THE ASSOCIATION BETWEEN LOWER EXTREMITY FUNCTION, FRAILTY, AND LOW-MILEAGE DRIVER STATUS AMONG OLDER ADULTS

Abstract The crash rate per mile driven among older adults is higher than that of most age groups and comparable to that of the youngest, most inexperienced drivers. The low-mileage bias posits that the elevated rate among older adults results from an increased rate among those who accrue the fewest annual miles. This study evaluated whether low physical capacity among older drivers, measured by the National Health and Aging Trends Study (NHATS) Expanded Short Physical Performance Battery (SPPB) and Fried’s frailty phenotype, increases the risk of being low-mileage drivers. Data were collected for 2,990 older drivers via questionnaires and assessments in addition to 61,528 person-months of driving data. Multivariable log-binomial regression was used to estimate risk ratios. Those with fair and good function had 0.53 (95% CI: 0.40-0.69) and 0.60 (0.47-0.78) times the risk of driving fewer than 3,000 miles/year and 0.45 (0.26-0.77) and 0.48 (0.32-0.72) times the risk of driving fewer than 1,865 miles/year, respectively, compared to those with poor function. For an increase from not frail to pre-frail and from pre-frail to frail, the risk of driving fewer than 3,000 or 1,865 miles/year increased 1.36 (1.11-1.65) or 2.38 (1.63-3.46) times, respectively. Having low physical capacity is associated with an increased risk of low annual mileage. Given the known association between low-mileage driver status and increased crash rates and the modifiable nature of the risk factors examined in this study, interventions aimed at improving physical capabilities may lead to an improvement in safety among older drivers.

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Use of seroprevalence to guide dengue vaccination plans for older adults in a dengue non-endemic country

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0009312 ◽

2021 ◽

Vol 15 (4) ◽

pp. e0009312

Author(s):

Yi-Hua Pan ◽

Mei-Ying Liao ◽

Yu-Wen Chien ◽

Tzong-Shiann Ho ◽

Hui-Ying Ko ◽

...

Keyword(s):

Older Adults ◽

Adult Population ◽

Age Groups ◽

The Elderly ◽

Denv Infection ◽

Serum Samples ◽

Increased Risk ◽

Southern Taiwan ◽

Older Populations ◽

Age Range

A shift in dengue cases toward the adult population, accompanied by an increased risk of severe cases of dengue in the elderly, has created an important emerging issue in the past decade. To understand the level of past DENV infection among older adults after a large dengue outbreak occurred in southern Taiwan in 2015, we screened 1498 and 2603 serum samples from healthy residents aged ≥ 40 years in Kaohsiung City and Tainan City, respectively, to assess the seroprevalence of anti-DENV IgG in 2016. Seropositive samples were verified to exclude cross-reaction from Japanese encephalitis virus (JEV), using DENV/JEV-NS1 indirect IgG ELISA. We further identified viral serotypes and secondary DENV infections among positive samples in the two cities. The overall age-standardized seroprevalence of DENV-IgG among participants was 25.77% in Kaohsiung and 11.40% in Tainan, and the seroprevalence was significantly higher in older age groups of both cities. Although the percentages of secondary DENV infection in Kaohsiung and Tainan were very similar (43.09% and 44.76%, respectively), DENV-1 and DENV-2 spanned a wider age range in Kaohsiung, whereas DENV-2 was dominant in Tainan. As very few studies have obtained the serostatus of DENV infection in older adults and the elderly, this study highlights the need for further investigation into antibody status, as well as the safety and efficacy of dengue vaccination in these older populations.

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Association of Photopic and Mesopic Contrast Sensitivity in older drivers with risk of motor vehicle collision using naturalistic driving data

BMC Ophthalmology ◽

10.1186/s12886-020-1331-7 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Cynthia Owsley ◽

Thomas Swain ◽

Rong Liu ◽

Gerald McGwin ◽

Mi Young Kwon

Keyword(s):

Older Adults ◽

Contrast Sensitivity ◽

Motor Vehicle ◽

Age Groups ◽

Time Of Day ◽

Motor Vehicle Crash ◽

Older Drivers ◽

Crash Risk ◽

Sensitivity Testing ◽

Naturalistic Driving

Abstract Background Older drivers have a crash rate nearly equal to that of young drivers whose crash rate is the highest among all age groups. Contrast sensitivity impairment is common in older adults. The purpose of this study is to examine whether parameters from the photopic and mesopic contrast sensitivity functions (CSF) are associated with incident motor vehicle crash involvement by older drivers. Methods This study utilized data from older drivers (ages ≥60 years) who participated in the Strategic Highway Research Program Naturalistic Driving Study, a prospective, population-based study. At baseline participants underwent photopic and mesopic contrast sensitivity testing for targets from 1.5–18 cycles per degree. Model fitting generated area under the log CSF (AULCSF) and peak log sensitivity. Participant vehicles were instrumented with sensors that captured continuous driving data when the vehicle was operating (accelerometers, global positioning system, forward radar, 4-channel video). They participated for 1–2 years. Crashes were coded from the video and other data streams by trained analysts. Results The photopic analysis was based on 844 drivers, and the mesopic on 854 drivers. Photopic AULCSF and peak log contrast sensitivity were not associated with crash rate, whether defined as all crashes or at-fault crashes only (all p > 0.05). Mesopic AULCSF and peak log sensitivity were associated with an increased crash rate when considered for all crashes (rate ratio (RR): 1.36, 95% CI: 1.06–1.72; RR: 1.28, 95% CI: 1.01–1.63, respectively) and at-fault crashes only (RR: 1.50, 95% CI: 1.16–1.93; RR: 1.38, 95% CI: 1.07–1.78, respectively). Conclusions Results suggest that photopic contrast sensitivity testing may not help us understand future crash risk at the older-driver population level. Results highlight a previously unappreciated association between older adults’ mesopic contrast sensitivity deficits and crash involvement regardless of the time of day. Given the wide variability of light levels encountered in both day and night driving, mesopic vision tests, with their reliance on both cone and rod vision, may be a more comprehensive assessment of the visual system’s ability to process the roadway environment.

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Changes in the Dynamic Stability of Walking in Active Healthy Older Adults Independent of Changes in Walking Speed

Volume 2: Biomedical and Biotechnology Engineering ◽

10.1115/imece2008-67807 ◽

2008 ◽

Author(s):

Hyun Gu Kang ◽

Jonathan B. Dingwell

Keyword(s):

Older Adults ◽

Young Adults ◽

Dynamic Stability ◽

Walking Speed ◽

Age Groups ◽

Leg Strength ◽

Age Related ◽

Increased Risk ◽

Risk Of Falls ◽

Walking Speeds

Older adults commonly walk slower, which many believe helps improve their walking stability. However, they remain at increased risk of falls. We investigated how differences in age and walking speed independently affect dynamic stability during walking, and how age-related changes in leg strength and ROM affected this relationship. Eighteen active healthy older and 17 younger adults walked on a treadmill for 5 minutes each at each of 5 speeds (80–120% of preferred). Local divergence exponents and maximum Floquet multipliers (FM) were calculated to quantify each subject’s responses to small inherent perturbations during walking. These older adults exhibited the same preferred walking speeds as the younger subjects (p = 0.860). However, these older adults still exhibited greater local divergence exponents (p<0.0001) and higher maximum FM (p<0.007) than young adults at all walking speeds. These older adults remained more unstable (p<0.04) even after adjusting for declines in both strength and ROM. In both age groups, local divergence exponents decreased at slower speeds and increased at faster speeds (p<0.0001). Maximum FM showed similar changes with speed (p<0.02). The older adults in this study were healthy enough to walk at normal speeds. However, these adults were still more unstable than the young adults, independent of walking speed. This greater instability was not explained by loss of leg strength and ROM. Slower speeds led to decreased instability in both groups.

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USEFUL FIELD OF VIEW AND DRIVING SIMULATION ACROSS TWO AGE GROUPS

Innovation in Aging ◽

10.1093/geroni/igz038.3511 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S968-S969

Author(s):

Rebecca A Dunterman ◽

Robert C Intrieri ◽

Marisa Guernsey

Keyword(s):

Older Adults ◽

Digit Span ◽

Age Groups ◽

Reaction Times ◽

Community Dwelling ◽

Older Drivers ◽

Field Of View ◽

Driving Simulation ◽

Risk Scores ◽

Useful Field Of View

Abstract The Insurance Information Institute (2017) reports that drivers aged 65 and older have the second highest rate of fatal car crashes. Research with the useful field of view (UFOV) assessment has predicted crashes in older drivers (Ball, 2006). “UFOV is defined as the area from which an individual can extract information quickly without head or eye movement” (Posit Science, 2019). Research demonstrates that older drivers are limited by poorer vision, divided attention and the inability to ignore distractions, and slower reaction time to critical stimuli (Owsley et al. 1998). As a result UFOV is an effective variable in assessing driver safety. We hypothesized that older compared to younger drivers would be less likely to inhibit attention to task irrelevant visual stimuli while engaged in a simulated driving task. Participants were community dwelling older adults and students recruited from a research pool and through word of mouth. Participants completed a series of demographic and health questions, Snellen visual acuity test a series of cognitive measures (e. g., Trails 1 and 2, digit symbol, digit span) and the UFOV assessment. Participants completed a driving simulation task while information on driving performance: number of collisions, speed limit deviations, turn signal use, time spent tailgating another vehicle, and braking reaction times. ANOVA demonstrated that as hypothesized, younger participants had significantly lower UFOV risk scores (p = .000). Older adults’ (M = 2.15, SD = .945) and younger adults’ (M = 1, SD = 0).

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Distance from home to motor vehicle crash location: Implications for license restrictions among medically-at-risk older drivers

10.1101/2021.08.20.21262345 ◽

2021 ◽

Author(s):

Nina R Joyce ◽

Marzan A Khan ◽

Andrew R Zullo ◽

Melissa R Pfieffer ◽

Kristina B Metzger ◽

...

Keyword(s):

Older Adults ◽

At Risk ◽

New Jersey ◽

Motor Vehicle ◽

Medical Condition ◽

Motor Vehicle Crash ◽

Older Drivers ◽

Fee For Service ◽

Medical Conditions ◽

Crash Rates

Background/Objectives: Thirty states allow licensing agencies to restrict the distance from home that medically–at–risk drivers are permitted to drive. However, there is little information on where older drivers crash relative to their home or how distance to crash varies by medical condition, and thus, what impact distance limits may have on motor vehicle crash rates for medically–at–risk drivers. Design: Observational study of crash-involved drivers. Setting: Medicare fee–for–service claims linked to geocoded crash locations and residential addresses from police crash reports in the state of New Jersey from 2007 through 2017. Participants: New Jersey Medicare fee–for–service beneficiaries aged 68 years and older involved in police–reported crashes. Measurements: The outcome was Euclidian distance from home to crash location. Covariates included driving-relevant medical conditions from Medicare claims, crash characteristics from police reports, and demographics from both sources. Results: There were 197,122 crash-involved older drivers for whom approximately 70% of crashes occurred within 5 miles and 95% within 25 miles of the drivers residence. The mean distance to crash was 6.0 miles. Although distance from home to the crash was generally lower among drivers with (versus without) each of the medical conditions studied, the differences were small (maximum mean difference of 2.1 miles). The largest difference in distance was by licensure status, where unlicensed/suspended drivers crashed significantly farther from home than validly licensed drivers (8.8 miles, 95% Confidence Interval [CI]: 8.4—9.1 vs 5.9 miles, 95% CI: 5.9 — 6.0). Conclusions: Findings suggest that the majority of older adults who crash do so within a few miles from home and that the distance to crash does not differ substantially by the presence of a driving–relevant medical condition. Thus, distance restrictions may not reduce crash rates among older adults and the tradeoff between safety and mobility warrants consideration.

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Trends of polypharmacy among older adults with schizophrenia in Quebec, Canada between 2000 and 2017

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.822 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

C Lunghi ◽

L Rochette ◽

A Ouali ◽

C Sirois

Keyword(s):

Older Adults ◽

Disease Surveillance ◽

Variance Estimation ◽

Age Groups ◽

Population Based ◽

Older Individuals ◽

Noticeable Increase ◽

Disease Surveillance System ◽

Increased Risk ◽

Age And Sex

Abstract Background Schizophrenia is a severe psychiatric disorder associated with an increased risk of type 2 diabetes, dyslipidemia and obesity. As adults with schizophrenia age, they become at high risk for multimorbidity and polypharmacy. However, little is known about the trends in total medications use within this population. The objective of this study was to draw a portrait of polypharmacy among Quebec older adults with schizophrenia from 2000 to 2017. Methods This population-based cohort study used the data of the Quebec Integrated Chronic Disease Surveillance System of the National Institute of Public Health of Quebec to characterize recent trends and patterns of medications use, according to age and sex. We identified all Quebec residents over 65 years with an ICD-9 or ICD-10 diagnosis of schizophrenia. We calculated the total number of medications used by every individual in each year under study, and the age- and sex-standardized proportion of individuals with polypharmacy (10+ medications, 15+, and 20+). We further identified the clinical and socio-demographic factors associated with polypharmacy using Poisson regression models with robust variance estimation. Results From 2000 to 2017, the prevalence of total medications used increased across all age groups, with a median of 8 medications consumed in 2000-2001, which rose to 11 in 2016-2017. The age-standardized proportion of people exposed to different degrees of polypharmacy also increased over time: 5+: 76.6% to 89.3%; 10+ drugs: 36.9% to 62.2%; 15+: 13.3% to 34.4%; 20+: 3.9% to 14.4%. In the multivariate regression, the only clinically significant factor associated with polypharmacy was the high number of diseases (e.g., 5+: RR = 1.29; 95% IC:1.44-1.53). Conclusions This study shows a noticeable increase in polypharmacy exposure of older adults with schizophrenia, raising concerns about the growing risks for adverse effects and drug interactions with antipsychotic treatments. Key messages Polypharmacy has constantly grown in the last two decades. Further research is needed to better understand outcomes of polypharmacy among older individuals with schizophrenia.

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Application of Machine Vision in Classifying Gait Frailty Among Older Adults

Frontiers in Aging Neuroscience ◽

10.3389/fnagi.2021.757823 ◽

2021 ◽

Vol 13 ◽

Author(s):

Yixin Liu ◽

Xiaohai He ◽

Renjie Wang ◽

Qizhi Teng ◽

Rui Hu ◽

...

Keyword(s):

Older Adults ◽

Machine Vision ◽

Area Under The Curve ◽

Predictive Performance ◽

Premature Death ◽

Frailty Phenotype ◽

Adverse Health Outcomes ◽

Increased Risk ◽

Gait Feature ◽

Identification Processes

Background: Frail older adults have an increased risk of adverse health outcomes and premature death. They also exhibit altered gait characteristics in comparison with healthy individuals.Methods: In this study, we created a Fried’s frailty phenotype (FFP) labelled casual walking video set of older adults based on the West China Health and Aging Trend study. A series of hyperparameters in machine vision models were evaluated for body key point extraction (AlphaPose), silhouette segmentation (Pose2Seg, DPose2Seg, and Mask R-CNN), gait feature extraction (Gaitset, LGaitset, and DGaitset), and feature classification (AlexNet and VGG16), and were highly optimised during analysis of gait sequences of the current dataset.Results: The area under the curve (AUC) of the receiver operating characteristic (ROC) at the physical frailty state identification task for AlexNet was 0.851 (0.827–0.8747) and 0.901 (0.878–0.920) in macro and micro, respectively, and was 0.855 (0.834–0.877) and 0.905 (0.886–0.925) for VGG16 in macro and micro, respectively. Furthermore, this study presents the machine vision method equipped with better predictive performance globally than age and grip strength, as well as than 4-m-walking-time in healthy and pre-frailty classifying.Conclusion: The gait analysis method in this article is unreported and provides promising original tool for frailty and pre-frailty screening with the characteristics of convenience, objectivity, rapidity, and non-contact. These methods can be extended to any gait-related disease identification processes, as well as in-home health monitoring.

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Herpes zoster in older adults in Ontario, 2002–2016: Investigating incidence and exploring equity

PLoS ONE ◽

10.1371/journal.pone.0246086 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0246086

Author(s):

Sarah A. Buchan ◽

Nick Daneman ◽

Jun Wang ◽

Sarah E. Wilson ◽

Gary Garber ◽

...

Keyword(s):

Older Adults ◽

Herpes Zoster ◽

Age Groups ◽

Population Based ◽

Income Quintile ◽

Increased Risk ◽

Neighbourhood Level ◽

Before And After ◽

Future Work ◽

The Impact

Older adults are at increased risk of herpes zoster (HZ) and post-herpetic neuralgia (PHN) and HZ vaccines are available to help prevent infection. The objective of our study was to provide updated data on incidence of HZ and PHN related to clinical and demographic factors in older adults to inform immunization practices. We conducted a population-based, retrospective cohort study and included all cases of HZ seen in outpatient, emergency department, and hospital settings for adults aged 65 years and over between April 1, 2002 to August 31, 2016 in Ontario, Canada. We calculated the incidence of HZ and PHN, and estimated the proportion within each subgroup that developed PHN. We also assessed incidence by neighbourhood-level income quintile before and after the availability of vaccine for private purchase. The average annual incidence of HZ in any setting was 59.0 per 10,000 older adults, with higher incidence in outpatient as opposed to hospital settings. Incidence was higher in the oldest age groups, females, and those classified as immunocompromised or frail. Relative to the pre-vaccine era, the disparities in incidence of HZ by neighbourhood-level income increased, with higher rates of HZ and PHN seen in those residing in lower income quintiles. Additional prevention efforts should be targeted toward adults who are immunocompromised, frail, and those living in lower socioeconomic quintiles. Future work should assess the impact of the zoster vaccine program with a particular focus on equity in the publicly-funded era.

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Perceived fear of COVID-19 and its associated factors among Nepalese older adults in eastern Nepal: A cross-sectional study

PLoS ONE ◽

10.1371/journal.pone.0254825 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0254825

Author(s):

Uday Narayan Yadav ◽

Om Prakash Yadav ◽

Devendra Raj Singh ◽

Saruna Ghimire ◽

Binod Rayamajhee ◽

...

Keyword(s):

Older Adults ◽

Associated Factors ◽

Age Groups ◽

Psychological Needs ◽

Cross Sectional Study ◽

Current Evidence ◽

Severe Illness ◽

Sectional Study ◽

Cross Sectional ◽

Increased Risk

Background Coronavirus disease 2019 (COVID-19) has affected all age groups worldwide, but older adults have been affected greatly with an increased risk of severe illness and mortality. Nepal is struggling with the COVID-19 pandemic. The normal life of older adults, one of the vulnerable populations to COVID-19 infection, has been primarily impacted. The current evidence shows that the COVID-19 virus strains are deadly, and non-compliance to standard protocols can have serious consequences, increasing fear among older adults. This study assessed the perceived fear of COVID-19 and associated factors among older adults in eastern Nepal. Methods A cross-sectional study was conducted between July and September 2020 among 847 older adults (≥60 years) residing in three districts of eastern Nepal. Perceived fear of COVID-19 was measured using the seven-item Fear of COVID-19 Scale (FCV-19S). Multivariate logistic regression identified the factors associated with COVID-19 fear. Results The mean score of the FCV-19S was 18.1 (SD = 5.2), and a sizeable proportion of older adults, ranging between 12%-34%, agreed with the seven items of the fear scale. Increasing age, Dalit ethnicity, remoteness to the health facility, and being concerned or overwhelmed with the COVID-19 were associated with greater fear of COVID-19. In contrast, preexisting health conditions were inversely associated with fear. Conclusion Greater fear of the COVID-19 among the older adults in eastern Nepal suggests that during unprecedented times such as the current pandemic, the psychological needs of older adults should be prioritized. Establishing and integrating community-level mental health support as a part of the COVID-19 preparedness and response plan might help to combat COVID-19 fear among them.

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60 Obesity in Older Adults in the Epic Norfolk Study is Associated with Reduced 20-Year Falls Hospitalization

Age and Ageing ◽

10.1093/ageing/afz164.60 ◽

2019 ◽

Vol 48 (Supplement_4) ◽

pp. iv13-iv17

Author(s):

Sheng Hui Kioh ◽

Mat Sumaiyah ◽

Phyo Myint ◽

Maw Pin Tan

Keyword(s):

Older Adults ◽

Body Height ◽

Age Groups ◽

Age Group ◽

Future Studies ◽

Increased Risk ◽

Risk Of Falls ◽

Using Data ◽

The Relationship

Abstract Background One in three older adults fall each year leading to increased disability, hospitalizations and mortality. Recent studies suggested an increased risk of falls among obese individuals which may correlate with increased rates of falls hospitalizations. However, there is not much information supporting the hypothesis that obesity may influence the risk of falls related hospitalizations. Aims To prospectively investigate whether body mass index (BMI) is a predictor for falls hospitalization by age group in the population of the EPIC-Norfolk Study. Methods Body height and weight were measured at baseline and BMI calculated. Falls hospitalization status over 20 years’ follow-up was ascertained using data linkage with centralized NHS records. Participants were categorized into the four BMI groups: underweight (BMI <18.5kg/m2 ), normal (18.5 ≤ BMI < 25.0 kg/m2), overweight ( 25.0 ≤ BMI < 30.0 kg/m2 ) and obese ( BMI ≥ 30.0kg/m2 ), and according to three age groups ( < 55 years, 55-64 years, ≥ 65 years). Results Data from 25636 individuals, (54.7%) women and (45.3%) men, mean age 59.2 ± 9.3 years, were included. For individuals within the under 55-year age group at baseline, individuals who were overweight (HR = 1.25; 95% CI= 1.01-1.56) and obese (HR = 1.54; 95% CI= 1.17-1.81) were at higher risk of falls hospitalization compared with those with normal BMI. As for individuals aged ≥ 65 years at recruitment, individuals who were obese were less likely to be hospitalized after a fall (HR = 0.85; 95% CI= 0.74 – 0.97) compared to those with normal BMI. Conclusions The relationship between obesity and falls hospitalization over 20 years differed between those aged <55years and 65years, with an increased risk observed for those <55years and reduced risk in those 65years. The underlying rationale for this finding will need to be evaluated in future studies.

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