Morbidity In Older Adults Research Articles

2737. Comparison of Antibody Responses to Vaccination with a Pure Hemagglutinin Influenza Vaccine (rHA) and Licensed Subvirion Influenza Vaccine Made in Eggs or Cell Culture in Adults 60 Years and Older

BackgroundInfluenza is associated with increased mortality and morbidity for older adults. High-dose egg grown trivalent inactivated influenza vaccine (Fluzone HD) is safe and provides superior immune responses in older adults compared with standard dose (SD). Recently, two new vaccines have been licensed in the United States: cell cultured inactivated vaccine FluCelVax and baculovirus-expressed pure hemagglutinin (HA) vaccine FluBlok. Data from one study demonstrated higher efficacy with FluBlok than SD Fluzone in older adults. There is no data however comparing HD Fluzone to FluBlok and FluCelVax has not been studied at all. The purpose of this study was to assess hemagglutinin inhibition (HAI) antibody responses to vaccination with three vaccines in adults ≥ 60 years.MethodsAdults ≥ 60 years were randomly assigned to receive one of the three vaccines: Fluzone HD, FluBlok and FluCelVax (Figure 1). Active influenza-like illness (ILI) surveillance was conducted with bi-weekly telephone calls. Serum samples were collected prior to vaccination and at day 7, 14, 28 and 180 and antibody responses assessed by HAI titer to A/Singapore/INFIMH-16–0019(H3N2), A/Michigan/45/2015(H1N1) and B/Colorado/6/2017 (Victoria) viruses as well as a circulating H3N2 strain. The primary endpoint was a 4-fold rise in antibody titer at day 28.Results48 subjects were vaccinated in October 2018. Mean age was 69 and 65% were female. Two subjects reported ILI symptoms and one was positive for infection (H1N1). A majority of subjects demonstrated pre-existing antibody to all three viruses (Figure 2, Blue). Geometric mean titers (GMT) for antibody responses to the influenza A viruses were similar for FluBlok (FB) and HD Fluzone (FZ) but lower for FluCelVax(FCB) subjects (Figure 2, Orange). A higher percent of FlubBlok subjects demonstrated 4-fold rise in antibody responses to the Victoria influenza B virus (FB GMT 140 vs. FZ GMT 116, P = 0.26).ConclusionIn this small study, antibody responses were similar or higher in older adults after vaccination with FluBlok compared with Fluzone HD with lower responses demonstrated with FluCelvax. Emerging concerns about HA egg adaptation during vaccine development compels further study to determine the appropriate vaccination strategy for this vulnerable population. Disclosures All authors: No reported disclosures.

Epigenetic signatures of smoking associate with cognitive function, brain structure, and mental and physical health outcomes in the Lothian Birth Cohort 1936

Recent advances in genome-wide DNA methylation (DNAm) profiling for smoking behaviour have given rise to a new, molecular biomarker of smoking exposure. It is unclear whether a smoking-associated DNAm (epigenetic) score has predictive value for ageing-related health outcomes which is independent of contributions from self-reported (phenotypic) smoking measures. Blood DNA methylation levels were measured in 895 adults aged 70 years in the Lothian Birth Cohort 1936 (LBC1936) study using the Illumina 450K assay. A DNA methylation score based on 230 CpGs was used as a proxy for smoking exposure. Associations between smoking variables and health outcomes at age 70 were modelled using general linear modelling (ANCOVA) and logistic regression. Additional analyses of smoking with brain MRI measures at age 73 (n = 532) were performed. Smoking-DNAm scores were positively associated with self-reported smoking status (P < 0.001, eta-squared ɳ2 = 0.63) and smoking pack years (r = 0.69, P < 0.001). Higher smoking DNAm scores were associated with variables related to poorer cognitive function, structural brain integrity, physical health, and psychosocial health. Compared with phenotypic smoking, the methylation marker provided stronger associations with all of the cognitive function scores, especially visuospatial ability (P < 0.001, partial eta-squared ɳp2 = 0.022) and processing speed (P < 0.001, ɳp2 = 0.030); inflammatory markers (all P < 0.001, ranges from ɳp2 = 0.021 to 0.030); dietary patterns (healthy diet (P < 0.001, ɳp2 = 0.052) and traditional diet (P < 0.001, ɳp2 = 0.032); stroke (P = 0.006, OR 1.48, 95% CI 1.12, 1.96); mortality (P < 0.001, OR 1.59, 95% CI 1.42, 1.79), and at age 73; with MRI volumetric measures (all P < 0.001, ranges from ɳp2 = 0.030 to 0.052). Additionally, education was the most important life-course predictor of lifetime smoking tested. Our results suggest that a smoking-associated methylation biomarker typically explains a greater proportion of the variance in some smoking-related morbidities in older adults, than phenotypic measures of smoking exposure, with some of the accounted-for variance being independent of phenotypic smoking status.

PIH12 BURDEN OF ADVERSE DRUG EVENTS (ADE) DURING HOSPITALIZATION IN OLDER ADULTS- A CROSS SECTIONAL ANALYSIS USING NATIONWIDE READMISSION DATABASE

Adverse drug events (ADE) are a primary cause of significant morbidity in older adults and are associated with increased risk of mortality, length of stay, and substantial healthcare costs. This study was conducted to evaluate the clinical (readmission, in-hospital mortality, and length of stay (LOS)) and economic burden of ADE during hospitalization in older adults. Study was conducted in patients 65 years or older using Health Care Cost & Utilization Project’s Nationwide Readmission Database (NRD) 2014 dataset. Patients were selected based on 442 International Classification of Diseases 9th revision Clinical Modification (ICD-9-CM) & external causes of injury codes related to ADEs. Patients were categorized in ADE or non-ADE groups. A logistic regression model was used for multivariable analysis of readmission and in-hospital mortality. Generalized Poisson and inverse Gaussian models were used for LOS and cost multivariable analysis, respectively. 3,832,322 patients were included. Among these patients, 203,432 (5%) patients had at least one ADE during hospitalization. Majority of ADE were related to blood constituents (22%) and adverse effects of biological & medicinal substances in therapeutic use (23%). In adjusted models, older adults with ADE during hospitalization had 25% (p<0.0001) and 9% (p<0.0001) higher odds of readmission and in-hospital mortality, respectively, as compared to those without ADE. A 17% (p<0.0001) increase in LOS was estimated in ADE group and1% point estimate (p>0.05) rise in cost was observed in ADE group when compared with non-ADE group. ADE have substantial burden on in-patient care of older adults both clinically (increased readmission, in-hospital mortality, and LOS) & economically (increased cost). Targeted interventions can help to prevent ADE and, consequently, associated clinical and economic burden.

Evidence-Based, High-Intensity Exercise and Physical Activity for Compressing Morbidity in Older Adults: A Narrative Review.

Recent research in exercise science has important applications for middle-aged and older adults and points to how the programming of individual and multicomponent interventions including theory-based health behavior change strategies may be improved to compress morbidity by delaying or reducing the disabling process. High-intensity interval training and sprint interval training until recently were seen as only applicable to athletes. But recent lab-based research has adapted these interventions for even older adults and demonstrated their safety with beneficial outcomes on cardiometabolic risk factors comparable to or surpassing the usual lower- to moderate-intensity endurance training, and their potential translatability by showing the efficacy of much lower duration and frequency of training, even by systematic stair climbing. Moreover, people report positive affect while engaged in such training. For a century, resistance training was conceived as weightlifting with heavy weights required. Recent research has shown that using a higher degree of effort with lighter to moderate resistance in simple, time efficient protocols result in gains in strength and muscle mass similar to heavy resistance, as well as improvement of cardiometabolic risk factors, strength, body composition, and cognitive, affective, and functional abilities. More effort-based resistance training with moderate resistance may make resistance training more appealing and accessible to older adults. A key potential translational finding is that with correct technique and a high degree of effort, training with inexpensive, portable elastic bands, useable virtually anywhere, can provide appreciable benefits. More emphasis should be placed on long-term, translational interventions, resources, and programs that integrate interval and resistance trainings. This work may improve public health programs for middle-aged and older adults and reflects an emerging evidence base.

The added value of combined functional tests on predicting future falls in Chinese community-dwelling elderly

Falls are one of the major causes of mortality and morbidity in older adults, which needs a practical fall risk assessment tool to predict future falls. Recent researches suggested various functional tests produce more power than a single test in many aspects. So we aimed to determine whether combined functional tests could increase predictive ability of future falls, especially recurrent-falls, which may result in stronger adverse impacts. This was a prospective cohort study (N = 875) among residents of Hangu area of Tianjin, China, who were ≥ 60 years old. Falls were ascertained after one year. Meanwhile, sociodemographic information, medical history and physical performance data were also collected. The Timed Up and Go Test (TUGT), walking speed (WS) and grip strength (GS) are more recommended as tests targeting on balance, mobility and muscle strength by many studies. Therefore, we selected these three tests to clarity our hypothesis. The mean age was 67.1 years; 58.6% were women. According to ROC area, the cutoff point of TUGT, GS and WS of falls is 10.31 s, 0.3742 kg/kg and 0.9467 m/s, respectively. Therefore we defined good performance on the tests as “ + ”, and poor performance as “ − ” with the cutoff point. Towards any-falls, combination of “TUGT−, GS−, WS + ” was most correlated with its occurrence, with odds ratio (OR) 2.197, 95% CI: 1.204–4.009. Meanwhile, combined “TUGT−, WS + ” (OR: 2.103, 1.367–3.235) and combined “TUGT−, GS+, WS − ” (OR2.071, 1.124-3.814) were also more related to any-falls than a single test, like TUGT− (OR: 1.676, 1.170–2.401). However, compared with a single test (TUGT−, OR: 2.192, 1.225–3.922), only the combination of “TUGT−, GS−,WS + ” (OR: 2.536, 1.025–6.272) was a more stronger predictor. A simple tool using TUGT, GS and WS has better predictive power on future falls. Based on this result, individuals who show poor ability in TUGT and WS but have good grip strength ought to be more concerned about the high-risk of future falls, especially the likelihood of recurrent-falls.

New-Onset Cardiovascular Morbidity in Older Adults With Stage I to III Colorectal Cancer.

Purpose We sought to determine the long-term risk of cardiovascular disease (CVD)-stroke and myocardial infarction-and congestive heart failure (CHF) in older patients with colorectal cancer, as well as to understand the roles that preexisting comorbidities and cancer therapy play in increasing this risk. Patients and Methods We evaluated individuals from the SEER-Medicare database with incident stage I to III colorectal cancer at age older than 65 years between January 1, 2000, and December 31, 2011 (n = 72,408) and compared these patients with a matched cohort of Medicare patients without cancer (n = 72,408). Results Median age at diagnosis of colorectal cancer was 78 years (range, 66 years to 106 years), and median follow-up was 8 years since diagnosis. The 10-year cumulative incidence of new-onset CVD and CHF were 57.4% and 54.5% compared with 22% and 18% for control, respectively ( P < .001). The interaction between hypertension and chemotherapy was significant ( P < .001) for CVD, and that between diabetes and chemotherapy was significant ( P < .001) for CHF. Within the first 2 years since diagnosis, exposure to capecitabine alone increased CHF hazard (hazard ratio [HR], 3.6; 95% CI, 12.76 to 4.38) compared with exposure to fluorouracil alone. Conversely, patients who were treated with fluorouracil alone had a higher CVD hazard at < 2 years and > 2 years since diagnosis compared with patients who received capecitabine alone (< 2 years HR, 0.63; 95% CI, 0.53 to 0.75; > 2 years HR, 0.72; 95% CI, 0.62 to 0.84). Conclusion Older patients with colorectal cancer are at increased risk of developing CVD and CHF. Diabetes and hypertension interact with chemotherapy to increase the risk of cardiovascular morbidity. Future studies should assess the potential for personalized therapeutic options for those with preexisting morbidities and for structured monitoring for patients with a history of exposure to chemotherapy regimens, as well as explore the management of preexisting comorbidities to address long-term cardiovascular morbidity.

Accuracy of a wavelet-based fall detection approach using an accelerometer and a barometric pressure sensor.

Falls are a major source of morbidity in older adults, and 50% of older adults who fall cannot rise independently after falling. Wearable sensor-based fall detection devices may assist in preventing long lies after falls. The goal of this study was to determine the accuracy of a novel wavelet-based approach to automatically detect falls based on accelerometer and barometric pressure sensor data. Participants (n=15) mimicked a range of falls, near falls, and activities of daily living (ADLs) while wearing accelerometer and barometric pressure sensors on the lower back, chest, wrists and thighs. The wavelet transform using pattern adapted wavelets was applied to detect falls from the sensor data. In total, 525 trials (194 falls, 105 near-falls and 226 ADLs) were included in our analysis. When we applied the wavelet-based method on only accelerometer data, classification accuracies ranged from 82% to 96%, with the chest sensor providing the highest accuracy. Accuracy improved by 3.4% on average (p=0.041; SD=3.0%) when we also included the barometric pressure sensor data. The highest classification accuracies (of 98%) were achieved when we combined wavelet-based features and traditional statistical features in a multiphase fall detection model using machine learning. We show that the wavelet-based approach accurately distinguishes falls from near-falls and ADLs, and that it can be applied on wearable sensor data generated from various body locations. Additionally, we show that the accuracy of a wavelet-based fall detection system can be further improved by combining accelerometer and barometric pressure sensor data, and by incorporating wavelet and statistical features in a machine learning classification algorithm.

International classification of function, disability and health framework for fall risk stratification in community dwelling older adults

Falls is an important cause for mortality and morbidity in older adults. The fall risk assessment is an integral component of fall prevention in older adults. The international classification of function, disability and health (ICF) can be an ideal comprehensive model for fall risk assessment. There is lack of information relating ICF and fall risk assessment in community dwelling older adults. In this study we tried to assess the fall risk using different domains of ICF using various clinical tools. A total of 255 subjects were recruited through convenient sampling method from geriatric clinic (OPD) of All India Institute of Medical Sciences, New Delhi. The study was single session cross-section design. The body mass index (BMI), grip strength, depression score (Geriatric depression scale:short form; GDS-S) and co morbidities were used to assess body function and structure domain, timed up and go (TUG), Berg balance scale (BBS) and elderly fall screening test (EFST) scores were used for activity domain, selfreported cause of fall, medications and uses of assistive device for environmental factors. Then the association of body function and structure, activity and environmental factors were determined with falls. There was an association of fall in analysis in subjects with no fall and one or more falls for, BMI, grip strength (kg), GDS-S score, no. of co morbidities, chronic pain, TUG, BBS, TUG (s), BBS, EFST, slip/trip, walking cane, hypoglycemic and antihypertensives medications (unadjusted and adjusted odds ratio).The diabetes, and hyper tension showed association for adjusted odds ratio only. In subjects with one fall and more than one fall, TUG, BBS, EFST, GDS-S score, NSAIDS and antidepressants use showed a significant association with fall (unadjusted and adjusted odds ratio). The ICF may be used in routine for fall risk assessment in community dwelling older adults.

A comparison of the immunogenicity of a live attenuated herpes zoster vaccine (ZV) and the recombinant gE/AS01B candidate vaccine in older adults

Abstract Herpes zoster (HZ) has high morbidity in older adults. ZV, which is recommended for individuals ≥60 y, is 51% effective against HZ in the 1st 3 y after vaccination; efficacy decreases with the age of the vaccinee; and wanes to ~40% at 5 y. gE/ASO1B is a recombinant adjuvanted vaccine with 97% efficacy against HZ that does not vary with age of the vaccinee and wanes to 87% at 4y. We compared the cell-mediated immunity (CMI) of ZV and gE/ASO1B at 30 d after the last dose of vaccine and at 1 y. Subjects were 50–70+ yoa who never received ZV (1ary) and adults ≥70 yoa who received ZV ≥5 y previously (boosted). Participants received ZV at entry or gE/ASO1B at 0 and 60 d. Blood from days 0, 30 (ZV peak response), 90 (peak gE/ASO1B) and 365 was used to measure CMI to varicella zoster virus (VZV) and to gE by IFNg and IL2 fluorospot [spot forming cells/106 PBMC (SFC)] and by flow cytometry assessing VZV- and gE-specific proliferation and effector (Teff), effector memory (Tem), and central memory (Tcm) outcomes. The higher CMI responses that best distinguished gE/ASO1B from ZV recipients after adjusting for age, gender, prior ZV administration and baseline CMI were: 1) VZV-specific IL2 and gE-specific IL2 and IFNg SFC at peak response (p≤0.004); 2) higher VZV-specific CD8+ and gE-specific CD4+ and CD8+ responses measured by proliferation at peak (p&amp;lt;0.05); 3) higher CD4+ Tcm% and Tem% and lower Teff% at peak response (p≤0.005); 4) higher VZV-specific and gE-specific IL2 and IFNg SFC at 1 y in all gE/ASO1B groups, but only in the boosted ZV group. CMI did not differ among gE/ASO1B recipients by age or prior ZV administration. The higher memory CD4+ and CD8+ responses detected in gE/AS01B recipients might contribute to its superior efficacy and persistence of protection against HZ.

Higher plasma transforming growth factor (TGF)-\u03b2 is associated with kidney disease in older community dwelling adults

BackgroundTGF-β is induced in the vasculature with aging suggesting that high plasma TGF-β levels may be a risk factor for chronic kidney disease (CKD) in older adults.MethodsWe conducted a cross-sectional analysis of the association between plasma TGF-β levels and CKD including data for 1722 older adults who had participated in the 1996/97 visit of the Cardiovascular Health Study (CHS). Prevalent CKD was defined as eGFR < 60 mL/min/1.73 m2 or urinary albumin/creatinine ratio (ACR) ≥30 mg/g. We also evaluated whether baseline TGF-β levels predicted change in eGFR, cardiovascular (CV) events, or mortality in longitudinal analysis.ResultsPlasma TGF-β levels were significantly and independently associated with lower eGFR in cross-sectional analysis. Doubling of TGF-β was significantly associated with lower eGFR (β estimate after adjusting for CV risk factors = −1.18, 95% CI −2.03, −0.32). We observed no association with albuminuria. There was no association between baseline TGF-β and change in eGFR, but each doubling of TGF-β at baseline was associated with increased risk of a composite outcome of CV events and mortality, adjusted HR 1.10 (95% C.I. 1.02– 1.20, p = 0.006).ConclusionIn this large cohort of community-dwelling older individuals, high plasma TGF-β levels are modestly, but independently associated with lower eGFR but not with albuminuria in cross-sectional analysis. In addition, TGF-β levels are associated with increased risk of CV events and mortality. Further research is needed to determine the direction of association between plasma TGF-β and the risk of CKD and CKD-associated morbidities in older adults.

Multidimensional construct of life satisfaction in older adults in Korea: a six-year follow-up study.

BackgroundAging raises wide-ranging issues within social, economic, welfare, and health care systems. Life satisfaction (LS) is regarded as an indicator of quality of life which, in turn, is associated with mortality and morbidity in older adults. The objective of this study was to identify the relevant predictors of life satisfaction and to investigate changes in a multidimensional construct of LS over time.MethodsThis analysis utilized data from the large-scale, nationally representative Korean Retirement and Income Study (KReIS), a longitudinal survey conducted biennially from 2005 to 2011. Outcome measures were degree of satisfaction with health, economic status, housing, neighbor relationships, and family relationships. GEE models were used to investigate changes in satisfaction within each of the five domains.ResultsOf a total 3531 individuals aged 65 or older, 2083 (59%) were women, and the mean age was 72 (s.d = ±6) years. The majority had a spouse (60.8%) and lived in a rural area (58%). Analysis showed that physical and mental health were consistently and significantly associated with satisfaction in each of the domains after adjusting for potential confounders. Living in a rural area and living with a spouse were related to satisfaction with economic, housing, family relationships, and neighbor relationships compared to living in urban areas and living without a spouse; the only outcome that did not show relationship to these predictors was health satisfaction. Female and rural residents reported greater economic satisfaction compared to male and urban residents. Living in an apartment was associated with 1.32 times greater odds of economic satisfaction compared to living in a detached house (95% CI: 1.14–1.53; p < 0.0001). Economic satisfaction was also 1.62 times more likely among individuals living with a spouse compared to single households (95% CI: 1.35–1.96; p < 0.0001). Financial stress index value was found to be a significant predictor of satisfaction with family relationships.ConclusionsOur study indicates that a single domain of LS or overall LS will miss many important aspects of LS as age-related LS is multi-faceted and complicated. While most studies focus on overall life satisfaction, considering life satisfaction as multidimensional is essential to gaining a complete picture.

Gait Speed and Operative Mortality in Older Adults Following Cardiac Surgery.

Prediction of operative risk is a critical step in decision making for cardiac surgery. Existing risk models may be improved by integrating a measure of frailty, such as 5-m gait speed, to better capture the heterogeneity of the older adult population. To determine the association of 5-m gait speed with operative mortality and morbidity in older adults undergoing cardiac surgery. A prospective cohort study was conducted from July 1, 2011, to March 31, 2014, at 109 centers participating in the Society of Thoracic Surgeons Adult Cardiac Surgery Database. The 5-m gait speed test was performed in 15 171 patients aged 60 years or older undergoing coronary artery bypass graft, aortic valve surgery, mitral valve surgery, or combined procedures. All-cause mortality during the first 30 days after surgery; secondarily, a composite outcome of mortality or major morbidity during the index hospitalization. Among the cohort of 15 171 patients undergoing cardiac surgery, the median age was 71 years and 4622 were female (30.5%). Compared with patients in the fastest gait speed tertile (>1.00 m/s), operative mortality was increased for those in the middle tertile (0.83-1.00 m/s; odds ratio [OR], 1.77; 95% CI, 1.34-2.34) and slowest tertile (<0.83 m/s; OR, 3.16; 95% CI, 2.31-4.33). After adjusting for the Society of Thoracic Surgeons predicted risk of mortality and the surgical procedure, gait speed remained independently predictive of operative mortality (OR, 1.11 per 0.1-m/s decrease in gait speed; 95% CI, 1.07-1.16). Gait speed was also predictive of the composite outcome of mortality or major morbidity (OR, 1.03 per 0.1-m/s decrease in gait speed; 95% CI, 1.00-1.05). Addition of gait speed to the Society of Thoracic Surgeons predicted risk resulted in a C statistic change of 0.005 and integrated discrimination improvement of 0.003. Gait speed is an independent predictor of adverse outcomes after cardiac surgery, with each 0.1-m/s decrease conferring an 11% relative increase in mortality. Gait speed can be used to refine estimates of operative risk, to support decision-making and, since incremental value is modest when used as a sole criterion for frailty, to screen older adults who could benefit from further assessment.

Assessing the association of obesity and asthma morbidity in older adults

BackgroundObesity is a robust predictor of poor asthma control in younger adults. Given the high prevalence of asthma and obesity in older Americans, weight reduction could benefit asthma management in this population. ObjectiveTo assess the association between obesity and asthma outcomes among older adults. MethodsWe recruited from urban primary care clinics a prospective cohort of nonsmoking individuals with asthma who were 60 years or older without a history of other respiratory diseases. At baseline, body mass index (BMI) measurements were classified as normal (BMI, 18–25), overweight (BMI, 25–30), or obese (BMI, >30). Measures of asthma morbidity (Asthma Control Questionnaire [ACQ], and Mini Asthma Quality of Life Questionnaire [Mini-AQLQ]) and asthma-related resource utilization (inpatient or outpatient) were taken at baseline and at 3- and 12-month interviews. We used generalized estimating equation models to assess associations between obesity and asthma outcomes after controlling for potential confounders. ResultsOf the 437 older adults with asthma in the study, 17% had a normal BMI, 32% were overweight, and 51% were obese. Unadjusted analyses revealed that obesity was associated with lower ACQ scores (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.09–1.31) and poorer Mini-AQLQ scores (OR, 1.21; 95% CI, 1.11–1.33). Adjusted analyses revealed no significant association between obesity and ACQ (OR, 1.05; 95% CI, 0.96–1.15) and Mini-AQLQ (OR, 1.08; 95% CI, 0.99–1.19). ConclusionOur study suggests that obesity is not independently associated with worse asthma outcomes in older adults, reflecting potential differences in the mechanisms that link obesity with asthma control in older vs younger populations.

Relationships Between Performance on Assessments of Executive Function and Fall Risk Screening Measures in Community-Dwelling Older Adults.

Fall-related injuries are a leading cause of institutionalization and morbidity in older adults. Limitations in cognition, including deficits in higher cognitive processes, like executive function (EF), contribute to a higher risk of falling in older adults. Specifically, declines in EF have been associated with changes in gait, limited mobility, and an increased frequency of falling. It is unknown whether associations between performance on commonly used clinical assessments of EF and performance on commonly used physical performance measures of fall risk are present. The purpose of this study was to examine the relationship between a clinical measure of EF, the Trail Making Test Part B (TMT-B), and 3 physical performance measures of fall risk: the Timed Up and Go (TUG) test, gait speed, and the Five Times Sit to Stand (FTSTS) test, in a group of community-dwelling older adults. Forty-seven community-dwelling older adults met the inclusion/exclusion criteria. Demographic information was obtained and measures of fall risk and cognition were performed. Correlations and linear regression analyses to assess relationships between measures were completed. To account for the high prevalence of mild cognitive impairment (MCI) in this population, the sample was screened and stratified for MCI in post hoc analyses. The EF performance was not significantly correlated with performance on the FTSTS test (ρ = 0.26, P > .05) but was significantly correlated with the TUG test (ρ = 0.31, P < .05) and gait speed (r = -0.36, P < .05). These relationships remained after adjusting for age and education in multivariate models. Results from post hoc analyses demonstrated that only those with MCI had significant relationships between EF and physical performance measures. TMT-B scores in the MCI group were significantly correlated with gait speed (ρ = -0.51, P < .05) and TUG test (ρ = 0.58, P < .05). A significant relationship exists between performance on clinical assessments of EF and fall risk assessments that integrate a mobility task for those individuals who screen positive for MCI. For those who screened negative, no significant relationship exists. Given the large prevalence of undiagnosed MCI in community-dwelling older adults, this finding could be used as an indication to screen older adults for MCI. Screening tools that require cognitive resources such as gait speed appear to have significant relationships with performance of EF for those who screen positive for MCI. This information could be used clinically to identify older adults with cognitive limitations, which could put them at higher risk for falling.

Intake and Biomarkers of Folate and Risk of Cancer Morbidity in Older Adults, NHANES 1999-2002 with Medicare Linkage.

BackgroundAfter the 1998 mandatory folic acid fortification of enriched cereal-grain products in the U.S., safety concerns were raised that excess consumption of folic acid and high blood folate biomarkers detected in adults may increase the risk of certain types of cancer.MethodsBaseline data from about 1400 participants in the National Health and Nutrition Examination Survey (NHANES) 1999–2002, aged ≥ 57 years were linked to Medicare and mortality files through December 31, 2007. Using cox proportional hazards regression models, we assessed associations between dietary folate equivalents, folate biomarkers, the presence of unmetabolized folic acid and, overall cancer incidence.ResultsWith 8,114 person-years of follow-up (median follow-up, 6.3 years), about 125 cancer cases were identified. After adjusting for confounders, the hazard ratios of the highest quartile versus the second quartile of RBC folate and dietary folate equivalents were 0.54 (95% CI: 0.31–0.93) and 0.54 (95% CI: 0.30–0.95), respectively. Additionally, serum and RBC folate as continuous variables were inversely and significantly associated with cancer incidence (p<0.01). No significant associations were observed between the presence of unmetabolized folic acid, intake of naturally-occurring food folate or folic acid separately, and cancer incidence.ConclusionsHigh total folate intake and biomarkers in older adults appear to be protective against cancer in post-folic acid fortification years. This study does not show a negative impact of current level of folic acid fortification on cancer risk. As this is one of the few studies to examine the association between unmetabolized folic acid and cancer outcome, a study including a larger nationwide representative sample of the U.S. population is needed.

Abstract TP324: Mild Cognitive Impairment and Treatment for Ischemic Stroke and Acute Myocardial Infarction

Background and Objectives: Cardiovascular disease (CVD) is the leading cause of death and serious morbidity in older adults with mild cognitive impairment (MCI), many of whom will not progress to dementia. It is unclear whether patients with pre-existing MCI (without dementia) get evidence-based treatments for CVD less often than patients without MCI. We compared treatment for acute ischemic stroke and acute myocardial infarction (AMI) between MCI patients and cognitively normal patients in a nationally representative sample. Methods: Prospective study of patients aged ≥65 years hospitalized with ischemic stroke (n=517) or AMI (n=509) from the Health and Retirement Study and Medicare data from 2000-2011. We compared receipt of CVD process measures (Table) within 12 months of the stroke or AMI hospitalization from Medicare claims between subjects with pre-existing MCI (modified Telephone Interview for Cognitive Status [TICS-m] score, 7-11, a valid measure of MCI) and those with normal cognition (TICS-m score, 12-27), and used logistic regression to adjust associations for age, sex, race, education, number of preexisting functional limitations, and comorbidity. Results: Compared with cognitively normal patients, patients with pre-existing MCI were significantly less likely to receive all 3 AMI process measures, and they got stroke process measures less frequently but results were not statistically significant (Table). MCI patients were less likely than cognitively normal patients to receive any post-MI revascularization (adjusted odds ratio, 0.54; 95% CI, 0.33-0.88), but not the other CVD process measures, after adjustment (Table). Conclusion: Older MCI patients less frequently got process measures for AMI and ischemic stroke compared with cognitively normal patients. Patient factors explain some but not all of this reduced use. We need to better understand decision making for CVD treatment in older MCI patients and reasons for treatment differences.

The Effect of Aerobic Exercise on Quantity and Quality of Sleep Among Elderly People Referring to Health Centers of Lar City, Southern of Iran; A Randomized Controlled Clinical Trial.

Aging is associated with reduced quality and quantity of sleep. 50% of senior citizens living in the community and 70% of those living in nursing homes suffer from sleep disorders. Moreover, insomnia increases the risk of mortality and morbidity in older adults. We aimed to investigate the effect of aerobic exercise on quantity and quality of sleep among the elderly people referring to health centers of Lar city, southern Iran. We enrolled 60 elderly people whose age range was 60-75 years and (mean ±SD) age was (64.8±5.2). Participants were randomly assigned into two groups of 30 each (case group= 30 and control group=30). The patients in the case group participated in exercise trainings consisted of three one-hour sessions per week for 12 consecutive weeks. Sleep quantity and quantity in the participants was evaluated before and after intervention using Pittsburgh Sleep Quality Index (PSQI). Independent t-test showed that sleep quality score was improved by 44.46% in the case group (p<0.0001). Furthermore, sleep duration was improved by 98/16% (p=0.038) and sleep latency was improved by 76/6% in the case group; while, the difference between the two groups regarding the changes in the sleep latency was not statistically significant (p=0.089). Aerobic exercise program could improve the sleep quality and quantity in the elderly. It could also be used as a cost effective and long lasting method of therapy with no side effect which could be used for the treatment of insomnia in older people.

Exposure to High-Risk Medications is Associated With Worse Outcomes in Older Veterans With Chronic Pain

BackgroundChronic pain is common, costly and leads to significant morbidity in older adults, yet there are limited data on medication safety. The authors sought to evaluate the association of incident high-risk medication in the elderly (HRME) with mortality, emergency department (ED) or hospital care among older adults with chronic pain. MethodsA retrospective Veterans Health Administration cohort study was conducted examining older veterans with chronic pain diagnoses and use of incident HRME (opioids, skeletal muscle relaxants, antihistamines and psychotropics). Outcomes evaluated included all-cause mortality, ED visits or inpatient hospital care. Descriptive statistics summarized variables for the overall cohort, the chronic pain cohort and those with and without HRME. Separate generalized linear mixed-effect regression models were used to examine the association of incident HRME on each outcome, controlling for potential confounders. ResultsAmong 1,807,404 veterans who received Department of Veterans Affairs care in 2005 to 2006, 584,066 (32.3%) had chronic pain; 45,945 veterans with chronic pain (7.9%) had incident HRME exposure. The strongest significant associations of incident HRME were for high-risk opioids with all-cause hospitalizations (odds ratio [OR] 2.08, 95% confidence interval [CI] 1.95–2.23), skeletal muscle relaxants with all-cause ED visits (OR 2.62, 95% CI 2.52–2.73) and mortality (OR 0.80, 95% CI 0.74–0.86), antihistamines with all-cause ED visits (OR 2.82 95% CI 2.72–2.95) and psychotropics with all-cause hospitalizations (OR 2.15, 95% CI 1.96–2.35). ConclusionsOur data indicate that incident HRME is associated with clinically important adverse outcomes in older veterans with chronic pain and highlight the importance of being judicious with prescribing certain classes of drugs in this vulnerable population.

Effects of Resistance Training on Bone and Muscle Mass in Older Women: A Review

Aging is associated with declines of different physiological systems. These reductions are directly related to loss of mobility in older individuals, reducing the independence and quality of life for this population. Regular physical activity (e.g, resistance training, RT), has been shown to decrease mortality and age-related morbidity in older adults, including women. A fracture is closely related to the typical decline in bone mass (i.e, osteoporosis) especially in postmenopausal women. In fact, up to 30% of postmenopausal females have osteoporosis. In postmenopausal women the rate of bone mineral density loss progressively increases with age. In addition, decreases in muscle tissue (i.e, sarcopneia) may begin to occur before the fourth decade and gradually worsens through the later stages of adulthood. Sarcopenia, is characterized by low muscle mass, low muscle strength, and low physical performance, which can lead to disability, risk of falls and fractures, and death. Further, sarcopenia occurs to a greater degree in older women than men. Menopause is characterized by important changes in hormonal status and these changes have a significant effect on body composition (i.e, bone mass density, muscle mass, and body fat). Importantly, RT is effective in increasing bone and muscle mass and improving measurements of physical performance. Thus, this review is intended to summarize the effects of RT on bone and muscle mass in older postmenopausal women.

Epidemiology of falls among older adults: A cross sectional study from Chandigarh, India

BackgroundFall is an important cause of injury morbidity in older adults. However, epidemiological information on fall is limited in low- and middle-income countries. We investigated the extent, pattern, characteristics, and context of falls in Chandigarh. MethodsA cross sectional survey was carried out among 300 persons (≥60 years), sampled from urban, rural and slums areas of Chandigarh, India from March 2011 to October 2012 using multistage cluster sampling. A pre-tested interview schedule was used and relevant medical examinations were conducted. Multivariable logistic regression was carried out to estimate Odds Ratio (OR) and 95% confidence interval (CI). ResultsIn the past one year, 31% (92/300) respondents reported one or more falls. On an average 0.67 fall episodes occurred/person/year (202/300). Most (68%; 63/92) falls occurred at home; 75% (47/63) occurred while carrying out activities such as toileting, bathing, sleeping and eating etc. Injuries due to falls were reported by 67% (62/92). In these cases, lower extremities, 37% (23/62) were the most common site of injury. Eight percent (5/62) reported fractures. A general physician was consulted by 44% (27/62), and 11% (7/62) utilized emergency services whilst another 11% (7/62) of fall injuries required hospital admission. Risk of fall was higher among females (OR 1.6, 95%CI 1.0–2.8, p 0.068), those taking four or more medicines (OR 2.1, 95%CI 1.2–3.5, p 0.009) and having poor body balance (OR 1.9, 95%CI 1.0–3.4, p 0.037). ConclusionFall injuries were common in older adults of Chandigarh. Large cohort studies are needed to identify risk factors particularly those related to home environment.