Use of Fitbit Technology Does Not Impact Health Biometrics in a Community of Older Adults.

Introduction: To evaluate if the offering of Fitbit technology led to changes in cardiovascular health metrics in a cohort of older adults. Methods: A retrospective cohort study was developed in two community-embedded health monitoring sites, located in aggregate housing communities for older adults in Westchester County, NY. Participants included older adults (55 years or older) enrolled in the Telehealth Intervention Programs for Seniors (TIPS) initiative, a community-embedded remote patient monitoring initiative. Weekly blood pressure, heart rate, weight, and blood oxygenation were taken on all participants. For participants who accepted a Fitbit Zip device, a weekly step count was also collected. Results: Ninety-four TIPS participants were offered Fitbit technology. Thirty participants accepted the technology and used it for a minimum of 6 months. No significant differences in any of the regularly acquired biometrics were noted between Fitbit users and non-Fitbit users. Across all participants, regardless of Fitbit use, there was a significant decrease in systolic blood pressure (SBP) over time. Conclusions: Neither Fitbit Zip ownership or compliance to Fitbit Zip usage influenced any of the biometrics taken as part of the TIPS. However, participation in the TIPS initiative may have an overall positive effect on SBP in older adults.

Insulin-like Growth Factor-1 Impacts p53 Target Gene Induction in UVB-irradiated Keratinocytes and Human Skin.

The tumor suppressor protein p53 limits mutagenesis in response to ultraviolet-B (UVB) light exposure by activating the transcription of genes that mitigate the damaging effects of UVB radiation on DNA. Because most nonmelanoma skin cancers (NMSCs) occur in older individuals, it is important to understand the process of mutagenesis in the geriatric skin microenvironment. Based on previous studies demonstrating that geriatric skin expresses lower levels of the growth factor insulin-like growth factor-1 (IGF-1) than young adult skin, a role for IGF-1 in the regulation of p53 target genes was investigated in both human keratinocytes in vitro and human skin explants ex vivo. The products of the p53 target genes p21 and DNA polymerase eta (pol η) were found to be increased by UVB exposure in both experimental systems, and this induction was observed to be partially abrogated by depriving keratinocytes of IGF-1 in vitro or by the treatment of keratinocytes in vitro and human skin explants with an IGF-1 receptor antagonist. Because p21 and pol η function to limit mutagenic DNA replication following UVB exposure, these results suggest that NMSC risk in geriatric populations may be due to age-dependent decreases in IGF-1 signaling that disrupt p53 function in the skin.

Telehealth Intervention Programs for Seniors: An Observational Study of a Community-Embedded Health Monitoring Initiative.

Background:Chronic disease in older adults is estimated to account for 84% of annual health care spending in the United States, with many preventable costs expected to rise as the population continues to age.Introduction:Telehealth Intervention Programs for Seniors (TIPS) is a community-embedded program targeting low-income older adults, providing weekly assessment of vital signs and subjective wellness, and wrap-around aging services.Materials and Methods:TIPS recruited 765 volunteers over 55 years, who were Medicaid and/or Medicare eligible. Data were collected from 2014 to 2016 [median enrollment 343 days (105-435)] using 12 TIPS sites. This observational study evaluated the efficacy of TIPS by measuring within-subject changes in self-reported hospital visits and <30-day readmissions, before and during TIPS participation. Data of 617 participants (median age 74.3; interquartile range 16) were analyzed.Results:Self-reported hospital visits were reduced by 28.9% (p = 0.0013). Medicare participants benefited the most, with a 50% (p < 0.0001) reduction in hospital visits, and a 75.5% (p = 0.017) reduction in <30-day readmissions. Multivariate analysis revealed that participants (1) Medicaid-registered (odds ratio [OR] = 2.72, 95% confidence interval [CI] 0.392-1.611), (2) reporting feeling unwell (OR = 1.33, 95% CI 0.118-0.459), and (3) living alone (OR = 2.34, 95% CI 0.115-1.592) were significantly more likely than other participants to experience a hospital visit.Discussion:TIPS demonstrates that community-embedded health services can reduce rates of hospital visits in older adults.Conclusion:The success of TIPS highlights the potential of successfully deployed remote patient-monitoring initiatives in reducing the utilization of costly health services.

Depressive symptoms and suicidal ideation among older adults receiving home delivered meals.

OBJECTIVE: Homebound older adults may be vulnerable to the deleterious impact of untreated depression. Yet because these elders are difficult to reach, there is little data on the rates of depressive symptoms and suicidal ideation among this group. The objective of this study is to document the rates of depression and correlates among a population of homebound elders. METHODS: Using a community based participatory research partnership, we implemented a routine screening for depressive symptoms and suicidal ideation among older recipients of Westchester County's home meal program. Older adults enrolled in the home delivered meal program were administered the Physician Health Questionnaire-9 (PHQ-9), and questions to assess pain, falls, alcohol abuse and perceived emotional distress. RESULTS: In our sample of 403 meal recipients, 12.2% of older adults reported clinically significant depression (PHQ-9 > 9) and 13.4% reported suicidal thoughts. One-third of recipients with significant depressive symptoms were currently taking an antidepressant. Almost one-third of older adults who endorsed suicide ideation did not report clinically significant depressive symptoms. Among men, suicidal thoughts were associated with chronic pain and greater depression severity, whereas pain was not a predictor of suicidal thoughts among women. CONCLUSION: More than one in nine elders suffer from depression; most are untreated with one-third undertreated. Through partnerships between public agencies that provide age related services and academic investigators there is an opportunity for improved detection of unmet mental health needs. Future research should explore innovative models to improve access to mental health services once unmet need is detected.