Geriatrics Commons^™

Older Prisoners, Edward F. Ansello

Director's Editorials from Age in Action

The impact of an aging prison population is causing concern among different stakeholders, including prison officials, legislative bodies, clergy, and some gerontologists. Prison officials are scrambling to accommodate the numbers and needs of older inmates, but they are confounded by constrained budgets, inappropriate prison architecture, lack of gerontologically and geriatrically trained staff members, indifferent legislative bodies, and a general lack of awareness among the public of these problems. Our states need not only retrofitted and newly designed physical facilities but also staffs and providers with gerontological and geriatric training, from corrections personnel to health care providers to clergy and mental …

The Healthy Brain Initiative, Edward F. Ansello

Director's Editorials from Age in Action

Cognitive health is being recognized increasingly as a vital part of overall health and central to aging well. The CDC and Alzheimer's Association have published a revised framework for translating science to practice in public health, with particular focus on the role that state and local public health agencies can play to improve cognitive health and to recognize and report cognitive impairment.

Calorie Labeling, Edward F. Ansello

Director's Editorials from Age in Action

As required by the Affordable Care Act, chain restaurants with 20 or more locations in the US will soon have to display calorie information on their menus. Does knowing this information translate to changing our eating behavior and improving our nutritional intake? Will this change affect older adults in a meaningful way? Menu labeling should be viewed as an early approach in governmental policy to address the obesity epidemic.

The Lifelong Learning Institute In Chesterfield: Ten Years Of Growing, Edward F. Ansello, Monica Hughes

Case Studies from Age in Action

Educational Objectives

1. To review changes in patterns of continuing learning and non-traditional education.

2. To profile membership and their interests in lifelong learning.

3. To highlight the development of the Lifelong Learning Institute of Chesterfield as a possible model for replication.

Protecting The Vulnerable: Free Ways To Prevent Financial Exploitation, Christopher Desimone

Case Studies from Age in Action

Educational Objectives

1. Relate recurring patterns of perpetrators who exploit older adults.

2. Describe no-cost actions to protect assets from financial exploitation.

3. Explain differences among types of power of attorney.

Remembering Through Music: Music Therapy And Dementia, Melissa Owens

Case Studies from Age in Action

Educational Objectives

1. Define music therapy and its benefits with older adults with dementia and related disorders/ diseases.

2. Describe active and passive music therapy interventions and strategies for older adult populations.

3. Identify the ways a non-musician can use music to engage older adults and mitigate some symptoms of dementia.

Physician Clinical Management Strategies And Reasoning: A Cross-Sectional Survey Using Clinical Vignettes Of Eight Common Medical Admissions, K. L. Smith, S. Ashburn, J. A. Aminawung, M. Mann, J. S. Ross

Journal Articles

Background: Physicians often select clinical management strategies not strongly supported by evidence or guidelines. Our objective was to examine the likelihood of selecting, and rationale for pursuing, clinical management strategies with more or less guideline support among physicians using clinical vignettes of eight common medical admissions. Methods: We conducted a cross-sectional survey using clinical vignettes of attending physicians and housestaff at one internal medicine program in New York City. Each clinical vignette included a brief clinical scenario and a varying number of clinical management strategies: diagnostic tests, consultations, and treatments, some of which had strong evidence or guideline support (Level …

Integrating Palliative Care Into The Picu: A Report From The Improving Palliative Care In The Icu Advisory Board, R. Boss, J. Nelson, D. Weissman, M. Campbell, R. Curtis, J. Frontera, M. Gabriel, D. Lustbader, A. Mosenthal, R. Hays, +5 Additional Authors

Journal Articles

Objective: This review highlights benefits that patients, families and clinicians can expect to realize when palliative care is intentionally incorporated into the PICU. Data Sources: We searched the MEDLINE database from inception to January 2014 for English-language articles using the terms "palliative care" or "end of life care" or "supportive care" and "pediatric intensive care." We also hand-searched reference lists and author files and relevant tools on the Center to Advance Palliative Care website. Study Selection: Two authors (physicians with experience in pediatric intensive care and palliative care) made final selections. Data Extraction: We critically reviewed the existing data and …

Palliative Care In The Icu: Relief Of Pain, Dyspnea, And Thirst-A Report From The Ipal-Icu Advisory Board, K. Puntillo, J. E. Nelson, D. Weissman, R. Curtis, S. Weiss, J. Frontera, M. Gabriel, R. Hays, D. Lustbader, M. Campbell, +6 Additional Authors

Journal Articles

Purpose: Pain, dyspnea, and thirst are three of the most prevalent, intense, and distressing symptoms of intensive care unit (ICU) patients. In this report, the interdisciplinary Advisory Board of the Improving Palliative Care in the ICU(IPAL-ICU) Project brings together expertise in both critical care and palliative care along with current information to address challenges in assessment and management. Methods: We conducted a comprehensive review of literature focusing on intensive care and palliative care research related to palliation of pain, dyspnea, and thirst. Results: Evidence-based methods to assess pain are the enlarged 0-10 Numeric Rating Scale (NRS) for ICU patients able …

The Necessity Of Leisure And Physical Activity, Alison Clarke, Stephanie Goode

Case Studies from Age in Action

Educational Objectives

1. Explain the value and benefit of physical and leisure activity across the lifespan, regardless of physical limitations.

2. Identify barriers to participation in physical and leisure activity.

3. Discuss strategies to engage and maintain physical and recreational activity participation.

Ceftriaxone Potentiates Warfarin Activity Greater Than Other Antibiotics In The Treatment Of Urinary Tract Infections, Lindsay M. Saum, Ryan P. Balmat

Scholarship and Professional Work – COPHS

Background: The cephalosporin class has been associated with an increased risk of bleeding among elderly patients receiving warfarin. Urinary tract infections (UTI) are the most prevalent infection in elderly patients.

Objective: To determine the extent of interaction between antibiotics used in the treatment of UTI, particularly specific cephalosporins and warfarin.

Methods: A retrospective chart review was conducted on chronic warfarin patients with a diagnosis of UTI treated with ceftriaxone, a first-generation cephalosporin, penicillin, or ciprofloxacin. The primary outcome was the comparison of the extent of international normalized ratio (INR) change from baseline between each antibiotic group.

Results: The ceftriaxone group …

Differences In Mental Health Treatment Recommendations For Older And Younger Adults, Michelle M. Smith

Masters Theses

Failure to meet geriatric mental health needs is increasingly problematic. Research indicates that the problem is not simply a matter of insufficient numbers of mental health practitioners (MHPs), but also ageist attitudes and lack of knowledge about and training with older adults. The current study reviews the literature regarding knowledge about older people, education and training that mental health professionals receive, and the attitudes that are held by mental health professionals. The study also assessed for differences in treatment recommendations that MHP made for older versus younger clients, investigated whether MHP knowledge about the mental health of older adults, attitudes …

Let’S Play: Understanding The Role And Significance Of Digital Gaming In Old Age, Julie A. Skalsky Brown

Theses and Dissertations--Gerontology

Despite a marked increase in the use of digital games among older persons, there is insufficient research that provides insight into the gaming experiences of this population. A major demographic shift within the senior gaming market has ushered in a new perspective on the use of digital games as a tool for physical and cognitive health, and improved socialization. It is proposed that individual notions of play, which are developed over the life course, influence digital game play engagement and interaction preferences, and contribute to well-being. This study explored how self-perceptions of play over the course of the senior gamer’s …

Educating And Engaging Along Life's Journey, Decorntae Kpou, Matthew O'Donnell

Bridging the Gaps Posters 2014

No abstract provided.

The Use Of Physical Restraints Among Nursing Home Residents: Do Disparities Exist?, Shekinah Fashaw

HIM 1990-2015

Introduction: The purpose of this study is to examine how nursing home (NH) characteristics, specifically racial composition of nursing homes residents, influences the use of physical restraints. As the population ages and becomes more diverse, it is essential to mitigate/eliminate racial/ethnic disparities in quality care. Methods: This is cross-sectional study using a 2010 national data set from Brown University Center for Gerontology and Healthcare Research. This study employs Donabedian's Structure-Process-Outcome (SPO) conceptual framework. Statistical analysis includes univariate, bivariate, and a logistic regression model. It is hypothesized that nursing homes with higher proportions of black residents, more Medicaid residents, and for-profit …

Medication Noncompliance In Patients Over The Age Of 65: Risk Factors, Problems, And Potential Solutions, Rachel N. Cook

Honors Program Theses

Medication noncompliance is linked with a complex medication regimen, poor drug knowledge, physical limitations, psychosocial characteristics, and poor communication. As important as this problem is to patients’ health especially those over the age of 65, there really is no solution to this problem or even steps to a solution. After interviewing eight care providers, I have come up with a few steps to begin solving this problem. These steps include a medication dispenser, communication between care providers, and education provided to patients by all care providers. In the end, there is no solution that will solve every case of medication …

Three‐Dimensional Brain Mri For Dbs Patients Within Ultra‐Low Radiofrequency Power Limits, Subhendra N. Sarkar, Efstathios Papavassiliou, David Hackney, David Alsop, Ananth Madhuranthakam, Ludy Shih, Reed Busse, Susan Laruche, Rafeeque Bhadelia

Publications and Research

Background: For patients with deep brain stimulators (DBS), local absorbed radiofrequency (RF) power is unknown and is much higher than what the system estimates. We developed a comprehensive, highquality brain magnetic resonance imaging (MRI) protocol for DBS patients utilizing three-dimensional (3D) magnetic resonance sequences at very low RF power. Methods: Six patients with DBS were imaged (10 sessions) using a transmit/receive head coil at 1.5 Tesla with modified 3D sequences within ultra-low specific absorption rate (SAR) limits (0.1 W/kg) using T2, fast fluid-attenuated inversion recovery (FLAIR) and T1- weighted image contrast. Tissue signal and tissue contrast from the low-SAR images …

Making Space For Dying: Portraits Of Living With Dying, Elise Lark

Antioch University Dissertations & Theses

In Making Space for Dying: Portraits of Living with Dying, I describe the everyday lived experience of dying and the care culture within freestanding, community-based, end-of-life residences (CBEOLR) utilizing portraiture and arts-based research. I craft four case studies into “portraits,” based on interviews, on-site visits, up-close observation, and field notes. In the person-centered portraits, I reveal the inner landscape of two terminally ill women, with data represented in poetry. In the place-centered portraits, I “map” the social topography of two CBEOLRs to illustrate how lives and care of the dying are emplaced, from the perspectives of community leaders, …

Identification Of Plasma Lipid Biomarkers In Alzheimer's Disease, Rhona Creegan

Theses: Doctorates and Masters

Alzheimer’s disease (AD), the commonest form of dementia, is a chronic, progressive neurodegenerative disease which manifests clinically as a slow global decline in cognitive function, including deterioration of memory, reasoning, abstraction, language and emotional stability, culminating in a patient with end-stage disease, totally dependent on custodial care. With an ageing population, there is predicted to be a marked increase in the number of people diagnosed with AD in the coming decades, making this a significant challenge to socio-economic policy and aged care. Currently there is no cure for AD and while current therapies may temporarily ameliorate symptoms, death usually occurs …

Plasma Insulin-Degrading Enzyme: Characterisation And Evaluation As A Potential Biomarker For Alzheimer's Disease, Michelle Tegg

Theses: Doctorates and Masters

Alzheimer’s disease (AD) is increasing in prevalence due to increasing lifespan and altered lifestyle. It is the fourth major cause of death in Western countries, resulting in significant economic and social impact (Von Strauss, et al., 1999; Goate, 1997). There are no blood biomarkers currently accepted for the diagnosis of AD, and the identification of suitable biomarkers would eventually reduce the necessity for invasive, expensive and slow diagnostic procedures, as well as facilitate prognostic studies. An AD blood test would decrease the need for delaying diagnosis due to ambivalent presentation, and allow therapeutic intervention to commence at an earlier …

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 …

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 …

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 …

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 …

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. …

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 …

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 …