bluuebunny/crossref_metadata_2025 huggingface dataset:
FRAILTY ASSESSMENT BASED ON THE QUALITY OF DAILY WALKING
Authors: Kumar Danya Pradeep , Toosizadeh Nima , Mohler Jane , Laksari Kaveh
Published: November 2019

Frailty is an increasingly recognized geriatric syndrome resulting in age-related decline in reserve across multiple physiologic systems. An impaired physical function is a prime indicator of frailty. In this study, we aim to implement a body-worn sensor to characterize the quantity and quality of everyday walking, and establish associations between gait impairment and frailty. Daily physical activity was acquired for 48 hours from 125 older adults (≥65 years; 44 non-frail, 60 pre-frail, and 21 frail based on the Fried gold standard) using a tri-axial accelerometer motion-sensor. Continuous purposeful walks (≥60s) without pauses were identified from time-domain acceleration data. Power spectral density (PSD) analysis was performed to define higher gait variability, which was identified by a shorter and wider PSD peak. Association between frailty and gait parameters was assessed using multivariable nominal logistic models with frailty as the dependent variable, and demographic parameters along with the gait parameters as the independent variables. Stride times, PSD gait variability, and total and maximum continuous purposeful walking duration were significantly different between non-frail and pre-frail/frail groups (p<0.05). Using a step-wise model with the above qualitative and quantitative gait parameters as predictors, the pre-frail/frail group (vs. non-frail) was identified with 71.4% sensitivity and 75.4% specificity. Everyday walking characteristics were found to be accurate determinants of frailty. Along with quantitative measures of physical activity, qualitative measures are critical elements representing the stages of frailty. In-home gait analysis is advantageous over clinical gait analysis as it enables cost- and space-effective continuous monitoring.
INTERACTIONS BETWEEN GENES FROM AGING-RELATED PATHWAYS: IMPACT ON HUMAN LONGEVITY
Authors: Ukraintseva Svetlana , Duan Matt , Wu Deqing , Arbeev Konstantin , Kulminski Alexander , Zmuda Joseph M , Christensen Kaare , Yashin Anatoliy
Published: November 2019

Role of genetic interactions (GxG) in human longevity remains poorly understood. We hypothesized that GxG between genes from biologically connected pathways involved in aging may impact longevity. To test this hypothesis, we selected 53 candidate genes from the aging-related pathways (IGF-1/AKT/FOXO3A, TP53/P21/P16, and mTOR/S6K mediated) that are known to jointly influence outcomes of cell responses to stress and damage, such as apoptosis, senescence, growth/proliferation, and autophagy. We evaluated the effects of interactions between SNPs in these genes on longevity in LLFS and CARe data. RESULTS: The IGF1R, PPARGC1A and BCL2 genes were consistently involved in top GxG effects (p<10-6) on survival in the oldest old (85+ and 95+). One SNP, rs2970870 in PPARGC1A gene, was broadly involved in significant interaction effects on survival 96+ (p<10-7) when paired with SNPs in IGF1R and NFKB1 genes. This SNP individually was associated with survival with nominal significance only; therefore, it would have not been selected in a GWAS. We conclude that interactions between genes from aging-related pathways that regulate cell responses and resilience to damage may have major impact on human longevity and contribute to its genetic heterogeneity. The research was supported by the NIA/NIH grants R01AG062623, U19AG063893, P01AG043352.
PREMIGRATION, DISPLACEMENT, AND POSTMIGRATION EXPERIENCES OF LONELINESS AMONG HMONG OLDER ADULTS
Authors: Vang Cindy , Sieng Michael
Published: November 2019

Available evidence highlights the detrimental impact of loneliness on the mental and physiological health of older adults. While immigrant older adults report higher prevalence for experiencing loneliness compared to native born older adults, minimal research has simultaneously explored the premigration, displacement, and postmigration experiences of loneliness among older adults with a refugee history. This study aimed to explore loneliness in these three phases among Hmong older adults, an ethnic minority group resettled in the United States as refugees over 40 years ago. Drawing on data from a constructivist grounded theory study guided by an intersectionality framework, the first author interviewed 17 community-dwelling Hmong older adults age 65 and older residing in Fresno and Sacramento, California. Two coders coded and analyzed the transcribed interviews. Findings revealed negative, disruptive, and discriminatory experiences underscored by systems of oppression grounded on the social, political, psychological, and cultural context of each phase. Influencing factors that contributed to loneliness were identified as: trust, loss, aging-related issues, isolation, sense of community, access to cultural community, instability, violence, and cultural adjustments. In specific phases, particular influencing factors were more evident and persistent in producing loneliness. Some influencing factors remained a problem for participants across all phases. With the unprecedented growth of refugees all over the world, this study highlights the need for more research, practice, and policy focused on the context of the refugee experience to gain greater insight into their loneliness experiences and expand the notion of loneliness as an individual experience.
USE OF SERVICES BY PEOPLE LIVING ALONE WITH COGNITIVE IMPAIRMENT: A SYSTEMATIC REVIEW
Authors: Rosenwohl-Mack Amy , Chodos Anna , Dulaney Sarah , Fang Min-Lin , Merrilees Jennifer , Dubbin Leslie , Portacolone Elena
Published: November 2019

At least one third of older adults with dementia live alone in the United States. Living alone may represent an opportunity to maintain independence and autonomy, while remaining in a familiar home environment. However, living alone with cognitive impairment is also associated with health risks and unmet needs. No systematic reviews on this population have been published. We systematically reviewed research on use of healthcare and long-term services and supports (LTSS) by people living alone with cognitive impairment. Following PRISMA guidelines, we searched six electronic databases for studies reporting quantitative findings on use of services by people living alone with cognitive impairment; 33 studies met inclusion criteria. Nine countries were represented, all high-income economies. Race/ethnicity data was reported in just five studies, and only one included a majority of racial/ethnic minorities. Overall, people living alone with cognitive impairment appear to use health services at similar or lower rates compared to those living with others; however, LTSS use is higher among people living alone. Representation of non-white participants was poor, but the evidence available suggests that among racial/ethnic minorities with cognitive impairment, there is no difference in LTSS use between those living alone and living with others. Findings highlight inconsistencies in access to and use of essential services by older adults living alone with cognitive impairment. As the populations of the US and other high-income countries become both older and more diverse, with increasing numbers living alone, researchers and service providers must consider the specific needs and preferences of this population.
CANCER: ARE OFFSPRING OF LONG-LIVED SIBLINGS BOTH ROBUST AND RESILIENT?
Authors: Galvin Angéline , Pedersen Jacob Krabbe , Ukraintseva Svetlana , Perls Thomas T , Wojczynski Mary K , Christensen Kaare
Published: November 2019

Background: The mechanisms underlying clustering of longevity in families are unclear. We have previously shown a low cancer incidence in offspring of long-lived siblings, i.e. cancer robustness. Here we test whether such offspring are also more resilient in terms of survival after cancer diagnosis. Methods: Identification of offspring from long-lived families was undertaken in three nationwide, consecutive Danish studies (DOS, GeHA, LLFS). Cancer cases were identified through linkage with the Danish Cancer Registry. Each offspring cancer case was matched with two control cancer cases from the 5% random sample of the Danish population. Matching criteria were birth year, sex, year of diagnosis and cancer site. The main outcome was overall survival. Factors studied were sociodemographic, health-related and cancer-related. Survival analyses were performed using stratified Cox proportional hazards models based on the matching data. Results: Among the 5,377 offspring of the 634 families, 465 offspring of long-lived siblings with first primary cancer were included, along with 930 controls. Offspring of long-lived siblings had a significantly better survival than controls (HR=0.64 95%CI=[0.52-0.78]). The association attenuated only slightly after adjustment of marital status, education, Charlson Comorbidity Index, and number of prescribed drugs (HR=0.66 95%CI=[0.54-0.81]). Conclusion: Our results suggest that in addition to being more robust to cancer risk, offspring of long-lived siblings are also more resilient to cancer after its diagnosis and show better overall survival compared to individuals with cancer from general Danish population. Funding: The LLFS study is funded by the US National Institute on Aging / National Institutes of Health.
PHYSICAL ACTIVITY ATTENUATES AGE DIFFERENCES IN CHANGE IN PERCEIVED PHYSICAL FATIGABILITY
Authors: Qiao Yujia (Susanna) , Gmelin Theresa , Boudreau Robert M , Andersen Stacy L , Cosentino Stephanie , Christensen Kaare , Wojczynski Mary K , Glynn Nancy W
Published: November 2019

Lower physical activity is cross-sectionally associated with greater fatigability; whether such a relationship holds for longitudinal changes in fatigability is under-studied. We examined this question in offspring (≥60 years, range 60-93y, 99.7% white; 53.2% female) enrolled in the Long Life Family Study, a two-generation cohort enriched for exceptional longevity and their spousal controls. At Visit 2 (2014-2017), we measured self-reported physical activity (PA) with the Framingham Physical Activity Index (dichotomized by median value: less active <37 MET-hrs/wk and more active ≥37 MET-hrs/wk). Perceived physical fatigability was assessed using the Pittsburgh Fatigability Scale (PFS, 0-50) at Visit 2 and repeated during a follow-up contact 2.7±0.92 years later. We constructed a repeated-measures linear mixed-effect model to examine the effect of PA on longitudinal change in PFS by median age (younger <70y; older ≥70y) adjusted for family structure, field center, follow-up time, sex, and self-rated health. We found a strong dose-response relationship of PFS scores across the four age/PA groups (ptrend<0.001). Specifically, older/less active (N=310) participants had the highest annual PFS increases of 0.37 points/yr (p<0.001) while those older/more active (N=340) had annual increases of 0.17 points/yr (p=0.03). Younger/less active (N=371) participants had annual PFS increases of 0.09 points/yr (p=0.008); those younger/more active (N=341) had annual decreases (improvement) of 0.18 points/yr (p<0.001). Although annual PFS changes were modest, our findings indicate physical activity attenuated age differences in these trajectories. Physical activity is emerging as a potential target for intervention aimed at reducing fatigability - an important risk factor in the disability pathway.
PREVENTING FALLS AMONG OLDER FALLERS: LIVE-LIFE
Authors: Szanton Sarah L , Clemson Lindy , Liu Minhui , Gitlin Laura N , Roth David L , Hladek Melissa D , LaFave Sarah , Granbom Marianne
Published: November 2019

OBJECTIVES: To evaluate whether a fall prevention intervention, adapted from the LiFE program, reduces fall risk in older adults who have previously fallen. DESIGN: Randomized controlled pilot trial SETTING: Participants’ homes INTERVENTION: LIVE-LIFE is an occupational therapy delivered fall prevention intervention that integrates strength and balance training into daily habits in 8 visits over 12 weeks. The intervention also provides 1) up to $500 in home safety changes prioritized by the participants 2) vision contrast screening and referral, and 3) personalized fall risk medication recommendations to Primary Care Providers (PCP) from a Pharmacist. This multi-component intervention was compared to a control condition consisting of CDC fall prevention materials and an individualized fall risk summary. MEASUREMENT: Primary outcome: Fall risk measured by Timed Up and Go (TUG) and Tandem stand. Secondary outcomes: Falls efficacy, feasibility and acceptability of the intervention. RESULTS: The sample of 37 people was 65% female, 65% white and an average 77 years old. Two were lost to follow up (95% retention). Compared to the control group, the mean of each outcome improved in the intervention. The LIVE-LiFE intervention had a large effect size (1.1) for amount of time study participants could hold a tandem stand, a moderate effect (0.5) in falls efficacy, and a small effect (0.1) in the TUG. CONCLUSION: LIVE-LIFE was acceptable to participants, feasible to provide, and averaged large to small effect sizes. Simultaneously addressing preventable fall risk factors is feasible and should be investigated due to the growing population at risk for falls.
DIGITAL INEQUALITY IN OLDER ADULTS’ ONLINE SOCIAL ENGAGEMENT AND SOCIAL CAPITAL
Authors: Nguyen Minh Hao , Hunsaker Amanda E , Hargittai Eszter
Published: November 2019

The increasing popularity of social media and other online communities offers new possibilities for older adults to stay socially connected. This study examines the relationship of older adults’ online social engagement and bonding as well as bridging social capital based on a survey of over 1,000 adults aged 60 and over. Social bonding refers to support obtained from existing strong social ties while social bridging is creating connections across varied social networks. We estimated three multi-stage regression models to examine these relationships when controlling for sociodemographic factors, as well as Internet experiences and skills. We then extended the regression models with Internet skills as a moderator. Findings show that older adults who engage more often in specific online social activities (i.e., asking questions on social media, looking at photos of family members/others) enjoy greater bridging social capital (both in offline and online contexts) than those who do so less often. Furthermore, Internet skills moderate the relationship between online social engagement and social capital. Specifically, older adults with greater Internet skills benefit relatively more from engaging in specific online social activities more often with respect to online social bridging. These results imply that digital inequalities may put older adults who are less skilled in using the Internet at a disadvantage when it comes to building social capital from online social engagement. Thus, while social media has potential positive implications for well-being among older adults, the current manifestation of this does not suggest equitable distribution of those benefits across different older users.
INTEGRATING HEALTH IT INTO CLINICAL WORKFLOW FOR DEMENTIA CARE: PROVIDER AND CAREGIVER PERSPECTIVES
Authors: Ruggiano Nicole , Brown Ellen , Clarke Peter
Published: November 2019

Each year, more than 5.5 million people in the U.S. are affected by Alzheimer’s disease and related dementias (AD/RD), most of whom reside within the community, receive ongoing care from family caregivers, and medically managed by primary care providers. However, AD/RD caregiving and care is often compromised and costly, with medical costs projected to increase from $203 billion in 2013 to $1.2 trillion in 2050. A significant barrier to AD/RD care relates to collecting the health information needed for clinical decision making, due to patients’ communication problems associated with AD/RD, insufficient time to collect relevant patient information from caregivers during the medical visit, and lack of communication with in-home health and support providers. To address these issues, the research team has developed CareHeroes, a multi-functional web and mobile app designed to increase the quality of communication about patient symptoms between the caregivers and providers of people with dementia. This study integrates qualitative findings from two studies evaluating CareHeroes that involved: (a) interviews and a focus group with AD/RD caregivers and (b) focus groups with clinical staff at two memory clinics. Findings indicate that caregivers want technologies that can inform clinical decision making on a regular basis while providers emphasize the use of information technologies that prepare patients and caregivers for upcoming medical appointments. Implications for practice, research, and policy are discussed.
BINGE EATING AMONG OLDER WOMEN: PREVALENCE RATES AND HEALTH CORRELATES ACROSS THREE UNIQUE SAMPLES
Authors: Kilpela Lisa S , Becker Carolyn B , Gomez Francesca , Middlemass Keesha , Espinoza Sara E , Musi Nicolas
Published: November 2019

Emerging research indicates that older women struggle with disordered eating more frequently than once thought. Among older women, binge eating (BE; consuming unusually large amounts of food in one siting while feeling a loss of control) appears to be the most common form of disordered eating. Notably, BE is associated with significant medical morbidity, including metabolic dysfunction and chronic pain. Aging-related experiences, such as sleep disruptions following menopause, mood changes and psychosocial stressors, may increase risk for BE. This study comprises a 3-sample comparison of BE prevalence and health correlates among older women. We gathered self-reported frequencies of BE in three separate samples of older women, using three different methods and validated measures. Sample 1: N = 185 women aged 60-83; collected online via snowball sampling and Amazon MTurk; 86% White. Sample 2: N = 100 women aged 55-79; collected online via snowball sampling; 72% White; 50% Masters/Doctoral Degree; 72% married. Sample 3: N = 64 women aged 66+ living with food insecurity, collected in person at local food pantries; 65% Hispanic, 16% African American; 39% disabled status; 48% < high school/GED; 47% household income < $10,000/year. Per DSM-5 frequency criterion of BE at least weekly, we found prevalence rates ranging from 19%-26.5% across the samples; correlates included elevated negative mood, worry, and BMI, and less nutritious food consumption. Across three very different samples in terms of race/ethnicity, education, and food security status, we found consistent rates of self-reported BE at least weekly (roughly 1/5). Implications will be discussed.
LATINO HOSPICE PATIENTS’ INVOLVEMENT IN CARE DECISIONS AND PLANNING: FACTORS THAT SHAPE PARTICIPATION PREFERENCES
Authors: Beltran Susanny J
Published: November 2019

Patient participation in care decisions is a primary tenet of patient-centered care and has been emphasized in policies and programs shaping clinical practice. Patient self-determination and involvement is associated with improved outcomes, including patient satisfaction and compliance. However, studies exploring Latino patients’ care involvement preferences find a cultural preference for limited autonomy and shared or family-based decision-making. This study describes terminally-ill older Latinos and their proxies’ preferences regarding involvement in decision-making and care planning following a referral to hospice care. Semi-structured interviews were conducted with 13 hospice-enrolled Latinos 65 or older, or their proxies. The sample is predominantly female (54% of all patients; 80% of proxies) and Mexican (77%). The average age of all patients was 82 years, and of proxies 54. Patients interviewed had an average of 7 years of education and proxies an average of 11 years. Patients were receiving care in a variety of settings, including inpatient hospice units, nursing homes, and community. Interviews were transcribed verbatim in the original language and coded thematically using an inductive approach. A second coder was used to code a Spanish and an English transcript (15% of the data), and a high level of interrater reliability was obtained (k = 0.85). Findings elucidate the paths through which culture, religion, and trust in provider shape preferences for limited autonomy and planning, confirming previous findings. However, this was not replaced by a preference for family-based decision-making. Findings highlight the importance of Latinos having access to culturally-competent primary care providers and fostering lasting relationships.
INCIDENCE OF COGNITIVE IMPAIRMENT AMONG U.S. CHINESE OLDER ADULTS: DOES SOCIAL ENGAGEMENT MATTER?
Authors: Kong Dexia , Dong XinQi
Published: November 2019

The increasing diversity in U.S. aging population warrants improved understanding of risk factors of cognitive aging in minority populations. This study presents the prevalence of incident cognitive impairment (CI) among U.S. Chinese older adults; and the relationship between social engagement and incident CI. Data were obtained from the Population-based Study of Chinese Elderly in Chicago, a prospective cohort study of Chinese older adults. Baseline (collected between 2011 and 2013) and one subsequent wave of data (collected between 2013 and 2015) were used in analyses (N=2,713). Social engagement was measured by the frequency of participation in social and cognitive activities (range=0-65). Cognitive function was assessed by a battery of 5 validated instruments. Incidence of CI was defined as having a follow-up cognition score lower than 1.5 standard deviations below the mean baseline cognition score. Logistic regression analyses were conducted. Nearly 6% of the sample reported incident CI. Chinese older adults who are more socially-engaged had a lower likelihood of developing CI (odds ratio [OR] 0.94, 0.92-0.96). The relationship was consistent across cognitive domains, including episodic memory (OR 0.95, 0.92-0.97), working memory (OR 0.92, 0.88-0.95), and perceptual speed (OR 0.95, 0.92-0.98). Furthermore, older age (OR 1.12, 1.09-1.15), and lower education (OR 0.91, 0.87-0.96) were associated with incident CI. No significant association was observed between gender, income, marital status, household size, acculturation, medical morbidities, depressive symptoms, and incident CI. The findings highlight the importance of social engagement in cognitive aging. Discrepancies with prior literature and implications of these findings will be discussed.
BUILDING AN AGE-FRIENDLY UNIVERSITY: AN INTERGENERATIONAL CAREGIVER EDUCATION PROGRAM
Authors: Cordes Becky , Luz Clare C , Sun Fei , Lee Jaewon
Published: November 2019

A rapidly aging U.S. population means an increased need for supportive services that allows aging in place. Eighty percent of such support is provided by unpaid family caregivers, many of whom are juggling multiple obligations. There is clear evidence that mental health risks of caregiving include social isolation, depression and identity loss, and potentially “caregiver burnout”. This study focuses on the lesser known impact of caregiving on college students who care for older family members and if their experiences differ from older caregivers. Presumably, students face additional stressors related to their age and school demands. Further, we posited that learning more about the aging process and interfacing with older retirees who are family caregivers through an intergenerational educational program would benefit both populations. Hosted by a campus organization, AgeAlive, which is dedicated to building an Age-Friendly University, the team’s specific aims included: 1. Conducting focus groups to identify concerns among college student and retiree family caregivers related to aging, caregiving, dementia, and intergenerational relationships. 2. Developing and piloting an intergenerational, educational program with the objective of addressing these concerns, and 3. Evaluating the program’s impact on measurable outcomes such as perceptions of aging, caregiver stress, and knowledge of resources. Focus group findings indicate that there are both shared concerns and divergent perspectives that provide opportunities for cross-generational learning. All program participants reported improved knowledge of aging, communication skills, and resources that will have a direct, positive impact. Lessons learned can guide development of supportive services for student and retiree caregivers.
CHANGE IN PHYSICAL FUNCTION, SWALLOWING, AND NUTRITIONAL RISK IN PEOPLE WITH PARKINSON’S DISEASE OVER 4 YEARS
Authors: LoBuono Dara L , Dobiszewski Sarah Sarah , Tovar Alison , Leedahl Skye N , Delmonico Matthew J , Xu Furong , Leslie Mahler , Lofgren Ingrid E
Published: November 2019

Parkinson’s disease, a neurodegenerative disease, impacts physical function, swallowing, and nutritional risk, but research has not examined how these health markers change longitudinally in one study. This study was an observational, longitudinal study with assessments conducted every 6 months over 4 years. The assessments included: the short physical performance battery (SPPB) (scores 75)), and weight in pounds. A one-way repeated measures ANOVA compared outcomes variables at baseline, years 2 and 4. Partial eta square are reported for effect size. Eight participants, baseline mean age 67.1±4.0 years and time since diagnosis=8.1±7.5 years, were assessed. At baseline, 3 participants exhibited possible mobility issues (SPPB=9.9±1.8), 2 participants exhibited a possible swallow issue (swallow speed=15.7±9.8mL/s), and 7 were at possible or at nutrition risk (64.0±13.8). At year 4, 5 participants exhibited possible mobility issues (SPPB=8.1±3.2, (ηp2=0.5), 4 participants exhibited a possible swallow issue (swallow speed=13.4±10.4 ml/s, ηp2=0.3), and there was a decline in perceived swallow function (77.3±12.4 vs. 74.8±16.2, ηp2=0.5). Six participants were at possible or at nutrition risk. Participants experienced weight declines from baseline to year 4 (178.5±31.4 vs.168.8±24.9, ηp2=0.5). The demonstrated decline in physical and swallow functioning, presence of nutrition risk, and experienced weight loss suggests that interdisciplinary intervention strategies may need to be designed and tested in this population.
DIETARY INTAKE AND NUTRITIONAL RISK AMONG OLDER AMERICANS
Authors: Choi Yeon Jin , Ailshire Jennifer A , Crimmins Eileen
Published: November 2019

A suboptimal diet and nutritional deficiency are among the leading causes of chronic diseases (e.g., cardiovascular diseases, metabolic syndrome, cancer, and osteoporosis), morbidity, and mortality. The objective of this study is to assess dietary intake and nutritional risk among older Americans. The dietary intake of 15 food and nutrients that are closely associated with the risk of poor health was assessed based on the dietary guidelines and nutritional goals for older Americans using a nationally representative sample of older adults (N=7,737) in the Health and Retirement Study Health Care and Nutrition Survey. The average consumption of most food and nutrients was out of the optimal range. For example, older men and women consumed 1.32-1.35 cups of dairy products and 1.23-1.29 ounces of whole grains, which is less than half of the suggested amount. The average consumption of sodium, on the other hand, was over 12 times greater than suggested dietary recommendation for older men and about 10 times greater for older women. The nutritional risk index (range: 0–15) was created by summing the number of dietary risk factors (not meeting the dietary guidelines and nutritional goals), the index scores for older men and older women were 11.05 (SD=2.31) and 10.09 (SD=2.60) respectively, suggesting the high level of nutritional risk. A healthy diet should be encouraged to prevent chronic diseases and improve the health of older adults. Nutritional education may be an effective way to promote a healthy diet.
FACTORS ASSOCIATED WITH HOSPITAL-TO-HOME DISCHARGE: USING A DECISION TREE ANALYSIS
Authors: Lee Ji Yeon , Kim Kwang Joon , Kim Chang Oh
Published: November 2019

Because the number of older adults discharged home is increasing, a comprehensive geriatric assessment (CGA) becomes a helpful tool to make a decision about discharge destination. This study aimed to examine the predictors related with discharge destination using the component of CGA. We used decision tree analysis with the Classification and Regression Trees algorithm. Study participants were older adults over 65 years old who were admitted to geriatric department at a university-affiliated hospital in Korea. The older adults were assessed by multi-professional team at the initial stage of their hospitalization and received blood tests and the CGA. A total of 184 patients was included. The mean age was 84.6 years old and 61.6% were female. The analysis revealed arm circumference and level of frailty were significant predictors of home discharge. Specifically, 90.1% of patients had discharged home if their upper arm circumference was more than 18.3 centimeters, and 36.4% was discharged home if it was less than 18.3 centimeters. Among older adults with the arm circumference more than 18.3 centimeters, 57% of robust older adults and 91.7% of prefrail or frail older adults were discharged home. These robust older adults had relatively better daily living ability, and discharged to other facilities rather than home for rehabilitation. As many frail older adults are discharging to their own home, clinicians need to pay more attention to them. Also it is encouraged to perform the CGA, which includes nutritional assessment in it, for inpatient older adults.
HEALTH PROMOTION FOR PEOPLE WITH EARLY-STAGE DEMENTIA: A QUASI-EXPERIMENTAL STUDY
Authors: Testad Ingelin , Kajander Martine , Henriksen Anne Torsvik , Meling Målfrid , Vagle Vigdis , Gjestsen Martha Therese
Published: November 2019

With the limited advancements in medical treatment, there is a growing emphasis on supporting people with early-stage dementia adjusting to their diagnosis and improve their quality of life. This study aimed to evaluate the effects and experiences of people with early-stage dementia attending a 12-week Health Promotion, consisting of 2-hour sessions at weekly intervals focusing on understanding the progression of dementia, promoting physical activity, nutrition, coping, relationships, home- and travel safety, medication and communication with health care providers. Quantitative and qualitative assessments were conducted at baseline and follow-up 1-2 months post intervention, including cognition, self-rated health and depressive symptoms and individual short interviews. A total of 90 persons with dementia participated in this study. The results demonstrated a stable cognitive function, measured by Mini Mental State Examination, of people with dementia during the 4 month follow-up, and a significant improvement in self-rated health measured by EQ VAS (95% CI 0.2 to 7.6, p=0.037). Depressive symptoms measured by Cornell Scale for Depression in Dementia, demonstrated a decline by one point, which is an improvement in depressive symptoms, although not significant. 32 of the 90 qualitative interviews with participants and their carers were included and analyzed with systematic text condensation. The results demonstrated that the intervention was well received by the participants, learning about dementia, practical strategies and focusing on remaining resources was particularly highlighted as well as improved family communication. In conclusion, the intervention had beneficial effects on the cognitive function, self-rated health and depressive symptoms of people with dementia.
MEANINGFUL ENGAGEMENT AND QUALITY OF LIFE AMONG ASSISTED LIVING RESIDENTS WITH DEMENTIA: EMERGENT FINDINGS
Authors: Ciofi Joy , Kemp Candace L , Bender Alexis A , Burgess Elisabeth O , Morgan Jennifer C , Epps Fayron , Doyle Patrick , Perkins Molly M
Published: November 2019

This poster provides an overview of the aims, methods, and emergent findings from an ongoing five-year NIA-funded project (R01AG062310) examining meaningful engagement and quality of life among assisted living (AL) residents with dementia. The overall goal of this project is to determine how opportunities for meaningful engagement can best be recognized, created, and maintained for individuals with different dementia types and varying levels of functional ability. Guided by grounded theory, this qualitative study will involve 12 diverse AL communities in and around Atlanta, Georgia, USA. Presently, our interdisciplinary team is collecting data in four communities using ethnographic observations, semi-structured interviews, and resident record review. We are studying daily life in each community, following 30 resident participants, and actively recruiting and interviewing their formal and informal care partners. Based on ongoing analysis, we offer key emergent findings. First, meaningful engagement is highly individualized and dynamic. Differing personal interests, along with wide variations in cognitive and physical abilities, can present challenges for AL community staff and other care partners when trying to recognize what constitutes meaningful engagement for residents. Second, multiple complex factors interplay to shape the experience of meaningful engagement among persons living with dementia, such as personal characteristics, care partner background and training, AL community design and philosophy, and state/corporate regulations. Finally, flexibility and ‘meeting the resident where they are at’ appear to be critical to identifying and fostering meaningful engagement for persons living with dementia. We discuss the implications of these preliminary findings for translation, dissemination, and future research.
SEQUENTIAL IMPLEMENTATION AS A LEARNING HEALTH ORGANIZATION: THE EQUIPPED GERIATRIC MEDICATION SAFETY MODEL
Authors: Vandenberg Ann E , Kegler Michelle , Hastings Susan , Hwang Ula , Vaughan Camille
Published: November 2019

A learning health organization (LHO) is one that systematically integrates internal data and experience with external evidence to improve internal healthcare practice. Yet collaborative research networks implementing evidence-based interventions across sites with the goal of widespread dissemination are also effectively LHOs. The EQUIPPED (Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department) network formed to address an important public health issue: potentially inappropriate medications (PIMs) prescribed to older adults at discharge from hospital Emergency Departments (ED). EDs nationwide serve increasing numbers of older adults but lack clinical decision support to avoid prescribing PIMs associated with adverse events including hospitalization and death. The EQUIPPED geriatric safety program was adapted from the VA and implemented sequentially at three different academic institutions sharing the same electronic health record (Epic)(AHRQ R18HS24499). Implementation challenges, solutions, and innovations informed successive iterations. Using the Replicating Effective Programs framework, we conducted a process evaluation using data from implementation team focus groups (n=3), meeting minutes (n=98 hours), and organizational profiles (n =3) to understand how organizations working together within a research network build an intervention package for program scale-up. We present structural characteristics of the three organizations, implementation steps as they developed across three sites, and the resulting process protocol and a prototype toolkit. Lessons learned include having multiple internal champions at the intervention site, observing workflow pre-intervention, and streamlining data collection with a relational database and visualization software. Insights from the EQUIPPED experience can serve as a model for other systems and collaborative networks.
QUALITY IMPROVEMENT IN LTC: EFFECTIVENESS OF MONTESSORI-BASED ACTIVITY PROGRAMMING IN VA COMMUNITY LIVING CENTER
Authors: Chacko Thomas , Curyto Kim , Hilgeman Michelle M , Keleher Virginia
Published: November 2019

Montessori-based Activity Programming (MAP) was adapted for Veterans Affairs (VA) Community Living Centers (CLCs) and aims to increase independence and meaningful engagement in residents with cognitive impairment. The Montessori model prioritizes offering choice, knowing and harnessing a resident’s abilities, and enabling them to carry out purposeful roles and activities. Any perceived deficit in cognitive functioning is “circumvented” by preparing the environment to support maximum independence. The implementation of MAP-VA in VA Western NY CLC involved 3 lodges, 52 staff, 16 champions, and 65 CLC residents. Standardized implementation measures demonstrated improvements over six months in five domains assessing development of a resident-directed community. Hypothesized outcomes included improved national percentile quality improvement (QI) rankings related to psychological symptoms and medications (e.g., depressive symptoms and use of antipsychotic/antianxiety medications) and physical functioning (e.g., less falls and ability to move independently). Scores six months prior to the implementation of MAP-VA (April, 2018 to September, 2018) were compared with scores during six months of implementation post training (November, 2018 to March, 2019). Compared to pre-intervention QI measures related to psychological symptoms, a clinically meaningful trajectory of symptom decrease was observed with rankings during implementation (e.g., depressive symptoms, amount of antipsychotic medications). Likewise, compared to pre-intervention QI rankings regarding physical functioning, post-training rankings showed a trajectory of improvement (e.g., help with ADLs, ability to move independently). Implementation of the MAP-VA intervention demonstrates preliminary evidence for improvement in QI measures related to psychological symptoms and physical functioning. Implications for QI efforts in VA CLCs will be presented.
SURVEILLANCE PROGRAM IDENTIFIES HEALTH OUTCOMES FOR FORMER WORKERS
Authors: Golden Ashley , Miller Jeffery , Hubbell Zachariah , Howard Sara , Cragle Donna
Published: November 2019

According to the US Bureau of Labor Statistics, the average age of retirement is 62. While many retirees may have employer-provided or other access to healthcare, others have limited access to affordable care until full Medicare eligibility at 65. Regardless of access, retirees with toxic occupational exposures may not have providers with specialized knowledge of tests or diagnoses for exposure-related health conditions, especially those with long-latency. The National Supplemental Screening Program for U.S. Department of Energy Former Workers is described here as a nationwide program providing recurring (every 3 years) integrated health screenings designed to identify both occupational and non-occupational conditions in the context of exposure so that early identification can enable appropriate and timely diagnoses and treatments to improve health outcomes. Since September 2005, there has been 18,518 initial exams for former workers, of whom 5,461 returned for rescreening exams through April 2019. The average age of those returning was significantly younger at initial exam (63.4 years) compared to those who did not return (65.1 years). The most common occupational condition was noise-induced hearing loss not attributable to natural, age-related loss (67%). Rare and long-latency occupational health conditions, such as asbestosis or silicosis, were identified at rates expected (1-4%). The most common non-occupational condition was elevated body mass index (BMI>25, 77.3%), followed by hypertension (20.7%), of which 50% had no prior knowledge or clinical diagnosis. In conclusion, occupational health surveillance programs can provide value for identifying non-occupational health conditions and as a supplementary source of health information and care.
PERSONS LIVING WITH COGNITIVE IMPAIRMENT SHARE THEIR VIEWS ON TECHNOLOGY
Authors: Wehry Susan , Robnett Regula H
Published: November 2019

The purpose of this study was to examine the experience of adults living with cognitive impairments and that of their care partners with digital technology including current use of, ease with and openness to using smart assistive technologies (SATs). SATs for older adults with (and without) cognitive impairments have become increasingly commonplace. Research on various digital devices has focused primarily on supporting users’ independence and care partner concerns for safety and security. Our qualitative, interview-based research project provided digital devices chosen by participants to address a specific personal goal. Interviews were conducted in the home and set-up assistance was provided during the initial interview. At the conclusion of the trial period, a second interview was conducted in the home. We describe the participants’ commendations for, expectations of, and frustrations with current technology as well as recommendations for potential, helpful digital technology. Current technology offers great promise but a disconnect between the design of digital technologies and the needs and wishes of the end-user still exists. This study will help inform additional user-driven application SATs, including those aimed at enhancing enjoyment and a higher quality of life.
PATIENT PREFERENCES FOR LEVEL OF HEALTH LITERACY IN APPS FOR CHRONIC DISEASE SELF-MANAGEMENT
Authors: Goodyear Mary Louise , Toral-Garcia Juan J , Acevedo Amarilis , Waldrup-Valverde Drenna , Ownby Raymond
Published: November 2019

In spite of expert recommendations that written material should be provided at a level of health literacy that matches that of the person receiving it, there have been few studies of matching. In this study we evaluated the utility of a new strategy to assess patients’ preference for information at different difficulties and assessed the relation of their preference to measured health literacy and health locus of control (LOC). We measured health literacy in participants then asked them to choose between pairs of texts with the same content but at the 3rd, 6th, or 8th-grade levels. Statistical analyses assessed the relation of participants’ health literacy to their preference as well as personal characteristics. Participants (n = 155) were 84 women and 71 men aged from 40 to 82 years (mean=57; 136 African Americans and 19 whites). Participants had clear preferences: those with lower levels of health literacy preferred texts at the 3rd grade level and those with higher levels preferred more difficult texts. Preference was not related to age, gender or race but was to education and health literacy (p < 0.05). Persons who chose more difficult texts reported higher levels of internal health locus of control (t [144] = 2.68, p = 0.01). A predictive analytic model using education and preference resulted in 80% correct classification of participants. Using this model may be a simple way to match information presentation to patients’ level of health literacy. Further research on this strategy is needed.
BENEFICENCE, COMPANIONSHIP AND FINANCES AS MOTIVATORS FOR PARTICIPATION IN INTERGENERATIONAL HOME SHARING
Authors: Sweeney Cary , Bell Rachel K
Published: November 2019

In January 2019, the UC Berkeley Retirement Center began piloting Berkeley Home Match (BHM), a program that matches graduate students who need affordable housing with retirees who live near campus and have an extra room. BHM seeks to address affordable housing challenges for retirees and students while creating meaningful relationships. While some data exists for home sharing programs, less is known about the motivators and outcomes of retirees and students participating in these programs. In addition to decreasing the financial burden of housing, Social Exchange Theory suggests the built-in reciprocity of intergenerational home sharing may facilitate meaningful relationships. The purpose of this program evaluation was to understand the motivating factors for participation in a University-based home sharing program. Applicants (N=35) rated factors that influenced their decision to participate using a 7-point scale (1=“Not Influential”, 7=“Very Influential”). On average, homeowners (N=6) rated “helping a student” 5.2, “income” 5.2, and “companionship” 3.6, while home seekers (N=29) rated “helping an older adult” 5.03, “rent price” 6.1, and “companionship” 4.76. Surprisingly, ratings for “helping a student” and “helping a senior” were the same or close to ratings for “income” and “rent prices,” suggesting beneficence could be a key motivator and interdependence a mechanism for relationship development. Additionally, students’ rating for “companionship” was higher than expected, indicating an openness to the relationship. These findings as well as other factors impacting home matching will be discussed, including participant demographics, reduced housing cost, housing characteristics, and long-term program feasibility.
TYPE I INTERFERON-MEDIATED NEUROINFLAMMATORY PROGRAM AND SYNAPSE LOSS IN ALZHEIMER’S DISEASE
Authors: Roy Ethan , Wang Baiping , Zheng Hui , Cao Wei
Published: November 2019

The cytokine family type I interferon (IFN) is a major innate immune mediator extensively studied in the peripheral immune responses but largely under-investigated in AD. Previously, we established that innate immune cells readily produce IFN in response to amyloid fibrils containing nucleic acids as cofactor. Here, we investigated whether IFN pathway is associated with amyloidosis in AD brain and contributes to neuroinflammation. By systemically characterizing neuroinflammation in multiple murine AD models, we established a comprehensive core AD neuroinflammation profile that includes several key proinflammatory cytokine families, among which IFN pathway is consistently activated. When hippocampal slice culture was stimulated with different forms of amyloid fibrils, nucleic acid-containing amyloid fibrils, but not heparin-containing fibrils, potently activated IFN pathway and triggered comprehensive neuroinflammation. In addition, stereotaxic administration of IFNβ induced an immune response in the brain of wild type mice analogous to the core neuroinflammatory profile associated with Aβ pathology; whereas selective IFN receptor blockade significantly blunted the ongoing microgliosis in AD models in vivo. Furthermore, IFN promoted microglia-mediated synapse uptake from neurons, which depended on the induction of complement C3, and blockade of IFN signaling significantly abolished the pathogenic synapse loss in AD brain. Consistent with the findings in mice, we found that genes stimulated by IFN were grossly upregulated in human AD brains. Therefore, type I interferon constitutes a major pathway within the neuroinflammatory network of AD and may represent a molecular target to restrain the pathogenic inflammatory responses.
COMPLEMENT CONTRIBUTES TO ALZHEIMER’S DISEASE-INDUCED SYNAPSE DECLINE IN THE MURINE RETINA
Authors: Li Fenge , Jiang Danye , Samuel Melanie
Published: November 2019

Alzheimer's disease (AD) is among the most debilitating form of cognitive impairment in aged patients. Synapse deficits are thought to be a central trigger of neural miswiring and brain dysfunction in AD. However, the pathways that control synapse connectivity remain largely unknown. The retina is an easily accessible system with two distinct synapse layers and three cellular layers comprised of distinct neural types. In this study, we leveraged this system to assess synapse and cell integrity in the APPNLGF amyloid-beta AD mouse model. We showed that the expression of the complement component C3 is significantly increased in APPNLGF retina synapses, and that there is a significant decline of several synapse-associated markers by RT-PCR. These mice also display disorganized horizontal cell processes and visual function deficits. These results suggest that complement may drive AD-related changes in the synaptic and functional properties of the retina, which could serve as assessable preclinical biomarkers for AD. In ongoing studies, we are testing whether and how complement regulates synapse refinement and shapes retina synapse specificity in AD.