Functional Assessment in Younger and Older Adults with Sickle Cell Disease

Identifying Geriatric Syndromes in Adults with Sickle Cell Disease Using the Sickle Cell Disease Functional Assessment (SCD-FA): The Sickle Cell Disease Functional Assessment Validation and Refinement (SILVR) Study

Measuring Physical Activity in Younger and Older Adults with Sickle Cell Disease Using Accelerometers

Urinary C-Telopeptide of Type II Collagen As a Marker of Avascular Necrosis in Younger and Older Adults with Sickle Cell Disease

Speechreading and Aging

Characterizing Frailty in Adults with Sickle Cell Disease Using Frailty Phenotype

ABSTRACTMeaningful intergenerational interactions between older and younger adults are rare outside of family relationships. Interventions to increase positive intergenerational interactions are growing, but finding appropriate measures of attitudes toward both younger and older age groups is difficult. Many measures assessing attitudes toward older adults can remind participants of negative stereotypes of aging and are rarely used to assess attitudes toward younger adults. We adapted Pittinsky, Rosenthal, and Montoya’s allophilia measure to assess attitudes toward younger (18–25 years old) and older (over age 65) adults. In the first study, 94 traditional college age and 52 older adults rated older and younger adults. The allophilia measure distinguished between younger and older adults’ attitudes toward each age group. In the second study, we compared the age-related allophilia measures with seven traditional measures of attitudes toward older adults. Forty-seven traditional college age students completed measures. As predicted, correlations between allophilia toward older adults and the traditional semantic differential measures were weak (i.e., r = |0.15|or less), whereas correlations with general attitudes toward older adults were more moderate (r = 0.59 or less). Correlations between allophilia toward younger adults and the traditional measures were primarily non-significant as predicted. The allophilia measure differentiated between the five domains of positive attitudes toward younger and older adults and was not highly correlated with measures of more negative attitudes toward older adults. Results suggest that the allophilia measure can fill a need for a measure of positive attitudes toward older and younger adults.

Assessing Feasibility of a Focused Geriatric Assessment in Older Adults with Sickle Cell Disease to Address Functional Risk Factors for Morbidity and Mortality

High Diagnostic Uncertainty and Inaccuracy in Adult Emergency Department Patients With Dyspnea: A National Database Analysis.

Purpose: Background: In patients with sickle cell disease (SCD), pain results in varied physical and emotional consequences. Insufficient information about underlying mechanisms affecting pain remains a barrier to addressing SCD pain. Multiple biological and psychological factors (i.e., environmental stress) known to contribute to other pain conditions are understudied in SCD where the median survival (38 years for men and 42 years for women) is lower than the general population. Emotional stress has been shown to be a trigger of pain in patients with SCD. Genetics plays an important but still not fully-understood role in the variation of pain. The rs10877969 SNP in the Arginine vasopressin receptor 1A gene (AVPR1A) is associated with aspects of acute pain and stress-related to pain, but it is unknown whether the genotype frequency differs between those younger or older than the median survival age for SCD. Our aim was to determine the association between AVPR1A genotype with stress and age in adults with SCD who had chronic pain. Materials and methods: Materials and methods: In a cross-sectional study, 169 participants with SCD and chronic pain (100% African descent; 62% female, mean age 36.4±11.6 years [younger adults n =110, 18-39 years and older adults n=59, ≥40 years]), we used the Perceived Stress Questionnaire (PSQ). As a part of a larger study, we genotyped samples using the Axiom Precision Medicine Research Array. We used the Michigan Imputation server to examine our single nucleotide polymorphism (SNP) of interest, rs10877969. The SNP was evaluated as the imputed score was R2>0.8. We used ANOVA to compare stress by genotype and age (younger and older adults). Results: Results: The rs10877969 genotype frequency for the overall sample was: CC 47 (28%), CT 72 (43%), and TT 50 (30%). The genotype frequency was similar for older adults vs. younger adults: CC 16 (27%) vs. 31 (28%), CT 24 (41%) vs. 48 (44%), and TT 19 (32%) vs. 31 (28%). Mean stress scores were not significantly different by genotype: CC mean = 0.39 ± 0.16, CT mean = 0.41 ± 0.19, and TT mean = 0.36 ± 0.16, p=0.22. Mean stress scores also were not significantly different by genotype for younger adults: CC mean = 0.39 ± 0.15, CT mean = 0.44 ± 0.19, and TT mean = 0.36 ± 0.14, p=0.09 or older adults: CC mean = 0.37 ± 0.19, CT mean = 0.34 ± 0.16, TT mean = 0.34 ± 0.19, p=0.90. Mean stress scores were significantly lower (p<0.05) for the older adults (mean = 0.35 ± 0.18) than the younger adults (mean = 0.41 ± 0.17). Conclusion: Discussion-Conclusion: Younger adults had higher average stress than older adults. In contrast to prior research, in this study there was not an association between genotype and stress. Previously, the stand-out result was that individuals with SCD and CC genotype cited stress much less than the other two genotypes. The current result has a very different pattern. Further research is needed to examine stress and the rs10877969 genotype using other indicators of stress in this population. The authors do not declare any conflict of interest

Young adults with sickle-cell disease have increased emergency department (ED) utilization and increased risk of mortality for unclear reasons. Emergency Department Reliance (EDR) differentiates excessive ED use due to increased need in chronic illness from increased use due to limited access to outpatient care. A higher EDR has been used to define excessive reliance on the ED and thus access to care issues leading to increased ED utilization. We conducted a retrospective cohort study of sickle-cell disease patients within the Wisconsin Medicaid database over a 5-year period to examine EDR during the transition period from childhood to adulthood. The study population included four distinct groups: (1) children, (2) patients transitioning from pediatric to adult providers, (3) young adults, and (4) adults age 31-45. Rates of visits per year were calculated for ED visits and outpatient visits for all diagnoses and sickle-cell disease-related diagnoses. Overall, we found increased EDR among the transition group and young adults compared to children and adults for sickle-cell disease-related diagnoses. These findings suggest access to care issues play a significant role in the increased ED utilization seen during the transition period from pediatric to adult providers in sickle-cell disease.

The Influence of the Age of Adults with Sickle Cell Disease on the Uptake, Utilization and Efficacy of Hydroxyurea

Effective processing of multisensory stimuli relies on both the peripheral sensory organs and central processing in subcortical and cortical structures. As we age, there are significant changes in all sensory systems and a variety of cognitive functions. Visual acuity tends to decrease and hearing thresholds generally increase (Kalina 1997; Liu and Yan 2007), whereas performance levels on tasks of motor speed, executive function, and memory typically decline (Rapp and Heindel 1994; Birren and Fisher 1995; Rhodes 2004). There are also widespread changes in the aging brain, including reductions in gray and white matter volume (Good et al. 2001; Salat et al. 2009), alterations in neurotransmitter systems (Muir 1997; Backman et al. 2006), regional hypoperfusion (Martin et al. 1991; Bertsch et al. 2009), and altered patterns of functional activity during cognitive tasks (Cabeza et al. 2004; Grady 2008). Given the extent of age-related alterations in sensation, perception, and cognition, as well as in the anatomy and physiology of the brain, it is not surprising that multisensory integration also changes with age.Several early studies provided mixed results on the differences between multisensory processing in older and younger adults (Stine et al. 1990; Helfer 1998; Strupp et al. 1999; Cienkowski and Carney 2002; Sommers et al. 2005). For example, Stine and colleagues (1990) reported that although younger adults’ memory for news events was better after audiovisual presentation than after auditory information alone, older adults did not show improvement during the multisensory conditions. In contrast, Cienkowski and Carney (2002) demonstrated that audiovisual integration on the McGurk illusion was similar for older and younger adults, and that in some conditions, older adults were even more likely to report the fusion of visual and auditory information than their young counterparts. Similarly, in a study examining the contribution of somatosensory input to participants’ perception of visuospatial orientation, Strupp et al. (1999) reported an age-related increase in the integration of somatosensory information into the multisensory representation of body orientation.Despite providing a good indication that multisensory processing is somehow altered in aging, the results of these studies are somewhat difficult to interpret due to their use of complex cognitive tasks and illusions, and to the variability in analysis methods. Several newer studies that have attempted to address these factors more clearly demonstrate that multisensory integration is enhanced in older adults (Laurienti et al. 2006; Peiffer et al. 2007; Diederich et al. 2008).On a two-choice audiovisual discrimination task, Laurienti and colleagues (2006) showed that response time (RT) benefits for multisensory versus unisensory targets were larger for older adults than for younger adults (Figure 20.1). That is, older adults’ responses during audiovisual conditions were speeded more than younger adults’, when compared with their respective responses during unisensory conditions. Multisensory gains in older adults remained significantly larger than those observed in younger adults, even after controlling for the presence of two targets in the multisensory condition (redundant target effect; Miller 1982, 1986; Laurienti et al. 2006).Using similar analysis methods, Peiffer et al. (2007) also reported increased multisensory gains in older adults. On a simple RT task, where average unisensory RTs were equivalent in younger and older adults, older adults actually responded faster than younger adults on multisensory trials because of their enhanced multisensory integration (Peiffer et al. 2007). Diederich and colleagues (2008) have also shown that older adults exhibit greater speeding of responses to multisensory targets than younger adults on a saccadic RT task. The analysis methods used in this experiment indicate a slowing of peripheral sensory processing, as well as a wider time window over which integration of auditory and visual stimuli can occur (Diederich et al. 2008).These experiments highlight several possible explanations that could help answer a critical question about multisensory processing in aging: Why do older adults exhibit greater integration of multisensory stimuli than younger adults? Potential sources of enhanced integration in older adults include age-related cognitive slowing not specific to multisensory processing, inverse effectiveness associated with sensory deficits, alterations in the temporal parameters of integration, and inefficient top–down modulation of sensory processing. In the following sections we will investigate each of these possible explanations in greater detail and offer some alternative hypotheses for the basis of enhanced multisensory integration in older adults.

Red Blood Cell Adhesion Is Increased in the Young Adult Population with Sickle Cell Disease

The hyperemic response to passive leg movement (PLM) is largely (~80%) nitric oxide (NO) mediated in young adults, whereas both the overall response and NO contribution (~20%) are diminished in older adults. A transient hyperemic response remains in both groups after NO blockade, however, the mechanisms contributing to this remaining response are unknown. Vasodilatory substances including prostaglandins (PG) and endothelial derived hyperpolarizing factors (EDHF) are primary candidates contributing to PLM response. Moreover, these underlying mechanisms of the PLM response are likely influenced by exercise training in both young and older adults but this remains to be determined. Thus, we sought to determine if 1) PG and EDHF contribute to the hyperemic response in older adults, and 2) exercise training alters the mechanisms contributing to changes in PLM (i.e., NO, PG, or EDHF). The leg blood flow (LBF) response to PLM was measured by Doppler ultrasound in 9 young (25±4 yr) and 9 older (69±5 yr) adult males. PLM was performed with intra-arterial infusions of saline (control), NG-monomethyl-L-arginine (L-NMMA) to inhibit NOS and NO production, and a combination of L-NMMA, ketorolac tromethamine (KET) to inhibit cyclooxygenase and PG production, and fluconazole (FLUC) to inhibit cytochrome P-450 and EDHF (L-NMMA+KET+FLUC). This PLM and drug infusion protocol were repeated following 8 weeks of single leg knee-extension (KE) exercise training to determine if the vasodilatory mechanisms regulating PLM-induced hyperemia are altered by exercise training. The hyperemic response to PLM (total LBF area under the curve) was significantly attenuated from control with infusion of L-NMMA in young adults (-287±280 mL, p&lt;0.05) but remained unchanged in the older (-55±86 mL, P=0.70). Combined infusion of L-NMMA+KET+FLUC yielded similar results such that PLM decreased to the same degree as L-NMMA in young (-276±108 mL, p&lt;0.05) with no significant change in older adults (-116±81 mL, P=0.36). Following 8 weeks of single leg KE training, maximal power (KEmax) improved in both young (+33±13 W, p&lt;0.05) and older adults (+16±8 W, p&lt;0.05). Despite improvements in KEmax, the hyperemic response to PLM only increased in young adults by ~30% (454±194 v. 604±351 mL, p&lt;0.05), while no improvement was observed in older adults (225±142 v. 236±89 mL, P=0.86). The contribution of NO to PLM did not change following exercise training in either young (-238±217 mL, P=0.14) or older (-62±82 mL, P=0.72) adults. Likewise, the contribution of PG and EDHF also did not change in both young (-306±222 mL, P=0.68) and older (-108±116 mL, P=0.77) adults. These findings indicate that PG and EDHF do not have an additive effect to NO on the hyperemic response to PLM in both young and older adults. Therefore, the remaining hyperemic response following combined NO, PG, and EDHF inhibition is likely driven by non-endothelial dependent mechanisms. Moreover, these data indicate that 8 weeks of KE specific exercise training significantly improves the hyperemic response to PLM in young but not older adults. Interestingly, the observed improvements to PLM were not directly mediated through the NO, PG, or EDHF pathways but by some other, currently unidentified, mechanism. National Institutes of Health R01HL142603 (to J.D. Trinity) This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.

BackgroundCardiovascular diseases (CVDs) are a major cause of morbidity and mortality worldwide, with data showing an increasing trend. Previously uncommon, CVDs of lifestyle are now increasing in many Sub-Sahara African (SSA) countries including Tanzania. The study aimed at determining the spectrum and distribution of CVDs among young (< 45 years) and older (≥ 45 years) adults referred for echocardiography at Jakaya Kikwete Cardiac Institute (JKCI).MethodsHospital-based cross sectional study was conducted among adult patients referred for echocardiography at JKCI between July and December 2021. Patient’s socio-demographic and clinical characteristics were recorded. CVD diagnoses were made using established diagnostic criterias. Comparisons were done using chi-square test and student’s t-test. Multivariable logistic regression analysis was used to determine factors associated with abnormal echocardiography. A significance level was set at p-value < 0.05.ResultsIn total 1,050 patients (750 old and 300 young adults) were enrolled. The mean ± SD age was 62.2 ± 10.4 years and 33.5 ± 7.4 years for older and young adults respectively. Hypertension was the commonest indication for echocardiography both in the young (31%) and older (80%) adults. Majority of older adults were found to have abnormal echocardiography (90.7%), while only 44.7% of the young adults had abnormal echocardiography (p < 0.001). For the older adults, the commonest diagnoses were HHD (70.3%), IHD (9.7%), and non-ischemic cardiomyopathy (6.1%) while for young adults, HHD (16.7%), non-ischemic cardiomyopathy (8%), RHD (8%) and MVP (4.3%) were the commonest. The differences in the echocardiographic diagnoses between young and older adults were statistically significant, p < 0.001. Being an older adult, hypertensive, overweight/obese were independently associated with abnormal echocardiography (p < 0.01).ConclusionHypertensive heart disease is the most common diagnosis among adult patients referred for echocardiography at JKCI, both in young and older adults. Primary prevention, early detection and treatment of systemic hypertension should be reinforced in order to delay or prevent its complications.