Geriatrics Commons^™

Evaluation Of The University Of Nebraska Medical Center’S 4ms Geriatric Training Program At Nebraska Medicine Midtown, Holly M. Sesker

Capstone Experience: Master of Public Health

In 2015, the Health Resources and Services Administration (HRSA) created the Geriatrics Workforce Enhancement Program (GWEP) to address geriatric workforce challenges and improve the health outcomes of older adults. The GWEP redefines care delivery through a movement for age-friendly healthcare guided by evidence-based practices that align with the 4Ms: What Matters, Medication, Mentation, and Mobility. The 4Ms identify the key issues that should drive the decision-making and care for every older adult. 4Ms training sessions were conducted at the Nebraska Medicine Midtown Clinic and evaluated through a cross-sectional survey administered to both residents (trainees) and attendings (trainers). Data was collected …

Comprehensive Analysis Of Epigenetic Clocks Reveals Associations Between Disproportionate Biological Ageing And Hippocampal Volume, Lidija Milicic, Michael Vacher, Tenielle Porter, Vincent Doré, Samantha C. Burnham, Pierrick Bourgeat, Rosita Shishegar, James Doecke, Nicola J. Armstrong, Rick Tankard, Paul Maruff, Colin L. Masters, Christopher C. Rowe, Victor L. Villemagne, Simon M. Laws, Alzheimer’S Disease Neuroimaging Initiative, Australian Imaging Biomarkers And Lifestyle (Aibl) Study

Research outputs 2022 to 2026

The concept of age acceleration, the difference between biological age and chronological age, is of growing interest, particularly with respect to age-related disorders, such as Alzheimer’s Disease (AD). Whilst studies have reported associations with AD risk and related phenotypes, there remains a lack of consensus on these associations. Here we aimed to comprehensively investigate the relationship between five recognised measures of age acceleration, based on DNA methylation patterns (DNAm age), and cross-sectional and longitudinal cognition and AD-related neuroimaging phenotypes (volumetric MRI and Amyloid-β PET) in the Australian Imaging, Biomarkers and Lifestyle (AIBL) and the Alzheimer’s Disease Neuroimaging Initiative (ADNI). Significant …

Cpr-Directive Conversations In The Emergency Department: The Opinion Of Elderly Patients, Kelvin H. Kramp Dr., Rutger De Hond, Mirwais Mehrab, Martijn Van Hooft, Roger A.P.A. Hessels

Journal of Geriatric Emergency Medicine

Background: The average age of patients admitted to the emergency department (ED) continues to rise. Many face difficult discussions about cardiopulmonary resuscitation (CPR) and end-of-life decisions.

Objectives: This study aimed to determine which healthcare professionals elderly patients admitted via the ED preferred to discuss their CPR-directive with and their opinion about the ED as a setting for discussing their CPR-directive.

Methods: A mixed-methods study with an explanatory sequential design was conducted. A questionnaire was administered to 100 patients >65 years of age admitted to nursing wards via the ED that had a CPR-directive conversation during admission 24-48 hours earlier. Patients …

Integration Of Geriatric Content In Entry-Level Physical Therapy Education In The Philippines: A Pilot Study, Charlemaine Deane A. Perez

Philippine Journal of Physical Therapy

Introduction: Physical therapy (PT) practice is expected to dynamically respond to the growing needs of older adults. Currently, there is paucity in meeting the demands of the aging Filipino population that may be linked to the status of undergraduate PT education. To date, there are no known systematically analyzed data that explores the breadth of geriatric content in the local BSPT programs. This study aimed to describe the integration of geriatric-related content in the pre-clinical and clinical entry-level PT curricula.

Methods: Descriptive cross-sectional research design using survey instrumentation was conducted among heads and PT educators in higher educational …

Healthcare Expenditure Associated With Polypharmacy In Older Adults With Cardiovascular Diseases, Min Ji Kwak, Mihyun Chang, Simbo Chiadika, David Aguilar, Elenir Avritscher, Ashish Deshmukh, Parag Goyal, Dae Hyun Kim, Rajender Aparasu, Holly M Holmes

Faculty, Staff and Student Publications

No abstract provided.

Wellness Promotion Through Leisure Activity Among Community-Dwelling Older Adults, Gabriela Morrell-Zucker

Spring 2022 Virtual OTD Capstone Symposium

The purpose of this capstone project is to analyze the outcomes of an occupation-based wellness program which aims to address the problem of a lack of wellness promotion programs for community-dwelling older adults. Through structured programming older-adults demonstrated increased participation in leisure activities contributing to positive health and wellness. As the older adult population continues to grow, there is a need to engage community-dwelling older adult populations in wellness promotion through leisure activities. For this purpose, a quantitative approach examines the outcomes of program development from older adults' perspectives through a the CHAMPS Older Adult Physical Activity Questionnaire.

Association Between Concussions And Suicidality In High School Students In The United States, Grant L. Iverson, Justin E. Karr

Sanders-Brown Center on Aging Faculty Publications

Importance: Prior research has shown a statistically significant association between sustaining a concussion and suicidality in adolescents, but this prior research controlled for relatively few variables predictive of suicidality.

Objective: To examine whether sustaining a concussion remained a significant predictor of suicidality after controlling for relevant covariates (e.g., sexual abuse/assault, bullying, substance use, depression), hypothesizing that the relationship between concussion and suicidality would become non-significant after controlling for these variables.

Design: This study involved secondary data analysis of the 2019 Youth Risk Behavior Surveillance (YRBS) System, a national cross-sectional study of adolescents. Analyses were stratified by gender. …

Manifestations Of Alzheimer’S Disease Genetic Risk In The Blood Are Evident In A Multiomic Analysis In Healthy Adults Aged 18 To 90, Laura Heath, John C. Earls, Andrew T. Magis, Sergey A. Kornilov, Jennifer C. Lovejoy, Cory C. Funk, Noa Rappaport, Benjamin A. Logsdon, Lara M. Mangravite, Brian W. Kunkle, Eden R. Martin, Adam C. Naj, Nilüfer Ertekin-Taner, Todd E. Golde, Leroy Hood, Nathan D. Price, Erin Abner, David W. Fardo, Linda J. Van Eldik, Alzheimer’S Disease Genetics Consortium

Sanders-Brown Center on Aging Faculty Publications

Genetics play an important role in late-onset Alzheimer’s Disease (AD) etiology and dozens of genetic variants have been implicated in AD risk through large-scale GWAS meta-analyses. However, the precise mechanistic effects of most of these variants have yet to be determined. Deeply phenotyped cohort data can reveal physiological changes associated with genetic risk for AD across an age spectrum that may provide clues to the biology of the disease. We utilized over 2000 high-quality quantitative measurements obtained from blood of 2831 cognitively normal adult clients of a consumer-based scientific wellness company, each with CLIA-certified whole-genome sequencing data. Measurements included: clinical …

Obesogenic Environments And Cardiovascular Disease: A Path Analysis Using Us Nationally Representative Data, Fangqi Guo, Georgiana Bostean, Vincent Berardi, Alfredo J. Velasquez, Jennifer W. Robinette

Psychology Faculty Articles and Research

Introduction

People living in obesogenic environments, with limited access to healthful food outlets and exercise facilities, generally have poor health. Previous research suggests that behavioral risk factors and indicators of physiological functioning may mediate this link; however, no studies to date have had the requisite data to investigate multi-level behavioral and physiological risk factors simultaneously. The present study conducted serial and parallel mediation analyses to examine behavioral and physiological pathways explaining the association between environmental obesogenicity and cardiovascular disease (CVD).

Methods

This cross-sectional observational study used data from the 2012–2016 Health and Retirement Study, a representative survey of US older …

Call To Action: Improving The Care Of Older Patients In Emergency Departments. A Much-Needed Collaboration Between Emergency Medicine Physicians And Geriatricians., Saket A. Saxena

Journal of Geriatric Emergency Medicine

No abstract provided.

Patterns Of Amygdala Region Pathology In Late-Nc: Subtypes That Differ With Regard To Tdp-43 Histopathology, Genetic Risk Factors, And Comorbid Pathologies, Matthew D. Cykowski, Anithachristy S. Arumanayagam, Suzanne Z. Powell, Andreana L. Rivera, Erin L. Abner, Gustavo C. Roman, Joseph C. Masdeu, Peter T. Nelson

Sanders-Brown Center on Aging Faculty Publications

Transactive response (TAR) DNA-binding protein 43 kDa (TDP-43) pathology is a hallmark of limbic-predominant agerelated TDP-43 encephalopathy (LATE). The amygdala is afected early in the evolution of LATE neuropathologic change (LATE-NC), and heterogeneity of LATE-NC in amygdala has previously been observed. However, much remains to be learned about how LATE-NC originates and progresses in the brain. To address this, we assessed TDP-43 and other pathologies in the amygdala region of 184 autopsied subjects (median age=85 years), blinded to clinical diagnoses, other neuropathologic diagnoses, and risk genotype information. As previously described, LATE-NC was associated with older age at death, cognitive impairment, …

New Insights Into The Genetic Etiology Of Alzheimer’S Disease And Related Dementias, Céline Bellenguez, Fahri Küçükali, Iris Jansen, Luca Kleineidam, Sonia Moreno-Grau, Najaf Amin, Adam C. Naj, Rafael Campos-Martin, David W. Fardo, Yuriko Kastumata, Erin L. Abner, Radb, Gr@Ace, Degesco, Eadi, Gerad, Demgene, Finngen, Adgc, Charge

Sanders-Brown Center on Aging Faculty Publications

Characterization of the genetic landscape of Alzheimer’s disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/‘proxy’ AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly …

Does Age-Related Macular Degeneration (Amd) Treatment Influence Patient Falls And Mobility? A Systematic Review., Hannah Garrigan, Jacquelyn N. Hamati, Parth Lalakia, Rosemary Frasso, Brooke Salzman, Leslie Hyman

Student Papers, Posters & Projects

PURPOSE: Age-related macular degeneration (AMD), a leading cause of irreversible blindness, increases fall risk through impaired central vision. Falls place an enormous economic burden on healthcare systems. We hypothesized that AMD treatments may reduce patients' falls risk. This systematic review (ID #: 172623) synthesized the current understanding of wet and dry AMD treatments' impact on patient falls and mobility, connecting these two public health issues.

METHODS: On April 17, 2020, PubMed, Scopus, CINAHL, and the Cochrane Central Register of Controlled Trials were queried. Clinical trials and observational studies were included, while non-English and non-primary studies were excluded. Two authors screened, …

Health Care Services: Utilization And Perception Among Elderly In An Urban Resettlement Colony Of Delhi, Shivani Singh, Somdatta Patra, Amir M Khan

Faculty, Staff and Student Publications

CONTEXT: Health care utilization informs us about the utility of services which are available. We have a paucity of studies related to health care utilization among elderly in India.

AIMS: The aim of this study is to find out utilization of health care services by elderly (≥60 years), pattern, factors associated with, and perception of the elderly population regarding facilitators and barriers for the same.

SETTINGS AND DESIGN: A community based cross-sectional, observational study was conducted in a resettlement colony of East Delhi.

MATERIALS AND METHODS: A pretested, semi-structured, and interviewer-administered questionnaire was used. Duration of data collection was November …

Association Between Self-Reported Body Mass Index And Active Life Expectancy In A Large Community-Dwelling Sample Of Older U.S. Adults, Haomiao Jia, Erica I. Lubetkin

Publications and Research

Background: Obesity may have a protective effect (greater survival) in older adults, a finding known as the "obesity paradox." This study examined the association between self-reported body mass index (BMI) and active life expectancy (ALE) among older U.S. adults.

Methods: Using the Medicare Health Outcomes Survey Cohort 15 (2012 baseline, 2014 follow-up), we estimated life expectancy and ALE by participants' baseline BMI and age using multi-state models. A participant was classified as in an active state if this person reported having no difficulty for any of these six activities of daily living (ADLs).

Results: Small differences in life expectancy were …

Alzheimer's And Patient Caregiver Burnout: A Review Of The Literature, Madeline Hekeler

James Madison Undergraduate Research Journal (JMURJ)

The term “silent epidemic” is fitting for Alzheimer’s disease (AD), as its negative impact is widely felt but rarely discussed. Burnout among AD caregivers has become an epidemic of its own as caregivers experience an increase in health risks, stress, and financial burden. This literature review focuses on caregiver burnout and how imperative it is that caregivers are better supported in their role. Researchers have developed instruments to assess and intervene in caregiver burnout that have shown effectiveness among caregivers and their families.Nevertheless, further longitudinal research is warranted regarding more effective interventions, including stress management and social support mechanisms.

Level Of Comfort In Evaluating Older Patients Amongst Medical Students And Emergency Medicine Residents, Lily L. Berrin, Phraewa Thatphet, Anita N. Chary, Surriya C. Ahmad, Don Melady, Shan W. Liu

Journal of Geriatric Emergency Medicine

Introduction

As the population ages, emergency physicians must be better equipped to manage the complex needs of older patients. While geriatric core competencies have been developed for medical students and emergency medicine (EM) residents, little work has been done to evaluate EM trainees’ comfort with these competencies, or their interest in and barriers to learning more about Geriatric Emergency Medicine (GEM).

Methods

We conducted a cross-sectional study of EM residents and medical students in their clinical years of training with interest in EM. We used an online self-administered survey to evaluate trainees’ self-reported comfort with previously reported geriatric competency domains, …

Geriatric Emergency Medicine Fellowship Journal Club: To Ct Or Not, Marie-Pier Lanoue, Kira Gossack-Keenan, Don Melady

Journal of Geriatric Emergency Medicine

No abstract provided.

Covid-19 In Older Adults- A Practical Review For Emergency Providers In 2022, Michael L. Malone, Teresita Hogan, Alice Bonner, Kevin Biese, Patti Pagel, Kathleen Unroe

Journal of Geriatric Emergency Medicine

COVID-19 has posed a considerable threat to all aspects of older Americans’ lives. The pandemic generated acute illness, emergency department (ED) visits, hospitalization, respiratory failure, and death. Pandemic-associated social isolation and loneliness further endangered older adults. Recovery from COVID-19 illness has commonly been followed by chronic symptoms, which may also precipitate ED visits. While vaccination has mitigated risks of serious illness requiring hospitalization, a booster dose is required to sustain protection. New treatments and therapies, including monoclonal antibodies and antiviral agents, have shown efficacy for older adults who are at risk of hospitalization. Older adults remain vulnerable in 2022, after …

Dissociation Of Tau Pathology And Neuronal Hypometabolism Within The Atn Framework Of Alzheimer’S Disease, Michael Tran Duong, Sandhitsu R. Das, Xueying Lyu, Long Xie, Hayley Richardson, Sharon X. Xie, Paul A. Yushkevich, Alzheimer’S Disease Neuroimaging Initiative, David A. Wolk, Ilya M. Nasrallah, Charles D. Smith, Gregory A. Jicha, Peter A. Hardy, Partha Sinha, Elizabeth Oates, Gary Conrad, Michael W. Weiner, Paul Aisen, Ronald C. Petersen, Clifford R. Jack Jr.

Sanders-Brown Center on Aging Faculty Publications

Alzheimer’s disease (AD) is defined by amyloid (A) and tau (T) pathologies, with T better correlated to neurodegeneration (N). However, T and N have complex regional relationships in part related to non-AD factors that influence N. With machine learning, we assessed heterogeneity in ¹⁸F-flortaucipir vs. ¹⁸F-fluorodeoxyglucose positron emission tomography as markers of T and neuronal hypometabolism (N_M) in 289 symptomatic patients from the Alzheimer’s Disease Neuroimaging Initiative. We identified six T/N_M clusters with differing limbic and cortical patterns. The canonical group was defined as the T/N_M pattern with lowest regression residuals. Groups resilient to …

What’S In A Name? Understanding Failure To Thrive And Frailty In The Emergency Department, Katherine Selman, Christina Shenvi

Journal of Geriatric Emergency Medicine

No abstract provided.

Pitfalls Of Delirium Screening In Older Adults, Danya Khoujah, Debra Eagles

Journal of Geriatric Emergency Medicine

No abstract provided.

Region-Based Analysis Of Rare Genomic Variants In Whole-Genome Sequencing Datasets Reveal Two Novel Alzheimer’S Disease-Associated Genes: Dtnb And Dlg2, Dmitry Prokopenko, Sanghan Lee, Julian Hecker, Kristina Mullin, Sarah Morgan, Yuriko Katsumata, Michael W. Weiner, David W. Fardo, Nan Laird, Lars Bertram, Winston Hide, Cristoph Lange, Rudolph E. Tanzi

Sanders-Brown Center on Aging Faculty Publications

Alzheimer’s disease (AD) is a genetically complex disease for which nearly 40 loci have now been identified via genome-wide association studies (GWAS). We attempted to identify groups of rare variants (alternate allele frequency <0.01) associated with AD in a region-based, whole-genome sequencing (WGS) association study (rvGWAS) of two independent AD family datasets (NIMH/NIA; 2247 individuals; 605 families). Employing a sliding window approach across the genome, we identified several regions that achieved association p values <10⁻⁶, using the burden test or the SKAT statistic. The genomic region around the dystobrevin beta (DTNB) gene was identified with the burden and SKAT test and replicated in case/control samples from the ADSP study reaching genome-wide significance after meta-analysis (p_meta= 4.74 × 10⁻⁸ ). SKAT analysis also revealed region-based association around the Discs large homolog 2 (DLG2) …

Underutilization Of Endovascular Therapy In Black Patients With Ischemic Stroke: An Analysis Of State And Nationwide Cohorts, Youngran Kim, Anjail Sharrief, Min Ji Kwak, Swapnil Khose, Rania Abdelkhaleq, Sergio Salazar-Marioni, Guo-Qiang Zhang, Sunil A Sheth

Faculty, Staff and Student Publications

BACKGROUND AND PURPOSE: Endovascular therapy (EVT) is a very effective treatment but relies on specialized capabilities that are not available in every hospital where acute ischemic stroke is treated. Here, we assess whether access to and utilization of this therapy has extended uniformly across racial and ethnic groups.

METHODS: We conducted a retrospective, population-based study using the 2019 Texas Inpatient Public Use Data File. Acute ischemic stroke cases and EVT use were identified using the

RESULTS: Among 40 814 acute ischemic stroke cases in Texas in 2019, 54% were White, 17% Black, and 21% Hispanic. Black patients had similar admissions …

Healthy Ageing And Intellectual Disability Study: Summary Of Findings And The Protocol For The 10-Year Follow-Up Study, Marleen J. De Leeuw, Alyt Oppewal, Roy G. Elbers, Mireille W. E. J. Knulst, Marco C. Van Maurik, Marjoleine C. Van Bruggen, Thessa I.M. Hilgenkamp, Patrick J.E. Bindels, Dederike A.M. Maes-Festen

Physical Therapy Faculty Research

Introduction The Healthy Ageing and Intellectual Disability (HA-ID) study is a prospective multicentre cohort study in the Netherlands that started in 2008, including 1050 older adults (aged ≥50) with intellectual disabilities (ID). The study is designed to learn more about the health and health risks of this group as they age. Compared with the amount of research in the general population, epidemiological research into the health of older adults with ID is still in its infancy. Longitudinal data about the health of this vulnerable and relatively unhealthy group are needed so that policy and care can be prioritised and for …

Second Heart Field–Derived Cells Contribute To Angiotensin Ii–Mediated Ascending Aortopathies, Hisashi Sawada, Yuriko Katsumata, Hideyuki Higashi, Chen Zhang, Yanming Li, Stephanie Morgan, Lang H. Lee, Sasha A. Singh, Jeff Z. Chen, Michael K. Franklin, Jessica J. Moorleghen, Deborah A. Howatt, Debra L. Rateri, Ying H. Shen, Scott A. Lemaire, Masanori Aikawa, Mark W. Majesky, Hong S. Lu, Alan Daugherty

Sanders-Brown Center on Aging Faculty Publications

BACKGROUND: The ascending aorta is a common location for aneurysm and dissection. This aortic region is populated by a mosaic of medial and adventitial cells that are embryonically derived from either the second heart field (SHF) or the cardiac neural crest. SHF-derived cells populate areas that coincide with the spatial specificity of thoracic aortopathies. The purpose of this study was to determine whether and how SHF-derived cells contribute to ascending aortopathies.

METHODS: Ascending aortic pathologies were examined in patients with sporadic thoracic aortopathies and angiotensin II (AngII)–infused mice. Ascending aortas without overt pathology from AngII-infused mice were subjected …

The Remote Assessment And Dynamic Response Program: Development Of An In-Home Dementia-Related Care Needs Assessment To Improve Well-Being, Lindsey M. Miller, Diane N. Solomon, Carol J. Whitlatch, Shirin O, Hiatt, Chao-Yi Wu, Christina Reynolds, Wan-Tai Michael Au-Yueng, Jeffrey Kaye, Joel Steele

Psychology Faculty Publications and Presentations

Background and Objectives

The Remote Assessment and Dynamic Response (READyR) Program was developed in order to address the current lack of early-stage dementia care planning programs that assess the care needs of persons with dementia. The goal was to create a program informed by care values and ongoing ecologically valid data. The objectives of this study are to describe the development and design process of the READyR Program, and to evaluate the utility of the READyR Program for identifying dementia-related care needs.

Research Design and Methods

A prototype of the web-based READyR Program tool was first created using digital activity …

African-American Lay Pastoral Care Facilitators’ Perspectives On Dementia Caregiver Education And Training, Nik M. Lampe, Nidhi Desai, Tomeka Norton-Brown, Alexandra C. H. Nowakowski, Robert L. Glueckauf

The Qualitative Report

The African-American Alzheimer’s Caregiver Training and Support Project 2 (ACTS 2) is a faith-integrated, skills-training and support program for distressed African American family caregivers of persons living with dementia across Florida. Caregivers participate in a 12-week, telephone-based, skills-building and support program led by faith community workers (i.e., lay pastoral care facilitators) who provide volunteer services to their denominations. In this case study, we examined facilitators’ perspectives and recommendations for supplementary audiovisual and written training materials to optimize group process and goal-setting skills. Utilizing a qualitative approach, we explored facilitators’ needs, experiences in using current training materials, and recommendations for supplementary …

Cognitive Reserve And Mild Cognitive Impairment, Maryam Iraniparast, Yidan Shi, Ying Wu, Leilei Zeng, Colleen J. Maxwell, Richard J. Kryscio, Philip D. St. John, Karen S. Santacruz, Suzanne L. Tyas

Sanders-Brown Center on Aging Faculty Publications

Background and Objectives Little is known about the effect of education or other indicators of cognitive reserve on the rate of reversion from mild cognitive impairment (MCI) to normal cognition (NC) or the relative rate (RR) of reversion from MCI to NC vs progression from MCI to dementia. Our objectives were to (1) estimate transition rates from MCI to NC and dementia and (2) determine the effect of age, APOE, and indicators of cognitive reserve on the RR of reversion vs progression using multistate Markov modeling.

Methods We estimated instantaneous transition rates between NC, MCI, and dementia after accounting …

Prostacyclin Promotes Degenerative Pathology In A Model Of Alzheimer’S Disease, Tasha R. Womack, Craig T. Vollert, Odochi Ohia-Nwoko, Monika Schmitt, Saghi Montazari, Tina L. Beckett, David Mayerich, Michael Paul Murphy, Jason L. Eriksen

Sanders-Brown Center on Aging Faculty Publications

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder that is the most common form of dementia in aged populations. A substantial amount of data demonstrates that chronic neuroinflammation can accelerate neurodegenerative pathologies. In AD, chronic neuroinflammation results in the upregulation of cyclooxygenase and increased production of prostaglandin H2, a precursor for many vasoactive prostanoids. While it is well-established that many prostaglandins can modulate the progression of neurodegenerative disorders, the role of prostacyclin (PGI2) in the brain is poorly understood. We have conducted studies to assess the effect of elevated prostacyclin biosynthesis in a mouse model of AD. Upregulated prostacyclin expression …