Geriatrics Commons^™

An Investigation Of Factors Predicting The Type Of Bladder Antimuscarinics Initiated In Medicare Nursing Homes Residents, Daniela C. Moga, Qishan Wu, Pratik Doshi, Amie J. Goodin

Pharmacy Practice and Science Faculty Publications

Background: To examine factors predicting type of bladder antimuscarinics (BAM) initiated in nursing home (NH) residents.

Methods: Incident BAM initiators following NH admission were identified by constructing a retrospective cohort from Medicare files and Minimum Data Set (MDS). Participants included all residents 65 years and older admitted in Medicare-certified NH between January 1, 2007 and December 31, 2008 who were prescribed BAM and had continuous Medicare (Part A, B, and D) enrollment. Patient characteristics, medications, and comorbidities were derived from Medicare enrollment and claims. NH characteristics and health status were derived from MDS assessments. The outcome was defined as type …

Aging, Inflammation, And Gut Microbiota In Mice, Jody Demeo

Honors Projects

Inflammation and gut microbiota are two areas of study that can be linked to aging in the body. As a person ages, systemic inflammation tends to increase, and changes in microbiota in the gastrointestinal system occur as well.

Hyperhomocysteinemia-Induced Gene Expression Changes In The Cell Types Of The Brain, Erica M. Weekman, Abigail E. Woolums, Tiffany L. Sudduth, Donna M. Wilcock

Sanders-Brown Center on Aging Faculty Publications

High plasma levels of homocysteine, termed hyperhomocysteinemia, are a risk factor for vascular cognitive impairment and dementia, which is the second leading cause of dementia. While hyperhomocysteinemia induces microhemorrhages and cognitive decline in mice, the specific effect of hyperhomocysteinemia on each cell type remains unknown. We took separate cultures of astrocytes, microglia, endothelial cells, and neuronal cells and treated each with moderate levels of homocysteine for 24, 48, 72, and 96 hr. We then determined the gene expression changes for cell-specific markers and neuroinflammatory markers including the matrix metalloproteinase 9 system. Astrocytes had decreased levels of several astrocytic end feet …

Does Music Therapy Intervention Have An Effect On The Emotional Behavior Of Alzheimer Patients?, Alexandra P. Lahurd

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not music therapy intervention have an effect on emotional behavior of Alzheimer patients. Behavior variables measuring are agitation and anxiety.

STUDY DESIGN: Systematic review of two randomized, controlled trials published in 2009 and 2014, respectively, and one randomized control case study published in 2006.

DATA SOURCE: Three published studies comparing music therapy intervention on behavioral modifications with Alzheimer patients were found using PubMed and Medline

OUTCOMES MEASURES: All three studies measure behavior in Alzheimer patients based on a variety of well validated …

A Customized Quantitative Pcr Microrna Panel Provides A Technically Robust Context For Studying Neurodegenerative Disease Biomarkers And Indicates A High Correlation Between Cerebrospinal Fluid And Choroid Plexus Microrna Expression, Wang-Xia Wang, David W. Fardo, Gregory A. Jicha, Peter T. Nelson

Sanders-Brown Center on Aging Faculty Publications

MicroRNA (miRNA) expression varies in association with different tissue types and in diseases. Having been found in body fluids including blood and cerebrospinal fluid (CSF), miRNAs constitute potential biomarkers. CSF miRNAs have been proposed as biomarkers for neurodegenerative diseases; however, there is a lack of consensus about the best candidate miRNA biomarkers and there has been variability in results from different research centers, perhaps due to technical factors. Here, we sought to optimize technical parameters for CSF miRNA studies. We examined different RNA isolation methods and performed miRNA expression profiling with TaqMan® miRNA Arrays. More specifically, we developed a customized …

Cerebrovascular Pathology In Down Syndrome And Alzheimer Disease, Elizabeth Head, Michael J. Phelan, Eric Doran, Ronald C. Kim, Wayne W. Poon, Frederick A. Schmitt, Ira T. Lott

Sanders-Brown Center on Aging Faculty Publications

People with Down syndrome (DS) are at high risk for developing Alzheimer disease (AD) with age. Typically, by age 40 years, most people with DS have sufficient neuropathology for an AD diagnosis. Interestingly, atherosclerosis and hypertension are atypical in DS with age, suggesting the lack of these vascular risk factors may be associated with reduced cerebrovascular pathology. However, because the extra copy of APP leads to increased beta-amyloid peptide (Aβ) accumulation in DS, we hypothesized that there would be more extensive and widespread cerebral amyloid angiopathy (CAA) with age in DS relative to sporadic AD. To test this hypothesis CAA, …

Cognitive Trajectory Changes Over 20 Years Before Dementia Diagnosis: A Large Cohort Study., Ge Li, Eric B Larson, Jane B Shofer, Paul K Crane, Laura E Gibbons, Wayne Mccormick, J D Bowen, Mary Lou Thompson

Articles, Abstracts, and Reports

BACKGROUND/OBJECTIVES: Longitudinal studies have shown an increase in cognitive decline many years before clinical diagnosis of dementia. We sought to estimate changes, relative to "normal" aging, in the trajectory of scores on a global cognitive function test-the Cognitive Abilities Screening Instrument (CASI).

DESIGN: A prospective cohort study.

SETTING: Community-dwelling members of a U.S. health maintenance organization.

PARTICIPANTS: Individuals aged 65 and older who had no dementia diagnosis at baseline and had at least two visits with valid CASI test score (N = 4,315).

MEASUREMENTS: Average longitudinal trajectories, including changes in trajectory before clinical diagnosis in those who would be diagnosed …

Cardiovascular Health Is Associated With Physical Function Among Older Community Dwelling Men And Women., Yichen Jin, Toshiko Tanaka, Yan Ma, Stefania Bandinelli, Luigi Ferrucci, Sameera A Talegawkar

Exercise and Nutrition Sciences Faculty Publications

Background

Age related decline in physical function is a significant concern affecting the quality of life of older individuals.

Methods

We examined the associations between baseline overall cardiovascular health (CVH), its components, and physical function in 906 men and women from the InCHIANTI cohort. Physical function was assessed using the Short Performance Physical Battery and poor physical function was defined as an Short Performance Physical Battery score less than 10. Overall CVH score, ranging from 0 to 12 in the cohort, was operationalized using adherence to ideal levels for health behaviors including smoking status, physical activity, body mass index, and …

Legacy Of Research In Japanese Gerontology, Elijah Beaudoin

International ResearchScape Journal

No abstract provided.

Brain Imaging In Older Patients With Delirium, Laila M. Hasan, Ariba Khan, Maharaj Singh, Michael L. Malone

Journal of Patient-Centered Research and Reviews

Background: Delirium is a common, serious and costly condition in older patients admitted to the hospital. This study describes the prevalence and results of brain imaging among a cohort of older hospitalized patients with and without delirium.

Purpose: Investigate the frequency and results of brain imaging in older patients with delirium as compared to those without delirium.

Methods: This was a cross-sectional study. Data were collected on hospitalized patients age 65 years or older who were admitted to 3 hospitals in Milwaukee, Wisconsin, during a 1-month period in the fall of 2013. Subjects were tested for delirium via the “Confusion …

Conference Proceedings: Aurora Scientific Day 2017

Journal of Patient-Centered Research and Reviews

This supplement includes select abstracts presented at the 43rd Annual Aurora Scientific Day research symposium on May 24, 2017. Aurora Scientific Day hosts a forum for original research conducted by faculty, fellows, residents, and other allied health professionals affiliated with Aurora Health Care, an integrated health system headquartered in Milwaukee, Wisconsin.

Evaluating The Effectiveness Of Abilities Care Approach™ Training, Michelle E. D'Amato, Sophie E. Miller, April Perez, Carmen Joaquin, Louiza Alexandria Villarina

Student Research Posters

Approximately 50% of US nursing home residents have a diagnosis of dementia. Abilities Care Approach® was created by occupational therapists (OTs) to promote quality dementia care for residents in skilled nursing facilities (SNFs). Certified nursing assistants (CNAs) are often the primary caregiver for residents with dementia. To ensure carryover of ACA principles, ACE dementia training was targeted towards CNAs. The purpose of this study was to evaluate Abilities Care Experts®(ACE) training program which provides CNAs with an occupation-based dementia care approach by focusing on the importance of occupational engagement and knowledge of dementia stages. Results indicated that ACE trained CNAs …

Age-Related Changes In Visual Processing Speed: A Pilot Study Using The Motor-Free Visual Perception Test- 4 (Mvpt-4), Lauren Gollnick, Kassidy Ha, Stephanie Pawek, Zoe Studer, Amber Zadravecz

Student Research Posters

Evidence reveals that visual processing speed decreases with age. The Motor-Free Visual Perception Test- Third Edition (MVPT-3) has an age-normed Response Time Index that measures visual processing speed. In 2015, a new version, Motor-Free Visual Perception Test- Fourth Edition (MVPT-4), was published. The new MVPT-4 does not yet demonstrate its utility in measuring visual processing speed. The purpose of this study was to explore if differences in visual processing speed between younger adults ages 20-35 years and older adults ages 70 years and older could be detected using the new MVPT-4. Results revealed a significant difference between older and younger …

Fall Risk Reduction Using Lifestyle-Integrated Functional Exercise (Life), Kayla Comer, Tiffany Huang, Kelly Schmidt, Matthew Tong

Student Research Posters

As the population and longevity of older adults’ increases, the prevalence of falls is becoming an ever-growing issue. One in three adults aged 65 years and older experience a fall each year. Falls in older adults may lead to sedentary behavior, decreased independence, and lower quality of life. Evidence has shown that traditional exercise programs emphasizing strength and balance exercises can decrease the fall risk in older adults, but may be difficult to sustain over time. Emerging evidence suggests that exercises that are integrated into daily life may have a more lasting effect in reducing fall risk in older adults. …

Supporting Optimal Aging Through The Innovative Use Of Virtual Reality Technology, Sally Hughes, Kathryn Warren-Norton, Pat Spadafora, Lia Tsotsos

Publications and Scholarship

Although virtual reality (VR) technology has been implemented as a tool to address the health issues of older adults, its applicability to social connectedness is underrepresented in the literature, and less is known about its efficacy in this area in contributing to overall wellness and well-being in later life. Expanding the VR possibilities beyond traditional entertainment purposes holds considerable potential for the older adult market. Technological tools have been employed in the elder health care field for many years, and cutting-edge developments such as virtual and augmented reality have begun to be used to facilitate optimal wellness in aging. Such …

Building Connected Communities: Reducing Loneliness And Social Isolation In Immigrants 65+ – September 2017 – Research Update, Sheridan Centre For Elder Research

Publications and Scholarship

Sheridan Centre for Elder Research received a three year grant from the Social Sciences and Humanities Research Council (SSHRC) to explore new strategies to effectively reach and service immigrants age 65+ who may be experiencing, or are at risk of experiencing loneliness and/or social isolation. Research Update - Issue 4 (September, 2017) highlights the research team's progress and an invitation for interested organizations to participate in the research.

Onset Of Multiple Chronic Conditions And Depressive Symptoms: A Life Events Perspective., Maureen Wilson-Genderson, Allison R Heid, Rachel Pruchno

Rowan-Virtua School of Osteopathic Medicine Faculty Scholarship

Background: While the association between depressive symptoms and chronic illness has been the subject of many studies, little is known about whether depressive symptoms differ as a function of the illnesses people have as they transition to living with multiple chronic conditions.

Methods: Self-reports of five diagnosed chronic conditions (arthritis, diabetes, heart disease, hypertension, and pulmonary disease) and depressive symptoms were provided by 3,396 people participating in three waves of the ORANJ BOWL

Results: Between 2006 and 2014, controlling for age, gender, income, race, and a lifetime diagnosis of depression, people who transitioned to having a diagnosis of multiple chronic …

Health And Needs Assessment Of Geriatric Patients: Results Of A Survey At A Teaching Hospital In Karachi, Syed Nabeel Zafar, Hammad Ashraf Ganatra, Sarah Tehseen, Waris Qidwai

Waris Qidwai

Objective: To study the health and needs of geriatric patients

Methods: A questionnaire based survey of patients visiting the out-patient department of Aga Khan University was carried out. Ethical requirements were met and included administration of informed consent and provision of confidentiality to patients. Convenience sampling was used without any randomization for interviews. Epi-info and SPSS software were used for data management.

Results: Four hundred and two (402) subjects above the age of 65 were surveyed. Most of the subjects were retired (40.5%) married (76.4%) men (69.7%). Ages ranged from 65 to 90 years, the mean being 70.57 years and …

A New Opportunity For Memri, Ryan Cloyd, Moriel H. Vandsburger, Jose F. Abisambra

Sanders-Brown Center on Aging Faculty Publications

No abstract provided.

Patient Fall Prevention, R9 West Cardiovascular, Cathy Palleschi, Suneela Nayak, Ruth Hanselman, Stephen Tyzik

Maine Medical Center

PATIENT FALL PREVENTION STRATEGIES IN AN ACUTE HOSPITAL

Every year in the United States, hundreds of thousands of patients fall resulting in injury. Injured patients often require prolonged hospital stays and a resultant increase in medical costs.

The purpose of this study was to identify the current state of fall prevention strategies on a hospital inpatient acute care cardiac unit. Through a root cause analysis, some deficiencies were identified and a process improvement plan was implemented.

Several positive outcomes were attained as a result of the countermeasures initiated. Patient falls per month and total waste in dollars saw a decline …

Identification Strategies For The Very High Fall Risk Patient In An Acute Inpatient Psychiatric Unit, P6 Inpatient Geri-Med Psychiatry, Haley Pelletier, Suneela Nayak, Stephen Tyzik, Ruth Hanselman

Maine Medical Center

Patients falling as a result of geriatric and psychiatric impairments are at a much higher risk than the average patient population. An acute care inpatient psychiatric team used baseline metrics to demonstrate increasing fall rates per month that surpassed the unit’s target number. As a result, a quality improvement project around falls was felt to be warranted.

The overall goal of this study was to improve patient safety by reducing falls for their very high risk fall population. A root cause analysis determined that this population was not being properly identified and several tools were developed and employed to better …

Standing Balance And Spatiotemporal Aspects Of Gait Are Impaired Upon Nocturnal Awakening In Healthy Late Middle-Aged And Older Adults, Amanda L. Mcbean, Raymond P. Najjar, Ronald A. Schuchard, Courtney D. Hall, Cheng-Ann Wang, Ban Ku, Joseph M. Furman

Courtney D. Hall

Study Objectives: Nocturnal awakenings may constitute a unique risk for falls among older adults. We describe differences in gait and balance between presleep and midsleep testing, and whether changes in the lighting environment during the midsleep testing further affect gait and balance.

Methods: Twenty-one healthy, late middle-aged and older (64.7 ± 8.0 y) adults participated in this repeated-measures design consisting of four overnight laboratory stays. Each night, participants completed baseline visual acuity, gait, and balance testing. After a 2-h sleep opportunity, they were awakened for 13 min into one of four lighting conditions: very dim white light (< 0.5 lux); dim white light (∼28.0 lux); dim orange light (∼28.0 lux); and white room-level light (∼200 lux). During this awakening, participants completed the same sequence of testing as at baseline.

Results: Low-contrast …

Delirium Recognition In Hospitalized Older Patients: A Quality Improvement Project, Jodi Punke, Ariba Khan, Michael L. Malone

Aurora Geriatrics Fellows

Background: We noted a low reported prevalence of delirium (3%) in hospitalized older patients at a community teaching hospital in north central Wisconsin. Purpose: This was a quality improvement project to report recognition of delirium by nurses before and after an educational intervention. Methods: This project was performed on one medical unit in our hospital. Quality improvement data was collected at baseline and after the educational intervention. Data collected included observation by a geriatrician attending weekly interdisciplinary rounds to note any mention by nurses of delirium or confusion. The patient’s electronic health record (EHR) was reviewed to note delirium assessment …

Abstracts From The 23rd Annual Health Care Systems Research Network Conference, March 21–23, 2017, San Diego, California

Journal of Patient-Centered Research and Reviews

This proceedings supplement includes selected abstracts presented at the 23rd annual conference of the Health Care Systems Research Network (HCSRN), held March 21–23, 2017, in San Diego, California. Formerly called the HMO Research Network, HCSRN aims to improve individual and population health through research that connects the resources and capabilities of its member health care systems.

Endothelial Function Is Associated With White Matter Microstructure And Executive Function In Older Adults, Nathan F. Johnson, Brian T. Gold, Christopher A. Brown, Emily F. Anggelis, Alison L. Bailey, Jody L. Clasey, David K. Powell

Physical Therapy Faculty Publications

Age-related declines in endothelial function can lead to cognitive decline. However, little is known about the relationships between endothelial function and specific neurocognitive functions. This study explored the relationship between measures of endothelial function (reactive hyperemia index; RHI), white matter (WM) health (fractional anisotropy, FA, and WM hyperintensity volume, WMH), and executive function (Trail Making Test (TMT); Trail B - Trail A). Participants were 36 older adults between the ages of 59 and 69 (mean age = 63.89 years, SD = 2.94). WMH volume showed no relationship with RHI or executive function. However, there was a positive relationship between RHI …

Pro-Angiogenesis Therapy And Aging: A Mini-Review, Charles T. Ambrose

Microbiology, Immunology, and Molecular Genetics Faculty Publications

Apart from major illnesses and chronic afflictions, the elderly experience lesser ailments, such as muscle weakness, cold intolerance, and transient memory lapses. Physical signs in the aged include wrinkled skin and the slow healing of skin abrasions. These ailments and signs are grouped together because they may be due in part to an age-linked, waning microcirculation. A reduced capillary density (CD) throughout the body of aged people and animals has been reported in over 40 papers. The reduced CD is due in turn to declining levels of angiogenic growth factors (AGFs) throughout the body during old age, as documented in …

Comparing Total Expenditures By Source Of Long-Term Services And Supports., Maresa R. Corder

Electronic Theses and Dissertations

This study compares total expenditures between beneficiaries enrolled in traditional Long-Term Care (LTC) and beneficiaries enrolled in Home and Community Based Services (HCBS) in a Quasi-Experimental Simple Ex Post Facto study utilizing multiple linear regression with inverted propensity score weighting. The results demonstrated, during the two years of the study period, that total expenditures were on average $14,565.03 (with a p-value oflessfor the total two years of the study, for HCBS beneficiaries when compared to their LTC counterparts. There remains today a belief that expenditures of elderly, dual beneficiaries electing to age-in-place for supported self-care expend less than that of …

Impact Of Home Visit Capacity On Genetic Association Studies Of Late-Onset Alzheimer's Disease., David W Fardo, Laura E Gibbons, Shubhabrata Mukherjee, M Maria Glymour, Wayne Mccormick, Susan M Mccurry, James D Bowen, Eric B Larson, Paul K Crane

Articles, Abstracts, and Reports

INTRODUCTION: Findings for genetic correlates of late-onset Alzheimer's disease (LOAD) in studies that rely solely on clinic visits may differ from those with capacity to follow participants unable to attend clinic visits.

METHODS: We evaluated previously identified LOAD-risk single nucleotide variants in the prospective Adult Changes in Thought study, comparing hazard ratios (HRs) estimated using the full data set of both in-home and clinic visits (n = 1697) to HRs estimated using only data that were obtained from clinic visits (n = 1308). Models were adjusted for age, sex, principal components to account for ancestry, and additional health indicators.

RESULTS: …

Purple Urine Bag Syndrome: An Educational Case Of A Colorful Condition In The Chronically Catheterized, Teshome Gebrmichael, Fikirte Feleke, Waseem Ahmed, Madhulika Urella, Samson Teka

Samson Teka

Purple Urine Bag Syndrome is a rare condition characterized by purple discoloration of the urinary drainage bag. It is typically seen in elderly patients with chronic indwelling urinary catheterization, and is associated with urinary tract infections with high bacterial load, female gender, severe disability, constipation, and alkaline urine. This phenomenon occurs when tryptophan metabolites in the urine are broken down by bacteria containing indoxyl sulphatase and phosphatase enzymes. This results in the production of indigo and indirubin, which combine to give a purple appearance. This article presents a 78-year-old male with chronic urinary retention requiring intermittent Foley catheterization for the …

Trauma Team Activation For Geriatric Trauma At A Level Ii Trauma Center: Are The Elderly Under-Triaged?, Grant S. Buchanan, Daniel Scott Kahn, Harry Burke, Brian Czarkowski, Richard Boe, Milad Modarresi, Franklin D. Shuler

Franklin D. Shuler

Abstract Geriatric patients often sustain life-threatening injuries from minor trauma. A growing body of research suggests that these patients are often under-triaged in the emergency setting.The purpose of this research was to evaluate whether or not geriatric trauma patients are under-triaged at a community based level II trauma center. 1434 trauma patients over the age of 65 presenting from 2010-2015 were retrospectively reviewed from the Cabell Huntington Hospital trauma registry and analyzed for age, gender, arrival type, ED response, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), injury cause, ICD-9 diagnosis codes, and mortality. Under-triage and over-triage rates were determined …