Geriatrics Commons^™

Age-Related Modifications To The Magnitude And Periodicity Of Neuromuscular Noise, Niklas König Ignasiak

Physical Therapy Faculty Articles and Research

Background: Evaluation of task related outcomes within geriatric and fall-prone populations is essential not only for identification of neuromuscular deficits, but also for effective implementation of fall prevention strategies. As most tasks and activities of daily living are performed at submaximal force levels, restoration of muscle strength often does not produce the expected benefit in functional capacity. However, it is known that muscular control plays a key role in the performance of functional tasks, but it remains unclear to what degree muscular control and the associated neuromuscular noise (NmN) is age-related, particularly in the lower-extremities.

Objectives: The aim of this …

Clinically Relevant Intronic Splicing Enhancer Mutation In Myelin Proteolipid Protein Leads To Progressive Microglia And Astrocyte Activation In White And Gray Matter Regions Of The Brain, Adam D. Bachstetter, Scott J. Webster, Linda J. Van Eldik, Franca Cambi

Sanders-Brown Center on Aging Faculty Publications

INTRODUCTION: Mutations in proteolipid protein (PLP), the most abundant myelin protein in the CNS, cause the X-linked dysmyelinating leukodystrophies, Pelizaeus-Merzbacher disease (PMD) and spastic paraplegia type 2 (SPG2). Point mutations, deletion, and duplication of the PLP1 gene cause PMD/SPG2 with varying clinical presentation. Deletion of an intronic splicing enhancer (ISEdel) within intron 3 of the PLP1 gene is associated with a mild form of PMD. Clinical and preclinical studies have indicated that mutations in myelin proteins, including PLP, can induce neuroinflammation, but the temporal and spatial onset of the reactive glia response in a clinically relevant mild form of PMD …

2012 Año Europeo Del Envejecimiento Activo Y La Solidaridad Intergeneracional Una Mirada Multidimensional A Un Fenómeno Global, Diego A. Bernardini

Diego Bernardini MD, PhD

No abstract provided.

Grip Strength, Multimorbidity, And Disability, Amy M. Yorke

Dissertations

The presence of two or more chronic health conditions, also known as multimorbidity, is one of the most prevalent health disorders experienced by adults. Adults with multimorbidity and functional limitations represent clinical and financial challenges to the current health care system. The purpose of this three-paper dissertation is to examine the relationship between grip strength, multimorbidity, and the prediction of disability in adults. Data from the 2008 Health and Retirement Study (HRS), a nationally representative, longitudinal study completed on Americans age 50 years and over, are used for the dissertation.

The objective of the first paper is to investigate the …

Preparing The Leaders Of Tomorrow: A Model Of Applied Research Training In A Community College, Pat Spadafora, Lia Tsotsos

Publications and Scholarship

Depending on their program of study, many students graduating from colleges and universities will have had few educational opportunities to learn about the influence of a changing Canadian demographic. However, the reality is that an aging population can be expected to impact their careers regardless of their chosen field of work. At Sheridan College, the Sheridan Elder Research Centre (SERC) has developed a comprehensive applied research training and mentorship program for college students. This training is designed as a week-long immersive and interactive series of workshops. In addition to laying a solid theoretical foundation, exploring current issues in the field …

Online Elder Circles: A Guide To Their Creation And Benefits, Trudy Medcalf, Lia Tsotsos, Pat Spadafora

Publications and Scholarship

This participatory research project explored the experience of creating and delivering an elder circle program in an online format as well as investigating the benefits to the participants. Elder circles are facilitated, elder-centred small closed groups of older adults who explore collaboratively the experience of growing old and living in old age. The researcher, with the help of her participant co-researchers, successfully translated a face-to-face elder circle model to an online format. The six participants, aged 70 to 87, met online without previously knowing each other and for six weeks engaged in facilitated asynchronous discussion on a secure dedicated website. …

Circulating Micrornas In Alzheimer's Disease: The Search For Novel Biomarkers, Véronique Dorval, Peter T. Nelson, Sébastien S. Hébert

Sanders-Brown Center on Aging Faculty Publications

Alzheimer's disease (AD) is the most common neurodegenerative disease in the elderly. While advancements have been made in understanding the genetic and molecular basis of AD, the clinical diagnosis of AD remains difficult, and post-mortem confirmation is often required. Furthermore, the onset of neurodegeneration precedes clinical symptoms by approximately a decade. Consequently, there is a crucial need for an early and accurate diagnosis of AD, which can potentially lead to strategies that can slow down or stop the progression of neurodegeneration and dementia. Recent advances in the non-coding RNA field have shown that microRNAs (miRNAs) can function as powerful biomarkers …

Dose- And Time-Dependent Neuroprotective Effects Of Pycnogenol® Following Traumatic Brain Injury, Mubeen A. Ansari, Kelly N. Roberts, Stephen W. Scheff

Sanders-Brown Center on Aging Faculty Publications

After traumatic brain injury (TBI), both primary and secondary injury cascades are initiated, leading to neuronal death and cognitive dysfunction. We have previously shown that the combinational bioflavonoid, Pycnogenol® (PYC), alters some secondary injury cascades and protects synaptic proteins when administered immediately following trauma. The purpose of the present study was to explore further the beneficial effects of PYC and to test whether it can be used in a more clinically relevant fashion. Young adult male Sprague-Dawley rats were subjected to a unilateral moderate/severe cortical contusion. Subjects received a single intravenous (i.v.) injection of PYC (1, 5, or 10 mg/kg) …

Hippocampal Sclerosis Of Aging, A Prevalent And High-Morbidity Brain Disease, Peter T. Nelson, Charles D. Smith, Erin L. Abner, Bernard J. Wilfred, Wang-Xia Wang, Janna H. Neltner, Michael Baker, David W. Fardo, Richard J. Kryscio, Stephen W. Scheff, Gregory A. Jicha, Kurt A. Jellinger, Linda J. Van Eldik, Frederick A. Schmitt

Sanders-Brown Center on Aging Faculty Publications

Hippocampal sclerosis of aging (HS-Aging) is a causative factor in a large proportion of elderly dementia cases. The current definition of HS-Aging rests on pathologic criteria: neuronal loss and gliosis in the hippocampal formation that is out of proportion to AD-type pathology. HS-Aging is also strongly associated with TDP-43 pathology. HS-Aging pathology appears to be most prevalent in the oldest-old: autopsy series indicate that 5-30 % of nonagenarians have HS-Aging pathology. Among prior studies, differences in study design have contributed to the study-to-study variability in reported disease prevalence. The presence of HS-Aging pathology correlates with significant cognitive impairment which is …

The Relationship Among Ankle Function, Functional Capacity, And Body Composition To Balance In Geriatric Populations, Joseph Robert Chaney

Graduate Theses and Dissertations

The primary purpose of this research study was to identify significant relationships among measures of ankle strength, ankle range of motion, body composition, and functional capacity to balance ability in geriatric populations which may potentially assist in identifying older individuals with increased risk of falling. A battery of five test (ankle strength assessments, ankle range of motion , DXA, functional fitness, and balance) were administered to 20 participants (6 males, 14 females, mean age 69.78 ± 3.98) that had indicated to be at least 65 years of age or older and no history of falls within the previous 12 months. …

Successful Aging And Creativity : An Investigation On Functional Status And Psychological Wellbeing In Older Adults, Mirie E. Levy

Loma Linda University Electronic Theses, Dissertations & Projects

Objectives: While the literature supports the maintenance of functional status as integral to successful aging, the relationship of creativity on functional status has received little attention. Creativity has been associated with health and aging in the research but only a small number of studies have examined creativity interventions to enhance functional status and boost psychological wellbeing.

Methods: A pretest-posttest quasi-experimental design was used to investigate an 8-week creativity intervention on functional status and psychological wellbeing in older adults. Sample subjects were 92 men and women all over age 60. A series of two-way mixed ANOVAs measured differences between treatment and …

Adverse Drug Events Post-Hospital Discharge In Older Patients: Types, Severity, And Involvement Of Beers Criteria Medications, Abir O. Kanaan, Jennifer L. Donovan, Nerissa P. Duchin, Terry S. Field, Jennifer Tjia, Sarah L. Cutrona, Shawn J. Gagne, Lawrence D. Garber, Peggy Preusse, Leslie R. Harrold, Jerry H. Gurwitz

Lawrence D. Garber

Objective: To characterize adverse drug events (ADEs) occurring within the high-risk 45-day period post-hospitalization in older adults.

Design: Clinical pharmacists reviewed the ambulatory records of 1000 consecutive discharges.

Setting: A large multispecialty group practice closely aligned with a Massachusetts-based health plan.

Participants: Hospitalized patients aged 65 years and older who were discharged to home.

Measurements: Possible drug-related incidents occurring during the 45-day period post-hospitalization were identified and presented to a pair of physician-reviewers who classified incidents as to whether an ADE was present, whether the event was preventable, and the severity of the event. Medications implicated in ADEs were further …

Adverse Drug Events Post-Hospital Discharge In Older Patients: Types, Severity, And Involvement Of Beers Criteria Medications, Abir O. Kanaan, Jennifer L. Donovan, Nerissa P. Duchin, Terry S. Field, Jennifer Tjia, Sarah L. Cutrona, Shawn J. Gagne, Lawrence D. Garber, Peggy Preusse, Leslie R. Harrold, Jerry H. Gurwitz

Jennifer Tjia

Objective: To characterize adverse drug events (ADEs) occurring within the high-risk 45-day period post-hospitalization in older adults.

Design: Clinical pharmacists reviewed the ambulatory records of 1000 consecutive discharges.

Setting: A large multispecialty group practice closely aligned with a Massachusetts-based health plan.

Participants: Hospitalized patients aged 65 years and older who were discharged to home.

Measurements: Possible drug-related incidents occurring during the 45-day period post-hospitalization were identified and presented to a pair of physician-reviewers who classified incidents as to whether an ADE was present, whether the event was preventable, and the severity of the event. Medications implicated in ADEs were further …

Dissemination Of Evidence-Based Atypical Antipsychotic Information To Nursing Homes, Celeste A. Lemay, Jennifer Tjia, Kathleen M. Mazor, Terry S. Field, Abir O. Kanaan, Jennifer L. Donovan, Jerry H. Gurwitz

Jennifer Tjia

Background: Accumulating evidence demonstrates minimal benefit and increased risk of off-label use of atypical antipsychotic medications for dementia-related behaviors. Optimal strategy for disseminating evidence-based guides to nursing home (NH) stakeholders is unclear. Our objective is to describe the impact of differing dissemination efforts in Connecticut NHs.

Methods: Forty-three Connecticut NHs were randomized to one of 3 arms receiving incrementally intensive dissemination strategies of the Agency for Healthcare Research and Quality Comparative Effectiveness Review Summary Guide on the off-label use of atypical antipsychotic drugs, which was included in a toolkit informed by a needs assessment of NHs. All NHs received the …

Reducing Rehospitalizations Through Automated Alerts To Primary Care Providers And Staff When Older Patients Are Discharged From The Hospital: A Randomized Trial, Jerry H. Gurwitz, Terry S. Field, Jessica Ogarek, Jennifer Tjia, Sarah L. Cutrona, Leslie R. Harrold, Jennifer L. Donovan, Abir O. Kanaan, Shawn J. Gagne, Peggy Preusse, Lawrence D. Garber

Jennifer Tjia

Background: Inadequate continuity of care places older patients at very high risk during transitions from the hospital to ambulatory setting.

Methods: We conducted a randomized controlled trial of an HIT-based transitional care intervention in patients aged 65 and older discharged from hospital to home. All patients were senior plan members of a Massachusetts-based health plan, and cared for by a multispecialty medical group using the EpicCare Ambulatory Medical Record. In addition to notifying providers about the patient’s recent transition, the system provided information about new drugs added during the inpatient stay, warnings about drug-drug interactions, recommendations for dose changes and …

Understanding Antipsychotic Drug Use In The Nursing Home Setting, Celeste A. Lemay, Alice F. Bonner, Christina Compher, Terry S. Field, Jonathan Freedlander, Susan Joslin, Kathleen M. Mazor, Jennifer Tjia, Jerry H. Gurwitz

Jennifer Tjia

Introduction: The increasing prevalence of antipsychotic medication use in residents of nursing homes (NH) in the absence of psychiatric diagnoses is concerning. To address these concerns, it is essential to explore how these medications are being prescribed and managed in the NH setting. Our objectives were to understand the decision-making process that influences prescribing and factors that trigger administration of antipsychotic medications to residents with dementia in NHs and to explore why residents remain on antipsychotic medications over an extended period of time.

Methods: Interviews with prescribers, caregivers, and family members, on-site observations in study facilities, and review of NH …

Intervention To Reduce Adverse Outcomes Among Older Adults Discharged From Skilled Nursing Facilities To Home, Terry S. Field, Jessica Ogarek, Abir O. Kanaan, Jennifer L. Donovan, Peggy Preusse, Devi Sundaresan, Shawn J. Gagne, Lawrence D. Garber, Jennifer Tjia, Sarah L. Cutrona, Jerry H. Gurwitz

Jennifer Tjia

Background: Older adults may be at risk for adverse outcomes after discharge from skilled nursing facilities (SNF), but little research has focused on this transition.

Objective: To assess the impact of an alert system on the rates of adverse outcomes among older adults discharged from SNFs to home.

Methods: Within a multispecialty group practice, we tracked 30-day re-hospitalizations after SNF discharges during an intervention that provided discharge alerts to primary care physicians. We compared them to discharges from the pre-intervention period matched on age, gender and SNF. For the first 100 intervention discharges and their matches, we performed chart reviews …

Statin Discontinuation Among Nursing Home Residents With Advanced Dementia, Jennifer Tjia, Sarah L. Cutrona, Daniel J. Peterson, Becky A. Briesacher

Jennifer Tjia

Background: Statin use in elderly individuals with life-limiting illness such as advanced dementia is controversial.

Objective: To describe factors associated with statin discontinuation and estimate impact of discontinuation on 28-day hospitalizations in nursing home (NH) residents with advanced dementia.

Methods: Retrospective cohort study of NH residents ≥ 65 years with recent progression to advanced dementia from 5 large U.S. states drawn from the 2007-2008 Minimum Data Set 2.0. We identified residents using statins. Clinical characteristics and 28-day hospitalization risk were compared for residents discontinuing and continuing statins. Multivariable Cox proportional hazard models identified factors associated with time to statin discontinuation …

Reducing Rehospitalizations Through Automated Alerts To Primary Care Providers And Staff When Older Patients Are Discharged From The Hospital: A Randomized Trial, Jerry H. Gurwitz, Terry S. Field, Jessica Ogarek, Jennifer Tjia, Sarah L. Cutrona, Leslie R. Harrold, Jennifer L. Donovan, Abir O. Kanaan, Shawn J. Gagne, Peggy Preusse, Lawrence D. Garber

Abir O. Kanaan

Background: Inadequate continuity of care places older patients at very high risk during transitions from the hospital to ambulatory setting.

Methods: We conducted a randomized controlled trial of an HIT-based transitional care intervention in patients aged 65 and older discharged from hospital to home. All patients were senior plan members of a Massachusetts-based health plan, and cared for by a multispecialty medical group using the EpicCare Ambulatory Medical Record. In addition to notifying providers about the patient’s recent transition, the system provided information about new drugs added during the inpatient stay, warnings about drug-drug interactions, recommendations for dose changes and …

Care In Specialist Medical And Mental Health Unit Compared With Standard Care For Older People With Cognitive Impairment Admitted To General Hospital: Randomised Controlled Trial (Nihr Team Trial), Sarah E. Goldberg, Lucy E. Bradshaw, Fiona C. Kearney, Catherine Russell, Kathy H. Whittamore, Pippa E R Foster, Jil Mamza, John R F Gladman, Rob G. Jones, Sarah A. Lewis, Davina Porock, Rowan H. Harwood

Publications and Research

Objective To develop and evaluate a best practice model of general hospital acute medical care for older people with cognitive impairment.

Design Randomised controlled trial, adapted to take account of constraints imposed by a busy acute medical admission system.

Setting Large acute general hospital in the United Kingdom.

Participants 600 patients aged over 65 admitted for acute medical care, identified as “confused” on admission.

Interventions Participants were randomised to a specialist medical and mental health unit, designed to deliver best practice care for people with delirium or dementia, or to standard care (acute geriatric or general medical wards). Features of …

Vitamin D Status Of Older Adults Of Diverse Ancestry Living In The Greater Toronto Area, Jaime K. Ginter, S Krithika, Agnes Gozdzik, Heather Hanwell, Susan Whiting, Esteban J. Parra

Faculty Publications and Scholarship

Background: Physiological and lifestyle factors put older adults at an increased risk of vitamin D insufficiency and resulting negative health outcomes. Here we explore the vitamin D status in a sample of community dwelling older adults of diverse ancestry living in the Greater Toronto area (GTA).

Methods: Two hundred and twenty-four (224) adults over 60 years of age were recruited from the Square One Older Adult Centre, in Mississauga, Ontario. Circulating 25-hydroxyvitamin D (25(OH)D) concentrations were measured from dried blood spot cards. Dietary and supplemental intakes of vitamin D were assessed via questionnaires. Skin pigmentation was assessed quantitatively by measuring …

Development Of Novel In Vivo Chemical Probes To Address Cns Protein Kinase Involvement In Synaptic Dysfunction, D Martin Watterson, Valerie L. Grum-Tokars, Saktimayee M. Roy, James P. Schavocky, Brinda Desai Bradaric, Adam D. Bachstetter, Bin Xing, Edgardo Dimayuga, Faisal Saeed, Hong Zhang, Agnieszka Staniszewski, Jeffrey C. Pelletier, George Minasov, Wayne F. Anderson, Ottavio Arancio, Linda J. Van Eldik

Sanders-Brown Center on Aging Faculty Publications

Serine-threonine protein kinases are critical to CNS function, yet there is a dearth of highly selective, CNS-active kinase inhibitors for in vivo investigations. Further, prevailing assumptions raise concerns about whether single kinase inhibitors can show in vivo efficacy for CNS pathologies, and debates over viable approaches to the development of safe and efficacious kinase inhibitors are unsettled. It is critical, therefore, that these scientific challenges be addressed in order to test hypotheses about protein kinases in neuropathology progression and the potential for in vivo modulation of their catalytic activity. Identification of molecular targets whose in vivo modulation can attenuate synaptic …

Relationship Between Serum And Brain Carotenoids, Α-Tocopherol, And Retinol Concentrations And Cognitive Performance In The Oldest Old From The Georgia Centenarian Study, Elizabeth J. Johnson, Rohini Vishwanathan, Mary Ann Johnson, Dorothy B. Hausman, Adam Davey, Tammy M. Scott, Robert C. Green, L. Stephen Miller, Marla Gearing, John Woodard, Peter T. Nelson, Hae-Yun Chung, Wolfgang Schalch, Jonas Wittwer, Leonard W. Poon

Sanders-Brown Center on Aging Faculty Publications

Oxidative stress is involved in age-related cognitive decline. The dietary antioxidants, carotenoids, tocopherols, and vitamin A may play a role in the prevention or delay in cognitive decline. In this study, sera were obtained from 78 octogenarians and 220 centenarians from the Georgia Centenarian Study. Brain tissues were obtained from 47 centenarian decedents. Samples were analyzed for carotenoids, α-tocopherol, and retinol using HPLC. Analyte concentrations were compared with cognitive tests designed to evaluate global cognition, dementia, depression and cognitive domains (memory, processing speed, attention, and executive functioning). Serum lutein, zeaxanthin, and β-carotene concentrations were most consistently related to better cognition …

Antipsychotic Use Among Nursing Home Residents, Becky Briesacher, Jennifer Tjia, Terry Field, Daniel Peterson, Jerry Gurwitz

Jennifer Tjia

The prescribing of antipsychotic medications persists at high levels in US nursing homes (NHs) despite extensive data demonstrating marginal clinical benefits and serious adverse effects, including death.1- 2 However, imprecise and outdated data have limited the understanding of the current state of antipsychotic medication prescribing in NHs.3 We analyzed recent and detailed NH prescription data to address: (1) What is the current level of antipsychotic use? (2) Does antipsychotic use in NHs display geographic variation? and (3) Which antipsychotics are most commonly prescribed?

Potentially Inappropriate Use Of Antipsychotics In Community-Dwelling Adults With Dementia More Common In Those With Low Income, Jennifer Tjia

Jennifer Tjia

Comment on: The essential and potentially inappropriate use of antipsychotics across income groups: an analysis of linked administrative data. [Can J Psychiatry. 2012]

Studies To Reduce Unnecessary Medication Use In Frail Older Adults: A Systematic Review, Jennifer Tjia, Sarah Velten, Carole Parsons, Sruthi Valluri, Becky Briesacher

Jennifer Tjia

BACKGROUND: Overuse of unnecessary medications in frail older adults with limited life expectancy remains an understudied challenge.

OBJECTIVE: To identify intervention studies that reduced use of unnecessary medications in frail older adults. A secondary goal was to identify and review studies focusing on patients approaching end of life. We examined criteria for identifying unnecessary medications, intervention processes for medication reduction, and intervention effectiveness.

METHODS: A systematic review of English articles using MEDLINE, EMBASE, and International Pharmaceutical Abstracts from January 1966 to September 2012. Additional studies were identified by searching bibliographies. Search terms included prescription drugs, drug utilization, hospice or palliative …

Intracranial Injection Of Gammagard, A Human Ivig, Modulates The Inflammatory Response Of The Brain And Lowers AΒ In App/Ps1 Mice Along A Different Time Course Than Anti-AΒ Antibodies, Tiffany L. Sudduth, Abigail Greenstein, Donna M. Wilcock

Sanders-Brown Center on Aging Faculty Publications

Gammagard IVIg is a therapeutic approach to treat Alzheimer's disease currently in phase 3 clinical trials. Despite the reported efficacy of the approach the mechanism of action is poorly understood. We have previously shown that intracranial injection of anti-Aβ antibodies into the frontal cortex and hippocampus reveals important information regarding the time course of events once the agent is in the brain. In the current study we compared IVIg, mouse-pooled IgG, and the anti-Aβ antibody 6E10 injected intracranially into the frontal cortex and hippocampus of 7-month-old APP/PS1 mice. We established a time course of events ranging from 1 …

An Examination Of Executive Function, Mild Cognitive Impairment And Fall Risk In Community Dwelling Older Adults, Jennifer A. Blackwood

Dissertations

The aim of this three-paper dissertation was to examine the relationship between fall risk, executive function (EF) and mild cognitive impairment (MCI) in community dwelling older adults. Papers one and two describe how mild changes in cognition influence performance on four measures of fall risk, the Five Times Sit to Stand Test (FTSTS), usual gait speed, the Timed Up and Go (TUG) test, and the Activities Specific Balance Confidence Scale (ABC) in a group of community dwelling older adults. The third paper describes if participation in a progressively challenging domain specific computerized cognitive training intervention influenced performance on measures of …

Comprehensive Behavioral Characterization Of An App/Ps-1 Double Knock-In Mouse Model Of Alzheimer's Disease, Scott J. Webster, Adam D. Bachstetter, Linda J. Van Eldik

Sanders-Brown Center on Aging Faculty Publications

INTRODUCTION: Despite the extensive mechanistic and pathological characterization of the amyloid precursor protein (APP)/presenilin-1 (PS-1) knock-in mouse model of Alzheimer's disease (AD), very little is known about the AD-relevant behavioral deficits in this model. Characterization of the baseline behavioral performance in a variety of functional tasks and identification of the temporal onset of behavioral impairments are important to provide a foundation for future preclinical testing of AD therapeutics. Here we perform a comprehensive behavioral characterization of this model, discuss how the observed behavior correlates with the mechanistic and pathological observations of others, and compare this model with other commonly used …

Are Informal Carers And Community Care Workers Effective In Managing Malnutrition In The Older Adult Community? A Systematic Review Of Current Evidence, Skye Marshall, Judith Bauer, Sandra Capra, Elisabeth Isenring

Skye Marshall