bluuebunny/crossref_metadata_2025_split huggingface dataset:
Altered Febrile Responses in Older Adults: A Systematic Review
Authors: Holtzclaw Barbara 
Published: December 2020

Abstract
Human and animal studies support generalizations that older adults are less able than younger adults to mount an effective febrile response. Beyond difficulties this presents for assessing signs and symptoms of infection, concern exists that older adults may lack fever’s protective immuno-stimulant benefits. Fever is a systemic physiological host response to a pyrogen resulting in release of proinflammatory cytokines that produce a regulated elevation of thermoregulatory set-point. Heat is generated, by shivering and molecular activity, and conserved, by vasomotor activity, elevating and maintaining body temperature at the higher set-point level. Because immunological, vasomotor, and kinetic activities raise body temperature, age-associated alterations have been hypothesized to explain blunted febrile responses in older adults. Purpose: A systematic review was done to 1) determine factors underlying presumed origins and alterations in older adults’ febrile responses. 2) assess for gaps and controversies in emerging research that could inform care decisions. Comparisons of disciplinary assumptions, perspectives, and cross-disciplinary interpretations sought relevance to interdisciplinary care. Methods: Search of literature databases: Medline (OVID), and CINAHL (EBSCO). PubMed, and included relevant animal and human research findings since 2000 from physiology, gerontology, immunology, infectious disease, clinical medicine, and nursing. Findings: Altered innate immunity in sepsis shows early hyper-reactive response, prolonged inflammatory activity, and fever response contributing to cardiovascular and neurological morbidity, not temperature elevation. Morbidly was attributed to disease not age. Conclusions: Hazards of blunted febrile temperatures include undetected infections and possible loss of immune benefits. Significant evidence of age-related diminished febrile temperature’s immune consequences shown with animal models.
Determinants of Adherence to ADA Type II Diabetes Mellitus Guidelines: Implications for Longevity
Authors: Yashkin Arseniy , Akushevich Igor , Yashin Anatoliy 
Published: December 2020

Abstract
The aim of this study was to identify the differences in terms of demographics, socioeconomic status and overall levels of morbidity-related health burden between population strata characterized by high levels of adherence to American Diabetes Association screening guidelines and their low-adherence counterparts. Factor analysis was used to create a single continuous measure of adherence which was stratified and analyzed using the Cox proportional hazards model to identify adherence levels associated with protective effects for mortality. Based on the results, the entire population of Health and Retirement Study respondents newly diagnosed with diabetes mellitus, type II was then stratified into four levels of adherence – excellent, sufficient, insufficient, poor – based on the strength of the protective effect associated with that level of the adherence factor and compared. Mortality in the group associated with excellent adherence was 41 to 57 percentage points lower than among their counterparts. High levels of adherence were associated with White and Hispanic race, low morbidity burden, high education and economic status, and low levels of functioning limitations. Based on race-specific survival function estimates we found that the life expectancy at age 65 of an individual newly diagnosed with type II diabetes mellitus could be improved from 14.97 to 19.64 years for whites, 13.36 to 19.58 years for African Americans and 14.92 to 21.28 for Hispanics if average adherence levels are increased to the highest levels observed in our study. Finally, we found that adherence levels were improving over the 1991-2015 period suggesting successful diabetes awareness efforts.
Menopause Symptom Experience and Perceived Well-Being Among HIV Positive and Negative Older Women in Ibadan, Nigeria
Authors: Omobowale Olubukola , Adesina Olubukola 
Published: December 2020

Abstract
Globally, people are living longer with the Human Immunodeficiency Virus (HIV) and older individuals are becoming infected. Menopause symptoms affect women’s health and are associated with perceived declines in wellbeing. This study assessed and compared the menopause symptom experience and perceived wellbeing among HIV positive and negative older women in Ibadan Nigeria Focus group discussions were conducted among menopausal women attending the ARV and GOP clinics at the University College Hospital Ibadan. Opinions of discussants on knowledge and experience of menopausal symptoms, perceptions about the menopause and perceived health status were explored. A total of 90 HIV positive and 92 HIV negative women aged between 40 to 60 years were sampled. Knowledge of the cause of menopause was poor, with more HIV positive women opining that sexual promiscuity causes menopause. The majority of the discussants had adequate knowledge of menopausal symptoms with most of them reporting vasomotor and musculoskeletal symptoms. In both groups, perceptions about the menopause were generally positive as most of them opined that the menopause means freedom from sexual activity and child birth. More HIV negative women perceived themselves to be in good health compared to HIV positive women. Menopause induces many of the same metabolic changes that are being observed with HIV infection, and this may affect the health and quality of life of aging women with HIV infection. There’s a need for health education and health promoting interventions that will help these women in coping with the double burden of HIV infection and menopause.
Postmenopausal Bilateral Oophorectomy Is Associated With an Increased Risk of Restless Leg Syndrome
Authors: Huo Nan , Smith Carin , Rocca Liliana Gazzuola , Mielke Michelle , Rocca Walter A 
Published: December 2020

Abstract
Restless legs syndrome (RLS), a common neurologic disorder, is more prevalent in women than in men. Evidence indicates the potential role of female hormones in the pathophysiology of RLS. However, few studies have examined the relationship between premenopausal bilateral oophorectomy (BSO) and the risk of RLS. The Mayo Clinic Cohort Study of Oophorectomy and Aging-2 (MOA-2) includes all women residents of Olmsted County, Minnesota, who underwent premenopausal BSO before the age of 50 years for a non-cancer reason between 1988 and 2007 (n=1,653). In addition, 1,653 age-matched (± 1 year) referent women who did not undergo BSO prior to index-date were included. Survival analyses were used to examine the association between BSO and risk of RLS (defined by DSM-IV criteria) after adjustments using inverse probability weighting. The median (IQR) age at index-date was 40.0 (40.0-47.0) years for the BSO and 40.0 (40.0-47.0) for the non-BSO cohorts. Women who underwent BSO before menopause had a higher risk of RLS (HR,1.47; 95% CI, 1.08-2.01). In addition, women who underwent BSO before 46 years (HR:1.53, 95% CI, 1.03-2.28) or received BSO without benign ovarian indications (e.g., cysts, endometriosis, HR: 1.69, 95% CI, 1.11-2.56) were at greater risk of RLS. Estrogen use after BSO did not affect the risk of RLS. Premenopausal women who underwent BSO had an increased risk of RLS, especially those younger than 46 years and without benign medical indication. Women considering BSO for ovarian cancer prevention should be informed of the increased risk of neurological disorder including RLS.
Effects of a Fall Prevention Program on Fall Risks, Fear of Falling, and Depression in Older Active Adults
Authors: Karnes James , Bates Victoria , Chafin Ashley , Fisher Sarah , Gilmore Kelcie , Pack Kelsey 
Published: December 2020

Abstract
Falls are the leading cause of injury in older adults; one in four older adults fall each year. The Otago Exercise Program (OEP) is an evidence-based fall prevention program that has been shown to reduce fall risk factors. However, exercise dosage is not known. The purpose of this study was to investigate the effectiveness of different frequencies of an OEP-based program on fall risk factors, fear of falling, and depression in older adults. Of 62 subjects initially recruited at community centers, 28 subjects met inclusion criteria and were assigned to control (Con), once-weekly (Grp 1), or twice-weekly (Grp 2) intervention groups based on subject attendance. Intervention consisted of a 12-week OEP-based program. Pre-intervention dependent variables included: 4-Stage Balance Test, 30-Second Chair Stand, Timed Up and Go (TUG), Geriatric Depression Scale (GDS), and Modified Fall Efficacy Scale (MFES). After 12 weeks, post-intervention testing assessed changes in these variables. Preliminary analysis of data using mixed design ANOVA (p.05) indicated significant changes between and within all groups for TUG and 30-Second Chair Stand. Results also suggested all groups improved on all variables with a direct relationship to exercise frequency. Furthermore, Grp2 improved more than Grp1 and Con in the 4-Stage Balance Test. These findings suggest an OEP-based falls prevention program performed 2x/week is more beneficial in decreasing fall risks and increasing lower extremity muscle strength than 1x/week. Moreover, results imply exercise frequency may be important in improving the magnitude of select falls risks variables.
Apolipoprotein E Genotype and the Relationship Between Chitinase 3–Like Protein 1 and Postoperative Delirium
Authors: Vasunilashorn Sarinnapha , Ngo Long , Inouye Sharon , Fong Tamara , Jones Richard , Dillon Simon , Libermann Towia , Marcantonio Edward 
Published: December 2020

Abstract
Apolipoprotein E (APOE) ɛ4 does not confer increased risk of delirium in older surgical patients; however, ɛ4 status modifies the relationship of C-reactive protein (CRP) with delirium: increased risk for delirium in ɛ4 carriers with high CRP. We examine whether APOE genotype modifies the established association between inflammatory marker chitinase-3-like protein-1 (CHI3LI/YKL-40) and delirium in patients without dementia age≥70 undergoing major non-cardiac surgery. We performed APOE genotyping using PCR, considering APOE ɛ4 vs. non-ɛ4 carriers. Plasma YKL-40, measured on postoperative day 2 by ELISA, was examined using sample-based quartiles (Q1-Q4). Delirium status was determined with daily interviews rating the Confusion Assessment Method, augmented by a validated chart review. We used generalized linear models adjusted for age, sex, surgery type, and stratified by APOE ɛ4 status. Among the 557 patients, 19% were APOE ɛ4 carriers, and 24% developed postoperative delirium. The YKL-40-delirium relationship differed by APOE status. Among APOE non-ɛ4 carriers, we found a significant relationship between YKL-40 and delirium (relative risk [RR](95% confidence interval [CI] for YKL-40 Q4 vs. Q1: 2.6(1.4-4.9) and Q3 vs. Q1: 2.3(1.2-4.5); p-trend&lt;.01). Among APOE ɛ4 carriers, YKL-40 was not significantly associated with delirium (RR(95% CI) for YKL-40 Q4 vs. Q1: 2.0(0.6-6.6) and Q3 vs. Q1:1.1(0.3-3.5); p-trend=0.37). APOE non-ɛ4 carriers may have increased risk of delirium conferred by post-surgical inflammation specific to the type 2 immune response (high YKL-40). These results differ from prior results with CRP, and raise the possibility that APOE genotype may interact at different points in the inflammatory pathway leading to delirium.
Lifestyle Complexity and Dementia Risk: Examining Moderation by APOE Genotype and Mild Cognitive Impairment
Authors: Moored Kyle , Snitz Beth , Parisi Jeanine , Williamson Jeff , Fitzpatrick Annette , DeKosky Steven , Carlson Michelle 
Published: December 2020

Abstract
Prior studies suggest that the neuroprotective effect of physical exercise is moderated by APOE genotype and MCI status, but it remains unclear whether this extends to lifestyle complexity defined by a broader variety of physical, intellectual, and social activities. Participants were from the Ginkgo Evaluation of Memory (GEM) Study. We used 18 physical, intellectual, or social activities from the Lifestyle Activity Questionnaire. We performed latent class analysis to characterize subgroups with distinct activity response patterns and examined whether they have differential risk of incident dementia over time. A three-class model was chosen based on fit statistics and interpretability. Cox proportional hazards models, adjusted for potential demographic and health confounders, revealed that Class 1 (Highly intellectually/socially active) had a reduced risk of dementia compared to Class 3 (Less socially/less intellectually active; HR=.71, 95% CI: [.56,.88], p=.002). Class 2 (Socially/less intellectually active) did not differ in risk from Class 3 (HR=.90, 95% CI: [.73,1.1], p=.288). There was no evidence for effect modification for APOE e4 allele carriers (p’s&gt;.05), but the protective association for Class 1 only held for those without prevalent MCI at baseline (HR=.74, 95% CI: [.56,.98], p=.033). Results showed that subgroups characterized by a greater variety of social and intellectual activities had reduced risk for dementia, but only for those without MCI. This implies that late-life lifestyle complexity may be most neuroprotective for those in the preclinical stages of decline. Results also suggested that lifestyle complexity may act through a cognitive reserve pathway unrelated to amyloid pathology.
Older U.S. Adults With Nocturia Often Cannot Use the Only FDA-Approved Drugs for the Condition
Authors: Johnson Theodore , Suvada Kara , Plantinga Laura , Mirk Anna , Markland Alayne , Ali Mohammed , Vaughan Camille , Burgio Kathryn 
Published: December 2020

Abstract
Nocturia, waking from sleep at night to void, is a common, bothersome symptom for which many older adults seek treatment. In 2017, the US FDA approved the first of two desmopressin analogues indicated for nocturia. While efficacious, these drugs can potentially cause severe hyponatremia that can be fatal, particularly if older adults have comorbid conditions (e.g., congestive heart failure, uncontrolled hypertension), laboratory abnormalities (e.g., low sodium, reduced renal function) and concomitant medications (e.g., diuretics, analgesics). Using secondary data from the National Health and Nutrition Examination Survey (NHANES) to identify a sample of U.S. adults 50 years and older with 2 or more nightly nocturia episodes, we determined the prevalence of contraindications, warnings, and need for more frequent monitoring indicated by the product label. Among the sample of 1,521 older respondents, 70.0% of those with nocturia had contraindications or a need for frequent sodium monitoring. Contraindications to desmopressin analogues were more prevalent with older age (27.6%, 34.5%, and 38.8%, for ages 50-64, 65-79, and 80+, respectively, p&lt;0.001) as was the use of potentially interacting drugs (30.0%, 42.2%, 47.7%, respectively, p &lt; 0.001). Most older adults with nocturia have medical conditions and concomitant medication use that makes very difficult the routine and safe use of the only FDA approved medications for nocturia. Providers prescribing desmopressin analogues in older adults need to carefully screen patients, employ frequent monitoring, and use shared decision-making to prevent undue harm.
Higher-Level Cognitive Function and Obstacle Attributes: An fNIRS Study in Older Adults With Parkinson’s Disease
Authors: Hausdorff Jeffrey , Sharon Topaz , Kurz Ilan , Bernad-Elazari Hagar , Galperin Ira , Giladi Nir , Mirelman Anat , Maidan Inbal 
Published: December 2020

Abstract
Older adults with Parkinson’s disease (PD) rely on prefrontal activation to compensate for impaired motor function during the performance of complex mobility-related activities such as obstacle negotiation. However, the influence of the properties of the obstacles on prefrontal activation has not been systematically evaluated. Here, we examined the effects of obstacle height and anticipation time on prefrontal activation in patients with PD and older adults. 34 patients with PD (age: 67.4±5.7 years; 14 women) and 26 older adult controls (age: 71.3±8.9 years; 11 women) walked in an obstacle course while negotiating anticipated and unanticipated obstacles at heights of 50 mm and 100 mm. Prefrontal activation was measured using functional Near-Infrared Spectroscopy (fNIRS); obstacle negotiation performance was measured using Kinect cameras. PD patients showed greater increases in prefrontal activation during and after obstacle crossing compared to the older adults (p&lt;0.001). Obstacle height affected prefrontal activity only when crossing anticipated obstacles (time x height interaction, p=0.011); in that case, higher obstacles were accompanied by higher prefrontal activity. PD patients showed higher levels of activation during unanticipated obstacles, compared to anticipated obstacles (p=0.015). Different correlations between prefrontal activation and obstacle negotiation strategies were observed in the patients and the controls. These results point to the use of prefrontal activation as a compensatory mechanism in PD. Moreover, the higher activation of prefrontal regions during more challenging obstacles suggests that there is a greater reliance on cognitive resources in these demanding situations that may contribute to the higher risk of falls in patients with PD.
Frailty and Trajectories of Blood Pressure Among Older Mexican Americans Over Time
Authors: Snih Soham Al , Rodriguez Martin , Chou Lin-Na , Markides Kyriakos S , Ottenbacher Kenneth 
Published: December 2020

Abstract
The objective of this study was to examine whether blood pressure (BP) trajectories differ by frailty status among older Mexican Americans. Data are from an 18-year prospective cohort study of 1,781 non-institutionalized Mexican American aged ≥ 67 years from the Hispanic Established Population for the Epidemiological Study of the Elderly (1995/96-2012/13). Frailty was defined as meeting three or more of the following: unintentional weight loss of &gt;10 pounds, weakness, self-reported exhaustion, low physical activity, and slow walking speed. General linear mixed models were used to estimate trajectories of systolic and diastolic BP over an 18-year period as a function of frailty status. All variables were analyzed as time-dependent covariates except for gender and education. At baseline, 46.3% participants were non-frail, 44.8% were pre-frail, and 9.0% were frail; and the mean of systolic and diastolic BP was 136.9 mmHg (SD=18.6) and 77.3 mmHg (SD=12.2), respectively. Frail participants had greater systolic and diastolic BP decline over time than non-frail (estimate=-3.94, SE=0.88, p-value=&lt;0.0001 and estimate=-1.32, SE=0.54, p-value=0.0138, respectively); and pre-frail participants had greater systolic BP decline than non-frail (estimate=-1.51, SE=0.54, p-value=0.0049), after controlling for all covariates. Those with high body mass index and hypertension with and without treatment had increased levels of systolic and diastolic BP over time. Older age, female gender, arthritis, diabetes, and stroke had decreased levels of diastolic BP over time. This study showed progressive decline in systolic and diastolic BP in frail compared to non-frail older Mexican Americans, which might have implications when treating frail older adults with hypertension.
Non-Pharmacologic Interventions for Caregivers of People With Dementia in Latin America: A Review
Authors: Aravena Jose , Gajardo Jean , Gitlin Laura 
Published: December 2020

Abstract
In a scenario of increasing longevity and social inequalities, Latin-America is an important contributor to the worldwide dementia burden. Caregivers’ health is fundamental to maintain the person with dementia quality of life. However, caregiving is a culturally sensible role that requires tailored solutions. The aim is to synthesize the evidence about non-pharmacologic interventions targeted to caregivers of people with dementia in Latin-American contexts. A comprehensive review of interventions in caregivers and persons with dementia in Latin-American countries was conducted using MEDLINE, Embase, PsycINFO, and Scopus with studies published until January 27th, 2020. Randomized clinical trials of non-pharmacologic interventions targeted to caregivers of people with dementia or dyads where included. Qualitative synthesis of the evidence was presented and analyzed. Overall, 9 pilot RCT were included for the final analysis (6 Brazil, 1 Colombia, 1 Mexico, 1 Perú). The biggest study recruited 69 caregivers and the smallest 13 dyads, with follow-up range of 3-6 months. 5 control groups received at least some other non-standard care type of intervention. 8 were targeted exclusively to caregivers (4 group intervention, 3 individual, and 1 combined) and 1 multicomponent intervention. Most frequent measured outcomes were caregiver’s burden, anxiety, depressive symptoms, and quality of life, and person with dementia neuropsychiatric symptoms. Individual interventions report better results in caregiver parameters such as burden and depressive symptoms and person with dementia neuropsychiatric symptoms. Group interventions presented mixed results. Nevertheless, the quality of evidence was low. There is a critical need to study interventions for caregivers in Latin-American contexts.
The Effects of Dementia Knowledge on Dementia Worry, Attitudes, Social Comfort, and Affect
Authors: Ebert Alexandria , Huggins Maya , Wagner Hannah , Lightcap Zachary , Muir Tessla , Faulkenberry Mariah , Fiske Amy 
Published: December 2020

Abstract
Previous work has demonstrated that personhood-based knowledge of dementia is associated with less fear of dementia and greater social comfort with persons with dementia. Nonetheless, a causal link has not been tested. We examined the effects of types of dementia knowledge on dementia worry, fear, and social comfort, as well as affect more broadly and attitudes toward dementia, which have not previously been examined. Participants (N = 338) aged 19-78 (M = 44.82, SD = 16.66) were randomized into one of five experimental conditions: biomedical-knowledge (BK; read biological and medical facts about dementia); personhood-based knowledge (PBK; read accounts written by persons living with dementia); both BK and PBK; baseline control; and active control. Participants then completed outcome measures. Significant effects of knowledge on dementia worry (p &lt; .05) as well as personal distress, empathic concern, and negative affect (ps &lt; .001) emerged; groups did not significantly differ in attitudes, comfort, or dementia fear. Specifically, participants in the BK and PBK conditions exhibited significantly higher levels of personal distress than those in the control conditions. Similarly, participants in the PBK condition had significantly higher levels of negative affect than those in the control conditions and significantly higher levels of dementia worry than those in the baseline control condition. Participants in the PBK condition also had significantly higher levels of empathic concern than those in the biomedical knowledge and control conditions. Results suggest that although reading about dementia induces negative affect, it also induces empathic concern.