Community-living Adults Research Articles

Nutrition-focused care reduces healthcare costs among community-living adults at malnutrition risk: A simulation economic analysis for Latin America

Nutrition-focused care reduces healthcare costs among community-living adults at malnutrition risk: A simulation economic analysis for Latin America

Assessing rapid spatial working memory in community-living older adults in a virtual adaptation of the rodent water maze paradigm

Aging often leads to a decline in various cognitive domains, potentially contributing to spatial navigation challenges among older individuals. While the Morris water maze is a common tool in rodents research for evaluating allocentric spatial memory function, its translation to studying aging in humans, particularly its association with hippocampal dysfunction, has predominantly focused on spatial reference memory assessments. This study expanded the adaptation of the Morris water maze for older adults to assess flexible, rapid, one-trial working memory. This adaptation involved a spatial search task guided by allocentric cues within a 3-D virtual reality (VR) environment. The sensitivity of this approach to aging was examined in 146 community-living adults from three Chinese cities, categorized into three age groups. Significant performance deficits were observed in participants over 60 years old compared to younger adults aged between 18 and 43. However, interpreting these findings was complicated by factors such as psychomotor slowness and potential variations in task engagement, except during the probe tests. Notably, the transition from the 60 s to the 70 s was not associated with a substantial deterioration of performance. A distinction only emerged when the pattern of spatial search over the entire maze was examined in the probe tests when the target location was never revealed. The VR task's sensitivity to overall cognitive function in older adults was reinforced by the correlation between Montreal Cognitive Assessment (MoCA) scores and probe test performance, demonstrating up to 17 % shared variance beyond that predicted by chronological age alone. In conclusion, while implementing a VR-based adaptation of rodent water maze paradigms in older adults was feasible, our experience highlighted specific interpretative challenges that must be addressed before such a test can effectively supplement traditional cognitive assessment tools in evaluating age-related cognitive decline.

Association Between Restricting Symptoms and Disability After Critical Illness Among Older Adults.

Older adults who survive critical illness are at risk for increased disability, limiting their independence and quality of life. We sought to evaluate whether the occurrence of symptoms that restrict activity, that is, restricting symptoms, is associated with increased disability following an ICU hospitalization. Prospective longitudinal study of community-living adults 70 years old or older who were interviewed monthly between 1998 and 2018. South Central Connecticut, United States. Two hundred fifty-one ICU admissions from 202 participants who were discharged alive from the hospital. None. Occurrence of 15 restricting symptoms (operationalized as number of symptoms and presence of ≥ 2 symptoms) and disability in activities of daily living, instrumental activities of daily living, and mobility was ascertained during monthly interviews throughout the study period. We constructed multivariable Poisson regression models to evaluate the association between post-ICU restricting symptoms and subsequent disability over the 6 months following ICU hospitalization, adjusting for known risk factors for post-ICU disability including pre-ICU disability, frailty, cognitive impairment, mechanical ventilation, and ICU length of stay. The mean age of participants was 83.5 years ( sd , 5.6 yr); 57% were female. Over the 6 months following ICU hospitalization, each unit increase in the number of restricting symptoms was associated with a 5% increase in the number of disabilities (adjusted rate ratio, 1.05; 95% CI, 1.04-1.06). The presence of greater than or equal to 2 restricting symptoms was associated with a 29% greater number of disabilities over the 6 months following ICU hospitalization as compared with less than 2 symptoms (adjusted rate ratio, 1.29; 95% CI, 1.22-1.36). In this longitudinal cohort of community-living older adults, symptoms restricting activity were independently associated with increased disability after ICU hospitalization. These findings suggest that management of restricting symptoms may enhance functional recovery among older ICU survivors.

Psychometric Properties of the Swedish Version of the Person-Place Fit Measure for Older Adults.

Background and Purpose: Possibilities to age in place are increasingly important with the demographic shift toward aging populations. With the Person-Place Fit Measure for Older Adults (PPFM-OA), older adults self-assess how their home and community environments suit their needs. The aim of the study was to evaluate the psychometric properties of the Swedish version of PPFM-OA. Methods: Four hundred sixty community-living adults aged 65 and older answered the PPFM-OA. Rasch model was used for analyses. Results: A reduced 19-item version of PPFM-OA showed sufficient evidence of validity in response processes, internal structure, fairness in testing, and reliability/precision. Conclusions: The reduced version is recommended to use in Sweden to capture person-place fit, an aspect to consider when communities, healthcare, and elder care aim to facilitate aging in place.

Establishing the Predictive Validity of the Assessment of Motor and Process Skills for Driving Performance Outcomes.

Although the Assessment of Motor and Process Skills (AMPS) is an excellent tool for evaluating the functional performance of instrumental activities of daily living (IADLs), a limited number of studies have used the AMPS for decisions regarding the IADL of fitness to drive and community mobility. To determine the specificity and sensitivity of the AMPS as a tool for determining a person's fitness to drive. Cross-sectional observational design. Three driving rehabilitation programs in three states. Participants were 388 community-living adults (M age = 68.74 yr, SD = 11.53); 196 adults were recruited before completing a comprehensive driving evaluation, and 192 were recruited in two other studies of older drivers. AMPS and results of comprehensive driving evaluation or on-road assessment. Using a logistical regression, AMPS Motor and Process Skills scores yielded a sensitivity of 84.6% and a specificity of 88.8%. The odds ratio of the AMPS Motor Skills score was .347; for the AMPS Process Skills score, it was .014. Using cross-validations, the model with AMPS Motor and Process scores produced a cross-validation area under the curve of .918, with sensitivity and specificity of 84.6% and 88.4%, respectively, and a probability greater than .334 was used for predicting a fail or drive-with-restriction evaluation. The AMPS Motor and Process Skills scores revealed significant differences between those who failed or had driving restrictions and with those who passed the driving evaluation, which supported the AMPS as an effective tool for predicting fitness to drive. Plain-Language Summary: This study demonstrates how the Assessment of Motor and Process Skills (AMPS), as a top-down occupational therapy assessment tool, can be used to differentiate between medically at-risk drivers who are likely to pass a comprehensive driving evaluation and those who are likely to fail or need restrictions. AMPS will assist occupational therapy practitioners in determining who is most appropriate to receive driving rehabilitation services and/or when to refer a person for a comprehensive driving evaluation.

In-Shoe Sensor Measures of Loading Asymmetry during Gait as a Predictor of Frailty Development in Community-Dwelling Older Adults.

Clinical walk tests may not predict the development of frailty in healthy older adults. With advancements in wearable technology, it may be possible to predict the development of frailty using loading asymmetry parameters during clinical walk tests. This prospective cohort study aimed to test the hypothesis that increased limb loading asymmetry predicts frailty risk in community-living older adults. Sixty-three independently ambulant community-living adults aged ≥ 65 years were recruited, and forty-seven subjects completed the ten-month follow-up after baseline. Loading asymmetry index of net and regional (forefoot, midfoot, and rearfoot) plantar forces were collected using force sensing insoles during a 10 m walk test with their maximum speed. Development of frailty was defined if the participant progressed from baseline at least one grading group of frailty at the follow-up period using the Kihon Checklist. Fourteen subjects developed frailty during the follow-up period. Increased risk of frailty was associated with each 1% increase in loading asymmetry of net impulse (Odds ratio 1.153, 95%CI 1.001 to 1.329). Net impulse asymmetry significantly correlated with asymmetry of peak force in midfoot force. These results indicate the feasibility of measuring plantar forces of gait during clinical walking tests and underscore the potential of using load asymmetry as a tool to augment frailty risk assessment in community-dwelling older adults.

A call for caution when using network methods to study multimorbidity: an illustration using data from the Canadian Longitudinal Study on Aging

ObjectivesTo examine the impact of two key choices when conducting a network analysis (clustering methods and measure of association) on the number and type of multimorbidity clusters. Study Design and SettingUsing cross-sectional self-reported data on 24 diseases from 30,097 community-living adults aged 45–85 from the Canadian Longitudinal Study on Aging, we conducted network analyses using 5 clustering methods and 11 association measures commonly used in multimorbidity studies. We compared the similarity among clusters using the adjusted Rand index (ARI); an ARI of 0 is equivalent to the diseases being randomly assigned to clusters, and 1 indicates perfect agreement. We compared the network analysis results to disease clusters independently identified by two clinicians. ResultsResults differed greatly across combinations of association measures and cluster algorithms. The number of clusters identified ranged from 1 to 24, with a low similarity of conditions within clusters. Compared to clinician-derived clusters, ARIs ranged from −0.02 to 0.24, indicating little similarity. ConclusionThese analyses demonstrate the need for a systematic evaluation of the performance of network analysis methods on binary clustered data like diseases. Moreover, in individual older adults, diseases may not cluster predictably, highlighting the need for a personalized approach to their care.

Effects of a multicomponent lifestyle modification intervention on liver function, lipid profile, and body composition in adults with elevated hepatic steatosis index

Parallel to the escalating burden of obesity is the steadily increasing prevalence of metabolic dysfunction associated steatotic liver diseases (MASLD), a chronic condition that progresses from simple steatosis to advanced stages of steatohepatitis, fibrosis, and cirrhosis (1-2). MASLD, regarded as the hepatic manifestation of metabolic syndrome is known to be exacerbated by unhealthy lifestyle choices and the presence of comorbidities such as diabetes, dyslipidemia, and obesity (3-4). Therefore, early identification of the general population at risk of MASLD and the development of multicomponent interventions that can prevent the progression of liver damage and mitigate associated adverse cardiometabolic health outcomes are important. Our study aimed to evaluate the effects of a lifestyle modification program on glucose levels, lipid profile, liver function, and body composition measures in community-living adults with elevated hepatic steatosis index in Mumbai, India.Adults (n= 231, mean age 46.1(13.7) years), 58.6% men) were screened for risk of MASLD using a non-invasive screening tool, Hepatic Steatosis Index (HSI) (calculated as (HSI)= 8 x (ALT/AST ratio) +BMI (+2, if female; +2, if diabetes mellitus) (5). Eligible participants with HSI >36 (predictive of the presence of MASLD) were randomized to receive either a multicomponent lifestyle intervention (experimental group, EG) comprising weekly sessions of individualized dietary counseling (Participants having BMI >23kg/m2 (n = 36) received hypocaloric diets with 40% carbohydrates, 40% fat and 30% proteins (WLD) and those having BMI <22.9kg/m2 (n= 22) received weight maintenance diet (WMD) plans including 55% carbohydrates, 15% protein and 30% fats) and fortnightly group sessions of structured exercise and nutrition education or a standard of care package (control group, CG, n= 43) including general healthy eating and activity guidelines for the 8- week study duration. Paired t test and independent sample t tests were used to determine within and between group changes in variables from baseline to endline.Trial Registration: This study is registered as CTRI/2022/05/042927.Overall, the prevalence of MASLD was 52.2%, 32.8% were hypertensive, and 26.7% and 15.4% had diabetes and hypertriglyceridemia respectively. The intervention (WLD) resulted in decreased weight (mean (M)= 3.4 kg, standard error (SE) = 1.88 k, p = 0.02), body fat percent (M = 2.2%, SE = 1.1%, p= 0.042), serum triglycerides (M=28.8mg/dL, SE 8.5mg/dL, p<0.001) and AST (M= 3.8 U/L, SE= 2.2U/L, p <0.05) values. The WMD group reported improvements in serum cholesterol levels, and ALT/ AST ratio as compared to CG (p <0.001). In WMD, HDL-C increased from 45.8 mg/dl to 47.2 mg/dl and the mean AST values reduced from 28.8 (10.6) U/L to 25.6 (9.9) U/L, but these changes were not statistically significant.Multicomponent lifestyle modification programs integrating diet, physical activity and education are effective strategies to improve liver outcomes and optimize cardiometabolic health in people with MASLD.

'Normality in all the abnormality'-Older adults' experiences of holidays and celebrations from the COVID-19 pandemic.

The importance of holidays, traditions, and family celebrations to human culture and occupational engagement has been neglected. The aim of this study was to explore how older adults experienced holidays and celebrations with social and physical distancing during the COVID-19 pandemic. A secondary analysis was made on data from the At-Risk Study. Seventeen community-living adults (11 women and 6 men) aged 71-87 years, from Sweden participated. They were interviewed remotely four times during the first year of the pandemic. Data were analysed with qualitative content analysis. No consumer/community involvement occurred. Three categories on how the participants hoped for, planned, decided, adapted, avoided, and experienced holidays and celebrations with social and physical distancing included expectations and preparations in unpredictable times; the constant need for re-evaluation; and almost everything turned out differently. The desire to celebrate despite pandemic restrictions shows the importance and meaning holidays hold for older adults. Celebrations can be disrupted for many reasons, not only as extreme as the ongoing pandemic. For wellbeing in later life health care, social care, and society need to understand the inherent components and acknowledge ways of supporting participation in occasional events such as holidays, traditions, and family celebrations.

Use of a novel bluetooth-connected device to measure handgrip strength: A practical tool to help healthcare professionals identify adults at nutritional risk

Background and AimsLow muscle strength is strongly tied to poor nutrition status, and nutritional interventions are likewise linked to maintenance and restoration of muscle strength and functional status. Nutrition plays a vital role in muscle mass, strength, and function, and losses in muscle (strength, function, and mass) are associated with poor health outcomes and added costs for healthcare services. For this study of outpatients, the main objective was to identify those at risk for low muscle strength, as evidenced by low handgrip strength (HGS) measures with risk stratified by age and sex. MethodsThis was a two-part study on HGS measures in adults attending outpatient clinics in India. In part one, we conducted HGS tests on dominant and non-dominant hands of patients who qualified for the study. For HGS measures, we used a validated tool, the SQUEGG device, a smart handgrip trainer, along with its companion Bluetooth-connected app, the Muscle Strength Assessment Tool (MSAT) app. In part two, we collected Healthcare Practitioners’ (HCP) feedback via a short digital survey on the use of the SQUEGG device + the MSAT app to do HGS risk screening as an indicator of needed nutritional intervention. ResultsNearly a third of community-living adults in India exhibited low HGS among the 3036 sampled. At each age stratum, dominant-hand HGS in women was lower by 25% to 35% compared to men. Among 353 HCPs, 293 (83%) provided insights via survey, and 85% of surveyed HCPs (n=249) strongly agreed or agreed that the SQUEGG device + MSAT app helped them identify HGS issues among their patients, and 85% (n=248) agreed or strongly agreed they would like to continue using the SQUEGG device + MSAT app to inform their practice. Nearly all surveyed HCPs (98%, n=288) recommended an oral nutritional supplement (ONS) to their patients with identified low HGS. ConclusionsOur findings demonstrate that HCPs would like to continue use of the SQUEGG device + MSAT app as it helped them identify adult patients who had decreased HGS (about 30% of the study population), in turn identifying opportunities to use nutritional interventions such as ONS to address nutrition shortfalls and to restore functional status.

How to achieve delivery of a cardiovascular health intervention in community mental health settings: a process evaluation of Flinders Program using RE-AIM framework

Background, research problem & context: Globally, it is well recorded that adults with severe mental illness (SMI) die 10-20 years earlier than the general population, with cardiovascular disease being recorded as the key contributor to this health inequity. To address this health gap, the Flinders Chronic Condition Self-Management Program (will be referred to as Flinders Programme from here onward) was delivered within an NHMRC-funded randomised controlled trial (RCT) during 2018-2020 among 130 South Australian community-living adults diagnosed with SMI and CVD risk factors. Intervention design: The Flinders Programme is a person-centred care planning approach designed by Flinders University Behavioural Health Unit’s researchers. For this study, the programme aimed to improve the heart health and quality of life of the study participants. Intervention evaluation methods: This study sat alongside the RCT research and employed a longitudinal qualitative methodology underpinned by Roy Bhaskar’s Critical Realism philosophy and ontology. The aim was to understand why, how, and under which contexts the Flinders Program worked (or not). Alongside an outcome evaluation, this study also investigated how the Flinders Programme was delivered. Reach (R), Effectiveness/Efficacy (E), Adoption (A), Implementation/Delivery (I), Maintenance (M) or RE-AIM framework was used to conduct this qualitative process evaluation. Data were collected from 19 trial team members at multiple time points using multiple methods. In total, ten in-depth interviews, two focus group discussions, ten meeting minutes, and five reflective journals were analysed. Data analysis involved a Critical Realist Analysis (CRA) approach. Results & impact: The key findings were organised within the RE-AIM framework: Reach (low recruitment, strategies taken to increase recruitment), Effectiveness (non-specific effects, ‘invisible’ changes such as enhanced awareness, motivation, hope), Adoption (model of care, work atmosphere, the physical structure of the setting), Implementation (preparation, pilot survey, revising study design, actual trial and adaptations, fidelity), Maintenance (self-management capacity, resources, care continuity). Learning for the international audience: This study described the steps taken in delivering the Flinders Programme within a few South Australian metropolitan community mental health settings between the period November 2017 – September 2020. The trial team faced difficulties in fulfilling the recruitment target for the trial. There were a few critical reasons identified- the South Australian community mental health system went through a significant restructuring during the same time, resulting in enormous workload increases in an already resource-scarce sector. Health system-level politics had a direct negative effect on the trial. Besides, improving the cardiovascular health of SMI was not deemed a priority in a system that was struggling to deal with acute mentally ill patients within a crisis-driven system. There was a clear indication that most sites did not have enough clear communication from the trial team before recruitment and throughout the trial period. The next steps: In the future, more preparation, including education sessions among clinicians, are required before delivering such physical health interventions within mental health settings. 

EXAMINING FRAILTY SUBDOMAINS (PHYSICAL, PSYCHOLOGICAL, COGNITIVE, SOCIAL) IN COMMUNITY-LIVING ADULTS 45–85

Abstract Frailty prevalence estimates vary considerably (4.0% to 59.1% in one review). Understanding these differences and what drives frailty among individuals could lead to more focused interventions. Breaking frailty into subdomains and exploring their relationships is one approach to this. A 127-item overall Frailty Index (FI) based on data collected on Canadian Longitudinal Study on Aging (CLSA) Comprehensive Cohort participants (n = 30,097 community-living adults aged 45-85 at baseline) was used to create physical, psychological, cognitive, and social subdomain-specific FIs. Each FI was divided into quintiles with the highest 20% (Q5) considered the frailest. We assessed subdomain FI quintile concordance (Goodman and Kruskal’s gamma), described the joint distribution of those most frail (Q5), and estimated the association between sex and age with Q5 subdomain FIs membership (logistic regression). The concordance among FI subdomain quartiles was low. The highest gammas (0.25-0.36) were between the physical/psychological and psychological/cognition subdomains. Concordance was generally higher in females who had higher odds of Q5 membership for overall (1.5), physical (1.7), psychological (1.6) and social frailty (1.1), and lower odds for cognitive frailty (0.7). The odds of Q5 membership increased with age for overall frailty and all subdomains except psychological frailty, which decreased with age. Our results suggest low concordance among frailty subdomains and the relationship between Q5 membership with sex and age differed by subdomain. These data may help to better target frailty interventions, but longitudinal data are needed to explore both the time course and interrelationships across subdomains.

USING NETWORK ANALYSIS METHODS TO STUDY MULTIMORBIDITY PATTERNS

Abstract Multimorbidity is a risk factor for patient-important outcomes including quality of life and functional decline. Multimorbidity research has focused mainly on disease counts, with less attention to patterns among chronic conditions. Network analysis has been increasingly used to examine multimorbidity clusters, but there are no guidelines for its conduct. In 12 recent studies using network analysis, we found heterogeneity in association measures (10 different measures) and clustering algorithms (5 different methods) used to identify multimorbidity clusters. Using self-reported data on 24 diseases in community-living adults aged 45-85 from the Canadian Longitudinal Study on Aging, we conducted network analyses using the 10 association measures and 5 clustering algorithms to better understand how these choices impact the number and types of clusters identified. We compared the similarity among clusters using the adjusted Rand index (ARI); an ARI of 0 is equivalent to the diseases being randomly assigned to clusters and 1 indicates perfect agreement. Two clinicians independently identified potential disease clusters which we compared to network analyses results. We found results differed greatly across combinations of association measures and cluster algorithms. The number of clusters identified ranged from 1 to 12 and their similarity was generally very low. Compared to clinician-derived clusters, the ARIs ranged from 0 to 0.23 indicating little similarity. These analyses demonstrate the need for a systematic evaluation of the performance of network analysis methods on binary clustered data like diseases. Moreover, diseases may not cluster, and a personalized approach to the care of older adults may be needed.

Factors associated with change in moderate or severe symptoms of anxiety and depression in community-living adults and older adults during the COVID-19 pandemic

ObjectivesFew are the longitudinal studies on the changes in moderate or severe symptoms of anxiety or depression (MSS-ANXDEP) from before to during the COVID-19 pandemic in Canada. The aim was to study the change in MSS-ANXDEP and associated sociodemographic, economic, psychosocial, health behaviour and lifestyle, and clinical factors.MethodsThe current sample includes 59,997 adults aged ≥ 35 years participating in the 2018 and 2020 health surveys of the 5 established cohorts of the Canadian Partnership for Tomorrow’s Health (CanPath). MSS-ANXDEP was based on a cutoff score ≥ 10 on the 7-item Generalized Anxiety Disorder Scale and Patient Health Questionnaire (PHQ-8). Change in MSS-ANXDEP was categorized as follows: no MSS-ANXDEP, remitted, incident, and persistent. Multinomial regressions were used to study MSS-ANXDEP as a function of sociodemographic, economic, psychosocial, health behaviours and lifestyle, and clinical factors.ResultsSociodemographic and economic (i.e. age, gender, cohort, race/ethnicity, lower income, decreased in income, work status, being an essential worker), lifestyle and health behaviours (i.e. smoking, cannabis and alcohol use, drinking more alcohol), psychosocial (i.e. provide help to others, information and instrumental support, and change in relationships with friends, family, and partner) and clinical factors (i.e. lifetime mental disorder and multimorbidity) were associated with remitted, incident, and persistent MSS-ANXDEP.ConclusionHealth and socio-economic factors were associated with changes in symptoms of anxiety and depression during the pandemic, further increasing inequities in mental health needs. Public health campaigns on the importance of healthy behaviours should continue and health policies should reduce economic and social barriers to integrated substance use and mental health care.

Changes in Restricting Symptoms after Critical Illness among Community-Living Older Adults.

Rationale: Survivors of critical illness have multiple symptoms, but how restricting symptoms change after critical illness and whether these changes differ among vulnerable subgroups is unknown. Objectives: To evaluate changes in restricting symptoms over the six months after critical illness among older adults and to determine whether these changes differ by sex, multimorbidity, and individual- and neighborhood-level socioeconomic disadvantage. Methods: From a prospective longitudinal study of 754 community-living adults ⩾70 years old interviewed monthly (1998-2018), we identified 233 admissions from 193 participants to the ICU. The occurrence of 15 restricting symptoms, defined as those leading to restricted activity, were ascertained during interviews in the month before ICU admission (baseline) and each of the six months after hospital discharge. Measurements and Main Results: The occurrence and number of restricting symptoms increased more than threefold in the six months after a critical illness hospitalization (adjusted rate ratio [95% confidence interval], 3.1 [2.1-4.6] and 3.3 [2.1-5.3], respectively), relative to baseline. These increases were largest in the first month after hospitalization (adjusted rate ratio [95% confidence interval], 5.3 [3.8-7.3] and 5.4 [3.9-7.5], respectively] before declining and becoming nonsignificant in the third month. Increases in restricting symptoms did not differ significantly by sex, multimorbidity, or individual- or neighborhood-level socioeconomic disadvantage. Conclusions: Restricting symptoms increase substantially after a critical illness before returning to baseline three months after hospital discharge. Our findings highlight the need to incorporate symptom management into post-ICU care and for further investigation into whether addressing restricting symptoms can improve quality of life and functional recovery among older ICU survivors.

Development and Validation of a Lifespan Prediction Model in Chinese Adults Aged 65Years or Older.

Previous studies investigated factors associated with mortality. Nevertheless, evidence is limited regarding the determinants of lifespan. We aimed to develop and validate a lifespan prediction model based on the most important predictors. A prospective cohort study. A total of 23,892 community-living adults aged 65years or older with confirmed death records between 1998 and 2018 from 23 provinces in China. Information including demographic characteristics, lifestyle, functional health, and prevalence of diseases was collected. The risk prediction model was generated using multivariate linear regression, incorporating the most important predictors identified by the Lasso selection method. We used 1000 bootstrap resampling for the internal validation. The model performance was assessed by adjusted R2, root mean square error (RMSE), mean absolute error (MAE), and intraclass correlation coefficient (ICC). Twenty-one predictors were included in the final lifespan prediction model. Older adults with longer lifespans were characterized by older age at baseline, female, minority race, living in rural areas, married, with healthier lifestyles and more leisure engagement, better functional status, and absence of diseases. The predicted lifespans were highly consistent with observed lifespans, with an adjusted R2 of 0.893. RMSE was 2.86 (95% CI 2.84-2.88) and MAE was 2.18 (95% CI 2.16-2.20) years. The ICC between observed and predicted lifespans was 0.971 (95% CI 0.971-0.971). The lifespan prediction model was validated with good performance, the web-based prediction tool can be easily applied in practical use as it relies on all easily accessible variables.

Comparison of traditional vs. lighter load strength training on fat-free mass, strength, power and affective responses in middle and older-aged adults: A pilot randomized trial

ObjectivesStrength training is widely recommended to improve strength, muscle mass and power. However, the feasibility and potential efficacy of strength training using lighter loads near failure on these outcomes in middle and older-aged adults remains unclear. Methods23 community-living adults were randomized into two groups: Traditional strength training (ST) (8–12 repetitions) or a lighter load, higher repetitions (LLHR) (20–24 repetitions) group. Participants performed a full-body workout (twice a week) with 8 exercises at a perceived exertion of 7–8 (0–10 scale) for 10 weeks. Post-testing was performed by an assessor blinded to group assignments. An analysis of covariance (ANCOVA) was used to examine between group differences using baseline values as a covariate. ResultsThe study involved individuals with a mean age of 59 years, of which 61 % were women. The LLHR group demonstrated a high attendance rate of 92 % (9.5 %) and reported leg press exercise RPE of 7.1 (0.53), along with a session feeling scale of 2.0 (1.7). There was a trivial difference in fat free mass (FFM) favoring LLHR vs ST [0.27 kg 95 % CI (−0.87, 1.42)]. The ST group exhibited superior increases in leg press 1 repetition maximum (1RM) strength [−14 kg (−23, −5)], while the LLHR group showed greater strength endurance increases (65 % 1RM) [8 repetitions (2, 14)]. Leg press power [41 W (−42, 124)] and exercise efficacy [−3.8 (−21.2, 13.5)] demonstrated trivial between-group differences. ConclusionA pragmatic, full-body strength training program with lighter loads taken close to failure appears to be a viable option for promoting muscular adaptations in middle- and older-aged adults. These results are exploratory and require a larger trial for confirmation.

0726 Agreement Between an Electroencephalography-Measuring Headband and Polysomnography in Older Adults with Sleep Disturbances

Abstract Introduction Polysomnography (PSG) is the gold standard for objective sleep measurement but may not reflect habitual sleep patterns, especially in older adults with sleep disturbances. We compared measurements from an electroencephalography(EEG)-measuring headband, averaged over seven nights, to one night of home-based polysomnography. Methods In a prospective, observational study among 33 community-living adults ≥65 years reporting symptoms of insomnia and/or daytime sleepiness ≥once/week, we collected objective measures of total sleep time [TST], sleep latency [SOL], wake after sleep onset [WASO], and sleep efficiency [SE] from an EEG-headband (Dreem; Paris, France) and home-based PSG (NOX-A1 Sleep System; Reykjavik, Iceland). Measures from the EEG-headband were averaged over seven days and compared to measures from one night of PSG. Pearson correlation coefficients compared agreement between the EEG-headband and PSG for TST, SOL, WASO, and SE. Two-sample paired T-tests examined mean differences within subjects for TST, SOL, WASO, and SE between the headband and PSG. Results The mean age was 75 (±6) years, 76% were women, mean scores for the Epworth Sleepiness Scale and Insomnia Severity Index were 6 (±4) and 13 (±4), respectively, and the mean AHI was 19 (±16) events/hr. Correlations for TST, SOL, WASO, and SE between the EEG-headband and PSG were 0.58, 0.51, 0.48, and 0.64, respectively (p values < 0.01). On average, EEG-headband values for objective sleep measures were lower than PSG values. The mean differences for the EEG-headband and PSG within subjects for TST, SOL, WASO, and SE were 25 minutes (p=0.04), 15 minutes (p=0.06), 3 minutes (p=0.74), and 5 percent (p=0.02), respectively. Conclusion Among community-dwelling older adults with insomnia and daytime sleepiness, objective sleep measures from an EEG-headband, averaged over a week, were moderately correlated with values from one night of home-based PSG. While further validation of the EEG-headband is needed, these results suggest it may be inappropriate to infer habitual sleep patterns from PSG measures in older adults with sleep disturbances. Support (if any) Claude D. Pepper Older Americans Independence Center at Yale (P30AG021342), the Patterson Trust, and the National Institute on Aging (R03AG073991, K76AG074905).

0733 The Association of Nocturia and Napping with Obstructive Sleep Apnea Among Older Adults with Insomnia and/or Daytime Sleepiness

Abstract Introduction Obstructive sleep apnea (OSA) is underdiagnosed in older adults (OAs) due to the poor performance of screening questionnaires. Symptoms of nocturia and napping may improve the identification of OSA in this population. We examined the association of these symptoms with OSA in OAs, and whether the association differed by gender. Methods In a prospective, observational study among 39 community-living adults ≥ 65 years reporting symptoms of insomnia and/or daytime sleepiness ≥once/week, we evaluated the association of nocturia and napping with OSA. Nocturia was assessed by the self-reported average number of times getting up to urinate at night. Napping was evaluated by self-reported number of naps/week, average nap duration (in minutes), and napping minutes/week (naps/week x minutes/nap). OSA was assessed by the Apnea Hypopnea Index (AHI) from home-based polysomnography. We used Pearson correlation coefficients to examine the strength of the association of nocturia and napping with AHI among all subjects, and separately in men and women. Results In all participants, the mean age was 74+/- 6.8 years, 72% were women, and the mean AHI was 19+/- 15.9 events/hr. When compared to women, men reported more nocturia (1.6 vs.1.3 episodes/night), more napping (including naps/week [3 vs. 2], nap duration [31 vs.17 minutes], and napping minutes/week [150vs. 55 minutes]). In addition, they had higher AHIs (25 vs.16 events/hr). Among all participants, nocturia was not significantly correlated with AHI, while nap duration and napping minutes/week were significantly correlated with AHI (p values < 0.02). Among 11 men, nap duration and minutes per week were correlated with AHI (correlations 0.74 [p=0.009] and 0.56 [p=0.07], respectively). Among women, no napping characteristics were significantly correlated with AHI. Conclusion Among community-dwelling OAs with insomnia and daytime sleepiness, napping, and not nocturia, was associated with OSA. This association was driven by the strong correlation among men, particularly for nap duration. Napping may be a good screening question for OSA in older men, but examination of other symptoms is warranted in older women. Support (if any) Claude D. Pepper Older Americans Independence Center at Yale School of Medicine (P30AG021342), the Robert E. Leet and Clara Guthrie Patterson Trust, and the National Institute on Aging (R03AG073991, K76AG074905).

The role of social connections and support in the use of emergency care among older adults

ObjectivesLimited and inconsistent findings have been reported on the link between social connections and support and emergency department (ED) visits in older populations. Moreover, the adequacy of informal care for older adults has rarely been considered. This study explored the associations of social connections, social support, and informal care with ED visits in younger-old (<78 years) and oldest-old (≥78 years) adults. MethodsThis is a prospective cohort study based on community-living adults ≥60 years old participating in the Swedish National Study on Aging and Care in Kungsholmen (N=3066 at wave 1, 2001-2004; N=1885 at wave 3, 2007-2010; N=1208 at wave 5, 2013-2016). Standardised indexes were developed to measure social connections, social support, and informal care. The outcome variable was hospital-based ED visits within 4 years of the SNAC-K interview. Associations between exposure variables and ED visits were assessed through negative binomial regressions using generalised estimating equations. ResultsMedium (IRR 0.77; 95% CI 0.59–0.99) and high (IRR 0.77; 95% CI 0.56–0.99) levels of social support were negatively associated with ED visits compared to low levels of social support, but only in oldest-old adults. No statistically significant associations were observed between social connections and ED visits. Higher ED visit rates were seen in oldest-old adults with unmet informal care needs, even if the differences did not reach statistical significance. ConclusionsED visits were associated with social support levels among adults aged ≥78 years. Public health interventions to mitigate situations of poor social support may improve health outcomes and reduce avoidable ED visits in oldest-old adults.