Investigating the Status of Active Aging and Its Relationship with Self-Care in COVID-19 among older adults

Speechreading and Aging

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.

Psychosocial measures in relation to smartwatch alerts for atrial fibrillation detection

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

Background Falls are the leading cause of injuries in older adults in Thailand. Exercise appears to be a strategy to reduce falls. There is a need to develop a fall prevention exercise programme to encourage participation and adherence. The adapted Lifestyle-integrated Functional Exercise (aLiFE) programme may be suitable by integrating exercise into daily routines as opposed to attending an exercise class. This study aimed to explore the acceptability and feasibility of the aLiFE programme in older Thai adults and identify if modifications are necessary for this population. Method To obtain older Thai adults' perspectives and stakeholders’ views, 40 community-dwelling older adults aged ≥ 60 years, in urban and rural locations in Thailand, and 14 stakeholders (e.g. healthcare professionals) working with older Thai adults were included. Qualitative methods were used to conduct focus groups and in-depth interviews with older adults, and semi-structured interviews with stakeholders. Thematic analyses using Framework Approach were conducted. Results Findings revealed positive views and identified four themes including: (a) individual factors, (b) perceptions of aLiFE, (c) recommendations for implementing aLiFE in Thailand, and (d) motivation. Older participants expressed interest in performing aLiFE in their daily activities, although some activities may need to be modified to fit the Thai cultural context. Stakeholders were concerned about how to motivate older Thai adults to adhere to aLiFE. Healthcare professionals and family members could play a major role to support older adults in uptake of aLiFE. Benefits (e.g. independence and fall prevention) may motivate older adults to engage in aLiFE. Clear and simple instructions were requested. Conclusion The aLiFE programme should be feasible and acceptable among older Thai adults. The aLiFE programme has been appropriately modified to be ‘Thai LiFE (TLiFE)’. A feasibility randomised controlled trial of the TLiFE programme has been conducted in older Thai adults.

Since the initial scientific statement on Secondary Prevention of Coronary Heart Disease (CHD) in the Elderly was published in 2002,1 several trends have continued that make an update highly appropriate. First, the graying of the US population and those of other industrialized countries has progressed unabated because more adults are surviving into their senior years. The number of Americans aged ≥75 years was estimated at 18.6 million in 2010, representing ≈6% of the population,2 and it is expected to double by 2050. The population aged ≥85 years is growing the most rapidly, with numbers expected to reach 19.5 million by 2040. In 2008, 67% of the 811 940 cardiovascular deaths in the United States occurred in people aged ≥75 years.3 In parallel to this increase in the older adult demographic, the number of Americans with CHD has increased to an estimated 16.3 million, more than half of whom are >65 years of age.3 Similarly, 7 million have had a stroke, the incidence of which approximately doubles with successive age decades after 45 to 54 years.3 Peripheral artery disease (PAD) affects 8 to 10 million Americans, the majority of whom are >65 years of age. Between 2015 and 2030, annual US costs related to atherosclerotic cardiovascular disease (ASCVD) are projected to increase from $84.8 billion to $202 billion.3 Moreover, given that ASCVD often undermines functional capacity and independence and increases reliance on long-term care, indirect expenses related to ASCVD are also expected to increase. Thus, the need for effective secondary prevention measures in the older adult population with known ASCVD has never been greater. Notably, the 2011 American Heart Association (AHA)/American College of Cardiology Foundation (ACCF) updated guidelines for secondary prevention of CHD broadened …

Representations of older adults in COVID-related newspaper articles: A comparison between the perspectives of older and younger adults

Despite well-documented declines in most cognitive domains, some emotional processes appear to be preserved or even enhanced in late adulthood. A good example of this is the information processing bias older adults show towards positive relative to negative emotional stimuli, often referred to as the age-related positivity effect. The present thesis presents a series of experiments that were designed to better understand the mechanisms that contribute to age-related changes in emotional processing, focusing in particular on the role of cognitive mechanisms and neural networks. In Study 1 aimed to identify the underlying cognitive mechanisms of the positivity effect. The primary focus of this study was to explore the role of distractors during the early attention allocation stage, and to also measure how selective attentional processes during encoding influence later memory outcomes for emotional items. The results showed that consistent with prior literature, a memory positivity effect was found among older relative to younger adults. However, of particular interest was the finding that, participants’ memory for negative targets was not influenced by the presence of positive distractors. This finding suggests that positive distractors did not automatically capture older adults’ attention during encoding for negative items. Importantly, we found that participants’ pupillary responses to negative items mediated the relationship between age and the memory positivity effect, indicating that older adults use their cognitive control resources when encoding negative information, perhaps to down regulate the impact of negative emotions on their memory. Collectively, these two findings provide converging support for the cognitive control account of the positivity effect. Study 2 used a similar paradigm to Study 1 to examine the underlying neural networks involved in processing emotional items during working memory encoding among older and younger adults. Results indicated that a cognitive control network that included fronto-parietal regions, was functionally connected to the left ventrolateral prefrontal cortex during the encoding of negative items among older adults. This network contributed to performance, both accuracy and response times, in older adults’ group. A less distributed network was found for encoding of positive items among older and both items among younger adults. Although older adults recruited a same network that was functionally connected to the amygdala for encoding positive and negative items, younger adults recruited this particular network specifically for encoding negative items. This network facilitated older adults’ higher accuracy and faster response times during retrieval. Taken together, the results from these functional connectivity analyses suggest that there is differential engagement of brain networks connected to these two regions, which are modulated by the emotional valence. While two separate brain networks underlying the encoding of emotionally valence targets are connected to the vlPFC region, one distinct network is functionally connected to the amygdala and subserves the processing of both positive and negative targets. In Study 3 age-related differences in neural substrates involved when processing happy and angry expressions presented with direct versus averted gaze were investigated. This research was motivated by studies that show older adults not only have difficulties processing emotional cues such as facial expression and eye gaze cues, but also have problems integrating these cues. Study 3 provides the first empirical examination of the underlying neural correlates of age-related difficulties in integrating communicative cues. The results showed that for angry facial expressions, younger adults recruited distinct networks while processing direct versus averted eye-gaze cues, however, older adults showed a lack of neural sensitivity to these cues, recruiting a single network for both types of stimuli. In contrast, for happy facial expressions, only older adults showed neural sensitivity to eye gaze cues. Participants’ performance on the scanner task was then correlated with a measure of theory of mind (TOM). Younger (but not older) adults’ performance on a measure of TOM and recognition of angry expressions was differentially correlated with activation in two sets of brain regions as a function of eye gaze. Unlike younger adults, older adults’ performance on TOM was also differentially correlated with the key node of mentalizing brain network during happy expressions as a function of eye gaze. The findings from Study 3 suggest that the age-related difficulties in integrating facial cues could be associated with the recruitment of the mentalizing network when the task imposes high demand on social-cognitive processing. Taken together, the three Studies reported in this thesis provide novel insights into our understanding of age-related differences in the processing of emotionally valenced items, particularly with respect to initial encoding of this information, and how this relates to later memory outcomes. Moreover, for the first time the neural correlates of integrating two important types of facial cue has been identified, and potentially linked to broader social cognitive difficulties. Overall, the findings of this thesis have broad implications for understanding the underlying cognitive mechanisms and neural networks that contribute to age-related differences in the processing of emotional stimuli.

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.

BackgroundOlder adults are more prone to develop adverse drug reactions (ADRs) since they exhibit numerous risk factors. The first aim was to analyse the number of spontaneous ADR reports regarding older adults (> 65) in the ADR database of the German Federal Institute for Drugs and Medical Devices (BfArM) and to set them in relation to i) the number of ADR reports concerning younger adults (19–65), and ii) the number of inhabitants and assumed drug-exposed inhabitants. The second aim was to analyse, if reported characteristics occurred more often in older vs. younger adults.MethodsAll spontaneous ADR reports involving older or younger adults within the period 01/01/2000–10/31/2017 were identified in the ADR database. Ratios concerning the number of ADR reports/number of inhabitants and ADR reports/drug-exposed inhabitants were calculated. The reports for older (n = 69,914) and younger adults (n = 111,463) were compared using descriptive and inferential statistics.ResultsThe absolute number of ADR reports involving older adults increased from 1615 (2000) up to 5367 ADR reports (2016). The age groups 76–84 and 70–79 had the highest number of ADR reports with 25 ADR reports per 100,000 inhabitants and 27 ADR reports per 100,000 assumed drug-exposed inhabitants. For both ratios, the number of reports was higher for males (26 and 28 ADR reports) than for females (24 and 26 ADR reports). Fatal outcome was reported almost three times more often in older vs. younger adults. Six out of ten drug substances most frequently suspected were antithrombotics (vs. 1/10 in younger adults). For some drug substances (e.g. rivaroxaban) the ADRs reported most frequently differed between older (epistaxis) and younger adults (menorrhagia).ConclusionsThere is a need to further investigate ADRs in older adults since they occurred more frequently in older vs. younger adults and will likely increase in future. Physicians should be aware of different ADRs being attributed to the same drug substances which may be more prominent in older adults. Regular monitoring of older adults taking antithrombotics is recommended.

Background: Aging increased the risks of cognitive impairment and depression. Then, these conditions can lead to poor quality of life by reducing one’s ability to perform activities of daily living. Recently, it is established that physical activity can decrease the cognitive decline and the risk of depression in older adults. Moreover, regular physical activity can improve physical and mental functions in populations of all ages. However, level and speed of cognitive decline occurs varies greatly among individual especially the difference between middle-aged and older adults. Objective: This study aimed to focus on the comparison of physical activity, cognitive function and depression between older and middle-aged adults, which has never been done before. Moreover, the associations of physical activity with cognitive impairment and depression were also investigated in older and middle-aged adults. The information in this study will provide an understanding regarding the design of physical activity program for different age groups. Methods: All participants were divided into two groups of 50 middle-aged adults and 50 older adults. The assessments of physical activity, cognitive function, and level of depression were conducted for all participants. Results: The total level of physical activity and cognitive function in older adults was decreased when compared with middle-aged ones. Moreover, each work and transportation domain of physical activity in older adults also was decreased when compared with that in middle-aged ones. However, the leisure domain of physical activity in older adults was increased via a decreasing depression level. In addition, the level of physical activity associated with both cognitive function and depression and depression alone in middle-aged and older adults, respectively. Conclusion: We suggested that total level of physical activity in older adults can increase via stimulating work and transportation activities in physical activity program. Moreover, the level of physical activity associated with both cognitive function and depression and depression alone in middle-aged and older adults, respectively.

The proportion of older adults in high income nations is increasing, and ageing is often associated with a decline in health. Although regular physical activity (PA) improves health in older adults, they typically have the lowest levels of PA of any population group. Pole walking (PW) is a form of walking with the addition of hand-held poles, used in opposition to lower limb locomotion, and has characteristics which may be suited to older adults. The aim of this thesis was to explore PW as a form of health enhancing PA for older adults through a series of three studies. Study One (Chapters 2 and 3) was a systematic review of the effects of PW programs on physical and psycho-social health. A review of papers published to September, 2011 was described in Chapter 2. Fourteen papers describing randomised trials met the inclusion criteria. The results indicated that PW programs have beneficial effects on both physical and psycho-social health in adult populations, and the authors identified a need for future studies involving non-clinical populations of older adults. An update of the review, with 14 more papers published to October, 2014, was presented in Chapter 3. Three studies investigated PW exclusively in older adults. The beneficial effects of PW, compared with a variety of control programs, were confirmed for endurance, functional status, PA and muscle strength. Positive effects of PW, compared with non-exercise programs, were found for anthropometry (weight, body mass index and waist measurements) and oxygen uptake. The aim of Study Two (Chapter 4), was to describe the characteristics of PW leaders, pole walkers, and PW programs in Australia; and participants’ perceptions of PW and reasons for participation. Self-administered surveys were distributed to PW leaders (n=31), and pole walkers (n=108). Data on sociodemographic and health information, program characteristics, and perceptions of PW were collected. The results showed that PW was being practiced largely by older females, who were born in Australia. The main finding was that a range of personal, social, and environmental characteristics positively affect older adults’ participation in PW, and are important in a health promotion context. Study Three (Chapters 5 and 6) was a randomised trial which aimed to compare the effects of a PW and a walking program on physical and psycho-social wellbeing in older old adults. The study protocol is presented in Chapter 5, and the results are reported in Chapter 6. Participants were 42 men and women from assisted living communities with a mean age of 82 (SD, 10) years (range, 60-99 years). They were randomised into a group-based PW or walking program, each consisting of three light intensity sessions of 20 minutes per week, for 12 weeks. Primary outcomes were selected measures of the Senior Fitness Test (chair stand, arm curl, 6 minute walk, and up-and-go) and hand grip strength. Secondary outcomes included measures of health, health behaviours, and wellbeing. The results showed a slight within-group deterioration in the up-and-go scores in the PW group, and a within-group decrease in sitting time in both groups, which was significant in the walking group. There was large inter-individual variation in the change scores for each test, and there were no significant differences between the PW group and the walking group in any of the outcome measures. When data from the two groups were combined, no sociodemographic, attendance or baseline performance scores were associated with improvement in any of the primary outcome measures. Significance: Each study in this thesis contributes to our understanding of PW in older adult populations. Study One was the first systematic review of the physical and psycho-social health effects of PW with a quality rating of the reviewed papers. There were few investigations of PW in exclusively older adult populations. Study Two was the first rigorous and comprehensive survey of pole walkers and PW leaders in Australia. Study Three was one of the first intervention studies to compare the health effects of PW with walking in a group of older old adults. Three key findings of this thesis were: 1) PW has beneficial health effects in several groups including older adults with and without clinical conditions; 2) PW is being practiced by older, health conscious adults in Australia; and 3) in a sample of frail elderly people in the United States, functional outcomes of a 12 week exercise program were similar for PW and walking. Conclusions: PW has beneficial effects on physical and psycho-social health, which are relevant for older people. It is undertaken mostly by older adults in Australia, and has the potential to be used as a form of health enhancing PA in older people. Although PW was a feasible form of PA that was enjoyed by in a sample of frail elderly adults, there were no differences in the functional effects of short, low intensity PW and walking interventions.

Anemia in Frailty

Older Homeless Adults: Can We Do More?

Introduction: The aging population has been rapidly growing in the United States (U.S.). In line with this trend, older adults’ mobility and transportation safety are an increasing priority. Many states have implemented driver licensure laws specific to older adults to limit driving among the elderly with driving skill decline. Evaluations of these laws have primarily focused on their safety benefits related to older drivers’ fatal crash rate or injury rate. However, very few studies investigated licensure law effects on older adults’ mobility. Objective: The objective of our study is to evaluate the association between older driver licensure laws and older adult daily traveling and passenger exposure. Methods: The 2003–2017 American Time Use Survey (ATUS) data were linked with statewide driver licensure law provisions. Adults aged 55–64 years were used as the reference group to control for the effects of non-licensure-law factors (e.g., economic trend). We used modified Poisson regressions with robust variance to estimate the relationships between licensure law provisions and the likelihoods of older men and women’s daily traveling and passenger behaviors. Results: Laws requiring a vision test at in-person renewal were associated with increased daily traveling likelihood for women aged 75 years or older, primarily as a passenger. Laws requiring a knowledge test were related to a reduced daily overall traveling likelihood for women aged 75 years or older. Conclusions: In general, licensure law provisions are not strongly related to older adults’ mobility, in particular for older male adults. Older female adults’ daily mobility may be more likely to be influenced by the change of licensure laws than older male adults. The existence of gender-based disparities in responding to licensure laws requires future studies to account for the gender difference in estimating the effects of those traffic policies on older adults’ mobility and traffic safety.