Problem In Older Adults Research Articles

Excellence in Rehabilitation of Aging Persons Award: Developing a Function-Focused Approach to Pain Management for Older Adults with Chronic Low Back Pain

Abstract The overarching goal of our research program is to improve physical function and participation in older adults with chronic musculoskeletal conditions, particularly low back pain (LBP). Despite the fact that LBP is a common problem for older adults and is associated with poor outcomes in this vulnerable age group, little research has focused on LBP in people over age 65. With minimal research available, clinicians do not have clear evidence-based guidance regarding management of older adults with LBP. This presentation will focus on our pathway towards developing a focused treatment algorithm designed to prevent and address the pain-related disability found in older adults with LBP. Our work has largely focused on the identification of potentially modifiable "rehabilitation risk factors" that are associated with pain and functional limitations, as well as the development of interventions to address these risk factors. Specifically, we will discuss our findings relative to trunk muscle impairments and clinical hip impairments in the context of the older adult with low back pain.

Bringing Transdisciplinary Aging Research From Theory to Practice

There is a growing emphasis to use a transdisciplinary team approach to accelerate innovations in science to solve complex conditions associated with aging. However, the optimal organizational structure and process for how to accomplish transdisciplinary team science are unclear. In this study, we illustrate our team’s experience using transdisciplinary approaches to solve challenging and persistent problems for older adults living in urban communities. We describe our challenges and successes using the National Institutes of Health four-phase model of transdisciplinary team-based research. Using a de-identified survey, the team conducted an internal evaluation to identify features that created challenges including structural incongruities, interprofessional blind spots, group function, and group dynamics. The team then identified responses to address the features that created challenges and determined indicators for success. Indicators for success were identified by the team as a place for continued evaluation of the teams’ collaborative effectiveness, transdisciplinary integration, and impact on the university and aging community. This work resulted in the creation of the team’s Transdisciplinary Conceptual Model. This model became essential to understanding the complex interplay between societal factors, community partners, and academic partners. Conducting internal evaluations of transdisciplinary team processes is integral for teams to move beyond the multi- and interdisciplinary niche and to reach true transdisciplinary success. More research is needed to develop measures that assess team transdisciplinary integration. Once the process of transdisciplinary integration can be reliably assessed, the next step would be to determine the impact of transdisciplinary team science initiatives on aging communities.

Bringing Transdisciplinary Aging Research From Theory to Practice

Education is a strong predictor of cognitive health among older adults, and recent research indicates that apart from one’s own education, the educational resources of family members also play a crucial role in shaping cognitive health over the life course. We add to this literature by investigating whether the advantages of highly educated family members matter for both Blacks and Whites in the U.S. Specifically, we ask whether the resources of family members-parents and offspring-partially explain the racial gap in both the prevalence and incidence of cognitive health across both groups. For this, we employ logistic regression models to examine the prevalence of cognitive impairment at baseline, and discrete-time event history models to assess the incidence of cognitive impairment, using data from the Health and Retirement Study (HRS) for the years ranging from 2000 to 2012. Preliminary results indicate that at the baseline, respondent’s own education is predictive of cognitive impairment among Whites, but not Blacks. Once respondent-level health conditions and behaviors are taken into consideration, parental or offspring education is not associated with the prevalence of cognitive impairment. For respondents who are not impaired at the baseline, our results from the incidence models align with the “adjacent generations” literature suggesting that both parental and offspring education has a salient positive effect on later-life cognitive health. However, we find notable differences across groups to suggest that the education of parents and offspring may play a larger role in mitigating cognitive decline among African Americans, compared to Whites.

Factors that influence the emotional impact of memory problems in older adults: A qualitative descriptive study.

Associations among psychological health and memory concerns in older adults are well-established, but much of this research is quantitative. This study examined how memory problems influence emotional well-being in older adults without dementia, and whether this differs by cognitive status and current depressive or anxiety symptoms. A qualitative descriptive design was used to examine our research questions. Community-dwelling older adults without dementia (n=49, Mage =74.5[10.1], 63% women) completed a cognitive assessment, questionnaires and two semi-structured interviews. Content analysis was used to code and categorise the transcribed interview data, then identify themes within and across participant groups. Five themes described the influence of memory problems on emotional well-being: Evoking Emotions, Fearing Future, Undermining Self, Normalising Problems and Adjusting Thinking. Memory problems' impact on emotional well-being varied by current anxiety symptoms, characteristics of the problem and personal experience with dementia. The emotional impact of memory problems tended to differ by affective symptoms, not cognitive status. Older adults who report memory concerns without objective evidence of impairment may be at risk for negative impacts to mental health and well-being. Cognitive screening guidelines should consider best practices for responding to memory concerns when cognitive testing results are normal.

Prevalence of Care Problems in Older Adults in Turkish Hospitals

Prevalence of Care Problems in Older Adults in Turkish Hospitals

The relationship between uric acid and malnutrition in older adults

Rationale: Malnutrition, one of the most common problems in older adults; is closely related to infection, delayed wound healing, and deterioration of protective mechanisms against oxidative stress. Antioxidants reduce the risk of atherosclerotic disease, progression of dementia, and the incidence of cancer. We aim to evaluate the relationship between malnutrition and uric acid which is an antioxidant.

Navigating re-entry with older adults using ecosystems perspective and the eco-map

Currently, the population of older adults is growing at a rapid rate. The number of older adults in America is similarly represented in the justice system with the number of older adults aged 56 and older accounting for 11.8 percent of the total federal prison population. Older adults in the criminal justice system are at heightened risk for poor health, mental illness, and accelerated aging. For those exiting the carceral system, many older adults may not have community connections to aid in re-entry. Social service providers and community agencies that are tasked with advocating for marginalized populations, empowering clients, and addressing psychosocial problems of older adults, may be uniquely helpful in the re-entry process. Guided by ecological systems theory, this article presents the eco-map tool for social service professionals (e.g., social workers, probation officers) to use in tandem with eco-systems perspective. Using this tool in collaboration with older adult clients may assist with re-entry. Furthermore, social service providers can use this to navigate complex relationships within the community and society at large. Finally, the use of this tool may assist with facilitating comprehensive support and wrap-around services for older adults.

Persistence of pain and cognitive impairment in older adults.

No studies have examined the longitudinal association between the persistence of pain and its relationship to cognitive problems in older adults. The objective of this study was to examine how the persistent of pain associates with cognitive performance, cognitive impairment, and subjective memory decline. Across 10 biennial waves, 8515 adults ages 65 and over were assessed from the Health and Retirement Study (Mage =74.17, SD=6.87, 59.2% female). At each wave, individuals were asked to report on pain presence, and if present, rate its intensity and interference with daily activities such as housework or chores. Using running frequencies or averages, we calculated the persistence of pain using these three pain measures. Cognition was assessed using cognitive performance and different cognitive impairment cutoffs. Incident subjective memory decline was additionally measured as new self-reported memory change in the last 2 years. General estimating equations examined concurrent associations between persistence of pain and cognitive variables, adjusting for demographics, depressive symptoms, and medical comorbidities. Persistence of pain presence was associated with an increased risk of cognitive impairment. Only persistence of pain interference, not pain intensity, was significantly associated with poorer cognitive performance or being classified as cognitively impaired. For every 2 years, persistence of pain interference was associated with 21% increased odds of cognitive impairment. Only one of three pain variables was related to incident subjective memory decline. Persistence of pain is associated with poorer cognitive performance in community-dwelling older adults, especially when involving ongoing interference in chores and work. Facilitating pain management might be important for helping to maintain later-life cognition and reduce dementia risk.

Compromised intestinal integrity in older adults during daily activities: a pilot study

BackgroundMalnutrition is a common and significant problem in older adults. Insight into factors underlying malnutrition is needed to develop strategies that can improve the nutritional status. Compromised intestinal integrity caused by gut wall hypoperfusion due to atherosclerosis of the mesenteric arteries in the aging gastrointestinal tract may adversely affect nutrient uptake. The presence of compromised intestinal integrity in older adults is not known. The aim of this study is to provide a proof-of-concept that intestinal integrity is compromised in older adults during daily activities.MethodsAdults aged ≥75 years living independently without previous gastrointestinal disease or abdominal surgery were asked to complete a standardized walking test and to consume a standardized meal directly afterwards to challenge the mesenteric blood flow. Intestinal fatty acid-binding protein (I-FABP) was measured as a plasma marker of intestinal integrity, in blood samples collected before (baseline) and after the walking test, directly after the meal, and every 15 min thereafter to 75 min postprandially.ResultsThirty-four participants (median age 81 years; 56% female) were included. Of the participants, 18% were malnourished (PG-SGA score ≥ 4), and 32% were at risk of malnutrition (PG-SGA score, 2 or 3). An I-FABP increase of ≥50% from baseline was considered a meaningful loss of intestinal integrity and was observed in 12 participants (35%; 8 females; median age 80 years). No significant differences were observed in either baseline characteristics, walking test scores, or calorie/macronutrient intake between the groups with and without a ≥ 50% I-FABP peak.ConclusionThis study is first to indicate that intestinal integrity is compromised during daily activities in a considerable part of older adults living independently.

Dermatological conditions in older adults: clinical overview

The skin is one of the most important parts of the human body. It protects the underlying tissue from injury and is a valuable part of the homeostatic processes. Older people have more frail and aged skin, which must be treated correctly to avoid skin breaks, especially where there are any dermatological conditions present. Not only this, but where there is a wound, the dressing must be chosen and applied carefully, to treat the condition but also to avoid damage when it comes to removing the dressing, due to the risk of the skin tearing, which can be a common problem in older adults. Further, the thinner, drier skin of older people has moisture and barrier changes that lead to a higher susceptibility to eczema. This article provides an overview of the aetiological, diagnostic and treatment aspects of geriatric dermatology, with a focus on the common allergic skin conditions (dermatitis) seen in older adults.

Help-seeking for cognitive problems in older adults without dementia: A systematic review.

Understanding the help-seeking decision-making process in older adults experiencing cognitive problems is needed to improve early identification of cognitive impairment. The purpose of this systematic review was to determine what factors influence whether community-dwelling older adults without dementia seek help for cognitive problems. We conducted a mixed-methods systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search was conducted in PubMed, CINAHL, PsycINFO, Web of Science, and ProQuest Dissertations and Theses Global in June 2020. Quality appraisal was conducted using the Mixed Methods Appraisal Tool. A narrative synthesis was used to integrate findings across studies. Eighteen articles met eligibility criteria. All were cross-sectional studies, including nine quantitative, eight qualitative, and one containing quantitative and qualitative components. Factors that facilitated help-seeking were problem intensity, social support, valuing early detection, having a family history of dementia, and positive views of the healthcare system. Factors that detracted from help-seeking were normalizing cognitive problems, attributing problems to psychosocial causes, and not perceiving a benefit to disclosing cognitive problems. The decision to seek help for cognitive problems is influenced by a variety of factors. Our review suggests these differ in older adults without dementia compared to previous reviews of help-seeking for a dementia diagnosis. Given the importance of early detection of cognitive impairment to improve long-term outcomes, intervention development based on the factors we identified has important implications for older adults' cognitive health.

Associations between polypharmacy and physical performance measures in older adults

Objectives: A preserved ambulation is one of the keypoints for functionality and polypharmacy, a common problem in older adults, is associated with worse functional status. Our aim was to examine the associations of polypharmacy with certain physical performance measures used to evaluate ambulation.Methods: This retrospective, cross-sectional study was conducted in a geriatric outpatient clinic. Using ≥5 medications was accepted as polypharmacy. Usual gait speed (UGS), chair sit-to-stand test (CSST), timed up and go test (TUG) and short physical performance battery (SPPB) were performed to assess physical performance status. We created two models for logistic regression analyses: Model 1 was adjusted for age, sex and body mass index (BMI). We added comorbidities to Model 1 and further created Model 2.Results: There were 392 participants (69.1% were female, mean age: 73.9±6.2 years). Polypharmacy was seen in 62.5%. Participants with polypharmacy presented with a poor physical performance compared to the no-polypharmacy group (p<0.001, for each). In multivariate analyses, polypharmacy was independently associated with poor SPPB (Odds Ratio (OR)=2.5; 95% Confidence Interval (CI)=1.3-4.7 and OR=2.4; 95% CI=1.2-4.8 for Model 1 and 2, respectively) and long CSST (OR= 2.6; 95% CI=1.3-5.2 and OR=3.7; 95% CI=1.7-8.2 for Model 1 and 2, respectively). There was a significant association between polypharmacy and slow UGS in Model 1 (OR=1.9; 95% CI=1.0-3.5); but relationship did not persist after adding comorbidities into the first model (OR=1.6; 95% CI= 0.8-3.1). There was no significant association between long TUG and polypharmacy in any of the models.Conclusion: Polypharmacy is well-known with its association with falls and fractures in older adults and this might be explained by its association with poor physical performance. Whether polypharmacy causes a deterioration in physical performance is an issue needs to be enlightened by further longitudinal studies.

Activation of Microbiota Sensing - Free Fatty Acid Receptor 2 Signaling Ameliorates Amyloid-β Induced Neurotoxicity by Modulating Proteolysis-Senescence Axis.

Multiple emerging evidence indicates that the gut microbiota contributes to the pathology of Alzheimer’s disease (AD)—a debilitating public health problem in older adults. However, strategies to beneficially modulate gut microbiota and its sensing signaling pathways remain largely unknown. Here, we screened, validated, and established the agonists of free fatty acid receptor 2 (FFAR2) signaling, which senses beneficial signals from short chain fatty acids (SCFAs) produced by microbiota. The abundance of SCFAs, is often low in the gut of older adults with AD. We demonstrated that inhibition of FFAR2 signaling increases amyloid-beta (Aβ) stimulated neuronal toxicity. Thus, we screened FFAR2 agonists using an in-silico library of more than 144,000 natural compounds and selected 15 of them based on binding with FFAR2-agonist active sites. Fenchol (a natural compound commonly present in basil) was recognized as a potential FFAR2 stimulator in neuronal cells and demonstrated protective effects against Aβ-stimulated neurodegeneration in an FFAR2-dependent manner. In addition, Fenchol reduced AD-like phenotypes, such as Aβ-accumulation, and impaired chemotaxis behavior in Caenorhabditis (C.) elegans and mice models, by increasing Aβ-clearance via the promotion of proteolysis and reduced senescence in neuronal cells. These results suggest that the inhibition of FFAR2 signaling promotes Aβ-induced neurodegeneration, while the activation of FFAR2 by Fenchol ameliorates these abnormalities by promoting proteolytic Aβ-clearance and reducing cellular senescence. Thus, stimulation of FFAR2 signaling by Fenchol as a natural compound can be a therapeutic approach to ameliorate AD pathology.

Quantification of the Link between Timed Up-and-Go Test Subtasks and Contractile Muscle Properties.

Frailty and falls are a major public health problem in older adults. Muscle weakness of the lower and upper extremities are risk factors for any, as well as recurrent falls including injuries and fractures. While the Timed Up-and-Go (TUG) test is often used to identify frail members and fallers, tensiomyography (TMG) can be used as a non-invasive tool to assess the function of skeletal muscles. In a clinical study, we evaluated the correlation between the TMG parameters of the skeletal muscle contraction of 23 elderly participants (22 f, age 86.74 ± 7.88) and distance-based TUG test subtask times. TUG tests were recorded with an ultrasonic-based device. The sit-up and walking phases were significantly correlated to the contraction and delay time of the muscle vastus medialis (ρ = 0.55–0.80, p < 0.01). In addition, the delay time of the muscles vastus medialis (ρ = 0.45, p = 0.03) and gastrocnemius medialis (ρ = −0.44, p = 0.04) correlated to the sit-down phase. The maximal radial displacements of the biceps femoris showed significant correlations with the walk-forward times (ρ = −0.47, p = 0.021) and back (ρ = −0.43, p = 0.04). The association of TUG subtasks to muscle contractile parameters, therefore, could be utilized as a measure to improve the monitoring of elderly people’s physical ability in general and during rehabilitation after a fall in particular. TUG test subtask measurements may be used as a proxy to monitor muscle properties in rehabilitation after long hospital stays and injuries or for fall prevention.

The impact of physical pain and depression on sleep quality in older adults with chronic disease.

This study's purpose was to identify the correlates of sleep quality in older adults with chronic disease. Sleep quality is a common problem in older adults that may be affected by physical and mental status. A cross-sectional correlational design was employed. The study was conducted between July 2019 and April 2020 in a teaching hospital of southern Taiwan. The Geriatric Depression Scale, Pittsburgh Sleep Quality Index and Numerical Rating Scale were used to assess depression, sleep quality and physical pain respectively. Of the 120 older adults (age >65years) with chronic disease, the average Pittsburgh Sleep Quality Index score was 5.67. A total of 45.8% subjects had sleep disturbance. Older adults who were living with a partner and those who urinated at night were significantly more likely to report sleep disturbance. The presence of sleep disturbance was associated with greater levels of depression and higher levels of physical pain. Living with a partner, nocturia, physical pain and depression were associated with the presence of sleep disturbance in older adults with chronic disease. The results of this study can help healthcare providers understand the factors associated with sleep disturbance in older adults with chronic disease, thereby facilitating the early resolution of sleep disturbance issues in this population.

Effects of olfactory stimulation on cognitive function and behavior problems in older adults with dementia: A systematic literature review

The aim of this study was to examine the effects of olfactory stimulation on both cognitive and behavioral symptoms in neurodegenerative diseases. The criteria for selection of participants in the study included neurodegenerative disease, interventions using olfactory stimulation, and measured cognitive or psychological symptoms. 5301 articles were identified, excluding duplicate papers. Seven original articles were selected according to the full article review and eligibility criteria. The final selected studies were all quasi-experimental studies and were published between 2002 and 2015. To assess the risk of bias, we used Cochrane Collaboration's tool, Non-randomized Studies-of Interventions (ROBINS-I). Although olfactory stimulation reported various effects on behavioral and psychological symptoms, it is still in its infancy. We propose standardization of olfactory stimulation and olfactory training. In patients with neurodegenerative diseases, it is necessary to consider the symptoms and severity of olfactory stimulation.

Impact of Subjective and Objective Sleep Quality on Peptic Ulcer Rebleeding in Older Adults.

This study aimed to examine the association of subjective and objective sleep quality with subsequent peptic ulcer rebleeding among older patients. Of 1196 older patients with peptic ulcer bleeding (PUB) recruited from 12 grade A hospitals in the People's Republic of China, 1106 achieved full recovery from PUB, and they were followed up for up to 30 days. Using multiple measures at 1-week intervals, patients who presented PUB symptoms were invited to have an esophagogastroduodenoscopy examination. Subjective sleep quality was measured using the Pittsburgh Sleep Quality Index. Objective sleep quality domains were measured using an accelerometer, including sleep onset latency, sleep efficiency, total sleep time, and the number of awakenings. This study documented a 30-day cumulative ulcer rebleeding rate of 15.3%. Multivariate analyses showed that longer sleep onset latency (hazard ratio [HR] = 2.136 [1.336-2.558]) and more nighttime awakenings (HR = 1.698 [1.169-2.666]) increased the risk of ulcer rebleeding. However, a longer total sleep time (HR = 0.768 [0.698-0.887]) and better sleep efficiency (HR = 0.795 [0.682-0.975]) protected against ulcer rebleeding. Older patients who perceived poorer sleep quality were also more likely to experience ulcer rebleeding (HR = 2.295 [1.352-3.925]). The present results highlight the importance of proper treatment and prevention of sleep problems in older adults after successful PUB treatment. Our results, if replicable in future studies with more rigorous design and representative samples, might shed light on the etiology of ulcer rebleeding and suggest new pathways for preventing this disease.

Psychosocial status of older adults aged 65 years and over during lockdown in Turkey and their perspectives on the outbreak.

Older adults over the age of 65 were announced as a high-risk group in the COVID-19 outbreak and had to be placed on lockdown for a long time. The research was conducted to identify the psychosocial status, attitudes, and experiences of individuals aged 65 and over who were in-home lockdown during the COVID-19 outbreak in Turkey. In the study, 51 older adults were reached using the snowball sampling method. The research data were collected through qualitative interviews from older adults who were in house restrictions during the pandemic period, and thematic analysis was performed. As a result of the interviews, four main themes revealed as (a) Growing old is like a crime: The public perception of the older adults regarding the stigma associated with aging, (b) The inevitable course: Potential possibilities arising as a result of the pandemic period, (c) The cost of lockdown at home: Risk factors arising due to staying at home for a long time, (d) The desire for equality: The developing resistance against lockdown and demands for equality. The lockdown applied exclusively to older adults forced them to create new routines and made them aware of some values; however, they asserted that they were stigmatized and lonely, that their concerns about death/catching COVID-19 increased, and they were treated unfairly. Measures should be taken to prevent mental problems in older adults. In addition, public health nurses are advised to provide preventive care services and counselling for early intervention.

Sarcopenia versus cancer cachexia: the muscle wasting continuum in healthy and diseased aging.

Muscle wasting is one of the major health problems in older adults and is traditionally associated to sarcopenia. Nonetheless, muscle loss may also occur in older adults in the presence of cancer, and in this case, it is associated to cancer cachexia. The clinical management of these conditions is a challenge due to, at least in part, the difficulties in their differential diagnosis. Thus, efforts have been made to better comprehend the pathogenesis of sarcopenia and cancer cachexia, envisioning the improvement of their clinical discrimination and treatment. To add insights on this topic, this review discusses the current knowledge on key molecular players underlying sarcopenia and cancer cachexia in a comparative perspective. Data retrieved from this analysis highlight that while sarcopenia is characterized by the atrophy of fast-twitch muscle fibers, in cancer cachexia an increase inthe proportion of fast-twitch fibers appears to happen. The molecular drivers for these specificmuscleremodeling patterns are still unknown; however, among the predominant contributors to sarcopenia is the age-induced neuromuscular denervation, and in cancer cachexia, the muscle disuse experienced by cancer patients seems to play an important role. Moreover, inflammation appears to be more severe in cancer cachexia. Impairment of nutrition-related mediators may also contribute to sarcopenia and cancer cachexia, being distinctly modulated in each condition.

Peripheral Blood T Cell Gene Expression Responses to Exercise and HMB in Sarcopenia.

Background: Sarcopenia is a major health problem in older adults. Exercise and nutrient supplementation have been shown to be effective interventions but there are limited studies to investigate their effects on the management of sarcopenia and its possible underlying mechanisms. Here, we studied T cell gene expression responses to interventions in sarcopenia. Methods: The results of this study were part of a completed trial examining the effectiveness of a 12-week intervention with exercise and nutrition supplementation in community-dwelling Chinese older adults with sarcopenia, based on the available blood samples at baseline and 12 weeks from 46 randomized participants from three study groups, namely: exercise program alone (n = 11), combined-exercise program and nutrition supplement (n = 23), and waitlist control group (n = 12). T cell gene expression was evaluated, with emphasis on inflammation-related genes. Real-time PCR (RT-PCR) was performed on CD3 T cells in 38 selected genes. Correlation analysis was performed to relate the results of gene expression analysis with lower limb muscle strength performance, measured using leg extension tests. Results: Our results showed a significant improvement in leg extension for both the exercise program alone and the combined groups (p < 0.001). Nine genes showed significant pre- and post-difference in gene expression over 12 weeks of intervention in the combined group. Seven genes (RASGRP1, BIN1, LEF1, ANXA6, IL-7R, LRRN3, and PRKCQ) showed an interaction effect between intervention and gene expression levels on leg extension in the confirmatory analysis, with confounder variables controlled and FDR correction. Conclusions: Our findings showed that T cell-specific inflammatory gene expression was changed significantly after 12 weeks of intervention with combined exercise and HMB supplementation in sarcopenia, and that this was associated with lower limb muscle strength performance.