Group Of Community-dwelling Older Adults Research Articles

Plasma ADAM10 Levels and Their Association with Alzheimer's Disease Diagnosis in Older Adults with Fewer Years of Formal Education.

Low educational attainment is a potential risk factor for Alzheimer's disease (AD) development. Alpha-secretase ADAM10 plays a central role in AD pathology, attenuating the formation of beta-amyloid peptides and, therefore, their aggregation into senile plaques. This study seeks to investigate ADAM10 as a blood-based biomarker in mild cognitive impairment (MCI) and AD in a diverse group of community-dwelling older adults, focusing on those with limited educational attainment. Participants were recruited from public health services. Cognition was evaluated using Mini-Mental State Examination (MMSE) and Addenbrooke's Cognitive Examination - Revised (ACE-R) batteries. Blood samples were collected to analyze plasma ADAM10 levels. A logistic regression was conducted to verify the influence of plasma ADAM10 on the AD diagnosis. Significant differences in age, years of education, prescribed medications, and cognitive test scores were found between the MCI and AD groups. Regarding cognitive performance, both ACE-R and MMSE scores displayed significant differences between groups, with post hoc analyses highlighting these distinctions, particularly between AD and cognitively unimpaired individuals. Elevated plasma ADAM10 levels were associated with a 4.5-fold increase in the likelihood of a diagnosis of MCI and a 5.9-fold increase in the likelihood of a diagnosis of AD. These findings suggest ADAM10 levels in plasma as a valuable biomarker for assessing cognitive status in older individuals with low education attainment. This study underscores the potential utility of plasma ADAM10 levels as a blood-based biomarker for cognitive status, especially in individuals with low educational backgrounds, shedding light on their relevance in AD development and diagnosis.

INCIDENCE AND DYNAMICS OF MOBILITY DEVICE USE AMONG COMMUNITY-DWELLING OLDER ADULTS IN THE UNITED STATES

Abstract Mobility devices significantly enhance the activities and participation for individuals with mobility disability, particularly in the rapidly expanding population of older adults globally. This research reports patterns of mobility device use among community-dwelling older adults in the United States. Using the National Health and Aging Trends Study (NHATS) waves 1-9, data on basic demographics and mobility device use were collected in a nationally representative group of community-dwelling older adults (65+ years old). Mobility device use included canes, walkers, wheelchairs, and scooters. In a total of 47,722 person-years observed in community settings, 2,943 incident mobility device uses over an average of 3.8±3.0 years were identified among 2,591 participants, with an incidence rate of 61.7/1,000 person-year. Participants had an average age of 80.3±7.2 years, with 57.7% female, 70.2% White, 20.1% Black, and 5.7% Hispanic, and 34.6% living alone. The majority (51.3%) of incident mobility device use lasted no longer than one year, and only 18.6% continued for four or more years. The most popular combinations of mobility device types were cane only (44.3%), cane+walker (15.7%), walker only (15.1%), and walker+wheelchair (8.3%). 30.5% of community-dwelling older adults changed their patterns of mobility device use at least once, with the most common changes including cane only to cane+walker (16.4%), cane+walker to cane only (7.97%), walker only to walker+wheelchair (5.2%), and cane+walker to walker only (5.1%). Mobility device use among community-dwelling older adults is dynamic: use of mobility devices involves mostly short bouts and changes frequently, with a preference for a combination of mobility devices.

Adherence to a healthy lifestyle and its association with cognitive impairment in community-dwelling older adults in Shanghai.

There is a growing body of recent literature linking the association of specific or multiple lifestyles with cognitive impairment, but most of these studies have been conducted in Western populations, and it is necessary to study multiple lifestyles and cognitive abilities in different populations, with the primary population of this study being a select group of community-dwelling older adults in Shanghai, China. The sample included 2,390 community-dwelling Chinese participants. Their cognitive function was assessed using the Mini-Mental State Examination (MMSE). We defined a healthy lifestyle score on the basis of being non-smoking, performing ≥210 min/wk moderate/vigorous-intensity physical activity, having light to moderate alcohol consumption, eating vegetables and fruits daily, having a body mass index (BMI) of 18.5-23.9 kg/m2, and having a waist-to-hip ratio (WHR) <0.90 for men and <0.85 for women, for an overall score ranging from 0 to 6. Compared with participants with ≤2 healthy lifestyle factors, the adjusted odds ratio (OR) and 95% confidence interval (CI) for participants with 4, 5, and 6 healthy lifestyle factors were 0.53 (95% CI, 0.29-0.98), 0.40 (95% CI, 0.21-0.75), and 0.36 (95% CI, 0.16-0.79), respectively. Only WHR (OR = 0.54, 95% CI = 0.37-0.78) and physical activity (OR = 0.69, 95% CI = 0.51-0.92) were associated with cognitive impairment. A healthy lifestyle correlated with overall cognition (β = 0.066, orientation (β = 0.049), language ability (β = 0.060), delayed recall (β = 0.045) and executive function (β = 0.044) (P all < 0.05). The study provides evidence on an inverse association between healthy lifestyles and cognitive impairment. We investigated whether healthy lifestyle was related to specific cognitive functions to provide a theoretical basis for accurate clinical prescription.

The Association of Multiple Sensory Impairment and Telomere Length: The Health ABC Study.

The objective of this study was to characterize the associations of sensory impairments, including olfaction (OI), vision (VI), hearing (HI), and touch (TI), with telomere length (TL) in a group of community-dwelling older adults who participated in the Health ABC study. Across 1603 participants, OI was classified with the Brief Smell Identification Test (<11), HI with pure-tone averages (<25 dB), VI with visual acuity (20/50 or worse), and TI with monofilament testing (inability to detect three of four touches). Shorter TL was defined as the lowest quartile of sample TLs. Adjusted multivariable regressions were used to examine the cross-sectional association between the modality, severity, and number of sensory impairments with TL. Participants had an average age of 77.4 ± 2.84 years, and 89.7% (n = 1438) had at least one or more sensory impairments. Severe OI (odds ratio [OR] = 1.73, 95% confidence interval [CI] = [1.19, 2.6]) was independently associated with increased odds of shorter TL. Additionally, having one (OR = 2.79, 95% CI = [1.69, 4.70]), two (OR = 2.5, 95% CI = [1.51, 4.26]), three (OR = 3.04, 95% CI = [1.79, 5.36]), or four impairments (OR = 3.72, 95% CI = [1.52, 7.33]) was associated with increased odds of shorter TL in a dose-dependent manner. Severe OI and TI appear to be particularly robust markers of shortened TL. Additionally, multiple sensory impairment is strongly associated with shortened TL, suggesting that sensory dysfunction may represent a unique biomarker of unhealthy aging. Level II Laryngoscope, 133:3132-3138, 2023.

Prevalence and Risk Score for Hypertonic Dehydration among Community-Dwelling Older Adults: An Analysis of the Bangkok Falls Study

Introduction: Dehydration is associated with morbidity, and many factors affect dehydration in older adults including age and medication use. This study determined the prevalence of hypertonic dehydration (HD) and factors affecting HD in older adults and developed a risk score (a set of consistent weights that assign a numerical value to each risk factor) which is potentially useful in predicting HD among community-dwelling Thai older adults. Methods: Data were obtained from a cohort study of community-dwelling older adults aged ≥60 years in Bangkok, Thailand, between October 1, 2019, and September 30, 2021. Current HD was defined as a serum osmolality >300 mOsm/kg. Univariate and multivariate logistic regression analyses were used to identify factors associated with current and impending HD. The risk score for current HD was developed based on the final multiple logistic regression model. Results: A total of 704 participants were included in the final analysis. In this study, 59 (8.4%) participants had current HD and 152 (21.6%) had impending HD. We identified three risk factors for HD in older adults: age ≥75 years (adjusted odds ratio [aORs] 2.0, 95% confidence interval [CI]: 1.16–3.46), underlying diabetes mellitus (aORs 3.07, 95% CI: 1.77–5.31), and use of β-blocker medication (aORs 1.98, 95% CI: 1.04–3.78). The increasing risks of current HD with increasing risk scores were 7.4% for a score of 1, 13.8% for a score of 2, 19.8% for a score of 3, and 32.8% for a score of 4. Conclusion: One-third of the older adults in this study had current or impending HD. We identified risk factors for HD and created a risk score for HD in one group of community-dwelling older adults. Older adults with risk scores of 1–4 were at 7.4%–32.8% risk for current HD. The clinical utility of this risk score requires further study and external validation.

The influence of vitamin D supplementation and strength training on health biomarkers and chromosomal damage in community-dwelling older adults

Older adults lack of proper physical activity which is often accompanied by vitamin D deficiency. Those factors are known to contribute to health issues in the later years of life. The main goal of this intervention study was to investigate the effect of different vitamin D supplementation strategies for 4 weeks solely or combined with a 10-week strength training program on chromosomal stability in peripheral blood mononuclear cells in community-dwelling older people. One hundred women and men (65–85 years) received either vitamin D3 daily (800 IU), a monthly dose (50.000 IU) or placebo for 17 weeks. All groups received 400 mg calcium daily. The fitness status of the study participants was measured using the 30- second chair stand test, the handgrip strength test and the 6-min walk test. The cytokinesis block micronucleus cytome (CBMN) assay was applied to analyze chromosomal anomalies, including cytotoxic and genotoxic parameters. Changes in antioxidant markers were measured in plasma.Walking distance and chair stand performance improved significantly. Increased levels of the parameters of the CBMN assay were detected for all intervention groups at study end. At baseline micronuclei (MNi) frequency correlated significantly with BMI in both sexes (females: r = 0.369, p = 0.034; males: r = 0.265, p = 0.035), but not with vitamin D serum levels. In females, body fat (r = 0.372, p < 0.001) and functional parameter using the 30-s chair stand test (r = 0.311, p = 0.002) correlated significantly with MNi frequency. Interestingly, not vitamin D supplementation but 10 weeks of resistance training increased MNi frequency indicating elevated chromosomal instability and also adverse effects on antioxidant markers including glutathione and FRAP were detected in the group of community-dwelling older adults.

Know thyself: Executive functioning and sex predict self-appraisal of functional abilities in community-dwelling older adults

Objective: The capacity for accurate self-appraisals of age-related changes in cognitive and functional abilities is integral to the maintenance of independence in later life, yet there is little understanding of the factors that place nondemented older adults at risk for poor self-awareness. This study examined the potential contributions of executive functioning (EF), crystallized intelligence (IQ-Cr), and sex in predicting congruence between performance and self-appraisals of instrumental activities of daily living (IADL) in a group of community-dwelling older adults. Method: A group of 150 nondemented, community-dwelling older adults (White and majority highly educated) completed measures of EF and IQ-Cr. Participants also completed five timed IADL tasks and self-appraised their performance relative to others of similar age. Results: Sex [F(1,148) = 7.75, p = .006, ηp 2 = .05] and EF [(F(1,147) = 5.30, p = .02, ηp 2 = .04)], but not IQ-Cr, predicted the relationship between performance and self-appraisals, such that those with lower EF and those of male sex overestimated their performance more than those with higher EF and females. Conclusions: Findings indicate that having average to below average EF abilities and being of male sex are risk factors for less accurate self-report of IADL abilities and as such might represent important considerations when assessing IADL abilities via self-report among largely independent, community-dwelling older adults.

Identification of Subgroups of Activity Participation in Group of Community-Dwelling Older Adults.

Occupational therapy in public health is advancing for groups of older adults, but few studies have focused on measuring population-based activity engagement. This study aimed to identify subgroups based on the daily activity pattern of community-dwelling older adults. Japanese older adults aged ≥65 years responded to a 128-activity-item questionnaire. Sparse principal component analysis was applied to summarize the activities, and k-means clustering was used to identify subgroups. Respondents were divided into three subgroups (subgroup 1: n = 39, high instrumental/leisure and social/cognitive activity; subgroup 2: n = 51, high instrumental/leisure and low social/cognitive activity; subgroup 3: n = 44, low instrumental/leisure and social/cognitive activity). The three subgroups were associated with sociodemographics (sex, area, education, and activity level) (p < .05). This study highlighted the activity-based subgroups of older adults and provided a novel viewpoint regarding occupation-based community assessments in addition to previous community occupational therapy practice.

Contribuições da participação social para equilíbrio dinâmico, mobilidade e força muscular de diferentes faixas etárias de idosos: um estudo transversal

ABSTRACT This study aimed to investigate the contributions of social participation in health promotion groups and regular physical exercise programs to the physical and functional performance of different age groups of community-dwelling older adults. This is a cross-sectional study including 266 older adults. Physical and functional performances (dependent variables) were characterized based on dynamic balance (alternate step test), mobility (timed up and go test), upper (handgrip dynamometer) and lower limbs muscle strength (Sit-to-stand test). Participants were questioned about active social participation in primary care groups and in physical exercise programs. The data were analyzed by linear regressions. Among individuals aged over 80 years, women participated in less health promotion groups and both sexes practiced less physical exercise. Age combined with regular exercise significantly explained 18.7% of dynamic balance and 22.8% of lower limb muscle strength in women. Despite social participation, for men, age alone explained 11.9% of lower limb strength and 11.5% of mobility. Therefore, social participation in physical exercise programs was a protective factor for these physical and functional differences between women’s age groups. Among men, mobility and lower limb strength performance reduced with aging, regardless of social participation.

COGNITIVE RESERVE, PHYSICAL HEALTH, AND COGNITIVE FUNCTIONING IN OLDER ADULTS

Abstract Prior research has shown positive relationships between cognitive reserve (CR), physical health, and cognition, meaning that higher levels of physical health and CR are associated with higher cognitive functioning and vice versa. A group of community-dwelling older adults (N = 45, mean age = 70.5 years) completed a measure of CR (Life Experiences Questionnaire; LEQ), as well as cognitive tests, with number of physician diagnosed health conditions and number of medications measuring physical health. Initially, we ran correlations with the intention of running a mediation model (physical health factor as the independent variable, LEQ as the mediator, and cognitive test scores as dependent variables). Significant correlations were found between physical health and CR (r = -0.44, p = .01) with a medium effect size, and between CR and some test scores. However, there were no correlations between physical health and cognitive scores. Therefore, using linear regression analyses, the LEQ significantly predicted scores on some tests of executive functioning (DKEFS: Colour-Word Interference Test; Trial 3: F(1,39) = 7.42, p = .010), and processing speed (DKEFS: combined colour naming/reading: F(1,32) = 4.32, p = .046). However, the LEQ did not significantly predict verbal fluency, any set-switching tests, or a set-switching and inhibition test. Additionally, when physical health was added to the model, there was no significant improvement. The results suggest that CR may predict some types of executive functioning test scores, but not other executive functioning tests. Additionally, physical health did not predict cognitive test scores in this sample.

Contributions of early-life cognitive reserve and late-life leisure activity to successful and pathological cognitive aging

BackgroundThe identification of factors that specifically influence pathological and successful cognitive aging is a prerequisite for implementing disease prevention and promoting successful aging. However, multi-domain behavioral factors that characterize the difference between successful and pathological cognitive aging are not clear yet.MethodsA group of community-dwelling older adults (N = 1347, aged 70-88 years) in Beijing was recruited in this cross-sectional study, and a sub-cohort was further divided into successful cognitive aging (SCA, N = 154), mild cognitive impairment (MCI, N = 256), and cognitively normal control (CNC, N = 173) groups. Analyses of variance, regression models with the Shapley value algorithm, and structural equation model (SEM) analyses were conducted to determine specific influencing factors and to evaluate their relative importance and interacting relationships in altering cognitive performance.ResultsWe found that abundant early-life cognitive reserve (ECR, including the level of education and occupational attainment) and reduced late-life leisure activity (LLA, including mental, physical, and social activities) were distinct characteristics of SCA and MCI, respectively. The level of education, age, mental activity, and occupational attainment were the top four important factors that explained 31.6% of cognitive variability. By SEM analyses, we firstly found that LLA partially mediated the relationship between ECR and cognition; and further multi-group SEM analyses showed ECR played a more direct role in the SCA group than in the MCI group: in the SCA group, only the direct effect of ECR on cognition was significant, and in the MCI group, direct effects between ECR, LLA and cognition were all significant.ConclusionsResults of this large-sample community-based study suggest it is important for older adults to have an abundant ECR for SCA, and to keep a high level of LLA to prevent cognitive impairment. This study clarifies the important rankings of behavioral characteristics of cognitive aging, and the relationship that ECR has a long-lasting effect on LLA and finally on cognition, providing efficient guidance for older adults to improve their cognitive function and new evidence to explain the heterogeneity of cognitive aging.

Differential associations between simple physical performance tests with global and specific cognitive functions in cognitively normal and mild cognitive impairment: a cross-sectional cohort study of Asian community-dwelling older adults

BackgroundPhysical performance declines and executive dysfunctions are predictors of dementia. However, their associations are not well understood in Asian older adults without dementia (cognitively normal [CN] and mild cognitive impairment [MCI]), especially in a single study.ObjectiveExamine the associations between physical performance measures with executive function (EF)-based and non-EF-based neurocognitive tests and whether preclinical dementia cognitive status i.e., CN and MCI, moderated these associations.MethodsWe examined cross-sectional cohort of 716 community-dwelling older adults without dementia (CN = 562 and MCI = 154) using multivariable linear regression models. We associated three simple physical performance measures, namely timed-up-and-go (TUG), fast gait speed (FGS), and 30-s chair stand test (30 s-CST), with a comprehensive neurocognitive test battery measuring EF and non-EF cognitive functions. Moderating effects of cognitive status on the associations were examined. In all models, we controlled for pertinent covariates, including age, education, medical and psychiatric status.ResultsUpon controlling for covariates, TUG was most strongly and positively associated with multiple EF-based neurocognitive tests, followed by FGS, with 30 s-CST having the weakest associations. For all physical performance measures, no significant associations with non-EF-based neurocognitive tests were detected. Cognitive status significantly moderated the associations between all physical measures and several neurocognitive tests, with stronger associations in the MCI than CN.ConclusionCompared to FGS and 30 s-CST, TUG had the most robust associations with multiple EF-based cognitive functions. Given their differential associations with global and detailed neurocognitive tests and significant moderating effects of cognitive status, findings highlight a need to carefully consider the choices of simple physical performance tests when using these tests with a heterogenous group of community-dwelling older adults without dementia.

Nutritional risk and its relationship with physical function in community-dwelling older adults

BackgroundMalnutrition is a serious concern in older populations. Simple screening approaches are needed to identify signs of early nutritional risk in older people, to allow intervention before overt malnutrition develops, along with the poorer health outcomes associated with it, such as sarcopaenia and frailty. The main aim of this study was to compare nutrition risk scores, calculated from the DETERMINE Checklist (‘Determine Your Nutritional Health’, also known as the Nutrition Screening Initiative Checklist), with physical function variables in a group of community-dwelling older adults. Another aim was to assess the prevalence of nutrition risk using the DETERMINE and the MUST (Malnutrition Universal Screening Tool).MethodsParticipants of the Hertfordshire Cohort Study (HCS) were recruited and visited at home by a trained researcher. Self-reported physical function was assessed using the SF-36 PF (Short Form-36 Physical Function) scale. The Short Physical Performance Battery (SPPB) was performed, which included the assessment of gait speed, chair rise time and standing balance. Handgrip strength was measured using a Jamar dynamometer. Frailty was assessed according to the presence of at least three of the following Fried frailty criteria: unintentional weight loss, weakness, self-reported exhaustion, slow gait speed and low physical activity. Nutrition risk scores were calculated from the DETERMINE checklist (range 0–21). Nutritional risk was also assessed using the MUST. Analyses were adjusted for sex, age, age left education and number of comorbidities.ResultsIn the study, 176 participants (94 men and 82 women), median age 83.3 (IQR 81.5–85.7) years, were assessed. Almost half (47%) scored either ‘moderate’ (score 3–5) or ‘high’ (score ≥ 6) nutritional risk (9% were at high risk), using the DETERMINE checklist, whereas 8% were at risk using the MUST. Higher nutrition risk scores, calculated from DETERMINE, were associated with poorer self-reported physical function (difference in SF-36 PF score: − 0.36, 95% CI (− 0.60, − 0.12) SD per unit increase in nutrition risk score, P = 0.004) and higher odds of being frail (odds ratio Fried frailty: 2.23, 95% CI (1.15, 4.33), P = 0.017). There were no significant associations between DETERMINE nutrition risk scores and the other variables examined.ConclusionCross-sectional associations between higher nutrition risk scores, assessed from the DETERMINE checklist, and poorer self-reported physical function and greater likelihood of frailty suggest that this screening tool may have utility for screening older populations. Prospective studies are required to explore the ability of the tool to predict poor physical function and frailty, though these data suggest it has potential for early, simple detection of nutritional problems in community-living older adults.

Planning for a Healthy Aging Program to Reduce Sedentary Behavior: Perceptions among Diverse Older Adults.

Reducing prolonged engagement in sedentary behavior is increasingly considered a viable pathway to older-adult health and continued functional ability. Community-based programs that aim to increase physical activity can improve programs’ acceptability by integrating older adults’ perspectives on sedentary behavior and healthy aging into their design. The purpose of this study was to better understand the perceptions of a diverse group of community-dwelling older adults regarding sedentary behavior and its influence on healthy aging. Six focus group discussions with forty-six participants took place across two senior centers in New York City. Self-report questionnaires about daily activity patterns, general health status, and typical sedentary behaviors were also completed by the participants and analyzed using descriptive statistics. The focus group discussions were audio-recorded, transcribed, and analyzed using inductive and deductive approaches and an ecological framework to identify salient themes. A qualitative analysis revealed that the participants were aware of the physical costs of engaging in prolonged sedentary behavior. However, many routine sedentary activities were perceived to be health-promoting and of psychological, cognitive, or social value. The insights gained can inform the development of senior-center programs and health-promotion messaging strategies that aim to reduce older adults’ sedentary behavior.

P095 Epigenetic clocks have the potential to predict future grip strength in males but not females

Abstract Background/Aims Sarcopenia and muscle ageing are associated with substantial morbidity and mortality for the individual and significant costs to healthcare budgets. However, if we can identify those at particular risk of muscle decline it may be possible to intervene, prevent further deterioration and improve the musculoskeletal health of the ageing population. DNA methylation accumulates across the lifecourse and provides the basis for biological clocks, generating a measure of age acceleration (i.e. that an individual is biologically older or younger than their chronological age would suggest). An example is the GrimAge clock which was designed to estimate remaining longevity and thus may potentially represent a novel risk marker for muscle deterioration. We aimed to investigate whether there is an association between methylation-measured age acceleration and future grip strength in a group of community-dwelling older adults. Methods This study is based within the Hertfordshire Cohort Study. At baseline, participants attended research visits where health-related questionnaires were completed and blood samples were collected. DNA was extracted from peripheral blood leukocytes and DNA methylation at CpG sites was measured using the Infinium Human Methylation Beadchip arrays (Illumina Inc., San Diego, CA) (450k, n = 99 and 850k, n = 326). After pre-processing, GrimAge epigenetic age acceleration was measured, using the array-specific publicly available algorithms, and standardised to an SD scale. Grip strength was ascertained using the JAMAR dynamometer at baseline and follow-up. Linear regression was used to examine GrimAge acceleration in relation to grip strength at baseline and follow-up in unadjusted models and those adjusted for age, height and BMI. Results A total of 425 participants (213 males and 212 females) were included in our analyses. The mean age at baseline was 64.1 years (SD 2.6) for males and 65.9 years (SD 2.7) for females. The median follow-up time was 11.6 years (IQR 11.0-12.4) and mean GrimAge at baseline was 58.4 years (SD 5.6). Higher GrimAge acceleration was significantly associated with lower grip strength at baseline (β= -1.43kg [95% CI: -2.39,-0.47] per SD greater age acceleration in univariate model, p &amp;lt; 0.01) in unadjusted and adjusted models and at follow-up (β= -1.25kg [-2.24,-0.26] per SD, p &amp;lt; 0.02). No significant associations were observed in females. Conclusion Our results suggest that greater GrimAge acceleration, as a measure of biological age acceleration, is significantly associated with lower grip strength after approximately a decade of follow-up. However, this association was only observed in males and not in females. The GrimAge clock was designed using methylation surrogates of age-related plasma proteins and smoking pack years, and it may be that the variation in these was more marked in our male population compared to females. Further work is required to investigate and replicate the above association. Disclosure N.R. Fuggle: None. L. Westbury: None. F. Reswan: None. N. Graham: None. N. Kitaba: None. K.A. Ward: None. K.A. Ward: None. N. Harvey: None. J. Holloway: None. E. Dennison: None. C. Cooper: None.

OA22 Machine learning and computer vision of bone microarchitecture can improve the fracture risk prediction provided by DXA and clinical risk factors

Abstract Background/Aims High-resolution peripheral quantitative computed tomography (HR-pQCT) scanning provides such detailed, 3-dimensional reconstructions of the skeleton that the images have been called ‘a virtual bone biopsy’. Traditional analysis of the images results in a multitude of cortical and trabecular parameters which would be potentially cumbersome to interpret for clinicians compared to user-friendly tools such as FRAX®. A computer vision approach, where the entire scan is ‘read’ by a computer algorithm to ascertain fracture risk, would be far simpler. Thus, we investigated whether a computer vision and machine learning technique could improve the current methods of assessing fracture risk. Methods This study was nested in the Hertfordshire Cohort Study, a group of community-dwelling older adults. Participants attended research visits at which height and weight were measured; fracture history was determined via self-report and vertebral fracture assessment. Bone microarchitecture was assessed via HR-pQCT scans of the non-dominant distal tibia (Scanco XtremeCT) and bone mineral density measurement and lateral vertebral assessment were performed using dual X-ray absorptiometry (DXA) (Lunar Prodigy Advanced). Images were cropped and pre-processed and texture analysis was performed using a 3-dimensional local binary patterns method. These analyses, together with age, sex, height, weight, BMI, and dietary calcium, were used in the random-forest classification algorithm. Receiver operating characteristic (ROC) analysis was used to compare fracture risk identification methods. Results Overall, 247 males and 149 females were included in this study with a mean age of approximately 76 years. Using clinical risk factors alone gave an area under the curve (AUC) of 0.70 (95% CI: 0.56-0.84), which improved to 0.71 (0.57-0.85) with the addition of DXA-measured BMD. The addition of the machine learning classifier to clinical risk factors and DXA-measured BMD lead to an improved AUC of 0.90 (0.83-0.96) with a sensitivity of 0.83 and specificity of 0.74. Conclusion The results of this preliminary work demonstrate that using a 3-dimensional computer vision method to HR-pQCT scanning can enhance the identification of those at risk of fracture beyond that afforded by clinical risk factors and DXA-measured BMD. This approach has the potential to make the information offered by HR-pQCT more accessible and applicable to healthcare professionals in the clinic if the technology becomes more widely available. Whilst these findings require replication in other cohorts, they are an early indicator that the application of a machine learning technique to bone microarchitecture could improve fracture prediction and osteoporosis care. Disclosure N.R. Fuggle: None. S. Lu: None. M. Ó Breasail: None. L.D. Westbury: None. K.A. Ward: None. E. Dennison: None. S. Mahmoodi: None. M. Niranjan: None. C. Cooper: None.

Effects of a Nurse-Led Telehealth Self-care Promotion Program on the Quality of Life of Community-Dwelling Older Adults: Systematic Review and Meta-analysis.

BackgroundIn recent years, telehealth has become a common channel for health care professionals to use to promote health and provide distance care. COVID-19 has further fostered the widespread use of this new technology, which can improve access to care while protecting the community from exposure to infection by direct personal contact, and reduce the time and cost of traveling for both health care users and providers. This is especially true for community-dwelling older adults who have multiple chronic diseases and require frequent hospital visits. Nurses are globally recognized as health care professionals who provide effective community-based care to older adults, facilitating their desire to age in place. However, to date, it is unclear whether the use of telehealth can facilitate their work of promoting self-care to community-dwelling older adults.ObjectiveThis review aims to summarize findings from randomized controlled trials on the effect of nurse-led telehealth self-care promotion programs compared with the usual on-site or face-to-face services on the quality of life (QoL), self-efficacy, depression, and hospital admissions among community-dwelling older adults.MethodsA search of 6 major databases was undertaken of relevant studies published from May 2011 to April 2021. Standardized mean differences (SMDs) and their 95% CIs were calculated from postintervention outcomes for continuous data, while the odds ratio was obtained for dichotomous data using the Mantel–Haenszel test.ResultsFrom 1173 possible publications, 13 trials involving a total of 4097 participants were included in this meta-analysis. Compared with the control groups, the intervention groups of community-dwelling older adults significantly improved in overall QoL (SMD 0.12; 95% CI 0.03 to 0.20; P=.006; I2=21%), self-efficacy (SMD 0.19; 95% CI 0.08 to 0.30; P<.001; I2=0%), and depression level (SMD –0.22; 95% CI –0.36 to –0.08; P=.003; I2=89%).ConclusionsThis meta-analysis suggests that employing telehealth in nurse-led self-care promotion programs may have a positive impact on older adults, although more studies are needed to strengthen the evidence base, particularly regarding organization and delivery.Trial RegistrationPROSPERO (Prospective International Register of Systematic Reviews) CRD42021257299; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=257299

Increased Self-Efficacy among Older Adults Aging-in-Place during COVID-19

Sarcopenic obesity increases risk for dysmobility and loss of independence, (Gandham et al., 2021). However, the national burden of sarcopenic obesity and the resultant impacts for older adults has yet to be described. Within a nationally representative sample from the National Health and Aging Trends Study (NHATS), 2066 community-dwelling older adults were obese, representing 12,136,374 individuals in the United States, or 31.8% of all community dwelling older adults. Based on the European Working Group definition, 18% of the obese older adults were sarcopenic. Sarcopenic obese older adults were more likely to have fallen in the last month and been hospitalized over the prior year. After adjusting for age and sex, sarcopenic obese older adults were 3.7 times more likely (95% CI 2.2-5.0) to have 2 or more comorbid conditions and frailty was 6.4 times more likely (95% CI 4.4-9.5) compared to nonsarcopenic obese older adults. Sarcopenic obese older adults were also more likely to have 1+ ADL disabilities (OR 3.7; 95% CI 2.5-5.4). Further, they were more likely to be socially isolated (OR 2.1; 95% CI 1.3-3.2) and report food insecurity (OR 1.5; 95% CI 0.8-2.9). These findings suggest older adults with obesity and sarcopenia have higher rates of geriatric vulnerabilities, which might indicate a need for caution when recommending weight loss alone as an intervention. A more comprehensive intervention may be necessary to address social and physiological risks. Future studies should examine whether early intervention in sarcopenic obese older adults can reduce chronic health risk and preserve independence.

Increased Self-Efficacy among Older Adults Aging-in-Place during COVID-19.

Self-efficacy is defined as a person's belief in their capacity to execute behaviors necessary to produce specific performance attainments. It also reflects confidence in the ability to exert control over motivation, behavior, and environment. During the COVID-19 pandemic, older adults were stressed with forced isolation, concerns over mortality, and finding alternate means of fulfilling their home-based needs. We sought to assess how COVID-19 pandemic affected the self-efficacy of a cohort of older adults aging-in-place. The LITCOG cohort is a group of community-dwelling older adults (65 years and older) who have had longitudinally assessment of cognition, health literacy, and functional skills over the past 15 years. As part of a larger study of the LITCOG cohort assessing decision making for aging-in-place, we assessed self-efficacy using validated PROMIS (Patient-Reported Outcomes Measurement Information System) measures with older adults prior to COVID-19 and during the COVID-19 pandemic. Survey results were obtained from 214 subjects (n=66 pre-COVID and n=148 during COVID). Nearly half of the sample (48.2%) had either marginal (25.5%) or low health literacy (22.7%). PROMIS General Self Efficacy was higher among those assessed during the COVID-19 pandemic (45.8 (7.7) pre-COVID vs 43.7 (8.0), p=0.07). PROMIS Self Efficacy for managing social interactions was higher during the COVID pandemic (45.0 (6.1) pre-COVID-19 vs. 48.7 (8.3) during COVID-19, p=0.02). During the stress and social isolation of the COVID-19 pandemic, older adults exhibited increased levels of self-efficacy. Ongoing longitudinal follow-up will determine how this self-efficacy evolves after the COVID-19 pandemic and impacts the ability to age-in-place.

Nutritional status and body composition in cognitively impaired older persons living alone: The Takashimadaira study.

ObjectivesTo investigate nutritional status and body composition in cognitively impaired older persons living alone.MethodsThis cross-sectional study included 1051 older adults (633 women and 418 men, mean age: 77.1 years) from the Takashimadaira study. The study participants were categorized according to whether they lived alone, which was confirmed via questionnaire, and had cognitive impairment, which was defined as having a Mini Mental State Examination-Japanese score ≤23. Nutritional status was evaluated using the serum albumin level. The fat-free mass index (FFMI) was calculated based on anthropometric and body composition measurements. A logistic regression model with the outcome of a low serum albumin level (serum albumin <4 g/dL) and low FFMI (<16 kg/m2 in men and <14 kg/m2 in women) were used to analyze the data.ResultsThe percentages of participants in the living alone (-)/cognitive impairment (-) group, the living alone (+)/cognitive impairment (-) group, the living alone (-)/cognitive impairment (+) group, and the living alone (+)/cognitive impairment (+) group were 54.8%, 37.3%, 5.6%, and 2.3%, respectively. Compared to the living alone (-)/cognitive impairment (-) group, the living alone (+)/cognitive impairment (+) group was more likely to have a low serum albumin level (adjusted odds ratio = 3.10, 95% confidence interval = 1.31 to 7.33) and low FFMI (adjusted odds ratio = 2.79, 95% confidence interval = 1.10 to 7.06) after adjusting for potential confounders.ConclusionCognitively impaired older adults living alone had poorer nutrition than cognitively normal and cohabitating persons in this study. Our results highlight the importance of paying extra attention to nutritional status for this group of community-dwelling older adults.