Association of Sensory and Cognitive Impairment With Healthcare Utilization and Cost in Older Adults - American Geriatric Society

OBJECTIVES

To examine the association between self‐reported vision impairment (VI), hearing impairment (HI), and dual‐sensory impairment (DSI), stratified by dementia status, on hospital admissions, hospice use, and healthcare costs.

DESIGN

Retrospective analysis.

SETTING

Medicare Current Beneficiary Survey from 1999 to 2006.

PARTICIPANTS

Rotating panel of community‐dwelling Medicare beneficiaries, aged 65 years and older (N = 24 009).

MEASUREMENTS

VI and HI were ascertained by self‐report. Dementia status was determined by self‐report or diagnosis codes in claims data. Primary outcomes included any inpatient admission over a 2‐year period, hospice use over a 2‐year period, annual Medicare fee‐for‐service costs, and total healthcare costs (which included information from Medicare claims data and other self‐reported payments).

RESULTS

Self‐reported DSI was present in 30.2% (n = 263/871) of participants with dementia and 17.8% (n = 4112/23 138) of participants without dementia. In multivariable logistic regression models, HI, VI, or DSI was generally associated with increased odds of hospitalization and hospice use regardless of dementia status. In a generalized linear model adjusted for demographics, annual total healthcare costs were greater for those with DSI and dementia compared to those with DSI without dementia ($28 875 vs $3340, respectively). Presence of any sensory impairment was generally associated with higher healthcare costs. In a model adjusted for demographics, Medicaid status, and chronic medical conditions, DSI compared with no sensory impairment was associated with a small, but statistically significant, difference in total healthcare spending in those without dementia ($1151 vs $1056; P < .001) but not in those with dementia ($11 303 vs $10 466; P = .395).

CONCLUSION

Older adults with sensory and cognitive impairments constitute a particularly prevalent and vulnerable population who are at increased risk of hospitalization and contribute to higher healthcare spending.

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Corrigendum - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Nestle Purina PetCare Company Voluntarily Recalls a Limited Amount of Muse Wet Cat Food Natural Chicken Recipe in Gravy in Three-ounce Cans due to the Potential Presence of Rubber Pieces - FDA Safety Alerts & Drug Recalls

Out of an abundance of caution, Nestle Purina PetCare Company is voluntarily recalling a limited amount of Muse wet cat food Natural Chicken Recipe in Gravy in three-ounce cans. The product could contain rubber pieces that are translucent yellow with a blue backing, which may present a potential choking hazard.

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FDA approves new oral treatment for multiple sclerosis - FDA Press Releases

FDA approves Mayzent (cladribine), a new oral drug to treat multiple sclerosis

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Statement by FDA Commissioner Scott Gottlieb, M.D., Director of FDA’s Center for Drug Evaluation and Research Janet Woodcock, M.D. and Director of FDA’s Center for Biologics Evaluation and Research Peter Marks, M.D. on Expanded Access –Looking Forward - FDA Press Releases

Helping to facilitate access to promising medicines for patients with serious or immediately life-threatening diseases or conditions when no comparable or satisfactory alternative therapy options are available is a high priority for the FDA.

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Thomas Hammer Coffee Roasters Inc. Issues Allergy Alert on Undeclared Egg in Blueberry Bread - FDA Safety Alerts & Drug Recalls

Thomas Hammer Coffee Roasters Inc. of Spokane, WA is recalling 15 loaves of Blueberry Bread because it may contain undeclared EGG. People who have an allergy or severe sensitivity to egg run the risk of serious or life-threatening allergic reaction if they consume this product.

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Who Will Care for the Caregivers? Increased Needs When Caring for Frail Older Adults With Cancer - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Quality of Life of Caregivers of Older Patients with Advanced Cancer - American Geriatric Society

OBJECTIVES

To evaluate the relationships between aging‐related domains captured by geriatric assessment (GA) for older patients with advanced cancer and caregivers’ emotional health and quality of life (QOL).

DESIGN

In this cross sectional study of baseline data from a nationwide investigation of older patients and their caregivers, patients completed a GA that included validated tests to evaluate eight domains of health (eg, function, cognition).

SETTING

Thirty‐one community oncology practices throughout the United States.

PARTICIPANTS

Enrolled patients were aged 70 and older, had one or more GA domain impaired, and had an incurable solid tumor malignancy or lymphoma. Each could choose one caregiver to enroll.

MEASUREMENTS

Caregivers completed the Generalized Anxiety Disorder‐7, Distress Thermometer, Patient Health Questionnaire‐2 (depression), and Short Form Health Survey‐12 (SF‐12 for QOL). Separate multivariate linear or logistic regression models were used to examine the association of the number and type of patient GA impairments with caregiver outcomes, controlling for patient and caregiver covariates.

RESULTS

A total of 541 patients were enrolled, 414 with a caregiver. Almost half (43.5%) of the caregivers screened positive for distress, 24.4% for anxiety, and 18.9% for depression. Higher numbers of patient GA domain impairments were associated with caregiver depression (adjusted odds ratio [aOR] = 1.29; P < .001], caregiver physical health on SF‐12 (regression coefficient [β] = −1.24; P < .001), and overall caregiver QOL (β = −1.14; P < .01). Impaired patient function was associated with lower caregiver QOL (β = −4.11; P < .001). Impaired patient nutrition was associated with caregiver depression (aOR = 2.08; P < .01). Lower caregiver age, caregiver comorbidity, and patient distress were also associated with worse caregiver outcomes.

CONCLUSION

Patient GA impairments were associated with poorer emotional health and lower QOL of caregivers.

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Forthcoming Issues - Geriatrics

Anemia in Older Adults

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Contents - Geriatrics

Erratumix

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Contributors - Geriatrics

STEVEN C. CASTLE, MD

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Copyright - Geriatrics

ELSEVIER

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Falls Prevention - Geriatrics

CLINICS IN GERIATRIC MEDICINE

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New Strategies for Falls Prevention - Geriatrics

Despite committed effort of our nation’s experts to develop falls prevention strategies to address this major public health issue for older adults, death from falls continues to increase, by 30% over the past decade. Projections suggest that by 2030 seven older adults will die from a fall every hour (https://ift.tt/2hQUkJb). This issue of Clinics of Geriatric Medicine is meant to help health care stop doing what is not working and instead pivot to develop better “behaviors” to address this crisis. To do so, I have pulled together an innovative, multidisciplinary team to brainstorm on new approaches and to help identify our common practices that just do not work.

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Balance Problems and Fall Risks in the Elderly - Geriatrics

Falls in the elderly are an increasing problem causing a high degree of morbidity, mortality, and use of health care services. Identification of risk factors through medical assessment supports the provision of appropriate interventions that reduce rates of falling. Evaluation and intervention strategies are generally challenging because of the complex and multifactorial nature of falls. The clinician should consider screening for falls an important part of the functional evaluation in older adults. Several potential interventions have proven helpful as preventive strategies. Optimal approaches involve interdisciplinary collaboration in assessment and interventions, particularly exercise, attention to coexisting medical conditions, and reduction of environmental hazards.

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Erratum - Geriatrics

The article titled “Cognitive Frailty: mechanisms, tools to measure, prevention and controversy” published in August 2017 (Volume 33, Issue 3) has been retracted at the request of the Publisher. This article was plagiarised from the following sources:

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Theo Chocolate Issues Allergy Alert on Undeclared Milk in 3oz Sea Salt 70% Dark Chocolate Bars - FDA Safety Alerts & Drug Recalls

Theo Chocolate of Seattle, WA is voluntarily recalling 3oz Sea Salt 70% Dark Chocolate bars (UPC 8 74492 00325 8) because they may contain undeclared milk. People who have an allergy or severe sensitivity to milk run the risk of a serious or life-threatening allergic reaction if they consume this product.

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Older Patients with Low‐Energy Falls Presenting to the Emergency Department: Characteristics and Outcomes - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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FDA approves treatment for patients with a type of inflammatory arthritis - FDA Press Releases

The FDA is approving Cimzia (certolizumab pegol) injection for treatment of adults with a certain type of inflammatory arthritis. This is the first time that the FDA has approved a treatment for non-radiographic axial spondyloarthritis (nr-axSpA). nr-axSpA is a type of inflammatory arthritis that causes inflammation in the spine and other symptoms

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Statement from FDA Commissioner Scott Gottlieb, M.D., on actions to advance our comprehensive plan to reduce tobacco-related disease and death, through new efforts to improve the tobacco product application review process, including a newly proposed rule - FDA Press Releases

FDA announced several new actions as part of our commitment to ensure sound regulatory oversight of tobacco products and an effective application review process that considers the impact on public health.

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Remarks from FDA Commissioner Scott Gottlieb, M.D., as prepared for testimony before a U.S. Senate Subcommittee on Appropriations on FDA’s Fiscal Year 2020 budget - FDA Press Releases

Remarks from FDA Commissioner Scott Gottlieb, M.D., as prepared for testimony before a U.S. Senate Subcommittee on Appropriations on FDA’s Fiscal Year 2020 budget.

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FDA approves new oral testosterone capsule for treatment of men with certain forms of hypogonadism - FDA Press Releases

FDA approved Jatenzo (testosterone undecanoate), an oral testosterone capsule to treat men with certain forms of hypogonadism.

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Statement from FDA Commissioner Scott Gottlieb, M.D., on new steps to strengthen agency’s safety requirements aimed at mitigating risks associated with transmucosal immediate-release fentanyl products - FDA Press Releases

FDA is taking new steps to strengthen agency’s safety requirements aimed at mitigating risks associated with transmucosal immediate-release fentanyl products

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FDA advances landmark policy changes to modernize mammography services and improve their quality - FDA Press Releases

FDA proposes landmark policy changes to modernize mammography services and improve their quality

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Novel narrow spectrum benzyl thiophene sulfonamide derivatives to control Campylobacter - Journal of Antibiotics

Novel narrow spectrum benzyl thiophene sulfonamide derivatives to control Campylobacter

Novel narrow spectrum benzyl thiophene sulfonamide derivatives to control <i>Campylobacter</i>, Published online: 27 March 2019; doi:10.1038/s41429-019-0168-x

Novel narrow spectrum benzyl thiophene sulfonamide derivatives to control Campylobacter

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Acetaminophen Safety: Risk of Mortality and Cardiovascular Events in Nursing Home Residents, a Prospective Study - American Geriatric Society

BACKGROUND

Acetaminophen is the most widely used analgesic today. A recent systematic review found increased adverse events and mortality at therapeutic dosage. Our aim was to challenge these results in a large sample of older adults living in nursing homes (NHs).

DESIGN

Prospective study using data from the Impact of Educational and Professional Supportive Interventions on Nursing Home Quality Indicators project (IQUARE), a multicenter, individually tailored, nonrandomized controlled trial in NHs across southwestern France.

SETTING/PARTICIPANTS

We studied data from 5429 participants living in 175 NHs (average age, 86.1 ± 8.1 years; 73.9% women).

MEASUREMENTS

All prescriptions obtained at baseline were analyzed by a pharmacist for acetaminophen use as stand‐alone or associated. Myocardial infarction (MI) and strokes were reported from participants' medical records at 18‐month follow‐up. Dates of death were obtained. Data collection was done through an online questionnaire at baseline and at 18 months by NH staff. Analyses were realized in our total population and a population matched on propensity score of acetaminophen intake. Six models were run for each outcome.

RESULTS

A total of 2239 participants were taking, on average, 2352 ± 993 mg of acetaminophen daily. Results for mortality were: hazard ratio (HR) = 0.97 (95% confidence interval [CI] = 0.86‐1.10). No associations between acetaminophen intake and the risk of mortality or MI were found. In one of our models, acetaminophen intake was associated with a significant increased risk of stroke in diabetic subjects (HR = 3.19; 95% CI = 1.25‐8.18; P = .0157).

CONCLUSION

Despite old age, polypharmacy, and polymorbidity, acetaminophen was found safe for most, but not all, of our NH study population. Pain management in NHs is a health priority, and acetaminophen remains a good therapeutic choice as a first‐line analgesic. More studies are needed on older diabetic patients.

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FDA approves new oral drug to treat multiple sclerosis - FDA Press Releases

The U.S. Food and Drug Administration today approved Mayzent (siponimod) tablets to treat adults with relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease.

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Statement from FDA Commissioner Scott Gottlieb, M.D., on steps the Agency is taking to prevent potential medical device shortages and ensure safe and effective sterilization amid shutdown of a large contract sterilization facility - FDA Press Releases

The FDA is aware that the Illinois Environmental Protection Agency (EPA) issued a state EPA Order to stop a contract sterilizer, Sterigenics, from sterilizing medical products and other products with gas called ethylene oxide at their Willowbrook, Illinois facility. The EPA order was due to the presence of levels of ethylene oxide higher than the EPA found to be acceptable in air around the facility. The FDA has been closely monitoring the situation and working with device manufacturers affected by the closure to minimize any impact to patients who need access to these medical devices.

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Statement from FDA Commissioner Scott Gottlieb, M.D., and Director of FDA’s Center for Biologics Evaluation and Research Peter Marks, M.D., Ph.D., on efforts to promote and foster blood pathogen reduction technologies - FDA Press Releases

FDA statement on efforts to promote and foster blood pathogen reduction technologies

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Reply to: “Suggestions for Vitamin D Supplementation for Urgency Urinary Incontinence Study” - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Comment on Comparing Vitamin D Supplementation Versus Placebo for Urgency Urinary Incontinence: A Pilot Study - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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USA LESS Issues Voluntary Nationwide Recall of LEOPARD Miracle Honey Due to Presence of Undeclared Sildenafil - FDA Safety Alerts & Drug Recalls

USA LESS, is voluntarily recalling all lots of LEOPARD Miracle Honey, to the consumer level. FDA analysis has found LEOPARD Miracle Honey to be tainted with sildenafil.

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Dying With Dementia: Underrecognized and Stigmatized - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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A convergent total synthesis of the kedarcidin chromophore: 20-years in the making - Journal of Antibiotics

A convergent total synthesis of the kedarcidin chromophore: 20-years in the making

A convergent total synthesis of the kedarcidin chromophore: 20-years in the making, Published online: 25 March 2019; doi:10.1038/s41429-019-0175-y

A convergent total synthesis of the kedarcidin chromophore: 20-years in the making

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Henry Avocado Recalls Whole Avocados Because Of Possible Health Risk - FDA Safety Alerts & Drug Recalls

Henry Avocado Corporation is voluntarily recalling California-grown whole avocados sold in bulk at retail stores because they have the potential to be contaminated with Listeria monocytogenes. Henry Avocado is issuing this voluntary recall out of an abundance of caution due to positive test results on environmental samples taken during a routine government inspection at its California packing facility. There are no reported illnesses associated with this recall.

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Depressive Symptoms and Total Healthcare Costs: Roles of Functional Limitations and Multimorbidity - American Geriatric Society

OBJECTIVES

Depressive symptoms can be both a cause and a consequence of functional limitations and medical conditions. Our objectives were to determine the association of depressive symptoms with subsequent total healthcare costs in older women after accounting for functional limitations and multimorbidity.

DESIGN

Prospective cohort study (Study of Osteoporotic Fractures [SOF]).

SETTING

Four US sites.

PARTICIPANTS

A total of 2508 community‐dwelling women (mean age = 79.4 years) participating in the SOF year 10 (Y10) examination linked with their Medicare claims data.

MEASUREMENTS

At Y10, depressive symptoms were measured using the 15‐item Geriatric Depression Scale (GDS) and functional limitations were assessed by number (range = 0‐5) of impairments in performing instrumental activities of daily living. Multimorbidity was ascertained by the Elixhauser method using claims data for the 12 months preceding the Y10 examination. Total direct healthcare costs, outpatient costs, acute hospital stays, and skilled nursing facility during the 12 months following the Y10 examination were ascertained from claims data.

RESULTS

Annualized mean (SD) total healthcare costs were $4654 ($9075) in those with little or no depressive symptoms (GDS score = 0‐1), $7871 ($14 534) in those with mild depressive symptoms (GDS score = 2‐5), and $9010 ($15 578) in those with moderate to severe depressive symptoms (GDS score = 6 or more). After adjustment for age, site, self‐reported functional limitations, and multimorbidity, the magnitudes of these incremental costs were partially attenuated (cost ratio = 1.34 [95% confidence interval {CI} = 1.14‐1.59] for those with mild depressive symptoms, and cost ratio = 1.29 [95% CI = 0.99‐1.69] for those with moderate to severe depressive symptoms vs women with little or no depressive symptoms).

CONCLUSION

Depressive symptoms were associated with higher subsequent healthcare costs attributable, in part, to greater functional limitations and multimorbidity among those with symptoms. Importantly, even mild depressive symptoms were associated with higher healthcare costs.

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Understanding Caregiver Quality of Life in Caregivers of Hospitalized Older Adults With Cancer - American Geriatric Society

BACKGROUND/OBJECTIVES

Caregivers of older adults with cancer assist both with cancer care and other health issues, which may make them vulnerable to consequences of caregiving. Hospitalization may represent a time when a caregiver's ability to provide care at home is exceeded. We sought to characterize caregivers of hospitalized older adults with cancer, determine their quality of life (QOL), and identify factors associated with caregiver QOL.

METHODS

Patients (n = 100), aged 65 years and older, with an unplanned hospitalization and their caregivers were included. Caregivers completed a questionnaire about their health, social support, caregiving relationship, QOL (Caregiver Quality of Life Index‐Cancer [CQOLC] tool), and patient function. Patient medical history was obtained via chart review. The association between patient, caregiving, and caregiver factors and CQOLC was determined using multivariate linear regression.

RESULTS

Most patients (73%) had metastatic/advanced disease, and 71% received treatment for their cancer within 30 days of hospitalization. Median Karnofsky Performance Status (KPS) was 60%, and 89% required help with instrumental activities of daily living, as reported by caregivers. Median caregiver age was 65 years (range = 29‐84 years). The majority (60%) had no major comorbidities and rated their health as excellent/good (79%), though 22% reported worsening health due to caregiving. Caregivers had a median Mental Health Inventory‐18 score of 70 (range = 0–97), a median Medical Outcomes Study (MOS)‐social activity score of 56 (range = 0–87.5), and a median MOS‐Social Support Survey score of 68 (range = 0–100). Caregivers provided a median of 35 hours of care per week (range = 0‐168 hours of care per week). Mean CQOLC was 84.6 ± 23.5. Lower caregiver QOL was associated with poorer caregiver mental health, less social support, and poorer patient KPS (P < .05).

CONCLUSION

Caregivers of hospitalized older adults with cancer are older but generally in good health. Those with poorer mental health, less social support, and caring for patients with poorer performance status are more likely to experience lower QOL.

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Review of Programs to Combat Elder Mistreatment: Focus on Hospitals and Level of Resources Needed - American Geriatric Society

Background

Elder mistreatment is common and has serious social and medical consequences for victims. Though programs to combat this mistreatment have been developed and implemented for more than three decades, previous systematic literature reviews have found few successful ones.

Objective

To conduct a more comprehensive examination of programs to improve elder mistreatment identification, intervention, or prevention, including those that had not undergone evaluation.

Design

Systematic review.

Setting

Ovid MEDLINE, Ovid EMBASE, Cochrane Library, PsycINFO Elton B. Stephens Co. (EBSCO), AgeLine, CINAHL.

Measurements

We abstracted key information about each program and categorized programs into 14 types and 9 subtypes. For programs that reported an impact evaluation, we systematically assessed the study quality. We also systematically examined the potential for programs to be successfully implemented in environments with limited resources available.

Results

We found 116 articles describing 115 elder mistreatment programs. Of these articles, 43% focused on improving prevention, 50% focused on identification, and 95% focused on intervention, with 66% having multiple foci. The most common types of program were: educational (53%), multidisciplinary team (MDT) (21%), psychoeducation/therapy/counseling (15%), and legal services/support (8%). Of the programs, 13% integrated an acute‐care hospital, 43% had high potential to work in low‐resource environments, and 57% reported an attempt to evaluate program impact, but only 2% used a high‐quality study design.

Conclusion

Many programs to combat elder mistreatment have been developed and implemented, with the majority focusing on education and MDT development. Though more than half reported evaluation of program impact, few used high‐quality study design. Many have the potential to work in low‐resource environments. Acute‐care hospitals were infrequently integrated into programs.

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Combating Elder Mistreatment: Still Muddling—Not Yet Transformed - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Effect of C-2 substitution on the stability of non-traditional cephalosporins in mouse plasma - Journal of Antibiotics

Effect of C-2 substitution on the stability of non-traditional cephalosporins in mouse plasma

Effect of C-2 substitution on the stability of non-traditional cephalosporins in mouse plasma, Published online: 22 March 2019; doi:10.1038/s41429-019-0167-y

Effect of C-2 substitution on the stability of non-traditional cephalosporins in mouse plasma

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De novo synthesis of novel bacterial monosaccharide fusaminic acid - Journal of Antibiotics

De novo synthesis of novel bacterial monosaccharide fusaminic acid

De novo synthesis of novel bacterial monosaccharide fusaminic acid, Published online: 22 March 2019; doi:10.1038/s41429-019-0170-3

De novo synthesis of novel bacterial monosaccharide fusaminic acid

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Ata Int. Inc. Issues Voluntary Nationwide Recall of BLUEFUSION Capsules, due to presence of Undeclared Sildenafil, Tadalafil, Desmethyl carbodenafil, Dithiodesmethyl carbodenafil, Scutellarin and Daidzein - FDA Safety Alerts & Drug Recalls

Ata Int. Inc. is voluntarily recalling all lots within expiry of BLUEFUSION Capsules to the consumer level. FDA analysis has found the product to be tainted with sildenafil, tadalafil, desmethyl carbodenafil, dithiodesmethyl carbodenafil, scutellarin and daidzein. Sildenafil and tadalafil are FDA approved drugs for the treatment of male erectile dysfunction and are in a class of drugs called phosphodiesterase (PDE-5) inhibitors. Desmethyl carbodenafil and dithiodesmethyl carbodenafil are analogues of PDE-5 inhibitors and are likely to have the same pharmacological activity as PDE-5 inhibitors and thus carry the same clinical risks. Scutellarin and daidzein are derived from plants or herbs.

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Hill’s Pet Nutrition Expands Voluntary Recall of Select Canned Dog Food for Elevated Vitamin D - FDA Safety Alerts & Drug Recalls

Hill’s Pet Nutrition today announced it is expanding its recall of select canned dog food products due to elevated levels of vitamin D.

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FDA approves new device for treating moderate to severe chronic heart failure in patients - FDA Press Releases

Device to treat heart failure was given Breakthrough Device designation because it treats a life-threatening disease and addresses unmet clinical need.

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Better Made Snack Foods Issues Allergy Alert on Undeclared Milk In 10 Ounce $3.99 Original Potato Chips - FDA Safety Alerts & Drug Recalls

The recall was initiated after it was discovered that a package of 10-ounce Original Potato Chips dated 10 AUG 2019 did not contain Original Potato Chips but instead contained Cheddar and Sour Cream Potato Chips which contain milk. Subsequent investigation indicates the problem was caused by a temporary breakdown in the company's production and packaging processes which may have affected 660 bags of 10-ounce Original Potato Chips.

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Century Snacks LLC Recalls Snak Club Honey Bliss Nut Mix Due to Undeclared Allergen - FDA Safety Alerts & Drug Recalls

Century Snacks, LLC of Commerce, CA is recalling all packages of 3-oz. and 5.75-oz. SNAK CLUB HONEY BLISS NUT MIX due to undeclared MILK. People who have an allergy or severe sensitivity to MILK run the risk of serious or life-threatening allergic reaction if they consume these products.

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Finding Someone Like Me: The Secret to Successfully Mentoring Specialists in Aging Research - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Reply to: Comment on: Serum Cholesterol and Incident Alzheimer's Disease: Findings From the Adult Changes in Thought Study - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Comment on: Serum Cholesterol and Incident Alzheimer Disease: Findings From the Adult Changes in Thought Study - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Kingston Pharma, LLC RECALLS " DG™/health NATURALS baby Cough Syrup + Mucus” Because of Possible Health Risk - FDA Safety Alerts & Drug Recalls

Kingston Pharma, LLC of Massena, NY is recalling Lot KL180157 of its 2-fluid ounce (59 mL) bottles of DG™/health NATURALS baby Cough Syrup + Mucus” because it has the potential to be contaminated with Bacillus cereus/ Bacillus circulans. Bacillus cereus in food products has the potential to produce two forms of gastrointestinal illness, one being a syndrome primarily of vomiting, and the other of diarrhea. Most often, illnesses are mild and self-limiting, although more serious and even lethal cases have occurred. Individuals at risk for more severe forms of illness include infants, young children, and others with weakened immune systems. No illnesses have been reported to date in connection with this problem with the use of DG™/health NATURALS baby Cough Syrup + Mucus.

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Formal syntheses of (−)-isoretronecanol, (+)-laburnine, and a concise enantioselective synthesis of (+)-turneforcidine - Journal of Antibiotics

Formal syntheses of (−)-isoretronecanol, (+)-laburnine, and a concise enantioselective synthesis of (+)-turneforcidine

Formal syntheses of (−)-isoretronecanol, (+)-laburnine, and a concise enantioselective synthesis of (+)-turneforcidine, Published online: 20 March 2019; doi:10.1038/s41429-019-0169-9

Formal syntheses of (−)-isoretronecanol, (+)-laburnine, and a concise enantioselective synthesis of (+)-turneforcidine

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Influence of Multimorbidity on Burden and Appropriateness of Implantable Cardioverter‐Defibrillator Therapies - American Geriatric Society

OBJECTIVE

To determine whether burden of multiple chronic conditions (MCCs) influences the risk of receiving inappropriate vs appropriate device therapies.

DESIGN

Retrospective cohort study.

SETTING

Seven US healthcare delivery systems.

PARTICIPANTS

Adults with left ventricular systolic dysfunction receiving an implantable cardioverter‐defibrillator (ICD) for primary prevention.

MEASUREMENTS

Data on 24 comorbid conditions were captured from electronic health records and categorized into quartiles of comorbidity burden (0‐3, 4‐5, 6‐7 and 8‐16). Incidence of ICD therapies (shock and antitachycardia pacing [ATP] therapies), including appropriateness, was collected for 3 years after implantation. Outcomes included time to first ICD therapy, total ICD therapy burden, and risk of inappropriate vs appropriate ICD therapy.

RESULTS

Among 2235 patients (mean age = 69 ± 11 years, 75% men), the median number of comorbidities was 6 (interquartile range = 4‐8), with 98% having at least two comorbidities. During a mean 2.2 years of follow‐up, 18.3% of patients experienced at least one appropriate therapy and 9.9% experienced at least one inappropriate therapy. Higher comorbidity burden was associated with an increased risk of first inappropriate therapy (adjusted hazard ratio [HR] = 1.94 [95% confidence interval {CI} = 1.14‐3.31] for 4‐5 comorbidities; HR = 2.25 [95% CI = 1.25‐4.05] for 6‐7 comorbidities; and HR = 2.91 [95% CI = 1.54‐5.50] for 8‐16 comorbidities). Participants with 8‐16 comorbidities had a higher total burden of ICD therapy (adjusted relative risk [RR] = 2.12 [95% CI = 1.43‐3.16]), a higher burden of inappropriate therapy (RR = 3.39 [95% CI = 1.67‐6.86]), and a higher risk of receiving inappropriate vs appropriate therapy (RR = 1.74 [95% CI = 1.07‐2.82]). Comorbidity burden was not significantly associated with receipt of appropriate ICD therapies. Patterns were similar when separately examining shock or ATP therapies.

CONCLUSIONS

In primary prevention ICD recipients, MCC burden was independently associated with an increased risk of inappropriate but not appropriate device therapies. Comorbidity burden should be considered when engaging patients in shared decision making about ICD implantation.

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Development of an effective fluorescence probe for discovery of aminopeptidase inhibitors to suppress biofilm formation - Journal of Antibiotics

Development of an effective fluorescence probe for discovery of aminopeptidase inhibitors to suppress biofilm formation

Development of an effective fluorescence probe for discovery of aminopeptidase inhibitors to suppress biofilm formation, Published online: 20 March 2019; doi:10.1038/s41429-019-0166-z

Development of an effective fluorescence probe for discovery of aminopeptidase inhibitors to suppress biofilm formation

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Effects of Multicomponent Exercise on Frailty in Long‐Term Nursing Homes: A Randomized Controlled Trial - American Geriatric Society

OBJECTIVES

To determine the effect of multicomponent exercise on frailty and related adverse outcomes in residents of long‐term nursing homes (LTNHs).

DESIGN

A single‐blind randomized controlled trial.

SETTING

Ten LTNHs in Gipuzkoa, Spain.

PARTICIPANTS

The study sample comprised 112 men and women aged 70 years or older who scored 50 or higher on the Barthel Index, 20 or higher on the MEC‐35 test (an adapted and validated version of the Mini‐Mental State Examination in Spanish), and who were capable of standing up and walking independently for at least 10 m.

INTERVENTION

Subjects in the control group (CG) participated in routine activities. The intervention group (IG) participated in a 6‐month program of individualized and progressive multicomponent exercise at moderate intensity.

MEASUREMENTS

Frailty was assessed by four different scales at baseline and at 6 months. The Barthel Index was measured at baseline and at 12 months. Frailty‐related adverse outcomes were recorded from 12 months before to 12 months after starting the intervention.

RESULTS

A lower prevalence of frailty was observed in the IG compared with the CG according to Fried's frailty phenotype, Short Physical Performance Battery, and Tilburg Frailty Indicator after 6 months (p < .05). There was a decline in the CG on the Barthel Index after 12 months (p < .05), whereas score was maintained in the IG. Both groups experienced a similar number of falls before and after the intervention (p > .05), but during the 6‐month intervention period, fewer falls were observed in the IG than the CG (p < .05). Lower overall mortality was observed 12 months after starting the intervention for the IG than the CG (1 vs 6, respectively; p = .05).

CONCLUSION

Individualized and progressive multicomponent exercise at moderate intensity seems to be effective to prevent falls and reduce frailty and mortality.

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FDA approves first treatment for post-partum depression - FDA Press Releases

FDA approves Zulresso (brexanolone), the first drug for post-partum depression

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FDA issues warning letters to two breast implant manufacturers for failure to comply with post-approval study requirements - FDA Press Releases

FDA issues warning letters to two breast implant manufacturers for failure to comply with post-approval study requirements

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Statement from FDA Commissioner Scott Gottlieb, M.D., and Deputy Commissioner Frank Yiannas on new steps to strengthen FDA’s food safety program for 2020 and beyond - FDA Press Releases

New steps to strengthen FDA’s food safety program for 2020 and beyond

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FDA takes action against marketer of unapproved products claiming to treat addiction, chronic pain and other serious conditions - FDA Press Releases

FDA warned Nutra Pharma for illegally marketing unapproved products with claims about their ability to treat addiction, pain and other serious conditions.

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Paid Family Leave: An Emerging Benefit for Employed Family Caregivers of Older Adults - American Geriatric Society

As our population ages, the ability to take time off to care for an ill family member or close friend without losing income or a job is a growing social, health, and economic issue for American families. Therefore, the need for paid family leave policies for workers with caregiving responsibilities is an important topic for employers and policymakers, in the clinical care of older adults, and at kitchen tables across the United States. Despite this growing need, paid family leave is not available to most workers, and there is no national paid family leave policy. Health care and social service providers have a role in ensuring that family members of their patients with a serious health condition or disability are aware of the potential availability of paid family leave benefits in the states and businesses that provide them. Building a better system of care for older adults means changes not only in health care settings and in long‐term services and supports, but in workplaces too. This article describes the challenges faced by workers with family caregiving responsibilities, explains why paid family leave matters, indicates which states have adopted these protections, and reviews research on existing paid family leave policies. Finally, actions by clinicians and other stakeholders are offered to advance awareness about paid family leave benefits, including coverage for workers with care responsibilities for older people.

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Beyond Parental Leave: Paid Family Leave for an Aging America - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Healthcare and Financial Decision Making and Incident Adverse Cognitive Outcomes among Older Adults - American Geriatric Society

OBJECTIVES

To determine if poorer healthcare and financial decision making forecasts adverse cognitive outcomes in old age. Specifically, we hypothesized that poorer decision making would be associated with an increased risk of incident Alzheimer's dementia, an increased risk of incident mild cognitive impairment (MCI), and a more rapid decline in cognition.

DESIGN

An ongoing prospective observational cohort study of aging (the Rush Memory and Aging Project).

SETTING

The greater Chicago area.

PARTICIPANTS

A total of 952 community‐based older adults without dementia at baseline.

MEASUREMENTS

Participants completed a measure of healthcare and financial decision making at baseline and underwent annual standardized evaluations to track clinical status and cognitive functions (global cognition, episodic memory, semantic memory, working memory, perceptual speed, and visuospatial ability).

RESULTS

During up to 9 years of follow‐up (M = 5.2 y; standard deviation = 2.7), 156 participants developed Alzheimer's dementia (16.4% of 952), 253 participants developed MCI (33.2% of 760), and each cognitive measure declined (all Ps < .001). In Cox proportional hazards models adjusted for age, sex, and education, poorer decision making was associated with an increased risk of incident Alzheimer's dementia (hazard ratio [HR] = 1.17; 95% confidence interval [CI] = 1.10‐1.24; P < .001) and incident MCI (HR = 1.16; 95% CI = 1.10‐1.22; P < .001). Further, in linear mixed‐effects models, poorer decision making among those who were initially free of cognitive impairment was associated with a more rapid decline in global cognition and four of five specific cognitive domains (all Ps < .05).

CONCLUSION

Our results suggest that poorer healthcare and financial decision making heralds adverse cognitive outcomes in old age.

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Delirium Incidence and Functional Outcomes After Transcatheter and Surgical Aortic Valve Replacement - American Geriatric Society

Background

Transcatheter aortic valve replacement (TAVR) may be associated with less delirium and allow faster recovery than surgical aortic valve replacement (SAVR).

Objective

To examine the association of delirium and its severity with clinical and functional outcomes after SAVR and TAVR.

Design

Prospective cohort study.

Setting

An academic medical center.

Participants

A total of 187 patients, aged 70 years and older, undergoing SAVR (N = 77) and TAVR (N = 110) in 2014 to 2016.

Measurements

Delirium was assessed daily using the Confusion Assessment Method (CAM), with severity measured by the CAM‐Severity (CAM‐S) score (range = 0‐19). Outcomes were prolonged hospitalization (9 days or more); institutional discharge; and functional status, measured by ability to perform 22 daily activities and physical tasks over 12 months.

Results

SAVR patients had a higher incidence of delirium than TAVR patients (50.7% vs 25.5%; P < .001), despite younger mean age (77.9 vs 83.7 years) and higher baseline Mini‐Mental State Examination score (26.9 vs 24.7). SAVR patients with delirium had a shorter duration (2.2 vs 3.4 days; P = .04) with a lower mean CAM‐S score (4.5 vs 5.7; P = .01) than TAVR patients with delirium. The risk of prolonged hospitalization in no, mild, and severe delirium was 18.4%, 30.8%, and 61.5% after SAVR (P for trend = .009) and 26.8%, 38.5%, and 73.3% after TAVR (P for trend = .001), respectively. The risk of institutional discharge was 42.1%, 58.3%, and 84.6% after SAVR (P for trend = .01) and 32.5%, 69.2%, and 80.0% after TAVR (P for trend <.001), respectively. Severe delirium was associated with delayed functional recovery after SAVR and persistent functional impairment after TAVR at 12 months.

Conclusion

Less invasive TAVR was associated with lower incidence of delirium than SAVR. Once delirium developed, TAVR patients had more severe delirium and worse functional status trajectory than SAVR patients did.

Registration

NCT01845207.

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Putting Goal‐Oriented Patient Care Into Practice - American Geriatric Society

ABSTRACT

New efforts have begun to transform healthcare to focus on patient‐centered care. Such efforts will be facilitated by eliciting, operationalizing, and measuring the attainment of patient‐identified goals of healthcare. This article describes a practical approach to goal setting and measurement that can be used in efforts to implement patient‐centered care.

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Step-economy synthesis of β-steryl sialosides using a sialyl iodide donor - Journal of Antibiotics

Step-economy synthesis of β-steryl sialosides using a sialyl iodide donor

Step-economy synthesis of β-steryl sialosides using a sialyl iodide donor, Published online: 19 March 2019; doi:10.1038/s41429-019-0165-0

Step-economy synthesis of β-steryl sialosides using a sialyl iodide donor

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Mylan Institutional LLC Initiates Voluntary Nationwide Recall of Levoleucovorin Injection Due to the Presence of Particulate Matter - FDA Safety Alerts & Drug Recalls

Mylan Institutional LLC is conducting a voluntary nationwide recall of two lots (see table below) of Levoleucovorin Injection, 250 mg/25 mL to the consumer/user level. The lots were manufactured by Alidac Pharmaceuticals Limited and distributed by Mylan Institutional LLC.

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Visual Abstracts to Disseminate Geriatrics Research Through Social Media - American Geriatric Society

Dissemination of cutting‐edge geriatrics‐focused research is essential for academic geriatrics researchers, clinicians, and older adults and their caregivers. Social media channels, such as Twitter, provide a means of quickly reaching a wide array of users, globally. Besides standard tweets with links to research articles, visual abstracts are a means of delivering research results visually to end users succinctly. We compared the use of a standard tweet with a linked article with a tweet that held an added visual abstract, for a recent Journal of the American Geriatrics Society article. While the standard tweet received 24 984 impressions with 17 retweets and 36 likes over 8 days, the visual abstract inclusive tweet received 168 447 impressions with 81 retweets and 100 likes in 4 days. To assist researchers on future visual abstract development, we provide a framework and real‐world guide on translation of research abstracts into visual abstracts. We hope that by providing evidence and the means to create visual abstracts, researchers in geriatrics may be empowered to disseminate their research through this method and potentially advance the care of older adults worldwide.

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Making and Measuring an Impact in a Digital World: The Role of Social Media and the Medical Journal - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Emergency Department Interventions for Older Adults: A Systematic Review - American Geriatric Society

OBJECTIVES

To evaluate the effect of emergency department (ED) interventions on clinical, utilization, and care experience outcomes for older adults.

DESIGN

A conceptual model informed, protocol‐based systematic review.

SETTING

Emergency Department (ED).

PARTICIPANTS

Older adults 65 years of age and older.

METHODS AND MEASUREMENT

Medline, Embase, CINAHL, and PsycINFO were searched for English‐language studies published through December 2017. Studies evaluating the use of one or more eligible intervention strategies (discharge planning, case management, medication safety or management, and geriatric EDs including those that cited the 2014 Geriatric ED Guidelines) with adults 65 years of age and older were included. Studies were classified by the number of intervention strategies used (ie, single strategy or multi‐strategy) and key intervention components present (ie, assessment, referral plus follow‐up, and contact both before and after ED discharge [“bridge”]). The effect of ED interventions on clinical (functional status, quality of life [QOL]), patient experience, and utilization (hospitalization, ED return visit) outcomes was evaluated.

RESULTS

A total of 2000 citations were identified; 17 articles describing 15 unique studies (9 randomized and 6 nonrandomized) met eligibility criteria and were included in analyses. ED interventions showed a mixed pattern of effects. Overall, there was a small positive effect of ED interventions on functional status but no effects on QOL, patient experience, hospitalization at or after the initial ED index visit, or ED return visit.

CONCLUSION

Studies using two or more intervention strategies may be associated with the greatest effects on clinical and utilization outcomes. More comprehensive interventions, defined as those with all three key intervention components present, may be associated with some positive outcomes.

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Fall Ascertainment and Development of a Risk Prediction Model Using Electronic Medical Records - American Geriatric Society

OBJECTIVES

To examine the use of electronic medical record (EMR) data to ascertain falls and develop a fall risk prediction model in an older population.

DESIGN

Retrospective longitudinal study using 10 years of EMR data (2004‐2014). A series of 3‐year cohorts included members continuously enrolled for a minimum of 3 years, requiring 2 years pre‐fall (no previous record of a fall) and a 1‐year fall risk period.

SETTING

Kaiser Permanente Hawaii, an ambulatory setting.

PARTICIPANTS

A total of 57 678 adults, age 60 years and older.

MEASUREMENTS

Initial EMR searches were guided by current literature and geriatricians to understand coding sources of falls as our outcome. Falls were captured by two coding sources: International Classification of Diseases, Ninth Revision (ICD‐9) codes (E880‐889) and/or a fall listed as a “primary reason for visit.” A comprehensive list of EMR predictors of falls were included into prediction models enabling statistical subset selection from many variables and modeling by logistic regression.

RESULTS

Although 72% of falls in the training data set were coded as “primary reason for visit,” 22% of falls were coded as ICD‐9 and 6% coded as both. About 80% were reported in face‐to‐face encounters (eg, emergency department). A total of 2164 individuals had a fall in the risk period. Using the 13 key predictors (age, comorbidities, female sex, other mental disorder, walking issues, Parkinson's disease, urinary incontinence, depression, polypharmacy, psychotropic and anticonvulsant medications, osteoarthritis, osteoporosis) identified through LASSO regression, the final model had a sensitivity of 67%, specificity of 69%, positive predictive value of 8%, negative predictive value of 98%, and area under the curve of .74.

CONCLUSION

This study demonstrated how the EMR can be used to ascertain falls and develop a fall risk prediction model with moderate sensitivity/specificity. Concurrent work with clinical providers to enhance fall documentation will improve the ability of the EMR to capture falls and consequently may improve the model to predict fall risk.

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Legacy Pharmaceutical Packaging, LLC Issues Voluntary Nationwide Recall of Losartan Potassium Tablets, USP, 50mg Due to the Detection of Trace Amounts of N-Nitroso N-Methyl 4-amino butyric acid (NMBA) Impurity found in the Active Pharmaceutical Ingredient (API) - FDA Safety Alerts & Drug Recalls

Legacy Pharmaceutical Packaging, LLC is recalling 3 repackaged lots of Losartan Tablets USP 50mg to the consumer level. This recall was prompted due to Torrent Pharmaceuticals LTD issuing a Voluntary Nationwide Recall of Losartan Tablets, USP, due to the detection of trace amounts of N-Nitroso N-Methyl 4-amino butyric acid (NMBA) a possible process impurity or contaminant in an active pharmaceutical ingredient, manufactured by Hetero Labs Limited, (API manufacturer).

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Legacy Pharmaceutical Packaging, LLC Issues Voluntary Nationwide Recall of Losartan Potassium Tablets, USP, 25mg, 50mg, And 100mg Due to The Detection of Trace Amounts Of N-Nitroso N-Methyl 4-Amino Butyric Acid (NMBA) Impurity Found in The Active Pharmaceutical Ingredient (API) - FDA Safety Alerts & Drug Recalls

Earth City, MO, Legacy Pharmaceutical Packaging, LLC is recalling 40 repackaged lots of Losartan Tablets USP 25mg, 50mg, and 100mg to the consumer level. This recall was prompted due to Camber Pharmaceuticals, Inc. issuing a Voluntary Nationwide Recall of Losartan Tablets, USP, due to the detection of trace amounts of N-Nitroso N-Methyl 4-amino butyric acid (NMBA) a possible process impurity or contaminant in an active pharmaceutical ingredient, manufactured by Hetero Labs Limited, (API manufacturer).

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Hospira, Inc. Issues a Voluntary Nationwide Recall of 8.4% Sodium Bicarbonate Injection, USP Due to the Presence of Particulate Matter - FDA Safety Alerts & Drug Recalls

Hospira, Inc., a Pfizer company, is voluntarily recalling lot numbers 79-238-EV, 79-240-EV and 80-088-EV, NDC# 0409-6625-02, of 8.4% Sodium Bicarbonate Injection USP, 50 mEq/50 mL (1 mEq/mL), to the Hospital/Institution level. The recall was initiated due to the presence of particulate matter, confirmed as glass.

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Statement from FDA Commissioner Scott Gottlieb, M.D. and Jeff Shuren, M.D., Director of the Center for Devices and Radiological Health, on efforts to evaluate materials in medical devices to address potential safety questions - FDA Press Releases

The FDA is working to further evaluate materials like metals that are used in medical devices to learn more about how these materials interact with the immune system.

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Surtidoras Bakery Inc. Issues Allergy Alert on Undeclared Milk in Marble Muffin, Banana Muffin, and Blueberry Muffin - FDA Safety Alerts & Drug Recalls

Surtidoras Bakery Inc. of Auburn, Washington is recalling Marble Muffin, Banana Muffin, and Blueberry Muffin because it may contain undeclared milk. People who have an allergy or severe sensitivity to milk run the risk of serious or life-threatening allergic reaction if they consume these products.

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Statement from FDA Commissioner Scott Gottlieb, M.D., and Deputy Commissioner Frank Yiannas on advancing new tools and science for implementing agricultural water requirements for produce safety - FDA Press Releases

FDA implements agricultural water requirements for produce safety

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Association of Chronic Periodontitis on Alzheimer's Disease or Vascular Dementia - American Geriatric Society

OBJECTIVES

Although chronic periodontitis has been associated with Alzheimer's disease, the effect of chronic periodontitis on vascular dementia as well as the role of lifestyle behaviors such as smoking, alcohol consumption, and physical activity in this association are still unclear.

DESIGN

Retrospective cohort study.

SETTING

Population based.

PARTICIPANTS

The study population was derived from the Korean National Health Insurance Service‐Health Screening Cohort. Among 262 349 participants, diagnosis of chronic periodontitis was determined during 2003‐2004.

MEASUREMENTS

Starting from 2005, participants were followed up for overall dementia, Alzheimer's disease, and vascular dementia until 2015. Cox proportional hazards regression was used to determine the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of dementia according to chronic periodontitis.

RESULTS

Compared with nonchronic periodontitis participants, chronic periodontitis patients had elevated risk for overall dementia (aHR = 1.06; 95% CI = 1.01‐1.11) and Alzheimer's disease (aHR = 1.05; 95% CI = 1.00‐1.11). There was a tendency toward increased vascular dementia risk among chronic periodontitis patients (aHR = 1.10; 95% CI = 0.98‐1.22). The risk‐increasing effect of chronic periodontitis on dementia tended to be stronger among participants with healthy lifestyle behaviors including never‐smokers and those who exercised and did not consume alcohol.

CONCLUSION

Chronic periodontitis may be associated with a higher risk of developing dementia. Future studies that investigate whether preventing chronic periodontitis may lead to reduced risk of dementia are needed.

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New semisynthetic teicoplanin derivatives have comparable in vitro activity to that of oritavancin against clinical isolates of VRE - Journal of Antibiotics

New semisynthetic teicoplanin derivatives have comparable in vitro activity to that of oritavancin against clinical isolates of VRE

New semisynthetic teicoplanin derivatives have comparable in vitro activity to that of oritavancin against clinical isolates of VRE, Published online: 15 March 2019; doi:10.1038/s41429-019-0164-1

New semisynthetic teicoplanin derivatives have comparable in vitro activity to that of oritavancin against clinical isolates of VRE

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FDA allows marketing of new device to help treat carbon monoxide poisoning - FDA Press Releases

FDA allows marketing of a new device, ClearMate, intended to be used with patients suffering from carbon monoxide poisoning. This is the first carbon monoxide poisoning device authorized for marketing by the FDA for use in an emergency room setting.

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Statement by FDA Commissioner Scott Gottlieb, M.D., on new strategies to modernize clinical trials to advance precision medicine, patient protections and more efficient product development - FDA Press Releases

FDA issues statement on new strategies to modernize clinical trials to advance precision medicine, patient protections and more efficient product development

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FDA approves new indication for valve repair device to treat certain heart failure patients with mitral regurgitation - FDA Press Releases

Device is for treatment of patients to reduce mitral regurgitation in certain patients with heart failure symptoms who fail to respond to traditional therapy

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Metabolic Syndrome and Cognitive Impairment among High Socioeconomic, Nondemented Older US Adults - American Geriatric Society

OBJECTIVES

Nondemented cognitive impairment (CI) presents opportunities for early interventions among individuals at risk for dementia. Identification of modifiable determinants is paramount to the development of effective clinical interventions. Metabolic syndrome (MetS) was theorized as a risk factor, but current research yields inconsistent findings. Few studies have examined the association between MetS and CI among US populations, and global results may be ungeneralizable. We investigated the MetS‐CI association among high socioeconomic, nondemented older US adults, examining the roles of sociodemographic, clinical, behavioral, and genetic factors.

DESIGN

Cross‐sectional.

SETTING

Cooper Clinic of Dallas, Texas: Cooper Center Longitudinal Study (2009‐2017).

PARTICIPANTS

A total of 5200 dementia‐free older adult Cooper Clinic patients.

MEASUREMENTS

CI was detected with a Montreal Cognitive Assessment (MoCA) score lower than 26. MetS was established based on National Cholesterol Education Program Adult Treatment Panel guidelines. Unadjusted and multivariable log‐binomial regression were used to assess the MetS‐CI association, with modification assessment by age, sex, education, cardiorespiratory fitness (CRF), and apolipoprotein‐ε4 carrier status (APOE‐ε4).

RESULTS

MetS was not associated with CI when adjusting for age, sex, minority status, education, and marital status (prevalence ratio [PR] = 1.09; 95% confidence interval = .97‐1.23) or when additionally adjusting for body mass index, CRF, alcohol consumption, current smoking status, and APOE‐ε4 (PR = 1.07; 95% confidence interval = .80‐1.45). The association was not modified by age, sex, CRF, or APOE‐ε4 (P for interaction >.05).

CONCLUSION

In contrast with some global and US studies, MetS and CI were not associated among our study population of nondemented older US adults. MetS may not be a suitable intervention target for poor cognitive outcomes among high socioeconomic older US adults, although separate MetS components may have different recommendations. Future studies should explore more diverse older US populations. If replicated, these findings would inform clinical efforts to reduce the burden of poor cognitive outcomes in the United States.

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Implementing Advance Care Planning in Acute Hospitals: Leading the Transformation of Norms - American Geriatric Society

BACKGROUND

Despite being simply defined as a process to further one's understanding about future medical care, the process of implementing advance care planning (ACP) within acute hospital settings can be complex.

AIM

We describe different ACP service models adopted in Singapore, and the facilitators for, and barriers to, its effective implementation.

DESIGN

Qualitative focus group study with thematic analysis.

SETTINGS/PARTICIPANTS

We purposefully sampled four stakeholder groups involved in the implementation of ACP. Our sample included 63 participants, 12 physicians, 15 nurses, 24 medical social workers, and 12 ACP coordinators from seven public hospitals and one specialist center.

RESULTS

We describe three different acute‐care models adopted in Singapore, differentiated by leadership approach, target population, delivery process, and job roles. Our results revealed nine themes, organized into four categories, including: (1) hospital culture (curative norms, absence of preference‐supportive culture), (2) organizational priority and leadership (low priority on hospital agenda, inappropriate leadership), (3) goals and distinction (lack of shared purpose and goals, no clear differentiation from existing practices), and (4) work practices (pigeonholing of ACP practice, inappropriate resourcing, accountability and feedback).

CONCLUSION

We learned that to implement ACP effectively in an acute‐care setting, there needs to be a cultural and behavioral transformation, led by committed and empowered leaders. Organizations that can create a shared purpose built on an ethos of honoring patients' preferences, and support this with systematic processes and adequate resourcing, will be more equipped to implement ACP effectively.

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Decision Making for Older Adults With Multiple Chronic Conditions: Executive Summary for the American Geriatrics Society Guiding Principles on the Care of Older Adults With Multimorbidity - American Geriatric Society

Caring for older adults with multiple chronic conditions (MCCs) is challenging. The American Geriatrics Society (AGS) previously developed The AGS Guiding Principles for the Care of Older Adults With Multimorbidity using a systematic review of the literature and consensus. The objective of the current work was to translate these principles into a framework of Actions and accompanying Action Steps for decision making for clinicians who provide both primary and specialty care to older people with MCCs. A work group of geriatricians, cardiologists, and generalists: (1) articulated the core MCC Actions and the Action Steps needed to carry out the Actions; (2) provided decisional tips and communication scripts for implementing the Actions and Action Steps, using commonly encountered situations: (3) performed a scoping review to identify evidence‐based, validated tools for carrying out the MCC Actions and Action Steps; and (4) identified potential barriers to, and mitigating factors for, implementing the MCC Actions. The recommended MCC Actions include: (1) identify and communicate patients' health priorities and health trajectory; (2) stop, start, or continue care based on health priorities, potential benefit vs harm and burden, and health trajectory; and (3) align decisions and care among patients, caregivers, and other clinicians with patients' health priorities and health trajectory. The tips and scripts for carrying out these Actions are included in the full MCC Action Framework available in the supplement (www.GeriatricsCareOnline.org). J Am Geriatr Soc 00:1–9, 2019.

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Frequency and Documentation of Medication Decisions on Discharge from the Hospital to Hospice Care - American Geriatric Society

OBJECTIVES

To quantify the frequency and type of medication decisions on discharge from the hospital to hospice care.

DESIGN

Retrospective cohort study.

SETTING

A 544‐bed academic tertiary care hospital in Portland, Oregon.

PARTICIPANTS

A total of 348 adult patients (age ≥18 y) discharged to hospice care between January 1, 2010, and December 31, 2016.

MEASUREMENTS

Data were collected from an electronic repository of medical record data and a manual review of patients’ discharge summaries. Our outcomes of interest were the frequency and type of medication decisions documented in patients’ discharge summaries. Medication decisions were categorized as continuation, continuation but with changes in dose, route of administration, and/or frequency, discontinuation, and initiation of new medications. We also collected data on the frequency of patient/family in the participation of medication‐related decisions.

RESULTS

Patients were prescribed a mean of 7.1 medications (standard deviation [SD] = 4.8) on discharge to hospice care. The most prevalent medications prescribed on discharge were strong opioids (82.5%), anxiolytics/sedatives (62.9%), laxatives (57.5%), antiemetics (54.3%), and nonopioid analgesics (45.4%). However, only 67.8% (213/341) of patients who were prescribed an opioid on discharge to hospice care were also prescribed a laxative. Discharging providers made a mean of 15.0 decisions (SD = 7.2) per patient of which 28.5% were to continue medications without changes, 6.7% were to continue medications with changes, 30.3% were to initiate new medications, and 34.5% were to discontinue existing medications. Patients and/or family members were involved in medication decisions during 21.6% of discharges; patients were involved in 15.2% of decisions.

CONCLUSION

Patients averaged more than 15 medication decisions on discharge to hospice care. However, it was rarely documented that patients and/or their families participated in these decisions. J Am Geriatr Soc, 2019.

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Why Amyloid Is Still a Target for Alzheimer disease Clinical Trials - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Reply to: Major Clinical Trials Failed the Amyloid Hypothesis of Alzheimer's Disease - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Major Clinical Trials Failed the Amyloid Hypothesis of Alzheimer's Disease - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Reply to: Why Amyloid Is Still a Target for Alzheimer's Disease - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Comparing Three Methods for Reducing Psychotropic Use in Older Demented Spanish Care Home Residents - American Geriatric Society

BACKGROUND/OBJECTIVE

In nursing homes across the world, and particularly in Spain, there are concerns that psychotropic medications are being overused. For older Spanish nursing home residents who had dementia, we sought to evaluate the association between applying interventions designed to reduce inappropriate psychotropic medication use and subsequent psychotropic use.

DESIGN

Retrospective, propensity score–matched, controlled, patient‐level observational analysis.

SETTING

A total of 45 nursing homes in Spain.

PARTICIPANTS

A total of 1653 nursing home residents, aged 70 to 99 years, who had dementia and were prescribed an antipsychotic, anxiolytic, or antidepressant medication, 606 of whom received an intervention; the remainder served as propensity score–matched controls.

INTERVENTION

Team Rounds, Screening Tool of Older Persons' Prescriptions (STOPP)/Screening Tool to Alert Doctors to Right Treatment (START) criteria, or a Patient Decision Aid.

MEASUREMENTS

At 2 and 4 weeks following intervention: change from baseline drug class–specific milligram‐equivalent daily dose (MEDD); at 2 weeks: patient falls and restraint use.

RESULTS

Within each intervention/drug‐class cohort, intervention patients and matched controls had similar baseline demographic characteristics, Charlson scores, lengths of admission, and drug class–specific MEDDs. Compared to controls, patients exposed to Team Rounds experienced a 23.3% (95% confidence interval [CI] = 13.9%‐32.8%) reduction in antipsychotic and a 23.1% (95% CI = 18.3%‐28.0%) reduction in anxiolytic MEDDs; those exposed to Patient Decision Aids had a 24.8% (95% CI = 15.6%‐33.9%) reduction in antipsychotic and a 31.8% (95% CI = 25.5%‐38.2%) reduction in anxiolytic MEDDs; and those exposed to STOPP/START application had a 27.7% (95% CI = 22.4%‐33.0%) reduction in antipsychotic and a 39.5% (95% CI = 35.5%‐43.5%) reduction in anxiolytic MEDDs. Intervention‐associated antidepressant MEDD reductions were statistically significant but less dramatic. Interventions were associated with higher rates of medication discontinuation, but not higher rates of deaths, patient falls, or physical restraints.

CONCLUSION

We found strong evidence that the interventions we studied were associated with reduced psychotropic use without commensurate harms, suggesting that such interventions should be incorporated into Spanish nursing home care models. Public reporting of psychotropic medication use in Spanish care homes may encourage care homes to regularly monitor psychotropic medication use and implement such instruments. J Am Geriatr Soc, 2019.

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Self‐Reported Hearing Loss and Nonfatal Fall‐Related Injury in a Nationally Representative Sample - American Geriatric Society

BACKGROUND/OBJECTIVE

To evaluate the relationship between self‐reported hearing loss and nonfatal fall‐related injury in a nationally representative sample of community‐dwelling adults living in the United States.

DESIGN

Cross‐sectional analysis of national survey data.

SETTING

National Health Interview Survey (2016).

PARTICIPANTS

A total of 30 994 community‐dwelling adults in the United States, aged 18 years and older.

MEASUREMENTS

We evaluated the association between self‐reported hearing loss and nonfatal injury resulting from a fall in the previous 3 months. We used multivariate logistic regression to calculate adjusted odds ratios (ORs) and evaluated effect measure modification by age.

RESULTS

The odds of nonfatal fall‐related injury were 1.60 times higher among respondents with hearing loss compared to respondents without hearing loss (95% confidence interval [CI] = 1.20‐2.12; P = .0012). Results were unchanged when adjusting for demographics (OR = 1.59; 95% CI = 1.18‐2.15; P = .002). After adjustment for cardiovascular risk factors, cardiovascular disease, visual impairment, and limitation caused by nervous system/sensory organ conditions and depression, anxiety, or another emotional problem, the OR fell to 1.27 (95% CI = 0.92‐1.74; P = .14). In the fully adjusted model, including adjustment for vestibular vertigo, there was little support to link hearing loss and fall‐related injury (OR = 1.16; 95% CI = 0.84‐1.60; P = .36). Effect modification by age was not observed.

CONCLUSIONS

Self‐reported hearing loss may be a clinically useful indicator of increased fall risk, but treatment for hearing loss is unlikely to mitigate this risk, given that there is no independent association between self‐reported hearing loss and nonfatal falls after accounting for vestibular function and other potential confounders.

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Association Between Symptom Burden and Physical Function in Older Patients with Cancer - American Geriatric Society

OBJECTIVES

To evaluate the independent association between symptom burden and physical function impairment in older adults with cancer.

DESIGN

Cross‐sectional.

SETTING

Two university‐based geriatric oncology clinics.

PARTICIPANTS

Patients with cancer aged 65 years or older who underwent evaluation with geriatric assessment (GA).

MEASUREMENTS

Symptom burden was measured as a summary score of severity ratings (range = 0‐10) of 10 commonly reported symptoms using a Clinical Symptom Inventory (CSI). Functional impairment was defined as the presence of one or more impairments of instrumental activities of daily living (IADLs), any significant physical activity limitation on the Medical Outcomes Survey (MOS), one or more recent falls in the previous 6 months, or a Short Physical Performance Battery (SPPB) score of 9 or less. Multivariate analysis evaluated the association between symptom burden and physical function impairment, adjusting for other clinical and sociodemographic variables.

RESULTS

From 2011 to 2015, 359 patients with cancer and a median age of 81 years (range = 65‐95 y) consented. The mean CSI score was 23.2 ± 20.5 with an observed range of 0 to 90. Patients in the highest quartile of symptom burden (N = 91; CSI score 52 ± 13) had a higher prevalence of IADL impairment (91% vs 51%), physical activity limitation (93% vs 65%), falls (55% vs 21%), and SPPB score of 9 or less (92% vs 69%) (all P values <.01) when compared with those in the bottom quartile (N = 81; CSI score: 2 ± 2). With each unit increase in CSI score, the odds of having IADL impairment, physical activity limitations, falls, and SPPB scores of 9 or less increased by 4.8%, 4.4%, 2.9%, and 2.5%, respectively (P < .05 for all results).

CONCLUSIONS

In older patients with cancer, higher symptom burden is associated with functional impairment. Future studies are warranted to evaluate if improved symptom management can improve function in older cancer patients.

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Perspectives of Patients in Identifying Their Values‐Based Health Priorities - American Geriatric Society

OBJECTIVES

Patient Health Priorities Identification (PHPI) is a values‐based process in which trained facilitators assist older adults with multiple chronic conditions identify their health priorities. The purpose of this study was to evaluate patients’ perceptions of PHPI.

DESIGN

Qualitative study using thematic analysis.

SETTING

In‐depth semistructured telephone and in‐person interviews.

PARTICIPANTS

Twenty‐two older adults who participated in the PHPI process.

MEASUREMENTS

Open‐ended questions about patient perceptions of the PHPI process, perceived benefits of the process, enablers and barriers to PHPI, and recommendations for process enhancement.

RESULTS

Patient interviews ranged from 9 to 63 minutes (median = 20 min; interquartile range = 15–26). The mean age was 80 years (standard deviation = 7.96), 64% were female, and all patients identified themselves as white. Of the sample, 73% reported no caregiver involvement in their healthcare; 36% lived alone. Most patients felt able to complete the PHPI process with ease. Perceived benefits included increased knowledge and insight into disease processes and treatment options, patient activation, and enhanced communication with family and clinicians. Patients identified several factors that were both enablers and barriers to PHPI including facilitator characteristics, patient demographic and clinical characteristics, social support, relationships between the patient and their primary care provider, and the changing health priorities of the patient. Recommendations for process enhancement included more frequent and flexible facilitator contacts, selection of patients for participation based on specific patient characteristics, clarification of process aims and expectations, involvement of family, written reminders of established health priorities, short duration between facilitation and primary care provider follow‐up, and the inclusion of health‐related tasks in facilitation visits.

CONCLUSIONS

Patients found the PHPI process valuable in identifying actionable health priorities and healthcare goals leading to enhanced knowledge, activation, and communication regarding their treatment options and preferences. PHPI may be useful for aligning the healthcare that patients receive with their values‐based priorities.

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Stokes Healthcare Inc. Issues Voluntary Nationwide Recall of Pilocarpine 0.1% Ophthalmic Solution Due to a High Level of Preservative - FDA Safety Alerts & Drug Recalls

Stokes Healthcare Inc. is voluntarily recalling 1 lot of 81 units of Pilocarpine 0.1% Ophthalmic Solution, to the consumer and veterinarian office levels. The ophthalmic solution has been found to contain a higher level of the preservative benzalkonium chloride than is typical.

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Hometown Food Company Recalls Two Production LOT Codes of Pillsbury® Unbleached All-Purpose 5lb Flour Due to Possible Health Risk - FDA Safety Alerts & Drug Recalls

Please be advised the Hometown Food Company initiated a limited, voluntary retail-level recall on two specific lot codes of its Pillsbury® Unbleached All-Purpose 5 lb Flour (UPC 51500-22241) because it may be contaminated with Salmonella. Only Best If Used By Dates APR 19 2020 and APR 20 2020 are impacted.

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Statement from FDA Commissioner Scott Gottlieb, M.D., on advancing new policies aimed at preventing youth access to, and appeal of, flavored tobacco products, including e-cigarettes and cigars - FDA Press Releases

Statement from FDA Commissioner Scott Gottlieb, M.D., on advancing new policies aimed at preventing youth access to, and appeal of, flavored tobacco products, including e-cigarettes and cigars.

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FDA approves a new generic valsartan - FDA Press Releases

FDA has approved a new generic of Diovan (valsartan). The agency prioritized the review of this drug application to help relieve a recent shortage of the drug.

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Claire’s Stores, Inc., Announces Voluntary Recall of Three Make-Up Products - FDA Safety Alerts & Drug Recalls

Out of an abundance of caution, today Claire’s Stores, Inc., announced a voluntary recall of three cosmetic products: Claire’s Eye Shadows, Claire’s Compact Powder and Claire’s Contour Palette. We initiated this voluntary recall after testing by the U.S. Food and Drug Administration indicated the possible presence of asbestos fibers in product samples from one lot of each product. Inhalation of asbestos over time has been linked to serious adverse health consequences.

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Federal judge enters consent decree against Texas compounder, Guardian Pharmacy Services - FDA Press Releases

A federal court ordered a Texas-based company to stop producing compounded drug products intended to be sterile until the company complies with the Federal Food, Drug, and Cosmetic Act (FD&C Act).

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Statement from FDA Commissioner Scott Gottlieb, M.D., on Administration’s request for new FDA funding to continue to advance robust regulatory framework for oversight of e-cigarettes, prevent youth access and initiation; and harness innovation to advance the safety of food, compounded drugs, U.S. blood supply - FDA Press Releases

FDA is requesting new funding to continue to advance robust regulatory framework for oversight of e-cigarettes and harness innovation to advance the safety of food, compounded drugs, U.S. blood supply.

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Two new phenazine metabolites with antimicrobial activities from soil-derived Streptomyces species - Journal of Antibiotics

Two new phenazine metabolites with antimicrobial activities from soil-derived Streptomyces species

Two new phenazine metabolites with antimicrobial activities from soil-derived <i>Streptomyces</i> species, Published online: 11 March 2019; doi:10.1038/s41429-019-0163-2

Two new phenazine metabolites with antimicrobial activities from soil-derived Streptomyces species

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Fullei Fresh Recalls Organic Bean Sprouts Because of Possible Health Risk - FDA Safety Alerts & Drug Recalls

Fullei Fresh of Miami, Florida is voluntarily recalling Organic Bean Sprouts because it has the potential to be contaminated with Listeria monocytogenes, an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems.

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FDA takes steps to help reduce risks associated with surgical staplers and implantable staples - FDA Press Releases

FDA takes steps to help reduce risks associated with surgical staplers and implantable staples

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Statement from FDA Commissioner Scott Gottlieb, M.D., on continued efforts to advance safe biotechnology innovations, and the deactivation of an import alert on genetically engineered salmon - FDA Press Releases

Statement from FDA Commissioner Scott Gottlieb, M.D., on continued efforts to advance safe biotechnology innovations, and the deactivation of an import alert on genetically engineered salmon

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Norbrook Laboratories Limited Recalls Veterinary Products for Health Risk - FDA Safety Alerts & Drug Recalls

Norbrook Laboratories Limited of Newry, Northern Ireland is recalling two lots of Enroflox® 100 Injection (enrofloxacin), two lots of Noromectin® Injection (ivermectin) and two lots of Ivermax® 1% Injection (ivermectin) to the veterinarian/consumer level as a precautionary measure as product sterility cannot be assured. There is a concern that if the sterility of these products has been compromised, use of these products could result in introduction of infectious agents to the animal. This may result in the need for medical intervention(s) including, but not limited to the need for supportive care, antibiotics, and/or antifungal drugs.

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American Health Packaging Issues Voluntary Nationwide Recall of Valsartan Tablets Due to the Detection of NDEA (N-Nitrosodiethylamine) Impurity - FDA Safety Alerts & Drug Recalls

American Health Packaging is voluntarily recalling one lot of Valsartan Tablets, USP, 160 mg to the consumer level due to the detection of trace amounts of an unexpected impurity found in the finished drug product. The impurity detected in the finished drug product is N-Nitrosodiethylamine (NDEA), which is a substance that occurs naturally in certain foods, drinking water, air pollution, and industrial processes, and has been classified as a probable human carcinogen as per International Agency for Research on Cancer (IARC) classification. This recall is being initiated in response to the recall by the manufacturer (Aurobindo Pharma USA, Inc.), which included the affected lot that was repackaged by American Health Packaging.

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USDA and FDA Announce a Formal Agreement to Regulate Cell-Cultured Food Products from Cell Lines of Livestock and Poultry - FDA Press Releases

USDA’s Food Safety and Inspection Service and FDA announce a formal agreement to jointly oversee the production of human food products derived from the cells of livestock and poultry

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Statement from FDA Commissioner Scott Gottlieb, M.D., on FDA’s steps on naming of biological medicines to balance competition and safety for patients receiving these products - FDA Press Releases

FDA updates draft guidance to set a clear path for the nonproprietary naming of interchangeable biosimilars.

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Re(I)-catalyzed hydropropargylation of enamides: a useful method for the preparation of 4-pentynylamine derivatives - Journal of Antibiotics

Re(I)-catalyzed hydropropargylation of enamides: a useful method for the preparation of 4-pentynylamine derivatives

Re(I)-catalyzed hydropropargylation of enamides: a useful method for the preparation of 4-pentynylamine derivatives, Published online: 07 March 2019; doi:10.1038/s41429-019-0162-3

Re(I)-catalyzed hydropropargylation of enamides: a useful method for the preparation of 4-pentynylamine derivatives

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McDaniel Life-Line LLC Issues Voluntary Worldwide Recall of Life-Line Water - FDA Safety Alerts & Drug Recalls

McDaniel Life-Line LLC is voluntarily recalling all lots of Life-Line Water to the consumer level. This product is being recalled because FDA analysis found the product to be contaminated with Pseudomonas aeruginosa.

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FDA approves new nasal spray medication for treatment-resistant depression; available only at a certified doctor’s office or clinic - FDA Press Releases

FDA approved Spravato (esketamine) nasal spray, in conjunction with an oral antidepressant, for the treatment of depression in adults with treatment-resistant depression

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The Overlap Between Falls and Delirium in Hospitalized Older Adults - Geriatrics

Falls frequently occur in persons with cognitive impairment, including delirium. This article presents a systematic review of the association between falls and delirium in adults aged 65 years or older. For the studies that compared falls and delirium, the risk ratio was consistently elevated (median RR 4.5, range 1.4–12.6) and statistically significant in all but one study. These results suggest that falls and delirium are inextricably linked. There is a need to further refine fall risk assessment tools and protocols to specifically include delirium for consideration as a risk factor that needs additional assessment and management.

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Statement from FDA Commissioner Scott Gottlieb, M.D., and Susan Mayne, Ph.D., director of the Center for Food Safety and Applied Nutrition, on tests confirming a 2017 finding of asbestos contamination in certain cosmetic products and new steps that FDA is pursuing to improve cosmetics safety - FDA Press Releases

Statement from FDA Commissioner Scott Gottlieb, M.D., and Susan Mayne, Ph.D., director of the Center for Food Safety and Applied Nutrition, on tests confirming a 2017 finding of asbestos contamination in certain cosmetic products and new steps that FDA is pursuing to improve cosmetics safety

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Statement from FDA Commissioner Scott Gottlieb, M.D., on forceful new actions focused on retailers, manufacturers to combat youth access to e-cigarettes as part of FDA’s Youth Tobacco Prevention Plan - FDA Press Releases

Statement from FDA Commissioner Scott Gottlieb, M.D., on forceful new actions focused on retailers, manufacturers to combat youth access to e-cigarettes as part of FDA’s Youth Tobacco Prevention Plan.

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Apotex Corp. Issues Voluntary Nationwide Recall of Drospirenone and Ethinyl Estradiol Tablets, USP, 28x3 Blister Pack/Carton Due to Possibility of Missing/Incorrect Tablet Arrangement - FDA Safety Alerts & Drug Recalls

Weston, Florida, Apotex Corp. is voluntarily recalling four lots of Drospirenone and Ethinyl Estradiol Tablets, USP to the patient /user level. The four recalled lots of Drospirenone and Ethinyl Estradiol Tablets, USP may possibly contain defective blisters with incorrect tablet arrangements and/or an empty blister pocket. The affected product is manufactured by Oman Pharmaceutical Products Co. LLC. Oman under the subcontract from Helm AG, Nordkanalstrasse 28, Hamburg, 20097, Germany.

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Geriatric Polypharmacy - Geriatrics

This article highlights the significant health impact of falls among older adults. An emphasis is placed on the vital role of the pharmacist, regardless of practice setting, in assessing and reducing falls risk for this growing population. In addition, the importance of a stepwise comprehensive approach to falls assessment by pharmacists in collaboration with other clinicians is elucidated.

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Older Adult Falls in Emergency Medicine - Geriatrics

“Standing-level falls represent the most frequent cause of trauma-related death in older adults and a common emergency department (ED) presentation. However, these patients rarely receive guideline-directed screening and interventions during or following an episode of care. Reducing injurious falls in an aging society begins with prehospital evaluations and continues through definitive risk assessments and interventions that usually occur after ED care. Although ongoing obstacles to ED-initiated, evidence-based older adult fall-reduction strategies include the absence of a compelling emergency medicine evidence basis, innovations under way include validation of pragmatic screening instruments and incorporation of contemporary technology to improve fall detection rates.”

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Preventing Falls in Hospitalized Patients - Geriatrics

Falls in hospitalized patients are a pressing patient safety concern, but there is a limited body of evidence demonstrating the effectiveness of commonly used fall prevention interventions in hospitals. This article reviews common study designs and the evidence for various hospital fall prevention interventions. There is a need for more rigorous research on fall prevention in the hospital setting.

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Redesigning a Fall Prevention Program in Acute Care - Geriatrics

Through education, frontline nurse involvement, and redesigning fall prevention approach, hourly rounding was promoted as a proactive falls prevention strategy with the goal of decreasing falls and promoting patient safety, health, and comfort. Nurses in health care organizations increase patient safety and reduce patient falls in the hospital setting through hourly rounding with a purpose. Current practices must be redesigned to ensure that acute care fall prevention initiatives are consistent and transformational.

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Outcomes of Patient-Engaged Video Surveillance on Falls and Other Adverse Events - Geriatrics

Patient-engaged video surveillance implemented in 71 hospitals over 1 year revealed low rates in assisted and unassisted falls, room elopement, and line, tube, or drain dislodgement per 1000 days of surveillance. Monitor technicians interacted 20.5 times per day with patients who fell and initiated alarms for urgent unit staff response 2.38 times per day, and this accounted for the low fall rate (1.50 falls/1000 days of surveillance) in an adult population. Data on adverse events and timeliness of nursing response to actual urgent and emergent patient conditions provides evidence of the rapid contribution of patient-engaged video surveillance to patient safety.

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Optimizing Function and Physical Activity in Hospitalized Older Adults to Prevent Functional Decline and Falls - Geriatrics

Physical activity, defined as bodily movement that expends energy including such things as bed mobility, transfers, bathing, dressing, and walking, has a positive impact on physical and psychosocial outcomes among older adults during their hospitalization and the post hospitalization recovery period. Despite benefits, physical activity is not the focus of care in the acute care setting. Further there are many barriers to engaging patients in physical activity and fall prevention activities including patient, family and provider beliefs, environmental challenges and limitations, hospital policies, and medical and nursing interventions. This paper provides an overview of falls and physical activity prevalence among acute care patients, challenges to engaging patients in physical activity and falls prevention activities and innovative approaches to increase physical activity and prevent falls among older hospitalized patients.

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Despite Active Public Health Campaigns, Death from Falls Increased 30% in the Past Decade - Geriatrics

Public health messaging campaigns stating that falls are bad and can be prevented are not effective, as evidenced by a 30% increase in death from falls over the past decade. A first approach is to use measures of balance to show the magnitude of the problem. Second, the role of ageism as a barrier to required behavioral change should be addressed. Third, explanations should be provided regarding why mobility and balance have changed. As a counter to ageism, pros and cons for specific interventions and how these maximize momentum and mobility should be discussed

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Falls, Footwear, and Podiatric Interventions in Older Adults - Geriatrics

Footwear is a modifiable risk factor for falls in older adults, including populations with metabolic disease, inflammatory arthritis, and neurodegenerative disease. Ill-fitting footwear, and specific design features, such as elevated heels and backless styles, can impair balance control and heighten the risk of falling. Although foot care is routine practice for some older adults to prevent ulceration (eg, diabetes) or relieve symptoms (eg, foot pain), new footwear interventions are emerging with the potential to ameliorate balance and walking impairments. Multifaceted podiatric interventions, which include appropriate footwear and importantly patient education, may have the capacity to reduce falls in older adults.

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Sunstone Organics Issues Voluntary Nationwide Recall of Select Kratom Products Due to Potential Contamination by Salmonella - FDA Safety Alerts & Drug Recalls

Springfield, OR, Sunstone Organics is voluntarily recalling two lots of Sunstone Organics Kratom. These two lots include Sunstone Organics White Vein Kratom Lot 119 and Sunstone Organics Maeng Da Kratom Lot 124A in both capsules and powder form and in all sizes. The products have been found to potentially be contaminated with salmonella.

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Updated: Torrent Pharmaceuticals Limited Issues Voluntary Nationwide Recall of Losartan Potassium Tablets, USP and Losartan Potassium /Hydrochlorothiazide Tablets, USP - FDA Safety Alerts & Drug Recalls

Torrent Pharmaceuticals Limited is voluntarily recalling 60 lots of Losartan potassium tablets USP and 54 lots of Losartan potassium/ hydrochlorothiazide tablets, USP, to the consumer level due to the detection of trace amounts of an unexpected impurity found in an active pharmaceutical ingredient (API) manufactured by Hetero Labs Limited.

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Asia Foods Distributor Inc. Issues Allergy Alert on Undeclared Milk Allergens in “Nova Salted Biscuit” - FDA Safety Alerts & Drug Recalls

Asia foods Distributor Inc of 56-29 56 Drive, Maspeth, NY 11378 is recalling its 14.08 ounce packages of “Nova Salted Biscuit” food treats because they may contain undeclared milk allergens. Consumers who are allergic to milk allergens may run the risk of serious or lifethreatening allergic reactions if they consume this product.

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AurobindoPharma USA, Inc. Initiates a Voluntary Nationwide Consumer Level Recall Expansion of 38 Lots of Amlodipine Valsartan Tablets USP and Valsartan Tablets, USP due to the detection of NDEA (N-Nitrosodiethylamine) Impurity. - FDA Safety Alerts & Drug Recalls

AurobindoPharma USA, Inc. is conducting a voluntary recall expansion of 38 lots of Valsartan and Amlodipine and Valsartan tablets to the consumer level due to the detection of trace amounts of an unexpected impurity found in the finished drug product. This recall is an expansion of the recall initiated 12/31/18 The impurity detected in the finished drug product is N-nitrosodiethylamine (NDEA), which is a substance that occurs naturally in certain foods, drinking water, air pollution, and industrial processes, and has been classified as a probable human carcinogen as per International Agency for Research on Cancer (IARC) classification. The expansion relates to lots distributed under the labels for AurobindoPharma USA, Inc. and Acetris Health, LLC. To date, AurobindoPharma USA, Inc. has not received any reports of adverse events related to this recall.

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FDA provides update on its ongoing investigation into ARB drug products; reports on finding of a new nitrosamine impurity in certain lots of losartan and product recall - FDA Press Releases

FDA provides update on ongoing investigation into ARB drugs; new losartan recall announced

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