bluuebunny/crossref_metadata_2025 huggingface dataset:
USEFUL FIELD OF VIEW AND DRIVING SIMULATION ACROSS TWO AGE GROUPS
Authors: Dunterman Rebecca A , Intrieri Robert C , Guernsey Marisa
Published: November 2019

The Insurance Information Institute (2017) reports that drivers aged 65 and older have the second highest rate of fatal car crashes. Research with the useful field of view (UFOV) assessment has predicted crashes in older drivers (Ball, 2006). “UFOV is defined as the area from which an individual can extract information quickly without head or eye movement” (Posit Science, 2019). Research demonstrates that older drivers are limited by poorer vision, divided attention and the inability to ignore distractions, and slower reaction time to critical stimuli (Owsley et al. 1998). As a result UFOV is an effective variable in assessing driver safety. We hypothesized that older compared to younger drivers would be less likely to inhibit attention to task irrelevant visual stimuli while engaged in a simulated driving task. Participants were community dwelling older adults and students recruited from a research pool and through word of mouth. Participants completed a series of demographic and health questions, Snellen visual acuity test a series of cognitive measures (e. g., Trails 1 and 2, digit symbol, digit span) and the UFOV assessment. Participants completed a driving simulation task while information on driving performance: number of collisions, speed limit deviations, turn signal use, time spent tailgating another vehicle, and braking reaction times. ANOVA demonstrated that as hypothesized, younger participants had significantly lower UFOV risk scores (p = .000). Older adults’ (M = 2.15, SD = .945) and younger adults’ (M = 1, SD = 0).
DNA METHYLATION CLOCKS IN MOUSE
Authors: Meer Margarita , Gladyshev Vadim
Published: November 2019

One of important limiting factors in aging research is the time required to measure the effect of an intervention on lifespan. But this situation is now changing due to a recent discovery of DNA methylation-based markers (DNAm clocks). We developed a whole lifespan multi-tissue DNAm clock for mice with R2 =0.89. We also carried out comparative analyses of the available mouse DNAm clocks (single- or multi-tissue, based on different number of sites, based on one genomic locus or multi-loci). In general, tissue specific clocks are more accurate than muti-tissue clocks. We applied these tools to a variety of experimental systems, ranging from interventions to rejuvenation approaches, and analyzed various mouse tissues and public datasets. We further applied DNAm clocks to newly sequenced sets of blood and liver samples. Multi-loci blood clock outperforms other clocks when applied to blood samples, and the liver and multi-tissue clocks show similar precision on liver.
HOW THE IMPACT OF CHRONIC PAIN ON COGNITION VARIES BY POLYGENIC RISK SCORE (PRS)
Authors: Song Jieun
Published: November 2019

While prior research has found associations between chronic pain and cognition and genetic risk of cognitive decline, little research examined moderating effects of genetic risk on the association between chronic pain and cognition. This study investigate whether genetic risk of accelerated cognitive decline, assessed by polygenic risk score (PRS) of Alzheimer disease (AD), moderates the association between severe chronic pain and cognitive decline. The data are drawn from Midlife in the US (MIDUS), a survey of a nationally representative sample of US adults. The analytic sample consists of two groups: 201 individuals who reported severe chronic pain (116 women, 85 men) and 404 individuals without severe chronic pain (215 women, 189 men) who completed MIDUS 2 (2004-06) and MIDUS 3 (2013-14) surveys and participated in biomarker data collection. The findings showed that men who suffered from severe chronic pain were more vulnerable to genetic risk of cognitive decline than men who did not experience severe chronic pain. Specifically, men who suffered from severe chronic pain and had higher level of PRS of AD experienced a greater decline of episodic memory than men who experienced chronic pain with lower level of PRS of AD. This association was not found in women sufferers. For both men and women who did not have chronic pain, cognitive change was not a function of the level of genetic risk of cognitive decline. Findings suggest that genetic risk of cognitive decline would be manifested contingent on life circumstances as well as gender of individuals.
SYSTEMS BIOLOGY OF HUMAN AGING - NETWORK MODEL 2019
Authors: Furber John D
Published: November 2019

This network schema is presented to aid in conceptualizing the many processes of aging, the causal chains of events, and the interactions among them, including feedback and vicious cycles. Contemplation of this network suggests promising intervention points for therapy development. This diagram is maintained on the Web as a reference for researchers and students. Content is updated as new information comes to light. www.LegendaryPharma.com/chartbg.html At first glance the network looks like a complicated web. However, as a conceptual summary, in one view, we can see how the many biogerontological processes relate to each other. Importantly, examination of these relationships allows us to pick out reasonably plausible causal chains of events. Within these chains, we can see age-related changes or accumulations that appear to be promising targets for future therapy development. Especially harmful is damage to the body's regeneration and repair systems, because they normally repair damage to other structures and systems. The many observable signs of human senescence have been hypothesized by various researchers to result from several primary causes. Inspection of the biochemical and physiological pathways associated with age-related changes and with the hypothesized causes reveals several parallel cascades of events that involve several important interactions and feedback loops. This network model includes both intracellular and extracellular processes. It ranges in scale from the molecular to the whole-body level. Effects due to externalities, lifestyle, environment, and proposed interventions are highlighted around the margins of the network.
BUILDING H.O.U.S.E. (HEALTHY OUTCOMES USING A SUPPORTIVE ENVIRONMENT) FOR LGBTQ OLDER ADULTS
Authors: Rosenwohl-Mack Amy , Beld Matt , Greene Meredith , Skultety Karyn , Dubbin Leslie , Deutsch Madeline B , Flatt Jason D
Published: November 2019

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults face unique challenges in finding affordable, inclusive, and supportive housing. These challenges may be due to discrimination, income disparities, and higher rates of health problems compared to cisgender heterosexual seniors. To our knowledge, this is the first longitudinal study of the health and wellbeing of older adults who move into LGBTQ-welcoming, affordable senior housing. Participants completed a brief baseline survey at the time of their housing lottery application. Questions focused on physical, psychological, and social health and current health service use. We calculated descriptive statistics on health status at baseline. 184 participants completed the baseline survey, mean age was 68 years (SD 5.2), and nearly 75% reported an annual income under $30,000. Almost half reported a diagnosis of hypertension, 40% depression, 27% anxiety, and 25% HIV/AIDS. Around 70% reported their health as good to excellent, 21% fair, and 9% poor or very poor. However, 58% reported their physical activities were at least somewhat limited by their physical health, 43% reported difficulties with balance or walking, and 32% reported memory problems. Nearly 3% had been admitted into the hospital and 10% had visited the emergency room in the past 30 days. In terms of social wellbeing, 63% felt isolated from others at least some of the time. In summary, LGBTQ older adults seeking affordable senior housing report relatively good health, although they also experience functional and social difficulties. New forms of housing that are explicitly LGBTQ-welcoming may help address these health challenges.
QUALITY IMPROVEMENT IN DEMENTIA CARE: EFFECTIVENESS OF IMPLEMENTING STAR-VA IN A VA COMMUNITY LIVING CENTER
Authors: Chacko Thomas , Curyto Kim , Maller Marc , Eddy Connie
Published: November 2019

Staff Training in Assisted Living Residences adapted for Veterans Affairs (STAR-VA) is an evidence-based, interdisciplinary behavioral intervention to manage challenging Behavioral Symptoms of Dementia (BSD) at VA Community Living Centers (CLCs). Components of STAR-VA included creating realistic expectations for individuals with dementia, effective communication, using a behavioral problem-solving approach, and increasing resident-centered pleasant events. STAR-VA was implemented at VA Western New York CLC to help staff manage Veteran BSD. The purpose of the study was to examine the effectiveness of STAR-VA implementation in 17 CLC Veterans with Dementia who demonstrated BSD distressing to themselves, other Veterans and/or staff and documented in 2017-2018. STAR-VA was facilitated by the behavioral coordinator and nurse champion in partnership with the CLC behavior team during weekly rounds and as needed modeling and debriefing. The team included the medical provider, recreation therapist, social worker, and all levels of nursing. On average, the intervention involved four assessments over 75 days. Outcome measures at baseline and post-intervention included assessments of target behavior frequency and severity, direct care tracking of behaviors, and the Minimum Data Set distress behavior indicator. Compared to baseline scores, clinically meaningful reduction was documented using team assessment and direct care ratings of BSD frequency and severity, and overall inappropriate utilization of antipsychotic medication. CLC clinical staff tailored implementation of STAR-VA to be feasible and effective. Ongoing evaluation of STAR-VA implementation using routine measures promotes measurement based care, providing feedback to the team to improve care quality.
RESILIENCE OF CHINESE OLDER COUPLES LIVING WITH CHRONIC ILLNESSES
Authors: Chow Esther O
Published: November 2019

Applying theories of lifelong psycho-social growth and life course principles of human development, older couples generally possess rich and valuable resources from diverse aspects of life. However, empirical evidence, on whether these supports are fully transferred to benefit themselves as they age, remains uncertain due to inevitable physiological decline and increasing caregiving strains. The present study explicated the underlying processes of the older Chinese couples in forming a dyadic resilience model as they age with chronic illnesses. Using in depth interviews, 15 pairs of older Chinese couples were interviewed twice through home visits. The conversations were transcribed and analyzed using thematic analysis. Eight themes related to resilience and challenges of spousal caregiving were identified: 1) insights and acceptance of the chronicity of illnesses, 2) a sense of purpose and commitment as being the spouse in providing care for each other, 3) mastering skills and resources to handle the duties, 4) mixed feelings when the spouse was functioning changes, 5) realizing the importance of self-care and life-management, 6) cultivating positive meanings amidst difficult circumstances, 7) accepting things that cannot change, and cherishing on those aspects which are still functioning well, 8) working closely with other formal and informal support for common good. Findings have both practice and policy implications to health and social care practitioners in understanding different patterns of resilience as experienced by older Chinese couples in mitigating the developmental challenges from individual, relational and societal levels, and research implications in examining actor-partner interdependence practice in addressing caregiving challenges.
PARASYMPATHETIC INFLUENCE ON COGNITIVE AGING IS MODERATED BY SYMPATHETIC ACTIVITY, ESPECIALLY IN EARLY MIDLIFE
Authors: Knight Erik L , Giuliano Ryan , Shank Sean , Clarke Megan , Almeida David M
Published: November 2019

The two branches of the autonomic nervous system (ANS) have been individually linked to age-related changes in cognitive functioning: The parasympathetic nervous system (PNS) is thought to support healthy cognitive aging, whereas the sympathetic nervous system (SNS) has been linked to heightened cognitive decline. Despite these separate findings and despite the integrative nature of the ANS, little work has examined the two branches simultaneously to better understand their interactive effects on age-related cognitive changes. We examined cognitive change in two waves of the MIDUS cognitive project and indexed PNS and SNS activity from heart rate variability and epinephrine levels (respectively) from the MIDUS biomarker project (n = 764, 56% female, mean age = 54.1 years). Our findings indicate that higher PNS levels attenuate cognitive decline, but only among individuals with low SNS levels; at higher SNS levels, the beneficial effects of the PNS are blocked. Further, lower PNS levels can be somewhat compensated for by increased SNS levels. This pattern was most robust among individuals transitioning to mid-life (i.e., 35-40 years old at the initial cognitive test). These results suggest that interventions targeting the ANS as a modifiable factor in cognitive aging should consider both ANS branch’s effects simultaneously, particularly in the early stages of midlife.
A GENERIC METHODOLOGY FOR EFFECTIVE CREATION OF LABORATORY-TEST-BASED FRAILTY INDICES
Authors: Stubbings Garrett M , Mitnitski Arnold , Rutenberg Andrew
Published: November 2019

Laboratory test-based frailty indices (FI) are known to be highly predictive of adverse health outcomes and mortality. However, these FI depend on the proper classification of continuous valued health measurements into binary deficits (healthy or unhealthy). This classification is not standardized and is often done by using thresholds for medical intervention or maximally predictive values from statistical tests. This work proposes a simple and generic methodology for the creation of FI from laboratory values and measures its performance against existing methods. The methodology is as follows: a direction of risk is determined for each measurement, individuals are then assigned a score based on their relative standing in the population, binarization is then done using a global cut-point which binarizes all measures based on a given quantile. This method is shown to outperform FI created with medical risk thresholds for a range of global cut-points in both the NHANES and CSHA studies. Furthermore, our method is shown to be more robust to cohort effects than FI created using cut-points determined by maximum information measures, such as maximal separation of survival curves.
COMBINING MACHINE LEARNING WITH AUTOMATED NEMATODE LIFESPAN ANALYSIS TO IDENTIFY MODIFIERS OF ALZHEIMER’S DISEASE
Authors: Russell Joshua , Kaeberlein Matt
Published: November 2019

Here we present new computational and experimental methods to leverage the gene expression and neuropathology data collected from several large-scale studies of Alzheimer’s disease . These data sets include diverse data types, including transcriptomics, neuropathology phenotypes such as quantification of amyloid beta plaques and tau tangles in different brain regions, as well as assessments of dementia prior to death. This meta-analysis is a complex undertaking because the available data are from different studies and/or brain regions involving study-specific confounders and/or region-specific biological processes. We have therefore taken neural network and probabilistic computational approaches that reduce the data dimensionality, allowing statistical comparison across all brain samples. These approaches identify gene expression changes that are significantly associated with clinical and neuropathological assessment of Alzheimer’s disease. We then conduct in vivo validation of the genes through genetic screening of C. elegans models of Alzheimer's disease utilizing our automated robotic lifespan analysis platform. This approach allows for the greater leverage of existing Alzheimer’s disease biobank data to identify deep genetic signatures that could help identify new clinical gene-expression markers and pharmacological targets for Alzheimer’s disease.
NEURONAL-SPECIFIC PROTEASOME AUGMENTATION VIA EXTENDS LIFESPAN AND REDUCES AGE-RELATED NEURODEGENERATION
Authors: Pickering Andrew M
Published: November 2019

Cognitive function declines with age throughout the animal kingdom and increasing evidence shows that disruption of the proteasome system contributes to this decline. The proteasome has important roles in multiple aspects of the nervous system, including synapse function and plasticity, as well as preventing cell death and senescence. We report that augmentation of proteasome function, using overexpression of the proteasome β5 subunit, enhances proteasome assembly and function. Significantly, we go on to show neuronal-specific proteasome augmentation slows age-related declines in measures of learning, memory, and circadian rhythmicity. Surprisingly neuronal specific proteasome augmentation of proteasome function also produces a robust increase of lifespan in Drosophila melanogaster. Our findings appear specific to the nervous system; ubiquitous proteasome overexpression increases oxidative stress resistance but does not impact lifespan and is detrimental to some healthspan measures. These findings demonstrate a key role of the proteasome system in brain aging.
A SYSTEM TO IDENTIFY INHIBITORS OF MTOR SIGNALING USING HIGH-RESOLUTION GROWTH ANALYSIS IN S. CEREVISIAE
Authors: Kiflezghi Michael , Kaeberlein Matt
Published: November 2019

Age is the main risk factor for cancer, cardiovascular disease, neurodegeneration and other diseases prevalent in the world’s aging population. These diseases increase the pain and suffering and result in billions of dollars in healthcare costs. Addressing the common risk factor may allow for simultaneous amelioration of these diseases providing personal and economic relief to people and societies around the globe. The mTOR signaling pathway has been shown to be a robust target in the aging process with its inhibition resulting in increased lifespan in model organisms from yeast to mice. Rapamycin is an FDA approved drug for use in transplant patients and is a potent and specific inhibitor of mTOR complex 1. Rapamycin’s use as an anti-aging therapeutic in otherwise healthy individuals is complicated by the occurrence of side effects. As such, groups studying inhibition of the mTOR pathway are searching for alternative inhibitors that may be able decouple the deleterious effects of rapamycin administration from the lifespan extending effects. To address this issue, we have developed a high-throughput yeast-based assay for the identification of novel mTOR inhibitors. By utilizing mutant strains with differential sensitivity to mTOR inhibition, comparative growth kinetics of microcultures exposed to an inhibitor can be used to discern the mTOR inhibitory status of a compound. Furthermore, the assay can provide mechanistic insight on a compound’s mode of inhibition providing a rich, fast readout of a compound’s potential for inhibiting mTOR. This approach allows for the screening of large libraries of compounds speeding the discovery process.
A ROBOTIC SYSTEM FOR HIGH-THROUGHPUT AUTOMATED LIFESPAN ANALYSIS IN C. ELEGANS
Authors: Blue Ben , Vayndorf Elena , Kaeberlein Matt , Pitt Jason
Published: November 2019

Over the past decade, the identification of potential genetic and pharmacological modifiers of lifespan and age-related pathologies in C. elegans and other model organisms has yielded fruitful leads for follow-up investigation. A major limitation of such studies, however, is that they are often time-consuming and labor-intensive. The advent of affordable high-quality digital cameras, robotics systems, and 3D printers, as well as the decreasing costs of image storage and processing have allowed us to automate data capture and analysis at an unprecedented scale. To this end, our group developed a tool consisting of an unbiased, high-throughput, automated robotic system to perform genetic and pharmacological quantification of lifespan and health measures in C. elegans and related nematode species. The WormBot utilizes industry-standard, commercially available robotics components to position a digital camera over individual wells of standard 12-well culture plates, containing a small population of C. elegans per well. A high-resolution image is captured of each plate every 10 minutes throughout the course of the experiment. Our software processes the images for stabilization, compiles them into a time-lapse series for each well, and quantifies survival and mobility (paralysis) with minimal input. In addition, a short video is captured of each well once each day, to allow for quantitative analyses of activity and coordinated movement. We will describe this technology and present applications to screen genetic and pharmacological libraries in aging and age-related disease.
METABOLIC FLEXIBILITY IN CLASSICAL MONOCYTES IS NOT AFFECTED BY AGE
Authors: Yarbro Johnathan , Pence Brandt
Published: November 2019

Inflammaging is the chronic low-grade inflammation that occurs with age that contributes to the pathology of age-related diseases. Monocytes are innate immune cells that become dysregulated with age and which can contribute to inflammaging. Metabolism plays a key role in determining immune cell functions, with anti-inflammatory cells primarily relying on fatty acid oxidation and pro-inflammatory cells primarily relying on glycolysis. It was recently shown that lipopolysaccharide (LPS)-stimulated monocytes can compensate for a lack of glucose by utilizing fatty acid oxidation. Given that mitochondrial function decreases with age, we hypothesized that monocytes taken from aged individuals would have an impaired ability to upregulate oxidative metabolism and would have impaired effector functions. Aging did not impair LPS-induced oxygen consumption rate during glucose starvation as measured on a Seahorse XFp system. Additionally, aged monocytes maintained inflammatory gene expression responses and phagocytic capacity during LPS stimulation in the absence of glucose. In conclusion, aged monocytes maintain effector and metabolic functions during glucose starvation, at least in an ex vivo context.
INCREASED BETA2-ADRENERGIC RECEPTOR SIGNALING ENHANCES PROGRESSION OF HEPATOCELLULAR CARCINOMA
Authors: Pizzini Jason , Wang Hanzhou , Yeh Chih-Ko , Kamat Amrita
Published: November 2019

We investigated whether increased signaling by beta2-adrenergic receptors (β2-ARs), which mediate the action of catecholamines, enhances the progression of hepatocellular carcinoma (HCC). Mean age of patients with HCC, the most prolific form of liver cancer, has progressively increased over the last decade. Beta2-AR-mediated signaling in liver increases with age. We also observed increased β2-AR levels in liver tissues of patients with HCC compared to control subjects. We, therefore, hypothesized that increased β2-AR signaling enhances HCC progression while inhibition of β2-AR signaling by treatment with beta blockers suppresses its progression. To test this hypothesis, we used N-nitrosodiethylamine (DEN) to induce HCC in liver-specific β2-AR knockout (LKO) and control mice in the absence or presence of beta blocker propranolol. At the end of 25 weeks, we observed increased numbers of visible tumors, disarray of liver architecture, and mortality in DEN-induced control mice which was reduced by propranolol treatment. We also observed that DEN-treated LKO mice demonstrated reduced mortality, disarray of architecture, and phosphorylation of oncogene Src compared to DEN-treated control mice. Taken together, these results indicate that decreased β2-AR signaling because of a lack of receptors in the liver or inhibition of receptor action with propranolol reduces HCC progression. Studies are in progress to determine the β2-AR-mediated mechanisms involved in HCC progression. Our studies suggest that beta blocker propranolol, used to treat cardiovascular diseases, may be repurposed as a potential therapeutic option for treatment of HCC.
SKEWED MACROPHAGE POLARIZATION IN AGING SKELETAL MUSCLE
Authors: Cui Chang-Yi , Driscoll Riley , Piao Yulan , Chia Chee , Gorospe Myriam , Ferrucci Luigi
Published: November 2019

Skeletal muscle aging is a major cause of disability and frailty in the elderly. The progressive impairment of skeletal muscle with aging was recently linked to a disequilibrium between damage and repair. Macrophages participate in muscle tissue repair first as pro-inflammatory M1 subtype and then as anti-inflammatory M2 subtype. However, information on the presence of macrophages in skeletal muscle is still sporadic and the effect of aging on macrophage phenotype remains unknown. In this study, we sought to characterize the polarization status of macrophages in human skeletal muscle at different ages. We found that most macrophages in human skeletal muscle are M2, and that this number increased with advancing age. On the contrary, M1 macrophages declined with aging, making the total number of macrophages invariant with older age. Notably, M2 macrophages co-localized with increasing intermuscular adipose tissue (IMAT) in aging skeletal muscle. Old BALB/c mice showed increased IMAT and regenerating myofibers in skeletal muscle, accompanied by elevated expression of adipocyte markers and M2 cytokines. Collectively, we report that polarization of macrophages to the major M2 subtype is associated with IMAT, and propose that increased M2 in aged skeletal muscle may reflect active repair of aging-associated muscle damage.
IMPACT OF END-OF-LIFE PLANNING ON SURROGATE DECISION-MAKER ANXIETY
Authors: Aloiau April , Segal Daniel L , Mouchawar Alan , Benton Melissa J
Published: November 2019

At the end of life, adults with advanced illness frequently rely on surrogate decision makers to make health care decisions. Surrogate decision makers often have anxiety related to the difficulty and complexity of making end of life decisions. This project evaluated whether an educational intervention focused on creating a specific plan of care for hospice patients would reduce anxiety among their surrogate decision makers. The Geriatric Anxiety Scale (GAS), the State Trait Anxiety Inventory–State Anxiety Scale (STAI-S), and a single question about decision-making anxiety were used to measure surrogate decision maker anxiety before the intervention, immediately after the intervention, and 2 weeks following the intervention. After completing an informed consent, 12 patients (age 80 ± 14.7 years) and 18 surrogate decision makers (age 60 ± 12.9 years) from a Southern California hospice organization participated in the educational intervention. Immediately following the intervention surrogate decision maker anxiety decreased. Mean GAS anxiety scores decreased (p = 0.003) from 21.3 ± 9.8 to 16.6 ± 7.6 and STAI-S scores decreased (p = 0.003) from 43.3 ± 11.5 to 38.1 ± 9.9. However, when surrogate decision maker anxiety was measured 2 weeks post-intervention, anxiety had increased again, so that it was no longer significantly different from pre-intervention levels. Qualitative analyses showed high satisfaction, with 85% of decision makers reporting that the education was very or extremely helpful This project demonstrated that an educational intervention in the hospice setting can be effective in creating a short-term decrease in surrogate decision maker anxiety levels.
DEFINITIONS MATTER WHEN DIAGNOSING MILD COGNITIVE IMPAIRMENT
Authors: Derby Carol , Hall Charles B , Katz Mindy
Published: November 2019

Prior studies have shown that when standard diagnostic criteria are applied, the majority of individuals diagnosed with aMCI do not progress to clinical dementia, with a much larger proportion reverting to normal cognition. This suggests that a prospective confirmation of aMCI diagnosis may improve the specificity of the classification. We examined the rates of aMCI reversion using two definitions: one based on a single annual assessment, and one requiring a diagnosis over two consecutive annual assessments within the population based Einstein Aging Study Cohort. Using the definition that used a single annual assessment resulted in 224 incident aMCI cases in 5,321 person years of follow-up, for an incidence rate of 4.21 cases per 100 person years. Requiring the confirmatory diagnosis resulted in only 94 incident aMCI cases in 5736 person years of follow-up, for an incidence rate of 1.64 cases per 100 person years. 41% of the persons diagnosed with aMCI using the single annual assessment were cognitively normal at the next follow-up. Only 14% of the persons diagnosed with incident aMCI using the definition requiring later confirmation ever returned to being cognitively normal. When the aMCI definition that required confirmation was used, a dramatic reduction in the incidence rate of aMCI was observed in persons born after 1930, similar to what has been reported in the same cohort for dementia, but there was no such difference for the definition based on a single annual assessment.
PREVENTABILITY OF DEMENTIA IN PRIMARY CARE SETTINGS
Authors: Pham Anh , Drummond Neil , Voaklander Don , Wagg Adrian , Lindeman Cliff
Published: November 2019

Dementia is a long-term, chronic condition caused by a progressing physical damage in the brain. Evidence suggests that cardiovascular disease risk factors may contribute to the onset of dementia; however, the current literature on this association is inconsistent. To our knowledge, no study that has explored the occurrence of cardiovascular risk factors prior to a diagnosis of dementia using national primary care data in North America. We used electronic medical records from the Canadian Primary Care Sentinel Surveillance Network to create a Canadian cohort to conduct a retrospective analysis to (1) determine the number of incident diagnoses of dementia in primary care among community-dwelling seniors; (2) compare the risk of developing dementia in seniors (aged 65 and older) with and without modifiable cardiovascular risk factors. The cohort identified 21,628 patients who did not have a dementia diagnosis in 2008. During ten years of follow-up, 2,520 individuals developed dementia. The number of patients with dementia or cardiovascular risk factors increased slightly but steadily. Annually, the number of new cases of dementia increased from 0.5% in 2009 to 2.2% in 2017. Both Poisson regression and Cox’s proportional hazard model showed statistically significant relationships between hypertension, diabetes, dyslipidemia and obesity and dementia onset (p < 0.001), hazard ratio equals to 0.82, 1.11, 0.68 and 0.58, respectively. In other words, people with hypertension, dyslipidemia and obesity being managed in primary care are less likely to develop dementia. These findings support the hypothesis that good control over chronic diseases may benefit cognitive health.
ACUPUNCTURE AND ACUPRESSURE FOR DEMENTIA BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS: A SCOPING REVIEW
Authors: Harris Melissa L , Struble Laura M , Titler Marita
Published: November 2019

This scoping review synthesized the literature on acupuncture and acupressure therapy for treating behavioral and psychological symptoms of dementia (BPSD). BPSD affect most people with dementia and are overwhelming for caregivers and healthcare providers. Current evidence encourages use of nonpharmacologic interventions for BPSD due to the dangers of psychotropic medications. Acupuncture and acupressure present as alternative treatment options for BPSD. Systematic reviews examined acupuncture therapy for improving cognitive function, but not acupuncture and/or acupressure for BPSD. The methodology outlined by Joanna Briggs Institute Reviewers’ Manual guided this scoping review. Databases searched were PubMed, CINAHL, Embase, PsychINFO and AgeLine. Study inclusion criteria were published in English, subjects with dementia, acupuncture or acupressure tested and outcome measures included at least one BPSD. Gray literature was excluded. 836 citations were screened by title and abstract. 57 full texts were reviewed to determine inclusion criteria and 15 studies were retained. Nine studies examined acupressure and 6 examined acupuncture. Eight studies were RCT, 11 were conducted in China and 10 were conducted in long-term care. The percent of studies with statistically significant improvements in BPSD outcomes measured were: ADL’s (75%), agitation (100%), anxiety (67%), depression (100%), mood (100%), neuropsychological disturbances (67%) and sleep disturbances (100%). The therapies were safe and participant satisfaction was high across studies. Variations in research designs, outcome measures and incomplete descriptions of acupoints limit interpretations about effectiveness of these interventions for BPSD. Additional RCTs are needed to improve generalizability and to evaluate dosage/methods of acupressure and acupuncture for BPSD.
THE ROAD TO ACCEPTANCE OF DRIVER RETIREMENT FOR PATIENTS WITH DEMENTIA: PHYSICIANS’ AND PATIENTS’ PERSPECTIVES
Authors: Scott Theresa L , Liddle Jacki , Pachana Nancy A , Beattie Elizabeth , Mitchell Geoffrey
Published: November 2019

People living with Alzheimer’s disease and related dementias (ADRD) must eventually stop driving. While some will voluntarily retire, many others will continue to drive until a crisis. In Australia, like many other countries, general physicians/practitioners (“GPs”) play a key role in monitoring driving safety and driver retirement with their patients with ADRD. Advising patients about driving cessation is one of the most challenging aspects of clinical dementia care, complicated by limited time in consultations, lack of patient awareness and insight, and objective screening and assessment measures. We examined how to support best practice in relation to management of driving cessation with patients with ADRD through focus groups with 29 GPs and contrasted their perspectives with those of 11 retired drivers with ADRD. Focus groups and interviews were transcribed and thematically analysed. Themes discovered highlighted the importance of providing education about the effects of dementia on safe driving and incorporating regular assessment of driving safety into the care continuum. Key strategies that GPs successfully employed included acknowledging loss and encouraging continued community engagement, providing referral pathways, and deferring to other GPs within the practice in challenging circumstances. In conclusion, there is demand for an overhaul of the current system of management and a need to establish nationally aligned, standardized and evidence-based guidelines, in particular relating to assessment of safe driving. In the meantime, we can learn from these GPs who have implemented particular strategies that mitigate some of the challenges and complex driving related issues that present in primary care.
ASSESSING APATHY IN LONG-TERM CARE RESIDENTS WITH DEMENTIA: COMPARING SELF-EVALUATION WITH PROXY RATINGS
Authors: Jao Ying-Ling , Williams Kristine N , Berish Diane
Published: November 2019

Background: Apathy affects most individuals with dementia in long-term care. Apathy assessment is fundamental for appropriate treatment. Apathy involves subjective feelings thus individual’s self-evaluation may offer important perspectives for assessment. However, it is unclear whether self-evaluation is a valid assessment approach for this population. This study compared apathy ratings from resident self-evaluation to assessments from family, clinicians, and research staff. Methods: This pilot study enrolled 8 residents from two long-term care facilities in Pennsylvania. One family member, one certified nursing assistant (CNA), and one nurse or activity staff were also enrolled for each resident. Researchers interviewed each resident using the Apathy Evaluation Scale (AES) and rated their apathy levels. Family, CNAs, and nurses/activity staff independently rated the resident’s apathy level using the AES. Direct observations were conducted by researchers using the Person-Environment Apathy Rating (PEAR). Results: Correlation analysis revealed a discrepancy across raters in assessing apathy. While self-evaluation and family ratings where moderately positively correlated (r=0.48, p=.23), there was a moderate correlation in the opposite direction between self-evaluation and CNA ratings (r=-0.64, p=.09). Resident self-evaluation did not correlate with nurses/activity staff ratings (r=0.01, p=.99) or researcher observations (r=-0.08, p=.86). Discussion: These findings may reflect residents’ cognitive impairment and lack of insights, family and clinicians’ lack of understanding of apathy, or nurses’ and researchers’ lack of acquaintance with the resident. It remains undetermined whether self-evaluation provides valid information for apathy assessment for this population. Additional research is necessary to identify the most valid assessment approach for long-term care residents with dementia.
GERIATRIC ASSESSMENT ADOPTION IN COMMUNITY CANCER CENTERS: TRENDS, BARRIERS, AND RECOMMENDATIONS
Authors: Plotkin Elana , Lucas Lorna , Burhenn Peggy Sue , Nightingale Ginah , Loh Kah Poh , Allen Priscilla D , Dotan Efrat
Published: November 2019

Addressing the needs of older adults with cancer is critical for the delivery of high-quality, patient-centered care. The Association of Community Cancer Centers (ACCC) has identified barriers and best practices for serving this growing patient population in order to help support the multidisciplinary team in understanding and proactively preparing for this large subgroup of patients. A survey was administered to 332 cancer professionals. 95% agreed that their older adult patients would benefit from a comprehensive geriatric assessment, yet only 17% of respondents are performing CGAs. 74% of respondents are not using any screening tool to identify high risk patients. The top three barriers to this were time/personnel and limited familiarity with available, validated tools. 61% are not focused on increasing older adult participation in clinical trials which leads to a disparity in care. Techniques for evaluating fitness, cognitive status, psychological status, comorbidities, and toxicity risk were often informal and not recorded in an EMR. Three in-depth focus groups were completed at programs demonstrating effective, yet different models of care for an older population. City of Hope Cancer Center is running a Senior Adult program under a grant where patients receive care in concordance with a score (CARG toxicity calculator) and a team review with a geriatrician. Sidney Kimmel Cancer Center has a consultative clinic where patients attend a 2-hour appointment to complete a comprehensive geriatric assessment with oncology, geriatrics, and specialists including pharmacy and nutrition. ACCC has recommended resources to address deficits in care, particularly in the community setting.
EFFECT OF FREQUENCY OF PARTICIPATING IN THE REGION ACTIVITY ON FUNCTIONAL DECLINE
Authors: Yasunaga Masashi , Kawai Hisashi , Hirano Hirohiko , Suzuki Hiroyuki , Fujiwara Yoshinori , Obuchi shuichi
Published: November 2019

This 3-year prospective study was conducted to explore whether frequency of participating in the region activity exert independent effect on preventing functional decline among urban Japanese older adults after controlling for potential confounders. We examined a prospective cohort of 2,524 community-dwelling persons, aged 65 years or older, who responded to the baseline mail survey in Toshima ward, Tokyo, Japan in 2014. They were followed for the subsequent 3 years in terms of functional status. Multiple logistic regression models were used to analyze independent effects of frequency of participating in the region activity, such as 1) no participation, 2) no participation in the past year, 3) less than one day per month, 4) few days per month, 5) over one day per week, on functional status, controlling for potential confounders such as age, gender, self-rated health, chronic conditions and social capital at baseline. At baseline, the mean age of 1,261 participants who completely responded to follow-up survey in 2018 was72.1 years (SD=5.0), and 56.9% were women. As results of analyzing, only “over one day per week” was significant predictors of preventing subsequent functional decline even after adjustment for confounders (odds ratios .361; 95% CI .180–.725). Frequency of participating in the region activity over one day per week have effect on preventing functional decline among urban Japanese older adults after controlling for potential confounders.
ECONOMIC HARDSHIP INDICATORS ARE DIFFERENTIALLY ASSOCIATED WITH ADVERSE HEALTH OUTCOMES IN OLDER ADULTS
Authors: Anderson Loretta
Published: November 2019

Previous studies have shown that higher levels of economic hardship in older adults is associated with increased odds of adverse health outcomes such as insomnia, anxiety, and depressive symptoms. The objective of this study was to determine if there was a differential association between individual measures of economic hardship and aforementioned adverse health outcomes. Cross-sectional analysis was conducted using data from the 2012 National Health and Aging Trends Study (NHATS). Logistic models were developed to assess the association between each of the four measures of economic hardship and three previously reported adverse health outcomes. Participants were asked if in the last month they did not have enough money for food, utility bills, mortgage/rent, or medical bills/prescription drugs. Measures of adverse health outcomes were symptoms of depression, anxiety, and insomnia. There were 7,075 community dwelling older adults aged 65 and older in the 2012 NHATS data. Results indicated that those who skipped meals were more likely to have depression, anxiety, and insomnia symptoms than those who did not skip meals. After adjusting for race, age, gender, education, and comorbid health conditions, skipping meals was associated with depression (OR=4.11, p<.000), anxiety (OR=2.81, p<.01), and insomnia (OR=2.16, p<.05). These results were higher and more statistically significant than the other measures of economic hardship. These findings are relevant to population-based efforts of nutrition interventions to improve quality of life in aging populations.
CONTINUITY OF CAREER OVER THE LIFE COURSE ON LIFE SATISFACTION AND DEPRESSIVE SYMPTOMS IN LATER LIFE
Authors: Hill Melanie S , Hill James E , Richardson Stephanie , Brown Jessica , Yorgason Jeremy B , Hill Jeff
Published: November 2019

Identity scholars have suggested that having a unified sense of past, present, and future is related to positive well-being outcomes (Whitbourne, Sneed & Skultety, 2009). One’s occupation can have a profound influence on an individual’s identity throughout the life course (Nazar & van der Heijden, 2012). Research has looked at career mobility among younger age groups (Baiyun, Ramkissoon, Greenwood, & Hoyte, 2018); however, less is known about the impact of career stability later in life. Consistency in career choice over the life course may have positive outcomes down the line as career becomes part of an individual's identity. The current study uses the Life and Family Legacies dataset, a longitudinal state-representative sample of 3,348, to examine individual’s careers at three points in the life course: high school (projected career choice), early adulthood, and later life. Results revealed that a match of desired career in high school and actual career in early adulthood was not predictive of life satisfaction or depressive symptoms in later life. However, a match of career in early adulthood and later life was significantly related to better life satisfaction and less depressive symptoms, which was explained through higher levels of job satisfaction. This study highlights the importance of acquiring and maintaining a career that is fulfilling to the individual over the course of early adulthood to later life.
THE EFFECT OF RETIREMENT TIMING ON HEALTH AND WELL-BEING OF HISPANICS COMPARED TO NON-HISPANIC WHITES LIVING IN THE U.S.
Authors: Diaz-Valdes Iriarte Antonia E
Published: November 2019

In the context of an aging society, where the proportion of older adults is rapidly increasing, ensuring healthier longer lives is key for individuals, families, policy makers and the population as a whole. In this context the productive aging framework has gained increased importance. There is evidence showing that engagement is related to late-life well-being and health (i.e., Hinterlong, 2006; Everard et al, 2000; Rozario et al, 2004; Matz-Costa et al, 2012). However, the productive aging framework lacks cultural sensitivity and evidence about the association between the effect of retirement on health and well-being in late-life is mixed. The current study seeks to contribute to this gap by exploring the consequences of the discrepancies between planned and actual retirement age on subjective health and well-being, comparing Hispanics and non-Hispanic Whites. A series of regression models were conducted to explore the effect of the discrepancy between planned and actual retirement age on retirement satisfaction, self-rated health and mental health (CESD). Results indicates that native born Hispanics presented more differences when compared to foreign born Hispanic than non-Hispanic Whites, which could indicate the effect of acculturation and its fading effect on cultural attitudes, such as familismo. Hispanic tend to have higher retirement satisfaction than non-Hispanics which is aligned with the happiness paradox found by Calvo and collagues (2017). Additionally, SES has a significant effect on health for non-Hispanic Whites but not among Hispanics. Finally, retirement timing predicted mental health among foreign born Hispanic but among native born Hispanics and non-Hispanic Whites.
ALIVIADO DEMENTIA CARE-HOSPICE EDITION: FEASIBILITY AND ACCEPTABILITY RESULTS OF A TWO-PHASED PILOT STUDY
Authors: Lin Shih-Yin , Bristol Alycia A , Schneider Catherine E , Convery Kimberly , Sotelo Victor , Brody Abraham A
Published: November 2019

Limited work has been performed in helping hospice agencies to care for persons with dementia (PWD) and their caregivers in an evidence-based manner despite the increasing number of PWD cared for in this setting. To change the culture of care for PWD and their caregivers receiving hospice, we adapted Aliviado Dementia Care, an evidenced-based interdisciplinary quality improvement program, for use in hospice. The purpose of this pilot study is to examine feasibility and applicability of implementing the Aliviado Dementia Care-Hospice Edition sequentially in 2 hospice agencies in preparation for a nation-wide pragmatic trial. In the first pilot, concluded in March 2019, seven hospice interdisciplinary clinicians were trained as program champions and completed a two-day in-person intensive training on dementia symptom assessment and management, and quality improvement processes. Additionally, 47 interdisciplinary team (IDT) members were provided training via a 5-hour, online program covering dementia symptom assessment and management. All champions trained (100%) reported being satisfied/very satisfied with the program and agreed that the training is applicable to hospice practices. All IDT members who completed the online training (100%) reported being satisfied/very satisfied with the program quality, or agreed/strongly agreed that the content was relevant. The high rates of satisfaction and applicability, reported by the hospice champions and IDT members, provided preliminary evidence supporting the feasibility and applicability of the Aliviado Dementia Care-Hospice Edition.