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Presenters Kelsey Strout, Faith Ellerbe, Hazel Tapp, PhD, Lindsay Shade, MHS, [...], Context: COVID-19 has severely impacted traditional approaches to Practice Based Research recruitment strategies. The Center for Primary Care Research at Atrium Health is actively enrolling participants as a site for PRagmatic Evaluation of evENTs And Benefits of Lipid-lowering in oldEr adults (PREVENTABLE), a multi-center, decentralized trial. Objective: Pragmatic, decentralized trials are an effective way to reach individuals hesitant to come in-clinic as well as reducing study costs. Study Design and Analysis: REDCap is used to review and sign informed e-consents. The PREVENTABLE website allows sites to directly enter data. The central study pharmacy mails a 90-day supply of study drug to participants. A call center staffed with personnel trained on study protocol, which includes a phone screen for cognitive function (TICS-M), performs follow up. Settings or Dataset: PREVENTABLE is enrolling participants across 86 US based sites, including Veteran Affairs. We are recruiting from 77 primary care research practices across nearly 3,000 square miles. Participants are offered options for consenting and completing study related activities in clinic or via phone or video capable device. Population Studied: Participants aged [greater than or equal to] 75 years without dementia, disability, or clinically evident cardiovascular disease. Intervention/Instrument: The number of participants who e-consent compared to those who do not. Outcome Measures: The number of e-consents obtained is tracked through REDCap, while the length of virtual consents compared to in person consents is tracked via Atrium's healthcare software. Results: Currently, 12 of 53 participants e- consented, while the rest consented in-person. 5 patients were interested but did not participate due to limited internet or transportation access. Study drug order activity completed between site and central study pharmacy include more than 55 shipped and delivered orders. Based on check-in and out times in healthcare software, virtual visits take ~1.25 hours with 1 study personnel and on-site visits take ~ 2 hours with up to 3 study personnel. Conclusion: The study design has allowed Atrium Health to recruit, enroll, and retain participants living 40+ miles away or those with alternate addresses. Study related time and effort are saved by site personnel.

Background: Proactive geriatric trauma consultation service (GTCS) models have been associated with better delivery of geriatric care and functional outcomes. Whether such collaborative models can be improved and sustained remains [...]

Background. To estimate the associations of weight dynamics with physical functioning and mortality in older adults. Methods. Longitudinal cohort study using prospectively collected data on weight, physical function, and health status in four U.S. Communities in the Cardiovascular Health Study. Included were 3,278 participants (2,013 women and 541 African Americans), aged 65 or older at enrollment, who had at least five weight measurements. Weight was measured at annual clinic visits between 1992 and 1999, and summary measures of mean weight, coefficient of variation, average annual weight change, and episodes of loss and gain (cycling) were calculated. Participants were followed from 1999 to 2006 for activities of daily living (ADL) difficulty, incident mobility limitations, and mortality. Results. Higher mean weight, weight variability, and weight cycling increased the risk of new onset of ADL difficulties and mobility limitations. After adjustment for risk factors, the hazard ratio (95% confidence interval) for weight cycling for incident ADL impairment was 1.28 ( 1.12, 1.47), similar to that for several comorbidities in our model, including cancer and diabetes. Lower weight, weight loss, higher variability, and weight cycling were all risk factors for mortality, after adjustment for demographic risk factors, height, self-report health status, and comorbidities. Conclusions. Variations in weight are important indicators of future physical limitations and mortality in the elderly and may reflect difficulties in maintaining homeostasis throughout older ages. Monitoring the weight of an older person for fluctuations or episodes of both loss and gain is an important aspect of geriatric care. Key Words: Weight change--ADL--Mortality. doi: 10.1093/gerona/glp050

Purpose: Over the past two decades, a consensus has formed that increasing physical activity and reducing sedentary behavior in older adults are important for physical and cognitive health. Although there is strong evidence that regular physical activity can prevent or delay the onset of many chronic diseases, a major concern is ensuring that older adults take part in adequate levels of physical activity. Design and Methods: This article describes the amount of physical activity prescribed between 1980 and 2005 to sedentary older adults enrolled in randomized controlled trials (RCTs) using MEDLINE, Health and Psychological Instruments, EBM Reviews, CINAHL, ERIC, PsychInfo, and Social Science Abstracts with the key words 'exercise,' 'physical activity,' and 'older adult.' More than 13,502 research abstracts were reviewed, and 160 RCTs 12 weeks or more in duration with documented outcomes of physical activity were synthesized. Results: The average prescribed dose of aerobic activity provided by interventions for older adults was less than the recommended amount of 150 min or more per week of moderate-intensity physical activity. In interpreting the results of RCTs, there is an insufficient body of evidence on the relationship between physical activity and cognitive health. However, studies indicated that moderate-intensity physical activity had a positive effect on cognitive health. Implications: Given the broad consensus of a dose-response relationship between aerobic activity and a variety of health outcomes, the RCT literature appears to have underestimated the benefit of physical activity for previously sedentary older adults because the prescribed dosages are not consistent with those recommended. Key Words: Physical fitness, Exercise, Health promotion, RCT, Cognitive function

Author(s): Tammy Hoffmann 1,*, Jesse Jansen 2,3, Paul Glasziou 1 Typically, shared decision making, with or without a decision aid, involves patients in discussions about the options for treatment, the [...]

Background. This study applied item response theory (IRT) and computer adaptive testing (CAT) methodologies to develop a prototype function and disability assessment instrument for use m aging research. Herein, we report on the development of the CAT version of the Late-Life Function and Disability Instrument (Late-Life FDI) and evaluate its psychometric properties. Methods. We used confirmatory factor analysis. IRT methods, validation, and computer simulation analyses of data collected from 671 older adults residing in residential care facilities. We compared accuracy, precision, aud sensitivity to change of scores from CAT versions of two Late-Life FDI scales with scores from the fixed-form instrument. Score estimates from the prototype CAT versus the original instrument were compared in a sample of 40 older adults. Results. Distract function and disability domains were identified within the Late-Life FDI item bank and used to construct two prototype CAT scales. Using retrospective data. scores from computer simulations of the prototype CAT scales were highly correlated with scores from the original instrument. The results of computer simulation, accuracy, precision, and sensitivity to change of the CATs closely approximated those of the fixed-form scales, especially for the 10- or 15-item CAT versions. In the prospective study, each CAT was administered in Conclusions. CAT scores of the Late-Life FDI were highly comparable to those obtained from the full length instrument with a small loss in accuracy, precision, and sensitivity to change. Key Words: Outcome assessment (Health Care)--Geriatrics--Rehabilitation.

Purpose: Previous studies investigating adverse outcomes of hospitalized elders have focused on community-dwelling patients. Given the rapid growth of populations living in other settings, such as assisted living facilities, it is important to understand whether these patients are at higher risk of experiencing specific adverse outcomes during hospitalization, so that interventions can be developed to reduce risk. Methods: This is a prospective, observational study of 212 sequential patients admitted during a 1-month period in 2006 to a 38-bed Acute Care for Elders unit in Rochester, New York and followed until discharge. We categorized the patients by residence prior to admission (i.e., community, assisted living, and nursing home). Our outcome categories were: worsening function, delirium, depression, falls, pressure sores, and nursing home admission. Results: After adjusting for multiple characteristics, we found that patients admitted from assisted living facilities were at substantially higher risk than those admitted from the community for functional decline and falls. Patients from nursing homes had a trend toward increased risk for these outcomes, but the trend did not reach statistical significance. More than three fourths of assisted living facility residents were discharged to a nursing home after hospitalization, with a relative risk of 9.41 (p < .001) versus community-dwellers for this outcome. Implications: People who are admitted to the hospital from assisted living facilities are at high risk for falls and functional decline during hospitalization. Assisted living residents are at a particularly high risk of nursing home admission following hospitalization. Targeted preventive programs should be developed with a goal of reducing risk in this vulnerable population. Key Words: Falls, Frailly, Function, Long-term care

We used high-density oligonucleotide arrays to measure transcriptional alterations in the heart and brain (neocortex) of 30-mo-old B6C3[F.sub.1] mice supplemented with [alpha]-tocopherol ([alpha]T) and [gamma]-tocopherol ([gamma]T) since middle age (15 mo). Gene expression profiles were obtained from 5- and 30-mo-old control mice and 30-mo-old mice supplemented with [gamma]T (1 g/kg) or a mixture of [alpha]]T and [gamma]T (500 mg/kg of each tocopherol) from middle age (15 too). In the heart, both tocopherol-supplemented diets were effective in inhibiting the expression of genes previously associated with cardiomyocyte hypertrophy and increased innate immunity. In the brain, induction of genes encoding ribosomal proteins and proteins invorved in ATP biosynthesis was observed with aging and was markedly prevented by the mixture of [alpha]T and [gamma]T supplementation but not by [alpha]T alone. These results demonstrate that middle age-onset dietary supplementation with [alpha]T and [gamma]T can partially prevent age-associated transcriptional changes and that these effects are tissue and tocopherol specific.

Derived from Buddhism, mindfulness is a unique approach for understanding human suffering and happiness that has attracted rapidly growing interest among health care professionals. In this article I describe current thinking about the concept of mindfulness and elaborate on why and how mindfulness-based interventions have potential within the context of geriatric medicine and gerontology. Upon reviewing definitions and models of the concept, I give attention to the unique role that the body plays in cultivating mindfulness and the advantages that this focus has for older adults because they have aging biological systems and may experience chronic disease, pain, and disability. In the final section I discuss why mindfulness may be particularly useful in promoting physical activity among older adults and how physical activity may be used as a vehicle to promote mindfulness. Key Words: Disability, Interventions in aging, Pain, Physical activity

The objective of this study, undertaken in the USA, was to investigate the consequences of autonomy-related companion behaviors on patient decision-making activity during geriatric primary care visits, Videotapes were analyzed to characterize patient and companion decision-making activity and related companion behaviors. These behaviors were coded throughout the visit using an autonomy-based framework that included both autonomy enhancing (i.e. facilitating patient understanding, patient involvement, and doctor understanding) and detracting behaviors, (i.e. controlling the patient and building alliances with the physician). Patients (N = 93) in this cross-sectional sample range in age from 65 to 95 years and are mostly white (n = 73, 79%) and female (n = 67, 72%), Companions are spouses (n = 42, 46%), adult children (n = 33.36%), or other relatives and friends (n = 15, 16%) of patients. Companions are active participants in medical visits and engage in more autonomy enhancing than detracting behaviors. Companions of sicker (compared with less sick) patients were more likely to facilitate patient understanding, p < .05; doctor understanding, p < .01; and patient involvement, p = .06, in care. Patients whose companions facilitated their involvement in the medical visit by asking the patient questions, prompting the patient to talk, and asking for the patient's opinion were more than four times as likely to be active in decision-making as patients whose companions did not assist in this manner (unadjusted OR 3.5. CI 1.4-8.7, p < .01; adjusted OR 4.5, CI 1.6-12.4, p < .01). Companions can play an important role in the visits of geriatric patients by facilitating communication throughout the visit as well as patient activity in decision-making. Keywords: Patient provider communication; Geriatrics; Autonomy; Decision-making; USA

Purpose: We describe the development of a 24-hr curriculum for nonclinical direct care workers in elder care that features active-learning strategies and consumer-directed approaches. Design and Methods: Our curricular design was based on adult education theory and a survey of 70% of the community's service providers. Training was completed by 88 participants, 90% of whom had no prior formal training in elder care. Questionnaires measured participant knowledge, attitudes, and perceived improvements in understanding, empathy, and skills. A subgroup of participants and employers provided additional feedback through focus groups. Results: Participants significantly improved their scores on knowledge and attitude measures. In addition, direct care workers and employers gave the training high marks and identified ways in which the course helped increase workers' competence, empathy toward elders, and self-esteem. Lack of time and funds for training were two major barriers to broader participation. Implications: This active-learning curriculum represents a frugal yet effective way to train current and future direct care workers. Key Words: Direct care workers, Adult learners, Curricula, Elder care, Geriatrics, Nurse aides, Work-force development

The use of interventions claiming to prevent, retard, or reverse aging is proliferating. Some of these interventions can seriously harm older persons and aging baby boomers who consume them. Others that are merely ineffective may divert patients from participating in beneficial regimens and also cause them economic harm. 'Free market regulation' does not seem to weed out risky, ineffective, and fraudulent anti-aging treatments and products. Public health messages, apparently, are having little effect. What more can be done to achieve better protection for older consumers? An analysis of the potential for federal and state action reveals many barriers to effective governmental regulation of anti-aging interventions. In view of dim prospects for stronger public regulation, physicians and other professionals--especially geriatricians and gerontologists--will need to be more aggressive in protecting older consumers. In particular, The Gerontological Society of America and the American Geriatrics Society should undertake a sustained program of specific educational efforts, directed at health professionals and the general public, in which they sort out as best they can the helpful, the harmful, the fraudulent, and the harmless anti-aging practices and products. Key Words: Anti-aging, Geriatrics, Gerontology, Government regulation, Professional regulation

Purpose: This study examined medical students' interest in geriatrics: Are knowledge, positive attitudes, and prior experience with older adults associated with an interest in geriatric medicine? Design and Methods: Entering University of Michigan medical students completed three surveys: the Revised Facts on Aging Quiz, the University of California at Los Angeles Geriatric Attitudes Scale, and the Maxwell-Sullivan Attitudes Scale. The students were also asked questions about their prior experience with older adults and their interest in geriatric medicine. Results: The results indicate that incoming medical students have minimal knowledge about aging, moderately positive attitudes toward older adults, and low interest in geriatric medicine. Having more positive attitudes toward older adults ([beta] = .28) and having cared for older persons prior to medical school ([beta] = .14) were associated with greater interest in geriatric medicine. Implications' These findings suggest that interventions to increase the number of geriatric-oriented physicians should focus on influencing learners' attitudes through experiences in the care of older adults. Key Words: Prior experience, Practice preference

This article discusses the relationship between aging, disease, and genetics. An analysis of blood pressure, glucose tolerance, and geriatric research is presented.

Long before modern medicine thought of old age as a disease, the Greeks and Romans appear to have referred to it as such and their learned men to have worked out theories on similar lines. Aristotle distinguished old age as a 'natural' disease; both he and the Hippocratic school sought to devise a pathology of aging on the basis of the four 'humours.' Both were agreed that a loss of heat lay at the root of the matter, but Aristotle thought this was accompanied by dryness, the Hippocratic school by humidity. In the end it was the Aristotelian position which posterity accepted and embraced into the last century.

This study investigates the effects of genetic and environmental influences on perceived control of health in octogenarian twins. Results indicate that there were modest associations between health related beliefs and measures of well-being such as depression, life satisfaction, and hospitalization.

This article discusses the need for research in geriatric medicine because of the aging population and the need for advocates for the elderly. Special needs of the elderly and health care for older people in Britain is discussed.

Research presented concerns on the prevalence of syndrome X in elderly persons with hypertension and glucose intolerance. Topics addressed include syndrome X, a group of risk factors thought to increase the risk of coronary artery disease, and the impact of beta cell dysfunction on glycemic control.

This article describes a community initiative to improve the care of elders in largely rural areas. An organization development framework guided pilot projects in two communities, with support from a regional geriatric program. Two interdisciplinary teams, representing primary service agencies in the communities, have been trained to serve as local resources in geriatric assessment and intervention. Through the resource teams, the communities are developing a more integrated and coordinated approach to care for the elderly population. The process has yielded valuable insights into the implementation of system change. Key Words: Comprehensive geriatric assessment, Community development, Integrated health system

Background. Functional status at admission has been shown consistently to predict rehabilitation results, but the impact of previous disability has been seldom considered. Methods. A prospective follow-up study of elderly patients admitted to a geriatric rehabilitation unit in Madrid, Spain, was carried out. The study population comprised 135 subjects aged 65 years or older, who were consecutively admitted during a 7-month period. Outcome variables included the Barthel Index (BI) at discharge, the improvement in BI from admission to discharge, the achieved percentage of potential gain, and the efficiency of gains. Previous BI, admission BI, diagnosis, source (hospital/others), mental status, age, and gender were examined as explanatory variables. Results. In multiple regression analysis, previous BI was the only significant independent predictor for all the outcome variables. For each 5-point increase in previous BI, the increase in BI at discharge was 1.7 (p = .007). Corresponding values for the achieved percentage of potential gain and for the efficiency of gains were 0.05 (p = .01) and 0.05 (p = .04), respectively. Except for the achieved percentage of potential gain, admission BI and source of referral were also independent significant predictors of outcome. Conclusions. Previous functional situation of elderly people is important to predict rehabilitation outcome, even after taking into account information on disability at admission. As a consequence, a measure of the achieved percentage of potential gain corrected by the preadmission functional status is proposed, especially in the case of elderly patients.

Several family-based tests of association have been developed using discordant sib pairs (DSPs), those in which one sib is affected with a disease and the other is not. The tests are based on statistics that compare counts of alleles or genotypes or that test for symmetry in tables of genotypes or alleles. A permutation framework was used to assess the significance of the statistics obtained. For late-onset diseases methods that require genotypes on affected persons and their parents may not be suitable. The properties of the DSP-based tests have been compared by computer simulations. An application to Alzheimer's disease and the apolipoprotein E (apoE) polymorphism is illustrative. The discordant-alleles test seems to be the most powerful among those considered.

Background. Selection methods vary greatly in ease and cost-effectiveness. The effects of selection factors associated with subjects' recruitment into studies can introduce bias and seriously limit the generalizability of results. Methods. For an epidemiologic study, we recruited an age-stratified random sample of 1,422 community-dwelling individuals aged 65+ years from the voter registration lists in a rural area of southwestern Pennsylvania. The first 1,366 of these were accrued through intensive recruitment efforts; the last 56 of them responded to a single mailing. To increase sample size for future risk factor analyses, we also recruited by direct advertisement a sample of 259 volunteers from the same area. The three groups were compared on selected baseline characteristics and subsequent mortality. Results. The two subgroups of the random sample were not significantly different on any of the variables we examined. Compared to the random sample, in cross-sectional analyses, volunteers were significantly more likely to be women, more educated, and less likely to have used several health and human services. Volunteers also had higher cognitive test scores and Instrumental Activities of Daily Living (IADL) ability. Over 6-8 years (10,861 person-years) of follow-up, volunteers had significantly lower mortality rates than randomly selected subjects. Conclusions. Health-related studies with populations composed partly or entirely of volunteers should take potential volunteer bias into account when analyzing and interpreting data.

Introduction Visual analogue scales (VAS) are widely used in human clinical and psychological research to assess subjective states. They consist of 10 cm lines, the ends of which are marked [...]

Introduction Despite increasing use in the literature of old age, `frailty' remains an ill-defined term. The components of frailty have not been sufficiently defined to be used to identify a [...]

Background: knowledge of the circumstances and consequences of falls in older adults is important for understanding the aetiology of falls as well as for effective clinical assessment and design of [...]