Healthy Community-dwelling Adults Research Articles

The association between adherence to the EAT-Lancet diet and cognitive ageing.

The EAT-Lancet commission has proposed a dietary pattern that is both sustainable and healthy. However, the impact of this diet on cognition in older adults remains unexplored. Therefore, we examined the association between adherence to the EAT-Lancet diet and cognitive ageing. We used data from a previous intervention study involving cognitively healthy community-dwelling adults aged ≥65years. Adherence to the EAT-Lancet diet was calculated using a recently published index and a 190-item food frequency questionnaire. Global and domain-specific cognitive functioning were assessed at baseline and after 2 years using a neuropsychological test battery. Multivariate-adjusted linear regression was conducted to examine associations between EAT-Lancet diet adherence and cognitive functioning (n = 630) and 2-year change (n = 302). Greater adherence to the EAT-Lancet diet was associated with better global cognitive functioning (β per SD = 3.7 points [95% CI]: 0.04 [0.00, 0.08]) and slower rate of decline (β per SD [95% CI]: 0.05 [0.02, 0.08]). With respect to domain-specific functioning, beneficial associations were observed cross-sectionally for executive functioning (P < 0.01), and longitudinally for change in executive functioning (P < 0.01) and attention and working memory (P < 0.01). The degree of adherence to the EAT-Lancet was not associated with (changes in) information processing speed or episodic memory. We demonstrated that greater adherence to the EAT-Lancet diet is associated with better global cognitive functioning and slower cognitive decline among cognitively healthy older adults. Further research is needed to confirm these findings and assess the potential benefits of the EAT-Lancet diet for the ageing population in a broader context.

Association Between Visual Acuity and Prospective Fall Risk in Generally Healthy and Active Older Adults: The 3-Year DO-HEALTH Study

ObjectiveAlthough aging has a strong impact on visual acuity (VA) and falls, their interaction is understudied in generally healthy older adults. This study aimed to examine if and to what extent baseline VA is associated with an increased risk of all and injurious falls over 3 years in generally healthy community-dwelling older adults. DesignObservational analysis of DO-HEALTH, a double-blind, randomized controlled trial. Setting and ParticipantsMulticenter trial with 7 European centers: Zurich, Basel, Geneva (Switzerland), Berlin (Germany), Innsbruck (Austria), Toulouse (France), and Coimbra (Portugal), including 2157 community-dwelling adults aged 70 years and older without any major health events in the 5 years prior to enrollment, sufficient mobility, and good cognitive status. MethodsThe numbers of all and injurious falls were recorded prospectively by diary and in-person assessment every 3 months. Decreased VA at baseline was defined as better-eye VA lower than 1.0. We applied negative binomial regression models for all and injurious falls, adjusted for age, sex, prior falls, treatment allocation, study site, baseline body mass index, and use of walking aids. ResultsAmong the 2131 participants included in this analysis (mean age: 74.9 years, 61.7% were women, 82.6% at least moderately physically active), 1464 (68.7%) had decreased VA. Overall, 3290 falls including 2116 injurious falls were recorded over 3 years. Decreased VA at baseline was associated with a 22% increased incidence rate of all falls [adjusted incidence rate ratio (aIRR) = 1.22, 95% CI 1.07, 1.38, P = .003] and 20% increased incidence rate of injurious falls (aIRR = 1.20, 95% CI 1.05, 1.37, P = .007). Conclusions and ImplicationsOur findings suggest that decreased VA is an independent predictor of an about 20% increased risk of all and injurious falls, highlighting the importance of regular eye examinations and VA measurements for fall prevention, even in generally healthy and active older adults.

Utricular Dysfunction and Hearing Impairment Affect Spatial Navigation in Community-dwelling Healthy Adults: Analysis from the Baltimore Longitudinal Study of Aging.

Spatial navigation, the ability to move through one's environment, is a complex skill utilized in everyday life. The effects of specific vestibular end-organ deficits and hearing impairments on spatial navigation have received little to no attention. We hypothesized that hearing impairment adversely affects spatial navigation and that bi-modal impairments (vestibular and hearing) further impair navigation ability. Data from 182 participants in the Baltimore Longitudinal Study of Aging who had interpretable results for the video head impulse test (vHIT), cervical (cVEMP) and ocular (oVEMP) vestibular evoked myogenic potentials, audiometric testing, and the triangle completion test (TCT) were retrospectively analyzed. Multiple linear regression, controlling for age, sex, and cognition, was employed to identify predictors of TCT performance in terms of end-point error, angle deviation, and distance walked. oVEMP abnormalities were associated with larger end-point error (p=0.008) and larger angle deviation (p=0.002) but were not associated with distance walked (p=0.392). Abnormalities on cVEMP and vHIT were not associated with distance walked (p=0.835, p=0.300), end-point error (p=0.256, p=0.808), or angle deviation (p=0.192, p=0.966). Compared with normal hearing adults, hearing impaired adults walked a shorter distance during the TCT (p=0.049) but had similar end-point error (p=0.302) and angle deviation (p=0.466). There was no interaction between vestibular and hearing function for predicting spatial navigation ability. In this cohort analysis, utricular dysfunction and hearing impairment were associated with poorer spatial navigation performance. We postulate that hearing impairment negatively affects one's ability to use real-time, intrinsic auditory cues and/or prior experience to guide navigation.

Sex differences in the frailty phenotype and mortality in the I-Lan longitudinal aging study cohort

BackgroundFrailty is a common geriatric syndrome related to multiple adverse outcomes. Sex differences in its prevalence and impact on mortality remain incompletely understood.MethodsThis study was conducted with data from the I-Lan Longitudinal Aging Study, in which community-dwelling subjects aged > 50 years without coronary artery disease or diabetes were enrolled. Sex disparities in phenotypically defined frailty and sex–morality predictor interactions were evaluated. Sex- and frailty-stratified analyses of mortality were performed.ResultsThe sample comprised 1371 subjects (51.4% women, median age 61 years). The median follow-up period was 6.3 (interquartile range, 5.8–7.0) years. The frailty prevalence did not differ between men (5.3%) and women (5.8%). Frail individuals were older and less educated and had poorer renal function than did non-frail individuals. Body composition trends differed between sexes, regardless of frailty. Relative to non-frail men, frail men had significantly lower body mass indices (BMIs; 24.5 vs. 23.4 kg/m2, p = 0.04) and relative appendicular skeletal muscle masses (7.87 vs. 7.05 kg/m2, p < 0.001). Frail women had significantly higher BMIs (25.2 vs. 23.9 kg/m2, p = 0.02) and waist circumferences (88 vs. 80 cm, p < 0.001) than did non-frail women. Frailty was an independent mortality predictor for men only [hazard ratio (95% confidence interval) = 3.395 (1.809–6.371), psex–frailty interaction = 0.03].ConclusionFrailty reflected poorer health in men than in women in the present cohort. This study revealed sex disparities in the impact of frailty on mortality among relatively healthy community-dwelling older adults.

Case-Finding for Sarcopenia in Community-Dwelling Older Adults: Comparison of Mini Sarcopenia Risk Assessment with SARC-F and SARC-CalF.

We compared the diagnostic performance of the short five-item and full seven-item Mini Sarcopenia Risk Assessment Questionnaire (MSRA-5 and MSRA-7) against the Strength, Assistance walking, Rise from a chair, Climb stairs, and Falls (SARC-F) and SARC-F with calf circumference (SARC-CalF) scales for sarcopenia in healthy community-dwelling older adults. We conducted a post-hoc cross-sectional secondary data analysis of a prospective cohort study, using data from 230 older adults (mean age 67.2±7.4 years, 92% Chinese, and 73% female) from the "Longitudinal Assessment of Biomarkers for characterization of early Sarcopenia and Osteosarcopenic Obesity in predicting frailty and functional decline in community-dwelling Asian older adults Study" (GeriLABS-2) conducted between December 2017 and March 2019 in Singapore. We performed receiver operating characteristic curve analysis to ascertain the area under the curve (AUC) for sarcopenia diagnosis using the Asian Working Group for Sarcopenia 2019 consensus criteria. We applied the Delong method to compare the AUCs of the four instruments. The MSRA-5 and MSRA-7 demonstrated poor diagnostic performance (AUC of 0.511, 95% confidence interval [CI] 0.433-0.589 and AUC of 0.526, 95% CI 0.445-0.606, respectively), compared to that in SARC-CalF (AUC of 0.739, 95% CI 0.671-0.808) and SARC-F (AUC of 0.564, 95% CI 0.591-0.636). The SARC-CalF demonstrated significantly superior discriminatory ability compared to that in the SARC-F, MSRA-5, and MSRA-7 (all p&lt;0.01). The MSRA-5 demonstrated lower sensitivity (0.464) and specificity (0.597) than in the SARC-CalF (0.661 and 0.738, respectively), whereas the MSRA-7 had higher specificity (0.887) and lower sensitivity (0.145). Conclusions: The poor diagnostic performances of the MSRA-5 and MSRA-7 in our study suggest limitations of self-reported questionnaires for assessing general and dietary risk factors for sarcopenia in healthy and culturally diverse community-dwelling older adults. Studies in different populations are needed to ascertain the utility of the MSRA for the community detection of sarcopenia.

Screening for Executive Impairment in Patients with Frontotemporal Dementia: Evidence from the Greek Version of the Frontier Executive Screen.

The aim of the present study was to adjust the frontier executive screen (FES) for the Greek population, to develop normative data, and to investigate its ability to discriminate patients diagnosed with frontotemporal dementia from healthy individuals. The FES was administered to 142 community-dwelling healthy adults (age: M = 65.9, SD = 8.5; education: M = 10.8, SD = 4.3; sex: 59% female) and 32 patients diagnosed with frontotemporal dementia (age: M = 69.3, SD = 8.6; education: M = 11.7, SD = 4.8; sex: 31% female). Correlation and regression analyses were performed to determine the association between the FES scores, demographic, and clinical characteristics. Cronbach's α coefficient was used to determine internal consistency. Group differences on the FES were examined with independent samples t-test and Mann-Whitney test. Discriminant and ROC analyses were used to determine diagnostic accuracy and to identify the optimal cutoff score for the discrimination between groups. Regression analyses indicated associations between demographic characteristics and FES scores (age: R2 = .08; education: R2 = .33). Internal consistency was marginally acceptable (α = .69). Patients scored lower than healthy participants on the total FES score (d = 1.91) and its three subscores (verbal fluency: η2 = .60; inhibition: η2 = .52; working memory: d = 0.90). The results indicated high diagnostic accuracy (94%) and the optimal cutoff score was 7 (91% sensitivity, 78% specificity). The Greek version of the FES is a useful tool for the brief evaluation of executive functions in patients diagnosed with frontotemporal dementia.

Prevalence of osteoporosis, sarcopenia, and high falls risk in healthy community-dwelling Thai older adults: a nationwide cross-sectional study.

Thailand has transitioned from an aging society to an aged society, which implies that the prevalence of age-related disorders will increase; however, epidemiological data specific to the prevalence of age-related degenerative musculoskeletal disorders among Thai older adults remain limited. Accordingly, the aim of this study was to investigate the prevalence of age-related musculoskeletal diseases, including osteoporosis, sarcopenia, and high falls risk among healthy community-dwelling Thai older adults. This cross-sectional nationwide study enrolled Thai adults aged ≥60yr from 2 randomly selected provinces from each of the 6 regions of Thailand via stratified multistage sampling during March 2021 to August 2022. All enrolled participants were evaluated for BMD, skeletal muscle mass, grip strength, and gait speed. Osteoporosis was diagnosed according to the World Health Organization definition, and sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Falls risk was determined using the self-rated Fall Risk Questionnaire. A total of 2991 eligible participants were recruited. The mean age of participants was 69.2 ± 6.5yr (range: 60-107), and 63.1% were female. The prevalence of osteoporosis, sarcopenia, and high falls risk was 29.7%, 18.1%, and 38.5%, respectively. Approximately one-fifth of subjects (19.1%) had at least 2 of 3 risk factors (ie, osteoporosis, sarcopenia, and high falls risk) for sustaining a fragility fracture, and 3.4% had all 3 risk factors. In conclusion, the results of this study revealed a high and increasing prevalence of osteoporosis, sarcopenia, and high falls risk in healthy community-dwelling Thai older adults. Since these conditions are all major risk factors for fragility fracture, modification of Thailand's national health care policy is urgently needed to address the increasing prevalence of these conditions among healthy community-dwelling older adults living in Thailand.

Acute and Acclimated Effects of Wearing Compression Garments on Balance Control in Community-Dwelling Older Adults.

Falls are very serious health concerns among older adults. Providing additional cutaneous and proprioceptive feedback to older adults may enhance their balance control and therefore reduce the incidents of falls. This study aimed to investigate the acute and acclimated effect of wearing waist-to-above-ankle compression garments (CGs) on balance control in community-dwelling older adults. Thirty-one older adults participated in the study. The Timed Up and Go, Berg Balance Scale, and the Fall Risk Test of the Biodex Balance System were used in a random order to examine balance control in three testing sessions 1week apart. Results indicated wearing CGs had a significant impact on the Timed Up and Go test (p < .001), Berg Balance Scale (p = .001), and the Fall Risk Test (p = .001). For the Timed Up and Go test, participants exhibited significant improvement in both the acute (8.68 vs. 7.91s) and acclimated effect (7.91 vs. 7.41s) of wearing CGs. For the Berg Balance Scale, participants showed significant improvement after wearing CGs for 1week in comparison to the no CGs condition (55.77 vs. 55.39 points). For the Fall Risk Test, participants showed a significant improvement in the acute effect of wearing CGs in comparison to the no CGs condition (1.55° vs. 1.31°). This exploratory study showed that wearing waist-to-above-ankle CGs provided a positive impact on balance control in healthy community-dwelling older adults. It lays the foundation for future studies with a larger sample size to investigate the potential benefits of wearing CGs in individuals with balance control deficits and/or other comorbidities.

Yubi-Wakka Test for Sarcopenia Screening in the Community: Comparative Agreement, Diagnostic Performance and Validity with Calf Circumference Measurements.

Screening tools such as calf circumference (CC) and Yubi-wakka (finger-ring) test have been recognized as effective tools by Asian Working Group for Sarcopenia 2019 (AWGS'19) for sarcopenia screening but their comparative agreement, diagnostic performance and validity are unclear. This study aims to determine: (i)agreement between calf and finger-ring circumference, (ii)diagnostic performance for low muscle mass and AWGS'19 sarcopenia diagnosis, (iii)correlation with muscle mass, strength, and physical performance, and (iv)association with frailty, life space mobility and physical activity. We studied 187 healthy community-dwelling older adults (mean age=66.8+7.0years) from the GERILABS-2 study. CC was measured via (i) both calves in sitting and standing positions, and (ii) Yubi-wakka test by encircling the thickest part of the non-dominant calf with index fingers and thumbs of both hands. We performed Cohen's kappa to check for agreement, area under receiver operating characteristic curve (AUC) to compare diagnostic performance, partial correlations adjusted for age and gender to compare convergent validity, and logistic regression to determine predictive validity for outcome measures. Sarcopenia prevalence was 24.0% (AWGS'19). Yubi-wakka identified 16.6% of participants as screen-positive ("smaller"), showing moderate agreement only with non-dominant sitting CC measurements (k=0.421,p<0.001) and having lower diagnostic performance in determining low muscle mass (AUC=0.591 vs 0.855-0.870,p<0.001; sensitivity=57.1% vs 75.5-90.8%; specificity=58.4% vs 70.8-80.9%) and sarcopenia diagnosis (AUC=0.581 vs 0.788-0.818,p<0.001; sensitivity=55.6% vs 57.5-71.8%; specificity=74.4% vs 75.6-88.9%) compared to CC measurements. Yubi-wakka correlated significantly with muscle mass, grip strength and knee extension but not physical performance. When adjusted for age, gender and hypertension, Yubi-wakka was significantly associated with frailty (OR=3.96,95%CI:1.09-14.38), life space mobility (OR=2.38,95%CI:1.08-5.24) and physical activity (OR=2.50,95%CI:1.07-5.86). Yubi-wakka provides a self-administered, low-cost and practicable community screening tool for sarcopenia. Our study affirmed the convergent and predictive validity of Yubi-wakka, albeit with lower sensitivity and specificity in diagnostic performance compared to CC measurements.

PET OWNERSHIP AND LONGITUDINAL CHANGE IN PSYCHOLOGICAL ADAPTATION – EVIDENCE FROM THE BLSA

Abstract Successful aging depends in part on maintaining psychological adaptation. Research examining the relationship of pet ownership (PO) or human-animal interaction (HAI) to human health supports contributions to psychological status, mostly in populations with diseases or disabilities. We examine the contributions of PO to maintaining psychological adaptation among generally healthy community-dwelling older participants in the Baltimore Longitudinal Study of Aging (BLSA). Participants (N=637, age M=68.3, SD=9.6 years, pet owners N=149) completed assessments of anxiety (Perceived Stress Scale-10), depression (Center for Epidemiological Studies Depression), happiness (1-10 rating) and psychological wellbeing (SF-12 Mental Component Score) every 1-4 years and a 10-year PO history. Linear mixed models with random intercepts were used to examine changes in psychological adaptation outcomes over up to 13 years (M=7.5, SD=3.6) according to time-varying PO. Overall anxiety decreased (b=-0.0360,se=0.0104,p=0.001) and depression increased (b=.099141, se=0.015837, p&amp;lt; 0.001) with aging. Psychological wellbeing (b=0.00055, se=0.00119, p=0.644) and happiness (b=-.00405,se=0.0206,p=0.844) did not change. PO moderated changes in anxiety (b=0.058452,se=0.024376,p=0.017), happiness (b=-0.101373,se=0.04779,p=0.034), and psychological wellbeing (b=-0.005541,se=0.002764,p=0.045), but not depression (b=-0.01134, se=.037065,p=0.769). Anxiety and happiness improved in pet owners and deteriorated in non-owners. Psychological wellbeing deteriorated faster for pet owners than non-owners. This study provides important longitudinal evidence that PO may promote some aspects of psychological adaptation among generally healthy community-dwelling older adults by moderating age-related declines in psychological adaptation later in life. It also highlights differences in psychological responses to animal assisted interventions in residents of care facilities from changes during the life-courses of generally healthy community-residing older adults.

SARC-F and modified versions using arm and calf circumference: Diagnostic performance for sarcopenia screening and the impact of obesity.

SARC-F is limited by low sensitivity for sarcopenia identification. As surrogates of muscle mass, mid-arm circumference (MAC) and/or calf circumference have been proposed as additions to SARC-F to enhance sarcopenia identification. The aim of this study was to evaluate the diagnostic performance of SARC-F, SARC-CalF, SARC-F + MAC, and SARC-CalF + MAC in sarcopenia detection, and to assess the impact of obesity on their diagnostic performance. We studied 230 healthy non-frail community-dwelling older adults age >50 years. We performed receiver operating characteristic curve analysis for SARC-F, SARC-CalF, SARC-F + MAC and SARC-CalF + MAC against sarcopenia diagnosed by the Asian Working Group for Sarcopenia (AWGS) 2019 as the reference standard. Obesity was defined by high waist circumference (men ≥90 cm, women ≥80 cm). We performed subgroup analysis to compare between obese and non-obese groups. The prevalence of sarcopenia was 27.0% by AWGS 2019. SARC-CalF + MAC had the best diagnostic performance (area under the curve [AUC] 0.74, 95% confidence interval [CI] 0.67-0.81; sensitivity 66.1%; specificity 69.1%), followed by SARC-CalF (AUC 0.70, 95% CI 0.62-0.78; sensitivity 21.0%; specificity 95.8%). SARC-F (AUC 0.57, 95% CI 0.49-0.66; sensitivity 0%; specificity 100%) performed significantly worsethan its modified versions (P < 0.05). There was higher accuracy of sarcopenia identification in obese compared with non-obese groups for SARC-F + MAC (AUC 0.75, 95% CI 0.65-0.85 vs. 0.58, 95% CI 0.46-0.70) and SARC-CalF + MAC (AUC 0.75, 95% CI 0.66-0.85 vs. 0.70, 95% CI 0.59-0.81). The addition of arm circumference to SARC-CalF confers better diagnostic accuracy for sarcopenia identification, especially in the obese group. Thus, MAC may complement SARC-CalF for community screening of sarcopenia amongst healthy community-dwelling older adults by increasing sensitivity for the detection of sarcopenic obesity. Geriatr Gerontol Int 2024; 24: 182-188.

Physical and psychological effects of outdoor fitness equipment training on middle-aged and older adults: study protocol of a randomised controlled trial

This project will investigate the effectiveness of an 8-week outdoor fitness equipment (OFE) programme on health parameters in healthy community-dwelling middle and older adults, corresponding to the present paper to...

2459. Prevalence of Nasopharyngeal Carriage of Macrolide and Lincosamide Resistance Genes Among a Household-based cohort of Children and Adults in a Peri-urban Community in Peru

Abstract Background Antibiotic resistant infections commonly occur in healthcare settings, but the prevalence of antibiotic resistant genes (ARGs) in healthy individuals in the community is unknown. We provide an initial assessment of nasopharyngeal carriage of ARGs conferring resistance to macrolides and/or lincosamides, including erm, mph, ABC-F, and lnu genes. Methods Nasopharyngeal swabs were systematically obtained at enrollment and weekly thereafter from children and adults enrolled in a household-based prospective cohort study in Lima, Peru. Samples were sequenced using the Illumina Respiratory Pathogen/ID AMR Panel to detect common respiratory bacteria and ARGs. We defined ‘any erm gene’ (erm) as the detection of any specific erm gene class, ‘any mph gene’ as detection of any specific mph gene class, ‘any ABC-F gene’ as any specific ABC-F gene class, and ‘any lnu gene’ as any specific lnu gene detection. We compared the prevalence of erm, mph, ABC-F and lnu gene colonization at enrollment among age groups (ages 0-4, 5-17, 18-44, and 45+ years) using the Fisher's exact test. We then compared the frequency of co-detection of two or more macrolide or lincosamide ARGs between both pediatric age groups (ages 0-17 years) and both adult age groups (18+ years). Results 114 individuals were included in this analysis (Table 1). At least one macrolide or lincosamide ARG was detected in 61/114 (53.5%) individuals. The prevalence of erm, mph, ABC-F, or lnu gene detection was similar among age groups (Figure 1). Two or more genes were co-detected in 45/114 (39.4%) individuals. Co-detections with two or more erm, mph, ABC-F, or lnu genes were more frequent in children 0-17 years compared to adults 18+ years (p=0.013) (Figure 2). Conclusion Conclusions: These preliminary results indicate that macrolide or lincosamide ARGs were commonly detected in healthy community-dwelling children and adults in Lima, Peru. The prevalence of erm, mph, ABC-F, and lnu genes was similar across age groups, and co-detection of ARGs was more common in children. Future studies will assess changes in ARG carriage over time, transmission among household members, and its clinical relevance. Disclosures Claudio Lanata, MD, MPH, CureVAc AG Germany: Grant/Research Support|HilleVac Inc.: Advisor/Consultant|HilleVac Inc.: Grant/Research Support Carlos G. Grijalva, MD, MPH, AHRQ: Grant/Research Support|CDC: Grant/Research Support|FDA: Grant/Research Support|Merck: Advisor/Consultant|NIH: Grant/Research Support|Syneos Health: Grant/Research Support

Interleukin 10 (IL10) promoter region polymorphism is associated with IL10 serum concentrations and processing speed in healthy community-dwelling older adults

Inflammation is repressed by interleukin 10 (IL10), a potent anti-inflammatory cytokine, and unchecked inflammation can have detrimental effects on cognition. In healthy older adults enrolled in the Australian Research Council Longevity Intervention (ARCLI) cohort we explored whether a known functional single nucleotide polymorphism (SNP) in the promoter region of IL10, −1082 G/A (rs1800896), was associated with reaction times on computerized cognitive testing that included elements of processing speed (i.e., reaction time). Participants were aged 60–75 years (240 females, 158 males), free of dementia and psychiatric disorders, and provide a blood sample. Processing speed was measured using the Swinburne University Computerized Cognitive Assessment Battery (SUCCAB), which includes measures of reaction time (in milliseconds, ms) on six tasks. Blood-derived DNA was genotyped for the IL10 rs1800896 SNP and presence of the APOE E4 allele. General linear models for each SUCCAB subtest were fitted, with age, sex, education (years), APOE E4 carrier status, and IL10 genotype as independent variables. Carriers of the IL10 AA genotype had significantly slower reaction times on multiple tests compared to carriers of the minor allele (AG, GG) and lower IL10 serum levels. Although IL10 SNPs have not been detected in Alzheimer’s disease genome-wide associated studies, these results support further exploration of IL10 mechanisms as a possible resilience factor.

Estimation of reference intervals for physical fitness indicators in healthy community-dwelling older adults

Estimation of reference intervals for physical fitness indicators in healthy community-dwelling older adults

1 Examining Gender Invariance in Repeatable Battery for the Assessment of Neuropsychological Status Learning Ratio

Objective:Process-based measures of verbal learning, such as the recently described learning ratio (LR; Hammers et al., 2022) may add valuable data to neuropsychological assessment. Women tend to have higher episodic verbal memory ability compared to men at all ages, including older adulthood (Golchert et al., 2019; Maitland et al., 2004). However, it is unclear whether gender is related to the process of learning, as quantified through measures of learning slope and ratio. To date only one study has examined this, with Hammers et al. (2021) finding no gender differences on LR in the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS); therefore, further study is necessary. We examined whether men and women differed in LR, learning over time (LOT), and raw learning slope (RLS) in a healthy older adult sample, as well as whether these learning process variables predicted delayed memory equally for men and women.Participants and Methods:203 cognitively healthy community-dwelling adults aged 50 and above (mean age 67.7; 133 women) were taken from a larger archival database; all were administered the RBANS in the context of other studies. LR, LOT, and RLS were calculated from the List Learning task. We examined whether men and women differed in these learning process measures. We then examined whether process measures differentially predicted performance on list recall and delayed memory index (DMI) of the RBANS for men and women.Results:Men and women did not differ in age or years of education. After accounting for age and education, there were no gender differences on LR (p=.455) or RLS (p=.502) but LOT was lower in women (p=.013).LR was equally predictive of list recall across genders (p&lt;.001 for LR; p=.21 for gender). Correlations between LR and list recall were r=.65 (p&lt;.001) for men and r=.56 (p&lt;.001) for women. Both LR (p&lt;.001) and gender (p=.008) predicted DMI but the interaction was nonsignificant. Correlations between LR and DMI were r=.52 for men (p&lt;.001) and r=.46 for women (p&lt;.001).RLS predicted list recall equally across genders (p&lt;.001 for RLS; p=.07 for gender; p=.18 for interaction). Correlations between RLS and list recall were r=.43 for men (p&lt;.001) and r=.23 for women (p=.008). RLS (p&lt;.001) and gender (p=.002; p=.19 for interaction) predicted DMI scores. Correlations between RLS and DMI were r=.31 for men (p=.008) and r=.21 for women (p=.015).LOT predicted list recall equally across genders (p&lt;.001; p=.97 for gender; p=.80 for interaction). Correlations between LOT and list recall were r=-.50 for men (p&lt;.001) and r=-.60 for women (p&lt;.001). LOT also predicted DMI equally across genders (p&lt;.001; p=.084 for gender; p=.159 for interaction). Correlations between LOT and DMI were r=-.46 for men (p&lt;.001) and r=-.49 for women (p&lt;.001).Conclusions:Of the three process variables, LR was the only one that did not show gender differences and was related to delayed memory outcomes with medium to large effect across both genders. Results suggest that LR can be used consistently across genders. As this sample consisted of healthy, independently-living older adults, future study should examine LR by gender in MCI and dementia samples.

4 Comparing Learning Process Variables to Memory Performance and Salivary Cortisol: Is Gender a Moderator of Relationships?

Objective:Learning process variables such as the serial position effect and learning ratio (LR) are predictive of cognitive decline and dementia. Gender differences on memory measures are well documented, but there is inconsistent evidence for gender effects on learning process variables. In the present study, we examined the relationship of serial position and LR to memory performance and to cortisol levels, considering gender as a potential moderator.Participants and Methods:Data were taken from a deidentified dataset of a study on stress and aging in which 123 healthy community-dwelling adults over age 50 completed various assessments. Our analyses included 100 participants (56% female, 93% white, Mage 60.65, Meducation 15.22 years) who completed all measures of interest. LR, primacy effect, and recency effect were calculated from the learning trials of the Auditory Verbal Learning Test (AVLT). Additional memory measures included recall measures from the AVLT and from the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). AUC cortisol was calculated from salivary cortisol samples taken across 6 time points in the study.Results:Women performed better than men on LR, primacy, and traditional memory measures (ps=&lt;.001 to .018) but not on recency (p=.40). LR was moderately correlated with primacy (r=.481, p&lt;.001) and weakly correlated with recency (r=.271, p=.008), after controlling for age, gender, and education. After controlling for age, gender, and education, better LR was related to better memory performance across all measures (rs=.276-.693, ps= &lt;.001-.007) and better recency was related to better performance on all memory measures (rs=.212-.396, ps=&lt;.001-.038). Better primacy was related to better AVLT immediate and delayed recall and RBANS Immediate Memory Index (rs=.326-.532, p&lt;.001) but not RBANS delayed (r=.115, p=.263).Hierarchical linear regressions were conducted to examine gender as a moderator of relationships between learning process variables and memory performance, after accounting for age, gender, and education. There were no gender by LR (ps=.349-.830) or gender by primacy interactions (ps=.124-.671). There was an interaction between gender and recency on AVLT memory measures (ps=.006-.022), but not on RBANS measures (ps=.076-.745). For men, higher recency was related to higher AVLT immediate and delayed recall (rs=.501-.541, ps&lt;.001), but not for women (rs=.-.029-.020, ps=.839-.888), after controlling for age and education. The relationship of AUC salivary cortisol to learning process measures was also moderated by gender (LR/gender interaction p=.055; primacy/gender interaction p=.047; but not recency/gender p=.79). Interestingly, for women, higher cortisol was related to higher LR (r=.16) and higher primacy (r=.36), while for men, it was related to lower LR (r=-.22) and not to primacy (r=-.05). Cortisol was not related to recency (rs=-.04 to -.07).Conclusions:Women performed better on LR and primacy, as well as on other traditional memory variables, but gender did not appear to differentially impact the relationship of LR or primacy to memory outcomes. Findings suggest some differential relationships of recency to memory outcomes by gender. Results also suggested potential gender differences in the relationship of cortisol to learning process variables, but further study is necessary, especially with samples of individuals with memory impairment.

The mindfulness bridge: Exploring education and cognitive performance in older adults with low educational attainment

BackgroundLow literacy is associated with poor cognitive performance and it is a risk factor for dementia. Recently, research suggests an association between levels of mindfulness and cognitive performance of older adults. This study aims to analyze if levels of mindfulness mediate the relationship between years of education and cognitive performance in older adults with low education. MethodsThis is a quantitative, observational, and analytical study whose participants were cognitively healthy community-dwelling older adults. Participants were assessed through a sociodemographic questionnaire, ACE-III, Langer Mindfulness Scale – 21 items, and Geriatric Depression Scale. Descriptive and regression analyses were performed, and the significance level was set at p<0.05. ResultsMean scores for cognitive performance, levels of mindfulness, and depressive symptoms were, respectively, 74.4 (±18), 104 (±17.4), and 2.5 (±1.9). The mediation analysis suggested a total effect of years of education on cognitive performance of 2.29 (p<0.001), a direct effect of years of education on cognitive performance, controlling for levels of mindfulness, of 1.87 (p<0.001), and an indirect effect of years of education on cognitive performance, via levels of mindfulness, of 0.42 (95 % Bias-Corrected and Accelerated Confidence Interval [0.09 to 0.76]). ConclusionOur findings suggested that levels of mindfulness mediate the relationship between years of education and cognitive performance among healthy older adults with low educational attainment.

Metabolic dysfunction-associated steatotic liver disease in older adults is associated with frailty and social disadvantage.

The burden of metabolic dysfunction-associated steatotic liver disease (MASLD) is growing rapidly, as is the number of older adults globally. However, relatively few studies have been performed evaluating the prevalence and risk factors for MASLD in older adults. As such, we aimed to identify the prevalence of MASLD in older adults, as well as sociodemographic, clinical, functional and biochemical associations. The study population included older adults without a history of cardiovascular disease, dementia or independence-limiting functional impairment who had participated in the ASPirin in Reducing Events in the Elderly (ASPREE) randomised trial. MASLD was defined using the Fatty Liver Index (FLI). Associations were identified using Poisson regression with robust variance for FLI ≥ 60 vs FLI < 30. 9097 Australian participants aged ≥70 years had complete biochemical and anthropometric data to identify MASLD. The study population had a mean age of 75.1 ± 4.3 years and was 45.0% male. Almost one-third (33.0%) had prevalent MASLD, and the prevalence decreased with increasing age (adjusted RR [aRR] 0.96, 95% CI: 0.96-0.97). MASLD was also negatively associated with social advantage (aRR 0.94, 95% CI: 0.90-0.99) and exercise tolerance and was positively associated with diabetes mellitus (aRR: 1.22, 95% CI: 1.16-1.29), hypertension (aRR: 1.31, 95% CI: 1.22-1.41), male sex (aRR: 1.66, 95% CI: 1.57-1.74), pre-frailty (aRR: 1.99, 95% CI: 1.82-2.12) and frailty (aRR: 2.36, 95% CI: 2.16-2.56). MASLD and nonalcoholic fatty liver disease (NAFLD) results were 100% concordant. This study in a large cohort of relatively healthy community-dwelling older adults shows that MASLD is common, decreases with age and is associated with poorer metabolic health, social disadvantage and frailty.

S15-4 Challenges in translating research from controlled to real-life settings: preliminary results and evaluation of the “Take your brain for a walk” study

Abstract Purpose Developing strategies to promote healthy cognitive ageing is a priority given the growing ageing population. Recent research has shown that cognitive activity (CA) combined with physical activity (PA) improves cognitive functioning. However, most studies on PA+CA have been conducted in controlled settings, and there is a need for real-life PA+CA interventions. We developed a real-life cognitively enriched walking program “Take your brain for a walk” in co-creation with older adults and experts. Currently, we are conducting a six-month randomized controlled trial (RCT), including an outcome and process evaluation. Methods Participants are cognitively healthy community-dwelling adults aged 65+ years. They were randomly assigned to a: 1) cognitively enriched walking program (PA+CA) (performing cognitive tasks while walking); 2) walking program (PA only); or 3) passive control group. Both walking programs consist of two supervised 60-minute group-based walking sessions per week, with a total duration of six months (October 2022-April 2023). Memory and executive functioning are assessed using the Cambridge Neuropsychological Test Automated Battery at baseline (T0), three months (T1), six months (T2) and twelve months (T3; T1-T3 2023). Furthermore, a mixed-method process evaluation will be implemented based on the framework of Saunders et al. (2005), including a questionnaire and a semi-structured interview for the coaches and participants of the walking programs. Results At baseline, 148 participants were included with a mean age of 70.4 (4.3) years, 70.9% was female. Seventeen participants dropped out in the first 3 months of the study. Three- and six-months effects (data from T0, T1 and T2) of the program on memory and executive functioning will be presented. We expect to see positive changes in cognitive functioning in both the PA+CA and PA arms, with larger effects for the PA+CA arm. Furthermore, the process evaluation results regarding fidelity, dose (delivered or received), satisfaction, adherence and context will be presented. The focus will be on the challenges of research in real-life settings. Conclusions Findings will inform future lifestyle programs to promote cognitive functioning by simultaneously focusing on PA and CA for older adults in real-life settings. Support/Funding Source This project is funded by the Research Foundation Flanders (FWO).