bluuebunny/crossref_metadata_2025 huggingface dataset:
Lightweight design of concentrated load traction locomotive gearbox
Authors: Lei Lei , Sui Yunan , Guan Tianmin
Published: November 2019

This paper proposes a method based on topology optimization to improve the overall performance of the concentrated load traction locomotive gearbox. The parameterized model of the gearbox was established in Creo3.0, and the parameters to be optimized were set. The seamless connection function between Creo3.0 and ANSYS was optimized in ANSYS, and the final model of the gearbox was obtained through superposition calculation. The optimized model was compared with that before optimization. The improved results show that the maximum stress after optimization is reduced by 53.217%, the maximum strain is reduced by 53.4836%, and the mass is reduced by 2.98%.
Adaptive nonparametric regression with the K-nearest neighbour fused lasso
Authors: Madrid Padilla Oscar Hernan , Sharpnack James , Chen Yanzhen , Witten Daniela M
Published: November 2019

The fused lasso, also known as total-variation denoising, is a locally adaptive function estimator over a regular grid of design points. In this article, we extend the fused lasso to settings in which the points do not occur on a regular grid, leading to a method for nonparametric regression. This approach, which we call the $K$-nearest-neighbours fused lasso, involves computing the $K$-nearest-neighbours graph of the design points and then performing the fused lasso over this graph. We show that this procedure has a number of theoretical advantages over competing methods: specifically, it inherits local adaptivity from its connection to the fused lasso, and it inherits manifold adaptivity from its connection to the $K$-nearest-neighbours approach. In a simulation study and an application to flu data, we show that excellent results are obtained. For completeness, we also study an estimator that makes use of an $\epsilon$-graph rather than a $K$-nearest-neighbours graph and contrast it with the $K$-nearest-neighbours fused lasso.
Distinct Manifestations of Cooperative, Multidimensional Stimulus Representations in Different Auditory Forebrain Stations
Authors: Shih Jonathan Y , Yuan Kexin , Atencio Craig A , Schreiner Christoph E
Published: November 2019

Classic spectrotemporal receptive fields (STRFs) for auditory neurons are usually expressed as a single linear filter representing a single encoded stimulus feature. Multifilter STRF models represent the stimulus-response relationship of primary auditory cortex (A1) neurons more accurately because they can capture multiple stimulus features. To determine whether multifilter processing is unique to A1, we compared the utility of single-filter versus multifilter STRF models in the medial geniculate body (MGB), anterior auditory field (AAF), and A1 of ketamine-anesthetized cats. We estimated STRFs using both spike-triggered average (STA) and maximally informative dimension (MID) methods. Comparison of basic filter properties of first maximally informative dimension (MID1) and second maximally informative dimension (MID2) in the 3 stations revealed broader spectral integration of MID2s in MGBv and A1 as opposed to AAF. MID2 peak latency was substantially longer than for STAs and MID1s in all 3 stations. The 2-filter MID model captured more information and yielded better predictions in many neurons from all 3 areas but disproportionately more so in AAF and A1 compared with MGBv. Significantly, information-enhancing cooperation between the 2 MIDs was largely restricted to A1 neurons. This demonstrates significant differences in how these 3 forebrain stations process auditory information, as expressed in effective and synergistic multifilter processing.
The relative importance of wetland area versus habitat heterogeneity for promoting species richness and abundance of wetland birds in the Prairie Pothole Region, USA
Authors: Elliott Lisa H , Igl Lawrence D , Johnson Douglas H
Published: November 2019

Recent work has suggested that a tradeoff exists between habitat area and habitat heterogeneity, with a moderate amount of heterogeneity supporting greatest species richness. Support for this unimodal relationship has been mixed and has differed among habitats and taxa. We examined the relationship between habitat heterogeneity and species richness after accounting for habitat area in glacially formed wetlands in the Prairie Pothole Region in the United States at both local and landscape scales. We tested for area–habitat heterogeneity tradeoffs in wetland bird species richness, the richness of groups of similar species, and in species’ abundances. We then identified the habitat relationships for individual species and the relative importance of wetland area vs. habitat heterogeneity and other wetland characteristics. We found that habitat area was the primary driver of species richness and abundance. Additional variation in richness and abundance could be explained by habitat heterogeneity or other wetland and landscape characteristics. Overall avian species richness responded unimodally to habitat heterogeneity, suggesting an area–heterogeneity tradeoff. Group richness and abundance metrics showed either unimodal or linear relationships with habitat heterogeneity. Habitat heterogeneity indices at local and landscape scales were important for some, but not all, species and avian groups. Both abundance of individual species and species richness of most avian groups were higher on publicly owned wetlands than on privately owned wetlands, on restored wetlands than natural wetlands, and on permanent wetlands than on wetlands of other classes. However, we found that all wetlands examined, regardless of ownership, restoration status, and wetland class, supported wetland-obligate birds. Thus, protection of all wetland types contributes to species conservation. Our results support conventional wisdom that protection of large wetlands is a priority but also indicate that maintaining habitat heterogeneity will enhance biodiversity and support higher populations of individual species.
The Outcomes of Emergency Admissions With Ulcerative Colitis Between 2007 and 2017 in England
Authors: King Dominic , Rees James , Mytton Jemma , Harvey Philip , Thomas Tom , Cooney Rachael , Patel Prashant , Trudgill Nigel
Published: November 2019

Background and Aims

Patients with ulcerative colitis [UC] may present as emergencies and require rapid escalation of therapy. This study aimed to assess the mortality, colectomy, and readmission risks, during and following a first emergency admission with UC.

Methods

Using Hospital Episode Statistics, subjects aged between 18 and 60 years, coded with a first emergency admission with UC, were identified between 2007 and 2017. Influences of demographic factors, comorbidity, anti-tumour necrosis factor [TNF] therapy, and provider UC activity on mortality and colectomy were examined.

Results

A total of 10 051 subjects (46% female; median age 33 years [interquartile range [IQR] 25–44]) were identified. Mortality was 0.2% in hospital and 0.5% at 12 months and, following colectomy during acute admission, it was 1.4% in hospital and 2.1% at 12 months. Females had reduced risk of colectomy during admission: odds ratio [OR] 0.73 (95% confidence interval [CI] 0.62–0.85). Comparing the period 2007–2011 with 2012–2017, the rate of colectomy fell during acute admissions: OR 0.85 [0.72–0.99], p = 0.038 and at 12 months after admission: OR 0.73 [0.61–0.87]. Anti-TNF therapy increased 4-fold in acute UC admissions from 2007–2017. Those receiving anti-TNF therapy had a 70% increased risk of colectomy during index admission compared with those not receiving anti-TNF: OR 1.72 [1.29–2.31]. Increased time to colectomy during first admission was associated with female sex: hazard ratio [HR] 0.84 [0.72–0.98] and Asian ethnicity: HR 0.61 [0.44–0.85], whereas reduced time was associated with increased comorbidity, lower deprivation, and high provider volume of colectomies for UC: HR 1.59 [1.31–1.93].

Conclusions

Mortality following colectomy was 1.4% in hospital and 2.1% at 12 months, and no significant change over time was observed. Colectomy during emergency admission for UC was less common in females. Rates of anti-TNF therapy during emergency admission for UC have increased and overall colectomy rates have fallen.

Podcast

This article has an associated podcast which can be accessed at https://academic.oup.com/ecco-jcc/pages/podcast
Human milk sIgA antibody in relation to maternal nutrition and infant vulnerability in northern Kenya
Authors: Fujita Masako , Wander Katherine , Paredes Ruvalcaba Nerli , Brindle Eleanor
Published: November 2019

Background

The maternal buffering hypothesis posits that human lactation biology can buffer milk against the mild-to-moderate malnutrition that occurred routinely in evolutionary history through the mobilization of maternal body reserves. This perspective may provide insights for understanding human milk immune content variation, such as milk sIgA, which protects infants’ intestines from microbial colonization and prevents diarrheal disease.

Objective

To investigate how maternal delivery of sIgA to milk may vary in a way that can buffer milk against maternal malnutrition, while taking into consideration infants’ varying needs for immune protection across age or by sex.

Methodology

A cross-sectional study analyzed archived milk specimens from breastfeeding mothers in Ariaal communities of northern Kenya surveyed during the 2006 Horn-of-Africa drought. Multiple regression models for ln-transformed sIgA were constructed using maternal nutrition, infant age/sex and their interactions as predictors. Maternal nutrition variables included iron-deficiency anemia (IDA), vitamin A deficiency (VAD) and mid-upper arm circumference (MUAC). Infant vulnerability was considered high in young age and/or male sex.

Results and implications

Milk sIgA did not significantly differ by maternal IDA. Milk sIgA increased with infant age and maternal MUAC (n = 202). Significant interactions were observed between infant age and maternal VAD and between infant sex and maternal MUAC, such that milk sIgA content was low for younger infants particularly among VAD mothers, while among mothers with low MUAC, sIgA was lower for male infants. Results imply that mothers’ ability to deliver/buffer milk sIgA may be lowered when nutritional stress is combined with high infant vulnerability to infection.

Lay Summary

Human milk sIgA antibody content was low for younger infants among vitamin A deficient mothers. Among mothers with small arm-circumference, milk sIgA was lower for sons. Double burden of raising young or male infants with high needs for immune protection and being malnourished, might lower maternal sIgA delivery to milk.
ENHANCING PERSON-CENTERED DEMENTIA CARE BY NURSING HOME STAFF USING MICROLEARNING: LITTLE MESSAGE WITH A BIG IMPACT
Authors: Inker Jenny , Jensen Christine J , Barsness Sonya
Published: November 2019

Effective training is critical to providing quality care in long-term care environments, where many residents have dementia. Training has been linked to positive resident care outcomes and improved job satisfaction of staff. The aim of this study was to develop, pilot, and evaluate a Microlearning training curriculum, using short (5-10 minute) “bursts” of training available through an online platform on demand (i.e. 24/7). The expected outcomes were to improve staff knowledge, attitudes, and skills regarding person-centered dementia care and to increase job satisfaction. Researchers translated the Centers for Medicare and Medicaid Hand-in-Hand training curriculum into 52 weekly Microlearning lessons delivered via an online platform (accessible by computer, IPad or smart phone) followed by a short quiz. Using pre- and post-tests, nine focus groups, and fourteen telephone interviews, the researchers engaged with a convenience sample of staff (N = 244) working at all levels from direct care to leadership in nine nursing homes in Virginia. Pre- and post-tests comprised items from the Dementia Attitudes Scale and the Nursing Home Nurse Aide Job Satisfaction Scale. Results from a between subjects t-test demonstrated significant improvements in attitudes to people with dementia. Focus groups and interviews revealed high satisfaction with the training with a significant majority agreeing it was a helpful way to learn and that they were able to apply what they had learned to caring for residents. This pilot demonstrates a promising new practice for training long-term care staff. Further research using a control group receiving usual training is indicated.
DISPARITIES IN HUMAN CAPITAL INVESTMENT OVER THE GENDERED LIFE COURSE: AN INTERNATIONAL COMPARISON
Authors: Cummins Phyllis , Yamashita Takashi , Phillipson Christopher
Published: November 2019

Income disparities by gender are a persistent problem throughout the world. These disparities place women at risk for economic insecurity both while working and in retirement. Education and continued skill upgrading are key to reducing income disparities, but it is well documented that both older men and women are less likely to participate in adult education and training (AET) than their younger counterparts. In this symposium we present gender and age-based differences in AET in Australia, Canada, England/Northern Ireland and the United States. Also, given the increasing use of technology, technology-related problem-solving skills are compared across these four nations. In addition, we discuss current, and potentially new, country level policies and practices that facilitate the provision of AET over the second half of the life course. Yamashita and colleagues use data from the Program for the International Assessment of Adult Competencies (PIAAC) to provide an overview of AET participation, income, and technology-related problem-solving skills by sex and age groups in the four countries. Vickerstaff and van der Horst use data from five different organizations in the United Kingdom to examine attitudes of older workers about participation in training and the extent to which these attitudes result from self-imposed ageism. Taylor presents survey data from Australia that analyzes types of training women are undertaking, factors associated with participation in training, and the importance of employer support. Finally, Harrington and Cummins use PIAAC data to analyze age variations in AET participation and gender differences in employer sponsored training in Canada.
ADULT EDUCATION AND TRAINING IN CANADA: OPPORTUNITIES, FUNDING, AND GENDER GAPS
Authors: Harrington A Katherine , Cummins Phyllis
Published: November 2019

Labor force participation rates for middle-aged and older Canadians have increased substantially over the past two decades, with increases for women outpacing men. Given the importance of adult education and training (AET) to stay competitive in later career, we used a mixed methods approach to examine gender differences. Our analysis of the 2012 Program for the International Assessment of Adult Competencies (PIAAC) data indicated that, for ages 55-65, rates of AET participation are similar for both men and women. However, women are less likely than men to have AET funded by their employers. Findings suggest that women are more likely to need alternate funding sources for AET, such as other organizations or through self-funding. In addition, our review of literature, policy-related documents, and key informant interviews identified possible changes in policies and practices for the promotion of AET for middle-aged and older Canadians.
AN INTERNATIONAL COMPARISON OF INCOME DISPARITIES BY PROBLEM-SOLVING SKILLS, GENDER, AND AGE
Authors: Mehri Nader , Yamashita Takashi , Millar Roberto , Cummins Phyllis
Published: November 2019

Income disparities by gender have been a persistent problem in economically-developed countries for decades, with income gaps often widening over the adult life course. We use data from the 2012 Program for the International Assessment of Adult Competencies (PIAAC) to examine relationships among problem solving skills in technology-rich environments (PSTRE), income, sex, and age in Australia, Canada, England/Northern Ireland and the United States. Women age 35 to 44 in the middle-to-high (i.e., 50th - 75th percentile) income group had significantly higher PSTRE scores than their male counterparts in Australia and Canada. For the same income group, women ages 55 to 65 had significantly higher. PSTRE scores than men in Canada and England/Northern Ireland. These results suggest that women with similar skills lagged their male counterparts in income in specific sub-populations in specific countries. We provide possible explanations for these differences and conclude with implications for policy and practice.
INFLUENCE OF ECONOMIC WELL-BEING ON HEALTH, AND MODERATING EFFECT OF SOCIAL ENGAGEMENT AMONG OLDER CAMBODIANS
Authors: Kuy Kakada , Park Sojung
Published: November 2019

Similar to other post-conflict nations in Southeast Asia, impacts of civil wars and violence, coupled with the present poverty, place older Cambodians in vulnerable health conditions. Older Cambodians have limited access to basic healthcare and decent living conditions. To date, little research has been conducted to understand their health and related determinants. This study aimed to examine the influence of economic wellbeing and the moderating effect of social engagement on the physical health of older Cambodians. Data came from Survey of Elderly Cambodia (2004), the only existing nationally representative dataset of older Cambodians age 60 and above (N=1,273). Economic wellbeing was measured in two dimensions: (1) subjective economic wellbeing with three indicators of self-rated economic satisfaction and (2) objective economic wellbeing with household item possession and current housing conditions. Social engagement was examined with four types of engagement in the community. For physical health, the number of health complaints was examined. Results of Poisson regression showed objective economic wellbeing, such as access to basic household items and decent housing conditions, was significantly related to physical health (p < .001). However, we found no role of social engagement in the association between the subjective economic wellbeing and health. Furthermore, social engagement has a significant moderating effect on the association between objective economic wellbeing and physical health (p < .001), controlling for all covariates. For anti-poverty and health policy development for older Cambodians, a promising intervention effort may focus on the ways to facilitate social engagement in later years.
NATURALLY OCCURRING VARIABILITY IN FINANCIAL STRESS AND INFLAMMATORY BIOMARKERS AMONG OLDER ADULTS
Authors: Samuel Laura , Szanton Sarah L , Fedarko Neal , Simonsick Eleanor M
Published: November 2019

Financial strain (i.e. difficulty making ends meet) is associated with earlier disability and mortality among older adults, but inflammatory response to financial stress is untested. This study leverages monthly increases in financial stress among older adults receiving Social Security payments monthly on the 3rd. The Health ABC Study randomly sampled black and white adults aged 70-79 free of disability from Memphis, TN and Pittsburgh, PA in 1997 and 1998. Baseline biomarkers included TNF α, IL-6, CRP, and soluble receptors were measured for about half the sample (IL-2, IL-6, and TNF α Type I and II). Days since Social Security payment was calculated using clinic visit date, which naturally varied in the sample. Restricted cubic spline models stratified by financial strain status tested hypothesized associations, adjusting for financial strain scores, food insecurity, employment status and monthly invariant potential confounders (age, gender, number of inflammatory conditions, waist circumference and anti-inflammatory medications). Among those with financial strain, each additional day since payment was associated with higher TNF-α levels during first week of the month (n=1,633, coefficient=0.0830, p=0.030) and higher IL-6 soluble receptor levels during the last week of the month (n=828, coefficient=12033.44, p=0.037), but not with other biomarkers nor during the middle of the month. Days since payment was not associated with biomarkers among those without financial strain. These results suggest upregulation of pro-inflammatory and not anti-inflammatory pathways during the beginning and end of the month among financially strained older adults. Financial strain is modifiable and these results call attention to addressing it.
ROBBING PETER TO PAY PAUL: HANDLING FINANCIAL CHALLENGES AMONG LOW-INCOME OLDER ADULTS
Authors: Samuel Laura , Wright Rebecca , Spahr Melissa , Roberts Laken C , Szanton Sarah L
Published: November 2019

Low income older adults often face financial challenges which increase their risk for earlier disability and mortality. This study explored the social norms, beliefs and practices relevant to handling financial challenges among low-income community-dwelling older adults residing near Baltimore, MD whom we recruited using convenience and snowball sampling. Four vignette-based focus group sessions included 28 participants. Using hierarchical thematic analysis, three key themes emerged. First, the theme “Rob Peter to pay Paul” describes the consensus that individuals must prioritize financial needs, which required individuals to “work with a budget”, apply for aid, “cry for [aid]” and, when needed, “work something out” with landlords and lenders. One participant described the amount of work by saying “We’re retired but we’re working for ourselves.” Secondly, the theme “Your rent should be first” describes how low income older adults prioritize housing over food and other needs because “resources for housing is a problem” and because homelessness is both more permanent and socially stigmatizing than hunger - “Don’t nobody know you’re hungry unless you tell them, but everybody know when you outdoors.” Finally, the theme “We need to put the word out” describes the consensus that public benefits and community resources should be made more visible and accessible. Many individuals only know about resources because they seek information (“you go and you find out”), but “ it’s hard to ask for help. ” These results can inform the development and improvement of financial and community programs and policies for low-income older adults addressing financial challenges.
CULTURAL COMPETENCE TRAINING FOR HOSPICE STAFF: FINDINGS FROM A NATIONAL HOSPICE SURVEY
Authors: Boucher Nathan , Johnson Kimberly S
Published: November 2019

Compared to whites, racial/ethnic minorities are less likely to enroll in hospice and if they enroll, more likely to experience poor quality care. Building cultural competence (CC) among hospice staff is a strategy that may reduce these disparities. We conducted a national survey of hospices’ practices to promote CC. A total of 197 hospices participated; most were not-for-profit (80%) with an average daily census over 100 (53%); 73% offered staff cultural competence training (CCT). There were no differences in characteristics of hospices who offered CCT and those that did not. Of hospices offering CCT, 54% held it annually. Most trainings were one hour (60%); content was delivered via web (58%) and/or lecture (57%). While over 90% of staff (i.e., nurses, social workers, and chaplains) completed CCT, a smaller proportion of medical directors (63%), senior leaders (70%) and board members (23%) did so. Most common (>70%) topics were: cross-cultural communication, death and illness beliefs, and spirituality’s role, and healthcare disparities. The majority focused on African-Americans (83%), Hispanics (76%), and Asians (61%)—the most common U.S. minority groups. Almost 30% reported no assessment of effectiveness of CCT while 45% reported a quiz at the end. In this study, most hospices offered some CCT. CCT has been shown to improve healthcare providers’ knowledge and skills in caring for diverse patients and is associated with increased patient satisfaction. Future research should evaluate effectiveness of CCT in improving the ability of hospices to deliver high quality end-of-life care to diverse groups of older adults.
DEVELOPMENT AND PILOT TESTING OF THE END-OF-LIFE READINESS ASSESSMENT (ERA) SURVEY
Authors: Coulourides Kogan Alexis M , Taguchi Julie
Published: November 2019

An emerging conceptual framework on the relationship between serious and sensitive end-of-life (EOL) discussions and patient hope points to the mediating role that patient readiness may play. Additional research has also found that among some patients, engaging in and EOL conversation before they are ready may actually cause harm. Presently, health practitioners do not have a way to measure patient readiness. Therefore, the purpose of this study was to develop a survey assessment tool, rooted in research, to measure patient readiness to engage in an EOL discussion. The 16-item survey was initially developed by a gerontological researcher and clinical oncologist, and tested for face reliability and appropriateness among a geriatrician and three patients with chronic illness. In May 2018, the final version of the survey was pilot tested among 168 patients attending their regularly scheduled oncology appointment. On average, most participants identified as Caucasian (74%) females (61%) in partnerships (58%) and having a cancer diagnosis (64%). Bivariate analyses revealed that older age (60+, p=0.008), Caucasian race (p=0.04), and reported greater knowledge of community and supportive services (p=0.049) was significantly associated with increased readiness to engage in an EOL discussion. Additionally, a higher score on the Advance Care Planning Engagement Survey was significantly associated with increased readiness (p<0.001). Findings reveal patient groups that might be more appropriate targets for interventions, education, and resources and highlight the role of interprofessionals in outpatient health settings to “prime the pump” for these types of conversations.
USING LONGITUDINAL HEALTH INFORMATION TO ENHANCE MORTALITY PREDICTION
Authors: Beckett Megan K , Elliott Marc N , Ritenour Doug , Giordano Laura A , Saliba Debra
Published: November 2019

The Vulnerable Elders Survey-13-Health Outcomes Survey (VES-13-HOS) 2.5 is a simple, validated method to predict two-year mortality using older adults’ responses to the Medicare HOS. We explore whether adding longitudinal function measures and expanded sociodemographic information significantly improves the performance of the VES-13-HOS 2.5. Using Medicare HOS data, we developed risk scores that used coefficients from three logistic regressions predicting two-year mortality (2013-2015): (1) standard 0-10 VES-HOS 2.5 inputs at 2013 (function and limited demographics), (2) expanded demographics at 2013 (adding gender, fine-grained age, race/ethnicity, marital status, missing income indicator, and Medicaid status), (3) expanded demographics at 2013 plus change in pre-baseline (2011) health score two years prior. Fine-grained age and sociodemographic information slightly improve VES mortality prediction. Holding the 2013 VES-HOS 2.5 0-18 enhanced-demographic risk score constant, seniors with worse 2011 than 2013 functioning had higher two-year mortality than seniors with better 2011 functioning. Adding this prior health status further improved model performance slightly- 80% of mortality prediction is explained by “current” health and function and 20% by status two years earlier; such weighted scoring could be employed. We find that prior health status measurements do not generally indicate a trajectory that is likely to continue. Rather, health and function information from two years prior reduces measurement error via a second assessment of health; those with much worse health and function two years earlier are at slightly higher mortality risk. The VES-HOS can be used to identify patients with high mortality risk and to guide their care.
EXPANDING THE NETWORK: NONTRADITIONAL ANIMAL MODELS IN GEROSCIENCE
Authors: Cohen Alan A
Published: November 2019

Important insights into the biology of aging are coming from research on animals that have not been traditional staples of geroscience research. This symposium will highlight cutting-edge approaches to understand aging biology in the African killifish, exceptionally long-lived mammals such as the Naked Mole Rat, and across primate species, including the short-lived Marmoset.
CAPTURING REAL-WORLD LOSSES OF BALANCE AND RECOVERY RESPONSES IN OLDER ADULTS AT RISK FOR FALLS
Authors: Alexander Neil , Handelzalts-Pereg Shirley , Nyquist Linda , Strasburg Debbie , Mastruserio Nicholas , Ojeda Lauro
Published: November 2019

Losses of balance (LOBs) such as trips can lead to falls in older adults; what actually happens during real-world LOBs is unclear. With 4 wearable inertial measurement units (IMUs), we recorded feet, trunk and wrist movements over 2 weeks. Using a wrist voice recorder to report the LOBs, we applied our IMU processing algorithms and reconstructed the full body LOB and recovery motions. We recruited 7 at-risk older adults (M=76 yrs) who reported 114 LOBs of which we reconstructed over 90%. Using a rating system, 52% of the LOBs involved a significant trip, stumble, recovery step, and/or large trunk motion. 25% involved double or stutter steps and smaller trunk motions. The other 23% had less striking associated motions. These data suggest that most, but not all, self-reported real world LOBs involve substantial postural destabilization and near falls. Analyses of the voice-recorded context under which the LOBs occurred are ongoing.
VALIDATION OF A WALKING SPEED MEASUREMENT DEVICE: GAITBOX
Authors: Jarvis Leighanne , Peterson Matthew J , Morey Miriam C , Caves Kevin
Published: November 2019

The NIH 4m Walk Test is a clinically validated tool to measure adult walking speed. Human reaction limitations can contribute to measurement error when manually timing gait speed. This is important considering a 0.10m/s decrease in walking speed is associated with a 12% decrease in life expectancy for older adults. The goal of this study was to validate a low cost, custom built device, Gait Box (GB), compared to human timer (HT) and a research grade Sprint Timing System (STS) with an older adult (mean 72.4 + 7.4 years of age) population (N = 35). Validity was assessed via accuracy (correlations), precision (mean differences), and bias (Bland-Altman plots). Results showed strong correlations between the GB and HT (0.99) and the GB and STS (0.98), with negligible mean differences. This demonstrates the GB can be used to accurately and precisely measure gait speed in clinical and research settings.
FEASIBILITY OF VIRTUAL REALITY TREADMILL TRAINING IN OLDER ADULTS WITH MOBILITY AND FITNESS DEFICITS
Authors: Castle Steven , Lee Cathy C , Blanchard Erin H , Roberts Christian K , Jones Malcolm J , Schroeder E T
Published: November 2019

Only 23.6% of adults and <10% of adults age >75 years meet physical activity (PA) guidelines (aerobic & muscle-strengthening). Health benefit gym memberships has not improved participation. Therefore, Blue Goji developed a Virtual Reality (VR) treadmill to improve PA through fitness gamification with cognitive involvement in postural control to improve balance. Feasibility testing was done with seven older Veterans and one spouse, mean age of 81.3 years who participate in the VA Gerofit program & were near the 50th percentile (by age & gender) in strength, balance and endurance. Even those with lower levels of fitness, balance or chronic conditions (i.e., kyphosis or vision impairment) strongly supported this for enjoyment, benefit, comfort, safety and strongly recommended this (mean of 4.65 out of 5). The Gamification approach supports anti-ageism and intergenerational fitness activities. Further study on the additive effect on exercise intensity and improvement in fitness, balance and cognition is needed.
VALIDITY AND RELIABILITY OF REMOTE, SMARTPHONE-BASED ASSESSMENT OF DUAL-TASK STANDING AND WALKING IN OLDER ADULTS
Authors: Manor Brad , Yu Wanting , Lo On-Ye , Zhu Hao , Travison Thomas G , Lipsitz Lewis , Zhou Junhong
Published: November 2019

Dual task walking assessments provide valuable insights into cognitive-motor function in aging. To date, such assessments have been limited primarily to laboratory-based settings. We thus created a smartphone App utilizing multi-media instructions and the phone’s motion sensors to record movements during normal and dual task walking, with the phone placed in the user’s pants pocket. Thirty younger and older adults completed two lab visits, during which walking data were simultaneously acquired by the App and the GAITRite mat. Participants also completed App-based assessments in their homes on three separate days. Across all detected strides in laboratory trials, gait metrics derived from the App correlated closely with those derived from the GAITRite mat (r2>0.96). Across trials, gait metrics demonstrated excellent test-retest reliability, both within and between laboratory visits and home-based assessments (ICC: 0.79–0.90). Remote, smartphone-based dual task walking assessments may therefore be feasible for relatively healthy younger and older adults.
HARNESSING THE POWER OF PROFESSIONAL NETWORKS: IDENTIFYING FACILITATORS AND BARRIERS TO CAREERS IN GEROPSYCHOLOGY
Authors: Allen Rebecca S , Carpenter Brian
Published: November 2019

This symposium presents data from a mixed method study designed to explore how to harness the power of professional networks to increase the pipeline of trainees pursuing careers in academic and clinical geropsychology. Participants were recruited through professional websites, listserves, announcements at annual meetings, and emails from directors of clinical training at pre-and post-doctoral training sites. A total of 107 geropsychologists completed the survey, including 28 graduate students/interns and 76 post-doctoral psychologists ranging from early to late career. The mean age of respondents was 39.18 (SD = 12.05). The sample was largely female (71.7%) and Caucasian (88.7%), paralleling previous work. The first paper describes attractive and unattractive aspects of clinical and academic career options, including gender differences in perceptions of the feasibility of changing career foci. The second paper examines perceptions of clinically-focused and academic jobs, and discrepancies between professional psychologists’ actual and ideal job activities. Examining content analysis of 28 qualitative transcripts, the third paper focuses on VA training and the convenience and comfort of transitioning into a VA job after training within this system, identifying benefits and challenges of work in the VA. The fourth explores these 28 transcripts to identify perceptions of mentorship and supervision during training, including time spent in the training sites (graduate school vs internship) and observations of how working environments impact future career choices. Discussion will address the critical shortage of geropsychologists in academic and clinical settings and strategies to improve the professional pipeline to increase the numbers of trainees pursuing these careers.
REFLECTIONS ON VA TRAINING AND EMPLOYMENT FROM INTERVIEWS ON CAREER PATHS IN GEROPSYCHOLOGY
Authors: Shumaker Elizabeth M , Jacobs M Lindsey , Strong Jessica V , Allen Rebecca S
Published: November 2019

The U.S. Department of Veterans Affairs (VA) is one of the largest trainers and employers of psychologists in the world and many clinical geropsychologists have worked for the VA for some portion if not all of their careers. The current qualitative analysis was conducted on phone interviews with 28 psychologists and psychology trainees regarding careers in geropsychology that focused on participants’ reflections on factors that influenced their career paths. This presentation will summarize subthemes from the many participant responses that included statements about the VA. Examples include discussion of the convenience and comfort of transitioning to a VA job after training within this system as well as reflections about the timing of professional development conversations with supervisors and mentors on VA internships and fellowships given the proximity to entering the workforce. Identified benefits and challenges of work in the VA will also be discussed (e.g., varied roles and responsibilities).
NIA HEALTH DISPARITIES RESEARCH NETWORK: APPROACHES AND FINDINGS FROM GERIATRICS AND CLINICAL GERONTOLOGY
Authors: Joseph Lyndon , Hill CarlV
Published: November 2019

Health disparities are differences in the incidence, prevalence and burden of diseases, mortality rates and causes of death that exist among population groups. Health disparities are associated with a broad, complex, and interrelated array of factors that influence health, accelerate aging and reduce life expectancy. NIA’s health disparities research goals are to understand environmental and sociocultural factors and related behavioral and biological mechanisms that diminish health and reduce life expectancy for vulnerable populations, explore the biological mechanisms through which disparities influence age-related change, and identify where disparities emerge in diagnosis, prognosis or treatment in geriatric conditions. Presentations will focus on whether structural-level discrimination may be a key factor in potentiating well known race-related health disparities especially those with an accelerated onset and may be associated with MRI-indicators of subclinical brain pathology; identifying biomarkers for early detection of cognitive and functional decline in high risk subpopulations and how ethnicity influences cerebral spinal fluid and imaging biomarkers link to early identification of cognitive and functional impairment ; effects of medication management and deprescribing among African American and Hispanic older adults with Alzheimer’s disease and related dementias and multiple chronic conditions; examine the use of multi-level factors and technology to overcome the barriers to urban-rural health disparities in managing many chronic diseases such as hepatitis C virus infection and delivery of appropriate medical services; and understanding the racial and ethnic differences in the link between environmental exposures and auto-immune comorbid asthma.
ASTHMA IN OLDER ADULTS: IDENTIFYING PHENOTYPES AND FACTORS IMPACTING OUTCOMES
Authors: Folz Rodney
Published: November 2019

Asthma, of all chronic diseases, has the highest disease burden attributed to environmental exposures. Few studies have attempted to characterize the prevalence of co-existing auto-inflammatory disease and asthma, or to link environmental exposure as a factor that may increase asthmatic lung obstruction and racial disparity with auto-inflammatory comorbidity. While there is an increased risk for asthma development and severity linked to certain autoimmune diseases, there is a known racial disparity in the prevalence of these autoimmune diseases. Racial and ethnic differences in the link between environmental exposures and auto-immune comorbid asthma as a potential common trigger of inflammation is not well understood. This talk will focus on developing a model to longitudinally predict asthma control and quality of life associated with home environmental triggers and volatile organic chemical (VOC) exposure in older adults and investigate the direct and indirect effect of autoimmune disease in racial disparities of the longitudinal relationships of home environmental asthma triggers on airway obstruction and functional status in older adults with asthma.
UTILITY OF EXECUTIVE FUNCTION TO IDENTIFY EARLY COGNITIVE IMPAIRMENT IN AFRICAN AMERICANS
Authors: Garrett Stephanie , Goldstein Felicia C , Chen Yunyun , Easley Kirk , McDaniel Darius , Lea Janice , Thomas Tiffany , Saleh Sabria , Hajjar Ihab
Published: November 2019

Within diverse cohorts, African Americans (AA) demonstrate higher rates of Alzheimer’s dementia (AD) and Alzheimer’s dementia combined with multiple comorbid conditions. AA are also two times more likely to develop late-onset AD than whites and less likely to be diagnosed. Yet, our understanding of this disparity in cognition remains limited. Cognitive impairment (CI) and dementia are both underdiagnosed and underreported in primary care patients. The lack of early detection of cognitive and functional decline in high risk populations results in failure to provide care and interventions to members of vulnerable groups. This talk will focus on research that seeks to identify a more sensitive cognitive marker for early identification of cognitive impairment for AA and advances this objective by linking the cognitive marker to AD cerebral spinal fluid biomarkers (Aβ1-42, p-tau) and testing whether this association differs between AA and whites.
OLDER ADULTS’ SOCIAL RELATIONSHIPS AND WELL-BEING IN A DIGITAL WORLD
Authors: Mejia Shannon T , Czaja Sara J
Published: November 2019

As adults age into a digitally connected world, communication technologies such as the internet, email, social media, and video chats offer new opportunities to connect with others. The implications of older adults’ use of technology in the context of their social relationships—such as the implications for social integration, the relational circumstances of technology adoption, implications for daily experiences of well-being, and opportunities to form new relationships—are less understood. This symposium brings together diverse and complementary perspectives on the contribution of technology to older adults’ social experiences. We begin with inquiry into implications of internet use for social integration. Hees and colleagues use data from the German Ageing Survey to examine how internet use is associated with change in loneliness over a three-year period in older adults who are either before or after retirement. Our symposium continues with papers on technology use within the context of older adults’ existing close relationships. Chopik examines individual and dyadic predictors of technology adoption. Mejía and colleagues consider the implications for digital social interactions for older adult’s well-being on that day. Our final paper discusses the potential for technology to aid in the development of new relationships. Rogers and colleagues describe findings from their OneClick.chat project, a web-based video chat application that connects older adults based on their shared interests. Our session concludes with a discussion led by Czaja, who will integrate the four papers and discuss the challenges and opportunities of using technology to support older adults’ social relationships and well-being.
WHAT’S OLD IS NEW: USING ARTIFICIAL INTELLIGENCE TO ACCELERATE DISCOVERY OF NEW TREATMENTS
Authors: Marras Connie , Maclagan Laura C , Cheng Yi , Visanji Naomi , Tadrous Mina , Bronskill Susan E
Published: November 2019

Given the high cost of drug development and low success rates, repurposing drugs already proven safe provides a promising avenue for identifying effective therapies with additional indications. The IBM Watson artificial intelligence system was used to search 1.3 million Medline abstracts to prioritize medications that may be potentially disease-modifying in Parkinson’s disease. We assessed patterns of use of the top 50 Watson-ranked drugs among 14,866 adults with Parkinson’s disease aged 70 and older who were matched to persons without Parkinson’s disease on age, sex, and comorbidity. Sociodemographic characteristics, chronic conditions, and use of other medications were compared using standardized differences. Patterns of potentially disease-modifying drug use were examined prior to and following ascertainment of Parkinson’s disease. Preliminary findings from multivariable conditional logistic regression models on the association between previous exposure to potentially disease-modifying drugs and Parkinson’s disease diagnosis will be presented.
DEFINING THE RELATIONSHIP BETWEEN ACTIVE CITIZENSHIP AND HEALTHY RURAL AGING: A CRITICAL APPROACH
Authors: Winterton Rachel
Published: November 2019

Active citizenship is romanticized in policy for its role in keeping older adults healthy, and rural communities sustainable. However, as proportions of older adults resident in rural communities continue to increase, the gerontological literature has begun to highlight challenges associated with both the capacity and desire of rural older adults to be active citizens. Through an integrative review of the international literature, this paper interrogates how active citizenship trends among rural older adults support or hinder healthy aging in rural settings. Findings indicate that active citizenship among older adults can increase rural age-friendliness and facilitate individual wellbeing. However, practices associated with active citizenship among this cohort can disenfranchise certain groups of older adults, through reshaping societal norms relating to citizenship, age-friendliness and rurality. These findings indicate that programs designed to promote active citizenship must both consider, and account for, diverse capacities and desires for active citizenship among rural older adults.
MULTIPLE MEDICATION USE AND RISK OF TREATED FALL INJURY: THE HEALTH ABC STUDY
Authors: Xue Lingshu , Boudreau Robert M , Donohue Julie M , Zgibor Janice C , Marcum Zachary A , Costacou Tina , Newman Anne B , Strotmeyer Elsa
Published: November 2019

Multiple medication use within one year is associated with increased fall injury risk in older adults. However, chronically using multiple medications and treated fall injury have rarely been explored, particularly in cohort studies linked with claims data. We examined using >5 medications in 2 or more consecutive years (chronic medication use) as a risk factor for treated fall injury in 1,898 community-dwelling adults (age 73.6±2.9 years; 53% women; 37% black) with linked Medicare Fee-For-Service (FFS) claims from the Health, Aging and Body Composition Study since 1997/98 clinic visit. Incident fall injury (N=546) was the first claim from 1998/99 clinic visit to 12/31/08 with an ICD-9 fall code and non-fracture injury code, or fracture code with/without a fall code. Stepwise Cox models with a time-varying predictor of chronic medication use before fall injury or censoring (N=414) vs. not using >5 medications at the same time (N=1008) were adjusted for baseline demographics, lifestyle factors, fall history, quadriceps strength, cardiovascular disease (CVD), diabetes, sensory nerve impairment, and kidney function. Fall injury risk increased for chronic medication users (37%) vs. non-users (29%) (HR=1.25[1.00-1.57]), though was attenuated after adjustment for CVD and diabetes (HR=1.18[0.93-1.51]). Sensitivity analyses excluding fall-risk-increasing drugs (FRIDs) from medication counts (HR=1.32[0.54-3.20]), or including those using >5 medications non-chronically (N=365) in referent groups (HR=1.22[0.96-1.55]) had consistent findings. Unmeasured comorbidity differences may confound associations of chronic medication use and treated fall injury risk in older adults with Medicare FFS. Considering both chronic diseases and medication use in fall risk assessments is needed.