Gerontological Research Research Articles

Gerontologic Biostatistics and Data Science: Aging Research in the Era of Big Data.

Introduced in 2010, the sub-discipline of gerontologic biostatistics was conceptualized to address the specific challenges of analyzing data from clinical research studies involving older adults. Since then, the evolving technological landscape has led to a proliferation of advancements in biostatistics and other data sciences that have significantly influenced the practice of gerontologic research, including studies beyond the clinic. Data science is the field at the intersection of statistics and computer science, and although the term "data science" was not widely used in 2010, the field has quickly made palpable impacts on gerontologic research. In this Review in Depth, we describe multiple advancements of biostatistics and data science that have been particularly impactful. Moreover, we propose the sub-discipline of "gerontologic biostatistics and data science", or GBDS, which subsumes gerontologic biostatistics into a more encompassing practice. Prominent GBDS advancements that we discuss herein include cutting-edge methods in experimental design and causal inference, adaptations of machine learning, the rigorous quantification of deep phenotypic measurement, and analysis of high-dimensional -omics data. We additionally describe the need for integration of information from multiple studies and propose strategies to foster reproducibility, replicability, and open science. Lastly, we provide information on software resources for GBDS practitioners to apply these approaches to their own work and propose areas where further advancement is needed. The methodological topics reviewed here aim to enhance data-rich research on aging and foster the next generation of gerontologic researchers.

Kidney Disease Aging Research Collaborative (KDARC): Addressing barriers in geriatric nephrology research.

Kidney Disease Aging Research Collaborative (KDARC): Addressing barriers in geriatric nephrology research.

Validation of the Japanese version of the Patient Health Questionnaire-4 (PHQ-4-J) to screen for depression and anxiety

ObjectiveWe aimed to validate the Japanese version of the Patient Health Questionnaire-4 (PHQ-4-J). People in Japan, especially healthcare workers (HCWs) suffer from high rates of mental health symptoms. The PHQ-4 is an established ultra-brief mental health measure used in various settings, populations and languages. The Japanese version of the PHQ-4 has not been validated.MethodsTwo hundred eighty people in Japan (142 HCWs and 138 from the general public) responded to the PHQ-4-J. Internal consistency, and factorial validity were assessed using confirmatory factor analysis (CFA) and Multiple Indicators Multiple Causes (MIMIC) models.ResultsInternal consistency was high (α = 0.70–0.86). CFA yielded very good fit indices for a two-factor solution (RMSEA = 0.04, 95% CI 0.00–0.17) and MIMIC models indicated the performance differed between HCWs and the general population.ConclusionsThe PHQ-4-J is a reliable ultra-brief scale for depression and anxiety in Japanese, which can be used to meet current needs in mental health research and practice in Japan. Disaster research and gerontology research can benefit from this scale, enabling mental health assessment with little participant burden. In practice, early detection and personalised care can be facilitated by using the scale. Future research should target specific populations in Japan during a non-emergency time.

UNEQUAL AGING: DISPARITIES IN GERIATRIC RESEARCH AND A CALL FOR UNIFIED ACTION

An increase in aging population poses significant challenges which are more pronounced in low- and lower middleincome countries. This editorial explores the multifaceted challenges in geriatric research such as demographic disparities, methodological complexities, ethical concern, challenges in data analysis and underrepresentation in studies with a focus on autoimmune and rheumatic diseases. To effectively address the challenges, a concerted multinational research consortia for the development of universally applicable care model is critical. Methodological advancements, increased funding at individual and institutional levels, and implementation of evidence-based healthcare policy will help in ensuring that the aged worldwide receive comprehensive care.

THE DEVELOPMENT OF GERIATRIC AND ANTI-AGING SCIENTIFIC SCHOOL IN UKRAINE

This manuscript explores the historical development and significance of geriatric and anti-aging research in Ukraine, emphasizing its vital role in advancing global gerontology and geriatrics.The manuscript highlights the multidisciplinary aims of Ukrainian gerontological research, including understanding the biological mechanisms of aging, developing medical treatments for chronic diseases prevalent in older populations, and addressing the social and psychological aspects of aging. It also discusses the challenges of Ukraine’s aging population, such as healthcare policy reform, improved geriatric care integration, and increased funding for aging research. A significant emphasis is placed on incorporating anti-aging studies into medical education. By updating medical curricula to include comprehensive anti-aging education, Ukraine can better prepare future healthcare professionals to meet the evolving needs of its aging population. The manuscript concludes that such educational reforms are crucial for enhancing the effectiveness and sustainability of Ukraine’s healthcare system, ultimately improving the quality of life for older adults and aligning with global trends in aging research.

Advancing Loneliness as a National Health Priority: Results of a Multisectoral Roundtable

Abstract Background Ireland has the highest rates of loneliness of all EU countries. Those in the older old category (aged 80+) are at increased risk of developing loneliness, which is in turn a risk factor for many adverse health outcomes. Ireland has a strong tradition of Irish gerontological loneliness research, and it is critical to now know how best to focus research efforts to mitigate the impact of loneliness on older adults. Methods We held a roundtable discussion on priorities in Irish loneliness research at the Loneliness Taskforce Research Network inaugural event on 16th April 2024. 75 attendees were present, including those from non-governmental organisations, health and social care professionals, experts by lived experience, academic experts, researchers, and representatives from the private sector and governmental agencies. Of seven tables discussing loneliness research priorities, two tables were devoted to the discussion of priorities in research on loneliness in older people (with 18 participants in total). The priorities were noted, then amalgamated and organised. Results There was considerable heterogeneity in priorities raised, with little overlap across the two roundtable outputs. Of particular note was the need to evaluate the many services being delivered across Ireland to reduce loneliness, which operate without an evidence base. Other priorities included: Conclusion Results are informative for those planning future research on loneliness among older adults in Ireland and will form the basis for a report from the Loneliness Taskforce to the Irish Government, who have pledged funding for alleviation of loneliness.

The impact of multidisciplinary geriatric follow-up on quality of life in older, non-surgical prefrail and frail patients with cancer [sbnd] A randomized controlled trial

IntroductionCancer management in older frail patients can be complex, given the high decline in functional status, comorbidity, and limited life expectancy affecting this group of patients. Therefore, this study aimed to investigate whether oncological treatment combined with comprehensive geriatric assessment (CGA) and tailored follow-up interventions improved or maintained quality of life (QoL) in older prefrail and frail patients with cancer. Materials and MethodsA single-center randomized controlled trial included participants aged 70 or older with head, neck, lung, upper gastrointestinal tract, colon, or rectum cancer referred to non-surgical treatment. All participants underwent CGA conducted by a multidisciplinary geriatric team in an outpatient oncological clinic. The team consisted of a geriatrician and a specialized nurse who provided tailored follow-up visits and phone calls within 90 days after randomization. Exclusion criteria were fit patients, referral for specialized palliative care, or participating in another geriatric research program. In patients with well-functioning cognition, QoL was assessed using the EORTC QLQ-C30 and QlQ-ELD-14 questionnaires before and after the intervention. In patients with cognitive impairment, the Overall QoL-Depression List was used. Changes in QoL were dichotomized into improved/unchanged or worsened and analyzed in a logistic regression model. ResultsIn total, 363 participants were included with a mean age of 76 years (SD 4.6) and 45 % were female. Sixty percent in the intervention group had improved or unchanged QoL compared to 66 % in the control group (odds ratio: 0.75 [95 % confidence interval(CI): 0.45–1.23]). Overall, clinically important changes were found in fatigue and reduced worries about the future. The intervention showed improvements in insomnia symptoms and reported decreased role functioning. Discrepancies were found in the burden of illness without a clinically important difference, where the intervention group experienced an increased burden while the control group had a decreased burden (coefficient: 9.02 [95 % CI, 0.49–17.5]). DiscussionMultidisciplinary geriatric follow-up did not universally improve QoL in older frail patients with cancer. However, positive changes in specific aspects of QoL revealed nuanced impacts, warranting further exploration and larger studies to validate these observations. Tailored interventions targeting fatigue, insomnia, and emotional well-being are crucial for improving QoL in this population. Trial RegistrationRegistered in January 2016 at ClinicalTrials.gov (ID: NCT02837679).

An intersectional life course approach to explore the narratives of ageing migrant women

This article aims to demonstrate a concrete example of how to apply an intersectional life course perspective into the study of ageing migrant women. The empirical material is based on a qualitative in-depth interview study conducted with 20 Turkish-born women who have migrated to Sweden in their early to mid-adulthood years. Despite increasing urgings from gerontologists to include intersectionality in studies on migrants, research often neglects how age, gender, and migration status interact, failing to recognise the diverse experiences of racialised older migrants. The analysis shows that the intersection of age, gender and migrancy generates racialised and gendered experiences of later life which renders the women in different positions of power. The analysis also reveals the importance of agential capacity through the mobilisation of resources, negotiation, and resistance. By cross-fertilising two perspectives, the study suggests that intersectional life course could shed light on the experiences of ageing migrant women, thus, sensitising gerontological research to diversity and heterogeneity.

Developing a National Study That Integrates the Geriatric Assessment into the Care of Older Patients with Myeloid Malignancies.

To highlight the priorities in geriatric assessment research in myeloid malignancies and discuss design considerations necessary to ensure research is patient-centric, generalizeable, and high quality. Older adults with myeloid malignancies including those who are perceived to have excellent performance status have multiple functional impairments. These impairments are associated with early mortality. Older adults have different functional trajectories through the course of treatment; this will be further investigated in our ongoing multicenter study. In a single-center study, we have demonstrated the use of geriatric assessment to guide treatment is feasible. Key priorities include designing a multicenter validation study to confirm the role of geriatric assessment in determining treatment tolerance and survival. Such a study should include core geriatric assessment measures and should enroll diverse patient population across various practices. Conducting such a study is necessary to advance patient care and trial design, and to open venues to conduct studies to confirm the role of geriatric assessment in treatment selection.

Histone H3-K27 and H3-K9 methylation does not predict lifespan in divergent populations of Drosophila melanogaster

A universal theory of aging remains elusive despite decades of research. Traditional gerontological research has focused on genetic alterations as the driving unit of the aging processes. Recent breakthroughs in cellular reprogramming, transgenerational epigenetic inheritance, and molecular aging clocks have motivated theories proposing that the disruption of epigenetic regulation is the proximal cause of aging. The claim that aging is fundamentally an epigenetic process, however, is largely based on studies using clonal cell populations and genetically identical organisms. Consequently, there has been limited experimental evidence demonstrating the correlation between epigenetic differences and longevity differences among genetically diverse populations. To address this gap in literature we leveraged laboratory populations of the model organism Drosophila melanogaster. Using sister populations with evolved differences in longevity after more than 1 500 generations of divergent life history selection, we measured the methylation at the H3K27 and H3K9 sites which have previously been shown to become dysregulated with age. Here we report that there were no differences in the amount of H3K27me3 or H3K9me2 between 3 replicate population pairs of the divergent lines. These results do not support that epigenetic dysregulation is the underlying cause of aging. Future studies investigating additional indicators of epigenetic dysregulation are required to clarify the role of epigenetics in aging.

Application of High-Dimensional Propensity Score Methods to the National Health and Aging Trends Study.

High-dimensional propensity scoring (HDPS) is a method for empirically identifying potential confounders within large healthcare databases such as administrative claims data. However, this method has not yet been applied to large national health surveys such as the National Health and Aging Trends Study (NHATS), an ongoing nationally representative survey of older adults in the United States and important resource in gerontology research. In this Research Practice article, we present an overview of HDPS and describe the specific data transformation steps and analytic considerations needed to apply it to national health surveys. We applied HDPS within NHATS to investigate the association between self-reported visual difficulty and incident dementia, comparing HDPS to conventional confounder selection methods. Among 7 207 dementia-free NHATS Wave 1 respondents, 528 (7.3%) had self-reported visual difficulty. In an unadjusted discrete time proportional hazards model accounting for the complex survey design of NHATS, self-reported visual difficulty was strongly associated with incident dementia (odds ratio [OR] 2.34, 95% confidence interval [CI]: 1.95-2.81). After adjustment for standard investigator-selected covariates via inverse probability weighting, the magnitude of this association decreased, but evidence of an association remained (OR 1.44, 95% CI: 1.11-1.85). Adding 75 HDPS-prioritized variables to the investigator-selected propensity score model resulted in further attenuation of the association between visual impairment and dementia (OR 0.94, 95% CI: 0.70-1.23). HDPS can be successfully applied to national health surveys such as NHATS and may improve confounder adjustment. We hope developing this framework will encourage future consideration of HDPS in this setting.

Young Investigator Interview with CSCI Awardee, Dr. Kenneth Rockwood.

[Figure: see text] Dr. Kenneth Rockwood is a Professor of Medicine in the Division of Geriatric Medicine and Neurology and Clinical Research Professor of Frailty and Aging at Dalhousie University, as well as an actively practising geriatric physician. Dr. Rockwood has made significant contributions to geriatric medicine and research, including his involvement in developing the Clinical Frailty Scale. He has been recognized with countless prestigious awards, the most recent being the Distinguished Scientist Award from the Canadian Society for Clinical Investigation.

Undergraduate students engaging in hands-on gerontology research: a participatory case study of value gained and lessons learned

ABSTRACT As the population ages, it is essential that professionals across disciplines have experience and competence working with older adults. Though experiential learning opportunities have been extensively documented as a tool to accomplish this goal, student engagement in gerontology research has not been examined in detail. This participatory case study highlights the perspectives of undergraduate student researchers involved in a hands-on pilot research study that explored connections between cognitive, physical, and everyday function in midlife and older adults while testing the feasibility of a mobile app for early detection of cognitive decline related to Alzheimer’s disease and related dementias. As participants, students (n = 11) completed a survey about their experience and participated in focus groups. As researchers, students and faculty coded open-ended survey and focus group responses. We found that students gained both personal and professional skills from their experience. Emergent themes relevant to their experience included the overarching research lab environment and study-specific conditions related to interpersonal and technical aspects. Although these findings reflect student perspectives in one case, they can be used as a guide to support future endeavors to include undergraduate students as testers in gerontology research.

Impact of Veterans Affairs Geriatric Research, Education, and Clinical Centers: Incubators of innovation in geriatrics.

Since their inception in 1975, the Department of Veterans Affairs Geriatric Research, Education, and Clinical Centers (GRECCs) have served as incubators of innovation in geriatrics. Their contributions to the VA mission were last reviewed in 2012. Herein, we describe the continuing impact of GRECCs in research, clinical, and educational areas, focusing on the period between 2018 and 2022. GRECC research spans the continuum from bench to bedside, with a growing research portfolio notable for highly influential publications. GRECC education connects healthcare professions trainees and practicing clinicians, as well as Veterans and their caregivers, to engaging learning experiences. Clinical advancements, including age-friendly care, span the continuum of care and leverage technology to link disparate geographical sites. GRECCs are uniquely positioned to serve older adults given their alignment with the largest integrated health system in the United States and their integration with academic health centers. As such, the GRECCs honor Veterans as they age by building VA capacity to care for the increasing number of aging Veterans seeking care from VA. GRECC advancements also benefit non-VA healthcare systems, their academic affiliates, and non-Veteran older adults. GRECCs make invaluable contributions to advancing geriatric and gerontological science, training healthcare professionals, and developing innovative models of geriatric care.

ChatGPT's Role in Gerontology Research.

ChatGPT and other ChatBots have emerged as tools for interacting with information in manners resembling natural human speech. Consequently, the technology is used across various disciplines, including business, education, and even in biomedical sciences. There is a need to better understand how ChatGPT can be used to advance gerontology research. Therefore, we evaluated ChatGPT responses to questions on specific topics in gerontology research, and brainstormed recommendations for its use in the field. We conducted semi-structured brainstorming sessions to identify uses of ChatGPT in gerontology research. We divided a team of multidisciplinary researchers into four topical groups: a) gero-clinical science, b) basic geroscience, c) informatics as it relates to electronic health records (EHR), and d) gero-technology. Each group prompted ChatGPT on a theory-, methods-, and interpretation-based question and rated responses for accuracy and completeness based on standardized scales. ChatGPT responses were rated by all groups as generally accurate. However, the completeness of responses was rated lower, except by members of the informatics group, who rated responses as highly comprehensive. ChatGPT accurately depicts some major concepts in gerontological research. However, researchers have an important role in critically appraising the completeness of its responses. Having a single generalized resource like ChatGPT may help summarize the preponderance of evidence in the field to identify gaps in knowledge and promote cross-disciplinary collaboration.

Geriatric Trauma: Identifying Research Gaps and Opportunities for Improvement.

Geriatric trauma is a critical area of research owing to the increasing elderly population and the unique challenges associated with their injuries. This study aimed to explore the intellectual structure, growth, spatial analysis, seminal publications, most frequent keywords, trending topics, conceptual structure, and thematic evolution of geriatric trauma research (GTR).A comprehensive analysis was conducted using VOSviewer (Centre for Science and Technology Studies, Leiden University, The Netherlands) and Biblioshiny (K-Synth Srl, University of Naples Federico II, Italy) to examine a corpus of scholarly publications (N = 682) related to GTR (2004-2024). Bibliographic data were collected from the Scopus database and analyzed to highlight the key findings and trends.The analysis revealed the leading contributors to GTR. Over the years, there has been an increased interest in geriatric trauma, as demonstrated by the increasing trend in research publications. Collaboration patterns among nations were determined through spatial analysis, and insights into significant topics and their influence were offered by influential publications. Keywords used frequently as well as current issues formed part of this study's findings, which give insight into what was most focused on within the GTR. Themes and their development over time were made explicit by revealing their conceptual structures and thematic evolutions.GTR has increased significantly. Interdisciplinary approaches are suggested for future research. Furthermore, gaps need to be addressed using technological advancements that will help improve geriatric trauma management and lead to better patient outcomes.

Public Interest in Research on Aging: Analysis of Altmetric Attention Scores Over 5 Years.

This study pinpoints the areas in gerontological research that have commanded the most public attention as scored by Altmetric. We collected 12,740 outputs published in gerontological journals over 5 years from 2017 to 2022. Next, we identified the top 5% of outputs with the highest Altmetric Attention Scores. After removing duplicate publications and those without an abstract, 588 outputs remained. Our content analysis of the abstracts was conducted deductively and inductively. Theme 1 (50%; N = 293) revolved around "Health and Well-Being" (Theme 1). Theme 2 (28%; N = 164) was about "Health Services, Interventions and Innovations." Theme 3 was about "Informal and Long-Term Care" (13%; N = 80). Theme 4 focused on "Structural Inequalities" affecting older adults (9%; N = 51). Gerontologists should strengthen collaboration with other stakeholders to better engage the public across different age-related issues. These partnerships will enable the creation of initiatives that better serve the needs of aging populations.

A scoping review of geriatric emergency medicine research transparency in diversity, equity, and inclusion reporting.

The intersection of ageism and racism is underexplored in geriatric emergency medicine (GEM) research. We performed a scoping review of research published between January 2016 and December 2021. We included original emergency department-based research focused on falls, delirium/dementia, medication safety, and elder abuse. We excluded manuscripts that did not include (1) original research data pertaining to the four core topics, (2) older adults, (3) subjects from the United States, and (4) for which full text publication could not be obtained. The primary objective was to qualitatively describe reporting about older adults' social identities in GEM research. Secondary objectives were to describe (1) the extent of inclusion of minoritized older adults in GEM research, (2) GEM research about health equity, and (3) feasible approaches to improve the status quo of GEM research reporting. After duplicates were removed, 3277 citations remained and 883 full-text articles were reviewed, of which 222 met inclusion criteria. Four findings emerged. First, race and ethnicity reporting was inconsistent. Second, research rarely provided a rationale for an age threshold used to define geriatric patients. Third, GEM research more commonly reported sex than gender. Fourth, research commonly excluded older adults with cognitive impairment and speakers of non-English primary languages. Meaningful assessment of GEM research inclusivity is limited by inconsistent reporting of sociodemographic characteristics, specifically race and ethnicity. Reporting of sociodemographic characteristics should be standardized across different study designs. Strategies are needed to include in GEM research older adults with cognitive impairment and non-English primary languages.

Exploring the association of physical activity on cognitive function in older adults from observational and genetic insights: a combined NHANES and Mendelian randomization study.

Cognitive function (CF) deterioration is a pressing concern in geriatric research. This study aimed to explore the relationship between physical activity (PA) and CF in older adults. This study adopted a dual approach, employing both observational and genetic approaches through data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014 and Mendelian Randomization (MR) analysis. For the NHANES component, PA levels were evaluated using the Global Physical Activity Questionnaire, and CF was assessed via standardized tests. Multivariate regression, threshold effect analysis, smoothing curve fitting, and subgroup analyses were conducted to examine the association between PA and CF. In parallel, MR methods, using genetic variants as instrumental variables, assessed the causal impact of PA on CF and related conditions such as Alzheimer's disease and dementia. Observational findings from NHANES demonstrated a positive correlation between PA and CF, notably among female participants. The detailed analysis identified specific thresholds of PA that correlate with cognitive enhancements. However, MR results did not support a significant causal relationship between PA and CF or dementia-related outcomes, indicating an absence of a direct genetic basis for the observational associations. Although observational data from NHANES suggest that PA is positively associated with CF in older adults, particularly among women, MR analysis did not confirm these findings as causally related. The discrepancy highlights the complexity of the PA-CF relationship and underscores the need for further research. These results emphasize the potential of PA as a modifiable risk factor for CF, though causal effects remain to be definitively established.

The impact of geriatric-specific variables on long-term outcomes in patients with hepatopancreatobiliary and colorectal cancer selected for resection

BackgroundPreoperative geriatric-specific variables (GSV) influence short-term morbidity in surgical patients, but their impact on long-term survival in elderly patients with cancer remains undefined. Study designThis observational cohort study included patients ≥65 years who underwent hepatopancreatobiliary or colorectal operations for malignancy between 2014 and 2020. Individual patient data included merged ACS NSQIP data, Procedure Targeted, and Geriatric Surgery Research variables. Patients were stratified by age: 65–74, 75–84, and ≥85 and presence of these GSVs: mobility aid, preoperative falls, surrogate signed consent, and living alone. Bivariable and multivariable analyses were used to evaluate 1-year mortality and postoperative discharge to facility. Results577 patients were included: 62.6 % were 65–74 years old, 31.7 % 75–84, and 5.7 % ≥ 85. 96 patients were discharged to a facility with frequency increasing with age group (11.4 % vs 22.4 % vs 42.4 %, respectively, p < 0.001). 73 patients (12.7 %) died during 1-year follow-up, 32.9 % from cancer recurrence. One-year mortality was associated with undergoing hepatopancreatobiliary operations (p = 0.017), discharge to a facility (p = 0.047), and a surrogate signing consent (p = 0.035). Increasing age (p < 0.001), hepatopancreatobiliary resection (p = 0.002), living home alone (p < 0.001), and mobility aid use (p < 0.001) were associated with discharge to a facility. ConclusionGeriatric-specific variables, living alone and use of a mobility aid, were associated with discharge to a facility. A surrogate signing consent and discharge to a facility were associated with 1-year mortality. These findings underscore the importance of preoperative patient selection and optimization, efficacious discharge planning, and informed decision-making in the care of elderly cancer patients.