Self-reported Impairment Research Articles

Longitudinal associations between self-reported vision impairment and all-cause mortality: a nationally representative cohort study among older Chinese adults

ObjectiveTo compare the effects of pre-existing and new self-reported vision impairment (VI), and its correction, on all-cause mortality among Chinese adults aged 45 years and older.MethodsWe used four waves of...

Allostatic load and risk of hearing impairment

BackgroundPrevention of hearing loss via addressing potentially modifiable risk factors may offer means of reducing the global burden of hearing loss. Prior studies reported associations between individual markers of inflammation and risk of hearing impairment. Allostatic load is an index of cumulative physiological stressors, including inflammation, to multiple biological systems. Our aims were to investigate associations between allostatic load and both audiometric and self-reported hearing impairment and examine whether associations are stronger over time due to prolonged high allostatic load. MethodsData were taken from the English Longitudinal Study of Ageing (ELSA), a nationally representative study of people aged 50+ living in England over 3 time points between 2008 and 2014. Allostatic load score was comprised of thirteen different measures available at baseline and 4 years post-baseline (high-density lipoprotein/total cholesterol, triglyceride, fibrinogen, haemoglobin A1c, C-reactive protein, insulin-like growth factor 1 (IGF-1), systolic and diastolic blood pressure, mean arterial pressure, resting pulse rate, peak expiratory flow, BMI and waist circumference), measured using clinical cut-off points for normal biomarker parameters. Hearing acuity was measured with a simple handheld tone-producing device at follow-up 7 years post-baseline, while self-reported hearing impairment was measured at time point. ResultsWe included samples of 4373 and 4430 for the cross-sectional and longitudinal analysis, respectively. In the cross-sectional model high allostatic load was associated both self-reported (OR = 1.08, 95% CI 1.0,1.1; p < 0.01) and objective hearing loss (OR = 1.10, 95% CI 1.1,1.2; p < 0.001) adjusting for age and sex. Cross-sectional associations between allostatic load and hearing were not significant after further adjustment for covariates (qualification, physical activity and smoking).In longitudinal modelling, high allostatic load was associated with both audiometric (Z score OR = 1.11, 95% CI 1.1,1.2; p < 0.001) and self-reported hearing impairment (OR = 1.08, 95% CI 1.0,1.1; p < 0.001) adjusting for age and sex. Allostatic load was no longer associated with self-reported hearing loss but the association with audiometric hearing impairment (OR = 1.08, 95% CI 1.03,1.13; p < 0.001) remained following additional adjustment for baseline self-reported hearing, education, physical activity, and smoking. ConclusionsProlonged high allostatic load was associated with risk of hearing impairment. Reducing allostatic load via healthy lifestyle changes including non-smoking, healthy diet and exercise may offer an opportunity to reduce the risk of hearing impairment in later life.

Capturing daily-life executive impairments in adults: Does the choice of neuropsychological tests matter?

Objective Standardized executive functioning (EF) measures do not reliably capture EF-related difficulties reported in daily life. We aim to determine if an ecologically relevant neuropsychological battery is more strongly associated with self-reported everyday EF impairments than classically used tests. Method Fifty-nine adults aged 18–49 self-rated their EF abilities using the Barkley Deficits in EF Scale (BDEFS) and were randomly assigned to complete either a test battery composed of EF measures with hypothesized ecological relevance (Six Elements, Zoo Map, Hayling Sentence Completion, Iowa Gambling, and Auditory Startle Tasks) or one composed of traditional EF tasks (Card Sorting, Trail Making, Color-Word Interference, and Verbal Fluency). Associations were examined using linear regression. Results There were no strong associations between BDEFS subscales and performance on either test battery. Only the regression model predicting Emotional Regulation from ecological tasks was significant. Iowa Gambling Task performance and corrugator muscle contraction in the Auditory Startle Task individually contributed significantly to the model, with small and moderate effect sizes respectively. Conclusion Results align with evidence that self-reported EF difficulties are not adequately captured by formal neuropsychological measures, even for performance-based measures which directly tap everyday constructs. Findings are interpreted cautiously in the context of a small, high-functioning sample.

Usability and feasibility of a cognitive-behavioral mobile app for ADHD in adults.

Cognitive-behavioral therapy (CBT) has growing evidence of efficacy for Attention-Deficit/Hyperactivity Disorder (ADHD) in adults. Mobile health apps are promising tools for delivering scalable CBT. In a 7-week open study of Inflow, a CBT-based mobile app, we assessed usability and feasibility to prepare for a randomized controlled trial (RCT). 240 adults recruited online completed baseline and usability assessments at 2 (n = 114), 4 (n = 97) and after 7 weeks (n = 95) of Inflow use. 93 participants self-reported ADHD symptoms and impairment at baseline and 7 weeks. Participants rated Inflow's usability favorably, used the app a median of 3.86 times per week, and a majority of those using the app for 7 weeks self-reported decreases in ADHD symptoms and impairment. Inflow demonstrated usability and feasibility among users. An RCT will determine whether Inflow is associated with improvement among more rigorously assessed users and beyond non-specific factors.

Bidirectional association between visual impairment and frailty among community-dwelling older adults: a longitudinal study

BackgroundVision impairment is common among older adults, and it may be related to frailty. However, the longitudinal relationship between visual impairment and frailty is still unclear.MethodsWe used data from Round 1 to Round 5 from the National Health and Aging Trend Study. Two samples were community-dwelling older adults, sample 1 (without visual impairment) was classified according to whether they have pre-frailty/frailty at R1 (N = 3013) and sample 2 (without pre-frailty/frailty) was classified according to whether they have visual impairment at R1 (N = 1422), respectively. Frailty was measured using five criteria: experiencing exhaustion, unintentional weight loss, low physical activity, slow gait, and weak grip strength. Visual impairment was assessed by asking participants if they had any visual impairment. Generalized estimating equation models were used to examine the concurrent and lagged association between visual impairment and frailty.ResultsThe participants were on average 76 ± 7 years old, female (59%), non-Hispanic white (74%) with less than bachelor educated (73%), and 44% were pre-frail/frail in the older adults without visual impairment. Approximately 5% of participants had visual impairment at R1, and they tended to be female and non-Hispanic White in the older adults without frailty. The concurrent (OR, 95% CI = 1.55, 1.17-2.02) and lagged (OR, 95% CI = 1.79, 1.25-2.59) associations between frailty and visual impairment were significantly after controlling the covariates. Similarly, the concurrent (OR, 95% CI = 1.63, 1.32-2.04) and lagged (OR, 95% CI = 1.49, 1.20-1.87) associations between visual impairment and frailty were also significant.ConclusionsOverall, this study provides evidence for a longitudinal, bidirectional association between self-reported visual impairment and frailty. Future intervention programs to delay frailty progression should include strategies that may reduce the incidence of visual impairment.

Relationship of psychological/mild traumatic brain injury (mTBI) history and invalid reporting to self-reported executive function

Individuals with mild traumatic brain injury (mTBI) often complain of executive functioning (EF) difficulties. There is a discrepancy between self-reported EF impairment and EF deficits on neuropsychological tests, with some arguing that self-report EF is more related to real-world functioning than EF tests. However, research suggests that self-reported EF may be related more to emotional distress and is vulnerable to invalid reporting. We examined the vulnerability of the short form Barkley Deficits in Executive Functioning Scale (BDEFS) to invalid reporting, using a simulated mTBI paradigm. We included four groups: individuals simulating mTBI with (N = 24) and without (N = 21) histories of mTBI/other psychological conditions and controls with (N = 21) and without (N = 25) histories of mTBI/other psychological conditions. As hypothesized, simulators performed worse on the BDEFS Total Score and EF Symptom Count relative to controls; however, this effect was larger within those who had no self-reported history of mTBI/other psychological conditions. We identified a preliminary cutoff on the EF Symptom Count that detected 42.8% of simulators, with 95% specificity relative to the controls with histories of mTBI/other psychological conditions. The present study emphasizes the need for validity scales on self-report EF measures such as the BDEFS.

Are Pain Screening and Functional Assessment Results Associated with New Diagnoses and Treatment for Pain in Primary Care? An Observational Study

PurposeTo determine if pain screening and functional assessment results are associated with new diagnoses and treatment for pain in primary care.Patients and MethodsObservational study at 13 primary care sites of a statewide federally qualified health center that implemented routine screening and functional assessment for all adults in primary care. The study group included 10,091 adults aged 18+ who had an in-person visit between July 2, 2018, and June 1, 2019, where they screened positive for chronic pain and completed a 3-question functional assessment with the PEG (Pain, Enjoyment of Life, General Activity). Multivariate logistic regressions quantified associations between pain frequency, diagnosis and treatment, sociodemographics, comorbidities, and self-reported severe pain impairment with pain diagnoses and treatment documented after screening.ResultsPatients were mostly women (60.3%), Latinx (41.1%), English-speaking (80.1%), and Medicaid-insured (62.0%); they averaged 49.1 years old (SD = 13.7 years). Patients with severe pain impairment or who were Latinx were more likely to get a newly documented pain diagnosis (absolute risk difference [ARD]: 13.2% and 8.6%, ps < 0.0001), while patients with mental health/substance use or medical comorbidities were less likely (ARDs: −20.0% to −6.2%, ps < 0.001). Factors most consistently associated with treatment were prior treatment of the same modality (4 of 7 treatments, ARDs = 27.3% to 44.1%, ps <0.0001), new pain diagnosis (5 of 7, ARDs = 3.2% to 27.4%, ps <0.001), and severe impairment (4 of 7, ARDs = 2.6% to 6.5%, ps < 0.0001). A new diagnosis had the strongest association with non-opioid pain analgesics and physical medicine (ARD = 27.0% and 27.4%, p < 0.0001). Latinx patients were less likely to receive opioid analgesics and mental health/substance use medications and counseling (ARDs = −3.3% to 7.5%, ps <0.0001).ConclusionScreening and assessment with patient-reported tools may influence pain care. Care for Latinx patients differed from non-Latinx white patients.

Comparison Of The Effectiveness Of Back School Exercises And Mckenzie Exercises In The Treatment Of Chronic Low Back Pain; A Randomized Controlled Trial”RCT

Low back pain has become the most common critical health problem and it is well known for causing a personal, and community financial burden globally. Low back pain is demarcated as non-specific, non-radiating pain with no accompanying neurological signs and symptoms. Objective: The purpose of this study was to compare the effectiveness between Mckenzie exercises and back school exercises in the treatment of low back pain. Methods: This research included 36 patients who met the eligibility criteria. Prior to undertaking any examinations or receiving treatments, each participant in this study gave their ethical approval via filling out informed consent. Patients with nonspecific chronic back pain were divided randomly into 3 groups. In ‘group A’ only the conventional treatment was provided and in group 2 patients performed back school exercises. Similarly, in group 3 patients performed Mckenzie exercises. The lottery method was used to assign patients to these three randomized groups. All of these aforementioned groups received conventional therapy, which remained identical throughout the study. The conventional treatment included a hot pack for 10 minutes and back isometrics. Additionally, group A received conventional therapy, group B received conventional therapy along with back school exercises, and group 3 received Mckenzie exercises and conventional therapy. Each patient received treatment three times a week for of total 4 weeks. Roland Morris’s disability questionnaire was used to measure self-reported physical impairment due to low back pain. Moreover, a numeric pain rating scale was used to measure pain severity. Results: This study showed that patients receiving back school and Makenzie exercises showed marked improvement in pain and disability scores. Conclusion: This study concluded that Mckenzie exercises are more effective than back school exercises for the management of chronic nonspecific low back pain. That is because Mckenzie’s exercises not only decrease pain but equally improve, the flexibility and posture of the spine

Association of Dual Sensory Impairment with Cognitive Decline in Older Adults

Introduction: The prevalence of hearing and visual impairment (HI and VI) and dual sensory impairment (DSI), which is a combination of both, is increasing as the population ages. These sensory impairments are expected to increase the cognitive load of information processing from hearing and vision and impair appropriate cognitive processing. Although an association between DSI and cognitive decline has been reported, a more detailed study of the effects on each cognitive domain is required. This study aimed to investigate the prevalence of self-reported sensory impairment in community-dwelling older adults and to examine the impact of DSI on the severity of mild cognitive impairment (MCI) and on each cognitive domain (memory, attention, executive function, and processing speed). Methods: The participants were recruited from a sub-cohort of the National Center for Geriatric Gerontology-Study on Geriatric Syndromes (NCGG-SGS) conducted by the National Center for Geriatrics and Gerontology. We included 4,471 community-dwelling older adults (age: 75.9 ± 4.3 years; females: 52.3%) who fulfilled the inclusion criteria. The HI and VI were identified using a self-report questionnaire. Cognitive and other parameters were also assessed by trained staff. Logistic regression analysis was used to evaluate the relationship between the presence of HI and VI and the severity of MCI, and functional decline in each cognitive domain. Results: DSI was identified in 11.4% of community-dwelling older adults. Regarding sensory impairment and MCI severity, the odds ratio (OR) for single-domain MCI was significantly higher in VI (OR: 1.31; 95% CI: 1.06–1.61), and the OR for multiple-domain MCI was significantly higher in DSI (OR: 1.58; 95% CI: 1.10–2.29). In relation to the four cognitive domains, ORs for impaired executive function were higher for VI and DSI (VI, OR: 1.37; 95% CI: 1.09–1.72. DSI, OR: 1.39; 95% CI: 1.06–1.81). DSI also exhibited a higher odds ratio for reduced processing speed (OR: 2.03; 95% CI: 1.42–2.91). Discussion/Conclusion: DSI is predicted to increase as the population ages and is associated with various health problems. Further, DSI has been reported to decrease quality of life, which needed to establish appropriate treatment and prevention measures.

Relationship between self-reported hearing impairment and occupational exposure to aggressive agents in workers

The goal of this study was to estimate the relationship between self-reported hearing impairment and occupational exposure to too aggressive agents in Mosul workers. This is an analytical cross-sectional study was conducted in out-patient of Ibn Sina Teaching Hospital in City of Mosul, Iraq. Data collection: data were categorized into two parts; part one included information related to workers' socio-demographic characteristics like (age, gender, duration of working, work Environment, and specific diseases like hypertension). Part two included a hearing assessment. A Self-reported questionnaire (HHIE) which was developed by Ventry and Weinstein and its scores were classified based on American Speech-Language-Hearing Association (ASHA) draft guidelines, was used in the present study. A total of 500 workers participated in this study. The largest proportion of the sample was composed of men (63.7%). Regarding the occupational environment, 62 % of workers had between 0 and 4 years of work, followed by individuals with ten years or more (28%). In addition, there was a higher prevalence of closed work environments (50.5%). Among the most prevalent occupational exposures, 30.5% were exposed to noise, followed by chemical substances (17.3%) and industrial dust (8.2%). Difficulty hearing was reported by 8.2 % of participants.

Relationship between self-reported hearing impairment and occupational exposure to aggressive agents in workers

The goal of this study was to estimate the relationship between self-reported hearing impairment and occupational exposure to too aggressive agents in Mosul workers. This is an analytical cross-sectional study was conducted in out-patient of Ibn Sina Teaching Hospital in City of Mosul, Iraq. Data collection: data were categorized into two parts; part one included information related to workers' socio-demographic characteristics like (age, gender, duration of working, work Environment, and specific diseases like hypertension). Part two included a hearing assessment. A Self-reported questionnaire (HHIE) which was developed by Ventry and Weinstein and its scores were classified based on American Speech-Language-Hearing Association (ASHA) draft guidelines, was used in the present study. A total of 500 workers participated in this study. The largest proportion of the sample was composed of men (63.7%). Regarding the occupational environment, 62 % of workers had between 0 and 4 years of work, followed by individuals with ten years or more (28%). In addition, there was a higher prevalence of closed work environments (50.5%). Among the most prevalent occupational exposures, 30.5% were exposed to noise, followed by chemical substances (17.3%) and industrial dust (8.2%). Difficulty hearing was reported by 8.2 % of participants.

Assessing proprioceptive acuity in people with multiple sclerosis.

BackgroundProprioceptive acuity and impairments in proprioceptively guided reaches have not been comprehensively examined in people with multiple sclerosis (MS).ObjectiveTo examine proprioceptive acuity in people with MS who self-report and who do not self-report upper limb (UL) impairment, and to determine how people with MS reach proprioceptive targets.MethodsTwenty-four participants with MS were recruited into two groups based on self-reported UL impairment: MS-R (i.e. report UL impairment; n = 12) vs. MS-NR (i.e. do not report UL impairment; n = 12). Proprioception was assessed using ipsilateral and contralateral robotic proprioceptive matching tasks.ResultsParticipants in the MS-R group demonstrated worse proprioceptive acuity compared to the MS-NR group on the ipsilateral and contralateral robotic matching tasks. Analyses of reaches to proprioceptive targets further revealed that participants in the MS-R group exhibited deficits in movement planning, as demonstrated by greater errors at peak velocity in the contralateral matching task in comparison to the MS-NR group.ConclusionOur findings suggest that people with MS who self-report UL impairment demonstrate worse proprioceptive acuity, as well as poorer movement planning in comparison to people with MS who do not report UL impairment.

Associations of self-reported vision impairment with depression symptoms among middle-aged and older Chinese.

Vision impairment (VI) and depression are highly prevalent among adults. However, few nationally representative studies from China on the self-reported VI and its association with depression symptoms. This study re-estimated the relationship between self-reported VI and depression symptoms. In this analysis, 62,525 respondents from the China Health and Retirement Longitudinal Study 2011-2018 were included. Based on self-reports, respondents with VI were allocated to distance VI (DVI), near VI (NVI), both distance and near VI (DNVI), or a blindness group. Multivariable pooled logistic regression models were used to evaluate the groups' odds ratios (ORs) for depression symptoms and self-reported VI. Overall, 35.9% of the respondents were self-reported VI. DVI (OR: 1.51, 95% confidence interval [95% CI]: 1.28-1.79) and DNVI (OR: 1.51, 95% CI: 1.21-1.88) showed the highest ORs for depression symptoms, followed by NVI (OR: 1.31, 95% CI: 1.11-1.54). Depression symptoms were associated with a significantly increased risk of DVI (OR: 1.49, 95% CI: 1.26-1.76), DNVI (OR: 1.49, 95% CI: 1.20-1.86), and NVI (OR: 1.29, 95% CI: 1.10-1.52), respectively. However, these associations between self-reported blindness and depression symptoms were not significant. All models provided similar results by excluding respondents aged 45-59years. Self-reported DVI, NVI, and DNVI are associated with depression symptoms. A strong reverse association was found between depression and self-reported DVI, NVI, and DNVI, but not for blindness. Our findings emphasize the urgent need for depression screening for self-reported VI among Chinese adults.

Prevalence, causes, and impact of self-reported vision impairment among older people in China: Findings from the China health and retirement longitudinal study

This article investigated the prevalence, causes, and impact of self-reported vision impairment among older people in China. A total of 12,910 participants aged ⩾50 years were included in this study from China Health and Retirement Longitudinal Study (CHARLS) over the periods of 2011, 2013, and 2015. All data were reported by participants via a self-reported questionnaire. Distance vision was assessed by asking if they could see the face of a person on the other side of the street. Near vision was assessed by asking if they could read ordinary newspaper. Depressive symptoms were evaluated by 10-item Center for Epidemiological Studies Depression Scale. The analysis method included the χ2 – square distribution test and multiple regression analysis. This article first found that prevalence of self-reported vision impairment was much higher in rural than in urban areas; in urban areas, females had a greater chance of being affected than males, and for both sexes, it increases with increasing age. Second, some factors found are significantly associated with increased vision impairment rates, include increasing age, female gender, rural residents, elementary-level education, unmarried individuals, and non-agricultural occupations. Third, the leading cause of vision impairment was a refractive error and the most common causes of vision impairment include cataracts and glaucoma. Fourth, vision impairment was significantly associated with falls and depressive symptoms and has a negative effect on the quality of life of older Chinese. The article concluded that older people with self-reported vision impairment were relatively low and it is majorly caused by refractive error. Older people with distance vision impairment and near vision impairment were more likely to report falls and depressive symptoms in the future. In line with these findings, a couple of policy recommendations for further research were made.

Scalable psychological interventions for Syrian refugees: Preliminary results of a randomized controlled trial on the peer-refugee delivered Problem Management Plus (PM+) intervention in the Netherlands

Introduction In the past decade, millions of Syrians have sought refuge in neighboring countries and Europe. Refugees are at increased risk for the development of common mental disorders (CMD), such as depression and posttraumatic stress disorder (PTSD), but only a small percentage access mental health services. Problem Management Plus (PM+) is a brief, scalable intervention targeting symptoms of CMDs that can be delivered by non-specialist helpers in communities affected by adversity, such as refugees.ObjectivesThe aim of this randomized controlled trial (RCT) is to evaluate the effectiveness of PM+ among Syrian refugees in the Netherlands.MethodsAdult Syrian refugees and other Arabic-speaking refugees of 18 years and older with self-reported psychological distress (K10 &gt;15) and functional impairment (WHODAS 2.0 &gt;16) are included. Participants are randomized into PM+ or care as usual. Follow-up assessments are conducted at one-week, three-month and twelve-month follow-ups. Clinical outcomes are symptoms of depression/anxiety (HSCL-25), PTSD (PCL-5), and functional impairment (WHODAS 2.0).ResultsBy November 2021 [recruitment ends by December 2021], 214 participants were screened for eligibility and 184 participants were included. Participants are M=36.5yrs old (range 18-69yrs), and 73 participants are female (39.7%). We will present preliminary results for the effects of PM+ on depression, anxiety, PTSD, and functional impairment at one-week follow-up, as well as barriers and facilitators for implementing PM+ in a European country.ConclusionsAfter positive evaluation of peer-refugee delivered PM+, the Arabic manual and training materials will be made available through WHO to encourage scaling-up.DisclosureNo significant relationships.

Vision Impairment and Patient Activation among Medicare Beneficiaries

ABSTRACT Purpose Low patient activation is associated with poor patient outcomes. People with vision impairment may have low patient activation as a result of communication and access barriers. We examined the association of patient activation with vision impairment. Methods Cross-sectional study using the 2016 Medicare Current Beneficiary Survey. Older Medicare beneficiaries, without dementia, who completed the topical patient activation questionnaire were included. The primary exposure was self-reported vision impairment (no vision impairment, a little vision impairment, a lot of vision impairment), and the secondary exposure was dual sensory impairment (no sensory impairment, vision impairment only, hearing impairment only, dual sensory impairment). Patient activation scores were categorized as low, moderate, or high based on their distribution around the mean. Multivariable-adjusted ordinal regression models examined the association of patient activation with vision impairment, and then with dual sensory impairment. Results In total, 6,683 participants were included. Those with a little vision impairment had 20% lower odds of higher patient activation (odds ratio [OR] = 0.80, 95% confidence interval [CI] = 0.71–0.90), and those with a lot of vision impairment had 26% lower odds of higher patient activation (OR = 0.74, 95% CI = 0.55–0.98). In the second model, having vision or hearing impairment only was associated with lower odds of higher activation than having no sensory impairment. Having dual sensory impairment was associated with even lower odds of higher activation. Conclusion Older Medicare beneficiaries with sensory impairment may be a group to target to improve patient activation levels, which could potentially improve health outcomes and health care utilization patterns in this population.

Genome-wide association meta-analysis identifies 48 risk variants and highlights the role of the stria vascularis in hearing loss

SummaryHearing loss is one of the top contributors to years lived with disability and is a risk factor for dementia. Molecular evidence on the cellular origins of hearing loss in humans is growing. Here, we performed a genome-wide association meta-analysis of clinically diagnosed and self-reported hearing impairment on 723,266 individuals and identified 48 significant loci, 10 of which are novel. A large proportion of associations comprised missense variants, half of which lie within known familial hearing loss loci. We used single-cell RNA-sequencing data from mouse cochlea and brain and mapped common-variant genomic results to spindle, root, and basal cells from the stria vascularis, a structure in the cochlea necessary for normal hearing. Our findings indicate the importance of the stria vascularis in the mechanism of hearing impairment, providing future paths for developing targets for therapeutic intervention in hearing loss.

Longitudinal relationship between sensory impairments and depressive symptoms in older adults: The mediating role of functional limitation.

The underlying mechanism between sensory impairments (SIs) and depressive symptoms among Chinese older adults is not well understood. This study aims to explore the mediating role of functional limitation on the longitudinal relationship between SIs and depressive symptoms among older adults in China. A total of 4130 older adults who participated in the 3-year follow-up China Health and Retirement Longitudinal Study (CHARLS) were included in the analysis. The hierarchical multiple linear regression model and nonparametric bootstrapping method were employed to explore the relationship between SIs and depressive symptoms, and the mediating role of functional limitation in this link. The prevalence of self-reported hearing impairment (HI) only, vision impairment (VI) only, and dual sensory impairment (DSI) at baseline were 5.7%, 22.2%, and 58.6%, respectively. After adjusting for controlling variables, older adults with DSI hadsignificantly higher levels of depressive symptoms compared with those without SIs at baseline (β = .07, p = .005). The magnitude of mediation effect from DSI to depressive symptoms via functional limitation was a*b = 0.060 (BCa 95% confidence interval: 0.031-0.094). Functional limitation partially mediated the relationship between DSI and depressive symptoms among Chinese older adults. Interventions of DSI and functional limitation should be included in depressive symptoms prevention among older adults in China.

Brain-predicted Age Difference Mediates the Association between Self-reported Pain and PROMIS Sleep Impairment in Persons with Knee Osteoarthritis.

Knee osteoarthritis (KOA) is the most common cause of musculoskeletal pain (MSK), constituting a major public health burden. Sleep is among the multiple factors contributing to KOA-related pain, as sleep disturbance increases risk for worse pain-related outcomes in KOA. In addition, our lab found that brain cortical structure mediated the relationship between sleep qualities and pain severity in older adults with MSK. Further, using a machine-learning-based brain-aging biomarker (brain-PAD; brain-predicted age minus chronological age), we also found that individuals with high-impact KOA pain showed greater brain aging than their low-impact pain counterparts. Considering this, we examined whether brain-PAD mediated the relationship between KOA pain and sleep problems. KOA participants (mean age 57.9 years) were classified into low-impact (n=87), and high-impact (n=60) pain. Demographic, pain and sleep assessments were followed by a T1-weighted anatomical scan. Exploratory Spearman and Pearson partial correlations, controlling by age, sex and race, were used to determine associations of brain-PAD with clinical pain and sleep measures. We then tested if brain-PAD mediated the sleep-pain association using PROCESS 3.5 on SPSS 28. Brain-PAD correlated with the affective domain of the McGill Pain Questionnaire (MPQ) (r=0.215, p=0.010) and MPQ total score (r=0.181, p=0.033). Moreover, Brain-PAD significantly mediated (bootstrapped 95% CIs p<0.05) the effect of the short form PROMIS Sleep impairment total score on the MPQ affective, continuous and total score. Brain-PAD did not significantly mediate the sleep-pain effect. Our finding in this KOA sample extends our prior work demonstrating advanced brain aging among older individuals with chronic pain and more pain severity, implicating brain-PAD as a significant mediator of the sleep-KOA pain association. Future replication studies are needed, as well as studies to further understand if the brain can be a therapeutic target to reverse the possible effect of sleep problems on chronic pain. Funding from NIAR01AG067757.

Associations Between Intrinsic Capacity and Adverse Events Among Nursing Home Residents: The INCUR Study.

The predictive ability of the novel intrinsic capacity (IC) construct has been scarcely investigated in the nursing home setting. The objective of this study was to investigate the associations of IC and its individual domains with mortality, hospitalization, pneumonia onset, and functional status decline in a population of nursing home residents (NHRs). We undertook an analysis using data from the INCUR study, a prospective observational study. Data were collected at baseline, at 6 and 12months by trained staff. A total of 371 NHRs (mean age 85.91 ± 7.34) dwelling in Southern France. A baseline IC composite score was constructed from scores in the Short Physical Performance Battery, Abbreviated Mental Test, 10-item Geriatric Depression Scale, The Short Form of the Mini-Nutritional Assessment, and self-reported hearing and vision impairments. Adverse outcomes were registered by medical records checking. Functional status evolution was evaluated through changes in the Katz Index. Cox regression was used for associations between IC and its domains and adverse outcomes. Linear mixed models were used in the case of functional status evolution. Our analysis revealed associations between a composite score of IC and death [hazard ratio 0.33; 95% confidence interval (CI) 0.15-0.73] and functional status evolution (β= 0.14; 95% CI 0.018-0.29) in our population. Although greater values in IC vitality/nutrition domain were associated with survival (HR 0.84; 95% CI 0.70-0.99), IC cognitive domain was associated with decreased odds of hospitalization (HR 0.91; 95% CI 0.84-0.99) and lower declines in functional status (β= 0.04; 95% CI 0.01-0.07), whereas the IC locomotion domain was inversely associated with pneumonia incidence (HR 0.84; 95% CI 0.72-0.98). Our results contribute to preliminary evidence linking greater IC levels and lower risk of late-life adverse outcomes.