bluuebunny/crossref_metadata_2025_split huggingface dataset:
HARMONY Study: Pimavanserin Significantly Prolongs Time to Relapse of Dementia-Related Psychosis
Authors: Tariot Pierre , Foff Erin P , Cummings Jeffrey L , Soto-Martin Maria-Eugenia , McEvoy Bradley , Stankovic Srdjan , Howard Amy 
Published: December 2020

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

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

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

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

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

Abstract
Regular physical activity, dietary variety, and active social participation are modifiable and influential factors of adverse health outcomes. However, the cumulative effects of these behaviors are unknown. We examined these cumulative associations with active life loss in older adults. We analyzed 3-year longitudinal data from 7246 initially non-disabled residents aged 65-84 years from 18 districts of Ota City, Tokyo. Sufficiency of moderate- to vigorous-intensity physical activity (MVPA) of ≥150 minutes/week, dietary variety score (DVS) of ≥3, and social participation of ≥1 time/month were assessed using self-administered questionnaires. We operationally defined active life loss for individuals as being newly certified for long-term care insurance or death without prior certification. Multilevel survival analyses were applied to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). During an average follow-up of 2.9 years, the cumulative incidence of active life loss was 11.3% (817 individuals: 650 new certifications and 167 deaths without prior certification). Multivariate-adjusted HRs (95% CIs) for active life loss were 0.73 (0.58-0.92) in only MVPA of ≥150 minutes/week, 0.88 (0.67-1.15) in only DVS of ≥3, 0.75 (0.51-1.09) in only social participation of ≥1 time/month, 0.56 (0.45-0.70) in the group satisfying any two, and 0.52 (0.40-0.67) in the group satisfying all three behaviors, compared with a reference group that did not satisfy any of the behaviors. Sensitivity analysis that excluded active life losses during the first year showed similar results. The combination of regular physical activity, dietary variety, and social participation further enhances the effects on active life expectancy than individual practices.
Telehealth Use in a Home-Based Dementia Care-Coordination Program
Authors: Johnston Deirdre , Reuland Melissa , Marshall Kelly , Antonsdottir Inga , Bunting Morgan , Samus Quincy 
Published: December 2020

Abstract
In the coming decades, greater numbers of people will either have Alzheimer’s Disease or a related dementia or will take care of a family member with dementia. The dementia syndromes are associated with increased risk of medical, social, and behavioral complications in both the person with dementia (PWD) and the caregiver (CG), many of which are preventable. These complications, and the dementia itself, can impede access to care and ultimately hasten residential care placement, which can be both undesirable and costly. A nearly universal unmet need in PWD/CG dyads is dementia-specific education. Therefore, it is vital we find ways to support and provide education to CG/PWD dyads to manage dementia in the community and home setting. MIND at Home is a dementia-care model developed and tested at Johns Hopkins University School of Medicine to minimize dementia complications and delay institutionalization by training non-clinical Memory Care Coordinators (MCCs) working under clinical supervision to support and guide PWD/CG dyads in the community. MCCs collaborate with CGs and PWDs in the community using an individualized care plan structured around the dyads’ specific dementia-related needs. This presentation will describe how the MIND at Home team used handheld tablets to connect MCCs to clinicians from participants’ homes, and will report on challenges encountered, strategies to address them, and participant and caregiver satisfaction with the telehealth experience.
Use of Video-Enabled Tablet for Virtual Care Among Older Veterans
Authors: Yefimova Maria , Hu Jiaqi , Slightam Cindie , Greene Liberty , Chaudhary Camila , Hayworth Leonie , Zulman Donna 
Published: December 2020

Abstract
With the proliferation of virtual care, healthcare systems are exploring ways to bridge the digital divide among vulnerable patients. Department of Veterans Affairs (VA) is distributing devices for qualifying Veterans to enable video visits with medical providers at home, yet their use among older patients is unknown. This retrospective cohort study used administrative data to characterize the use of VA-loaned iPads among older Veterans compared to younger Veterans and identify demographic predictors of utilization. Among 16,385 patients who were shipped a VA-loaned iPad in 2014-2019, 33.66% (n=5,516) were over 65 years old, and 3.1% (n=503) were over the age of 85. Two thirds (n=6799) of younger patients had a video visit (mean=3 visits) with provider using iPad in the 6 months since shipment, compared to 50% (n=253) of 85+ year-olds (mean=1.8 visits). Most common types of virtual visits for the oldest old patients were for geriatrics or home-based primary care, compared to mental health visits among younger patients. Logistic regression identified characteristics of older patients who were more likely to use iPads, such a marital status, urban location, and lower disease burden, which is similar to their younger counterparts. While older age groups used VA-loaned tablets less frequently, those who engaged with the devices were similar in demographics as their younger counterparts. Older patients used iPads differently, with higher engagement in geriatric and primary care services. Providing devices for virtual care may allow health systems to more easily reach older patients in the comfort of their home.
If You Don’t Use It, You Lose It: Perspectives of Older Adults on Aging in Place in Subsidized Housing
Authors: Reyes-Farias David , Jahan Momana , Pandit Sonia , Reid Carolina , Resnick Barbara , Brown Rebecca 
Published: December 2020

Abstract
Nearly 3 million older Americans with low incomes live in subsidized housing. This population has disproportionate rates of functional impairment, cognitive impairment, and nursing home admission. Patient-centered interventions are needed to improve aging in place for this population, but little is known about resident perspectives on this topic. We interviewed 58 residents aged 62 or older and 8 caregivers from 7 housing sites. We analyzed transcripts using qualitative thematic analysis. Participants reported that several factors impacted their ability to age in place. First, most participants noted the importance of physical environment, including the design and location of their apartment building. Physical accessibility and proximity to community resources facilitated aging in place, while features such as heavy doors and smoke in communal areas posed challenges. Second, most participants identified the importance of the building’s social environment; support received from other residents and on-site staff facilitated aging in place, while gossip and unpleasant residents were barriers. Third, participants noted that health issues such as arthritis limited their ability to function independently, regardless of environment. Participants emphasized the importance of physical activity for preventing functional decline, stating, “if you don’t use it, you lose it.” Older adults living in subsidized housing view their environment as central to their ability to age in place. Our findings suggest that interventions to improve aging in place in these settings must focus not only on optimizing residents’ physical function, but also on using the environment to promote resident independence and quality of life.
The Factors Associated With Daily Life Support for Single Older Adults to Remain at Their Home
Authors: Sakurai Rika , Inagaki Asa , Komazawa Yukitsugu , Kimata Mari , Goto Jun 
Published: December 2020

Abstract
Japan aims to enable older adults to remain at home in their familiar environment. However, the factors associated with daily life support for older adults who require medical and nursing care to remain at home are unclear. This study aimed to clarify the factors associated with daily life support for single older adults needing medical and nursing care to remain at home. Our participants were single older adults aged 65-94 years receiving medical and nursing care and their care providers. First, we analyzed records, which were written by care providers, regarding ten older adults who received medical and nursing care from 2014 to 2018. We categorized occurrences which exert single older adults’ life on change into six factors, such as gradual frailty and loss of a loved one. Then, to consider how they experience these factors, we conducted semi-structured interviews with three additional older adults who were single and received home visiting nursing care service in 2020. During this process, four multidisciplinary researchers discussed the factors associated with daily life support for single older adults; finally, three factors were derived. The first one pertained to health conditions: receiving sufficient medical and nursing care maintain older adults’ physical condition. The second related to the environment: maintaining social interactions (neighbors and friends). The third pertained to older adults’ values and meanings to remain at home. This study suggests that care providers focus on these three factors to help older adults who received medical and nursing care to remain at their home.
A Systematic Review of Missouri Lymphedema Symptom Assessment Tools in Original Research and Review Articles
Authors: Oyewusi Christiana , Armer Jane 
Published: December 2020

Abstract
Despite advances in cancer treatment, many survivors face a significant challenge of cancer-related lymphedema, together with aging. Aging results in structural changes in the lymphatic system. Beginning in 1998, tools have been developed at the University of Missouri to assess symptoms of lymphedema in cancer patients. The objective of this review was to synthesize evidence regarding use of Missouri lymphedema symptom assessment tools in original research and review articles. A search of six electronic databases was conducted for articles published within 1998 and 2018 on review and use of the tools which are Lymphedema and Breast Cancer Questionnaire (LBCQ), Melanoma and Lymphedema Questionnaire (MELQ), and Gynecologic Cancer and Lymphedema Questionnaire (GCLQ). In all, 210 articles were retrieved, and 32 full-text articles meeting the inclusion criteria were reviewed. The studies reported a cumulative number of 5,872 study participants. Most manuscripts (70.97%) reported data on breast cancer lymphedema, 19.35% on gynecological cancer lymphedema, 3.23% on breast cancer and melanoma lymphedema, and 6.45% on melanoma. The use of LBCQ was reportedly more than the use of GCLQ and MELQ. Tool reliability ranged from r = 0.785 - 0.82 for LBCQ and 0.95 for internal reliability for GCLQ. The tools have been used in many countries including the United States of America. The importance of using valid and reliable quantitative measures in lymphedema symptom assessment across diverse populations and sites cannot be overstated. The tools have been modified and used over the past 20 years in various settings and across languages and cultures.
Physician Attitudes and Confidence Toward Dementia Capability: Screening, Diagnoses, and Referrals
Authors: Herrick Tamara , Ward Michelle 
Published: December 2020

Abstract
The MaineHealth Alzheimer’s Disease Partnership is working to improve integration between the healthcare system and community partners through training and a referral network. Primary care providers are often the first to assess cognitively impaired patients, so it is important to understand their attitudes and confidence in dealing with dementia. The objective of this study is to determine barriers to care and evaluate healthcare providers’ attitudes towards their dementia capability, which includes screening for cognitive impairment, disclosing diagnoses, and making referrals to community-based organizations or specialists. A 27-item survey was developed and sent to 474 providers from MaineHealth practices via email. Fifty-three providers responded to the survey. Five healthcare professionals also took part in a focus group; looking more specifically at challenges encountered throughout the dementia care system. This poster will present the findings from the survey and focus group. There was strong agreement that much can be done to improve the quality of life for patients with dementia (86% agreed/strongly agreed) and that screening all patients over age 65 is important (85% agreed/strongly agreed). Confidence levels in ability to diagnose dementia, provide memory loss information, and refer patients to specialists were significantly associated with training (p&lt;.05). The majority of providers identified barriers to cognitive screening and referring patients to community-based organizations, showing that improvements are needed at the system level to remove these barriers. Overall, the results suggest that dementia specific training can improve confidence in care and allow physicians to provide more information about memory loss to patients.