Social Isolation and Healthcare Utilization in Older Adults Living With Dementia and Mild Cognitive Impairment in the United States.

Background And Objectives: Social isolation is commonly experienced by older people and is associated with adverse health outcomes. Little is known about the influence of social isolation on the risk of acute care utilization among people living with mild cognitive impairment (MCI) or dementia. Our objective was to investigate the impact of social isolation on the risk of death, hospitalization, and emergency department (ED) use among people living with MCI or dementia who are followed in our Community Internal Medicine practice at Mayo Clinic, Rochester, Minnesota.

Exploring social determinants of health and physical activity levels in older adults living with mild cognitive impairment and dementia in the Upper Midwest of the United States.

Background: Physical activity can improve physical health for people living with mild cognitive impairment (MCI) and dementia and may have cognitive benefits. Identifying modifiable social factors inhibiting physical activity among this group is needed. We sought to examine the relationship between reported physical activity levels and social determinants of health (SDOH) in a population of older adults living with MCI or dementia.

Impact of a machine learning algorithm on time to palliative care in a primary care population: protocol for a stepped-wedge pragmatic randomized trial.

Background: As primary care populations age, timely identification of palliative care need is becoming increasingly relevant. Previous studies have targeted particular patient populations with life-limiting disease, but few have focused on patients in a primary care setting. Toward this end, we propose a stepped-wedge pragmatic randomized trial whereby a machine learning algorithm identifies patients empaneled to primary care units at Mayo Clinic (Rochester, Minnesota, United States) with high likelihood of palliative care need.

Dementia Care in the Last Year of Life: Experiences in a Community Practice and in Skilled Nursing Facilities.

Objective: People living with dementia often have high care needs at the end-of-life. We compared care delivery in the last year of life for people living with dementia in the community (home or assisted living facilities [ALFs]) versus those in skilled nursing facilities (SNFs).

Methods: A retrospective study was performed of older adults with a dementia diagnosis who died in the community or SNFs from 2013 through 2018.

Associations of Skilled Nursing Facility Quality Ratings With 30-Day Rehospitalizations and Emergency Department Visits.

Skilled nursing facilities (SNFs) increasingly provide care to patients after hospitalization. The Centers for Medicare & Medicaid Services reports ratings for SNFs for overall quality, staffing, health inspections, and clinical quality measures. However, the relationship between these ratings and patient outcomes remains unclear.

Design and Implementation of a Skilled Nursing Facility COVID-19 Unit.

Coronavirus disease 2019 (COVID-19) has challenged the health care system's capacity to care for acutely ill patients. In a collaborative partnership between a health system and a skilled nursing facility (SNF), we developed and implemented an SNF COVID-19 unit to allow expedited hospital discharge of COVID-positive older adults who are clinically improving, and to provide an alternative to hospitalization for those who require SNF care but do not require or necessarily desire aggressive disease-modifying interventions.

Approach to the Older Adult With New Cognitive Symptoms.

Dementia affects nearly 50 million people worldwide, translating into one new case every 3 seconds. Dementia syndrome is one of the leading causes of disability among older adults, yet it remains vastly underdiagnosed. A timely diagnosis of dementia is essential to ensuring optimal care and support of individuals and their loved ones.

Dementia Care at End of Life: Current Approaches.

Purpose Of Review: Dementia is a progressive and life-limiting condition that can be described in three stages: early, middle, and late. This article reviews current literature on late-stage dementia.

Recent Findings: Survival times may vary across dementia subtypes.

Health Outcomes From Assisted Living Facilities: A Cohort Study of a Primary Care Practice.

The population of older adults residing in assisted living facilities (ALF) in the United States is growing, yet health data about this population is relatively sparse. We aimed to compare health outcomes of ALF residents with those of age- and sex-matched community dwelling adults in a retrospective cohort study of 808 older adults. Linear regression analyses were conducted to describe the relationship between ALF residency and our outcomes of hospitalizations within 1 year of the index date (earliest recorded date in the ALF), 30-day rehospitalization following index hospitalization, emergency department (ED) visits, and mortality at 1 year.

Pulling your hair out in geriatric psychiatry: a case report.

Trichotillomania is a relatively understudied psychiatric disorder. Even less is known about this disorder in the elderly. We describe an unusual case of an elderly woman presenting for the first time with trichotillomania at age 70 and highlight the treatment complexities we encountered.

Timing of Physical Activity, Apolipoprotein E ε4 Genotype, and Risk of Incident Mild Cognitive Impairment.

Objectives: To investigate the timing (mid- vs late life) of physical activity, apolipoprotein (APO)E ε4, and risk of incident mild cognitive impairment (MCI).

Design: Prospective cohort study.

Setting: Mayo Clinic Study of Aging (Olmsted County, MN).

Frailty and Mortality Outcomes in Cognitively Normal Older People: Sex Differences in a Population-Based Study.

Objectives: To characterize frailty in cognitively normal older adults at baseline and to investigate the relationship between frailty and mortality.

Design: Population-based prospective cohort study: Mayo Clinic Study of Aging.

Setting: Olmsted County, Minnesota.

Neuropsychiatric symptoms, APOE ε4, and the risk of incident dementia: a population-based study.

Objective: To investigate the population-based interaction between a biological variable (APOE ε4), neuropsychiatric symptoms, and the risk of incident dementia among subjects with prevalent mild cognitive impairment (MCI).

Methods: We prospectively followed 332 participants with prevalent MCI (aged 70 years and older) enrolled in the Mayo Clinic Study of Aging for a median of 3 years. The diagnoses of MCI and dementia were made by an expert consensus panel based on published criteria, after reviewing neurologic, cognitive, and other pertinent data.

Sexual dimorphism in healthy aging and mild cognitive impairment: a DTI study.

Previous PET and MRI studies have indicated that the degree to which pathology translates into clinical symptoms is strongly dependent on sex with women more likely to express pathology as a diagnosis of AD, whereas men are more resistant to clinical symptoms in the face of the same degree of pathology. Here we use DTI to investigate the difference between male and female white matter tracts in healthy older participants (24 women, 16 men) and participants with mild cognitive impairment (21 women, 12 men). Differences between control and MCI participants were found in fractional anisotropy (FA), radial diffusion (DR), axial diffusion (DA) and mean diffusion (MD).

Using support vector machines with multiple indices of diffusion for automated classification of mild cognitive impairment.

Few studies have looked at the potential of using diffusion tensor imaging (DTI) in conjunction with machine learning algorithms in order to automate the classification of healthy older subjects and subjects with mild cognitive impairment (MCI). Here we apply DTI to 40 healthy older subjects and 33 MCI subjects in order to derive values for multiple indices of diffusion within the white matter voxels of each subject. DTI measures were then used together with support vector machines (SVMs) to classify control and MCI subjects.

Multiple indices of diffusion identifies white matter damage in mild cognitive impairment and Alzheimer's disease.

The study of multiple indices of diffusion, including axial (DA), radial (DR) and mean diffusion (MD), as well as fractional anisotropy (FA), enables WM damage in Alzheimer's disease (AD) to be assessed in detail. Here, tract-based spatial statistics (TBSS) were performed on scans of 40 healthy elders, 19 non-amnestic MCI (MCIna) subjects, 14 amnestic MCI (MCIa) subjects and 9 AD patients. Significantly higher DA was found in MCIna subjects compared to healthy elders in the right posterior cingulum/precuneus.

Using diffusion tensor imaging and mixed-effects models to investigate primary and secondary white matter degeneration in Alzheimer's disease and mild cognitive impairment.

White matter (WM) degeneration in Alzheimer's disease (AD) and mild cognitive impairment (MCI) may be a key indicator of early damage in AD. Here, we analyzed WM diffusion tensor data using Tract-Based Spatial Statistics in conjunction with mixed-effects models. Four indices of diffusion were assessed in 61 healthy control, 19 non-amnestic MCIs, 14 amnestic MCIs, and 9 AD patients.

Transportation and driving in longitudinal studies on ageing.

Background: the associations between transportation, driving and successful ageing are as yet poorly understood. As longitudinal studies are the best methodology for clarifying associations and relationships between health, ageing and environmental factors, we sought to determine how transportation is incorporated into longitudinal studies, and which aspects are assessed.

Methods: of 55 longitudinal studies on ageing on the National Institute on Aging register, online survey instruments, where available, were scrutinised for references to transport.

Stroke and newspapers: inattention or neglect?

Background: Services for stroke are poorly developed in Europe, and research into stroke is underfunded compared with heart disease or cancer. This may arise from the low profile of stroke within the public domain. Our aim was to assess the coverage of stroke compared with heart disease in a popular form of mass media, newspapers in the United Kingdom and Ireland.