Interventions For Older Adults Research Articles

Pilot randomized controlled trial of EMBOLDEN: a novel co-designed community-based intervention to enhance mobility in older adults.

Introduction: Physical mobility and social participation are essential for maintaining independence and improving quality of life with aging. These are also interrelated, with barriers to mobility leading to social isolation, as well as poor physical and mental health. Most mobility-enhancing interventions in older adults have been designed by researchers without public input and delivered in controlled settings. This traditional approach to intervention design and testing may not meet the needs of older adults or prove effective in real-world implementation. To have sustained real-world impact, a model aimed at improving mobility that is person-centred, supports social network engagement, and leverages existing community health and social services is more likely to realize impacts. The EMBOLDEN intervention is a novel evidence-informed and contextually relevant community program. A Strategic Guiding Council comprised of older adults and health and social service providers co-designed the 3-month, multi-component group-based program to enhance mobility in older adults living in neighbourhoods experiencing health inequities. In this analysis, we present the implementation results of our pilot randomized controlled trial (RCT).
 Aims & Methods: The pilot trial aimed to explore the feasibility and implementation of a multi-component intervention to improve mobility in older adults in preparation for a large effectiveness-implementation pragmatic RCT (EMBOLDEN, NCT05008159). Core intervention components include physical activity, healthy eating, socialization, and system navigation. Community-dwelling older adults (≥55 years) living in one neighbourhood in Hamilton, Canada, were randomized (2:1) to either: a weekly 90-minute virtual group program for 9 weeks (intervention) or continued normal routine (control). The intervention team integrated providers from recreation, primary care, and public health. A Community Advisory Board, including older adults and local providers, informed intervention modifications and implementation. Data were collected through participant quantitative surveys, study documentation, and qualitative interviews with participants and interventionists. Survey data were analyzed descriptively; survey open-text data, intervention team documentation, and transcripts were analyzed using content analysis. Process outcomes included program acceptability, intervention fidelity, implementation barriers and facilitators, and intervention feasibility/acceptability to participants and interventionists. 
 
 Results: 11 participants were enrolled; 10 were randomized (6 INT; 4 CON). Participant age ranged from 57-76 years. Most participants identified as female (73%), had a total household income of <$50,000 (73%) and lived alone (55%). Five participants received the allocated intervention. Quantitative and qualitative data collection are complete; analyses are underway. Intervention participants expressed perceived changes to their behaviours related to program outcomes: mobility and health; as well as increased awareness of community supports. Intervention group participants expressed positive experiences with the intervention and perceived impacts on their health and community connections. However, participants expressed a preference for in-person delivery. Interventionists gained experience delivering this multi-component intervention as a team. The COVID-19 pandemic impacted intervention duration (9 vs. 12 weeks), mode of delivery (virtual vs. in-person), and recruitment. Adaptations for the RCT include in-person delivery, longer duration, and new recruitment approaches.
 Conclusions: This pilot trial demonstrated that implementing the EMBOLDEN intervention was feasible and acceptable to participants and interventionists. The team gained important insight into modifications necessary for the larger, pragmatic RCT.

EFFECT OF HEARING INTERVENTION ON LONELINESS AND SOCIAL ISOLATION IN THE ACHIEVE STUDY

Abstract Social health interventions in older adults typically have small effect and limited large-scale implementation. Treating hearing loss is a potential intervention, but efficacy is unknown. This study presents baseline associations between hearing loss, loneliness, and social isolation as well as the 3-year effect of a hearing intervention on social health. The Aging and Cognitive Health Evaluation in Elders Study (ACHIEVE) randomized controlled trial (n=977) tests the effect of hearing intervention (provision of hearing aids/related technologies, counseling/education) vs. successful aging health education control intervention on loneliness (UCLA Loneliness Scale) and social network characteristics (Cohen Social Network Index) (pre-specified exploratory outcomes) among older adults with untreated hearing loss. Hearing loss was quantified by better ear, speech-frequency pure tone average (PTA). Speech-in-noise recognition and hearing-related quality of life were also measured. Baseline associations between hearing loss and social health outcomes are assessed by robust Poisson regression adjusted for demographic and health characteristics. Three-year hearing intervention effects are assessed by generalized linear mixed effects models. Participants were 70-84 years, 54% female, and 87% White. At baseline, better speech-in-noise recognition was associated with greater social network characteristics (e.g., larger social network size [IRR: 1.04, 95% CI: 1.00, 1.07]). Worse hearing-related quality of life was associated with higher prevalence of loneliness (PR: 1.15, 95% CI: 1.11, 1.20) and smaller social network size (IRR: 0.96, 95% CI: 0.93, 1.00). Hearing intervention effect results will be available prior to the conference (data collection ends early 2023). Hearing treatment could be an effective social health intervention with greater scalability.

OLDER ADULTS’ SAVORING ABILITY IS ASSOCIATED WITH LONGITUDINAL CHANGE IN WELL-BEING

Abstract Well-being in older adults is an important concern as the aging population grows, as is identifying modifiable factors that contribute to well-being over time. The ability to savor the moment (i.e., to notice and enhance one’s emotional response to positive events) has been shown to be associated with greater well-being, though few studies have examined these relationships longitudinally or in older adults. The current study examined whether savoring ability moderated the trajectory of older adults’ life satisfaction and depressive symptoms over time. A sample of 5777 older adults (Mage = 83.83, SD = 6.61; 66.6% female), recruited from Life Plan Communities, completed four consecutive annual surveys. Multilevel growth curve models revealed main effects of small but significant declines in well-being over time (life satisfaction: B = -.09, SE = .01, p < .001; depressive symptoms: B = .13, SE = .01, p < .001), after accounting for age, gender, education, life stress, and health. Interactions between time and savoring ability indicated that participants with greater savoring ability were better able to maintain their levels of well-being (i.e., smaller decline in life satisfaction [B = .05, SE = .01, p < .01] and smaller increase in depressive symptoms [B = -.10, SE = .01, p < .01]). In contrast, individuals lower in savoring ability experienced less favorable well-being trajectories. Savoring is a malleable emotion regulation ability that is associated with attenuated declines in well-being over time. Implications for savoring interventions in older adults will be discussed.

DEVELOPING CONTENT FOR A VIRTUAL SOCIAL ENGAGEMENT INTERVENTION FOR PERSONS WITH MCI

Abstract Older adults, especially those with mild cognitive impairment (MCI), are at increasing risk of social isolation and loneliness, leading to poorer health outcomes. Video technology has the potential to provide socially and cognitively engaging activities from their homes. We are exploring the benefits of a virtual social engagement intervention in older adults with and without MCI (clinicaltrials.gov NCT05380180). We are using a video-technology called OneClick.chat to present participants with a short presentation followed by conversational breakout groups. One challenge for the intervention development was the selection of content that would be engaging but not too memory demanding and of interest to a broad range of people. We worked with iN2L to design 60 unique events that met predefined criteria: could facilitate conversations, did not rely on episodic memory, covered a range of topics, and reflected a diversity of individuals, identities, cultures, and interests. Events were categorized into five predefined categories: Arts & Culture; Nature, Health, & Wellness; Life Experiences; Science & Technology; and Recreation & Sports. We carefully curated each event to ensure consistency of presentation length, picture type, readability, visibility, number of slides, and audio quality. Presentation format was carefully tested through multiple iterations to ensure the best participant experience. Conversational prompts were designed for each event to stimulate engaging conversations through open-ended questions. During the trial we are gathering data on participants’ preferences for different topics that can guide future iterations. Our systematic process of development can guide content design for research on social engagement interventions.

DAYS AT DUNROVIN: ANALYSIS OF FIELD NOTES FROM AN ONLINE NATURE-BASED INTERVENTION FOR OLDER ADULTS

Abstract Implementing novel interventions for older adults is often challenging, and understanding processes is as important as evaluating outcomes. Days at Dunrovin (D@D) is an online program providing virtual access to a Montana ranch. While originally designed as an individual activity, researchers converted D@D into a group activity for older adults. In this presentation, researchers present an analysis of field notes from 65 group sessions (n = 65) in an assisted living community. Results are organized using the first four elements of the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance). Reach (i.e., participation) depended on encouraging participation and transporting residents to activity areas – often time-consuming, and diminished by limited resources. Effectiveness (preliminary) was evidenced by participant engagement with the activity, and by staff and family observations of participants’ affect and behavior. Laugher, conversations, and reminiscence were consistently observed. Adoption, the level of facility acceptance, was mixed as some staff welcomed the new activity while others found it difficult to support while attending to regular work. Implementation depended on many factors, including the environment (e.g., room arrangement), time of day, fluctuations in participant well-being, and technological capacities such as broadband width. Most notable was a lightning strike on the D@D cameras that resulted in the temporary use of archival content rather than viewing livestreams. Results suggest the feasibility and potential effectiveness of using nature-based livestream broadcasts as a group activity in assisted living and reveal the invaluable role field notes play in understanding implementation and evaluating interventions in applied research.

THE ROLE OF PSYCHOSOCIAL AND LIFESTYLE FACTORS IN PROMOTING COGNITIVE HEALTH

Abstract This symposium will highlight the role of psychosocial and lifestyle factors in cognitive health. Across four talks, we consider a wide range of psychosocial and lifestyle factors including personality, stress, physical activity, and nutrition, and a wide range of cognitive health outcomes including subjective and objective cognitive performance, clinical diagnoses of cognitive status, and cognitive healthspan. First, Dr. Patrick Hill will share findings on links between Big Five personality traits and the degree of concordance between subjective and objective cognitive functioning. Second, Dr. Tomiko Yoneda uses longitudinal data to investigate personality trait predictors of transitions between cognitive states (no cognitive impairment, mild cognitive impairment, dementia) and death, as well as personality effects on cognitive healthspan (i.e., years without cognitive impairment) and total longevity. Third, Nicole Stuart used ecological momentary assessment and activity trackers to investigate links among daily stress, daily physical activity, and daily cognitive performance. Finally, Dr. Julia Sheffler will discuss how we can apply our knowledge of psychosocial and lifestyle factors in cognitive health to inform the development of interventions. She will share quantitative and qualitative findings from proof-of-concept (N=9) and pilot (N=58) studies of a nutrition intervention in older adults at risk for dementia, and she will discuss implications for lifestyle intervention development more broadly. Together, this symposium showcases how a wide range of methods can be employed to reveal the importance of psychosocial and lifestyle factors for promoting healthy cognitive aging.

MULTILEVEL LIFESTYLE INTERVENTIONS ARE NEEDED TO IMPROVE DIABETES SELF-MANAGEMENT IN OLDER ADULTS

Abstract Type 2 diabetes (T2D) is a major public health concern in older adults. Physical activity (PA) and healthy eating (HE) are two major lifestyle intervention strategies in diabetes self-management for controlling glucose levels, preventing complications, and improving functionality and quality of life. This qualitative study aimed to explore perceived factors influencing PA and HE among predominately Latino older adults with T2D ((age=70.5±4.8; Latinos=73.3%). We conducted semi-structured interviews with 15 community dwelling older adults with T2D at the end of a 12-week pre- and post- study assessing self-monitoring on lifestyles and health outcomes. All interviews were recorded and transcribed. Two researchers analyzed the data independently using a combination of deductive and inductive thematical analysis. Codes were categorized into five themes based on the socio-ecological framework, and sub-themes were identified. The themes included five levels of factors: 1) individual (e.g., knowledge, self-efficacy, self-monitoring, perceived benefits and threats, health status,); 2) interpersonal (e.g., family, friend, health provider); 3) organizational (e.g., availability of physical activity equipment in senior apartments); 4) environment (e.g., culture norms); and 5) policy factors (e.g., health provider, retirement). The factors in one level could influence the factors in another level. Most current lifestyle interventions focus on individual level, and multilevel lifestyle interventions to promote healthy lifestyles, and improve health, independence, and quality of life in older adults with T2D are warranted. The input of additional stakeholders such as family members and community staff need to be accounted when designing multilevel intervention in older adults with T2D.

Assessing sleep architecture and cognition in older adults with depressive symptoms attending a memory clinic

BackgroundWhile depression is intrinsically and bidirectionally linked with both sleep disturbance and cognition, the inter-relationships between sleep, cognition, and brain integrity in older people with depression, especially those with late-onset depression are undefined. MethodsOne hundred and seventy-two older adults (mean age 64.3 ± 6.9 years, Depression: n = 66, Control: n = 106) attending a memory clinic underwent a neuropsychological battery of declarative memory, executive function tasks, cerebral magnetic resonance imaging and overnight polysomnography with quantitative electroencephalography. ResultsThe time spent in slow-wave sleep (SWS) and rapid eye movement (REM) sleep, slow-wave activity, sleep spindles, hippocampal volume and prefrontal cortex thickness did not differ between depression and control and depression onset groups. However, sleep onset latency (p = 0.005) and REM onset latency (p = 0.02) were later in the Depression group compared to controls. Less SWS was associated with poorer memory (r = 0.31, p = 0.023) in the depression group, and less SWS was related to better memory in the control group (r = −0.20, p = 0.043; Fishers r-to-z = −3.19). LimitationsLongitudinal studies are needed to determine if changes in sleep in those with depressive symptoms predict cognitive decline and illness trajectory. ConclusionOlder participants with depressive symptoms had delayed sleep initiation, suggestive of delayed sleep phase. The association between SWS and memory suggests SWS may be a useful target for cognitive intervention in older adults with depression symptoms. Reduced hippocampal volumes did not mediate this relationship, indicating a broader distributed neural network may underpin these associations.

Protein and Exercise to Reverse Frailty in Older Men and Women Undergoing Transcatheter Aortic Valve Replacement: Design of the PERFORM-TAVR Trial

Despite the high procedural success of transcatheter aortic valve replacement (TAVR), 2 out of 5 older adults report poor physical performance and health-related quality of life (HRQOL) in the ensuing months, particularly those with frailty. There has yet to be a trial examining the synergistic effects of exercise and protein supplementation to counteract frailty and improve patient-centred outcomes following TAVR. The PERFORM-TAVR trial is a multicentre parallel-group randomised clinical trial that is enrolling 200 frail older adults ≥ 70 years of age undergoing TAVR. Patients will be randomly allocated to 1 of 2 treatment groups: standard-of-care lifestyle education (control group) or protein-rich oral nutritional supplement for 4 weeks before TAVR with the addition of home-based supervised exercise sessions for 12 weeks after TAVR (intervention group). The primary outcome will be physical performance as measured by a blinded observer using the Short Physical Performance Battery at 3 months. Secondary outcomes at 3, 6, and 12 months will include HRQOL, as measured by the Short-Form 36 Physical and Mental Component summary scores, and a composite safety end point. The PERFORM-TAVR trial is testing a novel frailty intervention in older adults undergoing TAVR to optimise recovery and downstream HRQOL. This represents a potential paradigm shift that highlights the value of assessing and treating patients’ frailty in parallel with their underlying heart valve disease. Clinical Trial RegistrationURL: https://www.clinicaltrials.gov. Unique identifier: NCT03522454.

Trazodone in the Management of Major Depression Among Elderly Patients with Dementia: A Narrative Review and Clinical Insights.

Major depressive disorder (MDD) often co-occurs with dementia and other neurological disorders, and treatment with antidepressants can improve symptoms, quality of life, and survival in these patients. This narrative review provides an expert opinion about the role and effectiveness of trazodone in the treatment of older adults with MDD and cognitive impairment due to physical illnesses, such as dementia. Because of its mechanism of action, trazodone can treat several depression symptoms often seen in people with dementia, including insomnia, agitation, anxiety, cognitive impairment, and irritability. Trazodone may be beneficial for patients with dementia or other neurological disorders comorbid with MDD, especially when the clinical picture of depression includes or is comorbid to symptoms of insomnia, irritability, inner tension, anxiety, or psychomotor agitation.

Brief, Interoceptive Exposure Focused Treatment for Anxiety in Older Adults

AbstractBackgroundOlder adults with Mild Cognitive Impairment (MCI), Alzheimer’s disease (AD) and related dementias, and their care partners often experience high levels of anxiety. This not only diminishes their quality of life but also serves as a marker for earlier onset of ADRD symptoms for individuals experiencing MCI. Moreover, there is no well‐established treatment for those with MCI/mild AD. Anxiety sensitivity (AS) is a mechanism central to the genesis and maintenance of anxiety psychopathology that exacerbates the experience of somatic and emotional sensations, leading to increased distress. Brief, computerized, mechanism‐focused interventions have been shown to effectively reduce AS. This study sought to evaluate the acceptability and efficacy of a brief AS focused intervention in older adults with probable MCI including a repeated interoceptive exposure component and the participation of a care partner.MethodParticipants (N = 16) were recruited from the community varied in age from 65 to 81 (M = 72.44; SD = 4.83). Eligible participants enrolled in an open trial consisting of a 2‐hour intervention focused on interoceptive exposure (systematic exposure to anxiety and stress symptoms to achieve habituation). All participants completed a brief cognitive assessment, AS measures pre‐ and post‐intervention, and acceptability measures post‐intervention.ResultAverage baseline Montreal Cognitive Assessment scores were 24.25 (SD = 3.24; Range = 19‐29), which is generally indicative of MCI. Paired samples t‐tests were conducted to examine changes in total ASI‐3 scores pre‐ to post‐intervention. Despite the relatively small sample, we observed statistically significant reductions in ASI‐3 total scores with a large effect size (Δ = 4.38, Hedge’s g = .80, p<.01). Additionally, the intervention was highly acceptable with 100% of participants completing the intervention and rating the quality of the intervention as good or excellent.ConclusionThis study provides encouraging evidence that brief interventions can successfully target risk mechanisms of anxiety in older adults with probable MCI. The favorable acceptability of the intervention suggests that it would be well‐received by both those with MCI and mild AD. Future research should examine this intervention in randomized‐clinical trials and study its effects longitudinally to understand how decreases in AS persist over time and relate to cognitive outcomes.

Implementing Affordable Virtual Reality Interventions for Older Adults in Latin America: A Feasibility Study

Introduction:Virtual Reality (VR)-based meditation has shown to help reduce, stress, anxiety, sadness, and anger in younger adults. However, this has not been extensively studied in older adults. Furthermore, there are no standard guidelines on how VR mindfulness interventions should be implemented to ensure successful outcomes in different cultures and languages. The availability of affordable hardware raises the possibility of VR being used in low-income countries. The goal of this study is to describe and highlight some key considerations and challenges when implementing low-cost VR mindfulness interventions with older adults in Quito, Ecuador.Methods:We created a guided mindfulness intervention using low-cost VR (smartphones and Destek V5 headsets) for older adults with anxiety in Quito, Ecuador. This project is a collaboration between the Technology and Aging Lab at McLean Hospital and the Universidad San Francisco de Quito in Ecuador. Our goal was to recruit 20 older adults with anxiety from various outpatient settings in Quito. We used the free “Sites in VR” app and selected different nature scenes for each intervention. The intervention consists of a total of 10 sessions each lasting 30 minutes. We assessed depression using the Geriatric Depression Scale (GDS), and anxiety with the Generalized Anxiety Disorder 7-item scale (GAD-7). In addition, we also administered the Mindfulness Attention Awareness Scale (MAAS) and the Behavior Activation for Depression scale (BADS).Results:At the time of writing, we have reached 100% of our recruitment goal and anticipate completing data analysis by January 2023. Qualitatively, our intervention revealed barriers to designing scalable VR Spanish language interventions in Latin America. Some of the main difficulties we encountered are described below: (i) There are very few virtual reality videos (360° videos) that are available for use with the DesTeK VS VR Headset in Spanish. We therefore, used a standardized Spanish narration to guide the mindfulness practice based on a script used in the United States. (ii) We found that majority of the available content is not suitable for mindfulness. Using the application Sites in VR remedied this concern, as it provides static 360° images, suitable for mindfulness. (iii) Not all technology necessary for VR interventions is readily available in Latin America: smartphones sold in Latin America do not always have a gyroscope sensor.Conclusion:Mindfulness interventions using virtual reality may be an effective way to address stress and mood symptoms in older adults across cultures. However, there are many culture-specific aspects that must be addressed before applying these interventions in different cultures. This study, conducted in Latin America, is an initial step toward the establishment of best practices and standardized low-cost VR mindfulness intervention in older adults, and many aspects addressed here may be generalizable to other cultures, settings, and countries.

Prognostic Understanding in Newly Diagnosed Older Adults with Diffuse Large B Cell Lymphoma (DLBCL) or DLBCL/High Grade B-Cell Lymphoma with MYC and BCL2 rearrangements

Background: Diffuse large B cell lymphoma (DLBCL) is an aggressive lymphoid malignancy that often affects older adults. Therapy is potentially curative, with up to two-thirds of patients cured with chemoimmunotherapy but carries substantial risk of toxicity. Treatment of older adults must balance the potential for cure with the risk of therapy toxicity and intensive healthcare utilization. Therefore, prognostic understanding is a crucial component of informed decision-making for this patient population. Yet, data regarding prognostic understanding in older adults with DLBCL are lacking. Methods: We conducted a prospective study of older adults with aggressive non-Hodgkin lymphomas at two tertiary care hospitals between 9/2020 and 01/2023. Eligible patients were age >= 65 years at time of treatment initiation receiving a combination chemoimmunotherapy. Patients could enroll up until cycle 1 day 8 of therapy. Patients completed questionnaires at baseline that assessed demographics as well as information preferences and prognostic understanding (Prognosis and Treatment Perception Questionnaire) and underwent a comprehensive geriatric assessment. We used descriptive statistics to examine patient beliefs regarding likelihood of cure, the importance of knowing about prognosis, and preferences for information about treatment at baseline. We focused on the subset of patients (N=92) with DLBCL or DLBCL/high grade B-cell lymphoma with MYC and BCL2 translocations (double hit lymphoma) in order to have a relatively homogenous population for prognosis and likelihood of cure. Results: The parent study enrolled 106/163 (65.0%) patients, with 92 patients having DLBCL or double hit lymphoma. 88/92 enrolled patients with DLBCL (95.7%) submitted the prognostic understanding questionnaire. Among DLBCL/double hit lymphoma patients (N=92), the median age was 74 years (range: 66-99), and most were male gender (63%), White race (96.7%), and married/with a life partner (73.9%). 48/91 (52.7%) had an age-adjusted International Prognostic Index of 2 or 3, 30/92 (32.6%) had a Charlson comorbidity index of 2+ (not counting the patients' lymphoma), 14/92 (15.2%) had an Eastern Cooperative Group performance status of 2-4, and 50% (46/92) were frail based on comprehensive geriatric assessment. When asked about their likelihood of cure, 37.5% (33/88) selected >90% chance, 37.5% (33/88) selected 75-90% chance, 20.5% (18/88) selected 50-74% chance, 3.4% (3/88) selected 25-49% chance, and 1.1% (1/88) selected 10-24% chance of cure. Most (88.6%;78/88) patients believed that the primary goal of their current treatment was to cure their cancer, and most (93%; 80/86) believed that was their oncologist's primary goal. When asked if they would prefer a course of treatment focused on extending life as much as possible even if it meant more pain and discomfort versus a plan of care focused on relieving pain and discomfort as much as possible, even if it meant not living as long, 30.0% (26/88) chose extending life as much as possible, 40.9% (36/88) chose relieving pain as much as possible, and 30.0% (26/88) did not know. 94.0% (78/83) reported that they had a conversation about prognosis with their oncologist. The majority (91%; 78/86) felt it was extremely important or very important to know about their prognosis over time, and felt (81.4%; 70/86) they had just the right amount of information about their prognosis. Patients stated that knowing about their prognosis was extremely helpful in making decisions about treatment (75.3%; 61/81), preparing for the future (68.3%; 56/82), maintaining hope (79.3%; 65/82), and coping with the disease (72.5%; 58/80). 74.4% (61/82) said that overall knowing about prognosis was extremely helpful. Conclusion: In this cohort of older adults receiving treatment for DLBCL or double hit lymphoma, the vast majority felt it was important to know prognostic information over time and found that this information was helpful for decision making. Our finding that the majority estimated their likelihood of cure to exceed 75% despite most having aa-IPI scores indicating average cure rates < 60 suggests that older adults with newly diagnosed DLBCL hold overly optimistic views of their prognosis.

Maintenance Ruxolitinib Is Associated with Low Rates of Chronic Gvhd Requiring Systemic Treatment in Older Adults with AML/MDS Undergoing Allogeneic HCT: Results of a Phase II Multicenter Trial

Introduction: Despite recent advances in graft-versus-host disease (GVHD) prophylaxis, novel approaches to effective prevention of chronic GVHD remain of utmost importance. This is particularly true for older transplant recipients,for whom high-dose cyclophosphamide or prolonged treatment with corticosteroids is challenging. Ruxolitinib, an oral selective inhibitor of JAK1/2, is FDA-approved for the treatment of refractory acute and chronic GVHD. However, the clinical efficacy of JAK inhibition in preventing severe chronic GVHD is not well characterized. Methods: In this prospective, multicenter phase II trial (NCT03286530), older adult subjects (age 60-80) with AML in CR1 or MDS undergoing RIC allogeneic HCT were enrolled. Transplants could be conducted from HLA-matched related donors or 7/8 or 8/8 HLA-matched unrelated donors. Transplants were required to use busulfan- or melphalan-based reduced intensity conditioning and peripheral blood stem cells. Standard GVHD prophylaxis consisted of tacrolimus and methotrexate (5-10 mg/m 2 on Days +1, +3, and +6 ± +11). Subjects were enrolled prior to transplant. Ruxolitinib therapy could begin between Day +30 and Day +100, after meeting pre-treatment criteria, which included: donor engraftment, ongoing remission confirmed by biopsy, adequate hematopoietic recovery (Hgb ≥8 g/dL, PLT ≥50K/uL), and the absence of progressive acute GVHD. Ruxolitinib was administered at 10 mg BID continuously in 28-day cycles (allowing for dose reductions due to drug interactions or cytopenias), for up to 24 cycles. The primary objective was to evaluate the GRFS at 1-year after HCT. Key secondary objectives included the cumulative incidence of chronic GVHD, acute GVHD, and relapse, as well as overall survival. Results: Seventy-eight subjects were enrolled, and 63 subjects received ruxolitinib on trial. The reasons for not initiating ruxolitinib were acute GVHD (n=4), physician discretion (n=3), disease relapse (n=2), low chimerism (n=2), death (n=2), primary graft failure (n=1), and subject withdrawal (n=1). In the treated subjects, the median age was 68 years (range, 61-79). Fifty-five (87.3%) subjects had AML and 8 (12.7%) had MDS. Transplants were performed from HLA-matched related (n=16, 25.4%) or unrelated (n=47, 74.6%) donors with either Fludarabine/Melphalan (n=34, 54%) or Fludarabine/Busulfan (n=29, 46%). The median start date of ruxolitinib after HCT was day 45 (range, 32-93). The median follow-up of survivors was 19 months (range, 3-64) at last cutoff (2/14/23). At the time of analysis, the median number of cycles on treatment is 14 (range, 1-24). 17 subjects remain on therapy; the reasons for discontinuation include completed treatment (n=21), disease relapse (n=13), adverse events (n=7), and physician discretion (n=5). The most common (severe grade ≥3) adverse events experienced while on ruxolitinib were neutropenia (n=18, 29% of subjects), thrombocytopenia (n=17, 27% of subjects), and anemia (n=16, 25% of subjects). Seven subjects experienced grade ≥3 infectious events; no fungal infections have occurred. In subjects receiving ruxolitinib, the 6-month cumulative incidence of Grade II-IV acute GVHD was 14% (95%CI, 7-24) and Grade III-IV acute GVHD was 4.8% (95%CI, 1.3-12), with three cases of grade II-IV GVHD occurring prior to initiation of ruxolitinib. While the 12-month incidence of all cases of chronic GVHD is 27% (95%CI, 17-39), the 12-month incidence of chronic GVHD requiring systemic therapy is 8.4% (95%CI, 3.1-17). The 18-month cumulative incidence of NRM is 5.6% (95%CI, 1.4-14); with only one death attributed to GVHD and one death due to infection (COVID-19), thus far. The 18-month cumulative incidence of disease relapse is 27% (95%CI, 16-39). The 12-month GRFS (primary endpoint) is 70% (95%CI, 56-80). The 18-month OS, PFS, and CRFS are 78% (95%CI, 64-88), 68% (95%CI, 53-78) and 64% (95%CI, 50-76), respectively ( Figure 1). Conclusion: Prolonged administration of ruxolitinib following allogeneic HCT is associated with low rates of chronic GVHD requiring systemic treatment. The incidence of relapse is comparable to historical rates, suggesting no compromise of GVL effect. Despite the anticipated cytopenias with therapy, most subjects were able to remain on treatment. The incorporation of JAK inhibition into GVHD prevention approaches warrants further investigation.

Relationship of the SITLESS intervention on medication use in community-dwelling older adults: an exploratory study.

Sedentary behavior (SB) and physical activity (PA) interventions in older adults can improve health outcomes. Problems related with aging include prevalent comorbidity, multiple non-communicable diseases, complaints, and resulting polypharmacy. This manuscript examines the relationship between an intervention aiming at reducing SB on medication patterns. This manuscript presents a local sub-analysis of the SITLESS trial data on medication use. SITLESS was an exercise referral scheme (ERS) enhanced by self-management strategies (SMS) to reduce SB in community-dwelling older adults. We analyzed data from the ERS + SMS, ERS and usual care (UC) groups. Patient medication records were available at baseline and at the end of the intervention (4-month period) and were analyzed to explore the effect of SITLESS on medication patterns of use. A sample of 75 participants was analyzed, mostly older overweight women with poor body composition scores and mobility limitations. There was a significant reduction of 1.6 medicines (SD = 2.7) in the ERS group (p < 0.01), but not in the UC or ERS + SMS groups. Differences were more evident in medicines used for short periods of time. The findings suggest that an exercise-based program enhanced by SMS to reduce SB might influence medication use for acute conditions but there is a need to further investigate effects on long-term medicine use in older adults.

Does the Number of Comorbidities Predict Pain and Disability in Older Adults With Chronic Low Back Pain? A Longitudinal Study With 6- and 12-Month Follow-ups.

People who live longer often live with multimorbidity. Nevertheless, whether the presence of multimorbidity affects pain and disability in older adults with chronic low back pain (LBP) remains unclear. The aim of this study was to investigate whether multimorbidity predicts pain intensity and disability at 6- and 12-month follow-ups in older adults with chronic LBP. This was a prospective, longitudinal study with 6- and 12-month follow-ups. Participants with chronic LBP (age ≥ 60 years) were recruited and interviewed at baseline, 6 months, and 12 months. Self-reported measures included the number of comorbidities, assessed through the Self-Administered Comorbidity Questionnaire, pain intensity, assessed with the 11-point Numerical Rating Scale, and disability, assessed with the Roland-Morris Disability Questionnaire. Data were analyzed using univariate and multivariate regression models. A total of 220 participants were included. The number of comorbidities predicted pain intensity at 6-month (β= 0.31 [95% CI: 0.12 to 0.50]) and 12-month (β= 0.29 [95% CI: 0.08 to 0.50]) follow-ups. The number of comorbidities predicted disability at 6-month (β= 0.55 [95% CI: 0.20 to 0.90]) and 12-month (β= 0.40 [95% CI: 0.03 to 0.77]) follow-ups. The number of comorbidities at baseline predicted pain and disability at 6-month and 12-month follow-ups in older adults with chronic LBP. These results highlight the role of comorbidities as a predictive factor of pain and disability in patients with chronic LBP, emphasizing the need for timely and continuous interventions in older adults with multimorbidity to mitigate LBP-related pain and disability.

Development and validation of an occurrence-based healthy dietary diversity (ORCHID) score easy to operationalise in dietary prevention interventions in older adults: a French study.

Healthy diet and dietary diversity have been associated with healthy ageing. Several scores have been developed to assess dietary diversity or healthy diets in epidemiological studies, but they are not adapted to be used in the context of preventive nutrition interventions. This study aimed to develop an occurrence-based healthy dietary diversity (ORCHID) score easy to implement in the field and to validate it using dietary data from older participants in the latest French food consumption survey (INCA3). The ORCHID score was made of several components representing the consumption occurrences of twenty food groups, in line with French dietary guidelines. The score was then validated using dietary data (namely three 24-h recalls and a food propensity questionnaire) from 696 participants aged 60 years and over in the INCA3 survey. Score validity was evaluated by describing the association of the score with its components, as well as with energy intakes, solid energy density (SED) and the probability of adequate nutrient intakes (assessed by the PANDiet). Higher scores were associated with more points in healthy components such as 'fruits' and 'vegetables' (r = 0·51, and r = 0·54, respectively). The score was positively associated with the PANDiet (r = 0·43) and inversely associated with SED (r = -0·37), while no significant association was found with energy intakes. The ORCHID score was validated as a good proxy of the nutritional quality of French older adults' diets. It could therefore be a useful tool for both public health research and nutrition interventions.

Brentuximab Vedotin-Based Regimens for Older Patients with Newly Diagnosed Classical Hodgkin Lymphoma -Real World Experience

Introduction: Despite excellent outcomes for young patients with cHL, older patients (pts) age≥ 60 years have less favorable outcomes with a 5-year PFS of about 60% (Cheng, et al. Blood Advances 2022). This disparity is attributed to disease biology, comorbidities, treatment toxicity, dose reductions, and interruptions. Brentuximab vedotin (BV) is increasingly being used in the front-line setting for older pts. The aim of this study was to assess real-word outcomes with BV-based regimens in newly diagnosed older pts with cHL. Methods: We retrospectively reviewed older pts age ≥60 consecutively diagnosed with cHL between 03/2018-01/2023. Data on demographics, medical comorbidities, AEs, PFS and OS were extracted from electronic medical records and were evaluated. For a historical cohort, we reviewed older pts consecutively diagnosed with cHL between 01/2014-03/2018, representing the pre-brentuximab era. Matching 1:1 (the BV cohort to the historical cohort) by age, sex and ECOG was performed. Results: Forty-two patients were treated with BV-based regimens. Patient characteristics included median age of 72 years (range 60-88.5), 71% male, a median Cumulative Illness Rating Scale-Geriatric comorbidity score of 4 (range 0-10), 71% stage IV disease, 61% B symptoms, 49% EBV positive and had 54% had a non-nodular sclerosis histology, table. Twenty-seven (64%) patients received sequential BV-AVD; the rest either received co-current BV-AVD (9,21%) or other BV-palliative combinations (6,15%). The most common adverse events were peripheral neuropathy (35%), infections (16%), and deconditioning (12%), leading to a 33% reduction in treatment, primarily brentuximab vedotin. Twelve patients (28%) did not complete planned treatment, five of them due to AEs, four due to disease progression and three due to other co-morbidities. At median follow up of 2.4 years (95%CI 2.2-2.5), 2-year PFS and OS were 74% and 81%, respectively. After excluding patients treated with palliative regiments (n=36), 2-year PFS and OS were 76% and 93%, respectively. Seven patients died: four from other comorbidities, two from disease progression and one from AEs. Numerical difference in 2-year PFS favoring sequential vs. concurrent BV-AVD was observed, not significant possibly due to low number of pts receiving BV-AVD. When compared to the historical cohort of 43 older patients treated with AVD-based regimens, pts treated with non-palliative BV-based regimens had significantly improved PFS (2-year PFS 65% vs 80%, p=0.035) ,figure. However, there was no statistical significance difference in OS (2-year OS 93% vs 94%, p=0.46). In the BV-based group, all relapsed pts were treated with anti-PD-1-based therapies. In contrast, among the AVD-based group, salvage treatment involved BV-based therapy for 74% of patients, PD-1 therapy for 39%, and chemotherapy with subsequent ASCT for 13%. Conclusions: In this real-world series, sequential BV-AVD regimen was well-tolerated and safe with outcomes that are favorable and comparable to results from the phase II study by Evens et al (JCO 2018). Pts treated with BV-based regimens had significantly better PFS compared to the historical cohort, supporting the use of BV combinations for this elderly population. The lack of statistical significance in OS may be related to death from other comorbidities, limited sample size and the nature of a retrospective data. Additionally, the number of lymphoma-related deaths was low indicating that a significant number of patients can be successfully salvaged, thus also impacting OS observation. Ongoing multicenter data collection efforts are in progress to address the impact of novel agents on treatment of older adults with HL.

Physiotherapist-led, exercise-based telerehabilitation for older adults improves patient and health service outcomes: a systematic review and meta-analysis.

Telerehabilitation can be an appropriate alternative to face-to-face rehabilitation for adults; however, it is uncertain whether it is safe and effective for older adults. This review aimed to determine the effect of physiotherapist-led, exercise-based telerehabilitation for older adults on patient outcomes (health-related quality of life, activity limitation, functional impairment) and health service costs. Randomised or non-randomised controlled trials including community-dwelling older adults (mean age ≥ 65years) who received exercise-based telerehabilitation led by a physiotherapist were eligible. Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, PubMed and Cochrane Library were searched from the earliest available date to August 2022. Methodological quality was assessed using the Physiotherapy Evidence Database scale. Data were synthesised with inverse variance, random-effects meta-analyses to determine standardised mean differences and 95% confidence intervals. Certainty of evidence was determined by applying Grading of Recommendations, Assessment, Development and Evaluation criteria. Eleven studies (10 randomised) with 1,400 participants (mean age 65-74years) experiencing musculoskeletal and cardiopulmonary conditions were included. Telerehabilitation was safe, effective and well adhered to. Telerehabilitation was non-inferior to face-to-face physiotherapy in relation to range of movement, strength, 6-min walk distance (6MWD), timed up and go test (TUGT) and quality of life and had lower health-care costs compared with face-to-face physiotherapy. Compared with no intervention, telerehabilitation participants had significantly better range of motion, strength, quality of life, 6MWD and TUGT speed. Physiotherapist-led, exercise-based telerehabilitation is non-inferior to face-to-face rehabilitation and better than no intervention for older adults with musculoskeletal and cardiopulmonary conditions.

Telehealth interventions in occupational therapy with older adults: Results from a scoping review targeting better health promotion.

Telehealth interventions have the potential to enhance access to care and improve efficiency while reducing the burden on patients. Although telehealth interventions are well accepted and adopted in physical therapy, their usage in occupational therapy for older adults is less common, and limited information exists regarding their setting and context. To provide an inventory and synthesis of telehealth interventions in occupational therapy for older adults. For published studies on telehealth-based occupational therapy interventions in older adults between 2000 and 2022, six databases were reviewed. Data extraction and analysis were guided by the taxonomies developed by Tulu, McColl and Law and informed by the Canadian Model of Occupational Performance and Engagement. Twenty-three studies on telehealth interventions in occupational therapy for older adults were identified, mostly from North American authors (n = 11; 47.8%) and randomised clinical trials (n = 9; 39.1%). Most participants had a health problem (n = 20; 87.0%), mainly stroke (n = 9; 39.1%). Interventions focussed primarily on symptom management education (n = 12; 52.2%) of community-dwelling adults with health conditions, using videoconferencing systems or applications (n = 14; 60.7%). Interventions were delivered from the healthcare centre (n = 6; 26.1%) to the person's home (n = 18; 78.3%) synchronously (n = 19; 82.6%). About one third (n = 8; 34.8%) of the studies specified the therapist's location. Published studies on telehealth interventions in occupational therapy with older adults have mainly focussed on the synchronous training and education of participants using videoconferencing systems or applications. According to these studies, the scope of interventions is limited and could be expanded, for example, through occupational development and environmental modification. To better understand and describe best practices in the use of telehealth in occupational therapy, future studies should provide more details about the interventions performed, the technology used and the environmental settings of the therapist.