Heather Whitson - Academia.edu (original) (raw)

Papers by Heather Whitson

The journals of gerontology. Series A, Biological sciences and medical sciences, 2017

Resilience, the ability to resist or recover from adverse effects of a stressor, is of widespread... more Resilience, the ability to resist or recover from adverse effects of a stressor, is of widespread interest in social, psychologic, biologic, and medical research and particularly salient as the capacity to respond to stressors becomes diminished with aging. To date, research on human resilience responses to and factors influencing these responses has been limited. The National Institute on Aging convened a workshop in August 2015 on needs for research to improve measures to predict and assess resilience in human aging. Effects of aging-related factors in impairing homeostatic responses were developed from examples illustrating multiple determinants of clinical resilience outcomes. Research directions were identified by workshop participants. Research needs identified included expanded uses of clinical data and specimens in predicting or assessing resilience, and contributions from epidemiological studies in identifying long-term predictors. Better measures, including simulation test...

Journal of the American College of Surgeons, 2019

Journal of the American Geriatrics Society, 2019

BACKGROUND/OBJECTIVESEvery year, up to 40% of the more than 16 million older Americans who underg... more BACKGROUND/OBJECTIVESEvery year, up to 40% of the more than 16 million older Americans who undergo anesthesia/surgery develop postoperative cognitive dysfunction (POCD) or delirium. Each of these distinct syndromes is associated with decreased quality of life, increased mortality, and a possible increased risk of Alzheimer's disease. One pathologic process hypothesized to underlie both delirium and POCD is neuroinflammation. The INTUIT study described here will determine the extent to which postoperative increases in cerebrospinal fluid (CSF) monocyte chemoattractant protein 1 (MCP‐1) levels and monocyte numbers are associated with delirium and/or POCD and their underlying brain connectivity changes.DESIGNObservational prospective cohort.SETTINGDuke University Medical Center, Duke Regional Hospital, and Duke Raleigh Hospital.PARTICIPANTSPatients 60 years of age or older (N = 200) undergoing noncardiac/nonneurologic surgery.MEASUREMENTSParticipants will undergo cognitive testing ...

Alzheimer's & Dementia

Optometry and Vision Science

Significance.-Outpatient vision rehabilitation improves function in Veterans with vision impairme... more Significance.-Outpatient vision rehabilitation improves function in Veterans with vision impairment, but the prevalence of cognitive impairment and degree to which it may affect rehabilitation outcomes in the Veterans Affairs (VA) system is unknown. Purpose.-To determine the prevalence of cognitive impairment among Veterans receiving outpatient vision rehabilitation in the VA system and compare the benefits of rehabilitation in Veterans with and without cognitive impairment. Methods.-We conducted cognitive assessments and a nested longitudinal cohort study in Veterans with eye disorders at two outpatient rehabilitation sites. Cognition was assessed with the modified Telephone Interview for Cognitive Status (TICS-m) administered in person. Eligible Veterans and their companions in the longitudinal study responded to questions about the Veteran's function at baseline and 90 days later. Visual function was measured with the 48-item Low Vision Visual Function Questionnaire (LV-VFQ-48) and items from the Activity Inventory (AI). Results.-Of 291 Veterans assessed (mean age 78.2 ± 12 years), 136 (46.7%) were cognitively intact (TICS-m scores ≥33), while 58 (19.9%) had borderline scores 30-32, 82 (28.2%) had scores suggesting mild/moderate cognitive impairment (scores 20-29), and 15(5.2%) had scores

Innovation in Aging

Sensory loss (hearing, vision, touch, smell, taste) is common in older adults, with over 2/3 of a... more Sensory loss (hearing, vision, touch, smell, taste) is common in older adults, with over 2/3 of adults over age 55 experiencing loss in multiple senses. Sensory loss has been consistently linked to dementia and cognitive decline in epidemiologic studies. However, research gaps exist, with some senses having been studied more widely than others. Given differing underlying anatomy and physiology of the senses, the nature of the pathways linking sensory loss to dementia may vary and some have yet to be elucidated. For some, it may be that they are both caused by a common underlying biology (e.g., neurodegeneration). Alternatively, potential causal mechanisms include increased cognitive load, changes brain structure/function, social isolation and/or reduced activity. Additionally, gaps exist in how sensory loss may impact the lived experience of people with dementia. This session will address these research gaps by highlighting the work of outstanding junior investigators in the GSA Sen...

Journal of Clinical and Translational Science, 2017

OBJECTIVES/SPECIFIC AIMS: To investigate whether medical complexity (indicated by multiple provid... more OBJECTIVES/SPECIFIC AIMS: To investigate whether medical complexity (indicated by multiple providers or healthcare visits) is associated with lower levels of confidence in medication use and lower medication adherence METHODS/STUDY POPULATION: Data on socio-demographics, health encounters, health status, and health attitudes and behaviors from a nationally representative sample of 1575 older Singaporean adults were utilized. The association of medical complexity factors with self-reported medication confidence and adherence was analyzed using logistic regression analysis controlling for age, gender, ethnicity, education, and number of health conditions. RESULTS/ANTICIPATED RESULTS: The survey had a 60% response rate. The mean age of respondents was 72, and 42% were male. We found no significant association between number of visits and either confidence about usage (OR=1.07, 95% CI 0.95–1.20) or medication adherence (OR=1.01, 95% CI 0.90–1.13). We similarly found no significant assoc...

Innovation in Aging

Background Lower bodyweight/BMI was previously linked to AD and frailty; however, the role of lon... more Background Lower bodyweight/BMI was previously linked to AD and frailty; however, the role of long-term changes in the bodyweight/BMI in both AD and longevity is not well understood, as is the role of APOE polymorphism in such changes. Methods Using longitudinal data from the Framingham Heart Study (FHS) and the Health and Retirement Study (HRS), we estimated trajectories of the weight and BMI at ages 40 to 75, and compared them between individuals who did and who did not develop AD at ages 75+. We also evaluated associations between APOE4 carrier status and key characteristics of the age-trajectories of weight/BMI, including the age at peak value of the bodyweight/BMI (AgeMax), and slope of the decline in bodyweight/BMI after reaching the maximum. Results Women with late-onset-AD had lower bodyweight/BMI values up to three decades before AD diagnosis. They reached the peak of bodyweight in their 50s, about 10 years earlier than AD-free women. Younger AgeMax was associated with lowe...

Innovation in Aging, 2020

Cognitive and visual impairments frequently coexist. With the aging of populations worldwide, the... more Cognitive and visual impairments frequently coexist. With the aging of populations worldwide, the prevalence of these conditions are projected to increase substantially over time. A number of studies suggest that cognitive function and vision impairment are associated, and it is hypothesized to be due to a (1) common cause etiology, where both share common risk factors, and/or (2) causal association, where visual impairment causes cognitive decline. Sensory loss can lead to increased cognitive load, structural and functional changes in the brain, and/or decreased emotional, social, and physical well-being, all of which could potentially increase the risk of cognitive impairment. We conducted a systematic review of the existing literature, examining the association between cognitive and visual impairment among older adults. A total of 80 observational studies that reported a measure of association between visual and cognitive function and met the following criteria were included: (1)...

1 Using National Surgical Quality Improvement Project (NSQIP) Data to Decrease Ventilator Days an... more 1 Using National Surgical Quality Improvement Project (NSQIP) Data to Decrease Ventilator Days and Pneumonia in a Surgical ICU John McNelis, Roseann Grandelli, Maureen Keegan Jacobi Medical Center, Bronx, NY; Winthrop University Hospital, Mineola, NY Introduction: National Surgical Quality Improvement Project (NSQIP) is a risk-adjusted database tracking surgical outcomes. NSQIP has been demonstrated to decrease complications, expenses, and mortality. In the study institution, a high rate of nosocomial pneumonias was observed in surgical patients. The authors utilized NSQIP to track effectiveness of interventions made. Methods: NSQIP collected preoperative through 30-day postoperative data on surgical patients. Data acquired included demographic, perioperative, hemodynamic, and outcome data. Multiple outcome measures including Pneumonia (PNEU) and Ventilator > 48 hours (V48) were obtained and entered into a central database from which a risk-adjusted Semiannual Report (SAR) was ge...

Frontiers in Systems Neuroscience, 2021

Physiologic signals such as the electroencephalogram (EEG) demonstrate irregular behaviors due to... more Physiologic signals such as the electroencephalogram (EEG) demonstrate irregular behaviors due to the interaction of multiple control processes operating over different time scales. The complexity of this behavior can be quantified using multi-scale entropy (MSE). High physiologic complexity denotes health, and a loss of complexity can predict adverse outcomes. Since postoperative delirium is particularly hard to predict, we investigated whether the complexity of preoperative and intraoperative frontal EEG signals could predict postoperative delirium and its endophenotype, inattention. To calculate MSE, the sample entropy of EEG recordings was computed at different time scales, then plotted against scale; complexity is the total area under the curve. MSE of frontal EEG recordings was computed in 50 patients ≥ age 60 before and during surgery. Average MSE was higher intra-operatively than pre-operatively (p = 0.0003). However, intraoperative EEG MSE was lower than preoperative MSE at...

Journal of the American Geriatrics Society, 2021

Older adults with similar health conditions often experience widely divergent outcomes following ... more Older adults with similar health conditions often experience widely divergent outcomes following health stressors. Variable recovery after a health stressor may be due in part to differences in biological mechanisms at the molecular, cellular, or system level, that are elicited in response to stressors. We describe the PRIME‐KNEE study as an example of ongoing research to validate provocative clinical tests and biomarkers that predict resilience to specific health stressors.

International journal of geriatric psychiatry, Jan 27, 2015

The aim of this study was to examine the association between physical frailty and neurocognitive ... more The aim of this study was to examine the association between physical frailty and neurocognitive performance in late-life depression (LLD). Cross-sectional design using baseline data from a treatment study of late-life depression was used in this study. Individuals aged 60 years and older were diagnosed with major depressive disorder at time of assessment (N = 173). All participants received clinical assessment of depression and completed neuropsychological testing during a depressive episode. Physical frailty was assessed using an adaptation of the FRAIL scale. Neuropsychological domains were derived from a factor analysis that yielded three factors: (i) speeded executive and fluency, (ii) episodic memory, and (iii) working memory. Associations were examined with bivariate tests and multivariate models. Depressed individuals with a FRAIL score >1 had worse performance than nonfrail depressed across all three factors; however, speeded executive and fluency was the only factor tha...

Mechanisms of Ageing and Development, 2008

In this issue, Varadhan and colleagues propose a methodologic framework that seeks to quantify im... more In this issue, Varadhan and colleagues propose a methodologic framework that seeks to quantify impaired resiliency in dynamic systems underlying the frailty syndrome. We view this work, which is based on modeling stimulus-response data, as an exciting expansion of longstanding theories of age-related decline in physiologic reserve across systems. We outline ways in which this methodology might make substantial contributions in frailty research and clinical practice, and we discuss potential obstacles in its operationalization.

Journal of the American Geriatrics Society, 2008

Object-The goal of this study was to determine whether frail older adults, based on a deficit acc... more Object-The goal of this study was to determine whether frail older adults, based on a deficit accumulation index (DAI), are at increased risk of adverse outcomes following discharge from the emergency department (ED). Design-Secondary analysis of data from the Medicare Current Beneficiary Survey Participants-1851 community-dwelling, Medicare fee-for-service enrollees, ≥ 65 years old who were discharged from the ED between January 2000 and September 2002. Measurements-Primary dependent variable was time to first adverse outcome, defined as repeat outpatient ED visit, hospital admission, nursing home admission or death within 30 days of the index ED visit. Results-Time to first adverse outcome was shortest among individuals with the highest number of accumulated deficits. The most frail participants were at greater risk of adverse outcomes following ED discharge compared to those who were least frail (HR 1.44, CI 1.06, 1.96). The most frail individuals were also at higher risk of serious adverse outcomes defined as hospitalization, nursing home admission or death (HR 1.98, CI 1.29, 3.05). In contrast, no association was detected between degree of frailty and repeat outpatient ED visits within 30 days (HR 1.06, CI 0.73, 1.54).

Journal of the American Geriatrics Society, 2008

OBJECTIVES: To determine whether satisfaction of onsite nurses with after-hours telephone communi... more OBJECTIVES: To determine whether satisfaction of onsite nurses with after-hours telephone communication with off-site physicians improved in one long-term care (LTC) facility after a nurse-oriented intervention. DESIGN: Longitudinal quality improvement study. SETTING: Extended Care and Rehabilitation Center (ECRC), Durham Veterans Affairs Medical Center. PARTICIPANTS: Eighteen registered nurses. INTERVENTION: Communicating Health Assessments by Telephone (Project CHAT), a program of individualized training sessions and decision support tools to aid LTC nurses with symptom assessment and communication of health information over the telephone. MEASUREMENTS: Nurses completed six satisfaction surveys (three surveys in the 3 months before Project CHAT and three surveys in the 3 months after Project CHAT). RESULTS: The nurses' average satisfaction scores increased on several items, including those that assessed whether the nurse was pretty sure what pieces of information the physician was going to ask for (P 5.04), felt that the amount of patient information the physician asked for seemed reasonable (P 5.03), felt prepared to answer the questions the physician asked (P 5.01), and felt that the process of gathering patient information for the physician was easy (P 5.01). The percentage of calls that resulted in immediate evaluation by a physician (on-site or in the emergency department) increased from 2.0% in the period before Project CHAT to 8.6% in the period after Project CHAT (P 5.01). CONCLUSION: Nurses' satisfaction with several aspects of after-hours telephone medicine improved after an inexpensive, education-based intervention in one LTC facility. Further research is needed to determine how similar interventions might affect other quality measures, including patient outcomes.

The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2015

Background. Resilience has been described in the psychosocial literature as the capacity to maint... more Background. Resilience has been described in the psychosocial literature as the capacity to maintain or regain well-being during or after adversity. Physical resilience is a newer concept that is highly relevant to successful aging. Our objective was to characterize the emerging construct of resilience as it pertains to physical health in older adults, and to identify gaps and opportunities to advance research in this area. Methods. We conducted a systematic review to identify English language papers published through January 2015 that apply the term "resilience" in relation to physical health in older adults. We applied a modified framework analysis to characterize themes in implicit or explicit definitions of physical resilience. Results. Of 1,078 abstracts identified, 49 articles met criteria for inclusion. Sixteen were letters or concept papers, and only one was an intervention study. Definitions of physical resilience spanned cellular to whole-person levels, incorporated many outcome measures, and represented three conceptual themes: resilience as a trait, trajectory, or characteristic/capacity. Conclusions. Current biomedical literature lacks consensus on how to define and measure physical resilience. We propose a working definition of physical resilience at the whole person level: a characteristic which determines one's ability to resist or recover from functional decline following health stressor(s). We present a conceptual framework that encompasses the related construct of physiologic reserve. We discuss gaps and opportunities in measurement, interactions across contributors to physical resilience, and points of intervention.

The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2015

Background. Resilience has been described in the psychosocial literature as the capacity to maint... more Background. Resilience has been described in the psychosocial literature as the capacity to maintain or regain well-being during or after adversity. Physical resilience is a newer concept that is highly relevant to successful aging. Our objective was to characterize the emerging construct of resilience as it pertains to physical health in older adults, and to identify gaps and opportunities to advance research in this area. Methods. We conducted a systematic review to identify English language papers published through January 2015 that apply the term "resilience" in relation to physical health in older adults. We applied a modified framework analysis to characterize themes in implicit or explicit definitions of physical resilience. Results. Of 1,078 abstracts identified, 49 articles met criteria for inclusion. Sixteen were letters or concept papers, and only one was an intervention study. Definitions of physical resilience spanned cellular to whole-person levels, incorporated many outcome measures, and represented three conceptual themes: resilience as a trait, trajectory, or characteristic/capacity. Conclusions. Current biomedical literature lacks consensus on how to define and measure physical resilience. We propose a working definition of physical resilience at the whole person level: a characteristic which determines one's ability to resist or recover from functional decline following health stressor(s). We present a conceptual framework that encompasses the related construct of physiologic reserve. We discuss gaps and opportunities in measurement, interactions across contributors to physical resilience, and points of intervention.

Innovation in Aging

In 2019, the World Health Organization World Report on Vision estimated that that 2.2 billion peo... more In 2019, the World Health Organization World Report on Vision estimated that that 2.2 billion people have a vision impairment, of which almost half could have been prevented or is yet to be addressed. As the global population ages and the prevalence of visual impairment increases, inequities in eye care and the downstream health and aging consequences of vision loss will become magnified. This session will: (1) provide key information regarding the burden of eye disease and visual impairment among older adults worldwide; (2) outline a framework created to conceptualize the aging and long-term health implications of vision loss, and (3) discuss the global public health challenges to eye care and to maximizing health for older adults with visual impairments.

The journals of gerontology. Series A, Biological sciences and medical sciences, 2017

Resilience, the ability to resist or recover from adverse effects of a stressor, is of widespread... more Resilience, the ability to resist or recover from adverse effects of a stressor, is of widespread interest in social, psychologic, biologic, and medical research and particularly salient as the capacity to respond to stressors becomes diminished with aging. To date, research on human resilience responses to and factors influencing these responses has been limited. The National Institute on Aging convened a workshop in August 2015 on needs for research to improve measures to predict and assess resilience in human aging. Effects of aging-related factors in impairing homeostatic responses were developed from examples illustrating multiple determinants of clinical resilience outcomes. Research directions were identified by workshop participants. Research needs identified included expanded uses of clinical data and specimens in predicting or assessing resilience, and contributions from epidemiological studies in identifying long-term predictors. Better measures, including simulation test...

Journal of the American College of Surgeons, 2019

Journal of the American Geriatrics Society, 2019

BACKGROUND/OBJECTIVESEvery year, up to 40% of the more than 16 million older Americans who underg... more BACKGROUND/OBJECTIVESEvery year, up to 40% of the more than 16 million older Americans who undergo anesthesia/surgery develop postoperative cognitive dysfunction (POCD) or delirium. Each of these distinct syndromes is associated with decreased quality of life, increased mortality, and a possible increased risk of Alzheimer's disease. One pathologic process hypothesized to underlie both delirium and POCD is neuroinflammation. The INTUIT study described here will determine the extent to which postoperative increases in cerebrospinal fluid (CSF) monocyte chemoattractant protein 1 (MCP‐1) levels and monocyte numbers are associated with delirium and/or POCD and their underlying brain connectivity changes.DESIGNObservational prospective cohort.SETTINGDuke University Medical Center, Duke Regional Hospital, and Duke Raleigh Hospital.PARTICIPANTSPatients 60 years of age or older (N = 200) undergoing noncardiac/nonneurologic surgery.MEASUREMENTSParticipants will undergo cognitive testing ...

Alzheimer's & Dementia

Optometry and Vision Science

Significance.-Outpatient vision rehabilitation improves function in Veterans with vision impairme... more Significance.-Outpatient vision rehabilitation improves function in Veterans with vision impairment, but the prevalence of cognitive impairment and degree to which it may affect rehabilitation outcomes in the Veterans Affairs (VA) system is unknown. Purpose.-To determine the prevalence of cognitive impairment among Veterans receiving outpatient vision rehabilitation in the VA system and compare the benefits of rehabilitation in Veterans with and without cognitive impairment. Methods.-We conducted cognitive assessments and a nested longitudinal cohort study in Veterans with eye disorders at two outpatient rehabilitation sites. Cognition was assessed with the modified Telephone Interview for Cognitive Status (TICS-m) administered in person. Eligible Veterans and their companions in the longitudinal study responded to questions about the Veteran's function at baseline and 90 days later. Visual function was measured with the 48-item Low Vision Visual Function Questionnaire (LV-VFQ-48) and items from the Activity Inventory (AI). Results.-Of 291 Veterans assessed (mean age 78.2 ± 12 years), 136 (46.7%) were cognitively intact (TICS-m scores ≥33), while 58 (19.9%) had borderline scores 30-32, 82 (28.2%) had scores suggesting mild/moderate cognitive impairment (scores 20-29), and 15(5.2%) had scores

Innovation in Aging

Sensory loss (hearing, vision, touch, smell, taste) is common in older adults, with over 2/3 of a... more Sensory loss (hearing, vision, touch, smell, taste) is common in older adults, with over 2/3 of adults over age 55 experiencing loss in multiple senses. Sensory loss has been consistently linked to dementia and cognitive decline in epidemiologic studies. However, research gaps exist, with some senses having been studied more widely than others. Given differing underlying anatomy and physiology of the senses, the nature of the pathways linking sensory loss to dementia may vary and some have yet to be elucidated. For some, it may be that they are both caused by a common underlying biology (e.g., neurodegeneration). Alternatively, potential causal mechanisms include increased cognitive load, changes brain structure/function, social isolation and/or reduced activity. Additionally, gaps exist in how sensory loss may impact the lived experience of people with dementia. This session will address these research gaps by highlighting the work of outstanding junior investigators in the GSA Sen...

Journal of Clinical and Translational Science, 2017

OBJECTIVES/SPECIFIC AIMS: To investigate whether medical complexity (indicated by multiple provid... more OBJECTIVES/SPECIFIC AIMS: To investigate whether medical complexity (indicated by multiple providers or healthcare visits) is associated with lower levels of confidence in medication use and lower medication adherence METHODS/STUDY POPULATION: Data on socio-demographics, health encounters, health status, and health attitudes and behaviors from a nationally representative sample of 1575 older Singaporean adults were utilized. The association of medical complexity factors with self-reported medication confidence and adherence was analyzed using logistic regression analysis controlling for age, gender, ethnicity, education, and number of health conditions. RESULTS/ANTICIPATED RESULTS: The survey had a 60% response rate. The mean age of respondents was 72, and 42% were male. We found no significant association between number of visits and either confidence about usage (OR=1.07, 95% CI 0.95–1.20) or medication adherence (OR=1.01, 95% CI 0.90–1.13). We similarly found no significant assoc...

Innovation in Aging

Background Lower bodyweight/BMI was previously linked to AD and frailty; however, the role of lon... more Background Lower bodyweight/BMI was previously linked to AD and frailty; however, the role of long-term changes in the bodyweight/BMI in both AD and longevity is not well understood, as is the role of APOE polymorphism in such changes. Methods Using longitudinal data from the Framingham Heart Study (FHS) and the Health and Retirement Study (HRS), we estimated trajectories of the weight and BMI at ages 40 to 75, and compared them between individuals who did and who did not develop AD at ages 75+. We also evaluated associations between APOE4 carrier status and key characteristics of the age-trajectories of weight/BMI, including the age at peak value of the bodyweight/BMI (AgeMax), and slope of the decline in bodyweight/BMI after reaching the maximum. Results Women with late-onset-AD had lower bodyweight/BMI values up to three decades before AD diagnosis. They reached the peak of bodyweight in their 50s, about 10 years earlier than AD-free women. Younger AgeMax was associated with lowe...

Innovation in Aging, 2020

Cognitive and visual impairments frequently coexist. With the aging of populations worldwide, the... more Cognitive and visual impairments frequently coexist. With the aging of populations worldwide, the prevalence of these conditions are projected to increase substantially over time. A number of studies suggest that cognitive function and vision impairment are associated, and it is hypothesized to be due to a (1) common cause etiology, where both share common risk factors, and/or (2) causal association, where visual impairment causes cognitive decline. Sensory loss can lead to increased cognitive load, structural and functional changes in the brain, and/or decreased emotional, social, and physical well-being, all of which could potentially increase the risk of cognitive impairment. We conducted a systematic review of the existing literature, examining the association between cognitive and visual impairment among older adults. A total of 80 observational studies that reported a measure of association between visual and cognitive function and met the following criteria were included: (1)...

1 Using National Surgical Quality Improvement Project (NSQIP) Data to Decrease Ventilator Days an... more 1 Using National Surgical Quality Improvement Project (NSQIP) Data to Decrease Ventilator Days and Pneumonia in a Surgical ICU John McNelis, Roseann Grandelli, Maureen Keegan Jacobi Medical Center, Bronx, NY; Winthrop University Hospital, Mineola, NY Introduction: National Surgical Quality Improvement Project (NSQIP) is a risk-adjusted database tracking surgical outcomes. NSQIP has been demonstrated to decrease complications, expenses, and mortality. In the study institution, a high rate of nosocomial pneumonias was observed in surgical patients. The authors utilized NSQIP to track effectiveness of interventions made. Methods: NSQIP collected preoperative through 30-day postoperative data on surgical patients. Data acquired included demographic, perioperative, hemodynamic, and outcome data. Multiple outcome measures including Pneumonia (PNEU) and Ventilator > 48 hours (V48) were obtained and entered into a central database from which a risk-adjusted Semiannual Report (SAR) was ge...

Frontiers in Systems Neuroscience, 2021

Physiologic signals such as the electroencephalogram (EEG) demonstrate irregular behaviors due to... more Physiologic signals such as the electroencephalogram (EEG) demonstrate irregular behaviors due to the interaction of multiple control processes operating over different time scales. The complexity of this behavior can be quantified using multi-scale entropy (MSE). High physiologic complexity denotes health, and a loss of complexity can predict adverse outcomes. Since postoperative delirium is particularly hard to predict, we investigated whether the complexity of preoperative and intraoperative frontal EEG signals could predict postoperative delirium and its endophenotype, inattention. To calculate MSE, the sample entropy of EEG recordings was computed at different time scales, then plotted against scale; complexity is the total area under the curve. MSE of frontal EEG recordings was computed in 50 patients ≥ age 60 before and during surgery. Average MSE was higher intra-operatively than pre-operatively (p = 0.0003). However, intraoperative EEG MSE was lower than preoperative MSE at...

Journal of the American Geriatrics Society, 2021

Older adults with similar health conditions often experience widely divergent outcomes following ... more Older adults with similar health conditions often experience widely divergent outcomes following health stressors. Variable recovery after a health stressor may be due in part to differences in biological mechanisms at the molecular, cellular, or system level, that are elicited in response to stressors. We describe the PRIME‐KNEE study as an example of ongoing research to validate provocative clinical tests and biomarkers that predict resilience to specific health stressors.

International journal of geriatric psychiatry, Jan 27, 2015

The aim of this study was to examine the association between physical frailty and neurocognitive ... more The aim of this study was to examine the association between physical frailty and neurocognitive performance in late-life depression (LLD). Cross-sectional design using baseline data from a treatment study of late-life depression was used in this study. Individuals aged 60 years and older were diagnosed with major depressive disorder at time of assessment (N = 173). All participants received clinical assessment of depression and completed neuropsychological testing during a depressive episode. Physical frailty was assessed using an adaptation of the FRAIL scale. Neuropsychological domains were derived from a factor analysis that yielded three factors: (i) speeded executive and fluency, (ii) episodic memory, and (iii) working memory. Associations were examined with bivariate tests and multivariate models. Depressed individuals with a FRAIL score >1 had worse performance than nonfrail depressed across all three factors; however, speeded executive and fluency was the only factor tha...

Mechanisms of Ageing and Development, 2008

In this issue, Varadhan and colleagues propose a methodologic framework that seeks to quantify im... more In this issue, Varadhan and colleagues propose a methodologic framework that seeks to quantify impaired resiliency in dynamic systems underlying the frailty syndrome. We view this work, which is based on modeling stimulus-response data, as an exciting expansion of longstanding theories of age-related decline in physiologic reserve across systems. We outline ways in which this methodology might make substantial contributions in frailty research and clinical practice, and we discuss potential obstacles in its operationalization.

Journal of the American Geriatrics Society, 2008

Object-The goal of this study was to determine whether frail older adults, based on a deficit acc... more Object-The goal of this study was to determine whether frail older adults, based on a deficit accumulation index (DAI), are at increased risk of adverse outcomes following discharge from the emergency department (ED). Design-Secondary analysis of data from the Medicare Current Beneficiary Survey Participants-1851 community-dwelling, Medicare fee-for-service enrollees, ≥ 65 years old who were discharged from the ED between January 2000 and September 2002. Measurements-Primary dependent variable was time to first adverse outcome, defined as repeat outpatient ED visit, hospital admission, nursing home admission or death within 30 days of the index ED visit. Results-Time to first adverse outcome was shortest among individuals with the highest number of accumulated deficits. The most frail participants were at greater risk of adverse outcomes following ED discharge compared to those who were least frail (HR 1.44, CI 1.06, 1.96). The most frail individuals were also at higher risk of serious adverse outcomes defined as hospitalization, nursing home admission or death (HR 1.98, CI 1.29, 3.05). In contrast, no association was detected between degree of frailty and repeat outpatient ED visits within 30 days (HR 1.06, CI 0.73, 1.54).

Journal of the American Geriatrics Society, 2008

OBJECTIVES: To determine whether satisfaction of onsite nurses with after-hours telephone communi... more OBJECTIVES: To determine whether satisfaction of onsite nurses with after-hours telephone communication with off-site physicians improved in one long-term care (LTC) facility after a nurse-oriented intervention. DESIGN: Longitudinal quality improvement study. SETTING: Extended Care and Rehabilitation Center (ECRC), Durham Veterans Affairs Medical Center. PARTICIPANTS: Eighteen registered nurses. INTERVENTION: Communicating Health Assessments by Telephone (Project CHAT), a program of individualized training sessions and decision support tools to aid LTC nurses with symptom assessment and communication of health information over the telephone. MEASUREMENTS: Nurses completed six satisfaction surveys (three surveys in the 3 months before Project CHAT and three surveys in the 3 months after Project CHAT). RESULTS: The nurses' average satisfaction scores increased on several items, including those that assessed whether the nurse was pretty sure what pieces of information the physician was going to ask for (P 5.04), felt that the amount of patient information the physician asked for seemed reasonable (P 5.03), felt prepared to answer the questions the physician asked (P 5.01), and felt that the process of gathering patient information for the physician was easy (P 5.01). The percentage of calls that resulted in immediate evaluation by a physician (on-site or in the emergency department) increased from 2.0% in the period before Project CHAT to 8.6% in the period after Project CHAT (P 5.01). CONCLUSION: Nurses' satisfaction with several aspects of after-hours telephone medicine improved after an inexpensive, education-based intervention in one LTC facility. Further research is needed to determine how similar interventions might affect other quality measures, including patient outcomes.

The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2015

Background. Resilience has been described in the psychosocial literature as the capacity to maint... more Background. Resilience has been described in the psychosocial literature as the capacity to maintain or regain well-being during or after adversity. Physical resilience is a newer concept that is highly relevant to successful aging. Our objective was to characterize the emerging construct of resilience as it pertains to physical health in older adults, and to identify gaps and opportunities to advance research in this area. Methods. We conducted a systematic review to identify English language papers published through January 2015 that apply the term "resilience" in relation to physical health in older adults. We applied a modified framework analysis to characterize themes in implicit or explicit definitions of physical resilience. Results. Of 1,078 abstracts identified, 49 articles met criteria for inclusion. Sixteen were letters or concept papers, and only one was an intervention study. Definitions of physical resilience spanned cellular to whole-person levels, incorporated many outcome measures, and represented three conceptual themes: resilience as a trait, trajectory, or characteristic/capacity. Conclusions. Current biomedical literature lacks consensus on how to define and measure physical resilience. We propose a working definition of physical resilience at the whole person level: a characteristic which determines one's ability to resist or recover from functional decline following health stressor(s). We present a conceptual framework that encompasses the related construct of physiologic reserve. We discuss gaps and opportunities in measurement, interactions across contributors to physical resilience, and points of intervention.

The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2015

Background. Resilience has been described in the psychosocial literature as the capacity to maint... more Background. Resilience has been described in the psychosocial literature as the capacity to maintain or regain well-being during or after adversity. Physical resilience is a newer concept that is highly relevant to successful aging. Our objective was to characterize the emerging construct of resilience as it pertains to physical health in older adults, and to identify gaps and opportunities to advance research in this area. Methods. We conducted a systematic review to identify English language papers published through January 2015 that apply the term "resilience" in relation to physical health in older adults. We applied a modified framework analysis to characterize themes in implicit or explicit definitions of physical resilience. Results. Of 1,078 abstracts identified, 49 articles met criteria for inclusion. Sixteen were letters or concept papers, and only one was an intervention study. Definitions of physical resilience spanned cellular to whole-person levels, incorporated many outcome measures, and represented three conceptual themes: resilience as a trait, trajectory, or characteristic/capacity. Conclusions. Current biomedical literature lacks consensus on how to define and measure physical resilience. We propose a working definition of physical resilience at the whole person level: a characteristic which determines one's ability to resist or recover from functional decline following health stressor(s). We present a conceptual framework that encompasses the related construct of physiologic reserve. We discuss gaps and opportunities in measurement, interactions across contributors to physical resilience, and points of intervention.

Innovation in Aging

In 2019, the World Health Organization World Report on Vision estimated that that 2.2 billion peo... more In 2019, the World Health Organization World Report on Vision estimated that that 2.2 billion people have a vision impairment, of which almost half could have been prevented or is yet to be addressed. As the global population ages and the prevalence of visual impairment increases, inequities in eye care and the downstream health and aging consequences of vision loss will become magnified. This session will: (1) provide key information regarding the burden of eye disease and visual impairment among older adults worldwide; (2) outline a framework created to conceptualize the aging and long-term health implications of vision loss, and (3) discuss the global public health challenges to eye care and to maximizing health for older adults with visual impairments.