Innovative biomarkers for predicting type 2 diabetes mellitus:relevance to dietary management of frailty in older adults

Type 2 diabetes mellitus (T2DM) increases in prevalence in the elderly. There is evidence for significant muscle loss and accelerated cognitive impairment in older adults with T2DM; these comorbidities are critical features of frailty. In the early stages of T2DM, insulin sensitivity can be improved by a “healthy” diet. Management of insulin resistance by diet in people over 65 years of age should be carefully re-evaluated because of the risk for falling due to hypoglycaemia. To date, an optimal dietary programme for older adults with insulin resistance and T2DM has not been described. The use of biomarkers to identify those at risk for T2DM will enable clinicians to offer early dietary advice that will delay onset of disease and of frailty. Here we have used an in silico literature search for putative novel biomarkers of T2DM risk and frailty. We suggest that plasma bilirubin, plasma, urinary DPP4-positive microparticles and plasma pigment epithelium-derived factor merit further investigation as predictive biomarkers for T2DM and frailty risk in older adults. Bilirubin is screened routinely in clinical practice. Measurement of specific microparticle frequency in urine is less invasive than a blood sample so is a good choice for biomonitoring. Future studies should investigate whether early dietary changes, such as increased intake of whey protein and micronutrients that improve muscle function and insulin sensitivity, affect biomarkers and can reduce the longer term complication of frailty in people at risk for T2DM.

Participatory research with older adults with AMD:co-designing a SMART diet diary app

The global population of people aged 60 years and older is growing rapidly. In the UK, there are currently around 10 million people aged 65 and over, and the number is projected to rise by 50% in the next 20 years (RNIB, 2013). While ongoing advances in information technology (IT) are undoubtedly increasing the scope for IT to enhance and support older adults' daily living, the digital divide between older and younger adults - 43% of people below the age of 55 own and use a smartphone, compared to only 3% of people aged 65 and over (AgeUK, 2013) - raises concerns about the suitability of technological solutions for older adults, especially for older adults with impairments. Evidence suggests that sympathetic design of mobile technology does render it useful and acceptable to older adults: the key issue is, however, how best to achieve such sympathetic design when working with impaired older adults. We report here on a case study in order to outline the practicalities and highlight the benefits of participatory research for the design of sympathetic technology for (and importantly with) older adults with impairments.

Anticholinergic burden in older adults with intellectual disability; relationships with multimorbidity and adverse effects

Background: Anticholinergic medications may be associated with adverse clinical outcomes, including acute impairments in cognition and anticholinergic side effects, the risk of adverse outcomes increasing with increasing anticholinergic exposure. Older people with intellectual disability may be at increased risk of exposure to anticholinergic medicines due to their higher prevalence of comorbidities. We sought to determine anticholinergic burden in ageing people with intellectual disability. Methods: Medication data (self-report/proxy-report) was drawn from Wave 1 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), a study on the ageing of 753nationally representative people with an IDC40 years randomly selected from the National Intellectual Disability Database. Each individual’s cumulative exposure to anticholinergic medications was calculated using the Anticholinergic Cognitive Burden Scale (ACB) amended by a multi-disciplinary group with independent advice to account for the range of medicines in use in this population. Results: Overall, 70.1 % (527) reported taking medications with possible or definite anticholinergic properties (ACBC1), with a mean (±SD) ACB score of 4.5 (±3.0) (maximum 16). Of those reporting anticholinergic exposure (n=527), 41.3 % (217) reported an ACB score o fC5. Antipsychotics accounted for 36.4 % of the total cumulative ACB score followed by anticholinergics (16 %) and antidepressants (10.8 %). The most frequently reported medicine with anticholinergic activity was carbamazepine 16.8 % (127). The most frequently reported medicine with high anticholinergic activity (ACB 3) was olanzapine13.4 % (101). There was a significant association between higher anti-cholinergic exposure and multimorbidity, particularly mental health morbidity, and some anticholinergic adverse effects such as constipation and day-time drowsiness but not self-rated health. Conclusion: Using simple cumulative measures proved an effective means to capture total burden and helped establish that anticholinergic exposure in the study population was high. The finding highlights the need for comprehensive reviews of medications.

Participatory design with older adults for healthcare apps

The global population of people aged 60 years and older is growing rapidly [1]. Ongoing advances in mobile technologies have the potential to improve independence and quality of life of older adults by supporting the delivery of personalised and ubiquitous healthcare solutions. Suggested healthcare reforms reflect the need for a future model of healthcare delivery wherein older adults take more responsibility for their own healthcare in their own homes in an attempt to moderate healthcare costs without impairing healthcare quality. For such a paradigm shift to be realised, the supporting technology must address the needs of older patients efficiently and effectively to ensure technology acceptance and use. We argue this is not possible without employing participatory approaches for the informed and effective design and development of such technologies and outline recommendations for engaging in participatory design with older adults with impairments based on practical experience.

Co-designing a SMART diet diary application with older adults with AMD

The global population of people aged 60 years and older is growing rapidly. In the UK, there are currently around 10 million people aged 65 and over, and the number is projected to rise by 50% in the next 20 years (RNIB, 2013). While ongoing advances in information technology (IT) are undoubtedly increasing the scope for IT to enhance and support older adults’ daily living, the digital divide between older and younger adults – 43% of people below the age of 55 own and use a smartphone, compared to only 3% of people aged 65 and over (AgeUK, 2013) – raises concerns about the suitability of technological solutions for older adults, especially for older adults with impairments. Evidence suggests that sympathetic design of mobile technology does render it useful and acceptable to older adults: the key issue is, however, how best to achieve such sympathetic design when working with impaired older adults. We report here on a case study in order to outline the practicalities and highlight the benefits of participatory research for the design of sympathetic technology for (and importantly with) older adults with impairments.

Correlates of voluntary HIV testing and counseling among middle aged and older Latinas

This study identifies and describes HIV Voluntary Counseling and Testing (VCT) of middle aged and older Latinas. The rate of new cases of HIV in people age 45 and older is rapidly increasing, with a 40.6% increase in the numbers of older Latinas infected with HIV between 1998 and 2002. Despite this increase, there is paucity of research on this population. This research seeks to address the gap through a secondary data analysis of Latina women. The aim of this study is twofold: (1) Develop and empirically test a multivariate model of VCT utilization for middle aged and older Latinas; (2) To test how the three individual components of the Andersen Behavioral Model impact VCT for middle aged and older Latinas. The study is organized around the three major domains of the Andersen Behavioral Model of service use that include: (a) predisposing factors; (b) enabling characteristics and (c) need. Logistic regression using structural equation modeling techniques were used to test multivariate relationships of variables on VCT for a sample of 135 middle age and older Latinas residing in Miami-Dade County, Florida. Over 60% of participants had been tested for HIV. Provider endorsement was found to he the strongest predictor of VCT (odds ration [OR] 6.38), followed by having a clinic as a regular source of healthcare (OR=3.88). Significant negative associations with VCT included self rated health status (OR=.592); Age (OR=.927); Spanish proficiency (OR=.927); number of sexual partners (OR=.613) and consumption of alcohol during sexual activity (.549). As this line of inquiry provides a critical glimpse into the VCT of older Latinas, recommendations for enhanced service provision and research will he offered.

The Relationship between Civic Engagement and Health among Older Adults

This paper explores the relationship between civic engagement and health among older adults. As the U.S. population ages and people are living longer in the retirement phase, practitioners need to provide programs of growth and development for this population.

Health changes in Hispanic older adults in a Spanish arthritis self -management education program

Arthritis is the most common chronic condition affecting older people and is a major cause of limited activity. Arthritis education programs in English have demonstrated a positive impact on health but these programs have not reached the Hispanic communities where arthritis is the leading cause of disability. Minorities, such as Hispanics, have traditionally been reluctant to pursue self-help programs, and have been identified as an under-served population in terms of medical care. This study examined the effectiveness of one community health adult education program targeting Hispanic older adults with arthritis, the Spanish Arthritis Self Management Education Program (SASMEP), by evaluating changes in the participants' general health, pain, disability, self-efficacy, health perceptions, frequency of physician visits, and exercise. A pre and post control group experimental design and analyses of covariance were used to determine the pre and post differences in health status and health behaviors for a group participating in the SASMEP and a group who did not using gender and age as covariates. A repeated measures design was also used, and repeated measures analyses of variance and post hoc tests were done on health status and health behavior data collected pre, post and one-year post education to determine long-term differences. ^ Results indicated the participants' health status significantly improved in general health, significantly decreased in pain, and significantly decreased in arthritic disability immediately following the education. Self-efficacy and health perceptions increased for both groups but not significantly. The participants' health behaviors showed significantly fewer physician visits and significantly increased time spent performing stretching and strengthening exercise and time spent performing aerobic exercise. No group differences were found in the frequency of arthritis physician visits. ^ The improvements seen immediately after the SASMEP participation were not reflected in the post one-year scores. No significant differences were found for the participants' health status or health behaviors one year following the education. Health status and health behaviors did not return below baseline scores after one year suggesting the participants' health, although not improved, did not deteriorate. Therefore, the SASMEP education provided short-term health benefits for older Hispanic adults with arthritis, but not long-term health benefits. ^

Computer interaction : its effect on attitude and performance in older adults

This study examined the interaction of age, attitude, and performance within the context of an interactive computer testing experience. Subjects were 13 males and 47 females between the ages of 55 and 82, with a minimum of a high school education. Initial attitudes toward computers, as measured by the Cybernetics Attitude Scale (CAS), demonstrated overall equivalence between these older subjects and previously tested younger subjects. Post-intervention scores on the CAS indicated that attitudes toward computers were unaffected by either a "fun" or a "challenging" computer interaction experience. The differential effects of a computerized vs. a paperand- pencil presentation format of a 20-item, multiple choice vocabulary test were examined. Results indicated no significant differences in the performance of subjects in the two conditions, and no interaction effect between attitude and performance. These findings suggest that the attitudes of older adults towards computers do not affect their computerized testing performance, at least for short term testing of verbal abilities. A further implication is that, under the conditions presented here, older subjects appear to be unaffected by mode of testing. The impact of recent advanced in technology on older adults is discussed.

Incidentally Raised Cardiac Troponin I Has a Worse Prognosis in Older Patients Compared to Those with Normal Cardiac Troponin I and Patients with Acute Coronary Syndrome : A Cohort Study

Acknowledgement J.H.B.-S. was supported by the Norfolk and Norwich University Hospital (NNUH) Research and Development (R&D) research capability funds between July 2013 and December 2014.

Older woman with cello in senior citizens band

General note: Title and date provided by Bettye Lane.

Older woman for senior action

General note: Title and date provided by Bettye Lane.

Older woman at NOW conference, Phildelphia

General note: Title and date provided by Bettye Lane.

Older women play cards at the YWCA

General note: Title and date provided by Bettye Lane.

Older woman at "Women learn from Women" conference at Barnard College

General note: Title and date provided by Bettye Lane.