bluuebunny/crossref_metadata_2025 huggingface dataset:
Social Isolation, Health, and Health Care: Perspectives Among Older Adults Residing in Public Housing
Authors: Sanchez Ruth , Wagen Brooke , Williams Whitney , Jacobs Elizabeth
Published: December 2020

By 2035, U.S. adults > 65 will outnumber children. The growing lack of affordable housing combined with fixed incomes will lead to more older adults residing in public housing. Public housing authorities, in turn, will face growing health and social needs among their residents. In partnership with a local housing authority, we conducted a qualitative study to better understand the health and social needs of older adult public housing residents. We conducted semi-structured qualitative interviews with 27 older adults at two public housing sites in Austin, Texas; we asked about their experience of aging in public housing, their health, healthcare, and community life. Interviews were audio-recorded and transcribed; interviews were systematically coded and verified by a second coder. Themes were identified using comparative analysis. We interviewed 16 females and 11 males (mean age = 71.7 years). We identified three themes. Residents characterized good healthcare as that which is provided by physicians who are consistent educators that listen to residents’ primary concerns. They defined health as being mobile and lacking pain. Finally, they desire more, recurring opportunities to learn about health and connect interpersonally within their housing community; they perceive limited meaningful relationships as a significant contributor to poor health among residents. The older adult public housing residents in our study outlined what good health and healthcare looks like. These themes can be utilized to improve relationships between residents and their healthcare providers. Social isolation can be mitigated through public housing programming that promotes physical and mental acuity.
Cognitively Impaired Old Mice Display Correlated Reduction in Cortical NMDA Receptor and Complex IV
Authors: Thiyagarajan Ramkumar , Redae Yonas , Seldeen Kenneth , Troen Bruce
Published: December 2020

Cognitive decline in older adults represents a major challenge since cognitive impairment is found in 10% of those ≥ 65 and 50% ≥ 85. Thus it is increasingly important to understand the impact of aging on cognitive health. We performed a battery of tests to assess cognition in 6 month-old (n=12) and 24 month-old (n=8) C57BL/6J mice, equivalent to 30 and 70 year old humans, respectively, and also assessed protein markers in cortex for mitochondrial health and cognition. We found that aged mice displayed fewer spontaneous alternations in the T maze test (p=0.034) and lower recognition of novel objects (p=0.022). In addition, aged mice showed prolonged escape time in the Barnes maze (p=0.035), all of which taken together suggest reduced capacity for learning and recall. Aged mice also exhibited diminished nest building (p<0.001), revealing an impaired functional capacity analogous to the instrumental activities of daily living (IADL) geriatric assessment. We found reduced mitochondrial complex IV expression in the cortices of aged mice concomitant with less expression of N-Methyl D-Aspartate (NMDA) receptor subunits 1, 2A and 2B. The cortices from old mice also exhibited greater expression of immature brain derived neurotrophic factor (pro-BDNF). The alterations in NMDA receptors and pro BDNF are consistent with memory impairment and greater neuronal cell death. Therefore, aged mice exhibit significantly reduced recall and learning ability alongside marked alterations in mitochondrial complex, NMDA receptor, and pro-BDNF expression. Studies are underway to assess whether these molecular changes are responsible for the cognitive declines with aging.
A 3-Week Tryptophan-Deficient Diet Resulted in Decreased Body Weight and Increased Trabecular Bone Mass in Mice
Authors: Isales Carlos , Ding Kehong , McGee-Lawrence Meghan , Bollag Wendy , Hill William , Fulzele Sadanand , Awad Mohamed , Hamrick Mark
Published: December 2020

Tryptophan is an essential amino acid with a variety of bioactive metabolites including serotonin, melatonin and nicotinamide. Dietary Trp restriction results in increased lifespan but with detrimental side effects. The initial catabolite in the Trp breakdown pathway, kynurenine, increases with aging and induces bone loss. Thus, we hypothesized that eliminating Trp in the diet of older mice might be osteoprotective. In an IACUC-approved protocol, we fed either 0, 0.2 (standard), 0.7 or 1.25% Trp-containing diets to aged (23-month-old) C57BL/6 mice for a planned eight weeks. There was a rapid decrease in body weight in the mice fed the 0% tryptophan diet and the mice had to be sacrificed at three weeks (25.2±1.4 vs 35.4±3.6 vs 33.9±2.4 vs 33.4±3.1 gm, (Means+SD, No Trp: 0%; Standard Trp 0.2%; High Trp: 0.7%; High Trp: 1.25%, p=0.0004, 0 vs 0.2%, n=9-10/group). Removal of Trp from the diet had a differential effect on bone mineral density (BMD). Total BMD was increased in the low Trp group: (0.0548±0.0017 vs 0.518±0.0021 vs 0.0526±0.0021 vs 0.0524±0.0022, Means+SD, No Trp: 0%; Standard Trp 0.2%; High Trp: 0.7%; High Trp: 1.25%, p=0.016, 0 vs 0.2%). Femoral BMD did not change; however, spinal BMD rose (0.0603±0.005 vs 0.0477±0.06 vs 0.0505±0.005 vs 0.0535±006; Means+SD, Trp 0% vs 0.2%, p=0.00009). The mice on the 0% Trp diet also had lower body fat (22.4±2.3% vs 26.7±3.3%; Means+SD, Trp 0 vs 0.2%, p=0.005). Thus, dietary Trp restriction resulted in a beneficial increase in spinal BMD, though at least in part related to weight loss.
Longevity-Extending MetAP2 Inhibitors Induce Caloric Restriction Through P53-Dependent Induction of GDF-15
Authors: MacArthur Michael , Mitchell Sarah , Jung Jon , Torrence Margaret , Kane Alice , Mehmet Huseyin , Manning Brendan , Mitchell James
Published: December 2020

MetAP2 is a 67kDa protein which sits at the translation initiation complex and cleaves N-terminal methionine off of nascent peptides. Inhibitors of MetAP2 cause profound weight loss secondary to decreased food intake. These inhibitors also significantly extend longevity in mice in late-life intervention. However, the exact mechanism of action causing decreased food intake is not known. Here we investigated the molecular mechanism and target tissue of a MetAP2 inhibitor’s (Zgn1062) anorectic effects. First we identified the target tissue by testing targeted Zgn1062 delivery to specific brain regions. Delivery to the medio-basal hypothalamus did not have a significant effect but delivery to the lateral ventricle resulted in significantly decrease food intake and body weight after 2 and 14 hours. When we delivered a neuron-targeted AAV encoding MetAP2 shRNA we saw decreased efficacy of MetAP2 confirming the required for neuronal MetAP2 for anorectic effects. To determine the molecular mechanisms we performed RNAseq of wildtype and MetAP2 KO HT1080 cells across a timecourse of Zgn1062 treatment. The main pathway activated across timepoints in MetAP2-dependent manner was P53 signaling. A main P53 target that was upregulated was the known anorectic peptide GDF15. We confirmed GDF15 increases in vivo at both mRNA (liver and intestines) and protein level (serum) in response to Zgn1062. We also found that Zgn1062 treatment reduces senescent cell burden in visceral adipose tissue in vivo and reduces SASP gene expression in fat explants ex vivo. We hypothesize that Zgn1062’s potent P53 activation may play a role in clearance of senescent cells.
Mitochondrial Dysfunction and Cellular Senescence Due to Aging Contributes to Prostatic Fibrosis
Authors: Liu Teresa , Ricke Emily , DeFranco Donald , Ricke William
Published: December 2020

Aging is the single largest risk factor for many common diseases that burden public health. This is especially true in the prostate; as men age, the prostate undergoes a prototypical aging change, fibrosis. The aged fibrotic prostate causes urinary symptoms which will afflict nearly every man if they live long enough. However, the molecular mechanisms responsible for the aging-dependent promotion of fibrosis are largely unknown and understudied. In this study, we sought to reveal the contribution of mitochondrial dysfunction to fibrosis in the aging prostate, ultimately leading to prostate dysfunction, urinary symptoms, and overall poor health. The demise of mitochondrial function is well established in other aging-associated diseases but has not been investigated in the prostate. Our analysis revealed an increase in cellular senescence and mitochondrial dysfunction in BPH patient tissue compared to normal prostates. Furthermore, selective inhibition of mitochondrial complex I by rotenone in cultured human prostate fibroblasts led to myofibroblast phenoconversion as characterized by increased expression of Col1a1, Col3a1, and ACTA2. To determine the contribution of mitochondrial dysfunction on fibrosis and lower urinary tract dysfunction (LUTD), we examined the prostate lobes in both aging and steroid-induced LUTD in mice. These models have been extensively characterized and exhibit an age-mediated increase in LUTD and fibrosis. We observed a decrease in mitochondrial function and an increase in cellular senescence corresponding to an increase in fibrosis and LUTD. This suggests that normal aging-dependent reductions in mitochondrial complex I function in the prostate may promote fibrosis and contribute to urinary dysfunction.
Nursing Staffing Is Associated With Mobility and Food Intake in Older Hospitalized Patients
Authors: Tonkikh Orly , Shadmi Efrat , Zisberg Anna
Published: December 2020

Hospitalization processes related to patient mobility and food-intake significantly affect outcomes of older adults. Nurses are the front-line personnel responsible for promoting performance of these functioning-preserving processes. The degree to which nursing skill-mix is related to their performance is unclear. We investigated the association between staffing and hospitalization processes in a cohort of 836 older adults aged 70+ admitted to internal units for non-disabling conditions. Mobility and food-intake were assessed within 2 days of admission using validated questionnaires. Nurse-patient ratios and nursing skill-mix (i.e. registered nurses, nurse aides, and advanced practice nurses) were assessed using administrative and payroll/roster data. Decision-trees were developed for mobility and food-intake applying classification and regression tree analysis. The mobility decision-tree identified four characteristics that subdivided the patients into eight segments (nodes) (pre-admission functioning, sex, malnutrition risk and percent of advanced practice nurses). The food-intake decision-tree identified five characteristics (pre-admission functioning, sex, chronic morbidity, age and percent of nurse aids) that subdivided the patients into ten nodes. Percent of advanced practice nurses and the percent of nurse aids classified low functioning patients: higher percent of advanced practice nurses (>30% vs. ≤30%) was associated with higher probability of walking in corridors (20.7%) versus inside the room (4.3%), and higher percent of nurse aids (>23% vs. ≤23%) was associated with higher probability of eating more than half of the served meals (83.9%) versus others (66.3%). This study shows that staffing levels are associated with better performance of functioning-preserving processes. Future studies should investigate staffing interventions improving functioning-preserving processes.
Dietary Acid Load, Past Smoking Intensity and Mortality Among Breast Cancer Survivors
Authors: Wu Tianying , Hsu Fang-Chi , Pierce John
Published: December 2020

Cancer survivors are at accelerated risk of aging and more susceptible to unhealthy diets and lifestyles than people without cancers. However, current dietary guidelines for cancer survivors not quite different from that for general healthy population. Further, these guidelines are not specific for cancer survivors who are past smokers. Acid-producing diet can accelerate aging and stimulate cancer development if acid-base balance is not regulated properly. Cancer survivors and past smokers have reduced capacities to adjust acid-base balance. Thus, we conducted prospective cohort analyses among 2950 early-stage breast cancer survivors who enrolled in the Women’s Healthy Eating and Living study and provided dietary information through 24-hour recalls at baseline and during follow-up. We assessed dietary acid load using two common dietary acid load scores, potential renal acid load (PRAL) score, and net endogenous acid production (NEAP) score. We assessed past smoking intensity by pack-years of smoking. After an average of 7.3 years of follow-up, there were 295 total death, and 249 breast cancer-specific death. Increased PRAL and NEAP scores were positively associated with total mortality and breast cancer-specific mortality (p for trend <0.1 for PRAL and <0.01 for NEAP). Further, dietary acid load and pack-years of smoking had joint positive associations with mortalities (Comparing the highest to the lowest categories, risk increased by 2.5-3 times; P for trend <0.01 for both PRAL and NEAP). Our study provides valuable evidence for adding dietary acid load to dietary guidelines for breast cancer survivors and developing specific guidelines for past smokers.
Behaviors Characteristic of Autism Spectrum Disorder in Older Adults With Cognitive Impairment
Authors: Rhodus Elizabeth , Barber Justin , Abner Erin , Bardach Shani , Rowles Graham , Jicha Gregory
Published: December 2020

Autism spectrum disorder (ASD) is commonly recognized by the time of adolescence, but is poorly understood in older adults. The possibility of late-life emergence of ASD has been poorly explored. In order to investigate late-life emergence of behaviors characteristic of ASD in MCI and AD, we surveyed caregivers of 142 older adults with neurodegenerative cognitive impairment using the Gilliam Autism Rating Scale-2. Participants with high autism index ratings (Autism ‘Possible/Very Likely’, n=23) reported significantly (statistically and clinically) younger age at onset of cognitive impairment than those who scored in the Autism ‘Unlikely’ range (n=119): 71.14±10.9 vs. 76.65±8.25 (p = 0.034). Additionally, those in Autism ‘Possible/Very Likely’ group demonstrated advanced severity of cognitive impairment, indicated by Clinical Dementia Rating Scale Sum of Boxes scores. Data demonstrate that ASD behaviors may appear de novo of degenerative dementia and such behaviors are more prevalent in those with early onset dementia. Further work elucidating a connection between ASD and dementia could shed light on subclinical forms of ASD, identify areas of shared neuroanatomic involvement between ASD and dementias, and provide valuable insights that might hasten the development of therapeutic strategies.
Recognizing Healthcare Needs Among Older Adults With Dementia and With Migrant Background
Authors: Ramos Mary Dioise
Published: December 2020

Dementia, a syndrome affecting millions of people worldwide, can be challenging, especially in patients with a migrant background. Language barriers and language-based diagnostic tools, cultural differences in the perception of the syndrome as well as restricted access to healthcare can influence medical care. Healthcare providers play a key role in diagnosing persons with dementia and they are in the best position to raise awareness about dementia among older adults. They examine a large number of patients and are generally the first point of contact for people with any health complaints. Therefore, they are able to identify treatable causes of the syndrome at an early stage to prevent irreversible health impairment. This study investigates whether health care providers feel prepared to meet the diagnostic needs of these patient groups and whether there are challenges and support needs. A cross-sectional study is used in this study among a random sample of healthcare providers. Healthcare providers experienced barriers especially the uncertainties in identifying dementia in patients with a migrant background. Language barriers that affected or prevented diagnostics and information deficits in patients with a migrant background were the most frequently reported barriers. Lack of acceptance of the syndrome was also common. Public health measures supporting healthcare providers in their interaction with a migrant background patient as well as information and services for patients with dementia are needed. Efforts to facilitate access to interpreting services and to focus on people with a migrant background in healthcare are necessary.
A Practical Protocol for Reporting Depressive Symptoms in a Clinical Trial of Grandmother Caregivers
Authors: Wallace McKenzie , Jeanblanc Alexandra , Musil Carol
Published: December 2020

Intervention studies conducted in caregivers often focus on improving mental health. Consequently, researchers may discover incidental findings like elevated depressive symptoms. Researchers have an ethical obligation to report incidental findings to participants, but no protocols exist for reporting behavioral health symptoms. This presentation describes a protocol for reporting elevated depressive symptoms to participants, based on the protocol used in a national randomized clinical trial of stress-reduction methods for 348 grandmothers raising grandchildren. Each questionnaire included the CES-D scale and was scored immediately after completion. Based on our previous work showing higher CES-D scores in custodial grandmothers, and the desire to balance the principles of beneficence and nonmaleficence, we established a cut-off score of 30. A registered nurse on the research team called participants with scores over 30 and ascertained whether the participant 1) was aware of the problem and 2) had sought help, and then offered additional resources. Overall, 94 (27%) participants had a CES-D score > 30. The majority (91%) were aware of the problem. About a third of the participants were on medication for their symptoms, and a third were seeing a therapist. Nine participants were not aware they had depressive symptoms. While most of our participants were aware of their depressive symptoms, they were appreciative of our call and several noted that they would speak to their provider. Future studies should consider how to implement a similar protocol to deliver information critical to the mental health of participants.
Depressive Symptoms Longitudinally Mediate the Negative Effects of HbA1c on Memory Change Over 6 Years
Authors: Kraal A Zarina , Ellingrod Vicki , Zahodne Laura
Published: December 2020

Elevated glycated hemoglobin (HbA1c) has been associated with worse episodic memory in Type 2 diabetes. Prospective links between HbA1c and incident depressive symptoms suggest that behavioral mechanisms may underlie this association. Elevations in HbA1c may lead to depressive symptoms via biochemical changes directly caused by Type 2 diabetes or through distress associated with managing the treatment demands of the disease. This study aimed to determine whether depressive symptoms longitudinally mediate associations between HbA1c and episodic memory over 6 years. Participants (N=2,155) comprised adults aged 51+ with self-reported Type 2 diabetes and clinically elevated HbA1c (≥5.7%) at the time the Health and Retirement Study initiated blood collection. A longitudinal mediation model quantified associations between baseline HbA1c and 6-year change in episodic memory through 4-year change in depressive symptoms, controlling for baseline socio-demographics, other health conditions, and medication adherence. HbA1c was assayed from dried blood spots. Depressive symptoms were self-reported twice over four years. Episodic memory, assessed three times over six years, was a z-score composite of immediate and delayed recall of a word list. Increased depressive symptoms four years after baseline partially mediated the negative association between baseline HbA1c and 6-year memory decline. Depressive symptoms partially mediated the concurrent association between HbA1c and memory at baseline. This longitudinal study provides evidence that the deleterious effects of HbA1c on subsequent episodic memory may operate partly through behavioral mechanisms. Depressive symptoms may represent a critical target for interventions to reduce the enduring negative effects of hyperglycemia on memory aging in Type 2 diabetes.
Trajectories of Depressive Symptoms in Community-Dwelling Korean Older Adults
Authors: Shin Jinhee , Cho Eunhee
Published: December 2020

Objectives This study aimed to identify trajectories of depressive symptoms and investigate predictive variables of latent class in Korean community-dwelling older adults. Methods Study participants comprised 2,016 community-dwelling Korean adults aged over 65 years, using data from the Korean Longitudinal Study of Aging (KLoSA) from 2006–2016. The KLoSA, a nationally representative panel survey, has been conducted biannually since 2006. We used latent class growth analysis to identify depressive symptom trajectories. Multinomial logistic regression analysis was conducted to identify predictors of each class of depressive symptoms. Results Five depressive symptom trajectory groups were identified: Class 1, no depressive symptom (13.8%); Class 2, low depressive symptom (32.8%); Class 3, decreasing depressive symptom (10.6%); Class 4, increasing depressive symptoms (24.0%); and Class 5, persistent depressive symptoms (18.8%). We found that older adults followed five distinct depressive symptom trajectories over 10 years. Mini-Mental State Examination scores, number of chronic diseases, educational level, gender, current employment, contact with children, and social activity were associated with a higher risk of these trajectories. Conclusions Depressive symptoms are associated with social networks as cognitive function scores increase and number of chronic diseases decrease. Interventions to strengthening existing social networks and developing relationships should be tailored to target specific needs for each trajectory, and chronic disease management, including cognitive function, may be beneficial in preventing depressive symptoms among older adults. KEYWORDS Older adults, Depressive symptom, Trajectory, Latent class growth analysis, Korean
Functional Correlates of Self-Reported Energy in the Health, Aging, and Body Composition Study
Authors: Ehrenkranz Rebecca , Rosso Andrea , Sprague Briana , Tian Qu , Simonsick Eleanor , Glynn Nancy , Rosano Caterina , Gmelin Theresa
Published: December 2020

While fatigue in older age is well studied, the clinical relevance of maintaining higher energy late in life is less understood. We explored associations of self-reported energy with cognitive performance, depressive symptoms, and physical function in the Health, Aging and Body Composition study (n=2,529, mean age =75.9, 63.5% white, 44.9% men). Self-reported energy over the past month was recorded from 0-10 (least to most energy) and dichotomized at the median (≥7=high energy). Cognitive performance was measured using Modified Mini-Mental State Examination and Digit Symbol Substitution Test. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression scale. Physical function was assessed via fitness (timed 400-meter walk), self-reported physical activity, and usual and rapid gait speed. Variables bivariately associated with energy entered a logistic regression model with higher energy as the outcome, adjusted for demographics, chronic conditions, strength, and body mass index (BMI). Overall, 58% of the sample reported high energy, and self-reported energy was greater for males and those without chronic conditions (p<0.05). Lower odds of higher self-reported energy were found for participants with more depressive symptoms (aOR 95% CI= 0.55 [0.50, 0.62]) and longer time to walk 400m (aOR = 0.79 [0.70, 0.89]). Increased odds of higher self-reported energy were found for participants with faster usual and rapid gait speeds (aOR = 1.3 [1.2, 1.5]; aOR = 1.2 [1.1 – 1.4], respectively). Associations with cognitive performance were not significant. Higher self-reported energy reflects fewer depressive symptoms and greater physical function independent of demographics, chronic conditions, strength, and BMI.
Predicting Life Expectancy Using Veterans Affairs Electronic Health Record Data
Authors: Lee Alexandra , Jing Bocheng , Jeon Sun Young , Boscardin John , Lee Sei
Published: December 2020

Electronic health records (EHRs) are a rich source of health data that could be used to create individualized life expectancy predictions to aid in clinical decision-making for long-term preventative treatments, such as cancer screening. Few previous studies have incorporated all possible predictors from the EHR. We aimed to screen and incorporate a large number of possible predictors from EHR data into a life expectancy (LE) prediction equation. Using the national Veteran’s Affairs (VA) EHR databases, we identified all patients aged 50+ with a primary care visit during 2005 and assessed demographics, diseases, medications, laboratory results, healthcare utilization, and vital signs during the one year prior to the visit. Mortality follow-up was complete through 2017. We used an 80% random sample for model development and a 20% random sample for model validation. We used a Gompertz survival model with backwards selection to identify approximately 100 variables for the final LE prediction equation. In 1,263,595 VA patients, the mean age was 68 years and the majority were male (94%) and white (87%). During 12 years of follow-up, 602,576 (47.7%) died. Of 930 predictors from the EHR, 99 were included in the LE prediction equation. Harrell’s C-statistic was 0.7705 (95%CI: 0.7693, 0.7718). The model estimated 10-year life expectancy with sensitivity of 81.6% (81.4%, 81.8%) and specificity of 68.8% (68.5%, 69.1%). In conclusion, we developed an LE prediction equation from hundreds of predictors in the VA EHR with good discrimination and calibration that may help clinicians weigh the potential benefit of long-term preventative treatments.
Frailty, With or Without Cognitive Impairment, Is a Strong Predictor of Future Recurrent Falls
Authors: Ge Meiling , Xue Qian-Li , Simonsick Eleanor , Dong Birong , Kasper Judith
Published: December 2020

The associations between physical frailty and cognitive impairment with falls history are well-established. However, their associations with prospectively ascertained recurrent falls are unknown. We used data from the National Health Aging Trends Study (NHATS) and marginal means/rates model to analyze the associations between frailty and cognitive impairment and recurrent falls over 6 years (2012-2017). Of the 6,000 older adults, 1,787 (29.8%) had cognitive impairment only, 334 (5.6%) had frailty only, 615 (10.3%) had both, and 3,264 (54.4%) had neither. At baseline, compared to the group without cognitive impairment or frailty, individuals with both frailty and cognitive impairment were more likely to have a history of falls (odds ratios (OR)=2.48, 95% confidence interval (CI)=1.98-3.11), followed by those with frailty only (OR=1.53, 95% CI=1.19-1.97), and those with cognitive impairment only (OR=1.22, 95% CI=1.05-1.41), after adjusting for age, sex, race, education, living alone, obesity, comorbidity, and mobility disability. In longitudinal analysis, those with frailty and cognitive impairment alone or together at baseline had higher rates of recurrent falls than those without cognitive impairment or frailty (cognitive impairment only: rate ratios (RR)=1.07, 95% CI=1.00-1.13; frailty only: RR=1.31, 95% CI=1.18-1.44; both: RR=1.28, 95% CI=1.17-1.40). The risk appeared to be comparable between those with frailty alone or those with frailty and cognitive impairment. These findings offered robust evidence for a strong predictive association between frailty and recurrent falls in non-institutionalized older adults, and the association remained strong with or without comorbid cognitive impairment.
Social Determinants and Frailty in High-Need, High-Risk Veterans
Authors: Muralidhar Kiranmayee , Valencia Willy Marcos , Tang Fei , Dang Stuti
Published: December 2020

The VA Geriatrics and Extended Care Data Analysis Center uses national predictive modelling to identify High-Need High-Risk (HNHR) Veterans, to provide targeted services and reduce hospitalization and institutionalization risk. To learn the needs of Miami VA HNHR Veterans, we mailed a needs-assessment survey to 2124 Veterans, of whom 634 responded (29.8% response rate). The average respondent age was 70.5±9.2. Among them, 127(20%) were <65 years old, 326(51.4%) were 65-74, and 179(28.2%) were ≥75; 389(61.4%) White, 225(35.5%) Black/African Americans; 515(81.2%) were Non-Hispanic, 111(17.5%) Hispanic/Latino; 173(27.3%) were high school graduates, 350(55.2%) had at least some college credit, 39(6.2%) had a master’s degree or more and 536(84.5%) were health literate. As per Morley’s FRAIL scale, 266(42%) were frail, 242(38.2%) were pre-frail and 87(13.7%) were robust. Social risk factors possibly associated with frailty were analyzed using ordinal logistic regression. Univariate analysis showed significant association with poor health literacy, having a caregiver, social isolation, transportation trouble, delayed or missed doctors’ appointments due to transportation, a negative perception of aging, likelihood of depression, being homebound, inability to use the internet, lack of technology for video conferencing and lack of email use (p≤0.01). Through multivariate ordinal logistic regression analysis, adjusting for patients’ age and Jen Frailty Index, we found that the same social risk factors other than internet use showed significant association with frailty (p≤0.01). HNHR Veterans have complex social needs with a limited ability to manage their chronic conditions, necessitating interventions that address not only their medical issues but also their access barriers and social support.
Medicare Annual Wellness Visit for Nursing Home Residents
Authors: Malmstrom Theodore , Little Milta , Sanford Angela , Berg-Weger Marla , Morley John
Published: December 2020

The 2010 Patient Protection and Affordable Care Act includes the Annual Wellness Visit (AWV) for older adult (OA) patients. Medicare pays for an initial AWV per beneficiary and subsequent visits annually. Many Medicare beneficiaries have not taken advantage of the AWV preventive health benefit. The Saint Louis University Geriatrics Workforce Enhancement Program (GWEP) developed an AWV for OA, NH residents. This project describes the NH AWV and reports results. Data include age, gender, comorbidities, medications, hospitalizations, depression, frailty, pain, sarcopenia, sensory impairment, cognition, nutrition, smoking, falls, and advance directives. Two suburban academic for-profit NHs are included in this study (2016-17). OA NH residents (N=247) completed an AWV and 36.8% (n=91) had a 1-year follow-up AWV. OA NH residents were female (n = 177, 71.7%) and a majority ages 75+ (n = 172, 69.7%). Most (96.3%) had a documented advance directive. Comorbidities (7.8±2), polypharmacy (92.3%), vision impairment (52.8%), hearing impairment (52.8%), depression (65.2%), frailty (75.7%), sarcopenia (84.4%), risk of weight loss (53.9%), MCI (11.7%), and dementia (75.8%) were prevalent. Among OA NH residents (n=91) with an AWV follow-up, there was modest worsening in total comorbidities and medications as well as frailty, sarcopenia, and cognition scores (ps≤0.05). Pain, depression, and nutrition did not change. To our knowledge, no one has specifically analyzed the Medicare AWV in NHs. Data from the traditional AWV is an extension of the routine clinical care of OAs and therefore could also be useful for healthcare professionals focused on providing care to OA patients in the NH setting.
Research on the Relationship of the Organization Capacity and Job Satisfaction in Nursing Homes
Authors: Liao Lulu , Chen Huijing , Zhao Yinan , Ning Hongting , Feng Hui
Published: December 2020

Objective: To explore the occurrence of organization capacity and to examine the relationships among the organization capacity and job satisfaction in nursing homes in China. Methods: A total of 577 participants in sixteen nursing homes in Hunan province of China were enrolled using a cluster randomized controlled trial. Staff job satisfaction was measured by Minnesota Satisfaction Questionnaire(MSQ) in short form, nursing homes’ organization capacity was assessed by Shortell’s Organization and Management Survey. One-way analysis of variance examined differences between variables. The relationship and correlation of organization capability, MSQ total score and scores in each dimension was analyzed. Results: Overall score of nursing homes’ organization capacity was 99.5±8.6(level ranking, 21–105), and MSQ score was 78.2±8.2 (level ranking, 20–100). Staff job satisfaction levels were significantly different among nursing staffs with different levels of organization capability (F=9.40, P＜0.001). Correlation analysis showed that organization capability level was positively correlated with staff job satisfaction (r=0.52, P< 0.001). And Correlation analysis showed that Working conditions (r = 0.46, P < 0.001), Leaders (r = 0.46, P < 0.001), Responsibility (r = 0.51, P < 0.001) and External reward (r= 0.42, P < 0.001) were positively associated with organization capability. Conclusion: The organization capability can be improved by active staff job satisfaction. But the job satisfaction of nursing staffs was at a moderate level. Thus effective measures such as creating a supportive work conditions, appointing suitable leaders, enhancing responsibilities and providing external reward should be considered by nursing managers to promote organization capability in nursing homes.
Contraction Type Influences Critical Ages for Declines In Lower Body Specific Force in Women Ages 20 to 89 Years
Authors: Miller Ryan , Freitas Eduardo , Heishman Aaron , Bemben Debra , Bemben Michael
Published: December 2020

The ability for a muscle to produce force relative to its size, specific force, is an important characteristic for healthy aging. Few studies have identified the influence that different muscle groups or contraction types may have on the onset of declines in specific force. Therefore, the aims of the current study were to identify critical ages for changes in upper (quadriceps and hamstrings) and lower leg (soleus and tibialis anterior) specific force and to determine if the onset of decline is influenced by contraction type (isometric or dynamic) in women aged 20 to 89 years. One-hundred and fifty-two women (47.1±17.7years, 164.2±7.0cm, 67.1±10.7kg) matched for physical activity with approximately 10 participants per five-year interval (20-24, 25-29years, etc.), were included in the present analysis. Specific force was calculated from peak torque values measured from isometric (ISOM) or isokinetic testing (60deg/s and 240deg/s) and made relative to muscle area measured by peripheral quantitative computed tomography. An iterative segmental modelling approach was performed to identify critical age periods for changes in specific force. For the upper leg, ISOM and 60deg/s specific force was maintained across the lifespan, whereas 240deg/s revealed a critical age of 35.2±5.3years. Critical ages were identified for all contraction types for the lower leg and occurred earlier with increasing velocity (ISOM: 63±6.6years, 60deg/s: 53.9±4.5years, and 240deg/s: 49±3.9years). These data suggest that muscle groups of the leg do not display uniform changes across different contraction types and that high velocity contractions display earlier declines across the lifespan.
Effect of a Tai Chi-Based Exercise Program on Cognitive Function Among Older Adults With Dementia
Authors: Song Rhayun , Park Myonghwa , Jung Misook , Kim Hyun Li , Lee Hanna
Published: December 2020

Cognitive function with dementia is strongly associated with physical function decline. A low intensity aerobic exercise, such as Tai Chi, may help either prevent or slow down cognitive impairment. This study aimed to examine the effect of Tai Chi-based exercise program on cognitive function among older adults with early dementia. Individuals registered at the Dementia Support Center were invited to participate in the Tai Chi-based exercise program twice a week for one-hour session for 20 weeks. The comparison group with the same inclusion criteria but not participated in any formal exercise program were recruited by matching with age, education, and pre-cognitive function. Cognitive function (MOCA-K) was measured at the pretest and at the completion of the study period. Fifty-two older adults with dementia (29 in Tai Chi group, 23 comparisons) with the mean age of 80.5 years completed all measurements. All participants had at least one chronic disease. About 50% of the participants received no formal education. At the completion of the study, Tai Chi group improved their cognitive function, while their counterpart remained similar in their MOCA-K score, specifically in attention (F=5.21, p=.027) and short term memory recall (F=6.66, p=.013). In conclusion, Tai Chi-based exercise program was safely and effectively applied to older adults with early dementia. The participants were able to follow the movements with the attendance rates of 80% during the study period. Further studies are warranted to explore the relationship between physical exercise and cognitive function in this population with various types of cognitive impairment.
A Rural Tele-Video Model: Results From Educating Practitioners About Opioids and Alternative Pain Management
Authors: Tobey Leah , McAtee Robin , Hayes Corey
Published: December 2020

Providers in Arkansas wrote 105.4 opioid prescriptions for every 100 persons in 2017-nearly twofold greater than the average U.S. rate of 58.7 opioid prescriptions (CDC, 2017). This makes AR the second highest opioid prescribing state. AR-IMPACT (Arkansas Improving Multi-Disciplinary Pain Care and Treatment) is a tele-video case conference education model which was designed to improve AR providers’ knowledge and behavior in pain management and improve awareness of opioid-sparing alternatives. Conference panelists include a geriatrician, psychiatrist, physical therapist, psychologist, pharmacist, a chronic pain specialist and various guest speakers such as the Arkansas Drug Director. During weekly tele-video conferences, relevant actionable cases were presented regarding treating diverse patients who have chronic pain. AR-IMPACT provided hundreds of practitioners with up-to-date data and education regarding opioid use and misuse, methods and resources regarding titrating and eliminating opioids, and viable alternative pain-management solutions such as motivational interviewing and dry-needling. This poster will present the background of the opioid crisis in rural Arkansas followed by the specifics of the development and application of the AR-IMPACT tele-video model. Specific older adult cases studies, quantitative and qualitative outcomes, feedback from presenters and participants, and lessons learned will be reviewed. Specifically, lessons learned center around the practitioners’ culture of pain management and how that culture must evolve and change. New methods of pain management must be taught to practitioners and patients and adopted as the new norm. This will demonstrate that programs like AR-IMPACT are crucial in helping make that cultural change happen.
A Scoping Review of Current Telehealth Interventions for Care Partners of Persons With Dementia
Authors: Tran Leslie , Tarter Robin , Lindauer Allison
Published: December 2020

Many burdens come with caring for someone with dementia, but telehealth interventions can provide information and support and reduce barriers to access. In this review we describe current telehealth interventions for family care partners of people diagnosed with Alzheimer’s disease or related dementias (ADRDs). We conducted a systematic literature search using PubMed. Inclusion criteria were peer-reviewed, data-based research articles focusing on technological clinical interventions, published within the past two years, with participants providing unpaid care to persons with a diagnosis of ADRDs. We identified 53 relevant articles, of which 13 met our criteria. Included studies fell into three categories: peer support groups facilitated by gerontological social workers and psychologists, psychoeducation and behavior modification interventions delivered by nursing professionals, and symptom management advising overseen by physicians. Different technologies were used including computers, iPads, smartphones, and smartwatches. The duration of interventions also ranged from four weeks to three months, representing varying approached to participant engagement. The majority of caregivers were women, non-Hispanic white, spouses. Based on our findings of a lack of diversity in the samples of extant studies, and the need for interventions tailored to specific stages of ADRDs, future researchers can design studies to address these gaps. Overall, the interventions’ effectiveness and participant satisfaction were high, resulting in improvements in burden, competence, and coping skills. Although every approach has its own strengths and weaknesses, we believe that the continued expansion of telehealth interventions will not only offer many benefits, but also transform the delivery of health care.
Feasibility to Train Older Adults in India to Use Smart-Phone to Increase Participation in Daily Activities
Authors: Das Asish , Sethi Amit
Published: December 2020

Though 60% of 104 million older adults own a smart phone in India, up to 85% of these individuals find challenging to use smart-phone during daily activities. This is problematic because inability to use smart-phone limits their ability to participate in daily activities such as, managing their health, paying bills, shopping and communicating with their loved ones, resulting in social isolation and dependence on others. The purpose of this study was to examine the feasibility of training older adults to use smart-phone to increase participation in daily activities. This preliminary study was conducted over two phases. In phase-I, we used the principles of stakeholder engagement to interview 12 older adults to identify the barriers associated with the use of technology using a brief survey. Based on the results of Phase I, we implemented a single education and training session for 42 participant (> 60 years) in using smart-phone based applications in Phase II. Older adults were trained to use smart-phone based applications to manage money using banking apps, pay bills, shop, manage health to monitor vitals and medications and communicate with their loved ones. All participants rated their satisfaction with the program, 70% participants showed the ability to use the applications independently. Seventy five percent rated the program extremely useful, and 70% rated it extremely relevant to them. It is feasible to train older adults in using smart-phone based applications. Future studies need to focus on providing follow-up sessions to increase retention and carry-over to increase participation in daily activities.
IT Is Not for Me: Why Age Matters in Technological Innovation
Authors: Blackberry Irene , Wilding Clare
Published: December 2020

During 2017-2019, we conducted a randomized stepped-wedge cluster trial of an online program to increase ease of access to information and support for caregivers of a person living with dementia in rural Australia. The program, called Virtual Dementia Friendly Rural Communities (Verily) Connect, was innovative; it consisted of a custom-designed website and mobile application (app) in Android and iOS, use of videoconferencing for peer support, chat forum and use of volunteers to build technological skills and confidence for online users. The program overcame barriers experienced by rural Australian caregivers, particularly geographical distance from services and other caregivers, stigma, and lack of localized supports. Although participants identified that Verily Connect program afforded several benefits, including increased flexibility in accessing support, easier access to localized dementia-related information, and more opportunities for attaining support, uptake of the program was disappointingly low. A strong theme in the program evaluation, which used the Consolidated Framework of Implementation Research, was that although the program was perceived as advantageous, adaptable, of high quality, and easy to implement, engaging participants failed because the target users, people over 65 years, eschewed involvement with online technology. Our future research plans include finding ways to offer hybrid online/face-to-face support programs specifically designed for older adults, so that older adults have equitable opportunities to access technological innovations. Older adults ought not to be disadvantaged because it is difficult to keep pace in a rapidly changing world.
Using Wearable Sensors to Remotely Evaluate Progress on Goals Set by Patients With Dementia
Authors: Freytag Jennifer , Zhou He , Dindo Lilian , Naik Aanand
Published: December 2020

Patient Priorities Care (PPC) is a communication framework designed to facilitate priorities-based conversations between clinicians and older adults with multiple chronic conditions. PPC focuses on collaboratively setting specific and measurable goals based on what matters most, and patients often set goals involving physical activity. Measuring goal achievement for patients with dementia is difficult because they often struggle to report activity accurately. In this pilot study, we assessed the feasibility of using a wearable sensor to evaluate patient-defined goal achievement. The wearable sensor measured daily mobility and sleep performance, including length of walking bouts, time sitting, postural transitions, and sleep duration. Patients wore pendant sensors for 48 hours at baseline (before PPC conversations) and 3-6 month follow-up. We present a case in which remote monitoring exhibited evidence of goal achievement and another case in which monitoring exhibited failure to achieve a goal. In the former, the patient set a goal of walking his dogs daily. At baseline, mobility performance suggested that he was not engaged in this activity. At follow-up, in contrast, all parameters showed accomplishment of the patient’s goal. In the latter case, the patient set a goal of maintaining his habit of walking a mile per day. At follow-up, sensor measures showed that the patient was not making progress on this goal. Conclusion: Remote monitoring using wearable sensors can provide objective information about goal achievement for patients with dementia. Sensor measurement can assist clinicians in evaluating goal achievement for patients with dementia and adjusting care based on these measures.