bluuebunny/crossref_metadata_2025 huggingface dataset:
COVID-19 Transition: Does virtual exercise maintain physical function?
Authors: Jennings Stephen , Manning Kenneth , Pearson Megan , Mateas Catalin , Hall Katherine , Bettger Janet , Morey Miriam
Published: December 2020

Background: In March 2020, COVID-19 mandates to restrict face to face exercise and group based gatherings were enacted. These mandates were enforced within most states in the US. Gerofit, a facility-based exercise program for older Veterans in Durham, NC, transitioned to remote virtual exercise instruction to accommodate continuity of care. Objectives: To explore whether remote virtual exercise (RVE) can sustain physical function within individuals previously participating in onsite face to face exercise (OFF). Methods: Physical function assessments performed during OFF were compared with assessments conducted remotely over virtual platform. Assessments included the 30-second arm curl, the 30-second chair stand, time to complete five chair stands, and either 6-minute walk or 2-minute step test. All assessments for RVE were completed via a remote virtual platform. Only participants enrolled in both OFF and home based RVE with functional assessments within 6-months of pre and post COVID-19 transition were compared. Descriptive comparisons, opposed to statistical, were reported due to the limited sample size. Results: Fourteen OFF Gerofit participants were reassessed remotely within the first 6-months of transitioning to RVE (12 male, 2 female, mean age 73.1, mean body mass index 31.5). Functional assessments between OFF versus RVE were arm curls (21.0 vs 20.4 repetitions), chair stands (15.0 vs 17.5 repetitions), and time to 5 chair stands (9.0 vs 8.4 seconds). Cardiovascular function, reported in normalized percentiles (46.4%tile vs 58.9%tile) Conclusion: Among older Veterans engaged in regular structured exercise, physical function was preserved with transition to virtual exercise.
Front-line Perspectives from Aging Services Providers on the COVID-19 Pandemic and Older Community Residents
Authors: Raveis Victoria , Torres Anderson , Arce-Bello Jane , Atmore-Dolly Donna , Nickerson Allison
Published: December 2020

Older urban residents’ daily lives have been broadly impacted by the COVID-19 pandemic. Rapid acceleration of COVID-19 cases in mid-March 2020, forced the shuttering of senior centers in New York City’s (NYC) five boroughs. Center programming was suspended, including congregate meals for older adults. As centers, a focal point for social interaction, closed, older community residents experienced social isolation, compounded further by social distancing. Key informant interviews with the leadership of community-based multi-service agencies, provided frontline perspectives on essential programmatic services NYC’s oldest residents needed, challenges encountered, and strategies implemented to adjust to issues emerging from the pandemic. Alternative meal delivery plans were devised by the City and aging services agencies initiated wellness outreach calls and also facilitated access to technological resources to maintain social connections. Various advocacy and policy-relevant insights emerged from these experiences. Specifically, a priority in preparedness planning should be on solutions addressing the social isolation precipitated by the pandemic that older adults experienced. Technology may help. Devoting more programming to activities enabling older adults to utilize accessible technological resources is key. Efforts implemented during the pandemic have demonstrated that with preparation and access to resources, virtual communication is a feasible option for the older population. With limited access to alternative neighborhood food sources, devising a contingency plan for adequate food delivery services to replace congregate meals also merits attention. Overall, the pandemic’s widespread impact highlights the importance of creating an infrastructure that builds upon older persons’ strengths, while addressing their vulnerabilities, enabling them to thrive.
Online Social Environment Impacts Feelings of Social Connection in Older Adults During the COVID-19 Pandemic
Authors: Derynda Brittany , Goodyear Mary , Kushner Jade , Cook Nicole
Published: December 2020

Evidence suggests that nearly one-third of older adults experience loneliness and/or social isolation; an increase in these rates during the current pandemic is anticipated. The Lifelong Learning Institute (LLI) at Nova Southeastern University (NSU) in South Florida has worked to engage seniors in fun learning activities and social opportunities since 1977. When “stay at home” orders went into effect in March, 2020 the LLI moved to online program delivery via Zoom. To understand the implementation of zoom among LLI members, NSU students, researchers and LLI member advisory committee developed a cross-sectional research study using an online survey that was administered to LLI members three months post-zoom implementation in May, 2020. Results among the 127 responders demonstrated that a majority of members were not comfortable using zoom (57%) especially the chat, reactions or camera features. More than 80% of responders did report that zoom helped them keep their spirits up. Respondents had specific feedback to improve Zoom programming including Youtube videos on use, retraining, training on features (e.g. chat, camera, reaction), closed captioning, program reminders and links sent out more frequently and within 30 minutes of start time. There were also several comments about internet connectivity, identifying opportunities for router and internet plan education. Finally, respondents noted new opportunities to enhance virtual programming including engaging speakers from across the nation and world. In summary, direct feedback from seniors on how to improve the online social and learning environment is pivotal to improving experience, programming and social connection during COVID-19.
Positive Subjective Health of Older Homeless and Older Irish Travelers: a Participant-Led Approach
Authors: Carroll Bridin , Walsh Kieran
Published: December 2020

Older people experiencing homelessness and older Irish Travellers (OTOH) are both over-represented in the cohort who use acute health services. Impending health care reform in Ireland will be based on primary care models, meaning home and community care will be, for the first time, underpinned by a regulatory framework. For these reasons, this study aims to gain a nuanced understanding of how OTOH, as marginalised older people, might be best served by new home care and community care models. Using a qualitative, voice-led approach, a life course and structural determinants lens is employed to probe the health conditions, experiences and expectations of OTOH, as well as their perceptions and values around the concept of ‘home’. The research processes and outcomes of one of five phases of research are presented in this paper: participant-led research. In this phase, five OTOH were trained and assisted to complete a short research project which fed into the goals of the wider study. Emergent findings suggest that social connections underpin health and well-being for OTOH, throughout the life course, and presently. This was also seen as a fundamental element for healthy and positive ageing. In addition, ‘home’ was defined with reference to the presence (or absence) of familial or other social connections. This study represents an important contribution to scholarship on old age social exclusion. It is entirely novel in its approach to focusing on OTOH health and wellbeing. The outputs of this study also have important implications for upcoming health reform policies in Ireland.
Trends in Deaths of Despair Among Older Adults, 1999-2018
Authors: Sun Peter , Lawlor Edward , Morrow-Howell Nancy , Park Sojung , McBride Timothy
Published: December 2020

“Deaths of despair” (DOD) is a new phenomenon that includes deaths attributable to suicides, drug overdoses, and alcohol-related liver diseases. While many studies have focused on the rise of DOD in midlife, there is little research that focuses on the trends of DOD in later life. To address this gap, we used publicly available data from the Centers for Disease Control and Prevention to carry out descriptive and spatial analyses of DOD among older adults (aged 65 and over) from 1999 to 2018. Nationwide, we found that DOD rates of older adults increased from 2009 (44.7 deaths per 100,000) to 2018 (57.4). This increase was notable among male older adults who were Black non-Hispanics and White non-Hispanics (WNH); however, Hispanic populations saw a 4.8% decrease in DOD between 1999 and 2018. Of the WNH decedents in 2018, alcohol-related liver diseases were the most common cause of death (55%), followed by suicides (36%) and drug overdoses (9%). Additionally, 55% had a high school degree or less, 22% had some college but no bachelor’s degree (BA), and 22% had a BA or more. Geographically, we found that DOD was concentrated in the West in 1999 but has since then spread nationwide. In 2018, the highest rates of DOD among WNH were in the western and southern states. These findings suggest that attention to deaths of despair cannot be limited to midlife; policies and program interventions aimed at slowing this epidemic must include people in later life as well.
Commitment and Attachment to Pet and Emotional Well-Being Among Low-Income Pet Owners
Authors: Li Ke , Tang Fengyan , Rauktis Mary
Published: December 2020

Pets play an important role in older adults’ lives, as people treat pets as their companion and family members. Owning a pet has been believed to be beneficial; however, previous literature demonstrated mixed results of the effects of pet on people’s well-being. Using data collected from 392 food pantry users in Pittsburgh, this study examined the relationships of pet ownership, attachment and commitment with emotional well-being, and investigated whether sociodemographic profiles conditioned those relationships. emotional well-being was assessed by global mental health, positive functioning, perceived negative feelings, and perceived positive feelings. Commitment to pet was measured by a 10-item scale adapted from the Miller-Rada Scale about the likelihood of giving up pet under various difficult circumstances. Attachment to pet was measured by the 23-item Lexington Attachment to Pets Scale about emotional ties to pet. About two-thirds of respondents (66%) were pet owners. Multiple regression analysis showed that pet owners perceived fewer positive feelings (e.g. happy, joyful) than non-pet owners. However, among pet owners, a higher level of pet attachment was associated with more positive feelings. Gender and education significantly moderated the effects of pet ownership on emotional well-being, as male and employed respondents were more likely to benefit from owning a pet. Moreover, the positive effects of attachment and commitment to pet were stronger among respondents with higher levels of education or in the labor force. future studies need to investigate how to promote the benefits of pet companion and address the challenges faced by low-income pet owners.
Effects of Household Size and Partner Status on Financial Well-Being and Financial Exploitation
Authors: McLaughlin Jessica King , Anderson Elizabeth , Taeckens-Seabaugh Ashley , Greenfield Jennifer , Chess Eric , King Jessica
Published: December 2020

Social isolation and loneliness are significant risk factors for older adults (adults over the age of 50) for a multitude of reasons. This study explored the connections between social isolation, vulnerability to financial exploitation, and financial wellbeing in a sample of older adults. Using the concept of precarity as a guiding framework, this study assessed behaviors that expose individuals to financial exploitation as well as indicators of financial wellbeing in individuals with varying degrees of social isolation. One-hundred-eight community-dwelling older adults completed a pen-and-paper survey containing measures of risk to financial exploitation and financial wellbeing. Participants were predominantly female (75.9%), White (90.7%), and highly educated. Fifty-eight participants were unpartnered (53.7%) and 67 participants (62%) lived with at least one other person. Chi-square analyses resulted in a significant association between partner status and being a victim of financial exploitation (χ2(1) = 10.842, p≤.001). Furthermore, there was an association between social isolation and engaging in certain behaviors that put someone at risk for financial exploitation (such as reading junk mail). As for measures of financial wellbeing, partner status was significantly associated with feelings of financial freedom (χ2(3) =8.608, p =.035). These findings indicate that socially isolated individuals may be at greater risk of financial exploitation and have lower levels of financial wellbeing, such as feeling unprepared for retirement (χ2(2) =7.358, p =.025). The results of this study highlight the risks involved with social isolation and indicate further research is needed into ways to mitigate these negative effects.
Age 20 Cognitive Ability Moderates the Long-Term Influence of Lifestyle Behaviors on Brain Aging in Late Midlife
Authors: Franz Carol , Warren Teresa , Kremen William
Published: December 2020

We examined whether the longitudinal association between lifestyle behaviors and brain age is moderated by early general cognitive ability (GCA). The sample comprises 356 participants from the Vietnam Era Twin Study of Aging (VETSA). At mean age 40 (SD 2.7; range 34-44) a positive lifestyle index was created comprising three self-reported behaviors: not smoking, zero to moderate alcohol consumption, and high social engagement. GCA at mean age 20 was assessed with the Armed Forces Qualification Test. At mean age 68 (SD 2.6; range 61-72), participants underwent structural magnetic resonance imaging which was used to create predicted brain age difference (PBAD) scores. Multivariate models included GCA, lifestyle and their interaction as IVs, adjusted for age, ethnicity, APOE genotype, height, and family membership. Age 20 GCA and age 40 lifestyle significantly predicted age 68 PBAD [F=5.83; p=.02 and F=15.14; p<.001, respectively]. Both positive behaviors and higher age 20 GCA were associated with less brain aging. The GCA-lifestyle interaction was also significant. Those with both lower age 20 GCA and fewer positive behaviors had older brains relative to chronological age [F=5.00; p=. 03]. When GCA was high, however, participants had younger brains, regardless of lifestyle behaviors, suggesting a protective effect of early high GCA or cognitive reserve on later brain health. However, for those with lower cognitive reserve, positive lifestyle behaviors appeared to be protective against brain aging nearly three decades later. Results highlight the important role of cognitive reserve and lifestyle factors for later life brain health.
Aging Related Transcriptomic Changes in the Mouse Models of Alzheimer’s Disease
Authors: Uyar Asli , Pandey Ravi , Preuss Christoph , Kotredes Kevin , Howell Gareth , Sasner Michael , Carter Gregory
Published: December 2020

Alzheimer’s Disease (AD) is characterized by multiple clinical phenotypes and molecular signatures at different stages of the disease and aging is the major risk factor for sporadic AD. Aging and AD are linked at molecular, cellular and systems level with commonalities in inflammation and associated immune response in the brain. Mouse models of AD were developed that mimic various aspects of aging-associated neurodegeneration and inflammation. Research in mouse models of AD showed that drugs and treatments designed for AD can decelerate aging phenotypes suggesting efficient utilization of these models in aging research. We analyzed RNA-Seq transcriptomic data from transgenic mouse models of familial AD (APP/PS1 and 5XFAD) and knock-in mouse models of late-onset AD (APOE and TREM2) at the ages between 4-months and 24-months. The number of differentially expressed genes between transgenic/knock-in and WT mice increased by age in all mouse models. Gene set enrichment analysis identified metabolic pathways, including oxidative phosphorylation, altered in an age and genotype related manner in the brain of APP/PS1 and 5XFAD mice that recapitulate major features of amyloid pathology. Immunity related pathways were enriched in APOE4 model carrying Trem2*R47H mutation at >12 months-old. We also mapped the transcriptional signatures to co-expression gene modules of human LOAD from the AMP-AD consortium and observed correlations specific to each mouse model. Our study provides a detailed view of how the aging interacts with AD-relevant pathologies at the transcriptome level and demonstrates potential translational relevance of the AD mouse models in the context of human aging.
An Approach to Identify New Pleiotropic Genetic Loci From Publicly Available Univariate GWAS Results
Authors: Loika Yury , Kulminski Alexander
Published: December 2020

The connections between genes and multifactorial polygenic age-related traits are not trivial due to complexity of metabolic networks in an organism, which were primarily adapted to maximize fitness at reproductive age in ancient environments. Given this complexity, pleiotropy in predisposition to complex traits appears to be common phenomenon. Identifying mechanisms of pleiotropic predisposition to multiple age-related traits can be a key factor in developing strategies for extending health-span and lifespan. Correlation between complex traits may be a factor shedding light on these mechanisms. Recently, we used an omnibus test leveraging correlation between multiple age-related traits to gain insights into pleiotropic predisposition to them. The analysis using individual-level data identified large number of new pleiotropic loci and highlighted a novel phenomenon of antagonistic genetic heterogeneity, which was characterized by antagonistic directions of genetic effects for directly correlated traits. Here, we demonstrate feasibility of our approach using summary statistics from univariate genome-wide (GW) association studies (GWAS). Our analysis focused on the results for high density lipoprotein cholesterol (HDL-C) and triglycerides (TG) from the Global Lipids Genetic Consortium, which reported 94 GW significant loci (p≤5×10-8). The traits’ correlation was estimated from the individual level data. Our approach identified 28 loci with pleiotropic predisposition to HDL-C and TG at p≤5×10-8, which did not attain univariate GW significance with either of these traits. Fifteen of them (53%) demonstrated antagonistic heterogeneity. These results show that our approach can be efficiently used in the analysis of summary statistics from published studies to identify novel pleiotropic loci.
Effect of Combined Dasatinib and Fisetin Treatment on Senescent Cell Clearance in Monkeys
Authors: Colman Ricki , Tchkonia Tamara , Pirtskhalava Tamar , Giorgadze Nino , Prata Larissa , Schaefer Kalli , Kirkland James
Published: December 2020

Aging is the biggest risk factor for the most serious chronic diseases and disabilities. Cellular senescence, a state in which cells stop dividing but release factors that damage other cells, may contribute to both age-related and chronic diseases. Removal of senescent cells from aged mice has been shown to delay aging and age–related disabilities. Our goal was to determine the ability of potential senolytic agents to remove senescent cells in a primate model. Several agents and combinations were tested including Fisetin, Navitoclax, combined Dasatinib and Quercetin, and combined Dasatinib and Fisetin. Here we describe the Dasatinib and Fisetin trial. Dasatinib is an FDA approved oral anticancer drug that has been used to treat chronic myelogenous leukemia in humans. Fisetin is a flavonoid that can be found in many plants, particularly strawberries, and acts as a coloring agent. After baseline measurements, six older (mean age=21 years) female rhesus monkeys (Macaca mulatta) were given a combined oral dose of Dasatinib (5 mg/kg) and Fisetin (100 mg/kg) on two consecutive days. Animals were additionally assessed at 1- and 7-weeks following dosing. At 7 weeks post dosing, there were fewer (p<0.05) p16+ cells in the epidermis compared to baseline. Similarly, there was a reduction (p<0.05) in p21+ cells in the epidermis at 1- and 7-weeks post dosing compared to baseline. There were no negative outcomes associated with treatment. This study provides preliminary evidence for the senolytic potential of combined Dasatinib and Fisetin treatment and indicates that pharmacological mitigation of age-related changes is possible.
Older Sepsis Survivors Suffer Persistent Disability Burden and Poor Long-Term Survival
Authors: Mankowski Robert , Anton Stephen , Ghita Gabriela , Leeuwenburgh Christiaan , Moldawer Lyle , Efron Philip , Brakenridge Scott , Moore Frederick
Published: December 2020

As in-hospital sepsis mortality has decreased, more “sepsis survivors” are progressing into poorly characterized long-term outcomes. The purpose of this study was to describe the current epidemiology of sepsis in older adults compared to middle-aged and young adults. Design: Prospective longitudinal study with patients categorized into young (≤ 45 years), middle-aged (46-64 years) and older (≥ 65 years) patient groups. 328 sepsis patients were characterized by a) baseline demographics and predisposition factors, b) septic event, c) hospital outcomes and discharge disposition, d) 12-month mortality and e) Zubrod Performance status, physical function and cognitive function at three, six and 12-month follow-up. Follow-up visits were not completed due to death (in 68) and withdrawal of consent (in 32). Compared to young and middle-aged patients, older patients had: 1) significantly more comorbidities at presentation (example chronic renal disease 6% vs 12 % vs 21%), intra-abdominal infections (14% vs 25% vs 37%), septic shock (12% vs 25% vs 36%) and organ dysfunctions, 2) higher 30 day mortality (6% vs 4% vs 17%) and fewer ICU free days (median 25 vs 23 vs 20), 3) more progression into CCI (22%, vs 34% vs 42%) with higher poor disposition discharge to non-home destinations (19% vs 40% vs 62%), 4) worse 12-month mortality (11% vs 14 % vs 33%) and, 5) poorer Zubrod Performance status and objectively-measured physical and cognitive functions with slight improvement over 12 month follow-up. Conclusion: Compared to younger patients, older sepsis survivors suffer with both a higher persistent disability burden and 12-month mortality.
Survival After Discharge From Geriatrics vs. Internal Medicine Wards, by Risk Status and Diagnosis
Authors: Giordano Antonella , Carreras Giulia , Bari Mauro Di , Esposti Luca Degli , Michelozzi Paola , Bernabei Roberto , Marchionni Niccolò , Balzi Daniela
Published: December 2020

In randomized clinical trials, compared to Internal Medicine (IM), admission to Geriatrics (G) improved clinical outcomes of frail older patients accessing the Emergency Department (ED). Whether this advantage is maintained also in the “real world” is uncertain. We compared long-term survival of patients admitted to G or IM wards after stratification for background risk and across a variety of discharge diagnoses. Data were derived from the “Silver Code National Project (SCNP)”, an observational study of 180,079 unselected 75+ years old persons, admitted via the ED to IM (n=169,717, 94.2%) or G (n=10,362) wards in Italy. The Dynamic Silver Code (DSC), based on administrative data, was applied to balance for background risk between participants admitted to G or IM. One-year mortality was 33.7%, it was lower in participants discharged from G than IM (32.1 and 33.8%, respectively; p<0.001), and increased progressively across four DSC risk classes (p<0.001). Admission to G was associated with survival benefit in DSC class II to IV participants, with HR (95% CI) of 0.88 (0.83-0.94), 0.86 (0.80-0.92) and 0.92 (0.86-0.97), respectively. Cerebrovascular diseases, cognitive disorders, and heart failure were the ICD-9 coded diagnoses with the widest survival benefit from admission to G, which was mostly observed in DSC class III. In conclusion, admission to G may provide long-term survival benefit in subjects who, based on the DSC, may be considered at an intermediate risk. Specific clinical conditions should be considered in the ED to improve selection of patients to be targeted for G admission.
Age-Related Changes in Molecular and Whole Muscle Function: Role of Fat Content?
Authors: Gordon III Joseph , Remillard Nicholas , Straight Chad , Nagarajan Rajakumar , Damon Bruce , Chipkin Stuart , Miller Mark , Kent Jane , Gordon Joseph
Published: December 2020

Decreases in muscle size and function are a general consequence of old age; the precise mechanisms of these changes remain unclear. Recent studies suggest that fat deposition in muscle may also contribute to dysfunction in older adults. Fat content was quantified in the quadriceps, and its effects on function in healthy young (21-45 y) and older (65-75 y) men and women (n=44) of comparable physical activity were compared. A subset of the young matched with the older group for muscle fat content were also examined. Peak fat-free whole muscle cross-sectional area (mCSA; cm2), volume (MV; cm3), fat content (fat fraction, FF; %), specific torque (Nm/mCSA) and peak contraction velocity (Nm∙s-1) were determined using fat-water magnetic resonance imaging and dynamometry (0-300□∙s-1). To examine potential molecular mechanisms of muscle weakness, vastus lateralis biopsies were obtained (n=31) and cross-bridge kinetics of type I and II fibers were determined. FF was higher in older adults than young (8.4±1.2% (SE), 7.6±1.4; p=0.03), while mCSA (48.9±10.4 vs. 64.2±17.3), MV (1536±532 vs. 2112±708), specific torque (2.6±0.4 vs. 3.2±0.4), and peak voluntary contraction velocity (422±20 vs. 441±23) were lower in older than young (p<0.01). Type II fiber myosin attachment rate was slower and attachment time longer in older muscle (p<0.017), providing a potential mechanism for the slowing of peak contraction velocity with age. Notably, differences at the whole muscle and molecular levels remained for the subset of young and older groups matched for FF, suggesting that fat deposition in muscle does not exacerbate age-related changes in function.
Spatial Analysis of Prostate Cancer in Texas Counties
Authors: Baniya Ganesh , Oppong Joseph
Published: December 2020

Prostate cancer (PCa) is the most common cancer in American men, with estimated 191,930 new cases and about 33,330 deaths for 2020 (American Cancer Society (ACS), 2020). In Texas, there were 10,660 new cases and 1,900 deaths from prostate cancer in 2019 and only about 53.6% of men had ever talked to a healthcare professional about the advantages of the PSA test (Texas Department of State Health Services, 2018). The incidence of PCa is about 60% higher in blacks than in whites for unknown reasons (ACS, 2019), and once cancer has reached to its latent state, other comorbidities such as low sexual satisfaction, urinary incontinence and obstruction, and bowel dysfunction can decrease the quality of life even after surgery. A four-fold, worldwide increase in males above 65 years is expected by 2050 (Ferlay et al., 2010). Thus, with an increasing elderly population, the percentage of men needing new diagnoses and effective treatment will also rise. Previous studies have identified increasing age, African ancestry, a family history of the disease, and certain inherited genetic conditions as significant risk factors for prostate cancer (ACS, 2019). This study examined the geography and change at county-level PCa mortality rates in Texas from 1999-2009 using Texas vital web dataset in relation to smoking, race/ethnicity, obesity, alcohol consumption, and insurance coverage. Results showed that PCa is concentrated mostly in the western, eastern and central parts of TX and is positively correlated with smoking, obesity, PCP per 100,000 and negatively related to alcohol consumption and percent uninsured.
Dementia Caregiver Satisfaction and Utilization of a Telehealth App: Results From the FamTechCare Trial
Authors: Williams Kristine , Shaw Clarissa , Perkhounkova Yelena , Hein Maria , Coleman Carissa
Published: December 2020

Technology can enhance support for families caring for persons with dementia but must be acceptable to be adopted. In the FamTechCare trial, caregivers used an app to videorecord care encounters that were reviewed by an expert panel who provided tailored feedback. The intervention reduced caregiver depression and improved caregiver competence. This mixed methods study reports caregiver satisfaction and utilization of the intervention and evaluation of the intervention by the expert panel. A convergent parallel mixed methods design was used to evaluate the satisfaction, usability, and feasibility of the intervention. Caregiver-person with dementia dyads were randomized to the FamTechCare video support or telephone attention control support groups. Caregivers completed a satisfaction survey at the completion of the 3-month trial. The number and duration of videos submitted and calls received by caregivers were used to evaluate utilization. Relationships between participant characteristics and satisfaction and utilization were evaluated. Feasibility and future directions for the intervention were assessed through interviews with the expert panel. The majority of caregivers in both groups reported benefits from participation. More FamTechCare caregivers found the interventionist support to be helpful (p=.001) and effective (p=.020) compared to attention control caregivers. FamTechCare caregivers of persons with more severe dementia were more likely to report that video recording intruded on their privacy (p=.050). Age, gender, education, dyad relationship, rural status, and type and severity of dementia were not associated with ratings of acceptability, ease of use, or intervention utilization. The expert panel rated FamTechCare as useful and identified adaptations to enhance feasibility.
Low Cognitive Function Is Associated With Reduced Functional Fitness Among Community-Dwelling Older Adults
Authors: Gray Michelle , Gills Joshua , Glenn Jordan , Madero Erica , Hall Aidan , Fuseya Nami , Vincenzo Jennifer , Bott Nick
Published: December 2020

Among older adults over 70, 22-30% report difficulty performing at least one activity of daily living (ADL). While the precipitants of ADL decline are multifactorial, over 50% of cognitively impaired adults require assistance with ADLs. The exact relationship between cognitive and functional decline remains unknown, but it is important to understand their relationship. Eighty-three older adults (80.9 + 5.4 years) enrolled in this study and completed functional fitness and cognitive assessments. Functional fitness assessments included: Short Physical Performance Battery (SPPB), 10-meter walk, dual-task, and power chair stand (average and peak). Cognition was assessed using the Montreal Cognitive Assessment (MoCA) and Visual Paired Comparison task (VPC). Categories of low cognitive function (LCF) and high cognitive function (HCF) were determined by VPC scores. SPPB was 10.2% greater among the HCF group. The HCF group walked 12.6% (0.16 m/s) faster than the LCF group. Dual-task (fast) performance was 13.2% faster among the HCF group. Additionally, when rising from a seated position during the average and peak power chair stand task, the HCF group moved 16.7% and 16.1% faster than the LCF group, respectively. MoCA scores were 2.8 points greater among the HCF group. Based on the current results, significant differences exist between cognitive groups suggesting a relationship between functional fitness and cognition. What remains unknown is the ability to influence functional fitness by changing cognition or vice versa. Future research is warranted to determine the relationship of change in either domain over time.
The Association Between Diabetes and Cognition Among Older Hispanics in the United States and Mexicans in Mexico
Authors: Avila Jaqueline , Wong Rebeca , Ternent Rafael Samper
Published: December 2020

The objective is to assess if the effect of diabetes on cognition differs by race/ethnicity in the U.S. and how this association differs between older Hispanics in the U.S. and older Mexicans in Mexico. Data comes from a sample of older adults 50 and older with direct interviews from the 2012 waves of the Health and Retirement Study (N=17,810) and the Mexican Health and Aging Study (N=13,270). Cognition was measured as a total cognition score. OLS regressions were used to test the association between diabetes and cognition by race/ethnicity in the U.S. and among older Mexicans in Mexico. Results showed that Non-Hispanic Whites (NHW) had the highest cognition scores in the U.S., followed by Hispanics and non-Hispanic blacks (NHB). Mean cognition score of older Mexicans was higher than for NHB and Hispanics in the U.S. but lower than NHWs. The prevalence of diabetes was highest among Hispanics (32.3%), followed by NHB (30.6%) and NHW (19.9%). The prevalence of diabetes in Mexico was like those NHW in the U.S. (19.9%). In the U.S., the effect of being NHB and Hispanic (compared to white) on cognition was equivalent to having 5.3 and 2.4 fewer years of education, respectively. However, the effect of diabetes on cognition did not differ by race/ethnicity. The final analysis will include a direct comparison between Hispanics in the U.S. and a matched sample of older adults in Mexico with similar sex and age to test differences in the effect of diabetes on cognition between these two samples.
Behavioral Patterns of Care Providers and Resistiveness to Care of Persons With Dementia
Authors: Kim Bo Ra , Lee Kyung Hee , Cho Eunhee , Kim Heejung , Kim Bora
Published: December 2020

Resistiveness to care in persons with dementia is a distinct obstacle for care providers to provide oral care. It is necessary to find out specific behaviors of care providers that affect resistiveness to care. This is a secondary data analysis to identify behaviors of care providers related to resistiveness to care using 70 videos that were taken when 23 persons with dementia received oral care in long-term care facilities at baseline, month 3 and month 6. The behavior patterns of care providers and resistiveness to care of persons with dementia were extracted in the form of the frequency of each behavior using a coding scheme for behavioral observation. The coding scheme for behavior patterns of care providers consists of 2 dimensions: person-centered behaviors including 18 items and task-centered behaviors including 4 items. In addition, the coding scheme for resistiveness to care of persons with dementia includes 13 items. The data were analyzed using a linear mixed model analysis considering the repeated measured data. Among person-centered behaviors, ‘assessing the comfort of resident,’ and ‘cooperatively negotiating’ were less likely to occur resistiveness to care. However, ‘physically controlling’ was the most significant to increase the occurrence of resistiveness to care of persons with dementia. Therefore, it is recommended that care providers try to understand the causes of discomfort for persons with dementia and meet his/her needs rather than to physically control when providing oral care.
HARMONY Study: Pimavanserin Significantly Prolongs Time to Relapse of Dementia-Related Psychosis
Authors: Tariot Pierre , Foff Erin P , Cummings Jeffrey L , Soto-Martin Maria-Eugenia , McEvoy Bradley , Stankovic Srdjan , Howard Amy
Published: December 2020

Dementia-related psychosis (DRP) is common among patients with Alzheimer’s disease (AD), Parkinson’s disease (PD), dementia with Lewy bodies (DLB), frontotemporal dementia (FTD), and vascular dementia (VaD) and is associated with poor outcomes. HARMONY (NCT03325556) was a Phase 3, placebo-controlled, randomized, relapse-prevention study evaluating the efficacy and safety of pimavanserin for treating hallucinations and delusions associated with DRP. Patients with dementia and moderate-severe psychosis received open-label (OL) pimavanserin for 12 weeks. Patients with sustained response (≥30% reduction in Scale for the Assessment of Positive Symptoms hallucinations+delusions Total Score AND Clinical Global Impression-Improvement score of much/very much improved) at Weeks 8 and 12 were randomized 1:1 to continue pimavanserin or receive placebo for up to 26 weeks in the double-blind (DB) period. The primary endpoint was time from randomization to relapse of DRP. 392 patients enrolled. 217 (61.8%) eligible patients experienced sustained response and were randomized. OL response was similar regardless of dementia subtype (randomization rates: 59.8% AD, 71.2% PDD, 71.4% VaD, 45.5% DLB, 50.0% FTD), baseline disease characteristics, age, dementia severity, or previous drug therapy. The study stopped early for superior efficacy when a prespecified interim analysis revealed >2.8-fold reduction in risk of relapse with pimavanserin (hazard ratio: 0.353; 95% CI: 0.172, 0.727; 1-sided p=0.0023). Adverse event rates were low and balanced (OL: 36.2%; DB: 41.0% pimavanserin, 36.6% placebo). No negative impact on cognition or motor function was observed. The Harmony study demonstrated a robust decrease in hallucinations and delusions and significant maintenance of efficacy with pimavanserin treatment in DRP.
Evidence of Mediation by Depressive Symptoms in the Association Between Frailty and Cognitive Decline in Older Adults
Authors: Resciniti Nicholas , Lohman Matthew , Merchant Anwar
Published: December 2020

Frailty and pre-frailty have been shown to predict cognitive decline in older adults; however, knowledge about mediating pathways in this association is lacking. This study aims to assess if depressive symptoms mediate the relationship between frailty and cognitive function. Frailty status, cognitive function scores, and depressive symptoms were measured in 4,672 community-dwelling US adults ≥65 and older from the Health and Retirement Study from 2006-2010. Fried’s frailty phenotype criteria (weakness, slowness, physical inactivity, low weight, and exhaustion) were used to categorize individuals as frail (3-5 criteria), pre-frail (1-2 criteria) and robust (0 criteria). Memory recall and global mental status (from 0-35) was used to determine cognitive function. The CES-D was used to assess depressive symptoms. A causal mediation analysis was performed to estimate the direct effect (DE), the direct effect (DE), and the indirect effect (IE). Both frailty (TE: β=-1.22; 95% CI: -1.75, -0.68) and pre-frailty (TE: β=-0.52; 95% CI: -0.86, -0.18) were found to be associated with lower cognitive scores, after adjusting for confounders. There was significant but small IE between frailty status and declining cognitive scores mediated by depressive symptoms [frailty: β=-0.09 (95% CI: -0.14, -0.03); pre-frailty: β = -0.03 (95% CI: -0.06, -0.01). Additionally, the DE was significant for frailty (β=-1.13; 95% CI: -1.67, -0.59) and pre-frailty (β=-0.49 95% CI: -0.82, -0.15). This study provides evidence that depressive symptoms may mediate the association between frailty and cognitive decline. The results suggest possible intervenable pathways for preventing or delaying cognitive decline.
Validating Older Adult Morbidity Trajectories Using Multiple Comorbidity Indices
Authors: Newman Michael , Hanson Heidi , Schliep Karen , Abdelrahman Samir , VanDerslice Jim , Smith Ken , Porucznik Christy
Published: December 2020

Many older adults lead healthy lives while aging, with little or no morbidity. This group has been identified as “Escapers”, for escaping the 10 most common lethal diseases in older adults. “Morbidity Trajectories” (MOTRs) are a metric based on the temporal patterning of comorbidity, which is used to characterize changes in disease status as a person ages. While these trajectories have been used to identify Escapers in various populations, they are sensitive to the choice of the disease metric. This study seeks to describe the differences in MOTR scale by alternative comorbidity indices. Understanding these differences is important because of the need to validate the potential end-point in health trajectory risk scores that may be used in a clinical setting. We found that 15-19 percent of a Medicare utilizing population (n=321722) aged >= 65 between 1992 and 2012 fall into the Escaper category, where there is a consistent Quan modification Charlson Comorbidity Index (CCI) score of 0 during the entire study period. Using the vanWalraven (vW) Elixhauser Comorbidity Index modification, we found that about a third (35.2%) of the study population have a vW Elixhauser score of 0 over the span, a significantly higher portion than the CCI estimate. We will discuss this difference and the resulting varying trajectories from each of these indices. Future work includes further validation of the MOTR scale using unsupervised machine learning clustering methods, and using supervised machine learning models to identify clinical factors and early life conditions that may influence MOTR membership.
Prevalence and Associated Risk Factors of Sarcopenia Among Elderly With Diabetes in Japan and Taiwan
Authors: Yamaguchi Yuko , Greiner Chieko , Ryuno Hirochika , Lee Pi-Hsia , Yen Hsin-Yen , Lee Shu-Chun , Lin Chiou-Fen , Lee Ting-I
Published: December 2020

The aim of this study was to investigate the prevalence of sarcopenia and its associated risk factors among elderly with diabetes in Japan and Taiwan. A cross-sectional study was conducted through convenience sampling. This study was approved by the institutional review boards of Kobe University Graduate School of Health Sciences (No. 543) and Taipei Medical University (No. N201905065). Of the 114 Japanese participants (24.9% females) and 226 Taiwanese participants (75.1% females), the mean age were 73.7±6.9 years and 74.2±6.6 years, respectively. Sarcopenia was found in 10.6% in Japan and 11.1% in Taiwan with no significant difference between both countries. Older age, poor relationships with neighbors, and poor consciousness for health management were significantly associated with sarcopenia in both countries. Additionally, Japanese participants with sarcopenia had significantly longer duration of diabetes, higher level of emotional distress assessed by the Problem Areas In Diabetes (PAID) scale, and lower level of total protein, but no significant differences were shown in Taiwanese participants. Binomial logistic regression analyses were performed to detect risk factors related to sarcopenia. After adjusting for age, sarcopenia was found to be significantly associated with poor consciousness for health management in Japanese participants (OR:0.12 P=0.02) and significantly associated with poor relationships with neighbors and poor consciousness for health management in Taiwanese participants (OR:0.18 P=0.008 and OR:0.45 P=0.04, respectively). These findings are expected to contribute to the development of effective strategies for preventing sarcopenia among elderly with diabetes in Japan and Taiwan.
Self-Reported Health and Sarcopenia Phenotypes: Data From the National Health and Aging Trends Survey
Authors: Batsis John , Dowd-Sivigny Cameron , Haudenschild Christian , Crow Rebecca , Gooding Tyler , Lohman Matthew , Vasquez Elizabeth
Published: December 2020

Background: Obesity in combination with sarcopenia (age-related loss of muscle mass, strength or function) is increasing in adults aged ≥65 years which places individuals at risk for functional decline and worse health. We ascertained the relationship between sarcopenic obesity and self-reported health in a representative US population. Methods: We identified participants ≥65 years with grip strength and body mass index (BMI) measures from the baseline wave of the National Health and Aging Trends Survey. Sarcopenia was defined using the Sarcopenia Definitions and Outcomes Consortium grip strength cut-points (males<35.5kg; females<20kg), and obesity was defined using standard World Health Organization BMI categories. We also assessed grip divided by BMI cut-points (males<1.05; females<0.79). Self-reported health was evaluated using a one-item question (Excellent/Very Good/Good vs. Fair/Poor). Logistic regression models adjusted for age, sex, smoking, education, comorbidities, and an ability to walk. Results: Of the 8,245 participants (59.7% female), median age category was 75-79, and mean grip strength and BMI were 26.0 kg and 27.0 kg/m2, respectively. Prevalence of sarcopenia and sarcopenic obesity was 12.7% and 41.1%. Compared to those without sarcopenia or obesity, the odds of impaired self-reported health using grip strength defined sarcopenia cut-points was higher in sarcopenic obesity (OR 1.87 [1.50,2.32]), sarcopenia (OR 1.79 [1.50,2.14]), and obesity (OR 1.24 [0.99,1.56]). Using the Grip divided by BMI cutpoints, we found the odds of low self-reported health in sarcopenia was OR 1.38 [1.12, 1.59]. Conclusions: Both sarcopenia and sarcopenic obesity are associated with an increased odds of decreased self-reported health.
Cumulative Effects of Physical Activity, Dietary Variety, and Social Participation on Active Life Expectancy
Authors: Seino Satoshi , Kitamura Akihiko , Tomine Yui , Nishi Mariko , Nofuji Yu , Yokoyama Yuri , Amano Hidenori , Shinkai Shoji
Published: December 2020

Regular physical activity, dietary variety, and active social participation are modifiable and influential factors of adverse health outcomes. However, the cumulative effects of these behaviors are unknown. We examined these cumulative associations with active life loss in older adults. We analyzed 3-year longitudinal data from 7246 initially non-disabled residents aged 65-84 years from 18 districts of Ota City, Tokyo. Sufficiency of moderate- to vigorous-intensity physical activity (MVPA) of ≥150 minutes/week, dietary variety score (DVS) of ≥3, and social participation of ≥1 time/month were assessed using self-administered questionnaires. We operationally defined active life loss for individuals as being newly certified for long-term care insurance or death without prior certification. Multilevel survival analyses were applied to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). During an average follow-up of 2.9 years, the cumulative incidence of active life loss was 11.3% (817 individuals: 650 new certifications and 167 deaths without prior certification). Multivariate-adjusted HRs (95% CIs) for active life loss were 0.73 (0.58-0.92) in only MVPA of ≥150 minutes/week, 0.88 (0.67-1.15) in only DVS of ≥3, 0.75 (0.51-1.09) in only social participation of ≥1 time/month, 0.56 (0.45-0.70) in the group satisfying any two, and 0.52 (0.40-0.67) in the group satisfying all three behaviors, compared with a reference group that did not satisfy any of the behaviors. Sensitivity analysis that excluded active life losses during the first year showed similar results. The combination of regular physical activity, dietary variety, and social participation further enhances the effects on active life expectancy than individual practices.