Vulnerability Of Older Adults Research Articles

AN EVIDENCE-BASED APPROACH TO TELEPHONE REASSURANCE CALLS: A RANDOMIZED CONTROLLED TRIAL PROTOCOL

Abstract The COVID-19 Pandemic forced many health and community organizations to suspend some previously offered services and supports for older adults. This created heightened concerns about negative impacts of isolation and loneliness on already vulnerable older adults. In response, the Western Reserve Area Agency on Aging (WRAAA) began the TeleCare Program, providing weekly telephone reassurance calls to home and congregate meal clients to maintain contact and identify unmet service needs. Because of its success, the TeleCare Program has continued as a regularly offered service, but the WRAAA sought to improve the Program by integrating it with BRI Care ConsultationTM, an evidence-based program of the Benjamin Rose Institute on Aging (BRIA). This poster reports on initial results of a randomized controlled trial to test the efficacy and feasibility of a new protocol for delivering telephone reassurance calls. The new protocol is modeled after the Initial Assessment in BRI Care Consultation, which is a semi-structured, telephone conversation covering a comprehensive range of potentials problems. The protocol also connects high-risk clients to existing available home- and community-based services. Results demonstrate that components of proven evidence-based interventions are feasible to integrate into existing programs and services. This includes adapting a model for problem-identification and assessment based on a consumer-driven conceptual framework, a record keeping system to enhance consistency and fidelity of program delivery, and establishing a formal referral protocol to more seamlessly link clients to other available services.

THE LOOMING POST-ACUTE REORGANIZATION: IMPLICATIONS FOR OLDER ADULTS TRANSITIONING FROM THE HOSPITAL

Abstract Post-acute volume plays an important role in the care of millions of older adults transitioning from a hospital stay. To help reduce the total cost of care, many hospitals have been shifting more volume from institutional skilled nursing care to less expensive home health care. In fact, in 2017, home health volume eclipsed skilled nursing facility volume as the preferred post-acute destination for the first time. The COVID-19 pandemic further exacerbated this trend with many older adults preferring to avoid institutional care. Using 2016-2019 MedPAR data, we explored changes over time in hospital discharges to skilled nursing facilities versus to home health. We regress the ratio of home health to skilled nursing facility volume on a month-year variable. We find that the ratio of discharges to home health versus to skilled nursing facility increases by .07 percentage points per month (coefficient = .00073, 95% CI [.00063 to .00084]). This translates to a nearly one percentage point change in the ratio of home health to skilled nursing volume per year. These trends vary by patient characteristics (e.g. hospital diagnosis), organizational characteristics (e.g. hospital market relationships), and indicators of market capacity of post-acute services. This growing trend has implications on vulnerable older adults; health system leaders need policy guidance and incentives to invest in value-oriented care practices across this changing post-acute landscape.

INCREASING RISK FOR ELDER MISTREATMENT? A QUALITATIVE STUDY OF CAREGIVER EXPERIENCES DURING COVID-19

Abstract Family caregivers (CGs) of community-dwelling older adults faced unprecedented psychosocial challenges in the face of the COVID-19 pandemic. Social isolation, lack of social support, truncated care networks, financial hardship and other factors put many older adults at risk for elder mistreatment (EM). Even in normal times, incidents of EM are only identified and formally reported in about one out of every 24 cases. Social distancing restrictions in the caregiving context, including decreased access to healthcare providers, rendered older adults with higher dependency needs inordinately vulnerable to abuse and neglect. We collected qualitative data on the experiences of 24 CGs receiving telephonic support sessions between March 2020 and February 2021. Data from 100 distinct post-session case notes were analyzed using thematic content analysis to generate codes and themes. Caregivers reported rapid deterioration of care receiver’s (CRs) physical health, resulting in higher levels of dependency. Declines in mental health and cognitive impairment, including behavioral issues, were an indicator of stress for both CR and CG. CGs reported lack of access to services and social supports, fractured care networks, and increased feelings of isolation. Preliminary content analysis indicates that serious risk factors for EM were present across all 13 months of the study, and those risk factors continued or worsened over time. Findings suggest that the unintended consequences of the public health response to COVID-19 may have amplified the risk for EM in vulnerable community-dwelling older adults.

GEOGRAPHIC AVAILABILITY OF SUBSIDIZED SENIOR HOUSING AND NEIGHBORHOOD DISPARITIES IN MISSOURI

Abstract Subsidized senior housing (SSH) provides an affordable option to low-income older adults for economic stability and aging-in-place. To date, limited attention has been given to the geographic availability of SSH and its relation to neighborhood characteristics (e.g., socioeconomic characteristics and availability of supportive services). The current study aims to describe (1) the availability of government-subsidized senior housing (SSH-availability) in Missouri and examine (2) to what extent the housing availability is associated with county-level neighborhood characteristics. First, SSH-availability in each county was measured with the number of subsidized units for older adults divided by the eligible population (i.e., aged 65 or over, income below poverty level, and spending 30% or more of income on housing). The Geographic Information System (GIS) was used to examine the distribution of SSH in Missouri. Second, based on existing literature, we used principal component analysis with multiple indicators to create two neighborhood characteristics (i.e., socioeconomic deprivation and health and social service indices). Non-parametric bivariate analyses (Kruskal-Wallis tests) were conducted with the availability quartiles and each index. Our findings showed that in 66 counties (57% of entire counties in Missouri), SSH-availability was below 20%. Bivariate analyses showed SSH-availability was significantly associated with both neighborhood characteristics: counties with higher SSH-availability were more likely to be socioeconomically deprived and face a lack of health and social services. The current study suggests the government should address the geographic disparities in SSH for low-income older adults. Also, more supportive services are needed around SSH to facilitate aging-in-place of vulnerable older adults.

FINANCIAL HARDSHIPS AND MEDICATION ADHERENCE DURING THE COVID-19 PANDEMIC

Abstract Medication nonadherence is associated with numerous negative health outcomes among older adults, including myocardial infarction, stroke, preventable hospitalizations, and increased risk of decline in self-reported health status. Maintaining continuous use and access to needed medications in later life has important implications for quality and length of life. A primary barrier shown to interfere with medication adherence in older adults is an inability to pay for medication. Relative to their younger counterparts, older adults have more financial protections that increase access to needed prescription medication through health insurance coverage. Despite these added protections, older adults are more likely to experience financial insecurity, with some evidence suggesting that COVID-19 accentuated existing vulnerabilities. Data are derived from the Health and Retirement Study (HRS), leveraging data drawn from the 2016, 2018, and 2020 study waves (n=3,185). Logistic models were used to evaluate the association between five COVID-19 related financial setbacks (i.e., inability to pay mortgage/rent, credit card bills, utility or insurance bills, medical bills, and inadequate money for food), and medication nonadherence among adults 60+. Results show that net of pre-COVID financial vulnerabilities and socioeconomic status, individuals who reported being unable to pay medical bills and those unable to pay rent/mortgage after the start of the pandemic reported higher odds (19% higher and 230% higher odds, respectively) of not taking/filling their prescription medication due to cost. Results suggest that greater financial protections for housing and medical bills among financially vulnerable older adults will increase medication adherence.

STAKEHOLDER ENGAGEMENT IN THE DESIGN OF A FALL RISK PREDICTION SYSTEM FOR SOCIALLY VULNERABLE OLDER ADULTS

Abstract Falls and fall-related injuries are significant public health issues for adults 65 years of age and older. Fall-related injuries are among the most expensive medical conditions. Mild cognitive impairment (MCI) and housing conditions are each independent risk factors for multiple falls among older adults and there is increasing evidence of the adverse effect of MCI on balance, stride, gait speed and increasing fall risk. We developed an innovative technology-supported intervention called Sense4Safety to 1) identify escalating risk for falls through real-time in-home passive sensor monitoring (using depth sensors); 2) employ machine learning to inform individualized alerts for fall risk; and 3) link ‘at risk’ socially vulnerable older adults with a tele-coach who guides them in implementing evidence-based individualized plans to reduce fall-risk. The purpose of this study was a) to examine preferences and attitudes of low-income older adults towards an in-home sensor-based system to inform fall prevention strategies; and b) solicit feedback from and validate the intervention protocols by clinical experts in fall prevention, fall risk assessment and geriatrics. We conducted one hour interview sessions with a total of 10 older adults and 10 clinical experts. Sessions were transcribed and analyzed. Findings included perceived benefits and challenges, recommendations for refinement of the intervention (including educational components and different visualization approaches for sensor data) and the role of family members or trusted others in addressing fall risk. We highlight clinical and ethical implications resulting from the use of passive monitoring for socially vulnerable older adults with MCI.

PREDICTORS OF PARTICIPATION IN A TELEPHONE-BASED SOCIAL CONNECTEDNESS INTERVENTION FOR OLDER ADULTS

Abstract Background Social isolation is a well-documented contributor to poor mental and physical health, and interventions promoting social connectedness have been shown to be protective. This study examined predictors of participating in a telephone-based social connectedness intervention for socially isolated older adults. Methods Data was obtained from a social connectedness intervention that paired students with older adults. Eligible participants included Houston area older adults, 65 years or older, enrolled in Medicare Advantage plans. Eligible participants were contacted telephonically and asked to complete the 3-item UCLA Loneliness Scale. Those who screened positive for loneliness were invited to participate in the social connectedness intervention. Logistic regression models, that accounted for sociodemographic, clinical and functional indices, were used to identify predictors of participation. Results Females (OR: 1.23, 95% CI: 1.04-1.45), and racial/ethnic minorities (African American OR: 1.39, 95%CI: 1.16-1.68; Hispanic OR: 1.43, 95%CI: 1.04-1.99) were more likely to participate in a telephone-based social connectedness intervention. Older adults with a disability (OR: 2.37, 95%CI: 1.96-2.87), higher CMS Hierarchical Condition Category risk scores (OR: 1.15, 95%CI: 1.06-1.25) and those who reported having 1+ social needs (OR: 1.38, 95%CI: 1.14-1.66) were more likely to participate. Of all Charlson Comorbidity Index flags examined, diabetes was the single strongest predictor of participation (OR=2.49, p=0.02). Older adults who reported functional comorbidities for anxiety and depression were also more likely to participate. Conclusion Telephone-based social connectedness interventions can reach vulnerable older adults with clinical and social needs, and can be useful in addressing racial/ethnic health equity gaps in socially isolated older adults.

Sarcopenia and decline in appendicular skeletal muscle mass are associated with hypoperfusion in key hubs of central autonomic network on 3DSRT in older adults with progression of normal cognition to Alzheimer's disease.

Although sarcopenia is common in patients with Alzheimer's disease (AD), the neural substrates involved remain unclear. We investigated the relationship between sarcopenia, as well as its definition components, and regional cerebral blood flow (rCBF) in older adults with progression of normal cognition to AD. 99m Tc-ethyl-cysteinate-dimer single-photon emission computed tomography was carried out in 95 older adults with progression of normal cognition to AD (40 men and 55 women, mean ± SD age 80.9 ± 6.8 years). The associations of rCBF determined by 3-D stereotactic region of interest template software, with sarcopenia and its definition components, slower gait speed, weaker grip strength, and decline in appendicular skeletal muscle mass index (ASMI) were analyzed. Logistic regression analysis adjusted by age, sex, mini-mental state examination score and education showed that sarcopenia as well as ASMI less than the cut-off (men 7.0 kg/m2 , women 5.7kg/m2 ) were associated with significantly reduced rCBF in the key hub of the central autonomic network, including the insula, anterior cingulate cortex, subcallosal area, rectal gyrus, hypothalamus, amygdala and caudate head. Sarcopenia and ASMI decline were associated with hypoperfusion in the aforementioned cortical hubs of the central autonomic network in men, but with hypoperfusion of the hypothalamus in women. Linear regression analysis showed significant correlations of ASMI/cut-off with rCBF in the bilateral medial frontal cortex, as well as rCBF in the aforementioned key hubs. Hypoperfusion in key hubs of central autonomic network is implicated in the emergence of sarcopenia, probably through ASMI decline in vulnerable older adults. Geriatr Gerontol Int 2023; 23: 16-24.

Delirium superimposed on dementia in post-acute care: Nurse documentation of symptoms and interventions

Delirium superimposed on dementia (DSD) is common in older adults being discharged to post-acute care settings (PAC). Nurse documentation remains poorly understood. Aims were to describe nurse documentation and to determine associations in a secondary data analysis of a large, single-blinded randomized controlled trial (Recreational Stimulation For Elders As A Vehicle To Resolve DSD (Reserve For DSD). Just under 75% of the sample had at least one symptom of delirium documented by the nursing staff, while 25.9% had none despite being CAM positive by expert adjudication. Only 32% had an intervention documented. Number of documented interventions were significantly associated with number of documented symptoms. There is a need for research and innovation related to nurse documentation and communication of DSD symptoms and interventions in an efficient and accurate manner to impact care for vulnerable older adults in these settings.

Nearly one in five older adults in Danish nursing homes live with type 2 diabetes.

This study aimed to investigate the prevalence of type 2 diabetes (T2D) among Danish nursing home residents (aged ⩾65 years). Individuals with T2D in the Danish population of older adults in 2018 were identified using a Danish diabetes register based on administrative and clinical register data. Data on age, sex, type of housing, educational level and place of origin were obtained from various high-quality administrative registers. We calculated frequencies of T2D among older adults living in nursing homes and in other types of housing. We performed a multiple logistic regression analysis to estimate the odds ratio (OR) of T2D among people living in nursing homes and adjusted for sex, age, educational level and place of origin. All Danish older adults aged ⩾65 years, alive and living in Denmark on 31 December 2018 were included (N=1,170,517). Nursing home residents accounted for 37,891 older adults, and of these, 19% had T2D, whereas 14% of older adults living in other types of housing had T2D. According to the multiple logistic regression analysis, nursing home residents had a higher OR of having T2D compared to older adults living in other types of housing (OR=1.47; confidence interval 1.43-1.51) when adjusting for socio-demographic factors. The prevalence of T2D in nursing home residents exceeds the prevalence in the background population at ⩾65 years of age. This indicates a need for increased focus on individualised interdisciplinary care plans aimed at maintaining physical function and maximising quality of life for this group of vulnerable older adults.

Multidimensional vulnerability among older adults in Germany : Social support buffers the negative association with life satisfaction.

Multidimensional vulnerability among older adults, characterized by low levels of individual resources in different life domains, has been insufficiently studied. This phenomenon is considered to be associated with amarked decrease in overall life satisfaction. Social support is supposed to buffer the negative effect of multidimensional vulnerability on life satisfaction. Analyses are based on the German Health Update dataset (GEDA 2014/2015-EHIS). The analytic sample includes respondents ≥ 65years (N = 5826). Confirmatory factor analyses were performed to construct alatent variable from the indicators income poverty, activities of daily living (ADL) limitations, multimorbidity, mental problems, and living alone. Multivariate linear regression models estimate the relationship between vulnerability and life satisfaction with a special focus on the interaction between vulnerability and social support. The analyses supports the multidimensional construct of vulnerability. Social support considerably moderates the negative relationship between vulnerability and life satisfaction. As the degree of vulnerability increases, the influence of social support becomes more pronounced. The assessment of vulnerability as amultidimensional construct helps to depict the life situation of older people in amore differentiated way. Vulnerable older adults with asmall or unreliable social network while finding it difficult to access practical help need additional external social support to achieve ahigh level of life satisfaction.

Social, Resource, and Institution Disruptions and the Evolving Lives of Economically Vulnerable Older Adults: Implications for Policies and Programs in the New Normal

This article focuses on the impact of pandemic-related reorganization on the lived experiences of economically vulnerable older adults receiving food assistance. Thematic analysis of life narrative interviews from ninety older adults suggests three focal types of disruptions produced by policy, program, and system innovations: social, resource, and institutional. For the majority of study participants, modified or reduced social support, increased need for material resources, and changing institutions, programs, and policies have created significant disruptions in their lives at an age when capacity for adaptation is diminished. Understanding the impact of these disruptions is important to inform policies and programs that will emerge in the post-pandemic era. Efforts to protect vulnerable seniors have also decreased opportunities to access channels for communicating their needs.

Motivation and Psychotherapy in Older Adults with Care Needs and Depression

Abstract: The utilization of psychotherapy for home-living, vulnerable older adults with depression is limited. Understanding patients’ motivation is essential to tailoring psychotherapy to their needs and improving therapeutical efficacy. Based on cross-sectional data obtained from a pragmatic, randomized controlled trial (PSY-CARE study), this study investigated general intake concerns (ICs) and patients’ treatment goals (PTG) of home-living older adults with depression. Data on ICs ( N = 251 older adults interested in participation) were analyzed using qualitative content analysis. Data on PTGs ( N = 86 participants receiving psychotherapy) were analyzed quantitatively. Main ICs included reducing depressive symptoms and coping with new (health) situations. PTGs focused on coping with health problems and age-related losses. The results provide clinicians with valuable insights into motivational factors in this vulnerable and hard-to-reach population.

Financial hardship and change in emotional well-being before to during COVID-19 pandemic among middle-aged and older Americans: Moderating effects of internal coping resources

ObjectiveThe purpose of this study was to investigate associations between financial hardship and change in emotional well-being—positive and negative affect—before to during the COVID-19 pandemic among middle-aged and older Americans and to examine the extent to which associations were moderated by internal coping resources—dispositional mastery and optimism. MethodData derived from the Leave-Behind Questionnaire in the 2016 and 2020 waves of the Health and Retirement Study, a nationally representative longitudinal survey of U.S. adults aged 51 and older (N = 1312). We estimated multivariate ordinary least squares regression models with interaction terms to evaluate prospectively the benefits of mastery and optimism as internal coping resources for middle-aged and older adults. ResultsDispositional mastery moderated the effects of financial hardship on changes in negative and positive affect, respectively, before to during the COVID-19 pandemic; however, optimism did not significantly moderate the effects of financial hardship on change in negative and positive affect before to during the COVID-19 pandemic. ConclusionsOur findings have implications for interventions aimed at improving middle-aged and older adults' emotional well-being by promoting internal coping resources. Specifically, interventions should focus on financial hardship and mastery for vulnerable middle-aged and older adults in the context of public health crises.

Vulnerability, ageism, and health: is it helpful to label older adults as a vulnerable group in health care?

Despite the diversity of ageing, society and academics often describe and label older persons as a vulnerable group. As the term vulnerability is frequently interchangeably used with frailty, dependence, or loss of autonomy, a connection between older age and deficits is promoted. Concerning this, the question arises to what extent it may be helpful to refer to older persons as vulnerable specifically in the context of health care. After analyzing different notions of vulnerability, I argue that it is illegitimate to conclude that older age is related to increased vulnerability. Much more, identifying older adults as a vulnerable group is closely related to ageism and can be associated with paternalistic benevolence and a tendency to overprotection, especially within health care. Additionally, even though older adults are more often in situations of increased vulnerability due to their potentially higher need for health care, I argue further that older adults mainly become a vulnerable group due to ageism. In this way, it can be concluded that the vulnerability of older adults does not originate in certain attributes of the group, but arises from a characteristic of society and, in turn, health personnel, namely ageism. Labeling older adults as vulnerable therefore is only helpful, when it is used to raise awareness of the widespread ageism in society, in this context, especially in the setting of health care, and the negative consequences thereof for older adults.

Degree of protection provided by poverty alleviation policies for the middle-aged and older in China: evaluation of effectiveness of medical insurance system tools and vulnerable target recognition

BackgroundChina’s medical insurance schemes and poverty alleviation policy at this stage have achieved population-wide coverage and the system's universal function. At the late stage of the elimination of absolute poverty task, how to further exert the poverty alleviation function of the medical insurance schemes has become an important agenda for targeted poverty alleviation. To analyse the risk of catastrophic health expenditure (CHE) occurrence in middle-aged and older adults with vulnerability characteristics from the perspectives of social, regional, disease, health service utilization and medical insurance schemes.MethodsWe used data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) database and came up with 9190 samples. The method for calculating the CHE was adopted from WHO. Logistic regression was used to determine the different characteristics of middle-aged and older adults with a high probability of incurring CHE.ResultsThe overall regional poverty rate and incidence of CHE were similar in the east, central and west, but with significant differences among provinces. The population insured by the urban and rural integrated medical insurance (URRMI) had the highest incidence of CHE (21.17%) and health expenditure burden (22.77%) among the insured population. Integration of Medicare as a medical insurance scheme with broader benefit coverage did not have a significant effect on the incidence of CHE in middle-aged and older people with vulnerability characteristics.ConclusionsBased on the perspective of Medicare improvement, we conducted an in-depth exploration of the synergistic effect of medical insurance and the poverty alleviation system in reducing poverty, and we hope that through comprehensive strategic adjustments and multidimensional system cooperation, we can lift the vulnerable middle-aged and older adults out of poverty.

Neighborhood social cohesion is associated with the willingness toward the booster dose of COVID-19 vaccines among the Chinese older population

ABSTRACT Neighborhood social cohesion is a prominent psychosocial factor during the pandemic, and trust in neighbors is critical for implementing health prevention-related behaviors with public health messages. We planned to specifically explore the association between neighborhood social cohesion and vaccine acceptability among older adults (≥60 years) in China. Using a random stratified sampling method, an anonymous cross-sectional online survey was conducted in mainland China via a professional scientific data platform from May 25 to June 8, 2022. A revised Social Cohesion Scale was applied to evaluate the level of neighborhood social cohesion. Of the 3,321 recruited respondents aged 60 and above, 82.8% (95% CI: 81.5–84.1) reported their willingness to be vaccinated. With all significant covariates adjusted, older adults with moderate (aOR = 1.77, 95% CI: 1.04–3.04) and high level of social cohesion (aOR = 2.21, 95% CI: 1.29–3.77) were more likely to receive the booster dose. Our findings remained robust in a series of models after controlling for different covariates. Uncertainty about contraindications (38.3%), underestimation of their vulnerability (33.1%), and concerns about vaccine safety (32.0%) were the three main reasons for vaccine hesitancy. Therefore, building a harmonious community environment, strengthening neighborhood communication and exchange, and making good use of peer education among neighbors may become a breakthrough to promote herd immunity, especially for vulnerable older adults with limited social networks.

Standardized assessment to support integrated care: Use of self-report instruments with vulnerable community-dwelling older adults during the pandemic

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.

Exploring Mediation Effects of Gait Speed, Body Balance, and Falls in the Relationship between Physical Activity and Health-Related Quality of Life in Vulnerable Older Adults.

The present study aimed to examine whether gait speed (GS), body balance (BB), and falls mediated the relationship between physical activity (PA) and health-related quality of life (HRQoL) in community-dwelling older adults. This is a cross-sectional study that included 305 men and 314 women (69.5 ± 5.6 years), residing in the Autonomous Region of Madeira, Portugal. HRQoL and PA were assessed using the SF-36 and Baecke Questionnaires, respectively. While BB was obtained by the Fullerton Advance Balance (FAB) scale, GS by the 50-foot (15 m) walk test, and the frequency of falls was obtained by self-report. According to the analyses, when GS and BB were placed concomitantly as mediators, the direct effect revealed by the model revealed a non-significant relationship between PA and falls. Thus, in the context of falls, GS and BB partially mediated the association between PA and HRQoL in approximately 29.7%, 56%, and 49.2%, respectively. The total HRQoL model explained a variance of 36.4%. The results can help to understand the role that GS, BB, and falls play in the relationship between PA and HRQoL of the vulnerable older adult population.

Exploratory studies of oral and fecal microbiome in healthy human aging.

Growing evidence has linked an altered host fecal microbiome composition with health status, common chronic diseases, and institutionalization in vulnerable older adults. However, fewer studies have described microbiome changes in healthy older adults without major confounding diseases or conditions, and the impact of aging on the microbiome across different body sites remains unknown. Using 16S ribosomal RNA gene sequencing, we reconstructed the composition of oral and fecal microbiomes in young (23-32; mean = 25years old) and older (69-94; mean = 77years old) healthy community-dwelling research subjects. In both body sites, we identified changes in minor bacterial operational taxonomic units (OTUs) between young and older subjects. However, the composition of the predominant bacterial species of the healthy older group in both microbiomes was not significantly different from that of the young cohort, which suggests that dominant bacterial species are relatively stable with healthy aging. In addition, the relative abundance of potentially pathogenic genera, such as Rothia and Mycoplasma, was enriched in the oral microbiome of the healthy older group relative to the young cohort. We also identified several OTUs with a prevalence above 40% and some were more common in young and others in healthy older adults. Differences with aging varied for oral and fecal samples, which suggests that members of the microbiome may be differentially affected by aging in a tissue-specific fashion. This is the first study to investigate both oral and fecal microbiomes in the context of human aging, and provides new insights into interactions between aging and the microbiome within two different clinically relevant sites.