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The paradigm of precision health aims to improve treatment decisions so that the right treatment is administered to the right patient at the right time. The long-term vision of precision health research is to leverage heterogeneity across physiology as well as broader contextual factors to produce algorithms for individualized treatment recommendations; these recommendations will be multidimensional and dynamic. Machine learning techniques, such as dynamic treatment rule estimations, can uncover heterogenous intervention responses and identify patient markers to guide selection of an optimal, individualized intervention. As the population of older adults continues to grow, guidelines for care emphasize the importance of tailoring care to individual-level. Although the potential impact for the paradigm of precision health to improve outcomes among complex and older adult populations has been discussed to our knowledge, the evidence base for such interventions remains scattered. This review will summarize the nature and impact of precision health interventions among older adults.

IntroductionIncreased abdominal visceral adipose tissue (VAT) implies an adverse cardio-metabolic profile. We examined the association of abdominal VAT parameters and all-cause mortality risk.MethodsWe systematically searched four databases. We performed citations/articles screening, data abstraction, and quality assessment in duplicate and independently (CRD42020205021).ResultsWe included 12 cohorts, the majority used computed tomography to assess abdominal VAT area. Six cohorts with a mean age ≤ 65 years, examining all-cause mortality risk per increment in VAT area (cm2) or volume (cm3), showed a 11-98% relative risk increase with higher VAT parameters. However, the association lost significance after adjusting for glycemic indices, body mass index, or other fat parameters. In 4 cohorts with a mean age >65 years, the findings on mortality were inconsistent. Conversely, in two cohorts (mean age 73-77 years), a higher VAT density, was inversely proportional to VAT area, and implied a higher mortality risk.ConclusionA high abdominal VAT area seems to be associated with increased all-cause mortality in individuals ≤ 65 years, possibly mediated by metabolic complications, and not through an independent effect. This relationship is weaker and may reverse in older individuals, most likely secondary to confounding bias and reverse causality. An individual participant data meta-analysis is needed to confirm our findings, and to define an abdominal VAT area cutoff implying increased mortality risk.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=205021, identifier CRD42020205021.

Multimodale Lebensstilinterventionen, besonders KR+AT+KT+VM, f��hren bei ��lteren Personen mit Adipositas zu einer (signifikanten) Reduktion des KG und der FM., Adipositas-Kongress 2021 ��� 37. Jahrestagung der Deutschen Adipositas-Gesellschaft e.V. /Kn��ttel (im Journal nur Abstract ver��ffentlicht/keg17.12.21)

Additional file 3. Appendix 3: Adverse Events

Bei ��lteren Personen mit Adipositas erhalten multimodale Lebensstilinterventionen die FFM und verbessern die k��rperliche Funktion, was f��r den Erhalt der Selbst��ndigkeit einen besonderen Beitrag leisten kann., Adipositas-Kongress 2021 ��� 37. Jahrestagung der Deutschen Adipositas-Gesellschaft e.V. (im Journal nur Abstract ver��ffentlicht/keg17.12.21)

Additional file 1: Table 1 examines the differences between individuals who had a blood sample collected and those that did not. Additionalanalysis examining the association between change in body measures and DNA methylation age in Table 2.

Additional file 4. Appendix 4: Preliminary Outcome Measures of All Participants.

Supplemental Material, sj-pdf-2-ahp-10.1177_0890117120983795 for Impact of Diet and Exercise on Weight and Cognition in Older Adults: A Rapid Review by John A. Batsis, Meredith N. Roderka, Vanessa K. Rauch, Lillian M. Seo, Xingyi Li, Peter R. DiMilia, Tyler Gooding, Diane Gilbert-Diamond, Auden C. McClure and Robert M. Roth in American Journal of Health Promotion

Supplemental Material, sj-pdf-1-ahp-10.1177_0890117120983795 for Impact of Diet and Exercise on Weight and Cognition in Older Adults: A Rapid Review by John A. Batsis, Meredith N. Roderka, Vanessa K. Rauch, Lillian M. Seo, Xingyi Li, Peter R. DiMilia, Tyler Gooding, Diane Gilbert-Diamond, Auden C. McClure and Robert M. Roth in American Journal of Health Promotion

Additional file 1. Appendix 1: CONSORT Table

Speech pause is an effective biomarker in dementia detection. Recent deep learning models have exploited speech pauses to achieve highly accurate dementia detection, but have not exploited the interpretability of speech pauses, i.e., what and how positions and lengths of speech pauses affect the result of dementia detection. In this paper, we will study the positions and lengths of dementia-sensitive pauses using adversarial learning approaches. Specifically, we first utilize an adversarial attack approach by adding the perturbation to the speech pauses of the testing samples, aiming to reduce the confidence levels of the detection model. Then, we apply an adversarial training approach to evaluate the impact of the perturbation in training samples on the detection model. We examine the interpretability from the perspectives of model accuracy, pause context, and pause length. We found that some pauses are more sensitive to dementia than other pauses from the model's perspective, e.g., speech pauses near to the verb "is". Increasing lengths of sensitive pauses or adding sensitive pauses leads the model inference to Alzheimer's Disease, while decreasing the lengths of sensitive pauses or deleting sensitive pauses leads to non-AD.

Additional file 1: Supplemental File 1: Components of the Healthy Lifestyle Program at the Dartmouth Weight and Wellness Center. Supplemental File 2 Standards for Reporting Implementation Studies: the StaRI checklist for completion. Supplemental File 3 – Staff Questions. Supplementary File 4 – Patient Satisfaction Questions. Supplemental File 4: Inner Setting Measures from the CFIR Framework – Fernandez et al (1-low to 5-high, strongly disagree to strongly agree): (n=8). Supplemental File 5 – Adapted General Organizational Index.

Voice Assistant Systems (VAS) are software platforms that complete various tasks using voice commands (e.g., Amazon Alexa), with increasing usage by older adults. It is unknown whether older adults have significant privacy concerns with VAS. 55 participants were evaluated from ambulatory practice sites for a study on VAS detection of early cognitive decline. The mean age was 73.3±5.6 years, 58% female, 93% white, and 53% had mild cognitive impairment. Privacy concerns were assessed via Likert-based surveys. Participants believed data was used with consent (71%) and stored properly (67%); however, 71% wanted new privacy regulations, 43% were comfortable with daily activity monitoring, and 85% thought the data needs to be highly protected. Qualitative themes included “listening-in”, “tracking”, and unwanted sharing of information. Findings suggest that older adults do not have significant privacy concerns for VAS use, but requested additional regulations. Future research can compare VAS privacy concerns between age groups.

Functional decline in older adults can often be mitigated by physical activity. As older adults increasing adopt wearable technology, an understanding of how remotely monitored activity is associated with clinical outcomes is needed. Data was analyzed from two cohorts of older adults with obesity (□65 years, BMI (□30kg/m2)) who completed weekly dietary and exercise-based weight loss interventions (n=93). Follow-up time varied between cohorts (n=37: 12-weeks; n=56: 16 weeks). All participants were provided a Fitbit to monitor physical activity. Baseline and follow up weight, 6-minute walk distance, grip strength, and Late Life Function and Disability Instrument (LLFDI) were collected. We used k-means clustering for longitudinal data to identify physical activity trajectories from Fitbit steps at the daily level. Linear regression models tested for differences in each outcome between trajectories, adjusting for age and sex. Baseline characteristics did not vary across cohorts: mean age 72.7±4.5 years, 76.5% were female, and mean BMI was 36.4±5.1 kg/m2. Two physical activity trajectories were identified, termed high and low activity based on differences in mean daily steps (7,476±4,117 vs. 2,960±2,453, p

Older adults often experience functional decline during hospitalization as a result of immobility. Such decline has associated adverse outcomes, including gait instability, falls, pressure injuries, delirium, and new nursing home admissions. Our objective was to create an effective and sustainable in-hospital mobility program through enhanced interdisciplinary cooperation in an Acute Care of the Elderly (ACE) unit. An interdisciplinary team at UNC’s 25-bed ACE unit planned and delivered enhanced patient mobility beginning in July 2020. We used an input-process-output model to design and analyze an intervention based on enhanced collaboration. Inputs included a mobility taskforce which was comprised of physicians, nurses, physical and occupational therapists, and quality improvement specialists. Through regular meetings, each taskforce member contributed to the study design and were empowered to identify barriers to implementation. Outputs included stakeholder engagement and mobility rates. Early results show a doubling in mobility rates over a 6-month period with consistent and enthusiastic stakeholder engagement. Observations of such benefits include: a) stakeholder inclusion from each discipline ensured implementation that was pragmatic and easily incorporated into the daily workflow; b) mobility champions regularly disseminated information to their respective disciplines, leading to changes using a quality improvement process; and c) barriers to implementation were rapidly identified, and mobility champions were motivated to find solutions, allowing cohesive incorporation of a broad spectrum of priorities. An interprofessional team model is effective to mobilize hospitalized older adults, potentially reducing adverse hospital outcomes. Successful implementation of such programs is dependent on interprofessional collaboration.

a: Age-Stratified Functional Outcome - Males. b: Age-Stratified Functional Outcome - Females. (DOCX 34Â kb)

Sensitivity analysis of excluded vs. Included participants. (DOCX 15Â kb)

Supplemental material, Supplemental_Table_1 for Prevalence of Sarcopenia Obesity in Patients Treated at a Rural, Multidisciplinary Weight and Wellness Center by John A Batsis, Diane Gilbert-Diamond, Auden C McClure, Aaron Weintraub, Diane Sette, John N Mecchella, Sivan Rotenberg, Summer B Cook and Richard I Rothstein in Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders

Supplemental material, Supplemental_Table_1 for Prevalence of Sarcopenia Obesity in Patients Treated at a Rural, Multidisciplinary Weight and Wellness Center by John A Batsis, Diane Gilbert-Diamond, Auden C McClure, Aaron Weintraub, Diane Sette, John N Mecchella, Sivan Rotenberg, Summer B Cook and Richard I Rothstein in Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders

Sensitivity analysis of excluded vs. Included participants. (DOCX 15Â kb)