Research Institute for Aging

Background: Up to 30% of hospital admissions in older adults may be attributed to drug-related problems (DRPs). DRPs encompass adverse drug reactions, interaction between medications, the use of potentially inappropriate medications, and non-adherence to prescribed medications. Objective: To evaluate and compare the average number of DRPs identified in older adults with cognitive impairment or dementia using the Medication Review in Cognitive Impairment and Dementia (MedRevCiD) checklist compared to the Medication Appropriateness Index (MAI) criteria. Methods: Forty-four participants from the Multi-specialty Interprofessional Team-based Memory Clinic were included in the study. The researcher used 2 distinct tools, the MAI criteria and MedRevCiD checklist, to perform a medication review. The Wilcoxon signed-rank test was applied to evaluate if a significant difference exists in the average number of DRPs identified by the MedRevCiD compared to the MAI. Bivariate logistic regression analysis was conducted to explore potential factors associated with the DRPs use. Results: In the study, a total of 134 DRPs were identified in 44 participants using the MedRevCiD checklist, averaging 3.05 DRPs per person ± standard deviation (SD) of 4.0. In comparison, 81 DRPs were identified with the use of the MAI in the same group of 44 participants, resulting in an average of 1.84 DRPs per person (SD ± 2.9). A significant difference was found in the average number of DRPs identified by the 2 instruments (Z = –4.8, p-value <0.001). Conclusion: The MedRevCiD Checklist demonstrated a heightened ability to uncover DRPs in this population.

BackgroundThere is limited research focused on lifestyle interventions for people living with dementia and recent systematic reviews primarily focus on the impact of exercise on cognition. However, functional abilities and quality of life (QoL) are the outcomes most consistently prioritized by people living with dementia, care partners, and healthcare professionals. We conducted a systematic review to understand the impact of two lifestyle interventions (physical activity, nutrition) on the functional abilities, quality of life, and nutritional status (nutrition interventions only) of people living with dementia living in the community. The results presented here focus on the effects of nutrition interventions.MethodSystematic literature searches for peer‐reviewed intervention studies were conducted in four databases (MEDLINE, EMBASE, Scopus, CINAHL). Articles were exported to Covidence, where duplicates were removed and two independent reviewers performed study selection, data extraction, and risk of bias assessments. A narrative synthesis was conducted.ResultSix studies met the inclusion criteria. Five studies compared nutrition interventions to usual care. Interventions included education/counselling on nutrition through various delivery modes; one study also included coaching to reduce care partner stress and encourage protein supplementation. Sample sizes (n = 12 – 946) and follow‐up periods varied substantially across studies (3 weeks – 12 months). Five studies assessed nutritional status, all of which used the Mini‐Nutritional Assessment. The two largest studies, a cluster‐randomized trial with 946 participants (intervention = 448; control=498) and a non‐randomized controlled trial with 225 participants (intervention = 151; control=74) found significantly better nutritional status in the intervention compared to control groups. Results showed no change for two studies and data collection was incomplete for one study. Other outcomes measures included: QoL (n = 2 studies), activities of daily living (ADL)/instrumental ADL (n = 3 studies), falls (n = 1 study), grip strength (n = 1 study), timed up and go test (n = 1 study), lower body strength (n = 1 study), and step test (n = 1 study).ConclusionExisting literature suggests that nutritional status can be improved through nutrition interventions, supporting a role for nutrition risk screening and intervention among people living with dementia. Additional large‐scale studies are needed to understand the impact of these interventions on nutritional status, QoL, and functional abilities while considering barriers to access.

BackgroundCommunity‐based programs, such as intergenerational programs, have been identified as a viable option to reduce dementia stigma and foster connections between generations. Cooking and eating with others is a social opportunity that bring people together. To date, few programs have been developed using food activities to connect community‐dwelling persons living with dementia (PWD) and young adults (18‐30 years old). Cooking Together is an innovative multi‐week intergenerational cooking and nutrition program that was collaboratively developed and evaluated. The aim of this ongoing pilot study is to test a revised program model in three separate offerings (up to 10 participants/offering) to determine feasibility, usability of procedures and outcomes, and program utility. We report preliminary feasibility based on two offerings.MethodWeekly 2‐hour sessions are chef‐facilitated, using a brain‐health focused menu. Feasibility was evaluated through recruitment (8‐10 eligible participants per offering in 2 months), attendance (70% sessions attended after enrolment), and completion of pre‐ and post‐program evaluation measures (85% participants). Young adults were recruited through a contact list of individuals who expressed interest in a previous offering but did not participate, campus advertisements, and word of mouth. PWD were recruited through a senior day program, repository of PWD interested in research studies, and word of mouth.ResultTen young adults (age (median (range)): 19 (18‐30), 90% women, 50% white) and 9 PWD (age (median (range)): 73 (36‐80), 56% women, 89% white) were recruited over two offerings within a two‐month time period. Long lead times to reserve kitchen space and scheduling meant that the offering start dates had limited flexibility, resulting in ongoing recruitment until the second week after the offering started. Fourteen participants (74%; 7 young adults and 7 PWD) completed both pre‐ and post‐program measures. Average attendance at cooking sessions was 87%, with 40% attending the full program. Common reasons for non‐attendance were prior commitments or illness.ConclusionPreliminary findings from two offerings indicate that Cooking Together is feasible and acceptable. Recruitment for the third offering is underway, with data collection expected to be completed by April 2025. Findings from this study will inform future efficacy testing.

BackgroundIntergenerational programs provide an opportunity to connect generations. Currently, there are few community‐based programs that combat dementia stigma, and few food‐based opportunities for connecting community‐dwelling persons living with dementia (PWD) with youth. Cooking Together is a collaboratively designed and tested intergenerational cooking and nutrition program. The aim of this study was to identify and develop components that would be meaningful and acceptable to potential end users (phase 1) and conduct a feasibility test (phase 2).MethodPhase 1 interviewed (n = 11) youth (14‐19 years) and PWD and care partners dyads to inform design of the proposed program and identify potential benefits. The phase 2, 4‐week prototype was tested with 15 participants, who had not participated in phase 1 development. Phase 2 participants included those from a dementia day program (n = 8), day program facilitators (n = 3), and youth (n = 4; 18‐30 years). Data collection included participant observation notes (e.g., engagement, feasibility issues) and interviews (n = 10) focused on improvements, participant experience, and potential outcomes. Content analysis was used to summarize findings.ResultFindings from phase 1 identified important components to include in the prototype for phase 2 testing. For example, potential challenges included daytime scheduling for youth under 18 years. Suggested benefits included socialization for PWD, and dementia education for youth. The phase 2 prototype was found to be feasible. Participants identified potential outcome measures and feedback led to refinement of the model for future feasibility pilot testing.ConclusionAn intergenerational cooking and nutrition program for community‐dwelling PWD and young adults (18‐30 years) was created and a prototype demonstrated interest in the program and outcomes that should be measured.

Frailty among older adults heightens their risk of negative health outcomes, and medication use plays a major role in this increased vulnerability. Various aspects of medication use elevate the risk of poor outcomes in individuals with frailty. The current scoping review was designed to explore medication use in older adults with frailty in primary care, focusing on the prevalence of potentially inappropriate medications (PIMs), polypharmacy, medication adherence, and their role in contributing to adverse drug events. This scoping review was conducted using the Arksey and O’Malley, supplemented by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews (PRISMA-ScR) guidelines. A search of the literature was conducted from inception to November 2023 in Ovid EMBASE, PubMed (MEDLINE), Scopus, EBSCOhost CINAHL, and Ovid International Pharmaceutical s. Studies which met the eligibility criteria included older adults with frailty (≥65 years) living at home, defined frailty criteria, and assessment of medication use. Out of the 4726 studies screened, 223 were included, conducted across 39 countries. Frailty prevalence varied widely from 0.9% to 89.2%. Polypharmacy (5–9 medications) and hyper-polypharmacy (≥10 medications) were notably more common among individuals with frailty, with polypharmacy rates ranging from 1.3% to 96.4%. Twelve studies reported PIM prevalence among individuals with varying levels of frailty, ranging from 2.4% to 95.9%. This scoping review highlights the challenges and complexities involved in understanding the relationship between medication use and frailty in older adults.

Speed of sound (SoS), or the propagation speed of acoustic waves through a medium, is an intrinsic property of human tissue and has emerged as a new biomarker in health diagnostics. Alas, no existing technique has practically demonstrated that the tissue SoS can be robustly measured from a single pulse-echo transmission with an imaging transducer, so incorporating SoS estimation into the ultrasound imaging pipeline remains technically challenging. In this paper, we propose a novel global SoS estimation algorithm that requires only a single steered plane wave transmission for operation. Our single-shot framework derives the SoS estimate by 1) calculating each pixel's pre-beamformed sum of normalized autocorrelation coefficients (SNAC) derived from the time-delayed channel data ensemble for an assumed SoS; 2) constructing a loss metric that is defined as, for different SoS candidates, the negated total SNAC over different pixels; 3) finding the SoS with the minimum loss value. Our single-shot SoS estimator was implemented in real-time (50ms processing time) on a portable ultrasound research scanner. It was tested in vitro using agar staircase phantoms (SoS range: 1508-1682m/s) and in vivo using svelte human calves (SoS range: 1573-1589m/s). All SoS estimates were validated with reference through-transmission measurements. Results show that our framework yielded accurate SoS estimates with a small mean signed difference (MSD) in vitro (0.4±6.5m/s) and in vivo (3.8±15.7m/s). When the framework was extended to a 10-angle multi-transmission sequence, its SoS estimation performance was further improved with a smaller MSD (0.2±2.0m/s). The advent of the proposed single-shot SoS estimator can help advance the emerging use of SoS in tissue characterization and improve other imaging processes that are influenced by SoS, such as beamforming and Doppler estimation.

Close social ties are known to increase survival, reduce chronic diseases, and promote healthful eating. Little research has explored whether adverse changes in these relationships lead to less healthful eating in older adults, with attention to gender differences. Prospective study using 3 waves of the Canadian Longitudinal Study on Aging (CLSA) in a sample of middle-age and older adults (45-85 y) reporting daily intake of fruit or vegetable (F/V) intake (at least one time per day) at baseline using dietary data collected by CLSA's Short Diet Questionnaire. We used multivariable multilevel logistic regression with interaction terms (social tie x gender) to determine whether adverse changes in close social ties (marital status and living arrangement) between baseline (2011-2015) and follow-up 1 (2015-2018) led to developing less healthful eating measured by non-daily intake of F/V at follow-up 2 (2018-2021) (n = 15,672); models adjusted for biological, behavioural, socioeconomic, and socio-political confounders. Distinct transitions by gender precipitated a change from daily F/V intake (healthful eating) to less frequent intakes (unhealthful eating). Compared to women remaining partnered, women remaining non-partnered over 3 years had 21% higher odds of reducing healthful intake of vegetables at 6-year follow-up (OR 1.21 [95% CI: 1.07, 1.38]). Becoming divorced increased the odds of reducing healthful intake of fruits among women (1.76 [1.16, 2.66]) compared to referent. Women remaining lone-living were less likely to reduce healthful fruit intake (0.86 [0.74, 0.99]), compared to remaining co-living. Compared to men remaining partnered, men who became divorced or widowed had 91% greater odds of reducing healthful vegetable intake (1.91 [1.25, 2.92] and 1.91 [1.17, 3.13], respectively). Men who remained non-partnered or became widowed were also more likely to reduce healthful fruit intake (1.20 [1.03, 1.41] and 1.99 [1.26, 3.15], respectively), compared to referent. Finally, men who became lone-living and co-living were more likely to reduce healthful intakes of vegetables (1.42 [1.06, 1.91] and 1.55 [1.04, 2.32]) and fruits (1.48 [1.11, 1.96] and 1.48 [1.00, 2.18]), compared to men remaining co-living. Findings showed that adverse changes in close social ties led to the development of less healthful eating among aging adults in Canada, and these prospective associations appeared to be gendered. Public health and nutrition interventions should consider the social context as a risk factor to address gender disparities in food intake in the aging population.

Recent innovations in vector flow imaging promise to bring the modality closer to clinical application and allow for more comprehensive, high frame-rate vascular assessments. One such innovation is plane-wave multi-angle vector Doppler, where pulsed Doppler principles from multiple steering angles are used to realize vector flow imaging at frame rates upward of 1000 frames per second (fps). Currently, vector Doppler is limited by the presence of aliasing artifacts that have prevented its reliable realization at the bedside. In this work, we present a new aliasing-resistant vector Doppler imaging system that can be deployed at the bedside using a programmable ultrasound core, graphics processing unit (GPU) processing, and deep-learning principles. The framework supports two operational modes: 1) live imaging at 17 fps, where vector flow imaging serves to guide image view navigation in blood vessels with complex dynamics, and 2) on-demand replay mode, where flow data acquired at high frame rates of over 1000 fps is depicted as a slow-motion playback at 60 fps using an aliasing-resistant vector projectile visualization. Using with our new system, aliasing-free vector flow cineloops were successfully obtained in a stenosis phantom experiment and in human bifurcation imaging scans. This system represents a major engineering advance toward the clinical adoption of vector flow imaging.