SPPB), and Six Minute Walk Test. Importantly, all improvements were far above minimally clinically important differences suggesting this novel exercise approach may contribute to substantial improvements in physical function to reduce frailty in this population of older adults. Participants had no adverse events and were highly satisfied with training.
Perceptions and Understandings of Frailty Language: A Scoping Review
Authors: Sakamoto Mariko , Durepos Pamela , Alsbury Kyla , Hewston Patricia , Takaoka Alyson , Borges Julia
Published: December 2020

Diagnosing and responding to frailty in older adult populations is of growing interest for health care professionals, researchers and policymakers. Preventing frailty has the potential to improve health outcomes for older adults, which in turn has significant implications for health care systems. However, little is known about how older people understand and perceive the term “frailty”, and what it means for them to be designated as frail. To address this concern, a scoping review was undertaken to map the breadth of primary research studies that focus on community-dwelling older adults’ perceptions and understanding of frailty language, as well as explore the potential implications of being classified as frail. Searches were conducted in MEDLINE, Ageline, PsychInfo, CINAHL and EMBASE databases for articles published between January 1994 and February 2019. 4639 articles were screened and ten articles met the inclusion criteria, detailing eight primary research studies. Using content analysis, three core themes were identified across the included studies. These themes included: 1) understanding frailty as a multi-dimensional concept and inevitable consequence of aging, 2) perceiving frailty as a generalizing and harmful label; and 3) resisting and responding to frailty. Recommendations stemming from this review include the need for health care professionals to use person-centered language with older adults, discuss the term frailty with caution, and be aware of the potential consequences of labeling a person as frail. Importantly, this review demonstrates that for frailty interventions to be successful and meaningful for older adults, ongoing and critical examination of frailty language is necessary.
Phase Angle as a Bioelectrical Marker to Identify Sarcopenia
Authors: Hou Lisha , Yue Jirong
Published: December 2020

Background: Phase angle (PhA) has been suggested as an indicator of cellular death and nutritional status. We aimed to evaluate the performance of phase angle as a sarcopenia marker among 50 years older and determine the optimal cut-off values. Materials and Methods: A cross section of 4500 with ≥50 years were assessed in terms of sarcopenia with bioelectrical indices. Phase angle can be determined through bioelectrical impedance analysis (In Body 770). Muscle strength and physical function were measured using hand grip and 4 m walking speed. Significant determinants of sarcopenia were further analyzed with multivariate logistic regression analysis. Results: 869 patients (19.31%) were diagnosed with sarcopenia. The average PhA was 5.03 ± 0.64° (Male: 5.31 ± 0.66°; Female: 4.87 ± 0.57°). After adjusting age, gender, race, occupation, BMI, marital status, smoking, drinking, exercise, chronic disease and ADL, phase angle was still independent associated factors with sarcopenia: phase angle (OR=0.25, 95% CI: 0.203-0.308, P < 0.001). Receiver operating characteristic analysis revealed that the optimal phase angle cutoff value to detect sarcopenia was ≤4.9º (AUC=0.768). Conclusions: Bioelectrical phase angle can be an useful bioelectrical marker to identify sarcopenia.
The Association Between Self-Reported and Objectively Measured Energy Level in Older Adults
Authors: Tian Qu , Glynn Nancy , Ehrenkranz Rebecca , Sprague Briana , Rosso Andrea , Rosano Caterina
Published: December 2020

Energy is an important concept in human health and diseases. Self-reported energy has been described as “the individual’s potential to perform physical and mental activity” and “the individual’s energy availability”. However, little empirical data exists on whether self-reported energy level is related to objectively measured energy level. Prior research suggests that more energy availability is associated with higher physical activity level. It remains unclear whether self-reported energy availability would be associated with objectively measured energy level, such as active energy expenditure and total energy expenditure. Using data from the Health, Aging and Body Composition Study, we identified 94 participants (mean age=86.2±2.4 y/o, 46%blacks, 52%women) with concurrent data on self-reported energy (scale 0-10) and objective energy level by the SenseWear Armband. We examined cross-sectional associations of self-reported energy with objectively measured energy and physical activity levels using Spearman correlation. Greater self-reported energy level was associated with higher daily active energy expenditure in kcal (r=0.30,p=0.004), higher METs (r=0.33,p<0.001), more minutes of physical activity (r=0.35,p<0.001), and more step counts (r=0.36,p<0.001). Self-reported energy was not associated with total energy expenditure (p=0.87) or estimated resting metabolic rate (p=0.53). Self-reported energy may reflect an individual’s activity energy expenditure but not total energy expenditure. It further supports the hypothesis that energy availability even by self-report connects to physical activity behavior. Whether self-reported energy correlates with other health outcomes warrants further investigation.
Factors Related to the Well-Being of Older Chinese Living in Institutional Care Facilities: A Systematic Review
Authors: Wang Kun
Published: December 2020

Due to the fast pace of population aging and the “4-2-1” family structure, institutional care was proposed as “support” for the elderly care service system in China. The purpose of this systematic review paper was to identify factors that are associated with the well-being of older residents living at institutional care facilities in China. Studies were included if participants (1)aged 60 years or older, (2) were living at an institutional care facility in mainland China. Studies were excluded if participants (1) were Chinese Immigrants, or residents in Hong Kong, Macao, and Taiwan, (2) were cognitively impaired, or (3) at the end of their lives and need palliative care in institutional facilities. A total of 12 articles were selected in this review study based on PRISMA guidelines: 10 quantitative studies and 2 qualitative studies. Anderson healthcare utilization model was used in this study to categorize related factors into three dynamics: predisposing factors, enabling factors, and need factors. Among predisposing factors, older, more educated, widowed adults with higher income were more likely to have higher levels of well-being in institutional care facilities. Social supports, such as family visit, activity engagement and peer support, were very important enabling factors. The actual need, such as ADL, health status and depression, was another important dimension for the well-being of older Chinese living in institutional care facilities. Aiming at increasing older residents’ well-being, the present study suggested more tailored interventions should be designed and implemented to enhance their social support, activity engagement and peer support.
Effects of Resistance Exercise on Mental Health in Older Chinese Americans: A Randomized Controlled Trial
Authors: Chen Mei-Lan , Burgess Elisabeth , Chao Ying-Yu , Gardenhire Douglas , Luo Ruiyan
Published: December 2020

Regular exercise has shown to be potentially beneficial for improving mental health in older adults. However, few studies evaluated the effect of resistance exercise on psychological well-being in older Chinese Americans. The purpose of this two-arm randomized controlled trial (RCT) was to test the effects of resistance exercise training on stress, depression, and social engagement in community-dwelling older Chinese Americans. A total of 30 older adults (mean age 77.9 ± 5.0 years) were randomly assigned into the resistance exercise intervention group (n = 15) or the wait-list control group (n = 15). The resistance training intervention includes 50-min group exercise session twice weekly for 12 weeks. Participants’ perceived stress, depressive symptoms, and social engagement were measured at baseline and 12 weeks follow-up. Descriptive statistics and t tests were performed for data analysis. The results revealed that the resistance exercise intervention group had significant improvements in perceived stress, depressive symptoms, and social engagement after receiving the 12-week intervention. At baseline, there were no significant differences between the intervention and the control groups on perceived stress, depressive symptoms, and social engagement. However, older adults received resistance exercise training had greater improvements in stress levels, depressive symptoms, and social engagement than their control counterparts at 12 weeks follow-up. The findings suggest resistance exercise has positive effects on psychosocial well-being for older adults. Further larger RCTs are needed to assess long-term effects of the resistance exercise intervention.
The Relationship Between Cognitive Decline and Sedentary Time
Authors: Phillips Lorraine , Bowen Mary
Published: December 2020

Early identification of functional decline in older adults with mild cognitive impairment (MCI) provides the opportunity to initiate behavioral interventions to slow decline. More frequent breaks in sedentary time has been associated with greater lower extremity function. This longitudinal study examined the effect of 6-month change in cognitive function on monthly sedentary time, controlling for lower extremity function, among community-dwelling older adults with MCI. Twenty adults with Montreal Cognitive Assessment Score (MoCA) between 19-25, who were age ≥ 60 years old, and ambulatory, wore an actigraph for 6 months and participated in monthly in-person assessments. Measures included MoCA change (baseline to month 6), Short Physical Performance Battery (SPPB; baseline, months 3 and 6); sedentary time and physical activity intensity; and falls (monthly). The sample was 70% female, 60% non-Hispanic white, with a mean age of 77 years. Sixteen participants provided complete data for mixed-model analysis. Over 6 months, 11 falls occurred among 7 participants. The mean MoCA score declined from 22.7 to 21.9 while SPPB remained stable. Overall time spent in sedentary behavior was high (71%) and physical activity intensity was low (light and moderate combined= 26.1%). Results of multi-level analysis with sedentary time as a continuous Level-1 variable and MoCA change scores, SPPB scores, and age in Level-2 showed that negative change in MoCA (β=-0.11; p≤0.05) was associated with increased sedentary time. Given sedentary time increases as cognitive function declines, older adults with MCI could benefit from interventions designed to interrupt sedentary time as well as increase physical activity.
Time-Varying Associations of Physical Activity on Weekdays and Weekend Days in Minority Older Adults
Authors: Hevel Derek , Kennedy-Malone Laurie , Sappenfield Kourtney , Scheer Heidi , Zecca Christine , Maher Jaclyn
Published: December 2020

Older adults are insufficiently physically active, and therefore, are at an increased health risk. However, less is known about the moment-to-moment physical activity behavior patterns that change across the day. The current study utilized accelerometry to better understand diurnal physical activity patterns. Minority older adults (N=91, age M=70.14, 96% Black/African American) participated in an 8-day study where they wore an ActivPAL accelerometer to measure physical activity. Physical activity was operationalized as stepping in the 60-minute window (±30-min) around a given moment. Time varying-effect modeling was used to determine how physical activity patterns change over the course of weekdays and weekend days. Results are rounded to the 5-min interval. On weekdays, time spent stepping increased from 8:00am (B=7.16, 95%CI: 5.04, 9.27) until peaking at 11:10am (B=8.46, 95%CI: 6.59, 10.33), slowly decreased to the lowest point at 6:10pm (B=6.72, 95%CI: 4.82, 8.62), and then increased slightly in the evening. On weekend days, time spent stepping was lowest at 8:00am (B=4.47, 95%CI: 2.14, 6.80), peaked at 12:20pm (B=5.50, 95%CI: 3.22, 7.78), gradually decreased until 5:50pm (B=5.21, 95%CI: 2.90, 7.52), and then increased slightly in the evening. Minority older adults engage in more stepping time around mid-day, but less stepping in the late afternoon to early evening on both weekdays and weekend days. Self-care activities (e.g., mealtime, bed-time routines) may influence older adults’ physical activity. This work identifies vulnerable times during the day when older adults engage in relatively low levels of physical activity which may be of interest for interventions.
Effectiveness of Servo-Assistive Robotic Rollator (RT.2) Among Older Adults Living in the Community
Authors: Yamanaka Takashi , Kidana Kiwami , Mizuki Maiko , Matsui Toshihumi
Published: December 2020

Older adults tend to need assistance for ambulation with the progression of aging or when suffering from diseases. With technological advances, servo-assistive robotic rollators are available besides canes and walkers to assist disabled older adults. This study aimed to investigate the appropriate person and conditions for using a servo-assistive robotic rollator and its effects. Participants were 10 older adults living in the community (80.5±9.7 years; 4 males and 6 females) who used a servo-assistive robotic rollator (RT.2). After evaluating their physical (body composition, diseases, care need level, and SF-36), mental (MMSE, GDS-15, and WHO-5), and living conditions, they began using the device in daily life. We evaluated their ways of using it and the effects of its use through our observation and their self-report. Participants suffered from a stroke, spinal bone fracture, Parkinson’s disease, osteoarthritis of the knees, or optic neuromyelitis. At the study’s onset, cognitive impairment (MMSE<23/30), depressive states (GDS-15≧5), decreased grip strength, and decreased muscle mass (InBody S10) was found in one, three, six, and one participant, respectively. Most participants had a clear purpose for using it, such as going outside by foot or maintaining muscle strength. During the three-month observation period, no participant fell while using it. Some participants used it in a rehabilitation program at home, while others used it in daily life and went to several places with its assistance. Servo-assistive Robotic Rollators enabled older adults with difficulty in ambulation to walk outside safely and provided a greater opportunity to participate in society.
Prevalence and Perceived Usefulness of Assistive Technology in Mind at Home Dementia Cohort
Authors: Morreale Michael , Johnston Deirdre , Bunting Morgan , Antonsdottir Inga , Samus Quincy
Published: December 2020

Dementia is generally characterized by both an increasing dependence in activities of daily living over the course of the illness, and a decreasing ability to self-manage everyday tasks. This places persons at risk for a number of undesirable outcomes including increased risk for injury in the home, increased risk for medical and behavioral complications, risk of premature institutionalization, and excessive burden on family caregivers (CG).3,4 Assistive Technology Devices (AT-Devices) could represent an efficient resource for supporting daily tasks while reducing both CG care burden and adverse risk to the person with dementia (PWD).3,4 In the context of a larger dementia care intervention clinical trial (The MIND at Home program) that involved persons living with dementia at home and their family caregivers, we conducted a supplemental baseline survey on 59 participants and their CGs to better understand the current prevalence of AT-Device use and which devices would be perceived as “most helpful”. Our analysis showed that 51% of our study population used at least 1 of our listed AT-Devices. The most common AT-Device used at baseline were door guards (29%), tablets/smartphones (20%), and constant temperature shower nozzles (13%). Our survey demonstrated devices perceived as most useful included: shower nozzles, GPS locating devices, door guards, and Bluetooth tracking stickers. Individuals who endorsed African-American/Other race were significantly more likely to use at least one AT-Device than those who identified as Caucasian (OR: 4.80; 95% CI: 1.50-17.58). This significance was lost during adjustment for other demographic variables (sex, age, cohabitation status, and dementia severity).
Evaluation of Agility and Walking Ability in Elderly People
Authors: Yamauchi Ken , Hasegawa Hiromichi , Ogita Akira , Ichikawa Tutomu , Kagawa Shota , Ken Yamauchi
Published: December 2020

An important aspect of independent living in a super-aging society is the achievement of “successful aging” in mind and body. Recent large-scale epidemiological studies found that reduced walking ability significantly affects “extended healthy life expectancy” and “successful aging.” In terms of anatomy and physiology, “usual aging” (i.e., the inevitable decrease in walking function due to aging) occurs unless one undertakes daily physical activity. Conversely, aggressive moderate and habitual physical activity may lead to “successful aging” (i.e., maintained and improved walking function). Previous studies revealed that agility and walking ability are related to healthy life expectancy. Thus, we measured agility with a stick response test to investigate its relationship to gait, and determined whether this test could be substituted for a battery test of walking ability. This test has the convenience of shortening measurement time and requiring a wider measurement place than gait evaluation performed by actually walking. Correlation was observed between the rod response test and stride length (r = 0.60), walking speed (r = 0.38), and walking ratio (r = 0.34). Therefore, we propose that the rod response measurement is simpler than a simple walking ability test and can be used as a physical function measurement item that predicts the health and longevity of the elderly.
Pain-Associated Clusters Among Nursing Home Residents
Authors: Budnick Andrea , Kreutz Reinhold , Kuhlmey Adelheid , Dräger Dagmar
Published: December 2020

Chronic pain is common in older adults, particularly among nursing home residents (NHR). Internationally, the reported pain prevalence among NHR ranges from 3.7% to 79.5%. At least one in two German NHR are diagnosed with pain. Unrelieved chronic pain is associated with reduced physical functioning and psychological parameters. Given the high prevalence of pain among NHR, we hypothesized that there were likely pain-associated clusters in our target group. Clustering is an opportunity to identify differences in pain management and may enable better targeted health-service delivery for professionals. There are no available data regarding pain-associated clusters (sub-groups of NHR) based on different items measuring pain. This study was performed using baseline data, and was part of a cluster-randomized controlled trial conducted in 12 nursing homes in Berlin. We assessed pain using the German Brief Pain Inventory (BPI-NHR) among 137 NHR (mean age, 83.33 years) capable of self-report. We performed hierarchical agglomerative cluster analysis to generate three clusters (naming is based on the mean value of each BPI-NHR item in each cluster): pain-relieved (46.72 %), pain-restricted (22.63 %), and severe pain (30.66 %). Body-Mass-Index (F(2,129) = 4.274, P = 0.016), Barthel-Index (F(2,133) = 3.246, P = 0.042), and appropriateness of pain medication (F(2,119) = 12.007, P = 0.000) differed between clusters. Parameters associated with an increased or decreased risk of being in a pain-diagnosed cluster will be discussed. The observed need for clinical interventions aiming at shifting from pain-diagnosed clusters to pain-relieved status will be reflected.
Self-Medication Practice Among Older Adults: Prevalence and Associated Factors
Authors: Locquet Medea , Beaudart Charlotte , Reginster Jean-Yves , Bruyère Olivier
Published: December 2020

The self-medication practice, or the self-administration of medicine or dietary supplements without any physician’s advice, represents a public health issue due to its potentially related adverse health events. In older adults, few data are available on self-medication behaviors. The main objective of our study was thus to assess the prevalence of self-medication in a population of older adults. As a secondary exploratory analysis, we seek to determine the determinants of self-medication practice and its association with adverse health outcomes. Our sample was comprised of men and women aged 65 and over from the SarcoPhAge study. Data regarding self-administration of substances were collected through self-administered questionnaire. Clinical and socio-demographic characteristics of the participants as well as medical history were recorded by the investigator. A total of 272 older adults were recruited with a mean age of 77.3±5.2 years. Among them, 119 (43.8%) reported resorting to self-medication (38.6% self-administration of vitamins and dietary supplements, 28.5% self-administration of drugs). Participants which resort to self-medication were older (78.9±4.7 years versus 77.1±3.9 years, p=0.04) and had a lower body mass index (25.7±3.9 versus 27.3±5.2, p=0.006). After adjustments for confounding factors, significant associations were noted between self-medication practice and fractures (OR=3.36[1.02-11.28]) and hospitalizations (OR=1.77 [1.03-3.05]) occurred during the previous year. The practice of self-medication seems widespread among the older age. It seems more frequent in more vulnerable subjects and having experienced adverse health outcomes. This type of health practice must therefore attract the attention of health actors.
Teaching Nurse Practitioner Students About Polypharmacy Through a Lived Experience
Authors: Kim Jennifer , Lewallen Kanah , Boll Taylor
Published: December 2020

Polypharmacy (typically defined as the concomitant use of 5 or more medications) affects 40-50% of older adults in the U.S., and is associated with geriatric syndromes, a higher risk of medication non-adherence, and adverse drug events. Medication non-adherence is a common frustrating clinical issue for clinicians who provide care for older adult patients. Simultaneously, patients often find medication regimens to be complicated and confusing. This may contribute to medication non-adherence, which may further lead to adverse drug events and/or negative health outcomes. The more medications a patient is taking, the higher the risk for non-adherence. Thirty-eight students enrolled in an adult-gerontology primary care nurse practitioner program were given a bag of five mock medications that are commonly prescribed for older adults. Students were instructed to follow the directions on each of the bottles for approximately one month. A private messaging system was available for students if refills were needed or if they had questions about their medications. A debriefing session for this month-long, ungraded simulation was held, at which time students returned medication bottles. Pill counts were not analyzed, but all returned bottles contained mock medications. Approximately 52.6% of students estimated adhering to the medication regimen 0-24% of the time, whereas 26.3% reported an adherence rate of 25-50%. The most commonly cited barrier to adherence (55.3%) was “forgetfulness”. Nearly all students (89.5%) reported that the exercise “very much” increased their awareness of challenges patients face when managing medications, and 97% cited an increased awareness of ways to improve medication adherence.
Systematic Review of Guidelines on Antihypertensive Treatment in Older Adults: SPRINTing to More Heterogeneity?
Authors: Bogaerts Jonathan , Ballmoos Leonie von , Achterberg Wilco , Gussekloo Jacobijn , Streit Sven , van der Ploeg Milly , Drewes Yvonne , Poortvliet Rosalinde
Published: December 2020

Clinical trials have demonstrated that antihypertensive treatment (AHT) in older adults is beneficial. Longitudinal studies, in contrast, have shown that low blood pressure is associated with higher all-cause mortality, especially in frail older adults. Despite the high quality of the available evidence, its translation into clinical guidance for the heterogeneous older population is challenging. To give a systematic overview of blood pressure targets for older adults recommended in clinical guidelines, we searched PubMed, Embase, Emcare, and five guideline databases. We selected guidelines with numerical thresholds for the initiation or the goal of non-disease-specific AHT (January 2008-October 2019). Guidelines with advices concerning AHT in older adults were analyzed. We appraised the guideline quality with the AGREEII-instrument. Of the 44 guidelines containing a numerical threshold for the initiation or the goal of AHT, 33 (75%) provided recommendations concerning AHT for older adults. Nineteen advised a higher target of systolic blood pressure (SBP) for older adults in comparison with the middle-aged population and 3 more recent advised a lower target. Over half (19/33) recommended to treat hypertension in the oldest old to a SBP <150 mmHg, while others advised intensive treatment to targets <120 mmHg. Although many guidelines mentioned frailty, only three gave specific thresholds and targets for frail older adults. The quality of the guidelines was not related with the recommended targets. Targets of AHT in older adults in international guidelines range from less strict to more intensive in comparison with the middle-aged and are set on chronological rather than biological age.
Hearing Loss and Healthcare Satisfaction
Authors: Jilla Anna , Reed Nicholas
Published: December 2020

Patient satisfaction with care has become increasingly important since Medicare’s shift to value-based reimbursement models using the Hospital Care Quality Information from the Consumer Perspective survey. Effective communication plays an underappreciated role in satisfaction with care. Hearing loss impacts two-thirds of adults over 70 years and is a barrier to communication. Previous research has found that adults with hearing loss have poorer health outcomes and incur higher medical expenditures. The present study aims to explore the association of hearing loss on satisfaction with care. Nationally representative data from the 2015 Medicare Current Beneficiary Survey (MCBS) collected information on self-reported hearing with a hearing aid (no trouble, a little trouble, or a lot of trouble) and satisfaction with quality of health care (very satisfied/satisfied and dissatisfied/very dissatisfied) for all adult Medicare beneficiaries. A weighted sample of 48.6 million Medicare Beneficiaries was analyzed using logistic regression, adjusted for sex, race, educational attainment, income, general health, and functional limitations in instrumental activities of daily living. The adjusted model found that compared to adults with no hearing trouble, those with a little trouble hearing and a lot of trouble hearing had 1.47 times (95% CI: 1.06, 2.03) and 1.74 times higher odds (95% CI: 1.15, 2.62) higher odds of reporting dissatisfaction with care, respectively. Hearing loss, possibly mediated by its impact on communication, is associated with satisfaction with care. Given the emphasis placed on patient-reported satisfaction value-based reimbursement programs, hearing loss may represent a potential, low-risk/high-reward area of intervention to improve satisfaction.
The Association of Vision, Hearing, and Dual Sensory Impairments With Walking Speed and Incident Slow Walking
Authors: Shakarchi Ahmed , Varadaraj Varshini , Assi Lama , Reed Nicholas , Swenor Bonnielin
Published: December 2020

Vision (VI), hearing (HI) and dual sensory (DSI, concurrent VI and HI) impairments are increasing in prevalence as populations age. Walking speed is an established health indicator associated with adverse outcomes, including mortality. Using the population-based Health and Retirement Study, we analyzed the longitudinal relationship between sensory impairment and walking speed. In multivariable mixed-effects linear models, we found differences in baseline walking speed (m/s) by sensory impairment: Beta=-0.05 (95%CI=-0.07, -0.04), Beta=-0.02 (95%CI=--0.03, -0.003), and Beta=-0.07 (95%CI=--0.08, -0.05) for VI, HI and DSI, respectively, as compared to those without sensory impairment. However, similar annual declines (0.014 m/s) in walking speeds occurred in all groups. In time-to-event analyses, events were defined as “slow walking” (speed <0.60m/s) and “very slow walking” (<0.40m/s). Incident “slow walking” was 43% (95%CI=25%, 65%), 29% (95%CI=13%, 48%) and 35% (95%CI=13%, 61%) greater in VI, HI and DSI, respectively, than the no sensory impairment group, while incident “very slow walking” was 21% (95%CI=-4%, 54%), 30% (95%CI=3%, 63%) and 89% (95%CI=47%, 143%) greater; the increase was significantly greater in DSI than VI and HI. These results suggest that older adults with vision and hearing impairments walk slower and are at increased risk of slow walking than older adults without these sensory impairments. Additionally, older adults with DSI are at greatest risk of very slow walking.
Use of the New ICD-10 Vision Codes Among Medicare Beneficiaries With Stroke
Authors: Hreha Kimberly , Ottenbacher Kenneth , Ehrlich Joshua , Whitson Heather
Published: December 2020

Older adults can experience vision impairment following stroke in combination with pre-existing ophthalmologic disease. The new ICD-10 coding system for identifying vision related health conditions provides a much higher level of detail for coding these complex scenarios than the previous ICD-9 system. While this new coding system has advantages for clinical care and billing, the degree to which providers are utilizing the expanded code structure is unknown. The study objective was to describe the use of ICD-10 vision codes in a large cohort of stroke survivors. We used a retrospective cohort design to study national 100% Medicare claims files from 2015 through 2017. Data were analyzed using all available ICD-10 vision codes for beneficiaries who had an acute care stay because of a stroke and who also had an ICD-10 visual code recorded at least once in their claims chart. The cohort (n= 269,314) was mostly female (57.1%) with ischemic stroke (87.8%). Approximately 15% were coded as having one or more vision impairments. Unspecified glaucoma was the most frequently used code among men (2.83%), beneficiaries over 85+ (4.80%) and non-Hispanic blacks (4.12%). But multiple vision codes were used in few patients, overall (0.6%). Less than 3% of those in the oldest group (85+ years) had two vision codes noted in their claims. Despite more available codes, the coding used to describe the vision impairments in this population of stroke survivors was not specific or diverse. Hospital providers should pay attention to specificity in order to improve coding practices.
Design and Preliminary Evaluation of a Community-Based Brain Health Promotion and Wellness Program
Authors: Block Laura , Peck Megan , Gilmore-Bykovskyi Andrea
Published: December 2020

Recommendations for risk reduction of dementia and cognitive decline emphasize addressing modifiable risk factors including physical activity, cognitive stimulation, and socialization. However, existing resources and programs to promote brain health through multifaceted risk factor reduction are often costly, challenging to individualize, and limited in their delivery format, narrowing their accessibility among older adults. To address community identified needs for brain health promotion resources, we applied a user-centered design approach to develop, implement, and evaluate feasibility/acceptability of a community-based brain health promotion program: Strength & Resilience Brain Health and Wellness Program. Design requirements were specified through ongoing end-user feedback via structured and open-ended surveys, group dialogue, and facilitator memoing which informed needed iterative refinements of program components. The resultant program incorporates information about brain health/dementia prevention, physical exercise, and cognitively-stimulating activities targeting attention, focus, problem solving, and communication. Integrated across components are deliberate adaptations for physical/cognitive abilities and activities to facilitate group cohesion and reduce stigma. Across two 10-week offerings, we found the program to be feasible as demonstrated through high enrollment (N=44) and retention (75%). A quarter of participants self-disclosed a dementia diagnosis in baseline surveys. Participants rated program components as acceptable, and perceived positive influences on target risk factors particularly social isolation, sense of self-worth, and cognitive stimulation. The current study provides a platform for a feasible and scalable group, community-based brain health promotion program, and suggests participant-centered outcomes extend beyond cognitive domains. More rigorous evaluation of the program is needed to evaluate fidelity across components and standardized outcomes.
Gendered Association Between Employment Status and Unmet Health Care Needs Among Middle-Aged Koreans
Authors: Song Si Young , Jun Hey Jung , Joo Susanna , Lee Sun Ah
Published: December 2020

Previous studies show that working people are less likely to experience unmet health care needs than non-workers. Also, employment and health are located in gendered social contexts. The present study aims to examine the moderating effect of gender on the association between employment status and unmet health care needs among middle-aged Koreans. We conducted logistic regression using the Korean Health Panel data (in 2016 and 2017; N=2,573, age range=45-64). Having experiences unmet health care needs in 2017 was the binary dependent variable. Employment status in 2016 was the binary independent variable and gender was the moderating variable. Age, education level, marital status, annual income, household type, type of medical security, disability, self-rated health, the number of chronic diseases, and stress level in 2016 were also in the analytic model based on the Andersen’s health behavioral model. The percentages of middle-aged people experiencing unmet health care needs were 18% for working men, 11% for non-working men, 13% for working women, and 16% for non-working women. The result showed there was significant moderating effect of gender (B= .72, p< .05). Specifically, working men were less likely to experience unmet health care needs than non-working men. On the contrary, there was not the significant difference in experiencing unmet health care needs between working and non-working women. It indicates that it is necessary to supplement medical services for especially for middle-aged men who are not employed because they might experience considerable amounts of unmet health care needs.
Impact of Oral Health on Quality of Life and Subjective Well-Being in Community-Dwelling Older Adults in Mexico
Authors: Díaz Irma , Mendoza- Ruvalcaba Neyda Ma , Arias Elva Dolores , Diaz Julio
Published: December 2020

Objective: Associate the impact of oral health with quality of life and subjective well-being in the community-dwelling older adults in Mexico. Methods: Non-random sample; 326 subjects: age collected (60-69 / ≥ 70); gender (male / female); marital status (couple / no partner); schooling (0-6 years / ≥7); income for basic needs (yes / no); no depression (GDS-15), no cognitive impairment (MMSE) and comorbidity (no disease / ≥ 1 disease) to control biases. Oral conditions; Caries index (ICPOD) WHO criteria: Very low-Low; Moderate and High. Need for dental prostheses (WHO Manual): No prostheses needed (27-28 natural teeth or fixed / removable / total combination; Need prosthesis: 2-28 tooth without replacement. Xerostomia (Thomson Inventory); moderate to severe xerostomia > 17 points. Dependent variables: Quality of Life Related to Oral Health (GOHAI); 57-60 points: High perception. Subjective well-being: Moral Scale of the Geriatric Center of Philadelphia (PGCMS): Low score (0-11). Results: Age: 71.84 ± 7,278; female / male (70.9 / 29.1%). Controlling confounding factors, multiple logistic regression showed that the need for multi-unit or total prostheses; high CPOD index; severe xerostomia; and low perception of well-being subjective, were associated with low GOHAI scores: P = 0.000; P = 0.004; P = 0.003; P = 0.02 respectively. Subjective well-being only was associated with severe xerostomia and low CVRSO perception: P = 0.0 1; P = 0.02 respectively. Conclusion: Taking into account various confounding factors, the Quality of Life related to Oral Health was the most affected by the deterioration of oral health.
Dietary Quality Among Older Overweight or Obese Veterans With Dysmobility
Authors: Parker Elizabeth , Bergamo Lauren , Perez Will , Katzel Leslie , Ryan Alice , Prior Steven , Serra Monica , Addison Odessa
Published: December 2020

Older adults have unique dietary challenges due to a myriad of factors including age-related taste and smell changes and lack of nutrition knowledge that increase the risk for poor dietary quality. Healthier dietary quality is associated with higher muscle mass, strength and physical performance which may reduce the development of frailty and disability later in life; however, few studies have examined dietary quality among older Veterans with limited physical functioning. The purpose of this study was to examine overall dietary quality among older, overweight/obese veterans with dysmobility. Habitual dietary intake was assessed at baseline using three, nonconsecutive 24-hour recalls and used to calculate healthy eating index (HEI-2015; higher scores indicate higher diet quality). Twenty-eight participants were included in analysis: 93% male; 54% black; aged=69.5±7.0 years; BMI=35.5±5.4 kg/m2. Means and standard deviations were calculated for average intake of total daily energy (2184±645 kcals) and protein (0.89±0.3g/kg), daily servings of fruits (0.84±0.94) and vegetables (1.3±0.87), and HEI-2015 (52.8±13.4). Overall, 96% consumed fewer than the recommended 5 daily servings of fruits and vegetables and 68% consumed <1.0g/kg/d of protein (1.0-1.3g/kg/d recommended for older adults). Mean HEI-2015 was below the US national average for adults >65 years (2015-2016 NHANES 65+ years: 64.0), suggesting poor dietary quality among our sample. This pilot study suggests that dietary intake quality is suboptimal in older, obese Veterans with disability and highlights the need to identify strategies that improve dietary intake quality of older Veterans who may benefit from obesity and disability management.
Bidirectional Relationship Between Subjective Age and Fear of Falling: Findings From the NHATS
Authors: Li Yuxiao , Liu Minhui , Miyawaki Christina E , Hou Tianxue , Sun Xiaocao , Tang Siyuan , Szanton Sarah
Published: December 2020

Subjective age refers to how young or old people experience themselves to be. It is associated with health status, physical function, and mental processes that influence the occurrence of fear of falling, which is a severe problem in older adults. The present study aims to contribute to existing knowledge by examining the relationships between subjective age and fear of falling. Participants were community-dwelling adults aged 65 years and older drawn from the 2011 (T1) - 2015 (T5) waves of the National Health and Aging Trends Study. Subjective age was measured by asking, “What age do you feel most of the time?” Fear of falling was measured with the question: “In the last month, did you worry about falling down?” The analyses included 1,984 participants without fear of falling at baseline, on average, 74.9±6.6 years old, female (53%), and non-Hispanic whites (76%). Eighty percent of the participants felt younger, and 4% felt older than their chronological age, but 21% of them had a fear of falling. Participants who experienced fear of falling at T5 tended to be female, non-Hispanic whites, and live alone. Generalized estimating equations revealed that an “older” subjective age independently predicted fear of falling (OR, 95%CI= 1.02, 1.01-1.02) controlling for demographics and health conditions. Fear of falling predicted an “older” subjective age (OR, 95%CI= 3.38, 1.72-6.66) after adjustment. These findings indicated bidirectional relationships between subjective age and fear of falling. Subjective age may help identify individuals who are at risk for fear of falling in older adults.
Medication Prescribed Within 1 Year Preceding Fall-Related Injuries in Older Adults in Ontario, Canada
Authors: Ming Yu , Zecevic Aleksandra , Booth Richard , Hunter Susan , Johnson Andrew , Tirona Rommel
Published: December 2020

Background: The consequences of fall-related injuries are becoming more significant due to ageing societies worldwide. This study aims to provide information on medications prescribed to older adults within one year before they experienced fall-related injury in Ontario, Canada. Methods: A population-based descriptive study of older adults (66 years and older) who experienced fall-related injury was conducted using administrative secondary health care data of Ontario. The percentages of patients prescribed each Anatomical Therapeutic Chemical 4th level medication class and fall-risk increasing drugs one year before their fall-related injuries was summarized. Results: From 2010 to 2014, 288,251 older adults (63.2% females) were admitted to Emergency Department due to fall-related injury, 39.9% were fall-related fractures, 12.6% were head injuries. One year prior to their injury, 48.46% of older adults were prescribed with statins; 35.23% were prescribed with diuretics; 26.84% were prescribed with antidepressants; 25.90% were prescribed with opioids and 16.61% were prescribed with anxiolytics. A higher percentage of females were prescribed with diuretics, antidepressants, and anxiolytics than males. 85 years and older people had higher percentage of prescription of diuretics, antidepressants and antipsychotics than other age group. Discussion: In general, older adults diagnosed with fall-related injuries were prescribed with more opioids, benzodiazepines and antidepressants than other general older adults. There were distinct patterns of prescription medication within each sex and age group (66-74 group, 75-84 group and 85 years and older group). Further association between medications and fall-related injuries need to be established using well-defined cohort studies.