bluuebunny/crossref_metadata_2025 huggingface dataset:
P. GINGIVALIS–LPS-INDUCED NLRP3 INFLAMMASOME ACTIVATION DRIVES AD PATHOLOGIES
Authors: Verma Ambika , Patyal Pankaj , Azhar Gohar , Wei Jeanne
Published: December 2023

Alzheimer’s disease (AD) is the leading cause of dementia among older adults. AD is characterized by amyloid-β deposition, abnormal hyperphosphorylation of tau leading to the formation of neurofibrillary tangles, and neuroinflammation. Porphyromonas gingivalis, the keystone-pathogen of periodontitis, is being increasingly linked with AD and Alzheimer’s disease-related dementias (ADRD). Poor oral health is common in older populations, and literature suggests that oral health correlates with prevalence of ADRD. NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome-mediated IL-1β is significantly involved in periodontal diseases. However, the exact mechanism by which NLRP3 inflammasome is regulated in response to pathogenic bacteria remains unclear. We hypothesized that P. gingivalis-LPS may be responsible for the neuroinflammation via TLR4 activation and its downstream caspase-1, caspase-3 or caspase-4/5/11 dependent cell signaling. Our results suggest that P. gingivalis accelerated the induction of NLRP3. Furthermore, NLRP3/Caspase-1/Caspase-4/5/11 dependent IL-1β production may contribute to the dysregulated neuroinflammatory response in AD pathogenesis.
RACE DIFFERENCES IN THE RELATIONSHIP BETWEEN HIGH AND VARIABLE BLOOD PRESSURE AND DOMAIN-SPECIFIC COGNITIVE CHANGE
Authors: Oliver Michael , Morrison Cassandra , El-Hulu Sondos
Published: December 2023

Elevated blood pressure (BP), or hypertension, is a risk factor for several health conditions including Alzheimer’s disease. High BP in early- and mid-life is associated with cognitive decline, whereas research is mixed regarding BP and cognition in late-life. Moreover, hypertension disproportionately affects minority populations. Consequently, the effects of hypertension on cognition may differ by race. The present study investigates the relationship between BP and cognition. 4419 older adults (Black, n=1189; White, n= 3230), with 32116 follow-ups for a maximum of 10-years were included from the Rush Alzheimer’s Disease Center. Results reveal individuals with high BP exhibit significantly greater declines in global cognition compared to normal BP, regardless of race. When stratifying high BP by race, Blacks exhibit greater declines in working memory and perceptual speed, whereas Whites exhibit greater declines in episodic memory, semantic memory, and visuospatial ability compared to normal BP. Blacks with high BP exhibit greater decline in perceptual speed compared to variable BP, whereas no cognitive domain was worse in Whites with high BP compared to variable. When stratifying variable BP by race, Blacks exhibited greater decline in working memory compared to normal BP. Alternatively, Whites exhibited greater decline in episodic memory, semantic memory, working memory, and global cognition compared to normal and high BP counterparts. Our findings reveal racial differences in the relationship between BP and cognitive decline. Specifically, Blacks and Whites with high and variable BP experience cognitive decline in different cognitive domains, which may give insight into differences in disease trajectory and cognitive outcomes.
UNIQUE MICROBIOME SIGNATURES RELATED TO CANCER SURVIVORSHIP AND COGNITIVE DECLINE IN OLDER ADULTS
Authors: Haggler Jayden , Miller Brandi , Chaudhari Diptaraj , Yadav Hariom , Jain Shalini
Published: December 2023

Significant scientific advancements have resulted in new and effective therapies for patients with cancer. Although this leads to an increased cancer survivor population, there are several long-term side effects of cancer treatments, including a high risk of developing dementia. Emerging evidence shows that the gut microbiota significantly contributes to brain health and dementia pathology; however, its role in cancer treatment-related side effects, specifically in older adults, is not well known. Here, we used 110 participants from our MiaGB (Microbiome in aging Gut and Brain) consortium aged 60 years and older and analyzed their gut microbiome (using whole genome sequencing) with cognitive function (using Montreal Cognitive Assessment (MoCA) and MiniCog). We observed an 8% increase in cognitive impairment (CI) in cancer survivors compared to non-cancer participants (46% vs 38%, respectively). When only comparing cognitively healthy versus CI, the abundance of Escherichia coli was significantly higher in the CI group, while Streptococcus thermophilus was higher in the cognitively healthy group. Additionally, the abundances of Dorea sp. CAG 317, Ruminococcus gnavus, Roseburia faecis, and Eggerthella lenta were significantly increased in the gut of cancer survivors compared to non-cancer participants. Specifically, the abundance of Dorea sp. CAG 317 was increased in cancer survivors with CI. These findings suggest that unique microbiome signatures induced by cancer treatments may impair cognitive function. Furthermore, understanding the associations between the microbiota and cognitive function in cancer survivors will aid the development of therapeutics to combat cancer treatment-related side effects, which are a growing public health concern.
CIRCULATING MICRORNA PROFILE IN OKINAWAN CENTENARIANS
Authors: Noureddine Sarah , Ashiqueali Sarah , Schneider Augusto , Strader Sydney , Allsopp Richard , Willcox D Craig , Willcox Bradley , Masternak Michal
Published: December 2023

Centenarians are a successful example of aging and extended longevity, exhibiting advanced regulation of biological mechanisms and homeostasis. Since human longevity is a complex field of study that navigates molecular and biological mechanisms that influence aging, we hypothesized that microRNAs, a class of small non-coding RNAs implicated in regulating gene expression at the post-transcriptional level, demonstrate altered expression profiles in circulation across young, middle-aged, and centenarian cohorts. We sequenced circulating microRNAs in Okinawan males and females < 40, 40-80, and >90 years of age accounting for FOXO3A genetic variations (TT and TG alleles) and validated the findings through RT-qPCR. We report 5 microRNAs exclusively upregulated in both male and female centenarians demonstrating predictive functional roles in TGF-β, FoxO, AMPK, Pi3K-Akt, and MAPK signaling pathways. Our findings suggest that these microRNAs upregulated in centenarians may provide novel insight into their enhanced longevity and warrant further exploration into their roles in human aging and longevity.
MID-LIFE PLASMA PROTEINS ASSOCIATE WITH PREFRAILTY AND FRAILTY: A PROTEOMIC ANALYSIS
Authors: Liu Fangyu , Schrack Jennifer , Walston Jeremy , Mathias Rasika , Coresh Josef , Walker Keenan
Published: December 2023

Physical frailty is a syndrome that typically manifests in later life, although the pathogenic process causing physical frailty likely begins decades earlier. To date, few studies have examined the biological signatures in mid-life associated with frailty in late life. We evaluated 4955 plasma proteins (log 2-transformed and standardized) measured using the SomaScan platform among 3810 participants (57.8+/-5.0 years, 58.2% women) at Visit 3 of the Atherosclerosis Risk in Community (ARIC) study, and their frailty status across up to 3 study visits in late-life (median follow-up 19 years). We used multinomial logistic regression models to examine the associations between the protein levels and the frailty status, adjusting for demographics, health indicators, comorbidities, and follow-up time. Two sets of 2 proteins were identified to be associated with prefrailty and frailty, respectively, after Bonferroni correction (p< 1.01×10-5). Higher concentration of hydroxymethylglutaryl-CoA synthase (HMGCS1; OR=1.22), a regulator of cholesterol synthesis, and lower concentration of dual specificity protein phosphatase 13 isoform A (DUSP13A; OR=0.82), a protein involved in cell apoptosis, were associated with higher odds of prefrailty. Higher concentration of growth differentiation factor 15 (GDF15; OR=1.39), a protein related to inflammation and cell senescence, and lower concentration of contactin-1 (CNTN1; OR=0.72), a protein involved in nervous system development and signalling, were associated with higher odds of frailty. The pathway and upstream regulator analyses of the physical frailty- or prefrailty-associated proteins (p< 0.01) revealed the dysregulation of apoptosis, inflammation, and neuromuscular communication in mid-life. Our findings provides new insights into frailty etiology earlier in the life course.
MULTIPLE ENRICHMENT TOOLS POINT TO A CENTRAL ROLE OF CARDIAC MUSCLE IN EXTREME LONGEVITY
Authors: Ukraintseva Svetlana , Wu Deqing , Duan Hongzhe , Arbeev Konstantin , Yashin Anatoliy
Published: December 2023

Few genes showed consistent positive associations with extreme longevity in humans. We conducted genome-wide association study of various parental lifespans, LS (85+, 90+, 95+, 100+ vs. 75-), using UK Biobank data. At ages 100+, the negative effect of APOE4 on LS diminished, while SNPs with positive associations with LS emerged among the top results, including rare variants. One of the top SNPs (rs756319938) was in CDKN1A (P21) gene involved in cell senescence, and its rare variant (protein truncating) was significantly (P-value< 10-7) overrepresented in extreme longevity cases. Such nonsense mutations generally result in non-functional protein. In case of P21, this might contribute to longevity via better regenerative response. The latter was previously demonstrated in mice that lacked the p21 expression. For SNPs that were associated with LS>=100 with P-value < 10-4, we identified ~400 corresponding genes and run multiple pathway/process enrichment analyses using different tools utilizing various resources (GO, KEGG, OMIM, MSigDB, and others), to identify pathways/processes that show up across most analyses. We found that cardiac muscle function was among the top pathways/processes yielded by majority of the enrichment tools. In conclusion, we found new rare and common SNPs that were positively associated with extreme longevity of mothers and fathers of UKB participants, and investigated relevant biological pathways. Results of multiple enrichment tools converged on a central role of cardiac muscle function in extreme longevity, while separate enrichment tools did not allow to see this picture. Our results imply that cardiac regeneration is a plausible target for interventions into longevity limits.
PROTOCOL OF A RANDOMIZED, PARALLEL, DOUBLE-BLIND, PLACEBO-CONTROLLED PILOT TRIAL OF A KETONE ESTER IN AGING
Authors: Stubbs Brianna , Peralta Sawyer , Diaz Stephanie Roa , Azanedo Gabriela Alvarez , Alexander Laura , Silverman-Martin Wendie , Johnson James , Newman John
Published: December 2023

Background

Ketone bodies function as an energy and signaling metabolite and are hypothesized to interact with several geroscience pathways. Ketone esters (KE) are a nutritional tool that induce ketosis without other dietary changes; no studies have addressed KE in an aging population.

Objectives

The primary objective of this randomized, placebo-controlled, double-blinded, parallel-group, pilot study is to determine the tolerability of 12-weeks of KE ingestion in older adults (>65y). Secondary outcomes include safety and acute ketone kinetics. Exploratory outcomes include physical function, cognitive function, quality of life, general and inflammatory aging biomarkers and gut microbiome.

Methods

Community dwelling older adults who are independent in activities of daily living, and with no unstable acute medical conditions (n=30) will be recruited. The study intervention is a KE (n=15) or a placebo (PLA). Firstly, ketone kinetics after 12.5 or 25g of KE consumption will be assessed over four hours. Secondly, after collection of baseline safety, functional and biological measurements, participants will be randomly allocated to consume KE or PLA daily for 12-weeks. A questionnaire will assess tolerance daily for 2-weeks, and then via recall at 2-week intervals. Safety assessments will be repeated at week 4. All measures will be repeated at week 12.

Conclusion

This study will provide data demonstrating the feasibility, tolerance, and safety of 12-weeks of KE consumption in older adults as well as exploratory data across a range of geroscience-related endpoints. This will facilitate our long-term goal: use of KE to study geroscience mechanisms and clinical outcomes relevant to frailty.
FRAILTY ASSESSMENT FROM PAPER TO ONLINE: THE E-FI-CGA WEB APP
Authors: Song Xiaowei , Kianpoor Kiarash , Sepehri Katayoun , Kwok Stanley , Glashutter Margit , McDermid Robert , Park Grace
Published: December 2023

Background

Early frailty assessment is crucial for improving care for older adults through enhancing frailty-informed care planning and execution. To increase the access and use of the established electronic Frailty Index based on the Comprehensive Geriatric Assessment tool, we developed an online software application: the web-based eFI-CGA.

Methods

End-user requirements primarily adapted the standalone version of the eFI-CGA and covered assessment competency, interface familiarity, accessibility and convenient use by front-line health professionals. Web app-bounded features included user-account authentication and authorization, user-space management, record-search and retrieval, and functions for data management, analysis and display. The web app development used the Microsoft Azure web server with the ASP.NET framework, combined Webforms and Model-View-Controller architecture, and C# programming language with standard client-side libraries incorporating scripting and mark-up languages.

Results

The web-based eFI-CGA was technically released and accessible online (efi-cga). Tests on the web pages for all the web pages (e.g., Home, Signup Login, Assessment, Search, and Analysis) using large sizes of systematically designed test data and mocked patient cohorts showed that the web software functions meet the requirements with 100% accuracy.

Conclusion

The web-based eFI-CGA provides a valuable remote frailty assessment and information retrieval method for healthcare professionals, promoting effective multidisciplinary integrated care of older adults. Further work is needed to allow the safe use of the web app. We are also planning a patient-oriented frailty assessment tool for community-dwelling older adults.
DOES HAND GRIP STRENGTH CORRELATE WITH SHOULDER DYSFUNCTION AMONG OLDER WOMEN?
Authors: Almardawi Ranyah , Davis Derik , Orwig Denise
Published: December 2023

Background

Shoulder dysfunction and pain are common problems among older adults. Nearly 20% of those aged 65 and older reported shoulder pain in the 2011 National Health and Aging Trends Study. Shoulder pain and dysfunction may lead to the inability to carry out essential household and daily activities, burdening both patients and society. HGS is commonly tested and considered a reliable measure to assess overall muscle strength and function. Objective: The aim of this cross-sectional study is to determine the association between hand grip strength (HGS) and shoulder dysfunction. We hypothesize that HGS is correlated with shoulder dysfunction among older women.

Methods

A total of 36 older women volunteers with an age range of 62 to 84 years were included. We assessed the HGS for dominant hands using Jamar Plus Digital Hand Dynamometer. We measured both hands twice and used the strongest measure for the dominant hand. Degree of shoulder dysfunction was self-reported using the American Shoulder and Elbow Surgeon survey (ASES) [0, worst; 100, best].

Results

Participants had a mean age of 70.9 years (SD:5.7), mean grip strength of 18.2kg (SD:5.9), and mean ASES score of 86.8(SD: 17.2). A significant and positive correlation was found between HGS and ASES score (r=0.612, P=0.001).

Conclusion

The moderate correlation of HSG with ASES score supports the hypothesis. The results suggest that future research is warranted to test the feasibility of HSG as a clinical screening tooling for shoulder dysfunction in larger diverse samples of older adults, including men and women.
MEDICATION DE-ESCALATION AND GLYCATED HEMOGLOBIN AMONG OLDER ADULTS WITH DIABETES AND DEMENTIA
Authors: Adeyemi Oluwaseun , Arcila-Mesa Mauricio , Rapozo Crystalinda , Chodosh Joshua
Published: December 2023

Patients with co-occurring diabetes and dementia and low (< 7.0) glycated hemoglobin (HbA1c) are at risk for adverse events and may require antihyperglycemic medication de-escalation. Whether de-escalation leads to a desired HbA1c is unknown. We assessed the relationship between antihyperglycemic de-escalation and attainment of a desired HbA1c. We selected older adults with diabetes and dementia with low HbA1c enrolled in the Enhanced Quality in Primary Care for Elders with Diabetes and Dementia, a multicenter cluster-randomized pragmatic trial. We determined whether antihyperglycemic medications were de-escalated during the twenty-four-month intervention. We classified a positive outcome as a subsequent desired HbA1c range for those who entered the study with HbA1cs < 7.0. We controlled for age, sex, race/ethnicity, Charlson comorbidity index, antihyperglycemic medications, and the COVID-19 pandemic. We performed a multivariable generalized linear binomial regression analysis and report the likelihood (adjusted risk ratio; aRR) (plus 95% confidence interval (CI)) of achieving the desired range HbA1c. The predominant population was older adults 85 years and older (42%), females (60%), and non-Hispanic Whites (64%). A tenth of the population had de-escalation and 19% of the population achieved the desired HbA1c range at the end of the study period. Metformin was the most frequently retained medication after de-escalation (66.7%). After adjusting for potential confounders, de-escalation was associated with 2.2 times the likelihood of attaining the desired HbA1c range (aRR: 2.20; 95% CI: 1.34 – 3.55). In conclusion, antihyperglycemic medication de-escalation improves the glycemic control of older adults with DM/ADRD.
EFFECT OF COVID-19 PANDEMIC ON A BODY MASS INDEX OF OLDER AMERICANS: A REPEATED CROSS-SECTIONAL STUDY
Authors: Sapkota Krishna , Brown J Scott , Kinney Jennifer
Published: December 2023

Introduction

The COVID-19 pandemic resulted in greater social and physical isolation, potentially leading to changes in eating, physical activity, and health behaviors, which may increase BMI. This study explored whether body mass index (BMI) among middle-aged and older Americans has been affected by the pandemic.

Methods

This study uses data from the Behavioral Risk Factor Surveillance System to assess the effects of COVID-19 on BMI changes among middle-aged (50-64 years) and older (65 years and above) Americans. Changes in BMI over time are measured for 2019 and 2021. Data from 2013, 2015, and 2017 are used to note the trend of BMI, and sex and racial differences in BMI trajectories are explored.

Results

Initial results show that the BMI of older adults increases over time but does so at a decreasing rate (2013 to 2105 BMI difference = 0.19, 0.16 from 2015 to 2017, 0.13 from 2017 to 2019, and 0.09 from 2019 to 2021). On the other hand, among middle-aged adults, BMI significantly increased over time and accelerated during COVID-19. The difference in BMI was 0.20 from 2013 to 2015, 0.16 from 2015 to 2017, 0.22 from 2017 to 2019, and 0.28 from 2019 to 2021. BMI increases consistently over the period for middle-aged men and older adult women, whereas BMI growth accelerates for middle-aged women and decelerates for older adult men. Similarly, racial differences are noted in the BMI changes of middle-aged and older adults.

Conclusion

The COVID-19 pandemic accelerated the accumulation of body mass among middle-aged Americans.
MORE ADULT AMERICANS ARE AT NUTRITIONAL RISK SINCE THE COVID-19 PANDEMIC
Authors: Monroe-Lord Lillie , Ardekani Azam , Whitman Cassidy
Published: December 2023

The nutritional status of individuals has changed since COVID-19 pandemic due to disruptions in social, economic, and psychological factors. This study determines how nutritional status has changed since COVID-19 among American adults. The second aim is to examine which age range group was at a higher risk of nutritional status due to the pandemic. The study design was cross-sectional, with 10,035 participants aged 40-100 who answered a survey distributed by Qualtrics. Nutritional status was measured twice before and since the COVID-19 pandemic by the Dietary Screening Tool (DST). The total DST score was calculated for each participant, which categorized them into three different groups, including “at risk,” “possible risk,” and “not at risk.” The results revealed that the mean DST score before the pandemic was 56.04 (IQR: 48.00–65.00); this score significantly decreased since COVID-19 to 55.54 (IQR: 47.00–64.00) (p <.001). Of those participants who were not at risk before COVID-19, 28.5% became either at risk or at possible risk since COVID-19. Of those participants who were at possible risk before COVID-19, 21% are now at risk since COVID-19. Almost 60% of the younger group (40-60) were at risk before COVID-19 compared to 54.8% of participants aged 61-80 and 45.8% of older participants (81-100). These percentages increased by about 2% since COVID-19 among all three age groups. As a good nutritional status reduce the risk of severe illness, these findings can help policymakers to develop heath-protecting behavior sessions against future pandemics to manage crises.
A SCOPING REVIEW FOR PERSON-FOCUSED FALL PREVENTIVE INTERVENTIONS IN LONG-TERM CARE FACILITIES
Authors: Jung Wonkyung , Lim Sungwon , Thompson Hilaire
Published: December 2023

Falls are a significant concern in long-term care facilities (LTCFs) as fall-related injuries (FRI) can result in functional impairment, disability, and death. Older adults living in LTCFs are at greater risk for falls than those in the community. Using scoping review methodology, we aimed to synthesize evidence examining intervention effects of person-focused interventions for risk assessment and prevention in LTCFs to identify evidence-based practices. Databases searched included Medline, CINAHL, and EMBASE to identify original research from 2017 to April 2022 in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guideline. Following the removal of duplicates, 888 articles were identified for possible review, following title and abstract screening 84 studies underwent full-text review against inclusion/exclusion criteria, with 30 studies remaining for analysis. We conducted a narrative synthesis to summarize the included studies. Evidence-based interventions for fall prevention identified include (1) exercise programs (e.g., high-intensity functional exercise, aerobic exercise, short stick exercises, etc.); (2) balance training programs (e.g., Wii Fit); (3) multifaceted, nurse-led education; and (4) others (e.g., whole body vibration, and lavender olfactory stimulation). Outcomes of included studies included the number of falls, fall rate, risk of falls, and fear of falls before and after interventions. Overall, most studies reported significant effects of person-focused interventions in LTCFs. Available evidence supports that well-designed person-focused interventions can reduce falls and fear of falls for individuals in LTCFs.
FALL ENCOUNTERS AMONG OLDER ADULTS: IMPACT OF COVID-19
Authors: Lach Helen , salas Joanne
Published: December 2023

It was suspected that the restrictions in activity and clinical care during the COVID-19 pandemic would result in increased fall risks and falls in older populations. To explore the impact of the pandemic on falls, we examined the trajectory of fall rates among older adults cared for through a large, multi-state, Midwest healthcare system. De-identified medical record data was used to measure falls presenting to emergency, urgent, and hospital care in adults age 50+ from April 2019 through September 2022. We compared the fall rate during the pre-and post-COVID-19 time periods. Differences in fall rates were compared based on age groups, gender, race, and neighborhood socioeconomic status (nSES). The overall fall rate after COVID onset was significantly greater compared to prior to before COVID (11.59; 95%CI:11.50-11.67 vs. 11.20; 95%, CI:11.06-11.33). While White patients had a significantly higher rate of falls post-pandemic, changes in fall rates did not differ based on age, gender, or race. The changes did vary based on nSES, with the lower groups experiencing the largest increases. Findings may be related to differences in access to care and other services both early in the pandemic and as restrictions were lifted. Given the high cost of fall injuries, further work is needed to reduce falls and injuries in older adults.
OLDER WOMEN WITHOUT AND WITH DIABETES MELLITUS: RISK OF FALLS
Authors: de Silva Alessandro Oliveira , Funghetto Silvana , de Lima Luciano Ramos , Stival Marina Morato
Published: December 2023

Evidence points to an association between hyperglycemic state and worsening mobility, with increased risk of falls. The aim of this study was to compare the risk of falls in the women older with and without diabetes mellitus in a sample of women older 60 to 65 years of age (N = 205) care in primary health care in the Federal District - Brazil. The results of the statistical model showed that the highest prevalence of falls was in the group of older women with type 2 diabetes mellitus (52.8%). It was possible to verify in the Time Up and Go performance test that most older women with type 2 diabetes mellitus were at risk of falling (79.2%) (p=0.003). Furthermore, women with type 2 diabetes mellitus showed a higher risk of falls in the Berg Balance test (51.76±5.87). The results suggest that type 2 diabetes mellitus significantly increased the risk of falls in this population. The potential benefits of this approach contribute to the planning of strategies and interventions to prevent falls in this population of older women.
IMPLEMENTING SMART AMBIENT BRIGHT LIGHT (SABL) IN NURSING HOME RESIDENTS WITH DEMENTIA: CHALLENGES AND STRATEGIES
Authors: Jao Ying-Ling , Wang Julian , Liao Yo-Jen , Berish Diane , Boltz Marie , Calkins Margaret
Published: December 2023

Effective non-pharmacological interventions are critically needed to reduce agitation for nursing home residents with dementia. Lighting interventions (LIs) improve agitation among persons with dementia. However, LIs have not been widely implemented in “real-world” care settings, and a feasible implementation approach to ambient LIs has not been established. This study describes challenges and strategies in implementing the smart ambient bright light (SABL) to provide auto-controlled, consistent indoor lighting that incorporates natural daylight. This SABL includes tunable LED lights, photosensors, and controllers and has a pre-programmed 24-hour control schedule for illuminance. The SABL will be installed in participants’ bedrooms, dining areas, and activity rooms for four weeks. Key challenges include nursing home leadership team’s concerns about compliance with regulations and increased staff workload. Our implementation strategies include 1) engaging the nursing home stakeholders early on to address their concerns, 2) setting up an advisory board at each facility to involve the administrator, director of maintenance, and frontline healthcare workers to ensure the implementation protocol is congruent with their regulations, policy, and staffing, 3) tailoring lighting schedule based on the care routine and resident schedules, and 4) monitoring the SABL operation on-site and remotely. Moreover, the study incorporates a mixed methods design to interview staff/administrators and evaluate the intervention’s acceptability, feasibility, and appropriateness from their perspectives. This is the first study that addresses the implementation strategies of LIs. Findings will establish evidence-based implementation strategies and the best design for SABL to reduce agitation for nursing home residents with dementia.
PATTERNS OF SOCIAL CARE USE WITHIN THE OLDER POPULATION: WHAT CAN WE LEARN FROM ROUTINELY COLLECTED DATA?
Authors: Brotherhood Kelly , Hanratty Barbara , Spiers Gemma , Caiado Camila , Newton Julia
Published: December 2023

Research with routinely collected social care data has untapped potential to inform new care delivery approaches and techniques. To identify opportunities for service improvement and enhance our understanding of care pathways experienced by the older population, we collaborated with a local authority in the North East of England. We set out to characterise the use of social care services and associated outcomes within the local older population (aged 65+). 171,386 records were extracted from the local authority’s social care case management system, relating to 38,191 unique individuals across the last 40 years. We identified the care packages provided to the local population, including care provided in care homes (with and without nursing), private households and assisted living facilities. The study population varied in terms of the number of care packages provided to each individual (median 7 packages, IQR 4-11) and the average duration of individual care packages (median 41 days, IQR 14 - 274 days). The care pathways that are most common amongst the older population will be described, including sequencing and outcomes, and grouped by the reason for providing care (e.g., respite, long-term care) and the reason why each care package ended (e.g., death, returning home). The wide range of care pathways experienced demonstrate the heterogeneity in needs and preferences within the older population. This dataset and analyses are an invaluable way of identifying areas of potential unmet need and evaluating the effectiveness of short-term care services.
PRESERVING THE DISCRETENESS OF DEFICITS LEADS TO LOWER FRAILTY INDEX IN INDIVIDUALS LIVING IN LONG-TERM CARE
Authors: Greeley Brian , Low Hilary , Kelly Ronald , McDermid Robert , Song Xiaowei
Published: December 2023

The frailty index (FI), based on the deficit accumulation model, has potential to advance healthcare, but conventional coding of raw scores introduces noise. This study assesses the impact of the two different coding approaches on the FI. Two FI were calculated using 43 variables from 29,758 older (> 65 years old) Canadians adults (84.6 ± 8 years old; 64% female) living in long-term care. Scores were coded as 0, 0.5, or 1 regardless of the number of levels (grouped), or preserved (e.g., a 4 level variable was coded as 0, 0.33, 0.67, or 1; discrete). FI was correlated to age. Each ordinal variable was removed from the FI to further test the impact of the two coding approaches. The median FI for the grouped approach (0.302 (0.221 – 0.372)) was higher relative to the discrete approach (0.237 (0.170 - 0.307)). The discrete (r = .91) and grouped (r = .93) FI showed similar relationships to age. Removal of any ordinal variable reduced the grouped FI it by 0.004 or 0.016, whereas removal lead to both increases (range: 0.003 - 0.001) and reductions (range: 0.002 - 0.008) for the discrete FI. Using a grouped coding approach when quantifying frailty status artificially inflates FI among a large sample of older Canadians adults living in long-term care. The study underscores the importance of future FI research to adopt a discrete coding approach that accurately reflects the true level of impairment, for reducing noise in statistical models and better clinical utility.
A SYSTEMATIC REVIEW OF FUNCTIONAL TRAINING EXERCISE IN COMMUNITY-DWELLING OLDER ADULTS WITH COGNITIVE IMPAIRMENT
Authors: Shin Yun Chan , Liu Chiung-ju , Breton Kellen , Mason Justin , Hu Yi-Ling , Morgan-Daniel Jane
Published: December 2023

Older adults with cognitive impairment are at risk of becoming care dependent. Functional training involves movements necessary for daily tasks, which may help maintain or improve independence. As part of a larger systematic review examining the effects of a functional training exercise in community-dwelling older adults, this study aimed to synthesize the functional and cognitive outcomes in those with cognitive impairment. A systematic search was conducted in 10 electronic databases to identify relevant studies published between January 2010 and September 2021. Studies were selected if recruited adults aged > 60 years, participants had a cognitive impairment that was not due to acquired brain injury, and activities of daily living and/or cognitive function were measured. Nine studies (847 participants) were identified. Five studies were conducted on older adults with mild cognitive impairment, all showed an improvement in activities of daily living, and 4 showed an improvement in global cognition. Three were conducted on older adults with dementia, and one showed an improvement in activities of daily living but not global cognition. One was conducted on older adults with mild cognitive impairment or dementia and reported an improvement in both outcomes. Functional training exercise seems effective in improving cognitive function and activities of daily living in older adults with mild cognitive impairment. For those with dementia, although research on functional training is limited, some preliminary evidence suggests that incorporating functional training with other components may be beneficial. Despite inconclusive findings, functional training exercises may hold potential for older adults with cognitive impairment.
COMPARISON OF CUT POINTS FOR PREDICTING PHYSICAL ACTIVITY INTENSITY IN OLDER ADULTS
Authors: Chakravarthy Ameera , Resnick Barbara , Galik Elizabeth , Doran Kelly , Renn Cynthia , Lehr Eric , Knopp Kasey
Published: December 2023

The differences between cut-points, and scarcity of comparative impact studies have prevented researchers from reaching consensus regarding the application of intensity-related accelerometer cut-points for older adults. This study will focus on the measure of physical activity using the MotionWatch 8 in older adults and compare the differences using traditional Freedson cut points versus those developed by Landry for older adults and evaluate the impact of these differences on age, gender, race, cognition, comorbidities as well as function based on the Barthel Index. A total of 177 participants between the ages of 59 to 101 (M 83) from an acute care study were used for the analysis. Physical activity intensity was estimated using 24-hour count data and compared using two independently developed cut-points. Impact on outcomes were evaluated with hierarchical regression and Multivariate analysis of variance. After controlling for age, gender, race, comorbidities, and cognition, Landry sedentary cut-points were all significantly associated with function. Overall, 14% of the variance in function was explained by all the variables in the model. The findings provide support for use of the Landry cut points to quantify physical activity intensity in hospitalized older adults living with dementia to identify low levels of activity.
SELF-REGULATION AND SELF-EFFICACY OF EXERCISERS DURING COVID-19
Authors: Brown Candace , Chiles Kira
Published: December 2023

Employment, which was greatly impacted by the COVID-19 pandemic, caused alterations to the ‘work-from-home’ culture, and resulted in increased time sitting and decreased time in leisure activities, like exercise. This study explored the relationship of full time employment, intrinsic motivation, and self-efficacy to exercise with the understanding that social distancing and quarantining led to increased social isolation among all ages around the world. Methods Guided by the Self-determination theory, online data was collected from U.S. exercisers ages 18 and older who completed the Exercise Self-Regulation Questionnaire and Self-Efficacy for Exercise Scale during the height of the pandemic, in April 2020, and after, in February 2022. Results There were n = 320 participants that completed the surveys at T1 and n = 107 returned for T2 for a total of N = 427 participants. MANOVA results revealed a significance in intrinsic motivation (p < .001) in 2020 to exercise when gyms and outdoor spaces were closed. The greatest determinants of not achieving self-efficacy to exercise in 2022, when gyms and outdoor spaces were reopened, included “being bored” (36.1%) and “not enjoying” (29.6%) the activity. Conclusion Results suggest that full time employees, regardless of age, endorse high levels of personal accepted values and goals to exercise that are enjoyable, to them, for continued self-efficacy to exercise.
THE VARIATION IN DAILY HABITUAL PHYSICAL ACTIVITY LINKS TO GLOBAL COGNITIVE FUNCTION IN OLDER ADULTS
Authors: Ask Levi , Manor Brad , Lo On-Yee
Published: December 2023

Being physically active is critical to the maintenance of physical and cognitive function into old age. Wearable sensors with the ability to monitor step counts have become popular, making it easier for individuals to track their physical activity levels from day to day. While average daily step count has traditionally been used to quantify physical activity, emerging evidence suggests that the magnitude of day-to-day variation in physical activity or other clinical outcomes may provide additional insight into health. This study aimed to investigate the relationship between the characteristics of habitual physical activity and global cognitive function in older adults. A secondary analysis from a pilot randomized controlled trial was conducted. Thirty-two older adults (79±7 y/o, 29 women) completed the Montreal Cognitive Assessment (MoCA) of global cognitive function at baseline (Total MoCA score: 25.0±2.9). Physical activity was tracked using a Fitbit wrist-worn activity tracker for two consecutive weeks with all participants having 10 complete days. Daily step count mean and standard deviation were calculated to quantify the daily average (4435.12±2768.88 steps) and daily variation (1671.05±1134.03 steps) in physical activity, respectively. After adjusting for age and sex, participants with greater daily variation in step counts exhibited better global cognitive function (r=0.52, p=0.02). In contrast, average daily steps did not significantly correlate with MoCA performance. Neither of these physical activity outcomes were significantly linked to any MoCA subscore. These results suggest that monitoring day-to-day step count variation may serve as a particularly sensitive indicator of global cognitive health in older adults.
ACCEPTABILITY OF HIGH-INTENSITY FUNCTIONAL STRENGTH TRAINING AT HOME FOR POSTINJURY OLDER ADULTS
Authors: Morgan Ashley , Heisz Jennifer , Tang Ada , Thabane Lehana , Richardson Julie
Published: December 2023

Regular exercise plays a vital role in optimizing aging and preventing functional decline. Despite the recognized benefit of exercise, adherence is challenging, and acceptability of exercise interventions is crucial. Acceptability is influenced by various factors, including content, context, and delivery. The purpose of this qualitative descriptive study is to determine the acceptability to older adult participants of a home-based high-intensity functional strength training (HIFST) intervention delivered by a physiotherapist via videoconferencing. HIFST involves the use of periods of ‘hard’ effort using everyday strength-building movements alternating with ‘easy’ recovery periods. This study accompanies an ongoing pilot randomized controlled trial investigating the feasibility of HIFST (completion: spring 2023). We are conducting semi-structured interviews and a short anonymous survey with participants who have completed HIFST. Data collected is being analyzed using qualitative content analysis. To date, results from 8 participants (2 men, 6 women, 55-81 years) demonstrate a positive overall impression of HIFST with all participants noting enjoyment, a good experience, and/or meeting their expectations. Participants reported certain aspects less/more enjoyable than others (e.g., specific exercises). No technical difficulties have been noted and many participants appreciated the convenience of an online format. Prior knowledge of interval-based exercise was minimal for most participants and the majority commented on a preference for shorter intervals with shorter rest periods. Further data collection and analysis will provide a contextualized understanding of the HIFST intervention and important considerations for exercise prescription in an aging population.
OLDER ADULTS’ ACCEPTANCE OF TELEGRACE: A HYBRID TELEHEALTH CARE MODEL
Authors: Preddie Alaina , Penney Lauren , Schwartzkopf Ashley , Schubert Cathy , Bravata Dawn , Damush Teresa
Published: December 2023

The VA Geriatric Resources for Assessment and Care of Elders (GRACE) at Veterans Health Indiana is an interdisciplinary, home-based program providing comprehensive geriatric assessment and ongoing care management for community-dwelling older Veterans’ experiencing geriatric syndromes. TeleGRACE is an extension of the GRACE program and delivers care via a hybrid, telehealth home visit. The TeleGRACE technician operates the audio-visual equipment in the patient’s home while the clinical dyad (GRACE nurse practitioner and social worker) conducts the assessment. The specific aim of this study was to evaluate patient acceptability of TeleGRACE. We conducted a mixed methods study which included Likert-scale ratings and open-ended interviews. Participants used a 5-point scale to indicate agreement (5) to disagreement (1) regarding the acceptability of program elements ratings including ease with technician and virtual dyads; access; and clinical telepresence. The sample included 12 Veterans (mean [M] age, 78.7 years; standard deviation [SD] 7.5) who completed both an initial and follow-up TeleGRACE visit. Veterans reported high agreement of TeleGRACE acceptability (M=4.9, SD=0.3). They agreed: TeleGRACE hybrid visits helped them get care that they could not access otherwise (M=4.7, SD=0.65), they were as well taken care of by TeleGRACE virtual clinicians as those met at in-person visits (M=4.8, SD=0.4), they could hear (M=4.8, SD=0.6) and see (M=5.0, SD=0) the clinical dyads through the video visits, and they were able to ask direct questions of the TeleGRACE clinical staff (M=5.0, SD=0). These results indicated that TeleGRACE’s key elements of a hybrid telehealth home visit were acceptable to older, community-dwelling Veterans.
“IT’S NOT THE DESTINATION BUT THE JOURNEY”: PERSPECTIVES AND ADVICE ON WISDOM
Authors: Lehpamer Nicole
Published: December 2023

While wisdom has been a common topic of contemplation for hundreds of years, a common theme in the wisdom literature relates to how wisdom is acquired through experiences. However, others have found that it can also be developed through individual factors, such as cognition, emotional intelligence, and personality, and cultivated through social interactions and self-reflection. Older adults have more experience than those of any other generation, giving them the time to develop the individual factors associated with wisdom and the skills to cultivate it. Given their unique social position, older adults are thus most qualified to share wisdom. In attempts to capitalize on the wisdom of older adults, the study uses survey data from adults aged 55 and better to examine how older adults characterize wisdom, it’s association with age, and how it can be achieved. Data was collected using surveys administered through the Survey Monkey Platform and the Mather Institute Research Panel. Findings indicate that most older adults believe that wisdom increases with age. They further believe that wise individuals accept their limitations, are realists, have developed strong relationships with others, and seem in control of their lives. Older adults believe that wisdom can primarily be achieved by making mistakes, interacting with people who are different, experiencing adversity, and trying new things. Understanding the ways in which older adults perceive wisdom can be used to enhance intergenerational interactions that are mutually beneficial.
AGEISM IN SUB-SAHARAN AFRICA: PROFESSIONALS’ PERSPECTIVES
Authors: Adeniji Dolapo , Teshome Abraham , Ashirifi Gifty , Adamek Margaret
Published: December 2023

While ageism is increasing across the globe, older adults in Sub-Saharan Africa are more vulnerable to ageism and are often denied a stable means of livelihood leading to poor health and a decreased quality of life. Scholars report that ageism can be experienced in multiple forms including economic, employment, and healthcare, with the intersectionality of gender and other factors complicating ageism. As little is known about ageism in Sub-Saharan Africa, this study explored the perspectives of scholars and professionals about the levels of ageism and age discrimination against older Africans. A cross-sectional study was conducted with scholars and professionals from sub-Saharan Africa. The 78 respondents ranged in age from 24-75 and over half (55.2%) were female. Using descriptive analysis, our findings show that the perceived level of discrimination against older adults is moderate with over half of the respondents (55.7%) indicating that ageism is getting worse. Respondents indicated that older adults are most discriminated against and face barriers in the areas of economic advantages (72.1%), employment opportunities (60.3%), healthcare access (49.4%), and housing (35.3%). Social workers, practitioners, and policymakers should directly address the problem of ageism to promote the healthy living of older adults in sub-Saharan Africa. To turn the tide of ageism and age discrimination in Sub-Saharan Africa, governments need to provide basic social protection to older adults so that they can have a stable means of support in their later years and will be less likely to be perceived as a burden to families and societies.
STRATEGIES TO MITIGATE MACHINE LEARNING BIAS AFFECTING OLDER ADULTS: RESULTS FROM A SCOPING REVIEW
Authors: Chu Charlene , Donato-Woodger Simon , Khan Shehroz , Leslie Kathleen , Shi Tianyu , Nyrup Rune , Grenier Amanda
Published: December 2023

Digital ageism, defined as age-related bias in artificial intelligence (AI) and technological systems, has emerged as a significant concern for its potential impact on society, health, equity, and older people’s well-being. This scoping review aims to identify mitigation strategies used in research studies to address age-related bias in machine learning literature. We conducted a scoping review following Arksey & O’Malley’s methodology, and completed a comprehensive search strategy of five databases (Web of Science, CINAHL, EMBASE, IEEE Xplore, and ACM digital library). Articles were included if there was an AI application, age-related bias, and the use of a mitigation strategy. Efforts to mitigate digital ageism were sparse: our search generated 7595 articles, but only a limited number of them met the inclusion criteria. Upon screening, we identified only nine papers which attempted to mitigate digital ageism. Of these, eight involved computer vision models (facial, age prediction, brain age) while one predicted activity based on accelerometer and vital sign measurements. Three broad categories of approaches to mitigating bias in AI were identified: i) sample modification: creating a smaller, more balanced sample from the existing dataset; ii) data augmentation: modifying images to create more training data from the existing datasets without adding additional images; and iii) application of statistical or algorithmic techniques to reduce bias. Digital ageism is a newly-established topic of research, and can affect machine learning models through multiple pathways. Our results advance research on digital ageism by presenting the challenges and possibilities for mitigating digital ageism in machine learning models.