bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bidirectional Longitudinal Relationships Between Homebound Status and Falls Among Older Adults
Authors: Liu Minhui , Li Yuxiao , Sun Xiaocao , Miyawaki Christina , Hou Tianxue , Tang Siyuan , Szanton Sarah 
Published: December 2020

Abstract
Research has shown an association between homebound status and falls among older adults. However, this association was primarily drawn from cross-sectional studies. Using the National Health and Aging Trends Study, we examined 1) whether prior-wave falls predicted homebound status in a later wave in 2,916 non-homebound participants in Wave 1 and 2) whether prior-wave homebound status predicted falls in 2,512 participants with no falls in Wave 1. Homebound status (non-homebound and homebound) was determined by the frequency, difficulty, and needing help of outdoor mobility. Falls were ascertained by asking participants whether they had a fall in the last year. Generalized estimation equation models were used to examine their bidirectional association, adjusting for demographics, health-related, and behavioral factors. Participants who had fallen in later waves were more likely to be older non-Hispanic black, comorbid, and have more pain, depression, disabilities, worse health status vision impairment, and low physical activities. Participants who were homebound in later waves tended to older, female, non-Hispanic black, less-educated, living alone or with others only, comorbid, obese, and have more pain, depression, disabilities, worse health status, more hospitalizations, vision and hearing problems, and low physical activities. Previous falls significantly predicted later homebound status (adjusted odds ratio [OR]: 1.28, 95% CI: 1.09-1.50). Prior wave homebound status also significantly contributed to falls in the next year (adjusted OR: 1.28, 95% CI: 1.12-1.46). The bidirectional longitudinal association between homebound status and falls suggests a vicious circle between them. Fall prevention programs should particularly target homebound older adults for falls reduction.
Machine Learning in Aging: An Example of Developing Prediction Models for Serious Fall Injury in Older Adults
Authors: Speiser Jaime , Callahan Kathryn , Fanning Jason , Gill Thomas , Newman Anne , Pahor Marco , Rejeski Jack , Houston Denise 
Published: December 2020

Abstract
Advances in computational algorithms and the availability of large datasets with clinically relevant characteristics provide an opportunity to develop machine learning prediction models to aid in diagnosis, prognosis, and treatment of older adults. Some studies have employed machine learning methods for prediction modeling, but skepticism of these methods remains due to lack of reproducibility and difficulty understanding the complex algorithms behind models. We aim to provide an overview of two common machine learning methods: decision tree and random forest. We focus on these methods because they provide a high degree of interpretability. We discuss the underlying algorithms of decision tree and random forest methods and present a tutorial for developing prediction models for serious fall injury using data from the Lifestyle Interventions and Independence for Elders (LIFE) study. Decision tree is a machine learning method that produces a model resembling a flow chart. Random forest consists of a collection of many decision trees whose results are aggregated. In the tutorial example, we discuss evaluation metrics and interpretation for these models. Illustrated in data from the LIFE study, prediction models for serious fall injury were moderate at best (area under the receiver operating curve of 0.54 for decision tree and 0.66 for random forest). Machine learning methods may offer improved performance compared to traditional models for modeling outcomes in aging, but their use should be justified and output should be carefully described. Models should be assessed by clinical experts to ensure compatibility with clinical practice.
Racial and Ethnic Disparities at End of Life Among Persons With Alzheimer’s Disease and Related Dementias
Authors: Rising Morgan , Hair Nicole 
Published: December 2020

Abstract
End-of-life (EOL) care for persons with Alzheimer’s disease and related dementias (ADRD) is heterogeneous and, often, inconsistent with patients’ priorities. While differences in physician-patient communication or the health care decision-making process likely contribute to disparities in EOL care, little is known about the relationships between race, advance care planning (ACP), and quality of care among persons with ADRD. The aim of this study was to (1) characterize trends in both ACP and EOL treatment intensity in persons with ADRD and (2) test whether racial differences in ACP mediate disparities in EOL care. We analyzed a population-based cohort of older adults with cognitive impairment or dementia who participated in the Health and Retirement Study (HRS) and died between 2000 and 2014 (n = 5,316). While participation in ACP among persons with ADRD increased from 2000 to 2014 (66% to 83%, P &lt; 0.05), models stratified by race showed that differences in participation rates across white and nonwhite persons with ADRD persisted over the sample period. Racial disparities in the location of death, a proxy for the intensity of EOL care, narrowed from 2000 to 2014. However, next-of-kin surrogates of nonwhite persons with ADRD were much more likely to report the decedent received “all care possible…in order to prolong life”. Assignment of a durable power of attorney was found to influence location of death, while both creation of a living will and participation in discussions about EOL care preferences were found to influence the likelihood that decedents received all possible life-prolonging treatments.
Reasons for Non-Participation in an Actigraphy Study in an Alzheimer’s Disease Center Registry
Authors: Laffer Alex , Hicks Hilary , Losinski Genna , Watts Amber 
Published: December 2020

Abstract
When recruited individuals decline to participate in research, it can lead to sampling bias, increased costs, and extended duration of data collection. Understanding reasons why eligible participants decline participation may improve study enrollment rates. We aimed to understand barriers to recruitment and data collection in older adults with and without Alzheimer’s disease in the University of Kansas Alzheimer’s Disease Center Registry annual visit. We recruited Registry participants to join an observational sub-study using wrist-worn actigraphy to measure physical activity and sleep. We analyzed reasons for non-enrollment from encounters with non-participating individuals. Of 104 encounters, 37 were never recruited due to appointment cancellation, rescheduling, or no-show. Of the remaining encounters, the most common reasons for non-participation were physical limitations (N = 13), study logistics (e.g., limited supplies; N = 12), participant travel plans (N = 10), and unknown (N = 8). Other categories (N = 6) included disinterest, study partner concerns about pragmatics (e.g., fear that an individual with AD would lose the ActiGraph), problems with the study design (e.g., lack of feedback to participants), and participants’ limited availability or deferment to a later date. These findings offer insight into potential avenues to overcome barriers to participation in older adults already engaged in ongoing research through an Alzheimer’s Disease Center Registry. Researchers could benefit from adapting study procedures to correct for reasons of non-participation. For example, giving more education and reassurance to potential participants about observation and giving feedback regarding activity patterns.
Is Immediate Recall test scores affected by Anxiety in a memory clinic population? A clinical correlation study
Authors: Khachan Hamed , Nair Anil , Andrea Fioralba , Kanjolia Mahak 
Published: December 2020

Abstract
Background: It is unknown if anxiety affects performance on immediate recall testing (IR) in memory clinic patients. Method: We performed a retrospective analysis of memory clinic patients in the south shore of Boston from 2010 to 2019. We correlated anxiety screen data (GAD7) to IR scores. Univariate analyses used Spearman correlation. A multivariate regression model analyzed GAD7 to covariates of IR, age, sex, and race. Hypothesis: We hypothesized a positive correlation between anxiety levels scored by GAD7 and IR. Results: 994 patients in the memory clinic between 2010-2020 had analyzable data. Patients were 58.6% female, 84.6 % White. The mean age was 70.1±14.4, IR 6.62 ± 5.4, GAD7 5.5±5.71. On univariate analysis, IR correlated significantly to age (⍴ = 0.08, p = 0.01), gender (⍴ = 0.06, p = 0.046), and race (⍴= - 0.25, p &lt;0.001), but not to GAD7 (⍴=-0.07, p=0.14). The multivariate model confirmed the lack of association of anxiety scores to (□=-0.05, p=0.41) to GAD7 scores. IR task performance was significantly associated only to age (□= -0.04, p=0.03) and gender (□= -1.18, p=0.04) in the regression model. Conclusions: Immediate recall task performance was not significantly affected by anxiety measured by GAD7 scores in a memory clinic population. However, a negative correlation was shown on immediate recall scores in males and older subjects.
Moderating Effect of Cognitive Reserve on Brain Integrity and Cognitive Performance
Authors: Nelson Monica , Andel Ross , Martinkova Julie , Čechová Kateřina , Marková Hana , Hort Jakub 
Published: December 2020

Abstract
Dementia is arguably the most devastating condition of older adulthood with treatment options still elusive. Alzheimer’s is the most prevalent form of dementia where cognitive deficits relate strongly to underlying brain pathology. However, there exist cases in which cognitive performance does not match the corresponding level of neuropathology. Attempts to explain this phenomenon often include the concept of cognitive reserve (CR), whereby greater CR (e.g., more education or higher occupational position) presumably results in less impairment relative to the extent of pathology early in disease progression but also greater impairment once cognitive symptoms manifest. We examined the influence of CR proxy variables (education and occupation) on the relationship between hippocampal volume and cognitive performance on tests of executive control and memory using data from the Czech Brain Aging Study (CBAS). Participants were cognitively normal/with subjective cognitive decline but without actual impairment (CN; n=115; M(age)=66.43; M(education)=15.90; 37 men) or had amnestic mild cognitive impairment (aMCI; n=165; M(age)=71.37; M(education)=14.92; 85 men). We found that hippocampal volume was significantly related to executive control (b=-.0001, p=.03) and memory (b=.0002, p&lt;.001) for participants with aMCI, but only memory (b=.0002, p=.03) for CN participants. Occupational position moderated the association between memory and hippocampal volume in aMCI, with the result approaching significance (p=.07), whereby a greater link between memory problems and hippocampal atrophy was present in those previously in high occupational positions. No other moderations for occupational position or education emerged (ps&gt;.25). We found evidence for the concept of CR using occupational position as proxy.
Music and Memory in Dementia Care: Comfort With Harmony
Authors: Vinoo Deepa 
Published: December 2020

Abstract
Data show a substantial increase in the number of people with diagnosis of dementia nationally and globally. Behavioral disturbances among persons with dementia including agitation and psychosis form a constellation of symptoms referred to as behavioral and psychological symptoms of dementia (BPSD).BPSD impacts heavily on resident’s quality of life, caregivers stress and management options for the team. FDA do not approve usage of psychotropic for Dementia related Behaviors.This study was conducted in six memory care units ,N-150.Prior to the project Psychotropic usage was 64% ,physical altercations, fallsand staff been out due to work related injury were high in those units. In 2014 a memory care team came together , identified gaps and created structured memory care units with memory care programs which includes , consistent trained staffing, meaningful engagement of residents, psychotropic stewardship program , shift from medical model to palliative model of care,person centered approach, music& memory program, shared governance, staff empowerment. All residents in those units were assessed for Psychotropic usage, falls, pain management. transfer to acute hospitals and 1;1 from 2014 to 2019. Results, Usage of Music& Memory increased from 4% 75%, Anti psychotic usage reduced by 18%, Falls reduced by 12%, Physical altercation decreased from 12 to 0, Improved pain Management .Significant reduction in transfer to acute hospitals. Reduced 1;1 from 6 to 1.Staff verbalized increased satisfaction and decreased stress. Improved family involvement. Increased bonding between residents, staff and families.Decresed work related injury while giving care.
Stress Mediating Genes in Aging, Health, and Longevity Traits: Effects of Multiple Interactions
Authors: Yashin Anatoliy , Wu Dequing , Arbeev Konstantin , Yashkin Arseniy , Gorbunova Galina , Akushevich Igor , Duan Matt , Ukraintseva Svetlana 
Published: December 2020

Abstract
Persistent stress of external or internal origin accelerates aging, increases risk of aging related health disorders, and shortens lifespan. Stressors activate stress response genes, and their products collectively influence traits. The variability of stressors and responses to them contribute to trait heterogeneity, which may cause the failure of clinical trials for drug candidates. The objectives of this paper are: to address the heterogeneity issue; to evaluate collective interaction effects of genetic factors on Alzheimer’s disease (AD) and longevity using HRS data; to identify differences and similarities in patterns of genetic interactions within two genders; and to compare AD related genetic interaction patterns in HRS and LOADFS data. To reach these objectives we: selected candidate genes from stress related pathways affecting AD/longevity; implemented logistic regression model with interaction term to evaluate effects of SNP-pairs on these traits for males and females; constructed the novel interaction polygenic risk scores for SNPs, which showed strong interaction potential, and evaluated effects of these scores on AD/longevity; and compared patterns of genetic interactions within the two genders and within two datasets. We found there were many genes involved in highly significant interactions that were the same and that were different within the two genders. The effects of interaction polygenic risk scores on AD were strong and highly statistically significant. These conclusions were confirmed in analyses of interaction effects on longevity trait using HRS data. Comparison of HRS to LOADFS data showed that many genes had strong interaction effects on AD in both data sets.
Functional Measures Are Severely Under-Captured in Electronic Health Records
Authors: Schiltz Nicholas , Foradori Megan , Reimer Andrew , Dolansky Mary 
Published: December 2020

Abstract
Electronic health records (EHR) data are increasingly used to inform clinical care decisions, assess quality of care, and identify patients at high-risk of poor outcomes (e.g. readmission). Functional measures—including mobility and the ability to perform activities of daily living (ADLs)—are key indicators associated with health-related quality of life and chronic disease management in older adults. The goal of this analysis was to quantify the extent that measures of function are used in a national pool of structured EHR data. We used 2017-2019 data from IBM Watson Health Explorys, representing EHR data from 27 health systems and 360 hospitals nationwide (n=5,224,530 adults age 65 and older). Structured EHR data were mapped to SNOMED-CT codes that identifed six categories of function: mobility, fine motor, gross motor, large muscle, ADLs, and instrumental ADLs. Results indicated that only 3 of the 6 categories were used: ADLs (4.2% of study population), mobility (3.2%), and gross motor skills (2.4%). Fine motor, IADLs, and large muscle function were not recorded in any patients. These results indicate that functional measures appear to be under-reported in structured EHR data when compared to published estimates of the population prevalence. In conclusion, measures of function and mobility remain largely unused in structured EHR data, likely because this information is either not assessed, unavailable for inclusion, or is captured in a non-structured format (e.g. clinical notes). Comprehensive functional measures need to be added to EHRs to assess quality and improve delivery and outcomes in older adult patients.
Diverse Sources of Social Support and Cognitive Functioning by Race, Ethnicity, and Nativity
Authors: Gauthier G Robin , Garcia Marc , García Catherine 
Published: December 2020

Abstract
This study examines the relationship between social support profiles and cognitive functioning by race, ethnicity and nativity in older adults using cross-sectional data drawn from the Health and Retirement Study (2010 and 2012). We employed a hierarchical clustering routine to generate nine support profiles that differentiated three sources of support: children, wider family relationships and friendships. Cognitive functioning was measured as the score on the Telephone Interview for Cognitive Status (TICS-m), a 27 point scale of cognitive function. Our approach explicitly acknowledges the ambivalence and multidimensionality of close relationships and the resources embedded within them. Descriptive analyses revealed significant differences in access to support across demographic groups. White respondents are over-represented in profiles that are characterized by support from friends, and under-represented in family support profiles. The reverse is found among Foreign-born Hispanic respondents who are over-represented in the profiles characterized by high family support and under-represented in those with high friend support. Native-born Hispanic respondents and Black respondents have less clear support patterns, although both are more likely to receive support from family and children compared to friends. Findings from the poisson regression suggest that the relationship between familial support and cognitive decline is stronger among Hispanic respondents, particularly those who are foreign born. These findings are supported even with the inclusion of other relationship quality indicators including negative support and frequency of contact.
Efficacy of Different Types of Exercise on Cognitive Function in People With MCI or Dementia: A Network Meta-Analysis
Authors: Wan Qiaoqin , Huang Xiuxiu , Zhao Xiaoyan , Li Bei , Cai Ying , Zhang Shifang 
Published: December 2020

Abstract
With the accelerating progress of population aging, cognitive dysfunction is becoming increasingly prevalent. Exercise, as a promising non-pharmaceutical therapy, showed favorable effects on cognitive function. But which type is the most effective exercise treatment is still unclear. This study compared the efficacy of different types of exercise interventions based on network meta-analysis and aimed to explore the optimal exercise treatment for cognitive decline. The electronic databases of PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, SPORTDiscus, PsycInfoy, and OpenGrey were searched from inception to September 2019. We only included randomized controlled trials that examined the effectiveness of exercise interventions in people with MCI or dementia. Primary outcomes were global cognition, executive function and memory function. Standard mean difference (SMD) and its 95% confidence interval (CI) were calculated to estimate the effect sizes. Finally, 73 articles with 5748 participants were included. The results showed all kinds of exercise interventions were effective on global cognition and resistance exercise was probably the most effective exercise treatment to prevent the decrease of global cognition (SMD=1.05, 95%CI 0.56-1.54), executive function (SMD=0.85, 95%CI 0.21-1.49) and memory function (SMD=0.32, 95%CI 0.01-0.63) for people with cognitive dysfunction. Subgroup analysis revealed multi-component exercise showed more favorable effects on global cognition (SMD=0.99, 95%CI 0.44-1.54) and executive function (SMD=0.72, 95%CI 0.06-1.38) in people with MCI. In conclusion, resistance exercise tended to be the optimal exercise type for people with cognitive dysfunction, especially for people with dementia. And multi-component exercise also should be recommended for people with MCI.
Awareness of Losses and Not Gains Predicts Moderate-to-Vigorous Physical Activity
Authors: O’Brien Erica , Diehl Manfred , Cerino Eric , Almeida David 
Published: December 2020

Abstract
The current study used data from a nationally representative sample of middle-aged and older adults to examine the synergistic relationship between negative and positive self-perceptions of aging on two types of physical activity (PA) and sedentary behavior. Participants from Wave 3 of the National Study of Daily Experiences reported on their awareness of age-related losses and gains, the frequency, duration, and intensity of their PA, and their sedentary behavior across seven days. We performed separate hierarchical models that regressed moderate-to-vigorous exercise, walking, and sitting on perceived losses and gains. Results revealed a significant main effect of perceived losses on moderate-to-vigorous exercise (p=.005, 95% CI=[-121.79,-22.267]). People who perceived more losses than average also reported engaging in fewer minutes of effortful PA. Results also suggested a marginal trend for more perceived losses to predict less walking (p=.055, 95% CI=[-42.85,0.42]) but to have no impact on sitting time (p=.58). Neither perceived gains nor the interaction between perceived gains and perceived losses emerged as significant predictors (ps&gt;.17). Previous work demonstrates a facilitative role played by positive (self-)perceptions of aging on engagement in preventive health behaviors that have important impacts on long-term developmental outcomes. We explored additive and multiplicative effects associated with gain- and loss-related perceptions on PA and sedentary behavior to improve our understanding of the psychological context that surrounds the views of aging and health link. Initial findings suggest differential consequences of positive and negative self-perceptions of aging on distinct health-related behaviors, with the latter being stronger and contributing to activity inhibition.