bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multilevel Factors for Life Satisfaction Among Residents in Non-Urban Subsidized Senior Housing
Authors: Kim BoRin , Park Sojung , Golomsky Casey , Corvini Marguerite , Wilder Allison , Wilcox John , Winburn Allysha 
Published: December 2020

Abstract
Although a quarter of HUD-assisted properties for older adults are located in rural/non-metropolitan areas, there is limited understanding of the population living in these locations. Advanced age and low income are known risk factors for poor physical and mental health. Older adults in rural subsidized housings may be at increased risk for poor health and social isolation due to their isolated locations and small-scale housing complexes. This presents the additional challenge of service provision for the residents’ needs. This study aims to explore multi-level factors affecting life satisfaction among residents in subsidized senior housing. Data were collected for five subsidized senior housings in New Hampshire: two in Coos county (rural, population=33,055) and three in Strafford county (suburban, population=128,613). Mixed-methods approaches were used: Community/organizational-level data were collected using semi-structured interviews conducted with the directors of senior housings. At the individual level, quantitative survey data were collected from 82 residents of five senior housings. Contrary to expectations, we found that residents in rural senior housings were likely to report better life satisfaction (Coef.=0.597, p&lt;.01) than those in suburban areas despite controlling for individual-level factors such as age, gender, education, marital status, health, social relations, and service use. The most salient terms used in the interviews with directors of rural senior housings include limited resources, tight community, and emotional support. The last two may be protective factors positively influencing life satisfaction among their residents. Our results contribute to development strategies to improve quality of life among residents in rural/non-metropolitan subsidized senior housing.
Quantitative EEG Features of Level of Consciousness in Critically Ill Nonagenarians
Authors: Roberson Shawniqua Williams , Haas Kevin 
Published: December 2020

Abstract
The standard for monitoring sedation levels in critically ill patients is intermittent bedside evaluation, and is prone to anchoring bias. Quantitative electroencephalography (qEEG) allows automated processing of recorded brain electrical activity and could be used to continuously monitor level of consciousness in critically ill patients. The majority of qEEG studies have included persons 80 years of age or less, and the qEEG profiles of nonagenarians have been incompletely characterized. Knowledge of the qEEG patterns of patients 90 years and older is essential for appropriate interpretation of such metrics in this population. This retrospective cohort study characterized qEEG profiles of acutely ill nonagenarians. We investigated whether the relationship between qEEG and level of consciousness differed between patients with and without a history of dementia. We included patients 90-100 years old admitted to Vanderbilt University Medical Center who underwent EEG and as part of their clinical care. We compared qEEG features to nursing-defined level of arousal as measured by the Richmond Agitation-Sedation Scale (RASS) in patients with and without history of dementia. Between January and December 2019, 26 nonagenarians underwent EEG for clinical purposes. One study was excluded due to excessive artifact. Of the remaining, 6 (24%) were male and 18 (72%) were Caucasian. Among all patients, RASS decreased with increases in EEG theta variability (coefficient -7.7, 95%CI -10.6 to -4.8). This relationship was not significantly modified by history of dementia (coefficient of interaction term -0.36, 95%CI -3.7 to 2.9). Dementia does not impact qEEG features of level of consciousness in nonagenarians.
Role of Intramuscular Fat and Lean Muscle in Surface Electromyography Amplitude of the Gluteus Medius in Older Adults
Authors: Lanza Marcel , Gray Vicki , Ryan Alice , Perez Will , Addison Odessa 
Published: December 2020

Abstract
Surface electromyography (sEMG) is frequently used to assess muscle activation in older individuals. Subcutaneous fat is one well-known factor that influences sEMG amplitude. The amount of intramuscular fat (IMAT) may negatively impact the muscles ability to produce force with aging, while high density lean tissue (HDL; fat free muscle) has an opposite effect. However, influence of IMAT or HDL on sEMG amplitude remains unclear. Thus, the aim was to investigate the influence of IMAT and HDL on sEMG amplitude of the gluteus medius (GM) muscle during a maximal voluntary isometric contraction (MVIC) in older adults. Twelve older adults (7 females; age: 71±3 y; BMI= 29±4 Kg/m2; X ± SD) underwent a CT scan to determine IMAT and HDL cross-sectional area in the GM. IMAT and HDL were normalized as a percentage of the total muscle area. Maximal hip abduction MVIC was measured at 30□ hip abduction in standing, while sEMG was recorded from the GM muscle. Spearman correlations showed a positive association between GM HDL and sEMG amplitude (r = 0.692, P = 0.013) and negative between GM IMAT and sEMG amplitude (r = -0.683, P = 0.014). This is the first study to demonstrate the amount of IMAT may limit the ability to activate the hip abductor muscle. Given that muscle activation is a determinant of strength, interventions to lower levels of IMAT and increase levels of lean muscle may be important to slowing decreases in strength with aging.
Baseline Characteristics of Participants in a Randomized Controlled Trial of Metformin for Frailty Prevention
Authors: Cortes Tiffany , Musi Nicolas , Wang Chen-pin , Michalek Joel , Espinoza Sara 
Published: December 2020

Abstract
We are conducting a double-blind, randomized controlled trial of metformin for frailty prevention. Participants 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, 85 subjects have been randomized; 120 completers are planned. Mean age is 72.8 ± 5.7 years, 55.3% are male, and 43.5% were Hispanic. Mean BMI is 30.2±5.8 kg/m2, waist circumference is 104.4 ±15.5 cm, fasting glucose is 102.3 ± 10.0 mg/dL, Hemoglobin A1c is 5.8 ±0.3, and glucose at 2 hours during OGTT is 167.3 ± 17.8 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.
Intranasal Oxytocin Improves Lean Muscle Mass in Older Adults With Sarcopenic Obesity: A Pilot Study
Authors: Lee Jessica , Espinoza Sara , Odejimi Adetutu , Wang Chen-pin , Ganapathy Vinutha , Pascucci Chiara , Musi Nicolas , Volpi Elena 
Published: December 2020

Abstract
Obese older adults often have sarcopenia with increased functional impairments. Unfortunately, conventional weight loss treatments can lead to further muscle mass loss. Increasing evidence from animal studies suggests that the pituitary hormone oxytocin has trophic effects on skeletal muscle cells and can induce weight loss. We piloted a clinical trial testing whether intranasal oxytocin would decrease adiposity without lowering muscle mass in older adults with sarcopenic obesity. Twenty-one older (≥60years), obese (30-43kg/m2), sedentary (&lt;2 strenuous exercises/week) adults with slow gait speed (&lt;1m/sec) were randomized to intra-nasal oxytocin (24IU four times/day) or placebo for 8 weeks. Pre and post body mass index (BMI), 2-hour oral glucose tolerance test (OGTT), hemoglobin A1c (HbA1c), short physical performance battery (SPPB), and whole body lean and fat mass (via dual-energy X-ray absorptiometry) were assessed. Generalized estimation equation method was used to evaluate effects of oxytocin on these continuous measures. At baseline, results were: age 67.5±5.4years, 71% female, BMI 36.0±3.6kg/m2, HbA1c 5.7±0.4%, 2-hr OGTT glucose 140.8±4.1mg/dL, SPPB 9.2±1.9, fat mass 45,429±7,037g, and lean mass was 49,892±10,470g. From baseline to follow-up, total lean mass increased significantly (2,250g) in the oxytocin group (pre- vs. post-treatment difference of -690g in placebo and +1,559g in oxytocin, p&lt;0.01). Oxytocin did not lead to significant changes in other measures. This data suggests that oxytocin leads to significant improvement in whole body lean mass. Future studies in a larger study population will help determine whether older adults with sarcopenic obesity may benefit from intranasal oxytocin to improve lean muscle mass and physical function.
Perceptions of Care Among Older Adults Identified as Fall Risk During a Hospital Stay
Authors: King Barbara 
Published: December 2020

Abstract
In-hospital falls are a significant clinical, legal and regulatory problem. The Centers for Medicare and Medicaid no longer reimburse hospitals for falls that result in injury, adding increase pressure on acute care settings to prevent falls. Additionally, evidence-based practice recommendations for fall prevention in hospitals do not exist, thus leaving administrators to create their own programs. One common strategy used by hospital providers to prevent falls is to restrict patient mobility. Little information on how older adult patients experience fall prevention during a hospital stay has been published. The purpose of this study was to understand perceptions of care among older adults identified as fall risk during a hospital stay. This qualitative study utilized inductive content analysis. Older adults (N=20) from a large academic medical center in the Midwest were recruited to participate in one-to one in-depth interviews. Open coding, categorization and abstraction was used to analyze the data. Three main categories were identified that summarized the older adult patient perception of hospitalization: Act of Caring, something they received from staff, provide to staff or provided to self; Being Restricted in movement resulting in either accepting or rejecting the restriction and Being Freed at discharge, often being told “just be careful”. Older adult identified as fall risk described being restricted in movement during a hospital stay. Many passively accepted this restriction even though they felt a lack of movement would be harmful to them. Additional research on the patient experience with fall prevention is needed.
The Role of Comorbid Diseases in Geographic Disparities of Mortality From Septicemia Among Older Adults Across the United States
Authors: Kravchenko Julia , Akushevich Igor 
Published: December 2020

Abstract
Sepsis is a prominent cause of death in the US. However, few studies examined its regional variations. Using the Multiple-Cause-of-Death and 5%-Medicare data, we analyzed mortality among the US patients aged 65+ who had septicemia and various comorbid diseases in the states with the highest (HI,FL,AZ,CT,CO, and MN––a.k.a. leading states) and lowest (AR,TN, LA,OK,KY,AL,MS, and WV–a.k.a. lagging states) life expectancy. In 2010-2018, age-adjusted mortality from septicemia was almost twice as high in lagging (85.2±0.5/100,000) comparing to leading (45.2±0.3/100,000) states. Between-the-states difference was the most pronounced at age 65-74 (44.7±0.4 vs. 20.8±0.2) and gradually reduced in older age groups. Higher mortality from septicemia in the lagging US states could be, at least in part, because of poorer health of the beneficiaries who enter Medicare at age 65. Mortality rates were the highest among septicemia patients who had comorbid cancer, ischemic heart disease, influenza/pneumonia, or kidney failure. Mortality rates of patients with co-existing Alzheimer’s disease or arterial hypertension were lower, but these comorbidities contributed most to geographic disparities. The role of complications due to surgical and other medical procedures in disparities across the states was minimal. Substantial contributions to geographic disparities in septicemia mortality were detected not only for well-known and highly-lethal comorbidities such as diabetes, heart failure, and kidney diseases, but also for less frequently discussed conditions with lower per se mortality such as disease of intestine, skin/subcutaneous tissue, and cystitis, urethritis, or unspecified infections of urinary tract.
Pilot Study of a Surgical-Oncology Geriatric Co-Management Program
Authors: Patel Megha , Chow Stephanie , Munoz Lizette 
Published: December 2020

Abstract
Purpose: This study aims to evaluate clinical outcomes of a pilot co-management model for patients 65 years and older that were referred by their surgical oncologist for a comprehensive geriatric assessment prior to surgery. Methods: A retrospective chart review was conducted for 9 patients. Patients’ pre-operative Charlson Comorbidity Index (CCI) and frailty index were measured. Additional measures included advanced care planning (ACP) documentation and whether patients transferred primary care. Post-operative courses and complications were followed, including length of stay (LOS) and discharge outcomes. Results: A total of 9 patient charts were reviewed. The average age was 79 years. The average CCI and frailty indices were 9 and 4, respectively. Every patient had ACP during the initial assessment. Five patients had multiple outpatient geriatrician visits. Of the 9 referrals, 7 proceeded with surgery. LOS ranged from 6 – 22 days, with a median and average of 8 and 11 days, respectively. Of those undergoing surgery, 4 had an inpatient geriatrics consult. Complications included 1 mortality, 2 aborted cases and 4 with other complications. Four patients were discharged to previous living situations and 2 to SAR. Two patients had one ED/UC visit and 2 had multiple readmissions. No patients transferred their primary care. Conclusion: This is a small pilot showing a promising collaboration between geriatrics and surgical oncology. It outlines a supportive framework for initial and peri-operative geriatric assessments with favorable experiences for both providers. More studies are necessary to make clinical associations with this co-management model.
Reliability of the Capacity to Consent to Treatment Instrument in Metastatic Cancer
Authors: Fowler Mackenzie , Marotta Dario , Kennedy Richard , Triebel Kristen 
Published: December 2020

Abstract
Metastatic cancer patients undergo numerous treatment strategies with known cognitive side effects. It is unclear how medical decision-making capacity (MDC) is impacted by cognitive deficits in metastatic cancer. This study examines reliability of an objective measure of MDC compared with self-report. Participants with newly diagnosed metastasis to the brain and other sites were enrolled at the University of Alabama at Birmingham over seven years. At the study visit, participants completed a comprehensive neuropsychological battery including memory and executive functioning, and the Capacity to Consent to Treatment Instrument (CCTI) assessing medico-legal domains of MDC. The CCTI is a reliable and valid instrument containing two vignettes of hypothetical medical situations assessing four standards of consent. We examined reliability between the CCTI and self-reported MDC using Gwet’s AC1 statistic. Participants with brain metastasis with impairment on the CCTI demonstrated significantly lower executive functioning and memory skills than those without impairment (Trails B Raw: 158.20±86.82 vs. 118.90±77.98 p: 0.0248; Digit-Span Raw Forward: 9.13±2.30 vs. 10.12±2.03 p: 0.0254). There were no significant differences between intact and impaired participants with other metastases. Low reliability was observed between self-report and all medico-legal standards on the CCTI across both metastatic groups [Gwet’s AC1 Appreciation: 0.70 (0.58, 0.81); Reasoning: 0.34 (0.16, 0.52); Understanding: 0.44, (0.27, 0.60)]. Self-rating of MDC is unreliable in metastatic cancer patients. Patients with metastases (particularly brain metastases) may lack awareness of deficits in their MDC, so providers must affirm proper autonomy in their decisions.
Alcohol Consumption and Cognitive Function in an Older Population in China
Authors: Bai Anying , Hou Bo , Chen Junsong , Fu Boming 
Published: December 2020

Abstract
The relationship between alcohol consumption and cognitive function has only been studied to a limited extent in China. This paper examines this relationship using the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative dataset of the Chinese population aged over 45. Alcohol consumption was measured by drinking status (never, former, moderate, excessive drinkers) based on number of standard drinks per week. Mental status and episodic memory function were used as measures of cognitive function. Lagged dependent variable models were used to examine independent associations between alcohol consumption and cognitive function. Our models controlled for demographic factors, socioeconomic factors, baseline cognitive functioning and an indicator for lifestyle. We also tested for an inverted J shaped relationship between alcohol consumption and cognitive functioning. A total of 10404 nondrinkers (60.09%), 2450 former drinkers (14.15%), 1599 moderate drinkers (9.24%) and 1525 excessive drinkers (8.81%) were included. Compared to never drinkers, there were no statistically significant difference between this group and moderate drinking group. While, excessive drinkers were consistently associated with on average 0.13-point decrease in episodic memory scores (p =0.031). For mental intactness, there were no statistically significant differences between never drinkers and other groups. Furthermore, we did not find evidence to support an inverted J-shaped association between standard drinks per week and measures of cognitive functioning. Excessively drinking was associated with greater decline in episodic memory function, but not in mental intactness in elder Chinese population. There is no significant association between moderate drinking and cognitive functioning measures.
Reciprocal Association Between Cognitive Function and Oral Health: A Systematic Review and Meta-Analysis
Authors: Qi Xiang , Zhu Zheng , Wu Bei 
Published: December 2020

Abstract
Increasing evidence suggests that there is a linkage between cognitive function and oral health. However, there are few systematic reviews with meta-analysis have been conducted to evaluate the strength of this association. Moreover, existing studies usually focused on unidirectional associations between cognitive function and oral health; no research has demonstrated this inter-relationship in a longitudinal study. This study aims to systematically assess the magnitude of the bidirectional association between oral health and cognitive decline for studies using longitudinal data. Six international databases were searched up until December 31, 2019. Random-effects pooled Risk Ratios (RRs) with 95% confidence intervals (CIs) were calculated. The grading of recommendations assessment, development, and evaluation (GRADE) system was used to assess the quality of evidence. From 13,251 potentially eligible articles, 54 longitudinal studies were included in the systematic review and 18 were in meta-analysis. Meta-analysis was performed for tooth loss and periodontitis disease. Random effects analysis showed, with statistically low heterogeneity, Risks of cognitive decline included suboptimal dentition (&lt;20 teeth) (RR 1.44, 95% CI 1.03-3.65) and periodontitis diseases (RR 1.48, 95% CI 1.22-1.81). Cognitive decline was a risk factor for tooth loss (RR 1.54, 95% CI 1.23-9.69). The overall quality of evidence, however, was rated as very low. The result of this review highlights that cognitive decline is a risk factor for poor oral health, and older adults with suboptimal oral health appear to have an increased risk of cognitive impairment. More studies with rigorous designs are needed to further examine this association.
The Relationship Between Daily Rapid-Eye Movement Sleep and Cognitive Functioning in Older Adults
Authors: Broen Tiana , Yoneda Tomiko , Rush Jonathan , Knight Jamie , Lewis Nathan , Vendittelli Rebecca , Hofer Scott , Piccinin Andrea 
Published: December 2020

Abstract
Previous cross-sectional research suggests that age-related decreases in Rapid-Eye Movement (REM) sleep may contribute to poorer cognitive functioning (CF); however, few studies have examined the relationship at the intraindividual level by measuring habitual sleep over multiple days. Applying a 14-day daily diary design, the current study examines the dynamic relationship between REM sleep and CF in 69 healthy older adults (M age=70.8 years, SD=3.37; 73.9% female; 66.6% completed at least an undergraduate degree). A Fitbit device provided actigraphy indices of REM sleep (minutes and percentage of total sleep time), while CF was measured four times daily on a smartphone via ambulatory cognitive tests that captured processing speed and working memory. This research addressed the following questions: At the within-person level, are fluctuations in quantity of REM sleep associated with fluctuations in next day cognitive measures across days? Do individuals who spend more time in REM sleep on average, perform better on cognitive tests than adults who spend less time in REM sleep? A series of multilevel models were fit to examine the extent to which each index of sleep accounted for daily fluctuations in performance on next day cognitive tests. Results indicated that during nights when individuals had more REM sleep minutes than was typical, they performed better on the working memory task the next morning (estimate = -.003, SE = .002, p = .02). These results highlight the impact of REM sleep on CF, and further research may allow for targeted interventions for earlier treatment of sleep-related cognitive impairment.