bluuebunny/crossref_metadata_2025_split huggingface dataset:
ORAL HEALTH AND MORTALITY AMONG OLDER ADULTS: A DOUBLY ROBUST SURVIVAL ANALYSIS
Authors: Qin Weidi , Yu Jiao , Huang Wenxuan , Thomas Kristi 
Published: December 2022

Abstract
Evidence on the association between oral health and mortality is inconclusive, and few studies have accounted for non-random selection bias in estimating their relationship. The present study aims to investigate the link between oral health and mortality in community-dwelling older adults by adjusting confounding factors with a doubly robust survival estimation. Data came from the third National Health and Nutrition Examination Survey (NHANES III, 1988-1994) and linked the National Death Index (NDI) mortality data through December 2015. The analytic sample consisted of 4,880 adults aged 50 years and above. Oral health measures included subjective oral health evaluation (self-rated oral health) and objective clinical indicators (edentulism, periodontitis, and untreated dental caries). Cox proportional hazards regression models and inverse probability weighting with regression adjustment (IPWRA) were utilized to assess the relationship between oral health and mortality. Good self-rated oral health was significantly associated with lower mortality risk (hazard ratio: 0.83, 95% CI: 0.74-0.93). Moderate periodontitis (hazard ratio: 1.18, 95% CI: 1.05-1.33), severe periodontitis (hazard ratio: 1.50, 95% CI: 1.21-1.87), and edentulism (hazard ratio: 1.13, 95% CI: 1.01-1.26) were significantly associated with higher risks of all-cause mortality, adjusting for socio-demographic characteristics, medical conditions, and health behaviors. Untreated dental caries was related to mortality in Cox models, but became non-significant when IPWRA estimators were applied. Both subjective and objective oral health are risk factors for mortality among older adults. Maintaining good oral health plays a crucial role in longevity.
IMPACT OF SEX AND ANTIHYPERTENSIVE MEDICATION ON GLOBAL COGNITION IN PRIMARY CARE OLDER ADULTS
Authors: de la Colina Adrian Noriega , Vasiliadis Helen-Maria , Berbiche Djamal , Bherer Louis , Girouard Helene , Kaushal Navin 
Published: December 2022

Abstract
Hypertension is one of the strongest modifiable risk factors for the development of cognitive impairment and dementia. However, there are conflicting reports regarding which class of antihypertensive medication is the best for reducing the risk of cognitive decline. The objective of this study is to determine whether sex determines the pharmacological therapy that is the most effective in preserving cognitive outcomes. This study examined 1607 participants from the ESA Services Study, a longitudinal survey of older adults over 65 years old in Quebec-Canada. They were examined for the Mini-Mental State Examination(MMSE) at baseline (T1) and followed up three (T2) and four years after (T3). Hypertensive women had the highest mean MMSE score at each time point (T1 28.591 (SE .064); T2 28.282 (SE .118); T3 28.524 (SE.119)), while hypertensive men had the worst (T1 28.038(SE.070); T2 27.694(SE.125); 27.809(SE.128)). Women taking angiotensin II receptor antagonists (ARBs) showed the highest MMSE scores (p&lt;.003), and men taking diuretics and other antihypertensives had the lowest MMSE scores(p&lt;.001) after a 3-year follow-up. Combination therapy of two or three antihypertensives drugs was associated with higher scores in women at T1 and T2 (p&lt;.001). In men, taking three antihypertensives showed a sharp decrease in MMSE scores from T1 to T3 (p&lt;.001). Sex differences in global cognition outcomes in older adults are in part due to the heterogeneity in effects related to the type and number of antihypertensive drugs used. Effective antihypertensive treatment should consider the impact of sex to optimize the effect of pharmacological interventions on cognition.
FREQUENT CAUSES OF 30-DAY READMISSION FOLLOWING A FIRST EPISODE OF HEART FAILURE IN OLDER ADULTS
Authors: Zadeh Ali Vaeli , Crawford Andrew , Wong Alan , Collado Elias , Larned Joshua 
Published: December 2022

Abstract
Older adults with heart failure (HF) have a greater propensity to experience poor clinical outcomes, hospital readmission, and functional decline. It is important that healthcare workers are aware of the comorbidities that may lead to poor outcomes. A deeper understanding of potential causes of readmission will help in adequate prevention. Employing an all-payers claims database, we aimed to examine the diagnoses related to 30-day readmission in patients aged 65-75 with an Elixhauser-Comorbidity Index score &lt; 4 upon the first episode of HF. Exclusion criteria included in-hospital death, readmissions for the same condition, and discharge against medical advice. Using ICD codes 9-10, a cohort of 323,678 patients (mean age: 70, SD: 3.22; male: 60%) with the first episode of HF between 2015-2019 were identified. We found 7,729 (2.4%) readmissions within 30 days and examined the frequency of 118 diagnoses as the primary cause. Cardiovascular etiologies including HF, hypertension, arrhythmias, and coronary artery disease were the most prevalent causes of readmission (40.64%), with HF being the most frequent (13.25%). Non-Cardiovascular causes included pulmonary (5.94%), sepsis (7%), renal (3.8%), and cerebrovascular (1.58%). Metabolic, liver, gastrointestinal diseases, and other infections accounted for 19.32%. Understanding the diagnoses related to readmissions in different populations is crucial for improving care, conducting research, and lowering costs. We focused on the first episode of HF in a relatively healthy older population to control for confounding factors. Further studies considering demographics, HF characteristics, and baseline comorbidities are needed.
THE EFFECT OF AGE WHEN USING LLLT TO TREAT PAIN IN OLDER ADULTS
Authors: Habegger Alex , Curtis Danny , James Dawn , Kendrick Alexis , Traywick LaVona S , Varela Antonio , Brown Teressa , Handlery Reed 
Published: December 2022

Abstract
Low-level laser therapy (LLLT) is commonly used to treat pain; however, little is know about the effects of age on outcomes of the treatment. Participants included community dwelling adults (22 females, 9 males) with a mean age of 55 (n=31, range 29 to 77 years). Prior to participation, physical therapist examined each subject to determine appropriateness for treatment with LLLT. Following the examination, subjects received 12 sessions of LLLT using a Class 3B laser device. Intervention was administered by researchers trained in appropriate application of the intervention. The WALT guidelines and specific anatomical location of pain determined dosage of LLT. The most common site of pain or discomfort was hip and thigh pain (23%). Subjects completed the Patient-Specific functional Scale (PSFS) pre- and post-treatment and used the Numeric Pain Rating Scale (NPRS) before and after each intervention session. An analysis of the data showed that age was positively correlated (r=xx) and statistically significant (p &lt; 0.05) with changes in both current and worst pain ratings and the first item on the PSFS. Age explained 13.4% of worst pain (p=0.024). Although not statistically significant, age explained 9.2% of the variability in current pain (p =0.054) and 3.9% of variability in patient identified changes in function (p = 0.147). Results suggest that older patients treated with LLLT may experience greater positive changes in pain than younger patients.
HEALTH BEHAVIORS AND MENTAL HEALTH OUTCOMES OF INFORMAL CAREGIVERS DURING THE COVID-19 PANDEMIC
Authors: Liu Yujun , Zhao Yuxin , Hughes M Courtney 
Published: December 2022

Abstract
Differences exist in health behaviors and mental health outcomes between spouse and adult children caregivers and between caregivers of individuals with or without dementia. We aimed to examine the change in health behaviors and mental health outcomes of informal caregivers of older adults during the COVID-19 pandemic and explore disparities based on caregiver relationship and care recipient. Using the 2020 National Health and Aging Trends Study (NHATS) COVID-19 supplement for Family Members and Friends, our sample included adult family or friend caregivers of Medicare beneficiaries aged 65 or older in the US (N = 2,062). We used ANOVA and two-way ANCOVA to assess the effects of the pandemic, caregiver relationship type, and care recipient condition (dementia vs. non-dementia) on seven health behaviors and two mental health outcomes. We performed all post hoc analyses using Bonferroni corrections controlling the covariates age, gender, marital status, education, and self-reported health of the caregiver. Compared to before the pandemic and to spouse caregivers, adult children caregivers reported: 1) significantly less time walking and significantly more time watching TV or online programs, and 2) a significantly higher level of emotional distress and depressive symptoms. Compared to caregivers for people without dementia, those who provide care for people with dementia experienced less sleep and a higher level of depressive symptoms during the pandemic than before the pandemic. Health professionals should consider the impact of COVID-19 and the vulnerability of adult children caregivers and caregivers of individuals with dementia when designing and delivering health and wellness programs.
FAMILY DEPENDENCE AND ITS ASSOCIATION WITH SELF-REPORTED HEALTH AMONG OLDER ADULTS IN EASTERN NEPAL
Authors: Shrestha Aman , Karmacharya Isha , Ghimire Saruna , Mehta Ranju , Yadav Uday Narayan 
Published: December 2022

Abstract
Historically, filial piety (caring for one’s parents) has been prevalent in Nepal. The demographic transition has resulted in a burgeoning population of older adults, but limited institutional support is available to address their socio-economical and health needs. As such, the family has remained the paramount source of support to meet the health, social and economic needs of Nepali older adults. In this study, we explored the relationship between family dependency (conceptualized as the source of family support) and self-reported health among Nepali older adults. A community-based cross-sectional survey was conducted in two districts (Sunsari and Morang) of eastern Nepal. Using a multistage cluster random sampling design 847 older adults (≥ 60 years) were interviewed. Self-reported health was assessed in terms of a five-item Likert scale dichotomized into poor and good health. Two independent variables of interest were dependency on family for living and for daily activities. Binary logistic regression drew the inferences while adjusting for important confounders. About 29.4% of the participants reported poor health, 77% reported dependency on family for living and 46% reported dependency for daily activities. Those dependent on family for living had 46% higher odds of good health but the statistical significance was lost after adjusting for control variables. Likewise, those dependent on family for daily activities were three times more likely (OR: 3.22; 95%CI: 2.15 - 4.83) to report good health than their counterparts after controlling for confounders. Our findings emphasize the importance of family support for the health of older adults in Nepal.
COMMUNICATION AND WORKFLOW ON A TYPICAL DAY IN NH VERSUS A DAY WITH A CHANGE IN RESIDENT CONDITION
Authors: Ashcraft Alyce , Owen Donna , Culberson John , Song Huaxin 
Published: December 2022

Abstract
A major reason technologic innovations for nursing home (NH) communication have not worked is because testing of technology fails to consider workflow of the environment. The aim of this observational study was to examine communication and workflow surrounding assessment of NH residents on a dementia care unit with suspected UTI to establish baseline data prior to introduction of technology to enhance NH staff communication. The flow of communication between CNAs, LVNs, and PCPs was recorded using a structured observation on an online survey platform. For a 3-month period, 3 days a week, an observation period from 7am to 11am was chosen to reflect one peak staff interaction time. Field notes describing the environment and what was being talked about during communication events were analyzed using content analysis. A total of 185 communication events were recorded by 3 trained observers, yielding 22 assessments for change in condition (pain, UTI, falls). The LVN was the center of 44% of communication. After the LVN assessed the resident, 43% of the time no further action was taken by the LVN; 17% of the time the PCP was texted about a change in condition. Types of change in condition was limited. Workflow surrounding LVN collection of information on days related to change in condition reflected focused communication among staff occurring away from resident rooms and nurses’ station. The NH is a stable environment for provision of nursing care, thus suggesting communication technology can be accepted by staff and added into the care routine.
POLYPHARMACY, ANXIETY, AND QUALITY OF LIFE IN LONG-TERM CARE RESIDENTS
Authors: Dangerfield Hannah , Scott Judith , Zohn Jennifer , Segal Daniel , Benton Melissa 
Published: December 2022

Abstract
The prevalence of polypharmacy (≥5 medications per day) is rising among older adults. Multiple medications are increasingly prescribed to treat multiple comorbidities in this growing population. An increase in anxiety and a decline in quality of life are also seen with polypharmacy, although evidence is limited. This study investigated the relationship between anxiety and quality of life in long-term care residents with polypharmacy. Sixty-nine long-term care residents who reported polypharmacy completed a questionnaire regarding anxiety and quality of life. Anxiety was measured with the Geriatric Anxiety Scale Long-term Care (GAS-LTC), health-related quality of life was measured with two questions from the RAND-36, and medication-related quality of life was measured with the Medication-related Quality of Life Scale (MRQoLS). Mean age was 80.74 ± 7.8 years. The majority were female (72%) and white (88%). The mean GAS-LTC score was 2.75 ± 2.4, indicating relatively low overall anxiety. There were moderate-strong, negative correlations between anxiety and all quality of life measures indicating that as anxiety increased, quality of life decreased. Specifically, anxiety was negatively related to general health-related quality of life (r = -.51, p &lt; 0.001), health-related quality of life compared to one year ago (r = -.54, p &lt; 0.001), and medication-related quality of life (r = -.57, p &lt; 0.001). Among this group of older adults with polypharmacy residing in long-term care, those with greater anxiety reported diminished quality of life related to both overall health and use of medications. Further studies to examine mechanism and causality are needed.
PUNCTUATED EQUILIBRIA: AN ANALYSIS OF HEALTHCARE UTILIZATION PATTERNS FOR OLDER ADULTS WITH CHRONIC DISEASE
Authors: Crowley Christopher , Stuck Amy , McBride A Camille , Andrews Claire 
Published: December 2022

Abstract
The growing population of older adults requires healthcare delivery models that are both cost effective and directed toward the higher rates of chronic conditions, frailty and functional impairment often present as one ages. Analyzing healthcare utilization patterns of older adults—especially those over the age of 75—will better inform how to re-design care delivery processes.While the presence of chronic conditions requires consistent treatment, the intensity of health services required on a day-to-day basis is highly variable. Many individuals with at-risk health status are remarkably stable, exhibiting high levels of function and low utilization of care over extended periods of time. Periodically, however, these phases are punctuated by catastrophic episodes that can lead to greater health decline, morbidity, and mortality. During cycles of health decline, a cascade of other challenges stemming from an individual’s underlying risks, predispositions, and complexities can arise. This punctuated equilibrium of utilization for older adults offers insight to assess ways to improve care and lower costs. In this paper, we analyze and quantify both these states of punctuated equilibria as well as the extensive periods of stability. The associated utilization patterns are analyzed by processing Medicare claims data. Our analysis showed that over 80% of members in a group of anticipated high-risk Medicare beneficiaries over the age of 75 exhibited low utilization for 11 months out of a given year. These findings complement research exploring care redesign processes at a system level, specifically directed to high-cost episodes of care as opposed to patient-level targeting.
INTRACELLULAR WATER CONTENT IN LEAN MASS IS ASSOCIATED WITH MUSCLE FUNCTION AND PHYSICAL ACTIVITY AMONG OLDER ADULTS
Authors: Taani Murad , Dembinski Kimberly 
Published: December 2022

Abstract
High intracellular water (ICW) content in lean mass (LM) has been associated with better functional capacity and lower frailty risk in older adults and suggested to be a useful muscle quality indicator. However, limited research exists on the relationship of ICW to muscle function and physical activity among older adults. The purpose of this study is to examine the relationship between ICW/LM ratio and muscle function and physical activity among older adults. In a cross-sectional correlational study of older adults aged 70 years or older, a tetrapolar bioimpedance spectroscopy device (Impedimed SFB7, Australia) was used to assess both ICW and LM, and the ICW/LM ratio (mL/kg) was calculated. The Short Physical Performance Battery (SPPB) and Timed Up and Go (TUG) tests were used to measure muscle function. The Actigraph GT3X+ accelerometer (Actigraph, Inc., FL, USA) was used to measure light and moderate-vigorous physical activity and steps per day. Multiple regression analyses were used. For 96 recruited participants (mean age 82.5 ± 7.4 years; 79 [82.3%] were female), mean ICW/LM ratio was 245.1 ± 28.1 mL/kg. The ICW/LM ratio was positively associated with SPPB score, gait speed, moderate-vigorous physical activity, and steps per day, after adjusting for age, sex, and LM. The ICW/LM ratio was negatively associated with TUG score, after adjusting for age, sex, and LM. The findings suggest that intracellular water content in lean mass may affect muscle function and physical activity among older adults. Further studies are needed to verify these findings and determine any potential cause-and-effect relationships.
ASSOCIATION OF PERSISTENT DEPRESSIVE SYMPTOMS WITH PHYSICAL ACTIVITY IN KNEE OSTEOARTHRITIS
Authors: Mehta Rhea , Shardell Michelle , Ryan Alice , Dong Yu , Beamer Brock , Hochberg Marc , Rathbun Alan 
Published: December 2022

Abstract
Comorbid depression in knee osteoarthritis (OA) is associated with declines in physical activity, but how persistent depressive symptoms impact physical activity over time remains unclear. We aimed to determine how the persistence of depressive symptoms affects physical activity in knee OA. Participants (n=2,222) from the Osteoarthritis Initiative had radiographic disease (Kellgren-Lawrence grade ≥ 2) in at least one knee. The Center for Epidemiologic Studies Depression Scale (CES-D; range = 0-60) assessed depressive symptoms from baseline through the first three annual follow-up visits, and persistence was operationalized using the cumulative average severity of symptoms over time. Self-reported physical activity was measured from the first to fourth annual follow-up visit using the Physical Activity Scale for the Elderly (PASE; range = 0-793). The primary method of analysis utilized marginal structural models and included exposure by time interactions in the structural outcome model. Baseline depressive symptoms negatively impacted physical activity at the first follow-up (β = -0.7279; 95% CI: -1.1645, -0.2912), but at later time points, effect estimates were closer to the null and not statistically significant. The association between time-averaged CES-D scores from baseline through the first follow-up and physical activity at year two was -0.1410 (95% CI: -0.7105, 0.4286); and 0.2578 (95% CI: -0.3261, 0.8415) for average CES-D scores through follow-up visit two and physical activity at year three. Thus, the negative influence of persistent depressive symptoms on physical activity decreased over time. Physical activity may not consistently decline with persistent depressive symptoms in adults with knee OA.
ASSOCIATION BETWEEN CALF MUSCLE FATTY INFILTRATION AND PHYSICAL PERFORMANCE AMONG HEALTHY OLDER ADULTS
Authors: Kim Miji , Won Chang Won 
Published: December 2022

Abstract
Muscle fatty infiltration is associated with impaired physical performance. However, the association between ectopic fat, such as lower extremity fat distribution, and sex-specific differences among older adults remains to be determined. This study aimed to examine sex-specific differences in calf muscle fat infiltration and their association with physical performance among healthy older adults aged 76 to 80 years. The pilot study comprised 40 subjects (20 men; 20 women) matched by age and body mass index. The participants underwent dual-energy X-ray absorptiometry, magnetic resonance imaging (MRI), and proton magnetic resonance spectroscopy (1H-MRS) to assess body composition and lower extremity fat distribution. The tibialis anterior intramyocellular lipid (IMCL) as assessed by 1H-MRS was negatively associated with the five-times sit-to-stand test scores (rs=0.518, p=0.023) in men, while the soleus IMCL content was negatively associated with the timed up-and-go test scores (rs=0.472, p=0.048) in women. However, the soleus extramyocellular lipid (EMCL) content was positively associated with the five-times sit-to-stand test scores (rs=−0.488, p=0.040) in women, but this association was not statistically significant in men. Regarding the calf cross-sectional area (CSA) parameters assessed by MRI, calf subcutaneous fat CSA was positively associated with the usual gait speed (rs=0.447, p=0.048) in women only. To conclude, this study showed an inverse correlation between IMCL content and physical performance in healthy older individuals and calf muscle-specific IMCL based on sex differences. Furthermore, our results suggest that greater EMCL content in the soleus and calf subcutaneous fat might affect physical performance positively in older women but not older men.