bluuebunny/crossref_metadata_2025 huggingface dataset:
GAIT SLOWING AMONG FRAIL OLDER ADULTS: IS HIGHER DOPAMINERGIC SIGNALING PROTECTIVE?
Authors: Rosano Caterina , Studenski Stephanie , Bohnen Nicolaas , Rosso Andrea
Published: November 2019

Strategies to reduce gait slowing in frail older adults are urgently needed. Higher dopaminergic (DA) signaling is emerging as a protecting factor against age-related gait slowing, in the absence of Parkinson’s Disease (PD). DA signaling is potentially modifiable, thereby offering promising novel strategies to reduce gait slowing. In 3,752 PD-free participants of the Cardiovascular Health Study (72.3 years, 81% white, 39% male), we measured gait speed (usual pace, 15 feet), frailty (Fried definition), and genetic polymorphism of Catechol-O-methyltransferase (COMT, rs4680), an enzyme regulating tonic brain DA levels. Multivariable linear regression models of COMT predicting gait speed were adjusted for age, gender, BMI, ankle-arm index, vision, and arthritis. Strength, education, medications, pulmonary, cardio- and cerebro-vascular diseases, diabetes, mood, and cognition were considered as additional covariates. We examined the full cohort and the subgroup with frailty (n=222), without and with race-stratification to address racial differences in allele frequencies. Average (SE) gait speed was 0.88 (0.003) and 0.58 (0.01) m/sec in the full cohort and the frail subgroup, respectively. COMT was linearly associated with gait speed; gait was faster for met/met (higher DA signaling) and slower for val/val (lower DA signaling) participants. In adjusted models, differences between these two groups were: 0.02 (0.01) m/sec in the full cohort (p=0.4); 0.07(0.02) m/sec in the frail subgroup (p=0.02); 0.10 (0.02) m/sec in white with frailty (p=0.01). COMT genotyping may help identify frail adults who are less vulnerable to gait impairments. Studies of frailty should examine whether higher DA signaling offers resilience against age-related gait slowing.
SERVICE PROVIDERS' PERSPECTIVES OF UNDERREPORTING ABUSE OF OLDER ADULTS IN ALBERTA, CANADA
Authors: Liepert Carla R , Walsh Christine , Roger Kerstin , Goodridge Donna , Ranville Michelle
Published: November 2019

Minimal research has investigated disclosure/non-disclosure of abuse of older adults. To address this gap, this exploratory, qualitative study gathered the perspectives on reporting of elder abuse from 10 service providers working with elder abuse survivors across Alberta. Face-to-face and online interviews were conducted, audio-recorded, transcribed, and thematically analyzed. Four major barriers to abuse disclosure for older adults were identified. First, complex parent/adult-child relationships reduce the likelihood of disclosure among older adults who are experiencing abuse perpetrated by a family member; the corollary is that disclosure for non-familial perpetrators results in higher rates of disclosure. Second, older adults residing in rural and remote locations face greater barriers to disclosure compared to those residing in urban/suburban settings. Third, older adults are unlikely to report even if they recognize that they are in a situation of abuse, as a consequence of their internalized ageist beliefs that policing and social services agencies have more pressing needs to address than their well-being. Finally, local policing bodies and legal authorities may inadequately serve older adults facing abuse, particularly in cases of non-physical abuse, due to prioritized client and community needs. This study highlights the need for additional supports and service provision for vulnerable older adults in Alberta, specifically for those residing in rural and remote regions and those dependent on family members. It also points to the critical need for a greater understanding and awareness of violence against older adults among the general public and those tasked with ensuring the safety and well-being of older adults.
CHILD ABUSE AND ADULT MENTAL HEALTH: DOES GENDER MATTER?
Authors: Morton Patricia M , Kemp Blakelee , Ahmed Frass
Published: November 2019

Numerous studies have demonstrated that child abuse is associated with poor adult mental health, but few have investigated the extent to which the frequency of different types of abuse increase mental health conditions, especially at the nexus of gender. The present study examines whether parental abuse frequency and abuse perpetrator have distinct effects for men and women on three mental health outcomes—depressive symptoms, generalized anxiety, and global self-reported mental health. Data came from three waves of the National Survey of Midlife Development in the United States (MIDUS), comprising a baseline sample of 3,032 adults aged 25-74. Estimating a series of mixed effects models revealed that maternal abuse and frequent abuse during childhood were associated with poorer adult mental health during our 20-year observation period, net of childhood and adult risk factors. Specifically, maternal emotional abuse raised the risk of depression, anxiety, and lower self-rated mental health, and was more strongly associated with depression and anxiety for women than men. Compared to adults who did not experience parental abuse during childhood, adults who experienced frequent emotional and physical abuse by either parent were more likely to experience depression and anxiety and report lower ratings of mental health in adulthood. Frequent child abuse was more strongly associated with anxiety for women than men. These results demonstrate that gender differences in adult mental health have early-life antecedents. Future research investigating the long-term mental health consequences of child abuse should consider the type and magnitude of abuse as well as the perpetrator.
DIETARY INTAKE AND SELF-REPORTED NUTRITION CONCERNS OF PEOPLE WITH PARKINSON’S AND THEIR INFORMAL CAREGIVERS
Authors: LoBuono Dara L , Shea Kyla , Dobiszewski Sarah Sarah , Tovar Alison , Leedahl Skye N , Xu Furong , Leslie Mahler , Lofgren Ingrid E
Published: November 2019

Dietary recommendations for managing Parkinson’s disease (PD) can be confusing for people with PD (PwPD) and their informal caregivers (ICGs) who often have the responsibility to buy and prepare foods. PwPD (63-78 years of age) and their ICGs (39-75 years of age) completed two 24-hour dietary recalls and semi-structured, dyadic interviews which were conducted to gather information about dyads’ (n=9) nutrition concerns. Calorie, macro- and micro-nutrient intake were averaged over two days and compared to the National Academy of Sciences’ dietary reference intakes. Independent t-tests and the Mann-Whitney U tests compared PwPD and ICG. Interviews were audio-recorded, transcribed verbatim, and analyzed for preliminary themes. Mean calorie intake was 1766.6±658.5 kcal/d; the majority of calories were from carbohydrates. Calorie and nutrient intake between PwPD and ICG did not differ. All participants were below recommendations for fiber (17.2±7.9g/d) and potassium (2213.3±890.0mg/d) and exceeded recommendations for sodium (2741.2±1396.9mg/d) and added-sugars (59.5 ±38.3g/d). More than half of participants (55.6%) agreed an eating plan to manage PD symptoms is important and that a nutrition consultation would be helpful. Emerging themes from qualitative interviews include: nutrition concerns related to PD symptoms, managing other conditions and PD, perceptions regarding diet quality, impact of diet on PD symptoms, and complementary medicine. In conclusion, there were no differences in dietary intake between PwPD and ICG, and participants presented with lack of adherence to recommended dietary reference intakes. Sub-optimal dietary intake and self-reported nutrition concerns strongly suggest including both nutrition professionals and ICGs when providing care for PwPD.
HAND GRIP STRENGTH ASSESSMENT IN A HOME-DELIVERED MEAL PROGRAM: FEASIBILITY AND PRELIMINARY FINDINGS
Authors: Hutchins-Wiese Heather L , Walsh and Sarah E
Published: November 2019

Declining hand grip strength is associated with adverse health outcomes and is a relatively quick and easy-to-administer functional assessment; however, grip strength is not routinely assessed in home-delivered meal (HDM) programs. The purpose of this sub-study was to test if grip strength assessment is feasible and useful in a HDM population. Among HDM clients (n=258) who completed health assessments between 2016 and 2018, a voluntary convenience sample of 34 HDM clients (23 women, 11 men) participated in the grip strength assessment sub-study. Sub-study participants were younger (72.2+/-7.35 vs. 77.0+/-10.50 years), with no other significant differences compared to the full sample of HDM participants. The average maximum grip strength was 21.99+/-6.97 kg for the dominant hand; 16 clients were categorized as having normal, 6 intermediate, and 12 weak grip strength. Normative categories for grip strength vary by gender because men typically have higher grip strength measures than women. In this population, more men were categorized as having weak grip strength compared to women (X (2, 34) =11.44, p=.03). In men, hand grip strength tended to be lower in those who reported a fall in the previous 6 months compared to those who did not report a fall (20.8+/-7.01 vs 29.3+/-6.32, p=.079). The gender differences and 8 kg difference in grip strength relative to reported falls are clinically meaningful in this vulnerable population. Future research is needed with a larger sample of HDM clients to confirm these preliminary findings.
EPIGENETIC PROFILES OF ALZHEIMER’S DISEASE
Authors: Thrush Kyra , Levine Morgan E
Published: November 2019

Although age is highly correlated with incidence of Alzheimer’s Dementia (AD), the field continues to lack a clear understanding of how either normal and/or pathological aging processes drive neurodegeneration. As such, there remains a clear lack of valid and reliable clinical biomarkers to predict that disease’s future development and severity. Epigenetic age based on DNA methylation (DNAm) in brain have been shown to relate to AD neuropathology and cognitive decline. However, they were not initially designed as AD biomarkers. We hypothesized that supervised and unsupervised machine learning techniques (e.g. network analysis, clustering, and regressed-based techniques) could be used to build composite scoring variables from DNAm data that are predictive of AD progression. This work analyzes the methylation of 3 brain regions (cerebellum (CBM), prefrontal cortex (PFC), striatum (ST))—totaling 1,047 brain methylation samples. The samples contain neuropathologically confirmed AD cases and controls, and is enriched for APOE4+ carriers. Detailed subject-level information concerning cognitive measures, lifestyle choices, medications, and neuropathology at death were also considered. Based on epigenome-wide association study (EWAS), we identified a CpG in AIMP2 that is a robust predictor of AD-related phenotypes. Using network analysis, we have also identified co-methylation modules that relate to multifactorial AD phenotypes. Following validation, we intend to follow-up on the biological processes and molecular pathways associated with these epigenetic signatures. In moving forward, predictors of AD diagnosis and prognostication have major implications for early detection and treatment of this major age-related disease.
HOUSING COSTS BURDEN AND SELF-RATED HEALTH: PRELIMINARY FINDINGS FROM A U.S. SAMPLE
Authors: Cheon Ji Hyang , Cagle John , Lehning Amanda
Published: November 2019

Self-rated health is a multidimensional construct that includes not only physical health but also emotional and social well-being. Previous research has demonstrated that multiple factors contribute to individual self-rated health, including income. Because income is a somewhat limited indicator of older adults' financial circumstances, alternative measures such as housing cost burden may enhance our understanding of contributors to self-rated health. Further, because homeowners and renters may have a different attachment to their home and neighborhood, homeownership may moderate the association between housing cost burden and self-rated health. This study examined these relationships using data from 3,212 older adults in round 7 (2017) of the National Health & Aging Trends Study. Findings from multiple linear regression models indicate that the housing cost burden is associated with lower self-rated health, and this association is stronger for renters compared to homeowners. The findings indicate the potential for reduced housing cost burden to have a positive effect on health. The poster will conclude with practice and policy implications, including the potential benefits of expanding rental assistance programs to older adults who may not meet current income requirements but are experiencing high housing cost burden, as well as research implications, including the need for longitudinal approaches.
REFLECTIONS FROM HOMELAB: DEVELOPING TASKS TO MEASURE UPPER-BODY FUNCTION IN A SIMULATED HOME
Authors: Carmichael Alicia G , Wisniewski Maren , Nielsen Karen , Leonard Natalie M , Wank Marianthie , Raichur Vineet , Gonzalez Richard
Published: November 2019

Homelike research spaces provide a unique context for studying older adulthood by blurring the boundaries between the participant’s own home and traditional laboratories. Such intermediary spaces hold promise for developing measures of functional performance with increased ecological validity. While “home labs” are becoming more accessible at institutions around the world, the research design process in these spaces contains hidden challenges that can be a barrier to entry for the uninitiated. We identify and reflect on these challenges through the lens of a recent protocol built to assess upper-body performance among older adults during activities of daily living. The U-M HomeLab served as a proving ground for four example tasks: opening a water bottle, sorting pills, tying an apron, and hanging laundry. The evolution of each task is traced through ideation, testing, and refinement, culminating in a pilot among nine community-dwelling volunteers aged 61 to 72 with upper-body pain. Based on this experience, we recommend that designers of naturalistic tasks in homelike environments give special consideration to (1) feasibility, (2) scorability, and (3) safety while carefully balancing standardization against verisimilitude. In turn, each of these elements must be grounded not only in the context of the facility itself but also in the population using that facility. Among older adults with upper body pain, considerations included remaining cognizant of fall risk, anticipating and capturing compensatory behaviors, tailoring task difficulty for a wide range of physical ability, and accounting for the impact of historically gendered divisions of labor on task performance.
USE IT TOO MUCH AND LOSE EVERYTHING? THE EFFECTS OF HOURS OF WORK ON HEALTH
Authors: McKenzie Colin , Sakata Kei , Kajitani Shinya
Published: November 2019

We examine the causal impact of working hours on various health outcomes of Australian men aged 40 and over. To capture the potential non-linear dependence of health status on working hours, the models for health outcomes include working hours and its square. We deal with the potential endogeneity of working hours by using the instrumental variable estimation technique using instruments based on the age for pension eligibility. A non-linear causal effect of working hours on health is confirmed. For males working relatively moderate hours (up to 20–24 hours for a week), an increase in working hours has a positive impact on health, but thereafter an increase in working hours has a negative impact on health. The results also indicate that there is a non-linear dependence of working hours on the pension eligibility age, and also a non-linear dependence of health outcomes on the pension elgibility when this last relationship is treated as a "reduced form" relationship.
EXPOSURE TO FINE PARTICULATE MATTER, GLOBAL COGNITIVE PERFORMANCE, AND EMOTIONAL DISTRESS IN OLDER WOMEN
Authors: Petkus Andrew J , Wang Xinhui , Younan Diana , Espeland Mark M , Manson JoAnn E , Whitsel Eric , Resnick Susan , Chen Jiu-Chiuan
Published: November 2019

Among older adults, exposure to ambient PM2.5 (particulate matter with aerodynamic diameter <2.5 μm) has been associated with more rapid decline in cognitive performance and greater emotional distress. However, the inter-relationship between PM2.5 exposure, emotional distress, and global cognitive decline is unexamined. We examined whether long-term PM2.5 exposure affects global cognitive ability and emotional distress in 5,982 older women (baseline age 70.6 ± 3.8 years) from the Women’s Health Initiative Memory Study. PM2.5 exposure for the three-years prior to baseline was estimated at each participant’s residence via a national kriging model. Using structural equation models (SEM), a z-score standardized latent factor consisting of items from the 6-item CESD and the SF-36 Emotional Well-Being scale was constructed to estimate emotional distress at baseline and one-year follow-up. Individual-specific trajectories of global cognitive performance (Modified-Mini Mental State Examination; 3MS) were also estimated. All effects reported were adjusted for multiple demographic, lifestyle, and clinical variables. Higher PM2.5 exposure was associated with lower baseline 3MS performance (β= -.159 per IQR=3.38 μg/m3; 95% CI = -.276 to -.042), which was associated with increased emotional distress over the subsequent year (β= -.011; 95% CI= -.017 to -.004). A statistically significant indirect association of PM2.5 on changes in emotional distress via worse baseline 3MS performance (β=.002; 95% CI = .001 to .004) was present. In contrast, no statistically significant association between PM2.5 on baseline emotional distress occurring prior to declines in 3MS performance was present. PM2.5 neurotoxicity may contribute to global cognitive decline, which precedes increased emotional distress.
DAILY INTERACTIONS WITH THE VERY OLD PARENTS AND OLD CHILDREN: CONCORDANCE IN REPORTS AND RELATIONSHIP TYPE
Authors: Kim Joohyun , Min Joohong
Published: November 2019

Objectives: Studies have been increased on daily lives of older adults; however, little is known about daily interactions between parents and children, especially both are in their later lives. Utilizing parent-child dyadic data, this study aims to investigate the joint daily interactions of the very old parents and their old children with focus on the relationship type and differences in parent’s and child’s report. Methods: A sample of 105 parents (aged ≥ 80) and 105 children (aged ≥ 65) were interviewed to assess frequency on daily interactions (e.g., contact by phone or email, talking, eating and going out together). Structural Equation Modeling was used to examine differences in amounts of daily interactions by relationship type (e.g., mother-daughter, mother-son and mother-in-law – daughter-in-law). Results: Both parents and children reported high level of daily interactions; however, frequency of watching TV and going out together were relatively lower, compared to other forms of daily interactions. Parents and children showed high concordance in reports; 84% of dyads had the same reports in interactions (absolute mean discrepancy score < 0.1). Mother-daughter relationship reported significantly higher frequency on daily interactions, comparted to mother-son relationship. No significant differences were found between the mother-daughter dyads and the mother-in-law and daughter-in-law dyads. Discussion: Findings suggest that very old parents and old children tend to have high levels of daily interactions, with high concordance in reports. It also highlights its importance of considering relationship type in the dynamic of daily lives and experiences between very old parents and old children.
QUANTIFICATIONS OF BIOLOGICAL AGING PREDICT DISABILITY AND MORTALITY IN OLDER ADULTS IN THE DUKE EPESE
Authors: Parker Daniel C , Kraus Virginia B , Belsky Daniel
Published: November 2019

Methods to quantify biological aging have been proposed to measure age-related decline in system integrity for population surveillance and evaluation of geroprotective therapies. However, quantifications of biological aging have been little-studied in geriatric populations. We conducted analysis of three clinical-biomarker-algorithm methods to quantify biological aging, the Klemera-Doubal Method (KDM) Biological Age, homeostatic dysregulation (HD), and Levine Method (LM) Biological Age in a cohort of N=1,374 older adults aged 71-102 years (35% male, 52% African American), the Duke-EPESE. We parameterized algorithms from analysis of US NHANES data (N=36,207). We conducted criterion validity analyses using measures of disability and mortality as end-points. We analyzed counts of ADLs and iADLs using negative binomial regression. We analyzed time-to-death using Cox regression. Models were adjusted for age, sex, and race/ethnicity. We evaluated algorithms derived from analysis of different biomarker groupings. We also compared algorithms derived from analysis of mixed age and race/ethnicity samples to algorithms derived from older-age (65+) and individual race/ethnicity samples. Duke-EPESE participants with older KDM Biological Age reported dependence in more ADLs and iADLs, and were at increased risk of death (ADL IRR=1.19 [1.12, 1.27]; IADL IRR=1.18 [1.10, 1.26]; mortality HR=1.09 [1.06, 1.13]). Quantifications of biological aging derived from analysis of a mixed-age and race/ethnicity sample predicted disability and mortality in African-American and white older adults.
LATENT DYADIC CHANGE MODEL OF SPOUSAL SIMILARITY IN PHYSIOLOGICAL MARKERS OF AGING
Authors: Mejia Shannon T , Gonzalez Richard
Published: November 2019

Older adult populations are known for their diversity in health. Within couples, however, population studies have documented exceptional levels of spousal similarity in health and health behaviors. The presence of spousal similarity in health among older adults suggests a process of convergence, yet few studies have examined this phenomenon longitudinally. We present a latent dyadic change model to estimate the extent to which couples’ similarity in grip strength, Cystatin C, and lung function--indicators of frailty/physiologic reserve. The model is a longitudinal extension of the latent dyadic model, where husbands’ and wives’ markers of health are parsed into variance that is attributed to the couple and individual levels. Change in the biomarkers of aging is then estimated at the couple and individual levels, resulting in estimates of husbands’ change, wives’ change, and shared change. We illustrate our model using physiological data from the Health and Retirement Study, a nationally representative panel study of individuals aged 51+ in the United States (3,500+ eligible couples). At the individual level, grip strength and lung function decreased, whereas Cystatin C increased for both husbands and wives. The shared change parameter estimated 16% to 25% of the change in markers of aging existed at the couple level. This suggests, consistent with convergence, that similarities in markers of aging at T2 were due to shared processes of change. Shared processes held after adjusting for indicators of partner selection. The latent dyadic change model offers a methodology to examine change in couples’ shared processes over time.
APOLIPOPROTEIN E, LEUKOCYTE TELOMERE LENGTH AND MEMORY IN EXCEPTIONALLY LONG-LIVED FAMILIES
Authors: Ashrafi Adiba , Barker Megan , Honig Larry , Lee Joseph , Andersen Stacy L , Zmuda Joseph M , Wojczynski Mary K , Cosentino Stephanie
Published: November 2019

Exceptional aging has heritable components. One genetic risk factor for cognitive aging may be Apolipoprotein E (APOE), but it is unclear to what extent APOE relates to cognitive aging versus risk of Alzheimer’s disease. Cognitive aging may also be influenced by leukocyte telomere length (LTL), posited to be a marker of “biological age”. We examine the relationship between APOE, LTL, and memory in aging. For APOE, effects of ε4 (ε3ε4/ε4ε4) and ε2 (ε2ε3/ε2ε2) versus the more common ε3ε3 referent genotype on episodic (EM) and working memory (WM) were examined, comparing longevous families to the general population. Participants belonged to a multi-generational, international cohort (Long Life Family Study) including relatives from long-lived families and spouse-controls. 3,654 participants with valid memory, APOE, and telomere data at baseline were included. Regression analyses were stratified by age group and relative status, adjusting for sex, education, and country. Among controls, ε2 was associated with better WM (p<0.05) in those aged 70-79. In relatives, ε2 was linked to better EM (p<0.05) in those 60-69. Within ε2 carriers, longer LTL related to higher EM/WM for those <60, but lower EM/WM among those 60-69 (p<0.05). In relatives, ε4 was linked to worse EM, but better WM in those <50. Within ε4 carriers ≥80, longer LTL related to poor EM/WM. Thus, APOE related differently to distinct memory functions, and such associations varied by familial longevity and age. LTL demonstrated both positive and negative associations with memory functions depending on APOE status and age group.
RELATIONSHIPS BETWEEN PERSONAL NEEDS AND THE ENVIRONMENT: A STUDY OF ABUSE AND SELF-NEGLECT
Authors: Ye Minzhi , Ejaz Farida , Rose Miriam
Published: November 2019

Estimates of self-neglect among older and/or disabled adults are much higher than the estimated 10% of older adults in the U.S. who experience physical or emotional abuse, neglect, and exploitation by others. It is not clear how the social environment affects these vulnerable adults who become self-neglecting. This study uses network analysis and a GIS approach to explore patterns of needs and environmental risks for adult healthcare patients who had risk factors for self-neglect. Sources of data included face-to-face interviews, self-neglect risk factors (e.g., depression, dependency in activities of daily living, etc.) from electronic medical records, and neighborhood information from census block data. More than two-thirds of the 480 study participants reported an average income of less than $1,360 monthly, and 89% self-identified as Hispanic or Latino. Using ArcGIS Pro, respondents’ geocoded addresses were matched to mapped neighborhood census information. The maps showed that most respondents live in Hispanic-dominated communities, in neighborhoods with crime rates above average and median household income of less than $49,066/year. These neighborhoods were probably resource-poor and had spatial inequalities. Using network analysis, the study found that the at-risk patients’ most frequently reported needs (e.g., food assistance/nutrition, functional limitations, social isolation) appear clustered together, demonstrating that people had multiple needs. The study findings suggest that practitioners and policymakers must not only provide a range of services to help disadvantaged groups, but also focus specifically on offering services in neighborhoods where low-income minority groups reside and there is a lack of community resources.
END-OF-LIFE CARE DURING THE NATIONAL OPIOID CRISIS: A NATIONAL SURVEY OF HOSPICE PROVIDERS
Authors: Cagle John , McPherson Mary Lynn , Frey Jodi , Sacco Paul , Ware Orrin , Guralnik Jack
Published: November 2019

No national data exist on drug shortages, missing medications, opioid diversion, and opioid diversion prevention in hospice. We conducted a national survey of hospices (administered June-September, 2018). We randomly selected 600 hospices to survey representatives about: (1) care for patients/families with substance use disorder (SUD) (2) drug shortages; (3) instances of drug diversion; and, (4) drug disposal practices. Surveys were conducted by phone and online. Sample weights were used to adjust for non-response. A total of 371 hospices completed surveys (response rate=62%), 63% of which were administered by phone. Half (50%) of agencies were mid-sized (26-100 patients) and non-profit. Two thirds (66%) of hospices reporting that medications either “never” or “rarely” go missing. On average, there were 0.80 reported cases of confirmed diversion per agency within the past 90 days. Although a majority of hospices (78%) screen patients for SUD, only 43% screen informal caregivers. Just under half (42%) of hospices reported drug shortages over the past year. A minority (8%) of hospices stopped prescribing certain medications altogether due to concerns about diversion. 52% of hospices reported that employees are not allowed to dispose of medications after a home death. Agency representatives estimated that, after a home death, unused opioids were left in the home 32% of the time. On average, hospices have nearly one case of opioid diversion per quarter. Hospices are experiencing medication shortages and restrictions on medication disposal. Changes are needed in policy and practice to address these challenges.
AGE-ASSOCIATED INCREASE IN KYNURENINE INHIBITS AUTOPHAGY AND PROMOTES SENESCENCE IN BONE MARROW STEM CELLS
Authors: Kondrikov Dmitry , Elmansi Ahmed , Shi Xing-ming , Fulzele Sadanand , mcGee-Lawrence Meghan , Hamrick Mark , Isales Carlos , Hill William D
Published: November 2019

Aging is characterized by progressive decline of tissue functionality and age-related accumulation of cellular and molecular damage leading to multiple pathological conditions including osteoporosis and increased fracture rates. Bone marrow mesenchymal stem cells (BMSCs) play an essential role in bone development and regeneration with their ability to undergo differentiation into osteogenic, chondrogenic, myogenic, and adipogenic cell lines cell lines. Proliferation rate of MSC is declined with ages leading to misbalance between bone resorption and osteogenesis. A recently identified age-related change in bone and bone marrow is an accumulation of tryptophan metabolite, kynurenine (KYN), catalyzed by indoleamine-2,3-dioxygenase (IDO) or free-radical oxidation. We previously reported that KYN suppresses autophagy in BMSC. We now investigated the effect of KYN on BMSC cellular function. In vitro treatment of murine BMSC isolated from 18 month old mice with kynurenine disrupted autophagy suppressing autophagic flux. KYN treatment also induces senescence in BMSC marked by increase in SA-beta-galactosidase activity as well as, increased expression of senescence marker p21. Inhibition of Aryl Hydrocarbon Receptor (AhR) by AhR inhibitors significantly reduced β-galactosidase activity increase and blocked p21 expression elevation suggesting that KYN induces senescence in BMSC through the AhR pathway. Interestingly, KYN treatment failed to up-regulate beta-gal activity in BMSC isolated from 6 month-old mice suggesting that KYN induction of senescence maybe potentiated with aging. Together those data support the idea that KYN shifts the homeostatic balance of BMSC during prolonged stress or in aging through downregulating survival autophagic pathway in favor of driving BMSCs to senescence.
DATABASE FOR INDICES OF AGING IN NONHUMAN PRIMATES
Authors: Kemnitz Joseph W
Published: November 2019

The Primate Aging Database (PAD) is a multi-centered, relational database of biological variables in aging, captive monkeys and apes containing approximately one million data points for body weight, blood chemistry and hematology, for male and female subjects over time (https://primatedatabase.org). More than forty species are currently represented, primarily chimpanzees, macaques and common marmosets. Metadata include housing environment, social context and diet. Life history information for each species is also provided. Data in PAD is gathered from various research facilities, sanctuaries and zoos. PAD has recently been extensively revamped to enhance ease of use. Tools for data visualization and analysis in multiple formats are included. PAD has been useful for exploring biomarkers of aging in primates and for examining physiological dysregulation in aging across primate species. It also provides age-specific normative values that are valuable in clinical veterinary medicine. New data are being added to PAD, including additional subjects and variables, and additional contributors are solicited. (Supported by contract HHSN2711201800025C from the National Institute on Aging to CleMetric Data Analytics and Management, LLC.)
ASSOCIATION BETWEEN GERIATRIC HOME VISIT AND EMERGENCY ROOM OR HOSPITAL UTILIZATION: A RETROSPECTIVE STUDY
Authors: Zhang Xin , Takahashi Paul
Published: November 2019

Homebound older adults tend to have more medical comorbidities, higher risk of mortality, and higher healthcare utilization compared to non-homebound, community dwelling older adults in the U.S. Preventative primary care home visit have been shown to reduce hospitalizations and total healthcare costs in this population. Through a retrospective study, we aim to explore characteristics associated with ED and hospital utilization in patients who have received a home visit. A total 608 subjects, 70% female and median age of 86 years, were involved. A 184 (30%) of homebound subjects were hospitalized or visited the ED in 90 days. Comparing those with hospitalization or ED and those without, there was no significant difference in sex, age, race, marital status, or advance care planning. A 74% of those with 90 day ED/hospitalization had prior ED visit within 1 year of home visit compared to 59% of those without (p=0.0004). In addition, 58% of those with 90 day ED/hospitalization had prior hospitalization within 1 year of home visit compared to 44% of those without (p=0.0015). They also had significantly higher number of total medical comorbidities (median 4.5 vs 4, p=0.02). Our study suggests that prior healthcare utilization and medical comorbidity burden may be better predictors of 90 day hospitalization or ED use in geriatric patients who have received a home visit. Advance care planning and age did not significantly differ between the two groups in our study. Further studies should be performed to validate our findings in a prospective manner.
DEVELOPING RURAL INSIGHTS FOR BUILDING SUSTAINABLE AGE-FRIENDLY COMMUNITIES INITIATIVES
Authors: McCrillis Elizabeth , Skinner Mark , Colibaba Amber
Published: November 2019

Researchers have questioned the focus on describing features of preliminary age-friendly implementation and the absence of program evaluations or analyses of long-term implementation. This lack of knowledge inadvertently simplifies unique pathways to age-friendly sustainability, preventing researchers from conducting in-depth, retrospective examinations of age-friendly and post-age-friendly perspectives. Seeking to address this critique, this research examines the challenges to rural age-friendly program sustainability, and the factors that may help committees overcome these barriers. Data were collected through a succession of qualitative studies, including a provincial age-friendly program evaluation and a series of studies examining sustainability in rural initiatives. Eighty in-depth interviews with age-friendly leaders and older participants from 27 rural Canadian programs were conducted, seeking knowledge about programs’ development and implementation. Key findings include the conceptualization of an implementation gap between early development and long-term viability, the important role played by individual communities, the challenges of capacity and jurisdictional fragmentation, and the inability of rural age-friendly programs to tackle bigger picture issues such as housing and transportation given their necessarily limited scope and reach. Implications relevant for research and practice suggest that drawing on individual, community, and jurisdictional factors will maximize the success and sustainability of rural age-friendly programs, thereby extending the reach and scale of programs to more directly affect older people. From this, we conclude that the sustainability and success of rural age-friendly programs would benefit from consistent, renewable government funding that considers factors relevant to overcoming the implementation gap and challenges created by jurisdictional fragmentation and de-emphasizing community individuality.
RESEARCH FOR ACTION: IDENTIFYING SERVICE NEEDS OF MONGOLIAN OLDER ADULTS
Authors: Batzogs Uyanga , Braun Kathryn , Perskinson Margaret , Terada Tyran M
Published: November 2019

Although adults aged 60 years and older currently represent 6% of the total population of Mongolia, they are projected to increase to 19% by 2050. More than 21% of Mongolians live below the poverty line. Social security payments represent the main source of income for many retirees. With little government funding, eldercare services are limited, creating a large gap between service needs and availability. Before an effective system of eldercare can be developed, in-depth understanding of older adults’ needs and resources is required. A mixed methods design was used. Four-hundred twenty-seven Mongolians aged 55 years and older were surveyed. Two focus groups with 10 older adults and eight in-depth interviews with senior center stakeholders were conducted between June 2019 and August 2019. Descriptive statistics were run to determine frequencies of participants’ service needs. Linear regression examined the relationship between age groups, service needs, and ability to pay for services. Focus group and interview transcripts were analyzed for underlying themes. Findings indicated high service needs among older adults. Retirement homes, assisted living, home care, and places to socialize were identified as the most needed services. Lack of services, employment opportunities, and income sources concerned them the most. Ability to pay for services was negatively correlated with age groups. Qualitative analysis yielded two themes: importance of services and lack of resources. Further research on starting and sustaining networks of supportive services for older adults living in Mongolia is needed.
ECOLOGICAL MOMENTARY ASSESSMENT OF ASSOCIATIONS AMONG HIGH AND LOW AROUSAL AFFECT AND COGNITIVE HEALTH
Authors: Cerino Eric S , Sliwinski Martin
Published: November 2019

Negative affect (NA) and positive affect (PA) vary from moment-to-moment and these variations are associated with cognitive health. Past work has primarily focused on valence (negative/positive), however, largely ignoring the potential import of arousal (high/low). We address this gap by assessing the impact of high and low arousal NA and PA on daily cognition. A sample of 238 older adults (Mage=77.30 years, SD=5.14, Range=70–90) completed mobile surveys up to four times daily for 14 days. Participants reported current levels of high and low arousal NA and PA and performed processing speed and working memory tasks. For processing speed, there were significant within-person affect by age interactions. Moments when low arousal NA was higher than usual were associated with slower processing speed (Est.=0.87, SE=0.44, p<.05), and this effect was amplified in older participants (Est.=1.69, SE=0.60, p<.01). Moments when high arousal PA was higher than usual were associated with faster processing speed (Est.=-0.81, SE=0.40, p<.05), and this effect was amplified in younger participants (Est.=-1.81, SE=0.56, p<.01). For working memory, a significant within-person high arousal PA by age interaction emerged (Est.=0.001, SE=0.00, p=.046) such that moments when high arousal PA was higher than usual were marginally associated with worse working memory performance only among older participants (Est.=0.004, SE=0.002, p=.06). Results suggest momentary increases in low arousal NA and high arousal PA may confer greatest risk to daily cognitive health among older adults with more limited capacity and/or cognitive resources, whereas affective influences may be more facilitative among comparatively younger adults.
ADULT FOSTER HOME OWNERS' PERSPECTIVES ON REWARDS AND CHALLENGES OF OPERATING AN ADULT FOSTER HOME
Authors: Elliott Sheryl , Dys Sarah , Winfree Jaclyn , Carder Paula
Published: November 2019

Adult foster homes (AFHs) are small, residential settings providing older adults and persons with disabilities an alternative to nursing facilities and larger residential care settings. Some groups, including individuals with Alzheimer’s disease and related dementias, are well served by smaller settings. Although AFHs are common throughout the US, research on this setting is scant and dated. This study summarizes four years of qualitative data from Oregon AFH owners’ (N=726) responses to open-ended questions about the challenges and rewards of owning and operating an AFH. Content analysis of 924 comments indicate that providing resident care (42%), finding the work meaningful and “a life calling” (21%), developing a family-like connection with residents (15%), and working at home (8%) were the most commonly reported rewards. The most frequently described challenges included caring for residents with multiple chronic health conditions—including those with difficult behaviors (17%), difficulty hiring and retaining qualified caregivers (15%), low Medicaid reimbursement rates (14%), and adhering to administrative rules (14%). Results highlight AFH providers’ personal satisfaction with caring for and establishing connections with residents, and challenges associated with residents’ increasingly complex care needs, Medicaid reimbursement rates, and attitudes about state regulations. Although AFHs are licensed by states, they are subject to federal regulations, including the 2014 Centers for Medicare & Medicaid Services home and community-based services ruling. The new regulations, Oregon administrative rules, Medicaid reimbursement rates, and caregiver supply are presented to contextualize AFH owner comments and regulatory considerations.
DISPARITIES IN HEALTH STATUS, HEALTH BEHAVIORS AND PREVENTIVE HEALTH SERVICES OF OLDER ADULTS WITH DIABETES
Authors: Chun Sang Ah
Published: November 2019

The prevalence of diabetes among older adults has increased substantially and health complications resulting from diabetes have significant adverse effects on health status of older adults. While diabetes cannot be cured, it can be managed successfully with healthy lifestyle choices. The purpose of this study is to examine the disparities in health status, health behaviors, and preventive health services for older adults with diabetes. This study used data from the 2018 Behavioral Risk Factor Surveillance System. The sample included older adults 50 and over. Health behaviors included exercise, smoking, and heavy alcohol drinking. Preventive health services included dental visit, flu shot, and colorectal cancer screening. Chi-Square analysis and weighted multivariate logistic regression was performed. Not surprisingly, older adults with diabetes were significantly more likely to be in poor health than those without diabetes. Compared to non-diabetic group, older adults with diabetes were more likely to have had no exercise in the previous month. Interestingly, more older adults with diabetes reported having visited dentist, had flu shot and colonoscopy than those without diabetes. In both groups, older adults who presented health behaviors and received preventive health services were more likely to report good health compared to those who did not. The results suggest that further efforts are needed to address the health disparities for older adults with diabetes. Given the risk of comorbidities and its complications for older adults with diabetes, further research should be directed toward designing better health promotion programs and policies for older adults with diabetes.
MICROGLIA MAY INSTRUCT SYNAPTIC FATE VIA SIRPα IN MOUSE RETINA
Authors: Jiang Danye , Samuel Melanie
Published: November 2019

As we age, our nervous system undergoes many deleterious alterations: cognitive and sensory functions decrease while the risk of disease increases. Synapses are responsible for neural information processing, and the decline of these structures via microglia-mediated remodeling is thought to underline many age-related neural changes. However, the molecular pathways responsible for microglia-mediated synapses removal in development and old age remain unknown. To begin to elucidate these pathways, we leveraged the precisely organized murine retina where neurons form synapses in distinct lamina. Using this system, we screened 102 lacZ reporter lines available through the Knockout Mouse Project (KOMP) and uncovered a unique synapse regulatory candidate, SIRPα. We show that SIRPα is present in microglia prior to synapse formation but becomes selectively enriched in neural synapse terminals as these connections mature. Further, the levels of SIRPα decrease in the context of age-related neural decline. In ongoing studies, we are testing the hypothesis that neuronal SIRPα regulates its receptor CD47 to modulate refinement by microglial SIRPα. Together, these studies will resolve the molecular cues through which microglia prune synapses in development and dissect how these programs may go awry in the context of aging and disease.
ANTICHOLINERGIC DRUGS: CUT-OFF FOR IMPAIRED COGNITION AND MOBILITY IN SENIORS
Authors: ATTOH-MENSAH Elpidio K , Loggia Gilles , Morello Remy , Schumann-Bard Pascale , Descatoire Pablo , Marcelli Christian , Chavoix Chantal
Published: November 2019

Background and Objectives: Anticholinergic drugs are commonly prescribed in older adults despite growing evidence of their adverse outcomes. We aimed to improve knowledge about deleterious effects of anticholinergic drugs on both cognition and mobility, in particular whether there is a threshold value for the number of anticholinergic drugs or for the anticholinergic burden leading to mobility or cognitive impairment. Methods: 177 community-dwelling individuals aged 55 years or over, with a fall history in the previous year, took part in the study. Anticholinergic drugs were identified using the Anticholinergic Drug Scale (ADS), and global cognition and mobility were assessed using the Mini Mental State Examination (MMSE) and the Time-Up-and-Go (TUG) test, respectively. Results: ROC (Receiver Operating Characteristics) curve analysis indicated that consumption of a single anticholinergic drug per day was a risk factor for impaired MMSE (p < .05) and TUG scores (p < .05). There was also a cut-off of anticholinergic burden of one for impaired MMSE scores (p < .05). Logistic regressions showed that impaired cognition induced by anticholinergic drugs were independent of confounding factors including comorbidities, while impaired mobility would be influenced by age and cardiac comorbidities. Conclusion: Daily consumption of a single anticholinergic drug, regardless of its anticholinergic burden, impairs both cognition and mobility community-dwelling seniors. Alternative solutions to anticholinergic drug prescription should thus be considered whenever possible.