Background/Objectives Physical distancing during the COVID‐19 pandemic may have unintended, detrimental effects on social isolation and loneliness among older adults. Our objectives were to investigate 1) experiences of social isolation and loneliness during shelter‐in‐place orders and 2) unmet health needs related to changes in social interactions. Design Mixed‐methods, longitudinal phone‐based survey administered every 2 weeks. Setting Two community sites and an academic geriatrics outpatient clinical practice. Participants 151 community‐dwelling older adults. Measurements We measured social isolation using a 6‐item modified Duke Social Support Index, social interaction sub‐scale, which included assessments of video‐based and internet‐based socializing. Measures of loneliness included self‐reported worsened loneliness due to the COVID‐19 pandemic, and loneliness severity based on the 3‐item UCLA loneliness scale. Participants were invited to share open‐ended comments about their social experiences. Results Participants were on average 75 years old (SD = 10), 50% had hearing or vision impairment, 64% lived alone, and 26% difficulty bathing. Participants reported social isolation in 40% of interviews, 76% reported minimal video‐based socializing, and 42% minimal internet‐based socializing. Socially isolated participants reported difficulty finding help with functional needs, including bathing (20% vs 55%, p = .04). Over half (54%) of participants reported worsened loneliness due to COVID‐19, which was associated with worsened depression (62% vs 9%, p < .001) and anxiety (57% vs 9%, p < .001). Rates of loneliness improved on average by time since shelter‐in‐place orders (4–6 weeks: 46% vs 13–15 weeks: 27%, p = .009), however, loneliness persisted or worsened for a subgroup of participants. Open‐ended responses revealed challenges faced by the subgroup experiencing persistent loneliness, including poor emotional coping and discomfort with new technologies. Conclusions Many older adults are adjusting to COVID‐19 restrictions since the start of shelter‐in‐place orders. Additional steps are critically needed to address the psychological suffering and unmet medical needs of those with persistent loneliness or barriers to technology‐based social interaction.

Background Androgen deprivation therapy (ADT) can decrease the physical performance (PP) of older men with prostate cancer (PC). Methods We conducted a three-arm randomized pilot study (n = 19) comparing a home-based walking and resistance intervention (EXCAP) and a technology-mediated walking and resistance intervention using Wii-Fit to a usual-care-arm in men ≥ 70 years with PC receiving ADT. The intervention lasted for 6-weeks, with follow-up at 12-weeks. The primary pre-specified outcome was change in Short Physical Performance Battery (SPPB) score. Mixed effects regression models were used to assess change in outcomes over time. Results Mean participant age was 70 years (range: 67-93). Eight patients were randomized to the Wii-Fit-arm, 6 to EXCAP-arm, and 5 to usual-care-arm. SPPB scores remained nearly constant in the usual-care-arm (β=−0.12; p=0.79), while individuals in the EXCAP-arm had on average a 1.2 point increase at each follow-up (β=1.20; 95% CI: 0.36, 2.06). The Wii-fit-arm had a non-significant increase in SPPB score over time relative to usual-care (β=0.32; 95% CI −0.43,1.06; p=0.46). Individuals in the EXCAP-arm had an increase in steps per day over time compared to the usual-care-arm (p-value = 0.006); the EXCAP-arm had an increase of 2720 steps (95% CI: 1313, 4128) while the usual-care-arm had an increase of 97 steps (95% CI: −1140, 1333). Participants in the Wii-Fit-arm had an increase of 1020 steps (95% CI: −474, 1238, p=0.710). Other outcomes (i.e., handgrip strength, lean muscle mass, and chest press repetitions) were not statistically significant. Conclusions A home-based aerobic and resistance exercise program, EXCAP, shows promise for improving PP in older men with PC on ADT.

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It is well established that gene expression patterns are substantially altered in cardiac hypertrophy and heart failure, but the reasons for such differences are not clear. MicroRNAs (miRNAs) are short noncoding RNAs that provide a novel mechanism for gene regulation. The goal of this study was to comprehensively test for alterations in miRNA expression using human heart failure samples with an aim to build signaling pathway networks using predicted targets for the miRNAs and to identify nodal molecules that control these networks. Genome-wide profiling of miRNAs was performed using custom-designed miRNA microarray followed by validation on an independent set of samples. Eight miRNAs are significantly altered in heart failure of which we have identified two novel miRNAs that are yet to be implicated in cardiac pathophysiology. To gain an unbiased global perspective on regulation by altered miRNAs, predicted targets of eight miRNAs were analyzed using the Ingenuity Pathways Analysis network algorithm to build signaling networks and identify nodal molecules. The majority of nodal molecules identified in our analysis are targets of altered miRNAs and are known regulators of cardiovascular signaling. A heart failure gene expression data base was used to analyze changes in expression patterns for these target nodal molecules. Indeed, expression of nodal molecules was altered in heart failure and inversely correlated to miRNA changes validating our analysis. Importantly, using network analysis we have identified a limited number of key functional targets that may regulate expression of the myriad proteins in heart failure and could be potential therapeutic targets.Heart failure has been classified as an epidemic of the 21st century and is now the major cause of morbidity in the elderly in the United States. End-stage heart failure is characterized by significantly perturbed neurohormonal and mechanical (hemodynamic) stimuli to the heart. The altered pathological signaling leads to remodeling of the heart with adaptive to maladaptive hypertrophy transitioning into dilated cardiomyopathy (DCM).3 DCM is the most common and well documented outcome of various deleterious stimuli the heart perceives (1). DCM is characterized clinically by left ventricular dilatation, ventricular wall thinning, and homogeneous myocardial dysfunction leading to congestive heart failure (1). The myocytes under the continuously changing conditions of biomechanical stress during this transition undergo a remodeling process through the activation of intracellular signaling pathways and transcriptional mediators (2). The pathological end-stage DCM is a result of the concomitant cross-talk between various deleterious and compensatory signaling pathways. The balance between these two dynamic pathways ultimately determines the progression of the pathology. Despite significant advances in identification of genes and signaling pathways, the overall complexity of hypertrophic remodeling suggests the involvement of additional global regulatory mechanisms...

BACKGROUND: An early sign of cognitive decline in older adults is often a disruption in social function, but our understanding of this association is limited. OBJECTIVE: We aimed to determine whether those screening positive for early stages of cognitive impairment have differences across multiple dimensions of social function and whether associations differ by gender. DESIGN: United States nationally representative cohort (2010), the National Social life, Health, and Aging Project (NSHAP). PARTICIPANTS: Community-dwelling adults aged 62-90 years (N = 3,310) with a response rate of 76.9 %. MAIN MEASURES: Cognition was measured using a survey adaptation of the Montreal Cognitive Assessment categorized into three groups: normal, mild cognitive impairment (MCI), and dementia. We measured three domains of social relationships, each comprised of two scales: network structure (size and density), social resources (social support and social strain), and social engagement (community involvement and socializing). We used multiple linear regression to characterize the relationship of each social relationship measure to cognition. KEY RESULTS: Individuals screened as at risk for MCI and early dementia had smaller network sizes by 0.3 and 0.6 individuals (p < 0.001), and a 10 % and 25 % increase in network density (p < 0.001), respectively. For social resources, individuals at risk for MCI and dementia had 4 % and 14 % less social strain (p = 0.01), but only women had 3 % and 6 % less perceived social support (p = 0.013), respectively. For social engagement, individuals screened positive for MCI and dementia had 8 % and 19 % less community involvement (p = 0.01), but only men had 8 % and 13 % increased social involvement with neighbors and family members (p < 0.001), respectively. CONCLUSION: Changes in social functioning provide an early indication to screen for cognitive loss. Recognition that early cognitive loss is associated with differences in social function can guide counseling efforts and help identify social vulnerabilities to ease the transition to overt dementia for both patients and caregivers.

Wave 2 of NSHAP included a variety of measures assessing the chronic conditions that are the most prevalent in older adults. These data are a valuable resource for the study of the impact of chronic conditions on overall health and aging.

Most measures of cognitive function used in large-scale surveys of older adults have limited ability to detect subtle differences across cognitive domains, and clinical instruments are impractical to administer in general surveys. The Montreal Cognitive Assessment (MoCA) can address this need, but has limitations in a survey context. Therefore, we developed a survey-adaptation of the MoCA, called the MoCA-SA, and describe its psychometric properties in a large national survey. Using a pretest sample of older adults (n=120), we reduced MoCA administration time by 26%, developed a model to accurately estimate full MoCA scores from the MoCA-SA, and tested the model in an independent clinical sample (n=93). The validated 18-item MoCA-SA was then administered to community-dwelling adults aged 62–91 as part of the National Social life Health and Aging Project (NSHAP) Wave 2 sample (n=3,196). In NSHAP Wave 2, the MoCA-SA had good internal reliability (Cronbach α=0.76). Using item-response models, survey-adapted items captured a broad range of cognitive abilities and functioned similarly across gender, education, and ethnic groups. Results demonstrate that the MoCA-SA can be administered reliably in a survey setting while preserving sensitivity to a broad range of cognitive abilities and similar performance across demographic subgroups.

A survey-based adaptation of the MoCA was successfully integrated into a nationally representative sample of older adults, NSHAP Wave 2.