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BACKGROUND AND AIMS: Obesity significantly impacts older adults. Intensive nutrition counseling can aid in weight reduction and improve diet quality, but data are sparse in this population. The objective of this intervention is to determine how intensive nutrition counseling affects diet quality and anthropometric measures during a multi-component weight loss intervention in rural older adults with obesity. METHODS: A series of 12-week, single-arm feasibility pilots were conducted in fall 2017 and winter/spring 2018 in a community aging center in rural Northern New England. Adults were eligible if ≥65 years old with a Body Mass Index (BMI) ≥30kg/m(2). Exclusion criteria included dementia/cognitive impairment, uncontrolled psychiatric illness, weight-loss surgery, weight loss >5% in previous 6-months, life-threatening illness, palliative/hospice services, current participation in another weight-loss study/program, obesogenic medications, or presence of major chronic conditions. Participants received once-weekly nutrition counseling by a registered dietitian nutritionist (RDN), and twice-weekly exercise sessions by a physical therapist (PT). Primary outcomes were diet quality changes measured by total Rapid Eating and Activity Assessment for Patients-Short Version (REAP-S) and Automated Self-Administered 24-hour dietary recall (ASA-24). Secondary outcome measures were changes in weight (kilograms) and waist circumference (centimeters). McNemar test was conducted for all paired categorical data while paired t-tests were conducted for all paired continuous data. All analyses were conducted in R; p-value

OBJECTIVES: The prevalence of obesity with sarcopenia is increasing in adults aged ≥65 years. This geriatric syndrome places individuals at risk for synergistic complications that leads to long-term functional decline. We ascertained the relationship between sarcopenic obesity and incident long-term impaired global cognitive function in a representative US population. DESIGN: A longitudinal, secondary data set analysis using the National Health and Aging Trends Survey. SETTING: Community-based older adults in the United States. PARTICIPANTS: Participants without baseline impaired cognitive function aged ≥65 years with grip strength and body mass index measures. METHODS: Sarcopenia was defined using the Foundation for the National Institutes of Health Sarcopenia Project grip strength cut points (men

Background Acute health care interventions for residents of skilled nursing facilities (SNFs) are often unwarranted, unwanted, and/or harmful. We describe a provider-focused care model to reduce unwarranted or unwanted acute health care utilization. Objective Assess the capability of the Reducing Avoidable Facility Transfers (RAFT) model to reduce unwanted and unwarranted acute health care utilization among residents in 3 rural SNFs between January 1, 2016 and June 30, 2017. Design Prospective cohort, pre/post study. Setting Three rural SNFs in collaboration with a geriatric practice in a tertiary academic medical center. Participants Post-acute care (PAC) and long-term care (LTC) residents of 3 rural SNFs. Intervention RAFT includes the following components: (1) a small team of providers who manage longitudinal care and after hours call; (2) elicitation of advance care plans and preferences regarding acute care; (3) standardized communication process engaging the provider at the identification of an acute care event; (4) a biweekly case review of all emergency department (ED) transfers. Measures ED and hospital utilization. Results RAFT demonstrated a 35% reduction in monthly ED transfers and a 30.5% reduction in monthly hospitalizations. These reductions were greatest for LTC residents. Conclusions/Implications The RAFT approach substantially reduced unwarranted ED and hospital utilization in this study. Results support replication and evaluation in a larger, more diverse setting and population.

Background Disparities in healthcare access and delivery, caused by transportation and health workforce difficulties, negatively impact individuals living in rural areas. These challenges are especially prominent in older adults. Design We systematically evaluated the feasibility, acceptability, and effectiveness in providing telemedicine (TMed), searching the English-language literature for studies (January 2012 to July 2018) in the following databases: Medline (PubMed); Cochrane Library (Wiley); Web of Science; CINAHL; EMBASE (Ovid); and PsycINFO (EBSCO). Participants Older adults (mean age = 65 years or older, and none were younger than 60 years). Interventions Interventions consisted of live, synchronous, two-way videoconferencing communication in nonhospital settings. All medical interventions were included. Measurements Quality assessment, using the Cochrane Collaboration's Risk-of-Bias Tool, was applied on all included articles, including a qualitative summary of all articles. Results Of 6616 citations, we reviewed the full text of 1173 articles, excluding 1047 that did not meet criteria. Of the 17 randomized controlled trials, the United States was the country with the most trials (6 [35%]), with cohort sizes ranging from 3 to 844 (median = 35) participants. Risk of bias among included studies varied from low to high. Our qualitative analysis suggests that TMed can improve health outcomes in older adults and that it could be used in this population. Conclusions TMed is feasible and acceptable in delivering care to older adults. Research should focus on well-designed randomized trials to overcome the high degree of bias observed in our synthesis. Clinicians should consider using TMed in routine practice to overcome barriers of distance and access to care. J Am Geriatr Soc 67:1737-1749, 2019.

BACKGROUND: Mobile health (mHealth) technologies comprise a multidisciplinary treatment strategy providing potential solutions for overcoming challenges of successfully delivering health promotion interventions in rural areas. We evaluated the potential of using technology in a high-risk population. METHODS: We conducted a convergent, parallel mixed-methods study using semi-structured interviews, focus groups, and self-reported questionnaires, using purposive sampling of 29 older adults, 4 community leaders and 7 clinicians in a rural setting. We developed codes informed by thematic analysis and assessed the quantitative data using descriptive statistics. RESULTS: All groups expressed that mHealth could improve health behaviors. Older adults were optimistic that mHealth could track health. Participants believed they could improve patient insight into health, motivating change and assuring accountability. Barriers to using technology were described, including infrastructure. CONCLUSIONS: Older rural adults with obesity expressed excitement about the use of mHealth technologies to improve their health, yet barriers to implementation exist.

Older adults have been markedly impacted by the coronavirus disease 19 (COVID-19) pandemic. The American Geriatrics Society previously published a White Paper on Healthy Aging in 2018 that focused on a number of domains that are core to healthy aging in older adults: health promotion, injury prevention, and managing chronic conditions; cognitive health; physical health; mental health; and social health. The potentially devastating consequences of COVID-19 on health promotion are recognized. The purpose of this article is multifold. First, members of the Healthy Aging Special Interest Group will present the significant difficulties and obstacles faced by older adults during this unprecedented time. Second, we provide guidance to practicing geriatrics healthcare professionals overseeing the care of older adults. We provide a framework for clinical evaluation and screening related to the five aforementioned domains that uniquely impact older adults. Last, we provide strategies that could enhance healthy aging in the era of COVID-19.

Background Assessing functional ability is an important component of understanding healthy aging. Objective measures of functional ability include grip strength, gait speed, sit-to-stand time, and 6-min walk distance. Using samples from a weight loss clinical trial in older adults with obesity, we examined the association between changes in physical function and DNA-methylation-based biological age at baseline and 12 weeks in 16 individuals. Peripheral blood DNA methylation was measured (pre/post) with the Illumina HumanMethylationEPIC array and the Hannum, Horvath, and PhenoAge DNA methylation age clocks were used. Linear regression models adjusted for chronological age and sex tested the relationship between DNA methylation age and grip strength, gait speed, sit-to-stand, and 6-min walk. Results Participant mean weight loss was 4.6 kg, and DNA methylation age decreased 0.8, 1.1, and 0.5 years using the Hannum, Horvath, and PhenoAge DNA methylation clocks respectively. Mean grip strength increased 3.2 kg. Decreased Hannum methylation age was significantly associated with increased grip strength (β = −0.30, p = 0.04), and increased gait speed (β = 0.02, p = 0.05), in adjusted models. Similarly, decreased methylation age using the PhenoAge clock was associated with significantly increased gait speed (β = 0.02, p = 0.04). A decrease in Horvath DNA methylation age and increase in physical functional ability did not demonstrate a significant association. Conclusions The observed relationship between increased physical functional ability and decreased biological age using DNA methylation clocks demonstrate the potential utility of DNA methylation clocks to assess interventional approaches to improve health in older obese adults. Trial registration: National Institute on Aging (NIA), NCT03104192. Posted April 7, 2017, https://clinicaltrials.gov/ct2/show/NCT03104192

Objectives Pre-operative exercise may improve functional outcomes for lung cancer patients, but barriers associated with cost, resources, and burden make it challenging to deliver pre-operative exercise programs. The goal of this proof-of-concept study was to determine level of moderate-vigorous physical activity (MVPA) and change in aerobic capacity after participation in a home-based pre-operative exercise intervention. Materials and methods Eighteen patients scheduled for surgery for suspected stage I-III lung cancer received an exercise prescription from their surgeon and wore a commercially-available device that tracked their daily MVPA throughout the pre-operative period. Descriptive statistics were used to calculate adherence to the exercise prescription. A one-sample t-test was used to explore change in aerobic capacity from baseline to the day of surgery. Results Participants exhibited a mean of 20.4 (sd = 46.2) minutes of MVPA per day during the pre-operative period. On average, the sample met the goal of 30 min of MVPA on 16.4% of the days during the pre-operative period. The mean distance achieved at baseline for the 6-min walk test was 456.7 m (sd = 72.9), which increased to 471.1 m (sd = 88.4) on the day of surgery. This equates to a mean improvement of 13.8 m (sd = 37.0), but this difference was not statistically different from zero (p = 0.14). Eight of the 17 participants (47%) demonstrated a clinically significant improvement of 14 m or more. Conclusion A surgeon-delivered exercise prescription plus an activity tracker may promote clinically significant improvement in aerobic capacity and MVPA engagement among patients with lung cancer during the pre-operative period, but may need to be augmented with more contact with and support from practitioners over time to maximize benefits. Trial registration The study protocol was registered with ClinicalTrials.gov prior to initiating participant recruitment (NCT03162718).

Background Older adults with obesity residing in rural areas have reduced access to weight management programs. We determined the feasibility, acceptability and preliminary outcomes of an integrated technology-based health promotion intervention in rural-living, older adults using remote monitoring and synchronous video-based technology. Methods A 6-month, non-randomized, non-blinded, single-arm study was conducted from October 2018 to May 2020 at a community-based aging center of adults aged ≥65 years with a body mass index (BMI) ≥30 kg/m2. Weekly dietitian visits focusing on behavior therapy and caloric restriction and twice-weekly physical therapist-led group strength, flexibility and balance training classes were delivered using video-conferencing to participants in their homes. Participants used a Fitbit Alta HR for remote monitoring with data feedback provided by the interventionists. An aerobic activity prescription was provided and monitored. Results Mean age was 72.9±3.9 years (82% female). Baseline anthropometric measures of weight, BMI, and waist circumference were 97.8±16.3 kg, 36.5±5.2 kg/m2, and 115.5±13.0 cm, respectively. A total of 142 participants were screened (n=27 ineligible), and 53 consented. There were nine dropouts (17%). Overall satisfaction with the trial (4.7+ 0.6, scale: 1 (low) to 5 (high)) and with Fitbit (4.2+ 0.9) were high. Fitbit was worn an average of 81.7±19.3% of intervention days. In completers, mean weight loss was 4.6±3.5 kg or 4.7±3.5% (pp=0.005) but no differences were observed in gait speed or grip strength. Subjective measures of late-life function improved (3.4±4.7 points, p Conclusions A technology-based obesity intervention is feasible and acceptable to older adults with obesity and may lead to weight loss and improved physical function. Clinical trial registration Registered on Clinicaltrials.gov #NCT03104205. Registered on April 7, 2017. First participant enrolled on October 1st, 2018.

Objective The purpose of this study was to explore the feasibility, acceptability and perceived utility of the provision of a wearable fitness device and an exercise prescription from a surgeon, prior to surgery for lung cancer. Methods A single-arm, pre-post feasibility study was conducted with 30 participants scheduled for surgery to treat stage I, II or III lung cancer. Participants were given a Garmin Vivoactive HR device and a prescription for 150 min of moderately to vigorous exercise per week. Participants completed assessments on four occasions and completed a semi-structured interview on two occasions. Descriptive statistics were used to assess the feasibility and acceptability of study procedures, including synchronising the Garmin device and engaging in study assessments. Results Seventy-nine per cent of enrolled participants completed the pre-operative study activities. Seventy-one per cent of enrolled participants successfully synchronised their device during the pre-operative period. Data were transmitted from the device to the study team for an average of 70% of the pre-operative days. Conclusion This pilot study demonstrated the feasibility and acceptability of a pre-operative exercise program for patients scheduled to undergo surgery for lung cancer. Trial registration The study protocol was registered with ClinicalTrials.gov prior to the initiation of participant recruitment (NCT03162718).

Background Older persons with obesity aged 65+ residing in rural areas have reduced access to weight management programs due to geographic isolation. The ability to integrate technology into health promotion interventions shows a potential to reach this underserved population. Methods A 12-week pilot in 28 older rural adults with obesity (body mass index [BMI] ≥ 30 kg/m2) was conducted at a community aging center. The intervention consisted of individualized, weekly dietitian visits focusing on behavior therapy and caloric restriction with twice weekly physical therapist-led group strengthening training classes in a community-based aging center. All participants were provided a Fitbit Flex 2. An aerobic activity prescription outside the strength training classes was provided. Results Mean age was 72.9 ± 5.3 years (82% female). Baseline BMI was 37.1 kg/m2, and waist circumference was 120.0 ± 33.0 cm. Mean weight loss (pre/post) was 4.6 ± 3.2 kg (4.9 ± 3.4%; p < .001). Of the 40 eligible participants, 33 (75%) enrolled, and the completion rate was high (84.8%). Objective measures of physical function improved at follow-up: 6-minute walk test improved: 35.7 ± 41.2 m (p < .001); gait speed improved: 0.10 ± 0.24 m/s (p = .04); and five-times sit-to-stand improved by 2.1 seconds (p < .001). Subjective measures of late-life function improved (5.2 ± 7.1 points, p = .003), as did Patient-Reported Outcome Measurement Information Systems mental and physical health scores (5.0 ± 5.7 and 4.4 ± 5.0, both p < .001). Participants wore their Fitbit 93.9% of all intervention days, and were overall satisfied with the trial (4.5/5.0, 1–5 low–high) and with Fitbit (4.0/5.0). Conclusions A multicomponent obesity intervention incorporating a wearable device is feasible and acceptable to older adults with obesity, and potentially holds promise in enhancing health.

Older adults with obesity are at a high risk of decline, particularly in rural areas. Our study objective was to gain insights into how a potential Mobile Health Obesity Wellness Intervention (MOWI) in rural older adults with obesity, consisting of nutrition and exercise sessions, could be helpful to improve physical function. A qualitative methods study was conducted in a rural community, community-based aging center. Four community leaders, 7 clinicians and 29 patient participants underwent focus groups and semi-structured interviews. All participants had a favorable view of MOWI and saw its potential to improve health and create accountability. Participants noted that MOWI could overcome geographic barriers and provided feedback about components that could improve implementation. There was expressed enthusiasm over its potential to improve health. The use of technology in older adults with obesity in rural areas has considerable promise. There is potential that this intervention could potentially extend to distant areas in rural America that can surmount accessibility barriers. If successful, this intervention could potentially alter healthcare delivery by enhancing health promotion in a remote, geographically constrained communities. MOWI has the potential to reach older adults with obesity using novel methods in geographically isolated regions.

This study was a 12-week feasibility weight-loss intervention consisting of caloric restriction and aerobic/resistance exercise in older adults with obesity (body mass index ≥ 30kg/m(2)) in a geographically isolated area. Primary outcomes assessed weight and physical function. Mean age was 71.0±5.1years (67% female). Individuals completed 100% of all assessments, attended 88% of the physical therapy classes and 89% of the nutrition sessions. Level of satisfaction (5-point Likert) was high (5.0, 1 – low; 5 - high). Weight decreased from 93.7±9.7 to 89.4±4.0kg (p

OBJECTIVE: Body composition changes with aging can increase rates of obesity, frailty and impact function. Measuring adiposity using body fat (%BF) or central adiposity using waist circumference (WC) have greater diagnostic accuracy than traditional measures such as body mass index (BMI). DESIGN: This is an observational study SETTING: This study focused on older community-dwelling participants PARTICIPANTS: We identified individuals age ≥ 60 years old using the 1999–2004 cross-sectional National Health and Nutrition Survey (NHANES). INTERVENTION: The primary analysis evaluated the association between frailty and %BF or WC. Frailty was the primary predictor (robust=referent) and %BF and WC were considered continuous outcomes. Multiple imputation analyses accounted for missing characteristics. MEASUREMENT: Dual energy x-ray absorptiometry was used to assess %BF and WC was objectively measured. Frailty was defined using an adapted version of Fried’s criteria that was self-reported: (low BMI

Objective: To compare estimates of the prevalence of mobility and physical function limitations by race and ethnicity using data from the Medical Expenditure Panel Survey (MEPS). Method: The sample comprised of 28,854 adults aged ≥60 from the MEPS (2004-2013). Physical function (limitations in basic and instrumental activities of daily living [ADL/IADL]) and mobility limitations were assessed by self-report. Results: Non-Hispanic Whites (NHWs) represented the majority of the sample followed by non-Hispanic Blacks (NHBs), Hispanic and non-Hispanic Other (Other). For mobility limitation, NHBs had the highest prevalence followed by NHWs and Hispanics (33.3%, 28.6%, and 26.2%, respectively). Multivariable logistic regression analyses were performed for the primary outcome of mobility limitation. In the adjusted model, Hispanics had lower odds of mobility limitations (prevalence odds ratio [POR]: 0.78; 95% confidence interval [CI] = [0.67,0.91]) compared with NHWs. For ADL limitations, NHBs had higher odds of having ADLs (POR: 1.87; 95% CI = [1.44, 2.44]) when compared with NHWs. Conclusion: This article evaluated the influence of race and ethnicity, on the prevalence of mobility and functional limitations that are not always consistent with expected racial and ethnic differences.

Aiming to assess the association between measures of obesity and outcomes in coronary artery disease (CAD) patients. We included consecutive patients referred to cardiac rehabilitation because of prior CAD events, who were classified using BMI groups and sex-specific tertiles of waist-to-hip ratio (WHR). Follow-up was ascertained using a population-based, record linkage system that consists of complete data on all residents. A major cardiovascular event (MACE) was defined as the composite outcome including acute coronary syndromes, coronary revascularization, ventricular arrhythmias, stroke or death from any cause. The association between obesity measures and MACE was assessed using cox proportional hazards models adjusted for potential confounders. The cohort included 1529 patients (74% men) mean age ± SD 63.1±12.5 years, 40% were obese by BMI. Eighty-eight percent of men and 57% of women were classified as having central obesity by WHR. Median follow-up was 5.7 years and 415 patients had a MACE event. After adjustment, a high WHR tertile was a significant predictor for MACE in women (HR=1.85 [95% Cl: 1.16, 2.94]; p=0.01), but not in men (HR=0.92 [95%CI: 0.69, 1.22]; p=0.54). This relationship in women persisted after further adjustment for BMI (HR=1.75 [95%CI: 1.07, 2.87]; p=0.03). Obesity by BMI was not associated with MACE in either men (HR=1.07 [95%CI: 0.76, 1.51]; p=0.69) or women (HR=0.98 [95%CI: 0.62, 1.56]; p=0.95). In conclusion WHR is associated with a higher risk of MACE among women with CAD but not in men. There was no obesity paradox when assessing obesity by BMI and MACE in CAD patients when including non-fatal events.

Telomere shortening is associated with age and risk of medical comorbidity. We assessed the relationship between measures of adiposity, leukocyte telomere length, and mortality and whether it is modified by age. Subjects with dual-energy X-ray absorptiometry measures were identified using the National Health and Nutrition Examination Survey 1999–2002. Obesity was categorized using two body fat definitions (BF1%: men ⩾25%; females ⩾35%; BF2% ⩾28% and ⩾38%, respectively), body mass index (BMI) and waist circumference (WC; men ⩾102 cm; females ⩾88 cm). Telomere length relative to standard reference DNA (T/S ratio) was assessed using quantitative PCR. Weighted multivariable regression models evaluated the association of telomere length with adiposity, both continuously and categorically (low/normal BF%, low/high WC and standard BMI categories). Differences in telomere length by age and adiposity were ascertained and subsequent models were stratified by age. Proportional hazard models assessed the risk of mortality by adiposity status. A telomere by adiposity interaction was tested in the entire cohort and by age category (

BACKGROUND: Food insecurity refers to the physical, social, and economic inability to access and secure sufficient, safe and nutritious food. Food insecurity has been found to be associated with poor health status, obesity, and chronic disease. To date, a relationship between food insecurity and functional limitations has not been described in of older adults. METHODS: We examined 9,309 adults ≥60 years old from the 2005–2014 National Health and Nutrition Examination Surveys (NHANES). Food security was categorized as full, marginal, low, and very low. Functional limitations were assessed as having difficulty in physical, basic or instrumental activities of daily living. RESULTS: Of adults ≥60 years old (mean age: 70.5±0.08, 51% female), the prevalence of full, marginal, low, or very low food insecurity was 7,572 (81%), 717 (7%), 667 (8%), and 353 (4%), respectively. The prevalence of any functional limitations was 5,895 (66.3%). The adjusted odds (OR [95%CI]) of having any functional limitation in marginal, low, and very low food security levels compared to full food security are: 1.08 [1.02–1.13], 1.16 [1.10–1.22], 1.14 [1.07–1.21], respectively. The association between levels of food insecurity and functional limitation is modified by race/ethnicity. CONCLUSIONS: Functional limitation is significantly associated with increasing food insecurity in older adults.

Food insecurity refers to restricted or uncertain access to and ineffective utilization of nutritious and safe foods. Although food insecurity is linked to poorer physical health consequences among older adults, national estimates are not well known on food insecurity and depression. Using the 2005–2014 National Health and Nutrition Examination Survey, this study examines the associations between varying food insecurity levels and clinically relevant depressive symptoms (defined by PHQ-9≥10) among adults ≥60 years old (n=7,969). Rates of clinically relevant depressive symptoms in marginal, low, and very low food security were 12.3%, 16.3%, and 25.2%, respectively. Marginal, low, and very low food security were significantly associated with clinically relevant depressive symptoms: odds ratio (OR)=1.12 (95% confidence intervals [CI] 1.07–1.18), OR=1.07 (95% CI 1.03–1.12), and OR=1.24 (95% CI 1.16–1.32), respectively. Given the intersection of food insecurity and depression, geriatric health professionals should work to improve health and nutrition programs for older adults at risk for or experiencing both public health concerns.

Bariatric surgery is the most effective approach to treating morbid obesity, resulting in decreased morbidity, mortality, and improved quality of life. Research on outcomes has generally been restricted to young and middle-aged adults, despite a growing epidemic of obesity in older adults. The use of bariatric surgery has been limited in older individuals, in part due to concerns that pre-existing cognitive dysfunction increases the risk of poor post-surgical outcomes, including cognitive decline. The literature on the relationship between obesity and cognition in older adults is emerging, but fraught by several methodological limitations. While there is insufficient research to determine the nature of cognitive outcomes following bariatric surgery in older adults, the aim of this paper is to review the existing evidence and make the case for further study.

This study sought to determine whether the association between varying levels of physical activity (PA) and all-cause and cardiovascular mortality differ by race/ethnicity in older adults.The sample comprised 2520 women and 2398 men drawn from National Health and Nutrition Examination Survey III (1988-1994) aged ≥ 60 years. We used the metabolic equivalent (MET) of self-reported PA levels to define activity groups (inactive: those who did not report any PA; active: those who reported 3-6 METs for ≥5 times/week or6 METs, ≥3 times/week; insufficiently active: those meeting neither criteria). Racial/Ethnic differences were modeled using proportional hazard regression (HR) adjusting for age, education, smoking, diabetes, and hypertension.Among those classified as inactive, Non-Hispanic Blacks (NHB) (HR: 0.72, 95% CI: 0.58-0.90) and Mexican Americans (HR: 0.59, 95%CI: 0.45-0.78) had a lower risk of all-cause mortality when compared to non-Hispanic Whites (NHW). Among those classified as insufficiently active, Mexican Americans (HR: 0.63, 95% CI: 0.51-0.77), but not NHB (HR: 0.81, (95% CI: 0.64-1.02) had a lower risk of all-cause mortality when compared to NHWs Similar results were observed for cardiovascular mortality.Overall, PA in the elderly (either insufficient or active) is associated with a lower all-cause mortality across all race/ethnic groups as compared to NHW. Further investigation, including studies with larger sample, is needed to address the health consequences of varying degrees of PA in ethnically diverse populations.

Background/Objectives Determine the prevalence of muscle weakness using the two 2014 Foundation for the National Institutes of Health (FNIH) Sarcopenia Project criteria and its relationship to physical limitations, basic and instrumental activities of daily living (ADL). Subjects/Methods We performed a cross-sectional analysis of community-dwelling adults from the Health and Retirement Study 2006-2008 and identified a subsample of 5,092 adults aged ≥60 years with grip strength data. Self-reported physical limitations, basic and instrumental activities of daily living (ADL) were assessed. Criteria for grip strength (GS) (men

Background: Malnutrition in elderly inpatients hospitalized on medical wards is a significant public health concern. The aim of this study was to investigate nutritional markers as mortality predictors following discharge in hospitalized medical elderly patients. Materials and methods: This is a prospective observational cohort study with follow-up of 48 months. Two hundred and twenty-five individuals aged 60 and older admitted from the hospital emergency room in the past 48 h were investigated at the medical ward in the University hospital in Palermo (Italy). Anthropometric and clinical measurements, Mini-nutritional Assessment (MNA) questionnaire, bioelectrical (BIA) phase angle (PA), grip strength were obtained all within 48 h of admission. Mortality data were verified by means of mortality registry and analysed using Cox-proportional hazard models. Results: Ninety (40%) participants died at the end of follow-up. There were significant relationships between PA, MNA score, age and gender on mortality. Patients in the lowest tertile of PA (< 4·6°) had higher mortality estimates [I vs II tertile: hazard ratio (HR) = 3·40; 95% confidence interval (CI): 2·01–5·77; II vs III tertile: HR = 3·83; 95% CI: 2·21–6·64; log-rank test: χ2 = 43·6; P < 0·001]. Similarly, the survival curves demonstrated low MNA scores (< 22) were associated with higher mortality estimates (HR = 1·85; 95% CI: 1·22–2·81 χ2 = 8·2; P = 0·004). Conclusions: The MNA and BIA-derived phase angle are reasonable tools to identify malnourished patients at high mortality risk and may represent useful markers in intervention trials in this high-risk subgroup.

The Foundation for the National Institutes of Health Sarcopenia Project validated cutpoints for appendicular lean mass (ALM) to identify individuals with functional impairment. We hypothesized that the prevalence of sarcopenia and sarcopenic obesity would be similar based on the different Foundation for the National Institutes of Health criteria, increase with age, and be associated with risk of impairment limitations. We identified 4984 subjects at least 60 years of age from the National Health and Nutrition Examination Surveys 1999-2004. Sarcopenia was defined using ALM (men19.75 kg, women15.02 kg) and ALM adjusted for body mass index (BMI; men0.789 kg/m2, women0.512 kg/m2). Sarcopenic obesity is defined as subjects fulfilling the criteria for sarcopenia and obesity by body fat (men ≥25%, women ≥35%). Prevalence rates of both sarcopenia and sarcopenic obesity were evaluated with respect to sex, age category (60-69, 70-79, and80 years) and race. We assessed the association of physical limitations, basic and instrumental activities of daily living and sarcopenia status. The mean age was 70.5 years in men and 71.6 years in women. Half (50.8%; n = 2531) were female, and mean BMI was 28 kg/m2 in both sexes. Appendicular lean mass was higher in men than in women (24.1 vs. 16.3; P.001), but fat mass was lower (30.9 vs. 42.0; P.001). In men, sarcopenia prevalence was 16.0% and 27.8% using the ALM and ALM/BMI criteria. In women, prevalence was 40.5% and 19.3% using the ALM and ALM/BMI criteria. Sarcopenia was associated with a 1.10 (0.86-1.41) and 0.93 (0.74-1.16), and 1.46 (1.10-1.94), and 2.13 (1.41-3.20) risk of physical limitations using the ALM and ALM/BMI definitions in men and women, respectively. Prevalence of sarcopenia and sarcopenic obesity varies greatly, and a uniform definition is needed to identify and characterize these high-risk populations.

Background Sarcopenia, defined as the age-associated loss of muscle mass and strength, can be effectively mitigated through resistance-based physical activity. With compliance at approximately 40% for home-based exercise prescriptions, implementing a remote sensing system would help patients and clinicians to better understand treatment progress and increase compliance. The inclusion of end users in the development of mobile apps for remote-sensing systems can ensure that they are both user friendly and facilitate compliance. With advancements in natural language processing (NLP), there is potential for these methods to be used with data collected through the user-centered design process. Objective This study aims to develop a mobile app for a novel device through a user-centered design process with both older adults and clinicians while exploring whether data collected through this process can be used in NLP and sentiment analysis Methods Through a user-centered design process, we conducted semistructured interviews during the development of a geriatric-friendly Bluetooth-connected resistance exercise band app. We interviewed patients and clinicians at weeks 0, 5, and 10 of the app development. Each semistructured interview consisted of heuristic evaluations, cognitive walkthroughs, and observations. We used the Bing sentiment library for a sentiment analysis of interview transcripts and then applied NLP-based latent Dirichlet allocation (LDA) topic modeling to identify differences and similarities in patient and clinician participant interviews. Sentiment was defined as the sum of positive and negative words (each word with a +1 or −1 value). To assess utility, we used quantitative assessment questionnaires—System Usability Scale (SUS) and Usefulness, Satisfaction, and Ease of use (USE). Finally, we used multivariate linear models—adjusting for age, sex, subject group (clinician vs patient), and development—to explore the association between sentiment analysis and SUS and USE outcomes. Results The mean age of the 22 participants was 68 (SD 14) years, and 17 (77%) were female. The overall mean SUS and USE scores were 66.4 (SD 13.6) and 41.3 (SD 15.2), respectively. Both patients and clinicians provided valuable insights into the needs of older adults when designing and building an app. The mean positive-negative sentiment per sentence was 0.19 (SD 0.21) and 0.47 (SD 0.21) for patient and clinician interviews, respectively. We found a positive association with positive sentiment in an interview and SUS score (ß=1.38; 95% CI 0.37 to 2.39; P=.01). There was no significant association between sentiment and the USE score. The LDA analysis found no overlap between patients and clinicians in the 8 identified topics. Conclusions Involving patients and clinicians allowed us to design and build an app that is user friendly for older adults while supporting compliance. This is the first analysis using NLP and usability questionnaires in the quantification of user-centered design of technology for older adults.

BACKGROUND: Self-reported weight change may lead to adverse outcomes. We evaluated weight change with cutpoints of low lean mass (LLM) in older adults. METHODS: Of 4,984 subjects ≥60 years from NHANES 1999-2004, we applied LLM cutoffs of appendicular lean mass (ALM):body mass index (BMI) males

Sarcopenia is a gradual loss of muscle mass and strength that occurs with aging. This muscle deterioration is linked to increased morbidity, disability, and other adverse outcomes. Although reduced handgrip strength can be considered a marker of sarcopenia and other aging-related decline in the elderly, there is limited research on this physical health problem in at-risk groups with common biopsychosocial conditions such as depression. Our primary objective was to ascertain level of combined handgrip strength and its relationship with depression among adults aged 60 years and older. Unadjusted and adjusted linear regression models were conducted with a cross-sectional survey dataset. Secondary dataset from the 2011–2014 National Health and Nutrition Examination Survey (NHANES). Community-dwelling, noninstitutionalized adults ≥60 years old (n=3,421). The predictor variables included a positive screen for clinically relevant depression (referent=PHQ-9 score

The prevalence of obesity in combination with sarcopenia (the age-related loss of muscle mass and strength or physical function) is increasing in adults aged 65 years and older. A major subset of adults over the age of 65 is now classified as having sarcopenic obesity, a high-risk geriatric syndrome predominantly observed in an ageing population that is at risk of synergistic complications from both sarcopenia and obesity. This Review discusses pathways and mechanisms leading to muscle impairment in older adults with obesity. We explore sex-specific hormonal changes, inflammatory pathways and myocellular mechanisms leading to the development of sarcopenic obesity. We discuss the evolution, controversies and challenges in defining sarcopenic obesity and present current body composition modalities used to assess this condition. Epidemiological surveys form the basis of defining its prevalence and consequences beyond comorbidity and mortality. Current treatment strategies, and the evidence supporting them, are outlined, with a focus on calorie restriction, protein supplementation and aerobic and resistance exercises. We also describe weight loss-induced complications in patients with sarcopenic obesity that are relevant to clinical management. Finally, we review novel and potential future therapies including testosterone, selective androgen receptor modulators, myostatin inhibitors, ghrelin analogues, vitamin K and mesenchymal stem cell therapy.

OBJECTIVE: To identify the strategies peer specialists use to provide illness self-management support for older adults with serious mental illness (SMI) through text messaging. METHODS: Transcripts of text message exchanges were analyzed between eight older adult participants with SMI who completed the PeerTECH intervention and three older adult certified peer specialists who delivered the 12-week program. Text message analyses explored themes relevant to peer support and health behavior change. Quantitative data comprised frequency of text messages by either the peer or consumer. RESULTS: Consumers (N=8) had a mean age of 68.8 years (SD=4.9) and were mainly women (88%), White (100%), and married (75%). Certified peer specialists (N=3) were all aged 55 years or older, 100% were female, and 66% identified as White and 33% identified as African-American. Overall, peers sent 215 text messages while consumers sent 141 text messages. We identified four themes in the peer specialist-consumer text message exchanges on different aspects of illness self-management, including health behavior change, self-management therapeutic techniques, engagement in health technology, and peer support. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This exploratory qualitative study offers preliminary support that peers are able to use text messages to support the delivery of a peer-delivered home-based medical and psychiatric self-management intervention. Certified peer specialists can potentially provide a range of illness self-management support to older adults with SMI via text messaging. These findings will inform the development of standardized peer text messaging services to augment evidence-based illness self-management interventions for older adults with SMI. IMPACT: This study offers preliminary support that certified peer specialists’ services can potentially be advanced with the use of text messaging to provide illness self-management support to older adults with SMI.

Objectives To compare the ability of frailty status to predict fall risk with that of community fall risk screening tools. Design Analysis of cross‐sectional and longitudinal data from NHATS. Setting National Health and Aging Trend Study (NHATS) 2011‐2015. Participants Individuals aged 65 and older (N = 7,392). Measurements Fall risk was defined according to the Stopping Elderly Accidents, Deaths and Injuries (STEADI) initiative. Frailty was defined as exhaustion, weight loss, low activity, slow gait speed, and weak grip strength. Robust was defined as meeting 0 criteria, prefrailty as 1 or 2 criteria, and frailty as 3 or more criteria. Falls were self‐reported and ascertained using NHATS subsequent rounds (2012–2015). We compared the ability of frailty to predict future falls with that of STEADI score, adjusting for age, race, sex, education, comorbidities, hearing and vision impairment, and disability. Results Of the 7,392 participants (58.5% female), there 3,545 (48.0%) were classified as being at low risk of falling, 2,966 (40.1%) as being at moderate risk, and 881 (11.9%) as being at high risk. The adjusted risk of falling over the 4 subsequent years was 2.5 times as great for the moderate‐risk group (hazard ratio (HR) = 2.50, 95% confidence interval (CI) = 2.16–2.89) and almost 4 times as great (HR = 3.79, 95% CI = 2.76–5.21) for the high‐risk group as for the low‐risk group. Risk of falling was greater for those who were prefrail (HR = 1.34, 95% CI 1.16–1.55) and frail (HR = 1.20, 95% CI = 0.94–1.54) than for those who were robust. Conclusion STEADI score is a strong predictor of future falls. Addition of frailty status does not improve the ability of the STEADI measure to predict future falls.

Objectives To determine the relationship between frailty and overall and cardiovascular mortality. Design Longitudinal mortality analysis. Setting National Health and Nutrition Examination Survey (NHANES) 1999–2004. Participants Community‐dwelling older adults aged 60 and older (N = 4,984; mean age 71.1 ± 0.19, 56% female). Measurements We used data from 1999–2004 cross‐sectional NHANES and mortality data from the National Death Index, updated through December 2011. An adapted version of Fried's frailty criteria was used (low body mass index, slow walking speed, weakness, exhaustion, low physical activity). Frailty was defined as persons meeting 3 or more criteria, prefrailty as meeting 1 or 2 criteria, and robust (reference) as not meeting any criteria. The primary outcome was to evaluate the association between frailty and overall and cardiovascular mortality. Cox proportional hazard models were used to evaluate the association between risk of death and frailty category adjusted for age, sex, race, smoking, education, coronary artery disease, heart failure, nonskin cancer, diabetes, and arthritis. Results Half (50.4%) of participants were classified as robust, 40.3% as prefrail, and 9.2% as frail. Fully adjusted models demonstrated that prefrail (hazard ratio (HR) = 1.64, 95% confidence interval (CI) = 1.45–1.85) and frail (HR = 2.79, 95% CI = 2.35–3.30) participants had a greater risk of death and of cardiovascular death (prefrail: HR = 1.84, 95% CI = 1.45–2.34; frail: HR = 3.39, 95% CI = 2.45–4.70). Conclusion Frailty and prefrailty are associated with increased risk of death. Demonstrating the association between prefrail status and mortality is the first step to identifying potential targets of intervention in future studies.

Summary Background Obesity recognition in primary care is important to address the epidemic. We aimed to evaluate primary care clinician-reported documentation, management practices, beliefs and attitudes toward obesity compared to body mass index (BMI) calculation, obesity prevalence and actual documentation of obesity as an active problem in electronic health record in a rural academic center. Methods Our target population for previously validated clinician survey was 56 primary care providers working at 3 sites. We used calendar year 2012 data for assessment of baseline system performance for metrics of documentation of BMI in primary care visits, and proportion of visits in patients with obesity with obesity as a problem. Standard statistical methods assessed the data. Results Survey response rate was 91%. Average age of respondents was 48.9 years and 62.7% were females. 72.5% clinicians reported having normal BMI. The majority of clinicians reported regularly documenting obesity as an active problem, and utilized motivational interviewing and basic good nutrition and healthy exercise. Clinicians identified lack of discipline and exercise time, access to unhealthy food and psychosocial issues as major barriers. Most denied disliking weight loss discussion or patients taking up too much time. In 21,945 clinic visits and 11,208 annual preventive care visits in calendar year 2012, BMI was calculated in 93% visits but obesity documentation as an active problem only 27% of patients meeting BMI criteria for obesity. Conclusions Despite high clinician-reported documentation of obesity as an active problem, actual obesity documentation rates remained low in a rural academic medical center.

Physical activity (PA) improves function in older obese adults. However, body mass index is an unreliable adiposity indicator better reflected by waist circumference (WC). The impact of PA on physical impairment and mobility with high WC is unclear. We performed a secondary data analysis of 4,976 adults ≥ 60 years of age using the National Health and Nutrition Examination Survey (NHANES) 2005–2010. Physical limitations (PL), activities of daily living (ADL) impairments, and PA (low = < 1 day/week or high = > 1 day/week) were self-reported. WC was dichotomized (females: 88 cm; males: 102 cm). Mean age was 70.1 years and 55.1% were female. Prevalence of PL and ADL impairment in the high WC group were 57.7% and 18.8%, respectively, and high PA was present in 53.9%. Among those with high WC, high PA vs. low PA participants were at lower risk of PL (OR 0.58 [0.48−0.70]) and ADL impairment (OR 0.46 [0.32−0.65]). Those with high WC had higher odds of PL irrespective of PA (high PA: OR 1.57 [1.30−1.88]; low PA: OR 1.52 [1.29−1.79]) and ADL impairment (high PA: OR 1.27 [1.02−1.57] and low PA: OR 1.24 [0.99−1.54]). High PA in viscerally obese individuals is associated with impairments.

Objective To determine whether leptin is related to all-cause and cardiovascular (CV) mortality in older adults. Patients and Methods Participants 60 years and older with plasma leptin level measurements from the National Health and Nutrition Examination Survey III (1988-1994) and mortality data linked to the National Death Index were included. We created sex-specific tertiles of leptin (men: 4.2-7.7 μg/L; women: 11.5-21.4 μg/L) to identify the effect of leptin on all-cause and CV mortality. We also determined whether leptin predicted mortality in patients with obesity. We classified obesity using 4 possible definitions: body mass index 30 kg/m 2 or greater; body fat 25% or more in men and 35% or more in women; waist circumference 102 cm or greater in men and 88 cm or greater in women; and waist-hip ratio 0.85 or higher in women and 0.95 or higher in men. Sex-specific proportional hazard models were used to assess the effect of leptin on all-cause and CV mortality. Results Of 1794 participants, 51.6% were women; the mean age was 70.3±0.4 years, and the follow-up period was 12.5 years with 994 deaths (469 were CV deaths). All-cause mortality in the highest leptin tertile was significant neither in men (hazard ratio [HR], 1.23; 95% CI, 0.93-1.63) nor in women (HR, 0.97; 95% CI, 0.68-1.40). CV mortality was the highest in the highest leptin tertile in men (HR, 1.69; 95% CI, 1.06-2.70) but not in women (HR, 1.21; 95% CI, 0.73-1.98). Evaluating the effect of leptin in subgroups of different obesity definitions, we found that high leptin levels as predict CV mortality in men as measured by waist circumference or body fat. Conclusion Elevated leptin level is predictive of CV mortality only in men. Leptin may provide additional mortality discrimination in obese men.

Objective To compare patient experience with healthcare services and providers among older patients (≥50 years old) with and without serious mental illness. Methods Using secondary data from the Medical Expenditures Panel Survey from 2003 through 2013, we compared adults aged 50 years and older with schizophrenia spectrum disorder ( n = 106), mood disorders (i.e., major depressive disorder and bipolar disorder) ( n = 419), and no serious mental illness ( n = 34,921). Results Older adults with schizophrenia spectrum disorder reported significantly worse provider communication than older adults without serious mental illness. Older adults with mood disorders reported the greatest barriers to shared decision-making and the greatest difficulty accessing services. Conclusions Our results highlight the need to improve the patient experience of older adults with serious mental illness. Addressing provider communication, shared decision-making, and access to care among this vulnerable group of older adults may impact clinical outcomes and costs. Future research examining the extent to which improving the patient experience may improve health outcomes and enhance treatment for this highly vulnerable older group is warranted.

The prevalence of obesity continues to rise in the United States and impacts on morbidity, mortality and overall costs in health care considerably. In 2013–2014, more than one-third (37.9%) of U.S. adults were classified as obese, and the prevalence of those with a body mass index (BMI) ≥40kg/m2, was 7.7%. (1) The heaviest groups (BMI ≥50kg/m2) increases in prevalence at the fastest rates. (2) Pertinent to healthcare providers—the larger the patient, the more health care resources utilized and the worse the survival. (3) Having a BMI >40kg/m2 predicts use of more than double the healthcare dollars of a normal weight individual. (4) Providing care to individuals with severe obesity is complex, as the physiologic changes associated with morbid and super obesity alter the pharmacokinetic properties of most drugs. (5) Derangements in cardiovascular and respiratory physiology make the patients with morbid obesity more vulnerable to drug-induced respiratory depression and upper airway obstruction, thus increasing the risk of treating them with opioids. In reviewing the literature, it appears that much of what is understood regarding the care of patients with super obesity must be extrapolated from what is known regarding the morbidly obese, a group that has been studied more frequently. The term “super obesity” has been used variably, but defined often as weighing 150 pounds or more than ideal body weight or having a BMI ≥50kg/m. (6) Herein we present a case of a patient with a BMI of 100kg/m2 admitted with uncontrolled pain due to large necrotic skin ulcers from nonuremic calciphylaxis. Through this case, we review the limitations of data regarding pharmacologic properties for those with super obesity, and provide palliative medicine providers with a framework for such management.

Objective Arthritis and depressive symptoms often interact and negatively influence one another to worsen mental and physical health outcomes. Better characterization of arthritis rates among older adults with different levels of depressive symptoms is an important step toward informing mental health professionals of the need to detect and respond to arthritis and related mental health complications. The primary objective is to determine arthritis rates among US older adults with varying degrees of depression. Methods Using National Health and Nutrition Examination Survey 2011 to 2014 data (N = 4792), we first identified participants aged ≥50 years. Measures screened for depressive symptoms and self-reported doctor-diagnosed arthritis. Weighted logistic regression models were conducted. Results Prevalence of arthritis was 55.0%, 62.9%, and 67.8% in participants with minor, moderate, and severe depression, respectively. In both unadjusted and adjusted regression models, a significant association between moderate depression and arthritis persisted. There were also significant associations between minor and severe depression with arthritis. Conclusions Arthritis is commonly reported in participants with varying degrees of depression. This study highlights the importance of screening for and treating arthritis-related pain in older adults with depressive symptoms and the need for future geriatric psychiatry research on developing integrated biopsychosocial interventions for these common conditions.

Patient-centeredness is an important factor in patient health and engagement but its association in patients with obesity is not thoroughly understood. Of 28,854 participants aged ≥60 from the Medical Expenditure Panel Survey 2004-2013, we evaluated four patient-centered domains: patient/provider relationship, shared-decision making, access to care, overall medical care provider rating, and prescription care. Weighted logistic (OR [95% CI]) and linear (β±s.e.; p-value) regression models demonstrated that participants as having obesity reported a marginally higher delay in getting the necessary care than healthy BMI (OR 1.25 [1.01, 1.53]). Older adults with obesity report reduced perceived access to care.

Background Sarcopenia is defined as the loss of muscle mass or function with aging and is associated with adverse outcomes. Telomere shortening is associated with mortality, yet its relationship with sarcopenia is unknown. Methods Adults ≥60 years from the 1999–2002 NHANES with body composition measures were identified. Sarcopenia was defined using the two Foundation for the National Institute of Health definitions: appendicular lean mass (ALM) (men

Background The Foundation for the NIH Sarcopenia Project validated cutpoints for appendicular lean mass. We ascertained the relationship between low lean mass (LLM), obesity, and mortality and identified predictors in this subgroup. Methods A total of 4,984 subjects aged 60 years and older were identified from the National Health and Nutrition Examination Survey 1999-2004 linked to the National Death Index. LLM was defined using reduced appendicular lean mass (men < 19.75 kg; females < 15.02 kg). Obesity was defined using dual-energy x-ray absorptiometry body fat (males ≥ 25%; females ≥ 35%). LLM with obesity was defined using criteria for both LLM and obesity. Proportional hazard models determined mortality risk for LLM and LLM with obesity, separately (referent = no LLM and no LLM with obesity, respectively). Results Mean age was 71.1 ± 0.19 years (56.5% female). Median follow-up was 102 months (interquartile range: 78, 124) with 1,901 deaths (35.0%). Prevalence of LLM with obesity was 33.5% in females and 12.6% in males. In those with LLM, overall mortality risk was 1.49 (1.27, 1.73) in males and 1.19 (1.02, 1.40) in females. Mortality risk in LLM with obesity was 1.31 (1.11, 1.55) and 0.99 (0.85, 1.16) in males and females, respectively. Age, diabetes, history of stroke, congestive heart failure, cancer, and kidney disease were predictive of death. Conclusions Risk of death is higher in subjects with LLM than with LLM and obesity. Having advanced age, diabetes, stroke, heart failure, cancer, and renal disease predict a worse prognosis in both classifications.

Background The growing prevalence of obesity is paralleling a rise in the older adult population creating an increased risk of functional impairment, nursing home placement and early mortality. The Centers for Medicare and Medicaid recognized the importance of treating obesity and instituted a benefit in primary care settings to encourage intensive behavioral therapy in beneficiaries by primary care clinicians. This benefit covers frequent, brief, clinic visits designed to address older adult obesity. Discussion We describe the challenges in the implementation and delivery into real-world settings. The challenges in rural settings that have the fastest growing elderly population, high obesity rates, but also workforce shortages and lack of specialized services are emphasized. The use of Telemedicine has successfully been implemented in other specialties and could be a useful modality in delivering much needed intensive behavioral therapy, particularly in distant, under-resourced environments. This review outlines some of the challenges with the current benefit and proposed solutions in overcoming rural primary care barriers to implementation, including changes in staffing models. Conclusions Recommendations to extend the benefit’s coverage to be more inclusive of non-physician team members is needed but also for improvement in reimbursement for telemedicine services for older adults with obesity.

Obesity is a multifactorial syndrome and the likelihood of success of a medical nutritional treatment (MNT) over the long term is low. As psychological and behavioural factors have an important role in both pathogenesis and the treatment of obesity, these issues were investigated in individuals with obesity who reported a long-term success or a failure in terms of weight loss following a MNT. Eighty-eight individuals of an original cohort of 251 subjects were re-evaluated 10 years after a MNT with cognitive-behavioural approach for uncomplicated obesity. Fifty-three participants were classified as failure (body weight change ≥0.5 kg) and 35 as a success (10-year body weight change

Obesity is a risk factor for heart failure (HF), but the benefit of weight loss in HF is unknown. We assessed the effects of bariatric surgery (BSx) compared to non-operative treatment for morbid obesity on overall quality of life (QoL), functional capacity, and symptoms in 13 HF patients undergoing BSx and six HF patients treated without surgery. In the BSx group, median age was 62, body mass index (BMI) was 55 kg/m(2), and 5/13 were males; in the non-operative group, median age was 69, BMI was 42 kg/m(2), and 1/6 were male. Median follow-up was 4.3 and 2.7 years, respectively. At follow-up, BMI was less in the BSx group (35 vs 47 kg/m(2), p0.001); QoL (p0.01), frequency of exertional dyspnea (p = 0.01), and leg edema (p = 0.04) improved only in the BSx group. BSx induced weight loss and improved QoL and symptoms in morbidly obese patients with HF.

Objectives To evaluate whether the Hospital Admission Risk Profile (HARP) score is associated with skilled nursing or acute rehabilitation facility discharge after an acute hospitalization. Design Retrospective cohort study. Setting Inpatient unit of a rural academic medical center. Participants Hospitalized individuals aged 70 and older from October 1, 2013 to June 1, 2014. Measurements Participant age at the time of admission, modified Folstein Mini-Mental State Examination score, and self-reported instrumental activities of daily living 2 weeks before admission were used to calculate HARP score. The primary predictor was HARP score, and the primary outcome was discharge disposition (home, facility, deceased). Multivariate analysis was used to evaluate the association between HARP score and discharge disposition, adjusting for age, sex, comorbidities, and length of stay. Results Four hundred twenty-eight individuals admitted from home were screened and their HARP scores were categorized as low (n = 162, 37.8%), intermediate (n = 157, 36.7%), or high (n = 109, 25.5%). Participants with high HARP scores were significantly more likely to be discharged to a facility (55%) than those with low HARP scores (20%) (P < .001). After adjustment, participants with high HARP scores were more than four times as likely as those with low scores to be discharged to a facility (odds ratio = 4.58, 95% confidence interval = 2.42–8.66). Conclusion In a population of older hospitalized adults, HARP score (using readily available admission information) identifies individuals at greater risk of skilled nursing or acute rehabilitation facility discharge. Early identification for potential facility discharges may allow for targeted interventions to prevent functional decline, improve informed shared decision-making about post-acute care needs, and expedite discharge planning.

To ascertain whether rural status impacts self-reported health and whether the effect of rural status on self-reported health differs by obesity status.We identified 22,307 subjects aged ≥60 from the Medical Expenditure Panel Survey 2004-2013. Body mass index (BMI) was categorized as underweight, normal, overweight, or obese. Physical and mental component scores of the Short Form-12 assessed self-reported health status. Rural/urban status was defined using metropolitan statistical area. Weighted regression models ascertained the relative contribution of predictors (including rural and BMI) on each subscale.Mean age was 70.7 years. Rural settings had higher proportions classified as obese (30.7 vs 27.6%; P.001), and rural residents had lower physical health status (41.7 ± 0.3) than urban (43.4 ± 0.1; P.001). Obese or underweight persons had lower physical health status (39.5 ± 0.20 and 37.0 ± 0.82, respectively) than normal (44.7 ± 0.18) or overweight (44.6 ± 0.16) persons (P.001). BMI category stratification was associated with differences in physical health between rural/urban by BMI. Individuals classified as underweight or obese had lower physical health compared to normal, while the differences were less pronounced for mental health. No differences in mental health existed between rural/urban status. A BMIRural residents report lower self-reported physical health status compared to urban residents, particularly older adults who are obese or underweight. No interaction was observed between BMI and rural status.

BACKGROUND: The Foundation for the National Institutes of Health Sarcopenia Project validated cutpoints for appendicular lean mass (ALM) to identify individuals at risk for functional impairment. Recognizing possible underlying mechanisms between adipose tissue and muscle, we sought to apply the recent definitions and determine the relationship with markers of glucose homeostasis and inflammation in individuals with sarcopenia and sarcopenic obesity. METHODS: The National Health and Nutrition Examination Surveys 1999–2004 were used to identify 4,984 adults aged ≥60 years with DEXA measures. Sarcopenia was defined using ALM (men

To assess the use of the Medicare Obesity Benefit (MOB) by a licensed physician or associate provider in an outpatient setting in older adults.A serial cross-sectional analysis of fee-for-service Medicare claims (2012 and 2013) was used to assess the use of the MOB. Number and proportion of Medicare beneficiaries over age 65 using the benefit were assessed. Correlation between state-obesity rates and MOB uptake was determined based on state-specific obesity prevalence data from the Behavioral Risk Factor Surveillance System. Results There were 27,338 (0.10%) Medicare beneficiaries over age 65 in 2012 using the MOB and slightly more in 2013 (n = 46,821 [0.17%]). Mean age of MOB users in both years was 73 years, and 62% were females. Use declined with older age and was highest in the Northeast and lowest in the Midwest. High state obesity prevalence was not correlated with higher uptake of the MOB. Estimated proportion of persons with obesity using the MOB was 0.35% and 0.60% in successive years. A mean of 1.99 and 2.16 claims/MOB user was observed.While the rate of MOB use increased in the second full year of its implementation, few were availing themselves of this benefit.

IF 6.686; International audience; OBJECTIVE:To study the relationship between body mass index (BMI) and central obesity and mortality in elderly patients with coronary artery disease (CAD).PATIENTS AND METHODS:We identified 7057 patients 65 years or older from 5 cohort studies assessing mortality risk using either waist circumference (WC) or waist-hip ratio (WHR) in patients with CAD from January 1, 1980, to December 31, 2008. Normal weight, overweight, and obesity were defined using standard BMI cutoffs. High WHR was defined as 0.85 or more for women and 0.90 or more for men. High WC was defined as 88 cm or more for women and 102 cm or more for men. Separate models examined WC or WHR in combination with BMI (6 categories each) as the primary predictor (referent = normal BMI and normal WC or WHR). Cox proportional hazards models investigated the relationship between these obesity categories and mortality.RESULTS:Patients' mean age was 73.0±6.0 years (3741 [53%] women). The median censor time was 7.1 years. A normal BMI with central obesity (high WHR or high WC) demonstrated highest mortality risk (hazard ratio [HR], 1.29; 95% CI, 1.14-1.46; HR, 1.29; 95% CI, 1.12-1.50, respectively). High WHR was also predictive of mortality in the overall (HR, 2.14; 95% CI, 1.93-2.38) as well as in the sex-specific cohort. In the overall cohort, high WC was not predictive of mortality (HR, 1.04; 95% CI, 0.97-1.12); however, it predicted higher risk in men (HR, 1.12; 95% CI, 1.01-1.24).CONCLUSION:In older adults with CAD, normal-weight central obesity defined using either WHR or WC is associated with high mortality risk, highlighting a need to combine measures in adiposity-related risk assessment.Copyright © 2016. Published by Elsevier Inc.

Bariatric surgery (BSx) produces clinically relevant weight loss that translates into improved quality of life, decreased mortality, and reduction in medical comorbidities, including cardiovascular (CV) risk. Little is known about patients' decision-making process to undergo BSx, but risk perception is known to influence medical decision-making. This study examined CV and BSx risk perception in obese subjects undergoing BSx (n = 268) versus those managed medically (MM) (n = 273). This retrospective population-based survey of subjects evaluated for BSx had 148 (55%) and 88 (32%) responders in the BSx and MM groups, respectively. Survey questions assessed risk perceptions and habits prior to weight loss intervention. CV risk was calculated using the Framingham Risk Score (FRS). At baseline, BSx subjects had a greater body mass index and greater prevalence of diabetes and depression. Follow-up mean weight loss was greater in the BSx group. BSx subjects perceived obesity as a greater risk to their overall health than the surgical risk. FRS declined in the BSx group (10 to 5%; p 0.001) while there was no change in the MM group (8 to 8%; p = 0.54). Those without a measurable decrease in CV risk had a greater tendency to perceive the risk of BSx as greater than that of obesity. Obese subjects undergoing BSx are more likely than MM subjects to perceive obesity as a greater risk to their health than BSx. MM subjects generally underestimate their CV risk and overestimate the risk of BSx. Active discussion of CV risk using the FRS and the perception of risk associated with bariatric surgery can enhance patients' ability to make an informed decision regarding their management.

Aerobic capacity, as indicated by maximal oxygen uptake (VO(2) max) has an important role in contrasting the traditional cardiovascular risk factors and preventing cardiovascular morbidity and mortality. It is known that endothelial function, measured as flow-mediated dilation (FMD) of the brachial artery, is strictly linked to atherogenesis and cardiovascular risk. However, the relationship between VO(2) max and FMD has not been fully investigated especially in healthy non-obese subjects. This preliminary study cross-sectionally investigated the relationship between VO(2) max and FMD in 22 non-obese, healthy sedentary male subjects. Dividing the cohort in two subgroups of 11 subjects each according to the median value of VO(2) max, the FMD was significantly lower in the subgroup with lower VO(2) max (mean ± sem: 7.1 ± 0.7 vs. 9.5 ± 0.8 %; P = 0.035). Absolute VO(2) max (mL min(-1)) was significantly and independently correlated with body fat mass (r = -0.50; P = 0.018) and with FMD (r = 0.44; P = 0.039). This preliminary study suggests that maximal oxygen uptake is independently correlated with endothelial function in healthy non-obese adults. These results are also in agreement with the possibility that improving maximal oxygen uptake may have a favorable effect on endothelial function and vice versa.