FDA In Brief: FDA advances policies related to bolstering security of drug products in the U.S. supply chain - FDA Press Releases

FDA issues drug supply chain guidances to alert industry of changes to pharmaceutical product identification and tracing procedures.

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Association of Symptoms of Obstructive Lung Disease and All‐Cause Mortality in Older Adult Smokers - American Geriatric Society

OBJECTIVES

This study aims to investigate the impact of respiratory symptoms in current and former smokers with and without obstructive lung disease (OLD) on all‐cause mortality.

DESIGN

Secondary analysis in a prospective cohort (the Health, Aging and Body Composition study).

SETTING

Memphis, Tennessee, and Pittsburgh, Pennsylvania.

PARTICIPANTS

Black and white men and women with a history of current and former smoking (N = 596; 63% male and 37% female) aged 70‐79 years followed for 13 years. Participants were categorized into 4 mutually exclusive groups based on symptom profile and forced expiratory volume in the 1st second to forced vital capacity ratio. The groups were Less Dyspnea‐No OLD (N = 196), More Dyspnea‐No OLD (N = 104), Less Dyspnea‐With OLD (N = 162), and More Dyspnea‐With OLD (N = 134).

MEASUREMENTS

All‐cause mortality.

RESULTS

Overall, 53% in Less Dyspnea‐No OLD, 63% in More Dyspnea‐No OLD, 67% in Less Dyspnea‐With OLD, and 84% in More Dyspnea‐With OLD died within the 13‐ year follow up period (log‐rank χ² = 44.4, P < .0001). The hazard ratio was highest for participants with OLD, both with (HR =1.91, 95% CI 1.44 ‐ 2.54; P < .0001) and without dyspnea (HR = 1.52, 95% CI 1.15 ‐ 2.02; p = .004). Participants without OLD but with dyspnea had a similar risk of death to subjects who had OLD but fewer symptoms.

CONCLUSIONS

OLD is associated with high risk of death with different risk profiles based on symptom group. Patients with symptoms of shortness of breath without OLD should be considered an at‐risk group given their similar mortality to those with OLD with minimal symptoms.

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The MedSafer Study: A Controlled Trial of an Electronic Decision Support Tool for Deprescribing in Acute Care - American Geriatric Society

OBJECTIVES

Polypharmacy is common, costly, and harmful for hospitalized older adults. Scalable strategies to reduce the burden of potentially inappropriate medications (PIMs) are needed. We sought to leverage medication reconciliation in hospitalized older adults by pairing with MedSafer, an electronic decision support tool for deprescribing.

DESIGN

This was a nonrandomized controlled before‐and‐after study.

SETTING

The study took place on four internal medicine clinical teaching units.

PARTICIPANTS

Subjects were aged 65 years and older, had an expected prognosis of 3 or more months, and were taking five or more usual home medications.

INTERVENTION

In the baseline phase, patients received usual care that was medication reconciliation. Patients in the intervention arm also had a “deprescribing opportunity report” generated by MedSafer and provided to their in‐hospital treating team.

MEASUREMENTS

The primary outcome was ascertained at the time of hospital discharge and was the proportion of patients who had one or more PIMs deprescribed.

RESULTS

A total of 1066 patients were enrolled, and deprescribing opportunities were present for 873 (82%; 418 during the control and 455 during the intervention phases, respectively). The proportion of patients with one or more PIMs deprescribed at discharge increased from 46.9% in the control period to 54.7% in the intervention period with an adjusted absolute risk difference of 8.3% (2.9%‐13.9%). Not all classes of drugs in the intervention arm were associated with an increase in deprescribing, and new PIM starts were equally common in both arms of the study.

CONCLUSION

Using an electronic decision support tool for deprescribing, we increased the proportion of patients with one or more PIMs deprescribed at hospital discharge as compared with usual care. Although this type of intervention may help address medication overload in hospitalized patients, it also underscores the importance of powering future trials for a reduction in adverse drug events.

Trial registration: NCT02918058.

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FDA warns patients and health care providers about potential cybersecurity concerns with certain Medtronic insulin pumps - FDA Press Releases

FDA warns patients and providers that certain Medtronic MiniMed insulin pumps are recalled due to potential cybersecurity risks and recommends patients switch to models better equipped to protect against these potential risks.

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FDA approves first treatment for neuromyelitis optica spectrum disorder, a rare autoimmune disease of the central nervous system - FDA Press Releases

FDA approves Soliris (eculizumab) injection for intravenous use for the treatment of neuromyelitis optica spectrum disorder (NMOSD) in adult patients who are anti-aquaporin-4 (AQP4) antibody positive.

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FDA issues third status report on investigation into potential connection between certain diets and cases of canine heart disease - FDA Press Releases

This press release highlights an update on the FDA’s investigation into a potential connection between certain diets and cases of canine heart disease

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Association Between Postextubation Dysphagia and Long‐Term Mortality Among Critically Ill Older Adults - American Geriatric Society

BACKGROUND

Dysphagia following extubation is common in intensive care unit (ICU) patients. Diagnosing postextubation dysphagia allows identification of patients who are at highest risk for aspiration and its associated adverse outcomes. Older adults are at an increased risk of postextubation dysphagia and its complications due to multiple comorbidities, a higher baseline risk of dysphagia, and increased risk of pneumonia.

OBJECTIVES

We aimed to investigate the association between postextubation dysphagia and 1‐year mortality in older patients. Secondary outcomes included ICU and hospital lengths of stay, ICU readmission, and place of discharge.

METHODS

We performed a retrospective cohort study from January 1 to December 31, 2013. ICU patients, aged 65 years and older, who were successfully extubated and underwent a formal swallow evaluation by a speech and language pathologist (SLP) were included. Dysphagia was graded using a seven‐point scale, and those with at least mild‐moderate dysphagia were labeled as having clinically significant dysphagia.

RESULTS

Of 1075 patients who were screened, 359 were survivors, aged 65 years and older; and of these survivors, 111 had a swallow evaluation performed by an SLP after liberation from mechanical ventilation. Mean age was 73.8 years (SD = 7.0 years), and 41.4% had clinically significant dysphagia. In a multivariable regression model, there was no significant association between dysphagia and 1‐year mortality. Furthermore, there was no statistically significant difference in ICU or hospital length of stay, ICU readmission, or place of discharge of those with clinically significant dysphagia compared to those without.

CONCLUSIONS

Among mechanically ventilated ICU patients, aged 65 years and older, who underwent a swallow evaluation following extubation, dysphagia was not associated with mortality, ICU and hospital lengths of stay, ICU readmission, and place of discharge. Given conflicting evidence in the literature, larger prospective studies are needed to clarify whether postextubation dysphagia is associated with worse outcomes in older patients admitted to the ICU.

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Geriatric Syndromes in Older Adults Living with HIV and Cognitive Impairment - American Geriatric Society

Objectives

Nearly half of the population living with human immunodeficiency virus (HIV) in the United States is now older than 50 years with at least 6% over age 65. Between 35% and 50% live with mild to moderate cognitive impairment. Older persons living with HIV (PLWH) also have a substantial burden of HIV‐associated non‐acquired immunodeficiency syndrome medical conditions and are at risk for frailty, geriatric syndromes, and early mortality compared with HIV‐uninfected peers. We sought to define the magnitude of geriatric conditions and multimorbidity in PLWH older than 60 years who are living with symptomatic cognitive impairment. In a subset of participants, we examined associations between these geriatric conditions.

Design

Retrospective cohort study.

Setting

HIV Elders Study at the University of California, San Francisco, Memory and Aging Center.

Participants

Participants were HIV infected, virally suppressed, 60 years or older, and clinically diagnosed with mild neurocognitive disorder (MND).

Measurements

We conducted standardized assessment of geriatric conditions and everyday function and investigated multimorbidity burden using the Veterans Aging Cohort Study (VACS) index.

Results

Among 141 older PLWH with MND, 58% report incontinence, 55% meet criteria for pre‐frailty, and a substantial proportion report dependence with instrumental activities of daily living (52%) or activities of daily living (41%). The mean VACS index score is 33 (standard deviation = 14), suggesting a 13.8% 5‐year all‐cause mortality risk.

Conclusions

Older PLWH with symptomatic cognitive impairment carry a substantial burden of other geriatric conditions. Our work supports the need for comprehensive geriatric systems of care for cognitively impaired individuals aging with HIV.

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Impact of Social Network on the Risk and Consequences of Injurious Falls in Older Adults - American Geriatric Society

OBJECTIVES

A smaller social network is associated with worse health‐related outcomes in older people. We examined the impact of social connections and social support on the risk of injurious fall and on fall‐related functional decline and mortality.

DESIGN

Prospective study with 6‐year follow‐up.

SETTING

Community.

PARTICIPANTS

A total of 2630 participants (aged ≥60 years) from the Swedish National Study on Aging and Care in Kungsholmen.

MEASUREMENTS

Social connections (social network size and contact frequency) and social support (social resource perception and satisfaction) were assessed through validated questionnaires. Data on injurious falls (falls requiring inpatient or outpatient care) and mortality came from official registers. We defined injurious falls as severe if they caused fracture and/or intracranial injury and as multiple if two or more occurred during the 6‐year follow‐up. Functional decline was defined as the loss of ability to perform one or more activities of daily living during the follow‐up.

RESULTS

During the follow‐up, 322 participants experienced injurious falls. After adjusting for potential confounders, the hazard ratio of injurious falls was 1.7 (95% confidence interval [CI] = 1.1‐2.4) for people with poor social connections and 1.5 (95% CI = 1.1‐2.1) for people with moderate social connections (reference: rich social connections). Social support was not associated with fall risk. The odds of functional decline among those with severe/multiple falls and (1) poor social connections (odds ratio [OR] = 5.2 [95% CI = 2.1‐12.9]) or (2) poor social support (OR = 4.5 [95% CI = 1.7‐12.0]) was up to twice as high as among those with severe/multiple falls and (3) rich social connections (OR = 2.5 [95% CI = .9‐6.6]) or (4) rich social support (OR = 2.7 [95% CI = 1.2‐6.3]). Similar but more attenuated results emerged for mortality.

CONCLUSIONS

Social network may influence fall risk and fall‐related functional decline and mortality.

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Pyrazinamide may possess cardioprotective properties - Journal of Antibiotics

The Journal of Antibiotics, Published online: 27 June 2019; doi:10.1038/s41429-019-0202-z

Pyrazinamide may possess cardioprotective properties

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FDA approves first treatment for chronic rhinosinusitis with nasal polyps - FDA Press Releases

FDA approves Dupixent to treat adults with nasal polyps accompanied by chronic rhinosinusitis or prolonged inflammation of the sinuses and nasal cavity.

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Cyclic tetrapeptides from the marine strain Streptomyces sp. PNM-161a with activity against rice and yam phytopathogens - Journal of Antibiotics

The Journal of Antibiotics, Published online: 26 June 2019; doi:10.1038/s41429-019-0201-0

Cyclic tetrapeptides from the marine strain Streptomyces sp. PNM-161a with activity against rice and yam phytopathogens

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Statement on stem cell clinic permanent injunction and FDA’s ongoing efforts to protect patients from risks of unapproved products - FDA Press Releases

Statement by Acting FDA Commissioner Ned Sharpless, M.D., and Biologics Center Director Peter Marks, M.D., Ph.D. on stem cell clinic permanent injunction and FDA’s ongoing efforts to protect patients from risks of unapproved products

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FDA issues warnings to companies selling illegal, unapproved kratom drug products marketed for opioid cessation, pain treatment and other medical uses - FDA Press Releases

FDA issued warning letters to two marketers and distributors of kratom products – Cali Botanicals and Kratom NC– for illegally selling unapproved, misbranded kratom-containing drug products with unproven claims about their ability to treat or cure opioid addiction and withdrawal symptoms.

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Establishing the First Geriatric Medicine Fellowship Program in Ghana - American Geriatric Society

As life expectancy in Ghana improves, a large and growing population of older adults require healthcare. Despite governmental support for the care of older adults, there have been no geriatricians and no in‐country educational path for those desiring to become specialists in this field. In fact, 23 of 54 countries in sub‐Saharan Africa (SSA) lack even a single geriatrician. We describe a novel and collaborative approach used to develop the first geriatric training fellowship in Ghana. Faculty from the Ghana College of Physicians and Surgeons and the University of Michigan worked together to develop a rigorous and evidence‐based geriatrics curriculum, based on US standards but adapted to be appropriate for the cultural, economic, educational, and social norms in Ghana. This approach led to a strong training model for care of older adults while also strengthening the ongoing collaboration between the two partner universities in Ghana and the United States. The fellowship has been inaugurated in Ghana and can serve as a concrete educational model for other countries in SSA.

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Tunicamycin: chemical synthesis and biosynthesis - Journal of Antibiotics

The Journal of Antibiotics, Published online: 25 June 2019; doi:10.1038/s41429-019-0200-1

Tunicamycin: chemical synthesis and biosynthesis

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Management of Sleep Disorders in Community‐Dwelling Older Women and Men at the Time of Diagnosis - American Geriatric Society

Objectives

Sedative and hypnotic medications are associated with harm, and guidelines suggest limiting their use. Only limited evidence has described how older adults are managed following an initial sleep disorder diagnosis. We aimed to describe clinical management patterns of sleep disorders in older women and men at the time of initial diagnosis.

Design

Population‐based retrospective cohort study using linked administrative databases.

Setting

Ontario, Canada.

Participants

Community‐dwelling adults aged 66 and older, diagnosed with a new sleep disorder by a primary care provider (n = 30 729; 56% women and 44% men). We compared women and men for each outcome.

Measurements

The primary outcome was prescription of a medication used for sleep within 30 days of a new sleep disorder diagnosis. Additional analysis included medical investigations such as sleep studies and visits to specialists who manage obstructive sleep disorders within 90 days of diagnosis.

Results

Among the 30 729 older adults with a new sleep disorder diagnosis, 5512 (17.9% total; 18.8% of women and 16.9% of men) were prescribed a medication used for sleep. Compared with men, women were somewhat more likely to be prescribed at least one sedative medication (adjusted odds ratio = 1.09; 95% confidence interval = 1.03‐1.16). A total of 2573 (8.4%) older adults underwent a sleep study, and 3743 (12.2%) were evaluated by a specialist; both occurred more commonly in men.

Conclusion

In our cohort, almost 1 in 5 older adults with a new sleep disorder diagnosis were prescribed a medication used for sleep; of these, a higher proportion were women. Comparatively few older adults were further evaluated; of these, a higher proportion were men. Our study highlights the high rates at which medications are prescribed to older adults with a new sleep disorder diagnosis and identifies potential sex differences in the management of such diagnoses. J Am Geriatr Soc 1–8, 2019.

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FDA approves new treatment for hypoactive sexual desire disorder in premenopausal women - FDA Press Releases

FDA approved Vyleesi (bremelanotide) to treat acquired, generalized hypoactive sexual desire disorder (HSDD) in premenopausal women.

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FDA expands approval of treatment for cystic fibrosis to include patients ages 6 and older - FDA Press Releases

FDA expanded the indication for Symdeko for treatment of pediatric patients ages 6 years and older with cystic fibrosis who have certain genetic mutations.

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Statement on agency’s efforts to increase transparency in medical device reporting - FDA Press Releases

The FDA is taking a number of important steps to update its Medical Device Reporting Program.

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Forthcoming Issues - Geriatrics

Cardiac Rehabilitation

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Contents - Geriatrics

William B. Ershler

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Contributors - Geriatrics

WILLIAM B. ERSHLER, MD

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Copyright - Geriatrics

ELSEVIER

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Anemia in Older Adults - Geriatrics

CLINICS IN GERIATRIC MEDICINE

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Anemia in the Elderly: Not to be Ignored - Geriatrics

Readers of Clinics in Geriatric Medicine are well aware of the demographic shifts throughout all world populations—industrialized or not—resulting in constantly increasing numbers of old and very-old individuals. Some of this is based upon increased birth rates after the Second World War, but also longer survival resulting from healthier life style and reduction in early deaths from acute illnesses including infection, coronary artery disease and cancer. As a consequence, chronic diseases such as diabetes, atherosclerotic vascular disease, arthritis and Alzheimer’s have become more prevalent, as has the numbers of patients with two or more of these chronic illnesses (comorbidities).

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Synthesis and insecticidal efficacy of pyripyropene derivatives. Part II—Invention of afidopyropen - Journal of Antibiotics

The Journal of Antibiotics, Published online: 20 June 2019; doi:10.1038/s41429-019-0193-9

Synthesis and insecticidal efficacy of pyripyropene derivatives. Part II—Invention of afidopyropen

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Incidence of Dementia and Alzheimer Disease Over Time: A Meta‐Analysis - American Geriatric Society

BACKGROUND/OBJECTIVES

Population‐based incidence estimates of dementia and Alzheimer disease (AD) provide important information for public health policy and resource allocation. We conducted a meta‐analysis of published studies that reported age‐specific incidence rates of dementia and AD to determine whether dementia and AD incidence rates are changing over time.

DESIGN

PubMed and MEDLINE were searched for publications through June 30, 2017, using key words “dementia”, “Alzheimer”, and “incidence.” Inclusion criteria for the meta‐analysis are: (1) population‐based studies using personal interviews and direct examinations of the study subjects, (2) standardized clinical diagnosis criteria, (3) reporting age‐specific incidence rates, (4) published in English, and (5) sample size of 500 or greater and length of follow‐up of 2 years or greater. Mixed‐effects models were used to determine the association between birth year and incidence rates.

MEASUREMENTS

Age‐specific dementia/AD incidence rates and their standard errors reported in each study.

RESULTS

Thirty‐eight articles with 53 cohorts on dementia incidence and 31 articles with 35 cohorts on AD incidence met the inclusion criteria. There were significant associations between later birth years and decreased dementia incidence rates in all three age groups (65‐74, 75‐84, and 85 years and older). There were no significant associations between birth year and AD incident rates in any of the three age groups. In particular, AD incidence rates reported from Western countries stayed steady in all age groups, while studies in non‐Western countries showed significantly increased AD incidence rates for the 65 to 74 years age group (odds ratio = 2.78; P = .04), but a nonsignificant association for the 75 to 84 or 85 years and older groups.

CONCLUSION

Dementia incidence declined over the past four decades, but AD incidence did not decline. Further research, especially from non‐Western countries, is needed to elucidate the mechanism underlying the trends in dementia and AD incidence over time.

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The Importance of Birth Year for the Incidence of Dementia - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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The Bundled Hospital Elder Life Program—HELP and HELP in Home Care—and Its Association With Clinical Outcomes Among Older Adults Discharged to Home Healthcare - American Geriatric Society

OBJECTIVES

To describe the Bundled Hospital Elder Life Program (HELP and HELP in Home Care), an adaptation of HELP, and examine the association of 30‐day all‐cause unplanned hospital readmission risk among older adults discharged to home care with and without Bundled HELP.

DESIGN

Matched case‐control study.

SETTING

Two medical‐surgical units within two midwestern rural hospitals and patient homes (home health).

PARTICIPANTS

Hospitalized patients, aged 65 years and older, discharged to home healthcare with and without Bundled HELP exposure between January 1, 2015, and September 30, 2017. Each case (Bundled HELP, n = 148) was matched to a control (non‐Bundled HELP, n = 148) on Charlson Comorbidity Index, primary hospital diagnosis of orthopedic condition or injury, and cardiovascular disease using propensity score matching.

MEASUREMENTS

The primary study outcome was 30‐day all‐cause unplanned hospital readmission. Additional outcomes measured were 30‐day emergency department (ED) visit, hospital length of stay (LOS), and total number of skilled home care visits.

RESULTS

Fewer cases (16.8%) than controls (28.4%) had a 30‐day all‐cause unplanned hospital readmission. The fully adjusted model showed significantly lower risk of 30‐day hospital readmission for case (Bundled HELP) patients (0.41; 95% confidence interval = 0.22‐0.77; P < .01). The difference between case (10.8%) and control (15.5%) 30‐day ED visit was not significant (P = .23). A lower LOS for the case group was shown (P < .01), while the number of skilled home care visits was not significantly different between groups (P = .28).

CONCLUSION

HELP protocol implementation during a patient's hospital stay and as a continued component of home care among older adults at risk for cognitive and/or functional decline appears to be associated with favorable outcomes. Our initial evaluation supports continued study of the Bundled HELP. Further research is needed to confirm the initial findings and to evaluate the impact of the adapted model on functional outcomes and delirium incidence in the home. J Am Geriatr Soc 00:1–7, 2019.

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Statement on the FDA’s benefit-risk framework for evaluating opioid analgesics - FDA Press Releases

FDA issues a new draft guidance on the application of the benefit-risk assessment framework for evaluating applications for opioids.

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Adult Day Service Use Decreases Likelihood of a Missed Physician's Appointment Among Dementia Caregivers - American Geriatric Society

BACKGROUND/OBJECTIVE

Adult day services (ADSs) that provide community‐based supervised support for persons with dementia (PWD) may also function as a respite for familial caregivers to attend to self‐care needs. Guided by a revised version of the Andersen Healthcare Utilization Model, the objective of this study was to identify the association between use of ADSs and a missed physician's appointment among family caregivers for community‐dwelling familial PWD. A secondary objective was to identify other predisposing, enabling, and need factors associated with a missed physician's appointment.

DESIGN

Secondary analysis of baseline, cross‐sectional data from two randomized controlled trials (Advancing Caregiver Training, n = 272; and Care of Persons With Dementia in Their Environments, n = 237).

SETTING

Community.

PARTICIPANTS

Community‐dwelling caregivers for PWD (n = 509).

MEASUREMENTS

Missed physician's appointment was measured using the caregivers' self‐report of one or more missed physician's appointments (yes/no) in the past 6 months. ADS use was measured using the caregivers’ self‐report of ADS use (yes/no).

RESULTS

Over a third of the caregivers utilized ADSs for their PWD. Caregivers who utilized ADSs for their familial PWD were 49% less likely (95% confidence interval = 0.32‐0.81) to miss a physician's appointment in the past 6 months. More black compared to white caregivers missed appointments regardless of ADS use. Caregivers with increased chronic health conditions were more likely to miss a physician's appointment compared to those with fewer conditions.

CONCLUSION

ADSs’ provision of respite enables caregivers the time to address self‐care needs by decreasing the likelihood that caregivers miss a physician's appointment. Findings suggest that ADSs may promote positive health behaviors for caregivers and should be expanded as part of comprehensive dementia care for families. Factors associated with missed physician appointments need further examination and intervention to support black caregivers.

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Corrigendum - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Isolation and characterization of side-products formed through ∆2-isomerization in the synthesis of cefpodoxime proxetil - Journal of Antibiotics

The Journal of Antibiotics, Published online: 19 June 2019; doi:10.1038/s41429-019-0190-z

Isolation and characterization of side-products formed through ∆2-isomerization in the synthesis of cefpodoxime proxetil

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Effect of Vitamin K2 on Postural Sway in Older People Who Fall: A Randomized Controlled Trial - American Geriatric Society

OBJECTIVES

Vitamin K is thought to be involved in both bone health and maintenance of neuromuscular function. We tested the effect of vitamin K2 supplementation on postural sway, falls, healthcare costs, and indices of physical function in older people at risk of falls.

DESIGN

Parallel‐group double‐blind randomized placebo‐controlled trial.

SETTING

Fourteen primary care practices in Scotland, UK.

PARTICIPANTS

A total of 95 community‐dwelling participants aged 65 and older with at least two falls, or one injurious fall, in the previous year.

INTERVENTION

Once/day placebo, 200 μg or 400 μg of oral vitamin K2 for 1 year.

MEASUREMENTS

The primary outcome was anteroposterior sway measured using sway plates at 12 months, adjusted for baseline. Secondary outcomes included the Short Physical Performance Battery, Berg Balance Scale, Timed Up & Go Test, quality of life, health and social care costs, falls, and adverse events.

RESULTS

Mean participant age was 75 (standard deviation [SD] = 7) years. Overall, 58 of 95 (61%) were female; 77 of 95 (81%) attended the 12‐month visit. No significant effect of either vitamin K2 dose was seen on the primary outcome of anteroposterior sway (200 μg vs placebo: −.19 cm [95% confidence interval [CI] −.68 to .30; P = .44]; 400 μg vs placebo: .17 cm [95% CI −.33 to .66; P = .50]; or 400 μg vs 200 μg: .36 cm [95% CI −.11 to .83; P = .14]). Adjusted falls rates were similar in each group. No significant treatment effects were seen for other measures of sway or secondary outcomes. Costs were higher in both vitamin K2 arms than in the placebo arm.

CONCLUSION

Oral vitamin K2 supplementation did not improve postural sway or physical function in older people at risk of falls.

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Joint AGS‐CCEHI Survey Offers Insights into Patient Engagement in Geriatric Clinical Settings - American Geriatric Society

OBJECTIVES

Many clinical practices and health systems are increasingly interested in adopting structures for consumer engagement to inform organizational policies and programs. These structures can include patient and family advisory committees, patient representation on an organization's board of directors, or inclusion of patients and family members in quality improvement activities. However, to date only limited information has been available on the uptake of patient engagement strategies and structures, and none specific to geriatrics. We surveyed American Geriatrics Society (AGS) members to ascertain how and when consumer engagement is occurring in the clinical settings where AGS members provide care, and to identify opportunities to improve engagement.

DESIGN

Descriptive survey.

PARTICIPANTS

A total of 20% (829) of eligible AGS members responded to this section of the survey.

MEASUREMENTS

Respondents’ primary work site, methods and staffing of patient and family engagement, barriers to engagement, and strategies to improve engagement.

RESULTS

The most common methods of engagement were through advisory committees (28%), quality improvement and program evaluations (27%), and focus groups (21%). However, more than one‐third of respondents (35%) said they were not sure whether their clinical setting had any structures or strategies in place for consumer engagement. Respondents identified barriers to engagement as well as the tools and information that would help improve engagement.

CONCLUSION

The survey findings provide insight into what patient engagement looks like in the hospitals, health systems, and other clinical settings where geriatrics health professionals work. Making structures for patient and family engagement more widespread in geriatric practice settings will require addressing the barriers identified by survey respondents including the need for funding and staff time, transportation, and training and supports for participating patients and caregivers.

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A Practical Two‐Stage Frailty Assessment for Older Adults Undergoing Aortic Valve Replacement - American Geriatric Society

Objectives

Despite evidence, frailty is not routinely assessed before cardiac surgery. We compared five brief frailty tests for predicting poor outcomes after aortic valve replacement and evaluated a strategy of performing comprehensive geriatric assessment (CGA) in screen‐positive patients.

Design

Prospective cohort study.

Setting

A single academic center.

Participants

Patients undergoing surgical aortic valve replacement (SAVR) (n = 91; mean age = 77.8 y) or transcatheter aortic valve replacement (TAVR) (n = 137; mean age = 84.5 y) from February 2014 to June 2017.

Measurements

Brief frailty tests (Fatigue, Resistance, Ambulation, Illness, and Loss of weight [FRAIL] scale; Clinical Frailty Scale; grip strength; gait speed; and chair rise) and a deficit‐accumulation frailty index based on CGA (CGA‐FI) were measured at baseline. A composite of death or functional decline and severe symptoms at 6 months was assessed.

Results

The outcome occurred in 8.8% (n = 8) after SAVR and 24.8% (n = 34) after TAVR. The chair rise test showed the highest discrimination in the SAVR (C statistic = .76) and TAVR cohorts (C statistic = .63). When the chair rise test was chosen as a screening test (≥17 s for SAVR and ≥23 s for TAVR), the incidence of outcome for screen‐negative patients, screen‐positive patients with CGA‐FI of .34 or lower, and screen‐positive patients with CGA‐FI higher than .34 were 1.9% (n = 1/54), 5.3% (n = 1/19), and 33.3% (n = 6/18) after SAVR, respectively, and 15.0% (n = 9/60), 14.3% (n = 3/21), and 38.3% (n = 22/56) after TAVR, respectively. Compared with routinely performing CGA, targeting CGA to screen‐positive patients would result in 54 fewer CGAs, without compromising sensitivity (routine vs targeted: .75 vs .75; P = 1.00) and specificity (.84 vs .86; P = 1.00) in the SAVR cohort; and 60 fewer CGAs with lower sensitivity (.82 vs.65; P = .03) and higher specificity (.50 vs .67; P < .01) in the TAVR cohort.

Conclusions

The chair rise test with targeted CGA may be a practical strategy to identify older patients at high risk for mortality and poor recovery after SAVR and TAVR in whom individualized care management should be considered.

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Investigating and Remediating Selection Bias in Geriatrics Research: The Selection Bias Toolkit - American Geriatric Society

OBJECTIVES

Selection bias is a well‐known concern in research on older adults. We discuss two common forms of selection bias in aging research: (1) survivor bias and (2) bias due to loss to follow‐up. Our objective was to review these two forms of selection bias in geriatrics research. In clinical aging research, selection bias is a particular concern because all participants must have survived to old age, and be healthy enough, to take part in a research study in geriatrics.

DESIGN

We demonstrate the key issues related to selection bias using three case studies focused on obesity, a common clinical risk factor in older adults. We also created a Selection Bias Toolkit that includes strategies to prevent selection bias when designing a research study in older adults and analytic techniques that can be used to examine, and correct for, the influence of selection bias in geriatrics research.

RESULTS

Survivor bias and bias due to loss to follow‐up can distort study results in geriatric populations. Key steps to avoid selection bias at the study design stage include creating causal diagrams, minimizing barriers to participation, and measuring variables that predict loss to follow‐up. The Selection Bias Toolkit details several analytic strategies available to geriatrics researchers to examine and correct for selection bias (eg, regression modeling and sensitivity analysis).

CONCLUSION

The toolkit is designed to provide a broad overview of methods available to examine and correct for selection bias. It is specifically intended for use in the context of aging research.

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Predicting Risk of Potentially Preventable Hospitalization in Older Adults with Dementia - American Geriatric Society

OBJECTIVES

Reducing potentially preventable hospitalization (PPH) among older adults with dementia is a goal of Healthy People 2020, yet no tools specifically identify patients with dementia at highest risk. The objective was to develop a risk prediction model to identify older adults with dementia at high imminent risk of PPH.

DESIGN

A 30‐day risk prediction model was developed using multivariable logistic regression. Patients from fiscal years (FY) 2009 to 2011 were split into development and validation cohorts; FY2012 was used for prediction.

SETTING

Community‐dwelling older adults (≥65 years of age) with dementia who received care through the Veterans Health Administration.

PARTICIPANTS

There were 1 793 783 participants.

MEASUREMENTS

Characteristics associated with hospitalization risk were (1) age and other demographic factors; (2) outpatient, emergency department, and inpatient utilization; (3) medical and psychiatric diagnoses; and (4) prescribed medication use including changes to psychotropic medications (eg, initiation or dosage increase). Model discrimination was determined by the C statistic for each of the three cohorts. Finally, to determine whether predicted 30‐day risk strata were stable over time, the observed PPH rate was calculated out to 1 year.

RESULTS

In the development cohort, .6% of patients experienced PPH within 30 days. The C statistic for the development cohort was .83 (95% confidence interval [CI] = .83‐.84) and .83 in the prediction cohort (95% CI = .82‐.84). Patients in the top 10% of predicted 30‐day PPH risk accounted for more than 50% of 30‐day PPH admissions in all three cohorts. In addition, those predicted to be at elevated 30‐day risk remained at higher risk throughout a year of follow‐up.

CONCLUSION

It is possible to identify older adults with dementia at high risk of imminent PPH, and their risk remains elevated for an entire year. Given the negative outcomes associated with acute hospitalization for those with dementia, healthcare systems and providers may be able to engage these high‐risk patients proactively to avoid unnecessary hospitalization.

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Statement on a new effort to improve transparency and predictability for generic drug applicants to help increase timely access to high-quality, lower cost generic drugs - FDA Press Releases

FDA is enhancing one of the agency’s most viewed databases for industry, the Paragraph IV Patent Certifications List, which provides information about exclusivity related to generic challenges of patents on “brand” drug products (180-day exclusivity).

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Statement on new guidance for the declaration of added sugars on food labels for single-ingredient sugars and syrups and certain cranberry products - FDA Press Releases

This is a statement regarding the FDA’s new guidance for the declaration of added sugars on food labels for single-ingredient sugars and syrups and certain cranberry products.

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Statement from Susan Mayne, Ph.D., director of the FDA’s Center for Food Safety and Applied Nutrition, on new guidance for the declaration of added sugars on food labels for single-ingredient sugars and syrups and certain cranberry products - FDA Press Releases

This is a statement regarding the FDA’s new guidance for the declaration of added sugars on food labels for single-ingredient sugars and syrups and certain cranberry products.

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Homeless Veterans in Nursing Homes: Care for Complex Medical, Substance Use, and Social Needs - American Geriatric Society

OBJECTIVES

The homeless population is aging, and their use of nursing homes is not well understood. We compared comorbidities (substance use, mental health conditions, and physical illness) and nursing home measures (source of admission, length of stay, and mortality in the facility) of veterans who were homeless, at risk for being homeless, or stably housed in the year prior to admission.

DESIGN

Cross‐sectional analysis.

SETTING AND PARTICIPANTS

All veterans admitted to a nursing home between January 2010 and December 2016 and their housing status in the year prior to their nursing home admission.

MEASUREMENTS

Adjusted relative risks (ARRs) for the association between housing status, comorbidities, and nursing home measures.

RESULTS

Veterans who were homeless in the year prior to their community nursing home admission were younger (n = 3355; 62.5 years [SD = 10.3 years]) at admission compared to stably housed veterans (n = 64 884; 75.3 years [SD = 11.9 years]). After adjustment for demographic characteristics, homeless veterans were more likely to have diagnoses for alcohol abuse (ARR = 2.18; 95% confidence interval [CI] = 2.05‐2.31), drug abuse (ARR = 3.03; 95% CI = 2.74‐3.33), mental health condition (ARR = 1.49; 95% CI = 1.45‐1.54), dementia (ARR = 1.14; 95% CI = 1.04‐1.25), liver disease (ARR = 1.32; 95% CI = 1.23‐1.41), lung disease (ARR = 1.08; 95% CI = 1.04‐1.13), and trimorbidity (co‐occurring substance abuse, mental illness, and physical illness) (ARR = 2.57; 95% CI = 2.40‐2.74) compared to stably housed veteran nursing home users. Homeless veterans were more likely to be admitted to a nursing home from a hospital (ARR = 1.13; 95% CI = 1.08‐1.17) and remain in the nursing home 90 days after admission (ARR = 1.10; 95% CI = 1.04‐1.16), but were less likely to die in the facility (ARR = 0.72; 95% CI = 0.67‐0.78) compared to stably housed veterans.

CONCLUSIONS

Homeless veteran nursing home users have different characteristics than stably housed veteran nursing home users. These differences may challenge nursing home staff caring for homeless patients. Nursing homes should assess resident housing status to help provide linkages with existing social services.

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FDA approves new treatment for pediatric patients with type 2 diabetes - FDA Press Releases

: FDA approves Victoza (liraglutide) injection for pediatric patients with type 2 diabetes. Victoza creates the same effect as GLP-1 receptor protein and is the first non-insulin drug approved since metformin in 2000.

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Statin Adherence and Mortality in Patients Aged 80 Years and Older After Acute Myocardial Infarction - American Geriatric Society

BACKGROUND/OBJECTIVES

The goal of this study was to describe the pattern of statin adherence in older patients, aged 80 years or older; identify factors associated with high adherence; and determine the association between statin adherence and all‐cause mortality.

DESIGN

Retrospective population‐based cohort study.

SETTING

An integrated healthcare system in Southern California.

PARTICIPANTS

Patients hospitalized with a principal diagnosis of acute myocardial infarction (MI) between January 1, 2006, and December 31, 2016.

MEASUREMENTS

Statin adherence, as measured using pharmacy dispensing records over the 365 days following hospital discharge, based on proportion of days covered (PDC). Adherence levels were categorized as high (PDC 80% or higher), partial (PDC 40% or higher and lower than 80%), and low (PDC lower than 40%).

RESULTS

Between 2006 and 2016, 5629 patients, 80 years or older, hospitalized for acute MI met the inclusion criteria. Among this group, 68.8% were highly adherent to statin therapy, 20.4% were partially adherent, and 10.8% were not adherent. Male sex (odds ratio [OR] = 1.42; 95% confidence interval [CI] = 1.25‐1.62) and white race (OR = 1.35; 95% CI = 1.18‐1.55) were associated with high statin adherence. Follow‐up was 4.3 ± 2.6 years. Both low and partial adherence were associated with increase mortality (low adherence: adjusted hazard radio [HR] = 1.12; 95% CI = 1.01‐1.25; partial adherence: adjusted HR = 1.22; 95% CI = 1.12‐1.32).

CONCLUSIONS

In older patients, aged 80 years or older, high adherence to statins after MI was associated with improved survival. This association may not have been due only to adherence to statins but to other related factors as well. Findings from this study may inform discussions on the potential benefits of statin adherence.

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Associations of Adverse Childhood Experiences with Past‐Year DSM‐5 Psychiatric and Substance Use Disorders in Older Adults - American Geriatric Society

OBJECTIVES

To examine the prevalence of adverse childhood experiences (ACEs) and the associations of ACEs with psychiatric and substance use disorders among older adults in the United States.

DESIGN

Cross‐sectional analysis of the 2012‐2013 National Epidemiological Survey on Alcohol and Related Conditions Wave III (NESARC‐III).

SETTING

Nationally representative drug‐related health interview survey in the United States.

PARTICIPANTS

Survey respondents aged 65 or older (n = 5806 unweighted).

MEASUREMENTS

ACEs, the key independent variable, were assessed using validated measures. Outcome variables consisted of past‐year psychiatric disorders (eg, major depressive disorder and generalized anxiety disorder) and substance use disorders (eg, alcohol use disorder) using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. We estimated the national prevalence of ACEs in older adults and used multivariable‐adjusted logistic regression analyses to assess the association between ACEs and the outcomes after adjusting for sociodemographics and clinical comorbidities.

RESULTS

Overall, 35.9% of older adults, representative of 14.8 million older adults nationwide, reported some form of ACEs. The most common types were parental psychopathology (20.3%), other traumatic events (14.0%), and physical/psychological abuse (8.4%). Having experienced any ACEs was associated with higher odds of having a past‐year psychiatric disorder (adjusted odds ratio = 2.11; 95% confidence interval = 1.74‐2.56). Similar results were found for substance use disorders (P < .01).

CONCLUSION

ACEs are linked to an increased risk for past‐year psychiatric and substance use disorders in older adults. ACEs may have long‐term effects on older adults’ mental well‐being. Although further research is needed, preventing ACEs may lead to large improvements in public mental health that persist well into older age.

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Follow‐Up of a Virtual‐Group‐Exercise at Home Program to Reduce Fall Risks - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Fusaramin, an antimitochondrial compound produced by Fusarium sp., discovered using multidrug-sensitive Saccharomyces cerevisiae - Journal of Antibiotics

The Journal of Antibiotics, Published online: 17 June 2019; doi:10.1038/s41429-019-0197-5

Fusaramin, an antimitochondrial compound produced by Fusarium sp., discovered using multidrug-sensitive Saccharomyces cerevisiae

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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 latest steps to strengthen FDA’s 510(k) program for premarket review of medical devices - FDA Press Releases

FDA takes more steps toward strengthening 510(k) program for premarket review of medical devices

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FDA Statement on the FDA’s ongoing investigation into valsartan and ARB class impurities and the agency’s steps to address the root causes of the safety issues - FDA Press Releases

FDA describes the ongoing investigation into the ARB class impurities and agency’s steps to address the root causes of the safety issues

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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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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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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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End‐of‐Life Care in Patients Exposed to Home‐Based Palliative Care vs Hospice Only - American Geriatric Society

OBJECTIVES

The current evidence base regarding the effectiveness of home‐based palliative care (HomePal) on outcomes of importance to multiple stakeholders remains limited. The purpose of this study was to compare end‐of‐life care in decedents who received HomePal with two cohorts that either received hospice only (HO) or did not receive HomePal or hospice (No HomePal‐HO).

DESIGN

Retrospective cohorts from an ongoing study of care transition from hospital to home. Data were collected from 2011 to 2016.

SETTING

Kaiser Permanente Southern California.

PARTICIPANTS

Decedents 65 and older who received HomePal (n = 7177) after a hospitalization and two comparison cohorts (HO only = 25 102; No HomePal‐HO = 22 472).

MEASUREMENTS

Utilization data were extracted from administrative, clinical, and claims databases, and death data were obtained from state and national indices. Days at home was calculated as days not spent in the hospital or in a skilled nursing facility (SNF).

RESULTS

Patients who received HomePal were enrolled for a median of 43 days and had comparable length of stay on hospice as patients who enrolled only in hospice (median days = 13 vs 12). Deaths at home were comparable between HomePal and HO (59% vs 60%) and were higher compared with No HomePal‐HO (16%). For patients who survived at least 6 months after HomePal admission (n = 2289), the mean number of days at home in the last 6 months of life was 163 ± 30 vs 161 ± 30 (HO) vs 149 ± 40 (No HomePal‐HO). Similar trends were also noted for the last 30 days of life, 25 ± 8 (HomePal, n = 5516), 24 ± 8 (HO), and 18 ± 11 (No HomePal‐HO); HomePal patients had a significantly lower risk of hospitalizations (relative risk [RR] = .58‐.87) and SNF stays (RR = .32‐.77) compared with both HO and No HomePal‐HO patients.

CONCLUSION

Earlier comprehensive palliative care in patients’ home in place of or preceding hospice is associated with fewer hospitalizations and SNF stays and more time at home in the final 6 months of life. J Am Geriatr Soc, 2019.

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Quality of Life with Late‐Stage Dementia: Exploring Opportunities to Intervene - American Geriatric Society

BACKGROUND/OBJECTIVES

In late‐stage dementia, families often prioritize quality of life (QoL) and comfort, yet little research examines factors impacting QoL. We sought to (1) describe temporal trends in QoL in late‐stage dementia, and (2) explore associations between patient characteristics, care interventions, and QoL.

DESIGN

Secondary analysis of data from the Goals of Care clinical trial.

SETTING

Twenty‐two nursing homes (NHs) in North Carolina.

PARTICIPANTS

Family decision makers for residents with late‐stage dementia.

MEASUREMENTS

Family‐reported QoL at baseline and at 9 months using the Alzheimer's Disease‐Related Quality of Life Instrument (ADRQL) with five subscales scored 0 to 100 (higher scores indicate better quality). Families reported demographics, primary goal of care, and described their perceptions of residents’ QoL. Chart reviews provided data on hospital transfers, treatment plans, and hospice enrollment. We ran mixed effects models of hypothesized variables and change in ADRQL over time.

RESULTS

The study sample was 241 dyads of residents with late‐stage dementia and family decision makers. Family‐reported ADRQL scores reflected moderately good QoL at baseline and at 9 months (69.1 vs 66.9; p = .106). Subscales for Awareness of Self (62.8; Global Deterioration Scale [GDS] = 5; 30.5; GDS = 7; p > .01) and Enjoyment of Activities (53.4; GDS = 5; 39.4; GDS = 7; p > .01) were lower in later stage disease. Qualitatively, family members associated better QoL for dementia with (1) activities, (2) opportunities to leave NH, (3) NH‐structured activities, (4) attentiveness in NH, and (5) passive interaction. ADRQL at 9 months was associated with later dementia stage and referral to hospice (p < .01). Age (p = .004) and hospice enrollment were significantly associated with a larger decrease in ADRQL over 9 months (p = .019). A primary goal of comfort was associated with a larger increase in ADRQL (p = .022).

CONCLUSION

Families judge QoL to be moderately good in late‐stage dementia. They perceive activities, opportunities to leave the NH, and quality of interpersonal care as ways to improve dementia‐specific QoL.

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Prevalence of Retinal Signs and Association With Cognitive Status: The ARIC Neurocognitive Study - American Geriatric Society

Objective

To determine the prevalence of retinal microvascular signs and associations between retinal signs and cognitive status.

Design

Cross‐sectional analysis of visit 5 (2011‐2013) of the Atherosclerosis Risk in Communities (ARIC) cohort. Data analysis took place November 30, 2017, to May 1, 2018.

Setting

Biracial population‐based cohort from four US communities.

Participants

A total of 2624 participants with a mean age of 76 years (SD = 5 years) (19% African American) with data on cognitive status and complete retinal examination.

Measurements

Retinal signs measured with fundus photography. Cognitive status: normal cognition, mild cognitive impairment (MCI)/dementia with a primary diagnosis of Alzheimer disease (AD) without cerebrovascular disease (CVD), and MCI/dementia with a primary or secondary diagnosis of CVD (irrespective of AD).

Results

Overall, 6% of the cohort had mild retinopathy and 2% had moderate/severe retinopathy. Of the cohort, 7% had microaneurysms, 6% had retinal hemorrhages, and 8% had arteriovenous (AV) nicking. There was a low prevalence of soft exudates (1%) and focal narrowing (1%). In weighted fully adjusted models, individuals with retinal hemorrhages had a two‐fold higher odds of all‐cause MCI/dementia (95% confidence interval [CI] = 1.3‐3.0; P = .001) and a 2.5‐fold higher odds (95% CI = 1.6‐3.9; P < .001) of MCI/dementia with CVD compared to individuals with no retinal hemorrhages. Individuals with AV nicking had a 1.6‐fold higher odds of MCI/dementia with CVD (95% CI = 1.0‐2.4) compared to individuals with no AV nicking (P < .05). There were no associations between retinal signs and MCI/dementia without CVD.

Conclusion

Our findings are confirmatory of recent research, and suggest that retinal microvascular signs may reflect microvascular pathology in the brain, potentially contributing to dementia and earlier MCI. The low prevalence of retinal signs and modest associations with cognitive status, however, limit the current clinical utility of these findings. Further work is needed to determine whether more sophisticated imaging may detect more subtle retinal signs with higher sensitivity to identify individuals at risk of dementia.

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Medication Appropriateness in Vulnerable Older Adults: Healthy Skepticism of Appropriate Polypharmacy - American Geriatric Society

Older adults are prescribed a growing number of medications. Polypharmacy, commonly considered the receipt of five or more medications, is associated with a range of adverse outcomes. There is a debate about the reason(s) why. On one side is the assertion that older persons are being prescribed too many medications, with the number of medications increasing the risk of adverse events. On the other side is the observation that polypharmacy is associated both with overprescribing of inappropriate medications and underprescribing of appropriate medications. This leads to the concept of “inappropriate” vs “appropriate” polypharmacy, with the latter resulting from the prescription of many correct medications to persons with multiple chronic conditions. Few studies have examined the health outcomes associated with adding and/or removing medications to address this debate directly. The criteria used to identify underutilized medications are based on results of randomized controlled trials that may not be generalizable to older adults. Several randomized controlled trials and many more observational studies provide evidence that these criteria overestimate medication benefits and underestimate harms. In addition, evidence suggests that the marginal effects of medications added to an already complex regimen differ from their effects when considered individually. Although in selected circumstances adding medications results in benefit to patients, patients with multimorbidity and frailty/disability have susceptibilities that can decrease the likelihood of medication benefit and increase the likelihood of harms. The identification of appropriate polypharmacy requires more robust criteria to evaluate the net effects of complex medication regimens.

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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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A Team Disclosure of Error Educational Activity: Objective Outcomes - American Geriatric Society

Medical errors can involve multiple team members. Few curricula are being developed to provide instruction on disclosing medical errors that include simulation training with interprofessional team disclosure. To explore more objective evidence for the value of an educational activity on team disclosure of errors, faculty developed and assessed the effectiveness of a multimodal educational activity for learning team‐based disclosure of a medical error.

This study employed a methodological triangulation research design. Participants (N = 458) included students enrolled in academic programs at three separate institutions. The activity allowed students to practice team communication while: (1) discussing a medical error within the team; (2) planning for the disclosure of the error; and (3) conducting the disclosure. Faculty assessed individual student's change in knowledge and, using a rubric, rated the performance of the student teams during a simulation with a standardized family member (SFM).

Students had a high level of preexisting knowledge and demonstrated the greatest knowledge gains in questions regarding the approach to disclosure (P < .001) and timing of an apology (P < .001). Both SFMs and individual students rated the team error disclosure behavior highly (rho = 0.54; P < .001). Most participants (more than 80%) felt the activity was worth their time and that they were more comfortable with disclosing a medical error as a result of having completed the activity.

This activity for interprofessional simulation of team‐based disclosure of a medical error was effective for teaching students about and how to perform this type of important disclosure.

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Colonoscopy in Nonagenarians Is Safe and May Be Associated with Clinical Benefit - American Geriatric Society

OBJECTIVES

Data regarding colonoscopy in patients older than 90 years old is scarce. Yet the number of colonoscopies done on nonagenarians is rising. We aimed to determine the yield, safety, and therapeutic benefits of colonoscopy in these patients.

DESIGN

Case‐control study of older patients who underwent colonoscopy.

SETTING

Gastroenterology institute at an academic medical center.

PARTICIPANTS

Patients older than 90 years (n = 128) compared with patients aged 80 to 89 years (n = 218) who underwent colonoscopy.

INTERVENTION

Colonoscopy.

MEASUREMENTS

Indication for the procedure, completion rates, adequacy of preparation, complications, colonoscopic findings, 30‐day mortality, advanced adenoma and carcinoma detection rate, treatment, and long‐term survival of patients diagnosed with colorectal cancer.

RESULTS

Mean ages were 83.3 and 92.2 years old. Nonagenarians were more likely to undergo a colonoscopy while hospitalized (56.2 vs 23.4%; P < .001) and to undergo the examination due to rectal bleeding or sigmoid volvulus (35.2 vs 25.2 and 10.9 vs 0.5%, respectively; P < .001) and less likely for surveillance or constipation (11.7 vs 25.7 and 0 vs 6.9%, respectively; P < .001). Completion rates and severe adverse events were comparable. The 30‐day mortality was 3.9% in nonagenarians and 0.4% in octogenarians (P = .02). Advanced adenomas and carcinoma were more common in nonagenarians (25.8 vs 16.5%, P = .03, and 14.8 vs 6.4%, P = .01, respectively). Increasing age, inpatient status, past polypectomy surveillance, and anemia were associated with higher rates of carcinoma. Half of the nonagenarians diagnosed with adenocarcinoma underwent surgery compared with 100% of octogenarians (P = .01). Among nonagenarians with colorectal cancer who died, mean survival was 605 (interquartile range = 11‐878) days in those who underwent surgery and 112 (48‐341) in those treated conservatively (P = .055 log‐rank test).

CONCLUSION

Colonoscopy in nonagenarians has a high yield and is generally safe. Colonoscopy findings lead to surgery in more than half of these patients and was associated with a median survival of 20 months.

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The Effect of Multidomain Lifestyle Intervention on Daily Functioning in Older People - American Geriatric Society

OBJECTIVE

To investigate the effect of a 2‐year multidomain lifestyle intervention on daily functioning of older people.

DESIGN

A 2‐year randomized controlled trial (ClinicalTrials.gov, NCT01041989).

SETTING

Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability.

PARTICIPANTS

A total of 1260 older adults, with a mean age of 69 years at the baseline, who were at risk of cognitive decline.

INTERVENTION

A multidomain intervention, including simultaneous physical activity intervention, nutritional counseling, vascular risk monitoring and management, and cognitive training and social activity.

MEASUREMENTS

The ability to perform daily activities (activities of daily living [ADLs] and instrumental ADLs) and physical performance (Short Physical Performance Battery).

RESULTS

The mean baseline ADL score was 18.1 (SD = 2.6) points; the scale ranges from 17 (no difficulties) to 85 (total ADL dependence). During the 2‐year intervention, the ADL disability score slightly increased in the control group, while in the intervention group, it remained relatively stable. Based on the latent growth curve model, the difference in the change between the intervention and control groups was −0.95 (95% confidence interval [CI] = −1.61 to −0.28) after 1 year and −1.20 (95% CI = −2.02 to −0.38) after 2 years. In terms of physical performance, the intervention group had a slightly higher probability of improvement (from score 3 to score 4; P = .041) and a lower probability of decline (from score 3 to scores 0‐2; P = .043) for chair rise compared to the control group.

CONCLUSION

A 2‐year lifestyle intervention was able to maintain the daily functioning of the at‐risk older population. The clinical significance of these results in this fairly well‐functioning population remains uncertain, but the study results hold promise that healthy eating, exercise, and cognitive and social activity may have favorable effects on functional independence in older people.

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Factors Considered by Interprofessional Team for Treatment Decision in Hip Fracture with Dementia - American Geriatric Society

Objectives

Patients with dementia are at high risk for hip fractures and often have poor outcomes when a fracture is sustained. Despite this poor prognosis, little data are available on what factors should be prioritized to guide surgical decision making in these cases. We aimed to understand the decision‐making process for older dementia patients hospitalized after hip fractures.

Design

We performed a qualitative analysis of in‐depth elite interviews conducted with a clinical care team involved in management of patients with dementia after hospitalization for hip fractures.

Setting

Interviews were conducted with an interprofessional team involved in the care of patients with dementia after being hospitalized for hip fractures.

Participants

Interviewees included nine orthopaedic surgeons, three hospitalists, three geriatricians, five nurses, three occupational therapists, three physical therapists, and two clinical ethicists.

Measurements

Verbatim transcripts of the interviews were analyzed and coded using QSR International's NVivo 10 qualitative database management software.

Results

The three main themes that most interviewees discussed were pain control, functional status, and medical comorbidities. Interviewees brought up many factors related to restoring functional status including baseline functional status, rehabilitation potential, social support, and the importance of mobility. Dementia and its impact on rehabilitation potential were mentioned by all geriatricians.

Conclusion

Although frailty, prognosis, and life expectancy were largely absent from the responses, the emphasis on dementia, advanced directives, and involving family or caregivers by the three geriatricians indicates the importance of including geriatricians in the decision‐making team for these patients.

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Attitudes of Older Adults and Caregivers in Australia toward Deprescribing - American Geriatric Society

BACKGROUND/OBJECTIVES

Use of harmful and/or unnecessary medications in older adults is common. Understanding older adult and caregiver attitudes toward deprescribing will contribute to medication optimization in practice. The aims of this study were to capture the attitudes and beliefs of older adults and caregivers toward deprescribing and determine what participant characteristics and/or attitudes (if any) predicted reported willingness to have a medication deprescribed.

DESIGN

Self‐completed questionnaire.

SETTING

Australia.

PARTICIPANTS

Older adults (n = 386), 65 years or older, taking one or more regular prescription medications and caregivers of older adults (n = 205) who could self‐complete a written questionnaire in English.

MEASUREMENTS

Older adult and caregiver versions of the validated revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire were completed. The rPATD includes two global questions and four factors: perceived burden of medications, belief in appropriateness of medications, concerns about stopping, and involvement in medication management. Participant characteristics, self‐rated health, trust in physician, and health autonomy were also collected.

RESULTS

Older adult participants had a median age of 74 years (interquartile range [IQR] = 70‐81 y), and caregivers were aged 67 years (IQR = 59‐76) and were caring for a person aged 81 years (IQR = 75‐86.25 y). Most of both older adults (88%) and caregivers (84%) agreed or strongly agreed that they would be willing to stop one or more of their or their care recipient's medications if their or their care recipient's doctor said it was possible. In a binary logistic regression model, a low concern about stopping factor score was the strongest predictor of willingness to have a medication deprescribed in older adults (odds ratio [OR] = 0.12; 95% confidence interval [CI] = 0.04‐0.34). Excellent/good rating of physical health was the strongest predictor in caregivers (OR = 3.71; 95% CI = 1.13‐12.23).

CONCLUSIONS

Most older adults and caregivers are willing to have one of their or their care recipient's medication deprescribed, although different predictors (characteristics/attitudes) of this willingness were identified in these two groups.

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Effect of Monthly High‐Dose Vitamin D on Mental Health in Older Adults: Secondary Analysis of a RCT - American Geriatric Society

OBJECTIVES

To test the effect of monthly high‐dose vitamin D supplementation on mental health in pre‐frail older adults.

DESIGN

Ancillary study of a 1‐year double‐blind randomized clinical trial conducted in Zurich, Switzerland.

SETTING AND PARTICIPANTS

A total of 200 community‐dwelling adults 70 years and older with a prior fall event in the last year. Participants were randomized to receive 24 000 IU vitamin D₃ (considered standard of care), 60 000 IU vitamin D₃, or 24 000 IU vitamin D₃ plus 300 μg calcifediol per month.

MEASURES

The primary end point was the Mental Component Summary (MCS) of the SF‐36. Secondary end points were the SF‐36 Mental Health (MH) subscale and the Geriatric Depression Scale (GDS‐15).

RESULTS

Participants’ mean age was 78 years (67% women), and 58% were vitamin D deficient (<20 ng/mL). Over time, primary and secondary end points did not differ significantly among the three treatment groups or in subgroups by vitamin D status at baseline. Given the lack of a true placebo group, we explored in a predefined observational analysis the change in mental health scales by achieved 25(OH)D levels at 12 months. After adjusting for confounders, participants achieving the highest 25(OH)D quartile (Q) at 12 months (44.7‐98.9 ng/mL) had the greatest improvements in MCS (Q4 = 0.79 vs Q1 = −2.9; p = .03) and MH scales (Q4 = 2.54 vs Q1 = −3.07; p = .03); these associations were strongest among participants who were vitamin D deficient at baseline. No association was found for GDS (p = .89).

CONCLUSIONS

For mental health, our study suggests no benefit of higher monthly doses of vitamin D₃ compared with the standard monthly dose of 24 000 IU. However, irrespective of vitamin D treatment dose, achieving higher 25(OH)D levels at 12‐month follow‐up was associated with a small, clinically uncertain but statistically significant improvement in mental health scores.

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The Association of Resident Communication Abilities and Antibiotic Use in Long‐Term Care - American Geriatric Society

OBJECTIVES

To determine whether decreased communication ability among long‐term care residents is associated with increased antibiotic exposure.

DESIGN

Retrospective cohort study.

SETTING

All long‐term care homes in Ontario, Canada.

PARTICIPANTS

All adults aged 66 years or older residing in long‐term care and undergoing a full assessment between January 1 and December 31, 2016 (N = 87,947).

MEASUREMENTS

Data were obtained from linkable, population‐wide administrative data sets. Residents were identified, and characteristics were abstracted from the Resident Assessment Instrument Minimum Dataset version 2.0. The primary predictors of interest were residents' ability to make themselves understood and ability to understand others. The primary outcome was antibiotic days of treatment per 1000 resident days in the 90 days following assessment (obtained from the Ontario Drug Benefits Database).

RESULTS

Those who were sometimes/rarely/never able to make themselves understood received 50.7 antibiotic days per 1000 person‐days of follow‐up, compared to 62.1 received by those who were able to make themselves understood. Those who were sometimes/rarely/never able to understand others received 50.0 antibiotic days per 1000 person‐days of follow‐up, compared to 61.4 by those who were able to understand others. Multivariable Poisson regression, accounting for resident characteristics, confirmed that compared to those with highest levels of communication ability, those who could sometimes/rarely/never make themselves understood had significantly fewer days on antibiotics (rate ratio [RR] = 0.76; confidence interval [95% CI] = 0.73‐0.79) as did those who could sometimes/rarely/never understand others (RR = 0.76; 95% CI = 0.74‐0.79).

CONCLUSION

Poor resident communication ability is not a driver of antibiotic overuse in long‐term care. In fact, lower ability to understand others and/or be understood by others is associated with less antibiotic exposure. Further work is needed to optimize antibiotic use in long‐term care residents across the entire spectrum of communication skills.

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Polypharmacy, Gait Performance, and Falls in Community‐Dwelling Older Adults. Results from the Gait and Brain Study - American Geriatric Society

BACKGROUND AND OBJECTIVES

Polypharmacy, defined as the use of five or more medications, has been repeatedly linked to fall incidence, and recently it was cross‐sectionally associated with gait disturbances. Our objectives were to evaluate cross‐sectional and longitudinal associations between polypharmacy and gait performance in a well‐established clinic‐based cohort study. We also assessed whether gait impairments could mediate associations between number of medications and fall incidence.

DESIGN

Prospective cohort of community‐dwelling older adults, with 5 years of follow‐up.

SETTING

Geriatric clinics in an academic hospital in London, ON, Canada.

PARTICIPANTS

Community‐dwelling older adults aged 65 and older (n = 249; 76.6 ± 8.6 y; 63% women).

MEASUREMENTS

Number of medications, quantitative spatiotemporal gait parameters, and fall incidence during follow‐up.

RESULTS

The number of medications was cross‐sectionally associated with poor gait performance (slow gait, speed p < .001; higher variability, p < .001; and higher stride, p < .001; step, p = .013, and double support times, p < .001). Prospectively, the number of medications was associated with overall gait decline (odds ratio = 1.23; 95% confidence interval [CI] = 1.13‐1.33; p < .001), faster gait decline (hazard ratio = 4.62; 95%CI = 1.82‐11.73; p < .001), and higher falls incidence (p = .006). These associations remained true after adjusting for age, sex, and accounting for “confounding by indication bias” by using a comorbidity propensity score adjustment. Each additional medication taken, significantly increased gait decline risk by 12% to 16% and fall incidence risk by 5% to 7%. Mediation analyses revealed that gait impairments in stride length, step length, and step width mediated the strength of the association between medications and fall incidence.

CONCLUSION

Polypharmacy was cross‐sectionally associated with poor gait performance and longitudinally associated with gait decline and fall incidence. Despite our use of propensity matching, confounding by indication could have influenced the results. Quantitative spatial gait parameters performance mediated the strength of the association between medications and falls, suggesting a role of gait disturbances in the medication‐related falls pathway.

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Changes in Older Adults' Oral Health and Disparities: 1999 to 2004 and 2011 to 2016 - American Geriatric Society

OBJECTIVES

To examine changes in tooth loss and untreated tooth decay among older low‐income and higher‐income US adults and whether disparities have persisted.

DESIGN

Sequential cross‐sectional study using nationally representative data.

SETTING

The 1999 to 2004 and 2011 to 2016 National Health and Nutrition Examination Survey.

PARTICIPANTS

Noninstitutionalized US adults, aged 65 years and older (N = 3539 for 1999‐2004, and N = 3514 for 2011‐2016).

MEASUREMENTS

Differences in prevalence of tooth loss (having 19 teeth or fewer, 8 teeth or fewer, and no teeth) and untreated decay and mean number of decayed and missing teeth (DMT) between low‐ and high‐income adults 65 years and older in each survey and changes between surveys. Adjusted prevalence and count outcomes were estimated with logistic and negative binomial regression models, respectively. Models controlled for sociodemographic characteristics and smoking status. Reported findings are significant at P < .05.

RESULTS

In 2011 to 2016, unadjusted prevalence of having 19 teeth or fewer, 8 teeth or fewer, no teeth, and untreated decay among low‐income adults 65 years and older was 50.6%, 42.0%, 28.6%, and 28.6%, respectively. Multivariate analyses indicated that although most tooth loss measures improved between surveys for both income groups, tooth loss among low‐income adults remained at almost twice that among higher‐income adults. The disparity in untreated decay prevalence in 2011 to 2016, 15.2 percentage points (26.1% vs 10.9% for low vs high income) was twice that in 1999 to 2004, 8.5 percentage points (22.9% vs 14.4% for low vs high income). DMT decreased for both groups, with lower‐income adults having about five more affected teeth in both surveys.

CONCLUSION

Tooth loss is decreasing, but differential access to restorative care by income appears to have increased.

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Tricyclic Antidepressant and/or γ‐Aminobutyric Acid–Analog Use Is Associated With Fall Risk in Diabetic Peripheral Neuropathy - American Geriatric Society

BACKGROUND/OBJECTIVES

Peripheral neuropathy is a common diabetes complication that can increase fall risk. Regarding fall risk, the impact of pain management using tricyclic antidepressants (TCAs) or γ‐aminobutyric acid (GABA) analogs is unclear because these medications can also cause falls. This study investigates the impact of these drugs on fall and fracture risk in older diabetic peripheral neuropathy (DPN) patients.

DESIGN

Historical cohort study with 1‐to‐1 propensity matching of TCA/GABA‐analog users and nonusers.

SETTING

Nationally representative 5% Medicare sample between the years 2008 and 2010.

PARTICIPANTS

After applying all selection criteria, 5,550 patients with prescription and 22,200 patients without prescription of TCAs/GABA‐analogs were identified. Both patient groups were then stratified for fall history and matched based on propensity of receiving TCAs/GABA‐analogs within each group.

MEASUREMENTS

Patients were followed until the first incidence of fall or the first incidence of fracture during the follow‐up period (for up to 5 years).

RESULTS

After matching, users and nonusers were largely similar. After covariate adjustment, TCA/GABA‐analog use was associated with a statistically significant increase in fall risk (adjusted hazard ratio [HR] = 1.11; 95% confidence interval [CI] = 1.03‐1.20), but was not associated with fracture risk (adjusted HR = 1.09; 95% CI = 0.99‐1.19) in the conventional analysis. Treating TCA/GABA‐analog use as a time‐dependent covariate resulted in statistically significant associations of TCA/GABA‐analog use with both fall and fracture risk (HR = 1.26 [95% CI = 1.17‐1.36]; and HR = 1.12 [95% CI = 1.02‐1.24], respectively).

CONCLUSION

Among older patients with DPN, GABA‐analogs or TCAs increase fall risk and possibly fracture risk. Use of these medications is therefore a potentially modifiable risk factor for falls and fractures in this population.

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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 (OR = 3.19; 95% CI = 1.25‐8.18; P = .0157). [Correction added March 16, 2019, after first publication online. In the previous sentence, “HR” was mistakenly used instead of “OR”.]

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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Educational Differences in Cognitive Life Expectancy Among Older Adults in Brazil - American Geriatric Society

Objectives

To investigate the differences in life expectancy with and without cognitive impairment (CI) by educational levels and sex in Brazil.

Design

Longitudinal observational study.

Setting

The sample was drawn from three waves (2000, 2006, and 2010) of the Health, Well‐Being, and Aging Study (Saúde, bem‐estar e envelhecimento; SABE) collected in São Paulo, Brazil.

Participants

Adults aged 60 years and older (N = 2116).

Measurements

Educational levels were estimated in the baseline wave (2000), cognition was assessed in all waves, and mortality data were obtained through the state and municipal mortality system in Brazil. Interpolation of Markov chain methods was used to estimate life expectancy with and without CI by education and sex.

Results

Life expectancy without CI at the age of 60 years was 13.0 years among men with no education and 17.6 years among their counterparts with 8 years of schooling. On the other hand, life expectancy with CI was higher among men with no education than those with more education (3.2 and 0.6 years, respectively). Among 60‐year‐old women without education, life expectancy without CI reached 16.2 years, but it was considerably higher among more educated women (22.7 years). Life expectancy with CI reached 4.5 years among women aged 60 years with no education, vs 1.0 year among women with 8 years of schooling.

Conclusions

Adults older than 60 years with no education live shorter lives and with longer periods of CI than those with education. Women in São Paulo live longer lives than men, but they live with CI for a greater number of years.

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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, Volume 67, Issue 6, Page 1300-1301, June 2019.

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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, Volume 67, Issue 6, Page 1302-1303, June 2019.

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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, Volume 67, Issue 6, Page 1299-1299, June 2019.

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Leveraging Home‐Delivered Meal Programs to Address Unmet Needs for At‐Risk Older Adults: Preliminary Data - American Geriatric Society

BACKGROUND

Home‐delivered meal programs serve a predominantly homebound older adult population, characterized by multiple chronic conditions, functional limitations, and a variety of complex care needs, both medical and social.

DESIGN

A pilot study was designed to test the feasibility of leveraging routine meal‐delivery service in two home‐delivered meal programs to proactively identify changes in older adult meal recipients’ (clients’) health, safety, and well‐being and address unmet needs.

INTERVENTION

Meal delivery personnel (drivers) were trained to use a mobile application to submit electronic alerts when they had a concern or observed a change in a client's condition. Alerts were received by care coordinators, who followed up with clients to offer support and help connect them to health and community services.

RESULTS

Over a 12‐month period, drivers submitted a total of 429 alerts for 189 clients across two pilot sites. The most frequent alerts were submitted for changes in health (56%), followed by self‐care or personal safety (12%) and mobility (11%). On follow‐up, a total of 132 referrals were issued, with most referrals for self‐care (33%), health (17%), and care management services (17%). Focus groups conducted with drivers indicated that most found the mobile application easy to use and valued change of condition monitoring as an important contribution.

CONCLUSION

Findings suggest that this is a feasible approach to address unmet needs for vulnerable older adults and may serve as an early‐warning system to prevent further decline and improve quality of life. Efforts are underway to test the protocol across additional home‐delivered meal programs.

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Post–Hip Fracture Mortality in Nursing Home Residents by Obesity Status - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Prostate Laser Photovaporization in Older People With and Without Bladder Catheter - American Geriatric Society

OBJECTIVES

To compare results of prostate laser photovaporization (PVP) by age groups to evaluate morbidity and functional results. Then, to specifically analyze surgical data for patients with an indwelling bladder catheter.

DESIGN

Monocentric retrospective study of a prospective maintained database of all laser PVPs performed at our university hospital between December 2012 and June 2017.

SETTINGS AND PARTICIPANTS

A total of 305 patients (three groups: younger than 70, 70‐80, and older than 80 years) were operated on in our hospital center for the treatment of urinary tract disorders related to benign prostatic hyperplasia.

RESULTS

A difference was found between the three age groups, with a higher rate of complications for patients older than 80 years (45%) (P = .013). Rate of patients with postoperative bladder catheters at 1 year was higher for patients older than 80 years (15%) (P = .004). Postoperative quality‐of‐life (QoL) score was worse for patients older than 80 years (P = .04).

For patients with an indwelling bladder catheter undergoing surgery, morbidity was greater in patients older than 80 years, but the difference was not significant. International Prostate Symptom Score and QoL score were not significantly different between the three groups.

Rate of patients with a remaining bladder catheter at 1 year was higher for patients older than 80 years (17.1% vs 7.1% for patients between 70 and 80, and 4.8% for patients under 70.) but with no statistical difference.

CONCLUSION

PVP had a greater morbidity in octogenarians compared to younger subjects. Functional results were less satisfactory for patients older than 80 years compared to younger ones. For subjects operated on with an indwelling bladder catheter, no significant difference in outcome and morbidity was found between the three groups.

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