Impairment In Old Age Research Articles

Cognitive Rehabilitation Programme (CRP): An Effective Tool Against Mild Cognitive Impairment Among Elderly

Background: With a steady increase in life expectancy seen worldwide, age-associated cognitive decline and mild cognitive impairment in old age are major public health challenges. Objective: To determine the effectiveness of the Cognitive Rehabilitation Program on cognition parameters in old age people with mild cognitive impairment. Materials and Methods: Design: This study was a quasi-experimental design using a non-equivalent control group pretest post-test design. Setting/Location: Mullana and Adhoya villages of Ambala, Haryana. Subjects: Eighty old age people with mild cognitive impairment. Intervention: The pre- and post-interventional cognition parameters were assessed using Addenbrooke’s cognitive examination on Day 1 and Day 29. The cognitive Rehabilitation Program was administered in the experimental group once a day for 28 days. Outcome Measures: Dependent variables were cognition parameters. Results and Conclusion: In the experimental group, a significant increase in cognition parameters score was observed from Day 1 (62.28 ± 6.23) to Day 29 (63.25 ± 5.10) after administration of the Cognitive Rehabilitation Program. In the comparison group, there was a non-significant decrease in cognition parameters score from Day 1 (56.73 ± 8.24) to Day 29 (55.85 ± 8.90). The post-implementation cognition parameters score of old age people in the experimental group (mean = 63.25) was significantly higher than in the comparison group (mean = 55.85). The mean gain in cognition scores was significantly higher in the experimental group than in the comparison group with a moderate effect size. It is concluded that the cognitive rehabilitation program is an effective tool in improving cognition parameters score among old age people with mild cognitive impairment.

The relationship between playing musical instruments and cognitive trajectories: Analysis from a UK ageing cohort.

The accumulation of age-associated cognitive deficits can lead to Mild Cognitive Impairment (MCI) and dementia. This is a major public health issue for the modern ageing population, as it impairs health, independence and overall quality of life. Keeping the brain active during life has been associated with an increased cognitive reserve, therefore reducing the risk of cognitive impairment in older age. Previous research has identified a potential relationship between musicality and cognition. Explore the relationship between musicality and cognitive function in a large cohort of older adults. This was a nested study within the PROTECT-UK cohort, which collects longitudinal computerised assessments of cognitive function in adults over 40. Participants were invited to complete the validated Edinburgh Lifetime Musical Experience Questionnaire (ELMEQ) to assess their musical experience and lifetime exposure to music. Linear regression analysis was performed using cognitive data from PROTECT-UK. Analysis identified an association between musicality and cognition in this cohort. Playing a musical instrument was associated with significantly better performance in working memory and executive function. Significant associations were also found between singing and executive function, and between overall musical ability and working memory. Our findings confirm previous literature, highlighting the potential value of education and engagement in musical activities throughout life as a means of harnessing cognitive reserve as part of a protective lifestyle for brain health.

Comorbidity of cerebral amyloid angiopathy and Alzheimer's disease. Clinical case analysis

The development of cognitive impairment in old age is often caused by overlapping neurodegenerative and cerebrovascular changes which have a mutually aggravating clinical effect. In recent years, the problem of cerebral amyloid angiopathy (CAA), which is one of the variants of such an interaction, has gained importance. Despite the frequent occurrence of this pathology in the elderly, a unified approach to the treatment of these patients has not yet been developed, especially taking into account the frequent combination with other nosological forms. CAA is a disease associated with both Alzheimer's type neurodegeneration and cerebrovascular pathology. The article presents a clinical case illustrating this situation and discusses the diagnostic algorithm in detail. The characteristics of the pathogenesis and clinical manifestations of CAA and the link between neurodegenerative and cerebrovascular pathologies are discussed.

Long-term environmental enrichment overcomes depression, learning, and memory impairment in elderly CD-1 mice with maternal sleep deprivation exposure.

Early-life stress disrupts central nervous system development and increases the risk of neuropsychiatric disorder in offspring based on rodent studies. Maternal sleep deprivation (MSD) in rodents has also been associated with depression and cognitive decline in adult offspring. However, it is not known whether these issues persist into old age. Environmental enrichment is a non-pharmacological intervention with proven benefits in improving depression and cognitive impairment; however, it is unclear whether these benefits hold for aging mice following MSD exposure. The aim of this study was to explore the effects of MSD on depression and cognition in elderly offspring CD-1 mice and to determine whether long-term environmental enrichment could alleviate these effects by improving neuroinflammation and synaptic plasticity. The offspring mice subjected to MSD were randomly assigned to either a standard environment or an enriched environment. At 18 months of age, the forced swimming and tail suspension tests were used to evaluated depression-like behaviors, and the Morris water maze test was used to evaluate cognitive function. The expression levels of hippocampal proinflammatory cytokines and synaptic plasticity-associated proteins were also measured. MSD increased depression-like behaviors and impaired cognition function in aging CD-1 offspring mice. These effects were accompanied by upregulated interleukin (IL)-1β, IL-6, and tumor necrosis factor-α expression, and downregulated brain-derived neurotrophic factor, tyrosine kinase receptor B, postsynaptic density-95, and synaptophysin expression in the hippocampus. All of these changes were reversed by long-term exposure to an enriched environment. These findings suggest that MSD exerts long-term effects on the behaviors of offspring in mice, leading to depression and cognitive impairment in older age. Importantly, long-term environmental enrichment could counteract the behavior difficulties induced by MSD through improving hippocampal proinflammatory cytokines and synaptic plasticity-associated proteins.

Correlation between serum lipid profiles and cognitive impairment in old age: a cross-sectional study

BackgroundThe correlation between cognitive function and lipid profiles, including total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides, is inconsistent.AimsThis cross-sectional study investigated the association between serum...

Creativity across the lifespan: changes with age and with dementia

BackgroundIt is well known that older age is associated with losses in cognitive functioning. Less is known about the extent to which creativity is changing with age or dementia. Aim of the current study was to gain more insights into psychometric aspects of creativity in younger and older people as well as people with dementia.MethodOur sample comprised three groups, (1) participants between age 18—30 years (n = 24), (2) participants 65 + years without cognitive impairment (n = 24), and (3) participants 65 + years with cognitive impairment / dementia (n = 23). Cognitive abilities were assessed via the Standard Progressive Matrices Test (SPM), Montreal Cognitive Assessment Test (MoCa), and Trail Making Test (TMT). Creativity was assessed via the Creative Reasoning Task (CRT), Test of Creative Thinking-Drawing Production (TCT-DP), and Alternate Uses Task (AUT).ResultsCompared to younger people, older people scored significantly lower in only two out of eleven creativity sub-scores (one in the CRT and one in the TCT-DP). Performance in the SPM was significantly associated with these two sub-scores and age. Cognitively impaired older people had significantly lower scores in the creativity task AUT compared to cognitively healthy older people and younger people. The associations between MoCa and AUT scores were also significant.ConclusionCreativity appears relatively stable in older age, with exception of those creativity skills that are affected by abstract reasoning (SPM), which appear susceptible to aging. As our findings suggest, cognitive impairment in older age might impair only some aspects of creativity with other creativity aspects being comparable to cognitively healthy people. The age-related and the cognitive status-related effects seem to be independent. The preserved creative abilities can be used in dementia care programs.

Beyond vision:Cataract and health status in old age, a narrative review.

Cataract is a leading cause of visual impairment in old age. Lens opacification is notoriously associated with several geriatric conditions, including frailty, fall risk, depression and cognitive impairment. The association is largely attributable to visual impairment, while other mechanisms, associated with extraocular comorbidity and lifestyle, might partly explain this correlation. Available literature suggests that cataract surgery may be effective in decreasing fall risk, improving depressive symptoms and limiting the risk of cognitive impairment and dementia incidence, although intervention studies on these outcomes are still limited. In this review we also emphasize the need to move from the concept of visual acuity to functional vision, especially in the context of the geriatric patient. Research is needed regarding the effect on the cited outcomes of different cataract treatment strategies, such as systematic bilateral versus monolateral surgery and use of different intraocular lenses.

Purpose in life promotes resilience to age-related brain burden in middle-aged adults

BackgroundDisease-modifying agents to counteract cognitive impairment in older age remain elusive. Hence, identifying modifiable factors promoting resilience, as the capacity of the brain to maintain cognition and function with aging and disease, is paramount. In Alzheimer’s disease (AD), education and occupation are typical cognitive reserve proxies. However, the importance of psychological factors is being increasingly recognized, as their operating biological mechanisms are elucidated. Purpose in life (PiL), one of the pillars of psychological well-being, has previously been found to reduce the deleterious effects of AD-related pathological changes on cognition. However, whether PiL operates as a resilience factor in middle-aged individuals and what are the underlying neural mechanisms remain unknown.MethodsData was obtained from 624 middle-aged adults (mean age 53.71 ± 6.9; 303 women) from the Barcelona Brain Health Initiative cohort. Individuals with lower (LP; N = 146) and higher (HP; N = 100) PiL rates, according to the division of this variable into quintiles, were compared in terms of cognitive status, a measure reflecting brain burden (white matter lesions; WMLs), and resting-state functional connectivity, examining system segregation (SyS) parameters using 14 common brain circuits.ResultsNeuropsychological status and WMLs burden did not differ between the PiL groups. However, in the LP group, greater WMLs entailed a negative impact on executive functions. Subjects in the HP group showed lower SyS of the dorsal default-mode network (dDMN), indicating lesser segregation of this network from other brain circuits. Specifically, HP individuals had greater inter-network connectivity between specific dDMN nodes, including the frontal cortex, the hippocampal formation, the midcingulate region, and the rest of the brain. Greater functional connectivity in some of these nodes positively correlated with cognitive performance.ConclusionExpanding previous findings on AD pathology and advanced age, the present results suggest that higher rates of PiL may promote resilience against brain changes already observable in middle age. Furthermore, having a purposeful life implies larger functional integration of the dDMN, which may potentially reflect greater brain reserve associated to better cognitive function.

Ensemble-specific deficit in neuronal intrinsic excitability in aged mice

With the prevalence of age-related cognitive deficits on the rise, it is essential to identify cellular and circuit alterations that contribute to age-related memory impairment. Increased intrinsic neuronal excitability after learning is important for memory consolidation, and changes to this process could underlie memory impairment in old age. Some studies find age-related deficits in hippocampal neuronal excitability that correlate with memory impairment but others do not, possibly due to selective changes only in activated neural ensembles. Thus, we tagged CA1 neurons activated during learning and recorded their intrinsic excitability 5 hours or 7 days post-training. Adult mice exhibited increased neuronal excitability 5 hours after learning, specifically in ensemble (learning-activated) CA1 neurons. As expected, ensemble excitability returned to baseline 7 days post-training. In aged mice, there was no ensemble-specific excitability increase after learning, which was associated with impaired hippocampal memory performance. These results suggest that CA1 may be susceptible to age-related impairments in post-learning ensemble excitability and underscore the need to selectively measure ensemble-specific changes in the brain.

Genetic risk for attention‐deficit/hyperactivity disorder is associated with amyloid‐dependent cognitive decline in older adults

AbstractBackgroundRecent epidemiological studies using population‐based registers showed that patients with Attention‐Deficit/Hyperactivity Disorder (ADHD) are more likely to be diagnosed with mild cognitive impairment (MCI) and Alzheimer’s disease (AD), suggesting a higher risk for cognitive impairment in older age. Here, we aimed to assess whether genetic liability for ADHD, as measured by a validated polygenic risk score (ADHD‐PRS), is associated with cognitive decline in cognitively unimpaired (CU) subjects and whether these effects vary according to baseline amyloid‐β (Aβ) burden.MethodWe studied 212 CU participants (116 women [54.7%], mean [SD] age of 73.1 [5.9]) from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) cohort. Subjects had available baseline Aβ burden (measured by [18F]Florbetapir Aβ‐PET) and genetic information, as well as a minimum of 2 cognitive assessments (Preclinical Alzheimer Cognitive Composite [PACC] and MMSE) in a 6‐year period. Aβ positivity was defined using a previously published cutoff of global [18F]Florbetapir PET SUVR > 1.11. We calculated ADHD‐PRS using data from the latest genome‐wide association study on ADHD, with a p‐value threshold of 1. Statistical analyses were performed using linear mixed‐effects models adjusted for age, sex, APOE ε4 status, and the first seven principal components to adjust for population stratification.ResultADHD‐PRS was normally distributed and was not associated with age, sex, or APOE ε4 status (Figure 1). We observed a significant ADHD‐PRS by time interaction (β=‐.03, 95% CI ‐.05 to ‐.01, p‐value=.001 for PACC, β=‐.04, 95% CI ‐.07 to ‐.009, p‐value=.01 for MMSE) on cognitive performance, indicating that higher ADHD‐PRS is associated with decreased cognitive function over time (Figure 2). Additionally, we observed a significant interaction between ADHD‐PRS, time, and baseline Aβ burden (β=‐.05, 95% CI ‐.10 to ‐.008, p‐value=.02 for PACC, β=‐.08, 95% CI ‐.15 to ‐.01, p‐value=.02 for MMSE), suggesting that higher ADHD‐PRS is associated with longitudinal cognitive decline only in Aβ‐positive individuals (Figure 3).ConclusionOur findings indicate that higher genetic liability for ADHD is associated with cognitive decline in Aβ‐positive older adults without cognitive impairment. These findings support the hypothesis that higher rates of MCI and AD in patients with ADHD may result from decreased resilience to Aβ pathology.

Psychosocial working conditions and cognitive and physical impairment in older age

BackgroundPsychosocial working conditions are associated with cognitive and physical impairments. The aim of this study was to investigate the associations between mid-late life psychosocial working conditions and the combination of physical and cognitive impairment among older adults, and the potential sex differences in these associations. MethodsData were derived from two Swedish nationally representative surveys (n = 839; follow-up: 20–24 years). Multinomial and binary logistic regressions assessed the associations between work stressors (job demand-control model), and a combination of cognitive and physical impairment. ResultsLow control jobs were significantly associated with higher odds of cognitive (OR: 1.41, CI: 1.15–1.72) and physical impairment (OR: 1.23, CI: 1.02–1.47), and cognitive and physical impairment combined (OR: 1.50, CI: 1.19–1.89). Passive jobs (low control, low demand) were associated with higher odds of cognitive impairment (OR: 1.57, CI: 1.12–2.20), and combined cognitive and physical impairment (OR: 1.59, CI: 1.07–2.36). Active jobs (high control, high demand) were associated with lower odds of cognitive impairment (OR: 0.48, CI: 0.29–0.80). Sex-stratified analyses showed stronger associations among men; passive jobs were associated with both cognitive (OR: 2.18, CI: 1.31–3.63) and physical impairment (OR: 1.78, CI: 1.13–2.81), while low strain jobs were associated with less physical impairment (OR: 0.55, CI: 0.33-0.89). No significant associations between work stressors and impairment were found for women. ConclusionsThese results highlight the importance of psychosocial working conditions for late-life physical and cognitive impairment, especially among men. Jobs characterised by low control and low demands are associated with higher risk for impairments.

Physical activity and gender buffer the association of retirement with functional impairment in Ghana

Females on average live longer but with higher rates of functional impairment and lower physical and economic activities than men. However, research linking retirement to functional impairment and the modifying role of gender and physical activity (PA) is limited especially in low- and middle-income countries. This paper examines the association between retirement and functional impairment in Ghana and evaluates the effect modification of the association by gender and PA. The sample included 1201 adults aged ≥ 50 years from a population-based study. Functional impairment was assessed with the activities of daily living scale. Ordinary least squares regression models adjusted for confounding variables and estimated gender-wise and PA heterogeneity effect of retirement on functional impairment. Regressions showed that retirement predicted an increase in functional impairment score in the full sample (β = .76, p < .001) and in men (β = 1.96, p < .001), but not in women. Interestingly, retirement significantly increased functional impairment in ≥ 65 age cohort (full sample: β = .71, p < .005; men: β = 1.86, p < .001) although not in women. However, the effect was significantly moderated by PA such that retirement × PA predicted a decrease in functional impairment in the full sample (β = −.81, p < .005) and the ≥ 65 age group (β = −.43, p < .005). Functional impairment risk of retirement is gender-specific, but PA buffers the relationship. Retirement is generally commonplace, but these findings imply that promoting PA may hold promise for addressing functional impairment in old age. Attending to the physical health needs of men during retirement should be a social policy priority.

Multiple exposures to sevoflurane across postnatal development may cause cognitive deficits in older age.

The aim of the study was to determine the effects of repeated anesthesia exposure across postnatal development. Seventy-two newborn Sprague-Dawley rats were randomly divided into Sev group and Con-aged group. Sev groups were exposed to 2.6% sevoflurane for 2 h on postnatal day (P) 7, P14, and P21; the Con groups only received carrier gas for 2 h. Learning and memory were evaluated using the MWM test at P31 (juvenile), P91 (adult), and 18 months postnatally (aged). The relative expression of APP and Mapt mRNA was detected by RT-PCR, while Aβ, tau, and P-tau protein levels were analyzed by immunohistochemistry. After repeated inhalation of sevoflurane, MWM test performance was significantly decreased in the Sev-aged group compared to the Con-aged group (P > 0.05). The relative expression of APP and Mapt mRNA was not significantly different between groups in each growth period (P > 0.05). The tau expression in the juvenile hippocampal CA1, CA3, and dentate gyrus regions increased markedly in the Sev group, while P-tau only increased in the hippocampal CA3 region in the Sev-adult group. The expression of tau, P-tau, and Aβ in the hippocampal regions was upregulated in the Sev-aged group. Multiple exposures to sevoflurane across postnatal development can induce or aggravate cognitive impairment in old age. Whether multiple sevoflurane exposures across postnatal development cause cognitive impairment in childhood, adulthood, or old age, as well as the relationship between sevoflurane and the hippocampal Aβ, tau, and P-tau proteins, remains unknown. This study's results demonstrate that multiple exposures to sevoflurane across postnatal development do not appear to affect cognitive function in childhood and adulthood; however, multiple exposures may lead to a cognitive function deficit in old age. The underlying mechanism may involve overexpression of the tau, P-tau, and Aβ proteins in the hippocampus.

Prevalence and correlates of vision impairment and its association with cognitive impairment among older adults in India: a cross-sectional study

ObjectiveThis study aimed to investigate the predictors of vision impairment in old age and how impaired vision is associated with cognitive impairment among the ageing population.DesignA cross-sectional study was conducted...

Leisure activities and cognitive impairment in old age: The role of life course socioeconomic status

Objectives: In the current literature on cognitive function, life course socioeconomic status (SES) and engaging in leisure activities are often viewed as parallel measures of cognitive reserve that independently affect cognitive impairment in old age. Some studies also suggest that leisure activity mediates the effect of SES on cognitive impairment. What is less examined is the modification effect of SES on the association between engaging in leisure activities and cognitive impairment, especially from a life course perspective. In this study, we focus on the interaction effects of specific measures of SES and leisure activities on cognitive impairment. Method: We use data from the Chinese Longitudinal Healthy Longevity Survey, which includes five waves of interviews with adults aged 65 and older between 2002 and 2014. Cognitive impairment is measured by the Chinese version of the Mini-Mental Status Examination. Childhood and adulthood SES and participation in seven leisure activities are included in this analysis. We adopt a lagged independent variable approach and the Generalized Linear Mixed Model to conduct the analysis. Results: Findings confirm that higher SES in both childhood and adulthood are associated with low levels of cognitive impairment in the older Chinese population. Furthermore, there are significant interaction effects between specific life course SES and leisure activities with a consistent pattern: Those of higher life course SES enjoy extra benefits from engaging in leisure activities. Conclusion: The findings point to a modification mechanism that connects life course SES, leisure activities, and cognitive health inequality among older adults.

Cognitive impairment in elderly patients suffering from Alzheimer's disease

The purpose of the study: to study destructive forms of cognitive impairment in old age. Materials and methods. A study of 38 people was conducted, of which 16 were men and 22 were women. The control sample consists of 23 people, of which 8 are men and 15 are women. The definition of the control sample was based on the fact that this category of people had cognitive impairments that are the result of other age-related changes that are not the result of AD, whereas the experimental sample needed to have cognitive impairments that are the result of AD. The experimental sample consisted of 15 people, 7 men, 8 women. In the process of MMSE testing, 6 subjects (15.8%) entered the first group, 10 subjects (26.3%) entered the second group, and 22 (57.9%) entered the last group. 42.1% of respondents had mild Alzheimer's type dementia, while 57.9% of respondents had cognitive impairment due to age-related changes. According to the indicators obtained by the method of the short scale of assessment of mental status (Mini-Mental State Examination, MMSE), it can be concluded that memory, attention and orientation in time and space are primarily reduced. Data on the Frontal Dysfunction Battery (FAB) technique showed the absence of a grasping reflex in 29 out of 38 subjects (76.3%), so the presence of a grasping reflex most often indicates a severe degree of Alzheimer's type dementia.

The Interaction of Life Course Socioeconomic Status and Leisure Activities on Cognitive Performance in Old Age

While the separate effects of socioeconomic status and engaging in leisure activities on cognition have been well documented, their interaction effect has rarely been examined. After examining life course socioeconomic status (SES) on cognitive impairment in old age, this paper is focused on exploring the interaction effects between life course SES and leisure activities. We use data from the Chinese Longitudinal Healthy Longevity Survey, which covers five waves of interviews of adults aged 65 or older between 2002 and 2014. Cognitive impairment is measured by the Chinese version of Mini-Mental Status Examination. Two sets of variables are used to reflect an older person’s life course SES in childhood and adulthood, respectively. Seven leisure activities are included in this analysis. We adopt the lagged independent variable approach and a Generalized Linear Mixed Model to examine the association between leisure activity and cognitive impairment over time. Results show that there is an independent impact of SES in both childhood and adulthood on cognitive decline in Chinese older population. Furthermore, as the focus of this study, there are substantial interactions between life course SES and engaging in leisure activities with a consistent pattern: those of higher life course SES enjoy extra benefits from engaging in leisure activities. The interactions between life course SES and leisure activities promise a competing approach accounting for cognitive health inequality among older adults.

Reablement in need of theories of ageing: would theories of successful ageing do?

AbstractThe reablement approach is becoming a popular social and health-care model in many Western countries, providing support strategies for older people experiencing impairment. Reablement programmes have been criticised for a lack of theories, explicating the understanding of the problem that it is intended to address, i.e. ageing and impairment in old age. We need to discuss the inherent theories in intervention programmes to question taken-for-granted assumptions about not only what works, but also how these assumptions affect the sociocultural models of ageing. Theories on successful ageing have been suggested as underpinning reablement. This article aims to present and discuss theories of successful ageing compared to key principles, components and outcomes in reablement. A medical and epidemiological, a psychological and a sociocultural theoretical approach to successful ageing are included. Contemporary reablement programmes mirror medical and psychological theories of successful ageing, including models of ageing that are associated with continuity, optimisation, selection, individuality and goal orientation. Most reablement programmes do not address sociocultural perspectives on ageing. As older people experience impairment in a pertinent liminality within and between the sociocultural values of the third and fourth age, it is important for reablement programmes and practice to consider the theoretical assumptions and underpinning theories of ageing and how to help older people balance between optimising capacity and accepting losses in their everyday life.

Circulating Mediators of Apoptosis and Inflammation in Aging; Physical Exercise Intervention.

Sarcopenia is an age-related loss of skeletal muscle mass caused by many cellular mechanisms and also by lifestyle factors such as low daily physical activity. In addition, it has been shown that sarcopenia may be associated with inflammation and cognitive impairment in old age. Regular exercise is key in reducing inflammation and preventing sarcopenia and diseases related to cognitive impairment. The study was designed to assess the impact of exercise training on circulating apoptotic and inflammatory markers of sarcopenia in older adults. Eighty older adults aged 70.5 ± 5.8 years were randomized to the physically active group who participated in a 10-month Tai-Chi training session (TC, n = 40) and the control group who participated in health education sessions (HE, n = 40). Tai-Chi training caused a significant decrease in fat mass (FM) by 3.02 ± 3.99%, but an increase in appendicular skeletal muscle mass index (ASMI) by 1.76 ± 3.17% and gait speed by 9.07 ± 11.45%. Tai-Chi training elevated the plasma levels of C-reactive protein (CRP), tumor necrosis factor (TNFα), and tumor necrosis receptor factor II (TNFRII), and decreased caspases 8 and 9. Despite the increase in TNFα, apoptosis was not initiated, i.e., the cell-free DNA level did not change in the TC group. The study demonstrated that Tai-Chi training significantly reduced the symptoms of sarcopenia through the changes in body composition and physical performance, and improvements in cytokine-related mechanisms of apoptosis.

Development of a Physical Impairment Prediction Model for Korean Elderly People using Synthetic Minority Over-Sampling Technique and XGBoost

The old people's 'physical functioning' is a key factor of active ageing as well as a major factor in determining the quality of life and the need for long-term care in old age. Previous studies that identified factors related to ADL mostly used regression analysis to predict groups of high physical impairment risk. Regression analysis is useful for confirming individual risk factors, but has limitations in grasping multiple risk factors. As methods for resolving this limitation of regression models, machine learning ensemble boosting models such as random forest and eXtreme Gradient Boosting (XGBoost) are widely used. Nonetheless, the prediction performances of XGBoost, such as accuracy and sensitivity, remain to be verified additionally by follow-up studies. This article proposes an effective method of dealing with imbalanced data for the development of ensemble-based machine learning, by comparing the performances of disease data sampling methods. This study analyzed 3,351 old people aged 65 or above who resided in local communities and completed the survey. As machine learning models to predict physical impairment in old age, this study compared the logistic regression model, XGBoost and random forest, with respect to the predictive performances of accuracy, sensitivity, and specificity. This study selected as the final model a model whose sensitivity and specificity were 0.6 or above and whose accuracy was highest. As a result, synthetic minority over-sampling technique (SMOTE)-based XGBoost whose accuracy, sensitivity, and specificity were 0.67, 0.81, and 0.75, respectively, was determined as the most excellent predictive performance. The results of this study suggest that in case of developing a predictive model using imbalanced data like disease data, it is efficient to use the SMOTE-based XGBoost model.