Months In Older Adults Research Articles

Training and provision of mobility aids to promote autonomy and mobility of older patients in a geriatric emergency department: A protocol for a randomized controlled trial.

Older adults have higher rates of emergency department (ED) admissions when compared to their younger counterparts. Mobility is the ability to move around, but also encompasses the environment and the ability to adapt to it. Walking aids can be used to improve mobility and prevent falls. According to international guidelines, they must be available in Geriatric EDs. This study aims to evaluate the efficacy of a program of training and provision of walking aids (WA), associated or not with telemonitoring, on fear of falling, mobility, quality of life and risk of falls up to 3 and 6 months in older adults cared for in an ED. A randomized controlled trial will be carried out in the ED. Participants will be randomized and allocated into three groups, as follows: A) walking aid group will be trained for the use of a walking aid and receive guidance on safe gait; B) walking aid and telemonitoring group will receive training for the use of a walking aid, guidance on safe gait, and telemonitoring (every two weeks for first three months); C) Control group will receive only guidance on safe gait. Patients will undergo a baseline evaluation encompassing sociodemographic and clinical data, mobility in life spaces, gait speed, muscle strength, functionality, quality of life, fear of falling, history of falls, cognition and mood before the intervention. Gait time and fear of falling will be assessed again after the intervention in ED. Finally, mobility in life spaces, functionality, quality of life, fear of falling, history of falls, cognition, and mood will be assessed 3 and 6 months after discharge from the geriatric ED through a telephone interview. Provision of walking aids in the geriatric ED is currently recommended. This study will be the first randomized controlled trial that will evaluate the impact of training and provision of these devices in the ED. Trial registration number: NCT05950269.

Follow-up of Cardiopulmonary Responses Using Submaximal Exercise Test in Older Adults with Post-COVID-19.

Data on cardiopulmonary fitness in older adults in the longer term after coronavirus disease 2019 (COVID-19) are of interest as the time required for the full recovery of physical fitness after COVID-19 remains unclear. Some studies have reported that patients do not recover physical fitness for up to 6 or 12 months after COVID-19, whereas other studies have observed full recovery after 12-months. Therefore, this study evaluated and compared the cardiopulmonary responses induced by the 6-minute walk test (6MWT) and 1-minute sit-to-stand-test (STST) results at 3, 6, and 12 months in older adults with and without COVID-19. This study included 59 older adults with and without a history of COVID-19. The cardiopulmonary response parameters including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse oxygen saturation (O2 sat), rate of perceived exertion (RPE), and leg fatigue were evaluated in the participants after 6MWT and 1-min-STST assessments. Post-COVID-19, older adults showed statistically significant differences in HR, SBP, DBP, O2 sat, RPE, leg fatigue, 6MWT time, and 1-min-STST step numbers at 3, 6, and 12 months (P < 0.001). Moreover, older adults showed statistically significant differences in HR, SBP, DBP, RPE, leg fatigue, O2 sat, and 6MWT distance at 3 months post-COVID-19 compared with those in older adults without COVID-19 (P < 0.001). While older adults showed recovery of cardiopulmonary response parameters according to 6MWT and 1-min-STST findings at the 12-month follow-up post-COVID-19, these results of these measurements did not return to the values observed in older adults without COVID-19.

Precision nutrition impact on metabolic health and quality of life in aging population after a 3-month intervention: A randomized intervention

ObjectivesInnovative precision dietary procedures are required to promote healthy aging. This study aimed to evaluate the effects of a personalised strategy based on the inclusion of individualised foods and digital tools on overall health status and quality of life within a follow-up of 3 months in older adults with overweight or obesity. Methods127 men and women aged between 50 and 80 years with overweight/obesity participated in the study—between January 2020 and September 2020 at the Center for Nutrition Research-University of Navarra and IMDEA-ALIMENTACIÓN—and were randomly assigned to a usual-care group (standard recommendations) or precision group (precision nutrition strategy based on the inclusion of individualised foods and a mobile application). Anthropometry, body fat percentage, biochemical parameters, diet, and quality of life (SF-36 Health Survey) were assessed at baseline and after 3 months. ResultsBoth strategies were found to improve overall metabolic health; however, the precision approach demonstrated significantly better outcomes. The precision strategy reduced body weight at 3 months (−4.3 kg; p < 0.001) with significant improvements in body fat percentage, blood pressure and general metabolic health (glycated haemoglobin; alanine aminotransferase; aspartate aminotransferase; hepatic steatosis index) in comparison with the standard recommendations. The precision approach significantly enhanced the quality of life (SF-36) of individuals, with additional improvements in emotional well-being (p = 0.024) and vitality (p = 0.008). Adherence to the Mediterranean diet was significantly associated with a higher quality of life and vitality. ConclusionThese results support the benefit of precision nutrition approaches for promoting healthy aging and emotional well-being, enhancing the quality of life in aging populations, during the COVID-19 pandemic.

Impact of deintensifying hypoglycaemic drugs in older adults with type 2 diabetes: protocol for an emulation of a target trial

IntroductionIn older adults with type 2 diabetes (T2D), overtreatment with hypoglycaemic drugs (HDs: sulfonylureas, glinides and/or insulins) is frequent and associated with increased 1-year mortality. Deintensification of HD is thus...

The impact of mental health outcomes on cognition during the COVID‐19 pandemic in older adults with remitted depression, mild cognitive impairment, or normal cognition

AbstractBackgroundOlder adults may be vulnerable to worsening cognition during pandemics because of public health restrictions that increase social isolation and negatively impact mental health. In the current study, we assessed mental health outcomes during the COVID‐19 pandemic and their relationship with cognitive status at 6 months in older adults with remitted major depressive disorder (rMDD), mild cognitive impairment (MCI), or normal cognition (NC).MethodThe sample consisted of 108 older adults enrolled from ongoing studies [37M, mean age = 70.6 (SD = ±5.75)], including 71 NC, 21 rMDD, and 16 MCI]. Participants completed self‐report measures including the Patient Health Questionnaire‐9 to assess depression, Patient Reported Outcomes Measurement Information System to assess anxiety, Perceived Stress Scale to assess general stress, Impact of Events Scale‐Revised to assess post‐traumatic stress, and the Clinical Dementia Rating Scale (CDR) at baseline, 3 and 6 months. Repeated measures ANCOVA of mood and cognitive measures with time as a within‐subject factor and covariates of parent study and mood/memory diagnosis assessed change over time in mental health and cognition. Regression modelling of CDR Sum of Boxes (CDR‐SB) score at 6 months with baseline mood and anxiety scores as predictors and age, gender, parent study, and mood/memory diagnosis as covariates were used to assess the association between mental health and future cognition.ResultMood and cognition did not significantly vary over the three time‐points. Depression and general stress at baseline were predictive of CDR‐SB at 6‐month follow‐up, accounting for 14% of its variance (F(6,55) = 2.69, p = .023, B = .28, p = .038; F(6,72) = 3.16, p = .008, B = .21, p = .088, respectively). Neither anxiety nor post‐traumatic stress symptom severity predicted CDR‐SB.ConclusionThese findings are consistent with epidemiological studies supporting associations between depression or stress and risk of dementia (Byers &amp; Yaffe, 2011; Stuart &amp; Padgett, 2020). Limitations of the study include non‐random sampling and small rMDD and MCI samples. Nevertheless, these preliminary findings suggest the need to address adverse mental health outcomes in seniors during the COVID‐19 pandemic to potentially reduce risk of future cognitive decline.

What is the impact of ongoing statin use on cognitive decline and dementia progression in older adults with mild-moderate Alzheimer disease?

In addition to the clear cardiovascular benefit, there has been renewed interest in the potential of statins in the prevention of cognitive impairment and dementia in older adults. However, whether ongoing statin use can delay cognitive decline or dementia progression in those with established Alzheimer dementia, is unclear. Using data from NILVAD, we analysed the association between ongoing statin use and cognitive decline (Alzheimer Disease Assessment Scale-Cognitive Subsection [ADAS-Cog])/dementia progression (Clinical Dementia Rating Scale [CDR-Sb]/Disability Assessment for Dementia [DAD]) over 18 months in older adults with mild-moderate AD. Additionally, we assessed the association between ongoing statin use and adverse events in mild-moderate AD. Over one-third (34.9%) of 510 older adults with mild-moderate AD (aged: 72.9 years; 61.9% female) used a statin for the 18-month study duration. Statin use was not associated with the rate of cognitive decline (β: -0.67; 95% CI: -1.71, 0.36, p = 0.20) or dementia progression (β: -0.34; 95% CI -0.71, 0.02; p = 0.07 for CDR-Sb/ β: -2.00; -5.70, 1.70; p = 0.29 for DAD). Further, ongoing statin use was not associated with adverse events, serious adverse events, unscheduled GP visits, or unscheduled hospitalisation. Ongoing statin use was not associated with cognitive decline or dementia progression in mild-moderate AD. Similarly, use was not associated with adverse events including abnormal liver function tests or falls. Whilst safe in those with AD, the current results suggest ongoing statin use does not delay cognitive decline or clinical progression in established AD.

Higher knee flexion moment during walking is associated with a lower risk of knee pain developing among the elderly after 24 months.

Knee pain is one of the main problems associated with knee osteoarthritis. The peak external knee adduction moment (KAM) in gait is commonly used to estimate medial knee loading, and elevated KAM has been related to a higher risk of developing knee pain in older adults. Although knee flexion moment (KFM) also contributes to medial knee loading, its role in the development of knee pain remains unclear. To investigate the association between knee moments and the incidence of knee pain in 24 months in asymptomatic older adults. Prospective cohort study. University laboratory. Community-dwelling adults aged 60-80 years were recruited. We excluded participants with knee pain/known arthritis, knee injury, knee/hip joint replacement, cognitive impairment, or neurological conditions. Three-dimensional gait analysis was conducted to compute the peak KFM and KAM. Telephone surveys were conducted 12 and 24 months after the baseline assessment. Self-reported knee pain and its intensity and frequency were captured. Logistic regression with generalized estimating equations was used to examine associations between knee moments and the risk of knee pain. Of the 162 eligible participants who completed the baseline assessment (age: 65.8±4.0 years, 61.1% females), 157 and 138 were also assessed for incident knee pain after 12 and 24 months, respectively. Compared with the lowest tertile, the highest tertile of KFM was significantly related to a lower incidence of frequent knee pain (RR=0.25, 95% CI: 0.08-0.85, P=0.027) in 24 months. In addition, a higher KFM was significantly associated with the lower intensity of incident knee pain after 24 months (β=-1.513; 95% CI: -2.879, -0.147; P=0.030). We also observed trends showing that a higher peak KAM was related to higher risks of developing any (RR=2.48, 95% CI: 0.99-6.20, P=0.053) and frequent (RR=3.82, 95% CI: 0.96-15.1, P=0.057) knee pain in 24 months. A higher sagittal knee moment is associated with a lower risk of knee pain developing in 24 months in older adults. Interventions for promoting sagittal knee moment may be considered in preventative training programs for reducing knee pain among older adults.

Combined effect of diabetes and frailty on mortality among Chinese older adults: A follow-up study.

Frailty and diabetes are two important health problems associated with aging in older individuals. This paper seeks to analyze the frailty in older adults suffering from diabetes and the combined effect of diabetes and frailty on mortality risk. The frailty index (FI) model was employed when evaluating frailty among the older adults based on the baseline data conducted in 2009; and death as outcome variables collected in 2020 were analyzed. The influence of diabetes on age-related changes in frailty in the older adults and resulting mortality rates was analyzed. Cox regression and Kaplan-Meier curves were applied to evaluate the influence on the risk of death and the 11-year survival of the older adults with varying diabetes and frailty statuses. Ultimately, 1,213 older people aged between 60 and 101, with an average age of (74.79 ± 8.58) at baseline, were included in the analysis. By 2020, there had been 447 deaths with mortality at 36.9% (447/1,213); there were 271 cases of diabetes, with a prevalence of 22.3% (271/1,213). The mean FI value for older adults with diabetes was higher than that of those without regardless of age, and the average annual relative growth rate of the FI value for older adults with diabetes was higher than that of those without diabetes (β = 0.039 vs. β = 0.035, t = 8.367, P < 0.001). For all FI value levels, the mortality rate among older adults with diabetes was higher than that of those without. The Cox Regression analysis showed that, compared with those suffering from neither diabetes nor frailty, older adults with both had the higher mortality risk (HR = 1.760.P < 0.001), followed by older adults suffering from frailty alone (HR = 1.594, P = 0.006), and then by older adults suffering from only diabetes (HR = 1.475, P = 0.033). The survival analysis showed that the median survival of those suffering from diabetes and frailty to be the shortest at just 57.23 (95% CI: 54.05 to 60.41) months, lower than the 83.78 (95% CI: 79.33 to 88.23) months in those suffering from frailty alone, and 119.93 (95% CI: 113.84 to 126.02) months in those with only diabetes, and 124.39 (95% CI: 119.76 to 129.02) months in older adults with neither diabetes nor frailty (P < 0.001). Frailty is common among older adults suffering from diabetes, and there is an increased risk of poor health outcomes, such as death, among older adults suffering from diabetes and frailty. When diagnosing, treating, and dealing with older adults with diabetes, attention should be paid to screening and assessing frailty in hopes of identifying it early so that appropriate measures of intervention can be taken to avoid or delay the resulting adverse effects.

Can timed up and go subtasks predict functional decline in older adults with cognitive impairment?

The aim of this study was to verify if the TUG test and its subtasks can predict functional decline over 32 months in older adults with mild cognitive impairment (MCI) and mild Alzheimer's disease (AD). This is a prospective 32-month follow-up study, including at baseline 78 older adults (MCI: n=40; AD: n=38). The TUG and its subtasks (e.g., sit-to-stand, walking forward, turn, walking back, and turn-to-sit) were performed at baseline using the Qualisys Motion system. Functional capacity was assessed at baseline and after 32 months. After follow-up, the sample had 45 older adults (MCI: n=25; AD: n=20). Of these, 28 declined functional capacity (MCI: n=13; AD: n=15). No TUG variable significantly predicted (p>0.05) functional decline in both groups, by univariate logistic regression analysis with the covariate gender. Although older adults with MCI and mild AD declined functional capacity, the TUG test and its subtasks could not predict this decline over 32 months.

Trajectories of Physical Function and Disability Over 12 Months in Older Adults With Chronic Low Back Pain.

Understanding prognosis is critical for clinical care and health policy initiatives. The purpose of this study was to determine whether distinct prognostic trajectories of physical function and disability exist in a cohort of 245 community-dwelling older adults with chronic low back pain (LBP), and to characterize the demographic, health, and pain-related profiles of each trajectory subgroup. All participants underwent standard clinic examinations at baseline, 3 months, 6 months, and 12 months. At each time point, the Late Life Function & Disability Instrument (LLFDI) was used to measure general physical function (LLFDI Function) and disability (LLFDI Disability-Limitation); the Quebec LBP Disability Questionnaire was used to measure disability due to pain. Growth mixture modeling (GMM) was performed on each outcome to identify distinct trajectory classes/subgroups; baseline demographic (eg, age and sex), health (eg, comorbidities, depressive symptoms, and physical activity level), and pain-related (eg, LBP intensity, pain-related fear, and pain catastrophizing) characteristic profiles were compared across subgroups. GMM statistics revealed an optimal number of 3 to 4 trajectory subgroups, depending on the outcome examined. Subgroups differed across demographic, health, and pain-related characteristics; the classes with the most favorable prognoses had consistent profile patterns: fewer depressive symptoms, fewer comorbidities, higher physical activity levels, lower LBP intensities, less pain-related fear, and less pain catastrophizing. Our findings indicate that several distinct trajectory subgroups exist that would have been masked by observing mean cohort change alone. Furthermore, subgroup characteristic profiles may help clinicians identify likely prognostic trajectories for their patients. Future research should focus on identifying modifiable risk factors that best predict group membership, and tailoring interventions to mitigate the risk of poor prognosis.

Vitamin D Supplementation for 12 Months in Older Adults Alters Regulators of Bone Metabolism but Does Not Change Wnt Signaling Pathway Markers.

ABSTRACTVitamin D status and supplementation regulates bone metabolism and may modulate Wnt signaling. We studied the response of hormonal regulators of bone metabolism, markers of Wnt signaling and bone turnover and bone mineral density (BMD) and bone mineral content (BMC) in a randomized vitamin D intervention trial (12,000 IU, 24,000 IU, 48,000 IU/mo for 1 year; men and women aged >70 years; n = 379; ISRCTN35648481). Associations with total and free 25(OH)D concentrations were analyzed by linear regression. Baseline vitamin D status was (mean ± SD) 25(OH)D: 40.0 ± 20.1 nmol/L. Supplementation dose‐dependently increased total and free 25(OH)D concentrations and decreased plasma phosphate and parathyroid hormone (PTH) (all p < 0.05). The procollagen 1 intact N‐terminal (PINP)/C‐terminal telopeptide (CTX) ratio, C‐terminal fibroblast growth factor‐23 (cFGF23), and intact FGF23 (iFGF23) significantly increased with no between‐group differences, whereas Klotho was unchanged. 1,25(OH)2D and PINP significantly increased in the 24 IU and 48,000 IU groups. Sclerostin (SOST), osteoprotegerin (OPG), receptor activator of NF‐κB ligand (RANKL), BMD, BMC, and CTX remained unchanged. Subgroup analyses with baseline 25(OH)D <25 nmol/L (n = 94) provided similar results. Baseline total and free 25(OH)D concentrations were positively associated with 1,25(OH)2D, 24,25(OH)2D (p < 0.001), vitamin D binding protein (DBP) (p < 0.05), BMD, and BMC (p < 0.05). Associations with PTH (p <0.001), cFGF23 (p < 0.01), and BAP (p < 0.05) were negative. After supplementation, total and free 25(OH)D concentrations remained positively associated only with 24,25(OH)2D (p < 0.001) and DBP (p < 0.001) and negatively with estimated glomerular filtration rate (eGFR) (p < 0.01). PTH and SOST were significantly associated only with free 25(OH)D. There were no significant relationships with BMD and BMC after supplementation. The decrease in PTH and increase in PINP/CTX ratio suggest a protective effect of supplementation on bone metabolism, although no significant effect on BMD or pronounced changes in regulators of Wnt signaling were found. The increase in FGF23 warrants caution because of its negative association with skeletal and cardiovascular health. Associations of total and free 25(OH)D with biomarkers were similar and known positive associations between vitamin D status and BMD were confirmed. The change in associations after supplementation might suggest a threshold effect. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Correlation between changes in Timed Up and Go performance and cognition in older people with mild cognitive impairment: A longitudinal study

BackgroundCompare changes in performance on subtasks of the Timed Up and Go test over 32 months in older adults with and without mild cognitive impairment; analyze the correlation between frontal cognitive functions at baseline and changes in Timed Up and Go subtasks over time. MethodsA longitudinal study was conducted involving 31 older adults (15 with and 16 without cognitive impairment). Functional mobility was assessed at both evaluations using an adapted version of the Timed Up and Go test and the Qualisys motion system. The test was divided into five subtasks: sit-to-stand, walking forward, turn-to-walk, walking back and turn-to-sit. Cognition was assessed at baseline using the Frontal Assessment Battery and the Clock Drawing Test. FindingsSignificant differences in changes in the sit-to-stand subtask over time were found between groups. The difference in the time required to conclude this subtask was greater in the older adults with cognitive impairment. However, the difference in kinematic variables (peak trunk speed and range of motion) was greater in the group without cognitive impairment. Strong and moderate correlations were found between frontal cognitive functions and changes in Timed Up and Go subtasks, especially those involving transitions (sit-to-stand, turn-to-walk and turn-to-sit) in both groups. InterpretationMotor intervention protocols should incorporate the sit-to-stand subtask in older adults with mild cognitive impairment. Moreover, changes in more complex subtasks seem to be related to frontal cognitive performance at baseline. Therefore, treatments that combine motor and cognitive functions should be administered to older adults regardless of cognitive impairment.

Genetic interaction of APOE and BDNF is associated with changes in cognitive function over 36 months in older adults.

The association between human cognitive function and genetic variants of Apolipoprotein E (APOE) or brain-derived neurotrophic factor (BDNF) vary greatly between studies. Our previous work have shown significant APOE×BDNF interactions with cognitive function at baseline. However, the long-term associations between APOE×BDNF interaction and the changes in cognitive function remain unclear. 464 healthy older adults with genotype data were obtained from longitudinal prospective study, who underwent annual assessment of neuropsychological and health. APOE and BDNF were assessed as predictors of average level and change in cognitive function as well as APOE×BDNF interaction. The APOE ε4 was significantly associated with the increase in episodic memory over 36 months. There were no associations between APOE/BDNF and longitudinal changes in other cognitive domains. Additionally, APOE and BDNF interaction significantly associated with an increase in language processing. APOE and BDNF my be direct or combine together to influence changes in specific cognitive domains in healthy older adults.

Hypomethylating Agent (HMA) Therapy and Venetoclax (VEN) with FLT3 Inhibitor “Triplet” Therapy Is Highly Active in Older/Unfit Patients with FLT3 Mutated AML

Hypomethylating Agent (HMA) Therapy and Venetoclax (VEN) with FLT3 Inhibitor “Triplet” Therapy Is Highly Active in Older/Unfit Patients with FLT3 Mutated AML

Orthostatic Hypotension is a Risk Factor for Falls Among Older Adults: 3-Year Follow-Up

ObjectivesTo assess the prevalence of orthostatic hypotension (OH) and the association of OH with the risk of falls among community-dwelling older adults with a previous fall. DesignLongitudinal study. Setting and ParticipantsThe subjects (n = 561) were participants in fall prevention conducted in western Finland. MethodsBlood pressure (BP) was measured in supine position and at 30 seconds and 3 minutes after standing. The participants were divided according to the consensus definition to an OH group (OHG) and a non-OH group (non-OHG). Falls were recorded by fall diaries during 12 months. Falls requiring treatment were gathered from health center and hospital registers during 12 and 36 months. ResultsThe prevalence of OH was 23.4% (30 seconds) and 7.3% (3 minutes). The 30-second measurement showed that the incidence of falls and that of falls requiring treatment were significantly higher in OHG compared with non-OHG during 12 months. After adjustments, the incidence of falls remained higher in all 5 adjusted models whereas that of falls requiring treatment remained higher only after adjustment for functional balance. The 3-minute measurement showed that the incidence of falls was higher in OHG compared with non-OHG during 12 months and remained higher after adjustments for functional balance and for age and functional balance. During the 36-month follow-up, OH measured at 30 seconds or 3 minutes after standing was not associated with the occurrence of falls leading to treatment. Conclusions and ImplicationsOH at 30 seconds or 3 minutes after standing is associated with a greater risk for falling within 12 months in older adults. The 30-second blood pressure measurement is more reliable to detect the risk than the 3-minute measurement. The results support the usability of 30-second measurement in determining OH and the risk for falling among older persons.

Long‐term antipsychotic use and cognitive decline in community‐dwelling older adults with mild–moderate Alzheimer disease: Data from NILVAD

Previous evidence has suggested that antipsychotic use may be associated with accelerated cognitive decline in those living with dementia. However, the cognitive effects of long-term antipsychotic use in community-dwelling older adults with mild-moderate Alzheimer disease (AD) has not been explored to date. We assessed the impact of long-term antipsychotic use on the rate of cognitive decline (Alzheimer's Disease Assessment Scale-Cognitive Subsection) and dementia progression (Clinical Dementia Rating-Sum of Boxes [CDR-Sb]/Disability Assessment for Dementia [DAD]) over 18 months in older adults with mild-moderate AD. Of 509 participants with mild-moderate AD, one-tenth (54/509; 10.6%) were prescribed an antipsychotic for the 18-month study duration. Antipsychotic use was significantly associated with accelerated cognitive decline at both 12 (β: 3.53, 0.91-6.17, p=0.008) and 18 months (β: 3.81, 0.49-7.14, p=0.024) in addition to greater dementia progression at both 12 (β: 1.85, -0.97-2.73, p<0.001 for CDR-Sb/β: -3.33, -5.56-1.10, p=0.003 for DAD) and 18 months (β: 1.41, 0.16-2.67, p=0.027 for CDR-Sb/β: -3.86, -6.64 to -1.08, p=0.006 for DAD). APOE ε4 carriers experienced significantly greater cognitive decline with long-term antipsychotic use. Long-term antipsychotic use was associated with greater cognitive decline and dementia progression in community-dwelling older adults with mild-moderate AD. Our findings are consistent with previous evidence encouraging cautious and careful consideration of risks versus benefits of antipsychotic usage in those with AD.

Relative Fat Mass (RFM) as an Estimate of Total Adiposity in Older Adults

Abstract Objectives It is imperative to accurately estimate whole body fat percentage (%fat) in order to understand the deleterious nature of excess adiposity on cardiometabolic disease risk. However, cost and accessibility often preclude the use of advanced assessment methods. Relative fat mass (RFM), an emerging estimator of whole body %fat based upon waist circumference, height, and biological sex, has yet to be evaluated in an older adult population. The purpose of this study was to examine the relationship between RFM and gold standard measures of adiposity among older adults, and to evaluate whether changes in RFM reflected changes in %fat following a 12-month lifestyle intervention. Methods This study was ancillary to a randomized controlled trial investigating the effects of a lifestyle intervention with and without intentional energy restriction. (Clinicaltrials.gov #NCT00955903). Older adults with obesity (N = 163, 37.4% male, 70.3 ± 4.7 years) were randomized to one of three groups: exercise only, exercise + nutrient-dense weight maintenance diet, or exercise + nutrient-dense energy restriction of 500 kcal/d. Total and regional adiposity were determined by dual-energy X-ray absorptiometry (DXA) at baseline and 12 months. Data were analyzed using Spearman's correlations, Wilcoxon, Kruskal-Wallis, and linear regression tests. Results At baseline, significant correlations were observed between RFM and DXA whole body %fat (r = 0.751, P &amp;lt; 0.001), DXA total fat (r = 0.353, P &amp;lt; 0.001), and DXA trunk %fat (r = 0.661, P &amp;lt; 0.001). Additionally, RFM was a significant predictor of DXA whole body %fat (P &amp;lt; 0.001) and accounted for 63.5% of model variance. From baseline to 12 months, a significant reduction in RFM was observed among participants in the exercise only and exercise + energy restriction groups (P = 0.020, P &amp;lt; 0.001, respectively). Magnitude of RFM change did not differ among groups. Notably, changes in RFM were significantly correlated with changes in DXA whole body %fat (r = 0.279, P = 0.001) and DXA trunk %fat (r = 0.276, P = 0.001). Conclusions Results support use of RFM as an estimate of whole body %fat, as well as an indicator of its sensitivity to change in fat mass over 12 months in older adults. Incorporation of RFM in cardiometabolic research may provide meaningful information not reflected in conventional body composition measures such as body mass index. Funding Sources NIH

Quality of life and Comprehensive Geriatric Assessment (CGA) in older adults receiving Accelerated Partial Breast Irradiation (APBI) using a single fraction of Multi-Catheter Interstitial High-Dose Rate Brachytherapy (MIB). The SiFEBI phase I/II trial

ObjectivesThe SiFEBI trial demonstrated that a post-operative Multicatheter Interstitial Brachytherapy (MIB) appears feasible and with acceptable toxicity in older adults aged 70 years and older presenting with low-risk breast cancer. The aim of the present ancillary study was to analyze the quality of life and Comprehensive Geriatric Assessment (CGA) domains within 6 months in older adults receiving Accelerated Partial Breast Irradiation (APBI) using a single fraction of MIB. Materials and MethodsFrom 11/2012 to 09/2014, 37 patients were included and 26 were evaluable. Patients (pts) aged 70 years and older with a Balducci score of 1 or 2 and presenting with low-risk breast cancer were prospectively enrolled in this phase I/II trial (NCT01727011). After lumpectomy, intra-operative catheter implantation was performed for post-operative APBI after pathological findings. Quality of life (QoL) evaluation and CGA were scheduled at baseline and 1, 3, and 6 months after APBI. Autonomy decline was defined as a 1-point decrease in Activities of Daily Living (ADL). ResultsMean age was 77 years. Within the first 6 months of follow-up, no autonomy decline was observed in ADL, 3 patients had an autonomy decline in Instrumental Activities of Daily Living (IADL) and 2 patients had a slower gait speed but no changes in cognitive function, nutritional status, and depression screening. Global QoL was quite similar at baseline compared to 1, 3, and 6 months. No differences were observed for functional items. ConclusionAPBI based on a single fraction of MIB in older adults with low-risk breast cancer appears to be feasible with a minimal loss of autonomy regarding IADL, no loss of autonomy in ADL, an acceptable decrease in other CGA domains, and with no impact on global quality of life.

Assessment of discontinuation of oral nutritional supplement use at 6 months in older adults discharged from the internal medicine wards

Rationale: Compliance with oral nutritional supplements (ONSs) beyond one month has been reported is not satisfactory (1). Numerous patient, care model and ONS related factors influence persistent intake of ONSs. The present study was conducted to assess the discontinuation of physician prescribed ONS at 6-months in hospitalized complex older adults at advanced ages.

SEX AND THE BIOPSYCHOSOCIAL MODEL: SEXUAL ACTIVITY AND GENDER DISPARITY IN OLDER ADULTS

The biopsychosocial model emphasizes relational factors such as quality and availability as key components to older adult sexual activity (Gillespie, 2017). Supporting these findings, a previous study found that older adults aged 65 and over reported having more sex in the past six months but fewer sexual partners in the past year than younger adults. The current study seeks to further explore sexual activity by gender specifically, number of sex partners in the last year, and frequency of sex over the past six months in older adults. To better understand sexual activity and gender differences, 499 (male=59.7%, female 40.3%) participants aged 65 to 93 were selected from the de-identified Survey of Midlife in the US database (MIDUS-3). A Weltch T-test was used examining sexual activity among older adults based on gender. Results indicated that the number of sex partners within the past year was similar for females (M=1.10, SD=.49) and males (M=1.04, SD=.28), t(477)=1.62, p=.10, d^=.07. Further, results indicated sex frequency within the last six months was similar between females (M=3.41, SD=1.55) and males (M=3.66, SD=1.48), t(415)=1.76, p=.08, d^=.14. Contrary to previous research, the present findings suggest there are no gender differences in number of sex partners or sex frequency for older adults. The current findings draw attention to potential discrepancies within this under-explored subject area. While implications of these findings can improve communication regarding sexual health, future research should focus on how aspects of the biopsychosocial model can be a protective factor for the sexual health of older adults.