Development of GERAS DANcing for Cognition and Exercise (DANCE): a feasibility study

Mobility impairments are prevalent in older adults. Whereas walking had traditionally been viewed as an autonomous process, evidence over the last decade has shown that cognitive processes such as attention and executive function have a significant impact on gait function in older adults. However, the exact neural mechanisms underlying difficulties in the control of mobility in older adults remains an open question. We examine the changes in the executive control of mobility in older adults with mobility impairments using functional near-infrared spectroscopy, as operationalized by performance in the community balance and mobility scale (CB&M). We hypothesized that prefrontal cortical (PFC) activity increases would be higher in older adults with mobility impairments, compared with older adults without mobility impairment, as dual-task walking difficulty increased. Older adults with (n=10, mean±SD age: 77±8 years, 8 females, CB&M= 58±12) and without mobility impairment (n=14, mean±SD age: 63±9 years, 11 females, CB&M= 87±6) were recruited from the local community. Dual-task walking was performed at a comfortable pace, while the difficulty of the concurrent cognitive task was increased using the modified Stroop test. PFC activity was measured using measures of oxygenated hemoglobin across the PFC. Older adults with mobility impairments demonstrated disproportionate increases in PFC activity, in comparison to those without mobility impairments, as the difficulty of the concurrent cognitive task increased (P<.001), even after controlling for age. In conclusion, these data suggest that older adults with mobility impairments may require greater attentional resources than those without mobility impairments when concurrently performing thinking and walking tasks.

Alpha-actinin-3 (ACTN-3), a structural protein in type II skeletal muscle fibers, is important for maintaining structure of the myofibrillar array. Although not all studies agree, recent data suggest that the R577X variant in the ACTN3 gene explains some of the inter-individual variability in muscle functioning in older adults. PURPOSE: To examine the association of the ACTN3R577X polymorphism with muscle function and physical performance in older adults. METHODS: To determine the association of the R577X polymorphism (RR, RX, & XX groups) with muscle function and physical performance, we measured knee extensor torque, mid-thigh muscle cross-sectional area, muscle quality, short physical performance battery score, and 400-meter walk time at baseline and after five-years of age in white older adults between the ages of 70-79 yr in the Health, Aging and Body Composition (Health ABC) Study cohort (n = 1,367). Incident persistent lower extremity limitation (PLL) over five-years was also assessed. The X-homozygote frequency in the black sub-group was too low to include in the analysis. RESULTS: There were no significant differences between R577X genotype groups in men or women for baseline muscle function or for performance phenotypes, when these data were adjusted for potential confounders. Men who were X-homozygotes had a significantly greater adjusted five-year increase in their 400-meter walk time compared to R-homozygotes (p= 0.008) and heterozygotes (p= 0.075). In women, R-homozygotes had an ∼ 35% lower risk of incident PLL compared to X-homozygotes (HR = 0.65, 95% CI = 0.44 - 0.94), but this association was not observed in men. CONCLUSIONS: The present results indicate the ACTN3R577X polymorphism may influence declines in physical performance with age in older white adults. However, the influence of the ACTN3R577X polymorphism should be interpreted with caution based on the strength of these associations and lack of a replication sample. This research was supported in part by the Intramural Research Program of the NIH, National Institute on Aging. NIA contract #s: N01-AG-6-2101, N01-AG-6-2103, N01-AG-6-2106.

Previous studies investigating the relationship between sleep duration and cognitive function in older adults have suggested that longer sleep durations are associated with decreased cognitive performance. The intent of this study is to determine if performance on the Montreal Cognitive Assessment (MoCA) and the Mini Mental State Exam (MMSE) is associated with self-reported sleep duration in older adults. Data from 189 cognitively normal older adults aged 75 and older (mean age 89.29±7.62) and free of severe depression were used for this analysis. Individuals were grouped based on their self-reported hours of sleep (short duration=<7, normal duration=7, >9, and long duration=≥9). The Kruskal-Wallis test was used to discern group differences on the MoCA scores, while multinomial logistic regression was used to assess the association between MoCA and MMSE scores and sleep group. The long duration group had significantly lower MoCA scores than the normal duration group (p=0.02). The short duration group was not significantly different from the normal duration group (p=0.33). Individuals in the short duration group were more likely to have higher MoCA scores than those in long duration group after adjusting for age, gender, and presence of depressive symptoms [OR 0.86, 95% CI (0.76, 0.98), p=0.02]. The results of this study suggest that in a group of non-demented, very old subjects, self-reported sleep duration of nine or more hours is associated with decreased cognitive performance on the MoCA in older adults, even after accounting for age, gender, and presence of depressive symptoms.

Translation of a Motor Learning Walking Rehabilitation Program Into a Group-Based Exercise Program for Community-Dwelling Older Adults

BackgroundWhile functional and mobility impairments (FMIs) have garnered the attention of health researchers in low and middle-income countries (LMICs), including India, research has yet to explore whether and to what extent the perception of one’s social status is associated with FMIs. We fill this gap in the literature by examining (1) the association between subjective social status (SSS) and FMIs among older adults in India and (2) whether this association between SSS and FMIs is mediated and moderated by life satisfaction and depression.MethodsData come from the 2017-18 wave 1 of the Longitudinal Aging Study in India (LASI) with a sample of 31,464 older adults aged 60 years and above. FMIs were assessed using established scales on impairments in activities of daily living (ADLs), instrumental activities of daily living (IADLs), and mobility. SSS was assessed using the Macarthur scale. Life satisfaction was measured using responses to five statements gauging respondent’s overall satisfaction with life. Depression was calculated using the shortened version of the Composite International Diagnostic Interview (CIDI-SF). Multivariable regression was employed to examine the association between variables, and the interaction terms and Karlson-Holm-Breen (KHB) method were used separately to test the mediation and moderation effects.Results39.11% of the sample had a low SSS, 8.26% were depressed, and 32.07% reported low life satisfaction. A total of 8.74%, 10.91%, and 8.45% of the study population reported at least one impairment in ADL, IADL, and mobility, respectively. Older adults in the higher SSS group were less likely to have ADL impairment (beta: -0.017, CI: -0.030, -0.0032) and mobility impairment (beta: -0.044, CI: -0.076, -0.013). Depression moderated the association between SSS and mobility impairment (p-value: 0.025), and life satisfaction moderated the association between SSS and ADL impairments (p-value: 0.041) and SSS and IADL impairments (p-value: 0.037). Depression mediated 20.28%, 31.88%, and 18.39% of the associations of SSS with ADL, IADL, and mobility impairments, respectively. Similarly, life satisfaction mediated 23.24%, 52.69%, and 27.22% of the associations of SSS with ADL, IADL, and mobility impairments.ConclusionsThat SSS is associated with FMIs among older Indians, even after considering their objective socioeconomic status (SES), suggests that the use of SSS is relevant to the study of health inequalities in India. The finding that life satisfaction and depression mediate and moderate this association is crucial in pinpointing those older Indians at risk of the functional and mobility-related repercussions of lower SSS.

Electroconvulsive therapy (ECT) is a well-established treatment for mood disorders in younger adults and has been consistently shown to be safe and effective in unipolar depression in older adults. However, data on this treatment in older adults with bipolar disorder are limited. In this retrospective study, we report outcomes from all cases of older adults with bipolar depression who received ECT from a large academic institution over a 7-year period. We retrospectively identified all patients 65 years and older with bipolar depression who were treated with ECT over a 7-year period. Patients receiving ECT for an episode of bipolar depression were included in the study based on chart review and availability of documented outcome measures. Primary outcomes were changes in Montreal Cognitive Assessment and Clinical Global Impressions scores. We identified 34 patients meeting inclusion criteria. Collectively, patients had statistically significant improvement in Montreal Cognitive Assessment scores and reductions in Clinical Global Impressions severity scores after treatment. Pre- and posttreatment Montgomery-Asberg Depression Rating Scale scores were also available for a subset of 20 patients and demonstrated a similarly significant reduction in severity with treatment. There were no serious adverse effects of treatment, and no patients discontinued treatment. Electroconvulsive therapy was well tolerated and effective in treating bipolar depression in older adults. Importantly, these findings challenge commonly held worries about cognitive decline in older adults receiving ECT. It should be a regular consideration for management of this challenging illness in a population that may otherwise not respond to pharmacotherapy.

Cognitive reserve (CR) protects against cognitive decline and dementia but its relation to mobility impairment has not been established. To address this important gap in the literature, we conducted a longitudinal investigation to test the hypothesis that higher baseline CR was associated with a lower risk of developing mobility impairment in older adults. Participants were dementia-free older adults who received brain magnetic resonance imaging and had gait speed assessments during follow-up. Using the residuals approach, CR was computed as the variance in the Modified Mini-Mental Status Examination total score, that was left after accounting for structural brain integrity, education, and race. Mobility impairment was defined using a validated cutoff score in gait speed of 0.8 m/s. Logistic regression models using general estimating equations were utilized to examine longitudinal associations between baseline CR and the risk of developing mobility impairment across repeated assessments. Of the participants (n=237; mean age=82 years; %female=56%) who were free of mobility impairment at baseline, 103 developed mobility impairment during follow-up (mean=3.1 years). Higher CR at baseline was associated with a lower risk of developing incident mobility impairment-odds ratio (OR)=0.819, 0.67-0.98, p=0.038 (unadjusted); OR=0.815, 0.67-0.99, p=0.04 (adjusted for socio-demographic variables and depression); OR=0.819, 0.68-0.88, p=0.035 (adjusted for illness history); OR=0.824, 0.68-0.99, p=0.045 (adjusted for white matter hyperintensities); OR=0.795, 0.65-0.95, p=0.016 (adjusted for falls history). Higher CR at baseline was protective against developing incident mobility impairment during follow-up among community-residing older adults.

Aim: The aim of the research was to determine attitudes towards old age in older adults living in institutional facilities, and to compare them with the population standard. A further aim was to determine differences in attitudes towards old age by gender, age, level of education, and self-sufficiency in the older adults surveyed. Design: A cross-sectional study. Methods: A research sample consisting of 121 elderly people living in retirement homes. Data were collected using a Czech version of the AAQ questionnaire (Attitudes to Ageing Questionnaire), and Barthelʼs test of Activities of daily living was used to assess levels of self-sufficiency. Results: Older adults awarded the highest score (most positive attitude) in the domain of psychosocial losses. In comparison with the population standard, older adults rated the domain of physical change (p < 0.001) and psychological growth (p < 0.001) negatively. The domain of psychosocial losses was assessed more positively by men (p < 0.001) and the elderly with moderate dependence (p < 0.001); the domain of physical changes was also positively assessed by men (p = 0.001), and older adults with university education (p = 0.002); the domain of psychological growth was rated more positively by adults over 85 years (p = 0.001), and the elderly with basic education (p = 0.040). Conclusion: Determining older adults´ attitudes towards ageing in institutional care may help in the preparation of individual care plans aimed at supporting clients in areas that have been evaluated negatively. Keywords: institutional care, quality of life, attitudes, old age, ageing, self-sufficiency.

BackgroundMalnutrition in patients admitted to hospital may have detrimental effects on recovery and healing. Malnutrition is preceded by a state of malnutrition risk, yet malnutrition risk is often not detected during admission. The aim of the current study was to investigate the magnitude and potential predictors of malnutrition risk in older adults, at hospital admission.MethodsA cross-sectional was study conducted in 234 older adults (age ≥ 65 or ≥ 55 for Māori or Pacific ethnicity) at admission to hospital in Auckland, New Zealand. Assessment of malnutrition risk status was performed using the Mini Nutritional Assessment Short-Form (MNA®-SF), dysphagia risk by the Eating Assessment Tool (EAT-10), muscle strength by hand grip strength and cognitive status by the Montreal Cognitive Assessment (MoCA) tool.ResultsAmong 234 participants, mean age 83.6 ± 7.6 years, 46.6% were identified as at malnutrition risk and 26.9% malnourished. After adjusting for age, gender and ethnicity, the study identified [prevalence ratio (95% confidence interval)] high dysphagia risk [EAT-10 score: 0.98 (0.97–0.99)], low body mass index [kg/m2: 1.02 (1.02–1.03)], low muscle strength [hand grip strength, kg: 1.01 (1.00–1.02)] and decline in cognition [MoCA score: 1.01 (1.00–1.02)] as significant predictors of malnutrition risk in older adults at hospital admission.ConclusionAmong older adults recently admitted to the hospital, almost three-quarters were malnourished or at malnutrition risk. As the majority (88%) of participants were admitted from the community, this illustrates the need for routine nutrition screening both at hospital admission and in community-dwelling older adults. Factors such as dysphagia, unintentional weight loss, decline in muscle strength, and poor cognition may indicate increased risk of malnutrition.

Falls in older adults are a major public health concern due to high prevalence, impact on health outcomes and quality of life, and treatment costs. Physical therapists can play a major role in reducing fall risk for older adults; however, existing clinical practice guidelines (CPGs) related to fall prevention and management are not targeted to physical therapists. The purpose of this clinical guidance statement (CGS) is to provide recommendations to physical therapists to help improve outcomes in the identification and management of fall risk in community-dwelling older adults. The Subcommittee on Evidence-Based Documents of the Practice Committee of the Academy of Geriatric Physical Therapy developed this CGS. Existing CPGs were identified by systematic search and critically appraised using the Appraisal of Guidelines, Research, and Evaluation in Europe II (AGREE II) tool. Through this process, 3 CPGs were recommended for inclusion in the CGS and were synthesized and summarized. Screening recommendations include asking all older adults in contact with a health care provider whether they have fallen in the previous year or have concerns about balance or walking. Follow-up should include screening for balance and mobility impairments. Older adults who screen positive should have a targeted multifactorial assessment and targeted intervention. The components of this assessment and intervention are reviewed in this CGS, and barriers and issues related to implementation are discussed. A gap analysis supports the need for the development of a physical therapy-specific CPG to provide more precise recommendations for screening and assessment measures, exercise parameters, and delivery models. This CGS provides recommendations to assist physical therapists in the identification and management of fall risk in older community-dwelling adults.

Frailty and Long-Term Survival Among Older Adults with Blood Cancers

The mutual presence of impairments in physical and cognitive functions in older adults has been reported to predict incident disability, dementia, and mortality. The longitudinal transitions of phenotypes between these functional impairments, either individually or in combination, remain unclear. To investigate the natural course and prevalence of physical and/or cognitive impairments (CIs), we enrolled participants from a community-based population. Data were retrieved from the first (August 2011 and December 2012) and second wave (August 2013 and June 2015) of the I-Lan Longitudinal Aging Study (ILAS). All participants were classified into four groups: robust, mobility impairment (MI), CI, and physio-cognitive decline syndrome (PCDS). MI was diagnosed with weakness and/or slowness. CI was diagnosed if a subject met a cutoff below 1.5 standard deviations (SDs) of age-, sex-, and education-matched norms of any neuropsychological assessments. PCDS was combined with MI and CI. Our results showed that 38, 14, 30, and 18% of the participants were on the robust, MI, CI, and PCDS at the first wave, respectively. After 2.5 years, 17% robust, 29% MI, and 37% CI progressed to PCDS. In contrast, 33% of PCDS was reversed to non-PCDS. Predictors of conversion to PCDS included worse memory and language functions, older age, lower muscle mass, and the presence of diabetes. In PCDS, a stronger hand-grip strength, younger age, and better memory functions predicted reversion to non-PCDS status. In summary, we probed the transition of PCDS. The skeletal muscle mass/function and memory function are crucial factors associated with PCDS reversion or progression.

Mobility Impairments (MI) and Associated Distress Domains in African American and Caucasian Older Adults with Cancer in a Multisite Lay Navigation Program (LNP) (S793)

e24035 Background: The use of performance status (PS) assessments in patients with cancer is a common practice to determine their suitability for treatment, clinical trial enrollment, and prognosis. The Karnofsky Performance Scale (KPS) and Eastern Cooperative Oncology Group Performance Status (ECOG PS) score are widely used clinical instruments for this purpose. However, these tools are subjective and unidimensional, with potential for bias, and were validated in younger patients. KPS has demonstrated greater specificity than ECOG in evaluating PS. Frailty, a dynamic medical syndrome characterized by diminished strength, endurance, and reduced physiological function, is recognized as a predictor of vulnerability to adverse outcomes, especially in older adults with cancer. The Fried Frailty Phenotype (FP) is a widely validated tool that uses both objective and subjective measures to identify frailty based on presence of 3 or more criteria: unintentional weight loss, self-report of exhaustion (fatigue), weakness (measured by grip strength), slow walking speed, and low physical activity. Our study compares physician-rated KPS with FP (fit, prefrail, frail) and looks at correlation of both tools in older adults with cancer. Methods: Data from older adults with solid tumor malignancies referred to the geriatric oncology clinic for geriatric assessment (GA) from January 2015–August 2019 were abstracted. Physician-rated KPS (0-100) were categorized into 3 groups: normal activity, high functioning (80–100); intermediate, capable of self-care but unable to do active work (70); and poor PS, requires considerable assistance (&lt;60). These were compared to FP which classified patients based on the number of frailty criteria present: fit (0), prefrail (1-2), and frail (&gt;3). Frequency data calculation and bivariate analysis were done. Results: 241 older adults with cancer completed a GA, median age of 80 years, 52% female. 57% were frail, 37% prefrail, and 6% fit. 90% of patients with KPS 80-100, had prefrail and frail phenotypes. Patients with KPS 70 had 24% prefrail and 76% frail phenotypes and those with KPS &lt; 60 had 10% prefrail and 90% frail phenotypes. Conclusions: Majority of older patients with prefrail and frail phenotypes were assessed as high functioning (KPS 80-100). KPS is an inadequate substitute for FP and should not be used alone in assessing functional status of older adults with cancer.

Youthful feelings were shown to have a positive effect on the mental and physical conditions of the elderly. On the contrary, elderly people whose self-perceived age is older than their chronological age were shown to experience negative health outcomes. This study investigated whether the self-perceived age (younger or older) relative to chronological age promotes social activity. The baseline data acquired from 3094 older adults as part of the Keeping Active across Generations Uniting the Youth and the Aged study was used in the current study. The participants completed a questionnaire that solicits information pertaining to sociodemographic factors, felt age, self-rated health, physical activity, depression, disease burden, fall history, fear of falling, level of instrumental activities of daily living (IADLs) and social activity. The discrepancy between felt age and chronological age was defined as the self-perceived age. Self-perceived age was calculated by subtracting the participant’s chronological age from the felt age, and the score for the difference was divided by the chronological age. The Japan Science and Technology Agency Index of Competence was used to evaluate social activity. Regression analysis results revealed that a younger self-perceived age was associated with higher social activity after controlling for sociodemographic factors, self-rated health, depression, physical activity, disease burden, level of IADL, fall history and fear of falling. Fall history was significantly associated with higher social activity in young-old participants (65 - 74 years) (p = 0.014) but not in old-old participants (>75 years). This study suggests that a younger self-perceived age in older adults would lead to a high-level living function. This finding may provide useful information for interventions aimed at the promotion of health and/or the prevention of frailty.