Search

Scant research has attempted to understand the use and frequency of contemplative practices across social groups of older adults in the context of uniquely uncertain and stressful circumstances, such as the COVID-19 pandemic. Using data from a nationwide web-based survey (n = 1861), we examined the change in the frequency of contemplative practices and variation across sociodemographic, health, and psychological status and we documented a significant increase in the use of prayer and meditation since the beginning of the pandemic. Minority groups and those with lower income reported praying longer than their counterparts. Respondents who were unmarried, women, and more educated were more likely to meditate, whereas lower-educated respondents were more likely to pray during the pandemic. Greater use of these practices was found among participants with higher anxiety. Our study offers much-needed guidance for future intervention studies to improve psychological well-being among diverse groups of older adults facing stressful circumstances., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

This study examines temporal and racial/ethnic patterns in social engagement among older adults from 2019 to 2022, using data from the American Time Use Survey (ATUS) for adults aged 60 and older ( n = 13,605). Social engagement was operationalized as time spent on five activities in in-home and out-of-home settings. Descriptive analysis was used to characterize temporal trends of social engagement, and zero-inflated negative binomial regression was utilized to estimate year-specific racial/ethnic differences. Results indicate an initial decline in out-of-home social engagement, followed by a gradual recovery. Racial differences in social engagement became salient during the pandemic period. The evolving racial and ethnic patterns in social engagement underscore the challenges that Black and Hispanic older adults faced during the public health crisis. Understanding activity patterns specific to racial/ethnic groups has implications for targeted interventions, informing strategies to support Black, Hispanic, and other minoritized older adults in public health emergencies., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: This article intends to reveal the long-term effects of physical maltreatment in childhood on depressive symptoms in later life in China. Methods: Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS). 8676 respondents aged 45 and older were included in the study. In this study, we use ordinary least squares (OLS) regression models to estimate the long-term impact on children of physical punishment from their parents. Results: We found that individuals who recalled being hit by their mother in early life reported more depressive symptoms than those who recalled being punished by their father. Difficult family contexts (e.g., comparative poverty, family violence, and parent's poor mental health) had a weak association with higher risk of reporting physical maltreatment and more depressive symptoms among respondents in later life. Conclusion: This article extended the exploration of the long-term impact of child physical maltreatment beyond adolescence and into until later adult life. Effective policies to protect children from maltreatment in the form of physical punishment require further attention to the challenges posed by tradition and culture., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

How public policies convey dementia is an important source of the public's understanding of dementia, and newspapers are critical to depicting and disseminating this information to the public. The present study used topic modeling strategies to analyze Chinese newspaper portrayals of dementia from 2005 to 2020 to trace changes in key areas of dementia knowledge in relevant policies. Using WiseNews, the largest Chinese media database, we chose 45 newspapers from mainland China and identified 12,719 articles related to dementia. Using latent Dirichlet allocation (LDA), we performed a topic modeling analysis and identified the six most prevalent topics on dementia across articles: lifestyle recommendations, neighborhood life, foundational scientific research, celebrity and media portrayals, dementia caregiving, and pharmaceutical innovations - all related to the dementia knowledge scale's four dimensions. Findings suggest a steady increase in the number of articles on dementia caregiving and a decline in lifestyle recommendations from 2005 to 2020. However, newspapers continued to stigmatize aging by regularly co-depicting dementia and old age and by using biased terminology. Among the first to investigate dementia's portrayals in mainland Chinese newspapers, this study illuminates the need for expanding mass media campaigns to raise the country's dementia knowledge to foster a dementia-inclusive society.

Background: The gold standard anesthesia for deep brain stimulation (DBS) surgery is the "awake" approach, using local anesthesia alone. Although it offers high-quality microelectrode recordings and therapeutic-window assessment, it potentially causes patients extreme stress and might result in suboptimal surgical outcomes. General anesthesia or deep sedation is an alternative, but may reduce physiological testing reliability and lead localization accuracy., Objectives: The aim is to investigate a novel anesthesia regimen of ketamine-induced conscious sedation for the physiological testing phase of DBS surgery., Methods: Parkinson's patients undergoing subthalamic DBS surgery were randomly divided into experimental and control groups. During physiological testing, the groups received 0.25 mg/kg/h ketamine infusion and normal saline, respectively. Both groups had moderate propofol sedation before and after physiological testing. The primary outcome was recording quality. Secondary outcomes included hemodynamic stability, lead accuracy, motor and cognitive outcome, patient satisfaction, and adverse events., Results: Thirty patients, 15 from each group, were included. Intraoperatively, the electrophysiological signature and lead localization were similar under ketamine and saline. Tremor amplitude was slightly lower under ketamine. Postoperatively, patients in the ketamine group reported significantly higher satisfaction with anesthesia. The improvement in Unified Parkinson's disease rating scale part-III was similar between the groups. No negative effects of ketamine on hemodynamic stability or cognition were reported perioperatively., Conclusions: Ketamine-induced conscious sedation provided high quality microelectrode recordings comparable with awake conditions. Additionally, it seems to allow superior patient satisfaction and hemodynamic stability, while maintaining similar post-operative outcomes. Therefore, it holds promise as a novel alternative anesthetic regimen for DBS. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society., (© 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.)

Purpose: Achieving competency in cataract surgery is an essential component of ophthalmology residency training. Video-based analysis of surgery can change training through its objective, reliable, and timely assessment of resident performance., Methods: Using the Image Labeler application in MATLAB, the capsulorrhexis step of 208 surgical videos, recorded at the University of Michigan, was annotated for subjective and objective analysis. Two expert surgeons graded the creation of the capsulorrhexis based on the International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric:Phacoemulsification (ICO-OSCAR:phaco) rating scale and a custom rubric (eccentricity, roundness, size, centration) that focuses on the objective aspects of this step. The annotated rhexis frames were run through an automated analysis to obtain objective scores for these components. The subjective scores were compared using both intra and inter-rater analyses to assess the consistency of a human-graded scale. The subjective and objective scores were compared using intraclass correlation methods to determine relative agreement., Results: All rhexes were graded as 4/5 or 5/5 by both raters for both items 4 and 5 of the ICO-OSCAR:phaco rating scale. Only roundness scores were statistically different between the subjective graders (mean difference = -0.149, p-value = 0.0023). Subjective scores were highly correlated for all components (>0.6). Correlations between objective and subjective scores were low (0.09 to 0.39)., Conclusion: Video-based analysis of cataract surgery presents significant opportunities, including the ability to asynchronously evaluate performance and provide longitudinal assessment. Subjective scoring between two raters was moderately correlated for each component., Competing Interests: Dr Nambi Nallasamy reports a patent 63/445,053 pending. The authors have no other conflicts of interest in this work., (© 2024 Annadanam et al.)

Background: The capsulorhexis is one of the most important and challenging maneuvers in cataract surgery. Automated analysis of the anterior capsulotomy could aid surgical training through the provision of objective feedback and guidance to trainees., Purpose: To develop and evaluate a deep learning-based system for the automated identification and semantic segmentation of the anterior capsulotomy in cataract surgery video., Methods: In this study, we established a BigCat-Capsulotomy dataset comprising 1556 video frames extracted from 190 recorded cataract surgery videos for developing and validating the capsulotomy recognition system. The proposed system involves three primary stages: video preprocessing, capsulotomy video frame classification, and capsulotomy segmentation. To thoroughly evaluate its efficacy, we examined the performance of a total of eight deep learning-based classification models and eleven segmentation models, assessing both accuracy and time consumption. Furthermore, we delved into the factors influencing system performance by deploying it across various surgical phases., Results: The ResNet-152 model employed in the classification step of the proposed capsulotomy recognition system attained strong performance with an overall Dice coefficient of 92.21%. Similarly, the UNet model with the DenseNet-169 backbone emerged as the most effective segmentation model among those investigated, achieving an overall Dice coefficient of 92.12%. Moreover, the time consumption of the system was low at 103.37 milliseconds per frame, facilitating its application in real-time scenarios. Phase-wise analysis indicated that the Phacoemulsification phase (nuclear disassembly) was the most challenging to segment (Dice coefficient of 86.02%)., Conclusion: The experimental results showed that the proposed system is highly effective in intraoperative capsulotomy recognition during cataract surgery and demonstrates both high accuracy and real-time capabilities. This system holds significant potential for applications in surgical performance analysis, education, and intraoperative guidance systems., Competing Interests: The authors report no conflicts of interest in this work., (© 2024 Zeng et al.)

Purpose: Understanding of the mechanisms by which meditation imparts beneficial effects on later-life mental health is limited. The current study assessed the role of compassionate love in mediating the relationship between meditation and mental health in later life., Method: Using data from a nationwide web-based survey ( N = 1,861), we examined the indirect effects of meditation on depressive symptoms and anxiety via compassionate love., Results: Participants who practiced meditation (compared to those who did not) had significantly higher feelings of being loved ( b = 0.11, p < 0.05); those who experienced more love had lower depressive symptoms ( b = -2.10, p < 0.001) and anxiety ( b = -0.99, p < 0.001). Meditation also had significant indirect effects (via compassionate love) on depressive symptoms ( b = -0.23, p < 0.05) and anxiety ( b = -0.11, p < 0.05)., Conclusion: This study underscores the need for contemplative interventions that foster compassionate love to improve mental health in later life. [ Journal of Gerontological Nursing, 50 (3), 40-50.].

Background: Creutzfeldt-Jakob disease (CJD) is a fatal neurodegenerative disease characterized by rapidly progressive dementia, motor impairments, and psychiatric symptoms. Sensory disturbances were occasionally reported as well. The study aims to describe the sensory symptoms of the disease., Methods: The CJD Israeli National Database was screened for patients who presented sensory symptoms throughout the disease course. Symptoms, characteristics, and distribution were reviewed and the demographic and clinical data (sex, etiologies of the disease, age of onset, disease duration, neurological exam finding, tau protein level, EEG and MRI findings) were compared with the demographics and clinical data of CJD without sensory symptoms. Then, the patients with sensory symptoms were divided into patients with symptom distribution consistent with peripheral nervous system (PNS) involvement and central nervous system (CNS) involvement. The demographics and clinical data of the 2 groups were compared., Results: Eighty-four CJD patients with sensory symptoms and 645 CJD patients without sensory symptoms were included in the study. Sensory symptoms were more common in genetic E200K CJD patients (14.6% vs. 5.6% respectively, p = 0.0005) (chi-squared test). Numbness and neuropathic pain were the most common symptoms and distribution of symptoms of "stocking gloves" with decreased deep tendon reflexes suggesting peripheral neuropathy in 44% of the patients. In these patients, the classical EEG findings of Periodic Sharp Wave Complexes were less often found (58% vs. 22%, p = 0.02) (chi-squared test)., Conclusions: Sensory symptoms are more common in E200K patients and often follow peripheral neuropathy distribution that suggests PNS involvement., (© 2023. Fondazione Società Italiana di Neurologia.)

Objective: This study aims to explore the influence of health-related locus of control beliefs such as belief in the role of health professionals in influencing patient health, cognitive functioning, and multimorbidity on adherence to physician's recommendations among older adults., Methods: A cross-sectional study involving older adults (N=684, age range = 71-100 years) living in Clearwater, Florida, reported their adherence to physician's recommendations, cognitive functioning, physical health, and health-related locus of control beliefs. Ordered Logistic regression was used., Results: Older adults who believed that health professionals influence health and a person is likely to recover from illness because other people take good care of him/her had higher adherence to physician's recommendations. Older adults who believed that their own action affects their health had lower odds of reporting adherence by 27%. Additionally, those with cognitive impairment had lower odds of reporting adherence by 38%. Functional limitations, multimorbidity, and self-image of health were not associated with adherence., Conclusion: This is one of the first studies to consider the influence of locus of control beliefs on adherence of physician's recommendations among community dwelling older adults. With the exception of one item "My good health is largely a matter of good fortune", generally individuals with external locus of control had higher adherence. Our findings also underscore the policy and clinical significance of different health-related beliefs held by older adults., Competing Interests: The authors report no conflicts of interest in this work., (© 2024 Dahal and Kahana.)

Informed by Donabedian's quality-of-care framework, this study aims to examine elderly clients' service satisfaction and service recommendation for community-based meal services in Shanghai. We analyzed secondary survey data from randomly sampled elderly clients of a community-based meal service in the old Jing'an District in Shanghai ( N = 690). Quality of food and caregivers' attitudes were key to respondents' service recommendation while tidiness of tableware and interactions with caregivers were positively related to their service satisfaction. Overlaps and differences between structure and process factors are discussed. We also provide tailored policy recommendations.

Background: Evidence on the effects of neighborhood socioeconomic disadvantage on dementia risk in racially and ethically diverse populations is limited. Our objective was to evaluate the relative extent to which neighborhood disadvantage accounts for racial/ethnic variation in dementia incidence rates. Secondarily, we evaluated the spatial relationship between neighborhood disadvantage and dementia risk., Methods: In this retrospective study using electronic health records (EHR) at two regional health systems in Northeast Ohio, participants included 253,421 patients aged >60 years who had an outpatient primary care visit between January 1, 2005 and December 31, 2015. The date of the first qualifying visit served as the study baseline. Cumulative incidence of composite dementia outcome, defined as EHR-documented dementia diagnosis or dementia-related death, stratified by neighborhood socioeconomic deprivation (as measured by Area Deprivation Index) was determined by competing-risk regression analysis, with non-dementia-related death as the competing risk. Fine-Gray sub-distribution hazard ratios were determined for neighborhood socioeconomic deprivation, race/ethnicity, and clinical risk factors. The degree to which neighborhood socioeconomic position accounted for racial/ethnic disparities in the incidence of composite dementia outcome was evaluated via mediation analysis with Poisson rate models., Results: Increasing neighborhood disadvantage was associated with increased risk of EHR-documented dementia diagnosis or dementia-related death (most vs. least disadvantaged ADI quintile HR = 1.76, 95% confidence interval = 1.69-1.84) after adjusting for age and sex. The effect of neighborhood disadvantage on this composite dementia outcome remained after accounting for known medical risk factors of dementia. Mediation analysis indicated that neighborhood disadvantage accounted for 34% and 29% of the elevated risk for composite dementia outcome in Hispanic and Black patients compared to White patients, respectively., Conclusion: Neighborhood disadvantage is related to the risk of EHR-documented dementia diagnosis or dementia-related death and accounts for a portion of racial/ethnic differences in dementia burden, even after adjustment for clinically important confounders., (© 2023 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.)

Prayer is used as a coping resource to mitigate the adverse influences of stressful life situations on mental health. However, the mechanisms underlying its impact on mental health in later life still need to be better understood. In particular, scant research attention has been paid to the significance of prayer in enhancing positive emotions (e.g. compassionate love), which can lead to improved mental health. Using data from our nationwide web-based survey ( n  = 1,861), we evaluated if compassionate love mediates the relationship between prayer and mental health. Our findings suggest participants who prayed had significantly higher feelings of being loved ( b = .19, p < .001) and lower depressive symptoms. Compassionate love significantly mediated prayer's effect on depressive symptoms ( b  = -0.40, p < .001) and anxiety ( b  = -0.19, p < .001). Our findings highlight the importance of prayer in enhancing positive emotions and well-being in later life.

Introduction: The number of older, long-term cancer survivors is increasing. However, little is known about how cancer and aging affect the health trajectories of older adults differently. In addition, the impact of race, sex, and education on the processes of aging and the cancer experience needs further investigation. The current study aims to address this knowledge gap by combining two National Cancer Institute (NIC)-funded longitudinal studies conducted in Cleveland from 1998 to 2010., Materials and Methods: The unique cross-sequential design facilitates a comparison between the health changes in long-term (five years +) older cancer survivors (breast, prostate, and colorectal cancer) and demographically matched older adults without a history of cancer in the same geographic area within the same period. The study also captured comprehensive information on how socioeconomic status interacts with cancer and aging over time. General linear models were employed in the data analysis., Results: The findings showed that early cancer experience did not affect long-term cancer survivors' health status in later life. Conversely, comorbidities, being an African American, being female, and having education less than a college degree significantly decreased the health trajectory in later life for all older adults. Moreover, compared to other groups, older African American cancer survivors reported a dramatic decrease in self-reported health after controlling for other conditions., Discussion: Study findings can inform public policy and social services to offer comprehensive treatment plans and help individuals overcome their diseases and lead longer and healthier lives., Competing Interests: Declaration of Competing Interest The original data was funded by National Cancer Institute (R01CA098966; R01CA078975), The authors have declared no conflict of interest., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Despite emerging research on compassionate love's positive influence on later-life psychological well-being, investigations on the mediating processes accountable for such effects are scarce. Using data from a nationwide web-based survey ( N = 1,861), we performed a mediation analysis to assess the role of loneliness in explaining the impact of compassionate love on psychological well-being. Even after controlling for emotional support, our model estimates suggest that older adults who felt loved had significantly lower levels of loneliness (β = -0.84, p < 0.001), significantly fewer depressive symptoms (β = -0.86, p < 0.001), and lower anxiety (β = -0.25, p > 0.05). Loneliness completely mediated the effect of compassionate love on anxiety (β = -0.82, p < 0.001) and significantly mediated compassionate love's influence on depressive symptoms (β = -1.18, p < 0.001). Our findings underscore the need for interventions that increase compassionate love to reduce loneliness and improve psychological well-being in later life. [ Journal of Gerontological Nursing, 49 (4), 12-20.].

Osteoarthritis (OA) is a leading cause of disability among older adults. By 2050, approximately 60 million will suffer from arthritis adding up to a total societal cost of $65 billion. Chronic illnesses resulting in pain, and functional decline have been associated with depression in previous studies.A causal model was developed and tested using structural equation modeling that examined depression scores of 503 older (age 50-85), male Veterans with moderate to severe symptomatic OA of the knee\hip.The results of the structural equation modeling produced a final model of depressive symptomatology that fit the data well (Chi square = 12.23, DF = 11, p = .346; TLI = .99; CFI = 1.00; RMSEA = .02).The findings indicate the central role that OA severity (pain, stiffness, and functional difficulties) plays in the mental health of older Veterans in terms of the level of reported depressive symptoms.

Objectives: In this article, we assess the feasibility and acceptability and the effect of the Plan Ahead for community dwelling older adults. In addition, we investigated the effects of the program. In addition, we aimed to examine whether the completion of the specific Future Care Planning depended on the participants' competence level., Methods: In this single group feasibility study, trained facilitators delivered the program to a sample of 234 community-residing older adults. Participants completed both pre, post assessments about the acceptability of the program and their completion of the recommended future care planning activities., Results: Based on participant's report on the usefulness and satisfaction of the program after the completion of the program, we found that participants reported high levels of acceptance of the program. Participation rates also confirmed the feasibility of the program. In terms of effects of program implementation, statistically significant changes were noted for several outcomes, such as resource building and FCP activities. In particular, we found that these gains were particularly robust for participants in the low competence group., Conclusion: Pilot program results suggest the feasibility of a short community program enhancing proactive planning for future care needs among older adults residing in their community.

The objective of this mixed methods study is to evaluate the need for a comprehensive digital self-care support system (CDSSS) for older adults with multiple chronic conditions (MCC) and to examine whether such a system can be developed to enable daily capture of self-care data. The 3-phase study involved Phase-1: user needs assessment and prototype development; Phase-2: preliminary user evaluation of the prototype; and Phase-3: 4-week small group usability and feasibility testing of the tracking component of the prototype. Results of Phase-1 show the need for a CDSSS. Phase-2 results demonstrate interest among older adults in using such a CDSSS and Phase-3 findings show that older adults found the tracking component of the system easy to use for capturing daily inputs. Overall, the findings show that it is feasible to design a CDSSS for older adults with MCC in a way that is usable and functional for them.

Objectives: Considerable attention has been directed at increased social isolation and loneliness during the COVID-19 pandemic and their impact on later-life psychological well-being. There is a dearth of research on the effect of financial strain and associated psychosocial mechanisms on loneliness among women across racial groups. It is unclear how racial status and financial strain intersect to impact later-life loneliness amid immense uncertainty, social isolation, and anxiety induced by the pandemic. Methods: Based on our nationwide Web-based survey ( n  = 1,301), we used ordinary least square regression to examine the effects of financial strain on loneliness among Black and White women and assessed the role of emotional support in contributing to such effects. Results: We found that Black women face significantly more financial strain than White women but also receive more emotional support and experience less loneliness. Findings show that women experiencing financial strain report increased loneliness, but the negative effects of financial strain are significantly greater for Black women than for White women. Our mediation analysis revealed that emotional support made a significant contribution to the effects of financial strain on loneliness in White women but not in Black women. Discussion: Despite shared vulnerability and social isolation across the general population, our findings suggest that negative effects of financial strain on loneliness among women continue to differ across race, even amid the pandemic. Our findings demonstrate how emotional support explains the relationship between financial strain and later-life loneliness in a racially distinct manner.

Background: Sporadic Creutzfeldt-Jakob disease (s-CJD) is a rare, fatal neurodegenerative disorder. Familial cases of Creutzfeldt-Jakob disease (f-CJD) due to mutations in the PRNP gene are even rarer around the world; however, in Israel there is a focus of f-CJD patients carrying the E200K mutation. As the number of CJD E200K carriers in Israel is high and increasing, transmission of CJD to normal people was suspected. If such transmission occurs, the incidence of s-CJD would be expected to increase as well, resulting in changes of the ratio of familial/sporadic cases., Methods: Using data from the National CJD Registry and official statistics on the Israeli population, we studied incidence rates of f-CJD and s-CJD for the period from 1985 to 2018 applying the Surveillance Epidemiology and End Results (SEER) statistical packet developed in the US National Cancer Institute., Results: In total, 621 CJD patients (405 f-CJD and 216 s-CJD) cases are included in the registry. In the cohort of f-CJD patients, the mean age-adjusted annual incidence rate over the abovementioned period was 1.88 ± 0.09 (95% CI: 1.7-2.08) per 1,000,000. In the cohort of s-CJD patients, the mean age-adjusted incidence rate over the same period was 0.93 ± 0.06 (95% CI: 0.81-1.06) per 1,000,000 people. No significant time trends were found over the observation period in either s-CJD or f-CJD. The ratio f-CJD/s-CJD decreases over the observation period from 2.2 to 1.80., Conclusion: Israel has a high predominance of f-CJD compared to s-CJD. The mean incidence rate of s-CJD in Israel is similar to most countries. Between 1985 and 2018, the annual age-adjusted incidence rates for both forms of CJD remained stable. Thus, there is no evidence that CJD is transmitted from affected individuals to others., (© 2023 S. Karger AG, Basel.)

Background: The largest cluster of genetic Creutzfeldt- Jakob Disease (CJD) exists in Libyan Jews carrying the E200K mutation in the PRNP gene. However, there is another cluster of genetic CJD with E200K mutation in families of Turkish-Jewish origin., Aims: In this retrospective study, we aim to describe the demographic and clinical features of this population of patients., Material and Methods: The Israeli National CJD database was searched for demographic, clinical, imaging, and laboratory data of genetic CJD patients of Libyan and Turkish ancestry with the E200K mutation. The data of Libyan and Turkish patients were compared with notice similar or different demographic or clinical courses., Results: Four hundred and twenty-three patients with CJD of Libyan (L) ancestry and 27 patients with CJD of Turkish (T) ancestry were identified. There were no significant differences in demographic and clinical data between the two populations (age of onset: T = 62 ± 8.8, L = 60 ± 9.7; age of death: T = 63 ± 8.6, L = 61 ± 9.7; and disease duration: T = 7.8 ± 8.4 months, L = 9.6 ± 13.6 months). Rapidly progressive dementia was the most common presentation in both groups, followed by pure cerebellar onset. The levels of tau protein in CSF did not differ between groups (T = 1290 ± 397.6 pg/ml, L = 1276 ± 594.2 pg/ml). MRI and EEG showed classical CJD features in most patients in both groups., Discussion: The E200K mutation is the most common mutation among gCJD patients and was reported in different ethnical populations, suggesting several independent haplotypes of the mutation. The Turkish-Jew cluster, first described in this study, shares similar demographic and clinical features with the bigger cluster of Libyan-Jews CJD patients., Conclusion: E200K gCJD patients of Turkish ancestry share similar demographic and clinical features to patients of Libyan descent, suggesting a common origin of both populations., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Deep brain stimulation (DBS) is commonly and safely performed for selective Parkinson's disease patients. Many centers perform DBS lead positioning exclusively under local anesthesia, to optimize brain microelectrode recordings (MER) and testing of stimulation-related therapeutic and side effects. These measures enable physiological identification of the DBS borders and subdomains based on electrophysiological properties like firing rates and patterns, intra-operative evaluation of therapeutic window, and improvement of lead placement accuracy. Nevertheless, due to the challenges of awake surgery, some centers use sedation or general anesthesia, despite the distortion of discharge properties and interference with clinical testing, resulting in potential impact on surgical outcomes. Thus, there is a need for a novel anesthesia regimen that enables sedation without compromising intra-operative monitoring., Objective: This open-label study investigates the use of low-dose ketamine for conscious sedation during microelectrode recordings and lead positioning in subthalamic nucleus (STN) DBS for Parkinson's disease patients., Methods: Three anesthetic regimens were retrospectively compared in 38 surgeries (74 MER trajectories, 5962 recording sites) across three DBS centers: 1) Interleaved propofol-ketamine (PK), 2) Interleaved propofol-awake (PA), and 3) Fully awake (AA)., Results: All anesthesia regimens achieved satisfactory MER. Detection of STN borders and subdomains by expert electrophysiologist was similar between the groups. Electrophysiological signature of the STN under ketamine was not inferior to either control group. All patients completed stimulation testing., Conclusions: This study supports a low-dose ketamine anesthesia regimen for DBS which allows microelectrode recordings and stimulation testing that are not inferior to those conducted under awake and propofol-awake regimens and may optimize patient experience. A prospective double-blind study that would also compare patients' satisfaction level and clinical outcome should be performed to confirm these findings., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Creutzfeldt-Jacob disease (CJD) is a fatal neuro-degenerative disease, characterized by rapid and intense deterioration, mainly cognitive, leading to death. The typical onset of the disease is around the age of 67., Purpose: To characterize the demographic and clinical features of the population of CJD patients with late-onset disease., Methods: In this retrospective study, the Israeli national database of prion diseases was screened for CJD patients with disease age of onset > 80 years between 1960 and 2016. Patient's demographic and clinical data were collected including sex, type of disease (sporadic/ genetic), clinical presentation, lab results including tau protein level, imaging, and EEG characteristics. Then, the clinical and demographic data of patients with late onset (> 80 years) (L) and patients with usual age of onset (< 80 years) (U) were compared., Results: The study included 728 patients, 23 patients (3.3%) with late-onset disease (82.2.4±4 years, range 80-88) and 705 with usual disease onset (61.31 ± 9.47 years, range 34-80). Sporadic CJD was more common in the late-onset group (18/23 patients (78.2%) (L) vs. 256/705 patients (36.3%) (U)) (p = 0.0001, chi-square test). Classical EEG finding of periodic sharp wave activity were seen more often in the late-onset patients (55% (L) vs. 32.5% (U)) (p = 0.05, chi-square test). The rest of the demographic and clinical features were similar in both groups., Conclusion: Late- and usual-onset diseases are similar in most of demographic and clinical features suggesting a common disease type with normal distribution of age of onset., (© 2022. Fondazione Società Italiana di Neurologia.)

Stressful life events such as a recession, could be devastating on a macro and micro level. Although there have been a number of articles written examining the health effects of the recession, little is known about age differences in the relationship between financial stressors and health pre and post the 2008 recession. Using the Health and Retirement study, we investigated the relationship between two forms of financial hardships, mental and physical health among middle aged (N = 4403) and older adults) (N = 2709). Our findings indicate that with regard to financial hardships experienced pre/post recessionary periods there are differences by age. Specifically, older adults tend to report having less financial hardship than their younger counterparts. Additionally, reduced medication use due to costs was a significant predictor of poor self-rated health among middle aged participants compared to older adults. These results highlight the selective impact of recessions on certain age groups. They also suggests that economic recessions may also produce short-term procyclical health effects. Future research should focus on the relationship between other sources of financial hardship among middle-aged and older adults pre/post-recession at shorter time intervals., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors.)

The purpose of this study was to examine the temporal trends and dynamics of financial hardship among older adults in the U.S. between 2006 and 2016 using the Health and Retirement Study. Sample included a total of 13,537 eligible person observations with a median age of 68 years. Financial hardship included measures of difficulty paying bills, food insecurity, taking less medication due to cost, and ongoing financial strain. Regression analyses were performed using a three-wave quadrennial model to estimate the prevalence of financial hardship over time, to explore temporal patterns and identify persistent hardship. Findings reveal that 51% of respondents who experienced food insecurity at one or more waves were transient. This pattern was similar to respondents who experienced ongoing financial strain (52% transient). Respondents who reported difficulty paying bills (68%) and reduced medications due to cost (62%) were also transient. Significant predictors across all four domains of financial hardship include age, years of education, marital status, self-rated health. Being African American was positively associated with reduced medication use and food insecurity. This study provides insight into the temporal dynamics of financial hardship in later life. It also highlights the contiguous, intermediate and transient nature of financial hardship among older adult populations.

Background and Objectives: With the extension of healthy life expectancy, promoting active aging has become a policy response to rapid population aging in China. Yet, it has been inconclusive about the relative importance of the determinants of active aging. By applying a machine learning approach, this study aims to identify the most important determinants of active aging in 3 domains, i.e., paid/unpaid work, caregiving, and social activities, among Chinese older adults., Research Design and Methods: Data were drawn from the first wave of the China Health and Retirement Longitudinal Study, which surveys a nationally representative sample of adults aged 60 years and older (N = 7,503). We estimated Random Forest and the least absolute shrinkage and selection operator regression models (LASSO) to determine the most important factors related to active aging., Results: Health has a generic effect on all outcomes of active aging. Our findings also identified the domain-specific determinants of active aging. Urban/rural residency is among the most important factors determining the likelihood of engaging in paid/unpaid work. Living in a multigenerational household is especially important in predicting caregiving activities. Neighborhood infrastructure and facilities have the strongest influence on older adults' participation in social activities., Discussion and Implications: The application of feature selection models provides a fruitful first step in identifying the most important determinants of active aging among Chinese older adults. These results provide evidence-based recommendations for policies and practices promoting active aging., (© The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Interpersonal stressful events (ISE) have been shown to be potent predictors of major depressive symptoms among older adults. This study examines the relationships between recent ISE and depressive symptoms in late life and explores whether having coping cognitive resource (e.g. finding meaning and goal in life) can buffer the effects of ISE on depressive symptoms for older adults. We utilized a sample of residents in Florida retirement communities ( N  = 588) who participated in a long-term-panel study using yearly assessments for six years. Additionally, we modeled within-person differences in ISE and depressive symptoms simultaneously with multilevel modeling. Then, we tested the moderating effect of coping resource (i.e. meaning in life and goal in life) in the association between ISE and depressive symptoms. We found that the mean level of ISE is associated with higher depressive symptoms and lower life satisfaction. In addition, higher levels of within-person meaning and goal buffered the negative effect of ISE on depressive symptoms for older adults. Similarly, within-person meaning and goal also attenuated the negative effect of ISE on life satisfaction.

Objective: This study examined health and social support as mediators of the association between driving cessation and 10-year mortality among older men and older women. Method: Data were drawn from a prospective panel survey of 1000 community-dwelling older adults with follow-ups over a 10-year period. Extended Cox proportional hazard regression models were used to estimate the relative risk of driving cessation on mortality. Results: Mortality risk was 1.36 (CI = [1.06, 1.73]) times higher for nondrivers than drivers. This relationship was significantly mediated by health status in the overall sample. Physical health and cognitive health fully mediated the association between driving cessation and mortality among older men, whereas the mediation effects were partial among older women. Discussion: Gender differences in driving patterns may account for the differential mediation effects in the association between driving cessation and mortality.

Objective: This study investigated the associations between various financial hardship and debt indicators and mental health status among older adults., Methods: Using data from the Health and Retirement Study (HRS), we considered the association between different forms of financial hardship and debt of those who were identified as having high levels of depressive symptoms ( N  = 7678) and anxiety ( N  = 8079). Financial hardship indicators: difficulty paying bills, food insecurity, and medication need; debt indicators: credit card and medical debt. Associations were tested using multiple logistic regression analyses and are reported as relative risk (RR) ratios and 95% confidence intervals (CIs)., Results: Participants who had difficulty paying bills were more likely to have high levels of depressive symptoms (RR = 2.06, CI = 1.75-2.42, p  < 0.001) and anxiety (RR = 1.46, CI = 1.02-2.05, p  < 0.001) compared to those who did not have financial difficulty. Similarly, medical debt was associated with depressive symptoms (RR = 1.43, CI = 1.14-1.74, p  < 0.01) and anxiety (RR = 1.20, CI = 0.96-1.50, p  < 0.01). Credit card debt was not significantly associated with either mental health outcome., Conclusion: Indicators of financial hardship and medical debt were associated with depressive symptoms and anxiety in a cohort of older adults. In contrast, the influence of credit card debt appeared to be more complex and vary by individual. These findings indicate that doing without meeting personal salient needs has a particularly adverse effect on psychological well-being.

Objectives: Electroencephalogram (EEG) pattern in Creutzfeldt-Jakob disease (CJD) is characterized by diffuse abnormal activity, although lateralization to one hemisphere has been described in the first stages of the disease. This study aimed to determine whether abnormal EEG activity predominantly occurs in anterior versus posterior brain regions., Methods: As part of a prospective study, the demographics, clinical features and MRI findings of genetic E200K CJD patients were collected. EEG was performed and the recordings reviewed for the typical periodic sharp wave complex (PSWC) and non-specific slow activity. Data were analyzed using the qEEG tool, and the activity in anterior and posterior regions of the brain compared., Results: Eleven genetic E200K CJD patients were included in the study (67% women). The average age was 59.1 ± 8.4 SD years and the average disease duration was 2.4 ± 2.1 months. EEG showed the classic PSWC pattern in 5/11 (45%) of the patients, and slow activity was seen in 9/11 (82%). EEG was normal in 2 patients. PSWC activity was diffuse in 2/5 patients and unilateral in 3/5 patients; slow activity was diffuse in 9 patients. Quantitative analysis of PSWC and slow activity showed no significant difference between anterior and posterior distribution., Conclusion: The abnormal EEG activity in CJD is diffuse with no clear spatial predominance in anterior or posterior brain regions., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

This study explores gender differences in mental health sequelae of transition to widowhood among old-old retirement community dwellers. Data are based on a prospective panel survey of 748 older adults (mean age = 78) with follow-ups over a 10-year period. Mixed-effects models suggest that elderly widows and widowers experienced sharp increases of depressive symptoms subsequent to spousal loss. Men showed stable increases of depressive symptoms after widowhood whereas an inverted U-shape curve of depressive symptoms was prominent for older women. Findings indicate that women are more resilient and are better able to cope with spousal loss than are their male counterparts.

Background: Anesthetics aim to prevent memory of unpleasant experiences. The amygdala and dorsal anterior cingulate cortex participate in forging emotional and valence-driven memory formation. It was hypothesized that this circuitry maintains its role under sedation., Methods: Two nonhuman primates underwent aversive tone-odor conditioning under sedative states induced by ketamine or midazolam (1 to 8 and 0.1 to 0.8 mg/kg, respectively). The primary outcome was behavioral and neural evidence suggesting memory formation. This study simultaneously measured conditioned inspiratory changes and changes in firing rate of single neurons in the amygdala and the dorsal anterior cingulate cortex in response to an expected aversive olfactory stimulus appearing during acquisition and tested their retention after recovery., Results: Aversive memory formation occurred in 26 of 59 sessions under anesthetics (16 of 29 and 10 of 30, 5 of 30 and 21 of 29 for midazolam and ketamine at low and high doses, respectively). Single-neuron responses in the amygdala and dorsal anterior cingulate cortex were positively correlated between acquisition and retention (amygdala, n = 101, r = 0.51, P < 0.001; dorsal anterior cingulate cortex, n = 121, r = 0.32, P < 0.001). Neural responses during acquisition under anesthetics were stronger in sessions exhibiting memory formation than those that did not (amygdala median response ratio, 0.52 versus 0.33, n = 101, P = 0.021; dorsal anterior cingulate cortex median response ratio, 0.48 versus 0.32, n = 121, P = 0.012). The change in firing rate of amygdala neurons during acquisition was correlated with the size of stimuli-conditioned inspiratory response during retention (n = 101, r = 0.22 P = 0.026). Thus, amygdala and dorsal anterior cingulate cortex responses during acquisition under anesthetics predicted retention. Respiratory unconditioned responses to the aversive odor anesthetics did not differ from saline controls., Conclusions: These results suggest that the amygdala-dorsal anterior cingulate cortex circuit maintains its role in acquisition and maintenance of aversive memories in nonhuman primates under sedation with ketamine and midazolam and that the stimulus valence is sufficient to drive memory formation., (Copyright © 2021, the American Society of Anesthesiologists, Inc. All Rights Reserved.)

Objectives: Existing scholarship in social gerontology has paid relatively little attention to broader loving emotions, such as compassionate and altruistic love, as potentially meaningful mechanisms for improving later-life psychological well-being outside a family framework., Method: Drawing from a 3-wave longitudinal survey of community-dwelling older residents (n = 334) of Miami, Florida, we utilized generalized estimating equation models to examine the influence of changes in compassionate love (i.e., feeling love toward other persons and experiencing love from others) on depressive symptoms over time. We also explored cross-sectional relationship between compassionate love and positive and negative affects., Results: An increase in the feeling of being loved (β = -0.77, p < .001) and feeling love for others (β = -0.78, p < .001) led to a decline in odds of reporting greater levels of depressive symptoms over time. The odds of reporting higher level of positive affect were significantly greater for older adults who reported feeling loved by others (β = .63, p < .001) and expressed love for other people (β = 0.43, p < .05). Older adults who felt loved and expressed love for other people, respectively, had 0.71 and 0.54-point lower ordered log odds of reporting higher negative affect than those who reported lower levels of love. The statistically significant impact of feeling loved on all well-being outcomes was maintained even after adjustment for altruistic attitudes and emotional support. Except for depressive symptoms, such adjustments explained the positive influence of love for others on well-being outcomes., Discussion: Our findings underscore the powerful influence of both receiving and giving loving emotions for the maintenance of later-life psychological well-being., (© The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

This study examines the association between productive activity patterns and functional health trajectories of Chinese older adults and whether this association varies by urban/rural residence. Using three waves of the China Health and Retirement Longitudinal Study from a sample of 7,503 older adults, we first performed latent class analysis (LCA) to identify productive activity patterns based on four activities (work, caregiving, informal help, and formal volunteering). Next, multilevel regression analyses were conducted to assess the association between the identified productive activity patterns and functional health trajectories among older adults. Four productive activity patterns are identified from LCA: nonengagers, working-caregivers, workers, and helpers. We find that participation in productive activities is associated with slower functional health decline. The moderation effects of urban/rural differences are prominent across identified groups. Our findings highlight the importance of the urban/rural context in understanding productive aging and its health consequences among Chinese older adults.

Background and Objectives: Scholarly research has established the role of altruism in facilitating human cooperation and prosocial behaviors and highlighted its contribution to psychological well-being. Given the health significance of altruistic attitudes and orientations, we developed a valid and reliable measure of this construct that is suitable for use with older adults., Research Design and Methods: Based on data from a long-term panel study on adaptation to frailty among older adults ( n = 366; mean age = 86 years), we used confirmatory factor analysis to perform construct validation of a five-item Elderly Care Research Center Altruism Scale among older adults (e.g., "Seeing others prosper makes me happy"). Moreover, we examined the invariance of the scale's factor structure across time and gender using nested models., Results: Composite reliability (coefficient omega = 0.78), factor loadings (>0.45 with eigenvalue = 2.84) from exploratory factor analysis, and model fit indices (e.g., comparative fit index = 0.999) from confirmatory factor analysis suggest a single factor, supporting a unidimensional reliable construct of altruistic orientation at baseline. The results provided support for configural, metric, and scalar invariance across time. Findings pertaining to measurement invariance across gender confirmed full configural invariance but only offered support for partial metric, scalar, and residual invariance at baseline. Strong correlations among the altruism scale, salient personality traits, psychological well-being, religiosity, and meaning in life help establish construct validity., Discussion and Implications: The availability of a reliable and valid measure of altruistic attitudes enables a comprehensive evaluation of altruism's influence on later-life health and well-being., (© The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America.)

Objective: To characterize the demographic, clinical features and disease course of familial Creutzfeldt-Jakob disease (fCJD) patients homozygous to the E200K mutation., Methods: The Israeli National CJD Database was screened for patients homozygous to the E200K mutation. Patients' demographic data, clinical presentation and neurological findings, tau protein levels in the cerebrospinal fluid (CSF) and EEG, were assessed., Results: Ten homozygous E200K patients were identified (80% males). Average age of onset was 47.5 ± 6.1 years (range 40-56) and the average age of death was 49.3 ± 7. 7 years (range 42-63) with average disease duration of 27.7 ± 9.7 months (range 2-97). Initial clinical presentation included behavioral change in 4/10 patients, cognitive decline in 3/10 patients and focal neurological deficits in 2/10 patients. Throughout the disease course, the clinical signs in descending order of prevalence included cerebellar (70%), brainstem (60%), extrapyramidal (50%), pyramidal (50%), frontal lobe signs (30%), and disturbances of ocular motility (30%) Compared to the 228 heterozygous E200K fCJD patients, the 10 homozygous patients were significantly younger at disease onset (47.5 vs 59.7 years, p < 0.001), had a longer disease duration (27.7 vs 8.5 months, p < 0.001) and presented more frequently with behavioral changes as initial manifestation (4/10 vs. 34/228, p = 0.05)., Conclusions: Homozygous E200K fCJD patients are characterized by a relatively younger age of onset and longer disease duration. Behavioral changes as a presenting symptom were more common in homozygous patients and cerebellar dysfunction was the most common neurological manifestation throughout the disease course.

Background: The incidence of myasthenia gravis (MG) has traditionally been low, ranging between 2-6/10 6 . Several recent epidemiological studies have reported a higher incidence. We, therefore, aimed to assess and characterize the incidence of MG in Israel., Methods: We retrospectively reviewed the records of all four laboratories that performed the acetylcholine receptor antibody (AChR Ab) test in Israel between 1994 and 2013 and documented the number of newly diagnosed seropositive MG patients each year. To assure that data indeed reflect only newly diagnosed patients, patient's names and ID numbers were screened at the Hadassah medical center database since 1978, the year when the test was first performed in Israel. In order to calculate the annual incidence of the disease, the population at risk was derived from the annual publication of the Israeli Central Bureau of Statistics., Results: The annual incidence of MG for this time period was 13.1/10 6 inhabitants. The mean incidence of MG between 1994 and 2003 was 7.695/10 6 /y, while the mean incidence between 2004 and 2013 was 18.49/10 6 (P < .0001). Mean age of diagnosis between 1994 and 2003 was 56.65 ± 0.9351, while between 2004 and 2013, it was 59.89 ± 0.5336 (P = .0012). Male to female (M:F) incidence ratio in the years 1994-2003 and 2004-2013 was 2:3.2 and 3:1.8, respectively, reflecting increased incidence among males (P < .0001)., Conclusions: The incidence of MG in Israel has increased significantly during the last decade, especially among males of older age. These findings may reflect an etiological role of an environmental factor, increased awareness, and increased longevity in general., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Many organisms produce "functional" amyloid fibers, which are stable protein polymers that serve many roles in cellular biology. Certain Enterobacteriaceae assemble functional amyloid fibers called curli that are the main protein component of the biofilm extracellular matrix. CsgA is the major protein subunit of curli and will rapidly adopt the polymeric amyloid conformation in vitro . The rapid and irreversible nature of CsgA amyloid formation makes it challenging to study in vitro . Here, we engineered CsgA so that amyloid formation could be tuned to the redox state of the protein. A double cysteine variant of CsgA called CsgA CC was created and characterized for its ability to form amyloid. When kept under oxidizing conditions, CsgA CC did not adopt a β-sheet rich structure or form detectable amyloid-like aggregates. Oxidized CsgA CC remained in a soluble, non-amyloid state for at least 90 days. The addition of reducing agents to CsgA CC resulted in amyloid formation within hours. The amyloid fibers formed by CsgA CC were indistinguishable from the fibers made by CsgA WT. When measured by thioflavin T fluorescence the amyloid formation by CsgA CC in the reduced form displayed the same lag, fast, and plateau phases as CsgA WT. Amyloid formation by CsgA CC could be halted by the addition of oxidizing agents. Therefore, CsgA CC serves as a proof-of-concept for capitalizing on the convertible nature of disulfide bonds to control the aggregation of amyloidogenic proteins., (Copyright © 2020 Balistreri, Kahana, Janakiraman and Chapman.)

Objectives: Although many older adults fear frailty and loss of independence in late life, relatively few make plans for their future care. Such planning is particularly limited among racial minorities. Given the benefits of future care planning (FCP), it is important to understand factors that facilitate or hamper FCP in late life. Our study explored racial, demographic, and dispositional influences on thinking about and engagement in FCP among community-dwelling older adults. Design: This study utilized data from the Elderly Care Research Center's longitudinal study of successful aging based on interviews with 409 older adults. Along with race, education and other demographic factors, we explored dispositional influences of optimism and religiosity on FCP using logistic regression. Results: African American older adults had significantly lower odds of executing FCP ( β  =   0.36, p  < .05) when compared to White older adults. However, this estimate was no longer statistically significant after controlling for education, disability status, optimism, and religiosity. Older adults with higher education had significantly higher odds of thinking about and executing FCP. Higher level of optimism was associated with lower odds of FCP. Conclusions: Limited educational resources and the greater prevalence of dispositions of religiosity and optimism among African American older adults may contribute to their reluctance to engage in FCP in comparison to their white counterparts. Our findings offer practice implications indicating a need for interventions to encourage older adults, particularly racial minorities, to recognize and actively plan for their future care needs.

Background and Purpose: Previous studies have reported conflicting results regarding possible anticipation in familial E200K Creutzfeldt-Jakob disease (fCJD). Our objective was to use a large database to assess the age of disease onset (AODO) in CJD., Methods: The study population included 477 CJD patients [266 with fCJD, 145 with sporadic CJD (sCJD) and 66 patients of Libyan origin but negative family history] from the Israeli registry of CJD conducted since 1954. In all patients, AODO in relatives and family trees was documented. Comparison of AODO was done using a paired t test and regression using Pearson correlation for birth and year of onset., Results: The initial analysis in 52/73 families in which more than one generation was affected revealed an AODO of 63.30 ± 9.44 in the first generation compared to 56.96 ± 8.99 in the second generation (P < 0.001). However, inspection of individual AODO values plotted by year of birth showed a clear rhomboid methodological artifact generated by missing data of many young onset CJD patients who died before the database began to function in 1954 and of many late onset CJD patients missing at the present time since they will only develop the disease in the future. The 'generation' effect completely disappears if analysis is performed by year of disease onset or for the periods in which complete data are available., Conclusions: In this very large dataset, true anticipation in fCJD patients was not detected. It is plausible that previous reports supporting the presence of anticipation are biased by a rhomboid-shaped data availability artifact., (© 2019 European Academy of Neurology.)

Objective: We adopt a novel approach to mediation analysis to account for interrelated life course social processes that constitute later life health disparities. We examine gender-specific direct effect of parental education on functional limitations in later life. Method: Based on the first wave (2007-2010; n = 7,150) of the Study on Global Ageing and Adult Health (SAGE), we estimate both (natural) direct and indirect effects of parental education on functional limitations in later life. Results: We observed a significant indirect and positive effect of parental education on functional health. Contrary to prior literature, we documented adverse direct effect of parental education on later life functional health. The direct effect is statistically significant only for father's education, and is greater, though not statistically significantly so, for women than men. Discussion: The intersection of gender status and interrelated social stratification documented by this study highlights the need for gender-sensitive life course research. Such research can enhance our understanding of the ways patriarchal social systems produce heterogeneous effects of interrelated structural factors on later life health for men and women.

The Chinese old-old (80+) population has steadily increased in recent years; however, limited studies have examined how this group ages. The purpose of this study is to explore how the old-old in urban China define successful aging. Guided by grounded theory, we conducted semi-structured, in-depth interviews with community-dwelling old-old participants (N = 97). Participants identified self-reliance as the goal of successful aging, which was supported by four proactive behaviors: physical activity, financial security, community connectedness, and willing acceptance of reality. In our model, we conceptualized these four proactive behaviors to constitute the ribs of an umbrella, supporting a canopy to protect the pole of self-reliant successful aging. This study offers new understanding of the dynamic and nuanced ways that the old-old in urban China age successfully and of their valiant efforts to maintain self-reliance.

Discussions of disability in the gerontological and the disability studies literatures have seldom considered unique perspectives and needs of older adults. Disability has often been stigmatized and viewed as antithetical to successful aging. We call for expansion of prevailing paradigms of disability to address the resilience and continuing human potential of older adults living with disabilities. In addition to recognizing the environmental context of disability, we propose greater attention to adaptive potential of disabled older adults. We discuss 6 types of proactive adaptations that can contribute to empowerment, meaning, enhanced quality of life and psychological well-being among persons living with late-life onset disabilities. These include: (a) helping others, (b) planning for future care, (c) marshaling intergenerational support, (d) self-advocacy for responsive health care, (e) making environmental modifications to improve safety and comfort of the home, and (f) finding strength in spiritual pursuits. Enacting proactive adaptations can contribute to resilience in facing late life impairments and functional limitations. Such efforts can complement utilization of services and obtaining accommodations. Maintaining life satisfaction among older adults living with disabilities also involves focus on transcendent personal goals and acceptance of an altered self. We note how a more integrative view of medical and social dimensions of disability, infused with concepts of human agency, contributes to rapprochement between alternative disciplinary orientations to late life disability. Without negating society's important responsibilities for accommodating to needs of older adults living with disability, we reaffirm their potential for greater control and self-determination through proactive adaptations.

Previous studies have suggested that disease duration in Creutzfeldt-Jakob disease (CJD) may be related to the radiological findings or cerebrospinal fluid (CSF) tau levels; however, it is not yet established whether clinical, radiological, and laboratory findings at diagnosis can predict survival or have a prognostic value. The aim of this study was to examine whether the disease duration is correlated with clinical, radiological, and laboratory variables. The study population consisted of consecutive familial CJD (fCJD) patients that were assessed within 1 week from the diagnosis including the CJD neurological scale (CJD-NS), Minimental Status Examination, Frontal Assessment Battery, NIH Stroke Scale, and the expanded disability status scale. In addition, a single MRI study was done and measurements of the extent of the cortical and subcortical involvement were performed. CSF was examined as part of the workout, and tau levels were determined. Sixty-nine fCJD patients were included in the study (43 males, mean age 59.3 ± 8.4, range 44-79 years). The mean disease duration was 7.3 ± 6.9 months (median 5.6 months, range 2-20 months). A significant correlation was found between the disease duration and the CJD-NS, the disease burden as reflected by the degree of cortical involvement by DWI, and the CSF tau levels. The findings of the current study reveal that several findings at disease onset including the disease severity, the cortical changes, and the tau levels are each individually correlated with disease duration and can be used by the clinician as a tool to predict the disease course and prognosis.

Purpose: The purpose of this article was to examine the relative importance of patients' self-advocacy and perceived physicians' advocacy for impacting patients' satisfaction in terms of physician communication and physician-patient relationship. We also examine the influence of physicians' emotional support and patients' demographic as well as health characteristics on patients' satisfaction., Sample: Our sample includes interviews with 806 community dwelling older adults (mean age =77.82 years, SD=8.41). The sample included residents of a large retirement community in Clearwater, FL, USA. Respondents were also included from representative samples of older adults living in Orlando and Miami, FL, USA, and Cleveland, OH, USA., Methods and Results: Using multiple hierarchical regression analyses, we found that patients' age and functional limitations were negatively associated with their care satisfaction. When compared with White patients, African-American patients were less satisfied with their physicians while Latino patients expressed greater satisfaction with their medical care. We found limited evidence of patients' self-advocacy and such advocacy did not serve as a significant predictor of satisfaction with physicians. In contrast, patients' perception of physicians' readiness to act as patient advocates was a significant predictor of patients' satisfaction. Emotional support of physicians was also associated with patients' satisfaction., Conclusion: These findings raise questions about consumer empowerment among older adults and underscore their desire for and appreciation of physicians' advocacy. Findings are discussed in the context of power imbalance between elderly patients and their doctors., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

The purpose of this study is to explore direct carers' work experience and formal caring relationships with older adults in a community-based eldercare program in Shanghai. Existing evidence has primarily focused on direct carers' work experience in residential care settings. However, direct carers' experiences of caring older adults in the community also deserve exploration. This qualitative study purposively sampled direct carers who worked in government-sponsored programs. Carers participated in semi-structured, in-depth interviews ( N = 37). Results reveal that despite occasional frustration, direct carers undertook demanding workloads and fostered strong emotional attachments with older adult clients. "Karma" was a critical cultural factor pertaining to their work ethic and motivated their care provision to benefit their future elderly selves. This study recognizes the cultural aspects of caring relationships that contribute to the quality of care of the community-based older adults in urban China.