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Bowling CB, Berkowitz TSZ, Burrows BT, Ma JE, Whitson HE, Smith B, Crowley SD, Wang V, Maciejewski ML, Olsen MK. Trajectories of Physical Resilience Among Older Veterans With Stage 4 CKD. Am J Kidney Dis 2024; 84:154-163. [PMID: 38484869 DOI: 10.1053/j.ajkd.2024.01.529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/15/2024] [Accepted: 01/28/2024] [Indexed: 04/26/2024]
Abstract
RATIONALE & OBJECTIVE Although functional impairment is common among older adults with chronic kidney disease (CKD), functional reserve before an acute health event and physical resilience after the event have not been characterized in this population. The purpose of this study was to identify distinct patterns of physical function before and after an acute health event among older veterans with stage 4 CKD. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS National sample of veterans≥70 years of age with an estimated glomerular filtration rate (eGFR) of<30mL/min/1.73m2 who had an acute care encounter (emergency department visit or hospitalization) during the follow-up period (n = 272). PREDICTORS Demographic characteristics, eGFR, basic and instrumental activities of daily living (ADL/IADL) difficulty, symptom burden, cognition, depressive symptoms, social support. OUTCOME Function measured using the life-space mobility assessment obtained by telephone survey before and after an acute care encounter. ANALYTICAL APPROACH General growth mixture models to identify classes of functional trajectories. Calculation of percentages for demographic characteristics and means for eGFR, ADL/IADL difficulty, symptom burden, cognition, depressive symptoms, and social support by trajectory class. RESULTS Four trajectory classes were identified and characterized by different levels of life-space mobility before (reserve) and change in life-space mobility after (resilience) an acute care encounter: (1) low reserve, low resilience (n=91), (2) high reserve, high resilience (n=23), (3) moderate reserve, moderate resilience (n=89), and (4) high reserve, low resilience (n=69). Mean levels of ADL/IADL difficulty, symptom burden, cognition, and depressive symptoms, but not demographic characteristics, eGFR, or social support, differed by trajectory class. LIMITATIONS Veteran cohort was primarily male. CONCLUSIONS Among older adults with stage 4 CKD, physical function trajectories before and after an acute health event vary. Integrating reserve and resilience into care for this population may be useful for anticipating changes in function and developing tailored treatment plans.
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Affiliation(s)
- C Barrett Bowling
- Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham, North Carolina; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina; Center for the Study of Aging and Human Development (the Aging Center), Duke University, Durham, North Carolina; Department of Medicine, Duke University, Durham, North Carolina.
| | - Theodore S Z Berkowitz
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina
| | - Brett T Burrows
- Center for the Study of Aging and Human Development (the Aging Center), Duke University, Durham, North Carolina
| | - Jessica E Ma
- Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham, North Carolina; Department of Medicine, Duke University, Durham, North Carolina
| | - Heather E Whitson
- Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham, North Carolina; Center for the Study of Aging and Human Development (the Aging Center), Duke University, Durham, North Carolina; Department of Medicine, Duke University, Durham, North Carolina
| | - Battista Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina
| | - Steven D Crowley
- Durham Veterans Affairs Health Care System, Durham, North Carolina; Department of Medicine, Duke University, Durham, North Carolina
| | - Virginia Wang
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina; Durham Veterans Affairs Health Care System, Durham, North Carolina; Department of Medicine, Duke University, Durham, North Carolina; Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Matthew L Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina; Durham Veterans Affairs Health Care System, Durham, North Carolina; Department of Medicine, Duke University, Durham, North Carolina; Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Maren K Olsen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
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Hu FW, Li YP, Chang CM, Lin TY, Lai PH, Lin CY. Development and testing of a four-item version of the physical resilience instrument for older adults (PRIFOR-4). J Nutr Health Aging 2024; 28:100250. [PMID: 38677078 DOI: 10.1016/j.jnha.2024.100250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 04/17/2024] [Accepted: 04/17/2024] [Indexed: 04/29/2024]
Abstract
The 16-item Physical Resilience Instrument for Older Adults (PRIFOR) has good clinimetric properties; however, a shortened PRIFOR would greatly enhance physical resilience measurements in clinical settings. The current analysis aimed to reduce the number of PRIFOR while maintaining its clinimetric properties, emphasizing on its factor structure and convergent validity. A longitudinal study was conducted among 863 patients aged 65 years or older. Four PRIFOR items with high factor loadings were selected to generate the short version of PRIFOR (PRIFOR-4). The PRIFOR-4 was found to have a unidimensional structure (comparative fit index = 0.999; Tucker-Lewis index = 0.998 in the confirmatory factor analysis results) with good convergent validity with various external measures (absolute r = 0.109-0.597; p-values<0.01). Because the PRIFOR-4 contains only four items, the completion time for the respondents reduced three fourths from the original PRIFOR, which may have a marked reduction in the response burden. The PRIFOR-4 is thus an easy-to-use measurement that saves time for healthcare professionals in clinical practice.
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Affiliation(s)
- Fang-Wen Hu
- School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan; Center for Long-Term Care Research, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yueh-Ping Li
- Department of Nursing, National Tainan Junior College of Nursing, Tainan, Taiwan
| | - Chia-Ming Chang
- Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tzu-Yu Lin
- Center for Long-Term Care Research, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Master Program of Long-Term Care in Aging, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Hsuan Lai
- Department of Family Medicine and Community Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Abadir P, Whitson H. Geriatric research through the lens of AGS/NIA U13: Two decades of interdisciplinary dialogues that have propelled the field. J Am Geriatr Soc 2024; 72:1623-1626. [PMID: 38363144 DOI: 10.1111/jgs.18810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/09/2024] [Accepted: 01/14/2024] [Indexed: 02/17/2024]
Affiliation(s)
- Peter Abadir
- Department of Medicine, Division of Geriatrics Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Heather Whitson
- Department of Medicine, Duke University, Durham, North Carolina, USA
- Durham VA GRECC, Durham VA Geriatrics Research, Education, and Clinical Center, Durham, North Carolina, USA
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Zammit AR, Bennett DA, Buchman AS. From theory to practice: translating the concept of cognitive resilience to novel therapeutic targets that maintain cognition in aging adults. Front Aging Neurosci 2024; 15:1303912. [PMID: 38283067 PMCID: PMC10811007 DOI: 10.3389/fnagi.2023.1303912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/06/2023] [Indexed: 01/30/2024] Open
Abstract
While the concept of cognitive resilience is well-established it has not been defined in a way that can be measured. This has been an impediment to studying its underlying biology and to developing instruments for its clinical assessment. This perspective highlights recent work that has quantified the expression of cortical proteins associated with cognitive resilience, thus facilitating studies of its complex underlying biology and the full range of its clinical effects in aging adults. These initial studies provide empirical support for the conceptualization of resilience as a continuum. Like other conventional risk factors, some individuals manifest higher-than-average cognitive resilience and other individuals manifest lower-than-average cognitive resilience. These novel approaches for advancing studies of cognitive resilience can be generalized to other aging phenotypes and can set the stage for the development of clinical tools that might have the potential to measure other mechanisms of resilience in aging adults. These advances also have the potential to catalyze a complementary therapeutic approach that focuses on augmenting resilience via lifestyle changes or therapies targeting its underlying molecular mechanisms to maintain cognition and brain health even in the presence of untreatable stressors like brain pathologies that accumulate in aging adults.
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Affiliation(s)
- Andrea R. Zammit
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Aron S. Buchman
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
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Telpoukhovskaia MA, Murdy TJ, Marola OJ, Charland K, MacLean M, Luquez T, Lish AM, Neuner S, Dunn A, Onos KD, Wiley J, Archer D, Huentelman MJ, Arnold M, Menon V, Goate A, Van Eldik LJ, Territo PR, Howell GR, Carter GW, O'Connell KMS, Kaczorowski CC. New directions for Alzheimer's disease research from the Jackson Laboratory Center for Alzheimer's and Dementia Research 2022 workshop. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2024; 10:e12458. [PMID: 38469553 PMCID: PMC10925728 DOI: 10.1002/trc2.12458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 03/13/2024]
Abstract
INTRODUCTION In September 2022, The Jackson Laboratory Center for Alzheimer's and Dementia Research (JAX CADR) hosted a workshop with leading researchers in the Alzheimer's disease and related dementias (ADRD) field. METHODS During the workshop, the participants brainstormed new directions to overcome current barriers to providing patients with effective ADRD therapeutics. The participants outlined specific areas of focus. Following the workshop, each group used standard literature search methods to provide background for each topic. RESULTS The team of invited experts identified four key areas that can be collectively addressed to make a significant impact in the field: (1) Prioritize the diversification of disease targets, (2) enhance factors promoting resilience, (3) de-risk clinical pipeline, and (4) centralize data management. DISCUSSION In this report, we review these four objectives and propose innovations to expedite ADRD therapeutic pipelines.
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Affiliation(s)
| | - Thomas J. Murdy
- The Jackson Laboratory for Mammalian GeneticsBar HarborMaineUSA
| | | | - Kevin Charland
- The Jackson Laboratory for Mammalian GeneticsBar HarborMaineUSA
| | - Michael MacLean
- The Jackson Laboratory for Mammalian GeneticsBar HarborMaineUSA
| | - Tain Luquez
- Center for Translational and Computational NeuroimmunologyDepartment of NeurologyColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Alexandra M. Lish
- Ann Romney Center for Neurologic DiseasesDepartment of NeurologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Sarah Neuner
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Amy Dunn
- The Jackson Laboratory for Mammalian GeneticsBar HarborMaineUSA
| | - Kristen D. Onos
- The Jackson Laboratory for Mammalian GeneticsBar HarborMaineUSA
| | | | - Derek Archer
- Vanderbilt Memory and Alzheimer's CenterVanderbilt University Medical CenterNashvilleTennesseeUSA
- Department of NeurologyVanderbilt University Medical CenterNashvilleTennesseeUSA
- Vanderbilt Genetics InstituteVanderbilt University School of MedicineNashvilleTennesseeUSA
| | - Matthew J. Huentelman
- Neurogenomics DivisionTranslational Genomics Research Institute (TGen)PhoenixArizonaUSA
| | - Matthias Arnold
- Institute of Computational BiologyHelmholtz Zentrum München, German Research Center for Environmental HealthNeuherbergGermany
- Department of Psychiatry and Behavioral SciencesDuke UniversityDurhamNorth CarolinaUSA
| | - Vilas Menon
- Center for Translational and Computational NeuroimmunologyDepartment of NeurologyColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Alison Goate
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | | | - Paul R. Territo
- Department of MedicineDivision of Clinical PharmacologyIndiana University School of MedicineIndianapolisIndianaUSA
- Stark Neuroscience Research InstituteIndiana University School of MedicineIndianapolisIndianaUSA
| | - Gareth R. Howell
- The Jackson Laboratory for Mammalian GeneticsBar HarborMaineUSA
- Graduate School of Biomedical Science and EngineeringUniversity of MaineOronoMaineUSA
- Neuroscience Program, Graduate School of Biomedical ScienceTufts University School of MedicineBostonMassachusettsUSA
- Genetics Program, Graduate School of Biomedical ScienceTufts University School of MedicineBostonMassachusettsUSA
| | - Gregory W. Carter
- The Jackson Laboratory for Mammalian GeneticsBar HarborMaineUSA
- Graduate School of Biomedical Science and EngineeringUniversity of MaineOronoMaineUSA
- Neuroscience Program, Graduate School of Biomedical ScienceTufts University School of MedicineBostonMassachusettsUSA
- Genetics Program, Graduate School of Biomedical ScienceTufts University School of MedicineBostonMassachusettsUSA
| | - Kristen M. S. O'Connell
- The Jackson Laboratory for Mammalian GeneticsBar HarborMaineUSA
- Graduate School of Biomedical Science and EngineeringUniversity of MaineOronoMaineUSA
- Neuroscience Program, Graduate School of Biomedical ScienceTufts University School of MedicineBostonMassachusettsUSA
- Genetics Program, Graduate School of Biomedical ScienceTufts University School of MedicineBostonMassachusettsUSA
| | - Catherine C. Kaczorowski
- The Jackson Laboratory for Mammalian GeneticsBar HarborMaineUSA
- Department of NeurologyUniversity of MichiganAnn ArborMichiganUSA
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Newmark RL, Allison TA, Smith AK, Perissinotto CM, Tha SH, Kotwal AA. The Role of Digital Technologies in Facilitating Psychosocial Resilience to Sudden Social Isolation Among Older Adults: Lessons Learned from the COVID-19 Pandemic. J Appl Gerontol 2023; 42:2348-2359. [PMID: 37536316 PMCID: PMC11056268 DOI: 10.1177/07334648231190228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Abstract
This study investigated how older adults adopted new technologies in response to sudden social isolation caused by the COVID-19 pandemic and how this adoption was related to their long-term psychosocial well-being. The study involved a 6-month longitudinal survey of 151 older adults and two phone-based focus groups, which informed a semi-structured interview guide and purposive sampling of diverse community-dwelling older adults. We then conducted twenty qualitative interviews and thematic analysis and mapped themes to 6-month quantitative trajectories of psychosocial health. Three themes emerged: first, most participants adopted multiple technologies to maintain social connection and psychosocial well-being. Second, participants felt left behind by certain technologies due to complicated systems or ageist societal norms. Third, pandemic-related community resources promoted technology independence among isolated older adults and those wanting to avoid "burdening" family. Results challenge ageist stereotypes and provide a framework for encouraging access and comfort with multiple technologies to adapt to sudden health crises or disruptive events.
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Affiliation(s)
- Rebecca L Newmark
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA
- Department of Humanities and Social Sciences, University of California, San Francisco, CA, USA
- School of Medicine, University of California, San Francisco, CA, USA
| | - Theresa A Allison
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Alexander K Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Carla M Perissinotto
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA
| | - Soe Han Tha
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA
| | - Ashwin A Kotwal
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
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