Sample Of Community-dwelling Older Adults Research Articles

Computerized assessment of executive functioning: Validation of the CNS Vital Signs executive functioning scores in a sample of community-dwelling older adults

Objective: Computerized assessment of cognitive functioning has gained significant popularity over recent years, yet options for clinical assessment of executive functioning (EF) are lacking. One computerized testing platform, CNS Vital Signs (CNS-VS), offers tests designed to measure EF but requires further validation. The goal of the present study was to validate CNS-VS executive scores against standard clinical measures of EF. We also sought to determine whether a modified CNS-VS composite score that included variables purported to measure inhibition, switching, and working memory would outperform the currently available CNS-VS Executive Function Index. Method: A sample of 73 cognitively healthy older adults completed four tests from the Delis-Kaplan Executive Function System, the Digit Span subtest from the Wechsler Adult Intelligence Scale-fourth edition, and three CNS-VS tasks purported to measure inhibition, switching, and working memory. Results: Performances on the CNS-VS tests were predicted by performances on standard paper-and-pencil measures. Although the currently available CNS-VS Executive Function Index predicted unique variance in a well-validated paper-and-pencil EF composite score, our Modified CNS-VS EF composite accounted for unique variance above and beyond the original CNS-VS Executive Function Index, while the reverse was not true. Conclusions: The present results support the construct validity of CNS-VS EF tests but also suggest that modifications to their current composite scores would improve the prediction of EF performance.

Factors Associated With Negative Life Changes due to COVID-19 Among Older Adults Residing in an Urban Low-Income Neighborhood in Korea: Focused on Gendered Differences.

This study examined negative life changes due to coronavirus disease of 2019 (COVID-19) and its correlates in a sample of community-dwelling older adults from a low-income urban city in Korea, focusing on gendered differences. Negative life changes due to COVID-19 were categorized into four domains: behavioral/physical, psychosocial, goal-seeking, and control/freedom. Being female, not receiving basic livelihood security, and dissatisfaction with housing situation were significantly associated with negative life changes during the pandemic. Gender-stratified analyses revealed that most within-gender social disparities associated with changes due to COVID-19 occurred in older women. The odds of experiencing negative changes were higher among working women and those receiving security income aid. In low-income urban communities, those who were previously socially and economically active perceived more negative changes owing to the pandemic. The contribution of gender to negative life changes should be considered to effectively alleviate concerns among older adults during pandemics.

Health literacy in older adults: The newest vital sign and its relation to cognition and healthy lifestyle behaviors

Health literacy tends to decrease with age, and lower health literacy has been associated with lower levels of physical function, mental health, and medication adherence. The present study examined health literacy in relation to cognition in a sample of community-dwelling older adults. The study also examined the impact of health literacy on engagement in healthy aging lifestyle behaviors. Participants included 128 older adults (age: M = 72.07, SD = 6.71; education: M = 16.34, SD = 2.56; 74% female) who completed a health literacy measure (Newest Vital Sign; NVS), a lifestyle behavior questionnaire (Healthy Aging Activity Engagement scale; HAAE), and several neuropsychological tests. The cognitive domains assessed included memory, executive function, and attention/working memory. Two variables were computed from the NVS to represent the health literacy factors of document and numeracy literacy; these factors demonstrated a small correlation (r = .18). Results revealed that attention/working memory, executive function, and memory were all significantly related to numeracy literacy and overall health literacy. Only memory was significantly related to document literacy. After accounting for age, education, and cognition, a hierarchical regression revealed that health literacy significantly predicted engagement in healthy aging lifestyle behaviors. Multiple cognitive abilities are necessary for searching, finding, and processing information to make health-related decisions. Health literacy accounted for a significant amount of variance in older adults’ engagement in everyday lifestyle behaviors. Health literacy skills may be an area of focus for intervention efforts to improve brain health in older adults.

Abstract P531: Contralateral Differences in Ankle Systolic Blood Pressure and Pulse Wave Velocity: Associations With Incident Heart Failure and Mortality

Introduction: Contralateral differences in systolic blood pressure (SBP) are a risk assessment tool and indicative of underlying cardiovascular issues. Most of the available studies focused on brachial blood pressure and its clinical impact. This study evaluated whether interankle SBP differences and contralateral differences in pulse wave velocity (PWV) are associated with incident heart failure (HF) and all-cause and cardiovascular mortality in a community-dwelling sample of older adults. Methods: Sample included 5,077 participants (75.2 ± 5.1 years old) of the Atherosclerosis Risk in Communities (ARIC) study. The OMRON VP-1000 plus was used to measure PWV and blood pressure in the ankles. PWV was assessed between the brachial artery and ankle (baPWV) and heart and ankle (haPWV) on the right and left sides. Cut points for contralateral differences in PWV were set at the 90th percentile in our sample. Outcomes included incident HF (first definite or probable hospitalization for acute decompensated HF), all-cause and cardiovascular mortality (until December 31, 2020). Cox proportional hazards regression models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI). Results: Over a mean follow-up of 7.5 ± 2.1 years, incident HF was diagnosed in 457 participants, and 1,275 all-cause and 363 cardiovascular deaths occurred. The prevalence of interankle SBP difference ≥10 and ≥15 mmHg was 24.9% (1,268) and 12.0% (605), respectively. The prevalence of contralateral differences in baPWV (>240 cm/s) and haPWV (>80 cm/s) was 10.1% (513) and 9.1% (464), respectively. Interankle SBP difference ≥10 mmHg (HR 1.13; 95% CI 1.00-1.29), ≥15 mmHg (HR 1.25; 95% CI 1.06-1.48), contralateral difference in baPWV >240 cm/s (HR 1.18; 95% CI 1.00-1.41), and haPWV >80 cm/s (HR 1.21; 95% CI 1.01-1.44) were each independently associated with all-cause mortality after adjustment for demographics, traditional cardiovascular risk factors, and extreme values of ankle-brachial index ≤0.9 or >1.40. Contralateral differences in ankle SBP ≥15 mmHg (HR 1.55; 95% CI 1.16-2.06), and haPWV >80 cm/s (HR 1.40; 95% CI 1.02-1.91) were both independently associated with cardiovascular mortality. Crude analysis revealed that those with contralateral differences in ankle SBP ≥10 and ≥15 mmHg, baPWV >240 cm/s, and haPWV >80 cm/s had a significantly higher risk of HF (p<0.05 for all). However, these HF relationships were no longer statistically significant after adjustment for confounders. Conclusions: Contralateral differences in ankle SBP and PWV were independently associated with all-cause and cardiovascular mortality risk even after accounting for traditional cardiovascular risk factors and the ankle-brachial index. These results underscore the significance of evaluating contralateral differences in ankle SBP and PWV as potential markers of increased mortality risk among older adults.

PLASMA NEUROFILAMENT LIGHT CHAIN IS ASSOCIATED WITH PHYSICAL FRAILTY IN OLDER ADULTS WITHOUT DEMENTIA

Abstract Evidence suggests a link between brain biomarkers of neurodegeneration and physical function and frailty. However, the association of neurodegenerative biomarkers in the plasma with physical frailty in older adults remains unelucidated, as current evidence is limited and inconsistent. We tested the association between plasma neurofilament light chain (NFL), a plasma neurodegeneration biomarker, and physical frailty in a sample of community-dwelling older adults. We used baseline demographics, frailty, and plasma NFL data collected from 97 participants in a randomized controlled trial in community-dwelling, sedentary older adults without dementia [Montreal Cognitive Assessment (MoCA)>17]. Physical frailty was assessed using a composite measure of weakness, slow walking speed, unintentional weight loss, exhaustion, and low physical activity. Participants’ frailty levels were categorized into robustness, pre-intermediate frailty, and frailty. Multiple linear regression and ordinal logistic regression models adjusting for age, sex, race, education, and comorbidities were conducted to test the associations of NFL with frailty and levels of frailty. The sample was 70.0 ± 6.0 years old, with 80% being females, 72% having intact cognition, and 28% having mild cognitive impairment (MCI). In the adjusted models, higher plasma NFL was associated with higher frailty scores (β=0.16, 95%CI [Confidence Interval] = [0.06,0.26]) and a higher likelihood of being in a higher level of frailty group (odds ratio=1.28, 95% CI =1.02, 1.61). In summary, plasma NFL was associated with greater frailty in our sample of non-demented older adults. Plasma NFL may be a sensitive and promising neurodegenerative biomarker for physical frailty in older adults without dementia.

ASSOCIATIONS BETWEEN COGNITIVE CHANGE AND OBJECTIVE CHANGE IN PHYSICAL ACTIVITY AMONG OLDER ADULTS: THE LIFE STUDY

Abstract Objective To investigate the associations between domain-specific cognitive change and objectively measured change in physical activity in a sample of community-dwelling older adults. We hypothesized that domain-specific changes in cognition are associated with longitudinal changes in physical activity levels. Methods We used data from 955 participants from The LIFE Study, a multi-center randomized clinical trial. Longitudinal relationships between cognitive domains (i.e., memory, attention, processing speed, executive function) and accelerometer-measured change in daily minutes of physical activity were examined using multivariable linear regression. Cognitive tests included Modified Mini-Mental State Examination (3MSE), Hopkins Verbal Learning Test (HVLT), Digital Symbol Substitution Test (DSST), Task Switching Test, Eriksen Flanker Test and N-Back Test. Physical activity was measured longitudinally using an accelerometer and was categorized to total, light, and moderate to vigorous according to standardized activity count cut points. Results Our results showed an association between cognitive change in the processing speed domain and change in minutes of total (β = 0.47; 95% CI: 0.04, 0.89; p = 0.034) and light (β = 0.42; 95%CI: 0.03, 0.80; p= 0.033) physical activity. Relationships between all other cognitive assessments and physical activity categories were not statistically significant. Conclusions This study demonstrates an association between a decline in processing speed and a decline in the duration of total and light daily physical activity in older adults with low to moderate physical function.

SOCIAL ISOLATION AND HOSPITALIZATION IN A NATIONAL SAMPLE OF COMMUNITY-DWELLING OLDER ADULTS BY DEMENTIA STATUS

Abstract Social isolation poses risks for poor health, yet its impact on hospitalization for persons with dementia is unknown. Dementia may result in reduced social contact that increases the risk of hospitalization. This observational cohort study examined longitudinal associations between social isolation and hospitalization among a nationally-representative sample of community-dwelling older adults with and without dementia. Using the National Health and Aging Trends Study, we conducted multivariable analyses for 5,533 Medicare beneficiaries. Social isolation was measured using a multi-domain 4-item typology. Logistic regression tested associations between social isolation in 2015 and self-reported hospitalization over the next twelve months, stratifying by dementia status. Covariates included sociodemographics and health characteristics. About 21.5% of older adults were socially isolated, with a much higher proportion of social isolation among those with dementia (38.0%) versus without (20.7%) (p < .001). Overall, the odds of hospitalization were not significantly associated with social isolation (OR 1.13; p = .184). While there was no association between social isolation and hospitalization among those without dementia (OR 1.09; p = .394), social isolation was significantly associated with hospitalization among older adults with dementia (OR 2.07; p = .001). Among older adults with dementia, social isolation increased the predicted probability of hospitalization by about 14.1% over one year (p = 0.030). In this population-based study, social isolation was common among community-dwelling older adults with dementia and significantly associated with increased odds of hospitalization over twelve months. Efforts to reduce hospitalization should explore ways to bolster social relationships for older adults with dementia.

Association Between Trajectory of Socioeconomic Position and Regional Brain Volumes Related to Dementia: Results From the NEIGE Study.

Low socioeconomic position (SEP) has been linked to an increased risk of dementia. However, little is known about the association between SEP trajectory and regional brain volumes related to dementia. A random sample of community-dwelling older adults (n = 428, age = 73.1±5.5) living in Tokamachi City (Niigata Prefecture, Japan) without medical histories of dementia, Parkinson's disease, and depression who underwent automated assessment of brain volumes on magnetic resonance imaging and responded to a self-administered questionnaire survey in 2017. We measured SEP in childhood (household SEP at age 15), young adulthood (education), mid-adulthood (the longest occupation), and late adulthood (current wealth), and further performed group-based trajectory analysis to identify lifetime trajectory patterns on SEP. Multivariate regression models were employed to investigate the association between SEP trajectories and 4 regional brain volumes related to the development of Alzheimer's disease (ie, entorhinal cortex, hippocampus, amygdala, and the parahippocampus), the most common type of dementia. We found 3 distinct SEP trajectories (stable middle class [68%], downward [23%], and upward [9%]). Compared to those who experienced stable middle class, older adults who experienced the upward SEP mobility had significantly larger hippocampus (β: 213.2, 95% confidence interval: 14.7, 411.8). On the other hand, older adults who experienced downward SEP mobility showed no significant differences in any of the 4 brain structural volumes. Our findings indicate that upward life-course SEP mobility is associated with larger volumes of hippocampus in old age. SEP trajectory may offer us a useful lens to enhance our understanding of the etiology of dementia.

Relationship between chronic pain, depressive symptoms, and functional disability in community-dwelling older adults: mediating role of frailty.

Borim et al. showed that older adults with chronic pain exhibited more depressive symptoms and frailty components. Depressive symptoms were associated with more frailty components, and those with more depressive symptoms and frailty faced greater limitations in IADL performance. Frailty appears to mediate the pathway from chronic pain to functional impairment Chronic pain is directly associated with depressive symptoms and frailty. Chronic pain is not directly associated with functional disability. Depression and frailty are both directly associated with functional disabilities. Frailty mediates the association between chronic pain and functional disability. Depression; Disability evaluation; Frailty; Frail elderly. To evaluate the direct and indirect effects of chronic pain, depressive symptoms, frailty components, and functional disability through a pathway analysis approach in a sample of community-dwelling older adults. Data of 419 participants were cross-sectionally evaluated for the presence of depressive symptoms (Geriatric Depression Scale [15 items]), physical frailty components (phenotype criteria), chronic pain, and limitations in performing instrumental activities of daily living (functional disability scale by Lawton and Brody). Structural equation modeling via path analysis was used to explore the direct and indirect effects among these four variables. Statistical significance was set at p<0.05. Of the total participants, 69.8% were women and 59.3% had low education (1-4 years); the mean age was 80.3±4.6 years. Chronic pain and depressive symptoms were directly related and were associated to frailty. The number of frailty components and depressive symptoms were directly associated with functional disability. Frailty had an indirect effect on the association between chronic pain, depressive symptoms, and functional disabilities. The pathway from chronic pain and depressive symptoms to functional disability is potentially mediated by the number of frailty components.

Lower Adherence to a Mediterranean Diet Is Associated with High Adiposity in Community-Dwelling Older Adults: Results from the Longevity Check-Up (Lookup) 7+ Project

High adiposity impacts health and quality of life in old age, owing to its association with multimorbidity, decreased physical performance, and frailty. Whether a high adherence to a Mediterranean diet (Medi-Diet) is associated with reduced body adiposity in older adults is unclear. The present study was conducted to assess the prevalence of high adiposity in a large sample of community-dwelling older adults. We also explored the relationship between whole-body adiposity estimated through relative fat mass (RFM) and Medi-Diet adherence. Data were obtained from the Longevity Check-up 7+ (Lookup7+) project database. RFM was estimated from anthropometric and personal parameters using a validated equation. RFM was categorized as high if ≥40% in women and ≥30% in men. Information on diet was collected using a food frequency questionnaire, while Medi-Diet adherence was assessed through a modified version of the Medi-Lite scoring system. Analyses were conducted in 2092 participants (mean age 73.1 ± 5.9 years; 53.4% women). Mean RFM was 39.6 ± 5.14% in women and 29.0 ± 3.6% in men. High adiposity was found in 971 (46.4%) participants and was more frequent in those with a low (54.2%) or moderate (46.4%) Medi-Diet adherence compared with the high-adherence group (39.7%, p &lt; 0.001). Logistic regression indicated that older adults with high Medi-Diet adherence were less likely to have a high RFM. Other factors associated with a greater risk of having high adiposity were older age, female sex, and physical inactivity. Our findings support an association between healthy lifestyles, including a greater adherence to a Mediterranean-style diet, and lower body adiposity in older adults.

1 Social Support is Associated with Better Memory Performance among Hispanic/Latino, but not Non-Hispanic White Older Adults

Objective:Hispanic/Latino (H/L) older adults are at greater risk of developing Alzheimer’s disease and related dementias compared to non-Hispanic whites (NHW), and there is an urgent need to identify important factors that may help prevent and/or reduce age-related cognitive health disparities. Positive psychosocial factors, such as social support, may protect against cognitive impairment and decline. However, recent research has highlighted that the effect of social support on cognitive outcomes may differ across racial/ethnic groups. Given the emphasis placed on family relationships and support in H/L culture, the current study sought to clarify whether H/L ethnicity moderated the association between social support and cognitive functioning in a well-characterized sample of community-dwelling older adults residing in Texas.Participants and Methods:Participants included 766 NHW and 817 H/L (predominantly Mexican American) older adults (Mage = 66.25 ±8.64) without dementia enrolled in the Health and Aging Brain Study-Health Disparities. Participants completed study questionnaires and a comprehensive neuropsychological battery. Perceived social support was measured using the total sum score from the 12-item abbreviated version of the Interpersonal Support Evaluation List. Episodic memory performance was operationalized as the z-score composite of the immediate and delayed recall totals from the Spanish English Verbal Learning Test and the Weschler Memory Scale (WMS)-III Logical Memory 1 and 2. Executive functioning was operationalized as the z-score composite of scores from the WMS-III Digit Span, Verbal Fluency (FAS), and Trails B. Analyses of covariance were used to explore racial/ethnic group differences in self-reported levels of social support. Multiple linear regression models examined (1) ethnicity x social support interactions on cognition, and (2) ethnicity-stratified social support and cognition associations. Covariates included age, education, sex, yearly income, and depressive symptoms.Results:H/L older adults reported less perceived social support compared to NHWs (F = 41.16, p &lt; .001). There were no significant ethnicity x social support interactions on episodic memory (ß = 0.04, p = .53) or executive functioning (ß = 0.004, p = .95). However, stratified models revealed that more social support was associated with better memory performance in H/Ls (ß = 0.08, p = .01), but not in NHWs (ß = 0.0004, p = .99). No significant associations between social support and executive functioning were observed amongst H/Ls (ß = -0.01, p = .60) or NHWs (ß = 0.04, p = .29).Conclusions:Although H/Ls reported lower levels of social support relative to NHWs, we observed that social support was linked to better memory performance within the H/L group only. Results suggest that culturally tailored interventions which encourage strong interpersonal relationships and caring for family could enhance social support in H/Ls and thus help to prevent memory decline. Future work should focus on the development of assessment measures that better characterize unique cultural elements of social support within H/Ls, such as multigenerational households, and explore the direct effects of social support on brain metrics.

96 Short-Term Blood Pressure Variability and Cerebrovascular Health in OlderaAdults

Objective:Blood pressure variability (BPV), independent of traditionally targeted average blood pressure levels, is an emerging vascular risk factor for stroke, cerebrovascular disease, and dementia, possibly through links with vascular-endothelial injury. Recent evidence suggests visit-to-visit (e.g., over months, years) BPV is associated with cerebrovascular disease severity, but less is known about relationships with short-term (e.g., &lt; 24 hours) fluctuations in blood pressure. Additionally, it is unclear how BPV may be related to angiogenic growth factors that play a role in cerebral arterial health.Participants and Methods:We investigated relationships between short-term BPV, white matter hyperintensities on MRI, and levels of plasma vascular endothelial growth factor (VEGF) in a sample of community-dwelling older adults (n = 57, ages 55-88) without history of dementia or stroke. Blood pressure was collected continuously during a 5-minute resting period. BPV was calculated as variability independent of mean, a commonly used index of BPV uncorrelated with average blood pressure levels. Participants underwent T2-FLAIR MRI to determine severity of white matter lesion burden. Severity of lesions was classified as Fazekas scores (0-3). Participants also underwent venipuncture to determine levels of plasma VEGF. Ordinal logistic regression examined the association between BPV and Fazekas scores. Multiple linear regression explored relationships between BPV and VEGF. Models controlled for age, sex, and average blood pressure.Results:Elevated BPV was related to greater white matter lesion burden (i.e., Fazekas score) (systolic: OR = 1.17 [95% CI 1.01, 1.37]; p = .04; diastolic: OR = 2.47 [95% CI 1.09, 5.90]; p = .03) and increased levels of plasma VEGF (systolic: ß = .39 [95% CI .11, .67]; adjusted R2 = .16; p = .007; diastolic: ß = .48 [95% CI .18, .78]; adjusted R2 = .18; p = .003).Conclusions:Findings suggest short-term BPV may be related to cerebrovascular disease burden and angiogenic growth factors relevant to cerebral arterial health, independent of average blood pressure. Understanding the role of BPV in cerebrovascular disease and vascular-endothelial health may help elucidate the increased risk for stroke and dementia associated with elevated BPV.

Components of navigation ability and their predictors in a community-dwelling sample of older adults.

Introduction: Navigation, as a complex skill important for independent living, requires a variety of cognitive processes. Current scales tapping components are lengthy and can be burdensome for older adults. Methods: Community-dwelling older adults (n = 380, age 60-90years) completed an online survey tapping wayfinding, being lost navigating, and needing help navigating. Participants then completed objective measures of navigation ability and self-reported memory ability. Cronbach's α was calculated for navigation subscales consisting of subsets of the Wayfinding Questionnaire and Santa Barbara Sense of Direction Questionnaire, and an exploratory factor analysis (EFA) was conducted. Regression analyses were used to test whether objective navigation, memory, and demographic information navigation predicted navigation subscale performance. Results: Each of the individual subscales demonstrated high reliability. EFA generated five unique factors: routing, mental mapping, navigation in near vicinities, feeling lost in far vicinities, and needing help in far vicinities. Across regression analyses, memory, gender, and performance on the Spatial Orientation Test were significant predictors. Discussion: Navigation is a multi-faceted construct that can be reliably measured using concise surveys. Further research is necessary to understand the intricacies of aging and navigation.

The European Portuguese Version of the Composite Physical Function Scale: Cross-Cultural Adaptation and Validation in Community-Dwelling Older Adults.

This study aims to perform the cross-cultural adaptation to European Portuguese of the Composite Physical Function Scale and to assess its validity and reliability in a sample of community-dwelling older adults. The scale was translated into European Portuguese, back translated, and piloted in a sample of 16 representative individuals. Its validity and reliability were tested in an independent sample of 114 community-dwelling older adults (52 were tested twice to assess test-retest reliability). The results showed that the scale had good internal consistency (α = .90), construct validity (ρ = .71) and measurement error (78.8% agreement), and excellent test-retest reliability (κ = .98). However, a ceiling effect was found as 28% of the participants achieved the highest possible score. Although the scale has good measurement properties, the presence of ceiling effects is indicative that this tool is not able to distinguish higher levels of intrinsic capacity within community-dwelling older adults.

The Impact of Long-Term Conditions and Comorbidity Patterns on COVID-19 Infection and Hospitalisation: A Cohort Study

Introduction: Older adults are more vulnerable to COVID-19 infections; however, little is known about which comorbidity patterns are related to a higher risk of COVID-19 infection. This study investigated the role of long-term conditions or comorbidity patterns on COVID-19 infection and related hospitalisations. Methods: This study included 4,428 individuals from Waves 8 (2016−2017) and 9 (2018−2019) of the English Longitudinal Study of Ageing (ELSA) who also participated in the ELSA COVID-19 Substudy in 2020. Comorbidity patterns were identified using an agglomerative hierarchical clustering method. The relationships between comorbidity patterns or long-term conditions and COVID-19-related outcomes were examined using multivariable logistic regression. Results: Among a representative sample of community-dwelling older adults in England, those with cardiovascular disease (CVD) and complex comorbidities had an almost double risk of COVID-19 infection (OR = 1.87, 95% CI = 1.42−2.46) but not of COVID-19-related hospitalisation. A similar pattern was observed for the heterogeneous comorbidities cluster (OR = 1.56, 95% CI = 1.24−1.96). The individual investigations of long-term conditions with COVID-19 infection highlighted primary associations with CVD (OR = 1.46, 95% CI = 1.23−1.74), lung diseases (OR = 1.40, 95% CI = 1.17−1.69), psychiatric conditions (OR = 1.40, 95% CI = 1.16−1.68), retinopathy/eye diseases (OR = 1.39, 95% CI = 1.18−1.64), and arthritis (OR = 1.27, 95% CI = 1.09−1.48). In contrast, metabolic disorders and diagnosed diabetes were not associated with any COVID-19 outcomes. Conclusion: This study provides novel insights into the comorbidity patterns that are more vulnerable to COVID-19 infections and hospitalisations, highlighting the vulnerability of those with CVD and other complex comorbidities. These findings facilitate crucial new evidence that should be considered for appropriate screening measures and tailored interventions for older adults in the ongoing global outbreak.

Environment profiles, social participation patterns, depressive symptoms and quality of life of disabled older adults: a longitudinal investigation

Objectives This study used the World Health Organization’s healthy ageing framework to explore longitudinal influences of environment profiles and social participation (SP) patterns on depressive symptoms (DSs) and on quality of life (QOL). Methods Data were collected from a sample of community-dwelling older adults in Taiwan in 2018 (T1; N = 1,314) and a follow-up survey in 2020 (T2; N = 831). Latent class analysis was conducted to obtain environment and SP profiles. Multilevel modeling was carried out to explicate the hypothesized associations. Results Three unique environment profiles, labeled as Highly- (Highly-FE), Moderately- (Moderately-FE) and Weakly-Facilitative Environment (Weakly-FE), were identified from T1 data. The three SP classes that were obtained from T1 and T2 data denoted High-, Moderate- and Low-SP. Participants in the ‘Highly-FE’ class were more likely to belong to the ‘High-SP’ and ‘Moderate-SP’ subgroups and exhibited significantly fewer DSs and better QOL. The associations were confirmed both cross-sectionally and longitudinally. Conclusion Interventions should be developed to promote or maintain preferred SP to maximize the current and future mental health and subjective well-being of disabled older adults.

Association of Social Isolation With Hospitalization and Nursing Home Entry Among Community-Dwelling Older Adults

Social isolation is associated with adverse health outcomes, yet its implications for hospitalization and nursing home entry are not well understood. To evaluate whether higher levels of social isolation are associated with overnight hospitalization, skilled nursing facility stays, and nursing home placement among a nationally representative sample of community-dwelling older adults after adjusting for key health and social characteristics, including loneliness and depressive symptoms. This observational cohort study included 7 waves of longitudinal panel data from the Health and Retirement Study, with community-dwelling adults aged 65 years or older interviewed between March 1, 2006, and June 30, 2018 (11 517 respondents; 21 294 person-years). Data were analyzed from May 25, 2022, to May 4, 2023. Social isolation was measured with a multidomain 6-item scale (range, 0-6, in which a higher score indicates greater isolation). Multivariate logistic regressions were performed on survey-weighted data to produce national estimates for the odds of self-reported hospitalization, skilled nursing facility stays, and nursing home placement over time. A total of 57% of this study's 11 517 participants were female, 43% were male, 8.4% were Black, 6.7% were Hispanic or Latino, 88.1% were White, 3.5% were other ("other" includes American Indian or Alaska Native, Asian or Pacific Islander, and other race, which has no further breakdown available because this variable was obtained directly from the Health and Retirement Study), and 58.2% were aged 65 to 74 years. Approximately 15% of community-dwelling older adults in the US experienced social isolation. Higher social isolation scores were significantly associated with increased odds of nursing home placement (odds ratio, 2.01; 95% CI, 1.21-3.32) and skilled nursing facility stays (odds ratio, 1.16; 95% CI, 1.06-1.28) during 2 years. With each point increase in an individual's social isolation score, the estimated probability of nursing home placement or a skilled nursing facility stay increased by 0.5 and 0.4 percentage points, respectively, during 2 years. Higher levels of social isolation were not associated with 2-year hospitalization rates. This cohort study found that social isolation was a significant risk factor for nursing home use among older adults. Efforts to deter or delay nursing home entry should seek to enhance social contact at home or in community settings. The design and assessment of interventions that optimize the social connections of older adults have the potential to improve their health trajectories and outcomes.

Association of Performance on Olfactory and Cognitive Screening Tests With Conversion to Dementia in a Biracial Cohort of Older Adults.

Odor identification deficits are associated with transition to dementia, whereas intact odor identification and global cognition test performance may identify lack of transition. The purpose of this study was to examine intact odor identification and global cognition as prognostic indicators of lack of transition to dementia in a biracial (Black and White) cohort. In a community-dwelling sample of older adults from the Health, Aging, and Body Composition study, odor identification was measured using the Brief Smell Identification Test (BSIT), and global cognition was measured using the Teng Modified Mini-Mental State Examination (3MS). Survival analyses for dementia transition over 4 and 8 years of follow-up used Cox proportional hazards models. A total of 2,240 participants had an average age of 75.5 years (SD 2.8). Approximately 52.7% were female individuals. Approximately 36.7% were Black and 63.3% were White individuals. Impaired odor identification (hazard ratio [HR] 2.29, 95% CI 1.79-2.94, p < 0.001) and global cognition (HR 3.31, 95% CI 2.26-4.84, p < 0.001) were each independently associated with transition to dementia (n = 281). Odor identification remained robustly associated with transition to dementia for Black (HR 2.02, 95% CI 1.36-3.00, p < 0.001, n = 821) and White participants (HR 2.45, 95% CI 1.77-3.38, p < 0.001, n = 1,419), whereas global cognition was associated with transition among Black participants only (HR 5.06, 95% CI 3.18-8.07, p < 0.001). ApoE genotype was consistently associated with transition among White participants only (HR 1.75, 95% CI 1.20-2.54, p < 0.01). Among participants with intact performance on both odor identification (BSIT ≥9/12 correct) and global cognition (3MS ≥ 78/100 correct), 8.8% transitioned to dementia over 8 years. Intact performance on both measures had high positive predictive value for identifying individuals who did not transition to dementia over 4 years (0.98 for ages 70-75 years with only 2.3% transitioning, 0.94 for ages 76-82 years with only 5.8% transitioning). Odor identification testing paired with a global cognitive screening test identified individuals at low risk of transition to dementia in a biracial community cohort with a pronounced effect in the eighth decade of life. Identification of such individuals can reduce the need for extensive investigation to establish a diagnosis. Odor identification deficits showed utility in both Black and White participants, unlike the race-dependent utility of a global cognitive test and ApoE genotype.

Prevalence and determinants of sarcopenia in community-dwelling older adults in Ireland.

Data on the prevalence of sarcopenia among older adults in Ireland are lacking. To assess the prevalence and determinants of sarcopenia among community-dwelling older adults in Ireland. This cross-sectional analysis involved n = 308 community-dwelling adults aged ≥ 65 y living in Ireland. Participants were recruited via recreational clubs and primary healthcare services. Sarcopenia was defined according to the 2019 European Working Group on Sarcopenia in Older People (EWGSOP2) criteria. Skeletal muscle mass was estimated using bioelectrical impedance analysis, strength was measured via handgrip dynamometry, and physical performance was assessed using the Short Physical Performance Battery. Detailed information was collected on demographics, health, and lifestyle. Dietary macronutrient intake was measured via a single 24h recall. Binary logistic regression was used to examine potential demographic, health, lifestyle, and dietary determinants of sarcopenia (where both probable and confirmed sarcopenia were combined). The prevalence of EWGSOP2-defined probable sarcopenia was 20.8% and confirmed sarcopenia was 8.1% (5.8% had severe sarcopenia). Polypharmacy (OR 2.60, 95% confidence interval [CI] 1.3, 5.23), height (OR 0.95, 95% CI 0.91, 0.98), and Instrumental Activities Of Daily Living (IADL) score (OR 0.71, 95% CI 0.59, 0.86) were independently associated with sarcopenia (probable and confirmed combined). There were no independent associations between energy-adjusted macronutrient intakes, as determined by 24h recall, and sarcopenia. Sarcopenia prevalence within this sample of community-dwelling older adults in Ireland is broadly similar to other European cohorts. Polypharmacy, lower height, and lower IADL score were independently associated with EWGSOP2-defined sarcopenia.

Neuropsychiatric Symptoms and Trajectories of Dependence and Cognition in a Sample of Community-dwelling Older Adults with Dementia.

Neuropsychiatric symptoms (NPS), including psychotic symptoms (hallucinations, illusions, delusions), agitation/aggression, and depressed mood, are common in individuals with Alzheimer's disease (AD) and predict poorer outcomes, including faster disease progression. We aimed to evaluate associations between NPS and cognition and dependence in a multi-ethnic sample of community-dwelling older adults with AD. Predictors 3 (P3) is a cohort study of AD disease courses recruiting older adults aged 65 and above residing in upper Manhattan. A total of 138 of 293 participants had probable AD at the study baseline. We fit linear mixed models to examine longitudinal associations of time-varying NPS (psychotic symptoms, agitation/aggression, and depressed mood) with dependence and cognition, adjusted for race-ethnicity, sex, education, age, clinical dementia rating score, APOE-ε4, and comorbidity burden; separate interaction models were fit for age, Hispanic ethnicity, and sex. Psychotic symptoms were associated with faster rates of increasing dependence and declining cognition over time, agitation/aggression with faster rates of declining cognition, and depressed mood with faster rates of increasing dependence. Among psychotic symptoms, delusions, but not hallucinations or illusions, were associated with worse outcome trajectories. Depressed mood predicted an accelerated increase in dependence in males but not females. Our results confirm and extend prior results in clinic-based samples. The presence of NPS was associated with worse trajectories of dependence and cognition in this muti-ethnic sample of older adults with AD. Importantly, sex modified the association between depressed mood and dependence. Our results on NPS as predictors of differential AD progression in a community-dwelling, ethnically diverse sample serve to better inform the clinical care of patients and the future development of AD therapies.