Sample Of Community-dwelling Older Adults Research Articles

High Blood Pressure Associated with Depression, Not Anxiety: Results from the Tabriz Older People Survey (TOPS)

Objectives: To investigate the relationship between depression/anxiety and hypertension (HTN) in a large population-based sample in Iran. Design: A cross-sectional study. Setting: Tabriz, the capital of East Azerbaijan province in northwest Iran. Participants: A total of 1362 individuals were chosen from a representative sample of community-dwelling older adults aged 60 and above, residing in Tabriz. Participants were selected using the probability proportional to size sampling method. Outcome measures: A structured survey was used to measure socio-demographic variables, along with the hospital anxiety and depression scale. Blood pressure (BP) was measured using a standard mercury sphygmomanometer. Results: The results of a multiple logistic regression revealed that age (70-79 years old; P=0.01), employment status (housewives; P=0.02), level of education (illiterate; P<0.01), smoking status (having quit smoking; P<0.01), and depression (P=0.02) were related to HTN among these older adults. Conclusions: These findings highlight the critical importance of integrating mental health assessments and interventions in HTN management and prevention strategies, particularly for older populations.

Association Between Time Since Smoking Cessation and Frailty Trajectory Among Community-Dwelling Older People: English Longitudinal Study of Ageing

ObjectivesTo examine the associations of smoking cessation with the subsequent frailty status trajectory using data from a nationally representative sample of community-dwelling older adults living in England. DesignA prospective panel study. Setting and ParticipantsA total of 2600 community-dwelling older adults aged 60 or older in England who used to smoke. MethodsThe past smokers were divided into 5 groups based on years since smoking cessation: 0–10, 11–20, 21–30, 31–40, and 41+ years. The Frailty Index (FI) was constructed using 60 deficits and repeatedly calculated every 2 years over 16 years. Trajectories of FI according to years since smoking cessation were estimated by a mixed-effects model. ResultsA mixed-effects model adjusted for age, sex, education, wealth, and alcohol use showed that FI increased over time in all groups and that longer duration since smoking cessation was significantly associated with lower FI. Those who quit 41 years earlier or more had the lowest frailty trajectory, however, there was still a gap between them and never smokers. Conclusions and ImplicationsThe current study showed that past smokers with a longer duration of quitting smoking had a significantly lower degree of frailty at baseline and over time. These findings highlight beneficial effects of smoking cessation on frailty even in middle or old age and could be used in public health education to promote the importance of quitting smoking.

2250 A mixed-method feasibility study of an intervention to reduce sedentary behaviour in community-dwelling older adults aged ≥ 75 years

Abstract Introduction Older adults are the fastest growing and most sedentary group in society. With sedentary behaviour associated with negative health outcomes, reducing sedentary time may improve overall wellbeing. This single-arm mixed-method feasibility study explored the acceptability of an intervention to reduce sedentary behaviour in community-dwelling older adults aged ≥75 years. Methods Participants were recruited from the Community Ageing Research 75+ Study (CARE75+) cohort, with factors such as age, frailty status, living arrangements and levels of sedentariness being considered. The intervention consisted of an educational booklet including advice on how to reduce sedentary behaviour, a smartwatch with a sedentary reminder function, educational group sessions and follow up phone calls. The 9-week intervention was conducted from June–August 2023. Reach, uptake, adherence, and adverse events were recorded, and the acceptability of the intervention was explored through semi-structured exit interviews. Results Of the 39 eligible participants, 10 consented (5 M:5F) and had a mean age 84.3 years. The intervention had an uptake and reach of 25.6%, and retention of 100%. No falls, hospitalisations or deaths occurred, and three cases of mild irritation were reported which resolved during the study. 100% adherence was observed for the group sessions and follow-up phone calls, and 65% for self-monitoring. Qualitative data suggests that participants were receptive of the intervention according to the domains of the Theoretical Framework of Acceptability, and suggestions were provided on refining the intervention components. Conclusion Strategies to reduce sedentary behaviour were tested on a diverse sample of community-dwelling older adults in the oldest old age group, with varying levels of sedentary behaviour and frailty status. The presented strategies appear to be acceptable, appropriate, safe, and high levels of adherence were observed. Participant feedback will be used to refine the intervention.

Change in Depressive Symptoms and Longitudinal Regional Amyloid Accumulation in Unimpaired Older Adults

Depressive symptoms in older adults may be a harbinger of Alzheimer disease (AD), even in preclinical stages. It is unclear whether worsening depressive symptoms are manifestations of regional distributions of core AD pathology (amyloid) and whether cognitive changes affect this relationship. To evaluate whether increasing depressive symptoms are associated with amyloid accumulation in brain regions important for emotional regulation and whether those associations vary by cognitive performance. Participants from the Harvard Aging Brain Study, a longitudinal cohort study, underwent annual assessments of depressive symptoms and cognition alongside cortical amyloid positron emission tomography (PET) imaging at baseline and every 2 to 3 years thereafter (mean [SD] follow-up, 8.6 [2.2] years). Data collection was conducted from September 2010 to October 2022 in a convenience sample of community-dwelling older adults who were cognitively unimpaired with, at most, mild baseline depression. Data were analyzed from October 2022 to December 2023. Depression (Geriatric Depression Scale [GDS]-30-item), cognition (Preclinical Alzheimer Cognitive Composite-5 [PACC]), and a continuous measure of cerebral amyloid (Pittsburgh compound B [PiB] PET) examined in a priori-defined regions (medial orbitofrontal cortex [mOFC], lateral orbitofrontal cortex, middle frontal cortex [MFC], superior frontal cortex, anterior cingulate cortex, isthmus cingulate cortex [IC], posterior cingulate cortex, and amygdala). Associations between longitudinal GDS scores, regional amyloid slopes, and PACC slopes were assessed using linear mixed-effects models. In this sample of 154 individuals (94 [61%] female; mean [SD] age, 72.6 [6.4] years; mean (SD) education, 15.9 [3.1] years), increasing PiB slopes in the bilateral mOFC, IC, and MFC were associated with increasing GDS scores (mOFC: β = 11.07 [95% CI, 5.26-16.87]; t = 3.74 [SE, 2.96]; P = .004; IC: β = 12.83 [95% CI, 5.68-19.98]; t = 3.51 [SE, 3.65]; P = .004; MFC: β = 9.22 [95% CI, 2.25-16.20]; t = 2.59 [SE, 3.56]; P = .03). Even with PACC slope as an additional covariate, associations remained significant in these regions. In this cohort study of cognitively unimpaired older adults with, at most, mild baseline depressive symptoms, greater depressive symptoms over time were associated with amyloid accumulation in regions associated with emotional control. Furthermore, these associations persisted in most regions independent of cognitive changes. These results shed light on the neurobiology of depressive symptoms in older individuals and underscore the importance of monitoring for elevated mood symptoms early in AD.

Social support and frailty progression in community-dwelling older adults.

Despite the growing evidence regarding the influence of social factors on frailty in older adults, the effect of social support remains unclear. This study aims to assess the association between social support and frailty progression (transition and incidence) in a sample of community-dwelling older adults. Using a cohort study design, 1,059 older adults from the Berlin Initiative Study were followed up for 2.1 years. Multinomial and logistic regression analyses were performed to assess the association of social support using Oslo Social Support Scale-3 with frailty transition and incidence, respectively. Gender differences were explored using stratified analyses. At baseline, frailty prevalence in the study population [mean (SD) age 84.3 (5.6) years; 55.8% women] reached 33.1% with 47.0, 29.4 and 23.6% of the participants reporting moderate, strong and poor social support, respectively. Over the follow-up period, social support was not significantly associated with the frailty transition categories in the adjusted model. Conversely, the adjusted logistic regression analysis showed that participants with poor social support had twice the odds of becoming frail compared to those with strong social support (OR 2.07; 95% CI 1.08-3.95). Gender-stratified analyses showed comparable estimates to the main analysis but were statistically non-significant. Our study results underpin the role of social factors in frailty incidence and highlight social support as a potential target for frailty-preventing interventions in older adults. Therefore, it is important to adopt a biopsychosocial model rather than a purely biomedical model to understand and holistically improve the health of community-dwelling older adults.

History of Incarceration and Dental Care Use Among Older Adults in the United States

IntroductionDental care is a critical component of healthy aging; however, emerging evidence suggests that having been previously incarcerated is a risk factor for not using dental care services. This study investigates the relationship between prior incarceration and dental care among older adults and assesses whether wealth and dental insurance explain this relationship. MethodsData are from the Health and Retirement Study, a nationally representative sample of community-dwelling older adults in the United States, collected in 2012 and 2014. Multivariable logistic regression is used to assess the relationship between a history of incarceration and dental care. Mediation analyses were conducted using the Karlson-Holm-Breen method of indirect effects in non-linear models. Statistical analyses were conducted from February to April 2024. ResultsAdjusting for potential confounding variables, a respondent's prior incarceration is associated with a 25% lower odds of dental care use (adjusted odds ratio [aOR] = .748, 95% CI = .624, .896). The relationship between incarceration and dental care use is fully mediated—over 90% is explained by—wealth and having dental care insurance. Prior incarceration decreased the likelihood of dental care only among non-Hispanic White respondents. ConclusionsThe findings offer new evidence that prior incarceration is a risk factor for lacking the ability to utilize dental care among older adults and suggest that broader consequences of incarceration for wealth accumulation and access to dental insurance underpin this relationship. These results suggest the urgent need to expand access to affordable dental care services for older adults with a history of incarceration.

Computerized assessment of executive functioning: Validation of the CNS Vital Signs executive functioning scores in a sample of community-dwelling older adults

Objective: Computerized assessment of cognitive functioning has gained significant popularity over recent years, yet options for clinical assessment of executive functioning (EF) are lacking. One computerized testing platform, CNS Vital Signs (CNS-VS), offers tests designed to measure EF but requires further validation. The goal of the present study was to validate CNS-VS executive scores against standard clinical measures of EF. We also sought to determine whether a modified CNS-VS composite score that included variables purported to measure inhibition, switching, and working memory would outperform the currently available CNS-VS Executive Function Index. Method: A sample of 73 cognitively healthy older adults completed four tests from the Delis-Kaplan Executive Function System, the Digit Span subtest from the Wechsler Adult Intelligence Scale-fourth edition, and three CNS-VS tasks purported to measure inhibition, switching, and working memory. Results: Performances on the CNS-VS tests were predicted by performances on standard paper-and-pencil measures. Although the currently available CNS-VS Executive Function Index predicted unique variance in a well-validated paper-and-pencil EF composite score, our Modified CNS-VS EF composite accounted for unique variance above and beyond the original CNS-VS Executive Function Index, while the reverse was not true. Conclusions: The present results support the construct validity of CNS-VS EF tests but also suggest that modifications to their current composite scores would improve the prediction of EF performance.

Factors Associated With Negative Life Changes due to COVID-19 Among Older Adults Residing in an Urban Low-Income Neighborhood in Korea: Focused on Gendered Differences.

This study examined negative life changes due to coronavirus disease of 2019 (COVID-19) and its correlates in a sample of community-dwelling older adults from a low-income urban city in Korea, focusing on gendered differences. Negative life changes due to COVID-19 were categorized into four domains: behavioral/physical, psychosocial, goal-seeking, and control/freedom. Being female, not receiving basic livelihood security, and dissatisfaction with housing situation were significantly associated with negative life changes during the pandemic. Gender-stratified analyses revealed that most within-gender social disparities associated with changes due to COVID-19 occurred in older women. The odds of experiencing negative changes were higher among working women and those receiving security income aid. In low-income urban communities, those who were previously socially and economically active perceived more negative changes owing to the pandemic. The contribution of gender to negative life changes should be considered to effectively alleviate concerns among older adults during pandemics.

Health literacy in older adults: The newest vital sign and its relation to cognition and healthy lifestyle behaviors

Health literacy tends to decrease with age, and lower health literacy has been associated with lower levels of physical function, mental health, and medication adherence. The present study examined health literacy in relation to cognition in a sample of community-dwelling older adults. The study also examined the impact of health literacy on engagement in healthy aging lifestyle behaviors. Participants included 128 older adults (age: M = 72.07, SD = 6.71; education: M = 16.34, SD = 2.56; 74% female) who completed a health literacy measure (Newest Vital Sign; NVS), a lifestyle behavior questionnaire (Healthy Aging Activity Engagement scale; HAAE), and several neuropsychological tests. The cognitive domains assessed included memory, executive function, and attention/working memory. Two variables were computed from the NVS to represent the health literacy factors of document and numeracy literacy; these factors demonstrated a small correlation (r = .18). Results revealed that attention/working memory, executive function, and memory were all significantly related to numeracy literacy and overall health literacy. Only memory was significantly related to document literacy. After accounting for age, education, and cognition, a hierarchical regression revealed that health literacy significantly predicted engagement in healthy aging lifestyle behaviors. Multiple cognitive abilities are necessary for searching, finding, and processing information to make health-related decisions. Health literacy accounted for a significant amount of variance in older adults’ engagement in everyday lifestyle behaviors. Health literacy skills may be an area of focus for intervention efforts to improve brain health in older adults.

Abstract P531: Contralateral Differences in Ankle Systolic Blood Pressure and Pulse Wave Velocity: Associations With Incident Heart Failure and Mortality

Introduction: Contralateral differences in systolic blood pressure (SBP) are a risk assessment tool and indicative of underlying cardiovascular issues. Most of the available studies focused on brachial blood pressure and its clinical impact. This study evaluated whether interankle SBP differences and contralateral differences in pulse wave velocity (PWV) are associated with incident heart failure (HF) and all-cause and cardiovascular mortality in a community-dwelling sample of older adults. Methods: Sample included 5,077 participants (75.2 ± 5.1 years old) of the Atherosclerosis Risk in Communities (ARIC) study. The OMRON VP-1000 plus was used to measure PWV and blood pressure in the ankles. PWV was assessed between the brachial artery and ankle (baPWV) and heart and ankle (haPWV) on the right and left sides. Cut points for contralateral differences in PWV were set at the 90th percentile in our sample. Outcomes included incident HF (first definite or probable hospitalization for acute decompensated HF), all-cause and cardiovascular mortality (until December 31, 2020). Cox proportional hazards regression models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI). Results: Over a mean follow-up of 7.5 ± 2.1 years, incident HF was diagnosed in 457 participants, and 1,275 all-cause and 363 cardiovascular deaths occurred. The prevalence of interankle SBP difference ≥10 and ≥15 mmHg was 24.9% (1,268) and 12.0% (605), respectively. The prevalence of contralateral differences in baPWV (>240 cm/s) and haPWV (>80 cm/s) was 10.1% (513) and 9.1% (464), respectively. Interankle SBP difference ≥10 mmHg (HR 1.13; 95% CI 1.00-1.29), ≥15 mmHg (HR 1.25; 95% CI 1.06-1.48), contralateral difference in baPWV >240 cm/s (HR 1.18; 95% CI 1.00-1.41), and haPWV >80 cm/s (HR 1.21; 95% CI 1.01-1.44) were each independently associated with all-cause mortality after adjustment for demographics, traditional cardiovascular risk factors, and extreme values of ankle-brachial index ≤0.9 or >1.40. Contralateral differences in ankle SBP ≥15 mmHg (HR 1.55; 95% CI 1.16-2.06), and haPWV >80 cm/s (HR 1.40; 95% CI 1.02-1.91) were both independently associated with cardiovascular mortality. Crude analysis revealed that those with contralateral differences in ankle SBP ≥10 and ≥15 mmHg, baPWV >240 cm/s, and haPWV >80 cm/s had a significantly higher risk of HF (p<0.05 for all). However, these HF relationships were no longer statistically significant after adjustment for confounders. Conclusions: Contralateral differences in ankle SBP and PWV were independently associated with all-cause and cardiovascular mortality risk even after accounting for traditional cardiovascular risk factors and the ankle-brachial index. These results underscore the significance of evaluating contralateral differences in ankle SBP and PWV as potential markers of increased mortality risk among older adults.

Prevalence of positive serology for sexually transmitted infections among older adults

Objective: To determine the seroreactivity profile for sexually transmitted infections (STIs) in a sample of community-dwelling older adults. Methods: Epidemiological survey using serological screening tests for reactivity to Treponema pallidum, HIV 1/2, and hepatitis B and C viruses in 495 older individuals (59.9% women) investigated regardless of signs or symptoms of STIs. Results: Reactivity rates for the etiological agents of AIDS and viral hepatitis B and C were compatible with the usual prevalence of these STIs in the Brazilian population. However, there was a very high prevalence of reactivity to syphilis (symptomatic or asymptomatic) in the group, equivalent to approximately 1290 cases per 10 000 older population, which suggests a proportionally greater exposure of older adults to infection with T. pallidum and to the risk of morbidity and mortality associated with STIs. Conclusions: This scenario indicates that adjustments are needed in geriatric centers to consider screening for STIs as an integral part of the routine clinical care of older people.

Effects of Frailty Syndrome on Osteoporosis, Focusing on the Mediating Effect of Muscle Strength and Balance in Community-Dwelling Older Adults (≥60 years) in Iran: Results From the Amirkola Health and Aging Project Cohort Study.

For older adults, maintaining muscle strength and balance is crucial to preserve an upright posture and independently manage their basic activities of daily living (ADL). This study aimed to examine whether muscle strength and balance mediate the relationship between frailty syndrome (FS) and osteoporosis in a large sample of community-dwelling older adults. This cross-sectional study is part of the second phase (2016-2017) of the Amirkola Health and Ageing Project (AHAP), a cohort study conducted on all elderly aged 60 and over in Amirkola, Northern Iran, since 2011. Data from 2018 older adults were collected by a trained person using bone mineral density (BMD), frailty index, activities of daily living (ADL), instrumental activities of daily living (IADL), handgrip strength (HGS), quadriceps muscle strength (QMS), Berg Balance Scale (BBS), and Timed Up and Go test (TUG test) and analyzed using analysis of variance, chi-square, and path analysis tests. The mean indices of femoral neck BMD and lumbar spine BMD, HGS, QMS, BBS, ADL, and IADL were lower in the frail older adults than in the pre-frail and non-frail older adults. In addition, the mean TUG test level was higher in the frail older adults than in the non-frail and pre-frail older adults. The results of the present study have indicated that frailty is significantly related to osteoporosis, and that balance and muscle strength can predict osteoporosis; these variables play a mediating role in the relationship between frailty and osteoporosis. From the results of the present study, it can be concluded that frailty may increase the odds of osteoporosis. The results of the current study have indicated that balance (BBS and TUG test) and muscle strength (HGS and QMS) are associated with osteoporosis and these variables play a mediating role in the relationship between frailty and osteoporosis.

PLASMA NEUROFILAMENT LIGHT CHAIN IS ASSOCIATED WITH PHYSICAL FRAILTY IN OLDER ADULTS WITHOUT DEMENTIA

Abstract Evidence suggests a link between brain biomarkers of neurodegeneration and physical function and frailty. However, the association of neurodegenerative biomarkers in the plasma with physical frailty in older adults remains unelucidated, as current evidence is limited and inconsistent. We tested the association between plasma neurofilament light chain (NFL), a plasma neurodegeneration biomarker, and physical frailty in a sample of community-dwelling older adults. We used baseline demographics, frailty, and plasma NFL data collected from 97 participants in a randomized controlled trial in community-dwelling, sedentary older adults without dementia [Montreal Cognitive Assessment (MoCA)>17]. Physical frailty was assessed using a composite measure of weakness, slow walking speed, unintentional weight loss, exhaustion, and low physical activity. Participants’ frailty levels were categorized into robustness, pre-intermediate frailty, and frailty. Multiple linear regression and ordinal logistic regression models adjusting for age, sex, race, education, and comorbidities were conducted to test the associations of NFL with frailty and levels of frailty. The sample was 70.0 ± 6.0 years old, with 80% being females, 72% having intact cognition, and 28% having mild cognitive impairment (MCI). In the adjusted models, higher plasma NFL was associated with higher frailty scores (β=0.16, 95%CI [Confidence Interval] = [0.06,0.26]) and a higher likelihood of being in a higher level of frailty group (odds ratio=1.28, 95% CI =1.02, 1.61). In summary, plasma NFL was associated with greater frailty in our sample of non-demented older adults. Plasma NFL may be a sensitive and promising neurodegenerative biomarker for physical frailty in older adults without dementia.

ASSOCIATIONS BETWEEN COGNITIVE CHANGE AND OBJECTIVE CHANGE IN PHYSICAL ACTIVITY AMONG OLDER ADULTS: THE LIFE STUDY

Abstract Objective To investigate the associations between domain-specific cognitive change and objectively measured change in physical activity in a sample of community-dwelling older adults. We hypothesized that domain-specific changes in cognition are associated with longitudinal changes in physical activity levels. Methods We used data from 955 participants from The LIFE Study, a multi-center randomized clinical trial. Longitudinal relationships between cognitive domains (i.e., memory, attention, processing speed, executive function) and accelerometer-measured change in daily minutes of physical activity were examined using multivariable linear regression. Cognitive tests included Modified Mini-Mental State Examination (3MSE), Hopkins Verbal Learning Test (HVLT), Digital Symbol Substitution Test (DSST), Task Switching Test, Eriksen Flanker Test and N-Back Test. Physical activity was measured longitudinally using an accelerometer and was categorized to total, light, and moderate to vigorous according to standardized activity count cut points. Results Our results showed an association between cognitive change in the processing speed domain and change in minutes of total (β = 0.47; 95% CI: 0.04, 0.89; p = 0.034) and light (β = 0.42; 95%CI: 0.03, 0.80; p= 0.033) physical activity. Relationships between all other cognitive assessments and physical activity categories were not statistically significant. Conclusions This study demonstrates an association between a decline in processing speed and a decline in the duration of total and light daily physical activity in older adults with low to moderate physical function.

SOCIAL ISOLATION AND HOSPITALIZATION IN A NATIONAL SAMPLE OF COMMUNITY-DWELLING OLDER ADULTS BY DEMENTIA STATUS

Abstract Social isolation poses risks for poor health, yet its impact on hospitalization for persons with dementia is unknown. Dementia may result in reduced social contact that increases the risk of hospitalization. This observational cohort study examined longitudinal associations between social isolation and hospitalization among a nationally-representative sample of community-dwelling older adults with and without dementia. Using the National Health and Aging Trends Study, we conducted multivariable analyses for 5,533 Medicare beneficiaries. Social isolation was measured using a multi-domain 4-item typology. Logistic regression tested associations between social isolation in 2015 and self-reported hospitalization over the next twelve months, stratifying by dementia status. Covariates included sociodemographics and health characteristics. About 21.5% of older adults were socially isolated, with a much higher proportion of social isolation among those with dementia (38.0%) versus without (20.7%) (p < .001). Overall, the odds of hospitalization were not significantly associated with social isolation (OR 1.13; p = .184). While there was no association between social isolation and hospitalization among those without dementia (OR 1.09; p = .394), social isolation was significantly associated with hospitalization among older adults with dementia (OR 2.07; p = .001). Among older adults with dementia, social isolation increased the predicted probability of hospitalization by about 14.1% over one year (p = 0.030). In this population-based study, social isolation was common among community-dwelling older adults with dementia and significantly associated with increased odds of hospitalization over twelve months. Efforts to reduce hospitalization should explore ways to bolster social relationships for older adults with dementia.

Association Between Trajectory of Socioeconomic Position and Regional Brain Volumes Related to Dementia: Results From the NEIGE Study.

Low socioeconomic position (SEP) has been linked to an increased risk of dementia. However, little is known about the association between SEP trajectory and regional brain volumes related to dementia. A random sample of community-dwelling older adults (n = 428, age = 73.1±5.5) living in Tokamachi City (Niigata Prefecture, Japan) without medical histories of dementia, Parkinson's disease, and depression who underwent automated assessment of brain volumes on magnetic resonance imaging and responded to a self-administered questionnaire survey in 2017. We measured SEP in childhood (household SEP at age 15), young adulthood (education), mid-adulthood (the longest occupation), and late adulthood (current wealth), and further performed group-based trajectory analysis to identify lifetime trajectory patterns on SEP. Multivariate regression models were employed to investigate the association between SEP trajectories and 4 regional brain volumes related to the development of Alzheimer's disease (ie, entorhinal cortex, hippocampus, amygdala, and the parahippocampus), the most common type of dementia. We found 3 distinct SEP trajectories (stable middle class [68%], downward [23%], and upward [9%]). Compared to those who experienced stable middle class, older adults who experienced the upward SEP mobility had significantly larger hippocampus (β: 213.2, 95% confidence interval: 14.7, 411.8). On the other hand, older adults who experienced downward SEP mobility showed no significant differences in any of the 4 brain structural volumes. Our findings indicate that upward life-course SEP mobility is associated with larger volumes of hippocampus in old age. SEP trajectory may offer us a useful lens to enhance our understanding of the etiology of dementia.

Relationship between chronic pain, depressive symptoms, and functional disability in community-dwelling older adults: mediating role of frailty.

Borim et al. showed that older adults with chronic pain exhibited more depressive symptoms and frailty components. Depressive symptoms were associated with more frailty components, and those with more depressive symptoms and frailty faced greater limitations in IADL performance. Frailty appears to mediate the pathway from chronic pain to functional impairment Chronic pain is directly associated with depressive symptoms and frailty. Chronic pain is not directly associated with functional disability. Depression and frailty are both directly associated with functional disabilities. Frailty mediates the association between chronic pain and functional disability. Depression; Disability evaluation; Frailty; Frail elderly. To evaluate the direct and indirect effects of chronic pain, depressive symptoms, frailty components, and functional disability through a pathway analysis approach in a sample of community-dwelling older adults. Data of 419 participants were cross-sectionally evaluated for the presence of depressive symptoms (Geriatric Depression Scale [15 items]), physical frailty components (phenotype criteria), chronic pain, and limitations in performing instrumental activities of daily living (functional disability scale by Lawton and Brody). Structural equation modeling via path analysis was used to explore the direct and indirect effects among these four variables. Statistical significance was set at p<0.05. Of the total participants, 69.8% were women and 59.3% had low education (1-4 years); the mean age was 80.3±4.6 years. Chronic pain and depressive symptoms were directly related and were associated to frailty. The number of frailty components and depressive symptoms were directly associated with functional disability. Frailty had an indirect effect on the association between chronic pain, depressive symptoms, and functional disabilities. The pathway from chronic pain and depressive symptoms to functional disability is potentially mediated by the number of frailty components.

Lower Adherence to a Mediterranean Diet Is Associated with High Adiposity in Community-Dwelling Older Adults: Results from the Longevity Check-Up (Lookup) 7+ Project

High adiposity impacts health and quality of life in old age, owing to its association with multimorbidity, decreased physical performance, and frailty. Whether a high adherence to a Mediterranean diet (Medi-Diet) is associated with reduced body adiposity in older adults is unclear. The present study was conducted to assess the prevalence of high adiposity in a large sample of community-dwelling older adults. We also explored the relationship between whole-body adiposity estimated through relative fat mass (RFM) and Medi-Diet adherence. Data were obtained from the Longevity Check-up 7+ (Lookup7+) project database. RFM was estimated from anthropometric and personal parameters using a validated equation. RFM was categorized as high if ≥40% in women and ≥30% in men. Information on diet was collected using a food frequency questionnaire, while Medi-Diet adherence was assessed through a modified version of the Medi-Lite scoring system. Analyses were conducted in 2092 participants (mean age 73.1 ± 5.9 years; 53.4% women). Mean RFM was 39.6 ± 5.14% in women and 29.0 ± 3.6% in men. High adiposity was found in 971 (46.4%) participants and was more frequent in those with a low (54.2%) or moderate (46.4%) Medi-Diet adherence compared with the high-adherence group (39.7%, p &lt; 0.001). Logistic regression indicated that older adults with high Medi-Diet adherence were less likely to have a high RFM. Other factors associated with a greater risk of having high adiposity were older age, female sex, and physical inactivity. Our findings support an association between healthy lifestyles, including a greater adherence to a Mediterranean-style diet, and lower body adiposity in older adults.

1 Social Support is Associated with Better Memory Performance among Hispanic/Latino, but not Non-Hispanic White Older Adults

Objective:Hispanic/Latino (H/L) older adults are at greater risk of developing Alzheimer’s disease and related dementias compared to non-Hispanic whites (NHW), and there is an urgent need to identify important factors that may help prevent and/or reduce age-related cognitive health disparities. Positive psychosocial factors, such as social support, may protect against cognitive impairment and decline. However, recent research has highlighted that the effect of social support on cognitive outcomes may differ across racial/ethnic groups. Given the emphasis placed on family relationships and support in H/L culture, the current study sought to clarify whether H/L ethnicity moderated the association between social support and cognitive functioning in a well-characterized sample of community-dwelling older adults residing in Texas.Participants and Methods:Participants included 766 NHW and 817 H/L (predominantly Mexican American) older adults (Mage = 66.25 ±8.64) without dementia enrolled in the Health and Aging Brain Study-Health Disparities. Participants completed study questionnaires and a comprehensive neuropsychological battery. Perceived social support was measured using the total sum score from the 12-item abbreviated version of the Interpersonal Support Evaluation List. Episodic memory performance was operationalized as the z-score composite of the immediate and delayed recall totals from the Spanish English Verbal Learning Test and the Weschler Memory Scale (WMS)-III Logical Memory 1 and 2. Executive functioning was operationalized as the z-score composite of scores from the WMS-III Digit Span, Verbal Fluency (FAS), and Trails B. Analyses of covariance were used to explore racial/ethnic group differences in self-reported levels of social support. Multiple linear regression models examined (1) ethnicity x social support interactions on cognition, and (2) ethnicity-stratified social support and cognition associations. Covariates included age, education, sex, yearly income, and depressive symptoms.Results:H/L older adults reported less perceived social support compared to NHWs (F = 41.16, p &lt; .001). There were no significant ethnicity x social support interactions on episodic memory (ß = 0.04, p = .53) or executive functioning (ß = 0.004, p = .95). However, stratified models revealed that more social support was associated with better memory performance in H/Ls (ß = 0.08, p = .01), but not in NHWs (ß = 0.0004, p = .99). No significant associations between social support and executive functioning were observed amongst H/Ls (ß = -0.01, p = .60) or NHWs (ß = 0.04, p = .29).Conclusions:Although H/Ls reported lower levels of social support relative to NHWs, we observed that social support was linked to better memory performance within the H/L group only. Results suggest that culturally tailored interventions which encourage strong interpersonal relationships and caring for family could enhance social support in H/Ls and thus help to prevent memory decline. Future work should focus on the development of assessment measures that better characterize unique cultural elements of social support within H/Ls, such as multigenerational households, and explore the direct effects of social support on brain metrics.

96 Short-Term Blood Pressure Variability and Cerebrovascular Health in OlderaAdults

Objective:Blood pressure variability (BPV), independent of traditionally targeted average blood pressure levels, is an emerging vascular risk factor for stroke, cerebrovascular disease, and dementia, possibly through links with vascular-endothelial injury. Recent evidence suggests visit-to-visit (e.g., over months, years) BPV is associated with cerebrovascular disease severity, but less is known about relationships with short-term (e.g., &lt; 24 hours) fluctuations in blood pressure. Additionally, it is unclear how BPV may be related to angiogenic growth factors that play a role in cerebral arterial health.Participants and Methods:We investigated relationships between short-term BPV, white matter hyperintensities on MRI, and levels of plasma vascular endothelial growth factor (VEGF) in a sample of community-dwelling older adults (n = 57, ages 55-88) without history of dementia or stroke. Blood pressure was collected continuously during a 5-minute resting period. BPV was calculated as variability independent of mean, a commonly used index of BPV uncorrelated with average blood pressure levels. Participants underwent T2-FLAIR MRI to determine severity of white matter lesion burden. Severity of lesions was classified as Fazekas scores (0-3). Participants also underwent venipuncture to determine levels of plasma VEGF. Ordinal logistic regression examined the association between BPV and Fazekas scores. Multiple linear regression explored relationships between BPV and VEGF. Models controlled for age, sex, and average blood pressure.Results:Elevated BPV was related to greater white matter lesion burden (i.e., Fazekas score) (systolic: OR = 1.17 [95% CI 1.01, 1.37]; p = .04; diastolic: OR = 2.47 [95% CI 1.09, 5.90]; p = .03) and increased levels of plasma VEGF (systolic: ß = .39 [95% CI .11, .67]; adjusted R2 = .16; p = .007; diastolic: ß = .48 [95% CI .18, .78]; adjusted R2 = .18; p = .003).Conclusions:Findings suggest short-term BPV may be related to cerebrovascular disease burden and angiogenic growth factors relevant to cerebral arterial health, independent of average blood pressure. Understanding the role of BPV in cerebrovascular disease and vascular-endothelial health may help elucidate the increased risk for stroke and dementia associated with elevated BPV.