Sample Of Older Persons Research Articles

THE CANNABIS AND OLDER PERSONS STUDY: EXPANDING OUR MINDS THROUGH INTERDISCIPLINARY RESEARCH

Abstract The Cannabis and Older Persons Study has examined the increasing use of cannabis among Americans over 60 years old since 2016. This year’s symposium presents varied methodological approaches researchers have used to better understand the harms and benefits associated with cannabis use among older Americans. Divya Bhagianadh examines the association between cannabis legalization policies across the Untied States and corresponding use of end of life programs and services. Julie Bobitt analyzes interviews provided by older adults in Illinois and defines how attitudes held by medical doctors and other clinical care providers are critical to shaping cannabis use among older adults. Brian Kaskie considers the role of cannabis policy clusters. Jacobo Mintzer reviews findings from a controlled trial providing two cannabinoids to treat agitation among persons with Alzheimers in hospice. Thorsten Rudroff examines cannabis use among a sample of older persons at risk for falls. These studies reflect how cannabis use among older persons continues to grow and diversify, and how researchers have use different approaches to advance scientific understanding of determinants and outcomes, both desirable and undesirable, associated with cannabis use among older adults. This symposium offers policy makers and health care leaders a balanced perspective. On one side, we discuss how prevention and treatment efforts for substance use disorder, including cannabis use disorder, must increase proportionally to the increasing number of older cannabis users. On the other side, we consider how more than 5 million older Americans, especially those with pain, find some benefit in using cannabis.

Health of older people in places and work-related outcomes: are all health indicators equal?

Abstract Background Health has been posited as an explanation for why older people who live in more disadvantaged areas have worse work-related outcomes. The policy implication being that if a higher proportion of older persons in a place had better health, those labour markets would be better for everyone. No literature exists on this topic. Methods Data was used from 428,646 members of the Office for National Statistics Longitudinal Study (LS) who were 16-74y at the 2011 census and had information on employment status, economic activity and occupational socioeconomic classification. Generalised Structural Equation Modelling was used to examine whether each of the three work-related outcomes were equally related to nine 2011 local authority district (LAD)-level older adult health indicators. Results In age-adjusted analysis, all nine LAD-level health indicators (modelled in terciles) were associated with all three work outcomes. However, strengths of association varied both across and within each outcome. For example, the strongest associations were for being ‘sick or disabled' versus ‘In employment'. If an LS member lived in the ‘unhealthiest' versus ‘healthiest' third of LADs, associations varied between a high of 2.74 higher odds (95% CI: 2.53,2.95) for long-term illness and a low of 2.10 higher odds (1.89,2.32) for disease-free life expectancy at age 50y. The weakest associations were for part-time versus full-time employment: ranging from life expectancy at birth at 1.29 (1.21,1.38) to healthy-life expectancy at age 50y: 1.18 (1.10,1.27). Adjustment for individual health reduced, but did not eliminate, associations. Sensitivity analysis showed robustness to area health indicators being assessed for sub-groups of older people (ages 50-64 & 65-74), genders and a reduced sample of older persons (50-74y) only. Conclusions Health of older people in places is associated with work outcomes of people in those places; both the older people themselves and the wider community. Key messages At a place level, health and work outcomes are linked. Strengths of association between place-level health and work outcomes will depend on the health measure used.

Interaction of Skeletal and Left Ventricular Mass in Older Adults with Low Muscle Performance.

It was recently hypothesized the existence of "cardiac-skeletal muscle axis." However, the relationship between skeletal muscle mass (SMM) and left ventricular mass (LVM) has never been investigated in the specific group of older individuals with low skeletal mass and physical performance. We tested this hypothesis in the SPRINT-T (Sarcopenia and Physical Frailty IN older people: multicomponenT Treatment strategies Trial) population using LVM as independent variable and SMM as dependent variable. SMM was assessed by dual-energy X-ray absorptiometry scan and expressed as appendicular lean mass (ALM), and LVM was estimated through echocardiography. Low ALM was defined according to Foundation for the National Institutes of Health Sarcopenia Project criteria, and Short Physical Performance Battery (SPPB) was used to assess physical performance. The population consisted of 100 persons (33 men and 67 women), aged 70 years or older (mean age = 79 ± 5 years) with low ALM and SPPB ranged between 3 and 9, suggestive of physical frailty. Charlson Comorbidity Index median score was 0. Mean value of LVM was 193 ± 67 g, indexed LVM/body surface area (LVM/BSA) was 112 ± 33 g/m2, and cardiac output (CO) was 65 ± 19 L/min. ALM was strongly and positively correlated with LVM (r = 0.54602; P < .0001), LVM/BSA (r = 0.30761; P < .002), CO (r = 0.49621; P < .0001), body mass index (BMI) (r = 0.52461; P < .0001), sex (r = 0.77; P < .001), fat mass (r = 0.38977; P < .0001), and hemoglobin (Hb) (r = 0.26001; P < .01). In the multivariate analysis, LVM (β = .019 ± .005; P < .0001), CO (β = .038 ± .016; P = .019), BMI (β = .286 ± .051; P < .0001), and Hb (β = .544 ± .175; P = .0025) remained associated to ALM. In a sample of older persons with low muscle mass and physical performance, LVM was positively and significantly correlated with ALM, independently from blood pressure, physical activity, and other potential confounders. Future studies are needed to address the effect of interventions targeting LVM and SMM.

Examining the Motivation and Perceived Benefits of Pickleball Participation in Older Adults.

Pickleball, a paddle sport that combines aspects of tennis, badminton, and table tennis, is one of the fastest growing sports in America. The sport is especially popular with older adults as it provides a means for both competition and exercise. Limited research is available on the motivation and perceived benefits of participants in this unique and growing community. A total of 3,012 participants completed a survey instrument that included items from the Sport Motivation Scale, the Task and Ego Orientation in Sport Questionnaire, and the Quality and Importance of Recreational Services. Participants reported being more task oriented than ego oriented, suggesting that pickleball may effectively satisfy the need for persons to be engaged in physical activities that allow for the ongoing development of personal mastery. This finding is supported by respondents noting that their primary motivation to participate in pickleball involved mastering difficult training techniques. However, participants cited competition as the top perceived benefit to their participation. This result supports two possible conclusions that motivation and benefit are different and potentially disconnected constructs or that the benefit of competition among this sample of older persons is understood through the lens of personal mastery, whereby the demonstration of that mastery is only possible through competition.

Development and psychometric evaluation of the patient knowledge of, and attitudes and behaviours towards pressure ulcer prevention instrument (KPUP).

The Patient Knowledge of, and Attitude and Behaviour towards Pressure Ulcer Prevention Instrument (KPUP) was developed and validated using a two-stage prospective psychometric instrument validation study design. In Stage 1, the instrument was designed, and it is psychometrically evaluated in Stage 2. To establish content validity, two expert panels independently reviewed each item for appropriateness and relevance. Psychometric evaluation included construct validity and stability testing of the instrument. The questionnaire was administered to a convenience sample of 200 people aged more than 65 years, living independently in the community; reliability and stability were assessed by test/retest procedures, with a 1-week interval. Mean knowledge scores at 'test' were 11.54/20 (95% CI = 11.10-11.99, SD: 3.07), and 'retest' was 12.24 (95% CI = 11.81-12.66, SD: 2.93). For knowledge, correlation between the test/retest score was positive (r=. 60), attitude section-inter-item correlations ranged from r = -.31 to r = .57 (mean intraclass correlation coefficient of r = .42), and internal consistency for the retest was the same as the test (α = .41 for the eight items). For health behaviours, individual inter-item correlations for test items ranged from r = -.21 to r = .41 for the 13 standardised items. Psychometric testing of the KPUP in a sample of older persons in the community provided moderate internal consistency and general high test-retest stability.

ASSESSING HEALTH-RELATED OUTCOMES OF MEDICAL CANNABIS USE AMONG OLDER PERSONS IN COLORADO AND ILLINOIS

The use of cannabis is increasing among older Americans. A growing body of evidence shows cannabis and cannabinoids effective for treating chronic pain, spasticity, nausea, and sleep disturbances. States seeking to respond to the treatment needs of specific patient populations have legalized the use of cannabis for medical purposes. Few instruments offer standard outcomes for understanding the use of medial cannabis from the patient perspective, particularly focusing on older persons. Using cross-sectional survey data from a sample of older persons in Colorado and Illinois, we validate two scales to consistently measure patient-reported health related outcomes of medical cannabis use. We confirmed the validity of two separate, reliable outcome scales: a three-factor scale for measuring global health outcomes and a single-factor scale for capturing adverse health events. The COPS questionnaire revealed strong construct validity and internal consistency, and a lack of meaningful factor variance.

Prevalence rates of malnutrition using harmonized definitions in older adults from different settings in Europe and New Zealand – a manuel study

Rationale: Malnutrition is widespread among older people and related to poor outcome. Reported prevalence rates vary widely because of different diagnostic criteria used. This study aims to describe prevalence rates in several samples of older persons in different settings using harmonized definitions.

A Unique Yoga Meditation Program’s (Yo-Med) Effect on Balance and Proprioception in Older Fallers

Falls are a major factor affecting mortality and morbidity in older individuals. Proprioception is a central factor modulating fall frequency and severity. Although specific protocols have been developed to improve proprioception in older fallers, many are too challenging or not palatable to a large segment of the population. PURPOSE: Given the current popularity of yoga, and the effectiveness of mental imaging in training proprioception, this study examined the effectiveness of our newly developed yoga meditation program (Yo-Med) on balance and proprioception in a sample of older persons with moderate risk of falling. METHODS: Sixteen older persons were randomly assigned to one of two training interventions; Yo-Med Group (Yo-Med) or Proprioception Training Group (PT). Each group received 45 minutes of specified training, 3 days per week, for 6 weeks. Pre- and post-training outcome measures were used to quantify the effect of both interventions. Measurements taken included; The Balance Error Scoring System (BESS), The Tenetti Balance and Gait Assessment, Dynamic Posturography (Proprio 5000), Joint Position Sense, and Joint Kinesthesia. RESULTS: The primary findings of the study were that neither the Yo-Med or PT intervention groups showed statistical improvements in proprioception tests or field tests of balance. The Proprio 5000 overall dynamic motion analysis score (DMA) showed a significant time by group interaction (ηp2 = .271; p = .039) and the time spent on the test (TOT) showed a trend toward a significant time x group interaction (ηp2 = .221; p = .066), both favoring the Yo-Med group. CONCLUSION: Our results indicate that our Yo-Med program has the capacity to improve dynamic balance even beyond a standard proprioception training program. The lack of significant findings in our proprioception and field tests were likely due to the healthy nature of our sample and the duration of the intervention. Given our successful results in dynamic balance we suggest that this study be repeated with a larger sample with a greater risk of falls across a longer intervention period.

A New Grip Strength Measuring Device for Detailed Evaluation of Muscle Contraction among the Elderly.

We developed a new grip strength measuring device, which considers the time axis, for evaluating muscle contraction in detail in elderly people. To present the novel device and preliminary results concerning agility in gripping. Cross-sectional analysis. One hundred and twenty-one older persons (48 men and 73 women, mean age 74.4 years) referring for memory disorders to the outpatient clinic of our institute. A novel device taking advantage of an industrial force-gauge was developed for measuring gripping performance. The instrument graphically described participants' strength production. Nine indices were derived from four points identified by the graph: 1) starting point ("Go signal"), 2) time when gripping starts, 3) turning point (TP) when the inclination of the curve depicting strength production changes, and 4) peak of strength production. Results obtained from the study sample of older persons were compared (as ratios) to a control group of 30 healthy young adults in their thirties in order to calculate age-related decline rates. Differences between right and left side were compared. A significant difference was observed between right and left hands concerning the time to reach peak of strength, and time from TP to strength peak in both men and women. For women, the following indices were also significantly different: time to reach TP, strength at TP, time from TP to strength peak, curve inclination from TP to strength peak, and ratio of TP strength divided by peak strength. Declines in several indices of gripping agility were measured. The parameters which were more closely related to time than strength itself showed significant differences between right and left hands, especially in women.

Leptin, Abdominal Obesity, and Onset of Depression in Older Men and Women

The mechanisms that underlie the association between abdominal obesity and depression risk in older persons are not well known, but the "leptin hypothesis" of depression suggests that leptin resistance may be involved in mood regulation. We tested whether high circulatory concentration of leptin, alone and in combination with visceral adiposity, is associated with onset of depression in a sample of older persons. Participants were 1,220 men and 1,282 women aged 70-79 years and enrolled in the Health, Aging, and Body Composition study. Serum concentration of leptin and abdominal visceral fat, ascertained by computed tomography, were assessed at baseline (April 1997-June 1998). Onset of depression, the primary outcome measure, was defined as a Center for Epidemiologic Studies-depression scale 10-item score ≥ 10 and/or new antidepressant medication use at any annual visit over a 5-year follow-up. Higher leptin level was associated with the risk of depression onset in men with high levels of visceral fat (hazard ratio [HR] = 1.25; 95% CI, 1.06-1.46; P = .01) but not in those with normal visceral fat (HR = 0.98; 95% CI, 0.80-1.19; P = .80) (leptin-by-visceral fat, P = .04). No interaction between leptin and visceral fat was detected in the analysis focusing on women (P = .90). In older men, high leptin level was associated with an increased onset of depressive symptoms, especially in the presence of abdominal obesity, suggesting that underlying leptin resistance may play a role in this link. Differences in visceral fat levels and metabolic consequences may explain the absence of this association in women. These findings suggest a potential biological link between depression, obesity, and their joint association with negative health outcomes.

Contribution of Frailty Markers in Explaining Differences Among Individuals in Five Samples of Older Persons

There has been little research on the relative importance of frailty markers. The objective was to investigate the association among seven frailty domains (nutrition, physical activity, mobility, strength, energy, cognition, and mood) and their relative contribution in explaining differences among individuals in five samples of older persons. Data from five studies of aging were analyzed using multiple correspondence analysis. Aggregation of frailty markers was evaluated using graphical output. Decomposition of variability was used to assess the relative contribution of each marker in each sample. Results were combined across the samples to assess the average contribution. Frailty markers were found to consistently aggregate in each sample, suggesting a possible underlying construct. Physical strength had the highest contribution on average in explaining differences among individuals. Mobility and energy also had large contributions. Nutrition and cognition had the smallest contributions. Our results provide further evidence supporting the notion that frailty domains may belong to a common construct. Physical strength may be the most important discriminating characteristic.

Social Determinants of Active Aging: Differences in Mortality and the Loss of Healthy Life between Different Income Levels among Older Japanese in the AGES Cohort Study

We examined the relationship between income, mortality, and loss of years of healthy life in a sample of older persons in Japan. We analyzed 22,829 persons aged 65 or older who were functionally independent at baseline as a part of the Aichi Gerontological Evaluation Study (AGES). Two outcome measures were adopted, mortality and loss of healthy life. Independent variables were income level and age. The occurrence of mortality and need for care during these 1,461 days were tracked. Cox regressions were used to calculate the hazard ratio for mortality and loss of healthy life by income level. We found that people with lower incomes were more likely than those with higher incomes to report worse health. For the overall sample, using the governmental administrative data, the hazard ratios of mortality and loss of healthy life-years comparing the lowest to the highest income level were 3.50 for men and 2.48 for women for mortality and 3.71 for men and 2.27 for women for loss of healthy life. When only those who responded to questions about income on the mail survey were included in the analysis, the relationships became weaker and lost statistical significance.

Attitudes et perception de contrôle des personnes âgées envers la prise de médicaments à action anxiolytique, sédative et hypnotique (ASH)

This study examines the importance of variables from the Theory of Planned Behaviour (i.e., attitudes toward behaviour, subjective norms, and perceived control) for the prediction of consumption of anxiolytic and sedative-hypnotic (ASH) medications in a sample of older persons, aged 69 years on average, 62 consumers and 92 non-consumers. A favourable attitude toward ASH and a sense of having less control regarding these drugs predict both current usage and intention to continue. Perceived control predicts intention to start consumption of ASH in current non-consumers. This study underlines the importance of considering the role of the older person's decisional power in the consumption of these medications.

ACE-Inhibition and Physical Function: Results From the Trial of Angiotensin-Converting Enzyme Inhibition and Novel Cardiovascular Risk Factors (TRAIN) Study

Aim of the present study was to evaluate whether an ACE inhibitor intervention is able to significantly improve physical performance and muscle strength in a sample of older persons. Double-blind, cross-over, randomized, placebo-controlled trial. The Trial of Angiotensin-Converting Enzyme Inhibition and Novel Cardiovascular Risk Factors (TRAIN) study. Participants were 257 subjects aged 55 years and older with high cardiovascular risk profile. Six months of fosinopril use versus placebo. The Short Physical Performance Battery score (rescaled to obtain a continuous variable ranging from 0 to 3 points), and the hand grip strength were measured at the baseline visit, and after 6 and 12 months of follow-up. Paired t test analyses were performed to compare results of physical function measures after ACE inhibition and placebo interventions. Mean age of the sample population was 65.97 (standard deviation 7.41) years old. No statistically significant difference was found at the Short Physical Performance Battery (P=.23) and hand grip strength (P=.57) results after ACE inhibition (2.113, standard deviation [SD] 0.284; and 37.044 kg, SD 12.993 kg, respectively) compared to placebo (2.096, SD 0.298; and 36.898 kg, SD 13.178 kg, respectively). No significant effects from ACE inhibition were also found when the 3 subtests composing the Short Physical Performance Battery (ie, 4-meter walking speed, balance, and chair stand tests) were separately analyzed. Consistent negative results were obtained after analyses were restricted to participants showing the highest compliance to treatment and/or receiving the maximum fosinopril dosage. No significant modifications in physical performance and muscle strength were reported after 6 months of fosinopril use in older persons with high cardiovascular risk profile. Given these negative findings, it is possible that the beneficial effects of ACE inhibitors on physical function might be attributable to the activation of a virtuous cycle determined by an improved cardiovascular system. Further specifically designed studies are needed to confirm our findings, and expand them to different populations and ACE inhibitors. If our findings will be confirmed, the extracardiovascular properties of ACE inhibitors in older persons might be substantially resized.

The impacts of dwelling conditions on older persons’ psychological well-being in Hong Kong: the mediating role of residential satisfaction

About 11% of Hong Kong's population of 7 million people are aged 65 and over and many of them live in old urban areas. Many of these areas have been subjected to urban redevelopment and some of the residents have been relocated to newer estates in peripheral new towns. Previous studies have focused on the challenges the urban environment has placed on older persons in terms of capability to cope with the demands that the environment places upon them. This paper suggests that dwelling conditions can act as stressors and become contributing factors that impact on older persons’ residential satisfaction and psychological well-being (subjective well-being). This study examines the role of residential satisfaction (satisfaction with dwelling unit, estate and district) in mediating the effects of dwelling conditions (interior environment and exterior environment) on psychological well-being. A sample of older persons was recruited from a sampling frame of 16 urban sub-areas located in old urban areas and new towns. 518 older persons (224 males, 294 females) aged 60 and over were interviewed and the findings indicated that residential satisfaction was determined by assessment of both the interior environment and the exterior environment, although these were appraised differently. The interior environment had a greater impact on residential satisfaction than the exterior environment. It appeared that environmental dwelling conditions mainly affected older persons’ psychological well-being indirectly and, hence, probably influenced their opportunities for successful ageing. However, subsequent tests revealed that dwelling conditions had no direct impact on psychological well-being. In light of these findings, it is proposed that the role of environmental factors and their relation to older persons’ psychological well-being depends on the extent to which a person's expectations of residential satisfaction are met. Some implications of these findings for local housing and social care policy are discussed.

Neurological examination findings to predict limitations in mobility and falls in older persons without a history of neurological disease

Purpose To estimate the prevalence of neurological signs and their association with limitations in mobility and falls in a sample of older persons without known neurological disease. Methods A neurologist examined 818 participants from the InCHIANTI study who were aged ≥65 years and who did not have cognitive impairment, treatment with neuroleptics, and a history of neurological disease. Mobility was assessed as walking speed and self-reported ability to walk at least 1 km without difficulty. Participants were asked to report falls that had occurred in the previous 12 months. Results Less than 20% (160/818) of participants had no neurological signs. Neurological signs were more prevalent in older participants and those with impaired mobility. When all neurological signs were included in sex-and age-adjusted multivariate models, 10 were mutually independent correlates of poor mobility. After adjusting for age and sex, the number of neurological signs was associated with progressively slower walking speed ( P <0.001), a higher probability of reported inability to walk 1 km ( P <0.001), and a history of falls ( P <0.05). Conclusion Neurological signs are independent correlates of limitations in mobility and falls in older persons who have no clear history of neurological disease.

Impact of spouses' sleep problems on partners.

To analyze relationships between spouses' sleep problems and their partners' physical health, mental health, well-being, social involvement, and marital quality in a sample of older persons. The Alameda County Study is a population-based longitudinal study focusing on behavioral factors associated with health and mortality. Participants completed questionnaires for the sixth wave of data collection (1999). 405 couples (810 husbands and wives aged 51 to 94 years). Participants were asked how often they had experienced difficulty falling asleep, waking up in the middle of the night, and waking up very early in the morning over the past month. Response sets ranged from "never" to "often." Scores were summed. Analyses included multivariate statistical models using generalized estimating equations to adjust for paired data as well as partner age, sex, chronic conditions, financial problems, and own sleep problems. Although partners' associations with negative outcomes were stronger for their own sleep problems, spouses' sleep problems were associated with partners' poor health, depressed mood, poor mental health, unhappiness, low optimism, feeling left out, not satisfied with relationships, and unhappy marriage, even after adjusting for the partners' sleep problems. We found no sex differences in associations between spouses' sleep problems and partners' outcomes. Although data are cross-sectional, findings suggest that spouses' sleep problems negatively impact partners' health and well-being. Our analyses emphasize the importance of treating sleep problems to promote the health and well-being of both affected individuals and their partners.

Depression in Older Ethnic Groups

The generality of George's model of the social precursors of depression was tested in a sample of older persons ( N = 803) from three ethnic groups: U.S.-born African Americans, African Caribbeans, and U.S.-born European Americans. The social precursors model includes demographic variables, early events and achievements, later events and achievements, social integration, vulnerability and protective factors, and provoking agents and coping efforts. Zero-order correlations indicated that nearly all the predictor variables were significantly associated with depression. A test of the overall model with all six stages was followed by separate regressions for each ethnic group. Four of the six stages of the model contributed unique variance to the prediction of depressed affect in European Americans but only two in the case of African Americans and African Caribbeans. The most robust and consistent predictor of depression was the sixth-stage variables of stress and emotion regulation.

The feasibility of using a telephone-administered survey for determining nutritional service needs of noninstitutionalized older adults in rural areas: time and costs.

This study examined response, participation, time, and costs for a telephone-administered survey to obtain comprehensive information on general health, eating habits, living environment, and functional status from a sample of older persons in a rural North Carolina county. A probability sample of persons aged 60 years and older from the most recent electoral rolls were mailed a personalized letter, which was followed by telephone contact to recruit them into a contemporaneous survey that used a modified version of the Nutrition Screening Initiative's Level I and II screens. Time requirements and costs associated with the completion of surveys were calculated. Seventy-six percent of the persons contacted by telephone (residents of 96% of county precincts) completed the survey. Because minority elders were more likely to lack a working telephone, they were underrepresented in the sample. With 555 calling attempts (58% of surveys completed on first attempt), we estimated a cost of $10.65 per completed survey. Telephone-administered surveying of older adults may be considered as an appropriate component of an overall community-based service strategy. The estimation of the constituents of nutritional risk, by geographic area, economic status, or ethnicity, may aid in providing estimates of service needs and procuring and allocating resources. Additional methods of data collection are necessary in order to target older persons without telephone service.

Interview Modality

Objectives:To contrast the costs and quality of data collected in person, by telephone, and by self-administered questionnaires in a sample of older persons. Methods: Data collected via interviews with 586 women are contrasted on four dimensions. Results:The cost of data collection was 25% to 30% lower for the self-administered mode than for other modes. Response rates were highest for the inperson interviewand lowest for the self-administered questionnaire. The rate of missing data was highest for the self-administered questionnaire. Significant differences in response effects were found across mode, with respondants to self-administered questionnaires profiling the poorest. Discussion:The costs and quality of data collected by various modes are discussed in terms of their implications for understanding the physical and mental well-being of older people.