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While neuroimaging and blood biomarker have been two of the most active areas of research in the neurotrauma community, these fields rarely intersect to delineate subconcussive brain injury. The aim of the study was to examine the association between diffusion MRI techniques [diffusion tensor imaging (DTI) and neurite orientation/dispersion density imaging (NODDI)] and brain-injury blood biomarker levels [tau, neurofilament-light (NfL), glial-fibrillary-acidic-protein (GFAP)] in high-school football players at their baseline, aiming to detect cumulative neuronal damage from prior seasons. Twenty-five football players were enrolled in the study. MRI measures and blood samples were obtained during preseason data collection. The whole-brain, tract-based spatial statistics was conducted for six diffusion metrics: fractional anisotropy (FA), mean diffusivity (MD), axial/radial diffusivity (AD, RD), neurite density index (NDI), and orientation dispersion index (ODI). Five players were ineligible for MRIs, and three serum samples were excluded due to hemolysis, resulting in 17 completed set of diffusion metrics and blood biomarker levels for association analysis. Our permutation-based regression model revealed that serum tau levels were significantly associated with MD and NDI in various axonal tracts; specifically, elevated serum tau levels correlated to elevated MD (p = 0.0044) and reduced NDI (p = 0.016) in the corpus callosum and surrounding white matter tracts (e.g., longitudinal fasciculus). Additionally, there was a negative association between NfL and ODI in the focal area of the longitudinal fasciculus. Our data suggest that high school football players may develop axonal microstructural abnormality in the corpus callosum and surrounding white matter tracts, such as longitudinal fasciculus. A future study is warranted to determine the longitudinal multimodal relationship in response to repetitive exposure to sports-related head impacts.

PurposeUSA Football established five levels of contact (LOC) to guide the intensity of high school football practices. However, it remains unclear whether head impact exposure differs by LOC. The purpose of this study was to examine head impact frequency and magnitude by LOC in the overall sample and three position groups.MethodsThis longitudinal observational study included 24 high school football players during all practices and games in the 2019 season. Players wore a sensor-installed mouthguard that monitored head impact frequency, peak linear acceleration (PLA), and rotational head acceleration (PRA). Practice/game drills were filmed and categorized into 5 LOCs (air, bags, control, thud, live), and head impact data were assigned into 5 LOCs. Player position was categorized into linemen, hybrid, and skill.ResultsA total of 6016 head impacts were recorded during 5 LOCs throughout the season. In the overall sample, total number of impacts, sum of PLA, and PRA per player increased in an incremental manner (air

The objective of the study was to examine the association between diffusion MRI techniques [diffusion tensor imaging (DTI) and neurite orientation/dispersion density imaging (NODDI)] and brain-injury blood biomarker levels [Tau, neurofilament-light (NfL), glial-fibrillary-acidic-protein (GFAP)] in high-school football and cross-country runners at their baseline, aiming to detect cumulative neuronal damage from prior seasons. Twenty-five football players and 8 cross-country runners underwent MRI and blood biomarker measures during preseason data collection. The whole-brain, tract-based spatial statistics was conducted for six diffusion metrics: fractional anisotropy (FA), mean diffusivity (MD), axial/radial diffusivity (AD, RD), neurite density index (NDI), and orientation dispersion index (ODI). Diffusion metrics and blood biomarker levels were compared between groups and associated within each group. The football group showed lower AD and MD than the cross-country group in various axonal tracts of the right hemisphere. Elevated ODI was observed in the football group in the right hemisphere of the corticospinal tract. Blood biomarker levels were consistent between groups except for elevated Tau levels in the cross-country group. Tau level was positively associated with MD and negatively associated with NDI in the corpus callosum of football players, but not in cross-country runners. Our data suggest that football players may develop axonal microstructural abnormality. Levels of MD and NDI in the corpus callosum were associated with serum Tau levels, highlighting the vulnerability of the corpus callosum against cumulative head impacts. Despite observing multimodal associations in some brain areas, neuroimaging and blood biomarkers may not strongly correlate to reflect the severity of brain damage.

Objective To compare the relative ability of patient self-assessments and clinician assessments of functional limitations for predicting hospitalizations for older adults with left ventricular dysfunction. Study Design Latent growth model analyses used secondary data from a clinical drug study, the Studies of Left Ventricular Dysfunction. Self-report and clinician-report data of patients' functional limitations were collected at baseline, and 6 weeks, 12 months, and 24 months postbaseline to assess the effects of an angiotensin-converting enzyme inhibitor versus placebo. Latent growth model analyses were used to assess the relative effect of baseline ratings and changes in these 2 ratings of patient functional limitations over the initial 2 years of the study (ie, the drug study component) as potential predictors of the number of hospitalizations occurring over 3 subsequent years. Results Data from 1099 patients aged 65+ years were analyzed. Both baseline patient assessments and changes in patient assessments of functional limitations were significant predictors of the number of subsequent hospitalizations (β = 0.119 and 0.273, respectively). This was not the case for clinician assessments. Moreover, baseline patient and clinician assessments of the patient's functional limitations were correlated at 0.42, indicating only a modest relationship between the 2 assessments. Conclusions These results demonstrate the greater utility of patient self-report measures for predicting hospitalizations. Incorporating patient-reported outcomes into clinical practice will expand understanding of the effect of diseases. Assessing changes in patient reports yields important insights into those patients more likely to have multiple admissions for heart failure.

Objectives: To examine the potential facilitators of or deterrents to end-of-life planning for community-dwelling older adults, including personal (health-related and sociodemographic) and social (physician and family) influences. Design: In-person interviews with older adults, telephone interviews with physicians and family members. Setting: Cleveland, Ohio. Participants: Two hundred thirty-one adults aged 65 to 99 who were aging in place, 99 of their primary care physicians, and 127 of their family members. Measurements: Questions assessing older adults' discussions with others about end-of-life plans, implementation of advance directives, and physical (Older American Resources and Services) illness index and mental (Short Portable Mental Status Questionnaire) health status. Results: Just fewer than half of older adults had executed an advance directive and discussed their wishes with others. Only personal characteristics of elderly individuals were related to end-of-life plans, with whites, unmarried individuals, and younger adults more likely to have made preparations. Older adults' health status, as evaluated by the patient, physician, and caregiver, did not relate to the tendency to have made advance care plans. Older adults' family members were much more likely to report knowledge of advance care plans than were physicians. Conclusion: These findings suggest that many physicians are not talking with their patients about their end-of-life wishes. Furthermore, the propensity to have such discussions may relate more to the personal preferences and level of comfort of patients, physicians, and family members than on the health status of the older adult.

Maintenance of functional health and high quality of late life are crucial concerns for gerontologists and health researchers, as rapidly growing numbers of very old adults face the challenges and opportunities of increasing longevity and frailty in the twenty-first century (Atchley, 1995; Institute of Medicine [IOM], 1991). The present formulation outlines how older adults of tomorrow can enhance their own quality of life through a broad array of proactive adaptations. By recognizing and accepting older adults’ right to, and preference for, proactive involvement in shaping their own destiny, we can make important strides toward facilitating elders’ successful ageing. Successful ageing, based on our model, is an attainable goal within reach of even those aged traditionally relegated to ranks of passive and stigmatized recipients of care.

Completion of first-line treatment is an important milestone for adults newly diagnosed with cancer. However, for many adults, the cancer experience of the 21st century does not end with the completion of initial treatment. Decreased functional status, distressing symptoms, and residual effects of treatment impact the daily lives of cancer survivors. Cancer has evolved into a chronic illness, in which a disease-free period may be followed by recurrent cancer. Researchers face challenges in the design and analysis of symptom management studies in recurrent disease. Residual effects can preclude a true "baseline" measurement of the symptom(s) of interest to the researcher. In addition, as cancer survivors age, they are more likely to have comorbid conditions that increase the likelihood of developing toxicities and residual symptoms that are specific to cancer treatments. Research studies of cancer-related symptoms in adults with recurrent disease pose many methodological challenges. Selection of appropriate study design, sample inclusion and exclusion criteria, measures of comorbidity and symptoms, and advanced analysis techniques are among the strategies proposed to address these methodological challenges.

This paper examines the health care experiences of older adults over a five-year period, including continuity in care, changes in health insurance coverage, and satisfaction with care. Face-to-face interviews were conducted annually with 415 older adults (mean age = 84, range = 72–105), 100 of whom were originally health maintenance organization (HMO) subscribers and 315 of whom were receiving fee-for-service care. Several predictors of health care experiences were examined, including personal characteristics, health status and health care variables. Coverage type (HMO or fee-for-service) was the most consistent predictor. HMO subscribers were more likely than fee-for-service recipients to experience changes in insurance (both negative and positive changes) and discontinuity in physician care, although satisfaction with care did not vary among HMO and non-HMO members. Two-thirds of HMO subscribers and nearly one-third of fee-for-service recipients reported changes in insurance coverage over the five-year study period. In terms of perspectives on HMO care, the most frequently mentioned advantage of HMO care among those in HMOs was diminished costs, while fee-for-service subscribers did not believe there were any advantages to being in an HMO. Those not in HMOs viewed loss of physician choice and poor quality care as major disadvantages of HMOs. Results of this study demonstrate that older adults commonly experience changes in their health care coverage and physician care. They adapt to these changes through positive appraisals of the type of case they receive.

Background Falls are common in community-dwelling elderly persons and are a frequent source of morbidity. Simple indices to prospectively stratify people into categories at different fall-risk would be useful to health care practitioners. Our goal was to develop a fall-risk index that discriminated between people at high and low risk of falling. Methods We evaluated the risk of falling over a one-year period in 557 elderly persons (mean age 81.6) living in a retirement community. On the baseline interview, we asked subjects if they had fallen in the previous year and evaluated risk factors in six additional conceptual categories. On the follow-up interview one year later, we again asked subjects if they had fallen in the prior year. We evaluated risk factors in the different conceptual categories and used logistic regression to determine the independent predictors of falling over a one-year period. We used these independent predictors to create a fall-risk index. We compared the ability of a prior falls history with other risk factors and with the combination of a falls history and other risk factors to discriminate fallers from nonfallers. Results A fall in the previous year (OR = 2.42, 95% CI = 1.49-3.93), a symptom of either balance difficulty or dizziness (OR = 1.83, 95% CI = 1.16-2.89), or an abnormal mobility exam (OR = 2.64, 95% CI = 1.64-4.26) were independent predictors of falling over the subsequent year. These three risk factors together (c statistic =.71) discriminated fallers from nonfallers better than previous history of falls alone (c statistic =.61) or the symptomatic and exam risk factors alone (c statistic =.68). When combined into a risk index, the three independent risk factors stratify people into groups whose risk for falling over the subsequent year ranges from 10% to 51%. Conclusion A history of falling over the prior year, a risk factor that can be obtained from a clinical history (balance difficulty or dizziness), and a risk factor that can be obtained from a physical exam (mobility difficulty) stratify people into groups at low and high risk of falling over the subsequent year. This risk index may provide a simple method of assessing fall risk in community-dwelling elderly persons. However, it requires validation in other subjects before it can be recommended for widespread use.

This research compared attitudes of 143 nursing home employees toward three hypothetical target groups of older adults: well elderly persons, physically ill elderly persons, and elderly persons with Alzheimer's disease. Staff provided successively less positive evaluations of physically ill elderly persons and elderly persons with Alzheimer's disease compared to well elderly persons. Age, education, and contact with grandparents differentially predicted positive evaluations toward well and physically ill older adults. Self-efficacy was a significant predictor of positive evaluations across all target groups. Findings suggest that interventions designed to increase staff members' feelings of self-efficacy may lead to more positive evaluations of elderly clients and, ultimately, improved quality of care.