Patterns Of Older Adults Research Articles

Capacidad pulmonar y patrones respiratorios en adultos mayores de la población de Apatug y Atahualpa Tungurahua - Ecuador

Introducción: Los adultos mayores que residen en los Andes están expuestos a los efectos de la adaptación a gran altura y a los cambios fisiológicos provocados por el envejecimiento.
 Objetivo: Evaluar la capacidad pulmonar y los patrones respiratorios en los adultos mayores que residen a gran altura.
 Metodología: Estudio explicativo de corte experimental. Se seleccionaron dos comunidades de los Andes ecuatorianos de diferente altitud (Apatug y Atahualpa). Participaron 50 adultos mayores con edad promedio entre 75,44 ± 6,23 (Apatug) y 75± 8,25 (Atahualpa) Los criterios de inclusión fueron personas nativas mayores a 65 años. Los criterios de exclusión fueron la incapacidad de entender el procedimiento de las pruebas y contraindicaciones patológicas para realizar la prueba espirométrica. La espirometría se realizó de acuerdo con los criterios de la American Thoracic Society (ATS).
 Resultados: Los resultados de la capacidad pulmonar de la población geriátrica de Apatug es de 3,7 litros ± 0,6 y de Atahualpa 5,4 litros ± 0,4. Los adultos mayores de Apatug obtuvieron patrones restrictivos (n=20) y obstructivos (n=3). En la parroquia de Atahualpa se encontró 12 participantes con patrón restrictivo. Existe disminución de la saturación en Apatug, (85,16 ± 4,4) y presión arterial (107/30 mmHg). Mientras que los niveles de saturación y presión arterial fueron normales en Atahualpa (91,6 ± 2,9 y 120/89 mmHg, respectivamente). 
 Conclusiones: La población geriátrica de Apatug presenta niveles bajos de capacidad pulmonar y saturación en la sangre. Sin embargo, la presión arterial es normal. En la población de Atahualpa existen niveles normales de capacidad pulmonar, saturación y presión arterial.

1488-P: HbA1c and Potential Misclassification of Diabetes and Prediabetes Diagnoses in the U.S.

HbA1c levels are widely used for diabetes diagnosis and management but may misrepresent underlying glucose levels. To assess potential misdiagnoses of diabetes (T2DM) and prediabetes (PreDM) by HbA1c, we examined representative samples of non-pregnant adults and youth in the National Health and Nutrition Examination Survey (NHANES), 2005-2016, who had a 75g OGTT. Normal glucose metabolism (NGM), PreDM, and T2DM were defined by ADA criteria. For each glycemic group, a linear regression model of HbA1c vs. glucose (i.e., mean of FPG and 2hrPG) yielded predicted HbA1c for each participant. The Hemoglobin Glycation Index (HGI), defined as observed - predicted HbA1c, was partitioned into tertiles. Of 10,737 adults aged 18-79 year (representing N=199,270,935), 52% female and 10% non-Hispanic black, with mean age 43.7 year and BMI 28.5 kg/m2. By OGTT criteria, 81.2% had NGM, 14.1% PreDM, and 4.6% T2DM. The high HGI tertile had a higher proportion of non-Hispanic black race (17.7%, vs. middle 8.7%, low 7.0%), as well as higher mean BMI and age, all p<0.0001. A higher proportion of black race in the high HGI tertile was also found in adults >65 year (p=0.0016, weighted N=24,142,366) and youth aged 12-17 year (p<0.0001, n=2,218, weighted N=25,302,585). Across HGI tertiles, the distribution among diagnostic categories was similar by OGTT criteria, but differed by HbA1c criteria; those in the high HGI tertile were 53.7% PreDM and 3.5% T2DM - mostly abnormal, while those in the low HGI tertile were 98.0% NGM and 1.0% PreDM - mostly normal, with a similar pattern in older adults and youth, all p<0.0001. Across all age groups, 15% (weighted N=33,569,933) had clinically significant HGI deviations of >0.5%. Conclusion: Diagnostic classification by HbA1c alone could lead to misdiagnosis in over 33 million Americans, a problem across all age groups. Overdiagnosis is a particular risk in those with black race, higher BMI, and older age. Complementing HbA1c with glucose testing should improve diagnostic classification and management. Disclosure L.R. Staimez: None. L. Kipling: None. C.N. Ford: None. J. Ham: None. M.K. Rhee: None. L.S. Phillips: Advisory Panel; Self; Janssen Pharmaceuticals, Inc. Research Support; Self; AbbVie Inc., GlaxoSmithKline plc., Kowa Pharmaceutical Europe Co. Ltd., Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Pfizer Inc. Stock/Shareholder; Self; Diasyst Inc. Other Relationship; Self; Diasyst Inc., Janssen Pharmaceuticals, Inc.

Ambulation Patterns Post-Discharge in Older Adults Identified as Fall Risk: A Descriptive Pilot Study.

Older adults identified as fall risk during a hospital stay may be at high risk for decreased ambulation during hospitalization and after discharge. Little is known about ambulation frequency in older adults identified as fall risk during a hospital stay or their trajectory of ambulation patterns after an acute hospitalization. Individual ambulation frequency, patterns, functional performance, and fear of falls for 14 older adults were studied. Accelerometers were worn by patients during their hospital stay and for 4 weeks post-discharge. Novel analytics using piecewise regression were used to analyze data. Patterns of ambulation were heterogeneous, and 64% of patients demonstrated no change in the first 2 weeks post-discharge. Increase in ambulation frequency was positively correlated with higher Katz Activities of Daily Living Index scores, gait speed, and lower fear of falls score. Ambulation patterns in older adults identified as fall risk show promise in capturing ambulation recovery and functional ability post-discharge. [Res Gerontol Nurs. 2019; 12(3):113-119.].

Under-Recognition of Fractures as Osteoporosis Indicators.

After the first fracture, the risk of subsequent fractures increases significantly. Medical treatment can reduce the risk of a second fracture by about 50%, but many older adults do not receive osteoporosis medication following their first fracture. This observational study aimed to understand primary care management patterns of older adults after osteoporotic fractures at the Miami Veterans Affairs (VA) Healthcare System. A retrospective review of 219 fracture cases selected by International Classification of Disease (ICD-9) codes between October 2015 and September 2016 identified 114 individuals age ≥50 years who had a non-traumatic fracture code entered in their medical record for the first time. Among them, 72 (63%) did not undergo a bone mineral density (BMD) test or receive treatment in the 12 months following their fracture. Of the 40 individuals who had a BMD test post-fracture, 17 (100%) received or were considered for anti-osteoporosis treatment if their T-score indicated osteoporosis (T-score ≤−2.5), but only 8/23 (35%) if the T-score was >−2.5. Physicians are more likely to prescribe osteoporosis therapy based on a BMD T-score diagnosis of osteoporosis, rather than a clinical diagnosis of osteoporosis based on a low-trauma fracture. A change in practice patterns is necessary to decrease the incidence of fractures.

Amounts of physical activity and sedentary behavior patterns in older adults: using an accelerometer and a physical activity diary

본 연구는 만 65세 이상의 노인 49명을 대상으로 가속도계와 신체활동일기를 함께 사용하여 신체활동량과 좌식행동패턴을 성별에 따라 비교하고 WHO 신체활동지침의 실천율을 평가하였다. 1. CPM과 METs는 성별에 따른 유의한 차이가 없었으나 PAEE는 남자가 여자보다 유의하게 높았다. 활동 강도별 1일 평균 소요시간을 살펴보면, 본 연구대상자들은 좌식행동에 소요되는 시간 (남녀 각각 60.6%, 57.6%)이 가장 많았으며 좌식행동 및 중·고강도 활동의 소요시간에서는 남녀간의 유의한 차이를 보이지 않았으나 저강도 활동의 소요시간은 여자가 364.2 ± 74.5분으로 남자 (313.7 ± 70.8분)보다 유의하게 많았다. 2. 남녀 모두 수면시간을 제외한 좌식행동 (2 ~ 5단계) 중 2단계의 ‘휴식, 담화 및 TV보기’ 활동으로 가장 많은 시간 (남자 26.9%, 여자 22.0%)을 보내고 있었으며, 남자가 388.0 ± 134.3분으로 여자 (316.1 ± 65.2분)보다 유의하게 많았다. 저강도 활동에 포함되는 활동 중에서는 7단계의 ‘미용 및 옷 갈아입기’ 활동과 9단계의 ‘음식 준비 및 정리하기’ 활동의 소요시간에서 여자가 남자보다 유의하게 많았다. 중·고강도 활동에서는 15단계의 ‘체조, 탁구 및 자전거타기’ 활동의 소요시간에서 남자가 여자보다 유의하게 많게 나타났다. 3. 좌식행동패턴을 성별에 따라 비교한 결과, 좌식행동을 30분과 40분 이상 지속한 횟수에서 남자가 각각 3.10 ± 1.34회, 1.78 ± 1.09회로 여자 (2.34 ± 1.22회, 1.32 ± 1.07회)보다 유의하게 많았으나 시간당 좌식행동의 지속을 끊어주는 횟수는 남자 (5.74 ± 0.89회)가 여자 (6.44 ± 0.71회) 보다 유의하게 적었다. 좌식행동을 30분 이상 지속한 횟수 및 시간 당 좌식행동을 끊어주는 횟수는 2단계의 ‘휴식, 담화 및 TV보기’ 활동의 소요시간과 유의한 상관관계를 보였으며 주로 저강도 활동을 통해서 좌식행동의 지속이 끊어지는 것으로 나타났다. 4. 일주일 동안 중·고강도 활동을 각각 2분과 5분 이상 지속한 시간에서는 남자가 319.8 ± 255.2분과 247.3 ± 228.2분으로 여자 (193.3 ± 130.6분, 137.2 ± 101.9분)보다 유의하게 많은 것으로 나타났다. 또한 본 연구대상자의 경우 중·고강도 활동의 짧은 지속시간 (10분 미만)으로 인하여 WHO 신체활동지침의 실천율이 22.4% (남자 30.8%, 여자 13.0%)으로 매우 낮았다. 본 연구 결과를 통하여 노인의 경우 장시간 지속되는 좌식행동 패턴을 줄이기 위하여 노력해야함을 알 수 있었다. 이를 위하여 무엇보다도 앉아서 TV를 시청하는 시간을 줄이는 것이 중요함이 지적되었다. 앞으로 노인의 만성질환 예방을 위하여, 노인의 신체활동량 및 좌식행동 패턴과 건강 관련 지표와의 관련성 분석·평가 연구가 필요하다. 특별히 본 연구에서 노인만을 위한 별도의 신체활동지침 마련의 필요성이 제시된 바, 노인에게 적합한 신체활동의 적정 강도 및 적정 유지 시간 등이 반영된 새로운 지침이 개발되어야 할 것이다.

Reduced Gait Variability and Enhanced Brain Activity in Older Adults With Auditory Cues: A Functional Near-Infrared Spectroscopy Study

Background. Aging is associated with declining mobility, which negatively affects quality of life and incurs substantial economic costs. Techniques to maintain safe mobility in older adults are therefore essential. Rhythmic auditory cueing (RAC) can improve walking patterns in older adults. However, the neural correlates associated with RAC, how they are influenced by repeated exposure and their relationships with gait response, cognitive function, and depressive symptoms are unclear. Objectives. This study aimed to investigate the effects of RAC during walking on cortical activation and the relationship between RAC-related cortical changes and cognitive function, depressive symptoms, and gait response. Methods. Seventeen young adults and eighteen older adults walked on a motorized treadmill for 5 minutes (5 trials with alternating 30-second blocks of usual walking and RAC walking). Changes in oxygenated hemoglobin (HbO2) in the frontal cortex were recorded using functional near-infrared spectroscopy. Cognitive domains were assessed through validated tests. A triaxial accelerometer measured gait parameters. Results. Gait variability decreased and prefrontal HbO2 levels increased during cued walking relative to usual walking. Older adults showed greater HbO2 levels in multiple motor regions during cued walking although the response reduced with repeated exposure. In older adults, lower depression scores, higher cognitive functioning, and reduced gait variability were linked with increased HbO2 levels during RAC walking. Conclusion. These findings suggest that walking improves with RAC in older adults and is achieved through increased activity in multiple cortical areas. The cortical response decline with repeated exposure indicates older adults’ ability to adapt to a new task.

Exercise patterns in older adults instructed to follow moderate- or high-intensity exercise protocol \u2013 the generation 100 study

BackgroundMaking older adults exercise and keeping them in exercise programs is a major challenge. Understanding how older adults prefer to exercise may help developing tailored exercise programs and increase sustained exercise participation in ageing populations. We aimed to describe exercise patterns, including frequency, intensity, type, location and social setting of exercise, in older adults instructed to follow continuous moderate-intensity training (MCT) or high-intensity interval training (HIIT) over a one-year period.MethodsFrequency, intensity, type, location and social setting (alone vs. together with others) of exercise were assessed using exercise logs from 618 older adults (aged 70–77 years) randomized to MCT or HIIT. All participants completed exercise logs after each exercise session they performed during one year. Pearson Chi-square tests were run to assess the association between intensity, type, location and social setting of exercise with training group.ResultsBoth groups performed 2.2 ± 1.3 exercise sessions per week during the year. Walking was the most common exercise type in both groups, but MCT had a higher proportion of walking sessions than HIIT (54.2% vs. 41.1%, p < 0.01). Compared to MCT, HIIT had a higher proportion of sessions with cycling (14.2% vs. 9.8%, p < 0.01), combined endurance and resistance training (10.3% vs. 7.5%, p < 0.01), jogging (6.5% vs. 3.2%, p < 0.01) and swimming (2.6% vs. 1.7%, p < 0.01). Outdoors was the most common exercise location in both training groups (67.8 and 59.1% of all sessions in MCT and HIIT, respectively). Compared to MCT, HIIT had a higher proportion of sessions at a gym (21.4% vs. 17.5%, p < 0.01) and sports facility (9.8% vs. 7.6%, p < 0.01). Both groups performed an equal amount of sessions alone and together with others, but women had a higher proportion of sessions together with others compared to men (56% vs. 44%, p < 0.01).ConclusionThis is the first study that has followed older adults instructed to perform MCT or HIIT over a one-year period, collected data from each exercise session they performed and provided important knowledge about their exercise patterns. This novel information may help researchers and clinicians to develop tailored exercise programs in an ageing population.

Multimorbidity Patterns, Frailty, and Survival in Community-Dwelling Older Adults.

Frailty and multimorbidity are independent prognostic factors for mortality, but their interaction has not been fully explored. We investigated the importance of multimorbidity patterns in older adults with the same level of frailty phenotype. In a cohort of 7,197 community-dwelling adults aged 65 years and older, physical frailty status (robust, pre-frail, frail) was defined using shrinking, exhaustion, inactivity, slowness, and weakness. Latent class analysis was used to identify individuals with multimorbidity patterns based on 10 self-reported chronic conditions. We estimated hazard ratios (HR) and incidence rate differences (IRDs) for mortality comparing multimorbidity patterns within each frailty state. Five multimorbidity classes were identified: minimal disease (24.7%), cardiovascular disease (29.0%), osteoarticular disease (27.3%), neuropsychiatric disease (8.9%), and high multisystem morbidity (10.0%). Within each frailty state, the mortality rate per 1,000 person-years over 4 years was greatest in the neuropsychiatric class and lowest in the minimal disease class: robust (56.3 vs 15.7; HR, 2.11 [95% CI: 1.05, 4.21]; IRD, 24.1 [95% CI: -11.2, 59.3]), pre-frail (85.3 vs 40.4; HR, 1.74 [95% CI: 1.28, 2.37]; IRD, 27.1 [95% CI: 7.6, 46.7]), and frail (218.1 vs 96.4; HR, 2.05 [95% CI: 1.36, 3.10]; IRD, 108.4 [95% CI: 65.0, 151.9]). Although HRs did not vary widely by frailty, the excess number of deaths, as reflected by IRDs, increased with greater frailty level. Considering both multimorbidity patterns and frailty is important for identifying older adults at greater risk of mortality. Of the five patterns identified, the neuropsychiatric class was associated with lower survival across all frailty levels.

Effects of Age and Working Memory Load on Syntactic Processing: An Event-Related Potential Study.

Cognitive changes in aging include working memory (WM) decline, which may hamper language comprehension. An increase in WM demands in older adults would probably provoke a poorer sentence processing performance in this age group. A way to increase the WM load is to separate two lexical units in an agreement relation (i.e., adjective and noun), in a given sentence. To test this hypothesis, event-related potentials (ERPs) were collected from Spanish speakers (30 older adults, mean age = 66.06 years old; and 30 young adults, mean age = 25.7 years old) who read sentences to detect grammatical errors. The sentences varied with regard to (1) the gender agreement of the noun and adjective, where the gender of the adjective either agreed or disagreed with the noun, and (2) the WM load (i.e., the number of words between the noun and adjective in the sentence). No significant behavioral differences between groups were observed in the accuracy of the response, but older adults showed longer reaction times regardless of WM load condition. Compared with young participants, older adults showed a different pattern of ERP components characterized by smaller amplitudes of LAN, P600a, and P600b effects when the WM load was increased. A smaller LAN effect probably reflects greater difficulties in processing the morpho-syntactic features of the sentence, while smaller P600a and P600b effects could be related to difficulties in recovering and mapping all sentence constituents. We concluded that the ERP pattern in older adults showed subtle problems in syntactic processing when the WM load was increased, which was not sufficient to affect response accuracy but was only observed to result in a longer reaction time.

Differential associations between dual-task walking abilities and usual gait patterns in healthy older adults—Results from the Baltimore Longitudinal Study of Aging

BackgroundIt is well established that facing a cognitive challenge while carrying out a motor task interferes with the motor task performance, and in general the ability of handling a dual-task declines progressively with aging. However, the reasons for this decline have not been fully elucidated. Understanding the association between usual-walking gait patterns and dual-task walking performance may provide new insights into the mechanisms that lead to gait deterioration in normal aging and its link to motor and cognitive function. Research questionOur aim was to assess usual gait parameters in kinematics and kinetics to understand how these parameters are related with a specific task in dual-task walking. MethodsWe hypothesized that difficulty in dual-task walking would be associated with gait deteriorations as reflected in range of motion and mechanical work expenditure. We tested this hypothesis by quantifying the gait of 383 participants in the Baltimore Longitudinal Study of Aging (68% of whom successfully completed the dual-task walk, 21% failed the motor task, and 11% failed the cognitive task). ResultsCompared to successful performers, participants who failed the single motor task had slower gait speed, shorter stride length, higher cadence, and lower range of motion in the knee and ankle joints (p < 0.05, for all), while the participants who failed the cognitive task while walking had longer double support time (p = 0.003), and greater knee absorptive mechanical work (p = 0. 001) and lower ankle generative mechanical work (p < 0. 001). SignificanceThese results suggest that dual-task walking may be useful for monitoring subtle and diverse gait deteriorations in aging and possibly for designing interventions for maintaining and regaining proper gait patterns in older adults.

Alcohol consumption patterns of older adults: a study in a regional town in Western Australia

Aim: This study aimed to demonstrate that opportunistic health screening at health expos can provide an overall impression of alcohol consumption patterns.Design: A repeated cross-sectional survey design, completed over a four-year period (2011–2014), was used to assess the risk of harmful alcohol consumption, within a community setting of older adults, in the South West region of Western Australia.Methods: An alcohol screening survey (AUDIT) was used to collect data on alcohol consumption patterns on those aged 65 years and over. A total of 411 surveys were completed.Results: There was a statistically significant difference in mean risk scores across the four years (p < .001). 6.3–22.2% of survey completers presented as ‘risky’, and a further 3.8–12.3% as ‘high risk’ in terms of alcohol consumption.Conclusions: Opportunistic screening for alcohol consumption during health expos can aid the identification of at-risk individuals who may require further education or treatment.

Effects of a Long-Term Physical Activity Program on Activity Patterns in Older Adults.

To examine the effect of a long-term structured physical activity (PA) intervention on accelerometer-derived metrics of activity pattern changes in mobility-impaired older adults. Participants were randomized to either a PA or health education (HE) program. The PA intervention included a walking regimen with strength, flexibility, and balance training. The HE program featured health-related discussions and a brief upper body stretching routine. Participants (n = 1341) wore a hip-worn accelerometer for ≥10 h·d for ≥3 d at baseline and again at 6, 12, and 24 months postrandomization. Total PA (TPA)-defined as movements registering 100+ counts per minute-was segmented into the following intensities: low-light PA (LLPA; 100-759 counts per minute), high light PA (HLPA; 760-1040 counts per minute), low moderate PA (LMPA; 1041-2019 counts per minute), and high moderate and greater PA (HMPA; 2020+ counts per minute). Patterns of activity were characterized as bouts (defined as the consecutive minutes within an intensity). Across groups, TPA decreased an average of 74 min·wk annually. The PA intervention attenuated this effect (PA = -68 vs HE: -112 min·wk, P = 0.002). This attenuation shifted TPA composition by increasing time in LLPA (10+ bouts increased 6 min·wk), HLPA (1+, 2+, 5+, and 10+ bouts increased 6, 3, 2, and 1 min·wk, respectively), LMPA (1+, 2+, 5+, and 10+ bouts increased: 19, 17,16, and 8 min·wk, respectively), and HMPA (1+, 2+, 5+, and 10+ bouts increased 23, 21, 17, and 14 min·wk, respectively). The PA intervention increased PA by shifting the composition of activity toward higher-intensity activity in longer-duration bouts. However, a long-term structured PA intervention did not completely eliminate overall declines in total daily activity experienced by mobility-impaired older adults.

Equine Exercise in Younger and Older Adults: Simulated Versus Real Horseback Riding.

Horseback riding is an effective exercise for improving postural control and balance. To reduce costs and improve accessibility, simulated horseback riding has been developed; but no differential effects of simulated and real horseback riding on muscle activation patterns in older adults have been studied. Thus, we compared muscle activation patterns for older and younger adults engaged in real and simulated horseback riding exercises, using surface electromyography recordings of the erector spinae, rectus abdominis, internal oblique abdominis, and rectus femoris muscles. We recorded muscle activity for three riding patterns: walk, slow trot, and fast trot. Muscle activation was uniformly higher for simulated (vs. real) horseback riding and increased from the walking pattern through slow and fast trot. There was no age effect, but among older participants, muscle activation was higher for simulated (vs. real) horseback riding across all gait types. Simulated and real riding produced a similar pattern of muscle activation of the thigh and trunk. These results demonstrate that simulated horseback riding can be an effective alternative to actual riding for increasing trunk and thigh muscle activation and improving postural control and balance, perhaps especially among older adults.

Upper body accelerations during planned gait termination in young and older women

Transitory tasks, such as gait termination, involve interactions between neural and biomechanical factors that challenge postural stability and head stabilization patterns in older adults. The aim of the study was to compare upper body patterns of acceleration during planned gait termination at different speeds between young and older women. Ten young and 10 older women were asked to carry out three gait termination trials at slow, comfortable and fast speed. A stereophotogrammetric system and a 15-body segments model were used to calculate antero-posterior whole-body Center of Mass (AP CoM) speed and to reconstruct the centroids of head, trunk and pelvis segments. RMS of three-dimensional linear accelerations were calculated for each segment and the transmission of acceleration between two segments was expressed as a percentage difference. Older women reported lower AP CoM speed and acceleration RMS of the three upper body segments than young women across the three speed conditions. A lower pelvis-to-trunk attenuation of accelerations in the transverse plane was observed in older compared to young women, and mainly in the medio-lateral direction. As possible explanations, older women may not need to reduce acceleration as young women because of their lower progression speed and the subsequent acceleration at upper body levels. On the other hand, older women may prioritize a decrease in the whole body progression speed at expense of the involvement of upper body segments. This limits the attenuation of the accelerations, particularly in the transverse plane, implying an increased dynamic unbalance in performing this transitory task.

Frailty is associated with objectively assessed sedentary behaviour patterns in older adults: Evidence from the Toledo Study for Healthy Aging (TSHA).

ObjectiveThe aim of this study was to examine the association of sedentary behaviour patterns with frailty in older people.SettingClinical setting.DesignCross-sectional, observational study.Participants and measurementsA triaxial accelerometer was used in a subsample from the Toledo Study for Healthy Aging (519 participants, 67–97 years) to assess several sedentary behaviour patterns including sedentary time per day, the number and duration (min) of breaks in sedentary time per day, and the proportion of the day spent in sedentary bouts of 10 minutes or more. Frailty was assessed using the Frailty Trait Scale (FTS). Regression analysis was used to ascertain the associations between sedentary behaviour patterns and frailty.ResultsSedentary time per day and the proportion of the day spent in sedentary bouts of 10 minutes or more, were positively associated with frailty in the study sample. Conversely, the time spent in breaks in sedentary time was negatively associated with frailty.ConclusionIn summary, breaking up sedentary time and time spent in sedentary behaviour are associated with frailty in older people.

Multimorbidity Patterns in Older Adults: An Approach to the Complex Interrelationships Among Chronic Diseases

There is a growing need for evidence based answers to multimorbidity, especially in primary care settings. The aim was estimate the prevalence and patterns of multimorbidity in a Mexican population of public health institution users ≥60years old. Observational and multicenter study was carried out in four family medicine units in Mexico City; included older men and women who attended at least one consultation with their family doctor during 2013. The most common diseases were grouped into 11 domains. The observed and expected rates, as well as the prevalence ratios, were calculated for the pairs of the more common domains. Logistic regression models were developed to estimate the magnitude of the association. Cluster and principal components analyses were performed to identify multimorbidity patterns. Half of all of the patients who were ≥60years old and treated by a family doctor had multimorbidity. The most common disease domains were hypertensive and endocrine diseases. The highest prevalence of multimorbidity concerned the renal domain. The domain pairs with the strongest associations were endocrine+renal and hypertension+cardiac. The cluster and principal components analyses revealed five consistent patterns of multimorbidity. The domains grouped into five patterns could establish the framework for developing treatment guides, deepen the knowledge of multimorbidity, develop strategies to prevent it, decrease its burden, and align health services to the care needs that doctors face in daily practice.

The Effect of Information and Communication Technologies Utilization Patterns on Self-Rated Health

Background: An increasing number of older adults are using information and communication technologies (ICTs), and ICTs have become a major resource for older adults for improving health-related quality of life. ICTs possibly help older adults seek health information online, collaborate with other users in their decision making process, and receive social support. Although there have been some studies highlighting positive associations between ICT utilization and health, there is still limited knowledge about various patterns of ICT utilization among older adults. Objective: This study aims to extend the empirical evidence regarding the patterns of older adults’ ICT utilization, investigate different attributes across various ICT utilization patterns, and further examine how these patterns influence self-rated health. Methods: Data came from the 2012 and 2014 Health and Retirement Study, a nationally representative sample of Americans aged 51 and older. Our sample was restricted to individuals who responded to a special survey about technology use asked only to a subsample of 2012 interviews (N=1504). Latent class analysis was used to identify ICT utilization patterns based on ICT utilization variables: (1) communication-related utilization, including use of email, social networking sites, online video call, instant messenger, and smartphones; (2) finance-related utilization, such as online bill payment and online banking; (3) health-related utilization, including exercise equipment, exercise videos, online wellness programs, online health information, health monitoring devices, and Wii Fit; and (4) entertainment-related utilization, including e-readers/tablets, mp3 players, online streaming media, and video game. Ordinary least squares regressions were used to examine the effects of ICT utilization patterns on self-rated health at follow-up as compared to baseline. Results: Four ICT utilization patterns were identified: multifarious (n=90: high level of ICT utilization across most variables), e-commerce-oriented (n=147: high level of finance-related utilization), fundamental (n=280: email and online search focused utilization), and minimal users (n=552: low level of ICT utilization across most variables). We found that multifarious users were younger, more often female, married, and had higher education and income levels and better physical and mental health than other groups. Minimal users were more likely to be older, non-white, and single, and more likely to have lower level of education and income and poor physical and mental health. Regression models showed multifarious users were most likely to have better self-rated health, and minimal users tended to have the worst self-rated health over time, even after controlling for sociodemographic attributes and health conditions. E-commerce-oriented users were more likely to have better self-rated health than fundamental users. Conclusions: This study identified clearly different ICT utilization patterns among older adults and demonstrated positive effects of ICT utilization on health among older adults. Improving access to ICTs and ICT education programs will help to improve health outcomes of older adults, but the effects of different ICT utilization patterns need to be highlighted in future studies.

Associations Between β-Amyloid Kinetics and the β-Amyloid Diurnal Pattern in the Central Nervous System

Recent studies found that the concentration of amyloid-β (Aβ) fluctuates with the sleep-wake cycle. Although the amplitude of this day/night pattern attenuates with age and amyloid deposition, to our knowledge, the association of Aβ kinetics (ie, production, turnover, and clearance) with this oscillation has not been studied. To determine the association between Aβ kinetics, age, amyloid levels, and the Aβ day/night pattern in humans. We measured Aβ concentrations and kinetics in 77 adults aged 60 to 87 years with and without amyloid deposition by a novel precise mass spectrometry method at the Washington University School of Medicine in St Louis, Missouri. We compared findings of 2 orthogonal methods, enzyme-linked immunosorbent assay and mass spectrometry, to validate the day/night patterns and determine more precise estimates of the cosinor parameters. In vivo labeling of central nervous system proteins with stable isotopically labeled leucine was performed, and kinetics of Aβ40 and Aβ42 were measured. Serial cerebrospinal fluid collection via indwelling lumbar catheter over 36 to 48 hours before, during, and after in vivo labeling, with a 9-hour primed constant infusion of 13C6-leucine. The amplitude, linear increase, and other cosinor measures of each participant's serial cerebrospinal fluid Aβ concentrations and Aβ turnover rates. Of the 77 participants studied, 46 (59.7%) were men, and the mean (range) age was 72.6 (60.4-87.7) years. Day/night patterns in Aβ concentrations were more sharply defined by the precise mass spectrometry method than by enzyme-linked immunosorbent assay (mean difference of SD of residuals: Aβ40, -7.42 pM; P < .001; Aβ42, -3.72 pM; P < .001). Amyloid deposition diminished day/night amplitude and linear increase of Aβ42 but not of Aβ40. Increased age diminished day/night amplitude of both Aβ40 and Aβ42. After controlling for amyloid deposition, amplitude of Aβ40 was positively associated with production rates (r = 0.42; P < .001), while the linear rise was associated with turnover rates (r = 0.28; P < .05). The amplitude and linear rise of Aβ42 were both associated with turnover (r = -0.38; P < .001) and production (r = 0.238; P < .05) rates. Amyloid deposition is associated with premature loss of normal Aβ42 day/night patterns in older adults, suggesting the previously reported effects of age and amyloid on Aβ42 amplitude at least partially affect each other. Production and turnover rates suggest that day/night Aβ patterns are modulated by both production and clearance mechanisms active in sleep-wake cycles and that amyloid deposition may impair normal circadian patterns. These findings may be important for the designs of future secondary prevention trials for Alzheimer disease.

Injuries in Adults 65 Years of Age and Older Prescribed Muscle Relaxants.

The Beers criteria list skeletal muscle relaxants (SMR) as inappropriate for individuals 65 years of age and older because of anticholinergic effects, sedation, and risk of falls/fractures. Patients 65 years of age and older presenting to U.S. primary care clinics for injury, prescribed an SMR, are at risk for these events. SMR prescribing patterns in older adults with injury have not been well studied at the population level. Using nationally representative data, the prevalence of older adults prescribed an SMR presenting to U.S. primary care clinics with injury was examined. A cross-sectional study analyzing 2012 National Ambulatory Medical Care Survey (NAMCS) data using bivariate and multivariate techniques. NAMCS, a nationally representative database of the U.S. population, collects data from primary care office visits and uses a multi-stage sampling strategy. Primary care offices throughout the United States. Adults 65 years of age and older, presenting to rural primary care clinics with injury. Prescription for SMR. Multivariate analysis yielded that the study population presenting to rural clinics for injury had 28% greater odds, non-Caucasian adults had 11% greater odds, and those who had been seen at least twice in the past 12 months had 34% greater odds of being prescribed an SMR. Logistic regression analysis also yielded that females 65 to 74 years of age had greater odds of having a prescription for an SMR. The results of this study identified disparities among adults 65 years of age and older presenting to U.S. rural primary care clinics with injury and prescribed an SMR. Adults 65 years of age and older, Collaborative.

Rest-Activity Patterns in Older Adults with Heart Failure and Healthy Older Adults.

The purpose of this investigation is to examine differences in rest-activity patterns and sleep characteristics in older adults with heart failure (HF) and healthy older adults. The sample included older adults with HF (n = 20) and a reference group of healthy older adults (n = 20). Traditional cosinor analysis was used to assess three parameters of rest-activity from wrist actigraphy data: amplitude (range of activity), mesor (mean activity), and acrophase (time of peak activity). Traditional sleep characteristics were also determined from actigraphy data: total sleep time (TST), sleep latency (SL), sleep efficiency (SE), and wake after sleep onset (WASO). The HF group demonstrated significantly lower mesor and amplitude than the reference group (p < .01). The HF group had significantly greater TST (p < .01), but the groups had similar SE, SL, and WASO. Despite similar sleep characteristics to healthy older adults, overall rest-activity patterns were significantly dampened in those with HF.