bluuebunny/crossref_metadata_2025 huggingface dataset:
DATA SCIENCE TECHNIQUES TO GAIN NOVEL INSIGHTS ON QUALITY OF CARE: A SCOPING REVIEW OF LONG-TERM CARE FOR OLDER ADULTS
Authors: Aarts Sil , Hendriks Ard , Hacking Coen , Verbeek Hilde
Published: December 2023

The increase in powerful computers and technological devices as well as new forms of data analysis such as machine learning have resulted in the widespread availability of data science in healthcare. However, its role in organisations providing long-term care for older adults (LTC) has yet to be systematically synthesized. This study provides a state-of-the-art scoping overview of (1) data science techniques that are used with data accumulated in LTC and for what specific purposes, and (2) the results of employing these techniques in researching the study objective. PubMed and CINHAL was searched using keywords on data science techniques and LTC. The screening-and selection process was carried out by two authors and not limited by research design or publication date. A narrative synthesis was conducted based on the two aims. The search strategy yielded 1,277 studies; 18 were included (the majority conducted in the US and in nursing homes). Machine learning models/algorithms were the most used techniques and were primarily used for researching specific adverse outcomes including the identification of risk factors for falls and the prediction of frailty. This review reveals the limited use of data science techniques on data from LTC facilities. The low number of articles indicates the need for strategies aimed at the effective utilization of data science techniques and evidence of their practical benefits. There is a need for a wider adoption of these techniques in order to exploit data to their full potential and improve the quality of care in LTC by making data-informed decisions.
UTILIZATION OF LASSO AND POISSON REGRESSION DEALING WITH COUNT VARIABLES IN NURSING HOME RESEARCH
Authors: Shin Juh , Min Eun Jeong , Jung Sun Ok , Kim Jung Eun
Published: December 2023

Regression has been used for decades; thus, more empirical studies are necessary to choose appropriate regression methods, as traditional regression has many drawbacks and is limited in analysis and synthesis with large numbers of covariates. This study aims to investigate factors related to pressure ulcers in nursing homes using three regressions: least absolute shrinkage and selection operator (LASSO) Poisson, LASSO linear, and LASSO logistic regression. We represent how each model’s estimating, inferencing, and performance measures work. The datasets accrued from 51 nursing homes that operated between 2021 and 2022. A total of 35 independent variables included organizational and nurse staffing variables. The variable of interest was the number of residents in each nursing home who had an occurrence of pressure ulcers within the last 3 months. The significant factors were different; turnover of Certified Nurse Aides and government incentives of more RNs were significant in the LASSO Poison regression, no factors were significant in the LASSO Linear regression, while and the percentage of residents who are completely dependent for activities of daily living in LASSO was significant factor in the Logistic regression. Using the coefficients in the Poisson regression, we interpreted that more nursing staff turnover increased the percentage of residents with pressure ulcers by 3.02 times, which would not be possible with linear regression. The Lasso model uses a technique of shrinking coefficient estimates to zero to improve the fit of a model that includes all explanatory variables and improves model interpretability by identifying most important features.
DEMOGRAPHIC VARIATION IN BARRIERS TO VACCINATION AMONG OLDER ADULTS: LINKS TO VACCINATION BEHAVIORS
Authors: Fuller Heather , Huseth-Zosel Andrea , Van Vleet Bryce , Carson Paul
Published: December 2023

As older adults face increased infectious disease risks, understanding barriers to vaccination is vital. The current study examines associations between vaccination barriers, demographics, and vaccination behaviors among older adults (65+) in North Dakota, a rural state with low vaccination rates. A mailed survey, including closed- and open-ended questions regarding vaccine beliefs and behaviors was conducted with 901 older adults. Potential vaccine barriers (Disliking shots, Concerns about cost, Lacking doctor recommendation, Lacking transportation, and Uncertainty how to schedule) were rated on a four-point Likert-type scale (1=Strongly Disagree; 4=Strongly Agree). Vaccine behaviors were assessed with measures of uptake for influenza, shingles, pneumonia, and SARS-CoV-2 immunizations. While endorsement of perceived barriers was relatively low, the greatest perceived barriers were cost and disliking shots. Regarding demographic variation: lower income was associated with cost concerns, lower education and rurality were associated with lacking doctor recommendation, and lower education was associated with uncertainty how to schedule. Disliking shots was significantly associated with uptake for shingles and pneumonia. Cost concerns was associated with lower shingles uptake, whereas lacking doctor recommendation was associated with lower uptake for pneumonia and SARS-CoV-2 booster. No barriers were associated with influenza or SARS-CoV-2 initial immunization uptake. While perceived vaccination barriers were low, certain populations of older adults are more at-risk of experiencing barriers, suggesting intervention opportunities. Moreover, the relevance of barrier type varied by disease, suggesting the need for disease-specific interventions. These findings suggest that practitioners should consider the diverse factors influencing barriers to older adults’ vaccination receipt.
INCLUSION OF FAMILY MEMBERS INTO CONVERSATIONS ABOUT AGING RESEARCH: IMPORTANCE OF INTERGENERATIONAL INFLUENCE
Authors: Gaillard Trudy , Neff Donna , Morton Cynthia , Swagger Phildra , Webb Fern
Published: December 2023

Identifying effective strategies to increase recruitment and retention of culturally diverse adults (African Americans [AA], Caribbean [CN] and Hispanic/Latino [HL]) into aging research is a public health priority. Intergenerational influence (IGI), defined as the “influence of one generation on another in terms of the transfer of skills, attitudes, preferences, values, and behaviors” (Shah & Mittal, 1997), was used to engage AA, CN and HL adults ages 25+ into conversations about aging research. We recruited AA, CN, and HL adults ≥ 65 years and a family member/friend between 25-64 years to participate in virtual listening sessions (LS). A semi-structured guide was used to discuss IGI, attitudes, beliefs, and perspectives of research. All LS were recorded and transcribed verbatim. NVivo software was used for data management and analysis. The constant comparative method was used for analysis. A total of 134 LS was conducted with African American [N=131], Caribbean [N= 112] and Hispanic/Latino [118] adults, representing 93 males and 268 females. We found three major themes highlighting the importance of IGI: 1) transfer of cultural knowledge; 2) benefit of future generations and 3) the lived experiences. The importance of IGI and the inclusion of family members and friends into discussions about healthy aging and research participation was a consistent theme among all culturally diverse groups. Findings suggest that discussing research participation with family and friends can enhance research participation of older adults. Researchers should develop IGI strategies that include family and friends (i.e., younger trusted sources) into recruitment design of aging research.
NO DIFFERENCE IN SUBJECTIVE SLEEP MEASUREMENTS BETWEEN MIDDLE-AGED AND OLDER ADULTS
Authors: Paulson Sally , Gray Michelle , Jones Megan , Campitelli Anthony , Diehl Cody , Bryk Kelsey , Glenn Jordan , Gills Joshua
Published: December 2023

With age, sleep quality tends to decline. Poor sleep quality is associated with adverse physical and mental health outcomes, especially in the aging population. The purpose was to compare subjective sleep quality measurements between middle age (45-64 years) and older adults (over 65 years). Participants (N=200) completed the Pittsburgh Sleep Quality Index (PSQI) and were classified by age as either middle age (MID: n=105, 71.4% female, M±SD: age: 55.5±5.8 years; mass: 85.3±17.4 kg, height: 168.4±9.2 cm, education: 18.2±3.6 years) or older adults (OLD: n=95, 76.8% female, M±SD: age: 69.0±2.9 years; mass: 80.6±14.9 kg, height: 166.2±8.9 cm, education: 17.9±3.5 years). The PSQI Component and Global Scores were calculated. Data were analyzed using descriptive statistics, crosstabulations, and independent samples t-tests (p ≤ .05). The results showed there was no difference (p < .05) between the two age groups on subjective sleep measures, including sleep quality, latency, duration, and disruptions. The average Global score for the MID and OLD adults was 6.3±3.2 and 6.0±3.6, respectively. Only 17% of MID adults and 25% of OLD adults were classified as good quality sleepers (PSQI Global score ≤ 4) and 21.9% and 30.5% rated their sleep quality as very good, respectively. While previous research has shown deterioration in subjective sleep quality measures occurs with age, there was not a difference in subjective measures between middle age and older adults in the present investigation. Further analysis is warranted to examine additional factors impacting sleep quality such as physical activity levels, co-morbidities, and living situation.
REFRAMING AGING AND VISION LOSS AS A PUBLIC HEALTH IMPERATIVE
Authors: Rogers Priscilla
Published: December 2023

Severe vision impairment and blindness often have profound effects upon older people and those who care for and about them. Recent translational research reveals in the United States, 7.3% of older people report severe vision impairment or blindness. A recent study estimated that the population of people with vision impairment will increase by 118% by 2050. The greatest increases will be among the most senior, women, African Americans, and Hispanics. People with vision impairment report greater prevalence of chronic conditions, poorer health, and poorer quality of life than older people without vision impairment, and they are much more likely to experience multiple disabilities. These factors point to grave disparities in health equity. While the multiple studies have informed social, health, and economic disparities among older people with vision impairment at the national level, virtually nothing is known about the variability of the prevalence of vision impairment, chronic conditions, health-related quality of life, and disability at the state level. The geographic distribution of vision impairment varies among and within states. Often rural and poorer areas have a higher prevalence of vision impairment — areas that generally have a paucity of eye care providers, social support systems, and vision rehabilitation services. As aging issues are addressed at state and federal levels, vision loss and vision rehabilitation are frequently omitted from the conversations and plans (e.g., Master Plans on Aging and/or Age-Friendly Plans) and from policy instruments such as the Older Americans Act, which has no mention of vision or vision loss.
FACTORS ASSOCIATED WITH HAND GRIP STRENGTH AMONG OLDER ADULTS—FINDINGS FROM THE LASI STUDY INDIA
Authors: Kulkarni Snehal
Published: December 2023

Objective

To identify the factors associated with handgrip strength among older adults in India.

Methods

Data for the study were drawn from the baseline survey of Longitudinal Ageing Study in India (LASI, 2017–18). This study was conducted on respondents aged 60 years and above with a total sample of 27,347 older adults (men-13,241 and women-14,118). The study assessed handgrip strength using a handheld Smedley’s Hand Dynamometer. Descriptive statistics and independent t-test was used to measure the mean difference in the handgrip strengths according to presence of risk factors.

Results

The mean handgrip strength was 29.76 + 11.23 kgs for both the genders. There was statistically significant difference in the mean handgrip strength of men (36.26 + 10.83 kg) and women (23.70 + 7.65 kg respectively). Significantly lower handgrip strength was observed among participants in rural area (29.58 + 11.20 kg), difficulty in activities of daily living (28.24 + 10.97 kg), low level physical activity, balance impairment (21.09 + 8.83 kg) slowness in walking (25.14 + 9.87 kg), history of falls (28.24 + 10.97 kg), and presence of bone and joint disease (27.44 + 10.60 kg) as compared to their counterparts.

Conclusion

The study contributed to a better understanding of factors associated with HGS, and thus, the HGS is recommended as a section in the health evaluation among high-risk older adults as the strategy of disease control and prevention.
ASSOCIATION BETWEEN CARDIOVASCULAR DISEASE AND COGNITIVE IMPAIRMENT: IS DEPRESSION A MEDIATOR?
Authors: Bamgbade Benita , Lovato James , Reboussin David , Rapp Stephen , Jaeger Byron , Williamson Jeff
Published: December 2023

By 2040, over 9 million US adults will live with dementia. Understanding the relationship between risk factors and cognitive decline is critical to prevent disease and slow progression. Depression and cardiovascular disease (CVD) are independent risk factors for cognitive impairment (CI) which may interact, suggesting depression may play a mediating role in the relationship between CVD and CI, an hypothesis explored in this study. Data from the Systolic Blood Pressure Intervention Trial (SPRINT), a multi-center, randomized, controlled trial were used in this multivariate logistic regression analysis. CI was defined as adjudicated cases of mild CI and probable dementia. Depression was defined as a Patient Health Questionnaire-9 score ≥10 or current antidepressant therapy. We developed a CVD risk score using data from SPRINT participants and discretized the scores into tertiles. Of 9259 SPRINT participants, our analytic sample included 8456 who had adjudicated mild CI or dementia and had baseline depression scores. They were on average 68 years and 36% were female. After adjusting for age, sex, education, race, prior CVD, chronic kidney disease and treatment assignment, participants with high cardiovascular risk were more likely to have CI (OR: 1.55, 95% CI: 1.17-2.05). Participants with depression were more likely to have CI (OR: 1.29, 95% CI: 1.05-1.58) however, the interaction between cardiovascular risk and cognition was not significant. Findings from this study suggest that while depression and CVD are associated with CI, depression may not explain the CVD-CI relationship. More research is needed to understand the relationship between depression, CVD and CI.
LONGITUDINAL NORMS OF COGNITIVE TESTS IN THE ENGLISH LONGITUDINAL STUDY OF AGING
Authors: Marroig Alejandra , Massa Franklin , Muniz-Terrera Graciela
Published: December 2023

Longitudinal research on cognitive change has mostly been focused on mean change in cognition and its associated factors. In this paper, we aim to assess the role of socio-demographic characteristics on different percentiles of the distribution of cognitive trajectories considering sample attrition due to death and intermittent missing data. We used data from 9 waves of the English Longitudinal Study of Ageing (ELSA) covering the period 2002-2019. We consider the numeracy and literacy recall to assess cognition of older adults and applied weighted Generalized Estimating Equations to estimate the 10th, 50th (median), and 90th percentiles of the cognitive tests trajectories. We adjust for sample attrition due to death and assess the role of sex and education on the cognitive trajectories. The results show differences in the cognitive trajectories across the percentiles. There is a steeper cognitive decline for individuals with poorer cognitive condition (p< 0.001). Sociodemographic characteristics are associated with cognitive decline but there is heterogeneity across cognitive trajectory percentiles. Education is protective against cognitive decline but it is more effective for individuals with lower cognitive impairment (p< 0.001). In this approach we advance the understanding of cognitive trajectories of older adults, showing differences across percentiles. We address the process of missing information and the results show new insights. Thus, this may improve the practice and design of interventions aimed at cognitive decline of older adults. Our results provide important insights into longitudinal norms of cognitive decline in a population-representative of older adults.
MARKERS OF GLUCOSE METABOLISM ARE ASSOCIATED WITHCCOGNITIVE DECLINE AMONG FAMILIES WITH EXCEPTIONAL SURVIVAL
Authors: Miljkovic Iva , Cvejkus Ryan , Andersen Stacy , Cosentino Stephanie , Zmuda Joseph
Published: December 2023

Although the connection between type 2 diabetes (T2D) and dementia is known, it is less clear whether this relationship extends to cognitive decline. Our aim was to examine whether baseline fasting plasma glucose, insulin, HOMA-IR, and HbA1c, and T2D status predict cognitive decline in a multicenter cohort study of families with a clustering of exceptional survival. We analyzed change across five cognitive tests collected over 7.9 years: Mini-Mental State Examination, Digit Span, Logical Memory, Animal Fluency and Digit Symbol Substitution. Among 2,175 family members (mean age 63±11 years (range 32-100); 54% women), 39.8% had prediabetes and 6.8% had T2D. Multiple linear mixed models were adjusted for age, sex, field center, education, APOEε4 status, BMI and family relatedness. A trend was observed for immediate (p=0.047) and delayed (p=0.037) memory, with normal glucose tolerance (NGT) predicting increased scores, prediabetes showing no change, and T2D predicting decreased scores. Among those without T2D (N=2,026), each standard deviation (SD) higher glucose (11.5 mg/dl) was related to a greater decline in delayed memory (-0.34±0.16mg/dl; p=0.032), each SD higher HbA1c (0.32%) was related to a greater decline in immediate (-0.36±0.15 mg/dl; p=0.016) and delayed (-0.31±0.16 %; p=0.05) memory, while each SD higher HOMA-IR (1.5) was related to a greater decline in Digit Span Backwards (-0.13±0.06; p=0.047). Findings suggest that among individuals with a clustering of exceptional survival, T2D, glucose, and HbA1c may predict greater decline in episodic memory, an ability typically affected early in Alzheimer dementia. The possible mechanisms, including genetic and metabolic mediators, warrant further investigation.
MODELING HETEROGENEITY IN COGNITIVE TRAJECTORIES IN THE FRAMINGHAM HEART STUDY
Authors: Fang Yuan , Chen Jiachen , Murabito Joanne , Lunetta Kathryn
Published: December 2023

The prevalence of cognitive impairment in the population is growing. Maintaining good cognitive health is central to successful aging, independence, and well-being. Although older age is generally associated with worse cognitive function, there are substantial heterogeneities in the rate of cognitive decline across different cognitive domains and in terms of the clinical onset age of dementia. Recently, harmonized factor scores measuring global cognitive function for the memory, executive function, and language domains have been created in the Framingham Heart Study (FHS). In this work, we identified FHS participants with two or more repeated factor scores after the age of 60 (n=2339; 57% female; 17% APOE-ϵ4 carriers; 64% attended colleges) and were dementia-free at the baseline visits. We fitted latent class mixed models (LCMM) to cluster cognitive trajectories from all three domains using the harmonized factor scores. Non-linear trends with age in the trajectories were modeled via piecewise linear LCMM models followed by stepwise selections to select cluster-specific change points. We identified different latent classes of participants, some characterized by an early cognitive decline before age 70 as compared to late decliners, across different domains. Using 10-fold cross-validation, we also showed that the subgroupings of participants are stable. Our findings indicate class-related differential patterns in cognitive aging in the FHS. Future associations between the identified subclasses, cognitive outcomes, and physical or biological markers may advance the knowledge of multiple pathways of cognitive aging.
HYPERTENSIVE URGENCY IN OLDER ADULT WITHOUT HYPERTENSION HISTORY: THE DANGERS OF OVERTREATMENT WITH LEVOTHYROXINE
Authors: Evardone Vanessa Joyce , Gendernalik Jesssica , Blondet Ricardo , DiScala Sandra , Silverman Michael
Published: December 2023

A 72-yr old woman with well-controlled depression and active lifestyle was seen at urgent care for “nervousness.” She was found to have borderline tachycardia and blood pressure of 187/114 mmHg. There were no other associated symptoms. Physical examination and labs were unremarkable, with normal renal function. EKG showed sinus tachycardia at 110 bpm. Recheck of BP after 30 minutes was 135/80mmHg, and she was discharged home on Lisinopril. Two days later, she again had “nervousness” and was taken to the Emergency Department. Blood pressure was 200/105 mmHg. Again, she denied any other symptomatology, and had unremarkable physical exam and labs. Repeat BP was improved, and she was discharged home with instruction to follow up with PCP. Medication list included Bupropion for depression which she has been taking and tolerating well for years, and Levothyroxine 25 mcg daily, which was started by her PCP 8 weeks prior, for TSH of 5.43 mIU/L and FT4 of 1.1 ng/dL. Thyroid hormone therapy was stopped during recent ED visit, and she has had no recurrence of her anxiety symptoms. Her BP has been checked daily at home and has been at baseline level.
A PILOT STUDY OF YIN YOGA AND THE EFFECTS ON BURDEN AND SELF-COMPASSION IN CAREGIVERS OF PERSONS WITH DEMENTIA
Authors: Parkman Suzanne E , Olausson Jill
Published: December 2023

Informal caregivers for persons with dementia face tremendous challenges in balancing their own needs and those of the care recipient. The purpose of this pilot study was to test the feasibility and acceptability of a Yin yoga intervention on caregiver burden and self-compassion. Authors explored recruitment, retention, adherence, and satisfaction with the yoga intervention. Using the three elements of the Neff’s Model of Self-compassion, this pilot study was a quasi-experimental pre/post comparisons of caregiver burden (Zarit Burden Interview Scale-ZBI) and self-compassion (Neff Self-compassion Scale-SCS) in which the participants served as their own control group. A total of five participants (N=5) were recruited and completed an 8-week Yin yoga intervention via Zoom. Statistical analysis revealed non-significant results for ZBI (t (4) = .95, p= .39) and SCS (t(4) = -.23, p= .83). Wilcoxon signed rank test identified two questions on ZBI pre-and post-intervention had differences approaching significance (p= .059). Despite the non-significant results, burden was decreased in three participants and self-compassion scores were increased in four participants. The main perceived benefits were ease of survey process, feeling relaxed after intervention, and treatment fidelity. The main barriers identified were recruitment and retention of participants throughout the 8-week intervention. Overall, we found the study protocol to be feasible and acceptable. Possible modifications to the study would include extending the scope of the study nationally in efforts to recruit maximum participants. Future research is needed with larger sample sizes, randomization, control of confounding variables, and efforts to promote recruitment and retention of participants.
CHARACTERIZING END-OF-LIFE COMMUNICATION IN FAMILIES
Authors: Horning Melanie
Published: December 2023

The chronic disease course can be uncertain, contributing to delayed end-of-life discussion within families resulting in missed opportunity to articulate wishes, increased decisional uncertainty, and delayed hospice care. Consistent with the Family Communication Patterns Theory (FCPT), family communication patterns may increase understanding of end-of-life discussion, hospice utilization, and may affect the experience of “a good death.” This cross-sectional study used a modified Revised Family Communication Pattern instrument (RFCP) to examine the family communication characteristics of 56 family members of loved ones who died from chronic illnesses while in hospice. Most families (42.9%) were pluralistic, reporting communication styles with high conversation and low conformity orientation; (39.29%) were protective, reporting low conversation and high conformity orientation. Pluralistic families had more end-of-life conversations than did protective families. This study’s findings support the idea that using the RFCP to assess familial communication patterns may be useful for end-of-life conversation and decision-making
FEAR OF FAILING: PERSPECTIVES ON HOME- AND COMMUNITY-BASED SUPPORT SERVICES FOR RURAL CAREGIVERS
Authors: Marfeo Elizabeth , Chamberlin Elizabeth , Venegas Maria , Moo Lauren
Published: December 2023

Many older adults rely on family caregivers not only for day-to-day assistance, but also to help navigate the healthcare system and attend medical visits. Finding, scheduling, arranging transportation for, and attending medical visits involves considerable planning, adaptability to a broad array of contextual factors, and can often cause disruption in day-to-day routine of both the family caregiver and the older adult. For Veterans living in rural areas, limited VA and community resources may magnify these challenges leading to higher caregiving burden and negative health and quality of life outcomes for both the Veteran and caregiver. The aim of this study was to conduct in-depth interviews to better understand key contextual factors related to the logistics of managing and attending medical visits among family caregivers of Veterans living in rural communities (N = 19, mean age 65). A clear disconnect emerged between caregiver needs and (1) access to community support services and (2) effective utilization of existing services. Seventy-nine percent of the caregivers reported living with the Veteran and receiving no home services. Interviews revealed both the caregiver and Veteran having significant, complex healthcare needs. Caregivers described fears of their own health negatively affecting their ability to continue providing sufficient supports for their loved one, lack of resources for home management needs, and limited access to transportation assistance. Findings from this study are important for informing continued development and evaluation of caregiver support programs nationwide, especially among those living in rural communities.
UNMET NEEDS OF CAREGIVERS OF HOSPITALIZED VETERANS LIVING WITH DEMENTIA: A QUALITATIVE STUDY
Authors: Horstman Molly , Guo Crystal , Sonnenfeld Mandi , Evans Tracy , Stevens Alan , Kunik Mark
Published: December 2023

Family caregivers are essential to safe care transitions for hospitalized adults living with dementia. We aimed to identify resource and training needs of dementia caregivers during care transitions. We conducted semi-structured interviews with caregivers (6 Spouses, 5 Children, 1 Friend) of hospitalized Veterans with dementia at the Michael E. DeBakey Veterans Affairs (VA) Medical Center. Interviews were recorded and transcribed verbatim. Rapid qualitative analysis using structured summaries and matrices were conducted. Although caregivers received information about the Veteran’s admitting medical condition, health professionals did not ask about dementia or provide dementia-related health information to the caregiver. Caregivers were willing to assist Veterans with activities of daily living in the hospital; however, caregivers were either prevented from assisting or did not receive training to assist Veterans safely. Caregivers desired information on how to get the Veteran “back on track” and address cognitive and functional declines experienced in the hospital. Although pre-hospital services and supports were easy to restart, caregivers needed earlier and more consistent communication regarding new services and supports starting after discharge, such as rehabilitation at skilled nursing facilities and respite care. Caregivers expressed a need for health professionals to help set “realistic expectations” for post-discharge care as some services and supports did not meet their expectations. Caregivers valued access to support groups for themselves but received inconsistent referrals to the VA Caregiver Support Program. These results will inform the adaptation of a dementia caregiver support intervention for caregivers of hospitalized Veterans living with dementia.
COMPARISON OF DIAGNOSTIC COMPLEXITY AND IMAGING DECISIONS IN YOUNGER, MIDDLE AGE, AND OLDER ADULTS
Authors: Saraswathula Varun , Mwinyogle Aubrey , Schadt Lili , Kowdley Gopal , Kelz Rachel , Friedman Ari
Published: December 2023

A primary reason for visit of abdominal pain in the emergency department (ED) defines a syndromic presentation that can carry morbidity and mortality comparable to a myocardial infarction. Whether imaging decisions in the ED adequately account for this risk, and whether this risk is mediated in part by greater diagnostic complexity remains unknown. In a prospective cohort of 1,169 patient visits to a US community ED, a surgeon codified each visit according to history, examination, laboratory testing, imaging (the acuity of CT findings), diagnosis, and disposition. Chi square tests (two-tailed, alpha=.05) tested for differences between age groups (younger: 18-40, middle: 40-60, older adult: 60+). We found that 42.5% of younger adults received a CT, compared to 66.7% and 70.0% of middle age and older adults (P< 0.001). 20.5% of CT findings were acute in younger, 34.0% in middle, and 39.6% in older adults (P< 0.001). The top 3 acute diagnoses accounted for 75.5% of younger, 62.9% of middle, and 62.7% of older adults, with Herfindahl Indices of 0.25 for younger, 0.16 for middle, and 0.15 for older adults. ED clinicians tested modestly more in older adults, but still potentially over-test younger adults and under-test older adults as judged by test positivity. Older adults had greater diagnostic complexity than younger adults. Dissemination of these findings may improve appropriateness of testing.
LEVERAGING NURSING ASSESSMENT DATA TO IDENTIFY FRAILTY INDICATORS OF HOSPITAL DISCHARGE DISPOSITION
Authors: Ser Sarah , Solberg Laurence , Bjarnadottir Ragnhildur , Lucero Robert , Prosperi Mattia , Snigurska Urszula , Celso Brian
Published: December 2023

Frailty among older adults is associated with higher morbidity and mortality rates and poorer hospital outcomes. Although frailty is not routinely assessed in the hospital setting, elements of frailty are captured in nursing assessments. The purpose of this study was to examine components of the Risk Analysis Index (RAI) captured in electronic health record (EHR) assessment data and their associations with discharge disposition. This was a retrospective observational study of EHR assessment data which included encounters of older adult patients (≥ 65 years) who were admitted from home to a medical/surgical unit of an academic hospital in North Central Florida between January 2012 and May 2021. The components of the RAI included in the study were sex, age, cancer, renal failure, heart failure, cognitive decline, unintentional weight loss, poor appetite, and shortness of breath at rest. Descriptive statistics were generated and compared between patients discharged to home versus those who were discharged to Post-Acute Care (PAC) facilities. Unadjusted associations were assessed using univariate logistic regression. Consistent with existing literature on frailty, all but one of the included RAI components (i.e., male sex) exhibited higher odds of discharge to a PAC facility with strong statistical support. Recognizing functional decline due to frailty is integral to the mission of improving patient safety. This study provides a preliminary proof of concept for leveraging existing assessment data in the EHR to capture frailty in older adults. Future studies of the overall predictive value of RAI with disposition are warranted.
LARGE-SCALE ANALYSIS OF HUMAN GUT MICROBIOTA PATTERNS ACROSS GEOGRAPHY AND PEDIATRIC TO GERIATRIC AGES
Authors: Huang Sherri , Chaudhari Diptaraj , Kanani Pushti , Burrow Wesley , Lin Yi , Mankowski Robert , Jain Shalini , Yadav Hariom
Published: December 2023

Limited studies to-date have evaluated differences in gut microbiota across a global and temporal scale. Herein, we aim to examine the gut microbiota patterns across geography as defined by continent and countries and how gut microbiota vary across age groups within each geographic region. To approach these questions, we designed a large-scale analysis of gut microbiota across North America, Europe, Africa, Asia and Oceania. Literature across countries within each region was screened to include publications employing human stool samples and 16s rRNA sequencing of gut microbiota;116 publications resulted from this first screen. In the second screen, publications without metadata files or whose metadata files did not clarify sample type, collection timepoint or location were excluded. Raw 16s rRNA sequencing data for included publications were collected, and metadata for corresponding fastq files were screened to include only those of healthy, non-intervention groups. This final screen resulted a total of 25,665 metadata. Corresponding 16s rRNA gut microbiota sequences will be analyzed via the QIIME2 workflow in which we aim to compare and contrast gut microbiota and diversity across continents and countries and evaluate changes in gut microbiota from pediatric to geriatric age. This study will provide insight on biodiversity on a worldwide scale and inform on the changes in gut microbiota across time, allowing further examination of the role of the gut microbiome in the development of chronic disease in human aging. Altogether, our study represents one of the largest scale evaluation of gut microbiota patterns across geography and time.
UNIQUE MICROBIOME-PROTEOME SIGNATURES OF SALIVA IN PREDICTION OF COGNITIVE DECLINE IN OLDER ADULTS OF MIAGB COHORT
Authors: Chaudhari Diptaraj , Jain Shalini , Labyak Corinne , Golden Adam , GB Mia , Holland Peter , Masternak Michal , Yadav Hariom
Published: December 2023

The prevalence of age-related cognitive decline and dementia is increasing in older adults, with limited prevention and therapeutic options, increasing tremendous burden on healthcare system. Alzheimer’s disease (AD) is the most common age-related cognitive disorder, for which no treatment is available when its pathology is fully developed. Although current FDA-approved therapies are proven to be effective in delaying AD progression, however, inexpensive and non-invasive markers for routine laboratory examination are poorly developed. Studies indicate that poor oral health is associated with a higher risk of dementia via microbiome alteration. In this pilot study, we explored the importance of the multiomics analysis in discriminating cognitively healthy from mild cognitive impaired and dementia by comparing the microbiome and proteomic profiles of saliva from controls (n=37), MCI (n=16) and dementia (n=6) participants of the MiaGB (Microbiome in aging Gut and Brain) consortium. We detected significantly reduced abundance of oral commensals like B. animalis, E. brachy, and F. fastidiosum in MCI and dementia samples than controls with specific increase of P. histicola in MCI and neuronal Aβ1–42 promoting V. parvula in the dementia. In addition, proteome analyses revealed that highly neuronal relevant nitrite-nitrate conversion cycle genes were significantly differed in dementia and MCI than controls. Discriminatory predictive analyses revealed that combination of microbiome and proteome signature are stronger discriminator for dementia/MCI from cognitively healthy controls. Our results indicate the potential links among oral microbiome, proteome and dementia, as well as diagnostic potential for dementia risk.
DIETARY RESTRICTION OF ISOLEUCINE INCREASES THE HEALTHSPAN AND LIFESPAN OF GENETICALLY HETEROGENEOUS MICE
Authors: Green Cara
Published: December 2023

Low protein (LP) diets promote health and longevity in diverse species, andreducing dietary levels of the branched-chain amino acids (BCAAs) leucine, isoleucine and valine recapitulates these effects in C57BL/6J mice, promoting metabolic health in both sexes, and increases lifespan while reducing frailty in males. Each BCAA has unique metabolic effects, and we recently showed that restriction of isoleucine is both sufficient to promote metabolic health and required for the metabolic benefits of an LP diet in C57BL/6J males. Here, we tested the hypothesis that specifically restricting dietary isoleucine could promote healthy aging in adult genetically heterogenous UM-HET3 mice. We find that isoleucine restriction (IleR) improves the metabolic health of both young and old HET3 mice, promoting leanness and glycemic control in both sexes, and reprograms hepatic metabolism, blunting age-related molecular changes in males and, to a lesser extent, in females. Finally, we find that IleR reduces frailty and extends both the median and maximum lifespan of both male and female HET3 mice, but to a much greater degree in males. Our results demonstrate that restricting dietary isoleucine can increase health span and longevity in a genetically diverse population of mice and suggest that reducing dietary levels of isoleucine, or drug regimens that mimic this effect, may be a novel intervention to promote healthy aging.
L-VALINE TREATMENT IMPROVES CELLULAR MITOCHONDRIAL FUNCTION
Authors: Sharma Shakshi , Azhar Gohar , Zhang Xiaomin , Wei Jeanne
Published: December 2023

Branched-chain amino acids (BCAAs) are pivotal for the health of the human body. Leucine, isoleucine, and valine, which make up the BCAAs, are α-amino acids that promote skeletal muscle growth and development. Valine is one of the essential BCAAs required for the synthesis of muscle proteins and the support growth of skeletal muscles. Valine also plays a favorable role in enhancing insulin sensitivity, preserving intestinal health, and optimizing lipid metabolism. Considering the relevance of valine in promoting muscle growth and metabolism, we utilized C2C12 skeletal muscle cell line to investigate the role of valine in regulating mitochondrial functions. C2C12 cells grown on physiological normal glucose media (100mg/dL) were used for the experiments. Cells were treated with a 1.0 mM concentration of valine for 24 h. The effect of valine treatment on gene expression of important mitochondrial-related genes such as PGC-1α, and PGC-1β and mitofusin (MFN1, MFN), and mitochondrial fission 1 (Fis 1) was determined. Further, Oroboros oxygraph-O2K high-resolution respirometer was used to analyze the mitochondrial respiration in the intact C2C12 cells after valine treatment. The results showed increased gene expression of PGC-1α, PGC-1β, and mitochondrial fission and fusin genes after treatment with valine. The basal respiration, leak respiration, as well as maximal capacity of mitochondrial ETC (Electron Transport Chain), were also significantly improved after valine treatment. The findings from this study enhance our understanding of valine as an important nutrient to improve mitochondrial function to drive cellular function and biological processes.
MULTIOMIC SYSTEMS ANALYSIS OF LIFESPAN-EXTENDING INTERVENTIONS IN MOUSE TISSUES
Authors: Watanabe Kengo , Wilmanski Tomasz , Baloni Priyanka , Robinson Max , Fiehn Oliver , Moritz Robert , Miller Richard , Rappaport Noa
Published: December 2023

Aging is associated with dysregulation of molecular, cellular, and physiological processes. Nutritional and pharmacological interventions with different postulated modes of action have been shown to extend lifespan and delay aging-related diseases in model organisms, suggesting the existence of core cellular processes that mediate the effect on lifespan and healthspan. However, these underlying molecular processes remain largely uncharacterized. In this study, we analyzed multiomic tissue-derived data of lifespan-extending interventions in mice including metabolomics and proteomics from the NIA Longevity Consortium and previously reported transcriptomics. We applied three systems techniques, differential rank conservation (DIRAC) analysis, weighted gene co-expression network analysis (WGCNA), and mouse genome-scale metabolic model (GEM) reconstruction, to the mouse liver proteomic and transcriptomic datasets of lifespan-extending interventions (e.g., acarbose, 17α-estradiol, and rapamycin). We found that these interventions generally strengthen the rank conservation of biological processes and shift metabolic fluxes, with fatty acid metabolism emerging as a common process affected by multiple interventions. We then applied these approaches to an expanded experimental data with additional interventions (e.g., canagliflozin) and tissues (e.g., kidney, muscle, and plasma), confirming our results and further observing varied inter-omic and inter-tissue patterns exerted by lifespan-extending interventions. Our findings highlight the potential of integrative systems analysis to elucidate common and unique cellular and physiological changes relating to aging and lifespan-extending interventions, which have translational potential as preventive and prognostic measures to improve human health.
DELAYED RETIREMENT IN ISRAEL: FACTORS THAT CONTRIBUTE TO THE NEW POLICY SUPPORT
Authors: Ermoshkina Polina
Published: December 2023

Policies that defer retirement age are fiscally justifiable, but not unanimously supported by the citizens. Studies in other countries (United Kingdom, Sweden, and Norway) show that occupational environment (feeling unappreciated at work, having a physically demanding job) affects workers’ support for pension reform. Israel is a unique national context for this question because of the high proportion of immigrants who had not spent their working lives in Israel. This study used The Survey of Health, Ageing and Retirement in Europe (SHARE) Israel (2005-2006) to examine how the current job conditions (having a physically demanding job, having a job that allows workers to develop new skills, receiving support from the supervisors, job satisfaction) affect Israeli workers’ attitudes towards delayed retirement age. The analysis was limited to 482 respondents. The average age of the participants was 64.1 (SD=10.1) years. The participants included veteran Jewish-Israelis, Arab-Israelis, and new immigrants from the former Soviet Union. Nearly 40 percent of the respondents were very interested in working until the new retirement age yet 24.73% were not interested at all. Multiple correlation showed that low job satisfaction, having a physically demanding job, and having a job that does not allow one to develop new skills were associated with low interest in prolonged retirement age. Gender, birthplace, and having adequate support at work were not associated with workers’ support for delayed retirement. These findings indicate that older adults in demanding, low-reward work most strongly oppose extended working life.
FROM THE WORKROOM TO THE BEDROOM: MEDIATING EFFECTS OF WORK-TO-FAMILY SPILLOVER ON WORK CHARACTERISTICS AND SLEEP
Authors: Huang Kian , Mu Christina , Smith Claire , Lee Soomi
Published: December 2023

Negative and positive work experiences may spillover to the home domain and harm one’s sleep. This study investigated whether work-to-family spillover mediates the relationship between work characteristics and sleep health. Full-time workers (n=2,106) from the Midlife in the United States Study provided Time-1 data (T1: 2004-2006); a sub-set (n=1,444) was reassessed at Time-2 (T2: 2013-2015). Both negative work characteristics (perceived unfairness at work and job discrimination) and positive work characteristics (coworker support and supervisor support) were assessed. Mediating variables were negative work-to-family spillover (NWFS) and positive work-to-family spillover (PWFS), and outcome was an overall sleep health score that sums across irregularity, dissatisfaction, nap frequency, inefficiency, and suboptimal sleep duration (higher=poorer sleep health). PROCESS Macro evaluated cross-sectional (T1) and longitudinal (T1-T2) mediation pathways, adjusting for sociodemographics, neuroticism, and work hours. NWFS was a consistent mechanism connecting work characteristics and sleep health. Cross-sectionally, higher NWFS mediated the associations of higher unfairness with poorer sleep health and a sub-dimension of greater dissatisfaction (B=0.09, SE=0.04; B=0.12, SE=0.06, respectively). Higher NFWS also mediated the association between higher discrimination and higher sleep dissatisfaction (p=.008). Longitudinally, an increase in unfairness from T1 to T2 was associated with an increase in irregular sleep at T2 (adjusting for T1 unfairness) through increases in NWFS (p= 0.038). PWFS was not a significant mechanism linking positive work experiences and sleep health, although more coworker and supervisor support were associated with better sleep health. Findings suggest that organizations should limit instances of unfairness and discrimination at work to promote employee sleep health.
DECISION MAKING ABOUT LIFE-SUSTAINING TREATMENT FOR UNREPRESENTED ADULTS IN KOREAN HOSPITALS
Authors: Kim Hyejin , Choi Jiyeon , Lee Won , Lee Ilhak , Song Mi-Kyung
Published: December 2023

BACKGROUND

In South Korea, unrepresented adults are individuals who lack decision-making capacity, written treatment preferences, and available immediate family. Since the enactment of the Life-Sustaining Treatment Decision Act in 2018, ethical and legal dilemmas surrounding decision-making about life-sustaining treatments for unrepresented patients have emerged among healthcare providers in hospitals. Thus, the objectives of this qualitative descriptive study were to explore decision-making practices about life-sustaining treatments for unrepresented patients.

METHODS

We interviewed 37 healthcare providers including physicians, nurses, and social workers from 22 hospitals in South Korea, and analyzed the interview data using a directed content analytic technique. RESULTS: Healthcare providers reported a lack of decision-making guidelines regarding life-sustaining treatments for unrepresented patients in their institutions or being uncertain about the presence of such guidelines. Physicians primarily make decisions about life-sustaining treatments for these patients. Ethics committees’ involvement in such decision-making is minimal in most hospitals. Basic life-sustaining treatments are usually initiated if necessary. However, life-sustaining treatments unrepresented patients are currently receiving cannot be discontinued even though those treatments seem pointless. Thus, additional life-sustaining treatments (e.g., extracorporeal membrane oxygenation) tend to be withheld. Important considerations in the decision-making process include the person’s reversibility, risk of adverse events, and medical costs. CONCLUSION: Decision-making about life-sustaining treatments for unrepresented patients is currently in legally blind spots in South Korea. Reforms in regulations and policies surrounding such decision-making practices for unrepresented patients and the development of institutional guidelines are urgently necessary to improve decision-making practices about life-sustaining treatments for these individuals.