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BACKGROUND Understanding fall circumstances can help researchers better identify causes of falls and develop effective and tailored fall prevention programs. This study aims to describe fall circumstances among older adults from quantitative data using conventional statistical approaches and qualitative analyses using a machine learning approach. METHODS The MOBILIZE Boston Study enrolled 765 community-dwelling adults aged 70 years and older in Boston, Massachusetts. Occurrence and circumstances of falls (i.e., locations, activities, and self-reported causes of falls) were recorded using monthly fall calendar postcards and fall follow-up interviews with open- and close-ended questions during a 4-year period. Descriptive analyses were used to summarize circumstances of falls. Natural language processing was used to analyze narrative responses from open-ended questions. Results During the 4-year follow up, 490 participants (64%) had at least one fall. Among 1,829 falls, 965 falls occurred indoors and 804 falls occurred outdoors. Commonly reported activities when the fall occurred were walking (915, 50.0%), standing (175, 9.6%), and going down stairs (125, 6.8%). The most commonly reported causes of falls were slip or trip (943, 51.6%) and inappropriate footwear (444, 24.3%). Using qualitative data, we extracted more detailed information on locations and activities, and additional information on obstacles related to falls and commonly reported scenarios such as “lost my balance and fell”. conclusions Self-reported fall circumstances provide important information on both intrinsic and extrinsic factors contributing to falls. Future studies are warranted to replicate our findings and optimize approaches to analyzing narrative data on fall circumstances in older adults.

Background Beat-to-beat blood pressure (BP) is an important cardiovascular output and regulated by neurophysiological elements over multiple temporal scales. The multiscale dynamics of beat-to-beat BP fluctuation can be characterized by “BP complexity” and has been linked to age-related adverse health outcomes. We here aimed to examine whether BP complexity mediates the association between arterial stiffness and frailty. Method This cross-sectional study was completed between January and October 2021. A total of 350 older adults completed assessments for frailty, arterial stiffness (ie, average brachial–ankle pulse wave velocity), and beat-to-beat finger BP. The complexity of beat-to-beat systolic blood pressure (SBP) and diastolic blood pressure (DBP) BP series was measured using multiscale entropy. The relationships between frailty, BP complexity, and arterial stiffness were examined using analysis of variance and linear regression models. The effects of BP complexity on the association between arterial stiffness and frailty were examined using mediation analyses. Results Compared with non-frail, prefrail, and frail groups had significantly elevated lower SBP and DBP complexity (F > 11, p < .001) and greater arterial stiffness (F = 16, p < .001). Greater arterial stiffness was associated with lower BP complexity (β < −0.42, p < .001). Beat-to-beat SBP and DBP complexity mediated the association between arterial stiffness and frailty (indirect effects >0.28), accounting for at least 47% of its total effects on frailty (mediated proportion: SBP: 50%, DBP: 47%). Conclusion This study demonstrates the association between BP complexity and frailty in older adults, and BP complexity mediates the association between arterial stiffness and frailty, suggesting that this metric would serve as a marker to help characterize important functions in the older adults.

Background Wearable devices have become widespread in research applications, yet evidence on whether they are superior to structured clinic-based assessments is sparse. In this manuscript, we compare traditional, laboratory-based metrics of mobility with a novel accelerometry-based measure of free-living gait cadence for predicting fall rates. Methods Using negative binomial regression, we compared traditional in-clinic measures of mobility (6-minute gait cadence, speed, and distance, and 4-m gait speed) with free-living gait cadence from wearable accelerometers in predicting fall rates. Accelerometry data were collected with wrist-worn Actigraphs (GT9X) over 7 days in 432 community-dwelling older adults (aged 77.29 ± 5.46 years, 59.1% men, 80.2% White) participating in the Study to Understand Fall Reduction and Vitamin D in You. Falls were ascertained using monthly calendars, quarterly contacts, and ad hoc telephone reports. Accelerometry-based free-living gait cadence was estimated with the Adaptive Empirical Pattern Transformation algorithm. Results Across all participants, free-living cadence was significantly related to fall rates; every 10 steps per minute higher cadence was associated with a 13.2% lower fall rate (p = .036). Clinic-based measures of mobility were not related to falls (p > .05). Among higher-functioning participants (cadence ≥100 steps/minute), every 10 steps per minute higher free-living cadence was associated with a 27.7% lower fall rate (p = .01). In participants with slow baseline gait (gait speed Conclusion Data collected from biosensors in the free-living environment may provide a more sensitive indicator of fall risk than in-clinic tests, especially among higher-functioning older adults who may be more responsive to intervention. Clinical Trial Registration NCT02166333

ObjectiveDue to the long prodromal period for dementia pathology, approaches are needed to detect cases before clinically recognizable symptoms are apparent, by which time it is likely too late to intervene. This study contrasted two theoretically-based algorithms for classifying early cognitive impairment (ECI) in adults aged ≥50 enrolled in the Baltimore Longitudinal Study of Aging.MethodTwo ECI algorithms were defined as poor performance (1 standard deviation [SD] below age-, sex-, race-, and education-specific means) in: (1) Card Rotations or California Verbal Learning Test (CVLT) immediate recall and (2) ≥1 (out of 2) memory or ≥3 (out of 6) non- memory tests. We evaluated concurrent criterion validity against consensus diagnoses of mild cognitive impairment (MCI) or dementia and global cognitive scores using receiver operating characteristic (ROC) curve analysis. Predictive criterion validity was evaluated using Cox proportional hazards models to examine the associations between algorithmic status and future adjudicated MCI/dementia.ResultsAmong 1,851 participants (mean age=65.2±11.8 years, 50% women, 74% white), the two ECI algorithms yielded comparably moderate concurrent criterion validity with adjudicated MCI/dementia. For predictive criterion validity, the algorithm based on impairment in Card Rotations or CVLT immediate recall was the better predictor of MCI/dementia (HR=3.53, 95%CI: 1.59-7.84) over 12.3 follow-up years.ConclusionsImpairment in visuospatial ability or memory may be capable of detecting early cognitive changes in the preclinical phase among cognitively normal individuals.

Background: There is inconsistent evidence on the optimal time after standing to assess orthostatic hypotension (OH). Objectives: To characterize the timing of OH after standing in older adults and the fall risk associated with OH at specific times. Methods: We performed a secondary analysis of the Study to Understand Fall Reduction and Vitamin D in You (STURDY). Blood pressure (BP) was measured in the supine position. Participants stood upright and underwent 6 standing BP measurements: 3 (M1-M3) immediately after standing, and 3 (M4-M6) after 3 minutes of standing. OH was defined as a decrease from supine systolic BP (SBP) of 20 or supine diastolic BP (DBP) of 10 mm Hg. We used generalized estimating equations to characterize changes in SBP, DBP, and OH over time. We used Cox models to examine the relationship between OH at each time point and subsequent falls. Results: There were 425 falls among 491 adults with 6,055 BP measurements and a median follow-up of 275 days. SBP/DBP decreased by a mean 9.5/2.6 mm Hg immediately after standing (M1) vs. 2.2/0.9 about 5 minutes after standing (M6). OH was observed in 32% of assessments at M1, and only 16% at M5 and M6 ( Table ). Only OH at M5 (Hazard Ratio = 1.84 [95% confidence interval = 1.17, 2.91]) and M6 (1.85 [1.03, 2.91]) predicted higher fall risk among individual time points. However, average OH from early (M1-3) and late (M4-6) measurements, respectively, also predicted higher fall risk (M1-3 = 1.65 [1.08, 2.52]; M4-6 = 1.73 [1.03, 2.91]). Conclusions: OH was most prevalent immediately after standing, but most informative for fall risk in late and average measurements. Multiple standing BP measurements may improve the clinical assessment of OH.

Background/objectives To assess whether vitamin D supplementation prevents specific fall subtypes and sequelae (e.g., fracture). Design Secondary analyses of STURDY (Study to Understand Fall Reduction and Vitamin D in You)-a response-adaptive, randomized clinical trial. Setting Two community-based research units. Participants Six hundred and eighty-eight participants ≥70 years old with elevated fall risk and baseline serum 25-hydroxyvitamin D levels of 10-29 ng/ml. Intervention 200 IU/day (control), 1000 IU/day, 2000 IU/day, or 4000 IU/day of vitamin D3. Measurements Outcomes included repeat falls and falls that were consequential, were injurious, resulted in emergency care, resulted in fracture, and occurred either indoors or outdoors. Results After adjustment for multiple comparisons, the risk of fall-related fracture was greater in the pooled higher doses (≥1000 IU/day) group compared with the control (hazard ratio [HR] = 2.66; 95% confidence interval [CI]:1.18-6.00). Although not statistically significant after multiple comparisons adjustment, time to first outdoor fall appeared to differ between the four dose groups (unadjusted p for overall difference = 0.013; adjusted p = 0.222), with risk of a first-time outdoor fall 39% lower in the 1000 IU/day group (HR = 0.61; 95% CI: 0.38-0.97; unadjusted p = 0.036; adjusted p = 0.222) and 40% lower in the 2000 IU/day group (HR = 0.60; 95%CI 0.38-0.97; p = 0.037; adjusted p = 0.222), each versus control. Conclusion Vitamin D supplementation doses ≥1000 IU/day might have differential effects on fall risk based on fall location and fracture risk, with the most robust finding that vitamin D doses between 1000 and 4000 IU/day might increase the risk of first time falls with fractures. Replication is warranted, given the possibility of type 1 error.

Background Vision loss is associated with increased risk of falls and restricted physical activity, yet the relationship between multiple vision measures and objectively measured physical activity, especially activity patterns, in mid-to-late life is not well understood. Method This study included 603 participants aged 50 years and older (mean age = 73.5) in the Baltimore Longitudinal Study of Aging who had the following assessments: presenting and best-corrected visual acuity, contrast sensitivity, visual fields, stereo acuity, and free-living physical activity using a wrist-worn ActiGraph accelerometer for 7 days. Linear regression models were used to examine the association between vision measures and daily activity counts, active minutes, and activity fragmentation (defined as an active-to-sedentary transition probability), adjusting for potential confounders. Mixed-effects models estimated differences in activity by time of day comparing those with and without each visual impairment. Results In the fully adjusted model, worse presenting visual acuity, contrast sensitivity, and visual fields were associated with fewer activity counts, less active time, and more fragmented activity patterns (p < .05 for all). Participants with presenting or best-corrected visual acuity impairment had 19.2 and 29.3 fewer active minutes (p = .05 and p = .03, respectively) per day. Visual field impairment was associated with 268 636 fewer activity counts (p = .02), 46.2 fewer active minutes (p = .02) per day, and 3% greater activity fragmentation (p = .009). Differences in activity levels tended to be greatest from 6 am to 6 pm (p < .05). Conclusions Older adults with visual impairment have restricted and more fragmented patterns of daily activity. Longitudinal studies to quantify the long-term impacts of visual impairments on activity decline are warranted.

Background Beat-to-beat blood pressure (BP) is an important cardiovascular output and regulated by neurophysiologic elements over multiple temporal scales. The multiscale dynamics of beat-to-beat BP fluctuation has thus been characterized using “BP complexity” and has been linked to age-related adverse health outcomes. We here aimed to examine the relationship of BP complexity to frailty, and if BP complexity mediates the association between arterial stiffness and frailty. Method: A total of 350 older adults completed assessments for frailty (i.e., Fried frailty phenotype criteria), arterial stiffness (i.e., average brachial-ankle pulse wave velocity), and beat-to-beat finger BP. The complexity of beat-to-beat systolic (SBP) and diastolic (DBP) BP series were measured using multiscale entropy. The relationships between frailty, BP complexity and arterial stiffness were examined using ANOVA and linear regression models. The effects of BP complexity on the association between arterial stiffness and frailty were examined using mediation analyses. Results Compared to non-frail, pre-frail and frail groups had significantly elevated lower SBP and DBP complexity (F>11, p< 0.001), and greater arterial stiffness (F=16, p< 0.001). Greater arterial stiffness was associated with lower BP complexity (β0.28), account for at least 47% of its total effects on frailty (Mediated proportion: SBP: 50%, DBP: 47%). Conclusion This study demonstrates that BP complexity is associated with frailty in older adults, and mediates the association between arterial stiffness and frailty, suggesting that this metric would serve as a marker to characterize important functions in older adults.

Chronic pain is a risk factor contributing to mobility impairment and falls in older adults. Little is known about the patterns of fall circumstances among older adults with pain. This prospective cohort study described frequencies of fall circumstances (i.e., location, activities, and self-reported causes of falls) and examined the relationship between chronic pain and fall circumstances among 765 community-dwelling older adults (mean age=78.1, 63.9% women) in the MOBILIZE Boston Study. Pain severity, fall occurrence, and fall circumstances were recorded using monthly calendar postcards and fall follow-up interviews during a 4-year follow-up. Descriptive analyses summarized frequencies of fall circumstances. Generalized estimating equation (GEE) models examined the relation between monthly pain ratings and circumstances of the first fall in the subsequent month. Among 1,829 falls, 965 (52.8%) falls occurred indoors and 804 (44.0%) falls occurred outdoors, 60 (3.2%) falls with missing location information. Commonly reported activities and causes of falls were walking (915, 50.0%), slips/trips (943, 51.6%), and inappropriate footwear (444, 24.3%). GEE models suggested that compared to fallers without pain, fallers with moderate-to-severe pain had around twice the likelihood of reporting indoor falls (adj.OR=1.93, 95%CI:1.32-2.83), falls in living/dining rooms (adj.OR=2.06, 95%CI:1.27-3.36), and falls due to health problems (adj.OR=2.08, 95%CI:1.16-3.74) or feeling dizzy/faint (adj.OR=2.10, 95%CI:1.08-4.11), but they were less likely to report falls while going down stairs (adj.OR=0.48, 95%CI:0.27-0.87) or falls due to slips/trips (adj.OR=0.67, 95%CI:0.47-0.95) in the subsequent month. Future studies may investigate whether better pain management and tailored fall prevention in elders with chronic pain could lead to fewer falls.

Wrist-worn accelerometry metrics are not well defined in older adults. Accelerometry data from 720 participants (mean age 70 years, 55% women) were summarized into (a) total activity counts per day, (b) active minutes per day, (c) active bouts per day, and (d) activity fragmentation (the reciprocal of the mean active bout length). Linear regression and mixed-effects models were utilized to estimate associations between age and gait speed with wrist accelerometry. Activity counts per day, daily active minutes per day, and active bouts per day were negatively associated with age among all participants, while positive associations with activity fragmentation were only observed among those ≥65 years. More activity counts, more daily active minutes, and lower activity fragmentation were associated with faster gait speed. There were baseline age interactions with annual changes in total activity counts per day, active minutes per day, and activity fragmentation (Baseline age × Time, p

Background Chronic pain is a risk factor contributing to mobility impairment and falls in older adults. Little is known about the patterns of circumstances of falls among older adults with chronicpain. Objective To examine the relationship between chronic pain and circumstances of falls including location, activities at the time of falls and self-reported causes of falls in older adults. Design Prospective cohort study. Setting Communities in/around Boston, Massachusetts. Subjects The MOBILIZE Boston Study enrolled 765 adults aged ≥70 years. Methods Pain severity, fall occurrence and fall circumstances were recorded using monthly calendar postcards and fall follow-up interviews during a 4-year follow-up period. Generalised estimating equation models were performed to examine the relation between monthly pain ratings and circumstances of the first fall in the subsequent month. Results Compared to fallers without chronic pain, fallers with moderate-to-severe pain had around twice the likelihood of reporting indoor falls (aOR = 1.93, 95%CI: 1.32–2.83), falls in living or dining rooms (aOR = 2.06, 95%CI: 1.27–3.36), and falls due to health problems (aOR = 2.08, 95%CI: 1.16–3.74) or feeling dizzy or faint (aOR = 2.10, 95%CI: 1.08–4.11), but they were less likely to report falls while going down stairs (aOR = 0.48, 95%CI: 0.27–0.87) or falls due to a slip or trip (aOR = 0.67, 95%CI: 0.47–0.95) in the subsequent month. Conclusions Given the exploratory nature of the study, these findings should be interpreted with caution. Future studies may investigate whether better pain management and tailored fall prevention in older people with chronic pain could lead to fewer falls.

BackgroundThe blood pressure (BP) is regulated by multiple neurophysiologic elements over multiple temporal scales. The multiscale dynamics of continuous beat-to-beat BP series, which can be characterized by “BP complexity”, may, thus, capture the subtle changes of those elements, and be associated with the level of functional status in older adults. We aimed to characterize the relationships between BP complexity and several important functions in older adults and to understand the underlying factors contributing to BP complexity.MethodA total of 400 older adults completed a series of clinical and functional assessments, a finger BP assessment of at least 10 min, and blood sample and vessel function tests. Their hypertensive characteristics, cognitive function, mobility, functional independence, blood composition, arterial stiffness, and endothelial function were assessed. The complexity of systolic (SBP) and diastolic (DBP) BP series was measured using multiscale entropy.ResultsWe observed that lower SBP and DBP complexity was significantly associated with poorer functional independence (β > 0.17, p < 0.005), cognitive function (β > 0.45, p = 0.01), and diminished mobility (β < −0.57, p < 0.003). Greater arterial stiffness (β < −0.48, p = 0.02), decreased endothelial function (β > 0.42, p < 0.03), and excessed level of blood lipids (p < 0.03) were the main contributors to BP complexity.ConclusionBlood pressure complexity is closely associated with the level of multiple functional statuses and cardiovascular health in older adults with and without hypertension, providing novel insights into the physiology underlying BP regulation. The findings suggest that this BP complexity metric would serve as a novel marker to help characterize and manage the functionalities in older adults.

Background Self-reported low physical activity is a defining feature of phenotypic frailty but does not adequately capture physical activity performed throughout the day. This study examined associations between accelerometer-derived patterns of routine daily physical activity and frailty. Methods Wrist accelerometer and frailty data from 638 participants (mean age 77 [SD = 5.5] years; 44% women) were used to derive 5 physical activity metrics: active minutes/day, sedentary minutes/day, total activity counts/day, activity fragmentation (reciprocal of the average active bout length), and sedentary fragmentation (reciprocal of the average sedentary bout length). Robust, prefrail, and frail statuses were identified using the physical frailty phenotype defined as having 0, 1–2, or ≥3 of the following criterion: weight loss, exhaustion, slowness, self-reported low activity, and weakness. Frailty was collapsed into not frail (robust and prefrail) and frail, and each frailty criteria was dichotomized. Multiple logistic regression was used to model each accelerometer metric. Separate frailty criteria and interactions with age and sex were also examined. Results With higher amounts and intensity of daily activity (more active minutes, fewer sedentary minutes, higher activity counts) and lower activity fragmentation, the odds of frailty were lower compared to robust/prefrail states (p < .02 for all). For interactions, only an age by sedentary fragmentation interaction on the odds of frailty was observed (p = .01). For each separate criteria, accelerometer metrics were associated with odds of slowness, low activity, and weakness. Conclusion Less favorable patterns of objectively measured daily physical activity are associated with frailty and the components of slowness, low self-reported activity, and weakness.

Age-related sensory impairment, such as loss in vision or hearing, have been linked to poor brain health. Yet, the relationship between co-occurring sensory impairments and brain volumes remains unclear. We used cross-sectional sensory and brain imaging data from 208 cognitively normal participants of the Baltimore Longitudinal Study of Aging (mean age 72 years; 59% women). Sensory impairments were separately identified with vision, hearing, smell, proprioception, and vestibular function testing. Brain imaging volumes were derived using an automated multi-atlas approach. Multiple linear regression models were used to estimate brain volumetric differences by number of sensory impairments (0-5) or by multisensory impairment status (MSI; ≥2 impairments). For every one additional sensory impairment, there was lower volume in the orbitofrontal gyrus (beta=0.35 cc [SE=0.17], p=0.04) but higher volumes in the caudate (0.14 cc [0.05], p=0.006) and putamen (0.13 cc [0.06], p=0.043). Participants with MSI (versus no MSI) had lower volumes in superior frontal gyrus (-1.01 cc [=0.34], p=0.003), lower orbitofrontal gyrus (-0.91 cc [0.38], p=0.018), superior parietal lobe (0.68 cc [0.27], p=0.011), and precuneus (-0.74 cc [0.35], p=0.038), but similar volumes in the caudate (p=0.12) and putamen (p=0.14). A negative relationship between MSI and brain volume across multiple regions was largely observed yet our exploratory findings raise the possibility that MSI is associated with compensatory maintenance of brain volume structures in the basal ganglia. Future directions include replication of these findings in other studies and longitudinal analyses to determine how MSI relates to brain atrophy.

Revisiting the Teaching Nursing Home is a two-year pilot project to address the long-term care workforce shortage by introducing nursing students to geriatric nursing while improving quality of care within nursing homes. The initiative has multiple components: enhanced clinical rotations for nursing students with partner schools of nursing, implementation of the Institute for Healthcare Improvement Age-Friendly Health System “4M” quality improvement model, and an online learning network. Nursing students at three schools of nursing participated in the clinical rotations at regional nursing homes. The experience was limited to students in one specific course at each school of nursing. At the beginning and end of the spring 2022 semester, students rated their competence in: patient assessment, collaborating with the care team, gathering clinical information, medication review, eliciting resident values, and health promotion. Students also rated their preferences for working in long-term care and with older adults. Data from 85 responses at the start of semester and 64 responses to the end of semester survey were analyzed. Analysis of student responses found that students self-rated competencies improved in all areas except eliciting resident values. Prior to their clinical experience, students ranked working in long-term care and with older adults lower than other settings or populations. The rankings were unchanged after their clinical experiences. These initial findings suggest that although the Teaching Nursing Home Program is meeting the pedagogical goals, attitudinal shifts may require different strategies.

Higher energetic cost of walking per unit distance has been linked to many adverse health outcomes in older adults. Aging-related changes in gait characteristics have been postulated to contribute to energetic inefficiency, but previous studies focused on younger adults, and/or examined only a few gait characteristics. In the Baltimore Longitudinal Study of Aging, 507 older adults ≥50 years (72.3±9.8 years, 48.3% women, 48.3% black) without stroke and Parkinson disease had concurrent measurements of usual-paced gait characteristics using 3D motion analysis and energetic cost of walking using indirect calorimetry during a 2.5-min usual-paced overground walk. We tested the associations of the mean and the coefficient of variance (CV) of cadence (steps/min), swing time (ms), double support time (ms), stance time (ms), step time (ms), step length (cm), and step width (cm) with energetic cost of walking using linear regression models, adjusting for demographics, body composition, comorbidities, and gait speed. We found that a 5-cm shorter step length was associated with 0.40 ml/kg/100m higher cost of walking (p< 0.001). A 1% higher CV in swing time and 1% lower CV in step width was associated with 0.152 ml/kg/100m higher (p=0.044) and 0.023 ml/kg/100m lower (p=0.022) cost of walking, respectively. Our results suggest that mean step length and variability in swing time and step width could potentially contribute to the rising cost of walking in older adults. Future longitudinal studies are needed to understand whether changes in gait variability can predict increased energetic cost of walking and can be intervened to preserve energy efficiency.

Background Continuous electronic fetal monitoring (CEFM) is a standard of hospital care during the intrapartum period. We investigated its use on childbirth outcomes in low-risk pregnancies, and examined whether outcomes differed by gestational age within a term pregnancy. Methods A retrospective secondary data analysis using birth registry data from two diverse northeastern US states from 1992 to 2014. Chi-square test and the Fisher exact tests were used to examine associations between CEFM and childbirth outcomes. Multivariable Poisson regression models were used to estimate risk ratios of childbirth outcomes related to CEFM use, adjusting for potential confounders. Results Use of CEFM was independently associated with a 10% (State 1) and 40% (State 2) increased risk for primary cesarean delivery and an increased risk for assisted vaginal births (14% and 24%, respectively) after adjustment for confounders. CEFM use was not associated with reduced risk for infant mortality (neonatal mortality, 0-27 days, and post-neonatal mortality, 28-364 days) in term births (37-41 weeks' gestation). After stratifying term pregnancies into early term, full term, and late term, use of CEFM was associated with reduced risk for neonatal mortality in early-term births (37 0/7 weeks' to 38 6/7 weeks' gestation) in State 2 (RR 0.44 [95% CI 0.21-0.92]), but not in State 1. There was no association between CEFM use and infant mortality (neonatal and post-neonatal) in full-term or late-term births. Conclusions The study results do not support universal use of CEFM in pregnancies that are low-risk and at term.

Low physical activity (PA) is a common phenotype of frailty, but whether disengagement of daily lifestyle PA signals impending frailty remains unexplored. Using STURDY (Study to Understand Fall Reduction and Vitamin D in You) data from 499 robust/prefrail adults (mean age=76 + 5 years; 42% women), we examined whether accelerometer patterns (activity counts/day, active minutes/day, and activity fragmentation) were prospectively associated with incident frailty over 2 years of follow-up; 48 (10%) participants developed frailty. In Discrete-Cox hazard models adjusted for demographics, medical conditions, and device wear days, every 30 min/day higher baseline active time, 100,000 more activity counts/day, and 1% lower activity fragmentation was associated with a 13% (p=0.003), 10% (p=0.001), and 8% (p

Studies have demonstrated a link between sensory impairment and dementia risk, but little is known about the presence of beta-amyloid plaques in individuals with single and multisensory impairments. Sensory function (combinations of vision, hearing, vestibular function, and proprioception) and amyloid PET imaging were measured in 170 BLSA participants (age=78± 9 years; 53% women; 77% white; 28% amyloid positive) from 2012 to 2019. Log-binomial regression models were used to examine the prevalence ratios (PR) of amyloid positivity for individual sensory impairments and across categories of impairments. While crude associations indicate associations of vision impairment (PR=1.72, p=0.04) and impairments in all four senses (PR=2.38, p=0.03) with amyloid positivity, these associations were insignificant after adjusting for age, sex, race, and education. There were no other crude and adjusted associations. These results suggest sensory impairments may be related to dementia independent of AD pathology. Future studies with larger sample sizes are warranted.

Falls are a complex problem and play a leading role in the development of disabilities in the older population. While fall detection systems are important, it is also essential to work on fall preventive strategies, which will have the most significant impact in reducing disability in the elderly. In this work, we explore a prospective cohort study, specifically designed for examining novel risk factors for falls in community-living older adults. Various types of data were acquired that are common for real-world applications. Learning from multiple data sources often leads to more valuable findings than any of the data sources can provide alone. However, simply merging features from disparate datasets usually will not produce a synergy effect. Hence, it becomes crucial to properly manage the synergy, complementarity, and conflicts that arise in multi-source learning. In this work, we propose a multi-source learning approach called the Synergy LSTM model, which exploits complementarity among textual fall descriptions together with people's physical characteristics. We further use the learned complementarities to evaluate fall risk factors present in the data. Experiment results show that our Synergy LSTM model can significantly improve classification performance and capture meaningful relations between data from multiple sources.

Background Fall injuries are a leading cause of death in older adults. The potential impact of chronic pain characteristics on risk for injurious falls is not well understood. This prospective cohort study examined the relationship between chronic pain and risk for injurious falls in older adults. Method The MOBILIZE Boston Study enrolled 765 community-dwelling adults aged 70 years and older living in and around Boston, Massachusetts. Chronic pain characteristics, including pain severity, pain interference, and pain distribution, were measured at baseline using the Brief Pain Inventory subscales and a joint pain questionnaire. Occurrence of falls and fall-related injuries were recorded using monthly fall calendar postcards and fall follow-up interviews during the 4-year follow-up period. Results Negative binomial regression models showed that pain interference and pain distribution, but not pain severity, independently predicted injurious falls adjusting for potential confounders. Participants in the highest third of pain interference scores had a 61% greater risk of injurious falls compared to those reporting little or no pain interference. Compared to no pain, multisite pain was associated with a 57% greater risk of injurious falls. Stratified by gender, the association was only significant in women. In the short term, moderate-to-severe pain in a given month was associated with increased risk of injurious falls in the subsequent month. Conclusions Global pain measures are associated with increased risk of injurious falls in older adults. Pain assessment should be incorporated into fall risk assessments. Interventions are needed to prevent fall injuries among elders with chronic pain.

Purpose: There was a growth of approximately ten million Asian American individuals in the United States between 2000 and 2015. Asian Americans have conservative values surrounding sexual health and sexual communication is a cultural taboo. Researchers have shown discrepancies on whether the level of acculturation influences Asian mother-daughter sexual communication. In other minority populations there is evidence that a connected mother–daughter relationship increases sexual communication and delays sexual initiation. The purpose of this study was to examine whether motherdaughter connectedness and level of acculturation predict sexual communication in turn affecting the age of female Asian emerging adult’s sexual initiation. Methods: This was a longitudinal, secondary analysis of AddHealth examining whether mother-daughter connectedness and level of acculturation predict sexual communication. There were 243 Asian American mother-daughter dyads in Wave I with linked data in Wave III who were included in the study. Acculturation, connectedness, and sexual communication were all measured using interval level data. Results: Connectedness did not significantly contribute to the relationship between any of the concepts. Although it was predicted that sexual communication would delay initiation, the opposite was found. Also, communication mediated the relationship between acculturation and initiation. Conclusions: Further studies are needed to explore how connectedness is defined by Asian American mother-daughter dyads. In addition, more detailed operational definitions of acculturation and communication are needed, specifically the timing of sexual communication.

This cross-sectional study examines the association between chronic musculoskeletal pain and foot reaction time (RT) among older community-living adults. Participants were 307 adults aged 71 years and older in the MOBILIZE Boston Study II. Pain severity, interference, and location were measured by the Brief Pain Inventory and a joint pain questionnaire. With participants seated, simple foot reaction time was measured as self-selected foot response time to an intermittent light, and choice foot reaction time was measured as response time to the light on the corresponding side of the sensored gait mat. We performed multivariable linear regression to determine associations of pain and foot RT, adjusted for sociodemographic and health characteristics, and serially adjusted for cognitive function (MMSE or Trail Making A). Pain severity and interference were associated with slower simple foot reaction time (P < .05). Pain severity and knee pain were associated with slower choice foot reaction time (P < .05). Adjustment for cognitive measures had little impact on the pain-RT relationship. This significant relationship was only observed among participants with less education. These results support the idea that chronic pain may lead to slower foot RT, thus could represent a fall hazard in older adults. Neuromotor mechanisms underlying the pain-fall relationship warrant further investigation. PERSPECTIVE: This study provides insights on the mechanisms underlying the pain-fall relationship. Chronic pain may contribute to slower foot RT thus increase fall risk in older adults. This may help inform interventions such as stepping training to reduce fall risk in older adults living with chronic pain.

BACKGROUND: Given the evidence of the links between cognition and mobility, participation in cognitive activities may benefit neuromotor performance and mobility in older adults. AIMS: To examine the association between participation in cognitive activities and foot reaction time (RT) and gait speed in community-dwelling older adults. METHODS: The MOBILIZE Boston Study II (MBSII) re-enrolled 354 community-dwelling older adults aged ≥ 70 years from the original MBS cohort. Of these, 310 completed the performance testing and we excluded 3 participants who had Parkinson’s disease. Cognitive Activities Scale (CAS) assessed participation in 17 cognitive activities. Simple and Choice foot RT (SRT, CRT, msec) and gait speed (m/s) were measured using a sensored GAITRite® gait mat. RESULTS: The average age of the 307 participants was 84 years; 79% were white and 65% were women. The average CAS score was 25.5±11.7 indicating participation in approximately 26 activities per week on average. The average foot SRT was 245±57msec and average CRT was 323±85msec. Usual-paced gait speed was 0.9±0.3 m/s on average. More frequent participation in cognitive activities was associated with shorter SRT (β = −0.759, p=0.015) and CRT (β= −1.125, p=0.013), and faster gait speed (β=0.003, p=0.026), after adjusting for potential confounders. DISCUSSION: Participation in cognitively stimulating activities may be beneficial for neuromotor performance and mobility in older adults. CONCLUSIONS: Prospective and intervention studies are needed to determine whether participation in cognitive activities may prevent mobility decline over time, and thus reduce fall risk.

BACKGROUND: Chronic musculoskeletal pain is highly prevalent in the older adults, and individuals with musculoskeletal pain frequently report pain in two or more sites. AIMS: To determine the prevalence and characteristics of multisite pain in relation to other geriatric syndromes and to evaluate whether multisite pain may represent a distinct geriatric syndrome. METHODS: The MOBILIZE Boston Study is a population-based cohort study of older adults that enrolled 749 participants aged 70 and older. Persistent pain in the back and major joint areas was assessed using a joint pain questionnaire. Assessment of other geriatric syndromes included urinary incontinence, fall history, ADL disability, and frailty. A number of risk factors for geriatric syndromes were assessed. RESULTS: The prevalence of multisite pain was 40% in this population of older adults. Many participants had more than one geriatric syndrome, indicating substantial overlap in the prevalence of these conditions. Nearly half (48%) of participants with urinary incontinence or falls, 61% with ADL disability, and 49% of those with frailty also had multisite pain. Shared risk factors for established geriatric conditions were similarly distributed among the elderly population who had multisite pain. Demographic and health characteristics associated with multisite pain and other geriatric syndromes, included gender (female), depression, number of comorbid conditions, and mobility limitations. CONCLUSION: Although prior studies have explored risk factors for chronic multisite pain, these findings reveal that multisite pain, often unexplained, bears many similarities to established geriatric syndromes. Multisite pain warrants further consideration as a unique geriatric syndrome.

BACKGROUND: Chronic pain is associated with poorer cognition and mobility, and fall risk in older adults. AIMS: To investigate the feasibility of a randomized trial of mind-body exercise (Tai Chi) versus light physical exercise in older adults with multisite pain. METHODS: Adults aged ≥ 65y with multisite pain who reported falling in the past year or current use of an assistive device were recruited from Boston area communities. Participants were randomized to either a Tai Chi or a light physical exercise program, offered twice weekly for 12 weeks. The primary outcomes were feasibility and acceptability. Secondary outcomes included pain characteristics, cognition, physical function, gait mobility, fear of falling, and fall frequency. RESULTS: Of 176 adults screened, 85 were eligible, and 54 consented and enrolled (average age 75±8y; 96.30% white; 75.93% female). The dropout rate was 18% for Tai Chi and 12% for light physical exercise. For those completing the study, exercise class attendance was 76% for Tai Chi and 82% for light physical exercise. There were no significant group differences in most secondary outcomes. Tai Chi significantly lowered pain severity (4.58±1.73 to 3.73±1.79, p

Motor and sensory impairments are linked with dementia risk, but whether there is a joint effect of deficits in motor and sensory function is unknown. We analyzed 649 BLSA participants (aged 72±11 years; 55% women; 68% white) who had concurrent baseline 6-meter usual gait speed and sensory function (vision, hearing) between 2012-2019. Mild cognitive impairment (MCI) and dementia were adjudicated during an average follow-up of 3 years. We examined the association between baseline gait speed, z-scored sensory function, and a gait*sensory interaction with risk of MCI/dementia using Cox proportional hazard models, adjusted for demographics and chronic conditions. Each .01 m/s faster baseline gait was associated with a reduced risk (HR:0.98 (0.96-0.99)) of MCI/dementia, and each 1 SD higher in hearing and vision z-score was associated with an increased risk (HR:1.84 (1.1-3.1)) increased risk. The was no significant interaction, suggesting motor and sensory impairments may be independently associated with MCI/dementia risk.

The purpose of this exploratory study was to examine the effects of Tai Chi on blood levels of beta endorphin (β-endorphin) and inflammatory markers in older adults with chronic pain. Forty community-dwelling older adults with chronic pain were randomized to Tai Chi or light physical exercise, and each offered twice weekly for 12 weeks. Following the 12-week intervention, neither Tai Chi nor light physical exercise changed levels of β-endorphin and inflammatory markers. However, in older adults who completed 70% or more classes, Tai Chi significantly lowered levels of β-endorphin (p

Evidence suggests Vitamin D supplementation may reduce fall risk in older adults, but effects on fall location and severity are less well described. We used STURDY trial data to examine whether Vitamin D supplementation reduces indoor, outdoor, “consequential” (falls resulting in injury or medical care), and repeat fall risk. Participants (77[SD=5.4] years; 44% women) were randomized to receive 200 (n=339) or 1000IU/day (n=349) of vitamin D3. Indoor, outdoor and consequential fall rates were similar between the ≥1000IU/day and 200IU/day groups (rate ratio [RR]:1.22, 95%CI:0.96-1.55; RR:0.85, 95%CI:0.65-1.10; and RR:1.16, 95%CI:0.93-1.45, respectively) during follow-up. The proportion of repeat fallers was similar between ≥1000IU/day versus 200IU/day groups over 3 months (7.8%[27/346] versus 6.5%[22/336], p=0.22), 6 months (18.8%(60/319) versus 16.2%(51/315), p=0.40), 12 months (29.9%(81/271) versus 31.2%(84/269), p=0.78) and 24 months (48.2%(66/137) versus 49.6%(66/133), p=0.90). In conclusion, Vitamin D supplementation ≥1000IU/day did not reduce indoor, outdoor, consequential or repeat fall risk.

Older adults experience motor function decline early in the disablement process, impacting daily activities and contributing to adverse health outcomes. Few studies have comprehensively examined the interrelationships among motor and functional impairments and investigated whether their contributions to mobility difficulty vary in well-functioning older adults. We examined direct and indirect associations of motor and physical function impairments with slow gait speed (0.95). These findings suggest components of strength and balance are among the most important contributors to poorer functional performance in mid-to-late life. Future longitudinal studies gauging the effect of change in these factors are warranted.

Although total knee replacement (TKR) surgery has become a common treatment for knee osteoarthritis, little is known about the overall impact of TKR on pain and mobility in the older population. This cross-sectional study examined chronic pain and mobility among community living adults aged ≥70y with and without TKR. The MOBILIZE Boston Study enrolled 765 older adults living in the Boston area. Pain characteristics including pain severity and interference were measured using the Brief Pain Inventory (BPI), and mobility was assessed by the Short Physical Performance Battery (SPPB), gait speed, and self-reported mobility difficulty. History of TKR was confirmed during the clinic visit. We used independent t-test, multivariable linear and logistic regressions adjusting for sociodemographic and health characteristics. History of TKR, found in 10% of the study population, was significantly associated with body mass index (BMI), osteoarthritis, and walking shorter distances compared to no TKR. Adjusted for sociodemographic and health factors, TKR was associated with more pain, more mobility difficulty, lower SPPB scores, and slower gait speed compared to no TKR (p-value

Chronic pain is associated with a decline in physical function and an increased risk of falls in older adults. This study examined the effects of Tai Chi on pain severity, pain interference and physical function in older adults with multisite pain. Fifty-four community-dwelling older adults with multisite pain who reported falling in the past year or currently used an assisted device were randomized into a light exercise program or a Tai Chi program offered twice a week for 12 weeks. Pain severity and pain interference were measured using subscales of the Brief Pain Inventory, and physical function was measured by the Short Physical Performance Battery (SPPB). Paired t-tests were used to assess changes within each group, and independent t-tests were used to assess differences between groups. Twenty-three participants in the light exercise group and twenty-two participants in the Tai Chi group completed the study. There were significant improvements only in the Tai Chi group in pain severity score (p=0.01) and pain interference score (p=0.04); however, there were no significant group differences in changes of pain scores. There were no significant improvements in SPPB scores in either group. Therefore, pain severity and pain interference were improved after a 12-week Tai Chi intervention in older adults with multisite pain; however, no between-group differences were detected, likely due to a small sample size. A larger study with longer term is required to examine the effectiveness of Tai Chi on multisite pain and physical function in older adults. (Supported by NIH Grant R21 AG043883)

Fall injuries are a leading cause of death among older adults, and chronic pain has been identified as a fall risk factor. However, the potential impact of chronic pain on injurious falls is unknown. This prospective study examined the relation between chronic pain and injurious falls in a 4-year follow-up of community-dwelling older adults. The MOBILIZE Boston study recruited 765 older adults aged ≥70y living in the Boston area. Pain characteristics, including pain severity, pain interference, and pain location, were measured at baseline using the Brief Pain Inventory subscales and a joint pain questionnaire. Musculoskeletal pain distribution was categorized as “no pain”, “single site pain”, or “multisite pain”. Injurious falls were ascertained in telephone interviews following reports of falls on the monthly fall calendar postcards. The overall rate of injurious falls was 35/100 person-years. Negative binomial models, adjusting for sociodemographics, BMI, chronic conditions, mobility difficulty, analgesic and psychiatric medications, and depression, showed that pain interference and pain distribution, but not pain severity, independently predicted injurious falls. Participants in the highest third of pain interference scores had a 53% greater risk of injurious falls compared to those in the lowest pain interference group (adj.IRR=1.53, 95% CI: 1.15, 2.05). Older adults with multisite pain had a 50% higher risk of injurious falls than those without pain (adj.IRR=1.50, 95% CI: 1.16, 1.93). Risk of injurious falls related to pain was stronger among women than men. Research is needed to determine effective strategies to prevent fall injuries among older adults with chronic pain.

Chronic musculoskeletal pain is linked to increased fall risk among elders. Older adults with chronic pain also experience mobility limitations. This prospective study examined the mediating effect of gait measures in the relationship whereby pain leads to falls. In the MOBILIZE Boston Study II of adults aged ≥70y living in the Boston area, 294 completed the gait assessment. Chronic musculoskeletal pain was classified as multisite, single site, or no pain, based on pain assessment of the hand/wrists, shoulders, back, hip, knees and feet. The gait assessment included walking under each of 3 conditions, quiet walk (QW), easy dual task (DTE), and hard dual task (DTH), on a 16-foot sensored gait mat. Participants were instructed to subtract aloud from 100 by 5’s (DTE) and 3’s (DTH) while walking at a normal pace. Following baseline assessments of pain and gait, monthly fall calendars were collected over 2 years. Multivariable negative binomial models were performed to determine associations between pain and fall rates, adjusting for sociodemographic and health characteristics. Mediation effects of gait measures on the pain-fall relationship were evaluated using the Sobel test. Multisite pain was associated with a 51% increased risk of falls compared to no pain (adj. IRR=1.51, 95% CI: 1.51–2.10). A number of gait parameters mediated (p-value

Chronic musculoskeletal pain (CMP) contributes to increased fall risk among older adults. Fall often occurs due to loss of standing balance. Standing postural control is “complex”, depending upon numerous inputs interacting across multiple temporal-spatial scales. The decreased complexity has been linked to increased fall risk. Pain may interfere with this metric of postural control, thus, lead to falls. The aim of this study is to determine whether CMP is associated with sway complexity in older adults. In the MOBILIZE Boston Study, 738 community-dwelling adults aged ≥70y completed a functional assessment, including eyes-open standing postural sway on a force plate. The degree of sway complexity was quantified using multiscale entropy. The Brief Pain Inventory and McGill Pain Map assessed global pain severity and pain locations, respectively. Relationships between pain and sway complexity were analyzed using multivariable Generalized Linear Models. More severe pain was significantly associated with peripheral neuropathy, impaired processing speed (Trail Making A (TMT-A)) and global cognitive function (Mini-Mental State Examination (MMSE). Those with moderate-to-severe pain had lower complexity compared to those with mild or no pain (p=0.01), adjusted for age, gender, education, neuropathy, and TMT-A or MMSE. Participants with lower leg pain had lower sway complexity than those without (p=0.01); no association between pain in other body sites and sway complexity were observed. CMP severity and lower leg pain are associated with decreased sway complexity in older adults. Future studies are needed to explore the underlying mechanisms through which the CMP affects sway complexity, thus, contributes to falls.

Cognitively stimulating activities can improve both cognitive and physical function. Foot reaction time, a test of neuromotor performance and a possible risk factor for falls in older adults, might be influenced by participation in cognitively stimulating activities. The aim of this cross-sectional study was to examine the association between cognitive leisure activities and foot reaction time. We studied 310 community-dwelling older adults aged 71 to 101 years (mean=84.0y), in the MOBILIZE Boston Study II. Simple foot reaction time (SRT) and choice foot reaction time (CRT) were measured as time to initiation of movement in response to an intermittent light stimulus, seated with feet placed on a gait mat (CIR Systems, Inc., Franklin, NJ). The Cognitive Activity Scale (CAS), assessed frequency of participation in 17 cognitive leisure activities. SRT and CRT ranged from 0.17 to 0.55ms (mean=0.25 ± 0.06ms), and 0.21 to 0.72ms (mean=0.32 ± 0.08ms), respectively. Average SRT and CRT were shorter according to higher CAS scores. In multivariable models adjusted for age, sex, race, education, mobility difficulty, peripheral arterial disease, and number of joint pain sites, CAS scores were associated with shorter SRT (p=0.02) and CRT (p=0.01). The association persisted but was weaker after further adjusting for gait speed (SRT, p=0.05; CRT, p=0.03). Adjustment for vision impairment did not alter the relationship between CAS and reaction time. These results show that participation in cognitively stimulating activities is associated with shorter foot reaction time. Further research is needed to determine whether participation in cognitive activities could reduce fall risk in older adults.