Risk Factors In Older Adults Research Articles

Large Contribution of Oral Status for Death Among Modifiable Risk Factors in Older Adults: The Japan Gerontological Evaluation Study (JAGES) Prospective Cohort Study.

Oral diseases are preventable and modifiable, but highly prevalent, and cause worse oral status. Particularly, tooth loss has increased in aging societies. However, studies on population-attributable risks of modifiable risk factors for mortality have neglected oral status. This study aimed to investigate the impact of modifiable risk factors on mortality, including oral status. This cohort study used the Japan Gerontological Evaluation Study data, including participants aged ≥65 years. The outcome was death between August 2010 and March 2017. We calculated the hazard ratios (HRs) and population attributable fraction (PAF) of modifiable risk factors (oral status, hypertension, depression, heart disease, diabetes, physical activity, smoking status, and alcohol drinking history) for mortality. Analyses included 24 175 men and 27 888 women (mean age: 73.8 [6.0] and 74.2 [6.1], respectively). In men, after adjusting for covariates, having no teeth showed the highest hazard ratio (HR = 1.67, 95% confidence interval [CI] = 1.51-1.86) among the modifiable risk factors, and the PAF for the number of teeth (18.2%) was the second largest following age. In women, having no teeth had the third largest HR (HR = 1.37, 95% CI = 1.19-1.56) following current and former smoking. The PAF for the number of teeth (8.5%) was the sixth largest, which was larger than that of smoking status (4.8%). In the older population, the HR and PAF of the number of teeth on mortality were sufficiently large compared with other modifiable risk factors, especially in men. Therefore, maintaining good oral status should be included more in global health policies.

Metabolic syndrome and its association with changes in modifiable risk factors: Epifloripa aging study.

To estimate the prevalence of Metabolic Syndrome (MetS) and its association with changes in modifiable risk factors in older adults from southern Brazil. A longitudinal study was performed with data from EpiFloripa Aging study. We defined MetS by the existence of three or more of the following risk factors for cardiovascular disease (CVD): waist circumference (WC) (≥ 92cm in men and ≥ 87cm in women); fasting glucose (≥100mg/dl); decreased HDL cholesterol (<40mg/dl in men and <50mg/dl in women); hypertriglyceridemia (≥150mg/dl) and blood pressure (≥130/85mmHg). We evaluated the changes in modifiable risk factors (smoking, alcohol consumption, fruit and vegetable consumption, physical activity, and body mass index) between the two moments of the study (2009/10 and 2013/14). Directed acyclic graph and logistic regression models were used. Among the 599 participants, the prevalence of MetS was 64.0% (95% CI, 58.7-68.9). In the adjusted analysis, those who remained or became persons who are overweight (OR = 4.59; 95% CI: 3.05-6.89) and those who remained or became insufficiently active (OR = 1.92; 95% CI: 1.23-2.98) were more likely to present MetS. Our findings suggest that being or becoming overweight and being or becoming insufficiently active are modifiable factors associated with MetS. These results highlight the need for developing preventive strategies for the observed risk indicators to mitigate the prevalence of MetS in older adults.

Adaptation and virtual feasibility pilot of a mindfulness-based lifestyle program targeting modifiable dementia risk factors in older adults

Objectives We developed a group-based program (My Healthy Brain, MHB) to engage older adults at-risk for dementia in healthy lifestyles. We report on a two-part study to adapt MHB by incorporating mindfulness skills, using mobile health technology to monitor and reinforce behaviors, and delivering it via live video. Methods Participants were older adults (age ≥ 60) with subjective cognitive decline (SCD) and at least one lifestyle risk factor. In Aim 1 (n = 11, 2 groups), we conducted focus groups to obtain qualitative feedback on proposed adaptations. In Aim 2 (n = 10), we conducted a virtual open pilot with exit interviews to explore the feasibility and outcomes of the adapted MHB. Results Thematic analysis revealed: (1) barriers and facilitators to healthy lifestyles, (2) positive impressions of MHB, (3) interest in mindfulness skills, and (4) openness to study technologies. MHB met a-priori feasibility benchmarks and was associated with improvements in cognition, lifestyle (e.g. physical function), and proposed mechanisms (e.g. mindfulness). Exit interviews confirmed high feasibility and satisfaction. Conclusion The integration of mindfulness, live video, and mobile health technologies was feasible and promising for improving healthier lifestyles. The results inform the next feasibility RCT of MHB to prepare for efficacy testing. Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2022.2032600

Fear of falling and risk factors in older adults

Fear of falling is becoming the most common fear among people aged 65 and over,with a prevalence that varies within the range of 12% to 92% [1]. Monitoring the elderly's physical activity is highly recommended in order to improve their health. Several reports have demonstrated that a fall does not always result in a fear of falling, which may be caused by factors other than the fall itself[2][3]. Falls, on the other hand, and fear of falling share one feature: they are both associated with walking disorders. Falls are considered a significant risk that primarily affects the elderly. Slowness of movement, loss of motion, and balance issues are common in the elderly. In this article, we have proposed an intelligent insole system to detect falls, monitor patients’ physiological parameters, and reduce their fear of falling. Thus, the elderly will be surrounded in real time by professional clinicians working remotely to control them during their daily activities.

An Ecological Model of Risk Factors in Older Adults With Repeated Exposure to Elder Mistreatment

Limited empirical studies examined the factors related to repeated EM exposures among Chinese older immigrants. Guided by the ecological model, this study aims to explore what are the risk factors leading to recurrence of EM. Data were drawn from the two-wave PINE Study with 725 participants having EM at baseline and 191 reported repeated EM after two years. EM was evaluated by a 66-item instrument, including psychological, physical, and sexual mistreatment, financial exploitation, and caregiver neglect. Logistic regression was used. Increasing financial independence was associated with lower possibility of repeated EM (OR: 0.72, 95%CI 0.56-0.92). Every one unit increase in ADL impairment (OR: 1.10, 95%CI 1.02-1.18), IADL impairment (OR: 1.09, 95%CI 1.05-1.13) and increase frequency of alcohol consumption (OR: 1.33, 95%CI 1.06-1.66) were associated with higher possibility of repeated EM. Social service could improve physical function, provide financial support, and reduce health-risk behavior to prevent the recurrence of EM.

Sexual violence in older adults: a Belgian prevalence study

BackgroundSexual violence (SV) is an important public health problem which may cause long-lasting health problems. SV in older adults remains neglected in research, policies and practices. Valid SV prevalence estimates and associated risk factors in older adults are currently unavailable. In this study we measured lifetime and past 12-months sexual victimisation in older adults living in Belgium, its correlates, assailant characteristics and the way that victims framed their SV experiences.MethodsSV was measured using behaviourally specific questions based on a broad definition of SV. Participants were selected via a cluster random probability sampling with a random route finding approach. Information on sexual victimisation, correlates, assailant characteristics and framing was collected via structured face-to-face interviews with adults aged 70 years and older living in Belgium (community-dwelling, assisted living and nursing homes).ResultsAmong the 513 participants, the lifetime SV prevalence was 44% (55% F, 29% M). Past 12-months prevalence was 8% (9% F, 8% M). Female sex and a higher number of sexual partners were associated with lifetime SV (p < .05), non-heterosexual sexual orientation with past 12-months SV (p < .05). Correlates identified to be linked to elder abuse and neglect in previous studies were not linked with SV in our sample. ‘Someone unknown’ was identified as most common assailant.ConclusionsSexual victimisation appears to be common in older adults in Belgium. Both correlates and assailant characteristics seem to differ from previous studies on elder abuse and neglect. Recognizing older adults as a risk group for sexual victimisation in research, policies and practices is of the utmost importance.

Associations between empirically derived dietary patterns and cardiovascular risk factors among older adult men.

Cardiovascular disease (CVD) remains the leading cause of death globally, and epidemiological studies have suggested a link between diet and cardiometabolic risk. Currently, the prevalence of CVD is rapidly increasing with an aging population and continues to contribute to the growing economic and public health burden. However, there is limited evidence available regarding dietary patterns and cardiometabolic risk factors in older adults. We conducted a cross-sectional study to assess dietary patterns and cardiometabolic risk factors in males ≥60 years. Factor analysis identified a "healthy" diet and an "unhealthy" diet as the two primary dietary patterns. Multivariable logistic regression was used for estimating the associations of identified dietary patterns and cardiometabolic risk factors including anthropometric measures, blood pressure, glycemic biomarkers, lipid profile, and inflammatory biomarkers. A healthy dietary pattern was significantly associated with decreased odds of high serum fasting blood sugar (FBS) (OR: 0.32; 95% CI: 0.15-0.67; Ptrend=0.002), but increased odds of high serum low-density lipoprotein cholesterol (LDL-C) (OR: 1.82; 95% CI: 1.02-3.24; Ptrend=0.04). In comparison, an unhealthy diet was associated with increased odds of obesity (OR: 2.33; 95% CI: 1.31-4.15; Ptrend=0.004) and high LDL-C (OR: 2.00; 95% CI: 1.10-2.61; Ptrend=0.02). Thus, in older adults, adherence to an unhealthy dietary pattern has a significant impact on clinically relevant risk factors for cardiometabolic risk.

The Role of Social Connection/Engagement in Episodic Memory Change in Stroke.

Positive associations between social connection/engagement and cognitive function are well documented. However, little is known about whether social connection/engagement can buffer the impact of serious brain injury such as stroke on cognitive functioning. Participants were 898 individuals with incident stroke from the Health and Retirement Study between 1998 and 2012. Multilevel modeling was used to examine how social connection/engagement was associated with episodic memory pre- and poststroke. Models controlled for age, gender, education, race/ethnicity, number of health conditions, and functional health. Participants who were lonely prestroke recalled significantly fewer words at the time of stroke, and participants who had children residing within 10 miles prestroke showed significantly less decline in word recall over time. Participants who provided help to others prestroke showed less stroke-related decline in word recall. Within-person increase in partnered status, having friends, and helping others were related to better word recall in the poststroke period. Higher prestroke levels of social connection/engagement predicted better episodic memory at stroke, a smaller decline in episodic memory with stroke, and less decline in episodic memory over time. Increases in social connection/engagement from pre- to poststroke also predicted better poststroke episodic memory. Beyond the widely documented benefits of social connection/engagement to well-being, they may also increase cognitive stimulation and cognitive reserve and thus contribute to stroke recovery in the cognitive domain. Social connection/engagement is an important and modifiable risk factor in older adults.

Decreasing Older Adult COVID-19 Risk Factors Using Digital Technology to Implement a Plant-Based-Diet: An Opinion Paper.

A disproportionate number of COVID-19 cases affect older, minority populations. Obese older adults are at higher risk of developing severe COVID-19 complications and lower survival rates, and minority older adults often experience higher rates of obesity. A plant-based diet intervention may improve COVID-19-related modifiable risk factors for obesity. Encouraging the consumption of plant-based diets comprising vegetables, fruits, whole grains, legumes, seeds, and nuts by utilizing community outreach strategies and digital technology can contribute to improving COVID-19 risk factors among this population.

Sex Differences in Subsequent Falls and Falls Risk: A Prospective Cohort Study in Older Adults

Background: Sex differences for subsequent falls and falls risk factors in community-dwelling older adults who have fallen are unknown. Our aim was to: (1) compare the number of falls between sexes, (2) identify modifiable falls risk factors, and (3) explore the interaction of sex on falls risk factors in older adults who fall. Methods: Four hundred sixty-two community dwellers seeking medical attention after an index fall were recruited from the Vancouver Falls Prevention Clinic and participated in this 12-month prospective cohort study. Ninety-six participants were part of a randomized controlled trial of exercise. Falls were tracked with monthly falls calendars. Demographics, falls risk measures, and the number of subsequent falls were compared between sexes. A principal component analysis (PCA) was employed to reduce the falls risk measures to a smaller set of factors. The PCA factors were used in negative binomial regression models to predict the number of subsequent falls. Age, exposure time (i.e., number of falls monitoring days), and prescribed exercise (yes/no) were used as covariates, and sex (male/female) and PCA factors were used as main effects. The interaction of sex by PCA factor was then included. Results: Males fell more over 12 months (males: 2.80 ± 6.86 falls; females: 1.25 ± 2.63 falls) than females, and poorer executive function predicted falls in males. Four PCA factors were defined – impaired cognition and mobility, low mood and self-efficacy, mobility resilience, and perceived poor health – each predicted the number of falls. The sex by mobility resilience interaction suggested that mobility resilience was less protective of falls in males. Conclusion: Modifiable risk factors related to cognition, physical function, psychological wellbeing, and health status predicted subsequent falls. In males, better mobility was not as protective of falls compared with females. This may be due to males’ poorer executive function, contributing to decreased judgement or slowed decision-making during mobility. These results may inform efficacious sex-specific falls prevention strategies.

Medication-related hospital readmissions within 30 days of discharge-A retrospective study of risk factors in older adults.

Previous studies have shown that approximately 20% of hospital readmissions can be medication-related and 70% of these readmissions are possibly preventable. This retrospective medical records study aimed to find risk factors associated with medication-related readmissions to hospital within 30 days of discharge in older adults (≥65 years). 30-day readmissions (n = 360) were assessed as being either possibly or unlikely medication-related after which selected variables were used to individually compare the two groups to a comparison group (n = 360). The aim was to find individual risk factors of possibly medication-related readmissions focusing on living arrangements, polypharmacy, potentially inappropriate medication therapy, and changes made to medication regimens at initial discharge. A total of 143 of the 360 readmissions (40%) were assessed as being possibly medication-related. Charlson Comorbidity Index (OR 1.15, 95%CI 1.5-1.25), excessive polypharmacy (OR 1.74, 95%CI 1.07-2.81), having adjustments made to medication dosages at initial discharge (OR 1.63, 95%CI 1.03-2.58) and living in your own home, alone, were variables identified as risk factors of such readmissions. Living in your own home, alone, increased the odds of a possibly medication-related readmission 1.69 times compared to living in your own home with someone (p-value 0.025) and 2.22 times compared to living in a nursing home (p-value 0.037). Possibly medication-related readmissions within 30 days of discharge, in patients 65 years and older, are common. The odds of such readmissions increase in comorbid, highly medicated patients living in their own home, alone, and if having medication dosages adjusted at initial discharge. These results indicate that care planning before discharge and the provision of help with, for example, managing medications after discharge, are factors especially important if aiming to reduce the amount of medication-related readmissions among this population. Further research is needed to confirm this hypothesis.

Impact of Urinary Incontinence on Quality of Life Among Older Adults Living in a Rural Area of Turkey.

The current study aimed to identify the frequency of urinary incontinence (UI), its effects on quality of life, and risk factors in older adults living in rural areas of Turkey. For this descriptive study, 400 older adults aged 65 to 96 years were interviewed. Data were collected using a sociodemographic form and the Incontinence-Quality of Life Scale (I-QOL). Among those interviewed, 56.3% experienced UI. Logistical regression analysis revealed chronic illness, gender, and level of education as risk factors for UI. Significantly lower (p < 0.05) I-QOL scores were found for older adults having UI, holding urine, leaking urine while coughing/sneezing, involuntarily urinating more than once per day, or wetting themselves. Most participants did not seek help, citing embarrassment or viewing UI as normal. UI significantly reduces older adults' quality of life. Educational and consultation services, especially for older, illiterate, married women with chronic illness, would help these individuals sustain healthy lives. [Journal of Gerontological Nursing, 47(6), 43-52.].

Potentially Inappropriate Medication and Associated Factors Among Older Patients with Chronic Coronary Syndrome at Hospital Discharge in Beijing, China.

PurposeMedication therapy is crucial in the management of chronic coronary syndrome (CCS). The use of potentially inappropriate medications (PIMs) contributes to poor outcomes in older patients, making it a major public health concern. However, few studies are available on PIMs use in older Chinese CCS patients. To investigate the frequency of prescribed PIMs at discharge and explore risk factors in older adults with CCS.Patients and MethodsThe cross-sectional study was conducted in a tertiary hospital in China over three months, from 1st October to 31st December, 2019. CCS patients aged over 60 years who were discharged alive were recruited. Information on demographics and medications at discharge was collected. Clinical data including diagnoses, frailty status, New York Heart Association (NYHA) class and age-adjusted Charlson Comorbidity Index (ACCI) were evaluated in each patient. PIMs were identified using the 2019 Beers criteria. Binary logistic regression was performed to recognize variables related to PIMs.ResultsA total of 447 eligible patients with 2947 medications were included. The prevalence of PIMs use was 38%. Medications to be avoided, to be used with caution, and with drug–drug interactions were 38.4%, 48.9% and 12.7% of the PIMs, respectively. Medications with drug–disease/syndrome interactions and those adjusted for kidney function were not identified. The common PIMs were diuretics (37.1%), benzodiazepines and benzodiazepine receptor agonist hypnotics (15.2%), glimepiride (13.1%), and co-prescription of potassium-sparing diuretics and renin-angiotensin system (RAS) inhibitors (9.7%). Individuals with frailty syndrome, polypharmacy, multiple comorbidities, atrial fibrillation, psychiatric disorders and greater NYHA class severity were more likely to receive PIMs.ConclusionPrescription of PIMs was a common burden in older adults. A CCS multidisciplinary team is needed to control PIMs, especially in vulnerable older patients.

The GET FIT trial (NCT01635413): A randomized controlled trial of strength training versus Tai Ji Quan for fall prevention among female cancer survivors.

12059 Background: Women with cancer are significantly more likely to fall than women without cancer but there are not yet any evidence-based fall prevention strategies that specifically target cancer survivors. The GET FIT trial compares the efficacy of two distinct types of exercise, strength training vs. tai ji quan, to prevent falls in women finished with chemotherapy. Methods: We conducted a 3 group, single-blind, parallel design, randomized controlled trial in older, inactive women cancer survivors treated with chemotherapy. Women were randomly assigned to 1 of 3 intervention groups: 1) strength training, 2) tai ji quan or 3) a placebo control group (stretching) that trained 2x/week for 6 months. Additional follow-up occurred 6 months after formal training stopped. The primary outcome was fall rate across 6-and 12 months; secondary outcomes, reflective of training fidelity, were maximal leg strength (by 1-repetition maximum) and dynamic postural control (by computerized dynamic posturography), collected at 0, 3, and 6 months. Results: 442 women (mean age 62.4 + 6.3 yrs.) were enrolled and randomly assigned to study groups. Over the 6 months prior to enrollment, 21% of the sample (n = 94) reported at least one fall (of which, 37% (n = 35) reported two or more falls)), and 12% (n = 51) reported at least one injurious fall. Retention across the 12 months study period was 88%, while adherence to the study interventions over 6 months averaged 73%, 71%, and 74% for the strength, tai ji quan and stretching (control) groups, respectively. 26% of the sample (n = 99 of 382) reported at least one fall during the intervention and 27% (n = 102) reported falls during follow up. Using regression models, there were no significant differences in the odds of having at least one fall during the intervention period (1-6 months) or across the entire follow-up period (1-12 months) between the control and either the strength or tai ji quan groups. At 6 months, the strength group showed a greater increase from baseline in maximal leg strength (+14.3 kg, 95% CI: 11.4-17.1) than the control group (+7.5 kg, 95% CI: 4.6-10.4, p = 0.002). Whereas, the tai ji quan group showed a greater increase in dynamic postural control (+2.42%, 95% CI: 1.36-3.48) compared to the control group (+0.35%, 95% CI: -0.69-1.38, p = 0.007). Conclusions: Despite evidence for fidelity of strength and tai ji quan training to improve muscle strength and postural control, respectively, neither program significantly lowered fall rates over a placebo control group. It is possible that the dose of exercise was too low and/or the sample was not at high risk of falls. The etiology of fall risk in women cancer survivors needs to be better understood as it may differ from risk factors in older adults. Future trials should consider patient-centered, tailored fall-prevention interventions for cancer survivors based on identified fall risk factors. Clinical trial information: NCT01635413.

Diet Quality Indexes, Arterial Stiffness and Endothelial Function in Healthy Young Adults

Cardiovascular disease (CVD) is the number one cause of death globally. High quality dietary patterns such as the DASH diet and the Mediterranean diet are shown to be effective at improving endothelial function and other vascular risk factors in older adults and those with comorbid conditions. To our knowledge, no study has examined the relation between overall diet quality and vascular function in healthy young adults, which could have implications for preventing CVD onset. We aimed to test the hypothesis that lower diet quality, assessed by diet index scores, would be associated with greater arterial stiffness and poorer endothelial function in healthy, non-hypertensive young adults. Seventeen men and 28 women ages 27.0±0.9 y with normal blood pressure (systolic BP: 112±2 mmHg; diastolic BP: 70±1 mmHg), non-obese body mass index (BMI) (23.4±0.4 kg/m2) and no diagnosed chronic disease completed this cross-sectional study. Two DASH diet scores, the alternative Mediterranean diet score (aMED), and the Healthy Eating Index-2015 (HEI-2015) were calculated from 3-day diet records analyzed with NDSR software. Augmentation index (AIx) and carotid-femoral pulse wave velocity (PWV) were measured using the SphygmoCor XCEL system. Brachial artery flow mediated dilation (FMD) was assessed using ultrasound. Separate multiple linear regression analyses with appropriate physiological variables included in the models (for AIx: height, heart rate, age, and sex; for PWV: mean arterial pressure, BMI, age, and sex; for FMD: age and sex) were used to assess the relation between the dietary indexes and vascular outcomes. Average Mellen DASH score was 2.6±0.2 (out of 9), Fung DASH score was 24.1±0.8 (out of 40), aMED score was 3.9±0.3 (out of 9), and HEI-2015 was 60.8±1.9 (out of 100). Average AIx was 6.4±1.7%, average PWV was 5.5±0.1 m/s, and average FMD was 7.9±2.7%. The Mellen DASH score, the aMED score, and the HEI-2015 were inversely associated with AIx, though the associations did not reach statistical significance (B=-1.416, 95% CI: -3.415, 0.583, p=0.16; B=-1.223, 95% CI: -2.833, 0.388, p=0.133; and B=-0.159, 95% CI: -0.386, 0.069, p=0.167, respectively). No other associations between diet index scores and AIx, PWV, or FMD approached statistical significance. Our results suggest that overall diet quality, as assessed using dietary indexes, is not associated with arterial stiffness or endothelial function in healthy young adults. Notably, however, there was room for improvement in our participants’ diet index scores. Intervention studies are warranted to determine how improving diet quality may affect these vascular outcomes in this population.

Psychological and metabolic risk factors in older adults with a previous history of eating disorder: A cross-sectional study from the Predimed-Plus study.

To explore affective and cognitive status, later in life, in individuals with and without previous history of eating disorder (ED), and also its association with higher risk for metabolic syndrome (MetS) symptomatology. A cross-sectional analysis of 6756 adults, aged 55-75 years with overweight/obesity and MetS participating in the Predimed-Plus study was conducted. Participants completed self-reported questionnaires to examine lifetime history of ED, according to DSM-5 criteria, and other psychopathological and neurocognitive factors. Anthropometric and metabolic measurements were also collected. Of the whole sample, 24 individuals (0.35%) reported a previous history of ED. In this subsample, there were more women and singles compared to their counterparts, but they also presented higher levels of depressive symptoms and higher cognitive impairment, but also higher body mass index (BMI) and severe obesity, than those without lifetime ED. This is one of the first studies to analyse the cognitive and metabolic impact of a previous history of ED. The results showed that previous ED was associated with greater affective and cognitive impairment, but also with higher BMI, later in life. No other MetS risk factors were found, after controlling for relevant variables.

Effects of Controlled Whole-Body Vibration Training on Functional Performance Among Healthy Older Adults: A 6-Week Pilot Study.

Falling is the second leading cause of injury-related death worldwide and is a leading cause of injury among older adults. Whole-body vibration has been used to improve fall risk factors in older adults. No study has assessed if vibration benefits can be retained over time. The aims of this study were to examine if six-weeks of whole-body vibration could improve fall risk factors and to assess if benefits associated with the training program could be sustained two months following the final training session. Repeated measures randomized controlled design. Twenty-four independent living older adults were recruited and were randomly assigned to the WBV or control group. Participants performed three sessions of whole-body vibration training per week with a vibration frequency of 20Hz or with only an audio recording of the vibration noise. An assessment of fall risk factors was performed prior to, immediately following, and two-months after the completion of the training program. Fall risk factors including functional capacity, mobility, strength, and walking speed were assessed pre-training, post-training, and two-months post-training. Seventeen participants completed the study. No improvements (p<0.05) between groups were found in the measures of physical performance. Findings revealed that six weeks of whole-body vibration is not effective in improving fall risk factors or producing benefits post-training.

Effects of Household Size and Partner Status on Financial Well-Being and Financial Exploitation

Social isolation and loneliness are significant risk factors for older adults (adults over the age of 50) for a multitude of reasons. This study explored the connections between social isolation, vulnerability to financial exploitation, and financial wellbeing in a sample of older adults. Using the concept of precarity as a guiding framework, this study assessed behaviors that expose individuals to financial exploitation as well as indicators of financial wellbeing in individuals with varying degrees of social isolation. One-hundred-eight community-dwelling older adults completed a pen-and-paper survey containing measures of risk to financial exploitation and financial wellbeing. Participants were predominantly female (75.9%), White (90.7%), and highly educated. Fifty-eight participants were unpartnered (53.7%) and 67 participants (62%) lived with at least one other person. Chi-square analyses resulted in a significant association between partner status and being a victim of financial exploitation (χ2(1) = 10.842, p≤.001). Furthermore, there was an association between social isolation and engaging in certain behaviors that put someone at risk for financial exploitation (such as reading junk mail). As for measures of financial wellbeing, partner status was significantly associated with feelings of financial freedom (χ2(3) =8.608, p =.035). These findings indicate that socially isolated individuals may be at greater risk of financial exploitation and have lower levels of financial wellbeing, such as feeling unprepared for retirement (χ2(2) =7.358, p =.025). The results of this study highlight the risks involved with social isolation and indicate further research is needed into ways to mitigate these negative effects.

Emotional Salience and Interpersonal Problems in Depressed Older Adults With Personality Pathology

Research demonstrates reciprocal relationships between personality and depression as well as the important role interpersonal conflicts play, but rarely explores these risk factors in older adults. This study aimed to examine relationships of personality traits, processes, and the impact of emotional involvement and distress during an interpersonal conflict on depression in older adults. The study also investigated whether emotional involvement or interpersonal distress moderate the relationship between personality pathology and depression. Depressed middle and older adult inpatients (N=37; mean age=65.73, SD=7.81; 56.8% female; 86.5% White/Non-Hispanic) completed self-reports and interview-based assessments regarding personality traits (NEO-FFI Neuroticism, Agreeableness), interpersonal problems (IIP-25), and depression (GDS). Narrative responses regarding an interpersonal conflict were obtained and rated for contamination themes as well as emotional involvement and distress. Overall, findings indicated that living with others predicted higher depression (p= .046) and was related to higher neuroticism and interpersonal problems. Personality traits (Neuroticism) (r= .485, p= .001) and processes (Interpersonal problems-trend) (β= .307, p= .058), as well as higher levels of emotional distress (r= .486, p= .001) and involvement (r= .475, p= .001) in an interpersonal conflict were also tied to depression in bivariate but not multivariate analyses. The moderating effects of emotional involvement or distress on the relationship between personality and depression were not supported. Depressed older inpatients who live with others appear at higher risk of depression. Personality traits and processes may be more distal risk factors for depression. Findings are discussed in relation to stress generation as well as clinical implications targeting emotional regulation.

Special Report from the CDC Antidepressant subclass use and fall risk in community-dwelling older Americans

Introduction: Falls among older adults are a significant health concern affecting more than a quarter of older adults (age 65+). Certain fall risk factors, such as medication use, increase fall risk among older adults (age 65+). Aim: The aim of this study is to examine the association between antidepressant-medication subclass use and self-reported falls in community-dwelling older adults. Methods: This analysis used the 2009–2013 Medicare Current Beneficiary Survey, a nationally representative panel survey. A total of 8,742 community-dwelling older adults, representing 40,639,884 older Medicare beneficiaries, were included. We compared self-reported falls and psychoactive medication use, including antidepressant subclasses. These data are controlled for demographic, functional, and health characteristics associated with increased fall risk. Descriptive analyses and multivariate logistic regression analyses were conducted using SAS 9.4 and Stata 15 software. Results: The most commonly used antidepressant subclass were selective serotonin reuptake inhibitors (SSRI) antidepressants (13.1%). After controlling for characteristics associated with increased fall risk (including depression and concurrent psychoactive medication use), the risk of falling among older adults increased by approximately 30% among those who used a SSRI or a serotonin-norepinephrine reuptake inhibitors (SNRI) compared to non-users. The adjusted risk ratio (aRR) for SSRI was 1.29 (95% CI = 1.13, 1.47) and for SNRI was 1.32 (95% CI = 1.07, 1.62). Conclusion: SSRI and SNRI are associated with increased risk of falling after adjusting for important confounders. Medication use is a modifiable fall risk factor in older adults and can be targeted to reduce risk of falls. Practical Applications: Use of selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors increased the risk of falling in older adults by approximately 30%, even after controlling for demographic, functional, and health characteristics, including depression. Health care providers can work towards reducing fall risk among their older patients by minimizing the use of certain medications when potential risks outweigh the benefits.