Values For Older Adults Research Articles

Southwestern Assessment of Processing Speed (SWAPS): A new brief test with demographically-corrected norms in an ethnically and educationally diverse population

Objective. Neuropsychological measures of processing speed have long been used as sensitive indices of cognitive functioning. Most of these commonly used tests are proprietary, and there is a need for brief, freely available tools that can be used in diverse clinical and research settings. The Southwestern Assessment of Processing Speed (SWAPS) is a 60-second digit-symbol transcription task developed as a brief alternative to commercially available coding tests. Demographically-corrected normative data are presented along with reliability and sensitivity/specificity values in older adults with and without cognitive impairment. Method. SWAPS data from 915 healthy aging individuals (NC) and 858 subjects with clinical diagnoses of mild cognitive impairment (MCI; n = 430) and Alzheimer’s disease clinical syndrome (ADCS; n = 428) were obtained from the Texas Alzheimer’s Research and Care Consortium (TARCC). TARCC participants represent ethnically and educationally diverse community-dwelling individuals age 50+. Results. SWAPS scores showed the expected associations with age, sex, and education, and the interaction between age and education were significant predictors of SWAPS scores. Test-retest reliability in NC was good, and the SWAPS distinguished impaired and non-impaired groups with adequate to excellent sensitivity and specificity for the primary analyses, with optimal cut-off points provided. Raw score- to uncorrected normalized T-scores and demographically-corrected SWAPS T-scores using regression-based norms are presented along with scoring programs for the calculation of each. Conclusions. The SWAPS is a brief, free, easily administered test with demographically-corrected regression-based norms and promising utility for detection of cognitive impairment and efficient assessment of processing speed.

The Influence Of Hydration Status And Segmental Water Content On Echo Intensity In Older Men

Echo intensity (EI) has gained popularity as a method for quantifying ultrasound-derived muscle quality in older adults, which may reflect non-contractile tissue accumulation. However, since water is hypo-echoic, previous authors have suggested that alterations in hydration status and/or intracellular water content (ICW) may influence EI. PURPOSE: To assess the influence of hydration status and segmental ICW on EI in older men. METHODS: Twenty normal weight, healthy, older men (mean ± SD age: 69.5 ± 2.0 yrs; body mass index: 23.6 ± 1.2 kg/m2) refrained from vigorous exercise for 48 hours and fasted for a minimum of eight hours prior to visiting the laboratory on one occasion. A clinical handheld refractometer was used to assess hydration status via urine specific gravity (USG). Panoramic brightness mode ultrasound imaging was used to determine anatomical cross-sectional area (CSA) and EI. Following a 20-minute lying rest period, one scan of each superficial quadricep muscle (vastus lateralis, rectus femoris, vastus medialis) was taken of the right thigh at 50% femur length with the leg propped and supported at 50 degrees of flexion. Cross-sectional area was summed and EI was averaged across all three muscles. Segmental bioelectrical impedance spectroscopy was used to measure ICW and extracellular water content (ECW) of the right thigh. Total body water (TBW) of the segment was determined from the sum of ICW and ECW. The ICW values were normalized to TBW prior to analyses. Pearson’s product-moment correlation coefficients were used to assess the association between EI and USG and ICW/TBW. Given previous authors have suggested ICW reflects the amount of contractile tissue, a partial correlation was used to assess the association between EI and ICW/TBW while controlling for CSA. RESULTS: Echo intensity (96.9 ± 12.6 a.u.) was not associated with USG (1.016 ± 0.01) (P = 0.865). Poorer EI (higher value) was negatively associated (r = -0.527, P = 0.02) with lower ICW/TBW (0.50 ± 0.04) prior to and after accounting for CSA (29.8 ± 4.7 cm2) (r = -0.518, P = 0.02). CONCLUSIONS: Hydration status did not influence EI in a group of largely euhydrated (70%) older adults. Thigh specific segmental ICW content influences EI values in older adults. Future studies are needed to determine how ICW content influences age-related differences in EI.

7 The Elephant in the Room: An Innovative and Effective Approach to Multidisciplinary Advance Care Planning Training

Abstract Background Exploring patients’ preferences for future care is known to reduce adverse health outcomes, limit transfers between care settings institutionalisation and improve quality of life. Patients value opportunities to have honest conversations. In the recent “Talking about Dying” report from the Royal College of Physicians (RCP), it was found that healthcare professionals (HCPs) find it challenging to start conversations with patients and families. Yet the report highlights a need for HCPs to be equipped with the skills and confidence to provide opportunities for advance care planning in primary care, inpatient and outpatient settings. Methods A multi-disciplinary faculty delivered simulation sessions to 115 candidates (50.4% doctors, 33% nurses and 16.5% allied health professionals) from primary and secondary care. Eight half-day sessions have taken place across North London. Each session started with an introductory lecture, followed by simulated scenarios between a professional actor and candidate within small multi-disciplinary groups. Group discussion was facilitated and feedback given. We focused on acknowledging the progressive, complex and unpredictable nature of frailty. Scenarios included resuscitation, re-admission to hospital, risk feeding, complex discharge planning and cultural values in older adults. Results 100% would recommend this multidisciplinary simulation to teach advance care planning. Only 15.6% of candidates felt confident or very confident with conversations; this improved to 90.5% following the simulation and was maintained at 69.5% three months later. Understanding when advance care planning is appropriate improved from 70% to 100%. Three months after the training, 86% stated they had a sustained change in practice in ACP as a result of the course. Conclusion We have demonstrated that our multidisciplinary simulation is an effective format of improving understanding and confidence in having advance care planning conversations. These results are evident both immediately after and at the three month follow up stage demonstrating a sustained change in practice.

Postoperative Long-Term Independence Among the Elderly With Meningiomas: Function Evolution, Determinant Identification, and Prediction Model Development.

BackgroundMaintenance of postoperative long-term independence has value for older adults who undergo surgical procedures. However, independence has barely caught attention for the elderly with meningiomas. Preventing postoperative long-term independence decline in this population necessitates the identification of the factors related to this outcome and minimizing their implications. Therefore, we assessed the independence evolution and identified potential determinants and population.Materials and MethodsFrom 2010 to 2016, elderly meningioma patients (≥65 years old) undergoing operation at Beijing Tiantan Hospital were included in our study. The primary outcome was 3-year (i.e., long-term) postoperative independence measured by Karnofsky performance scale (KPS) score. We used univariate and multivariate analyses to determine the risk factors for postoperative long-term independence, and nomogram was established.ResultsA total of 470 patients were included eligibly. The distribution in each KPS was significantly different before and 3 years after resection (P < 0.001). Especially in patients with preoperative KPS 80 and 70, only 17.5 and 17.3% of the patients kept the same KPS after 3 years, and the remaining patients experienced significant polarization. The most common remaining symptom cluster correlated with postoperative long-term independence included fatigue (R = −0.795), memory impairment (R = −0.512), motor dysfunction (R = −0.636) and communication deficits (R = −0.501). Independent risk factors for postoperative long-term non-independence included: advanced age (70–74 vs. 65–69 OR: 2.631; 95% CI: 1.545–4.481 and ≥75 vs. 65–69 OR: 3.833; 95% CI: 1.667–8.812), recurrent meningioma (OR: 7.791; 95% CI: 3.202–18.954), location in the skull base (OR: 2.683; 95% CI: 1.383–5.205), tumor maximal diameter >6 cm (OR: 3.089; 95% CI: 1.471–6.488), nerves involved (OR: 3.144; 95% CI: 1.585–6.235), high risk of WHO grade and biological behavior (OR: 2.294; 95% CI: 1.193–4.408), recurrence during follow-up (OR: 10.296; 95% CI: 3.253–32.585), lower preoperative KPS (OR: 0.964; 95% CI: 0.938–0.991) and decreased KPS on discharge (OR: 0.967; 95% CI: 0.951–0.984) (P < 0.05). The discrimination and calibration of the nomogram revealed good predictive ability (C-index: 0.810).ConclusionElderly meningioma patients might present significant polarization trend in maintaining long-term independence after surgery. Our findings will be helpful for guiding surgical management for the elderly with meningioma and provide proposals for early functional rehabilitation.

Assessing attitudes and intention to work with older adults by American and Israeli nursing students: Adapting and testing a measure

BackgroundFinding workers to care for older adults in healthcare settings has become a priority, and research identifying factors influencing a nursing student's intention to make geriatrics a career choice is needed. This calls for the development of a reliable measure of students' perceptions and attitudes. ObjectivesTo determine the adaptability of Carolina Opinions on Care of Older Adults (COCOA) to assess nursing students' attitudes to older adults and their intentions to work with them in two countries. DesignCross-sectional survey. SettingsNursing students enrolled in an introduction to gerontological nursing course in the United States and Israel. ParticipantsA convenience sample of 231 undergraduates pursuing a Bachelor of Science in nursing in the United States (N=122) and Israel (N=109). MethodsStudents completed the COCOA instrument and basic demographics using an electronic platform. ResultsExploratory Factor Analysis (EFA) produced five factors explaining 59% of the variation, with the majority of the items (17, 71%) loading above 0.40 on subscales from the instrument's original structure. EFA led to the elimination of one subscale (Value of Older Adults) and the creation of a new subscale (Older versus Younger Adults) with three items. The reliability scores were good to acceptable for all subscales in both Israeli and American samples (α-Cronbach 0.80 to 0.60). Confirmatory FA supported the data's fit to the 21 items of the modified COCOA instrument (CMIN/DF=1.55, CFI=0.93, IFI=0.93, RMSEA=0.05). The analysis of model equivalence for American and Israeli samples revealed significant differences only on the Experience in Caring for Older Adults subscale. ConclusionsThe modified COCOA demonstrated good construct validity and reliability and can serve as estimation of nursing students' attitudes to older adults and their intention to make geriatrics a career choice. Future studies should further evaluate its predictive validity.

Attitudes and Intention to Work With Older Adults by USA and Israeli Nursing Students: Measure Adaptation and Testing

More nurses are needed to meet the healthcare needs of older adults. Valid and reliable measures are lacking that assess attitudes and intentions of nursing students to select a career in geriatrics. This paper discusses the applicability of the Carolina Opinions on Care of Older Adults (COCOA) instrument on attitudes towards and intention to work with older adults among nursing students. A cross-sectional survey design was used with samples of nursing students from the United States (N=122) and Israel (N=109). Students completed the COCOA instrument and the measure’s dimensionality, construct validity, reliability and equivalence among the nursing students was tested. Exploratory Factor Analysis (EFA) produced 5 factors explaining 59% of the variation with most of the items (17, 71%) loading above 0.40 on subscales according to the instrument’s original structure. Four items loaded on different subscales than originally described. One original subscale was eliminated (Value of Older Adults), and one new subscale was created (Older versus Younger Adults). The reliability scores were good to acceptable for all subscales (.60 - .80). Confirmatory FA supported the data’s fit to the modified COCOA instrument (CMIN/DF=1.55, CFI=.93, IFI=.93, RMSEA=.05). The analysis of model equivalence for USA and Israeli samples revealed significant differences attributed to Experience in Caring for Older Adults subscale. The modified COCOA instrument demonstrated good construct validity and reliability and can serve as estimation of nursing students’ attitudes towards older adults and intention to choose geriatrics as a career. Further studies are needed to test its predictive validity.

Association of smoking status and health-related quality of life: difference among young, middle-aged, and older adults in Shandong, China.

Few studies explored the relationship between smoking status and health-related quality of life (HRQOL) among adults in China. This study aims to explore the relationship between smoking status and HRQOL among adults (18 +) and examine whether there is a difference in this relationship among young, middle-aged, and older adults in China. A total of 23,021 respondents were included in this study. The HRQOL is measured by EQ-5D-3L. The smoking status is divided into never smokers, current smokers, and former smokers. Tobit regression and Logistic regression are employed to explore the association between smoking status and HRQOL. The interaction term is included to explore the difference among young, middle-aged, and older adults. This study finds smoking status is significantly associated with HRQOL. An interaction analysis shows that the association between smoking status and HRQOL is significantly different among young, middle-aged, and older adults (P < 0.05). The smoking status is only significantly associated with HRQOL in middle-aged and older adults, but not for young adults. Compared with never smokers, former smokers report significantly lower EQ-5D-3L utility value in middle-aged adults (coefficient = - 0.089; 95%CI - 0.128 to - 0.050), current smokers report significantly higher EQ-5D-3L utility value in older adults (coefficient = 0.041; 95%CI 0.005 to 0.076). This study demonstrates a significant association between smoking status and HRQOL among adults in China, and there is a difference in this relationship among young, middle-aged, and older adults. The government should take efforts to formulate a variety of measures to control tobacco use among adults.

Decreasing Incidence and Mortality in Traumatic Brain Injury in Korea, 2008-2017: A Population-Based Longitudinal Study.

Traumatic brain injury (TBI), a global public health concern, may lead to death and major disability. While various short-term, small-sample, and cross-sectional studies on TBI have been conducted in South Korea, there is a lack of clarity on the nationwide longitudinal TBI trends in the country. This retrospective study investigated the epidemiological TBI trends in South Korea, using a population-based dataset of the National Health Insurance (2008–2017). The crude and age adjusted TBI incidence and mortality values were calculated and stratified by age, sex, and TBI diagnosis. The age-adjusted incidence per 100,000 people increased until 2010 and showed a decreasing trend (475.8 cases in 2017) thereafter; however, a continuously decreasing age-adjusted mortality trend was observed (42.9 cases in 2008, 11.3 in 2017). The crude incidence rate increased continually in those aged >70 years across all the TBI diagnostic categories. The mortality per 100,000 people was significantly higher among participants aged ≥70 years than in the other age groups. We observed changing trends in the TBI incidence, with a continuously decreasing overall incidence and a rapidly increasing incidence and high mortality values in older adults. Our findings highlight the importance of active TBI prevention in elderly people.

Evaluation of Postoperative Functional Health Status Decline Among Older Adults

Functional outcomes have value for older adults who undergo surgical procedures. Preventing postoperative functional decline in this patient population necessitates the identification of the factors associated with this outcome and minimizing their implications. To assess the prevalence of functional decline 30 days after a surgical procedure among older adults 80 years or older, examine the risk factors of this decline, and identify ways to minimize this decline by addressing its mutable factors. This retrospective cohort study used patient data from the Geriatric Surgery Pilot Project, a multi-institutional data registry of the American College of Surgeons National Surgical Quality Improvement Program. Inclusion criteria were patients 80 years or older who underwent a surgical procedure that required an inpatient stay at 1 of 23 hospitals enrolled in the Geriatric Surgery Pilot Project from January 1, 2015, to December 31, 2018, and had preoperative and postoperative functional health status data. Data analysis was performed from January 7, 2019, to December 2, 2019. Adults 80 years or older who underwent an inpatient surgical procedure. The primary outcome was 30-day postoperative functional decline defined by a change in functional health status from admission or before the surgical procedure (ie, from independent to partially or totally dependent, or from partially dependent to totally dependent). Functional health status was measured by a patient's ability to perform activities of daily living. Secondary outcomes were hospital readmission and 30-day postoperative living location. Of the 2013 patients analyzed in this study, 1128 were women (56.0%) and the mean (SD) age was 84.9 (3.9) years. Functional decline at 30 days after the surgical procedure was present in 406 patients (20.2%). Prevalence of this outcome increased with age, with 337 of 1751 patients aged 80 to 89 years (19.2%) experiencing decline compared with 69 of 262 patients 90 years or older (26.3%). In a risk-adjusted model, the geriatric-specific risk factors statistically significantly associated with this outcome included preoperative mobility aid use (odds ratio [OR] 1.76; 95% CI, 1.39-2.22; P < .001) and malnutrition (OR, 1.88; 95% CI, 1.04-3.43; P = .04) as well as postoperative delirium (OR, 2.20; 95% CI, 1.60-3.02; P < .001), pressure ulcer (OR, 1.83; 95% CI, 1.02-3.30; P = .04), and mobility aid at discharge (OR, 2.49; 95% CI, 1.72-3.59; P < .001). Among patients with a 30-day functional decline, 106 (26.1%) required hospital readmission and only 219 (53.9%) were living at home compared with 388 patients (95.6%) living at home before the procedure. In this study, 1 in 5 older adults experienced a functional decline that persisted 30 days after a surgical procedure, an outcome that appeared to be associated with several geriatric-specific risk factors. Future trials are needed to evaluate whether the prevention or mitigation of these factors can decrease the rates of postoperative functional decline in this patient population.

Higher Aortic Stiffness Is Related With Lower Physical Fitness In Older Adults

PURPOSE: To compare physical fitness levels according to arterial stiffness reference values in older adults. METHODS: This is a cross-sectional study comprising 156 (75.24 ± 6.5 years; 69.2% female) apparently healthy older adults. Carotid-femoral pulse wave velocity (cfPWV) was assessed through applanation tonometry and classified as < or ≥ 10 meters per second (m/s). Physical fitness was assessed through the Senior Fitness Test [cardiorespiratory fitness (6-Min Walk), agility (8-foot Up and Go), upper (30-second Arm Curl) and lower body strength (30-second Chair Stand), and flexibility tests (Chair Sit & Reach and Back Scratch)]. A Z-score including all physical fitness components was computed as a global index of physical fitness. Total physical activity was objectively measured and recorded as counts per minute. Between-group comparisons were performed through ANCOVA. RESULTS: Eighty-five (59.1%) of the subjects had cfPWVs ≥ 10 m/s. After adjusting for age and total physical activity, compared to the cfPWV < 10m/s group, the cfPWV ≥ 10 m/s group exhibited significantly lower physical fitness scores (0.355 ± 0.074 vs. 0.076 ± 0.077, respectively; p = 0.017). CONCLUSION: Seniors with higher levels of arterial stiffness present lower values of physical fitness. Strategies to improve physical fitness might be important to prevent the rapid augmentation of arterial stiffness.

Similarity between predicted and obtained oxygen consumption during incremental cardiopulmonary exercise test in healthy men and chronic heart failure patients

ABSTRACT Cardiopulmonary exercise testing (CPX) is a noninvasive method for assessing physiological changes during physical exercise. Functional capacity has been evaluated using prediction equations. However, this evaluation method may yield different outcomes when applied to a healthy male population and patients with chronic heart failure (HF). This study aimed to compare the estimated and obtained values of oxygen consumption (VO2) during CPX both at the ventilatory anaerobic threshold (VAT) and at peak exercise for healthy men and HF patients. For that, 56 men were divided into 3 groups: (1) 18 young and healthy (YG) (27±6.01 years); (2) 14 healthy older adults (OG) (61±6.3 years); and (3) 24 chronic HF patients (HFG) (53±13.6 years). CPX in cycle ergometer was administered to all individuals for determining VO2 at the VAT and peak exercise. Then, VO2 was estimated at the two moments using a prediction equation, and estimated values were compared to those obtained. Estimated VO2 was significantly higher than obtained VO2 in OG (16.9±1.8 vs. 13.1±2.1mL/kg/min) and HFG (12±6.9 vs. 8.7±2.5mL/kg/min). We found no difference between estimated and obtained VO2 for the YG (22,6±5,5 vs. 23,1±8,7mL/kg/min). The prediction equation overestimated VO2 values for older adults and HF patients. However, the YG obtained similar values than those estimated.

Interprofessional, older adult, team-based home visits: A 6-year prospective analysis

ABSTRACT This 6-year prospective study describes the impact on student attitudes of an innovative, interprofessional geriatrics curriculum (IPGC) focused on team-based care with older adults in a home-based community setting. Dental, medical, occupational therapy, pharmacy, physical therapy, and physician assistant students were placed into teams each led by faculty members from all of the professions. The curriculum consisted of five, four-hour sessions over one academic year. Teams met with a community-dwelling older adult three times. Students completed the Geriatric Assessment Scale (GAS) before and after the IPGC experience. At the conclusion, improvements in attitudes toward older adults in the GAS and its four domains – social value, medical care, compassion, and societal resources–were observed across a wide spectrum of students. Students with the lowest initial attitudes improved the most, as did the scores of the youngest students. Older students improved more than younger students in the social value domain (i.e., the perceived social value of older adults). Among disciplines, occupational therapy and social work students improved the most in the social value domain. This study demonstrates improvement in attitudes toward older adults from student involvement in IPGC that combines didactic and experiential learning through community partnerships in a home-based setting.

Caring for older adults with multiple myeloma during the COVID-19 Pandemic: Perspective from the International Forum for Optimizing Care of Older Adults with Myeloma

The novel coronavirus (SARS-CoV-2, COVID-19) was first identified in the province of Wuhan, China in December 2019 [1], following the emergence of new cases of pneumonia of unknown etiology. Since then, the manifestations of COVID-19 infections have ranged from asymptomatic to severe respiratory infections, with increased morbidity in older adults including those with co-morbidities and cancer [2,3]. Presently, global mortality is reported at 4.7%, but this varies widely by location, from 0.7% in Germany to 10.8% in Italy [4]. As of April 13, 2020, the number of infections continues to rise well beyond the 1.9 million cases, and approximately 120,000 COVID-19-related deaths that have already occurred globally [5]. Multiple myeloma (MM) is a malignant plasma cell dyscrasia which predominantly affects older and often frail adults. Although tremendous gains have been made for older adults with MM, infections, including respiratory infections, significantly impact the rate of early mortality in these patients [6,7]. Furthermore, older adults with MM have age-associated vulnerabilities leading to heterogeneity in outcomes [8]. The complexity of caring for older patients have increased substantially during this pandemic, due to concern about their risk of severe morbidity of COVID19 infection. Optimal strategies for these patients will involve staging the malignancy/aging, while simultaneously considering the local prevalence of COVID-19 infection. Herein, we discuss strategies for the risk reduction of COVID-19 transmission, treatment stratification of anti-myeloma therapy and discussion regarding goals of care for older adults with MM during the COVID-19 pandemic.

Establishing Reference Cardiorespiratory Fitness Parameters in Alzheimer's Disease.

Evidence is growing for aerobic exercise training as a viable means to attenuate cognitive losses associated with Alzheimer’s disease. The mechanism of action for aerobic exercise’s cognitive benefits is likely enhanced cardiorespiratory fitness and its response to incremental aerobic exercise have been incompletely evaluated in Alzheimer’s disease. The aim of this analysis was to establish cardiorespiratory fitness reference values in older adults with mild to moderate Alzheimer’s disease using a cardiopulmonary graded exercise testing. Ninety-seven community-dwelling older adults with mild to moderate Alzheimer’s disease underwent a symptom limited cardiopulmonary graded exercise test on a cycle ergometer. Differences between sexes and between Alzheimer’s disease participants with and without diagnosis of cardiovascular diseases were assessed by independent T-tests. Peak oxygen consumption was 10–20% lower than those achieved by similar clinical populations on treadmill tests. As expected, males produced significantly higher peak oxygen consumption compared to females (p =0 .02). However, the presence of concurrent cardiovascular disease did not result in statistically significant lower peak oxygen consumption compared to those without cardiovascular disease. These data provide a frame of reference for metabolic, cardiovascular, and ventilatory function during cardiopulmonary graded exercise testing performed on cycle ergometer in older adults with mild to moderate Alzheimer’s disease.

Associations of decision making abilities with blood pressure values in older adults.

Decision making, key to successful aging, has implications for financial success, physical health, and well being. While poor decision making has been linked with increased risk of mortality, age-related cognitive decline, and dementia, less is known regarding its associations with chronic disease indicators. We investigated the associations of decision making with blood pressure (BP) values [i.e., SBP, mean arterial pressure (MAP), and pulse pressure (PP), separately] in a community-based cohort study of aging. Participants were 908 nondemented older adults (age ∼81 years; 75% women) from the Rush Memory and Aging Project. Decision making was measured using questions designed to simulate materials used in financial and healthcare settings in the real world and yielded a total score and domain-specific health and financial decision making scores. Two seated and one standing BP measurement were taken with all three contributing to average SBP, MAP that is, [SBP + (2 × DBP)]/3, and PP, that is, SBP - DBP. Participants were queried about hypertension status and antihypertension medications were visually inspected and coded. Participants also underwent medical history and cognitive assessments. In separate multivariable linear regression models, total decision making scores were inversely associated with SBP, MAP, and PP after adjusting for age, sex, education, antihypertension medication use, diabetes, and cumulative cardiovascular disease burden (P values = 0.03). Decision making remained associated with these BP values after additional adjustment for global cognition. Poorer decision making is associated with higher BP values in nondemented older adults.

Effect of Sleep Quality on the Prevalence of Sarcopenia in Older Adults: A Systematic Review with Meta-Analysis.

Sarcopenia is an age-related condition. However, the prevalence of sarcopenia may increase due to a range of other factors, such as sleep quality/duration. Therefore, the aim of the study is to conduct a systematic review with meta-analysis to determine the prevalence of sarcopenia in older adults based on their self-reported sleep duration. Methods: Three electronic databases were used—PubMed-Medline, Web of Science, and Cochrane Library. We included studies that measured the prevalence of sarcopenia, divided according to sleep quality and excluded studies (a) involving populations with neuromuscular pathologies, (b) not showing prevalence values (cases/control) on sarcopenia, and (c) not including classificatory models to determine sleep quality. Results: high prevalence values in older adults with both long and short sleep duration were shown. However, prevalence values were higher in those with inadequate sleep (<6–8 h or low efficiency) (OR 0.76; 95% CI (0.70–0.83); Q = 1.446; p = 0.695; test for overall effect, Z = 6.01, p < 0.00001). Likewise, higher prevalence levels were shown in men (OR 1.61; 95% CI (0.82–3.16); Q = 11.80; p = 0.0189) compared to women (OR 0.77; 95% CI (0.29–2.03); Q = 21.35; p = 0.0003). Therefore, the prevalence of sarcopenia appears to be associated with sleep quality, with higher prevalence values in older adults who have inadequate sleep.

Low-Value Prostate Cancer Screening Among Older Men Within the Veterans Health Administration.

Prostate-specific antigen (PSA) screening can be of low value in older adults. Our objective was to quantify the prevalence and variation of low-value PSA screening across the Veterans Health Administration (VA), which has instituted programs to reduce low-value care. Retrospective cohort. VA administrative data, 2014 to 2015. National random sample (N = 214 480) of male veterans, aged 75 years or older. We defined PSA screening in men aged 75 years or older without a history of prostate cancer as low value, per established definitions in Medicare. We calculated screening rates overall and by VA Medical Center (VAMC), adjusting for patient and VAMC-level factors. We characterized variation across VAMCs using the adjusted median odds ratio (OR) and compared the adjusted OR of screening between VAMCs in different deciles of low-value screening rates. In separate sensitivity analyses, we assessed screening in veterans at greatest risk of 1-year mortality and among veterans after excluding those who underwent prostatectomy, had a prior PSA elevation, or had a clinical indication for testing. Overall, 37 867 (17.7%) of veterans underwent low-value PSA screening (VAMC range = 3.3%-38.2%). The adjusted median OR was 1.88, meaning the median odds of screening would increase by 88% were a veteran to transfer his care to a VAMC with higher screening rates. Veterans at VAMCs in the top decile had an adjusted OR of 12.9 (95% confidence interval = 11.0-15.2) compared to those veterans in the lowest decile. Among veterans with the greatest mortality risk (n = 23 377), 3496 (15.0%) underwent screening (VAMC range = 1.7%-46.3%). After excluding veterans with a prior prostatectomy, PSA elevation, or a potential clinical indication, 31 556 (14.7%) underwent screening (VAMC range = 2.0%-49.9%). In a national cohort of older veterans, more than one in six received low-value PSA screening, with greater than 10-fold variation across VAMCs and high rates of screening among those with the greatest mortality risk. J Am Geriatr Soc 67:1922-1927, 2019.

Handgrip strength in old and oldest old Swiss adults \u2013 a cross-sectional study

BackgroundHandgrip strength is indicative of overall physical health and mobility in the elderly. A reduction in strength below a certain threshold severely increases the risk of mobility limitations and is predictive for adverse outcomes such as dependence in daily activities and mortality. An overview of age- and geography- specific handgrip strength values in older adults provide a reference for further investigations and measures in clinical practice to identify people at risk for clinically meaningful weakness. The aim of this study was to evaluate handgrip strength in the Swiss-German population aged 75 and over.MethodsIn a cross-sectional study, maximal isometric handgrip strength of the dominant hand was evaluated in 244 Swiss people aged 75 years and over (62.7% women), with mean age (SD) of 84.5 (5.6) years in men and 83.1 (5.9) years in women. Demographic data and information about comorbidities, medication, fall history, global cognitive function, self-reported physical activity and dependence in activities of daily living were collected, and correlated with grip strength measures. Age- and gender specific grip strength values are reported as means, standard deviations and standard error of mean.ResultsSex-stratified handgrip strength was significantly lower with advancing age in men (p < .01), from 37.7 (6.5) kg to 25.6 (7.6) kg and in women (p < .01) from 22.2 (4.0) kg to 16.5 (4.7) kg. Handgrip strength in our sample was significantly higher than in Southern European countries. Handgrip strength was independently associated with age, height and ADL dependence in men and women. Overall, 44% of men and 53% of women had handgrip strength measures that were below the clinically relevant threshold for mobility limitations.ConclusionThis study reports the age- and sex-stratified reference values for handgrip strength in a representative sample of the Swiss population, aged 75–99 years. Although grip strength decreased with advancing age in both sexes; the relative decline was greater in men than women. Nonetheless men had significantly higher grip strength in all age groups. While the Swiss population sampled had greater grip strength than that reported in other European countries, about 50% were still classified as at risk of mobility limitations.

Association of endothelial nitric oxide synthase (eNOS) gene polymorphisms and physical fitness levels with plasma nitrite concentrations and arterial blood pressure values in older adults.

Endothelial nitric oxide synthase (eNOS) gene polymorphisms are associated with reduced eNOS activity and nitric oxide (NO) production leading to an increase in blood pressure (BP). Regular exercise is the main strategy to minimize the deleterious effects of polymorphisms. However, due to the differences that physical exercise can be performed, some controversial results are found. Therefore it seems reasonable to evaluate the training status (TS). Thus, this study aimed to investigate the association of eNOS gene haplotypes and different levels of TS on nitrite concentrations (NO2-) and BP values in older adult. 424 elderly performed the following assessments: General Functional Fitness Index (GFFI) to estimate TS, systolic and diastolic blood pressure (SBP and DBP), blood collection for analysis of NO2- and g.-786T>C, intron 4b/a (VNTR) and 894G>T polymorphisms. Multivariate logistic regression showed that NO2- was influenced by GFFI and 4b/4a Intron 4. Regarding BP, GFFI influenced SBP and DBP, and just intron 4 was associated with variations in DBP. It can be observed that GFFI affected the NO2-, SBP and DBP independently of haplotypes. Therefore, maintenance of good level of TS can overcome the negative influence of genetics factors (intron 4) by increasing NO2- concentration and decreasing BP values.

Improvement of Cardio-Ankle Vascular Index by Arm-Swing Exercise in Older Adults

Objective: The purpose of this study was to determine the effect of the arm-swing exercise on cardio-ankle vascular index (CAVI), ankle-brachial index (ABI), heart rate and blood pressure (BP) in older adults with abnormal CAVI values.Material and Method: Seventeen participants aged 50 or over were asked to do the arm-swing exercise at least 30 minutes a day, at least 3 times per week for 8 weeks. The vascular function parameters, CAVI and ABI, resting heart rate and blood pressure were measured before and after exercising. The comparison of these parameters was performed using statistical analysis.Results: It was shown that the arm-swing exercise could lower both left and right CAVI significantly (left CAVI, pre: 10.0±0.2 vs. post: 9.7±0.2, p-value=0.017 and right CAVI, pre: 10.0±0.2 vs. post: 9.7±0.2, p-value=0.034). Furthermore, the arm-swing exercise also reduced arterial blood pressure and pulse pressure significantly (systolic BP, pre: 141.9±4.3 mmHg vs. post: 130.5±4.8 mmHg, p-value=0.004, diastolic BP, pre: 82.1±1.6 mmHg vs. post: 76.5±1.7 mmHg, p-value=0.003, and pulse pressure, pre: 59.7±3.7 vs. post: 54.0±4.0 mmHg, p-value=0.031). However, the study demonstrated that ABI, resting heart rate and body mass index were not affected by the exercise.Conclusion: This study demonstrated that 8 weeks of the arm-swing exercise could lower systolic and diastolic blood pressure. This simple physical activity could also reduce CAVI values in older adults.