bluuebunny/crossref_metadata_2025_split huggingface dataset:
Phase Angle as a Bioelectrical Marker to Identify Sarcopenia
Authors: Hou Lisha , Yue Jirong 
Published: December 2020

Abstract
Background: Phase angle (PhA) has been suggested as an indicator of cellular death and nutritional status. We aimed to evaluate the performance of phase angle as a sarcopenia marker among 50 years older and determine the optimal cut-off values. Materials and Methods: A cross section of 4500 with ≥50 years were assessed in terms of sarcopenia with bioelectrical indices. Phase angle can be determined through bioelectrical impedance analysis (In Body 770). Muscle strength and physical function were measured using hand grip and 4 m walking speed. Significant determinants of sarcopenia were further analyzed with multivariate logistic regression analysis. Results: 869 patients (19.31%) were diagnosed with sarcopenia. The average PhA was 5.03 ± 0.64° (Male: 5.31 ± 0.66°; Female: 4.87 ± 0.57°). After adjusting age, gender, race, occupation, BMI, marital status, smoking, drinking, exercise, chronic disease and ADL, phase angle was still independent associated factors with sarcopenia: phase angle (OR=0.25, 95% CI: 0.203-0.308, P &lt; 0.001). Receiver operating characteristic analysis revealed that the optimal phase angle cutoff value to detect sarcopenia was ≤4.9º (AUC=0.768). Conclusions: Bioelectrical phase angle can be an useful bioelectrical marker to identify sarcopenia.
The Association Between Self-Reported and Objectively Measured Energy Level in Older Adults
Authors: Tian Qu , Glynn Nancy , Ehrenkranz Rebecca , Sprague Briana , Rosso Andrea , Rosano Caterina 
Published: December 2020

Abstract
Energy is an important concept in human health and diseases. Self-reported energy has been described as “the individual’s potential to perform physical and mental activity” and “the individual’s energy availability”. However, little empirical data exists on whether self-reported energy level is related to objectively measured energy level. Prior research suggests that more energy availability is associated with higher physical activity level. It remains unclear whether self-reported energy availability would be associated with objectively measured energy level, such as active energy expenditure and total energy expenditure. Using data from the Health, Aging and Body Composition Study, we identified 94 participants (mean age=86.2±2.4 y/o, 46%blacks, 52%women) with concurrent data on self-reported energy (scale 0-10) and objective energy level by the SenseWear Armband. We examined cross-sectional associations of self-reported energy with objectively measured energy and physical activity levels using Spearman correlation. Greater self-reported energy level was associated with higher daily active energy expenditure in kcal (r=0.30,p=0.004), higher METs (r=0.33,p&lt;0.001), more minutes of physical activity (r=0.35,p&lt;0.001), and more step counts (r=0.36,p&lt;0.001). Self-reported energy was not associated with total energy expenditure (p=0.87) or estimated resting metabolic rate (p=0.53). Self-reported energy may reflect an individual’s activity energy expenditure but not total energy expenditure. It further supports the hypothesis that energy availability even by self-report connects to physical activity behavior. Whether self-reported energy correlates with other health outcomes warrants further investigation.
Factors Related to the Well-Being of Older Chinese Living in Institutional Care Facilities: A Systematic Review
Authors: Wang Kun 
Published: December 2020

Abstract
Due to the fast pace of population aging and the “4-2-1” family structure, institutional care was proposed as “support” for the elderly care service system in China. The purpose of this systematic review paper was to identify factors that are associated with the well-being of older residents living at institutional care facilities in China. Studies were included if participants (1)aged 60 years or older, (2) were living at an institutional care facility in mainland China. Studies were excluded if participants (1) were Chinese Immigrants, or residents in Hong Kong, Macao, and Taiwan, (2) were cognitively impaired, or (3) at the end of their lives and need palliative care in institutional facilities. A total of 12 articles were selected in this review study based on PRISMA guidelines: 10 quantitative studies and 2 qualitative studies. Anderson healthcare utilization model was used in this study to categorize related factors into three dynamics: predisposing factors, enabling factors, and need factors. Among predisposing factors, older, more educated, widowed adults with higher income were more likely to have higher levels of well-being in institutional care facilities. Social supports, such as family visit, activity engagement and peer support, were very important enabling factors. The actual need, such as ADL, health status and depression, was another important dimension for the well-being of older Chinese living in institutional care facilities. Aiming at increasing older residents’ well-being, the present study suggested more tailored interventions should be designed and implemented to enhance their social support, activity engagement and peer support.
Effects of Resistance Exercise on Mental Health in Older Chinese Americans: A Randomized Controlled Trial
Authors: Chen Mei-Lan , Burgess Elisabeth , Chao Ying-Yu , Gardenhire Douglas , Luo Ruiyan 
Published: December 2020

Abstract
Regular exercise has shown to be potentially beneficial for improving mental health in older adults. However, few studies evaluated the effect of resistance exercise on psychological well-being in older Chinese Americans. The purpose of this two-arm randomized controlled trial (RCT) was to test the effects of resistance exercise training on stress, depression, and social engagement in community-dwelling older Chinese Americans. A total of 30 older adults (mean age 77.9 ± 5.0 years) were randomly assigned into the resistance exercise intervention group (n = 15) or the wait-list control group (n = 15). The resistance training intervention includes 50-min group exercise session twice weekly for 12 weeks. Participants’ perceived stress, depressive symptoms, and social engagement were measured at baseline and 12 weeks follow-up. Descriptive statistics and t tests were performed for data analysis. The results revealed that the resistance exercise intervention group had significant improvements in perceived stress, depressive symptoms, and social engagement after receiving the 12-week intervention. At baseline, there were no significant differences between the intervention and the control groups on perceived stress, depressive symptoms, and social engagement. However, older adults received resistance exercise training had greater improvements in stress levels, depressive symptoms, and social engagement than their control counterparts at 12 weeks follow-up. The findings suggest resistance exercise has positive effects on psychosocial well-being for older adults. Further larger RCTs are needed to assess long-term effects of the resistance exercise intervention.
The Relationship Between Cognitive Decline and Sedentary Time
Authors: Phillips Lorraine , Bowen Mary 
Published: December 2020

Abstract
Early identification of functional decline in older adults with mild cognitive impairment (MCI) provides the opportunity to initiate behavioral interventions to slow decline. More frequent breaks in sedentary time has been associated with greater lower extremity function. This longitudinal study examined the effect of 6-month change in cognitive function on monthly sedentary time, controlling for lower extremity function, among community-dwelling older adults with MCI. Twenty adults with Montreal Cognitive Assessment Score (MoCA) between 19-25, who were age ≥ 60 years old, and ambulatory, wore an actigraph for 6 months and participated in monthly in-person assessments. Measures included MoCA change (baseline to month 6), Short Physical Performance Battery (SPPB; baseline, months 3 and 6); sedentary time and physical activity intensity; and falls (monthly). The sample was 70% female, 60% non-Hispanic white, with a mean age of 77 years. Sixteen participants provided complete data for mixed-model analysis. Over 6 months, 11 falls occurred among 7 participants. The mean MoCA score declined from 22.7 to 21.9 while SPPB remained stable. Overall time spent in sedentary behavior was high (71%) and physical activity intensity was low (light and moderate combined= 26.1%). Results of multi-level analysis with sedentary time as a continuous Level-1 variable and MoCA change scores, SPPB scores, and age in Level-2 showed that negative change in MoCA (β=-0.11; p≤0.05) was associated with increased sedentary time. Given sedentary time increases as cognitive function declines, older adults with MCI could benefit from interventions designed to interrupt sedentary time as well as increase physical activity.
Time-Varying Associations of Physical Activity on Weekdays and Weekend Days in Minority Older Adults
Authors: Hevel Derek , Kennedy-Malone Laurie , Sappenfield Kourtney , Scheer Heidi , Zecca Christine , Maher Jaclyn 
Published: December 2020

Abstract
Older adults are insufficiently physically active, and therefore, are at an increased health risk. However, less is known about the moment-to-moment physical activity behavior patterns that change across the day. The current study utilized accelerometry to better understand diurnal physical activity patterns. Minority older adults (N=91, age M=70.14, 96% Black/African American) participated in an 8-day study where they wore an ActivPAL accelerometer to measure physical activity. Physical activity was operationalized as stepping in the 60-minute window (±30-min) around a given moment. Time varying-effect modeling was used to determine how physical activity patterns change over the course of weekdays and weekend days. Results are rounded to the 5-min interval. On weekdays, time spent stepping increased from 8:00am (B=7.16, 95%CI: 5.04, 9.27) until peaking at 11:10am (B=8.46, 95%CI: 6.59, 10.33), slowly decreased to the lowest point at 6:10pm (B=6.72, 95%CI: 4.82, 8.62), and then increased slightly in the evening. On weekend days, time spent stepping was lowest at 8:00am (B=4.47, 95%CI: 2.14, 6.80), peaked at 12:20pm (B=5.50, 95%CI: 3.22, 7.78), gradually decreased until 5:50pm (B=5.21, 95%CI: 2.90, 7.52), and then increased slightly in the evening. Minority older adults engage in more stepping time around mid-day, but less stepping in the late afternoon to early evening on both weekdays and weekend days. Self-care activities (e.g., mealtime, bed-time routines) may influence older adults’ physical activity. This work identifies vulnerable times during the day when older adults engage in relatively low levels of physical activity which may be of interest for interventions.
Effectiveness of Servo-Assistive Robotic Rollator (RT.2) Among Older Adults Living in the Community
Authors: Yamanaka Takashi , Kidana Kiwami , Mizuki Maiko , Matsui Toshihumi 
Published: December 2020

Abstract
Older adults tend to need assistance for ambulation with the progression of aging or when suffering from diseases. With technological advances, servo-assistive robotic rollators are available besides canes and walkers to assist disabled older adults. This study aimed to investigate the appropriate person and conditions for using a servo-assistive robotic rollator and its effects. Participants were 10 older adults living in the community (80.5±9.7 years; 4 males and 6 females) who used a servo-assistive robotic rollator (RT.2). After evaluating their physical (body composition, diseases, care need level, and SF-36), mental (MMSE, GDS-15, and WHO-5), and living conditions, they began using the device in daily life. We evaluated their ways of using it and the effects of its use through our observation and their self-report. Participants suffered from a stroke, spinal bone fracture, Parkinson’s disease, osteoarthritis of the knees, or optic neuromyelitis. At the study’s onset, cognitive impairment (MMSE&lt;23/30), depressive states (GDS-15≧5), decreased grip strength, and decreased muscle mass (InBody S10) was found in one, three, six, and one participant, respectively. Most participants had a clear purpose for using it, such as going outside by foot or maintaining muscle strength. During the three-month observation period, no participant fell while using it. Some participants used it in a rehabilitation program at home, while others used it in daily life and went to several places with its assistance. Servo-assistive Robotic Rollators enabled older adults with difficulty in ambulation to walk outside safely and provided a greater opportunity to participate in society.
Prevalence and Perceived Usefulness of Assistive Technology in Mind at Home Dementia Cohort
Authors: Morreale Michael , Johnston Deirdre , Bunting Morgan , Antonsdottir Inga , Samus Quincy 
Published: December 2020

Abstract
Dementia is generally characterized by both an increasing dependence in activities of daily living over the course of the illness, and a decreasing ability to self-manage everyday tasks. This places persons at risk for a number of undesirable outcomes including increased risk for injury in the home, increased risk for medical and behavioral complications, risk of premature institutionalization, and excessive burden on family caregivers (CG).3,4 Assistive Technology Devices (AT-Devices) could represent an efficient resource for supporting daily tasks while reducing both CG care burden and adverse risk to the person with dementia (PWD).3,4 In the context of a larger dementia care intervention clinical trial (The MIND at Home program) that involved persons living with dementia at home and their family caregivers, we conducted a supplemental baseline survey on 59 participants and their CGs to better understand the current prevalence of AT-Device use and which devices would be perceived as “most helpful”. Our analysis showed that 51% of our study population used at least 1 of our listed AT-Devices. The most common AT-Device used at baseline were door guards (29%), tablets/smartphones (20%), and constant temperature shower nozzles (13%). Our survey demonstrated devices perceived as most useful included: shower nozzles, GPS locating devices, door guards, and Bluetooth tracking stickers. Individuals who endorsed African-American/Other race were significantly more likely to use at least one AT-Device than those who identified as Caucasian (OR: 4.80; 95% CI: 1.50-17.58). This significance was lost during adjustment for other demographic variables (sex, age, cohabitation status, and dementia severity).
Evaluation of Agility and Walking Ability in Elderly People
Authors: Yamauchi Ken , Hasegawa Hiromichi , Ogita Akira , Ichikawa Tutomu , Kagawa Shota , Ken Yamauchi 
Published: December 2020

Abstract
An important aspect of independent living in a super-aging society is the achievement of “successful aging” in mind and body. Recent large-scale epidemiological studies found that reduced walking ability significantly affects “extended healthy life expectancy” and “successful aging.” In terms of anatomy and physiology, “usual aging” (i.e., the inevitable decrease in walking function due to aging) occurs unless one undertakes daily physical activity. Conversely, aggressive moderate and habitual physical activity may lead to “successful aging” (i.e., maintained and improved walking function). Previous studies revealed that agility and walking ability are related to healthy life expectancy. Thus, we measured agility with a stick response test to investigate its relationship to gait, and determined whether this test could be substituted for a battery test of walking ability. This test has the convenience of shortening measurement time and requiring a wider measurement place than gait evaluation performed by actually walking. Correlation was observed between the rod response test and stride length (r = 0.60), walking speed (r = 0.38), and walking ratio (r = 0.34). Therefore, we propose that the rod response measurement is simpler than a simple walking ability test and can be used as a physical function measurement item that predicts the health and longevity of the elderly.
Pain-Associated Clusters Among Nursing Home Residents
Authors: Budnick Andrea , Kreutz Reinhold , Kuhlmey Adelheid , Dräger Dagmar 
Published: December 2020

Abstract
Chronic pain is common in older adults, particularly among nursing home residents (NHR). Internationally, the reported pain prevalence among NHR ranges from 3.7% to 79.5%. At least one in two German NHR are diagnosed with pain. Unrelieved chronic pain is associated with reduced physical functioning and psychological parameters. Given the high prevalence of pain among NHR, we hypothesized that there were likely pain-associated clusters in our target group. Clustering is an opportunity to identify differences in pain management and may enable better targeted health-service delivery for professionals. There are no available data regarding pain-associated clusters (sub-groups of NHR) based on different items measuring pain. This study was performed using baseline data, and was part of a cluster-randomized controlled trial conducted in 12 nursing homes in Berlin. We assessed pain using the German Brief Pain Inventory (BPI-NHR) among 137 NHR (mean age, 83.33 years) capable of self-report. We performed hierarchical agglomerative cluster analysis to generate three clusters (naming is based on the mean value of each BPI-NHR item in each cluster): pain-relieved (46.72 %), pain-restricted (22.63 %), and severe pain (30.66 %). Body-Mass-Index (F(2,129) = 4.274, P = 0.016), Barthel-Index (F(2,133) = 3.246, P = 0.042), and appropriateness of pain medication (F(2,119) = 12.007, P = 0.000) differed between clusters. Parameters associated with an increased or decreased risk of being in a pain-diagnosed cluster will be discussed. The observed need for clinical interventions aiming at shifting from pain-diagnosed clusters to pain-relieved status will be reflected.
Self-Medication Practice Among Older Adults: Prevalence and Associated Factors
Authors: Locquet Medea , Beaudart Charlotte , Reginster Jean-Yves , Bruyère Olivier 
Published: December 2020

Abstract
The self-medication practice, or the self-administration of medicine or dietary supplements without any physician’s advice, represents a public health issue due to its potentially related adverse health events. In older adults, few data are available on self-medication behaviors. The main objective of our study was thus to assess the prevalence of self-medication in a population of older adults. As a secondary exploratory analysis, we seek to determine the determinants of self-medication practice and its association with adverse health outcomes. Our sample was comprised of men and women aged 65 and over from the SarcoPhAge study. Data regarding self-administration of substances were collected through self-administered questionnaire. Clinical and socio-demographic characteristics of the participants as well as medical history were recorded by the investigator. A total of 272 older adults were recruited with a mean age of 77.3±5.2 years. Among them, 119 (43.8%) reported resorting to self-medication (38.6% self-administration of vitamins and dietary supplements, 28.5% self-administration of drugs). Participants which resort to self-medication were older (78.9±4.7 years versus 77.1±3.9 years, p=0.04) and had a lower body mass index (25.7±3.9 versus 27.3±5.2, p=0.006). After adjustments for confounding factors, significant associations were noted between self-medication practice and fractures (OR=3.36[1.02-11.28]) and hospitalizations (OR=1.77 [1.03-3.05]) occurred during the previous year. The practice of self-medication seems widespread among the older age. It seems more frequent in more vulnerable subjects and having experienced adverse health outcomes. This type of health practice must therefore attract the attention of health actors.
Teaching Nurse Practitioner Students About Polypharmacy Through a Lived Experience
Authors: Kim Jennifer , Lewallen Kanah , Boll Taylor 
Published: December 2020

Abstract
Polypharmacy (typically defined as the concomitant use of 5 or more medications) affects 40-50% of older adults in the U.S., and is associated with geriatric syndromes, a higher risk of medication non-adherence, and adverse drug events. Medication non-adherence is a common frustrating clinical issue for clinicians who provide care for older adult patients. Simultaneously, patients often find medication regimens to be complicated and confusing. This may contribute to medication non-adherence, which may further lead to adverse drug events and/or negative health outcomes. The more medications a patient is taking, the higher the risk for non-adherence. Thirty-eight students enrolled in an adult-gerontology primary care nurse practitioner program were given a bag of five mock medications that are commonly prescribed for older adults. Students were instructed to follow the directions on each of the bottles for approximately one month. A private messaging system was available for students if refills were needed or if they had questions about their medications. A debriefing session for this month-long, ungraded simulation was held, at which time students returned medication bottles. Pill counts were not analyzed, but all returned bottles contained mock medications. Approximately 52.6% of students estimated adhering to the medication regimen 0-24% of the time, whereas 26.3% reported an adherence rate of 25-50%. The most commonly cited barrier to adherence (55.3%) was “forgetfulness”. Nearly all students (89.5%) reported that the exercise “very much” increased their awareness of challenges patients face when managing medications, and 97% cited an increased awareness of ways to improve medication adherence.
Systematic Review of Guidelines on Antihypertensive Treatment in Older Adults: SPRINTing to More Heterogeneity?
Authors: Bogaerts Jonathan , Ballmoos Leonie von , Achterberg Wilco , Gussekloo Jacobijn , Streit Sven , van der Ploeg Milly , Drewes Yvonne , Poortvliet Rosalinde 
Published: December 2020

Abstract
Clinical trials have demonstrated that antihypertensive treatment (AHT) in older adults is beneficial. Longitudinal studies, in contrast, have shown that low blood pressure is associated with higher all-cause mortality, especially in frail older adults. Despite the high quality of the available evidence, its translation into clinical guidance for the heterogeneous older population is challenging. To give a systematic overview of blood pressure targets for older adults recommended in clinical guidelines, we searched PubMed, Embase, Emcare, and five guideline databases. We selected guidelines with numerical thresholds for the initiation or the goal of non-disease-specific AHT (January 2008-October 2019). Guidelines with advices concerning AHT in older adults were analyzed. We appraised the guideline quality with the AGREEII-instrument. Of the 44 guidelines containing a numerical threshold for the initiation or the goal of AHT, 33 (75%) provided recommendations concerning AHT for older adults. Nineteen advised a higher target of systolic blood pressure (SBP) for older adults in comparison with the middle-aged population and 3 more recent advised a lower target. Over half (19/33) recommended to treat hypertension in the oldest old to a SBP &lt;150 mmHg, while others advised intensive treatment to targets &lt;120 mmHg. Although many guidelines mentioned frailty, only three gave specific thresholds and targets for frail older adults. The quality of the guidelines was not related with the recommended targets. Targets of AHT in older adults in international guidelines range from less strict to more intensive in comparison with the middle-aged and are set on chronological rather than biological age.