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--- - |2 Abstract Bayesian methods incorporate model parameter information prior to data collection. Eliciting information from content experts is an option, but has seen little implementation in Bayesian item response theory (IRT) modeling. This study aims to use ethical reasoning content experts to elicit prior information and incorporate this information into Markov Chain Monte Carlo (MCMC) estimation. A six‐step elicitation approach is followed, with relevant details at each stage for two IRT items parameters: difficulty and guessing. Results indicate that using content experts is the preferred approach, rather than noninformative priors, for both parameter types. The use of a noninformative prior for small samples provided dramatically different results when compared to results from content expert–elicited priors. The WAMBS (When to worry and how to Avoid the Misuse of Bayesian Statistics) checklist is used to aid in comparisons. - Journal of Educational Measurement, Volume 55, Issue 3, Page 373-402, Fall 2018.

--- - |2 Abstract This study investigates the effect of multidimensionality on extraction of latent classes in mixture Rasch models. In this study, two‐dimensional data were generated under varying conditions. The two‐dimensional data sets were analyzed with one‐ to five‐class mixture Rasch models. Results of the simulation study indicate the mixture Rasch model tended to extract more latent classes than the number of dimensions simulated, particularly when the multidimensional structure of the data was more complex. In addition, the number of extracted latent classes decreased as the dimensions were more highly correlated regardless of multidimensional structure. An analysis of the empirical multidimensional data also shows that the number of latent classes extracted by the mixture Rasch model is larger than the number of dimensions measured by the test. - Journal of Educational Measurement, Volume 55, Issue 3, Page 403-420, Fall 2018.

--- - |2 Abstract Person reliability parameters (PRPs) model temporary changes in individuals’ attribute level perceptions when responding to self‐report items (higher levels of PRPs represent less fluctuation). PRPs could be useful in measuring careless responding and traitedness. However, it is unclear how well current procedures for estimating PRPs can recover parameter estimates. This study assesses these procedures in terms of mean error (ME), average absolute difference (AAD), and reliability using simulated data with known values. Several prior distributions for PRPs were compared across a number of conditions. Overall, our results revealed little differences between using the χ or lognormal distributions as priors for estimated PRPs. Both distributions produced estimates with reasonable levels of ME; however, the AAD of the estimates was high. AAD did improve slightly as the number of items increased, suggesting that increasing the number of items would ameliorate this problem. Similarly, a larger number of items were necessary to produce reasonable levels of reliability. Based on our results, several conclusions are drawn and implications for future research are discussed. - Journal of Educational Measurement, Volume 55, Issue 3, Page 421-432, Fall 2018.

--- - |2 Abstract This research derived information functions and proposed new scalar information indices to examine the quality of multidimensional forced choice (MFC) items based on the RANK model. We also explored how GGUM‐RANK information, latent trait recovery, and reliability varied across three MFC formats: pairs (two response alternatives), triplets (three alternatives), and tetrads (four alternatives). As expected, tetrad and triplet measures provided substantially more information than pairs, and MFC items composed of statements with high discrimination parameters were most informative. The methods and findings of this study will help practitioners to construct better MFC items, make informed projections about reliability with different MFC formats, and facilitate the development of MFC triplet‐ and tetrad‐based computerized adaptive tests. - Journal of Educational Measurement, Volume 55, Issue 3, Page 357-372, Fall 2018.

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Aim To cross‐culturally adapt and validate the Comprehensive Frailty Assessment Instrument (CFAI) among Chinese community‐dwelling older adults. Methods The Chinese CFAI was developed through forward–backward translations. An urban sample of 1235 community‐dwelling older adults received face‐to‐face interviews to examine the validity (construct validity and criterion validity) and reliability (internal consistency and test–retest reliability). Results The Chinese CFAI achieved semantic and idiomatic equivalence, and showed acceptable reliability and an expected factor structure, except for the social support domain. The exploratory factor analysis extracted five factors explaining 53.8% of the total variance of frailty. The confirmatory factor analysis showed that the data fit well to the second‐order factor theoretical model, with a root mean square error of approximation of 0.05, Tucker‐Lewis Index of 0.93 and Comparative Fit Index of 0.95. The receiver operating characteristic analysis presented an acceptable criterion validity using the Rockwood Frailty Index as an external criterion (area under the curve 0.80), with balanced sensitivity (65.31%) and specificity (81.19%) at the optimal 39‐point frailty cut‐off of the CFAI. Conclusions The Chinese CFAI has good validity and reliability as a practical frailty measure in Chinese community‐dwelling older adults.

Aim The aim of the present study was to investigate the relationship between physical activity (PA) and depressive symptoms in community‐dwelling older Japanese adults. Methods A cross‐sectional study design was used to obtain data from 3191 community‐dwelling older Japanese adults aged 70–95 years. Depressive symptoms were assessed using self‐reported scores on the Geriatric Depression Scale‐15. PA was objectively measured using an accelerometer worn for a maximum of 40 days, and average daily durations of light‐intensity PA (LPA), moderate‐to‐vigorous intensity PA (MVPA) and step count were calculated. PA was compared between participants with and without depressive symptoms by carrying out analysis of covariance and multivariable logistic regression analysis adjusted for all covariates by using propensity scores. Results Depressive symptoms were present in 598 participants (19.6%). A comparison of propensity‐score adjusted PA showed that step count (5059.6 ± 53.7 vs 5003.0 ± 112.1 count/day; P = 0.652) and moderate‐to‐vigorous intensity PA duration (23.0 ± 0.4 vs 23.8 ± 0.7 min/day; P = 0.358) were not significantly different between participants with and without depressive symptoms, respectively. However, participants without depressive symptoms had a significantly higher LPA duration than those with depressive symptoms (39.4 ± 0.3 vs 37.3 ± 0.7 min/day, respectively; P < 0.01). Conclusions The present results suggest that individuals with lower LPA have a higher risk of depressive symptoms. These findings imply that PA recommendations, especially for older adults, should emphasize LPA, which appears to be especially effective at preventing depressive symptoms.

Aim To evaluate the relationship between kidney function without diabetes and components of the frailty phenotype in community‐dwelling Japanese older adults. Methods Participants were 8343 residents who completed baseline assessments, classified into four categories according to eGFR. Frailty status was defined using five criteria: (i) slow gait speed; (ii) muscle weakness; (iii) low physical activity; (iv) exhaustion; and (v) unintentional weight loss. Results After multivariate adjustment, participants with the lowest kidney function were at higher risk of frailty (OR 1.57, 95% CI 1.02–3.50) than those with normal kidney function. In addition, after adjustment for multiple confounders, estimated glomerular filtration rate <30 was associated with a greater risk of the individual frailty components of weight loss (OR 2.14, 95% CI 1.11–4.12), low physical activity (OR 1.35, 95% CI, 1.01–2.54) and slowness (OR 1.82, 95% CI 1.36–3.77) compared with estimated glomerular filtration rate ≥60. Conclusions Lower kidney function was associated with a higher risk of weight loss, low physical activity and slowness among community‐dwelling Japanese older adults.

Objective To examine associations among substance use disorder (SUD) and measures of length of stay (LOS) and non‐psychiatric medical comorbidity (MEDCO) in older‐adult inpatients with serious mental illness (SMI), hypothesizing SUD would be related to worse clinical outcomes. Methods A cross‐sectional study analyzed medical records from 2010 to 2016 of 7258 inpatients with SMI ≥ age 50, obtained from a 274‐bed psychiatric hospital. Descriptive analyses examined prevalence rates for SUD status (+/−), individual drug classes, and total number of SUDs (polysubstance use disorders). Regression models examined the influence of 2 independent variables of interest: (1) SUD status (+/−) and (2) type of SUD (ie, specific drug), controlling for demographic factors and additional (non‐SUD) psychiatric disorders. Two dependent (outcome) variables were examined: LOS and MEDCO. Results The overall SUD rate was 26%; cocaine was the most common SUD (≈ 10%). SUD status and additional (non‐SUD) psychiatric diagnoses were significantly associated with longer LOS (both P < 0.001). For individual SUDs, cocaine, marijuana, opiates, and alcohol were all significantly associated with LOS (all P < 0.01). SUD status, age, sex, admission status, and race were significantly associated with MEDCO (all P < 0.002). For individual SUDs, barbiturates, opiates, and alcohol were all significantly associated with MEDCO (P < 0.01). Conclusions The prevalence of SUD in this sample underscores concerns related to treating older adults presenting providers with comorbid SUD and SMI. This combination may increase the burden and complexity of care, warranting further investigation into mechanisms and long‐term consequences.

Aim The aim of the present study was to evaluate whether the effect of one‐time brief additional counseling in periodic health examinations (PHE) through the National Screening Program for the Translational Ages in Korea is sustained after 2 years. Methods We collected data from National Screening Program for the Translational Ages participants in 2007 and 2008. To evaluate behavior change after 2 years, we collected the participants’ health behavior data 2 years later (2009 and 2010). We defined the basic group as participants who only received PHE, and the additional group as received PHE and counseling. We carried out propensity score matching to ensure that additional counseling was the only different variable affecting health behavior between the two groups. Results After propensity score matching, 50 630 remaining matched participants were matched for each group. Of these participants, 26.5% (26 855/101 260) were aged 66 years, and 60.9% (61 653/101 260) were men. The additional group showed a significant increase in odds of smoking cessation among the 66‐year‐olds (adjusted OR 1.173, 95% CI 1.003–1.372). This effect was significant, especially when the participants did not have hypertension or hypercholesterolemia (adjusted OR 1.193, 95% CI 1.000–1.423 for hypertension and adjusted OR 1.188, 95% CI 1.009–1.398 for hypercholesterolemia). However, there was no significant association for alcohol drinking and regular exercise. Conclusions The effect of one‐time brief counseling added to a PHE in cigarette smoking was observed only among the 66‐year‐olds. However, the effect was so small that it is doubtful to be clinically relevant. Repeated counseling is required to sustain the effect of the initial motivation of counseling. Geriatr Gerontol Int 2017; ••: ••–••

Objective To investigate the impact on patient waiting times of a role substitution model introducing an advanced allied health practitioner as the first point of contact within a geriatric outpatient context. Methods A pre‐ to postintervention design was used to determine impact over a five‐year period (2008–2012). All patients referred to the geriatric specialist outpatient department were included (n = 1514). Data relating to waiting times were analysed using one‐way ANOVA and post hoc Tukey tests to determine effects on patient waiting times. Results Waiting times were reduced from an average of 82 to as low as 35 days, in a context of increasing referral rates. Medical specialist capacity was increased through improvements to available outpatient times and reduced appointment lengths. Patients seen within their designated triage category timeframe increased from 47 to 86%. Conclusion Health professional substitution in geriatrics can be an effective intervention for reducing patient waiting times and improving access to care.

Aim To investigate whether being part of a community organization interfered with older adults’ overall functionality. The magnitude of responses to a community exercise program based on functional circuits in socially active and socially non‐active older adults was also investigated. Methods A total of 200 older adults aged ≥60 years from Requinoa, Chile, participated in the study. Participants were separated into two groups according to the level of social participation: socially active (SA) and socially non‐active (SNA). During an evaluation, data regarding the presence of comorbidities (Charlson Comorbidity Index), disability level (Modified Health Assessment Questionnaire), dynamic balance (Timed Up and Go test), muscle force (handgrip dynamometry) and sociodemographic conditions were collected. Participants followed an exercise program consisting of a functional exercise circuit including balance, resistance and aerobic exercises, twice a week, for 12 weeks. Results Both the Charlson Comorbidity Index and disability were higher in SNA compared with SA participants on inclusion. Both groups improved disability (Δ–0.25 patients [−0.5 – −0.0625 patients] for SNA and (Δ–0.125 patients [−0.5–0 patients] for SA) and balance (Δ–2 s [−3–0 s] for SNA and (Δ–1 s [−3–0 s] for SA) after training (P < 0.05 for all). Changes from baseline were statistically higher in the SNA group. Handgrip force improved only in participants in the SNA group (Δ1.7 kg [0.6–2.8 kg], P = 0.0001). No differences, however, were observed between the magnitude of improvements of handgrip between groups. Conclusions Although socially non‐active older adults had more comorbidity and disability than their socially active counterparts, they showed a higher response to a community exercise program. Geriatr Gerontol Int 2017; ••: ••–••.

Introduction Neuropsychiatric symptoms (NPS) are common at all stages of Alzheimer disease (AD). Delusions in AD are associated with negative clinical consequences and may signal rapid disease progression. Hence, we sought to determine the prevalence of delusions in drug‐naïve (no cholinesterase inhibitor or neuroleptic medications) AD patients. Methods In this meta‐analysis, a search of the EMBASE, MEDLINE, and PsycINFO databases was performed. We selected studies reporting delusion prevalence measured by the Neuropsychiatric Inventory (NPI) in drug‐naïve AD patients. An aggregate delusion event rate with 95% confidence interval (CI) was calculated. The I2 statistic was used to assess the magnitude of between‐study heterogeneity. Single variable meta‐regressions allowed examination of the effect of moderating factors and heterogeneity. Quantitative measures were used to appraise for publication bias. Results We identified 6 studies with 591 participants allowing calculation of the aggregate delusional prevalence rate. Irrespective of dementia severity, the aggregate event rate for delusions was 29.1% (95% CI: 20–41%; I2 = 84.59). No publication bias was observed. Conclusion This meta‐analysis calculates a 29.1% prevalence rate of delusions in AD patients. There is a trend towards increasing delusion prevalence in concordance with increasing severity of dementia. Given delusions are associated with poorer outcomes, the obtained prevalence should motivate clinicians to screen carefully for delusions. Current literature limitations warrant future studies, with sub‐analyses on dementia severity, and other neurobiological factors known to influence the presence of delusions.

Objective Despite the benefits of physical activity (PA) in older people with depression, many do not comply with the International PA guidelines. Thus, we investigated what factors influence PA participation among 915 community‐dwelling older adults (aged ≥65 years) with depression in 6 low‐income and middle‐income countries (LMICs). Methods Cross‐sectional data were analyzed from the World Health Organization's Study on Global Ageing and Adult Health. The sample was restricted to those with DSM‐IV depression or receiving depression treatment in the last 12 months. PA was assessed by the Global Physical Activity Questionnaire. Participants were dichotomized into low (ie, not meeting 150 minutes of moderate PA per week) and moderate‐to‐high physically active groups. Associations between PA and a range of correlates were examined using multivariable logistic regressions. Results The prevalence of low PA was 40.4% (95%CI = 34.8%–46.1%). After adjusting for age, sex, and country, larger household size and unemployment were significant sociodemographic correlates of low PA. Former smoking (vs never), anxiety, mild cognitive impairment (MCI), lower body mass index, bodily pain, asthma, chronic back pain, chronic obstructive pulmonary disease, hearing problems, stroke, slow gait, poor self‐rated health, higher levels of disability, and lower levels of social cohesion were identified as significant negative correlates of PA. Conclusions The current data provide guidance for future interventions across LMICs to assist older people with depression engage in regular PA. The promotion of social cohesion may increase the efficacy of future public health initiatives, while from a clinical perspective, somatic co‐morbidities, MCI, pain, and slow gait need to be considered. Key points More than 40% of older people with depression in low‐income and middle‐income countries do not meet physical activity guidelines. Somatic co‐morbidities, lower body mass index, pain, and slow gait need to be considered. The promotion of social cohesion may increase the efficacy of future public health initiatives.

Objective To determine how older people with dementia and their family caregivers experience dementia assessment services and preferences for future configuration of diagnostic services. Methods Qualitative, semistructured in‐depth interviews were conducted with nine individuals with dementia. In seven instances, the caregiver also took part in the interview, and on two occasions, the interview was with the person with dementia only. Results An important contact during assessment of dementia was the general practitioner, in particular working in a way or timeframe which provides clarity and comfort to the person with dementia and their family members. A problematic factor in clear diagnosis was when probable dementia was suspected during hospitalisation for another complaint. Participants expressed a wide range of views in terms of preferred settings for diagnostic services. Conclusion These findings highlight some key considerations, which should be included in future research leading to decisions about the design of dementia client services.

Objective To identify which specific depressive symptoms predict remission to aripiprazole augmentation in late‐life treatment resistant depression. Methods This is a secondary analysis of data from a late‐life treatment resistant depression trial examining the safety and efficacy of aripiprazole augmentation. Participants aged 60 and above were randomized to aripiprazole augmentation (N = 91) versus placebo (N = 90). The main outcome was depression remission. Clinical predictors included individual Montgomery‐Asberg Depression Rating Scale (MADRS) item scores categorized as symptomatic (scores >2) or nonsymptomatic (scores ≤2). Results Three MADRS items predicted depression remission with aripiprazole augmentation: symptomatic scores on sleep disturbance and nonsymptomatic scores on apparent sadness and inability to feel. The 2‐way and 3‐way interaction terms of these MADRS items were not significant predictors of remission; therefore, the models' ability to predict remission was not improved by combining the significant MADRS items. Conclusions The identification of specific depressive symptoms, which can be clinically assessed, can be used to inform treatment decisions. Older adults with treatment resistant depression that present with sleep disturbances, lack of apparent sadness, or lack of inability to feel should be considered for aripiprazole augmentation.

Objective The purpose of this study was to examine the impact of being exposed to a multimedia campaign on stigmatic beliefs towards a person with Alzheimer's disease (AD). Methods A cross‐sectional posttest online survey was conducted immediately after the campaign among 510 Jewish participants aged 40 and above. Results Most the participants reported being exposed to the campaign. The campaign elicited significantly higher positive than negative emotions. Exposure to the campaign was not significantly associated with any of the stigmatic beliefs as a direct or moderating variable. Worry about developing AD was associated with increased stigmatic beliefs. Conclusions More research is needed to better understand which types of media campaigns work best to increase awareness and reduce stigma associated with AD.

Objective As not speaking English as a first language may lead to increased difficulties in communication with staff and other residents, we (1) tested our primary hypotheses that care home residents with dementia speaking English as a second language experience more agitation and overall neuropsychiatric symptoms, and (2) explored qualitatively how staff consider that residents' language, ethnicity, and culture might impact on how they manage agitation. Methods We interviewed staff, residents with dementia, and their family carers from 86 care homes (2014–2015) about resident's neuropsychiatric symptoms, agitation, life quality, and dementia severity. We qualitatively interviewed 25 staff. Results Seventy‐one out of 1420 (5%) of care home residents with dementia interviewed spoke English as a second language. After controlling for dementia severity, age, and sex, and accounting for care home and staff proxy clustering, speaking English as a second language compared with as a first language was associated with significantly higher Cohen‐Mansfield Agitation Inventory (adjusted difference in means 8.3, 95% confidence interval 4.1 to 12.5) and Neuropsychiatric inventory scores (4.1, 0.65 to 7.5). Staff narratives described how linguistic and culturally isolating being in a care home where no residents or staff share your culture or language could be for people with dementia, and how this sometimes caused or worsened agitation. Conclusions Considering a person with dementia's need to be understood when selecting a care home and developing technology resources to enable dementia‐friendly translation services could be important strategies for reducing distress of people with dementia from minority ethnic groups who live in care homes.

Objective The purpose of this study was to analyze the age and sex‐related differences in socio‐demographic factors that influence suicide ideation and attempts in the elderly. Methods The total number of subjects was 93 151, of whom 8441 belonged to the high suicide‐risk group (2064 male; 6377 female). Following this identification, we investigated their socio‐demographic information, health status, and depressive symptoms, which might have influenced their suicide ideation and attempts. Results Residence in an urban area was identified as a risk factor for both male and female elderly in their 60s and 70s and female elderly in their 80s. Marital status showed a different influence on suicide ideation depending on age and sex. A negative perception of one's own health status was a significant risk factor that increased the likelihood of suicide ideation in all ages, except the female elderly in their 60s. No factor was identified that significantly influenced suicide attempts in the male elderly. However, in the female elderly, residence in an urban area and a negative perception of one's own health status were identified as significant risk factors. Conclusions This study revealed that factors known to influence suicide ideation in the elderly from previous studies, such as residence area, separation from a spouse, education level, religion, and drinking, show changed influence as the elderly reach their 70s and 80s. However, a negative perception of one's own health status was a risk factor that encompassed most ages and sexes.

Objective First, to evaluate the outcome of 2 transdiagnostic day treatment programs. A 20‐week psychotherapeutic day treatment (PDT) and an activating day treatment (ADT) program delivered in blocks of 4 weeks with a maximum of 24 weeks with respect to depression, anxiety, and hypochondriasis. Second, to explore the impact of cognitive impairment and personality pathology on treatment outcome. Methods The course of depression (Inventory of Depressive Symptoms), anxiety (Geriatric Anxiety Inventory), and hypochondriasis (Whitley Index) were evaluated by linear mixed models adjusted for age, sex, level of education, and alcohol usage among 49 patients (mean age 65 years, 67% females) receiving PDT and among 61 patients (mean age 67.1, 61% females) receiving ADT. Pre‐post effect‐sizes were expressed as Cohen's d. Subsequently, cognitive impairment (no, suspected, established) and personality pathology (DSM‐IV criteria as well as the Big Five personality traits) were examined as potential moderators of treatment outcome. Results Among patients receiving PDT, large improvements were found for depression (d = 1.1) and anxiety (d = 1.2) but not for hypochondriasis (d = 0.0). Patients receiving ADT showed moderate treatment effects for depression (d = 0.6), anxiety (d = 0.6), as well as hypochondriasis (d = 0.6). Personality pathology moderates treatment outcome of neither PDT nor ADT. Cognitive impairment negatively interfered with the course of depressive symptoms among patients receiving PDT. Conclusions Transdiagnostic day treatment is promising for older adults with affective disorders with high feasibility.

Objective Apathy is one of the most frequent neuropsychiatric symptoms encountered in dementia. Early diagnosis and timely treatment of apathy in dementia are crucial because apathy has been associated with poor disease outcome, reduced daily functioning, and caregiver distress. Design Extensive electronic search from the databases included in the National Library of Medicine as well as PsychInfo and Google Scholar for studies which have investigated the effect of non‐pharmacological treatments of apathy in dementia. Quality of the studies was appraised. Results A total of 1303 records were identified and 120 full‐texts assessed. Forty‐three unique studies were reviewed. A variety of interventions were found to be effective in reducing apathy in demented patients, particularly when provided in a multidisciplinary manner. However, quantification of the effect was limited by the marked methodological heterogeneity of the studies and the small number of studies where apathy was the primary outcome measure. Conclusions Treatment of apathy in dementia is a complex and underexplored field. Certain studies suggest promise for a variety of non‐pharmacological interventions. Standardized and systematic efforts primarily focusing on apathy may establish a benefit from individualized treatments for specific disease groups. Key points Apathy is one of the most frequent neuropsychiatric symptoms encountered in dementia. A variety of nonpharmacological interventions, when provided in a multidisciplinary manner, were found to be effective in reducing apathy in demented patients. Standardized and systematic efforts primarily focusing on apathy may establish a benefit from individualized treatments for specific disease groups.

Objective To investigate the relationship between anxiety symptoms and sleeping medication use among a nationally representative sample of US older adults. Design Cross‐sectional design using data from the 2011 National Health and Aging Trends Study to examine the relationship between anxiety symptoms as rated by the Generalized Anxiety Disorder‐2 and self‐reported sleeping medication use. Survey weights were applied to account for complex survey design. Logistic regression was used to measure the association between anxiety symptoms and sleeping medication use after adjusting for sociodemographic factors, physical health, and other sleep‐related issues. Results In 2011, 13.1% of respondents experienced high anxiety symptoms and 29.0% reported taking a sleeping medication at least once a week during the last 30 days. Results estimate that approximately 4 million US older adults have clinically significant anxiety symptoms and approximately 10 million US older adults used a sleeping medication in the last 30 days. Adjusted results revealed that high anxiety symptoms are significantly associated with sleeping medication use compared to low anxiety symptoms (AOR = 1.57; 95% CI, 1.29‐1.91). Depression symptoms were also associated with sleeping medication (AOR = 1.29; 95% CI, 1.08‐1.55). Conclusions Results demonstrated that anxiety symptoms are significantly associated with sleeping medication use among US older adults. We also found that depressive symptoms, chronic conditions, and worse self‐rated health are associated with sleeping medication use. As sleeping medications are associated with adverse health events, these results have clinical implications for treating anxiety symptoms among older patients.

Objective Several potentially modifiable risk factors for cognitive decline and dementia have been identified, including low educational attainment, smoking, diabetes, physical inactivity, hypertension, midlife obesity, depression, and perceived social isolation. Managing these risk factors in late midlife and older age may help reduce the risk of dementia; however, it is unclear whether these factors also relate to cognitive performance in older individuals without dementia. Method Data from 14 201 non‐demented individuals aged >50 years who enrolled in the online PROTECT study were used to examine the relationship between cognitive function and known modifiable risk factors for dementia. Multivariate regression analyses were conducted on 4 cognitive outcomes assessing verbal and spatial working memory, visual episodic memory, and verbal reasoning. Results Increasing age was associated with reduced performance across all tasks. Higher educational achievement, the presence of a close confiding relationship, and moderate alcohol intake were associated with benefits across all 4 cognitive tasks, and exercise was associated with better performance on verbal reasoning and verbal working memory tasks. A diagnosis of depression was negatively associated with performance on visual episodic memory and working memory tasks, whereas being underweight negatively affected performance on all tasks apart from verbal working memory. A history of stroke was negatively associated with verbal reasoning and working memory performance. Conclusion Known modifiable risk factors for dementia are associated with cognitive performance in non‐demented individuals in late midlife and older age. This provides further support for public health interventions that seek to manage these risk factors across the lifespan.

Aim To examine the longitudinal association between dentition status and incidence of frailty in older adults. Methods The present prospective cohort study included community‐dwelling Japanese adults aged 75 years at baseline (n = 322). Dental examinations, biochemical blood examinations, physical performance and anthropometric measurements, and structured questionnaires were carried out at baseline. The presence of ≥20 teeth with nine or more occluding pairs of teeth was defined as functional dentition. Annual follow‐up examinations, including physical performance, anthropometric measurements and structured questionnaires, were carried out over a 5‐year period to determine the incidence of frailty, defined as three or more of the following five components derived from the Cardiovascular Health Study: weight loss, weakness, slowness, poor energy and low physical activity level. Adjusted hazard ratios of frailty incidence according to dentition status were calculated from Cox proportional hazards regression analyses. Results At baseline, 118 participants (36.6%) were defined as having functional dentition. During the follow up, 48 participants (14.9%) developed frailty. The adjusted hazard ratio for frailty in participants with functional dentition was 0.50 (95% confidence interval 0.25–0.98) compared with participants without functional dentition, after adjusting for sex, income, education, smoking status, body mass index, serum biomarkers and comorbidities. Conclusions Functional dentition was significantly associated with a lower risk of frailty defined by the Cardiovascular Health Study frailty index in older Japanese adults. These results suggest that maintaining healthy and functional dentition into later life is important for frailty prevention. Geriatr Gerontol Int 2017; ••: ••–••.

Objective Cognitive fluctuations (CFs) occur commonly in dementia of all types. While it is generally accepted that CFs can affect the clinical rating of dementia severity and neuropsychological performance, little is known about their impact on patients' activities of daily living (ADLs) and quality of life (QOL). Our study aims to explore the impact of CFs on ADLs and QOL among institutionalized patients with dementia. Methods The present study examined the nature and frequency of CFs in 55 institutionalized dementia patients. We used the Dementia Cognitive Fluctuation Scale (DCFS) to assess the presence and severity of CFs. The Alzheimer's Disease Functional Assessment of Change Scale (ADFACS) was used to assess patients' ADLs, and the Quality of Life in Late Stage Dementia scale (QUALID) was used to assess QOL. Linear regression models were used to assess the relationships between CFs, ADLs, and QOL. Results The mean age of the patients was 90.41 years (SD = 2.84). Their mean Aggressive Behavior Scale score was 1.13 (SD = 1.59), mean Severe Impairment Battery total score was 86.65 (SD = 13.77), and mean DCFS score was 10.07 (SD = 3.04). The mean ADFACS‐ADL score was 10.88 (SD = 6.37), mean ADFACS‐IADL score was 16.61 (SD = 9.54), and mean QUALID total score was 18.25 (SD = 5.70). DCFS significantly predicted ADFACS‐ADL score (R2 = 0.39, β = 0.30, P = .011) although the relationship between ADFACS‐IADL score and DCFS score was not significant (R2 = 0.16, P = .111). DCFS significantly predicted QUALID score (R2 = 0.08, β = 0.29, P = .033). Conclusion More severe CFs in patients with dementia were significantly associated with impaired ability to engage in ADLs and poorer QOL.

Aim Hospital‐associated dysphagia, characterized by deconditioning of swallowing as a result of hospitalization, is sometimes observed in patients with aspiration pneumonia (AP). Cognitive impairment is known as a negative factor in dysphagia rehabilitation. The present study aimed to examine the association between cognitive impairment and hospital‐associated dysphagia in patients with AP receiving dysphagia rehabilitation. Methods A retrospective observational study was carried out in an acute geriatric hospital. A total of 249 AP patients receiving multidisciplinary individualized dysphagia rehabilitation were included. Patients were divided into four groups according to their Mini‐Mental State Examination scores. The Functional Oral Intake Scale (FOIS) was used to assess swallowing ability, and hospital‐associated dysphagia was defined as a FOIS decline of ≥1 or ≥2 levels. Body mass index and Barthel Index were obtained to assess nutritional status and activities of daily living. Results The mean age was 85.6 ± 7.3 years, and 47% were men. Frequencies of hospital‐associated dysphagia observed in lowest to highest Mini‐Mental State Examination groups were 43.0%, 36.2%, 47.4% and 27.3% (P = 0.133), and 13.9%, 20.7%, 17.5% and 5.5% (P = 0.117) based on FOIS decline ≥1 or ≥2 levels, respectively. Multivariable regression model showed that the Mini‐Mental State Examination score was not an independent determinant of FOIS at discharge (beta = 0.063, P = 0.378) after adjusting for age, sex, body mass index, Barthel Index, pneumonia severity, speech‐language pathologist intervention, comorbidities, length of hospital stay and premorbid FOIS. Conclusions The severity of cognitive impairment has no impact on hospital‐associated dysphagia in AP patients receiving dysphagia rehabilitation. A future interventional study will be expected to further validate our findings. Geriatr Gerontol Int 2017; ••: ••–••.

Objective Depressive symptoms are common among older adults with obesity and diabetes. Nonetheless, the mechanisms for this association are not clear but may involve changes in the insulin cascade signaling. We aimed to investigate the association, and potential mediators, between obesity, insulin resistance, and depressive symptoms among older adults from a homogenous cohort of Mexican‐Americans. Methods We included a total of 500 Mexican‐American older adults assessed in the Cameron County Health Study. We evaluated depressive symptoms using the Center for Epidemiologic Survey Depression Scale (CES‐D). Central obesity was defined by waist circumference. Insulin resistance was evaluated by the HOMA‐IR index. We estimated the association between obesity, insulin resistance, and depressive symptoms by carrying out univariate and multivariate regression analyses. Results In unadjusted regression analysis, HOMA‐IR (unstandardized β = 0.31 ± 0.12, P = 0.007), waist circumference (unstandardized β = 0.066 ± 0.0.028, P = 0.017), and Hb1Ac levels (unstandardized β = 0.52 ± 0.24, P = 0.03) were significantly associated with CES‐D scores. The association of HOMA‐IR and CES‐D remained statistically significant after controlling for socio‐demographic and clinical variables in multivariate analysis (unstandardized β = 0.28 ± 0.11, P = 0.01). Conclusion Our results suggest that depressive symptoms are associated with insulin resistance in older Mexican‐American adults. In addition, poorer glucose control and obesity are important mediators of this relationship. Additional studies are needed to evaluate whether interventions that increase insulin sensitivity can also reduce depressive symptoms in this population. Key points Depression is very common among older Mexican‐American population. Cardiometabolic disorders are common comorbidities in depression, and these conditions may share common pathophysiological mechanisms. Our findings provide further support to the role of insulin resistance as a mechanism linking depression and cardiometabolic disorders in the elderly.

Objective Several studies have shown that gout is associated with depression symptoms. In this study, a systematic review and meta‐analysis was performed to explore the relationship between gout and depression. Methods Published articles were identified through a comprehensive review of PUBMED and EMBASE. Data from studies reporting relative risks, odds ratios, or hazard ratios comparing the risk of depression among participants who had gout versus those without gout were analyzed. A random‐effect model was used to calculate pooled odds ratios and 95% confident intervals (CI). Results Seven studies, which included 411 745 participants, aligned with our inclusion criteria and were included in the meta‐analysis. Pooled analysis showed an association between gout and depression, with an odds ratio of 1.19 (95%CI, 1.11, 1.29; I2 = 60.2%). Subgroup‐analysis adjusted (or not) by study type or study quality showed a statistically significant association of gout and depression in all subgroups. Sensitivity analysis by 1‐study removed analysis, excluding articles of self‐reported gout assessment or male‐only, confirmed the robustness of our results. Conclusion Our meta‐analysis demonstrates a positive association between gout and depression. Further large‐scale prospective cohort studies are needed to investigate the causality between gout and depression.

Objective To identify diagnostic groups and the form of the trajectory of functional decline that has the potential to enhance advance care planning (ACP) in a nursing home (NH) population. Methods Retrospective, longitudinal study with dependent variable (function) derived from the Resident Classification Scale (RCS), 1997–2008. Trajectory modelling used linear and curvilinear terms. Results The organ failure or other residents have a linear average functional decline. The organ failure residents had an average decline of 6.5 points per year and average function score at death of 68.6, CI [62.4, 74.8]. The cancer and frailty residents had significant curvilinear terms. The frailty residents had a slower rate of decline at 9.54 points per year and were most care dependent at death, with an average function score of 77.1, CI [73.8, 80.9]. Conclusion Functional change is a measurable variable for a predictive tool to enhance ACP for NH residents based on their diagnosis.

Aim The present study was a comparison of the validity of the Medication Adherence Self‐Report Inventory (MASRI) questionnaire with other methods of assessing adherence to antimuscarinic drugs treatment in older patients with urge incontinence. Methods The experiment involved 733 men and women aged >65 years who had noted no less than one urge incontinence episode per day. At the beginning of the experiment, and after 4, 8 and 12 weeks, their adherence to treatment was monitored using the MASRI. Results The construct validity of the tool was confirmed by data on the correlation of the percentage of non‐adherent patients according to the MASRI and the percentage of patients having a belief barrier on the Brief Medication Questionnaire screen (r = 0.89, P ≤ 0.01; r = 0.91, P ≤ 0.01; and r = 0.91, P ≤ 0.05 at the 4th, 8th and 12th week of the follow up). The hypothesis of competitive validity was supported by comparing the percentage of non‐adherent patients according to the MASRI and the number of missed doses on the Brief Medication Questionnaire screen (r = 0.94, P ≤ 0.01; r = 0.85, P ≤ 0.05; and r = 0.7, P ≤ 0.05), and according to a visual count of pills. The area under the curve at the 4th, 8th, and 12th week was 0.95 ± 0.04, 0.92 ± 0.03 and 0.94 ± 0.04, respectively. Conclusion The MASRI questionnaire has high validity, and is effective for evaluating adherence to treatment among older patients with urge incontinence taking antimuscarinic drugs. Using the MASRI would imply lower costs and greater availability of diagnostics, and it is the tool of choice in clinical practice. Geriatr Gerontol Int 2017; ••: ••–••.

Aim We aimed to clarify the characteristics of malignancies in older adults focusing on distant metastasis in the whole body. Methods We retrospectively evaluated 7710 cases of autopsies (4011 men, 3699 women, median age of 80 years), and analyzed the characteristics of metastasis of adenocarcinoma, squamous cell carcinoma and urothelial carcinoma in each organ. Results The total number of cases with adenocarcinoma, squamous cell carcinoma or urothelial carcinoma was 2856, and most of them were adenocarcinomas. Among them, 1604 had metastatic lesions, and patients with metastasis were younger than those without metastasis. The major primary organs of adenocarcinoma were the stomach, colon, lung, prostate, gallbladder and pancreas, whereas those for squamous cell carcinoma were the lung, esophagus and uterus. Urothelial carcinoma cases were found in the urinary bladder, kidney and ureter. Metastatic adenocarcinomas mainly originated from the stomach, colon, lung, pancreas and gallbladder. Metastatic squamous cell carcinomas were from the lung, esophagus and uterus, whereas the kidney, bladder and ureter were the primary origins of metastatic urothelial carcinomas. Squamous cell carcinoma showed the highest incidence of metastasis, suggestive of it being of an aggressive phenotype. Furthermore, metastatic ability and the preferred metastatic sites varied among primary organs. Conclusions We revealed an accurate incidence and the characteristics of metastatic cancer in a large‐scale autopsy study of older Japanese patients from one institution. Identifying these features might prompt screening for malignancies, and consequently improve quality of life for older adults. Geriatr Gerontol Int 2017; ••: ••–••.

Aim We developed a simple self‐screening method, the “Yubi‐wakka (finger‐ring)” test to assess sarcopenia swiftly. This prospective cohort study aimed to examine the validity of this test as a practical method among community‐dwelling older adults for identifying sarcopenia, and for predicting disability and mortality. Methods We followed 1904 older adults, and analyzed associations between this “Yubi‐wakka” test result at baseline in 2012 and sarcopenia at baseline, new‐onset sarcopenia followed until 2014, and new‐certification for the long‐term care insurance and mortality followed until 2016. The “Yubi‐wakka” test checks whether the maximum non‐dominant calf circumference is bigger than the individual's own finger‐ring circumference, which is formed by the thumb and forefinger of both hands. We divided participants into three groups, “bigger,” “just fits” and “smaller” based on a comparison between the calf and finger‐ring circumference. Results Of 1904 participants (mean age 72.8 ± 5.4 years), 53% were grouped as “bigger,” 33% were in “just fits” and 14% were in “smaller.” Relative to “bigger,” the test results statistically associated with sarcopenia (“just fits” OR 2.4, 95% CI 1.4–4.1 and “smaller” OR 6.6, 95% CI 3.5–13), by multivariate analyses. The test results also increased the risk of new‐onset sarcopenia (“just fits” HR 2.1, 95% CI 1.2–3.8 and “smaller” HR 3.4, 95% CI 1.8–6.4). Furthermore, the “smaller” had 2.0‐ and 3.2‐fold increased risks for needing long‐term care insurance services and mortality, respectively. Conclusions The “Yubi‐wakka” test is an extremely practical method to identify older adults at risk of sarcopenia, disability and mortality. This test might contribute to increased primary prevention for sarcopenia by serving as an early wake‐up call for older adults against becoming sarcopenic. Geriatr Gerontol Int 2017; ••: ••–••.

When a 400‐m walk test with time constraint (in 15 minutes) is administered, analysis of the associated 400‐m gait speed can be challenging because some older adults are unable to complete the distance in time (noncompleters). A simplistic imputation method is to calculate the observed speeds of the noncompleters as the partially completed distance divided by the corresponding amount of elapsed time as an estimate of gait speed over the full 400‐m distance. This common practice has not been validated to the best of our knowledge. We propose a Bayesian multiple imputation (MI) method to impute the unobserved 400‐m gait speed for noncompleters. Briefly, MI is performed under the assumption that the unobserved 400‐m gait speed of noncompleters is left‐censored from a normal distribution. We illustrate the application of the Bayesian MI method using longitudinal data collected from the Lifestyle Interventions for Elders (LIFE) study. A simulation study was performed to assess the bias in estimation of the mean 400‐m gait speed using both methods. The results indicate that the simplistic imputation method tends to overestimate the population mean, whereas the Bayesian MI method yields minimal bias as the sample size increases.

Objective While there are several cognitive screening tests available for the detection of cortical dementias such as Alzheimer's disease (AD), these are rarely designed to be sensitive to vascular cognitive impairment (VCI). The Brief Memory and Executive Test (BMET) is a screening measure designed to be sensitive to the cognitive profile of both VCI and AD. This study investigated the ability of the BMET to detect AD, and to differentiate between VCI and AD. Methods This study included 150 patients, with either SVD, both with (n = 48) and without VCI (n = 51), or AD (N = 51) and 51 healthy controls. Participants were aged between 40 and 90 years of age and completed both the BMET and the MMSE. Results Receiver operator characteristic (ROC) curve analysis showed as before the BMET is a good predictor SVD. Additionally, the BMET was a good predictor of AD (AUC = 0.96) and performed at least as well as the MMSE (AUC = 0.92) when differentiating AD patients from healthy controls. The BMET had a sensitivity of 86% and specificity of 100% for detecting AD patients from control subjects. Using the difference in cognitive profile between the AD and VCI group, we developed an index score which correctly classified 76% of patients as either having VCI or AD. Conclusion The BMET is a brief and sensitive tool for the detection of cognitive impairment due to both SVD and AD and can be used to aid in the differentiation of the 2 diseases.

Aim Despite Japan being a developed nation, half of its older population does not attend regular health checkups. The aim of the present study was to examine the individual health beliefs and personal recommendations that strongly influence health checkup attendance among community‐dwelling older adults. Methods In 2013, questionnaires were sent to 5401 community‐dwelling older adults who were not receiving long‐term institutionalized care. The response rate was 94.3%. We analyzed response data from 4984 older adults using multiple imputation to manage missing data. Participation in health checkups was defined as having undergone at least one checkup in the past 3 years, and non‐participation as having attended no checkups in this period. Results The participants’ mean age was 75.8 years, and 57.9% were women. The adjusted odds ratio of health checkup participation ranged from 1.35 (95% confidence interval [CI] 1.13–1.61) to 1.62 (95% CI 1.34–1.95) for positive individual health beliefs about health checkups, and was 2.21 (95% CI: 1.51–3.24) and 1.28 (95% CI: 1.17–2.08) for recommendations to participate from family and neighbors, respectively. All odds ratios were adjusted for age, sex, driving by oneself to daily shopping or clinic, paid work, method of response, internal medical therapy, polypharmacy, serious disease, periodic blood test, frailty and neighborly relationships. Conclusions The present findings suggest that both individual and community approaches might be effective in promoting participation in health checkups among community‐dwelling older adults. Geriatr Gerontol Int 2017; ••: ••–••.

Aim Depression and mild cognitive impairment (MCI) are common among older adults. Most of the existing studies were carried out in developed countries, and evidence from developing countries are lacking. In the present study, using a national sample, we aimed to describe the prevalence of MCI and its associated factors among Chinese older adults with depression. Method The present study uses data from a national survey of the 2011 Comprehensive Assessment of Elderly Health, which involved 8113 older adults from eight provinces or municipalities directly under the Central Government of six regions in China. The Geriatric Depression Scale was used to assess depression, and the Mini‐Mental State Examination was used as the measurement of cognitive function. Results The results showed that the prevalence of geriatric depression was 15.9%, and 36.4% of those with depression had MCI. Geriatric depression was found to be significantly associated with MCI after controlling for demographics. Among participants with geriatric depression, female sex, older age, rural or suburban residence, poor physical health status, education level of illiterate or elementary school, having no daily physical activity, and living in Central China or West China were associated with an increased risk of MCI. Conclusions The present study showed a high prevalence rate of MCI among Chinese older adults with depression. Early screening and treatment for MCI are necessary among people with geriatric depression. Further research and health services innovations are required to address the high prevalence of MCI in this population. Geriatr Gerontol Int 2017; ••: ••–••.

The unprecedented changes happening in the American healthcare system have many on high alert as they try to anticipate legislative actions. Significant efforts to move from volume to value, along with changing incentives and alternative payment models, will affect practice and the health system budget. In tandem, growth in the population aged 65 and older is celebratory and daunting. The John A. Hartford Foundation is partnering with the Institute for Healthcare Improvement to envision an age‐friendly health system of the future. Our current prototyping for new ways of addressing the complex and interrelated needs of older adults provides great promise for a more‐effective, patient‐directed, safer healthcare system. Proactive models that address potential health needs, prevent avoidable harms, and improve care of people with complex needs are essential. The robust engagement of family caregivers, along with an appreciation for the value of excellent communication across care settings, is at the heart of our work. Five early‐adopter health systems are testing the prototypes with continuous improvement efforts that will streamline and enhance our approach to geriatric care.

We present 10 of the most effective articles from 2016 in geriatric medicine. They address wide‐ranging topics including the use of antipsychotics for delirium in palliative care, fall prevention and mobility interventions, efficacy and potential risks of testosterone, cranberry capsules and their effect on bacteriuria and pyuria, beta‐blockers after acute myocardial infarction in a nursing home population, the effect of a healthy lifestyle on disability, a goals‐of‐care intervention in individuals with advanced dementia, the benefits of regional anesthesia in hip repair, and mindfulness in chronic pain management.

Objective Behavioral and psychological symptoms of dementia (BPSD) are among the most challenging aspects of Alzheimer disease for patients and their families. Previous studies have found associations between informant‐reported retrospective personality and BPSD; we test whether prospective, self‐reported personality predicts who will experience these symptoms. Methods Deceased participants from the Health and Retirement Study who had evidence of cognitive impairment at the end of life (N = 1988) were selected to examine whether self‐reported five‐factor model personality traits, measured up to 8 years before death, were associated with proxy‐reported BPSD. Results Neuroticism was associated with increased risk of the 7 BPSD: got lost in familiar places, wandered off, were not able to be left alone, experienced hallucinations, suffered from depression, had periodic confusion, and an uncontrolled temper. These associations were not moderated by age, gender, race, or education. Conscientiousness was associated with fewer symptoms overall and especially with lower risk of getting lost in familiar places and not being able to be left alone. Conclusions The present research indicates that self‐reported personality, particularly Neuroticism, is associated prospectively with risk for a wide range of behavioral symptoms for individuals who had cognitive impairment at the end of life. The use of self‐reported personality traits can help aid in identifying who is most at risk for behavioral symptoms. Such information may be useful for nonpharmacological interventions tailored to the individual's personality to reduce the prevalence and burden of these BPSD.

Aim Maximum isometric tongue pressure (MIP) seems to have a diagnostic value for oral phase dysphagia. The present study aimed to examine the association between MIP and frailty, and to assess the screening validity of MIP for physical frailty. Methods We carried out a cross‐sectional study, and enrolled participants aged ≥60 years from Japanese national medical check‐ups in 2015 and 2016. The Fried frailty phenotype model was used. We analyzed odds ratios (OR) and 95% confidence intervals (CI) of physical frailty using one standard deviation increments of tongue pressure. Receiver operating characteristic curves were obtained to predict physical frailty using MIP values. Results Out of 1603 participants, 968 were categorized as non‐frail, 605 as pre‐frail and 30 as frail. In logistic regression analysis, one standard deviation increment of MIP significantly differentiated frail and pre‐frail: the OR for frail with one standard deviation increment in MIP was 0.37 (95% CI 0.26–0.54, P < 0.001), and the OR for pre‐frail was 0.63 (95% CI 0.57–0.70, P < 0.001). The area under the receiver operating characteristic curve for predicting frailty with MIP score was as high as 0.776 (95% CI 0.689–0.862). A point of MIP 35 kPa had a sensitivity of 90.0%, specificity of 40.4%, a positive likelihood ratio of 1.5 and a negative likelihood ratio of 0.2 for predicting frailty. Conclusions MIP performance is independently associated with frailty. MIP also can be used as a simple screening tool for frailty. Geriatr Gerontol Int 2017; ••: ••–••.

Aim Sodium–glucose cotransporter 2 (SGLT2) inhibitors are antidiabetic agents that act on the proximal renal tubules to lower blood glucose levels by inhibiting glucose reabsorption and promoting urinary glucose excretion. The present study assessed the long‐term use of SGLT2 inhibitors in older patients with diabetes. Methods A total of 117 older patients with type 2 diabetes who were given SGLT2 inhibitors were enrolled from April 2014 to March 2016. Results The mean age of the patients was 73.7 ± 10.0 years. During the follow‐up period (mean 289.3 days), there was no event associated with oral administration of SGLT2 inhibitors. These drugs significantly lowered fasting blood glucose and glycosylated hemoglobin levels at 6 months, and did not affect the creatinine level, blood urea nitrogen/creatinine ratio or estimated glomerular filtration rate during treatment. Although the treatment significantly increased hemoglobin and hematocrit levels, it did not affect the ultrasonographically determined diameter of the inferior vena cava, and no signs of intravascular collapse were observed. Changes in brain natriuretic peptide levels during the follow‐up period were assessed in 78 patients with a brain natriuretic peptide level exceeding the normal upper limit before treatment with SGLT2 inhibitors. The brain natriuretic peptide levels significantly decreased after 6 months of treatment. Conclusions In older Japanese patients with diabetes, treatment with SGLT2 inhibitors for 6 months exerted a favorable hypoglycemic effect, while no sign of dehydration was observed. Geriatr Gerontol Int 2017; ••: ••–••.

The early detection of item drift is an important issue for frequently administered testing programs because items are reused over time. Unfortunately, operational data tend to be very sparse and do not lend themselves to frequent monitoring analyses, particularly for on‐demand testing. Building on existing residual analyses, the authors propose an item index that requires only moderate‐to‐small sample sizes to form data for time‐series analysis. Asymptotic results are presented to facilitate statistical significance tests. The authors show that the proposed index combined with time‐series techniques may be useful in detecting and predicting item drift. Most important, this index is related to a well‐known differential item functioning analysis so that a meaningful effect size can be proposed for item drift detection.

Linking functions adjust for differences between identifiability restrictions used in different instances of the estimation of item response model parameters. These adjustments are necessary when results from those instances are to be compared. As linking functions are derived from estimated item response model parameters, parameter estimation error automatically propagates into linking error. This article explores an optimal linking design approach in which mixed‐integer programming is used to select linking items to minimize linking error. Results indicate that the method holds promise for selection of linking items.

This study proposes a structured constructs model (SCM) to examine measurement in the context of a multidimensional learning progression (LP). The LP is assumed to have features that go beyond a typical multidimentional IRT model, in that there are hypothesized to be certain cross‐dimensional linkages that correspond to requirements between the levels of the different dimensions. The new model builds on multidimensional item response theory models and change‐point analysis to add cut‐score and discontinuity parameters that embody these substantive requirements. This modeling strategy allows us to place the examinees in the appropriate LP level and simultaneously to model the hypothesized requirement relations. Results from a simulation study indicate that the proposed change‐point SCM recovers the generating parameters well. When the hypothesized requirement relations are ignored, the model fit tends to become worse, and the model parameters appear to be more biased. Moreover, the proposed model can be used to find validity evidence to support or disprove initial theoretical hypothesized links in the LP through empirical data. We illustrate the technique with data from an assessment system designed to measure student progress in a middle‐school statistics and modeling curriculum.

When dealing with missing responses, two types of omissions can be discerned: items can be skipped or not reached by the test taker. When the occurrence of these omissions is related to the proficiency process the missingness is nonignorable. The purpose of this article is to present a tree‐based IRT framework for modeling responses and omissions jointly, taking into account that test takers as well as items can contribute to the two types of omissions. The proposed framework covers several existing models for missing responses, and many IRTree models can be estimated using standard statistical software. Further, simulated data is used to show that ignoring missing responses is less robust than often considered. Finally, as an illustration of its applicability, the IRTree approach is applied to data from the 2009 PISA reading assessment.

Cross‐level invariance in a multilevel item response model can be investigated by testing whether the within‐level item discriminations are equal to the between‐level item discriminations. Testing the cross‐level invariance assumption is important to understand constructs in multilevel data. However, in most multilevel item response model applications, the cross‐level invariance is assumed without testing of the cross‐level invariance assumption. In this study, the detection methods of differential item discrimination (DID) over levels and the consequences of ignoring DID are illustrated and discussed with the use of multilevel item response models. Simulation results showed that the likelihood ratio test (LRT) performed well in detecting global DID at the test level when some portion of the items exhibited DID. At the item level, the Akaike information criterion (AIC), the sample‐size adjusted Bayesian information criterion (saBIC), LRT, and Wald test showed a satisfactory rejection rate (>.8) when some portion of the items exhibited DID and the items had lower intraclass correlations (or higher DID magnitudes). When DID was ignored, the accuracy of the item discrimination estimates and standard errors was mainly problematic. Implications of the findings and limitations are discussed.

Objectives We wished to clarify the link between bilingualism and cognitive decline, and examine whether improved executive function due to bilingualism may be a factor in preventing cognitive decline. Methods We used the Australian Longitudinal Study of Ageing which collected data on 2087 participants aged over 65 over 20 years. We compared baseline demographics, health, and social characteristics between bilingual and non‐bilingual participants. We used linear mixed models analysis to explore the effect of bilingualism on MMSE score over time and linear regression to explore the effect of bilingualism on baseline MMSE scores, controlling for pre‐specified potential confounders. Results Bilingual participants had lower baseline MMSE scores than the non‐bilingual population (mean difference = −2.3 points; 95% confidence intervals = 1.56–2.90). This was fully explained by education and National Adult Reading Test scores (17.4; standard deviation [SD] =7.7 versus 28.1; SD = 8.2) which also partly explained baseline executive function test scores differences. Bilingual and non‐bilingual participants did not differ in MMSE decline over time (−0.33 points, P = 0.31) nor on baseline tests of executive function (−0.26, P = 0.051). Conclusions In this cohort, education rather than bilingualism was a predictor of MMSE score, and being bilingual did not protect from cognitive decline. We conclude that bilingualism is complex, and when it is not the result of greater educational attainment, it does not always protect from cognitive decline. Neuroprotective effects of bilingualism over time may be attributable to the precise patterns of language use but not to bilingualism per se.

Objectives A growing body of literature indicates that social engagements, such as intergenerational programs, are effective strategies to improve a range of cognitive abilities. The present study examined whether the intergenerational program—REPRINTS—prevents age‐related hippocampal atrophy. Methods After comprehensive baseline assessment, participants were allowed to decide whether to participate in the REPRINTS intervention or in the control group, which required only completion of assessments. REPRINTS participants engaged in group activities that involved reading picture books to children at kindergarten and elementary schools, once every 1 to 2 weeks. A follow‐up assessment was conducted after 6 years. Two MRI scans were performed, one immediately after baseline assessment and the other after 6 years. Volumes of the hippocampus, thalamus, and caudate nucleus were derived from automated segmentation. The analysis included 17 REPRINTS and 42 control‐group participants. Results There was no significant difference in any variable of participants' characteristics at baseline between the REPRINTS and control groups. Hippocampal volume significantly declined in the control group but was maintained in the REPRINTS group. No significant differences between groups in thalamus or caudate nucleus volume were observed. Although cognitive function was unaffected by the program, greater decreases in hippocampal volume were significantly correlated with greater decreases in cognitive performance scores. Conclusions Our results suggest that the REPRINTS intergenerational program has protective effects on age‐related hippocampal atrophy in older adults. These changes precede improvements in cognitive performance, suggesting the validity of the concept of brain plasticity in later life following social engagement.

Objective The IDEAL Schedule was developed for staging “care needs” in patients with dementia. We here aim to validate the Spanish version, further test its psychometric properties and explore a latent construct for “care needs”. Methods A multicenter study was done in 8 dementia care facilities across Spain. Patients referred with a reliable ICD‐10 diagnosis of dementia (n = 151) were assessed with the IDEAL Schedule by pairs of raters. Inter‐rater reliability (intra‐class correlation [ICC] coefficients), internal consistency (Cronbach's alpha), and factor analysis were calculated. Convergent validity for individual items was tested against validated Spanish versions of international instruments. Results Pilot testing with numerical scales supported the feasibility, face, and content validity of the schedule. The psychometric coefficients were good/clinically acceptable: inter‐rater reliability (mean ICC = 0.861; 85% of the ICCs > 0.8), internal consistency (global alpha coefficient = 0.74 in 5 nuclear items), and concurrent validity (global score against the Clinical Dementia Rating schedule, r = 0.63; coefficients for individual items ranging from 0.40 to 0.84, all statistically significant, p < 0.05). Internal consistency was low for the “nonprofessional care” and “social support” dimensions. Factor analysis supported a unidimensional solution, suggesting a latent “care needs” construct. Conclusion The Spanish version of the IDEAL Schedule confirms the main psychometric properties of the original version and documents for the first time the convergent validity of individual items. Factor analysis identified a latent construct consistent with the concept “care needs” although 2 dimensions need further psychometric research.

Objective To investigate the prevalence of physical aggression among patients with dementia of different types and to analyze potential differences in clinical traits, in terms of singular or repetitive behavior and occurrence in early or late stage of the disease. We also aimed at examining against whom the physical aggression was exerted. Methods We included 281 cases with a neuropathological dementia diagnosis from the brain bank at the Department of Pathology, Lund University, for this retrospective medical records review. The study covers cases with a post‐mortem examination performed between 1967 and 2013. Results Of the 281 patients studied, 97 (35%) patients had a history of exerting physical aggression during the course of their disease. The patients with frontotemporal dementia exerted physical aggression earlier in the course of their disease than Alzheimer's disease patients. The most frequent victims of the patients' physical aggression were health staff and other patients. The aggression also affected family members as well as (to the demented patient) unknown people. The frequency of the physical aggression differed among the different diagnostic groups; frontotemporal dementia patients exhibiting a higher physical aggression frequency score than did Alzheimer's disease patients. Conclusions The patterns of manifested physical aggression thus differ between the frontotemporal dementia and Alzheimer's disease patient groups in this study. Knowledge about such differences may be of value in decision making in patient care.