Search

Background: There is a lack of evidence relating to cognitive‐communication difficulties following traumatic brain injury (TBI) sustained in older adulthood. A prominent area in which post‐TBI cognitive‐communication difficulties manifest is at the level of social communication. An investigation of social communication focusing on comparison of those injured in older and younger adulthood is a practical starting point for age‐related cognitive‐communication outcome comparison. Aims: The overall objective of this study was to explore the social communication of individuals who sustained severe TBI in an early period of older adulthood (50–70 years) compared to younger adulthood (18–40 years), as informed by self and close other reports. Methods & Procedures: This exploratory controlled group comparison study involved analysis of self‐reported and close other reported La Trobe Communication Questionnaire data for 22 adults with severe TBI (11 older at injury; 11 younger at injury) and 22 control participants (11 older; 11 younger). TBI participants were matched for injury variables and participant groups were matched for sex, age and education. Outcomes & Results: The close others of the older and younger adults with TBI reported them to have significantly more frequent difficulty with social communication than the close others of age‐matched control groups. Older adults with TBI reported significantly more frequent difficulty with social communication than uninjured older adults. In contrast, younger adults with TBI and uninjured younger adults reported a similar frequency of difficulty with social communication. No age‐based difference in the frequency of social communication difficulty was evident when comparing the self or close other reports of older and younger adults with TBI. Awareness of social communication difficulty, as indexed by comparing self and close other perceptions, showed a different pattern across the TBI groups. The older TBI group rated themselves as having significantly less frequent social communication difficulty than was perceived by their close others. In contrast, no statistically significant difference was evident between the self and close other social communication ratings of the younger TBI group. Conclusions and Implications: Where possible clinicians need to work with close communication partners to understand the nature and degree of social communication difficulty following severe TBI. This may be especially important when working with people who sustain TBI in older adulthood if future research shows that this population have greater difficulty with self‐awareness of social communication difficulty. What this paper adds: What is already known on the subject: Cognitive‐communication difficulties are a common consequence of traumatic brain injury (TBI) that can have long‐term impact on everyday functioning. These challenges have primarily been investigated in individuals who sustained TBI in younger adulthood. What this paper adds to existing knowledge: Individuals who sustain severe TBI in early older adulthood have a higher frequency of reported social communication difficulty to non‐injured adults of a similar age, albeit they may underreport such difficulties potentially in the context of reduced self‐awareness. What are the potential or actual clinical implications of this work?: Social communication difficulty is an issue for people who sustain severe TBI in early older adulthood. However, a poorer overall social communication outcome in comparison to those injured in younger adulthood should not be assumed. Clinical service delivery for these challenges is most optimally delivered in a collaborative manner with the individual and their close others. Future research is required to investigate the identified trends from this study. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the psychometric properties of the Advance Care Planning Readiness Scale (ACPRS‐C) within the context of community‐dwelling older adults with chronic diseases residing in suburban counties in China. Design: Descriptive, cross‐sectional survey. Method s : The research method employed in this study is characterized as a methodological study. Self‐reported survey data were collected among community‐dwelling older adults with chronic diseases residing in suburban counties in China. Including the following psychometric characteristics, item analysis was performed using the decision value method and Pearson's correlation analysis. Content validity was assessed through expert panel evaluation. The internal consistency of the questionnaire was determined by calculating Cronbach's alpha coefficient and corrected item‐total correlation. Additionally, confirmatory factor analysis (CFA) was utilized to assess the construct validity of the ACPRS‐C. Results: A total of 228 older adults participated in this psychometric study from August to October 2023. The item content validity index ranged from 0.80 to 1.00, while the scale content validity index was 0.945. The scale demonstrated excellent internal consistency (Cronbach's alpha = 0.931), and the correlation between items and total score was satisfactory. The structural validity was deemed robust (CFA model fit: chi‐square/df = 1.121, comparative fit index = 0.992). Conclusion: The ACPRS‐C is a scale with strong psychometric properties to assess the ACP readiness within the context of community‐dwelling older adults with chronic diseases residing in suburban counties in China. Its reliability and validity hold considerable significance for both research and clinical practice. [ABSTRACT FROM AUTHOR]

Purpose This paper describes the effectiveness of cognitive stimulation therapy (CST) on cognition and depressive symptoms in older adults in nursing homes (NHs). Design A randomized controlled trial, carried out from 2012 to 2013, included 56 residents from four NHs, 36 women and 20 men (randomized into experimental and control groups). Eight participants dropped out. Methods Participants of the experimental group underwent 14 CST sessions (7 weeks) in groups of six to eight older adults, and participants of the control group received usual care. The Montreal Cognitive Assessment, the Geriatric Depression Scale-15, and the Barthel Index of activities of daily living (ADLs) were administered at baseline and postintervention. Findings Repeated measures revealed that CST increased cognition ( F = 8.581; p = .005; partial η squared = 0.157; power = 0.82). There were no statistically significant differences in depressive symptoms ( F = 1.090; p = .302). Baseline level of ADLs did not affect the outcomes. Conclusions CST had significantly improved cognition, explaining the 15.7% variability, but there was no statistical evidence of its effectiveness on depressive symptoms. This improvement was not affected by the baseline level of dependence-independence in ADLs. Clinical Relevance CST offers a range of activities, providing general stimulation for thinking, concentration, and memory, usually in a social setting. These results will support implementation of CST in NHs. In addition to the impact on elderly independence and autonomy, CST may also have an economic impact by reducing the direct costs of the impact of elders' cognitive frailty. [ABSTRACT FROM AUTHOR]

Objectives: Previous studies have found an association between socioeconomic status (SES) and depressive symptoms among older adults, however the mechanisms underlying this association remained unclear. This study aimed to examine the mediating role of social support and the moderating role of living arrangement in the association between SES and depressive symptoms. Methods: Data was collected from the 2020 Household Health Interview Survey in Taian city, Shandong Province, China. A total of 3896 older adults aged 60 and above were included in this study. Depressive symptoms was measured by the Patient health Questionnaire‐9 (PHQ‐9), Social support by the Multidimensional Scale of Perceived Social Support (MSPSS), and other variables by related demographic scales. The moderated mediation model was examined using HAYES PROCESS 3.5. Results: SES negatively predicted depressive symptoms among older adults, and social support could mediate this association. Living arrangement played a moderating role in the relationship between social support and depressive symptoms (the second half of the mediating effect), and the effect was stronger among older adults who lived alone. Conclusions: Social support partially mediated the relationship between SES and depressive symptoms among older adults, and living alone strengthened the effect of social support on depressive symptoms. Interventions that address older adults' social support and living arrangement may ameliorate depressive symptoms among older adults. Key points: Socioeconomic status was negatively associated with depressive symptoms among Chinese older adults.Social support partially mediated the association between socioeconomic status and depressive symptoms.Living arrangement moderated the indirect effect of social support. Preventing depressive symptoms should be sensitive to differences in living arrangement. [ABSTRACT FROM AUTHOR]

Background: Outcomes of transvenous lead extraction (TLE) are well reported in the general population, However, data on safety, efficacy of TLE in octogenarians with a long lead dwell time, using powered extraction tools are limited. The aim of this multicenter study was to evaluate the safety, effectiveness of TLE in octogenarians using the bidirectional rotational mechanical sheaths and mid‐term outcome after TLE. Methods: The study population comprised 83 patients (78.3% male; mean age 85 ± 3 years; [range 80–94 years]) with 181 target leads. All the leads (mean implant duration 112 ± 77 months [range 12–377]) were extracted exclusively using the Evolution RL sheaths (Cook Medical, Bloomington, IN, USA). Results: The main indication for TLE was infection in 84.3% of cases. Complete procedural success rate, clinical success rate, per lead were 93.9% and 98.3%, respectively. Failure of lead extraction was seen in 1.7% of leads. The additional use of a snare was required in 8.4% of patients. Major complications occurred in one patient (1.2%). Thirty‐day mortality after TLE was 6%. During a mean time follow‐up of 22 ± 21 months, 24 patients (29%) died. No procedure‐related mortality occurred. Predictors of mortality included ischemic cardiomyopathy (HR 4.35; 95% CI 1.87–10.13; p =.001), left ventricularejection fraction ≤35% (HR 7.89; 95% CI 3.20–19.48; p <.001), and TLE for systemic infection (HR 4.24; 95% CI 1.69–10.66; p =.002). Conclusions: At experienced centers bidirectional rotational mechanical sheaths combined with different mechanical tools and femoral approach allowreasonable success and safety in octogenarian with long lead dwell time. Patient's age should not influence the decision to extract or not the leads, although the 30‐day and mid‐term mortality are significant, especially in the present of specific comorbidities. [ABSTRACT FROM AUTHOR]

Aims: Aim of the current study was to describe the prevalence, incidence, and severity of diabetes mellitus type 2 (T2D) in a cohort of older men and women aged 60 years and above over the course of on average 7 years, since longitudinal data on this topic are scarce for this age group in Germany. Methods: Baseline data of 1671 participants of the Berlin Aging Study II (BASE‐II; 68.8 ± 3.7 years) and follow‐up data assessed 7.4 ± 1.5 years later were analysed. The BASE‐II is an exploratory, observational study on cross‐sectional and longitudinal data of an older population. T2D was diagnosed based on self‐report, antidiabetic medication use and laboratory parameters. T2D severity was determined by the diabetes complications severity index (DCSI). Prognostic capacity of laboratory parameters was evaluated. Results: The proportion of participants with T2D increased from 12.9% (37.3% women) at baseline to 17.1% (41.1% women) with 74 incident cases and 22.2% not being aware of the disease at follow‐up. The incidence rate is 10.7 new T2D diagnoses per 1000 person‐years. More than half of the 41 newly identified incident T2D cases were diagnosed solely by the 2 h‐plasma glucose test (OGTT) and diagnosis based on OGTT as the only criterion among incident cases was found more frequently in women (p = 0.028). T2D severity expressed by the DCSI significantly increased from baseline to follow‐up (mean DCSI 1.1 ± 1.2 vs. 2.0 ± 1.8; range 0–5 vs. 0–6). Cardiovascular complications had the highest impact (43.2% at baseline and 67.6% at follow‐up). Conclusions: A comprehensive picture of T2D with respect to prevalence, incidence, and severity in older people of the Berlin Aging Study II is provided. [ABSTRACT FROM AUTHOR]

Background: There is a lack of real‐life data regarding the frequency and predictive factors of hypoglycemia in older patients with type 2 diabetes (T2D). This study aimed to determine the frequency and predictors of hypoglycemia in older patients with insulin‐treated T2D. Methods: This prospective multicenter study included 155 insulin‐treated T2D patients aged 75 years and older with ≥2 self‐monitoring of blood glucose (SMBG) daily controls. Participants underwent a geriatric and diabetic assessment and received ambulatory blinded continuous glucose monitoring (CGM) for 28 consecutive days with FreeStyle Libre Pro® sensor. Study population (n = 141) has >70% CGM active time. Multivariable logistic regressions were used to identify factors associated with SMBG confirmed hypoglycemia (≥70 mg/dL) and with nocturnal level 2 time below range (glucose concentration <54 mg/dL during ≥15 consecutive min between 0.00 and 6.00 am). Results: The mean age of the 141 analyzed patients was 81.5 ± 5.3 years and 56.7% were male. The mean baseline HbA1c was 7.9% ± 1.0%. After geriatric assessment, 102 participants (72.3%) were considered as complex and 39 (27.7%) as healthy. The primary endpoint (confirmed SMBG <70 mg/dL) occurred in 37.6% patients. In multivariable analysis, the risk of SMBG‐confirmed hypoglycemia was positively associated with a longer duration of diabetes (OR (+1 year) =1.04, (1.00–1.08), p = 0.04) and glycemic variability assessed by CGM (CV %) (OR (+1%) = 1.12, [1.05–1.19], p = <0.001). Nighty‐two patients (65.2%) experienced nocturnal time in hypoglycemia (i.e., <54 mg/dL during ≥15 consecutive min between midnight and 6 a.m.). In multivariable analyses, cognitive impairment (OR: 9.31 [2.59–33.4]), heart failure (OR: 4.81 [1;48–15.6]), and depressive disorder (OR: 0.19 [0.06–0.53]) were associated with nocturnal time in hypoglycemia. Conclusion: Nocturnal hypoglycemia is very common and largely underdiagnosed in older patients with insulin‐treated T2D. CGM is a promising tool to better identify hypoglycemia and adapt diabetes management in this population. [ABSTRACT FROM AUTHOR]

Introduction: Supported (assisted) healthcare decision‐making (ADM) focuses attention on how people with disabilities, including cognitive impairments, can be best supported to make decisions about their health and social care on an equitable basis with others. Meaningful implementation of legal frameworks for ADM challenges long‐held presumptions about who has access to valued decision‐making resources, influence and power within a particular socio‐cultural setting. This study aims to explore the relational power dynamics around ADM with older people in acute care settings. Methods: This study adopts a critical hermeneutic approach to qualitatively explore the lived experience of ADM from the perspectives of Health and Social Care Professionals (N = 26). This is supported by an exploration of the experiences of older people (N = 4), older people with a diagnosis of dementia (N = 4) and family carers (N = 5). Results: We present three themes of data analysis that represent three spaces where the relational aspects of power in ADM are manifested. The first space, centralising decision‐making power within multidisciplinary teams identified the privileging of physicians in traditional hierarchical leadership models that may lead to the implicit exclusion of family carers and some Health and Social Care Professionals in the ADM process. Privileging cognitive and communication competence identified a tendency to attribute decision‐making autonomy to those with cognitive and communication competency. The final space, balancing the duty of care and individual autonomy, recognises acute care settings as typically risk‐averse cultures that limit autonomy for decisions that carry risk, especially for those with cognitive impairment. Conclusion: Findings indicate the need to address cultural sources of power operating through social norms premised on ageist and ableist ideologies. It is necessary to challenge institutional barriers to meaningful ADM including positional power that is associated with hierarchies of influence and protectionism. Finally, meaningful ADM requires resistance to the disempowerment created by structural, economic and social circumstances which limit choices for decision‐making. Patient or Public Contribution: A public and patient involvement panel of older people were consulted in the development of the grant application (HRB: APA‐2016‐1878). Representatives from Alzheimer's Society Ireland and Family Carers Ireland were steering committee members guiding design and strategy. [ABSTRACT FROM AUTHOR]

Dry skin and pressure injuries in older persons have become global health care problems. This was a multicentre, prospective cross‐sectional study in 44 hospitals and 8 long term care institutions from 20 provinces, autonomous regions and municipalities in China and aimed to explore the relationship between the two skin problems in older patients. We mainly found 11 602 cases with dry skin and 1076 cases with pressure injuries in a total of 33 769 valid participants. The overall prevalence of dry skin and pressure injuries was 34.4% (95% confidence interval [CI] 33.9–34.9) and 3.1% (95% CI 2.9–3.3). Stage 2+ pressure injuries were the most (32.9%), followed by stage 1 (32.4%). The patients with dry skin had more pressure injuries than ones without dry skin (50.0% vs 33.9%). The patients with very severe and severe dry skin had more pressure injury risk (OR 2.22 and 1.90) and more stage 2+ pressure injury risk (OR 2.83 and 1.63). Other nine predictors associated with overall pressure injuries and stage 2+ pressure injuries. The area under receiver operating characteristic (ROC) curve of the predictive models of overall pressure injuries and stage 2+ pressure injuries were 0.89 (95% CI 0.88–0.90) and 0.91 (95% CI 0.90–0.92), respectively. [ABSTRACT FROM AUTHOR]

Background: Human papillomavirus (HPV) self‐sampling has shown to be acceptable and feasible across cultures and effective in reaching women who do not participate in regular cervical cancer screening. However, most of these studies have included younger women. There is a lack of knowledge of how older women reason about HPV self‐sampling. Objective: The aim of this study was to describe how women (>60 years old) experience the offering of self‐sampling of HPV, compared to having a sample collected by a healthcare professional. Design and Participants: The study had a qualitative explorative design. Four focus group discussions were conducted with women 60–69 years old (n = 22). Data were analysed using principles of interpretive description. Results: Five themes were identified: self‐sampling—convenient and without pain, lack of knowledge, worries related to HPV self‐sampling, need for information and taking a societal perspective. Conclusion: Women aged >60 years found that HPV self‐sampling was convenient and easy to perform. Further, they stressed the importance of being able to remain in the screening programme in advanced age and that self‐sampling could be a possible solution. This study also revealed a lack of knowledge among women in this age group regarding HPV infection, how the disease is transmitted and its relation to cervical cancer. Public Contribution: Women who had performed HPV self‐sampling participated in the focus group discussion. [ABSTRACT FROM AUTHOR]

Objectives: The present study attempted to adapt and validate the Turkish version of the Camberwell Assessment of Need for the Elderly (CANE‐T). Methods: The data of this methodological study were collected from 610 older people who volunteered between September 10 and December 15, 2019. The SPSS 20 and LISREL software were used to perform reliability (internal reliability, parallel forms reliability/equivalent forms, and test–retest reliability) and validity (exploratory factor analysis and confirmatory factor analysis) analyses for the CANE‐T. Results: The Kaiser–Meyer–Olkin test revealed the sampling adequacy to be 0.72. After deleting four items (psychological distress, behavior, alcohol, and money) with a factor loading below 0.30 from the dataset, it was found that the scores on the scale explained 55% of the total variance. Besides, the confirmatory factor analysis revealed the following fit indices: p < 0.05, root mean square error of approximation (RMSEA) = 0.08, root mean square residuals (RMR) = 0.07, standardized root mean square residual (SRMR) = 0.07, goodness‐of‐fit index (GFI) = 0.88, and adjusted goodness‐of‐fit index (AGFI) = 0.84. Concerning reliability, Cronbach's α values were calculated to be 0.78 for 'Physical Needs', 0.74 for 'Psychophysiological Needs', 0.75 for 'Security Needs', 0.75 for 'Social Needs', and 0.75 for 'Health Needs'. Conclusions: Overall, it was concluded that the 20‐item five‐factor CANE‐T is a valid and reliable tool to measure the needs of older adults in the Turkish context. [ABSTRACT FROM AUTHOR]

Background: The relevance of person‐centred care as an optimising approach to the quality of care provided to older adults has sparked the development of important instruments that measure this approach at residential care facilities and requires validation for the Portuguese population. Objectives: This study aims to adapt and validate the Person‐centered Care Assessment Tool (P‐CAT) to the Portuguese population. Methods: The P‐CAT assesses the level of person‐centred care provided by residential care facilities, according to staff. The process of adapting the P‐CAT to the Portuguese population includes its translation, backtranslation and a pilot study. To recruit participants for the validation study, we contacted the Portuguese residential care facilities with emails provided in the official registries, and the study was also divulged on social media. Results: The study had the participation of 573 staff members. The mean score of P‐CAT was 50.76 (SD = 7.65). The exploratory factor analysis showed three dimensions: the extent of care personalisation, the amount of organisational support and the degree of environmental accessibility. The results show good internal consistency for the total scale (α = 0.809) and good temporal stability in the test–retest assessed by intraclass correlation coefficient (0.893). Conclusions: This version of the P‐CAT for the Portuguese population has shown adequate psychometric properties and contributes to the study of care provided at residential care facilities in Portugal through self‐reporting from staff. Implications for practice: The availability of this instrument is useful for professional practice and research purposes and supports technical and scientific advancements that are necessary for the evolution of care frameworks. [ABSTRACT FROM AUTHOR]

Background: eHealth literacy can facilitate the uptake of benefits of health for older persons. The aim of this study was to examine the association of eHealth literacy with depression, health‐related quality of life (HRQoL) among older persons. Methods: A survey of 6183 participants (aged 60 years and above) from 17 communities was conducted in June 2019. Participants answered questions related to basic information, eHealth literacy scale (eHEALS), geriatric depression scale and the short‐form health survey (SF‐36). Mediation model and a linear regression analysis were performed to explore the association between the eHEALS scores and related factors. Results: The mean score of eHEALS was 21.17 (SD = 8.25). eHEALS was significant higher in men, those with living in the city, those with high educated and stable income and those with living with children, as compared to their counterparts, respectively. Moreover, chronic diseases and depressive symptoms negatively associated with eHEALS, while actively obtaining health information and physical activity positively influenced eHEALS. Furthermore, depressive symptoms had direct and indirect effects on HRQoL, as mediated by eHealth literacy. Conclusions: The eHEALS acts as a mediator between depressive symptoms and HRQoL. As eHealth literacy is a protector for older people, efforts to improve the older persons' eHealth literacy could help to maintain health status. Therefore, healthcare providers formulate effective programs to improve eHealth literacy for older persons, which can bring benefits for health ageing. [ABSTRACT FROM AUTHOR]

Background: Increasing evidence links obstructive sleep apnea (OSA) to cognitive decline. Autonomic dysfunction assessed by heart rate variability is a promising early biomarker of cognitive impairment in populations without major neurocognitive disorder (MND). We aimed to determine whether nocturnal pulse rate variability (PRV) extracted from oximetry signal and OSA severity could predict MND onset among older OSA patients. Methods: This study relied on data collected within the multicenter longitudinal Pays de la Loire Sleep Cohort, linked to health administrative data to identify new‐onset MND. We included patients ≥60 years with newly diagnosed OSA, and no history of MND or atrial fibrillation. Cox proportional‐hazards models were used to evaluate the association of MND with indices of PRV and OSA severity generated from sleep recordings. Results: After a median follow‐up of 6.8 [4.7–9.4] years, 70 of 3283 patients (2.1%) had been diagnosed with MND. In multivariable Cox models, MND incidence was associated with age (p < 0.0001), depression (p = 0.013), and PRV assessed by the root mean square of the successive normal‐to‐normal (NN) beat interval differences (RMSSD; p = 0.008) and standard deviation of NN beat intervals (SDNN; p = 0.02). Patients with the highest quartile of RMSSD had a 2.3‐fold [95%CI 1.11–4.92] higher risk of being diagnosed with MND. Indices of OSA and nocturnal hypoxia severity were not associated with MND. Conclusions: Within a large clinic‐based cohort of older patients with OSA, we found an association between oximetry‐based indices of PRV and the onset of MND. Nocturnal oximetry‐derived PRV indices could allow the early identification of OSA patients at higher risk of MND. See related Editorial by Miner et al. in this issue. [ABSTRACT FROM AUTHOR]

Objective: To describe general practitioners' (GP) perspectives of older patients presenting to the ED, reasons they would refer to the ED and how they utilise community services to help manage older adults. Methods: A descriptive study conducted in the Sutherland Shire, Sydney. Case files were compiled using electronic medical records for 50 patients over 70 years old who presented to the ED of The Sutherland Hospital, a teaching hospital in Sydney. Surveys were provided to 10 GPs who each analysed five patients' presentations. Primary outcome was whether the GP would refer the patient to the ED. Secondary outcomes included reasons GPs referred to the ED, and their referral patterns of local community services. Results: Of the 50 patients who presented to the ED, GPs would have referred 21 (42%) to the ED and managed 29 (58%) in the community. The most common reasons GPs would have referred to the ED was that they were 'too unwell', or needed 'urgent imaging or blood tests'. In 26 (52%) of the patients, GPs were aware of a local service that could help manage the patient and would have made that referral in 21 (42%) patients. Rapid Access Diagnosis and Intervention Unit and Geriatric Flying Squad are two of the local aged care services GPs would have referred to most commonly. Conclusion: GPs reported they would have been able to manage a significant proportion of older adults who presented to the ED in the community without referring to the ED. Severe and acute illness requiring urgent evaluation and intervention was the main reason GPs would refer to the ED. Older adults are increasingly presenting to the ED and contribute to the ED overcrowding. GPs were surveyed on how they would manage older adults who presented to the ED and if they would refer them to the ED. GPs reported that they would manage a significant proportion of older adults who presented to the ED in the community without referring to the ED. [ABSTRACT FROM AUTHOR]

Background: In managing older adults with atrial fibrillation (AF), their symptomatology impacts their well‐being and may inform treatment decision‐making. We examined AF symptom perception, its impact on quality of life (QoL), and its relation to treatment strategies in older adults with AF. Methods: Data were obtained from older adults with AF enrolled in a multicenter study conducted at clinic sites in Massachusetts and Georgia between 2016 and 2018. Participants were stratified into three age groups: 65–74 (youngest–old), 75–84 (middle–old), and ≥85 (oldest). Perception of AF symptoms was assessed by participant self‐report during their clinic visit and at study enrollment by the Atrial Fibrillation Effect on Quality‐of‐Life Questionnaire which assessed cardiac‐specific and non‐specific, non‐cardiac AF symptoms and their impact on QoL. Treatment strategies (rate or rhythm control) utilized were ascertained from electronic medical records. Results: Among the 1184 participants (mean age 75 years, 48% women, 86% Non‐Hispanic White), 51% were aged 65–74 years, 36% were 75–84 years, and 13% were ≥ 85 years. The most commonly reported AF symptoms were non‐specific, non‐cardiac symptoms (fatigue, dyspnea, lightheadedness) with similar prevalence and impact on QoL in all age groups. Cardiac‐specific AF symptoms (palpitations, irregular heartbeat, pause in heart activity) were less prevalent, but most commonly reported by the youngest participants (65–74 years), who endorsed considerable impact of these symptoms on their QoL. Overall, those who reported experiencing any AF symptoms during their clinic visit were more likely to have received rhythm compared with rate control (OR: 1.56; 95% CI: 1.18–2.04) with similar findings for all age groups except those aged ≥85 years. Conclusions: Our findings suggest a high prevalence of non‐specific, non‐cardiac symptoms among older adults with AF and that cardiac‐specific AF symptoms may exert considerable impact on their QoL. The presence of any AF symptoms may drive more rhythm control in a majority of older adults. See related Editorial by Blachman et al. in this issue. [ABSTRACT FROM AUTHOR]

Falls have a considerable impact on the functional prognosis of older adults. The main focus of this multicenter, retrospective, observational study was to examine the prevalence of falls in Spanish people aged 65−80 years still living at home. The secondary aims included examining the overall sociodemographic and clinical variables associated with a history of falls and then stratifying these findings by sex. We also aimed to determine the differences between sexes with regard to the history and consequences of falls and to evaluate associations between fall history and functional performance tests. The 747 older adults had all participated in the otago exercise program, which is a progressive home program of strength, balance, and endurance exercises. They were recruited by nurses in 21 primary care centers in 10 Spanish provinces between September 2017 to December 2018. The participants' mean age was 72.2 (SD: 4.3) years, and 67% were women. We recorded sociodemographic and clinical variables, functional performance test results, and any falls and/or injuries in the last 12 months. We found that 32% had fallen, 36% of those had fallen more than once, and 48% had sustained injuries when they fell. The bivariate analysis showed that women had more than twice the odds of falling than men and that living alone and being obese or overweight increased the odds of a fall, although living alone was not associated with falls in the multivariable analysis. Our results could guide the development of risk‐specific fall prevention programs to prevent disabilities in older people. [ABSTRACT FROM AUTHOR]

Background: Older adults represent a disproportionate share of severe COVID‐19 presentations and fatalities, but we have limited understanding of the differences in presentation by age and the association between less typical emergency department (ED) presentations and clinical outcomes. Methods: This retrospective cohort study used the RECOVER Network registry, a research collaboration of 86 EDs in 27 U.S. states. We focused on encounters with a positive nasopharyngeal swab for SARS‐CoV‐2, and described their demographics, clinical presentation, and outcomes. Sequential multivariable logistic regressions examined the strength of association between age cohort and outcomes. Results: Of 4536 encounters, median patient age was 55 years, 49% were women, and 34% were non‐Hispanic Black persons. Cough was the most common presenting complaint across age groups (18–64, 65–74, and 75+): 71%, 67%, and 59%, respectively (p < 0.001). Neurological symptoms, particularly altered mental status, were more common in older adults (2%, 11%, 26%; p < 0.001). Patients 75+ had the greatest odds of ED index visit admission of all age groups (adjusted odds ratio [aOR] 6.66; 95% CI 5.23–8.56), 30‐day hospitalization (aOR 7.44; 95% CI 5.63–9.99), and severe COVID‐19 (aOR 4.26; 95% CI 3.45–5.27). Compared to individuals with alternate presentations and adjusting for age, patients with typical symptoms (fever, cough and/or shortness of breath) had similar odds of ED index visit admission (aOR 1.01; 95% CI 0.81–1.24), potentially higher odds of 30‐day hospitalization (aOR 1.23; 95% CI 1.00–1.53), and greater odds of severe COVID‐19 (aOR 1.46; 95% CI 1.12–1.90). Conclusions: Older patients with COVID‐19 are more likely to have presentations without the most common symptoms. However, alternate presentations of COVID‐19 in older ED patients are not associated with greater odds of mechanical ventilation and/or death. Our data highlights the importance of a liberal COVID‐19 testing strategy among older ED patients to facilitate accurate diagnoses and timely treatment and prophylaxis. [ABSTRACT FROM AUTHOR]

E‐health technology has been widely implemented in healthcare systems and has many benefits. However, available studies that focus on the acceptance and adoption of e‐health technology, particularly among older people in primary care centers, are still limited. A qualitative approach was adopted in this study to explore the acceptability and adoption of health technology among older people who use primary health care. Semistructured interviews were conducted with 11 older people to gain in‐depth insight into their perspectives on health technology. An inductive thematic analysis was conducted to gain insight from older people. Three main themes emerged: (1) "demand of care" refers a situation where participants realized that they had a health problem, sought ways to solve the health problem, and expected to be cared and monitored; (2) "resistance and openness" represent technology acceptance by older people; and (3) "preference for home health monitoring": We found older people preferred home health monitoring in terms of comfort and ease of use. The study has provided important new knowledge in relation to acceptance and preference for health technology that currently exists, particularly among older people in Indonesia. [ABSTRACT FROM AUTHOR]

Background: There is incomplete information regarding evolution of antibody titers against SARS‐CoV‐2 after a two‐dose strategy vaccination with BNT162b2 in older adults in long‐term care facilities (LTCFs) with frailty, disability, or cognitive impairment. We aimed to determine IgG antibody titer loss in older adults in LTCFs. Methods: This is a multicenter longitudinal cohort study including 127 residents (90 females and 37 males) with a mean age of 82.7 years (range 65–99) with different frailty and disability profiles in two LTCFs in Albacete, Spain. Residents received two doses of BNT162b2 as per label, and antibody levels were determined 1 and 6 months after the second dose. Age, sex, previous history of coronavirus disease 2019 (COVID‐19), comorbidity (Charlson Index), performance in activities of daily living (Barthel Index), frailty (FRAIL instrument), and cognitive status were assessed. Results: The mean antibody titers 1 and 6 months after the second vaccine dose were 32,145 AU/ml (SD 41,206) and 6182 AU/ml (SD 13,316), respectively. Across all participants, the median antibody titer loss measured 77.6% (interquartile range [IQR] 23.8%). Notably, the decline of titers in individuals with pre‐vaccination COVID‐19 infection was significantly lower than in those without a history of SARS‐CoV‐2 infection (72.2% vs. 85.3%; p < 0.001). The median titer decrease per follow‐up day was 0.47% (IQR 0.14%) and only pre‐vaccination COVID‐19 was associated with lower rate of antibody decline at 6 months (hazard ratio 0.17; 95% confidence interval 0.07–0.41; p < 0.001). Frailty, disability, older age, cognitive impairment, or comorbidity were not associated with the extent of antibody loss. Conclusions: Older adults in LTCFs experience a rapid loss of antibodies over the first 6 months after the second dose of BNT162b2 vaccine. Only pre‐vaccination COVID‐19 is associated with a slower rate of antibody decrease. Our data support immunization with a third dose in this vulnerable, high‐risk population. [ABSTRACT FROM AUTHOR]

Background: Pharmacist‐led transitions of care (TOC) interventions have been described as some of the most promising interventions to reduce medication‐related harm (MRH) in older adults. This study analyzed the feasibility of pharmacist‐led TOC interventions between hospitals, multidisciplinary primary care clinics (PCC), and community pharmacies. Methods: Adults aged 65 years and older at risk of MRH in three regions of Quebec, Canada, with contrasting contexts of care based on university affiliation were recruited in this multicenter, single arm, and prospective intervention cohort. The hospital pharmacist developed the pharmaceutical care plan in collaboration with the hospital physician and transferred this plan with the hospitalization summary, at hospital discharge, to the PCC family physician and to the community and PCC pharmacists. A consultation with the community pharmacist was scheduled within seven days of hospital discharge and with the PCC pharmacist when appropriate. Feasibility outcomes included the time to complete the interventions and their location. Results: The 123 eligible patients had a mean age of 78.5 years, and 63.4% were females. The most frequent inclusion criterion was 10 medications or more, including one high‐risk medication for 90 patients (73%). Recruitment in one region was stopped after three months due to unsuccessful recruitment of key PCC. The hospital pharmacist interventions took a median of 165 min. The first consultations of the PCC and community pharmacists took a median of 15 and 50 min. Among the 96 patients with a post‐discharge pharmacist follow‐up, 23 (24.0%) had a consultation with a PCC pharmacist, with 65.2% of the consultations conducted at the PCC. The community pharmacists conducted a consultation with 88 patients (93%), with more than 70% of consultations conducted by phone. Conclusion: Our study showed the feasibility of pharmacist‐led TOC interventions between hospitals, PCC, and community pharmacies and detailed the novel role that PCC pharmacists played in optimizing TOC interventions. [ABSTRACT FROM AUTHOR]

Objectives: To assess the impact of a Consumer Directed Care (CDC) model of service delivery on the quality of life of older people receiving home care packages. Methods: Quality of life was assessed using validated instruments. The relationship between quality of life and length of time exposed to CDC was examined using descriptive statistical and multivariate regression analyses. Results: Consenting older adults (n = 150) in receipt of home care packages participated. Quality of life and capability scores were higher for older people in receipt of a CDC model of service delivery for <12 months compared to those receiving the model of care for longer, although this difference was not statistically significant. However, older people with more recent exposure to CDC indicated a stronger capability to do things that made them feel valued. Conclusion: Extended longitudinal follow‐up is needed to facilitate a detailed examination of the relationship between the evolution of CDC and its longer‐term influences on quality of life. [ABSTRACT FROM AUTHOR]

Background: Sensory impairments have been associated with dementia in older adults. However, the contribution of different impairments and how they interact in the development of dementia is not clear. We examined the independent and interaction effects of hearing impairment (HI) and visual impairment (VI) on incident dementia. Design: Multi‐centric population‐based prospective cohort study. Setting: Data were taken from the AgeDifferent.de platform, pooling participants aged 75 and older from the German LEILA75+ and AgeCoDe/AgeQualiDe cohorts. Participants: Older adults (N = 3497) with mean age 79.8 years, 67.2% female. Measurements: Standardized interviews and questionnaires were used to assess self‐reported HI and VI at baseline and all‐cause dementia in 9 follow‐ups, spanning over 20 years. Methods: Competing risk regression models were conducted to test the main and interaction effects of HI and VI on dementia incidence, adjusting for established risk factors of dementia and accumulated mortality. Results: HI and VI at baseline were reported by 30.3% and 16.6% of individuals, respectively. Adjusting for baseline information on sociodemographics, substance use, cognitive functioning and morbidity, and controlling for accumulated mortality risk, HI (sHR 1.16, 95% CI 1.04–1.30, p = 0.011) but not VI (sHR 1.07, 95% CI 0.90–1.28, p = 0.462) was significantly associated with incident dementia. There was no interaction between HI and VI (sHR 1.09, 95% CI 0.81–1.46, p = 0.567). Conclusions: Hearing impairment is associated with an increased incidence of all‐cause dementia in older adults. There is no excess risk or risk compensation through the additional presence or absence of visual impairment. Early prevention measures for hearing impairment might help to reduce the long‐term risk of dementia. [ABSTRACT FROM AUTHOR]

Aim: Current literature regarding the prevalence and consequences of poor dietary intake and risk of malnutrition in older adults is limited to wealthier regions including the United States, Europe and Australasia. With a rapidly ageing population in India, this prospective observational study aimed to evaluate hospital food intake and malnutrition risk and their impact on hospital length of stay, readmission rates and in‐hospital mortality of older adults in Indian hospitals. Methods: Data collected during nutritionDay worldwide audits (2014‐2016), in five urban, private hospitals in India included baseline demographic and clinical data on patients aged ≥60 years. Proportion of food consumed at one main meal was recorded and data on length of stay, readmissions and in‐hospital mortality were collected 30 days post‐baseline. Results: A total of 262 participants (mean age: 69 ± 8 years; 65% males) were recruited. Mapped malnutrition risk (mapped Malnutrition Screening Tool [mMST] score ≥ 2) on admission was 31% and increased to 44% during the course of hospitalisation. Over one quarter of participants consumed ≤50% of their meal (28%). Over half the participants were found to be eating poorly (59%) and those identified as at risk of malnutrition were not offered additional nutrition support. The median LOS was 8 days (range: 1‐92), 30‐day readmission rates were 7% and in‐hospital mortality was 0.4%. Malnutrition risk and poor food intake were not associated with health‐related outcomes. Conclusion: Older adults in Indian acute care hospitals have a noticeable prevalence of malnutrition risk and poor food intake. There is an opportunity for future research to focus on identifying and managing nutritional issues. [ABSTRACT FROM AUTHOR]

Rational: Life satisfaction is strongly associated with participation in everyday life activities. Yet, older adults with cognitive impairments have been found to experience difficulties in accessing and engaging in more complex everyday activities, especially, if these involve everyday technology. Considering the rapidly advancing technological landscape, this may substantially affect individuals' life satisfaction and their participation in meaningful community‐based and home‐based activities. Objectives: This study aimed to explore the associations between life satisfaction, ability to use everyday technology and number of relevant everyday technologies used in older adults (n = 117) with and without mild cognitive impairment (MCI) and Alzheimer's disease (AD). It also aimed to understand the role of depression, activity involvement and diagnosis regarding life satisfaction in this sample. Method: Descriptive statistics, Mann–Whitney U tests and t‐tests were applied to compare those satisfied and those dissatisfied with life regarding ability to use everyday technology and number of relevant everyday technologies used. Findings: The number of relevant community‐based everyday technologies currently not used was significantly associated with being dissatisfied with life (p < 0.05). Further, depression and withdrawal from activities and interests significantly differed across life satisfaction groups, while no group differences were found regarding overall number of everyday technologies in use and ability to use everyday technology. Conclusion: Attention from healthcare professionals and researchers to early withdrawal from activities that rely on community‐based everyday technologies is called for, especially in older adults with depression. Preventing everyday technology‐related barriers in community life may increase life satisfaction. [ABSTRACT FROM AUTHOR]

Background/Objectives: Non‐steroidal anti‐inflammatory drugs (NSAIDs) can cause kidney injury, especially in older adults. However, previously reported associations between NSAID use and kidney health outcomes are inconsistent and limited by reliance on serum creatinine‐based GFR estimates. This analysis investigated the association of NSAID use with kidney damage in older adults using multiple kidney health measures. Design: Cross‐sectional and longitudinal analyses. Setting: Multicenter, community‐based cohort. Participants: Two thousand nine hundred and ninty nine older adults in the Health ABC Study. A subcohort (n = 500) was randomly selected for additional biomarker measurements. Exposure: Prescription and over‐the‐counter NSAID use ascertained by self‐report. Measurements: Baseline estimated glomerular filtration rate (eGFR) by cystatin C (cysC), urine albumin‐to‐creatinine ratio (ACR), kidney injury molecule‐1 (KIM‐1), and interleukin‐18 (IL‐18) were measured in 2,999 participants; alpha‐1 microglobulin (α1m), neutrophil gelatinase‐associated lipocalin (NGAL), propeptide type III procollagen (PIIINP), and uromodulin (UMOD) were measured in 500 participants. GFR was estimated three times over 10 years and expressed as percent change per year. Results: Participants had a mean age of 74 years, 51% were female, and 41% African‐American. No eGFR differences were detected between NSAID users (n = 655) and non‐users (n = 2,344) at baseline (72 ml/min/1.73 m2 in both groups). Compared to non‐users, NSAID users had lower adjusted odds of having ACR greater than 30 mg/g (0.67; 95% confidence interval (CI) = 0.51–0.89) and lower mean urine IL‐18 concentration at baseline (−11%; 95% CI = −4% to −18%), but similar mean KIM‐1 (5%; 95% CI = −5% to 14%). No significant differences in baseline concentrations of the remaining urine biomarkers were detected. NSAID users and non‐users did not differ significantly in the rate of eGFR decline (−2.2% vs ‐2.3% per year). Conclusion: Self‐reported NSAID use was not associated with kidney dysfunction or injury based on multiple measures, raising the possibility of NSAID use without kidney harm in ambulatory older adults. More research is needed to define safe patterns of NSAID consumption. [ABSTRACT FROM AUTHOR]

Background: Lung ultrasound experts claim that 'B line' artefacts herald pulmonary oedema, but links between early recognition and improved outcome are unconfirmed, particularly for non‐expert clinicians. Objective: Assess individual and system impacts of early, non‐expert lung ultrasound (LUS) in breathless older patients. Methods: Prospective single‐blinded randomised controlled trial of point of care LUS by non‐expert clinicians, augmenting ED assessment of patients over 60 years, presenting with dyspnoea. After brief training, clinicians at three hospitals used computer‐generated block randomisation envelopes to allocate a convenience sample of consenting presenters to conventional or LUS‐augmented management. ED provisional diagnosis was compared to a post‐discharge chart audit diagnosis, blinded to ultrasound findings. Secondary outcomes were the length of stay in ED and hospital, costs and discharge destinations. Results: From three sites, 224 controls were compared with 218 interventions. LUS improved diagnostic accuracy, with a small effect size in favour of LUS (risk difference: 6.5%, 95% CI 0.9–12) and a number needed to scan of 16 (95% CI 8–107). With LUS, ED and hospital stay increased non‐significantly, while discharge destination trends improved. No harm ensued. Conclusions: Non‐expert LUS augmenting dyspnoea workup may improve diagnostic accuracy, but did not significantly alter costs or outcomes in the ED or the hospital. Trial registration: Australia and New Zealand Clinical Trials Registry (ACTRN12613001023741). [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine the relationship between significant others' expected and received knowledge and their background characteristics in three Mediterranean countries (Cyprus, Greece, Spain), all of which deal with economic restrictions, have similar social support systems with the family members acting as family caregivers, and cultural similarities. Background: Significant others' role is a key element in the older patients' postoperative recovery. However, people who take care of persons older than 65 years, as persons undergoing arthroplasty, are usually old themselves and need special support. Design: Multicentre, descriptive, correlational study. Methods: Data were collected preoperatively from 189 and postoperatively from 185 significant others using the Knowledge Expectations and the Received Knowledge of Significant Others Scales during 2010‐2012. Results: Approximately one‐fourth of the significant others were older than 65 years. Their knowledge expectations were not adequately addressed in any of the countries; they expected to be educated more on biophysiological issues and received the lowest knowledge regarding financial issues. The highest difference between expected and received knowledge was found in Greece and the lowest in Cyprus. Significant others may be less prepared for dealing with situations at home due to the knowledge difference between expected and received knowledge. Conclusions: Significant others receive less education comparing to what they expect; therefore, they are not prepared for dealing with problematic situations during their old relative's recovery. This is especially important in Mediterranean countries, where family members often provide patient care. Implications for practice: As health care is changing towards active participation of patients and family, it is important that nurses provide the education needed, as lower education may lead to poor patient outcomes and higher education may lead to significant others' anxiety. Nurses may keep in mind that older significant others do not report higher knowledge difference, but may have lower expectations. [ABSTRACT FROM AUTHOR]

Abstract: There has been little empirical investigation of the preferences of people living in aged care homes for food services. The aim of the present study was to elicit consumer preferences and their willingness to pay for food service in aged care homes. Current residents or their family members were invited to take part in the discrete choice experiment questionnaire administered via interview. Of the 109 eligible residents and 175 eligible family members approached for consent 121 (43%) participated, including 43 residents. Participant preferences were influenced by food taste, choice in relation to serving size, timing of meal selection, visual appeal, and additional cost. Participants indicated they would be willing to pay an additional $24 (US$18.42) per week for food which tasted excellent and $8 (US$6.14) per week to have choice in serving sizes. The study found that respondents were willing to pay a premium to receive food that met their expectations of taste, and for a high level of control over serving sizes, which has implications for the funding and provision of food and dining in long‐term care in the future. [ABSTRACT FROM AUTHOR]

Aim: Nutritional screening may not always lead to intervention. The present study aimed to determine: (i) the rate of nutritional screening in hospitalised older adults; (ii) whether nutritional screening led to dietitian consultation and (iii) factors associated with malnutrition. Methods: In this prospective study of patients aged ≥70 years admitted to a Geriatric Evaluation and Management Unit (GEMU), malnutrition was screened for using the Mini Nutritional Assessment Short Form (MNA‐SF) and identified using the Mini Nutritional Assessment (MNA). Results: Of the 172 patients participating in the study, 53 (30.8%) patients were malnourished, and 84 (48.8%) were at risk of malnutrition. Mean (SD) age was 85.2 (6.4 years), with 131 patients (76.2%) female. Nutritional screening was performed for all patients; however, it was incomplete in 59 (34.3%) because of omission of the anthropometric measurement. Overall, 62 (36.0%) of the total number of patients were seen by the dietitian, which included 26 (49%) of malnourished patients, 27 (32%) of at‐risk patients and 9 (26%) of the well‐nourished patients. No patients lost >1% of body weight during GEMU stay. Malnourished patients were more likely to be frail, have poor appetite, depression, and have lower levels of: albumin, cognition, physical function, grip strength and quality of life. Conclusions: The full benefits of nutritional screening by MNA‐SF may not be realised if it does not result in malnourished patients receiving a dietitian consultation. However, it is possible that enrichment of the foodservice with high protein/high‐energy options minimised patient weight loss in the GEMU. [ABSTRACT FROM AUTHOR]

ABSTRACT Pressure injuries, incontinence, malnutrition, and falls are important indicators of the quality of care in healthcare settings, particularly among older people, but there is limited information on their prevalence in New Zealand (NZ). The aim of this study was to establish the prevalence of these four problems among older people in nursing home facilities. The cross-sectional study was an analysis of data collected on a single day for the 2016 National Care Indicators Programme-New Zealand (NCIP-NZ). The sample included 276 people ages 65 and older who were residents in 13 nursing home facilities in a geographically diverse area of central NZ. Data were analyzed with descriptive statistics. Prevalence rates in these nursing home settings was pressure injuries 8%; urinary incontinence 57%; fecal incontinence 26%; malnutrition 20%, and falls 13%, of which half resulted in injuries. As people age, complex health issues can lead to increasing care dependency and more debilitating and costly health problems. Measuring the prevalence of basic care problems in NZ healthcare organizations and contributing to a NZ database can enable monitoring of the effectiveness of national and international guidelines. [ABSTRACT FROM AUTHOR]

Objectives To determine whether potentially inappropriate medications ( PIMs) or potentially inappropriate associations ( PIAs) prescribed knowingly are associated with patient monitoring. Design Prospective observational study. Setting Geriatric units (n = 56) in 28 hospitals. Participants Inpatients aged 75 and older (N = 1,327). Measurements Potentially inappropriate prescriptions ( PIP) were defined as a PIM or a PIA selected by an expert board from lists of explicit criteria (Beers, Priscus, Laroche, French Health Agency) using a Delphi process. They were considered to be prescribed knowingly if they were maintained after reassessment by the geriatrician and the clinical pharmacist. Primary outcome was the rate of PIPs maintained (prescribed knowingly) and for which a geriatrician declared that specific monitoring was performed. Secondary outcomes were the parameters monitored and the rate of participants receiving knowingly a PIP. Results One thousand sixty-three PIPs were detected in 607 participants (46%). After reassessment, 826 (78%) PIPs were maintained in 490 participants (37%), the main reasons being participant's regular treatment and lack of alternative. Psychotropic (36%), cardiovascular (including antithrombotics) (29%), and laxative or antiemetic drugs (16%) were the most-frequent classes prescribed knowingly. The geriatricians declared to perform clinical or biological monitoring for 69% (n = 570) of PIMs or PIAs prescribed knowingly. Three types of specific monitoring were identified: clinical, biological, and follow-up with a specialist. Conclusion Approximately three-quarters of PIMs or PIAs were prescribed knowingly, of which 69% were monitored, with wide variations in occurrence and in quality according to drug classes. This underlines the need for accurate guidelines on PIP monitoring. [ABSTRACT FROM AUTHOR]

Objectives To estimate the cost-effectiveness of an intervention to increase pneumococcal, influenza, and pertussis-containing vaccine uptake in adults aged 65 and older in primary care practices. Design Markov decision analysis model, comparing the cost-effectiveness of the 4 Pillars Practice Transformation Program with no intervention. Setting Diverse primary care practices in two U.S. cities. Participants Clinical trial participants aged 65 and older. Measurements Quality-adjusted life years ( QALYs), public health outcomes, and costs. Vaccination rates and intervention costs were derived from a randomized controlled cluster trial. Other parameters were derived from the medical literature and Centers for Disease Control and Prevention data. All parameters were individually and simultaneously varied over their distributions. Results With the intervention program and extrapolating over 10 years, there would be approximately 60,920 fewer influenza cases, 2,031 fewer pertussis cases, and 13,842 fewer pneumococcal illnesses in adults aged 65 and older. Total per-person vaccination and illness costs with the intervention were $23.93 higher than without the intervention, with a concurrent increase in effectiveness of 0.0031 QALYs, or $7,635 per QALY gained. In sensitivity analyses, no individual parameter variation caused the intervention to cost more than $50,000 per QALY gained. Conclusions Implementing an intervention based on the 4 Pillars Practice Transformation Program is a cost-effective undertaking in primary care practices for individuals aged 65 and older, with predicted public health benefits. [ABSTRACT FROM AUTHOR]

Rational The current state of knowledge about the prevalence of constipation among persons living in institutional geriatric-care settings is limited. Aim The aim was to investigate the prevalence of constipation among institutional geriatric-care residents and identify resident characteristics related to constipation. Methodological design In a cross-sectional study of all the institutional geriatric-care settings in a county in northern Sweden, 2970 residents were assessed. The member of staff who knew each resident best used the Multi-Dimensional Dementia Assessment Scale and the resident's records of prescribed medication to monitor cognitive function, activities in daily life, behavioural and psychological symptoms, physical restraints, speech ability, nutrition and pharmacologic agents. The study was approved by the Regional Ethical Review Board. Result The prevalence of constipation was 67%. The mean age was higher among those with constipation. A significantly higher proportion of the constipated had cognitive and/or physical impairments, physical restraints, impaired speech, problems with nutrition, and higher numbers of drugs for regular use. Of those with constipation, 68% were prescribed laxatives for regular use. Twenty-three per cent of the constipated residents were prescribed opioid analgesics (n = 465), and 29% (n = 134) of these were not prescribed any laxatives. Study limitation Due to the cross-sectional design, the results should be interpreted with caution in terms of causal reasoning, generalisation and conclusions about risk factors. Another limitation is the use of proxy assessments of constipation. Conclusion The results show that constipation is common among residents in institutional geriatric-care settings in Sweden, which is in line with previous studies from other Western countries. Despite being constipated when having prescribed opioid analgesics, a large number did not have prescribed laxatives. The results indicate the urgency of finding strategies and implementing suitable interventions to improve bowel management in residents in institutional geriatric-care settings. [ABSTRACT FROM AUTHOR]

Objectives To estimate the proportion of older adults in the emergency department ( ED) who are willing and able to use a tablet computer to answer questions. Design Prospective, ED-based cross-sectional study. Setting Two U.S. academic EDs. Participants Individuals aged 65 and older. Measurements As part of screening for another study, potential study participants were asked whether they would be willing to use a tablet computer to answer eight questions instead of answering questions orally. A custom user interface optimized for older adults was used. Trained research assistants observed study participants as they used the tablets. Ability to use the tablet was assessed based on need for assistance and number of questions answered correctly. Results Of 365 individuals approached, 248 (68%) were willing to answer screening questions, 121 of these (49%) were willing to use a tablet computer; of these, 91 (75%) were able to answer at least six questions correctly, and 35 (29%) did not require assistance. Only 14 (12%) were able to answer all eight questions correctly without assistance. Individuals aged 65 to 74 and those reporting use of a touchscreen device at least weekly were more likely to be willing and able to use the tablet computer. Of individuals with no or mild cognitive impairment, the percentage willing to use the tablet was 45%, and the percentage answering all questions correctly was 32%. Conclusion Approximately half of this sample of older adults in the ED was willing to provide information using a tablet computer, but only a small minority of these were able to enter all information correctly without assistance. Tablet computers may provide an efficient means of collecting clinical information from some older adults in the ED, but at present, it will be ineffective for a significant portion of this population. [ABSTRACT FROM AUTHOR]

Objectives To determine the extent of concern about falling in older adults with hypertension, whether lower blood pressure ( BP) and greater use of antihypertensive medications are associated with greater concern about falling, and whether lower BP has a greater effect on concern about falling in older and more functionally impaired individuals. Design Secondary analysis involving cross-sectional study of baseline characteristics of participants enrolled in the Systolic Blood Pressure Intervention Trial ( SPRINT). Setting Approximately 100 outpatient sites. Participants SPRINT enrollees aged 50 and older (mean age 69) diagnosed with hypertension (N = 2,299). Measurements Concern about falling was determined using the shortened version of the Falls Efficacy Scale International as measured at the baseline examination. Results Mild concern about falling was present in 29.3% of participants and moderate to severe concern in 17.9%. Neither low BP (systolic BP<120 mmHg, diastolic BP <70 mmHg) nor orthostatic hypotension was associated with concern about falling ( P > .10). Participants with moderate to severe concern about falling were taking significantly more antihypertensive medications than those with mild or no concern. After adjusting for baseline characteristics, no associations were evident between BP, medications, and concern about falling. Results were similar in older and younger participants; interactions between BP and age and functional status were not significantly associated with concern about falling. Conclusion Although concern about falling is common in older adults with hypertension, it was not found to be associated with low BP or use of more antihypertensive medications in baseline data from SPRINT. [ABSTRACT FROM AUTHOR]

Objectives To determine whether lifestyle factors, measured late in life, could compress the disabled period toward the end of life. Design Community-based cohort study of older adults followed from 1989 to 2015. Setting Four U.S. communities. Participants Community-living men and women aged 65 and older (N = 5,248, mean age 72.7 ± 5.5, 57% female, 15.2% minority) who were not wheelchair dependent and were able to give informed consent at baseline. Measurements Multiple lifestyle factors, including smoking, alcohol consumption, physical activity, diet, body mass index ( BMI), social networks, and social support, were measured at baseline. Activities of daily living ( ADLs) were assessed at baseline and throughout follow-up. Years of life (YoL) was defined as years until death. Years of able life ( YAL) was defined as years without any ADL difficulty. YAL/YoL%, the proportion of life lived able, was used to indicate the relative compression or expansion of the disabled period. Results The average duration of disabled years was 4.5 (out of 15.4 mean YoL) for women and 2.9 (out of 12.4 mean YoL) for men. In a multivariable model, obesity was associated with 7.3 percentage points (95% confidence interval ( CI) = 5.4-9.2) lower YAL/YoL% than normal weight. Scores in the lowest quintile of the Alternate Healthy Eating Index were associated with a 3.7% (95% CI = 1.6-5.9) lower YAL/YoL% than scores in the highest quintile. Every 25 blocks walked in a week was associated with 0.5 percentage points (95% CI = 0.3-0.8) higher YAL/YoL%. Conclusion The effects of healthy lifestyle factors on the proportion of future life lived free of disability indicate that the disabled period can be compressed, given the right combination of these factors. [ABSTRACT FROM AUTHOR]

Objectives To investigate the etiology of transient loss of consciousness (T- LOC) suspected to be syncope and unexplained falls in elderly adults with dementia. Design Prospective, observational, multicenter study. Setting Acute care wards, syncope units or centers for the diagnosis of dementia. Participants Individuals aged 65 and older with a diagnosis of dementia and one or more episodes of T- LOC of a suspected syncopal nature or unexplained falls during the previous 3 months were enrolled. Measurements The causes of T- LOC suspected to be syncope and unexplained falls were evaluated using a simplified protocol based on European Society of Cardiology guidelines. Results Of 357 individuals enrolled, 181 (50.7%) had been referred for T- LOC suspected to be syncope, 166 (46.5%) for unexplained falls, and 10 (2.8%) for both. An initially suspected diagnosis of syncope was confirmed in 158 (87.3%), and syncope was identified as the cause of the event in 75 (45.2%) of those referred for unexplained falls. Orthostatic hypotension was the cause of the event in 117 of 242 (48.3%) participants with a final diagnosis of syncope. Conclusion The simplified syncope diagnostic protocol can be used in elderly people with dementia referred for suspected syncope or unexplained falls. Unexplained falls may mask a diagnosis of syncope or pseudosyncope in almost 50% of cases. Given the high prevalence of orthostatic syncope in participants (~50%), a systematic reappraisal of drugs potentially responsible for orthostatic hypotension is warranted. [ABSTRACT FROM AUTHOR]

Background There is a high prevalence of communication difficulty among older people living in residential-aged care. Such functional deficits can have a negative impact on resident quality of life, staff workplace satisfaction and the provision of quality care. Systematic research investigating the nature of communication management in residential-aged care and factors impacting optimal communication management is lacking. Aims To use data triangulation across multiple sources to describe resident-staff communication and communication management in residential-aged care. Methods & Procedures Participants included a sample of 14 residents and 29 staff directly involved in communication interactions with residents. Data were obtained from: (1) resident file review ( n = 14), (2) observation of resident-staff communication ( n = 14), (3) resident surveys ( n = 14) and (4) staff surveys ( n = 29). Data from each source were examined separately then triangulated. Outcomes & Results All residents had limited opportunity for meaningful communication with staff. Documentation of residents' communication needs and strategies to facilitate resident-staff communication was insufficient to provide individualized recommendations. Although staff were observed to use various strategies to facilitate communication with residents, staff agreement about the applicability of these strategies to individual residents was inconsistent. Differences in resident-staff communication for residents who experience nil/mild versus moderate/severe communication difficulty were also found. Conclusions & Implications Resident-staff communication and communication management in residential-aged care is limited in scope and challenged in meeting residents' individual communication needs. Improvements in both documentation and staff knowledge of residents' communication needs are necessary. Strategies to facilitate communication with individual residents must be tailored, evidence based, documented in care plans and delivered to staff through ongoing education. Increased involvement of specialist providers such as speech pathologists to support better communication management in residential-aged care may provide one way of facilitating such change. [ABSTRACT FROM AUTHOR]

The purpose of the study was to assess the effect of different treatment regimens for chronic hepatitis C on patient-reported outcomes ( PROs) of individuals aged 65 and older with chronic hepatitis C. PRO data from eight multinational multicenter Phase 2 and 3 clinical trials were included. Of 3,120 participants in these clinical trials, 229 were aged 65 and older (67.8 ± 3.2, 57% male, 75% treatment-naïve, 22% cirrhotic), and 90 of those received ledipasvir plus sofosbuvir ( LDV + SOF), 119 received SOF plus ribavirin ( SOF + RBV), and 20 received pegylated IFN, SOF, and RBV ( IFN + SOF + RBV). Participants aged 65 and older had slightly more pretreatment PRO impairment in their physical functioning than younger individuals (−3.1% on a normalized 0-100% PRO scale, P < .001). Despite this, these participants experienced significant PRO improvement during treatment with IFN-free RBV-free regimens (up to +8.0%, P < .001), similar to improvements in younger participants. In contrast, participants aged 65 and older experienced substantial decline in PROs while receiving IFN- or RBV-containing regimens (up to −18.9% in IFN + SOF + RBV, −10.4% in IFN-free SOF+ RBV, P < .001), and some were greater than in the younger group. Nevertheless, after achieving sustained viral clearance at Posttreatment Week 12, PROs in participants aged 65 and older improved regardless of the regimen (up to +10.4%, P < .001). In multivariate analysis of the cohort aged 65 and older, the use of IFN and RBV was consistently associated with PRO impairment during treatment. The use of an IFN- and RBV-free anti- HCV regimen in older adults with hepatitis C results in significant improvement of PROs. [ABSTRACT FROM AUTHOR]

Objectives To investigate the effects of a high-intensity functional exercise program on independence in activities of daily living ( ADLs) and balance in older people with dementia and whether exercise effects differed between dementia types. Design Cluster-randomized controlled trial: Umeå Dementia and Exercise (UMDEX) study. Setting Residential care facilities, Umeå, Sweden. Participants Individuals aged 65 and older with a dementia diagnosis, a Mini-Mental State Examination score of 10 or greater, and dependence in ADLs (N = 186). Intervention Ninety-three participants each were allocated to the high-intensity functional exercise program, comprising lower limb strength and balance exercises, and 93 to a seated control activity. Measurements Blinded assessors measured ADL independence using the Functional Independence Measure ( FIM) and Barthel Index ( BI) and balance using the Berg Balance Scale ( BBS) at baseline and 4 (directly after intervention completion) and 7 months. Results Linear mixed models showed no between-group effect on ADL independence at 4 ( FIM=1.3, 95% confidence interval ( CI)=−1.6-4.3; BI=0.6, 95% CI=−0.2-1.4) or 7 ( FIM=0.8, 95% CI=−2.2-3.8; BI=0.6, 95% CI=−0.3-1.4) months. A significant between-group effect on balance favoring exercise was observed at 4 months ( BBS=4.2, 95% CI=1.8-6.6). In interaction analyses, exercise effects differed significantly between dementia types. Positive between-group exercise effects were found in participants with non-Alzheimer's dementia according to the FIM at 7 months and BI and BBS at 4 and 7 months. Conclusion In older people with mild to moderate dementia living in residential care facilities, a 4-month high-intensity functional exercise program appears to slow decline in ADL independence and improve balance, albeit only in participants with non-Alzheimer's dementia. [ABSTRACT FROM AUTHOR]

Backround Baseline depressive symptoms have been consistently associated with the onset of cardiovascular disease ( CVD). Objectives Since depressive symptoms vary over time in elderly persons, and to help clarify whether or not depression is an etiological factor for CVD, we quantified the association between the course of depressive symptoms and occurrence of first coronary heart disease ( CHD) and stroke events in older adults. Design A population-based prospective observational study. Setting Participants were randomly selected from the electoral rolls of three large French cities. Participants A total of 9,294 participants were examined at baseline between 1999 and 2001, and thereafter at repeated study visits over 10 years. Measurements High levels of depressive symptoms ( HLDS) were defined as a score ≥16 on the 20-item Center for Epidemiologic Studies Depression Scale. The number of study visits with HLDS was used as a time dependent variable in Cox proportional hazard models. Results There were 7,313 participants (36.6% males) aged 73.8 ± 5.4 years with no history of CHD, stroke or dementia at baseline. After a median follow-up of 8.4 years ( SD 2.3 years), 629 first CHD or stroke events occurred. After adjustment for sociodemographic characteristics and vascular risk factors, the risk of CHD and stroke combined increased 1.15-fold (95% CI: 1.06 to 1.25) per each additional study visit with HLDS. The results remained unchanged when accounting for the presence of disability and antidepressant intake at baseline and during follow-up. Conclusion Elderly persons exposed to HLDS at several occasions over 10 years showed substantial increased risk of coronary heart disease and stroke events. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the association between performance on a single chair stand and moderate to severe exertional dyspnea. Design Cross-sectional. Setting Cardiovascular Health Study. Participants Community-dwelling individuals aged 65 and older (N = 4,413; mean age 72.6; female, n = 2,518 (57.1%); nonwhite, n = 199 (4.5%); obese, n = 788 (17.9%); history of smoking, n = 2,410 (54.6%)). Measurements Performance on single chair stand (poor (unable to rise without arm use) vs normal (able to rise without arm use)), moderate to severe exertional dyspnea (American Thoracic Society grade ≥2), age, sex, ethnicity, obesity, smoking, frailty status (Fried-defined nonfrail, prefrail, frail), high cardiopulmonary risk (composite of cardiopulmonary diseases and diabetes mellitus), spirometric impairment, arthritis, depression, stroke, and kidney disease. Results Poor performance on the single chair stand was established in 369 (8.4%) and moderate to severe exertional dyspnea in 773 (17.5%). Prefrail status was established in 2,210 (50.1%), frail status in 360 (8.2%), arthritis in 2,241 (51.4%), high cardiopulmonary risk in 2,469 (55.9%), spirometric impairment in 1,076 (24.4%), kidney disease in 111 (2.5%), depression in 107 (2.4%), and stroke in 93 (2.1%). In multivariable regression models, poor performance on the single chair stand was associated with moderate to severe exertional dyspnea (unadjusted odds ratio ( OR) = 3.48, 95% confidence interval ( CI) = 2.78-4.36; adjusted OR = 1.85, 95% CI = 1.41-2.41). Conclusion Poor performance on a single chair stand was associated with an adjusted 85% greater likelihood of moderate to severe exertional dyspnea than normal performance. These results suggest that reduced proximal muscle function of the lower extremities is associated with moderate to severe exertional dyspnea, even after adjusting for multiple confounders. [ABSTRACT FROM AUTHOR]

Objectives To compare the effectiveness of chemotherapy in prolonging survival according to age in breast and colon cancer. Design Retrospective cohort study with a matched cohort analysis based on the conditional probability of receiving chemotherapy. Setting The 16 Surveillance, Epidemiology, and End Results ( SEER) areas from the SEER- Medicare linked database. Participants Women diagnosed with Stage I to IIIa hormone receptor-negative breast cancer (n = 14,440) and 26,893 men and women with Stage III colon cancer (n = 26,893) aged 65 and older in 1992 to 2009. Measurements The main exposure was the receipt of chemotherapy, and the main outcome was mortality. Results In women with breast cancer aged 65 to 69, the risk of all-cause mortality was statistically significantly lower in those who received chemotherapy than in those who did not in the entire cohort (hazard ratio ( HR) = 0.70, 95% confidence interval ( CI) = 0.57-0.88) and in a propensity-matched cohort ( HR = 0.82, 95% CI = 0.70-0.96) after adjusting for measured confounders. These patterns were similar in participants aged 70 to 74 and 75 to 79, but in women aged 80 to 84 and 85 to 89, risk of all-cause mortality was no longer significantly lower in those receiving chemotherapy in the entire and matched cohorts, except that, in a small number of women who received doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan), risk of mortality was significantly lower for those aged 80 to 84. Chemotherapy appeared to be effective in all ages from 65 through 84 in participants with Stage III colon cancer. For example, in those aged 85 to 89, chemotherapy was significantly associated with lower risk of mortality in the entire cohort ( HR = 0.79, 95% CI = 0.67-0.92) and the matched cohort ( HR = 0.79, 95% CI = 0.66-0.95). Conclusion The effectiveness of chemotherapy decreased with age in participants with breast cancer, in whom chemotherapy appears to be effective until age 79 except for the doxorubicin-cyclophosphamide combination, which was effective in participants aged 80 to 84. In individuals with Stage III colon cancer, chemotherapy appears to be effective to age 89. These findings were consistent with those of randomized clinical trials. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the effect of structured physical activity on sleep-wake behaviors in sedentary community-dwelling elderly adults with mobility limitations. Design Multicenter, randomized trial of moderate-intensity physical activity versus health education, with sleep-wake behaviors prespecified as a tertiary outcome over a planned intervention period ranging from 24 to 30 months. Setting Lifestyle Interventions and Independence for Elders Study. Participants Community-dwelling persons aged 70 to 89 who were initially sedentary and had a Short Physical Performance Battery score less than 10 (N = 1,635). Measurements Sleep-wake behaviors were evaluated using the Insomnia Severity Index ( ISI) (≥8 defined insomnia), Epworth Sleepiness Scale ( ESS) (≥10 defined daytime drowsiness), and Pittsburgh Sleep Quality Index ( PSQI) (>5 defined poor sleep quality) administered at baseline and 6, 18, and 30 months. Results The randomized groups were similar in terms of baseline demographic variables, including mean age (79) and sex (67% female). Structured physical activity resulted in a significantly lower likelihood of having poor sleep quality (adjusted odds ratios ( aOR) for PSQI >5 = 0.80, 95% confidence interval ( CI) = 0.68-0.94), including fewer new cases ( aOR for PSQI >5 = 0.70, 95% CI = 0.54-0.89), than health education but not in resolution of prevalent cases ( aOR for PSQI ≤5 = 1.13, 95% CI = 0.90-1.43). No significant intervention effects were observed for the ISI or ESS. Conclusion Structured physical activity resulted in a lower likelihood of developing poor sleep quality ( PSQI >5) over the intervention period than health education but had no effect on prevalent cases of poor sleep quality or on sleep-wake behaviors evaluated using the ISI or ESS. These results suggest that the benefit of physical activity in this sample was preventive and limited to sleep-wake behaviors evaluated using the PSQI. [ABSTRACT FROM AUTHOR]

Clinical reports suggest that superficial pressure ulcers produce pain, but that pain decreases as the wound advances in stage. This study of the relationship between pressure ulcer stage and bodily pain intensity in nursing home residents was a secondary analysis of the national Minimum Data Set 3.0 assessment data in long-term care facilities, collected from nursing home residents at least 65 years of age. Data were examined from residents with pressure ulcers who completed a bodily pain intensity interview between January and March 2012 ( N = 41,680) as part of the MDS comprehensive assessment. After adjusting for other variables (e.g., cognition, functional impairment, presence of comorbidities, use of scheduled pain medication, and sociodemographic variables), bodily pain intensity for those with more severe pressure ulcers in comparison to those with Stage I ulcers was higher by 11% (Stage II), 14% (Stage III), 24% (Stage IV), and 22% (suspected deep tissue injury). Because multivariate analysis showed that greater bodily pain intensity was associated with an advanced stage of pressure ulcer, health care providers should assess bodily pain intensity and order appropriate pain management for nursing home residents with pressure ulcers, particularly for those with advanced pressure ulcers who are vulnerable to greater bodily pain intensity. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the effect of an innovative model integrating telemonitoring of vital parameters and telephone support on 6-month survival and hospital admissions of elderly adults with heart failure ( HF). Design Parallel-arm, randomized trial. Setting Geriatric acute care ward and outpatient clinic at Policlinico Campus Biomedico (Rome, Italy). Participants Individuals with HF aged 65 and older (mean age 80) randomly assigned to intervention (n = 50) or control (n = 46). Participants had an average ejection fraction of 46%. Intervention Telemonitoring system (receives and communicates oxygen saturation, heart rate, and blood pressure readings) and office-hours telephonic support provided by a geriatrician. Measurements Combination of all-cause death and hospital admissions. Results The two groups were similar with the exception of the prevalence of women and of disability (both more common in the control group). Three patients for each group were lost to follow-up (final analyzed sample size: 90). Incidence of the main outcome was 42% in the control group and 21% in the intervention group (relative risk = 0.51, 95% confidence interval ( CI) = 0.26-0.98). The results were unchanged after taking into account the setting of enrollment, sex, and disability (hazard ratio = 0.42, 95% CI = 0.19-0.94). Conclusion Telemonitoring of elderly people with HF is feasible and reduces the risk of death and hospitalization. Further studies are needed to confirm these findings and evaluate the cost-efficacy of the service. [ABSTRACT FROM AUTHOR]

Objectives To determine life expectancy for older women with breast cancer. Design Prospective longitudinal study with 10 years of follow-up data. Setting Hospitals or collaborating tumor registries in four geographic regions (Los Angeles, California; Minnesota; North Carolina; Rhode Island). Participants Women aged 65 and older at time of breast cancer diagnosis with Stage I to IIIA disease with measures of self-rated health ( SRH) and walking ability at baseline (N = 615; 17% aged ≥80, 52% Stage I, 58% with ≥2 comorbidities). Measurements Baseline SRH, baseline self-reported walking ability, all-cause and breast cancer-specific estimated probability of 5- and 10-year survival. Results At the time of breast cancer diagnosis, 39% of women reported poor SRH, and 28% reported limited ability to walk several blocks. The all-cause survival curves appear to separate after approximately 3 years, and the difference in survival probability between those with low SRH and limited walking ability and those with high SRH and no walking ability limitation was significant (0.708 vs 0.855 at 5 years, P ≤ .001; 0.300 vs 0.648 at 10 years, P < .001). There were no differences between the groups in breast cancer-specific survival at 5 and 10 years ( P = .66 at 5 years, P = .16 at 10 years). Conclusion The combination of low SRH and limited ability to walk several blocks at diagnosis is an important predictor of worse all-cause survival at 5 and 10 years. These self-report measures easily assessed in clinical practice may be an effective strategy to improve treatment decision-making in older adults with cancer. [ABSTRACT FROM AUTHOR]

Aim Some studies have suggested that thiamin (vitamin B1) may have a protective effect on the maintenance of cognitive function in older people. The aim of this exploratory study was to investigate the association between dietary intakes, specifically protein and thiamin with cognitive function. Methods A cross-sectional analysis was conducted on community-living older adults aged ≥60 years in the Illawarra region of New South Wales. Dietary intakes were collected using a three-day food record and various domains of cognition were tested. Depressive symptoms were assessed using the Geriatric Depression Scale ( GDS). Correlations and regressions were conducted to investigate the association between dietary intakes and areas of cognitive function. Results Forty-eight volunteers participated (mean age: 78.2 ± 6.1 years; BMI: 28.8 ± 5.4 kg/m2; MNA Score: 26.8 ± 2.4; 35% men). Men had higher intakes of energy (kJ), carbohydrate, saturated fat and sodium than women. No significant association was found between protein or thiamin and the tested domains of cognition. Associations were found between vitamin D intake and the Letter Fluency Test (r = −0.302, P < 0.05) and Rey Auditory Verbal Learning Test (r = −0.400, P < 0.001), and between both carbohydrate (r = 0.383, P = < 0.05) and iron intake (r = 0.333, P < 0.05) and the GDS. Conclusions In a sample of generally healthy, well-nourished older adults, no associations were found between protein or thiamin intakes and the tested components of cognition. Further investigation is required to determine if an increase in these nutrients through the provision of food sources has benefits to improve cognitive function. [ABSTRACT FROM AUTHOR]