Diverse Population Of Older Adults Research Articles

A hand-in-hand phenomenon in older adults: Increased risk of frailty in geriatric outpatients associated with handgrip strength asymmetry and weakness

ObjectivesHandgrip strength (HGS) is accepted as a predictor of overall health status and a biomarker of aging, besides negative health outcomes and mortality. While differences in HGS between the dominant and non-dominant hands are expected, substantial discrepancies may signal impaired muscle function. This study aims to investigate whether handgrip asymmetry can serve as a reliable indicator of frailty in a diverse population of older adults. DesignCross-sectional study Setting and participantsA total of 512 patients aged 65 years and older who were admitted to the geriatric medicine outpatient clinic of a university hospital were enrolled in the study. MethodsThe Clinical Frailty Scale (CFS) was used to assess the overall level of frailty of the study population. The highest recorded HGS values from the non-dominant and dominant hand were used to calculate the HGS ratio. Those with a HGS ratio of dominant and non-dominant hand <0.90 or >1.10 were defined as HGS asymmetry. ResultsOf the whole study group, 61.1% was female and the mean age was 73.2 ± 6.1 years. The ratio of the participants living with frailty was 57.6% (n=219). The number of patients with HGS asymmetry was 264 (51.6%), and 48.4% (n=248) of the study population had symmetric HGS. The normal and symmetric HGS was found in 40.2% of the non-frail group, whereas it was 23.7% in patients living with frailty. Furthermore, the ratio of low and asymmetric HGS was 16.3% in the non-frail group, and 35.0% in the patients living with frailty (p<0.001). The presence of asymmetric and low HGS increased the risk of frailty three times independently of other confounding factors (OR:3.08; 95% CI:1.48-6.43; p=0.003). Conclusions and ImplicationsIdentifying HGS asymmetry along with low HGS as potential indicators of frailty may provide clinicians with a clear and quantifiable criterion for assessing older patients.

Preventing cognitive decline by reducing BP target (PCOT): A randomized, pragmatic, multi-health systems clinical trial

BackgroundGrowing evidence suggests that intensive lowering of systolic blood pressure (BP) may prevent mild cognitive impairment (MCI) and dementia. However, current guidelines provide inconsistent recommendations regarding optimal BP targets, citing safety concerns of excessive BP lowering in the diverse population of older adults. We are conducting a pragmatic trial to determine if an implementation strategy to reduce systolic BP to <130 and diastolic BP to <80 mmHg will safely slow cognitive decline in older adults with hypertension when compared to patients receiving usual care. MethodsThe Preventing Cognitive Decline by Reducing BP Target Trial (PCOT) is an embedded randomized pragmatic clinical trial in 4000 patients from two diverse health-systems who are age ≥ 70 years with BP >130/80 mmHg. Participants are randomized to the intervention arm or usual care using a permuted block randomization within each health system. The intervention is a combination of team-based care with clinical decision support to lower home BP to <130/80 mmHg. The primary outcome is cognitive decline as determined by the change in the modified Telephone Interview for Cognitive Status (TICS-m) scores from baseline. As a secondary outcome, patients who decline ≥3 points on the TICS-m will complete additional cognitive assessments and this information will be reviewed by an expert panel to determine if they meet criteria for MCI or dementia. ConclusionThe PCOT trial will address the effectiveness and safety of hypertension treatment in two large health systems to lower BP targets to reduce risk of cognitive decline in real-world settings.

Alzheimer’s disease blood tests of amyloid‐β 42/40, p‐tau217, p‐tau181 and p‐tau205 ratios in a diverse community‐based population: Preliminary results from SEABIR

AbstractBackgroundAlzheimer’s disease (AD) blood tests that can identify and quantify amyloid plaques, tau tangles, and cognitive and clinical decline are needed in clinical practice, including primary care. However, these tests require validation in diverse groups and real‐world settings. The goals of the Study to Evaluate Amyloid in Blood and Imaging Related to Dementia (SEABIRD) were to enroll 1120 participants to determine the accuracy and validity of blood amyloid‐β (Aβ) and phosphorylated tau (p‐tau) tests in a diverse, community‐based sample of older adults compared with amyloid PET, and to explore the impact of key factors (age, race, years of education, cognition, APOE genotype, and medical conditions) on validity estimates.MethodSEABIRD measured blood plasma Aβ42/40 ratio and ratios of phosphorylated to non‐phosphorylated p‐tau217, p‐tau181, and p‐tau205 (%p‐tau) in a diverse population of older adults. In addition, cognitive screening with the AD8® dementia screen and Montreal Cognitive Assessment (MoCA) were obtained. Approximately 25% of participants were selected for amyloid PET and CDR as a reference standard.ResultOf the 859 participants enrolled in this ongoing study, 20.6% self‐identified as Black or African American and the percentage of APOE ε4 carriers was 30.2%, as expected for a population‐based sample (Table 1). For a subset of 76 participants with completed amyloid PET and all blood measures, plasma Aβ42/40 had ROC‐AUC with amyloid PET status of 0.85, %p‐tau217 of 0.97, %p‐tau181 of 0.83, and %p‐tau205 of 0.81 (Figure 1). Spearman correlations with amyloid PET SUVR were ‐0.59 for plasma Aβ42/40, 0.69 for p‐tau217 ratio, 0.43 for p‐tau181 ratio and 0.48 for p‐tau205 ratio.ConclusionThese preliminary results demonstrate that AD blood tests have similar accuracies in a diverse population‐based sample to those reported in AD research cohorts. These findings suggest that rapid screening and diagnosis of amyloid pathology with AD blood tests is possible in a broader population with higher comorbid disease burden and greater diversity than typical AD research cohorts. Screening with AD blood tests could accelerate clinical trial recruitment and increase the representativeness of clinical trial populations, which may improve the generalizability of clinical trial results.

An Alzheimer’s disease blood test study in a diverse community‐based population: Preliminary results from SEABIRD

AbstractBackgroundAlzheimer’s disease (AD) blood tests are needed to aid in the evaluation of dementia, but the performance of these tests should be evaluated in diverse groups and real‐world settings. The goals of the Study to Evaluate Amyloid in Blood and Imaging Related to Dementia (SEABIRD) were to enroll 1120 participants to determine the participant acceptability and validity (relative to amyloid PET) of a plasma amyloid‐β 42/40 test in a diverse, community‐based sample of older adults, and explore the impact of important factors (age, race, education, cognition, APOE genotype, and medical conditions) on the blood test’s performance.MethodSEABIRD measured plasma amyloid‐β 42/40 in a diverse population of older adults in the Saint Louis, Missouri, USA area. Participants completed a blood collection, cognitive screening (AD8® dementia screening interview and Montreal Cognitive Assessment [MoCA]), and a survey about their study experience and perceptions of the blood test. A subset of participants completed additional blood collection for reproducibility, amyloid PET and MRI for validation of the blood test, and the Clinical Dementia Rating® (CDR) for validation of the cognitive screening measures.ResultOf the 859 participants enrolled in this ongoing study, 20.6% self‐identified as Black or African American and the percentage of APOE ε4 carriers was 30.2% (Table 1). Compared to the general population, SEABIRD participants were more likely to be female, aged 70‐79 years, and highly educated. They were less likely to report high cholesterol, diabetes, kidney disease, and stroke, and more likely to report depression. The receiver operating characteristic area under the curve for distinguishing cognitively unimpaired (CDR = 0) from cognitively impaired (CDR&gt;0) individuals was 0.72 for the informant‐rated AD8, 0.46 for the self‐rated AD8, 0.70 for the MoCA, and 0.79 for the AD8/MoCA composite (Table 2). Survey results indicated that the blood test was well accepted (Figure 1), but it was perceived more positively by white and highly educated individuals.ConclusionA study of an AD blood test achieved rapid enrollment, broader diversity than typical AD cohorts, and high rates of participation. These results suggest that an AD blood test could be used for screening in a diverse clinical population.

Determinants and effectiveness of annual wellness visits among Medicare beneficiaries in 2020.

Annual wellness visits (AWVs) have the potential to improve general health and well-being, but little is known about the role of AWVs during the COVID-19 pandemic. We examined the determinants and effectiveness of having an AWV among Medicare beneficiaries in 2020. We employed a cross-sectional study design using data from the 2020 Medicare Current Beneficiary Survey. Our outcomes included AWV utilization, preventive care utilization, health status, and care satisfaction. To examine the determinants for having an AWV, we performed a linear regression model and explored the associations with other individual-level variables (demographic, socioeconomic, and health characteristics). To examine the effectiveness of having an AWV, we performed a linear regression model on each outcome measure while adjusting for individual-level variables. We found that there were several determinants of having an AWV. The four most notable determinants were having a usual source of care, enrolling in Medicare Advantage, being non-Hispanic Black, and being Hispanic. We also found that having an AWV was associated with increases in preventive care use (COVID vaccine, flu shot, pneumonia shot, and blood pressure measurement), but was limited in improving health status and care satisfaction. Our finding raises critical concerns about inequitable access to health care services for disease prevention and health promotion during the pandemic. Furthermore, the effectiveness of AWVs was mostly in increased preventive care use, suggesting a limited role in meeting the wellness needs of a diverse population of older adults.

Factors influencing emotional support of older adults living in the community: a scoping review protocol

BackgroundEmotional support is key to improve older adults’ subjective health, and psychological, social and emotional well-being. However, many older adults living in the community lack emotional support, increasing the risk for loneliness, depression, anxiety, potentially avoidable healthcare use and costs, and premature death. Multiple intersecting factors may influence emotional support of older adults in the community, but these are poorly understood. Studies have focused on specific populations (e.g., older adults with depression, cancer). Although relevant, these studies may not capture modifiable factors for the wider and more diverse population of older adults living in the community. Our scoping review will address these important gaps. We will identify and synthesize the evidence on factors that influence emotional support of older adults in the community.MethodsWe will use the Johanna Briggs Institute updated methodological guidance for the conduct of scoping reviews to guide our review process. We will search MEDLINE, EMBASE, APA Psycinfo, CINAHL, Dissertations and Theses Global, and Scopus from inception. We will include studies published in English, examining factors influencing emotional support of older adults residing in community, without restrictions on the study design or year of publication. We will also include gray literature (dissertations and reports). Two independent reviewers will conduct title, abstract, and full-text screening, as well as risk of bias assessment, using validated quality appraisal tools based on study designs. Discrepancies will be resolved by consensus. The primary reviewer will extract the data from all studies, and the second reviewer will check the extractions of all the studies. We will use descriptive statistics and narrative synthesis for analysis. Family/friend caregivers and older adults involved as an advisory group will help with explaining the findings in terms of whether associations observed reflect their experiences and reality. We will analyze the discussion and generate themes, and summarize in a narrative form.DiscussionThis scoping review may identify factors that could be modified or mitigated to improve emotional support provision for older adults residing in community. The knowledge will inform the development of tailored interventions directed to older adults and their caregivers.Systematic review registrationhttps://doi.org/10.17605/OSF.IO/4TAEB (associated project link: osf.io/6y48t).

What are the Effects of Exercise on Trabecular Microarchitecture in Older Adults? A Systematic Review and Meta-analysis of HR-pQCT Studies.

The objective of this review was to determine the effects of exercise on high-resolution peripheral quantitative computed tomography (HR-pQCT) derived trabecular microarchitecture parameters in older adults. Five electronic databases were systematically searched by two independent reviewers. Inclusion criteria were adults age ≥ 50, any type of exercise as part of the intervention, and trabecular microarchitecture assessed via HR-pQCT. Data was extracted from included studies, and where suitable, included in a meta-analysis. Quality of included studies was appraised. Seven studies (397 participants) were included. All participants were postmenopausal women. Interventions included jumping, whole-body vibration, and power/plyometric training. All studies were rated as either weak or moderate quality. Meta-analysis (5 studies) showed no significant changes in any parameters when considering all exercise or sub-analysing based on type. Exercise was not found to have significant effects on trabecular microarchitecture in postmenopausal women over the age of 50. These findings should be interpreted with caution due to the small number of studies investigating few modes of exercise, their weak to moderate quality, and risk of bias. High-quality studies are needed to determine the effects of additional types of exercise in a more diverse population of older adults, including men.

Association of Habitual Intake of Probiotic Supplements and Yogurt with Characteristics of the Gut Microbiome in the Multiethnic Cohort Adiposity Phenotype Study.

Consumption of probiotics and/or yogurt could be a solution for restoring the balance of the gut microbiota. This study examined associations of regular intake of probiotic supplements or yogurt with the gut microbiota among a diverse population of older adults (N=1,861; 60-72 years). Fecal microbial composition was obtained from 16S rRNA gene sequencing (V1-V3 region). General Linear Models were used to estimate the associations of probiotic supplement or yogurt intake with microbiome measures adjusting for covariates. Compared to non-yogurt consumers (N=1,023), regular yogurt consumers (≥once/week, N=818) had greater Streptococcus (β=0.29, P=0.0003) and lower Odoribacter (β=-0.33, P<0.0001) abundance. The directions of the above associations were consistent across the five ethnic groups but stronger among Japanese Americans (Streptococcus: β=0.56, P=0.0009; Odoribacter: β=-0.62, P=0.0005). Regular intake of probiotic supplements (N=175) was not associated with microbial characteristics (i.e., alpha diversity and the abundance of 152 bacteria genera). Streptococcus is one of the predominant bacteria genera in yogurt products, which may explain the positive association between yogurt consumption and Streptococcus abundance. Our analyses suggest that changes in Odoribacter were independent of changes in Streptococcus abundance. Future studies may investigate whether these microbial genera and their sub-level species mediate potential pathways between yogurt consumption and health.

Changes in COVID-19 Vaccine Intent Among a Diverse Population of Older Adults, June 2021–February 2022

Introduction COVID-19 vaccination rates remain suboptimal in the United States. Clinicians and policymakers need to better understand how likely vaccine-hesitant individuals are to ultimately accept vaccination and what is associated with such changes. This study's aims were to 1) describe changes between vaccine intentions and actual uptake from June 2021 through February 2022, and 2) identify modifiable factors associated with vaccine uptake among those with initial hesitancy. Methods This cohort study included a stratified random sample of adults aged 65 years and older in an integrated health care system. The survey, conducted June through August 2021, elicited intent and perceptions regarding COVID-19 vaccination. Subsequent vaccine uptake through February 2022 was analyzed using electronic health records. Results Of 1195 individuals surveyed, 66% responded; 213 reported not yet having received a COVID-19 vaccine and were further analyzed. At baseline, most individuals said they would definitely not (42%) or probably not (5%) get the COVID-19 vaccine or were not sure (26%). During follow-up, 61 individuals (29%) were vaccinated, including 19% of those who initially said they would definitely not be vaccinated. Among vaccine-hesitant individuals, the rate of vaccination was highest for those who initially considered COVID-19 less dangerous than the vaccine (46%) or named short-term side effects (36%) as their most important concern. Conclusions COVID-19 vaccine intent among older adults was malleable during the pandemic's second year, even among those who initially said they would definitely not be vaccinated. Vaccine uptake could be enhanced by increasing awareness of COVID-19 risks and by addressing vaccine side effects.

Equitable implementation of innovations to promote successful aging in place.

Equitable implementation of innovations to promote successful aging in place.

Medicare's annual wellness visit: 10 years of opportunities gained and lost.

Medicare annual wellness visits (AWV) were initiated 10 years ago. Though AWVs emphasize on disease prevention and health promotion for older adults was a huge step forward, the current "one size fits all" approach does not adequately meet the wellness needs of a diverse population of older adults. Current AWVs do not sufficiently take into consideration the medical, psychological, functional, racial, cultural and socio-economic diversity of older adults. Updated AWVs should be tailored to meet the needs and priorities of older adults receiving them. Several geriatrics approaches to care, including geriatrics Glidepaths and the 4Ms of an Age-Friendly Health System, could help develop and guide a more patient-specific geriatrics focused approach to AWVs. Medicare's IPPE is an ideal time to advise new Medicare beneficiaries regarding what they should and should not do to maximize their ability to be healthy and functionally independent into their 80s, 90s, and 100s.

Induced Pluripotent Stem Cell-Derived Neural Culture Model of Alzheimer’s Disease: A 3D Organoid Approach

Alzheimer’s disease (AD) is a progressive neurologic disorder that impacts a diverse population of older adults. As three-dimensional (3D) models are powerful tools for advancing AD studies, the authors have been developed AD cortical organoids to enable the observation of AD pathology at the cellular, tissue, and organ levels. For creating the model, APPSwe/Ind (APP) and PSEN1 (PS1) mutant genes were transfected into mouse induced pluripotent stem cells (iPSCs) following which the iPSC lines that expressed mutant APP and PS1 proteins were obtained. Then, using modified serum-free suspended embryoid body culture, AD cerebral organoids were made successfully at various ages. The AD model can show AD’s biochemical and pathological alterations, such as overexpressions of Aβ40 and Aβ42 and a decrease of GABAergic interneurons. The proposed model has the potential for implementation in many biomedical applications, including AD drug screening, stem cell transplant, and neuronal tissue engineering.

Psychosocial Protective Factors in Cognitive Aging: A Targeted Review.

The lack of disease-modifying pharmacological agents for dementia highlights the critical importance of prevention, but known modifiable factors (e.g., education, physical health and health behaviors, depression, and social isolation) do not fully represent potential intervention targets. Positive psychosocial factors predict cognitive aging outcomes above and beyond known risk factors and may also correspond to upstream determinants that open up new avenues for prevention and intervention, as well as for reducing racial/ethnic inequalities in dementia. In this brief report, I summarize contemporary evidence for three positive psychosocial factors that appear to be particularly relevant to cognitive aging: perceived control, religious involvement, and social relations. Targeted review and synthesis of published studies. Each of the multidimensional constructs appears to contain "active ingredients" that could help to optimize cognitive aging through disparate mechanisms. Although historically marginalized racial/ethnic groups face disproportionate barriers to accessing certain psychosocial protective factors (e.g., perceived control), these same groups also exhibit naturally occurring sources of psychosocial resilience (e.g., religious involvement) that allow them to achieve better late-life cognitive health than would be otherwise expected. With regard to social relations, converging evidence from disparate studies shows that fostering late-life friendships in particular may have high potential for building cognitive reserve and promoting healthy cognitive aging. Positive psychosocial factors represent culturally relevant resources that, through careful research, could ultimately be harnessed to promote better cognitive aging for a growing and increasingly diverse population of older adults.

Evaluating racial disparities in healthcare system utilization and caregiver burden among older adults with dementia

ABSTRACT Objective: To evaluate racial differences in healthcare utilization and caregiver burden in a culturally diverse population of older adults with dementia. Method: One hundred and thirty-three dyads (person with dementia, PWD and caregiver, CG), with at least one emergency department (ED) visit or hospitalization 12 months prior, were enrolled. Independent sample t-tests and chi-squared analyses were performed to compare racial groups on healthcare utilization and CG burden. Mann–Whitney U test was used for item-level analyses, principal component analysis was used to examine relationships among outcomes, and regressions were used to identify the relationship between race and potential covariates. Results: PWD sample mean age was 79 years, predominantly female, and with high school education. Racial distribution was 65% White and 35% Black. CG sample mean age was 64 years, predominantly female, with more than 12 years of education. No differences were found for age or dementia severity across racial groups. Black PWD experienced more ED and ambulance utilization when compared to White counterparts. Non-emergency hospitalization rates were higher for White PWD. No significant differences were found by race for CG burden total score; however, item-level analysis suggested more anger, reduced social life, uncertainty, and inadequacy in White CGs. Regressions demonstrated a positive relationship between Black race and adult-child CGs with increased ED visits, while dyad educational attainment was associated with hospitalizations independent of race. Conclusions: Healthcare utilization disparities extend to older adults with dementia diagnoses. Our findings suggest that culturally tailored interventions may be appropriate. Future research is encouraged to explore the effect of other covariates.

Addressing Ageism and Ethnocultural Diversity With a Photo Essay Project.

By 2050, the percentage of older adults in the United States will double. By 2060, nonmajority individuals will comprise nearly half of our older adult population. Therefore, nursing students must have learning experiences that prepare them to care for a diverse population of older adults when they enter practice. Photo-elicitation and a photo essay project was initiated in an Aging and Health in Global Communities course in which 75 students created and presented photo essays of a diverse group of older adults. Through spending time with older adults to create a photo essay, students ably portrayed lives rich in meaning and ethnocultural heritage. The natural intersection of aging and diversity that occurred in the photo essays enlightened students to the rich experience of age and the similarities and unique differences in the lives of the older people portrayed. [J Nurs Educ. 2021;60(1):44-47.].

To Prescribe or Deprescribe Statins, That Is the Question

To Prescribe or Deprescribe Statins, That Is the Question

Designing Technology for Aging and Disability

Technology has massive potential to improve the lives of older adults in terms of their health, wellbeing, quality of life, and independence. However, benefits will not be realized unless these technologies are designed considering the needs, abilities, and attitudes of the diverse population of older adults. This is especially true when we consider older adults experiencing physical, sensory, or cognitive impairments that influence their ability to adopt and use technology-based solutions. This symposium highlights a variety of approaches to using technology to support older adults living with disability, and important design considerations. The first talk will highlight the important role technology can play in helping persons with cognitive and /or physical impairment in the workplace. The next talk outlines a framework and methodology designed to provide older adults with hearing or visual impairments the capability to use and adapt digital health tools. This is followed by a discussion of a research agenda to use technology to help older adults experiencing disability as a result of cognitive impairment participate in their community. Then, there will be a discussion of how digital health technologies, when considering their unique needs and abilities, can support older adults with cognitive impairment and dementia. The final talk focuses on the intersection of technology, cognitive impairment, and leisure, and explores engagement with digital games by older adults with and without dementia. Common themes that emerge and future directions will be highlighted.

Identification of Functional, Social, and Health Needs of Older Residents in Nonurban Settings: A Community Risk Assessment.

Objectives: We examined functional, social, and health needs and service delivery gaps among a geographically expansive and economically diverse population of older adults to identify service priorities. Methods: We conducted analyses based on 1280 respondents aged 60years and older surveyed for an 8-county needs assessment. Results: We identified three distinct risk profiles using two-step cluster analysis. ANOVA and chi-square analyses revealed significant differences between risk profiles on a range of health and social service needs. Discussion: Identifying high-risk residents can support community providers' efforts to help older adults age in place. Community-based organizations are well-positioned to respond early to social determinants of health needs. Targeting services and supports that reduce risk, extend independence, and prevent avoidable adverse healthcare situations to improve health and achieve health equity among historically underserved and hard-to-reach populations and prioritizing low-cost community interventions can reduce the need for high-cost interventions (e.g., emergency care and hospitalizations).

Variations Between Adult Day Services Centers in the United States by the Racial and Ethnic Case-Mix of Center Participants.

This is the first nationally representative study to identify differences between adult day services centers, a unique home- and community-based service, by racial/ethnic case-mix: Centers were classified as having a majority of participants who were Hispanic, non-Hispanic Black, or non-Hispanic other race/ethnicities and non-Hispanic White. The associations between racial/ethnic case-mix and geographic and operational characteristics of centers and health and functioning needs of participants were assessed using multivariate regression analyses, using the 2014 National Study of Long-term Care Providers' survey of 2,432 centers. Half of all adult day centers predominantly served racial/ethnic minorities, which were more likely to be for-profit, had lower percentages of self-pay revenue, more commonly provided transportation services, and had higher percentages of participants with diabetes, compared with predominantly non-Hispanic White centers. Findings show differences by racial/ethnic case-mix, which are important when considering the long-term care needs of a diverse population of older adults.

Patient Reported Advance Care Planning Conversations among a Diverse Population of Older Adults with Chronic, Serious Illness: Gaps and Opportunities (GP734)

Author(s): Gelfman, Laura; Volow, Aiesha; Shi, Ying; Goldstein, Nathan; Barnes, Deborah; Sudore, Rebecca