Microbiota Metabolite Profiles and Dietary Intake in Older Individuals with Insomnia of Short vs. Normal Sleep Duration.

Recent evidence suggests that the gut microbiota plays a role in insomnia pathogenesis. This study compared the dietary habits and microbiota metabolites of older adults with insomnia of short vs. normal sleep duration (ISSD and INSD, respectively). Data collection included sleep assessment through actigraphy, dietary analysis using the Food Frequency Questionnaire, and metabolomic profiling of stool samples. The results show that ISSD individuals had higher body mass index and a greater prevalence of hypertension. Significant dietary differences were observed, with the normal sleep group consuming more kilocalories per day and specific aromatic amino acids (AAAs) phenylalanine and tyrosine and branch-chain amino acid (BCAA) valine per protein content than the short sleep group. Moreover, metabolomic analysis identified elevated levels of the eight microbiota metabolites, benzophenone, pyrogallol, 5-aminopental, butyl acrylate, kojic acid, deoxycholic acid (DCA), trans-anethole, and 5-carboxyvanillic acid, in the short compared to the normal sleep group. The study contributes to the understanding of the potential role of dietary and microbial factors in insomnia, particularly in the context of sleep duration, and opens avenues for targeted dietary interventions and gut microbiota modulation as potential therapeutic approaches for treating insomnia.

Signs of aging in midlife: physical function and sex differences in microbiota.

Microbiota composition has been linked to physical activity, health measures, and biological age, but a shared profile has yet to be shown. The aim of this study was to examine the associations between microbiota composition and measures of function, such as a composite measure of physical capacity, and biological age in midlife, prior to onset of age-related diseases. Seventy healthy midlife individuals (age 44.58 ± 0.18) were examined cross-sectionally, and their gut-microbiota profile was characterized from stool samples using 16SrRNA gene sequencing. Biological age was measured using the Klemera-Doubal method and a composition of blood and physiological biomarkers. Physical capacity was calculated based on sex-standardized functional tests. We demonstrate that the women had significantly richer microbiota, p = 0.025; however, microbiota diversity was not linked with chronological age, biological age, or physical capacity for either women or men. Men had slightly greater ß-diversity; however, ß-diversity was positively associated with biological age and with physical capacity for women only (p = 0.01 and p = 0.04; respectively). For women, an increase in abundance of Roseburia faecis and Collinsella aerofaciens, as well as genus Ruminococcus and Dorea, was significantly associated with higher biological age and lower physical capacity; an increase in abundance of Akkermansia muciniphila and genera Bacteroides and Alistipes was associated with younger biological age and increased physical capacity. Differentially abundant taxa were also associated with non-communicable diseases. These findings suggest that microbiota composition is a potential mechanism linking physical capacity and health status; personalized probiotics may serve as a new means to support health-promoting interventions in midlife. Investigating additional factors underlying this link may facilitate the development of a more accurate method to estimate the rate of aging.

CRP, but not fibrinogen, is associated with gait speed as early as middle age, in females but not males.

Low grade systemic inflammation and age-related gait speed decline are known to be related in older adults, but their relations in the early stages of the aging process are yet to be fully described. The aim of this study was to examine the relationship between gait speed and two inflammation markers-c-reactive protein (CRP) and fibrinogen-in a cohort of middle-aged adults in Israel. 326 healthy, middle-aged, Muslim-Arabs from three villages in northern Israel participated in this cross-sectional study. Serum CRP and fibrinogen were measured via blood tests, and gait speed was assessed with the 6-min walk test (6MWT). After adjusting for sex, age, height, BMI, systolic blood pressure, fasting blood glucose and triglycerides, executive function, smoking status and aerobic physical activity, gait speed was negatively and significantly associated with CRP (b = - 0.01, p = 0.029). When stratifying by gender, this link remained significant only among females (b = - 0.012, p = 0.041), such as that an increase of one SD unit of CRP was associated with a 0.047 m/s decrease in gait speed. No significant link was found between fibrinogen levels and gait speed. Blood CRP levels are associated with a slower walking speed already in middle age, independent of age, executive function and cardio-metabolic factors, among female Arab-Muslims in Israel. Future studies should examine this relationship longitudinally and investigate a broader array of inflammation markers. Systemic inflammation may serve as an early marker for people at risk of decreased walking or accelerated aging; Early identification and intervention among at-risk individuals may help prevent or slow gait speed decline, and promote healthier aging.

Still WALKing-FOR: 2-year sustainability of the 'WALK FOR' intervention.

BACKGROUND: low mobility of hospitalised older adults is associated with adverse outcomes and imposes a significant burden on healthcare and welfare systems. Various interventions have been developed to reduce this problem; at present, however, their methodologies and outcomes vary and information is lacking about their long-term sustainability. This study aimed to evaluate the 2-year sustainability of the WALK-FOR (walking for better outcomes and recovery) intervention implemented by teams in acute care medical units. METHODS: a quasi-experimental three-group comparative design (N = 366): pre-implementation, i.e. control group (n = 150), immediate post-implementation (n = 144) and 2-year post-implementation (n = 72). RESULTS: mean participant age was 77.6 years (± 6 standard deviation [SD]) and 45.3% were females. We conducted an analysis of variance test to evaluate the differences in primary outcomes: number of daily steps and self-reported mobility. Levels of mobility improved significantly from the pre-implementation (control) group to the immediate and 2-year post-implementation groups. Daily step count: pre-implementation (median: 1,081, mean: 1,530 SD = 1,506), immediate post-implementation (median: 2,225, mean: 2,724. SD = 1,827) and 2-year post-implementation (median: 1,439, mean: 2,582, SD = 2,390) F = 15.778 P < 0.01. Self-reported mobility: pre-implementation (mean:10.9, SD = 3.5), immediate post-implementation (mean: 12.4, SD = 2.2), 2-year post-implementation (mean: 12.7, SD = 2.2), F = 16.250, P < 0.01. CONCLUSIONS: the WALK-FOR intervention demonstrates 2-year sustainability. The theory-driven adaptation and reliance on local personnel produce an effective infrastructure for long-lasting intervention. Future studies should evaluate sustainability from a wider perspective to inform further in-hospital intervention development and implementation.

Shared and distinct factors underlying in-hospital mobility of older adults in Israel and Denmark (97/100).

BACKGROUND: Low in-hospital mobility is widely acknowledged as a major risk factor in acquiring hospital-associated disabilities. Various predictors of in-hospital low mobility have been suggested, among them older age, disabling admission diagnosis, poor cognitive and physical functioning, and pre-hospitalization mobility. However, the universalism of the phenomena is not well studied, as similar risk factors to low in-hospital mobility have not been tested. METHODS: The study was a secondary analysis of data on in-hospital mobility that investigated the relationship between in-hospital mobility and a set of similar risk factors in independently mobile prior to hospitalization older adults, hospitalized in acute care settings in Israel (N = 206) and Denmark (N = 113). In Israel, mobility was measured via ActiGraph GT9X and in Denmark by ActivPal3 for up to seven hospital days. RESULTS: Parallel multivariate analyses revealed that a higher level of community mobility prior to hospitalization and higher mobility ability status on admission were common predictors of a higher number of in-hospital steps, whereas the longer length of hospital stay was significantly correlated with a lower number of steps in both samples. The risk of malnutrition on admission was associated with a lower number of steps, but only in the Israeli sample. CONCLUSIONS: Despite different assessment methods, older adults' low in-hospital mobility has similar risk factors in Israel and Denmark. Pre-hospitalization and admission mobility ability are robust and constant risk factors across the two studies. This information can encourage the development of both international standard risk evaluations and tailored country-based approaches.

Participation in daily activities after acute illness hospitalization among high-functioning older adults: a qualitative study.

AIMS AND OBJECTIVES: To describe high-functioning older adults' experiences of participation in daily activities and perceived barriers and facilitators to participation one- and 3-months post-acute hospitalization. BACKGROUND: Older adults discharged after acute illness hospitalization are at risk for functional decline and adverse health outcomes. Yet, little is known about the subjective experience of resuming participation in meaningful activities beyond the immediate post-discharge period among high-functioning older adults, a mostly overlooked sub-sample. DESIGN: Qualitative descriptive longitudinal study adhering to the COREQ guidelines. METHODS: Forty two participants ages ≥65 years (mean age 75, SD ± 7.9) were recruited from internal medicine wards. Semi-structured interviews were conducted at participants' homes one-month post-discharge, followed by a telephone interview 3-months after. Data were analyzed using thematic analysis. RESULTS: Participants perceived the hospitalization as a disruption of healthy and meaningful routines. This first key theme had unique expressions over time and included two sub-themes. At one month: (1) reduced life spaces and sedentary routines. At 3 months: (2) a matter of quality not quantity - giving up even one meaningful activity can make a difference. The second key theme was described as a combination of physical and psychological barriers to participation over time. These themes demonstrated the profound impact of the hospitalization on behavior (participation) and feelings (e.g., symptoms). The third key theme was described as a dyad of intrinsic and extrinsic facilitators to participation. CONCLUSIONS: Acute illness hospitalization may lead to subtle decreases in participation in meaningful health-promoting activities, even among high-functioning older adults. These changes may impact overall well-being and possibly mark the beginning of functional decline. RELEVANCE TO CLINICAL PRACTICE: This study highlights the need for a more comprehensive assessment of participation, relevant for high-functioning older adults, to enable person-centered care. Intervention programs should address the modifiable barriers and facilitators identified in this study.

Ethiopian immigrants with diabetes in Israel: Oscillating between two narratives.

AIM: The purpose of this project was to examine the role of cultural differences in shaping the management of diabetes among Ethiopian immigrants living in Israel. METHODS: A qualitative, in-depth study involved semistructured interviews with 16 Ethiopian immigrants with diabetes living in Israel. The interviews were audio-recorded, transcribed and translated into Hebrew, if necessary. The authors each identified themes in the responses and then through discussion came to a consensus about the most significant ones and how to categorize them. RESULTS: A main theme was revealed structuring the participants' perception of diabetes: an oscillation between a familiar narrative, associated with traditional life in Ethiopia, and a foreign one. Five additional subthemes were also identified as an oscillation about the causes of disease, between collectivism and individualism, between accessible food and a balanced diet, between relying on bodily sensations and prescribed treatment and between culturally oriented and translated knowledge. CONCLUSION: The participants understood that they could be adversely affected both by the changes in lifestyle following their move and by adhering to the traditional norms. They agreed that professional liaisons and peers who have successfully managed their diabetes could help provide a bridge between the narratives.

Hebrew version of the physical therapy patient satisfaction questionnaire: cross-cultural adaptation and psychometric properties.

PURPOSE: This study aimed at translating, culturally adjusting, and validating the Israeli version of the Physical Therapy Patient Satisfaction Questionnaire (PTPSQ-H). METHODS: Following the process of cross-cultural adaptation of self-report measures guidelines, we conducted a cross-cultural adaptation study among of adults completing outpatient physical therapy treatments. We formulated the PTPSQ-H using forward-backward translation procedures, a final review, and a pre-final version. The applied analyses were acceptability, reliability (measured by internal consistency; Cronbach's α), and factor analysis (exploring internal structure). Divergent validity was assessed by paralleling the PTPSQ-H with pain visual analogue scale (VAS), and a 5-point Likert scale evaluating the global perceived effect (GPE) of the physical therapy treatment. Preliminary analyses concluded that five items from the PTPSQ-H are irrelevant for the study population, thus these items were removed and the questionnaire was termed the PTPSQ-H[15]. RESULTS: The PTPSQ-H[15] exhibited high internal consistency (α = 0.883). Divergent validity was low for the GPE (r = 0.257, p < .0001) and insignificant for the VAS (r = -0.05, p = .480). A factor analysis indicated a significant two-factor structure related to "Overall Experience" and "Professional Impression", which explained nearly 60% of the total variance assuring its suitability to measure patient satisfaction. CONCLUSION: PTPSQ-H[15] was found to be a valid tool to measure physical therapy patient satisfaction.

Variation in Gut Microbiota Composition is Associated with Sleep Quality and Cognitive Performance in Older Adults with Insomnia.

Purpose: Insomnia, a chronic condition affecting 50% of older adults, is often accompanied by cognitive decline. The mechanism underlying this comorbidity is not fully understood. A growing literature suggests the importance of gut microbiota for brain function. We tested associations between sleep quality and cognitive performance with gut microbiota in older adults with insomnia. Patients and Methods: Seventy-two older adults with insomnia (age 73.2 ± 5.73 years, 56 females) provided stool samples for gut microbial sequencing. Microbiota profile was determined using the DADA2 bioinformatics pipeline. Cognition was assessed with the Cambridge Neuropsychological Test Automated Battery. Objective sleep quality was monitored by a two-week actigraphic recording, and participants completed the Insomnia Severity Index (ISI). We used partial canonical correspondence analysis (pCCA) to examine the relative contribution of insomnia, based on actigraphic sleep efficiency (SE) and ISI, and of cognitive status, based on the Multitasking test of Median Reaction Latency (MTTLMD) and the Spatial Working Memory Between Errors (SWMBE), to variance in microbiota composition. We used Pearson correlations to correlate insomnia and cognitive status parameters with microbiota amplicon sequence variants, genera, and families. Results: The pCCA revealed that sleep quality and cognitive performance explained a variation of 7.5-7.9% in gut microbiota composition in older adults with insomnia. Correlation analysis demonstrated that Lachnoclostridium (genus) correlates positively with SE (r=0.42; P=0.05) and negatively with MTTLMD (r=-0.29; P=0.03), whereas Blautia (genus) correlates negatively with MTTLMD (r=-0.31; P=0.01). Conclusion: Findings demonstrate the associations of sleep quality and cognitive performance with variance in gut microbiota composition and with specific genus abundance in older adults with insomnia. Further studies should validate the findings, determine causal relationships, and evaluate potential interventions for the comorbidity of insomnia and cognitive impairment in older adults with insomnia.

Can We Quantify Aging-Associated Postural Changes Using Photogrammetry? A Systematic Review.

BACKGROUND: Aging is widely known to be associated with changes in standing posture. Recent advancements in the field of computerized image processing have allowed for improved analyses of several health conditions using photographs. However, photogrammetry's potential for assessing aging-associated postural changes is yet unclear. Thus, the aim of this review is to evaluate the potential of photogrammetry in quantifying age-related postural changes. MATERIALS AND METHODS: We searched the databases PubMed Central, Scopus, Embase, and SciELO from the beginning of records to March 2021. Inclusion criteria were: (a) participants were older adults aged ≥60; (b) standing posture was assessed by photogrammetric means. PRISMA guidelines were followed. We used the Newcastle-Ottawa Scale to assess methodological quality. RESULTS: Of 946 articles reviewed, after screening and the removal of duplicates, 11 reports were found eligible for full-text assessment, of which 5 full studies met the inclusion criteria. Significant changes occurring with aging included deepening of thoracic kyphosis, flattening of lumbar lordosis, and increased sagittal inclination. CONCLUSIONS: These changes agree with commonly described aging-related postural changes. However, detailed quantification of these changes was not found; the photogrammetrical methods used were often unvalidated and did not adhere to known protocols. These methodological difficulties call for further studies using validated photogrammetrical methods and improved research methodologies.

The contribution of functional cognition screening during acute illness hospitalization of older adults in predicting participation in daily life after discharge.

BACKGROUND: Cognitive assessment in acutely hospitalized older adults is mainly limited to neuropsychological screening measures of global cognition. Performance-based assessments of functional cognition better indicate functioning in real-life situations. However, their predictive validity has been less studied in acute hospital settings. The aim of this study was to explore the unique contribution of functional cognition screening during acute illness hospitalization in predicting participation of older adults one and three months after discharge beyond traditional neuropsychological measures. METHODS: This prospective longitudinal study included 84 older adults ≥ 65 years hospitalized in internal medicine wards due to acute illness, followed by home visits at one month and telephone interviews at three months (n = 77). Participation in instrumental activities of daily living, social and leisure activities was measured by the Activity Card Sort. In-hospital factors included cognitive status (telephone version of the Mini-Mental State Examination, Color Trails Test), functional cognition screening (medication sorting task from the alternative Executive Function Performance Test), emotional status (Hospital Anxiety and Depression scale), functional decline during hospitalization (modified Barthel index), length of hospital stay, the severity of the acute illness, symptoms severity and comorbidities. RESULTS: Functional cognition outperformed the neuropsychological measures in predicting participation declines in a sample of relatively high-functioning older adults. According to a hierarchical multiple linear regression analysis, the overall model explained 28.4% of the variance in participation after one month and 19.5% after three months. Age and gender explained 18.6% of the variance after one month and 13.5% after three months. The medication sorting task explained an additional 5.5% of the variance of participation after one month and 5.1% after three months, beyond age and gender. Length of stay and the Color Trails Test were not significant contributors to the change in participation. CONCLUSIONS: By incorporating functional cognition into acute settings, healthcare professionals would be able to better detect older adults with mild executive dysfunctions who are at risk for participation declines. Early identification of executive dysfunctions can improve continuity of care and planning of tailored post-discharge rehabilitation services, especially for high-functioning older adults, a mostly overlooked population in acute settings. The results support the use of functional cognition screening measure of medication management ability in acute settings.

The effect of co-dependent (thinking in motion [TIM]) versus single-modality (CogniFit) interventions on cognition and gait among community-dwelling older adults with cognitive impairment: a randomized controlled study.

BACKGROUND: Cognition and motor skills are interrelated throughout the aging process and often show simultaneous deterioration among older adults with cognitive impairment. Co-dependent training has the potential to ameliorate both domains; however, its effect on the gait and cognition of older adults with cognitive impairment has yet to be explored. The aim of this study is to compare the effects of the well-established single-modality cognitive computerized training program, CogniFit, with "Thinking in Motion (TIM)," a co-dependent group intervention, among community-dwelling older adults with cognitive impairment. METHODS: Employing a single-blind randomized control trial design, 47 community-dwelling older adults with cognitive impairment were randomly assigned to 8 weeks of thrice-weekly trainings of TIM or CogniFit. Pre- and post-intervention assessments included cognitive performance, evaluated by a CogniFit battery, as a primary outcome; and gait, under single- and dual-task conditions, as a secondary outcome. RESULTS: CogniFit total Z scores significantly improved from baseline to post-intervention for both groups. There was a significant main effect for time [F (1, 44) = 17.43, p < .001, ηp2 = .283] but not for group [F (1, 44) = 0.001, p = .970]. No time X group interaction [F (1, 44) = 1.29, p = .261] was found. No changes in gait performance under single and dual-task performance were observed in both groups. CONCLUSIONS: The findings show that single-modality (CogniFit) and co-dependent (TIM) trainings improve cognition but not gait in older adults with cognitive impairment. Such investigations should be extended to include various populations and a broader set of outcome measurements. TRIAL REGISTRATION: ACTRN12616001543471. Date: 08/11/2016.

The Relationships of Fibrinogen and C-Reactive Protein With Gait Performance: A 20-Year Longitudinal Study.

Background: Gait speed, a central marker of aging, has been linked to various health outcomes, such as cognitive and physical functions in middle-aged adults. Although long-term systemic low-grade inflammation is considered a mechanism underlying a variety of aging-related risk factors, the longitudinal associations between inflammation markers and gait speed are yet to be fully investigated. Objective: To explore the associations of CRP and fibrinogen levels, measured two decades ago, with gait speed among community dwelling adults, considering the contribution of cardio-metabolic factors and cognition. Methods: Study participants took part in two phases of the of the "Kibbutzim Family Study" (i.e., Phase II, 1999-2000 and Phase III, 2017-2019). Blood samples collected in Phase II (baseline) were used to determine level of inflammatory markers. Gait speed was assessed under single-task (ST) and dual-task (DT) conditions in Phase III. Demographic, anthropometric and clinical data were collected in both phases. Linear regression models were used to assess the adjusted associations of inflammation and gait speed. Results: A total of 373 individuals aged 34-99 (mean 64 ± 13 years) in Phase III were included in the study. Gait speed under ST was negatively associated with baseline levels of fibrinogen (b per standard deviation (SD) = -0.053, p = 0.0007) and CRP (b per SD = -0.043, p = 0.010), after adjusting for baseline and concurrent cardiometabolic risk factors. Accounting for executive functions, associations of fibrinogen with gait under ST were somewhat attenuated, yet associations remained statistically significant (p < 0.05). Associations with CRP were attenuated to the null. In contrast, there were no associations between inflammation markers and gait under DT. Conclusion: Our findings demonstrate that in a sample including younger to older adults, higher systemic inflammatory activity was linked with gait 20 years later, beyond age and cardiometabolic health, and to a certain extent, beyond executive functions. Thus, systemic inflammation may serve as an early marker to identify individuals at risk for gait decline.

Many Paths to Recovery: Comparing Basic Function and Participation in High-Functioning Older Adults After Acute Hospitalization.

Function after acute hospitalization is mostly operationalized by Basic Activities of Daily Living (BADL), a limited concept that overshadows a wide range of instrumental, social, and recreational activities, otherwise referred to as participation. Participation is important for patients' health and quality of life after hospitalization. This study focuses on high-functioning older adults, examining functional recovery after hospitalization by comparing BADL assessment with assessment of participation at one and three months following discharge relative to pre-hospitalization. Quantitative data were collected from 72 participants divided into two age groups of hospitalized older adults (age 65-74, n = 38; age ≥75, n = 34), followed by home visits after 1 month and telephone interviews 3 months after discharge. Both groups experienced a significantly greater decline in participation, compared with BADL, which were mostly preserved. A comprehensive assessment of participation better captures functional changes in high-functioning older adults. Early identification of participation withdrawal is crucial for preventing disability.

The association between objective measurements of sleep quality and postural control in adults: A systematic review.

We systematically reviewed the association between objective sleep quality and postural control based on objective measurements. We searched the electronic databases PUBMED, CINAHL, SCOPUS and Web of Science for studies assessing the relationship between objective measurements of sleep and postural control or gait performance among adults above age 18. All types of articles until April 2020 were considered. The search yielded 2967 articles, and out of these, inclusion criteria were met by five cross-sectional and two longitudinal studies (N = 7). Three studies found a positive correlation between sleep efficiency and gait speed, three studies found a negative correlation between wake time after sleep onset (WASO) and gait speed or postural control, and one study found no association between sleep parameters and gait speed. Objectively measured sleep quality parameters such as sleep efficiency and WASO were associated with objective measures of posture and gait. More studies with longitudinal designs are needed to expose causal pathways and mechanisms underlying these relationships.

What can we learn from physical capacity about biological age? A systematic review.

OBJECTIVE: To systematically investigate the relationship between objective measures of physical capacity (e.g., cardio-respiratory fitness or daily step count) and biological age, measured in different ways. DATA SOURCE: PubMed; SCOPUS - Elsevier API; and Web of Science - ISI 1984-present, as well as contextual search engines used to identify additional relevant publications. STUDY SELECTION: Cross-sectional and longitudinal studies that assessed the association between objectively measured physical capacity and biological aging in adult individuals (age>18). RESULTS: Analysis of 28 studies demonstrated that physical capacity is positively associated with biological aging; the most dominant measures of physical capacity are muscular strength or gait speed. The majority of the studies estimated biological aging by a single methodology - either Leukocyte Telomere Length or DNA methylation levels. CONCLUSIONS: This systematic review of the objective physical capacity measures used to estimate aging finds that the current literature is limited insofar as it overlooks the potential contribution of many feasible markers. We recommend measuring physical capacity in the context of aging using a wide range of modifiable behavioral markers, beyond simple muscle strength or simple gait speed. Forming a feasible and diversified method for estimating physical capacity through which it will also be possible to estimate biological aging in wide population studies is essential for the development of interventions that may alleviate the burden of age-related disease.

Increased physical activity improves gut microbiota composition and reduces short-chain fatty acid concentrations in older adults with insomnia.

Physical activity (PA) can improve functional abilities, well-being, and independence in older adults with insomnia. Studies have shown that PA may be linked to changes in the gut microbiota composition and its metabolites' concentrations. This association among older adults with insomnia, however, is yet to be determined. We explored the relationships between physical activity (PA) levels, gut microbiota composition, and short-chain fatty acid (SCFA) levels in this population. Forty-nine community-dwelling adults with insomnia symptoms, aged 65 and older, participated in this study. Their average daily step-count and sleep continuity measures over a two-week period were calculated based on Actigraphic recordings. Each participant provided fecal samples for the microbiome and SCFA analyses, anthropometric measures, and information via questionnaires on medical history and food consumption. The gut microbiota composition and SCFA concentrations were determined by next-generation sequencing and Gas chromatography-mass spectrometry, respectively. Participants were divided into two groups (more and less active) according to their median step/day count. We compared the microbiota abundance and SCFA concentrations between groups and performed correlation analysis between gut microbiota abundances and study variables. Different microbiota taxa in each PA group and increased SCFAs in feces of less active individuals were found. Changes in step counts were positively or negatively associated with the relative abundance of 19 ASVs, 3 microorganisms at the family level, and 11 microorganisms at the genus level. Furthermore, significant associations were discovered among physical activity, gut microbiota, SCFAs, and sleep parameters. Our findings provide new insights on the relationship between PA, gut microbiota composition, and primary metabolites in older adults with insomnia.

"Behind the Scenes" of Accelerometer Use to Quantify In-Hospital Mobility of Older Adults.

Measuring in-hospital mobility of older adults with accelerometers is becoming more common practice. However, neither the unique challenges surrounding accelerometer use within acute hospital settings nor the potential solutions to these challenges have been well documented. The aim of this article is to present and discuss what occurs "behind the scenes" when using accelerometers to quantify in-hospital mobility among older adults in acute hospital wards. The article identifies the challenges related to accelerometer use that emerged over the course of daily data collection for 2 large-scale studies, including matters of recruitment, daily use, technical and methodological issues, loss of devices, missing data, and troubleshooting. The article details the tasks and the strategies we developed for overcoming these challenges and how we implemented them within the acute wards. Finally, the article provides recommendations for researchers and clinicians on how to improve future use of accelerometers or other devices aimed to enhance in- hospital mobility of older adults.

A bridge to cross: Tube feeding and the barriers to implementation of palliative care for the advanced dementia patient.

AIMS AND OBJECTIVES: To elucidate the attitudes and knowledge of nursing home (NH) staff involved in the decision-making process surrounding tube feeding for people with advanced dementia, and regarding palliative care and eating difficulties in this population. BACKGROUND: Dementia's final stage is associated with eating difficulties. "Comfort feeding" is the approach endorsed by the American Geriatrics Society for those with advanced dementia and eating difficulties. Despite this, tube feeding remains a persisting practice in NHs in Israel. DESIGN: A qualitative descriptive study. METHODS: Twenty-seven NH employees from different sectors employed by seven NHs in northern Israel underwent semi-structured, face-to-face interviews. The COREQ checklist was used to aid with reporting and analysis of results. RESULTS: In Israel, there is an emerging palliative care discourse in caring for people with advanced dementia living in the NH setting. However, many interviewed did not demonstrate an accurate understanding of this term or of the term "comfort feeding." Several barriers towards implementation of palliative care were identified and include a lack of formal education regarding nutrition in advanced dementia, socio-economic factors and their association with the two types of NHs operating in Israel (those with exclusively private funding and those reimbursed by the Ministry of Health). CONCLUSIONS: Interviews with NH staff regarding eating difficulties in advanced dementia shed light on the palliative care discourse, which is in a liminal stage in many countries. The themes that emerged may help inform future recommendations regarding palliative care in general and more specifically in NH residents with advanced dementia, in countries where policy is still being developed and refined. RELEVANCE TO CLINICAL PRACTICE: Understanding barriers towards implementation of a palliative approach and comfort feeding specifically could improve the care for people with advanced dementia in the NH setting.