John A. Batsis’s research while affiliated with Microbiome Core Facility USA and other places

Gait speed and grip strength are widely used measures of physical function in older adults and are predictive of disability, hospitalization, and mortality. However, there is a limited understanding of the long-term trajectories of these measures and which older adults are at the highest risk of functional decline. We used data from the National Health and Aging Trends Study (NHATS) to identify subgroups of community-dwelling older adults with distinct 10-year trajectories in gait speed and grip strength and to examine the baseline factors associated with these patterns. The sample included 4961 adults aged 65 years and older who completed gait speed and grip strength assessments in 2011 and at least one subsequent wave between 2013 and 2021. Using latent class growth analysis, we identified three trajectories for each measure: worsening, stable, and improving. More than one-third of participants were in the worsening group for at least one measure. In multinomial logistic regression models, lower income, Medicaid coverage, cognitive impairment, and multiple chronic conditions were associated with membership in worsening trajectory groups. These findings highlight the heterogeneity of physical aging and the importance of the early identification of older adults who may benefit from targeted interventions to maintain function and independence over time.

Early detection of cognitive decline is crucial for enabling interventions that can slow neurodegenerative disease progression. Traditional diagnostic approaches rely on labor-intensive clinical assessments, which are impractical for frequent monitoring. Our pilot study investigates voice assistant systems (VAS) as non-invasive tools for detecting cognitive decline through longitudinal analysis of speech patterns in voice commands. Over an 18-month period, we collected voice commands from 35 older adults, with 15 participants providing daily at-home VAS interactions. To address the challenges of analyzing these short, unstructured and noisy commands, we propose Cog-TiPRO, a framework that combines (1) LLM-driven iterative prompt refinement for linguistic feature extraction, (2) HuBERT-based acoustic feature extraction, and (3) transformer-based temporal modeling. Using iTransformer, our approach achieves 73.80% accuracy and 72.67% F1-score in detecting MCI, outperforming its baseline by 27.13%. Through our LLM approach, we identify linguistic features that uniquely characterize everyday command usage patterns in individuals experiencing cognitive decline.

Background: A frailty index (FI) can identify individuals with frailty in a population of interest. Previous literature suggests a need for frailty assessment methods for older adults in China and that urbanization may impact frailty status. We used a FI to examine the association between frailty and urbanization as living in a less urbanized area may put older adults at a higher risk frailty and poor healthcare outcomes. Methods: We included adults aged 55 years and older ( n = 7695) from the China Health and Nutrition Survey (2018). The FI was based on health outcomes correlating with a deficit score divided by number of health items: robust (<0.08), pre-frail (0.08–0.24), and frail (≥0.25). We used multinomial logistic regression models to examine associations between urbanization tertile (low, medium, and high) and frailty, using our novel FI. We also conducted sub-analyses examining how urbanization level modifies the relationship between frailty status and region of residence, and education and income levels. Results: Living in an area of low versus high urbanization was associated with higher odds of frail versus robust (1.5; 1.2–2.0), and pre-frail versus robust (1.6; 1.4–2.0) status in the fully adjusted model. Generally, higher odds of worse frailty status (e.g., pre-frail or frail) was associated with lower tertiles of urbanization for region, income, and education when compared to the highest urbanization tertile. Conclusions: A FI can help identify specific characteristics that may benefit from individualized interventions to counteract frailty. Living in less urbanized areas was associated with higher odds of pre-frailty and frailty. Inclusion of urbanization level, geographic residence, and social determinants of health in FI development can help identify older adults most at risk of frailty and contribute to individual and policy-level frailty prevention interventions.

Introduction Behavioral symptoms in hospitalized older adults with cognitive impairment often lead to physical and chemical restraint use, despite associated harms. Patient‐centered care models show promise in reducing restraint use but are rarely implemented in routine practice. This project implemented CoCare‐CI, a clinical innovation to address behavioral symptoms in hospitalized older adults with cognitive impairment. Methods CoCare‐CI was implemented on a 24‐bed ACE unit in a 128‐bed community hospital from January 2023 to August 2024 by a multidisciplinary team led by a geriatric nurse practitioner (GNP). CoCare‐CI emphasized (1) systematic screening and assessment of mentation, and (2) individualized management plans for delirium or dementia. Implementation followed a phased, cyclical approach with champions supporting process improvement. Baseline restraint data (January–August 2023) were compared to intervention data (September 2023–August 2024). Primary outcomes included physical and chemical restraint use; process measures included documentation rates of the Confusion Assessment Method (CAM), CAM‐Severity (CAM‐S), Six‐Item Cognitive Impairment Test (6CIT), and 4Ms checklist. Results Among 949 patients (mean age 81.5 years, 59% female, 80.6% White), 34.1% had cognitive impairment at baseline, including 22.6% with dementia and 11.5% with a significant 6CIT score (≥ 8). Documentation rates improved for CAM (68%–86%), CAM‐S (0%–79%), 6CIT (0%–89%), and 4Ms checklist (0%–96%). Physical restraint use decreased from 4.3% to 0.7%, and chemical restraint use dropped from 7.6% to 2.3%. Most restraint use (84.2%, 16/19) was deemed potentially avoidable, with root cause analysis revealing that 78.6% (11/14) of patients with restraint orders had moderate to severe dementia with behavioral symptoms. Conclusions CoCare‐CI is associated with reductions in reduced physical and chemical restraint use, demonstrating potential for dissemination within routine clinical practice. Future research should assess sustainability, broader applicability, and integration of additional 4Ms components.

The Global Leadership Initiative in Sarcopenia (GLIS) aims to standardize the definition and diagnostic criteria for sarcopenia into one unifying, common classification. Among other actions to achieve this objective, the GLIS has organized three different working groups (WGs), with the WG on outcomes of sarcopenia focusing on reporting its health outcomes to be measured in clinical practice once a diagnosis has been established. This includes sarcopenia definitions that better predict health outcomes, the preferred tools for measuring these outcomes, and the cutoffs defining normal and abnormal values. The present article synthesizes discussions and conclusions from this WG, composed of 13 key opinion leaders from different continents worldwide. Results rely on systematic reviews, meta-analyses, and relevant cohort studies in the field. With a high level of evidence, sarcopenia is significantly associated with a reduced quality of life, a higher risk of falls and fractures and a higher risk of mortality. Sarcopenia has been moderately associated with a higher risk of reduced instrumental activities of daily living (IADL). However, the GLIS WG found only inconclusive level of evidence to support associations between sarcopenia and higher risks of hospitalization, nursing home admission, mobility impairments, and reduced basic activities of daily living (ADL). This limitation underscores the scarcity of longitudinal studies, highlighting a barrier to understanding its progression and implications over time.

Background Physical function is a key determinant of independence among older adults. Yet, there are barriers to assessing physical function in clinic. We developed a wearable geriatric functional assessment system (GFAS) that quickly and effortlessly evaluates physical function. Methods A single-arm, non-randomized, mixed-methods, usability study evaluated the design, ergonomics, and usability of the GFAS. Participants aged >65 years with multiple chronic conditions were recruited and wore the GFAS about the clinic for 15-minutes. We assessed walking speed, 30-second sit-to-stand, and evaluated postural balance using a Footscan pressure plate system. In addition to transcribed exit-interviews and a Willingness to Pay questionnaire, the USE, Technology Acceptance, and System Usability Scales were evaluated. Results Of the 37 participants screened, 21 were recruited, enrolled, and consented, whose mean age was 76.6±5.45 years (52.4% female), with 28.6% non-White, 19% were on Medicaid, and 52.4% were classified as having a robust Fried frailty status. Participants favored the prototype and its existing functionality (7.14±2.35) and would wear it if recommended by their clinician (7.62±2.50, median 8.0). All felt it was easy to use, 74% of comments outlined they would use it again, and 81% noted it was comfortable. System Usability score was 78.2 ± 14.5, USE was 5.83 ± 3.59, and Technology Acceptance demonstrated satisfaction of 7.05 ± 2.18 in using the device. Conclusions The GFAS prototype shows considerable promise in evaluating physical function in older adults and that additional steps are needed to maximize usability.

Background: Frailty is a geriatric syndrome of significant public health concern that causes vulnerability to physiologic stressors and an increased risk of mortality and hospitalizations. Dietary intake and quality are contributing factors to the development of frailty. The Mediterranean diet is known to be one of the healthiest eating patterns with promising health impacts for prevention. We evaluated the association between Mediterranean diet patterns and frailty status. Methods: We conducted a cross-sectional study using National Health and Nutrition Examination Survey data from 2007 to 2017. We included 7300 participants aged > 60 years who completed the first day of a 24 h diet recall and had full covariate data. We constructed an alternate Mediterranean diet (aMED) score based on the quantity of specific food-group intake and categorized participants to low-, moderate-, and high-adherence groups (aMED adherence scores of 0–2, 3–4, and 5–9, respectively). Using a modified Fried Frailty phenotype (weakness, low physical activity, exhaustion, slow walking speed, and weight loss), participants were categorized as robust (met no criteria), pre-frail (met one or two criteria), and frail (met three or more criteria). Logistic regression evaluated the association of frailty (prefrail/robust as referent) and aMED adherence. Results: Included participants were mainly female (54.5%) and non-Hispanic White (80.0%). The mean (SD) aMED score was 3.6 (1.6) with 45% of participants falling into moderate aMED adherence (26% low adherence, 30% high adherence). Frailty prevalence among participants was 7.1%, with most participants classified as robust (51.0%) or pre-frail (41.9%). Fully adjusted models showed significantly reduced odds of frailty with moderate-adherence and high-adherence groups (odds ratio (95%CI) of 0.71 (0.55, 0.92) and 0.52 (0.36, 0.75), respectively). Conclusions: Mediterranean diet adherence is associated with decreased odds of frailty in older adults. These findings suggest that adherence to a Mediterranean diet may play a critical role in mitigating frailty and its associated conditions. Future research should include longitudinal and interventional studies that can definitively determine the effect of a Mediterranean diet on frailty and what food components provide the greatest benefit.