Subgroups Of Adults Research Articles

DETERMINANTS OF POSITIVE MARITAL QUALITY AMONG OLDER HISPANIC ADULTS IN THE US

Abstract Marital Quality can significantly influence a variety of health and well-being outcomes in later life. Yet, relatively little is known about how marital quality is determined across subpopulations given their cultural backgrounds. Social networks and familial relationships are culturally important to Hispanic adults over their life course. Also, the unique characteristics (e.g., high % of immigrants) of older Hispanic adults in the U.S. may make their determinants of marital quality different from others. Considering approximately one in three older Hispanic adults is an immigrant in the U.S., this subpopulation may have relatively small social networks as their family members live in their countries of origin. As such, sub-groups of married older Hispanic adults may depend more on their marital relationships for social and cultural support, compared to other racial and ethnic groups. Framed by socioemotional selectivity theory, this study aimed to investigate determinants of marital quality among older Hispanic adults (age 51 and older). Nationally representative samples of older Hispanic adults (n = 694) were derived from the 2010 Health and Retirement Study (HRS). Results from linear regression analysis indicated that women (b = -0.16, p < 0.05) reported lower positive marital quality than men. There was also a statistically significant negative association between depressive symptoms (b = -0.09, p < 0.05) and positive marital quality. This study further evaluated other marital quality determinants, gender differences, and possible sociocultural explanations.

USING NETWORK ANALYSIS TO EXPLORE DIFFERENCES IN DIETARY INTAKES ACROSS OLDER ADULTHOOD

Abstract Federal nutrition guidance in the Unites States (US) is based on the premise that healthy diets can help delay the onset or progression of age-related disease and disability. Yet, little is known about if or how dietary intakes differ across the older adulthood age span. We used NHANES 2015-2016 and 2017-March 2020 data to examine the dietary intakes of 60-69 year old (n=2079), 70-79 year old (n=1181) and 80+ year old (n=644) adults in the US. Mutual information was used to infer network relationships among all possible pairs of fourteen What We Eat in America food group categories. Based on edge weights, we observed some similarities and some differences in the manner in which food groups were co-consumed across older adulthood. For example, fruit and dairy were co-consumed similarly in the three age groups. Among the 60-69 and 70-79 year olds, protein and vegetables were co-consumed, while fruits were consumed with grains and mixed dishes. However, in the 80+ year olds, vegetables were mostly consumed with fats and oils, but less so with protein, and grains were consumed with dairy, but less so with fruit. Based on a network science approach, the manner in which food groups are consumed appears to change throughout older adulthood. Future studies are needed to evaluate consumption patterns of specific foods among age-defined and other subgroups of older adults and explore potential associations with age-related health outcomes.

HOME MODIFICATION ON FAVORITE ACTIVITY AND SELF-EFFICACY AMONG OLDER ADULTS WITH DEMENTIA

Abstract Globally, most older people with dementia live at home and want to remain at home as long as possible with a sense of agency, and engagement in preferred everyday activities. To remain at home, a safe and supportive home environment is crucial as dementia progresses. Yet research on environmental modification among people with dementia is focused on neighborhood or urban built environment, and less on home modification. Guided by the ecological model of aging, this study aimed to explore the impact of home modification on both affective (e.g., self-efficacy) and adaptive behavioral (e.g., favorite activities) responses as a result of person-environmental fit among people living with dementia. Using two waves (2018-2019) data from the National Health and Aging Trends Study (NHATS), we examined the extent to which home modification is associated with self-efficacy and engagement in favorite activities. Multi-group structural equation modeling was conducted on 273 older adults living with dementia in the communities, comparing 145 with functional limitations and 129 without. Although home modification did not affect one’s self-efficacy in any group, a positive impact of home modification on engaging favorite activities, especially those that require more physical effort (e.g., active leisure), was significant among older people with dementia with functional difficulties (p< 0.01). Our finding points to the importance of home modification for the most vulnerable subgroup of older adults with dementia, not only ensuring physical safety at home but their continued engagement in the activities meaningful for them, thereby helping them age in place.

SUBSIDIZED SENIOR HOUSING IN THE U.S.: A SCOPING REVIEW

Abstract Although Subsidized Senior Housing (SSH) has been considered an important model to promote healthy aging among vulnerable subgroups of older adults, progress in developing, expanding, and improving SSH has been limited compared to other housing models. A comprehensive review of the recent knowledge base is a critical step toward developing and expanding policies and programs for senior housing for low-income older adults. This scoping review used a five-stage scoping review methodology to answer two research questions: 1) What are the trends in SSH empirical studies? 2) What are the main topics in the existing literature on SSH in the US? This review explores the social, physical, and service environments related to SSH in older adults in the US. Personal and environmental factors were key in examining study outcomes or main focus. We reviewed a total of 61 articles and found several notable trends, including a focus on racial and ethnic minorities, cognitive impairment among SSH residents, and Collaborative partnerships between housing operators and healthcare providers. More than half of the studies (54%) were quantitative, while the rest were qualitative (38%) or mixed-methods (8%). The lack of longitudinal or causal design research reflects the limited empirical knowledge of SSH. Four themes emerged: health and well-being (52.5%), healthcare use and health behaviors (31.1%), social relations (8.2%), and housing relocation (8.2%). We discussed implications for future research and program development efforts in SSH. Future research should explore the fit between individual characteristics and the multiple-factor environmental context.

HOME BUT HOMEBOUND AFTER TBI: PREVALENCE AND CORRELATES OF HOMEBOUNDNESS AFTER TBI

Abstract Discharge home following post-acute care for traumatic brain injury (TBI) has historically been viewed as an unequivocally positive post-treatment outcome. Payors incentivize hospitals to discharge patients home and minimize readmissions. A historically overlooked topic in post-acute TBI care is homeboundness, which is the state where an individual rarely or never leaves home. Homeboundness is associated with premature mortality and poor physical and mental health. Our study investigates the prevalence and correlates of homeboundness among 6,595 non-institutionalized adults (mean age=42, range 16-99) who received inpatient rehabilitation for TBI in the TBI Model Systems National Database, a multicenter prospective cohort study. Our definition of homebound was based on self-reported number of days participants get out of the house in a typical week. We found that 14.2% of participants were completely homebound (never left the home) or partially homebound (left the home 1-2 times/week) 1-year after TBI. Using multivariable regression, we found the following variables were significantly associated with being completely/partially homebound at 1-year post-injury: older age, < college degree, Medicaid insurance, living alone and rural settings, not driving independently, and having functional needs for walking, upper body dressing, bowel and bladder, problem solving, and social interactions. These variables together had an area-under-the-curve of 0.81 distinguishing homeboundness. Our study elucidates an invisible subgroup of non-institutionalized adults living with TBI in the community who require ongoing support services or other follow-up care to improve functional status and participation. Implications for community integration will be discussed.

RACE/ETHNICITY DISPARITY FOR PEOPLE WITH LTSS NEEDS IN CALIFORNIA: DISABILITY, FINANCE, AND HEALTH AND WELL-BEING

Abstract Older adults and people with disabilities have high needs for Long-Term Services and Supports (LTSS). Disability status, financial difficulties, and health and well-being are likely not uniformly experienced by all people with LTSS needs. Subgroups of older adults and people with disabilities, such as racial/ethnic minorities, may be at significant risk of experiencing financial difficulties and stress about making ends meet. This study used the first cycle of data (2019-2020) from the California Long-Term Services and Supports (CA-LTSS) survey, merged with select data from the California Health Interview Survey (CHIS) (N = 2,030). Multivariate Regressions and Conditional Process Analysis (CPA) were applied to test the hypothesized relationships. Findings show that black/African American and Asian participants with LTSS needs were more likely to have cognitive impairments. Black/African American participants with LTSS needs were more likely to report difficulties in activities of daily living. Racial/ethnic minorities with LTSS needs experienced diverse and more financial difficulties on average than their white counterparts. Asian participants with LTSS needs reported worse psychological distress than other racial/ethnic groups. American Indians and Alaska Natives with cognitive impairments were more likely to have more financial difficulties, and those with difficulty in instrumental activities of daily living were more likely to report worse self-rated health. This study moves beyond the typical white/black disparities analyses and focuses on diverse racial/ethnic groups. We need to address the financial needs of various racial/ethnic groups of people with LTSS needs and target policies and service programs to meet their mental health needs.

Subsidized Senior Housing in the US: A Scoping Review.

Subsidized senior housing (SSH) is important to support healthy aging among vulnerable subgroups of older adults, yet progress in developing and expanding SSH has been limited. This scoping review had two research questions: (1) What are the trends in SSH empirical studies? (2) What are the main topics in the existing literature on SSH in the US? We reviewed a total of 61 articles and found several notable trends, including a focus on racial and ethnic minorities, cognitive impairment among SSH residents, and collaborative partnerships between housing operators and healthcare providers. More than half of the studies were quantitative, while the rest were qualitative or mixed-methods. The lack of longitudinal or causal design research reflects the limited empirical knowledge of SSH. Four themes emerged: health and well-being, healthcare use and health behaviors, social relations, and housing relocation. We discussed implications for future research and program development efforts in SSH.

Do the New Rural Pension Scheme promote the health status of chronic patients in old age? —Evidence from CHARLS 2018 in China

BackgroundMany researchers have examined the impact of social insurance on health in elderly. However, in most cases, they have only demonstrated correlational results and have not been able to determine causal effects, possibly because confounding biases have not been fully addressed. In this study, we investigated the health effects of the New Rural Pension Scheme (NRPS) on the elderly (age≥60 years old) with chronic diseases in rural areas, and to explore the causal relationship and effects of NRPS and health status.MethodsThis paper used data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) and applied Bayesian networks and fuzzy regression discontinuity design to conduct causal analysis. Bayesian networks were used to explore the causal directed acyclic graphs of factors related to NRPS and health status. Based on the results of Bayesian network, a fuzzy regression discontinuity design was employed to estimate the causal effect of NRPS on health status.ResultsAmong rural elderly with chronic diseases, Bayesian network mapping of causal relationships among NRPS, health status and covariates showed that age was a common cause of NRPS receipt and satisfaction with health. The results of the fuzzy regression discontinuity analysis showed that the effect of receiving NRPS on the health status was positive, but there was no statistically significant difference concerning the interval estimates. The results of the subgroup analysis with chronic obstructive pulmonary disease (COPD) and asthma indicated that the effect of NRPS receipt on the health status of elderly people with COPD was positive. There was a statistically significant effect of receiving NRPS on self-rated health description (β1=3.653,P=0.032\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\beta }_{1}=3.653,P=0.032$$\\end{document}) and health satisfaction (β1=4.204,P=0.033\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\beta }_{1}=4.204,P=0.033$$\\end{document}) in COPD population and a statistically significant effect of receiving NRPS on health satisfaction in asthma population (β1=9.844,P=0.008\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\beta }_{1}=9.844,P=0.008$$\\end{document}).ConclusionThis paper has confirmed the contribution and positive causal effect of NRPS on health status in a subgroup of older adults with COPD and asthma, using the CHARLS database as evidence. Thus, Chinese government should increase the take-up rate of the NRPS to enhance their positive impact on health status of elderly people with chronic diseases in rural areas.

Pharmaceutical Agents as Potential Drivers in the Development of Early-Onset Colorectal Cancer: Case-Control Study.

The incidence of early-onset colorectal cancer (EOCRC) rose abruptly in the mid 1990s, is continuing to increase, and has now been noted in many countries. By 2030, 25% of American patients diagnosed with rectal cancer will be 49 years or younger. The large majority of EOCRC cases are not found in patients with germline cancer susceptibility mutations (eg, Lynch syndrome) or inflammatory bowel disease. Thus, environmental or lifestyle factors are suspected drivers. Obesity, sedentary lifestyle, diabetes mellitus, smoking, alcohol, or antibiotics affecting the gut microbiome have been proposed. However, these factors, which have been present since the 1950s, have not yet been conclusively linked to the abrupt increase in EOCRC. The sharp increase suggests the introduction of a new risk factor for young people. We hypothesized that the driver may be an off-target effect of a pharmaceutical agent (ie, one requiring regulatory approval before its use in the general population or an off-label use of a previously approved agent) in a genetically susceptible subgroup of young adults. If a pharmaceutical agent is an EOCRC driving factor, regulatory risk mitigation strategies could be used. We aimed to evaluate the possibility that pharmaceutical agents serve as risk factors for EOCRC. We conducted a case-control study. Data including demographics, comorbidities, and complete medication dispensing history were obtained from the electronic medical records database of Maccabi Healthcare Services, a state-mandated health provider covering 26% of the Israeli population. The participants included 941 patients with EOCRC (≤50 years of age) diagnosed during 2001-2019 who were density matched at a ratio of 1:10 with 9410 control patients. Patients with inflammatory bowel disease and those with a known inherited cancer susceptibility syndrome were excluded. An advanced machine learning algorithm based on gradient boosted decision trees coupled with Bayesian model optimization and repeated data sampling was used to sort through the very high-dimensional drug dispensing data to identify specific medication groups that were consistently linked with EOCRC while allowing for synergistic or antagonistic interactions between medications. Odds ratios for the identified medication classes were obtained from a conditional logistic regression model. Out of more than 800 medication classes, we identified several classes that were consistently associated with EOCRC risk across independently trained models. Interactions between medication groups did not seem to substantially affect the risk. In our analysis, drug groups that were consistently positively associated with EOCRC included beta blockers and valerian (Valeriana officinalis). Antibiotics were not consistently associated with EOCRC risk. Our analysis suggests that the development of EOCRC may be correlated with prior use of specific medications. Additional analyses should be used to validate the results. The mechanism of action inducing EOCRC by candidate pharmaceutical agents will then need to be determined.

Bilateral and synchronous “dents de scie” spikes: A highly specific EEG pattern of young adult Dravet syndrome

BackgroundIn Dravet syndrome (DS), EEGs evolve over time. ObjectiveTo describe a peculiar EEG pattern in two adults with a de novo SCN1A gene mutation, in exon 5 (case 1) and 9 (case 2). MethodsTwo female patients underwent a prolonged video EEG (24 h) as part of their epilepsy assessment. ResultsIn both cases, the EEG showed a very peculiar and stereotypical pattern of bilateral synchronous spikes at about 5–6 Hz. This activity was present during wakefulness and highly activated at sleep onset and in NREM sleep, which could show nearly continuous spike activity. This activity dramatically decreased in REM sleep and after awakening. This pattern of “dents de scie” (sawtooth) spikes maintained the same morphology throughout the entire EEG recording. In both patients, the spikes were favored by passive eye closure. During wakefulness, the spikes could evolve into atypical absences while keeping the same “dents de scie” pattern. Neither patient had tonic or myoclonic seizures at the time of the EEG assessment. Both were moderately retarded, and neither one had a typical DS gait disorder. Previous EEG recordings of case 1 performed at 9.5 and 18.5 years showed spike-waves, but the morphology did not correspond to the EEG recording observed at 22 years. ConclusionsBoth patients have a similar electro-clinical phenotype. This “dents de scie” pattern appears to be very specific and could be pathognomonic in a subgroup of young adults with DS. Results of sleep EEG recording could be added to the diagnostic criteria for this syndrome.

Insight into age-related changes of the human facial skeleton based on medieval European osteological collection

Aging changes in the facial skeleton are concentrated mostly in orbits, maxilla and mandible. The aim of this study was to analyze metric traits of the adult viscerocranium in a medieval sample from Cedynia (Poland, Central Europe) and confront the results with literature data for modern populations. It was assumed that diet-related greater biomechanical forces generated during mastication in medieval versus modern times led to slower rate of bone resorption with age. 3D models of the facial skeleton are created for 230 individuals, categorized into young, middle and old adults, and a subgroup of edentulous middle adults is distinguished. Orbits, piriform aperture, maxilla and mandible are measured using Geomagic Studio 12 and analyzed among age categories as well as dentate and edentulous subgroups. The values of the orbital and piriform aperture measurements tend to increase with age and reached statistical significance in males (right orbit height, left orbit width, piriform aperture surface area). In females, maxillary height significantly decrease at right first premolar and first molar, together with height of the right mandibular ramus. In edentulous individuals of both sexes the orbits are wider, and maxillary and mandibular heights are lower than in dentate individuals. This study reveals similar character and direction of the aging process of the facial skeleton in medieval and modern adults, however slower rate of resorptive changes is found in the former sample, which suggests, that diet-related biomechanical forces can influence intensification of the aging processes in the facial skeleton.

Increased cerebral lactate levels in adults with autism spectrum disorders compared to non-autistic controls: a magnetic resonance spectroscopy study

IntroductionAutism spectrum disorder (ASD) encompasses a heterogeneous group with varied phenotypes and etiologies. Identifying pathogenic subgroups could facilitate targeted treatments. One promising avenue is investigating energy metabolism, as mitochondrial dysfunction has been implicated in a subgroup of ASD. Lactate, an indicator of energy metabolic anomalies, may serve as a potential biomarker for this subgroup. This study aimed to examine cerebral lactate (Lac+) levels in high-functioning adults with ASD, hypothesizing elevated mean Lac+ concentrations in contrast to neurotypical controls (NTCs).Materials and methodsMagnetic resonance spectroscopy (MRS) was used to study cerebral Lac+ in 71 adults with ASD and NTC, focusing on the posterior cingulate cortex (PCC). After quality control, 64 ASD and 58 NTC participants remained. Lac+ levels two standard deviations above the mean of the control group were considered elevated.ResultsMean PCC Lac+ levels were significantly higher in the ASD group than in the NTC group (p = 0.028; Cohen’s d = 0.404), and 9.4% of the ASD group had elevated levels as compared to 0% of the NTCs (p = 0.029). No significant correlation was found between blood serum lactate levels and MRS-derived Lac+ levels.LimitationsA cautious interpretation of our results is warranted due to a p value of 0.028. In addition, a higher than anticipated proportion of data sets had to be excluded due to poor spectral quality.ConclusionThis study confirms the presence of elevated cerebral Lac+ levels in a subgroup of adults with ASD, suggesting the potential of lactate as a biomarker for mitochondrial dysfunction in a subgroup of ASD. The lower-than-expected prevalence (20% was expected) and moderate increase require further investigation to elucidate the underlying mechanisms and relationships with mitochondrial function.

Typologies of dependency, household characteristics, and disparity in formal and informal care use: analysis of community-dwelling long-term care insurance claimants in an urban municipality of China

BackgroundA comprehensive understanding of subgroups of community-dwelling older adults and their long-term care (LTC) utilization can help to promote equality in the long-term services and support system. Dependency and household characteristics were found to affect the LTC utilization of homebound older adults. However, few studies considered the typologies of dependency of older populations according to co-occurring limitations, and little is known about differences in LTC use among elderly of typologies of dependency under distinct household conditions.MethodsWe aimed to identify typologies of dependency of older adults living at home and explore the disparities in formal care and informal care use among typologies of dependency by income and living situation. In this cross-sectional study, we used the public long-term care insurance (LTCI) database of Yiwu, Zhejiang Province, China, and included 1675 individuals aged ≥ 60 years living at home. Cluster analysis was conducted to determine typologies of dependency among older adults. A two-step multilevel analysis was used to examine disparities in formal and informal care use related to household income and living status among typologies of dependency.ResultsSeven dependency clusters were identified. Pro-wealthy inequalities in both formal and informal care use were found in the least dependent cluster and the limited-locomotion cluster. Pro-poor inequalities in formal care use were found in the fully dependent cluster without impaired vision and the cluster with intact continence and vision. Living with family members was positively associated with receiving formal care for the fully dependent cluster. Older adults in most clusters were more likely to use informal care when living with family members, except for the least dependent cluster and the limited-locomotion cluster.ConclusionsOur findings suggest that household inequalities in LTC use varied among typologies of dependency of older adults, which may provide insights for researchers and policymakers to develop tailored LTC and targeted LTCI programs for older adults living at home and their family caregivers, considering both typologies of dependency and household characteristics.

Initiation of Disease-Modifying Antirheumatic Drugs in Older Medicare Beneficiaries With New Diagnosis of Late-Onset Rheumatoid Arthritis.

Older adults with rheumatoid arthritis (RA) account for up to one-third of the RA population and are less likely to receive optimal treatment. For the subgroup of older adults with late-onset RA (LORA), who experience more symptomatic and progressive disease, suboptimal treatment could be more consequential than the general population who age with RA. We evaluated use of disease-modifying antirheumatic drugs (DMARDs) in older adults with a new diagnosis of LORA. In this retrospective observational study, we identified adults 66 years of age or older with a new diagnosis of LORA using Medicare data from 2008 to 2017. Information on baseline patient characteristics and DMARD initiation during the first 12 months after LORA diagnosis were collected. We also assessed concomitant use of glucocorticoids (GCs). We identified 33,373 older adults with new diagnosis of LORA. Average age at LORA diagnosis was 76.7 (SD 7.6); 75.4% were female, 76.9% were White, and 35.6% had low-income subsidy (LIS). Less than one-third were initiated on a DMARD (28.9%). In multivariable analyses, DMARD initiation was associated with younger age, fewer comorbidities, and absence of LIS status. Concomitant long-term (>3 months) GC use was higher among those on any DMARD (44.3%) compared with those without (15.2%). DMARD initiation after new diagnosis of LORA is low despite current clinical practice guidelines recommending early aggressive initiation of treatment. Long-term GC use is common among those on any DMARDs, raising concern for suboptimal DMARD use. Further studies are needed to understand drivers of DMARD use in older adults.

Sociodemographic and Health Indicators of Diet Quality in Pre-Frail Older Adults in New Zealand.

We collected detailed dietary intake from pre-frail (FRAIL scale 1-2) older adults using NZ Intake24, an online version of 24 h multiple pass dietary recall. Diet quality was ascertained with the Diet Quality Index-International (DQI-I). We used regression generalized linear models to determine predictors of diet quality as well as classification and regression tree (CART) analysis to examine the complex relationships between predictors and identified profiles of sub-groups of older adults that predict diet quality. The median age in this sample (n = 468) was 80.0 years (77.0-84.0). Living with others, a high deprivation index and a higher BMI were independent predictors of poorer diet quality. With CART analysis, we found that those with a BMI > 29 kg/m2, living with others and younger than 80 years were likely to have a lower diet quality. We found that BMI, living arrangement and socioeconomic status were independent predictors of diet quality in pre-frail older adults, with BMI being the most important variable in this sample when the interaction of these variables was considered. Future research is needed to determine the similarities and/or differences in the profile of subgroups of older adults with poorer diet quality.

Who crashes their car following wrist fracture?

BackgroundWrist fractures are common injuries associated with high disability in the early recovery period. The impact of wrist fractures on safe return to drive is not understood. Purpose(1) To compare the proportion of adults who were drivers in car crashes before and after wrist fracture; (2) To examine potential factors (demographic and/or clinical) associated with increased odds of being a driver in a car crash following wrist fracture. Study DesignRetrospective cohort study. MethodsThree state-wide government datasets (MainRoads Western Australia [WA], Hospital Morbidity Data Collection and the Emergency Department Data Collection) were used to obtain and link demographic, clinical and car crash information relating to adults with a wrist fracture sustained between 2008 and 2017. McNemar’s tests were used to compare the proportion of drivers in a car crash within the 2 years prior to and following the fracture date. Multivariable logistic regressions were used to identify if any variables were associated with increased odds of crashing in the post-fracture period. ResultsData relating to 37,107 adults revealed a 3.3% (95% CI 3.0%–3.6%, p < 0.05) decrease in the proportion of drivers in a car crash following wrist fracture, persisting for the entire 2 years post-fracture, when compared to the proportion who crashed before their fracture. Those with more severe wrist fracture injury patterns had 79%(95% CI 1.07–3.0, p = 0.03) higher odds of having a crash in the first 3 months following their injury, compared to those with isolated wrist fracture injuries. ConclusionsThese results inform and update return to drive recommendations. The reduced proportion of drivers involved in crashes following wrist fracture persisted for 2 years; longer than the expected physical recovery timeframe. It is important that hand therapists actively educate the sub-group of adults with more severe wrist fracture injury patterns of the increased likelihood of car crash for the 3 months following their fracture.

Allocation of cognitive resources for older adults with normal or impaired hearing when listening to temporally degraded and masked speech

Hearing impairment may affect how older listeners allocate cognitive resources when communicating in challenging environments. Older adults with normal or impaired hearing completed three speech recognition studies. The studies consisted of 15-16 measures of temporally filtered speech with (1) degraded spectral cues, (2) competing speech-modulated noise, and (3) speech vocoding in speech-modulated noise. Generalization was assessed with measures of speech interruption, segregation, and multitalker masking. To account for audibility differences, all listeners received spectral shaping fit to their hearing thresholds. Measures in each study were reduced to a single principal component (PC) that represented speech recognition abilities. Participants also completed a cognitive test battery that yielded domain-specific PCs and a measure of speech glimpsing. For each study, hierarchical linear regression analysis was completed separately for subgroups of older adults with normal or impaired hearing using cognitive PCs as predictor variables, followed by speech glimpsing, age, and hearing thresholds. Vocabulary knowledge was the best predictor of speech recognition for older adults with normal hearing, whereas working memory consistently explained ∼30%-40% of the variance in recognition for older adults with hearing loss. Thus, even with sufficient audibility, hearing impairment may alter allocation of cognitive resources for older adults listening to degraded speech.

Factors associated with Suicidal Ideation among Older Adults in the Community Using Data from the 2021 Community Health Survey

Purpose: The purpose of this study was to report the level of suicidal ideation in older Korean adults living in the community and identify the factors associated with suicidal ideation.Methods: A total of 73,326 older adults were selected and analyzed using the 2021 Community Health Survey. The collected data were analyzed using the Rao-scott test and logistic regression using SAS 9.4.Results: Among older adults, 9.2% had suicidal ideations. Life dissatisfaction was the factor most strongly associated with suicidal ideation, followed by depression, poor subjective health, high stress, cognitive disability, lower economic state, living alone, older age, smoking, low education, older women, and diabetes.Conclusion: When developing suicide preventive interventions for older adults, it is important to consider mental health indicators, such as life satisfaction, depression, and stress. In addition, active efforts to identify more vulnerable subgroups of older adults should consider older individual adult’s economic status, family structure, age, and education rather than taking a generalized approach.

Longitudinal Associations Between Higher Self-Reported Energy, Gait Speed, and Cognition in Older Adults With Fatigue.

Older adults reporting higher energy levels have better physical function. It is not known if these associations persist among older adults reporting fatigue or if higher energy is associated with cognitive function. We examined longitudinal associations between self-reported energy, gait speed, and cognition, stratified by fatigue, in 2 613 participants (aged 74.6 ± 2.87 years) in the Health, Aging and Body Composition Study. Self-reported energy (0-10, dichotomized at median) and fatigue (present/absent) were measured at baseline. Usual and rapid-paced gait speed (m/s), modified Mini-Mental State Examination (3MS), and Digit Symbol Substitution Test (DSST) were measured at baseline and annually over 8 years. Linear mixed effect models compared changes in gait speed, 3MS, and DSST between higher and lower energy groups within fatigue strata. At baseline, 724 participants (27%) were fatigued; 240 (33%) coreported higher energy (9% of total). The remaining 1 889 participants were fatigue-free (73%); 1 221 (65%) coreported higher energy (47% of total). Those with fatigue and higher energy had average rapid gait declines of 0.007 m/s per year (p = .04) after adjustment for demographics, comorbidities, depressive symptoms, and exercise. DSST declines were found among only fatigue-free participants (β = 0.17, p = .01). No statistically significant associations with energy were found for fatigue-free participants, or for usual gait or 3MS. Asking about older adults' energy levels as well as fatigue may identify a subgroup of older adults protected against physical and cognitive decline, even among those with fatigue.

Comparison of network structures between autistic and non-autistic adults, and autism subgroups: A focus on demographic, psychological, and lifestyle factors.

There are large differences in the level of demographic, psychological, and lifestyle characteristics between autistic and non-autistic adults but also among autistic people. Our goal was to test whether these differences correspond to differences in underlying relationships between these characteristics-also referred to as network structure-to determine which characteristics (and relationships between them) are important. We tested differences in network structure in (1) autistic and non-autistic adults and (2) two previously identified subgroups of autistic adults. We showed that comparing networks of autistic and non-autistic adults provides subtle differences, whereas networks of the autism subgroups were similar. There were also no sex differences in the networks of the autism subgroups. Thus, the previously observed differences in the level of characteristics did not correspond to differences across subgroups in how these characteristics relate to one another (i.e. network structure). Consequently, a focus on differences in characteristics is not sufficient to determine which characteristics (and relationships between them) are of importance. Hence, network analysis provides a valuable tool beyond looking at (sub)group level differences. These results could provide hints for clinical practice, to eventually determine whether psychological distress, cognitive failures, and reduced quality of life in autistic adults can be addressed by tailored support. However, it is important that these results are first replicated before we move toward intervention or support.