bluuebunny/crossref_metadata_2025 huggingface dataset:
AGE-SPECIFIC TRENDS IN LIMITATIONS TO DAILY ACTIVITIES IN AMERICANS AGED 50 AND OVER BY RACE AND ETHNICITY, 2000–2018
Authors: Bramajo Octavio , Mehta Neil , O’Grady Brandon
Published: January 2025

During the first decade of the 2000s the overall prevalence of limitations to daily activities (but not instrumental limitations) has increased in the US. It is not clear if the stagnation in mortality in the last decade, after decades of improvements in life expectancy, was accompanied by stagnation in disability as well or if the pace of increases of disabilities increased. However, it is not clear if specific age-groups drive these trends, and how those differences have manifested by sex, race, and ethnicity since the turn of the century. We used data from the National Interview Health Survey (NHIS), from years 2000 to 2018, and we ran a set of logistic regression models to establish age-specific trends by race for both types of limitations to activities in daily living (stratified by sex, decade and by the age-groups between 50-64,65-74-75-84) to disentangle the effect of time on how those trends developed, controlling by age, education and nativity. From 2000 to 2018 average prevalence of limitations to daily activities and instrumental limitations for adults aged 50 and above has not changed significantly, hovering on similar levels during the whole period. However, we identified an increase of limitations to daily activities and instrumental limitations for the 50-64 age group, with a steep increase during the first decade of the century and a stagnation afterward, mostly driven by Non-Hispanic Blacks and Hispanics, both for males and females. For other age groups, the trend was uneven, and we were unable to distinguish a clear direction.
BACKWARD GAIT CHARACTERISTICS: A NOVEL PERSPECTIVE ON PHYSICAL FUNCTIONING
Authors: Popelsky Braden , Ylitalo Kelly
Published: January 2025

Mobility is fundamental to healthy aging. Mobility measures such as gait velocity, double support phase, step length, and asymmetry can quantify ambulation and identify gait patterns that signify compensation for unsteadiness, poor balance, and physical functioning limitations. Forward walking is well-established as a measure of physical functioning, but fewer studies have assessed backward direction. Independently ambulatory young adults (n=20; age: 22.9 years ±1.6) and community-dwelling older adults (n=19; age: 70.2 years ±6.2) completed repeated forward and backward walking tests on a 3.9-m instrumented pressure mat. Paper surveys assessed sociodemographic characteristics, physical activity, fall history, and self-reported physical functioning (Physical Component Score (PCS) from the Short-Form Health-Survey 12). Forward and backward gait measures were evaluated using principal component analysis (PCA), and receiver-operating curves were used to model the diagnostic efficacy of gait measures on poor physical functioning. Four principal components explained 87.6% of the variance in gait. Principal component 1 accounted for 49.1% of the variance in gait with average backward step length (0.424) and backward walking speed (0.422) exhibiting the greatest loadings, indicating stronger influence. Principal component 1 was in moderate agreement (r=0.43, p=0.012) with PCS scores. Among older adults, backward gait velocity was a better predictor of poor physical functioning (PCS ≤ 50) than forward gait velocity (p=0.044; AUC=0.682 vs. 0.546). Backward gait characteristics may be novel indicators of physical functioning. Prospective studies should establish cut points for backward gait measures that classify poor physical functioning in diverse older adult populations.
FEAR OF FALLING INTERACTS WITH ACTN3 GENOTYPE TO PREDICT FAST GAIT SPEED IN OLDER ADULTS
Authors: Goldberg Allon , Burkhardt Summer , Norris Hayden , Garber Johnathon , Little Natalie , Kendall Jaiden , Sucic Joseph
Published: January 2025

Deficits in walking speed are associated with poor health outcomes in older adults. The alpha-actinin-3 gene (ACTN3) harbors the R577X polymorphism, which influences muscle function and physical performance in older adults. Fear of falling (FOF) is associated with gait, mobility and physical performance deficits in older adults. Our objective was to determine if effects of FOF on fast gait speed (FGS) are associated with ACTN3 genotype, to identify individuals based on ACTN3 genotype at risk for greatest declines in FGS with onset of FOF. Older adults (N=168, female=61.3%, mean age 72.8 years, range 65-85 years) attended a study visit at which demographic, self-rated health (SRH) and FOF information was collected, and 10-meter FGS was tested. Saliva was obtained for ACTN3 genotyping. Multiple regression evaluated variance in FGS explained by FOF, RR genotype (present/absent), and interaction of FOF with RR genotype, controlling for age, sex and SRH. The final regression model explained 36.9% of FGS variance (p<.001). FOF was a significant predictor (β=-.163; p=.026) of FGS. RR genotype did not independently predict FGS (β=.103; p=.161), but was interactively with FOF a significant predictor (β=-.181; p=.024) of FGS. The effect of FOF on FGS was greater in individuals with RR genotype than in the RX/XX genotype subgroup (partial eta squared 0.083 and 0.030 respectively). The significant FOF x RR genotype interaction suggests that effects of FOF on FGS vary based on ACTN3 genotype. Individuals with RR genotype (compared to the RX/XX subgroup) may experience greater FGS declines with onset of FOF.
NEW MEASURES OF MULTIMORBIDITY BASED ON A THEORY OF DEPENDENT COMPETING RISKS
Authors: Akushevich Igor , Yashkin Arseniy , Kravchenko Julia , Yashin Anatoliy
Published: January 2025

The phenomenon of multimorbidity is increasingly common among older U.S. adults, however the driving forces behind multimorbidity development remain unclear. In this study we develop a novel approach for the identification and explanation of causal pathways generating multimorbidity patterns in the population of older U.S. adults. Our approach is based on the evaluation of the dependent competing risks among diseases potentially determining the process of generating a given multimorbidity cluster using parametric and non-parametric methods. This approach allows for modeling the joint distribution of time-to-disease-onsets with mutual correlations; characterizing cluster properties such as speed of cluster formation and their prevalence in the population. This joint distribution is estimated using individual morbidity trajectories extracted from Medicare administrative claims data and dynamically constructed for all ages resulting in an age-specific-function of multimorbidity generation. The identified clusters and estimated properties were compared to those obtained using traditional methods (e.g., cluster analysis or latent structure analyses). Our method strongly outperforms the current methods of identification of multimorbidity clusters which were characterized by approximate cluster composition with no room for improvement without additional methodologic assumptions. The substantive results of this study encompass the identification of multimorbidity clusters and their properties and allows extensions for the quantification of the effects of risk factors on these clusters (including evaluating causality), the provision of causal explanations for disparities in multimorbidity, and the development and testing of novel approaches for multimorbidity analysis through simulation studies.
CAMKII HYPERACTIVATION IN SKELETAL MUSCLES IS A DRIVER AND POTENTIAL THERAPEUTIC TARGET OF SARCOPENIA
Authors: Wang Qinchuan , Bene Michael , Fountain William , Rosales-Soto Giovanni , Hernandez-Ochoa Erick , Chung Tae Hwan , Walston Jeremy
Published: January 2025

Sarcopenia, the loss of muscle mass and strength, is a major risk factor for physical frailty in older adults. Ca2+/calmodulin-dependent protein kinase II (CaMKII) is activated by Ca2+ and reactive oxygen species in contracting muscles to enhance muscle performance and adaptation to exercise training. We assessed CaMKII activity in the skeletal muscles of young (4-month-old) and old (20-month-old) C57BL/6J mice and found significantly increased CaMKII activity in old mice at rest, suggesting that CaMKII activity is chronically elevated and disconnected from muscle contractile activity in aged muscles. To determine the role of increased CaMKII, we used an adeno-associated viral vector (AAV9) to express a CaMKII inhibitor, CN19o, in the tibialis anterior (TA) muscles of 20-month-old mice and found a significant improvement of muscle contractile force at 24 to 26 months of age. Conversely, when we expressed a constitutively active CaMKII (CaMKIICA) in the TA muscles of young mice (3-month-old), we observed a striking reduction of muscle contractility. Electromyography studies showed that the muscles expressing CaMKIICA had a subtle but significant reduction of compound muscle action potential (CMAP) that could not explain the reduction of contractile force. Single muscle fiber analyses showed that CaMKIICA did not affect action potential-evoked Ca2+ release. Ongoing research is assessing the clinical relevance of CaMKII activation in humans and examining the histological and transcriptomic profiles of muscles with either inhibited or hyperactivated CaMKII to uncover the mechanisms underlying CaMKII-induced muscle dysfunction. Our findings suggest that CaMKII hyperactivation is a driver and potential therapeutic target of sarcopenia.
EFFECTS OF MULTICOMPONENT EXERCISE INTERVENTION ON SARCOPENIA PREVENTION IN COMMUNITY-DWELLING OLDER ADULTS
Authors: Shi Kewei , He Lingxiao , Fang Ya
Published: January 2025

Objective

To assess the effects of multicomponent exercise intervention on sarcopenia and its components among community-dwelling older adults. Design, Setting, and Participants: In a randomized controlled trial conducted in 11 communities across Xiamen, China, with 200 older adults (aged > 65 years) being randomly assigned to an exercise group (n=100) or a control group (n=100).

Interventions

The exercise group followed a multicomponent exercise program, consisting of resistance, balance and flexibility training, twice a week for six months. The control group received monthly sarcopenia-related health education. Outcome measures: The primary outcome was the incidence of sarcopenia. The secondary outcomes included muscle mass, muscle strength (knee extension and grip strength), the Short Physical Performance Battery (SPPB) score, 4-meter gait speed, and 5-time chair stand test (CST) performance. Generalized mixed-effects model was performed for primary outcome comparison between two groups. Repeated measures ANCOVA was performed to evaluate the effects on secondary outcomes.

Results

The exercise group showed a decrease of 4.3% on the incidence of sarcopenia after 6-month intervention, with no significant difference from the control group (P=0.171). The exercise group demonstrated significant improvements in knee extension (β=1.95, 95% CI [0.082, 3.84]), grip strength (β=2.07, 95% CI [0.857, 3.290]), SPPB score (β=1.99, 95% CI [1.600, 2.380]), gait speed (β=0.182, 95% CI [0.128, 0.235]) and CST (β=-1.590, 95% CI [-2.400, -0.786]). No between-group difference was observed in muscle mass (P=0.767).

Conclusion

A 6-month multicomponent training can significantly improve physical function and muscle strength but not muscle mass among community-dwelling older adults.
ASSOCIATION OF HEARING LOSS AND INCIDENT PARKINSON’S DISEASE: A COHORT STUDY IN US VETERANS
Authors: Neilson Lee , Reavis Kelly , Wiedrick Jack , Scott Gregory
Published: January 2025

Parkinson’s disease (PD) is a heterogeneous disease with non-motor manifestations that often precede motor symptom onset. Sensory disturbances such as loss of sense of smell and visual problems are well-characterized, but the impact of hearing loss on PD incidence remains unclear. We undertook an electronic health record-based cohort study of US military Veterans with objective audiogram data (n=3,596,365), using inverse probability of treatment weighting to calculate cumulative incidence of PD, adjusted for competing risk of death and key confounders. Risk difference and 95% confidence intervals (CI) were estimated by hearing loss severity. We also analyzed how this varied when combined with known comorbid conditions and receiving a hearing aid. Results suggest that hearing loss increases the risk of developing PD in a dose-dependent manner; worse hearing confers a higher risk. The number of additional cases of PD per 10,000 person-years at 5-years due to mild, moderate, moderately-severe, and severe-to-profound hearing loss was 2.0 (95% CI: 0.9, 3.1), 5.4 (95% CI: 3.7, 7.1), 5.8 (95% CI: 3.3, 8.3), and 10.6 (95% CI: 4, 17.2), respectively. Hearing loss also synergized with known prodromal disorders, increasing PD risk more than additively. Dispensation of a hearing aid within two years of the audiogram attenuated the risk of incident PD; the reduction in cases of PD per 10,000 person-years at 5-years was -9.2 (95% CI: -10.7, -7.7). Hearing loss appears to be an independent risk factor for development of PD. Widespread screening for hearing loss and appropriate use of hearing aids may attenuate this risk.
ASSOCIATION OF MELANOMA AND INCIDENCE OF PARKINSON’S DISEASE: A COHORT STUDY IN US VETERANS
Authors: Scott Gregory , Neilson Lee , Unni Vivek , Arnold Moriah
Published: January 2025

Melanoma is associated with subsequent Parkinson’s disease (PD) and identifying the clinicopathologic properties of melanoma driving this association could give insight into PD pathophysiology. We undertook a retrospective cohort study of US military Veterans (n=13,737,081) to determine if malignant and premalignant phenotypes were associated with PD by using propensity score matching 4-to-1 and adjustment for competing risk of death and key confounders. Broad cancer categories were obtained from the Oncology VA registry. Data about melanoma were obtained from clinical and pathology reports using manually validated natural language processing. Risk difference and 95% confidence intervals (CI) were estimated by presence or absence of cancer. For broad cancer categories, we found decreased PD incidence associated with multiple malignancies with some novel associations (e.g. HR = 0.4 [0.2,0.5] for myeloma). In terms of melanoma, BRAF and NRAS mutational status was not associated with incident PD. Atypical/dysplastic nevi was associated with increased PD incidence (HR = 1.4 [1.2,1.7]). Melanoma subtypes in the Oncology registry were associated with PD and included superficial spreading type (HR = 1.8 [1.0, 3.3]) and lentigo maligna (HR = 1.6 [1.2, 2.1]). In people with VA pathology reports, this effect was replicated with greater effect size for superficial spreading type (HR = 10.4 [6.5,16.9]) and lentigo maligna (HR = 6.4 [3.4,11.8]) although adjustment for ascertainment bias is needed. These data show PD is associated with melanoma subtypes and precursor lesions and suggest screening for PD could be appropriate in those with melanocytic lesions once early diagnostic tests are developed.
DIFFERENCES IN SELF-CARE AND QUALITY OF LIFE BETWEEN SPOUSES AND ADULT CHILDREN IN PATIENTS WITH PARKINSON’S DISEASE
Authors: Lee Juhee , Kim Eunyoung , Park Hyeran , Kim Kiyeon
Published: January 2025

Self-care of patients with chronic illness involves various caregiver types like spouses, adult children, and other relatives or friends. Several studies have reported differences in self-care and quality of life (QOL) according to caregiver type in patients with chronic illness. Nevertheless, there are few studies comparing the difference by caregiver type in patients with Parkinson’s disease (PD). This is a cross-sectional study to explore differences in self-care and QOL between spouse and adult child caregivers of patients with PD. Participants were recruited from two neurology outpatient departments of the tertiary hospitals in Korea. They reported self-care and QOL using a structured questionnaire. A total of 111 paired of PD patients and caregivers including 83 of spouse and 28 of adult child were analyzed using SPSS 26.0. Spouse caregivers reported higher in domains for self-care of efficacy and monitoring in both patients (p=0.014 to 0.054) and caregivers (p=0.026 to 0.002) compared with adult child caregivers. Patients with spouse caregivers showed better QOL of parkinson symptoms(p=0.008), and emotional function(p=0.003) with the exception of social functioning (p=0.31). Social functioning contained the questionnaire like hobby, vacation, or sexuality. This study finding showed that patients whose caregivers are spouses had better in both self-care and QOL domain than patients whose caregivers are adult children. These differences between spouse caregivers and adult child caregivers can suggest the needs of tailored care strategy for patients with PD according to caregiver type.
BINGE EATING DISORDER AND THE RISK OF SUICIDE IN OLDER WOMEN
Authors: Mendez Therese , O’Hanlon Ann
Published: January 2025

Binge Eating Disorder (BED) is a psychiatric condition marked by repeated instances of excessive food consumption without control. Research on eating disorders tends to focus on younger populations, but recent studies have shown an increasing prevalence of BED in older women. Binge Eating Disorder may pose unique challenges and heightened risks for older women, including an increased potential for suicidality. This review aims to spotlight the critical intersection of binge eating disorder, its prevalence among older women, and the associated risk of suicide. A scoping literature review was done in accordance with the PRISMA-ScR criteria, targeting studies published between 1996 and 2024 on PubMed, PsychINFO, CINHAL, Web of Science, and Google Scholar. The search focused on research pertaining to women aged 40 and above, exploring the association between BED and suicide risk within this demographic. Of the literature surveyed, there were no studies that focused explicitly on the population of interest. Only eight studies met the inclusion criteria for BED and the risk of suicidality in women. These studies show that BED significantly correlates with an elevated suicidality risk, highlighting a complicated relationship that adversely impacts mental health and possible mortality. Despite acknowledging the general risk BED poses for suicidality, the review underscores a concerning scarcity of research dedicated to understanding BED’s prevalence and specific suicidality risk among older women. The findings reveal a need for further research to delve into the nuanced psychological effects of BED on older women and its contribution to heightened suicide risk.
COVID-19 MORTALITY RATES AND CHANGES IN ANTI-DEMENTIA AND PSYCHOTROPIC MEDICATION USE AMONG NURSING HOME RESIDENTS
Authors: Rataj Alison , Alcusky Matthew , Ott Brian , Baek Jonggyu , Liang Shiwei , Lapane Kate
Published: January 2025

Objective. We examined the relationship between nursing home (NH) COVID-19 mortality rates and changes in antidementia and psychotropic medication initiation before and during the pandemic and explored the influence of staffing and resident factors. Methods. Changes in medication initiation were collected through a novel, nationally representative cross-sectional Dementia Treatment Survey (2022) of NH Directors of Nursing. Outcome measures were created by collapsing a 5-point Likert scale contrasting less/about the same vs. more initiation and less versus more/about the same initiation. NH’s peak monthly COVID-19 death rate per 1,000 residents (05/2020-12/2022) was calculated from the CMS COVID-19 Nursing Home data file. Covariates were drawn from NH Compare, Provider of Service, Master Beneficiary Summary, Minimum Data Set 3.0, and Medicare administrative claims files. Adjusted odds ratios (aORs) were estimated from multivariable logistic models. Results. NHs with higher COVID-19 death rates at the peak of the pandemic were less likely to report changes in antidementia medications (aORdecrease: 0.38, 95% CI: 0.15-0.94; aORIncrease: 0.27, 95% CI: 0.08-0.85), but no association with psychotropic medication initiation was observed. NH’s that reported increased resident behavior problems during the pandemic had higher odds of psychotropic initiation (aOR=11.25, CI=3.86-32.83). Discussion. Increased COVID-19 mortality rates were not associated with changes in antidementia medication use during compared to before the pandemic. Increased behavior changes may be due to consequences of COVID-19 (i.e., social isolation); our findings indicate that increased behavior changes were associated with more psychotropic drug use.
MICROBIOME-KIDNEY METABOLISM PROVIDES INSIGHT INTO THE MECHANISM OF ICARIIN ALLEVIATES AGING IN OLDER FEMALE MICE
Authors: Li Xiaoang , Zhang Yiming , Duan Liping
Published: January 2025

The average life expectancy of women in most countries and regions is significantly higher than men’s. Whether in rich developed countries or relatively poor third-world countries, women are more likely to live. Our previous study revealed that Icariin enhances youth-like features by attenuating the declined gut microbiota in older male mice. To further study the mechanism of icariin on delaying aging in older female mice on gut microbiota and metabolism, two age groups of C57BL/6J female mice (8 week- and 24 month- mice) were given a single dose of icariin at 100mg/kg by gavage for 15 days. The 16S rRNA gene pyrosequencing analyzed the fecal microbiome. We observed clear differences in gut microbial profiles between the young and older female mice. Interestingly, while older male mice did not show this effect, treatment with icariin increased the abundance of the short-chain fatty acid (SCFA)-producing bacteria Akkermansia muciniphila and Eubacterium ramulus in older female mice, bringing their levels close to those of untreated young female mice at the species level. Further, we used non-targeted metabolomics technology to detect all metabolites in the kidney. We found that the level of D-serine in the kidneys of older female mice was significantly lower than that of young female mice, and the metabolite levels were significantly increased after icariin treatment. SCFA and D-serine are gut microbial-derived products with kidney-protective properties. This study provides valuable insights into the molecular mechanisms of icariin, highlighting target characteristics and key pathways for slowing the aging process.
OLDER ADULTS’ PERCEPTION TOWARD DEPRESCRIBING INAPPROPRIATE MEDICATIONS
Authors: Rababa Mohammad , Ghazo Ali Al
Published: January 2025

Introduction

Inappropriate prescription of medications is a problem of growing interest in geriatrics. Initiatives have been ongoing to evaluate interventions targeting the hazards of inappropriate prescription of medications; Deprescribing is one of these initiatives. However, no current study has examined medicine-related perceptions toward deprescribing inappropriate medications among older adults.

Methods

A convenience sample of older adults who regularly visited the outpatient clinics during July 2023 for regular checkups were recruited. Data were collected by a graduate nursing student from one pharmacy located in a public hospital, five days per week, via in-person interviews using the Patient’s Perceptions of Deprescribing survey.

Results

The study found that older adults’ perceived interest in stopping medications, belief about medicine overuse, the unimportance of medicines, and medication concerns are significantly associated with a variety of sociodemographic (e.g., age), clinical (e.g., comorbidities), and PCP-related factors (e.g., knowledge of medications).

Conclusion

Inappropriate prescription of medication is one of the most common polypharmacy-related issues among older adults. The current study reported its findings on medicine-related perception toward deprescribing inappropriate medications among older adults. Care providers should discuss the benefits of deprescribing inappropriate medications with their patients to prevent the side effects associated with long-term unnecessary use. The long-term use of inappropriate medications by older adults should be carefully evaluated. Future studies on the effectiveness of an evidence-based deprescribing protocol on minimizing the clinical side effects associated with inappropriate prescription of medications among older adults are recommended.
TOWARD OPTIMIZED CLINICAL TRIALS OF BOTANICAL DIETARY SUPPLEMENTS IN OLDER ADULTS
Authors: Speers Alex , Soumyanath Amala
Published: January 2025

The use of dietary supplements, which includes botanical dietary supplements, is increasingly common among older adults. This is concerning due to a) the lack of high-quality efficacy studies for botanical products, b) issues with product quality and variability, and c) the potential for herb-drug interactions, which is increased in older adults due to higher rates of polypharmacy. Given the growing popularity of these products among consumers, more rigorous data are needed, but a rational, stepwise approach is required. At Oregon Health & Science University (OHSU) and collaborating institutes, a pipeline is being developed to study botanical dietary supplements in an older population. The BENFRA Botanical Dietary Supplements Center at OHSU studies Botanicals Enhancing Neurological and Functional Resilience in Aging, with a focus on two botanicals: Centella asiatica (gotu kola) and Withania somifera (ashwagandha). This work includes product characterization studies, exploration of mechanisms in vitro and in vivo, and the development of methods for measuring plant compounds in plasma. Separate from the BENFRA Center, studies are now underway at OHSU to investigate the safety, pharmacokinetics, and biological signatures of these botanicals in humans. Collectively, this pipeline of research will generate the necessary data to support future optimized efficacy trials in older adults. The presentation will outline the rigorous studies being undertaken and provide preliminary data from these preclinical and clinical investigations.
ACADEMIC DETAILING INTERVENTION: INCREASING TRENDS OF NALOXONE PRESCRIBING IN RURAL ARKANSAS
Authors: Tobey-Moore Leah , Breckling Meghan , Ali Mohab , McAtee Robin
Published: January 2025

This longitudinal study analyzes naloxone prescribing trends of rural primary care providers (PCPs) in Arkansas (AR). As one of the HRSA-funded Geriatric Workforce Enhancement grant recipients, the AR Geriatric Education Collaborative (AGEC) worked with a rural federally qualified healthcare system (ARcare) to reduce the likelihood of patient’s accidental overdose by co-prescribing naloxone, when indicated. A multi-disciplinary Academic Detailing (AD) team of a PT, PharmD and MBBChB conducted AD trainings. AD is clinician-to-clinician customized education connecting recipients to updated evidence and practice guidelines. These interactive telehealth trainings stimulated PCPs to share knowledge deficits and perspectives, encouraged a commitment to increase patient safety and adhere to naloxone prescribing guidelines from Centers for Disease Control and state laws especially during cases when naloxone should be co-prescribed alongside high-risk medications like opioids. ARcare PCPs received “Preventing Opioid Overdose with Naloxone” AD training. Before training, previous naloxone prescribers (group 1) prescribed naloxone 39 times, 106 times in period 1 (P1=11 months post-training), and 91 times in period 2 (P2=22 months post-training), a 14.2% decrease. Group 2 previously did not prescribe naloxone during the baseline period, then prescribed 46 times in P1 and 63 times in P2, a 40% increase. Group 3 did not prescribe naloxone in P1, but prescribed naloxone 13 times during P2. Overall, P1 data from all groups totaled 152 naloxone prescriptions after AD, a 290% increase; in P2, naloxone was prescribed 167 times, a 328% increase. In summary, AD was effective in encouraging naloxone prescribing among prescribers in rural AR.
EARLY DETECTION OF COGNITIVE IMPAIRMENT IN PRIMARY CARE: IMPLEMENTATION CHALLENGES AND OPPORTUNITIES
Authors: Deckert Amy , Chavira Laura , Selzler Katherine , Weyrauch Karen , Murray James , Kurzman Alissa , MacLeod Tim
Published: January 2025

Healthcare systems worldwide are not prepared to adequately address the needs of the 55 million individuals affected by Alzheimer’s and related dementias. A substantial 17 to 20-year lag exists between development of innovations and their widespread adoption, with less than 50% being used in clinical practice (Bauer et al. 2020). In the early stages of Alzheimer’s disease, cognitive impairment often goes unrecognized until later in the disease course, and it can take months or years to reach a diagnosis. Early detection in primary care is a pivotal factor in improving patient outcomes and ensuring timely access to appropriate care and interventions. The Davos Alzheimer’s Collaborative Healthcare System Preparedness (DAC-SP) Early Detection flagship program implemented digital cognitive assessments (DCA) and a blood-based biomarker (BBM) test in diverse primary care or other non-specialty settings across 7 healthcare systems in 6 countries (Brazil, Jamaica, Japan, Mexico, Scotland, US). We conducted a mixed methods evaluation of the process and outcomes of the DAC-SP flagship study guided by the Consolidated Framework for Implementation Research (CFIR; Damschroder et al., 2009) and report here the qualitative findings from the pre-implementation phase. We employed a directive content analysis of transcribed in-depth interviews with clinicians (n=51) and implementation team leads (n=7) across flagship sites. Our findings underscore the critical importance of addressing system-level factors in the design and implementation of DCA and BBM tests in primary and non-specialty care, suggesting that sustainable practice change requires a need to shift the focus from individual to systemic interventions.
PRIMARY CARE PHYSICIAN PERSPECTIVES ON THE INVOLVEMENT OF FAMILY MEMBERS IN THE CARE OF PEOPLE WITH DEMENTIA
Authors: de Jesús Alma Hernández , Brooks-Smith-Lowe Sharifa , Filippi Melissa , Wood Julie , Karliner Leah , Borson Soo , Sideman Alissa Bernstein
Published: January 2025

Involving family is integral to the care of people with dementia. Family medicine’s comprehensive “whole person” approach is ideally suited to this care. We interviewed 18 family physicians across the US to identify ways they involved and communicated with family members throughout dementia diagnosis and care. Interviews were thematically coded using ATLAS.ti. Participants identified several areas in which strong, open, and continuous communication with family made a difference in the care they provided to their patients with dementia: (1) Facilitating early diagnosis. Physicians in our study described the importance of family members in identifying the presence of cognitive impairment, communicating their observations to the physician, and providing information helpful in diagnostic evaluation. They also emphasized the importance of thoughtful communication with the family around disclosure once a dementia diagnosis is made; (2) Goal setting and care planning. Family physicians placed high value on supporting the patient’s quality of life, including prolonging life at home, and supporting patient autonomy. This included discussions about goals of care and intervening in challenging family dynamics; (3) Providing relevant disease education, facilitating access to resources, and acting as an interlocutor with specialists; and (4) Helping the patient avoid preventable hospitalizations by sharing safety measures and teaching family about managing medications and comorbidities. Although family physicians are uniquely suited to care for people with dementia, they also identified challenges to optimal communication: family members can be reluctant to address dementia care problems, and insufficient time, resources, and compensation challenge clinicians to sustain that communication over time.
INTEGRATING THE GERIATRIC 5MS INTO MOVEMENT ANALYSIS AND COLLABORATIVE GERIATRIC PHYSICAL THERAPY
Authors: Hartley Gregory , Miller Kenneth , Quiben Myla , Larkin Marni , Lusardi Michelle , Leach Susan , Gras Laura
Published: January 2025

The Geriatric 5Ms (Matters Most, Medications, Mind, Mobility, Multicomplexity) address complexity of health care for aging adults. The 5Ms are important for physical therapists (PT); members of the health care team concerned with musculoskeletal pain, mobility, and functional capacity. The Academy of Geriatric Physical Therapy, a component of the American Physical Therapy Association, was charged with incorporating emerging movement system science and geriatric care models into a comprehensive PT assessment framework for primary care and initial PT patient encounters. The product, a geriatric movement system assessment framework, incorporates principles of multiple models including the International Classification of Functioning Disability and Health, and other movement-based patient/client management models. Observational movement analysis of key tasks required for safe independent function using the 5M model helps detect needed resources and constraints. Results of movement analysis from the patient examination informed by the 5Ms, impact selection of tests and measures for further analysis of baseline functions. Results allow clinicians to set priorities for targeted interventions addressing body structure/function, activity, and/or participation, and assess outcomes of care. The theoretical basis for this novel approach to movement assessment in aging adults is discussed. Case studies illustrate application of the framework with attention to understanding patient resources as part of intervention strategies. Adoption of the 5Ms into geriatric physical therapy highlights essential geriatric principles and bridges practice across interprofessional teams.
RCT: SPECIALIST NURSE-LED EXERCISE REHABILITATION IN AECOPD- IMPACT ON ENDURANCE AND QUALITY OF LIFE
Authors: Ma Jiahui , Lin Hongjing , Qin Zeyu , Chen Zijing
Published: January 2025

This prospective randomized controlled trial (RCT) evaluates the efficacy of a specialist nurse-led exercise rehabilitation program, grounded in the Patient Health Engagement (PHE) model, for patients with acute exacerbations of COPD (AECOPD). 84 patients with AECOPD were recruited from a Changchun, China, hospital and randomly assigned to intervention or control groups (42 in each). The 12-week intervention featured conventional exercise rehabilitation for the control group and a novel program for the intervention group, incorporating personalized exercise prescriptions led by specialist nurses. Baseline and 3-month post-discharge assessments included 6-minute walk distance (6-MWD) for exercise endurance and SF-36 for quality of life. Participants, with a mean age of 65.70 ± 6.13 years, exhibited severe airflow obstruction (FEV1: 39.48 ± 10.50%) and impaired motor ability (6-MWD: 282.10 ± 92.34m). After 12 weeks of intervention, the 6-MWD in the intervention group was 371.69 ± 65.09m, while the control group was 324.95 ± 74.96m. Both groups demonstrated improved exercise endurance (t1=37.899,95%CI,84.12-97,45,P1 < 0.001;t2=7.766,95%CI,31,60-66.79,P2 < 0.001), yet the intervention group displayed significantly greater enhancement in 6-MWD (90.80 ± 5.36, vs 49.20±14.16, t=-9.537,P < 0.001), indicating clinical significance. Furthermore, the intervention group exhibited higher quality of life scores than the control group, with statistical significance (t=2.988,P<0.05). This RCT underscores the specialist nurse-led exercise rehabilitation program’s effectiveness in enhancing exercise tolerance, improving compliance, and elevating the quality of life in patients with COPD, contributing valuable insights to rehabilitation nursing for patients with COPD.
THE RELATIONSHIP BETWEEN DAY SERVICE UTILIZATION AND THE CARE LEVEL DETERIORATION FOR PEOPLE WITH DEMENTIA
Authors: Yang Liu , Miyae Yamakawa , Aki Sugiura , Reiko Kanaya , Yunfan Wu , Takeya Yasushi
Published: January 2025

In Japan, people diagnosed with dementia are often recommended to use day services (DS). This study aims to evaluate whether DS has a positive impact on preserving the independence of people with dementia in their daily lives.We analyzed 774 individuals aged 65-74, initially certified as care level 2 or below, between 2012 and 2019 from Osaka Prefecture National Health Insurance Database. The baseline was set three years after their initial certification, and the outcome measure was reaching level 3 or higher care levels. This retrospective cohort study categorized subjects into three groups: Group 1 (non-DS users during the exposure period), Group 2 (DS users for over one but less than two years continuously), and Group 3 (DS users for two years or more). Median survival time was not observed for Groups 1 and 2, while Group 3 had a median survival time of 921 days (95% CI 668-1174 days), showing a statistically significant difference among the three groups (Log Rank P< 0.000). In Cox analysis, the presence of fractures (HR = 2.33; 95% CI = 1.07–5.05, P = 0.032) and baseline care level (HR = 2.54; 95% CI = 1.98–3.28, P < 0.000) demonstrated positive correlations with the outcome measure. The results indicate that the use of DS does not effectively slow down the deterioration of care levels in people with dementia. The independence in daily life for people with dementia does not show a positive impact after using DS.
CONNECTIONS: INTERGENERATIONAL DIGITAL STORYTELLING FOR CULTIVATING RESILIENCE ACROSS LIFESPAN
Authors: Ansie Vera , Mbamba Crispin
Published: January 2025

This innovative study used intergenerational digital storytelling to explore resilience and fortitude across cultures. It aimed to develop and evaluate a culturally grounded intervention for synergistically cultivating resilience among older adults and youth through shared narratives and strengthened intergenerational ties. The participatory methods engaged older adult-youth dyads in one U.S. state (n=40) and Ghana (n=38) in a structured process of co-creating multimedia digital stories chronicling personal journeys of perseverance and overcoming hardship, with guided activities fostering reflection, reciprocal empathy, and intergenerational dialogue around resilience themes. Qualitative data from participant narratives, interviews, and observations were analyzed using constructivist grounded theory. Key findings highlighted storytelling’s transformative capacity for transmitting vital coping strategies, life lessons, and cultural wisdom between generations. For U.S. participants, salient themes included reframing challenges through optimism and self-reliance, while Ghanaian narratives emphasized fortitude rooted in spirituality, collectivism, and reverence for older adults’ resilience. Cross-cultural comparisons illuminated how social-ecological context distinctively shapes resilience processes. This study offers a novel, culturally responsive framework for designing intergenerational interventions that synergize resilience by providing hope through shared stories, modeling perseverance across ages, and honoring the fortitude of the human spirit, with implications for adaptation across diverse contexts, resilience theory, lifespan approaches, and culturally-grounded practice promoting well-being across generations.
EVALUATING THE VALIDITY AND QUALITY OF SELF-REPORTED IMPORTANT LIFE ACCOMPLISHMENTS BY ADULTS OVER AGE 50
Authors: Yu Wenshan , Smith Jacqui
Published: January 2025

Bluck (2003) proposed that autobiographical memories function to maintain a sense of fulfillment and well-being. In support of this, studies find that older adults prioritize reporting positive early-life content in life narratives. Questions remain however, about the validity of life narratives and whether content prioritization is observed in non-narrative contexts. We utilized data obtained in the Health and Retirement Study (HRS) Life History Mail Survey (LHMS: N = 10496, M age = 69.5) to ask if the content of participants’ narrative reports about personal life accomplishments was associated with the quality (item of missing rates; IMR) of responses to non-narrative retrospective questions about residential, education, job, marriage, caregiving, and health histories. Content analyses of the life accomplishment narratives revealed 16 topics relevant to autobiographical life history content (interrater reliability=0.921). Compared to HRS participants who did not provide narrative life accomplishments, those who did had higher cognitive status and more years of education (cognitive status OR=1.04, p< 0.001; education OR=1.02, p< 0.001). Multinomial regressions indicated gender-related narrative content differences: whereas men reported career-related accomplishments, women prioritized accomplishments such as children, marriage, and pride in self (OR=6.17 p< 0.001). Linear regressions revealed that when participants mentioned corresponding accomplishments (i.e., about education, career, care for others, health, and marriage), their IMRs significantly decreased in that section, even after controlling for demographic, socioeconomic, and health variables (p < 0.01). This suggests that the validity and quality of life history data is influenced by participants’ attitudes and beliefs about life in addition to their sociodemographic characteristics.
IMPACT OF A TELEPHONE REMINISCENCE PROGRAM ON THE MENTAL HEALTH OF OLDER ADULTS: A RANDOMIZED WAIT-LIST CONTROL TRIAL
Authors: Shellman Juliette , Yang Yuxuan , Graham Cameron
Published: January 2025

There is increasing evidence that social isolation and loneliness have negative effects on the mental health of older adults. Reminiscence is one example of a cost-effective intervention shown to improve mental health and wellness. A double-blinded randomized controlled trial was employed to test the effectiveness of a telephone reminiscence intervention on mental health outcomes in community-dwelling older adults. The telephone-based program (STORII) is designed to provide a service that automatically calls older adults three times a week asking them meaningful questions about their lives. Responses are recorded over the phone and automatically transcribed. Participants in the intervention group received 3 phone calls per week for 6 weeks. The primary outcome, mental health, was measured by the Mental Health Continuum Scale (MHC). After baseline assessment, eligible participants (N=90) were randomized to either the telephone simple reminiscence intervention (n=41) or 6-week wait-list group (n=39). All participants in the wait-list control subsequently received the telephone reminiscence intervention. An ANCOVA model was run to measure the treatment effect of the intervention, controlling for differences in baseline demographic variables between the groups. Results showed a significant improvement in the psychological well-being dimension of the MHC. Findings support of the use of a telephone reminiscence program for improving the psychological well-being dimension of mental health in older adults. Non-significant findings in the social and emotional well-being dimensions may be due to the length of the intervention. No adverse reactions were reported by any of the participants. Clinical trial registry number NCT05977608.
VIEWS ABOUT LIFE AFTER LIFE REVIEW: FROM LIFE REVIEW LEADERS’ PERSPECTIVES IN TAIWAN
Authors: Lin Yi-Hsiu , Kuo Tsuann
Published: January 2025

Guided Autobiography by Birren and Deutchman (1991) was developed and implemented as an evidence-based Life Review Program in Taiwan for over ten years. Using life course perspective, older adults were exposed to weekly topic and guided to reflect their life events. The purpose of this paper was to evaluate the impact on views about life between older adults and their program leaders after a ten-week session. This study used a mixed-method methodology to evaluate the effects of life review program on the leaders’ themselves and the older adults they served. A survey was conducted to ask leaders about the changes in older adults’ well-being, followed by qualitative interviews. Over 80 Life Review Leaders participated in this study with 87.32% were female and over 84.51% with at least a college degree. This program helped older adults communicate with family members and strengthen family bonding as well as having the courage to overcome negative events in life. The participants shared many episodes and observations that they saw older adults used each session to reflect the up and down sides of life. Older adults were able to integrate their past and forsee positive to the future life. In condusion, the structured Life Review Program helps older adults reduced depression and isolation, increased confidence and better views about self. Both clinical and policy implications can be generated to help older adults live life and face the future more positively.
BEYOND FALLS: HOW DO FALL PREVENTION PROGRAMS BENEFIT THE COMMUNITY?
Authors: VanderWerf Jess
Published: January 2025

This mixed methods research investigates the Co-Responder Program in Marion County and the CARES program in Pinellas County, Florida. It assesses their effectiveness in reducing fall-related injuries and mortality among older adults by analyzing community surveys administered to frequent 911 callers who subsequently participated in these programs and data from the counties and the state. The study explores the broader benefits of these programs beyond fall prevention, including their impact on reducing 911 calls and alleviating strain on community resources. In Pinellas County, about 65.22% of participants in the CARES program didn’t make any 911 calls post-enrollment, showcasing its effectiveness. Among those who still made calls, there was a 25.43% reduction in total calls. In Marion County, a sub-sample of 12 individuals used 1,330 hours of the sheriff’s office time for non-emergencies in 2021. Through the Co-Responders Program, there was an impressive 54% decrease in calls from these individuals. Further research is needed to understand the long-term impacts of these programs for the aging population while also standardizing what is and isn’t needed in one of these programs for effectiveness. The implications of this research show a growing need to expand training for first responders as it relates to aging issues as it relates to the potential for education in this research. These programs hold the potential to be implemented nationwide, thus freeing up community resources. However, to realize this future policy direction, a deeper understanding of these programs is imperative.