Muscle Quality in Older Adults

BACKGROUND Introduction: Type 2 diabetes is a major public health concern in older adults. Healthy lifestyles such as engaging in physical activity and adopting healthy eating are effective strategies in diabetes self-management for controlling glucose and improving physical function. Increasing evidence shows that health technologies could promote healthy lifestyles for type 2 diabetes management. However, few such studies have been conducted in older adults. Given the low digital literacy among older adults, this study assessed the feasibility of using health technology to self-monitor lifestyles for diabetes management, test the preliminary efficacy of lifestyle self-monitoring on health outcomes in older adults with type 2 diabetes, and Explore participants’ experiences with health technologies and identify strategies needed to support lifestyle changes for diabetes management. OBJECTIVE Given the low digital literacy among older adults, this study aimed to assess the feasibility of using health technology to self-monitor lifestyles for diabetes management, test the preliminary efficacy of lifestyle self-monitoring on health outcomes in older adults with type 2 diabetes, and explore participants’ experiences with health technologies and identify strategies needed to support lifestyle changes for diabetes management. METHODS This 12-week pilot study used a pre- and post-test design. Fitbit fitness trackers paired with smart phone applications were used to track physical activity and food intake over 12 weeks in 15 overweight/obese older adults with type 2 diabetes (Mean age=70.5±4.8). Baseline and 12-week health outcomes (e.g., HbA1c and physical function) were compared using paired t-tests; effect sizes were calculated using Cohen’s D. The associations with HbA1c and physical function (assessed by the Short Physical Performance Battery) of percentage of days with tracked steps (PDWTS), average daily steps, and percentage of days with food logs (PDWFL) were examined using Pearson Correlation analysis. Semi-structured qualitative interviews were conducted with participants at the end of the study. Facilitators and barriers of self-monitoring and lifestyle behaviors were collected and analyzed using thematic analysis. RESULTS HbA1c decreased significantly from baseline to 12-weeks (effect size=-0.49, p=0.036). Weight (effect size=-0.83), BMI (effect size=-0.61), and physical function (effect size=0.20) trended toward improvement (p>0.05). PDWFL showed a significant inverse correlation with HbA1c (r=-0.53, P<0.05) at 12-week follow-up. Qualitative data revealed that barriers and facilitators of self-monitoring of lifestyle and diabetes management through lifestyle modifications exist across multiple levels, including the individual, interpersonal, organizational/community, and societal levels in older adults with type 2 diabetes. Factors at one level could influence those at another level. For example, health technology not tailored to older adults may present challenges due to limited technological proficiency, while support from others can help mitigate these difficulties. CONCLUSIONS Technology-assisted self-monitoring of lifestyle behaviors may support glycemic control and related health outcomes in older adults with type 2 diabetes. In designing future diabetes management interventions, it is essential to address interconnected factors at multiple levels that address older adults’ unique needs and capacities in diabetes self-management.

Unclean cooking fuels (ie, polluting fuels including kerosene/paraffin, and solid fuels) are a major contributor to diseases and mortality, specifically in low- and middle-income countries. This review aimed to identify potential mechanisms, public health implications, and future directions of unclean cooking fuel use and health outcomes in older adults. There is an expanding body of literature to demonstrate associations between unclean cooking fuel use and multiple mental and physical health outcomes in older adults. Two key mechanisms likely driving such associations include inflammation and oxidative stress. Considering that inflammation and oxidative stress have been implicated in multiple other health conditions (eg, arthritis and osteoporosis) in addition to those investigated to date on this topic it would be prudent to continue investigation of unclean cooking fuel use and with yet to be studied health outcomes. Moreover, future research is indeed now required to identify pathways to eliminating unclean cooking fuel globally to better the health of an aging global population and to support the implementation of Sustainable Development Goal 7.

BackgroundGait speed is a strong predictor of a wide range of adverse health outcomes in older adults. Mean values for gait speed in community-dwelling older adults vary substantially depending on population characteristics, suggesting that social, biological, or health factors might explain why certain groups tend to self-select their gait speed in different patterns. The vast majority of studies reported in the literature present data from North American and European populations. There are few population-based studies from other regions with a different ethnicity and/or social and health conditions. To address this, the present study identified the mean usual and fast gait speeds in a representative multiracial population of community-dwelling older adults living in a developing country, and explored their association with sociodemographic, mental and physical health characteristics.MethodsThis was a cross-sectional population-based study of a sample of 137 men and 248 women, aged 65 years and over. Usual gait speed and fast gait speed were measured on a 4.6 m path. Participants were classified into slow, intermediate, and faster groups by cluster analysis. Logistic regression analysis was used to estimate the independent effect of each factor on the odds of presenting with a slower usual and slower fast gait speeds.ResultsParticipants had a mean (SD) usual gait speed of 1.11 (0.27) m/s and a mean fast gait speed of 1.39 (0.34) m/s. We did not observe an independent association between gait speed and race/ethnicity, educational level, or income. The main contributors to present a slower usual gait speed were low physical activity level, stroke, diabetes, urinary incontinence, high concern about falling, and old age. A slower fast gait speed was associated with old age, low physical activity, urinary incontinence and high concern about falling.ConclusionA multiracial population of older adults living in a developing country showed a similar mean gait speed to that observed in previously studied populations. The results suggest that low physical activity, urinary incontinence and high concern about falling should not be neglected and may help identify those who might benefit from early intervention.

Oral frailty and physical frailty are linked to adverse health outcomes in older adults, but their relationship with sleep quality is not well understood. This study examined the association between oral frailty and sleep quality, and the combined effects of oral and physical frailty on sleep in community-dwelling older adults. A cross-sectional study was conducted in Kaohsiung City, Taiwan (2018-2019), including 1180 adults aged ≥ 65 years selected by multistage stratified cluster sampling. Data were collected through questionnaires and dental exams. Sleep quality was measured by the Pittsburgh Sleep Quality Index. Oral frailty was assessed using indicators such as oral diadochokinesis, swallowing difficulty, masticatory performance, dry mouth, tongue coating, and number of natural teeth. Oral health-related quality of life (OHRQoL) was evaluated with the GOHAI. Logistic regression identified factors associated with poor sleep quality. Swallowing difficulty (AOR = 2.69) and dry mouth (AOR = 2.06) were significantly linked to poor sleep quality. A dose-response relationship was observed across stages of swallowing difficulty, with both suspected and confirmed cases reporting significantly poorer sleep quality compared to individuals without swallowing issues (p for trend < 0.001). Higher OHRQoL scores were linked to better sleep quality (AOR = 0.97). Additionally, the combined presence of oral frailty and physical frailty was significantly associated with poor sleep quality (AOR = 2.71). Oral and physical frailty are significantly associated with sleep quality in older adults. Interventions targeting swallowing difficulty, dry mouth, and physical frailty may improve sleep quality in this population.

Background The importance of sleep has become increasingly recognized in geriatric research. There is a growing body of evidence that links poor sleep with numerous adverse health outcomes in older adults. As a result, assessing sleep quality and patterns in later life has become essential for accurately diagnosing and effectively treating sleep problems and their associated consequences. The Geriatric Sleep Questionnaire-6 (GSQ-6) is a widely used self-report questionnaire that assesses sleep quality and disturbances specifically among older adults. This study aimed to translate the scale into Arabic and evaluate its psychometric properties in an older Arabic-speaking adults’ population. Methods The GSQ-6 was translated into Arabic using forward and backward translation procedures, and was administered to a convenience sample of 539 older adults along with the 13-item Older People Quality of Life-Brief (OPQOL-brief), the 15-item Resilience Scale of Older Adults (RSOA), and the 11-item Older Adult Neglect and Abuse Scale (NAS) for validation purposes. Reliability was examined using Cronbach’s alpha and McDonald’s omega coefficients. Confirmatory factor analysis (CFA) was also conducted to test the unidimensional factor structure. Results The CFA results supported the unidimensional factor structure proposed by the developers (CFI = 0.967, TLI = 0.945, RMSEA = 0.077. The McDonald’s omega values for the Arabic GSQ-6 was 0.70, indicating acceptable internal consistency. The measurement model had an equivalent factor structure, loadings, intercepts, and residuals across sex. correlated negatively with quality of life and resilience, and positively with neglect and abuse scores, supporting the validity of our Arabic translation. Conclusion The Arabic version of the GSQ-6 demonstrated good psychometric properties. The findings support its use as a valid and reliable measure for evaluating sleep quality among the Arabic-speaking older adult population.

Physical activity is a well-established predictor of health and longevity. Wearable accelerometers produce high-frequency, time series data that capture multiple aspects of daily physical activity across the spectrum of intensity. Historically, the majority of accelerometry-based physical activity research has employed summary threshold metrics such as moderate-to-vigorous physical activity, or “MVPA.” Although these measures are important for understanding compliance with physical activity guidelines, they underutilize the potential of this data. To advance the science of physical activity in older adults, more sensitive, clinically translatable measures are needed. This symposium will examine the associations between novel measures of accelerometry-derived physical activity and various aging-related health outcomes. Dr. Wanigatunga will discuss the association of physical activity volume and fragmentation with the frailty phenotype in the Study to Understand Vitamin D and Fall Reduction in You (STURDY). Dr. Cai will present evidence on the association of physical activity quantities and patterns with measures of visual impairment in the Baltimore Longitudinal Study of Aging. Ms. Qiao will present a novel accelerometry-derived measure of performance fatigability in the Developmental Epidemiologic Cohort Study. Finally, Dr. Urbanek will discuss the role of accelerometry-derived free-living gait cadence in defining fall risk in STURDY. Collectively, these presentations highlight critical associations between objective measures of physical activity and health outcomes in older adults and illuminate the need for thinking beyond MVPA to improve prevention and intervention efforts.

Falls are a major health concern, leading to severe injuries, fatalities, and increased risk of future falls. Severe falls, requiring medical care, necessitate targeted interventions. Socioeconomic status (SES), measured by income and education, influences health outcomes, with lower SES linked to greater multimorbidity and reduced physical activity. While SES broadly impacts fall risk, limited research explores its effects following severe falls. Therefore, this study aims to evaluate the associations between socioeconomic status (SES) and health outcomes in older adults following a fall with presentation to the emergency department (ED). We analyzed data from the SeFallED study, comprising individuals over the age of 60, who presented to the ED following a recent fall, without requiring subsequent hospitalization. Income and education were used to characterize SES. Health outcomes include mental and functional performance, physical activity, mental well-being, and utilization of the health system. Linear and logistic regression models, adjusted for age and sex, were used to assess associations with health outcomes, incorporating multicollinearity checks, residual diagnostics, and bias-corrected bootstrapping to ensure robustness and reproducibility. In this cross-sectional study of 172 older adults (median age 74 years) following a severe fall, education was positively associated with functional and mental outcomes, including Activities of Daily Living (ADLs), cognitive status, hand grip strength, and physical performance (p < .001). Regression analysis, adjusting for age and sex, revealed that higher education was significantly associated with better ADLs, cognitive status, hand grip strength, and physical performance, while income showed no significant associations with these outcomes. This study revealed that the associations with mental and functional health outcomes in older adults following a severe fall were the strongest for education, rather than income. Higher education was associated with better performance. Income showed limited associations but was negatively correlated with concerns about falling. Age and sex were critical covariates, influencing key health outcomes. These findings provide insights that may be relevant for future research and considerations in studies involving older adults presenting to EDs. DRKS00025949 https://drks.de/search/en/trial/DRKS00025949 , Registered on 4th November, 2021.

Cognitive frailty can increase the risk of adverse health outcomes in older adults. Estimates of the prevalence of cognitive frailty among older adults with diabetes varied widely in literature. This study aimed to conduct a systematic review and meta-analysis to assess the pooled prevalence of cognitive frailty and risk factors in community-dwelling older adults with diabetes, providing evidence for healthcare professionals to better understand the status of cognitive frailty and help develop effective interventions. Databases of PubMed, Web of Science, Cochrane Library, Embase, Cumulative Index of Nursing and Allied Health, Proquest, China National Knowledge Infrastructure and China Biology Medicine were searched from inception to February 10th, 2022. The reviewers independently selected studies, extracted data and assessed the quality of studies. Pooled prevalence of cognitive frailty and risk factors were estimated. Subgroup analysis, meta-regression analysis, sensitivity analysis and publication bias were also conducted. A total of 15 studies with 6391 participants were included in this review. The pooled prevalence of cognitive frailty was 11% (95%CI=7.9-14%) in community-dwelling older adults with diabetes. Pooled estimates showed that increasing age, higher level of HbA1c, shorter night sleep duration and depression were risk factors, and regular exercise was the protective factor of cognitive frailty in community-dwelling older adults with diabetes. Cognitive frailty was common in community-dwelling older adults with diabetes. Routine screening of cognitive frailty and effective interventions should be implemented for this population in community settings. PROSPERO ID CRD42021276973.

BackgroundIn recent years cognitive frailty has emerged as an important predictor of adverse health outcomes in older adults. Herein, we aimed to investigate the prevalence and associated factors of cognitive frailty in a population of community-dwelling older adults in Iran.MethodThis cross-sectional study was conducted as part of the second cycle of the Amirkola Health and Aging Project (AHAP). Physical frailty and cognitive impairment were evaluated using the FRAIL questionnaire and the mini-mental state examination (MMSE) respectively. Cognitive frailty was defined as co-existence of frailty and cognitive impairment without presence of dementia. Depression and disability were assessed using the Persian version of geriatric depression scale (GDS) and instrumental activities of daily living (IADL) questionnaire.ResultsOverall 1775 individuals (47.1% female) with mean age of 69.7 ± 7.3 years were included in the final analysis. The prevalence of cognitive frailty was 12.0%. The prevalence of cognitive frailty among males and females was 4.3% and 20.7%, respectively. After adjusting for all possible confounders through binary logistic regression analysis, factors such as older age (OR 1.06, CI 1.03–1.09), female gender (OR 2.25, CI 1.42–3.57), illiteracy (OR 3.84, CI 2.03–8.29), more comorbidities (OR 1.21, CI 1.12–1.31), depression (OR 2.01, CI 1.40–2.86), and greater IADL disability (OR 1.68, CI 1.44–3.96), were independently and significantly associated with cognitive frailty.ConclusionIn this population of Iranian older adults, prevalence of cognitive frailty was consistent with its estimated mean global prevalence. Age, gender, illiteracy, comorbidities, depression and IADL disability were associated with cognitive frailty. Further research is required to develop screening tools and prevention strategies.

Vitamin D deficiency is often associated with adverse health outcomes in older adults. The circulating 25-hydroxyvitamin D (25(OH)D) status predominately relies on UV exposure. However, the extent of which northerly latitude exasperates deficiency is less explored in ageing. We aimed to investigate vitamin D deficiency in community-dwelling, older adults, residing at latitudes 50–55° north. This study was comprised of 6004 adults, aged >50 years from wave 6 (2012–2013) of the English Longitudinal Study of Ageing (ELSA). Deficiency was categorised by two criteria: Institute of Medicine (IOM) (<30 nmol/L) and Endocrine Society (ES) (<50 nmol/L). The overall prevalence of Institute of Medicine (IOM) and Endocrine Society (ES) definitions of deficiency were 26.4% and 58.7%, respectively. Females (odds ratio (OR) 1.23; CI: 1.04–1.44), those aged 80+ (OR: 1.42; CI: 1.01–1.93), smoking (OR: 1.88; CI: 1.51–2.34); of non-white ethnicity (OR: 3.8; CI:2.39–6.05); being obese (OR: 1.32; CI:1.09–1.58), and of poor self-reported health (OR:1.99; CI:1.33, 2.96), were more likely to be vitamin D deficient (by IOM). Residents in the south of England had a reduced risk of deficiency (OR: 0.78; CI:0.64–0.95), even after adjustment for socioeconomic and traditional predictors (obesity, age, lifestyle, etc.) of vitamin D status. Other factors, such as being retired, having a normal BMI, engaging in regular vigorous physical activity, vitamin D supplement use, sun travel, and summer season were also significantly positive correlates of deficiency. Similar results were observed for the ES cut-off definition. Importantly, more than half of adults aged >50 years had 25(OH)D concentrations <50 nmol/L. These findings demonstrate that low vitamin D status is highly prevalent in older English adults and the crucial importance of public health strategies throughout midlife and older age to achieve optimal vitamin D status.

The purpose of this study was to understand the relationship of symptoms associated with polypharmacy (PPY) vs. no PPY in older adults with and without Alzheimer's Disease and Related Dementias (ADRD) and examine the impact of PPY and individual symptoms on health outcomes and physical function over time in community-dwelling older adults with and without ADRD by the presence of PPY. Polypharmacy, defined as taking five or more medications daily, is a common clinical problem impacting 30% of older adults and as many as 40-70% of those with ADRD. Little is known about symptoms and health outcomes associated with PPY in those with ADRD due to their exclusion from clinical studies resulting in a lack of evidence-based prescribing guidelines to support medication management. This longitudinal case-control study utilized the National Health and Aging Trends Study (NHATS), a nationally representative sample of Medicare beneficiaries who completed surveys from Round 6 to 9 (2016-2019). First, we identified symptoms (depression, anxiety, breathing problems, balance problems, general pain, stomach pain, fatigue, weight loss, insomnia) associated with PPY in those with and without ADRD, and then examined differences in symptom frequency over time in four groups: those with both ADRD and PPY (had both ADRD and PPY), ADRD only (had ADRD but did not have PPY), PPY only (did not have ADRD but did have PPY) and neither ADRD or PPY (N=2,052) . Next, we examined differences in health outcomes (falls, hospitalizations, mortality, and transition to a nursing home) and physical function (Short Physical Performance Battery (SPPB), handgrip strength, assistance with activities of daily living (ADLs)) over time in four groups of older adults: those with both ADRD and PPY, ADRD only, PPY only and neither ADRD or PPY. Lastly, we examined the impact of PPY and each individual symptom on health outcomes (falls, hospitalizations, mortality, and transition to a nursing home) and the trajectory of physical function in those with and without ADRD. Older adults with both ADRD and PPY experienced a mean of 5.06 symptoms over all time points compared to 3.31 (ADRD only), 2.55 (neither ADRD or PPY) and 3.66 (PPY only) (p=&lt;0.001). Symptom frequencies in those with both ADRD and PPY remained higher than all other groups across all four time points. Next, we found that participants with both ADRD and PPY had higher odds of falling in the last year compared to all other groups overtime (Round 6: OR=3.4, 95% CI [1.8,6.3], Round 7: OR=2.3, 95% CI [1.0-5.0], Round 8: OR=3.2, 95% CI [1.4-2.1]), and also experienced more hospitalizations and mortality. Older adults with both ADRD and PPY had lower SPPB scores at baseline and over all four timepoints when compared to all other groups (p=&lt;.001). Those with ADRD (ADRD only and both ADRD and PPY) had lower handgrip scores compared to those without ADRD (PPY only and neither ADRD or PPY) (p=&lt;.001). Those with both ADRD and PPY had higher assistive device utilization and needed more assistance with activities of daily living. Symptoms of PPY were associated with falls, hospitalizations, and nursing home transition. Those with both ADRD and PPY had more symptoms associated with falls and experienced more falls over time than the other groups (ADRD only, PPY only, neither ADRD or PPY). Our study identified the symptoms associated with PPY and its impact on negative health outcomes and physical function decline in older adults with both ADRD and PPY. This research can help inform medication management and support deprescribing practices that improve medication safety and enhance quality of life for older adults living with ADRD.

Sarcopenia in the era of precision health: Toward personalized interventions for healthy longevity

Recent findings suggest that the distribution of protein intake throughout the day has an impact on various health outcomes in older adults, independently of the amount consumed. We evaluated the association between the distribution of dietary protein intake across meals and all-cause mortality in community-dwelling older adults. Data from 3225 older adults aged ≥ 60 years from the Seniors-ENRICA-1 cohort were examined. Habitual dietary protein consumption was collected in 2008-2010 and in 2012 through a validated diet history. Protein distribution across meals was calculated for each participant as the coefficient of variation (CV) of protein intake per meal, in sex-specific tertiles. Vital status was obtained from the National Death Index up to 30 January 2020. Cox proportional hazards regression was performed to determine the hazard ratios (HR) and their 95 % CI for the association between the distribution of daily protein intake across meals and all-cause mortality. Over a median follow-up of 10·6 years, 591 deaths occurred. After adjustment for potential confounders, the CV of total protein intake was not associated with all-cause mortality (HR and 95 % CI in the second and third tertile v. the lowest tertile: 0·94 (0·77, 1·15) and 0·88 (0·72, 1·08); Ptrend = 0·22). Similarly, the HR of all-cause mortality when comparing extreme tertiles of CV for types of protein were 0·89 (0·73, 1·10) for animal-protein intake and 1·02 (0·82, 1·25) for plant-protein intake. Dietary protein distribution across meals was not associated with all-cause mortality, regardless of protein source and amount, among older adults. Further studies should investigate whether this picture holds for specific causes of death.

To review the current literature assessing the risks associated with the use of anticholinergic (AC) medications in older adults and to provide recommendations for pharmacists to incorporate the evaluation of AC burden as a component of a medication therapy management program for older adults. A MEDLINE/PubMed search was conducted from January 1990 to July 2011 using the terms anticholinergic, antimuscarinic, geriatric, aged, and elderly. References cited in studies and reviews identified in this search were also evaluated. Articles published in languages other than English or conducted in nonhuman species were not evaluated. Studies and reviews were included if they evaluated adverse events associated with the use of AC medications in the older adult population. Data were extracted by the method of independent extraction by multiple observers based on their selection of sections. The review presents evidence that AC medications are associated with negative outcomes in older adults and the importance of health care provider interventions to avoid these consequences. AC burden is associated with adverse drug events and negative health outcomes in older adults. Health care providers should carefully assess the risks versus benefits of using medications with AC properties to minimize AC burden and prevent adverse outcomes in this vulnerable patient population. AC burden should be considered as acomponent of a medication therapy management program for seniors.

ABSTRACTObjectives: High levels of religious involvement have been associated with positive mental health outcomes in older adults. This study investigated whether the effects of religion on healthy aging could generalize to older LGBTQ adults.Methods: This study examined religious affiliation in childhood versus at present, as well as the relationships of outness to religious community and religious engagement with depression and loneliness in 102 lesbian, gay, and bisexual cisgender, transgender, and questioning adults (LGBTQ) over the age of 55. As part of a larger study, participants completed several questions and measures including: one outness to religious community item, 4 religious engagement questions, the Center for Epidemiological Studies Depression Scale, and the 8-item UCLA Loneliness Scale.Results: Many older LGBTQ adults reported changes in religious affiliation from childhood to adulthood. Greater levels of outness to religious communities and lower religious engagement were related to lower levels of depression and loneliness.Conclusions: Findings suggest that outness to religious communities may be beneficial to the mental health of older LGBTQ adults. Higher levels of distress may lead to higher levels of religious engagement.Clinical Implications: Religion, especially those that are supportive of sexual minorities, may help to improve the well-being of older LGBTQ adults.