bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mitochondrial Dysfunction and Cellular Senescence Due to Aging Contributes to Prostatic Fibrosis
Authors: Liu Teresa , Ricke Emily , DeFranco Donald , Ricke William 
Published: December 2020

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

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

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

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

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

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

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

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

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

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

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

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