bluuebunny/crossref_metadata_2025_split huggingface dataset:
SCREENING FOR LOW SHORT PHYSICAL PERFORMANCE BATTERY SCORES: CAN GRIP STRENGTH AND SINGLE CHAIR STAND BE USEFUL?
Authors: Chaves Paulo H 
Published: November 2019

Abstract
The clinical value of low Short Physical Performance Battery (SPPB) scores for identification of older adults at-disability-risk who may benefit from structured intervention is well-established. Feasibility concerns – e.g., time, space constraints – are factors that often preclude SPPB implementation in clinical settings. We assessed whether grip strength (GS) and/or single chair stand (SCS), simple and highly feasible tests, could be useful for clinical identification of older adults with poor SPPB performance. Cross-sectional study using most recent data (Round 7) from the National Health and Aging Trends Study, which enrolled a large U.S. representative sample of Medicare beneficiaries 65 years and older (baseline round: 2011; yearly follow-ups). Nursing home residents were excluded. Sample size was 4,612. Outcome: poor SPPB performance (score &lt;8). Low GS: &lt;20 Kg (women) or &lt;30 Kg (men), and able to do a SCS without use of arm (yes/no) were predictors. Logistic regression, areas under the curves (AUC), and accuracy statistics were computed. AUC for low GS was 0.66, and SCS inability was 0.68; when both tests were considered together, AUC increased significantly: 0.76. Among those SCS-unable (n=752), 95.6% had SPPB&lt;8. A two-stage screening approach; i.e., detection of SCS inability first, followed by low GS in those SCS-able resulted in a net-sensitivity of 75.3%, and net-specificity of 83.5%. Sequential screening with SCS and GS testing might offer a case finding screening approach appealing to busy clinical settings from feasibility, accuracy, and/or efficiency perspectives for identification of older adults with low SPPB who may benefit from established interventions.
OPERATIONALIZING THE FRAILTY INDEX BASED ON WEARABLE SENSOR TO ASSESS FUNCTIONAL PERFORMANCE IN OLDER ADULTS
Authors: Nguyen Hung , Yang Jacqueline , Zahiri Mohsen , Najafi Bijan 
Published: November 2019

Abstract
Frailty status is a well-known predictor of adverse health outcomes and functional performance. An assessment tool based on a wearable sensor was developed to quickly assess frailty using an upper extremity flexion and extension test. However, the current tool has relied on conventional frailty assessment to classify the frailty status of the participant. The aim of this study is to operationalize the frailty index based on wearable sensor to classify frailty status of older adults. 104 older adults were recruited for the study (age=78.6 ±9.7 years old). Participants were asked to perform a quick 20-second upper flexion and extension task while wearing a gyroscope on the wrist. A sensor-based frailty index (FI) was derived using parameters extracted from the sensor. Participants were also assessed using the Fried Phenotype Criteria (FC) and were classified into three groups: robust, pre-frail, and frail. Mean-shift clustering algorithm was used to operationalize the FI by identifying the cut-off point for each group. Grip strength and physical activity level were used as functional outcome measures. Regression analysis (r) was used to compare the correlation of the FC and FI with the identified metrics. Bivariate analysis show that grip strength was highly associated with the sensor-based frailty classification (r=-0.547) and FC (r =-0.503). The sensor-based classification was significantly associated with walking activity (r=-0.355). The results showed that the sensor-based frailty assessment tool could be used to quickly classify frailty status in older adults and eliminated the need for subjective and time-consuming evaluation.
ADAMO INDOOR MOBILITY, PHYSICAL FRAILTY, AND AUTONOMY IN OLDER ADULTS: A MEDIATION MODEL
Authors: Rainoldi Alberto , Donini Lorenzo M , Brustio Paolo R , Mulasso Anna , Poggiogalle Eleonora , Zia Gianluca , Feletti Luca C , Signore Susanna Del 
Published: November 2019

Abstract
Physical frailty represents a clinical condition among older adults leading to adverse health outcomes, such as autonomy loss. To evaluate physical frailty in older adults, adopting information and communication technologies (ICT) may be useful. ADAMO (Caretek S.r.l.) is a care-watch accelerometer that allows to measure mobility in a non-intrusive way (Magistro et al., 2018) providing wider information on individual general health (Mulasso et al., in press). The aim of this study was to evaluate the relationship between indoor mobility, physical frailty and autonomy in a sample of Italian older adults. Methods: Thirty-two volunteers (age 65–84 years; women 56.2%) participated in the study. All wore ADAMO care-watch continuously over a 7-day period. The number of steps indoor was the main endpoint. Fragmented daily mobility was estimated. Physical frailty and autonomy were measured using the Tilburg Frailty Indicator (physical components) and the Groningen Activity Restriction Scale, respectively. Results: Significant inverse correlations were observed between number of steps and autonomy, and number of steps and physical frailty. Conversely, a significant direct correlation was observed between physical frailty and autonomy. Additionally, mediation analysis demonstrated full mediation effect of physical frailty between the number of steps and autonomy. Our results imply that high indoor mobility per se can reduce physical frailty and consequently helps to maintain autonomy. Conclusions: Indoor mobility captured by ADAMO accelerometer may be an important indicator of physical frailty and autonomy. ADAMO may be used as a non-intrusive telemonitoring solution to capture relevant information on individual general health in aged people.
A RANDOMIZED CONTROLLED TRIAL OF METFORMIN FOR FRAILTY PREVENTION: STUDY DESIGN AND BASELINE CHARACTERISTICS
Authors: Espinoza Sara E , Musi Nicolas , Wang Chen-pin , Michalek Joel 
Published: November 2019

Abstract
Inflammation and insulin resistance are major predictors of frailty. Here we describe the study design of an ongoing double-blind, randomized controlled trial of metformin for frailty prevention. Subjects are adults aged 65+ years with pre-diabetes assessed by 2-hour oral glucose tolerance test (OGTT). Those who are frail (Fried criteria) are excluded. Participants are randomized to metformin (maximum dose of 2,000 mg/day) vs. placebo and followed for 2 years. The primary outcome is frailty (category and score); secondary outcomes are physical performance and function (short physical performance battery, 6-minute walk, lower extremity strength), systemic and skeletal muscle tissue inflammation, muscle insulin signaling, insulin sensitivity (insulin clamp), glucose tolerance (OGTT), and body composition (dual-energy x-ray absorptiometry). Safety assessments occur every 3 months; frailty, systemic inflammation, and OGTT are assessed at baseline and every 6 months, and insulin clamp with muscle biopsies are assessed at baseline and every 12 months. To date, 51 subjects have been randomized; 120 completers are planned. Mean age is 73.4 ±5.7 years, 43% are female, and 39% Hispanic. Mean BMI is 30.5 ±5.5 kg/m2, waist circumference is 105 ±13.1 cm, fasting glucose is 102.3 ±8.8 mg/dL, Hemoglobin A1c is 5.8 ±0.3, and glucose at 2 hours during OGTT is 168.5 ±20.4 mg/dL. Metformin is being examined in this study as a potential therapeutic agent to prevent frailty in older adults with pre-diabetes. Findings from this trial may have future implications for the screening and potential treatment of pre-diabetes in older patients with metformin for the prevention of frailty.
DOES GENDER INFLUENCE RISK FOR ORTHOSTATIC HYPOTENSION IN OLDER ADULTS WITH SARCOPENIA?
Authors: Benton Melissa J , Silva-Smith Amy L , Spicher Jefferson M 
Published: November 2019

Abstract
Older adults with sarcopenia may be at risk for unstable postural blood pressure due to diminished lean mass that plays a role in maintaining fluid volume. Males have greater lean mass, so risk may be mediated by gender. We compared postural blood pressure changes in older men (77.1 ± 2.0 years; n = 15) and women (79.6 ± 2.0 years; n = 13) with sarcopenia before and after an overnight fast. Sarcopenia was defined using the Lean Mass Index (males ≤ 19.0 kg/m2; females ≤ 15.0 kg/m2). Body composition was measured using multi-frequency bioelectrical impedance, and blood pressure was measured lying, sitting, and standing. On Day 1 (normally hydrated) there were significant drops in systolic blood pressure, with an overall decrease of -9.1 ± 2.2 mmHg (p &lt; 0.001) between lying and standing. On Day 2 (overnight fast), postural changes were more profound, with an overall decrease of -14.1 ± 2.8 mmHg (p &lt; 0.001). However, when compared by gender, postural changes between lying and standing remained significant but did not differ between men and women (Day 1: men -8.9 ± 2.5 vs. women -9.3 ± 2.5 mmHg; Day 2: men -14.6 ± 4.6 vs. women -13.6 ± 3.1 mmHg). On both days diastolic blood pressure remained stable. In this group of older adults, significant decreases in postural systolic blood pressure were observed in the early morning fasted condition, increasing the risk for orthostatic hypotension (drop in systolic blood pressure -20.0 mmHg). Interestingly, gender did not influence risk.
WHEN STRANGERS BECOME FAMILY: THE ROLE OF CIVIL SOCIETY IN ADDRESSING THE NEEDS OF AGING POPULATION
Authors: Angel Ronald J 
Published: November 2019

Abstract
Mexico’s rapidly aging population presents serious short and long-term challenges to the state and to families, since relatively few individuals have formal retirement plans. Although health care access is formally universal, and non-contributory retirement income is provided to all elderly in need, the Mexican old-age welfare remains limited. In this study we assess the potential role of civil society organizations (CSOs), a category that includes secular non-governmental organizations (NGOs), faith-based organizations (FBOs), in advocacy for and service provision to elders in need. Social and demographic changes, including the migration of children away from their parent’s community, the need for women to work, smaller families, and more are undermining the capacity of the family to provide all of the care and support that frail aging parents need. Given the fact that the federal, state, and municipal governments are limited in what they can provide, the role of CSOs is potentially significant.
IMPACT OF HIGH BODY MASS INDEX ON FRAILTY AND MORTALITY IN MIDDLE-AGED AND OLDER ADULTS
Authors: Jayanama Kulapong , Theou Olga , Godin Judith , Cahill Leah , Rockwood Kenneth 
Published: November 2019

Abstract
Obesity is associated with higher risk of metabolic diseases. How body mass index (BMI) relates to mortality across frailty levels is controversial. We investigated the association of high BMI with frailty, and their effects on mortality. We included 36,583 participants aged ≥50 years from the 1999-2006 National Health and Nutrition Examination Survey (NHANES) cohorts (7,372) and 29,211 participants aged ≥50 years from wave 1 (2004) of Survey of Health Ageing and Retirement in Europe (SHARE). BMI was categorized as: normal: 18.5-24.9 kg/m2, overweight: 25-29.9, obese I: 30-34.9 and obese II+III: &gt;35. A frailty index (FI) was constructed excluding nutrition-related items using 36 items for NHANES and 68 items for SHARE. Mortality data were obtained until 2015. All analyses were adjusted for educational, marital, working and smoking status. In participant aged 50-65 years, higher BMI was associated with greater frailty. Being obese level II+III increased mortality risk in male participants aged 50-65 years with FI≤0.1 [NHANES (hazard ratio (HR) 2.10, 95%CI 1.17-3.79); SHARE (2.35,1.14-4.87)]. In males aged &gt;65 years with FI&gt;0.3, being overweight and obese (any level) decreased mortality risk. In females aged 50-65 years, higher BMI was not associated with mortality across all frailty levels. BMI and frailty were cross-sectionally associated. The subsequent mortality impact differed by age, sex, and frailty. Obesity was not associated with mortality in middle-aged females, regardless of the degree of frailty. In males, obesity was harmful in those who were fit in middle age and protective in moderately/severely frail older ones.
EFFECT OF CHAIR YOGA ON FRAILTY IN OLDER ADULTS WITH LOWER EXTREMITY OSTEOARTHRITIS: RANDOMIZED CLINICAL TRIAL
Authors: Park Juyoung , Liu Zuyun , Vieira Edgar R , Liehr Patricia 
Published: November 2019

Abstract
This study examined whether chair yoga (CY) could reduce severity of frailty in community-dwelling older adults with lower extremity osteoarthritis (OA). Participants were randomly assigned to CY or health education program (HEP) at each of two sites and attended twice-weekly 45-minute sessions for 8 weeks. Data were collected at baseline and 4 and 8 weeks. For primary analysis, followed by Rockwood’s suggesiton, 97 deficits/variables measuring OA symptoms, physical function, balance, fatigue, depression, social activities, and life satisfaction were used to construct a frailty index, ranging from 0 to 1. Fewer deficits/variables were used to construct three alternative versions of the index. Linear mixed-effects models with random intercept were used to analyze longitudinal repeated outcome measures. A total of 112 participants (n = 63 CY, n = 49 HEP; 75.3[7.5] years; 76% female, 46% Hispanic) completed the study. After adjusting for site, cohort effect, and baseline of frailty, there was no significantly greater decline in frailty in the CY group compared to the HEP group (between-group difference, -0.019; 95% CI, -0.063 to 0.025) or the trend of changes in the index (p for interaction = .489). Additional adjustment for baseline characteristics (age, gender, ethnicity, marital status, living alone, health status, pain medication) did not change results substantially. Secondary analysis of three alternative versions of the index indicated similar nonsignificant changes. Thus, an 8-week CY intervention did not reduce severity of frailty in older adults with lower extremity OA. A longer duration of CY with a larger sample size is needed.
THE ASSOCIATION BETWEEN LOWER EXTREMITY FUNCTION, FRAILTY, AND LOW-MILEAGE DRIVER STATUS AMONG OLDER ADULTS
Authors: Crowe Christopher L , Andrews Howard , Molnar Lisa J , Eby David W , DiGuiseppi Carolyn , Strogatz David , Li Guohua , Mielenz Thelma J 
Published: November 2019

Abstract
The crash rate per mile driven among older adults is higher than that of most age groups and comparable to that of the youngest, most inexperienced drivers. The low-mileage bias posits that the elevated rate among older adults results from an increased rate among those who accrue the fewest annual miles. This study evaluated whether low physical capacity among older drivers, measured by the National Health and Aging Trends Study (NHATS) Expanded Short Physical Performance Battery (SPPB) and Fried’s frailty phenotype, increases the risk of being low-mileage drivers. Data were collected for 2,990 older drivers via questionnaires and assessments in addition to 61,528 person-months of driving data. Multivariable log-binomial regression was used to estimate risk ratios. Those with fair and good function had 0.53 (95% CI: 0.40-0.69) and 0.60 (0.47-0.78) times the risk of driving fewer than 3,000 miles/year and 0.45 (0.26-0.77) and 0.48 (0.32-0.72) times the risk of driving fewer than 1,865 miles/year, respectively, compared to those with poor function. For an increase from not frail to pre-frail and from pre-frail to frail, the risk of driving fewer than 3,000 or 1,865 miles/year increased 1.36 (1.11-1.65) or 2.38 (1.63-3.46) times, respectively. Having low physical capacity is associated with an increased risk of low annual mileage. Given the known association between low-mileage driver status and increased crash rates and the modifiable nature of the risk factors examined in this study, interventions aimed at improving physical capabilities may lead to an improvement in safety among older drivers.
THE ELECTRONIC FRAILTY INDEX BASED ON THE COMPREHENSIVE GERIATRIC ASSESSMENT: DEVELOPMENT AND TESTING
Authors: Chinda Betty , Sepehri Katayoun , Zou Macy , Braley Mckenzie , Garm Antonina , Park Grace , Rockwood Kenneth , Song Xiaowei 
Published: November 2019

Abstract
Frailty is characterized by loss of biological reserves across multiple systems and associated with increased risks of adverse outcomes. A Frailty Index (FI) constructed using items from the Comprehensive Geriatric Assessment (CGA) has been validated in geriatric medicine settings to estimate the level of frailty. Traditionally, the CGA used a paper form and the CGA-based FI calculation was a manual process. Here, we reported building of an electronic version of the assessment on personal computers (PC), i.e., standalone eFI-CGA, to benefit frailty assessment at points of care. The eFI-CGA was implemented as a software tool on the WinForms platform. It automated the FI calculation by counting deficits accumulation across multiple domains assessing medical conditions, cognition, balance, and dependency of activities of daily living. Debugging, testing, and optimization were performed to enhance the software performance with respect to automation accuracy (processing algorithm), friendly user interface (user manual and feedback), and data quality control (missing data and value constraints). Systematically-designed simulation dataset and anonymous real-world cases were both applied. The optimized assessment tool resulted in fast and convenient conductance of the CGA, and a 100% accuracy rate of the eFI-CGA automation for up to four decimals. The stand-alone eFI-CGA implementation has provided a PC-based software tool for use by geriatricians and primary and acute care providers, benefiting early detection and management of frailty at points of care for older adults.
MIDLIFE FACTORS, GENDER, AND MIGRATION ARE KEY PREDICTORS OF COGNITIVE HEALTH IN LATE LIFE
Authors: Rote Sunshine , Angel Jaqueline L 
Published: November 2019

Abstract
Older Latinos are at 1.5 times greater risk for Alzheimer’s disease and other dementias than non-Latino Whites (Wu et al., 2018) and there is evidence of high levels of cognitive impairment, dementia, and dementia-related neuropsychiatric symptoms among older Mexican Americans in particular (Rote et al., 2015). We use data from the Hispanic Established Population for the Epidemiologic Study of the Elderly (HEPESE, 1993/94- 2010/11, N=2,665), a national study of Mexican American 65 years and older residing in the southwestern U.S. Older adults who were in the paid labor force, except for those who worked in the agricultural sector, exhibit lower risk for cognitive impairment. The results hold for both women and men. For family size, number of children is associated with greater risk for cognitive impairment and this is especially evident among women and immigrant men. Midlife factors, gender, and migration are key predictors of cognitive health in late life.
A GENETIC ALGORITHM-BASED APPROACH TO OPTIMIZE THE CONSTRUCTION OF A FRAILTY INDEX
Authors: Zucchelli Alberto , Marengoni Alessandra , Rizzuto Debora , Calderon-Larranaga Amaia , Onder Graziano , Fratiglioni Laura , Vetrano Davide 
Published: November 2019

Abstract
The frailty index (FI) is a reliable prognostic indicator based on an individual clinical and functional deficits, which is strongly associated with poor outcomes. We hypothesize that an optimization algorithm may help to select the best candidate deficits to generate a highly-predictive FI. We aimed to optimize the predictive accuracy (area under the curve; AUC) of a FI employing a “genetic algorithm”, an iterative meta-heuristic that selects and recombines the most accurate FIs among randomly-generated ones. We used data from 3363 individuals aged 60+ enrolled in the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). To avoid overfitting, the algorithm was run on a randomly-chosen subsample (70%) of 10 imputed datasets. About 825,000 FIs were built, evaluated, and recombined. The best genetic algorithm-based FI (ga-FI) was compared in terms of 3- and 6-year mortality prediction with a clinically-generated FI (c-FI) in the remaining 30% of the data. Ga-FI showed better AUCs in comparison to the c-FI, overall and in all age and sex subsamples. Several sensitivity analyses were carried out. The major AUC improvement was seen among participants aged &lt;75 [3-year mortality AUC: 0.83 vs 0.63; p&lt;0.001]; 6-year mortality AUC: 0.76 vs 0.63; p&lt;0.001], while smaller differences were seen among participants aged ≥75 [3-year mortality AUC: 0.86 vs 0.84; p=0.216; 6-year mortality AUC: 0.84 vs 0.81, p=0.017]. The genetic algorithm is a feasible method to optimize the construction of a highly performant FI that might be used to assess health comprehensively both in clinical and research settings.
OPTIMAL STAFFING MODELS TO CARE FOR FRAIL ELDERLY ADULTS IN PRIMARY CARE AND GERIATRIC PRACTICES
Authors: Auerbach David I , Michael Carie , Levy Douglas , Maramaldi Peter , Dittus Robert , Spetz Joann , Buerhaus Peter , Donelan Karen 
Published: November 2019

Abstract
As the US population ages, primary care is expected to be the health care “home” for older adults, and several initiatives are aimed at helping to transform primary care practice to care for this population. Wide variation in staffing has been observed. Meyers et al proposed ideal models of primary care staffing for a general population and for a frail elderly population (2018). We developed the 2018 Survey of Primary Care and Geriatric Clinicians to measure optimal team configuration in clinical practices caring for older adults. A majority employed NPs, MDs and PAs, with [r = -.53] between % of clinician labor of NPs and physicians). High-NP practices are more likely located in states with full scope of practice, perform well for frail elders and are less expensive. Meyers' models, with fewer physicians, more SW and CHWs, more RNs, perform better for frail elders, and are less expensive.
PATTERN OF HEALTH-RELATED BEHAVIORS AND RESOURCES AS PREDICTOR OF MEDICAL CARE AND MORTALITY RISK AMONG OLDER ADULTS
Authors: Zuo Dongmei , Silverstein Merril D 
Published: November 2019

Abstract
This study investigates the patterns and consequences of a wide range of health-related behaviors and resources that include health-compromising behaviors, health-promoting behaviors, preventive health behaviors, and health risks coping resources. We aim to identify the empirically-derived subgroups of individuals with unique profiles of health behaviors and resources to determine how subgroup membership predicts health outcomes and medical care utilization four years later. Data derived from 5,067 respondents in the 2010 and 2014 waves of the Health and Retirement Study. Latent class analysis was used to define classes based on 13 indicators in the 2010 wave, which also provided sociodemographic and health-related covariates. Outcomes were measured over 4 years. Six latent subgroups were identified: “Best Behavior/Resources”, “Low Social Support “, “Low Physical Activity”, “High Substance Abuse”, “Low Preventive Tests”, and “Low Governmental Health Insurance”. Compared with the “Best” group, older adults identified as “Low Physical Activity” and “High Substance Abuse” were found to have higher mortality risks and a lower likelihood of seeing doctors and less nursing home nights; older adults with the lowest level of receiving flu shots, cholesterol and cancer screen test (“Low Preventive Tests”) reported a less likelihood of seeing doctors; respondents in “Low Governmental Health Insurance” subgroup were associated with a lower likelihood of hospital stay and more nursing home nights. Results suggest that distinct groups of older individuals characterized by their health behaviors and resources provide a basis for identifying the high-risk segment of the older population for intervention.