bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors Associated With Positive Aging and Happiness of the Older People in Hong Kong
Authors: Lai Daniel W L , Lee Vincent , Yan Elsie 
Published: December 2020

Abstract
Happiness is essential to one’s well-being and impact on every aspect of our lives. Happier people are living longer, they are healthier. Happier people are more likely to be physically active and enjoy better sleep habits and practices. While few existing research studies had examined the determinants of happiness of older people, especially in Chinese society. Understanding happiness in the context of social unrest and political instability is thus limited. This study tested the correlates of happiness at interpersonal, psychological and environmental levels at a time when there were extended scale of violence, destructions, and clashes in the community between police and protesters in late 2019 during the anti-extradition campaign. In social unrest, older people, due to their function and mobility, could be emotionally and physically vulnerable. A total of 1,209 older persons aged 55 and above from Hong Kong answered the questionnaire by stratified random sampling. Our findings show that their overall resilience was strongly and positively associated with levels of happiness. Due to the recent political instability Hong Kong, their satisfaction toward social and political situation of Hong Kong also correlated positively to levels of happiness. We suggest that future interventions and policy initiatives should put extra emotional and tangible support to older adults, particularly during social unrests and unstable political conditions, in addition to strategies for the enhancement of resilience and mental capital.
Alzheimer’s Disease-Associated Pathology in a Transgenic Mouse Model Results in Altered Voiding Function
Authors: Hardy Cara , Rosenberg Dawn , Ramasamy Ramalakshmi , Hu Xiangyou , Smith Phillip 
Published: December 2020

Abstract
Alzheimer’s disease (AD) is a devastating disorder primarily affecting older adults and is the most common neurodegenerative disease in the US. More than one in three AD patients experience AD-associated urinary dysfunction (ADUD), which directly contributes to their institutionalization. While ADUD has been clinically regarded as a result of poor cognitive control over urinary function, the physiology underlying loss of urinary control remains unknown. We hypothesize that beta-amyloidosis in the CNS results in pathologic changes in urinary structure and function. Male and female Tg-APP/PS1DE9 mice were used before plaque deposition (4-6 months) and after plaque accumulation (8-10 months) and compared to their WT littermates. Pressure-flow cystometry was conducted under urethane anesthesia to assess urinary performance at the level of the autonomic nervous system in the absence of cortical control. Pharmacomyography was performed on bladder strips to determine tissue-level changes in the absence of CNS input. In Tg-APP/PS1DE9 mice, plaque accumulation resulted in diminished volume sensitivity and decreased voiding efficiency. Pharmacologic studies showed aberrant drug responses, altered cholinergic signaling, and decreased resilience of tissue longevity after plaque accumulation. Based on our findings, we conclude that the AD-related pathology of Aβ accumulation results in a distinct urinary phenotype in our model, analogous to the ADUD observed in AD patients. Establishing and expanding models of ADUD to other mouse models of AD-associated pathology may improve the efficacy of treating ADUD and increase quality of life for patients and their caregivers.
Greater Skeletal Muscle Oxidative Capacity Is Associated With Higher Resting Metabolic Rate: Results From the BLSA
Authors: Zampino Marta , Semba Richard , Adelnia Fatemeh , Schrack Jennifer , Spencer Richard , Fishbein Kenneth , Simonsick Eleanor , Ferrucci Luigi 
Published: December 2020

Abstract
Resting metabolic rate (RMR) tends to decline with aging. The age-trajectory of decline in RMR is similar to changes that occur in muscle mass, muscle strength and fitness. However, while the decline in these phenotypes have been related to changes of mitochondrial function and oxidative capacity, whether lower RMR is associated with poorer mitochondrial oxidative capacity is unknown. In 619 participants of the Baltimore Longitudinal Study of Aging, we analyzed the cross-sectional association between RMR (kcal/day), assessed by indirect calorimetry, and skeletal muscle maximal oxidative phosphorylation capacity, assessed as post-exercise phosphocreatine recovery time constant (tau-PCr), by phosphorous magnetic resonance spectroscopy. Linear regression models were used to evaluate the relationship between tau-PCr and RMR, adjusting for potential confounders. We found that independent of age, sex, lean body mass, muscle density and fat mass, higher RMR was significantly associated with shorter tau-PCr, indicating greater mitochondrial oxidative capacity. In conclusion, higher RMR appears to be associated with a higher mitochondrial oxidative capacity in skeletal muscle. This association may reflect a relationship between better muscle quality and greater mitochondrial health.
Hospitalization and Successful Aging of Community-Dwelling Older Adults: Using the Korean National Survey Data
Authors: Lee Ji Yeon , Kim Bora , Lee Kyung Hee , Park Changgi 
Published: December 2020

Abstract
Hospitalization experience can be an obstructive factor to successful aging. Although older adults who had hospitalization experience has been considered to have poor health status and low participation in one’s life, it is not obviously evident whether hospitalization itself affects successful aging. This study aimed to investigate whether three components of successful aging (i.e., diseases and disease-related complications, physical and mental functions, and engagement with life) were different in community-dwelling older adults who had hospitalization experience for the past one year compared to the counterpart older adults without hospitalization experience. A secondary data analysis was performed using a nationally representative survey data in Korea. A total of 1,812 who had hospitalization experience were matched to 1,812 control counterpart using propensity score matching. Sampling weight of the survey was considered for all statistical analysis. The community-dwelling older adults with hospitalization experience were less likely to be aging successfully than the older adults without hospitalization experience. The older adults with hospitalization experience had more chronic illnesses and malnourishment; they had more impairment in physical function and depressive symptoms; they were less active in working, social activities, and traveling. However, there were no differences in cognitive function and religious activities between the groups. In conclusion, the community-dwelling older adults who had hospitalization experience have poor health status and less engagement in one’s life in general after matching covariates using propensity score matching analysis. Therefore, more attention and assist are needed to the community-dwelling older adults with hospitalization experience to facilitate successful aging.
The Moderating Role of Age on Cognition Among Old Cancer Survivors: Comparison With Older Adults Without Cancer
Authors: Wang Kun , Lee Hee Yun , Neese Jessica 
Published: December 2020

Abstract
Considering that 64% of cancer survivors are older adults, it is plausible that the overlap of cancer and old age may worsen older cancer survivors’ cognitive functioning. The current study aimed to test the effect of cancer history on cognition in comparison with older adults without cancer history and examine how age groups moderated the association between cancer and cognition. A subsample of 9197 participants drawn from the Health and Retirement Study (HRS) Wave13 were included in this cross-sectional study. Total word recall (score range: 0-20), mental status (0-15), and total cognition (0-35) were the three continuous dependent variables. Multilinear regressions were conducted with and without the interaction term (cancer history * age group). Findings showed cancer survivors tended to be older, Non-Hispanic white males, and higher educational attainment. Cancer history (B= .14, p&lt; .05) was significant only for mental status. Cancer survivors had higher mental status scores than older adults without cancer history. The moderation effects of age groups on total word recall (p&lt; .05), mental status (p&lt; .01) and total cognition (p&lt; .01) were significant only in the 85+ group. After adjusting for other variables, cancer survivors in the 85+ age group had significantly higher mental status and total cognition scores than their non-cancer counterparts. Posttraumatic growth can potentially explain the surprising result that older cancer survivors had higher cognition scores. Another possible explanation is that high cognitive functioning lengthened survival, and not cancer increased cognition. More experimental studies are needed to explore the current study’s findings further.
Effect of Family Caregiver Need for Training on Medicare Home Health Care
Authors: Burgdorf Julia , Stuart Elizabeth , Wolff Jennifer 
Published: December 2020

Abstract
Medicare home health providers are required to offer family caregiver training; however, there is little information regarding the impact of family caregiver training on home health care intensity. A better understanding of this relationship is necessary to inform development and prioritization of caregiver training interventions in this setting. This research assesses whether and how family caregiver need for training affects care intensity during Medicare home health. We examine 1,217 (weighted n=5,870,905) fee-for-service Medicare beneficiaries who participated in the National Health and Aging Trends Study (NHATS) between 2011-2015 and received Medicare-funded home health care within one year of survey. Using propensity score adjusted, multivariable logistic and negative binomial regression, we model the relationship between family caregiver need for activity-specific training and the number/type of visits received during Medicare home health. We found that older adults whose family caregiver required training on self-care tasks had greater odds of receiving any therapy visits (aOR: 1.70; 95% CI: 1.01, 2.86), aide visits (aOR: 2.12; 95% CI: 1.11, 4.05), or training visits (aOR: 1.49; 95% CI:1.01, 2.21). Older adults whose family caregiver required training on medication management had greater odds of receiving any nursing visits (aOR: 3.03; 95% CI: 1.06, 8.68) and incurred 1.06 (95% CI: 0.11, 2.01) additional nursing visits. Findings support the importance of connecting family caregivers to training resources. Additionally, findings suggest that home health providers should consider prioritizing training interventions which focus on caregiving activities most closely tied to resource utilization: self-care and medication management.
An Ecological Model of Care for Older Adults With Cognitive Impairment
Authors: Rhodus Elizabeth , Rowles Graham , Bardach Shani , Hunter Elizabeth , Jicha Gregory 
Published: December 2020

Abstract
Living with dementia causes increasing dependence on the surrounding physical and social environment. There is limited information on environmental interactions of persons with cognitive impairment. Based on participant observation and repeated interviews with both members of nine dyads (primary care partner and person with cognitive impairment) in situ in their homes, a theoretical model depicting environmental interaction was developed. The model illustrates parallel and interwoven environmental experiences of each member of the dyad as they negotiate progressive cognitive impairment. Evolution of the dyad is situated within nested layers of the physical and contextual environment including physical structures, social norms, and political environments. Experiential elements for each member of the dyad are described. Elements include cognitive status, trial and error associated with care provision, adverse behavior linked with onset of caregiver burden, onset of a significant event leading to altered living situations, and maximum dependence on environmental factors prior to end of life. Evidence collected suggests that both persons of the dyad become increasingly susceptible to environmental influences with progression of the disorder. Implication of these findings offer a theoretical framework describing dyadic experiences of environmental interactions when living with dementia. This theoretical model provides a basis for clinical and social intervention to enhance the well-being of both members of the dyad. Interventions associated with environmental interactions may slow socially discordant behavioral manifestations associated with dementia and significantly improve quality of life for both members of the dyad.
Cognitive Impairment and Self-Care Among Congestive Heart Failure Patients in an Outpatient Clinic
Authors: Liu Chelsea , Williams Nicole L , Chandra Nisha , Rouf Rosanne , Gaddis Andrew , Gomez Yessenia , Simmons Tanya , Gottesman Rebecca 
Published: December 2020

Abstract
The burden of congestive heart failure (CHF) is the greatest among older adults. Cognition is important for carrying out self-care tasks such as monitoring sodium intake, but little is known about how cognition affects self-care in acutely ill CHF patients. We aimed to assess the association between cognition and self-care in CHF patients from an outpatient diuresis clinic. Cognitive function was measured using the Mini-Mental State Exam (MMSE) and other tests representing 5 cognitive domains. The Self-Care of Heart Failure Index (SCHFI), given to a subset of participants, consisted of 22 questions each scored on an ordinal scale of 1-4 with a total score ranging from 22-88; higher scores indicated better self-care. SCHFI questions were further categorized into maintenance, management and confidence sub-scores. Multiple linear regressions were used to analyze the association between neuropsychological test scores and SCHFI scores. A total of 68 CHF patients had complete SCHFI data, with a mean age of 65.6 years and a mean total SCHFI score of 70.9 points. Nine (13.2%) patients were cognitively impaired (MMSE&lt;24). Older age, lower education and history of stroke were associated with cognitive impairment. After adjusting for age, education, diabetes, and depressive symptoms, no associations were observed between the other neuropsychological test scores and any of the SCHFI scores. Though findings suggest that cognition is not associated with self-care, the analysis may have been underpowered. Further evaluation of a greater number of CHF patients is needed to understand the implications of cognition on self-care and provide guidance for interventions.
Evaluation of Intervention Acceptability in Community Studies With Individuals and Dyads Affected by Dementia
Authors: Harris Melissa , Titler Marita 
Published: December 2020

Abstract
Multiple non-pharmacologic interventions for symptom management in community dwelling individuals with dementia have demonstrated effectiveness, but have had limited uptake in practice. Prior reviews have evaluated acceptability of interventions for caregivers, but none have evaluated interventions for care recipients with dementia and dyads. This review synthesized the evidence about intervention acceptability for dyads (individuals with dementia and informal caregivers) and individuals with dementia residing at home. Four databases were searched (PubMed, CINAHL, AgeLine, PsycINFO) using inclusion criteria of: intervention studies, community dwelling individuals with dementia or dyads of care recipients and informal caregivers, non-pharmacologic intervention, evaluation of intervention acceptability. Gray literature and non-English articles were excluded. 173 citations were screened by title and abstract, 38 were reviewed by full text, and 19 studies were included. 18 studies focused on dyads, and 13 different non-pharmacologic intervention types were evaluated across studies. Qualitative (n=3), quantitative (n=8) and mixed methods (n=8) were used to evaluate acceptability. Approaches and measures of acceptability included field notes, behavioral checklists, focus groups, semi-structured interviews, questionnaires, and completion rates of intervention sessions and outcome measures. Although participants’ benefit and satisfaction with the interventions were high across studies, variability in definitions of acceptability, the methods and measures used constrain the interpretation and generalizability of findings. Psychometric properties of quantitative questionnaires were not addressed even as the most basic level of face or content validity. To enhance the applicability of non-pharmacologic treatments for this population, future research should emphasize the evaluation of intervention acceptability, as well as effectiveness.
Outcomes of Primary Care for People With Dementia: What’s Important?
Authors: Wray Laura , Vest Bonnie , Brady Laura , Vair Christina , Beehler Gregory , McCarten John 
Published: December 2020

Abstract
People with dementia (PWD) typically receive most of their healthcare in primary care (PC), but neurocognitive disorders can be challenging to recognize, assess, and manage in that setting. As a result, cognitive impairment in older adults is often missed or not addressed until later stages. The result is poor management of comorbid health conditions, increased healthcare utilization, and negative outcomes for the patient and family. Further, strategies for improvement and barriers to high quality PC for PWD have received limited attention. To improve PC for PWD, it is essential to understand what care outcomes should be targeted. To address this gap, we used a qualitative approach to examine potential outcomes of PC from the perspectives of older adults, family caregivers, primary care teams, and geriatrics specialists (n=79) from two Veterans Health Administration healthcare systems. Participants were interviewed individually or in focus groups. A directed content analysis based on the adapted Donabedian model was employed and expanded to fully capture transcript content. Three main categories of outcomes were identified: Personhood (i.e., independence), Physical Health and Safety, and Quality of Life. Regardless of participant type, respondents focused on similar desired outcomes and, notably, identified outcomes as important for both patients and their broader social context (i.e., caregivers, family). Discussion will: show how findings align with work conducted in specialty and residential care; describe how challenges to attaining these outcomes in PC can be overcome; and, challenge cognitive screening recommendations for PC that are based primarily on risk/benefit analysis of medication-focused outcomes.
Polysomnographic Sleep Parameters: Novel Digital Biomarkers for Developing Dementia
Authors: Razjouyan Javad , Nowakowski Sara , Sharafkhaneh Amir , Kunik Mark , Naik Aanand 
Published: December 2020

Abstract
Neuroprotection, early diagnosis, and behavioral intervention are priorities for dementia research. Sleep is emerging as an important potential remediable risk factor. Polysomnography using various digital parameters, qualitatively and quantitively, evaluates sleep. In this study, we examined whether sleep parameters derived from attended overnight polysomnography (PSG) studies are associated with developing dementia. We retrieved 61,165 free-text PSG reports from the VA national electronic health records from 2000 to 2019. Patients with dementia diagnosis up to one-year after PSG were excluded. Patients who developed dementia &gt;1 year after PSG (Dem) were classified using all-cause dementia ICD-9/10 codes documented on two separate visits starting a year after the PSG until the end of 2019 in a 1-year sliding period. Patients with no ICD-9/10 dementia codes (NDem) were propensity matched 1:1 for age, gender, race, ethnicity, BMI, and Charlston comorbidity index to the Dem group (n=1,534). We used natural language processing to identify sleep onset latency (SOL), total sleep time (TST), and apnea-hypopnea index (AHI). Univariate analysis was used to compare the groups. TST (254 v 266m, p=0.001) were significantly shorter and SOL (28 v 31m, p=0.047) were significantly prolonged in Dem compared to NDem. The odds ratio of individuals with an AHI ≥ 15 was significantly higher in Dem compared to NDem group (1.18, 95%CI: 1.04-1.35). Patients with incipient dementia exhibited longer SOL, shorter TST, and a greater proportion had moderate-to-severe apnea compared to patients without dementia. These objective sleep parameters may serve as potential biomarkers for patients at risk for developing dementia.
Development of a Claims-Based Algorithm to Identify Patients With Agitation in Alzheimer’s Dementia
Authors: Hwang Steve , Teigland Christie , Pulungan Zulkarnain , Parente Alexis , DePalma RoseAnn 
Published: December 2020

Abstract
Agitation is common in patients with Alzheimer’s dementia. Lack of a consensus definition has limited our understanding of the prevalence, patient profile, and added healthcare burden of agitation in Alzheimer’s dementia (AAD). We developed an algorithm to identify AAD patients using 100% of Medicare Fee-For-Service administrative claims from 2011-2017. We adapted the International Psychogeriatric Association (IPA) 2015 definition, which had not been tested using real-world data. Patients were required to have 2+ claims ≥30 days apart for Alzheimer’s disease and dementia, and continuous enrollment with medical/pharmacy coverage for 6-months pre- and 12-months post-index diagnosis. The AAD cohort included patients with 2+ claims ≥14 days apart with ICD-9-CM/ICD-10-CM codes selected based on the IPA definition (e.g., dementia with behavioral disturbance, irritability/anger, restlessness/agitation, violent behavior, impulsiveness, wandering). Patients with severe psychiatric disorders were excluded. The final population included 255,669 patients with (34.6%) and 482,710 patients without agitation (65.4%). The mean age in both populations was 82 years. Although the majority of patients in both groups was female, the proportion of males was slightly larger in the AAD group (31.2% vs 29.7%). Patients in the AAD group were also more likely to be low-income (dual-eligible: 44.0% vs 39.6%), disabled (10.4% vs 9.3%), and using antipsychotic and antidepressant medications. The 2 populations had similar comorbidity rates. AAD prevalence may be underestimated using claims data, given imprecise and under-coding. These findings suggest AAD patients can be identified using a claims-based algorithm to support early interventions that can potentially improve outcomes and reduce costs of care.