Medicine and Health Sciences Commons^™

Immersive Virtual Reality For The Management Of Pain In Community-Dwelling Older Adults., Sara Benham, Minhee Kang, Namrata Grampurohit

Department of Occupational Therapy Faculty Papers

Immersive virtual reality (VR) can provide a high level of engagement and distraction analgesia to address pain. However, community-based applications of this technology for older adults have not been studied. The objective of this study was to examine the applicability and effectiveness of an immersive VR intervention for pain, depression, and quality of life (QOL) in older adults. This pretest–posttest, mixed-methods design included senior center members (n = 12) with pain that interfered with daily functioning. The outcomes included the Numeric Pain Rating Scale, Patient-Reported Outcomes Measurement Information System (PROMIS^®) depression scale, World Health Organization Quality of Life …

Strategies And Challenges Associated With Recruiting Retirement Village Communities And Residents Into A Group Exercise Intervention, Rachel L. Duckham, Jamie L. Tait, Caryl A. Nowson, Kerrie M. Sanders, Dennis R. Taaffe, Keith D. Hill, Robin M. Daly

Research outputs 2014 to 2021

BACKGROUND: Randomized controlled trials (RCTs) provide the highest level of scientific evidence, but successful participant recruitment is critical to ensure the external and internal validity of results. This study describes the strategies associated with recruiting older adults at increased falls risk residing in retirement villages into an 18-month cluster RCT designed to evaluate the effects of a dual-task exercise program on falls and physical and cognitive function.

METHODS: Recruitment of adults aged ≥65 at increased falls risk residing within retirement villages (size 60-350 residents) was initially designed to occur over 12 months using two distinct cohorts (C). Recruitment occurred via …

Keep The Beat With Heart Failure Education: A Quality Improvement Project, Brenda L. Peterson

Master's Projects and Capstones

Abstract

Problem: Heart failure (HF), also known as congestive heart failure (CHF), is the number one diagnosis-related group (DRG) for people 65 years of age and older in the United States. This disease group is complicated and debilitating, requiring frequent hospitalizations with high mortality rates. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has identified CHF as an area for improvement in hospitals.

Context: This was a quality improvement project for an integrated medical center in the Central Valley, California with over 19,000 HF patients. In 2018, for patients 65 years and older, HF is the third-most admitted DRG …

Advanced Heart Failure Treatment Options Among The Elderly, German Guzman-Gutierrez, Yang Shi, Matthew Rappelt, Arshad Jahangir, Vinay Thohan

Aurora Heart Failure / Transplant Faculty

The aging human population has emerged as a critically important factor in health care, not only due to the unique physiologic and pathologic processes associated with aging but also because of the evolution of medical and surgical therapies that have increased quality and quantity of life. Heart failure is a disease found most commonly among older populations in whom it is associated with high morbidity and mortality. Heart failure disproportionately affects the elderly, and it stands to reason that the most terminal stage, known as advanced heart failure (AHF), is more common among the elderly. Despite limited data, treatment options …

Manganese-Enhanced Magnetic Resonance Imaging: Overview And Central Nervous System Applications With A Focus On Neurodegeneration, Ryan A. Cloyd, Shon A. Koren, Jose F. Abisambra

Physiology Faculty Publications

Manganese-enhanced magnetic resonance imaging (MEMRI) rose to prominence in the 1990s as a sensitive approach to high contrast imaging. Following the discovery of manganese conductance through calcium-permeable channels, MEMRI applications expanded to include functional imaging in the central nervous system (CNS) and other body systems. MEMRI has since been employed in the investigation of physiology in many animal models and in humans. Here, we review historical perspectives that follow the evolution of applied MRI research into MEMRI with particular focus on its potential toxicity. Furthermore, we discuss the more current in vivo investigative uses of MEMRI in CNS investigations and …

Age-Tastic! An Evaluation Of An Evidence-Based Intervention For Older Adults, Manoj Pardasani, Jackie Berman, Mebane Powell

Publications and Research

Background: Raising awareness of holistic health and safety among older adults is critical to enhancing their wellbeing in many cases, improving health outcomes and motivating positive behavioral changes. Age-Tastic! is a comprehensive health and safety promotion intervention that uses the concept of a competitive board game to entice older adults to participate and stay engaged.

Objective: The purpose of this study was to evaluate the impact of Age-Tastic! on the level of awareness, health literacy, self-efficacy and positive behavioral change among the participants.

Methods: A randomized control trial was conducted with 98 older adults assigned to an experimental and control …

Pharmacy Staff Perspectives On Alcohol And Medication Interaction Prevention Among Older Rural Adults, Faika Zanjani, Hannah Allen, Rachel Vickers Smith, Demetra Antimisiaris, Nancy E. Schoenberg, Catherine A. Martin, Richard Clayton

Behavioral Science Faculty Publications

Older adults are at high risk for alcohol and medication interactions (AMI). Pharmacies have the potential to act as ideal locations for AMI education, as pharmacy staff play an important role in the community. This study examined the perspectives of pharmacy staff on AMI prevention programming messaging, potential barriers to and facilitators of older adult participation in such programming, and dissemination methods for AMI prevention information. Flyers, telephone calls, and site visits were used to recruit 31 pharmacy staff members who participated in semistructured interviews. A content analysis of interview transcriptions was conducted to identify major themes, categories, and subcategories. …

Distinct White Matter Changes Associated With Cerebrospinal Fluid Amyloid-Β1-42 And Hypertension, Omar M. Al-Janabi, Christopher A. Brown, Ahmed A. Bahrani, Erin L. Abner, Justin M. Barber, Brian T. Gold, Larry B. Goldstein, Richard R. Murphy, Peter T. Nelson, Nathan F. Johnson, Leslie M. Shaw, Charles D. Smith, John Q. Trojanowski, Donna M. Wilcock, Gregory A. Jicha

Sanders-Brown Center on Aging Faculty Publications

BACKGROUND: Alzheimer's disease (AD) pathology and hypertension (HTN) are risk factors for development of white matter (WM) alterations and might be independently associated with these alterations in older adults.

OBJECTIVE: To evaluate the independent and synergistic effects of HTN and AD pathology on WM alterations.

METHODS: Clinical measures of cerebrovascular disease risk were collected from 62 participants in University of Kentucky Alzheimer's Disease Center studies who also had cerebrospinal fluid (CSF) sampling and MRI brain scans. CSF Aβ_1-42 levels were measured as a marker of AD, and fluid-attenuated inversion recovery imaging and diffusion tensor imaging were obtained to assess …

Optimizing Psychosocial Care Of Older Adults With Cancer: An Early Assessment And Intervention Model, Lora Rhodes, Lcsw, Andrew Chapman, Do, Facp

Department of Medical Oncology Posters

Background

Jefferson Multidisciplinary Senior Adult Oncology Center

History

• Established September 2010
• First multidisciplinary geriatric oncology evaluation center in the tristate area

Demographics

• 890 patients evaluated to date
• All tumor types
• Age 70 and above & Pre-transplant (Bone Marrow) evaluation age 65 and above

Format

• Consultative service
• Two sessions weekly
• Average evaluation time: two hours

Multidisciplinary Team

• Navigator, Medical Oncologist, Geriatrician, Pharmacist, Nutritionist, Social Worker
• As needed: Psychiatry, Rehab Medicine, Radiation Oncology, Surgery

Hyperhomocysteinemia As A Risk Factor For Vascular Contributions To Cognitive Impairment And Dementia, Brittani R. Price, Donna M. Wilcock, Erica M. Weekman

Physiology Faculty Publications

Behind only Alzheimer’s disease, vascular contributions to cognitive impairment and dementia (VCID) is the second most common cause of dementia, affecting roughly 10–40% of dementia patients. While there is no cure for VCID, several risk factors for VCID, such as diabetes, hypertension, and stroke, have been identified. Elevated plasma levels of homocysteine, termed hyperhomocysteinemia (HHcy), are a major, yet underrecognized, risk factor for VCID. B vitamin deficiency, which is the most common cause of HHcy, is common in the elderly. With B vitamin supplementation being a relatively safe and inexpensive therapeutic, the treatment of HHcy-induced VCID would seem straightforward; however, …

Glimepiride Administered In Chow Reversibly Impairs Glucose Tolerance In Mice, Dana M. Niedowicz, Sabire Özcan, Peter T. Nelson

Sanders-Brown Center on Aging Faculty Publications

Sulfonylureas are a class of antidiabetes medications prescribed to millions of individuals worldwide. Rodents have been used extensively to study sulfonylureas in the laboratory. Here, we report the results of studies treating mice with a sulfonylurea (glimepiride) in order to understand how the drug affects glucose homeostasis and tolerance. We tested the effect of glimepiride on fasting blood glucose, glucose tolerance, and insulin secretion, using glimepiride sourced from a local pharmacy. We also examined the effect on glucagon, gluconeogenesis, and insulin sensitivity. Unexpectedly, glimepiride exposure in mice was associated with fasting hyperglycemia, glucose intolerance, and decreased insulin. There was no …

Conference Proceedings: Aurora Scientific Day 2018

Journal of Patient-Centered Research and Reviews

This journal supplement includes selected abstracts from among the more than 50 presented at the 44th annual Aurora Scientific Day research symposium. Held May 25, 2018, in Milwaukee, Wisconsin, Aurora Scientific Day provides a forum for original research conducted by faculty, fellows, residents, and other allied health professionals affiliated with Aurora Health Care, an integrated health system with hospitals and clinics in Wisconsin and Illinois.

Octo- And Nonagenarians' Outlook On Life And Death When Living With An Implantable Cardioverter Defibrillator: A Cross-Sectional Survey, Ingela Thylén, Debra K. Moser, Anna Strömberg

Nursing Faculty Publications

Background: Elderly individuals are increasingly represented among patients with implantable cardioverter defibrillators (ICD), but data describing life with an ICD are scarse among octo- and nonagenarians. Moreover, few studies have reported those elderly patients’ perspective on timly discussions concerning what shock deactivation involves, preferences on battery replacement, and their attitudes about turning off the ICD nearing end-of-life. Consequently, the aim of the study was to describe outlooks on life and death in octo- and nonagenarian ICD-recipients.

Methods: Participants were identified via the Swedish Pacemaker- and ICD-registry, with 229 octo- and nonagenarians (82.0 ± 2.2 years, 12% female) completing the survey …

P-21 Activated Kinase As A Molecular Target For Chemoprevention In Diabetes, Kyle Dammann, Vineeta Khare, Clyde Coleman, Henrik Berdel, Christoph Gasche

Surgery Faculty Publications

Hypothesis: Anti-diabetic drugs modulate p-21 activated kinase (PAK) signaling. Introduction: Type 2 diabetes mellitus (T2DM) is a chronic inflammatory disease associated with increased cancer risk. PAK signaling is implicated in cellular homeostasis when regulated, and cancer when unrestrained. Recent reports provided a role for PAK signaling in glucose homeostasis, but the role of PAKs in the pathogenesis of T2DM is unknown. Here, we performed a mini-meta-analysis to explore if anti-diabetic drugs modify PAK signaling pathways, and provide insight regarding modulation of these pathways, to potentially reduce diabetes-associated cancer risk. Methods: PAK interacting partners in T2DM were identified using the online …

Intergenerational Adult Day Services Needs Assessment Project Final Report, University Of Maine School Of Social Work, Eastern Area Agency On Aging, University Of Maine Center On Aging

Maine Center on Aging Research and Evaluation

Focus group research conducted in the Greater Bangor, Maine area in 2016 identified respite services and intergenerational programming as important factors for supporting a more livable community.

This report outlines findings from a 2018 needs assessment of adult day services (ADS), funded by Maine Health Access Foundation. The needs assessment utilized a survey of local caregivers (N=84) and key informant interviews (N=10) with staff at Maine adult day service programs or service providers that could utilize adult day services for their clients.

Key survey findings indicate that lack of financial resources (identified by 20% of the survey sample), and lack …

Using Virtual Reality In Medical Education To Teach Empathy, Elizabeth Dyer, Barbara Swartzlander, Marilyn R. Gugliucci

Library Services Faculty Publications

Objective: The project adopted technology that teaches medical and other health professions students to be empathetic with older adults, through virtual reality (VR) software that allows them to simulate being a patient with age-related diseases, and to familiarize medical students with information resources related to the health of older adults.

Methods: The project uses an application that creates immersive VR experiences for training of the workforce for aging services. Users experience age-related conditions such as macular degeneration and high-frequency hearing loss from the patient’s perspective. Librarians and faculty partner to integrate the experience into the curriculum, and students go to …

Older Adults' Health Care Utilization A Year After Experiencing Fear Or Distress From Hurricane Sandy, Laura P Sands, Yimeng Xie, Rachel Pruchno, Allison Heid, Yili Hong

Rowan-Virtua School of Osteopathic Medicine Faculty Scholarship

OBJECTIVE: To determine whether self-reports of disaster-related psychological distress predict older adults' health care utilization during the year after Hurricane Sandy, which hit New Jersey on October 29, 2012.

METHODS: Respondents were from the ORANJ BOWL Study, a random-digit dialed sample from New Jersey recruited from 2006 to 2008. Medicare hospital, emergency department (ED) and outpatient claims data from 2012 and 2013 were matched to 1607 people age 65 and older in 2012 who responded to follow-up surveys conducted from July 2013 to July 2015 to determine their hurricane-related experiences.

RESULTS: In total, 7% (107) of respondents reported they experienced …

Astrocyte Activation And The Calcineurin/Nfat Pathway In Cerebrovascular Disease, Susan D. Kraner, Christopher M. Norris

Sanders-Brown Center on Aging Faculty Publications

Calcineurin (CN) is a Ca²⁺/calmodulin-dependent protein phosphatase with high abundance in nervous tissue. Though enriched in neurons, CN can become strongly induced in subsets of activated astrocytes under different pathological conditions where it interacts extensively with the nuclear factor of activated T cells (NFATs). Recent work has shown that regions of small vessel damage are associated with the upregulation of a proteolized, highly active form of CN in nearby astrocytes, suggesting a link between the CN/NFAT pathway and chronic cerebrovascular disease. In this Mini Review article, we discuss CN/NFAT signaling properties in the context of vascular disease and …

Humanin Prevents Age-Related Cognitive Decline In Mice And Is Associated With Improved Cognitive Age In Humans., Kelvin Yen, Junxiang Wan, Hemal H Mehta, Brendan Miller, Amy Christensen, Morgan E Levine, Matthew P Salomon, Sebastian Brandhorst, Jialin Xiao, Su-Jeong Kim, Gerardo Navarrete, Daniel Campo, G Jean Harry, Valter Longo, Christian J Pike, Wendy J Mack, Howard N Hodis, Eileen M Crimmins, Pinchas Cohen

Articles, Abstracts, and Reports

Advanced age is associated with a decline in cognitive function, likely caused by a combination of modifiable and non-modifiable factors such as genetics and lifestyle choices. Mounting evidence suggests that humanin and other mitochondrial derived peptides play a role in several age-related conditions including neurodegenerative disease. Here we demonstrate that humanin administration has neuroprotective effects in vitro in human cell culture models and is sufficient to improve cognition in vivo in aged mice. Furthermore, in a human cohort, using mitochondrial GWAS, we identified a specific SNP (rs2854128) in the humanin-coding region of the mitochondrial genome that is associated with a …

Isolation Of Cerebral Capillaries From Fresh Human Brain Tissue, Anika M. S. Hartz, Julia A. Schulz, Brent S. Sokola, Stephanie E. Edelmann, Andrew N. Shen, Ralf G. Rempe, Yu Zhong, Nader El Seblani, Bjoern Bauer

Sanders-Brown Center on Aging Faculty Publications

Understanding blood-brain barrier function under physiological and pathophysiological conditions is critical for the development of new therapeutic strategies that hold the promise to enhance brain drug delivery, improve brain protection, and treat brain disorders. However, studying the human blood-brain barrier function is challenging. Thus, there is a critical need for appropriate models. In this regard, brain capillaries isolated from human brain tissue represent a unique tool to study barrier function as close to the human in vivo situation as possible. Here, we describe an optimized protocol to isolate capillaries from human brain tissue at a high yield and with consistent …

In Vivo Brainstem Imaging In Alzheimer’S Disease: Potential For Biomarker Development, David J. Braun, Linda J. Van Eldik

Neuroscience Faculty Publications

The dearth of effective treatments for Alzheimer’s disease (AD) is one of the largest public health issues worldwide, costing hundreds of billions of dollars per year. From a therapeutic standpoint, research efforts to date have met with strikingly little clinical success. One major issue is that trials begin after substantial pathological change has occurred, and it is increasingly clear that the most effective treatment regimens will need to be administered earlier in the disease process. In order to identify individuals within the long preclinical phase of AD who are likely to progress to dementia, improvements are required in biomarker development. …

Life Review In Aging: A Primer, Thomas M. Meuser

Social Work Faculty Publications

Humans are narrative beings. We understand and speak of ourselves and the events of our lives in the context of stories. The stories we tell are influenced by our lived experiences, the quality of our memories (what’s recalled and forgotten), relationships, personality styles, values, accomplishments, regrets, spiritual beliefs, and a host of other factors. Telling our stories from the vantage point of old age is reflective of a maturational process of introspection and discovery called life review.

Comprehensive Geriatric Assessment: A Primer, Thomas M. Meuser

Social Work Faculty Publications

Comprehensive Geriatric Assessment is an integrative approach to diagnosis, treatment and management of older adults that takes the whole person into account. While deficits may be a primary focus, strengths are also considered.

Working Memory And Falls Risk In Older Adults: An Event-Related Potential Study, Yee (Michelle) S. Wong

Electronic Thesis and Dissertation Repository

BACKGROUND: The aging population is rapidly increasing, where currently in North America, the population of older adults (ages 60+) outnumbers the population of children. Falls are a major concern for older adults and their quality of life. Cognitive impairment has been shown to be declined in older adults at-risk for falls, but working memory has not been thoroughly investigated within this population. PURPOSE: To examine differences in Non-Fallers, Moderate Risk for Falls, and Fallers in a working memory task using electroencephalography (EEG). METHODS: Older adults (n=44, female=27) aged 60 – 80 years (m=68.8, SD=4.7) completed two sessions. The first session …

The Conceptual Relevance Of Assessment Measures In Patients With Mild/Mild-Moderate Alzheimer's Disease, Ann Hartry, Natalie V.J. Aldhouse, Tamara Al-Zubeidi, Myrlene Sanon, Richard G. Stefanacci, Sarah L. Knight

College of Population Health Faculty Papers

Introduction: This study aims to evaluate the conceptual relevance of four measures of disease activity in patients with mild/mild-moderate Alzheimer's disease (AD): (1) the Alzheimer's Disease Assessment Scale–Cognitive Subscale; (2) the Alzheimer's Disease Cooperative Study–Activities of Daily Living Inventory; (3) the Neuropsychiatry Inventory; and (4) the Dependence Scale. Methods: A conceptual model depicting patient experience of mild AD was developed via literature review; concepts were compared with the items of the four measures. Relevance of the concepts included in the four measures was evaluated by patients with mild AD in a survey and follow-up interviews. Results: The four measures assessed …

Prevalence Rates Of Arthritis Among Us Older Adults With Varying Degrees Of Depression: Findings From The 2011 To 2014 National Health And Nutrition Examination Survey, Jessica L. Brooks, Alexander J. Titus, Courtney A. Polenick, Nicole M. Orzechowski, Manney Carrington Reid, Todd A. Mackenzie, Stephen J. Bartels, John A. Batsis

Dartmouth Scholarship

Arthritis and depressive symptoms often interact and negatively influence one another to worsen mental and physical health outcomes. Better characterization of arthritis rates among older adults with different levels of depressive symptoms is an important step toward informing mental health professionals of the need to detect and respond to arthritis and related mental health complications. The primary objective is to determine arthritis rates among US older adults with varying degrees of depression. Using National Health and Nutrition Examination Survey 2011 to 2014 data (N = 4792), we first identified participants aged ≥50 years. Measures screened for depressive symptoms and …

Comparison Of The Acute Effects Of Traditional Versus High Velocity Resistance Training On Metabolic, Cardiovascular, And Psychophysiological Responses In Elderly Hypertensive Women, Vânia Silva Macedo Orsano, Wilson Max Almeida Monteiro De Moraes, Nuno Manuel Frade De Sousa, Felipe Carmo De Moura, Ramires Alsamir Tibana, Alessandro De Oliveira Silva, Silvana Schwerz Funghetto, Brad J. Schoenfeld, Jonato Prestes

Publications and Research

Objectives: The aim of the present study was to compare the acute effects of traditional resistance training (RT) versus high velocity RT (HVRT) on metabolic, cardiovascular, and psychophysiological responses in elderly hypertensive women.

Methods: Fifteen elderly women (mean age ± standard deviation, 67.1±6.9 years) classified as having hypertension stage 1 or 2 were randomly allocated to complete traditional RT or HVRT; 1 week later, subjects allocated to RT completed the HVRT session and vice-versa. Heart rate, blood pressure, affective response, perceived effort, and blood samples analyzing lactate, nitrate, nitrite, oxidative damage (thiobarbituric acid reactive substances [TBARS]), and 6-hydroxy-2,5,7,8- tetramethylchroman-2-carboxylic acid …

Designed Environment For Healthy Aging, Attila Lawrence

Architecture Faculty Research

A growing number of aging adults want to remain in multi generational communities rather than relocating to retirement communities, or having to resort to an institutional setting. To productively function in an environment where all generations interact and live well together, however, one’s ability to manage diminishing cognitive and physical conditions precipitated by the aging process is a major factor that bears on everyone’s quality of life. Because the designed environment frequently plays a significant role in the occurrence of neurodegenerative disorders that involve biological changes, it is self-evident that design strategies intended to support the management of these symptoms …

Influence Of Built Environment And Social Capital On Mental Health Of Residents Of Assisted Living Communities In Louisville, Ky., Sarah E. Walsh, A. Scott Lajoie

Faculty Scholarship

Objectives: Prior research has shown social capital and built environment quality are associated with overall health status and the incidence of mental illness. This study explores the relationship between social capital, built environment, and quality of life specifically for assisted living residents, currently a gap in the literature. Method: A total of 76 assisted living residents were interviewed for the study using researcher-administered questionnaires. In addition, site audits were conducted to quantitatively evaluate the built environment surrounding 12 assisted living communities in the Louisville Metro region. Results: There was a moderate, positive correlation between social capital and mental health, r …

Prognostic Factors For Elderly Patients Treated With Stereotactic Body Radiation Therapy For Pancreatic Adenocarcinoma, Philip A. Sutera, Mark E. Bernard, Hong Wang, Dwight E. Heron

Radiation Medicine Faculty Publications

Introduction: Pancreatic ductal adenocarcinoma (PDAC) commonly presents later in life with a median age at diagnosis of 70 years. Unfortunately, elderly patients are significantly underrepresented in clinical trials. Stereotactic body radiation therapy (SBRT) is a promising treatment modality in this population as it has demonstrated excellent local control with minimal toxicity. We aimed to determine prognostic factors associated with outcomes in elderly patients treated with SBRT.

Materials and Methods: Elderly patients older than 70 treated with SBRT for PDAC at our institution, from 2004 to 2014 were included. Our primary endpoints included overall survival (OS) and local-progression-free survival (LPFS). Secondary …