Assessment of executive function before and after vitamin D replacement in vulnerable adults who self-neglect

Purpose: Self-neglect (SN) is the inability to maintain self-care needs. It is thought that older adults who have impaired executive function (EF) develop the inability to do self-care and to protect themselves. The specific aims were to (1) determine the feasibility of using multiple EF measures with community-dwelling elders with SN, (2) identify changes in EF between baseline and 5-months in community-dwelling elders with SN who receive 50,000 IU or 400 IU of oral vitamin D monthly and (2) explore changes in specific dimensions of EF between the groups. ^ Methods: Fifty adults, 65 years of age and older, were recruited from Adult Protective Services with confirmed SN. A research nurse administered the following tests at baseline and five-months: Delis-Kaplan Card Sort Test (D-KEFS), Executive Interview (EXIT 25), CLOX Drawing Test (CLOX I, II), Trails Making Test A and B (TMT A & B) and the Mini-Mental State Examination (MMSE). Demographic data was collected at baseline and serum 25-OHD levels were collected at baseline and five-months. ^ Results: Older adults with SN were more likely to fail the CLOX1 and D-KEFS, while passing the MMSE, CLOX II, TMT A & B and the EXIT 25. At five-months, the only statistically significant difference between groups was in the TMT A & B test scores; the control group did better than the treatment group. There was a non-significant increase in serum vitamin D levels for both groups and no difference between groups. ^ Conclusions: Results from this study provide support that individuals who SN will complete a battery of EF tests and that they exhibit the following impairments consistent with executive dysfunction: 'concept generation', 'planning', 'inhibition', and 'spatial working memory'. Utilizing only one EF measure in individuals with intact cognition may result in unidentification of individuals with executive dysfunction, thus delaying necessary treatment. Future studies should attempt to determine different etiologies of executive dysfunction and determine if early treatment can prevent or reverse SN. ^ Key Words: Self-neglect, Executive Dysfunction, Executive Function, Adult Protective Services, Community-dwelling, Vitamin D ^

Mistreatment and self-neglect in community dwelling older adults: Studies of construct validity, measurement invariance and latent classes

Mistreatment and self-neglect significantly increase the risk of dying in older adults. It is estimated that 1 to 2 million older adults experience elder mistreatment and self-neglect every year in the United States. Currently, there are no elder mistreatment and self-neglect assessment tools with construct validity and measurement invariance testing and no studies have sought to identify underlying latent classes of elder self-neglect that may have differential mortality rates. Using data from 11,280 adults with Texas APS substantiated elder mistreatment and self-neglect 3 studies were conducted to: (1) test the construct validity and (2) the measurement invariance across gender and ethnicity of the Texas Adult Protective Services (APS) Client Assessment and Risk Evaluation (CARE) tool and (3) identify latent classes associated with elder self-neglect. Study 1 confirmed the construct validity of the CARE tool following adjustments to the initial hypothesized CARE tool. This resulted in the deletion of 14 assessment items and a final assessment with 5 original factors and 43 items. Cross-validation for this model was achieved. Study 2 provided empirical evidence for factor loading and item-threshold invariance of the CARE tool across gender and between African-Americans and Caucasians. The financial status domain of the CARE tool did not function properly for Hispanics and thus, had to be deleted. Subsequent analyses showed factor loading and item-threshold invariance across all 3 ethnic groups with the exception of some residual errors. Study 3 identified 4-latent classes associated with elder self-neglect behaviors which included individuals with evidence of problems in the areas of (1) their environment, (2) physical and medical status, (3) multiple domains and (4) finances. Overall, these studies provide evidence supporting the use of APS CARE tool for providing unbiased and valid investigations of mistreatment and neglect in older adults with different demographic characteristics. Furthermore, the findings support the underlying notion that elder self-neglect may not only occur along a continuum, but that differential types may exist. All of which, have very important potential implications for social and health services distributed to vulnerable mistreated and neglected older adults.^

(Table 1) Sea-surface temperatures, intermediate-water temperatures, and latitudinal gradient at three time slices at the end of the Cretaceous

Climatic and oceanographic variations during the last 2 m.y. of the Maastrichtian inferred from high-resolution (10 k.y.) stable isotope analysis of the mid-latitude South Atlantic Deep Sea Drilling Project Site 525 reveal a major warm pulse followed by rapid cooling prior to the Cretaceous-Tertiary boundary. Between 66.85 and 65.52 Ma, cool but fluctuating temperatures average 9.9 and 15.4°C in intermediate and surface waters, respectively. This interval is followed by an abrupt short-term warming between 65.45 and 65.11 Ma, which increased temperatures by 2-3°C in intermediate waters, and decreased the vertical thermal gradient to an average of 2.7°C. This warm pulse may be linked to increased atmospheric pCO2, increased poleward heat transport, and the switch of an intermediate water source from high to low-middle latitudes. During the last 100 k.y. of the Maastrichtian, intermediate and surface temperatures decreased by an average of 2.1 and 1.4°C, respectively, compared to the maximum temperature between 65.32 and 65.24 Ma.

Composition of particulate lipids in the intermediate zone between the Kara and Laptev Seas

Chemical group composition of particulate lipids from the intermediate zone between the Kara and Laptev Seas is studied by thin-layer chromatography with flame ionization detection (IATROSCAN TH-10). Hydrocarbons and complex polar lipids similar to those found in the previously studied southeastern area of the Kara Sea are basic components of particulate lipids. High content of triglycerides in the upper layers of the water mass north of the Severnaya Zemlya Islands is a characteristic feature of group composition of particulate lipids. Distribution of triglycerides correlates with localization of the ice cover boundary and complies with process of phytoplankton blooming in the ice edge zone. Distribution of lipid concentration depends on water stratification in the intermediate zone between the Kara and Laptev Seas.