Weeks In Older Adults Research Articles

Validity, Reliability, and Feasibility of Smartphone Application Intended for Home Measurement of Gait Speed and Other Gait Dynamics in Older Adults with Blood Cancers

Introduction: Gait speed is a cardinal measure of mobility and frailty recommended to be assessed in all older adults with cancer (Dale, JCO, 2023). Four-meter gait speed (4MGS) is strongly predictive of mortality and hospitalization in older adults with hematologic malignancies (Liu, Blood, 2019). Remote monitoring technology can expand measurement of gait speed beyond the clinic (Clancy, JCO CCI, 2023), and smartphone applications (App) have been developed and validated to measure meaningful gait metrics via embedded internal motion sensors (Manor, JMIR Mhealth Uhealth, 2018). However, the validity and reliability of a smartphone App for remotely measuring gait speed in older adults is not known, nor is the feasibility of using an App to measure longitudinal gait speed in older adults with blood cancers. Methods: We conducted two studies to (1) determine the validity and reliability of a smartphone App in measuring 4MGS in community-dwelling older adults, and (2) determine the feasibility of measuring 4MGS weekly for six weeks in older adults with multiple myeloma (MM) and myelodysplastic syndromes (MDS). For the validity and reliability study, we enrolled adults aged ≥ 65 years living in an independent living housing facility. Each participant self-administered two supervised and three unsupervised gait assessments at home via the smartphone carried in their pocket, with the App providing multimedia instructions on how to complete the test. For each gait assessment, the participants walked back and forth along a 4-meter strip of ribbon for 45 seconds. For the first two supervised sessions, while the participants were self-administering the gait assessment, the study team concurrently captured their walking performance with a video camera (as a gold standard). For the following three unsupervised sessions, the participants administered the gait assessment App alone. We obtained the time for the first instance of walking along the 4-meter ribbon before turning and compared the gait speed (i.e. dividing 4 meters by the time) between the smartphone and the video capture. For the feasibility study, we enrolled patients age ≥73 years with either MDS or MM cared for at Dana-Farber Cancer Institute. Patients self-administered the gait assessment described above alone at home once a day for six weeks after a dedicated teaching session with study staff. We reported completion rates and participants' feedback regarding acceptability. Results: 14 older adults (77.2±6.3, 13 females) completed the validity and reliability study. The smartphone 4MGS demonstrated strong criterion validity yielding a high correlation with the camera 4MGS ( Figure 1) along with high reliability as demonstrated by high internal consistency and low measurement error ( Figure 2). The smartphone 4MGS also showed good test-retest reliability over three unsupervised sessions (intra-class correlation coefficient 0.78). In the feasibility study, 12 patients (79.3±3.14, 4 females, 50% MDS, 42% MM, and 8% both) were enrolled out of 19 contacted for recruitment (63%). To date, nine have completed the study: 9/9 completed at least one 4MGS test, 8/9 (89%) completed at least three weeks, and 3/9 (33%) completed all six weeks. When asked, “How important is measuring your function and mobility to you?” on a scale of 1 (low) to 5 (high), 7/9 participants answered 4 or 5. When asked to rate their experience completing the walking tests on a scale of 1 (very poor) to 5 (very good), 6/9 participants answered 4 or 5. When asked the degree to which one agrees with the statement, “I feel that the walking tests are too burdensome,” on scale of 1 (strongly disagree) to 5 (strongly agree), 9/9 patients answered 1 or 2. Conclusions: The App was both valid and reliable in measuring 4MGS in older adults' homes. User acceptance was also high, and the app was rated as minimally burdensome by patients with blood cancers with the majority completing at least three weekly home 4MGS tests. Our findings support using existing smartphone technology to assess a key measure of mobility and frailty in the homes of older adults with blood cancers, allowing for more frequent longitudinal assessment of how blood cancers and their treatments impact older adult mobility and frailty.

Daily intranasal insulin at 40IU does not affect food intake and body composition: A placebo-controlled trial in older adults over a 24-week period with 24-weeks of follow-up

Centrally administered insulin stimulates the reward system to reduce appetite in response to food intake in animal studies. In humans, studies have shown conflicting results, with some studies suggesting that intranasal insulin (INI) in relatively high doses may decrease appetite, body fat, and weight in various populations. These hypotheses have not been tested in a large longitudinal placebo-controlled study. Participants in the Memory Advancement with Intranasal Insulin in Type 2 Diabetes (MemAID) trial were enrolled in this study. This study on energy homeostasis enrolled 89 participants who completed baseline and at least 1 intervention visit (42 women; age 65±9 years; 46 INI, 38 with type 2 diabetes) and 76 completed treatment (16 women, age 64±9; 38 INI, 34 with type 2 diabetes). The primary outcome was the INI effect on food intake. Secondary outcomes included the effect of INI on appetite and anthropometric measures, including body weight and body composition. In exploratory analyses, we tested the interaction of treatment with gender, body mass index (BMI), and diagnosis of type 2 diabetes. There was no INI effect on food intake or any of the secondary outcomes. INI also showed no differential effect on primary and secondary outcomes when considering gender, BMI, and type 2 diabetes. INI did not alter appetite or hunger nor cause weight loss when used at 40 I.U. intranasally daily for 24 weeks in older adults with and without type 2 diabetes.

Isometric Exercise and Blood Pressure: 12 Weeks of Training and Detraining in the Elderly

ABSTRACTBackgroundElderly people are particularly affected by rising systolic blood pressure (SBP). We hypothesized that resting blood pressure (RBP)-reducing isometric exercise training (IET) can be delivered in a group setting with older adults.MethodsParticipants (63–88 years; N = 19) completed IET at 30% maximum voluntary contraction, 3 days a week for 12 weeks. RBP was measured weekly throughout, plus 6 weeks posttraining. Control participants did not engage in IET (N = 5). Changes in RBP were assessed using a 2-way repeated-measures analysis of variance.ResultsIET induced significant reductions in SBP (−10.5 mmHg; P < 0.05), but SBP also declined unexpectedly in the control group (−4.5 mmHg; P < 0.05). Diastolic blood pressure declined in the IET group only (−4.7 mmHg; P < 0.05). There were no significant differences between groups for SBP or diastolic blood pressure (P > 0.05). At 6 weeks posttraining, SBP was still 9.4 mmHg below baseline in the IET group only. A unique finding was that the clinically significant RBP reductions persisted for 6 weeks after IET.ConclusionsHandgrip IET may be an effective antihypertensive intervention, which persists for several weeks in older adults, even when training ceases.

Greater Ecologically Assessed Positive Experiences Predict Heightened Sex Hormone Concentrations Across Two Weeks in Older Adults.

Sex hormones are important components of healthy aging, with beneficial effects on physical and mental health. Positive experiences such as elevated mood, lowered stress, and higher well-being also contribute to health outcomes and, in younger adults, may be associated with elevated sex hormone levels. However, little is known about the association between positive experiences and sex hormones in older adults. In this study, older men and women (N = 224, 70+ years of age) provided blood samples before and after a 2-week period of ecological momentary assessment (EMA) of positive and negative experiences (assessed based on self-reporting items related to affect, stress, and well-being). Concentrations of a panel of steroid sex hormones and glucocorticoids were determined in blood. Higher levels of positive experiences reported in daily life across 2 weeks were associated with increases in free (biologically active) levels of testosterone (B = 0.353 [0.106, 0.601], t(221.3) = 2.801, p = .006), estradiol (B = 0.373 [0.097, 0.649], t(225.1) = 2.645, p = .009), and estrone (B = 0.468 [0.208, 0.727], t(224.3) = 3.535, p < .001) between the start and the end of the 2-week EMA period. These findings suggest that sex hormones may be a pathway linking positive experiences to health in older adults.

Relationship between Fasting and Postprandial Glucose Levels and the Gut Microbiota.

Postprandial hyperglycemia increases the risk of mortality among patients with type 2 diabetes and cardiovascular diseases. Additionally, the gut microbiota and type 2 diabetes and cardio-vascular disease are known to be correlated. Currently, fasting blood glucose is the primary in-dex for the clinical diagnosis of diabetes; however, postprandial blood glucose is associated with the risk of developing type 2 diabetes and cardiovascular disease and mortality. Therefore, the dynamic change in blood glucose levels under free-living conditions is considered an important and better marker than fasting glucose levels to study the relationship between glucose levels and microbiota. Here, we investigated the relationship between fasting and postprandial glucose levels and microbiota under free-living conditions for one week in older adults. In addition, in order to clarify the relationship between blood glucose level and intestinal bacteria, postprandial 4-h AUC was calculated and the correlation with gut bacteria was investigated. As a result of the present study, we observed many of the most significant correlations between the gut bacteria and the peak glucose levels after dinner and the 4-h AUC after dinner. Together, these findings suggest that the individual pattern of microbiota may help to predict post-dinner hyperglycemia and the risk of abnormal glucose metabolism, such as diabetes.

Prospective Memory Assessed by the Virtual Week in Older Adults With HIV

Abstract Date Presented 04/21/21 Prospective memory (PM) impairment is common and limits daily function among individuals with HIV. We investigated PM and the relationships between PM, clinical characteristics, and cognitive test performance among older adults with HIV. Time-based PM tasks are problematic in this population potentially due to their memory and executive function demands. Thus, OT practitioners should implement compensatory strategies based on event-based PM to increase participation in meaningful activities. Primary Author and Speaker: Yves Carlo Pinpin

Colchicine is not effective for reducing osteoarthritic hand pain compared to placebo: a randomised, placebo-controlled trial (COLAH)

BackgroundColchicine may offer relief in osteoarthritis. This has never been investigated for hand osteoarthritis. ObjectivesTo investigate the effect of 1 mg daily colchicine vs placebo on hand pain and function over 12 weeks in older adults with hand osteoarthritis. MethodsCommunity-dwelling adults with diagnosed osteoarthritis of the hand aged 40–80 years were randomised to receive colchicine (0.5 mg twice daily) or matching placebo. Primary outcome measure was VAS hand pain score (0–100 mm). Secondary outcome measures included tender and swollen joint count, grip strength, C-reactive protein, and Michigan Hand Questionnaire total, function and pain scores. In an exploratory assessment, we compared synovial grade and power Doppler. All outcome measures were obtained at baseline and week 12. Stata v16 was used to perform constrained longitudinal data analysis models. Results64 adults (54 females, 10 males) aged 48–79 years of age were enrolled. 59 participants completed the study (N = 28 colchicine, N = 31 placebo) (withdrawal rate 8%). Adverse reactions to the study medication occurred in nine patients. VAS score was not significantly different at baseline (61 ± 17 mm in the colchicine, 64 ± 17 mm in the placebo group). Between-group difference for VAS score at week 12 was 7.6 mm (95% CI -3.5-18.7, p-value 0.18). There were no significant differences between groups for any secondary outcomes at baseline or week 12. Conclusions1 mg colchicine daily for 12 weeks was not effective for reducing pain, tender and swollen joint count or increasing grip strength in symptomatic hand osteoarthritis. Our results do not support the use of colchicine in hand osteoarthritis.

Protein intake distribution pattern does not affect anabolic response, lean body mass, muscle strength or function over 8 weeks in older adults: A randomized-controlled trial

In our recent acute metabolic study, we found no differences in the anabolic response to differing patterns of dietary protein intake. To confirm this in a chronic study, we investigated the effects of protein distribution pattern on functional outcomes and protein kinetics in older adults over 8 weeks. To determine chronic effects of protein intake pattern at 1.1g protein/kg/day in mixed meals on lean body mass (LBM), functional outcomes, whole body protein kinetics and muscle protein fractional synthesis rate (MPS) over 8-week respective dietary intervention, fourteen older subjects were randomly divided into either EVEN or UNVEN group. The UNEVEN group (n=7) consumed the majority of dietary protein with dinner (UNEVEN, 15/20/65%; breakfast, lunch, dinner), while the EVEN group (n=7) consumed dietary protein evenly throughout the day (EVEN: 33/33/33%). We found no significant differences in LBM, muscle strength, and other functional outcomes between EVEN and UNEVEN before and after 8-week intervention. Consistent with these functional outcomes, we did not find significant differences in the 20-h integrated whole body protein kinetics [net protein balance (NB), protein synthesis (PS), and breakdown (PB)] above basal states and MPS between EVEN and UNEVEN intake patterns. We conclude that over an 8-week intervention period, the protein intake distribution pattern in mixed meals does not play an important role in determining anabolic response, muscle strength, or functional outcomes. This trial is registered at https://ClinicalTrials.gov as NCT02787889.

Distribution pattern of dietary protein intake does not affect anabolic response, lean body mass, muscle strength or function over 8 weeks in older adults

Our recent acute study of dietary protein distribution indicated no difference in the anabolic response to differing patterns of dietary protein intake. However, it has been argued that acute metabolic studies may not predict functional changes over a longer period time. To examine the chronic effects of protein distribution pattern, older subjects (51– 69 yrs) consumed 1.1 g/kg/d in 2 distinct patterns. One group (n=7) consumed protein in a traditional, or uneven, manner (UNEVEN, 15/20/65%; breakfast, lunch, dinner), while the other group (n=7) consumed meals with an even distribution of protein (EVEN: 33/33/33%). Lean body mass (LBM), functional outcomes, and protein kinetics at whole‐body and muscle levels using stable isotope tracers were determined before and after 8 weeks of each respective protein intake pattern. There were no significant differences between the intake patterns in LBM, muscle strength, and other functional outcomes. Consistent with these findings, the 20‐h integrated whole body protein kinetics [net protein balance (NB), protein synthesis (PS), and breakdown (PB)] above basal states and muscle protein synthesis were not different between the intake patterns. We conclude that the distribution pattern of protein intake in mixed meals over an 8‐week period does not affect protein metabolism, lean body mass, muscle strength, or functional outcomes.Support or Funding InformationThe project was financially supported by a grant from National Dairy Council, Egg Nutrition Center, and National Cattlemen's Beef Association. This project was financially supported by Pepper Center Grant PG30‐AG‐028718 and Award Number UL1‐TR‐000039 and KL2‐TR‐000063 from the National Center for Advancing Translations Sciences (NCATS).

Finding the middle ground: Curvilinear associations between positive affect variability and daily cortisol profiles.

There is growing evidence that there are stable and meaningful individual differences in how much people vary in their experience of positive affect (PA), which in turn may have implications for health and well-being. Does such PA variability play a role in physiological processes potentially related to stress and health, such as daily cortisol profiles? We explored this question by examining whether PA variability across and within days in middle-aged adults (Study 1) and across weeks in older adults (Study 2) was associated with daily salivary cortisol profiles. In both studies, individuals who exhibited moderate PA variability demonstrated more favorable cortisol profiles, such as lower levels of cortisol and steeper slopes. Interestingly, for middle-aged adults (Study 1), high levels of within-day PA variability were associated with the least favorable cortisol profiles, whereas for older adults (Study 2), low levels of across-week PA variability were associated with the least favorable cortisol profiles. Collectively, these findings provide some of the first evidence that PA variability is related to daily cortisol profiles, suggesting that it may be better to experience a moderate degree of positive affect variability. Too much or too little variability, however, may be problematic, potentially carrying negative implications for stress-related physiological responding.

Effect of Low-dose Oral Prednisolone on Symptoms and Systemic Inflammation in Older Adults with Moderate to Severe Knee Osteoarthritis: A Randomized Placebo-controlled Trial

To investigate the efficacy of 6 weeks of daily low-dose oral prednisolone in improving pain, mobility, and systemic low-grade inflammation in the short term and whether the effect would be sustained at 12 weeks in older adults with moderate to severe knee osteoarthritis (OA). A total of 125 patients with primary knee OA were randomized 1:1; 63 received 7.5 mg/day of prednisolone and 62 received placebo for 6 weeks. Outcome measures included pain reduction and improvement in function scores and systemic inflammation markers. Pain was assessed using the visual analog pain scale (0-100 mm). Secondary outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index scores, patient global assessment (PGA) of the severity of knee OA, and 6-min walk distance (6MWD). Serum levels of interleukin 1 (IL-1), IL-6, tumor necrosis factor (TNF)-α, and high-sensitivity C-reactive protein (hsCRP) were measured. There was a clinically relevant reduction in the intervention group compared to the placebo group for knee pain, physical function, PGA, and 6MWD at 6 weeks. The mean difference between treatment arms (95% CI) was 10.9 (4.8-18.0), p < 0.001; 9.5 (3.7-15.4), p < 0.05; 15.7 (5.3-26.1), p < 0.001; and 86.9 (29.8-144.1), p < 0.05, respectively. Further, there was a clinically relevant reduction in the serum levels of IL-1, IL-6, TNF-α, and hsCRP at 6 weeks in the intervention group when compared to the placebo group. These differences remained significant at 12 weeks. The Outcome Measures in Rheumatology Clinical Trials-Osteoarthritis Research Society International responder rate was 65% in the intervention group and 34% in the placebo group (p < 0.05). Low-dose oral prednisolone had both a short-term and a longer sustained effect resulting in less knee pain, better physical function, and attenuation of systemic inflammation in older patients with knee OA (ClinicalTrials.gov identifier NCT01619163).

OP0129 Effect of low dose oral prednisolone on symptoms and systemic inflammation in older adults with moderate to severe knee osteoarthritis: A randomized placebo-controlled trial

BackgroundOsteoarthritis (OA), a common disabling condition, is the commonest type of arthritis worldwide. Knee OA is the 4th leading cause of disability in women. Pain is the leading symptom and...

Dose–response effect of 40 weeks of resistance training on bone mineral density in older adults

Resistance training is becoming popular for maintaining bone health. Previous studies examined high intensity exercise; we compared high and low intensity resistance training performed 2 or 3days per week in older adults. We found positive bone density responses for the hip and spine for all types of resistance training. This study determined the dose-response effect of resistance training on lumbar spine, proximal femur, and total body bone mineral density (BMD) in older men and women (55-74years). Subjects included 45 men and 79 women who were assigned to one of the following training groups: 1-high intensity (80% 1RM), 2days/week (2HI); 2-low intensity (40% 1RM), 2days/week (2LI); 3-high intensity (80% 1RM), 3days/week (3HI); and 4-low intensity (40% 1RM), 3days/week (3LI). Bone scans (dual energy X-ray absorptiometry) were performed at baseline and after 40weeks of training. Muscular strength (1-repetition maximum) was assessed every 5weeks. There were significant trial (p < 0.05) effects but no significant trial × training group interactions for the BMD sites. Spine, trochanter, and total hip BMD increased from baseline to 40weeks; however, the total body BMD site decreased in the 3LI group. Men and women exhibited similar improvements for the trochanter and total hip sites but the percent change in the spine tended (p = 0.054) to be higher for men (1.8%) than women (0.4%). The resistance training programs, regardless of intensity and frequency, were effective in improving BMD of the proximal femur and lumbar spine but not the total body. Both men and women responded similarly for the hip sites but men show a greater response at the lumbar spine than women.

Alcohol Consumption and Lower Extremity Arterial Disease among Older Adults: The Cardiovascular Health Study

Few studies of the relation of alcohol intake to lower-extremity arterial disease (LEAD) have included clinical events and objective measurements repeated longitudinally. As part of the Cardiovascular Health Study, a study of older adults from four US communities, 5,635 participants reported their use of beer, wine, and spirits yearly. Incident LEAD was identified by hospitalization surveillance. Technicians measured ankle-brachial index 6 years apart in 2,298 participants. A total of 172 cases of LEAD were documented during a mean of 7.5 years of follow-up between 1989 and 1999. Compared with abstention, the multivariable-adjusted hazard ratios were 1.10 (95% confidence interval (CI): 0.71, 1.71) for <1 alcoholic drink per week, 0.56 (95% CI: 0.33, 0.95) for 1-13 drinks per week, and 1.02 (95% CI: 0.53, 1.97) for > or =14 drinks per week (p for quadratic trend = 0.04). These relations were consistent within strata of sex, age, and apolipoprotein E genotype, and neither lipids nor inflammatory markers appeared to be important intermediates. Change in ankle-brachial index showed a similar relation (p for quadratic trend = 0.01). Alcohol consumption of 1-13 drinks per week in older adults may be associated with lower risk of LEAD, but heavier drinking is not associated with lower risk.

Contributions of force and velocity to improved power with progressive resistance training in young and older adults

We investigated the effects of age on changes in the force and velocity components of knee extension (KE) power during 16 weeks of traditional progressive resistance training (PRT). Thirty-one young (27 +/- 1 years, 16 men, 15 women) and 30 older (64 +/- 1 years, 14 men, 16 women) adults trained by KE, leg press, and squat 3 days/week. PRT consisted of three sets with an appropriate load for 8-12 repetitions to fatigue. Testing occurred at baseline, 8, and 16 weeks. Thigh lean mass (TLM) was measured by DEXA. KE load-power and load-velocity curves were generated from peak concentric contractions against loads equivalent to 20, 30, 40, 50, and 60% maximum voluntary isometric contraction (MVC) force. Quadriceps neural activation relative to maximum was assessed during a sit-to-stand task. Participants increased KE 1RM (P < 0.05) by 8 weeks with young adults also increasing strength from 8 to 16 weeks. Adjusting for TLM, all groups increased KE specific strength (P < 0.05). MVC improved by 8 weeks in older adults and by 16 weeks in young subjects (P < 0.05). Neural activation requirements during standing and sitting declined in older adults by 8 weeks (P < 0.05). The KE load-power curve improved for all groups (P < 0.05) by 8 weeks with only young adults improving from 8 to 16 weeks. Peak concentric velocity increased only in older adults (P < 0.05). Training improvements in power resulted primarily from increases in strength both early and late for young adults while older adults realized early improvements in both strength and peak concentric velocity.