bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and validation of two composite aging measures using clinical biomarkers in the Chinese population
Authors: Liu Zuyun
Published: December 2020

Quantifying aging is crucial for addressing aging and related issues. This study aimed to: 1) develop two composite aging measures in the Chinese population using two recent advanced algorithms (the Klemera and Doubal method and Mahalanobis distance); and 2) validate the two measures by examining their associations with mortality and disease counts. Based on data from the China Nutrition and Health Survey 2009 wave (N=8,119, aged 20-79 years, 53.5% women), a nationwide prospective cohort study of the Chinese population, we developed Klemera and Doubal method-biological age (KDM-BA) and physiological dysregulation (PD, derived from Mahalanobis distance) using 12 routine clinical biomarkers. For the validation analysis, we used Cox proportional hazard regression models (for mortality) and linear, Poisson, and logistic regression models (for disease counts) to examine the associations. We replicated the validation analysis in the China Health and Retirement Longitudinal Study (CHARLS, N=9,304, aged 45-99 years, 53.4% women). We found that both aging measures were predictive of mortality after accounting for age and gender (KDM-BA, per one-year, HR=1.14, 95%CI=1.08, 1.19; PD, per one-SD, HR=1.50, 95%CI=1.33, 1.69). With few exceptions, these mortality predictions were robust across stratifications by age, gender, education, and health behaviors. The two aging measures were associated with disease counts both cross-sectionally and longitudinally. These results were generally replicable in CHARLS although four biomarkers were not available. In summary, we successfully developed and validated two composite aging measures‒‒KDM-BA and PD, which have great potentials for applications in early identifications and preventions of aging and aging related diseases in China.
Embedding Age-Friendly Care using the 4Ms Framework in the Convenient Care Setting
Authors: Greenberg Sherry , Pino Lilia , McCormack Mary , Duffy Evelyn , Zimmermann Elizabeth , Hughes Robin , Pohnert Anne , Dolansky Mary
Published: December 2020

This late-breaker presentation highlights the implementation science plan for Age-Friendly care in CVS Health MinuteClinic’s convenient care clinics. This project, a partnership between MinuteClinic, Case Western Reserve University Frances Payne Bolton School of Nursing, and the Institute for Healthcare Improvement, funded by The John A. Hartford Foundation, increases the number of care providers trained in the provision of Age-Friendly care using the 4Ms Framework: What Matters, Medication, Mentation, and Mobility. The implementation team learned the MinuteClinic usual processes, then developed strategies for successful Age-Friendly care implementation. Data from 21 nurse practitioner, 5 patient interviews, educator focus groups and 14 site visits revealed time, resources, and perceived value as barriers to implementation. Most reported increased knowledge and willingness to change practice. Based on the Plan-Do-Study-Act change process data, the implementation team developed solutions that addressed gaps leading to the development of practice-based tools for successful Age-Friendly care project adoption and implementation.
Supporting relationships, providing presence: Arts-informed approaches to LTC staff dementia care literacy
Authors: O’Neil Kelly , Redden Marco , Aubrecht Katie
Published: December 2020

Early findings and insights are shared from an interpretive analysis of interviews with 15 leaders in arts-based approaches in dementia care. This was conducted as part of a larger project that has the goal of operationalizing ‘good’ literacy in social and relational care in long-term care (LTC). Interviews aimed to identify promising directions in arts-based approaches in education and training for LTC staff provincially, nationally, and internationally, and understand how they contribute to ‘good’ mental health and dementia literacy. Participants were recruited using a purposive snowball sampling method and semi-structured interview guide. Interviews were conducted in-person, via telephone and Zoom, and digitally recorded. Arts-making enhances mental health and dementia literacy of LTC staff by: 1) supporting relationships by generating trust and collaboration among persons living with mental health conditions and/or dementia, arts facilitators, and family members; 2) creating alternative communication spaces that allow people to see themselves and be seen by others from new perspectives; 3) fostering an artistic sensibility that: encourages imagination and empathy, brings spontaneity and playfulness to interactions, and disrupts restrictive expectations entrenched in typical caregiver/care receiver relationships. ‘Good’ literacy involves a relational and spatial awareness which manifests in the form of an artistic sensibility. Arts-based approaches can be used to enhance quality care by capacitating staff in the art of being open and curious, nimble and flexible, in how they know and make connections on an interpersonal level, in the moment.
Power Dynamics in a Triad Relationship: Advance Care Planning for Older Adults with Dementia in China
Authors: Lou Yifan , Liu Jinyu , Wu Bei
Published: December 2020

Objective: Primary family caregiver (CG), other family members (FM), and medical professionals (MP) play important roles in medical decision-making for older adults with dementia, who often have lost the capacity to make decisions on their own. Power dynamics within the CG-FM-MP triad relationship determine the process and outcome of the decision-making. Guided by Rahl’s relational power model, this study is among the first to understand the experiences of advance care planning among Chinese. Method: This study includes a total of 25 primary CGs or FMs and 5 MPs from 3 neurology departments. Hybrid grounded theory method was used to analyze the preliminary data we had so far. Based on the dimensions of power, we analyzed the power base, means, and scope of each agent in each interview to determine the power comparability. Results: Three types of triadic power relations were categorized: 1) shared-power with shared-decision, in which three agents shared the power of decision-making and CG as the lawful decision-maker makes the final decisions; 2) balanced-power with reversed-patriarchal decisions, in which FM’s power is over both CG and MP and become the actual decision-maker; and 3) unbalanced power with conflicting decisions, in which neither CG and FM has absolute power over each other and MP becomes the actual decision-maker implicitly. Conclusion: The study provides a framework for researchers and practitioners to understand the ACP process for Chinese older adults, which helps develop intervention strategies to improve surrogates’ ACP knowledge and reduce potential conflicts during the stressful process for the population.
The Enduring Strength of Biology and Gender: Care for Aging Parents Among Adult Children
Authors: Patterson Sarah , Schoeni Robert , Freedman Vicki , Seltzer Judith
Published: December 2020

Family complexity in the form of step-relationships are increasing across cohorts. Filial obligation, or the social norm that adult children should care for aging parents, are generally weaker in stepfamilies. Further, gender continues to be a main axis of stratification of who provides care within families. Taken together, we test whether biological versus step ties, the gender of the adult child, and the interaction between these two factors are associated with helping aging parents (ages 65 and older) with functional or health limitation based care needs. We use Round 5 (2015) of the National Health and Aging Trends Study. Results illustrate the enduring strength of both biological and gendered ties, with biological daughters being the most likely to help an aging parent, followed by biological sons, step-daughters, and lastly step-sons. This pattern holds even when we control for important characteristics of both the adult child and the care receiver. As families become more complex, these findings could mean that gaps in unmet care needs will emerge, especially for older adults who only have stepchildren.
Improvement in ADLs during a Nursing Home Stay for Older Adults with Stroke, Joint Replacement or Hip Fracture
Authors: Mathuba Warona , Downer Brian , Deer Rachel
Published: December 2020

Regularly assessing the health and function of older adults who are in the hospital is important for preventing poor outcomes. Such information may also be useful in post-acute care settings, such as skilled nursing facilities (SNFs) to identify older adults who are high risk for poor outcomes. This study had two objectives: Map items from the Acute Care for the Elderly (ACE) Tracker to items from the Minimum Data Set (MDS). (2) Examine the association between ACE Tracker items and improvement in activities of daily living (ADLs) during a SNF stay. We identified Medicare fee-for-service beneficiaries admitted to a SNF within 3 days of hospital discharge for a hip fracture (n=118,790), joint replacement (n=245,845), or stroke (n=64,153). Items from the ACE Tracker were matched to patients’ first MDS assessment. The first and last MDS assessments were used to calculate a total score for self-performance on seven ADLs. Multivariable logistic regression models were used to identify patient characteristics associated with the odds for improvement in ADL function. Severe ADL limitations at admission and greater hours of physical and occupational therapy were associated with significantly higher odds of ADL improvement. Cognitive impairment, vision limitations, indwelling catheters, and unhealed pressure ulcers were associated with significantly lower odds of ADL improvement. The characteristics associated with improved ADL function were similar between patients with joint replacement, hip fracture, and stroke. Many of the health and functional characteristics routinely measured in hospital settings are also collected in SNFs and are associated with improvement in ADL function.
Caregiver’s Relationship Type and Race/Ethnic Group Comparisons in a Community-based Caregiver Support Program
Authors: Cho Jinmyoung , Smith Donald , Stevens Alan
Published: December 2020

In the past decades, a number of evidence-based interventions has been implemented to improve caregiver outcomes; however, limited attention to specific subgroups (e.g., racial/ethnic groups) still exists in dementia caregiver support interventions in community settings. The purpose of this study is to examine the effect of caregiver’s race/ethnicity and relationship type to the care-recipient on the quality of life among caregivers. This study included 354 informal caregivers enrolled in REACH-TX, a community-based caregiver program, provided by the Alzheimer’s Association North Central Texas Chapter’s from November 2011 to June 2019. Propensity score matching extracted a subset of participants who enrolled in REACH-TX to balance caregivers from three race/ethnic groups (White: 171; African American: 103; Hispanic: 80). Five dimensions of quality of life (depression, caregiving burden, social support, self-care, and problem behaviors) were assessed at baseline and 6-month follow-up among spousal and adult-child caregivers by race/ethnic group. Generalized linear models showed that significant improvement on the five domains of quality of life among White child caregivers, whereas neither spousal nor child caregivers in African American group showed improvement on any domains after adjusting covariates (age, gender, risk levels, number of therapeutic contacts), These findings indicate that the responses to intervention components vary by race/ethnic group and relationship type. Advancing tailored dementia caregiver interventions to specific subgroup needs and unique context, especially for non-White caregivers, is needed to maximize the benefit of community resources and support for diverse caregivers.
Fear of Falling and Walking Quality: What Your Walking Reveals
Authors: Suri Anisha , Rosso Andrea , VanSwearingen Jessie , Torres-Oviedo Gelsy , Coffman Leslie , Redfern Mark , Brach Jennifer , Sejdic Ervin
Published: December 2020

Fear of Falling (FOF) is common among community-dwelling older adults and is associated with increased fall-risk. In this cross-sectional study we examined the relationships between FOF and factors associated with fall-risk such as gait quality, cognition, and walking-confidence. Using baseline data from older adult participants in a randomized exercise trial (N=232; age 77±6; 65% females; 40% reported FOF), we quantified the following outcome measure for (1) gait quality: harmonic ratio (smoothness) and time-frequency spatiotemporal variables from triaxial accelerometry during 6 minute walk; gait speed, step-time CoV (variability) and walk-ratio (step-length/cadence) on an instrumented walkway; (2) cognition: Trails A and B (3) walking-confidence: Gait efficacy Scale. Mann Whitney U-tests indicated individuals without FOF had better gait quality (p<0.05): greater smoothness (2.38±.58 vs 1.14±.73), speed (1.10±.15 vs 1.04±.17 m/s) and walk-ratio (.56±.07 vs .53±.08 cm/steps/min), lower step-time CoV (3.72±1.24 vs 4.17±1.66), and greater walking-confidence (89±11 vs 79±13). A random forest classifier predicted FOF with 64% (gait only) and 70% (additional variables: cognition, walking-confidence) accuracy; Gini-index based ranking indicated gait quality (smoothness vertical (V) direction, walking speed) were consistently important variables. Linear Support Vector Machine learning yielded accuracies of 60% (only gait) and 68% (with additional measures): smoothness V, mediolateral frequency bandwidth, gait speed among top 4 ranked variables in both models, and walking-confidence in the additional measures model; smoothness-V the highest weighted coefficient (-0.52). Based on these findings, interventions targeted for gait quality and walking-confidence may be important to overcome FOF and reduce fall risks.
Food and Nutrient Intake and Diet Quality among Older Americans
Authors: Choi Yeon Jin , Crimmins Eileen , Kim Jung Ki , Ailshire Jennifer
Published: December 2020

A suboptimal diet and nutritional deficiencies can have important influences on health with significant impact among older adults. This study aims to assess the presence of suboptimal dietary intake among older Americans and identify risk and protective factors influencing diet quality. For this study, data from a nationally representative sample of 5,614 community-dwelling older adults over age 54 in the Health and Retirement Study – Health Care and Nutrition Survey were used. Descriptive analyses were conducted to assess average intake of 17 food groups and nutrients and the percentage of respondents who consumed an optimal amount of food and nutrients. Differences in diet quality by sociodemographic, psychosocial, environmental, and geographic factors were assessed using chi-square and OLS regression was used to identify risk and protective factors for good quality diet. Overall, only 10.7% of respondents had a good quality diet (HEI score 81 and above); the majority had diets considered poor or needing improvement. Less than 50% of respondents met dietary guidelines and nutritional goals for most individual food groups and nutrients. Respondents with low socioeconomic status, fewer psychosocial resources, and those who had limited access to healthy food outlets were more likely to have a diet of suboptimal quality. Efforts to remove identified barriers that put older adults at risk for poor nutrition and to provide resources that increase access to healthy food should be made to encourage healthy eating and enhance diet quality.
Stressors and Pain Over the Late-Life Course: Findings from Two Parent Longitudinal Studies of Aging and Health
Authors: Brennan Penny
Published: December 2020

With this study we sought to determine how older adults’ stressors influence their levels and rates of change in pain during the late-life span. We harmonized repeated measures data from two parent longitudinal studies of aging and health, Longitudinal Late-Life Health (LLLH; n=1,1884) and the Health and Retirement Study (HRS; n=7,703), to determine how participants’ stressor levels in the domains of finances, spouse, children, extended family, and friends, and in stressors overall, influenced their average levels and rates of change in painful conditions, pain severity, and pain interference over 13-year (LLLH) and 8-year (HRS) intervals. Participants’ within-person stressor levels declined somewhat, whereas their number of painful conditions, pain severity, pain interference, and prescription painkiller use increased steadily, over these intervals. In both the LLLH and HRS samples, participants who experienced higher average stressor levels over the 13- and 8-year intervals had more numerous painful conditions and higher pain severity over these intervals. In the HRS sample, they also experienced higher levels of pain interference. These effects occurred independent of the demographic characteristics of age, gender, and race. In general, participants’ stressor levels did not influence rates of increase in their pain. Gender and race had some moderating effects on associations between stressors and pain, but these occurred only within certain specific stressor and pain domains. These findings demonstrate an association between stressors and pain across the late-life course. Further research is needed to determine the mediating mechanisms that account for this association and the moderating factors that affect its strength.
The Effect of Technology Use in Reducing Social Isolation or Loneliness in Older Adults: A Systematic Review
Authors: Kim Yoon Chung , Kohn Gail , Davis Carenado , Saunders Pamela
Published: December 2020

The US population over 65 is projected to increase to 21% by 2050. Given mobility issues arising from health concerns, economic status changes, loss of friends and partners, older people are at a higher risk for social isolation and loneliness. Since the declaration of national emergency for COVID-19 on March 13, 2020, many older adults have not been able to connect with others in traditional ways. Instead, activities and contacts have been facilitated virtually via videoconferencing or phone calls to maintain physical and social distance. Amidst COVID-19, the transition to using technologies to connect socially and reduce loneliness has been a critical factor in preventing social isolation and loneliness. Identifying effective strategies involving the use of technology, designing new ways to deliver services virtually, and developing educational programs to promote technology is vitally necessary. This systematic review explored the relationship between technology use and social isolation or loneliness, and examined interventions that reduced social isolation in older adults. A unified strategy was used to systematically search seven databases (MEDLINE, PubMed, Embase, CINAHL, Web of Science, PsycInfo, and AgeLine) to examine qualitative and quantitative studies published in English between 2010 and 2020. Preliminary results indicate that technology can alleviate social isolation and loneliness in older adults despite some mixed results. The findings of this study will provide a foundation for policymakers and practitioners to shape policies and design programs that help older adults to alleviate social isolation and loneliness, particularly amidst the COVID-19 pandemic.
Age Does Not Predict Mortality in Hospitalized COVID-19+ Older Adults: Rethinking Resource Allocation Based on Age
Authors: Sinvani Liron , Marziliano Allison , Makhnevich Alex , Zhang Meng , Carney Maria , Diefenbach Michael , Davidson Karina , Burns Edith
Published: December 2020

Older adults are disproportionately affected by the coronavirus (COVID-19) pandemic. While age has been used to guide resource allocation based on studies implicating age as the main risk factor for COVID-19-related mortality, most did not account for critical factors such as baseline functional and cognitive status, or life-sustaining treatment preferences. The objective of this study was to determine whether age is independently associated with mortality in older adults hospitalized with COVID-19. We conducted a retrospective cohort study of adults age 65+ with confirmed COVID-19 hospitalized in the greater NY metropolitan area between 3/1/20-4/20/20. Primary outcome was in-hospital mortality, with age as the primary predictor. Multivariate logistic regression was used to evaluate association between age and in-hospital mortality after controlling for demographics, severity of acute illness, comorbidities, and baseline function, cognition, and life-sustaining treatment preferences. 4,969 patients were included, average age 77.3, 56.0% male, 46.8% White, 20.8% African American, 15.1% Hispanic. Common comorbidities included hypertension (61.1%), and diabetes (36.8%); average number of comorbidities was 3.4 (SD 2.8) and 13.0% had dementia. 20.8% arrived from a facility and 5.7% had early do-not-resuscitate orders. On arrival, the Modified Early Warning System score was 4.2 (SD 1.7) and 79.6% required oxygen therapy. 35.3% of patients expired. In multivariate analysis, age was not independently associated with mortality (p = .173). Functional status, multi-morbidity, life-sustaining treatment preferences, and illness severity, not age, were associated with mortality among older adults hospitalized with COVID-19, suggesting age should not be used as the main indicator to guide resource allocation.
Development of Serum Antibodies to SARS-CoV-2 and Evidence of Immunity in Older Adults Convalescing from COVID-19
Authors: Caffrey Rebecca , Wright James , Waltrip Nicole , Bostwick David
Published: December 2020

The presence and magnitude of SARS-CoV-2 IgG, IgM, and Neutralizing Antibody (NAbs) response was investigated in study cohort comprised of 58 volunteers who survived COVID-19 in a Virginia LTC facility. All subjects were confirmed positive by PCR nasal swab at least once and blood samples were drawn a minimum of 14 days post symptom onset or first positive COVID-19 test. The cohort was split between LTC residents (n=32, mean age 77.8 yrs, age range 48-97), and the LTC staff (n=26, mean age 41.3 yrs, range 23-61); the age difference between groups was statistically significant (P<0.001). Serum IgG measurement was quantitative over 5 orders of magnitude (0.6-1250µg/mL) and IgM was qualitative, measured with sandwich ELISA; NAbs were measured with surrogate virus neutralization assay (sVNT) competition ELISA (both Genscript). The convalescent older adult LTC patients were fully immuno-competent and showed no significant difference in IgG, IgM, or NAbs compared to the younger staff group. All older adults developed NAbs and were positive for either IgG, IgM, or both. All study participants were then grouped by age range and IgG, IgM, and NAbs compared between the following groups: ≤ 50 yrs old(n=20), 51-60(n=6), 61-70(n=8), 71-80(n=14), 81-90(n=6), and ≥91(n=4). There was no significant difference in immune response parameters between the age groups. Furthermore, repeat testing at 3 months on a subset of participants showed that NAbs, IgG and IgM persist. We conclude that development of competent immune response was age-independent, and that presence of NAbs in serum suggests older adults may develop true immunity.
Differential Impact of the COVID-19 Pandemic on Students, Faculty and Staff at a Florida HBCU
Authors: Wheaton Felicia , Johnson Matilda , Cozart Thometta
Published: December 2020

The COVID-19 pandemic has caused major disruption to society, including education, the economy, daily life, etc. To understand the impact of the pandemic on both short-term and anticipated long-term mental and physical health, as well as potential period and cohort differences, surveys were emailed to all students, faculty and staff at a Florida HBCU. The survey included the GAD-7 anxiety scale, PHQ-9 scale of depression severity and the UCLA Revised Loneliness Scale (3rd revision), as well as questions about the pandemic’s impact on physical and mental wellbeing in the month of April and long-term physical and mental health. Although loneliness did not differ among groups, students reported the highest levels of moderate/severe depression (46.6%), followed by faculty (21.1%) and staff (6.9%). Students also reported the highest levels of moderate/severe anxiety (48.6%) compared with faculty (29.4%) and staff (12.1%). Students were more likely to say the pandemic moderately or very much impacted their overall physical and mental wellbeing in April. However, faculty were more likely to report that their long-term physical and mental health would be somewhat/greatly affected, followed by students, and then staff. Staff reported the highest levels of optimism about the future, followed by students and faculty. Taken together, these findings indicate substantial differences in the perceived impact of the COVID-19 pandemic.
Digital Technologies To Enhance Social Connectedness in Long-Term Care Facilities During COVID-19: A Review
Authors: Freeman Shannon , Abgoji Aderonke , Koopmans Alanna , Ross Christopher
Published: December 2020

A consequence of the strict visitor restrictions implemented by many Long-term Care Facilities (LTCFs), during the COVID-19 pandemic, was the exacerbation of loneliness and social isolation felt by older adult residents. While there had been a shift by some persons to utilize digital solutions to mitigate the effects of the imposed social isolation, many facilities did not have sufficient information regarding available solutions to implement institutional strategies to support social connectedness through digital solutions. To support our partners in evidence-based policy-making we conducted a scoping review to identify existing virtual technology solutions, apps, and platforms feasible to promote social connectedness among persons residing in a long-term care facility context during times of lockdown such as experienced during the COVID-19 pandemic. Initial identification of relevant literature involved a combination of keywords and subject headings searches within 5 databases (PubMed, CINAHL EBSCO, PsychINFO EBSCO, Embase OVIDSP, and Web of Science ISI). DistillerSR was used to screen, chart and summarize the data. There is growth in the availability of technologies focused on promoting health and well-being in later life for persons in long-term care facilities however a gap remains in widespread uptake. We will describe the breadth of technologies identified in this review and discuss how they vary in utility in smaller scale facilities common in rural areas. Of the technologies that can be used to mitigate the impacts of social isolation felt by long-term care residents, many “solutions” depend on stable highspeed internet, which remains a challenge in rural and northern areas.
Older age is associated with more positive reframing of memories from the spring phase of the covid-19 pandemic
Authors: Garcia Sandry , Ford Jaclyn , Fields Eric , Cunningham Tony , Kensinger Elizabeth
Published: December 2020

Older adults often focus on positive aspects of past events, showing resiliency that runs counter to negative stereotypes of aging. We asked whether older adults would retain this positive focus even during the COVID-19 pandemic that puts older adults at particular health risk. We examined how age would relate to the experience of affect during the spring phase of the pandemic and also how it would affect their memories of that spring phase. We predicted that when reflecting on the spring phase of the pandemic, older age would be associated with an increased tendency to focus on “silver linings” and a decreased focus on negative aspects. Furthermore, we explored whether focusing on those “silver linings” would be driven by (i) more positive experienced affect during the spring-phase, or (ii) by a memory-specific effect that would persist after controlling for experienced affect. As predicted, older age was associated with increased focus on “silver linings” such as feelings of hope that the measures would reduce disease spread (p <.001) or memories of the community coming together (p <.001). These effects remained even when controlling for older adults’ more-positive affect during the spring phase of the pandemic (community coming together, p=.03, and feeling hope, p=.008). These results suggest that older adults remain resilient during the ongoing pandemic. Compared to younger adults, older adults experience greater affective well-being in the moment and also benefit from a memory-specific mechanism allowing them to view the ongoing negative event through a rosier lens.
Group Differences in Patterns of Retirement and Social Security Benefits Receipt in the United States
Authors: Yeo Hyesu
Published: December 2020

Extended working lives are a clear phenomenon in the U.S. However, the Social Security benefits and old-fashioned retirement concept has not changed by the new trend. This study is to examine 1) whether retirement and Social Security benefits simultaneously happen as Social Security was planned, and 2) differences in groups based on the trajectories in retirement and Social Security benefits. This study used data from the Health and Retirement Survey (HRS) 2000-2016. The sample consisted of respondents the ages of 54 or older who worked for pay without receiving Social Security benefits in 2000 (N=1,924). A Latent Class Growth Analysis was conducted to classify the number of groups based on individuals’ trajectories in retirement and Social Security. The bivariate analysis tested group members’ characteristics. The final model included four groups: 1) ‘delayed retirement and Social Security,’ 2) ‘early Social Security but re-entry of the labor market after early retirement,’ 3) ‘delayed retirement but early Social Security,’ and 4) ‘retirement and Social Security at the same time point.’ The bivariate analysis demonstrated significant differences between groups in retirement age, Social Security age, education, health, and income. The result indicated that Group 2, with lower health status, education level, and income, was vulnerable in retirement. The group retired and received Social Security comparatively earlier, whereas they finally retired at the oldest age after reentering the labor market. This finding suggests that Social Security and retirement do not happen simultaneously, and Social Security is not enough for some people’s living.
LifePlanning: A Better Retirement Planning Option for Our Times
Authors: Nagaich Rajiv , Redfield Carol , Harvill Ben
Published: December 2020

Ten thousand turn 65 daily. Majority look forward to retiring in the beginning and then become afraid of outcomes they often hear about- dealing with institutional care, becoming a burden, or running out of money. This is not because retirees do not plan, but despite of having planned their entire life for retirement. Many employers provide financial retirement planning such as a 401K plan. Individuals have relied on employee benefit plans to ready themselves, yet few are “very confident” about it. Two-thirds of retirees say their most recent employers did “nothing” to help them transition into retirement; 16% are “not sure” what their employers did. Many may be overlooking important factors in their strategies. Among retirees who currently have a retirement strategy, 85% have factored Social Security and Medicare benefits into their strategy. Most have included on-going living expenses (79%), total savings and income needs (57%) into their plan. Fewer than half have considered other critical factors (e.g., investment returns, ongoing healthcare costs, inflation, long-term care needs, tax planning, etc.). Only 9% have contingency plans for retiring sooner than expected and/or savings shortfalls. The truth is that education offered by employers tends to be traditional planning advice, which may not be enough to address the concerns retirees will have in retirement. To this, we introduce a multi-disciplinary LifePlanning Framework which takes a wholistic, integrated approach in addressing the many complex issues of retirement found in health, housing, finance, legal, and family. Our results may impact future practice, research, and policy.
Productive Aging in India: Pre-Retirement Perceptions, Priorities, and Gendered Perspectives
Authors: Sen Reema , Kahana Eva
Published: December 2020

This study explores the perceptions of urban, middle class, white collar employees in India approaching retirement, to unpack ‘productive aging’ through a specific sociocultural lens. India, is aging fast with limited social security. Projected growth in the 60+ age group is 326% (2000 -2050) and 700% for the 80+. Prior studies largely focused on rural and blue collar adults. This study involves a sample of 76 people’s (41 men, 35 women of relatively high SES) attitudes to aging. Key findings show, self-perceived health status was different between men and women (ordinal regression analysis showed p value 0.034 at 95% CI). 51.22% men rated their health excellent/very good compared with 28.57% women. 12.2% men rated their health fair/poor compared with 25.72% women. Despite this, results of men and women’s perceptions of aging were remarkably similar though living in a country with entrenched gender inequality. Cultural influence was apparent from the gendered difference (p value 0.036, 95% CI) in response to the question “our society frowns upon paid work after retirement” (20% women agreed compared with 4.77% men). Interestingly, despite social constraints 68.58% women agreed that they prefer a paid alternate career after retirement compared with 53.66% men. Another difference (p value 0.006, 95% CI) on the question “I need to be gainfully occupied for my own personal satisfaction” had 100% women reporting they agree or strongly agree as compared with 85.37% men. Findings will be discussed in the context of gender and changing family structures among adults in late middle age.
Impaired Mitochondrial and Glycolytic Functions in Peripheral Blood Leukocytes of Alzheimer’s Disease
Authors: Bharadwaj Ravindra , Gibler Hayley , Srivastava Sanjay , Tewari Hena
Published: December 2020

Recent failures of the trials targeting amyloid to treat Alzheimer’s disease (AD) are prompting scientists to explore other pathological pathways. Brains of AD patients have been noted to have impaired mitochondrial function. It has not yet been determined if AD is caused by a systemic defect in cellular bioenergetics. To determine the cellular bioenergetics, we compared the Oxygen Consumption Rate (OCR – indicating oxygen dependent respiration) and Extra Cellular Acidification Rate (ECAR – indicating glycolytic function) in leukocytes of collected blood samples of Alzheimer’s and non-dementia patients. Methods: After IRB approval and consents, blood samples from each clinically diagnosed Alzheimer’s and age matched normal subjects were collected. Immediately after collection the blood samples were analyzed using Agilent Seahorse XFe/XF Analyzer as per protocol by manufacturer. Results: Impaired mitochondrial and glycolytic functions were noted in Alzheimer’s patients as compared to normal subjects. OCR was significantly lower in Alzheimer’s patients. A lower rate of respiration was noted both at basal as well as maximal respiration. Reduced spare respiration capacity was also noted in response to the stressors. Similarly reduced ECAR and reduced glycolytic reserve was also noted in Alzheimer’s patients, indicating impaired oxygen independent mitochondrial respiration. Discussion: This pilot study demonstrates that there is an impaired mitochondrial and glycolytic function in the peripheral blood cells. This indicates towards a systemic nature of the disease and a potential future bio-marker. Further studies should be planned in this direction.
Low Dose Brain Radiation Reduces Elevated Plasma Branch Chain Amino Acid Levels in APP/PS1 Mice
Authors: Maddens Michael , Wilson George , Graham Stewart , Yilmaz Ali
Published: December 2020

Branch Chain Amino Acids (BCAA) have recently been implicated in Alzheimer’s Disease (AD). We previously showed that low dose brain radiation (RT) [5 fractions of 2 Gy] reduces amyloid-beta plaque burden and results in improved cognition in the APP/PS1 model of AD. In this study we investigated whether this schedule of radiation altered the metabolomic profile of serum. 10 month old male (M) and female (F) APP/PS1 mice were either treated with whole brain radiotherapy (5 x 2 Gy) or received sham irradiation. Eight weeks later the animals were euthanized and blood, urine and brain tissue collected. 1H NMR spectra were acquired. 256 transients were acquired for each sample and chemical shifts (δ) are reported in parts per million (ppm). Analysis included: 3 F and 5 M with no transgene (as a background controls), 5 F who received no RT, 7 F who received RT, 12 M who received RT and 12 M who received no RT. A total of 46 metabolites were analyzed. The most significantly changed metabolites were the BCAAs leucine, isoleucine and valine.. The effect was most pronounced in female mice where levels were reduced to those found in non-transgenic mice. APP/PS1 mice spontaneously display increased plasma BCAA, suggesting that AD pathology potentiates defects in BCAA metabolism, putting patients with AD at a higher risk of BCAA-induced brain damage. Reduction of these levels by low dose radiation may be beneficial.
Metabolic Regulation of Longevity by One-Carbon Metabolism and Flavin-Containing Monooxygenase
Authors: Choi Christopher , Leiser Scott , Evans Charles , Beard Daniel
Published: December 2020

Nematode flavin-containing monooxygenase-2 (fmo-2) is induced by dietary restriction and hypoxia, and is required for the longevity and health benefits of these pathways. It is also sufficient to confer these benefits when overexpressed. As FMOs are well-conserved across taxa, the fmo-2 mechanism has high translational potential. To determine the changes that occur following fmo-2 induction, we performed RNA-seq and untargeted metabolomics analyses. Our data reveal that one-carbon metabolism (OCM) is significantly altered by fmo-2 overexpression. OCM is a nexus for essential metabolic pathways, including transmethylation, transsulfuration, nucleotide synthesis, and amino acid metabolism. We hypothesized that fmo-2 confers longevity benefits by altering key metabolic processes within or downstream of OCM. To test this, we asked whether fmo-2 and OCM interact to regulate longevity by knocking down expression of genes involved with OCM and measuring lifespan and oxidative stress resistance. To understand the biological implications of these interactions, we generated a computational model using qPCR data of key OCM-related genes to predict changes in OCM metabolic flux. Our model predicts significant changes in OCM flux that are regulated by fmo-2 expression levels and are consistent with our RNAi and multi-omics results. We are now testing this model by knocking down genes downstream of OCM to determine their role in fmo-2-mediated benefits. Preliminary results support our hypothesis that changes in metabolic flux through OCM are involved downstream of fmo-2 expression, and may also implicate the UPRER in this pathway. Our future work will elucidate this mechanism and link stress perception and fmo-2-mediated longevity.
Serum Factors Mediate the Bioenergetic Benefits of Exercise Training and Caloric Restriction
Authors: Gonzalez-Armenta Jenny , Nicklas Barbara , Molina Anthony
Published: December 2020

Diet and exercise interventions have been shown to improve age-related decline in mitochondrial function. While the systemic benefits of diet and exercise are apparent, the mechanisms underlying these changes are not known. Our lab and others have used blood-based bioenergetic profiling to demonstrate that systemic bioenergetic capacity is related to many aspects of healthy aging, including: gait speed, grip strength, and inflammation. This work suggests a potential role for circulating factors in mediating systemic mitochondrial function. In this study, we developed a high-throughput respirometry assay to examine the effects of circulating factors on mitochondrial function of myoblasts in vitro. We used serum from older, overweight and obese adults who participated in a clinical trial comparing resistance training (RT) and resistance training plus caloric restriction (RT+CR). When combined, both interventions significantly increased serum-mediated basal (42.08 to 50.14 pmol/min, p=0.004), ATP-linked (35.57 to 42.37 pmol/min, p=0.006), and maximal respiration (132.30 to 150.00 pmol/min, p=0.02). With RT, we found significantly increased basal (40.80 to 53.85 pmol/min, p=0.01) and ATP-linked respiration (34.36 to 46.39 pmol/min, p=0.007) and trends for increased maximal respiration (130.09 to 153.24 pmol/min, p=0.10) and spare respiratory capacity (89.30 to 101.38 pmol/min, p=0.07). With RT+CR, there were trends for increased maximal respiration (134.32 to 147.06 pmol/min, p=0.10) and spare respiratory capacity (91.06 to 100.41 pmol/min, p=0.11). Additionally, we found that post-intervention serum-mediated basal and ATP-linked respiration were significantly and positively correlated with physical ability, as reported by SPPB score. Future studies will focus on identifying circulating factors responsible for these changes.
Age-Dependent Changes in Nuclear Mechanotransduction as a Driver of Sarcopenia
Authors: Iyer Shama , Ward Christopher , Stains Joseph , Ryan Alice , Folker Eric , Lovering Richard
Published: December 2020

Informed by evidence that dysregulated nuclear dynamics and nuclear transport may contribute to atrophy in diseased skeletal muscle, the purpose of this study was to assess nuclear deformability, permeability, transport, and mechano-signaling outputs (YAP/TAZ, a marker of mechano-responsiveness, and their downstream genes) in aging skeletal muscle. We hypothesized that aging muscle would show changes in: proteins within LINC (linker of the nucleus to the cytoskeleton) complex, lamina and nuclear pore complex (NPC), and mechano-signaling outputs, with consequent decreased nuclear deformability and increased permeability. We further expected an increase in nuclear strain would increase nuclear YAP/TAZ and downstream indicators of YAP activity (Ankrd1, Cyr61). We used young, adult and aged C57BL6 mice (~4, 14, and 26 months, respectively). Nuclei were less deformable to passive mechanical stretch ex-vivo in adult muscle fibers compared to young muscle fibers. LINC protein gene expression, YAP/TAZ protein, and expression of their downstream genes were significantly increased in adult muscles compared to young muscles. YAP/TAZ protein and their downstream genes were further increased in aged muscles, indicating hyperactivation of YAP/TAZ in aging muscle. Changes with aging in the lamina and NPC included a loss of lamin β1, Nup107 and POM 121, which could underlie the increased nuclear permeability we found in nuclei of aged muscle. In summary, these data highlight a possible role for LINC, lamina and NPC in changes of aging-related nuclear dynamics and mechano-sensing, and may represent therapeutic targets for sarcopenia. Future studies will examine how altering these components affects muscle function during aging.
Age-Related Increased Onset and Progression of Prostate Cancer Is Revealed in Novel Pten-Null Mouse Models
Authors: Zhang Qiuyang , Liu Sen , Zhang Bing , Abdel-Mageed Asim , Steele Chad , Wang Alun , Jazwinski S , Myers Leann
Published: December 2020

Prostate cancer (PCa) is associated with advanced age. To better understand how age impacts PCa, it is critical to use PCa animal models generated at different ages (aged vs. non-aged). The PB-Cre4 driven phosphatase and tensin homolog (Pten) conditional knockout mouse model, which closely imitates human PCa initiation and progression. However, the Pten deletion is triggered in a 2-week-old prostate, when comparing the extent of PCa between aged and non-aged mice, it is difficult to distinguish the extent to which the onset and progression of PCa are due to the acceleration of the normal aging process or due to the manifestation of PCa pathologies over time. We present here a protocol to inject Cre-expressing adenovirus with luciferin tag intraductally into the prostate anterior lobes of Pten floxed mice, thus, the Pten-loss will be triggered at different ages post-Cre expression. The in vivo imaging of luciferin signals following viral infection was conducted to confirm the Cre expression and activity. Immunohistochemical staining was performed to confirm the Cre expression, Pten loss, and p-Akt and p-S6 activation. Prostate weight and histopathology were compared between aged and non-aged mice. The results showed that the virus infection was limited in the prostate glands and aged mice had significantly increased PCa onset and progression compared to young mice. Although technical skill is required to carry out this procedure and the success rate of viral infection is about 80%, this model of PCa is of great use to all investigators in the aging and cancer research field.
Hospital Discharge Interventions: A Cost-Savings Comparison
Authors: Albright Bonnie , Pelenur Yael
Published: December 2020

For an older patient, transitioning back into the community after an acute health incident is a critical juncture. Avoidable acute-care readmissions are expensive for hospitals and federal programs. Negative health outcomes for patients and negative financial outcomes for hospitals and federal programs have focused attention on effective discharge interventions to improve care transitions and decrease avoidable acute-care readmissions. This study compares cost and readmissions outcomes from peer-reviewed publication data for three discharge interventions: Care Transitions Intervention (CTI), Project RED (ReEngineered Discharge), and the Transitional Care Model (TCM). This study adjusted costs to 2015 rates and compared cost savings per patient, return on investment (ROI) and percent reduction of readmissions. Cost savings per patient (2015-adjusted) were found for all interventions: CTI ($152.89); Project RED ($327.03); TCM ($1565.84). ROI was positive for all interventions: CTI (832%); Project RED (535%); TCM (232%). Compared to control groups, intervention group readmissions were 3.6% lower for CTI (n.s.), 5.5% lower for Project RED (p<.05), and 13.2% lower for TCM (p<.05). These three discharge interventions differ in scale and intensity, but they all show cost savings and reductions in readmissions. The lower-cost intervention shows cost savings and ROI (CTI), and the more resource-intensive interventions (Project RED and TCM) reduce costs and statistically significantly reduce rates of readmission. Even with small budget dollars, hospitals have options for finding an effective discharge intervention to reduce costs and readmission rates.