Cardiac Rehabilitation for Older Adults: Vital Opportunity to Improve Patient-Centered Cardiovascular Disease Care amid Worldwide Patient Aging - Geriatrics

Cardiac rehabilitation (CR) has particular value for contemporary patients with cardiovascular disease (CVD) as it provides a unique opportunity to evaluate and address the distinctive needs of adults who are, on average, much older and complex than patients of years past. People are living longer in the United States and in much of the world, and aging is the number 1 risk factor for CVD as well as to its presentation in a context of multimorbidity, frailty, polypharmacy, and other geriatric complexities of care (also commonly including cognitive decline, sensory impairments, and increased falls).

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Tailoring Assessments and Prescription in Cardiac Rehabilitation for Older Adults - Geriatrics

Older adults have distinctive health challenges that are relevant to the prevention and treatment of cardiovascular diseases and are potentially modifiable by cardiac rehabilitation. Cardiac rehabilitation in older adults provides opportunity to assess sarcopenia, obesity, osteoporosis, frailty, falls risk, arthritis, cognition, special senses, self-efficacy, depression, social support, polypharmacy, and nutritional adequacy. Therefore, broadening standard assessments to include these domains can help detect modifiable vulnerabilities and inform therapeutic priorities.

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Resiliency Groups Following Hip Fracture in Older Adults - American Geriatric Society

OBJECTIVES

Defining common patterns of recovery after an acute health stressor (resiliency groups) has both clinical and research implications. We sought to identify groups of patients with similar recovery patterns across 10 outcomes following hip fracture (stressor) and to determine the most important predictors of resiliency group membership.

DESIGN

Secondary analysis of three prospective cohort studies.

SETTING

Participants were recruited from various hospitals in the Baltimore Hip Studies network and followed for up to 1 year in their residence (home or facility).

PARTICIPANTS

Community‐dwelling adults aged 65 years or older with recent surgical repair of a hip fracture (n = 541).

MEASUREMENTS

Self‐reported physical function and activity measures using validated scales were collected at baseline (within 15‐22 d of fracture), 2, 6, and 12 months. Physical performance tests were administered at all follow‐up visits. Stressor characteristics, comorbidities, and psychosocial and environmental factors were collected at baseline via participant report and chart abstraction. Latent class profile analysis was used to identify resiliency groups based on recovery trajectories across 10 outcome measures and logistic regression models to identify factors associated with those groups.

RESULTS

Latent profile analysis identified three resiliency groups that had similar patterns across the 10 outcome measures and were defined as “high resilience” (n = 163 [30.1%]), “medium resilience” (n = 242 [44.7%]), and “low resilience” (n = 136 [25.2%]). Recovery trajectories for the outcome measures are presented for each resiliency group. Comparing highest with the medium‐ and low‐resilience groups, self‐reported pre‐fracture function was by far the strongest predictor of high‐resilience group membership with area under the curve (AUC) of .84. Demographic factors, comorbidities, stressor characteristics, environmental factors, and psychosocial characteristics were less predictive, but several factors remained significant in a multivariable model (AUC = .88).

CONCLUSION

These three resiliency groups following hip fracture may be useful for understanding mediators of physical resilience. They may provide a more detailed description of recovery patterns in multiple outcomes for use in clinical decision making.

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Statement on federal and state collaboration to investigate respiratory illnesses reported after use of e-cigarette products - FDA Press Releases

FDA and CDC are providing updates about federal and state efforts to investigate respiratory illnesses reported after the use of e-cigarette products.

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Comorbidity Profiles Identified in Older Primary Care Patients Who Attempt Suicide - American Geriatric Society

OBJECTIVES

To identify comorbidity profiles of older patients last seen in primary care before a suicide attempt and assess attempt and clinical factors (eg, means and lethality of attempt) associated with these profiles.

DESIGN

Cohort study and latent class analysis using Department of Veterans Affairs (VA) national data (2012‐2014).

SETTING

All VA medical centers in the United States.

PARTICIPANTS

A total of 2131 patients 65 years and older who were last seen by a primary care provider before a first documented suicide attempt.

MEASUREMENTS

Fatal suicide attempt and means were identified using the National Suicide Data Repository. Nonfatal attempt was defined using the National Suicide Prevention Applications Network. Medical and psychiatric diagnoses and other variables were determined from electronic medical records.

RESULTS

Patients (mean age = 74.4 y; 98.2% male) were clustered into five classes based on medical and psychiatric diagnoses: Minimal Comorbidity (23.2%); Chronic Pain‐Osteoarthritis (30.1%); Depression‐Chronic Pain (22.9%); Depression‐Medical Comorbidity (16.5%); and High Comorbidity (7.3%). The patients in the Minimal Comorbidity and Chronic Pain‐Osteoarthritis classes were most likely to attempt fatally compared with classes with a higher burden of comorbidities. Overall, 61% of the sample attempted fatally, and 82.5% of suicide decedents used firearms.

CONCLUSION

This study provides evidence that most comorbidity profiles (>50%) in primary care patients attempting suicide were characterized by minimal depression diagnoses and fatal attempts, mostly with firearms. These findings suggest that more than a depression diagnosis contributes to risk and that conversations about firearm safety by medical providers may play an important role in suicide intervention and prevention.

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Mechanism of action of nucleoside antibacterial natural product antibiotics - Journal of Antibiotics

The Journal of Antibiotics, Published online: 30 August 2019; doi:10.1038/s41429-019-0227-3

Mechanism of action of nucleoside antibacterial natural product antibiotics

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Synthesis and biological activity of analogs of CPZEN-45, a novel antituberculosis drug - Journal of Antibiotics

The Journal of Antibiotics, Published online: 30 August 2019; doi:10.1038/s41429-019-0225-5

Synthesis and biological activity of analogs of CPZEN-45, a novel antituberculosis drug

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The Quality of Nursing Homes That Serve Patients With Human Immunodeficiency Virus - American Geriatric Society

BACKGROUND/OBJECTIVES

As the national population of persons living with human immunodeficiency virus (HIV) ages, they will require greater postacute and long‐term care use. Little is known about the quality of nursing homes (NHs) to which patients with HIV are admitted. In this study, we assess the association between the number of persons with HIV admitted annually to a given NH (HIV concentration) and that NH's quality outcomes.

DESIGN

A cross‐sectional comparative study.

SETTING

NHs in nine states, from 2001 to 2012.

PARTICIPANTS

A total of 46 918 NH‐years accounting for 67 301 admissions by patients with HIV.

MEASUREMENTS

We used 100% Medicaid Analytic Extract, Minimum Dataset 2.0 and 3.0, and Medicare claims from 2001 to 2012 from nine states to examine the association between HIV concentration and NH quality. Persons were classified as HIV positive on the basis of all available data sources, and a NH's percentage of new admissions with HIV was calculated (HIV concentration). We then compared differences in star ratings, rehospitalization rates, NH survey deficiencies, and restraint use by a NH's percentage of admissions with HIV, using linear random effects models.

RESULTS

After adjusting for NH characteristics, zip code characteristics, and state and year fixed effects, NHs with greater than 0% to 5% of admissions with HIV had a 0.6 lower star rating (P < .001), and a 0.4% percentage point higher 30‐day rehospitalization rate (P < .01), compared to those with no HIV admissions. NHs with 5% to 50% of admissions with HIV had 7.0 more deficiencies (P < .001), a 0.1 lower star rating (P < .001), and a 1.5 percentage point higher rehospitalization rate (P < .001).

CONCLUSION

Persons with HIV were generally admitted to lower‐quality NHs compared to persons without HIV. More efforts are needed to ensure that persons with HIV have access to high‐quality NHs.

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FDA recommends health care facilities and manufacturers begin transitioning to duodenoscopes with disposable components to reduce risk of patient infection - FDA Press Releases

FDA recommends duodenoscope manufacturers and health care facilities transition to different types of duodenoscopes that may pose less risk to patient safety.

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Predicting Hospital Readmissions from Home Healthcare in Medicare Beneficiaries - American Geriatric Society

OBJECTIVE

To use patient‐level clinical variables to develop and validate a parsimonious model to predict hospital readmissions from home healthcare (HHC) in Medicare fee‐for‐service beneficiaries.

DESIGN

Retrospective analysis using multivariable logistic regression and gradient boosting machine (GBM) learning to develop and validate a predictive model.

SETTING/PARTICIPANTS/MEAUREMENTS

A 5% national sample of patients, aged 65 years or older, with Medicare fee‐for‐service who received skilled HHC services within 5 days of hospital discharge in 2012 (n = 43 407). Multiple data sets were merged, including Medicare Outcome and Assessment Information Set, Home Health Claims, Medicare Provider Analysis and Review, and Master Beneficiary Summary Files, to extract patient‐level variables from the first HHC visit after discharge and measure 30‐day readmission outcomes.

RESULTS

Among 43 407 patients with inpatient hospitalizations followed by HHC, 14.7% were readmitted within 30 days. Of the 53 candidate variables, seven remained in the final model as individually predictive of outcome: Elixhauser comorbidity index, index hospital length of stay, urinary catheter presence, patient status (ie, fragile health with high risk of complications or serious progressive condition), two or more hospitalizations in prior year, pressure injury risk or presence, and surgical wound presence. Of interest, surgical wounds, either from a total hip or total knee arthroplasty procedure or another surgical procedure, were associated with fewer readmissions. The optimism‐corrected c‐statistics for the full model and parsimonious model were 0.67 and 0.66, respectively, indicating fair discrimination. The Brier score for both models was 0.120, indicating good calibration. The GBM model identified similar predictive variables.

CONCLUSION

Variables available to HHC clinicians at the first postdischarge HHC visit can predict readmission risk and inform care plans in HHC. Future analyses incorporating measures of social determinants of health, such as housing instability or social support, have the potential to enhance prediction of this outcome.

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Decisional Guidance Tool for Antibiotic Prescribing in the Skilled Nursing Facility - American Geriatric Society

OBJECTIVES

To derive weighted‐incidence syndromic combination antibiograms (WISCAs) in the skilled nursing facility (SNF). To compare burden of resistance between SNFs in a region and those with and without protocols designed to reduce inappropriate antibiotic use.

DESIGN

Retrospective analysis of microbial data from a regional laboratory.

SETTING

We analyzed 2484 isolates collected at a regional laboratory from a large mixed urban and suburban area from January 1, 2015, to December 31, 2015.

PARTICIPANTS

A total of 28 regional SNFs (rSNFs) and 7 in‐network SNFs (iSNFs).

MEASUREMENTS

WISCAs were derived combining Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, and reports restricted to fluoroquinolones, cefazolin, amoxicillin clavulanate, and trimethoprim/sulfamethoxazole.

RESULTS

Pooling the target isolates into WISCAs resulted in an average of 28 of 37 achieving a number greater than 30 with an average of 50 isolates (range = 11‐113; >97% urinary). Significant differences were found in antibiotic susceptibility between grouped rSNF data and iSNF data of 75% vs 65% (2.76‐11.77; P = .002). The susceptibilities were higher in iSNFs with active antibiotic reduction protocols compared with iSNFs without protocols and rSNFs (effect size = .79 vs .67 and .65, respectively) (I² = 93.33; P < .01). Susceptibilities to cefazolin (95% vs 76%; P < .001) and fluoroquinolones (72% vs 64%; P = .048) were significantly higher in iSNFs with active urinary tract infection protocols as compared with iSNFs without antibiotic reduction protocols.

CONCLUSION

These results suggest that WISCAs can be developed in most SNFs, and their results can serve as indicators of successful antibiotic stewardship programs.

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An inoculum-dependent culturing strategy (IDC) for the cultivation of environmental microbiomes and the isolation of novel endophytic Actinobacteria - Journal of Antibiotics

The Journal of Antibiotics, Published online: 29 August 2019; doi:10.1038/s41429-019-0226-4

An inoculum-dependent culturing strategy (IDC) for the cultivation of environmental microbiomes and the isolation of novel endophytic Actinobacteria

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Rehabbed to Death: Breaking the Cycle - American Geriatric Society

Many older adults transfer from the hospital to a post‐acute care (PAC) facility and back to the hospital in the final phase of life. This phenomenon, which we have dubbed “Rehabbing to death,” is emblematic of how our healthcare system does not meet the needs of older adults and their families. Policy has driven practice in this area including seemingly benign habits such as calling PAC facilities “rehab.” We advocate for practice changes: (1) calling PAC “after‐hospital transitional care,” rather than “rehab”; (2) adopting a serious illness communication model when discussing new care needs at the end of a hospitalization; and (3) policies that incentivize comprehensive care planning for older adults across all settings and provide broad support and training for caregivers. In realigning health and social policies to meet the needs of older adults and their caregivers, fewer patients will be rehabbed to death, and more will receive care consistent with their preferences and priorities.

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Rehabbed to Death Reframed: In Response to “Rehabbed to Death: Breaking the Cycle” - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Introduction of Abstracts to be presented at the Eighth Chinese Congress on Gerontology and Health Industry - American Geriatric Society

Journal of the American Geriatrics Society, Volume 67, Issue S4, Page S593-S594, September 2019.

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Paper Session - American Geriatric Society

Journal of the American Geriatrics Society, Volume 67, Issue S4, Page S595-S687, September 2019.

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Author Index - American Geriatric Society

Journal of the American Geriatrics Society, Volume 67, Issue S4, Page S688-S695, September 2019.

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Statement from FDA Commissioner Scott Gottlieb, M.D., on federal preparedness and FDA’s response efforts to the Ebola virus outbreak in the Democratic Republic of Congo - FDA Press Releases

FDA committed to helping the people of the Democratic Republic of Congo effectively confront and end the current Ebola virus outbreak

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FDA seeks permanent injunction against company selling unapproved hand sanitizers that claim to prevent infections from numerous pathogens - FDA Press Releases

FDA seeks permanent injunction against company selling unapproved hand sanitizers that claim to prevent infections from numerous pathogens

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FDA authorizes emergency use of first Ebola fingerstick test with portable reader - FDA Press Releases

FDA authorizes emergency use of first Ebola fingerstick test with portable reader

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Statement on the agency’s ongoing efforts to resolve safety issue with ARB medications - FDA Press Releases

The FDA is issuing an update regarding the ongoing efforts to resolve safety issues with ARB medications.

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New natural products to meet the antibiotic crisis: a personal journey - Journal of Antibiotics

The Journal of Antibiotics, Published online: 28 August 2019; doi:10.1038/s41429-019-0224-6

New natural products to meet the antibiotic crisis: a personal journey

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Pain Management in Nursing Home Residents: Findings from a Pilot Effectiveness‐Implementation Study - American Geriatric Society

OBJECTIVES

To evaluate the effectiveness and implementation of a multilevel pain management intervention in nursing homes (NHs) comprising a pain management guideline, care worker training, and pain champions.

DESIGN

An implementation science pilot study using a quasi‐experimental effectiveness‐implementation (hybrid II) design.

SETTING

Four NHs in Switzerland.

PARTICIPANTS

All consenting long‐term residents aged 65 years and older with pain at baseline (N = 62) and all registered and licensed practical nurses (N = 61).

INTERVENTION

Implementation of a contextually adapted pain management guideline, interactive training workshops for all care workers, and specifically trained pain champions.

MEASUREMENTS

Interference from pain, worst and average pain intensity over the previous 24 hours; proxy ratings of pain with the Pain Assessment in Advanced Dementia scale; and care workers' appraisal of the guideline's reach, acceptability, and adoption.

RESULTS

Pain‐related outcomes improved for self‐reporting residents (n = 43) and residents with proxy rating (n = 19). Significant improvements of average pain from baseline to T1 (P = .006), and in worst pain from baseline to T1 (P = .003) and T2 (P = .004). No significant changes in interference from pain (P = .18). With regard to the implementation efforts, about 76% of care workers indicated they were familiar with the guideline; 70.4% agreed that the guideline is practical and matches their ideas of good pain assessment (75.9%) and treatment (79.7%).

CONCLUSION

Implementation of a multilevel pain management intervention did significantly improve average and worst pain intensity in NH residents. However, to effect clinical meaningful changes in interference from pain, a more comprehensive approach involving other disciplines may be necessary.

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High‐Need Phenotypes in Medicare Beneficiaries: Drivers of Variation in Utilization and Outcomes - American Geriatric Society

OBJECTIVES

High‐need (HN) Medicare beneficiaries heavily use healthcare services at a high cost. This population is heterogeneous, composed of individuals with varying degrees of medical complexity and healthcare needs. To improve healthcare delivery and decrease costs, it is critical to identify the subpopulations present within this population. We aimed to (1) identify distinct clinical phenotypes present within HN Medicare beneficiaries, and (2) examine differences in outcomes between phenotypes.

DESIGN

Latent class analysis was used to identify phenotypes within a sample of HN fee‐for‐service (FFS) Medicare beneficiaries aged 65 years and older using Medicare claims and post‐acute assessment data.

SETTING

Not applicable.

PARTICIPANTS

Two cross‐sectional cohorts were used to identify phenotypes. Cohorts included FFS Medicare beneficiaries aged 65 and older who survived through 2014 (n = 415 659) and 2015 (n = 416 643).

MEASUREMENTS

The following variables were used to identify phenotypes: acute and post‐acute care use, functional dependency in one or more activities of daily living, presence of six or more chronic conditions, and complex chronic conditions. Mortality, hospitalizations, healthcare expenditures, and days in the community were compared between phenotypes.

RESULTS

Five phenotypes were identified: (1) comorbid ischemic heart disease with hospitalization and skilled nursing facility use (22% of the HN sample), (2) comorbid ischemic heart disease with home care use (23%), (3) home care use (12%), (4) high comorbidity with hospitalization (32%), and (5) Alzheimer's disease/related dementias with functional dependency and nursing home use (11%). Mortality was highest in phenotypes 1 and 2; hospitalizations and expenditures were highest in phenotypes 1, 3, and 4.

CONCLUSIONS

Our findings represent a first step toward classifying the heterogeneity among HN Medicare beneficiaries. Further work is needed to identify modifiable utilization patterns between phenotypes to improve the value of healthcare provided to these subpopulations.

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FDA approves new add-on drug to treat off episodes in adults with Parkinson’s disease - FDA Press Releases

FDA approves new add-on drug to treat off episodes in adults with Parkinson’s disease

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

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

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FDA requests recall of sterile compounded drug products produced by Pacifico National Inc., dba AmEx Pharmacy, reminds patients and health care professionals to stop using due to potential risks - FDA Press Releases

The FDA is requesting a recall of sterile compounded drug products produced by Pacifico National Inc., dba AmEx Pharmacy.

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Health Insurance and Disparities in Mortality among Older Survivors of Critical Illness: A Population Study - American Geriatric Society

Objectives

The 1.5 million Medicare beneficiaries who survive intensive care each year have a high post‐hospitalization mortality rate. We aimed to determine whether mortality after critical illness is higher for Medicare beneficiaries with Medicaid compared with those with commercial insurance.

Design

A retrospective cohort study from 2010 through 2014 with 1 year of follow‐up using the New York Statewide Planning and Research Cooperative System database.

Setting

A New York State population‐based study of older (age ≥65 y) survivors of intensive care.

Participants

Adult Medicare beneficiaries age 65 years or older who were hospitalized with intensive care at a New York State hospital and survived to discharge.

Intervention

None.

Measurement

Mortality in the first year after hospital discharge.

Results

The study included 340 969 Medicare beneficiary survivors of intensive care with a mean (standard deviation) age of 77 (8) years; 20% died within 1 year. There were 152 869 (45%) with commercial insurance, 78 577 (23%) with Medicaid, and 109 523 (32%) with Medicare alone. Compared with those with commercial insurance, those with Medicare alone had a similar 1‐year mortality rate (adjusted hazard ratio [aHR] = 1.01; 95% confidence interval [CI] = .99‐1.04), and those with Medicaid had a 9% higher 1‐year mortality rate (aHR = 1.09; 95% CI = 1.05‐1.12). Among those discharged home, the 1‐year mortality rate did not vary by insurance coverage, but among those discharged to skilled‐care facilities (SCFs), the 1‐year mortality rate was 16% higher for Medicaid recipients (aHR = 1.16; 95% CI = 1.12‐1.21; P for interaction <.001).

Conclusions

Older adults with Medicaid insurance have a higher 1‐year post‐hospitalization mortality compared with those with commercial insurance, especially among those discharged to SCFs. Future studies should investigate care disparities at SCFs that may mediate these higher mortality rates.

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The Clinical Course after Long‐Term Acute Care Hospital Admission among Older Medicare Beneficiaries - American Geriatric Society

Objectives

Long‐term acute care (LTAC) hospitals provide extended complex post–acute care to more than 120 000 Medicare beneficiaries annually, with the goal of helping patients to regain independence and recover. Because little is known about patients’ long‐term outcomes, we sought to examine the clinical course after LTAC admission.

Design

Nationally representative 5‐year cohort study using 5% Medicare data from 2009 to 2013.

Setting

LTAC hospitals.

Participants

Hospitalized Medicare fee‐for‐service beneficiaries 65 years of age or older who were transferred to an LTAC hospital.

Measurements

Mortality, recovery (defined as achieving 60 consecutive days alive without inpatient care), time spent in an inpatient facility following LTAC hospital admission, receipt of an artificial life‐prolonging procedure (feeding tube, tracheostomy, hemodialysis), and palliative care physician consultation.

Results

Of 14 072 hospitalized older adults transferred to an LTAC hospital, median survival was 8.3 months, and 1‐ and 5‐year survival rates were 45% and 18%, respectively. Following LTAC admission, 53% never achieved a 60‐day recovery. The median time of their remaining life a patient spent as an inpatient after LTAC admission was 65.6% (interquartile range = 21.4%‐100%). More than one‐third (36.9%) died in an inpatient setting, never returning home after the LTAC admission. During the preceding hospitalization and index LTAC admission, 30.9% received an artificial life‐prolonging procedure, and 1% had a palliative care physician consultation.

Conclusion

Hospitalized older adults transferred to LTAC hospitals have poor survival, spend most of their remaining life as an inpatient, and frequently undergo life‐prolonging procedures. This prognostic understanding is essential to inform goals of care discussions and prioritize healthcare needs for hospitalized older adults admitted to LTAC hospitals. Given the exceedingly low rates of palliative care consultations, future research is needed to examine unmet palliative care needs in this population.

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Statement calling on all sectors of the papaya industry to improve practices to better protect consumers - FDA Press Releases

FDA issues letter to all sectors of papaya industry to improve their safety practices

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Albicidin, a potent DNA gyrase inhibitor with clinical potential - Journal of Antibiotics

The Journal of Antibiotics, Published online: 26 August 2019; doi:10.1038/s41429-019-0228-2

Albicidin, a potent DNA gyrase inhibitor with clinical potential

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Structurally diverse metabolites from the rare actinobacterium Saccharothrix xinjiangensis - Journal of Antibiotics

The Journal of Antibiotics, Published online: 26 August 2019; doi:10.1038/s41429-019-0223-7

Structurally diverse metabolites from the rare actinobacterium Saccharothrix xinjiangensis

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Midlife Cardiovascular Status and Old Age Physical Functioning Trajectories in Older Businessmen - American Geriatric Society

OBJECTIVES

The associations between cardiovascular disease (CVD) risk and later physical functioning have been observed, but only a few studies with follow‐up into old age are available. We investigated the association between cardiovascular status in midlife and physical functioning trajectories in old age.

DESIGN

Prospective cohort study.

SETTING

Helsinki Businessmen Study.

PARTICIPANTS

We studied white men born between 1919 and 1934 in the Helsinki Businessmen Study (HBS, initial n = 3490).

MEASUREMENTS

Three CVD status groups were formed based on clinical measurements carried out in 1974: signs of CVD (diagnosed clinically or with changes in ECG, chronic disease present or used medication, n = 563); healthy and low CVD risk (n = 593) and high CVD risk (n = 1222). Of them, 1560 men had data on physical functioning from at least one of four data collection waves between 2000‐2010. Ten questions from the RAND‐36 (SF‐36) survey were used to construct physical functioning trajectories with latent class growth mixture models. Mortality was accounted for in competing risk models.

RESULTS

A five‐class solution provided the optimal number of trajectories: “intact,” “high stable,” “high and declining,” “intermediate and declining,” and “consistently low” functioning. Compared with low CVD risk, high CVD risk in midlife decreased the risk of being classified into the intact (fully adjusted β = −3.98; standard error = 2.0; P = .046) relative to the consistently low physical functioning trajectory. Compared with low CVD risk, those with signs of CVD were less likely to follow the intact, high stable, or high and declining relative to the consistently low trajectory (all P < .018).

CONCLUSION

Among businessmen, a more favorable CVD profile in midlife was associated with better development of physical functioning in old age.

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From Frailty to Gerastenia - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Reply to From Frailty to Gerastenia - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Vitamin D Status Among Older Women Initiating Osteoporosis Therapy - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Bimanual Gesture Imitation Links to Cognition and Olfaction - American Geriatric Society

OBJECTIVES

Given the need to detect subclinical changes in brain health that sometimes occur with aging in apparently healthy older adults, we assessed whether bimanual gesture imitation performance, simple to assess clinically, can detect age effects and alterations in cognition, olfaction, and movement.

DESIGN

Cross‐sectional study.

SETTING

Baltimore Longitudinal Study of Aging.

PARTICIPANTS

Men and women, aged 22 to 101 years, without cognitive impairment, dementia, stroke, Parkinson disease, resting tremor, abnormal muscle tone, or abnormal coordination (N = 507).

MEASUREMENTS

Bimanual gesture imitation was measured using a test validated in older adults. We assessed (1) cognition, including verbal memory, executive function, attention, visuospatial ability, visuoperceptual speed, and language; (2) manual dexterity with the Purdue Pegboard Test; (3) olfaction, using the 16‐item Sniffin' Sticks Identification Test; (4) upper extremity motor function, using a computer‐based finger tapping test; and (5) lower extremity motor function, including 6‐meter usual and rapid gait speeds, 400‐meter walk time, Health ABC Physical Performance Battery, and total standing balance time. Cross‐sectional associations between bimanual gesture imitation performance and each measure were examined using linear regression after adjustment for age, sex, race, education, and body mass index. Models with mobility measures also adjusted for height.

RESULTS

Higher gesture imitation performance was associated with younger age. After adjustment, a worse score was associated with worse olfaction, executive function, and visuospatial ability. Gesture imitation score was not associated with other cognitive measures or motor function.

CONCLUSION

In persons without clinically detectable neurological conditions, poor bimanual gesture imitation is associated with other indicators of brain health, including olfaction and selected cognitive function domains. Bimanual gesture imitation may be useful clinically to detect subtle brain changes in apparently healthy older adults.

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Validation of a Multi–Sensor‐Based Kiosk for Short Physical Performance Battery - American Geriatric Society

OBJECTIVES

We aimed to validate a multi–sensor‐based kiosk (automatically measured Short Physical Performance Battery [eSPPB] kiosk) that can perform automated measurement of the SPPB.

DESIGN

Prospective, cross‐sectional study.

SETTING

Rehabilitation clinic of a tertiary‐care hospital.

PARTICIPANTS

Ambulatory outpatients, aged 65 years or older (N = 40).

MEASUREMENTS

The eSPPB kiosk was developed to measure the three components of the SPPB: standing balance, gait speed, and chair stand test with embedded sensors and algorithms. Correlations between the total and component‐specific scores of the eSPPB and manually measured SPPB (mSPPB), assessed by a physical therapist, were assessed. Further, correlations between SPPB parameters and geriatric functional measures were also evaluated.

RESULTS

This study included 40 participants with a mean age of 74.4 ± 6.5 years, a mean total eSPPB score of 10.1 ± 2.1, and a mean total mSPPB score of 10.2 ± 2.1. The intraclass correlation coefficient between the eSPPB and mSPPB total score was 0.97 (P < .001), and the κ agreement was 0.79 (P < .001). The intraclass coefficients between the components of eSPPB and mSPPB were 0.77 (P < .001), 0.88 (P < .001), and 0.99 (P < .001) for standing balance, gait speed, and chair stand test, respectively.

CONCLUSION

The newly developed kiosk might be a viable and efficient method for performing the SPPB in older adults.

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FDA confirms elevated levels of belladonna in certain homeopathic teething products - FDA Press Releases

The U.S. Food and Drug Administration announced today that its laboratory analysis found inconsistent amounts of belladonna, a toxic substance, in certain homeopathic teething tablets, sometimes far exceeding the amount claimed on the label. The agency is warning consumers that homeopathic teething tablets containing belladonna pose an unnecessary risk to infants and children and urges consumers not to use these products.

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FDA proposes new, risk-based enforcement priorities to protect consumers from potentially harmful, unproven homeopathic drugs - FDA Press Releases

Today, the U.S. Food and Drug Administration proposed a new, risk-based enforcement approach to drug products labeled as homeopathic. To protect consumers who choose to use homeopathic products, this proposed new approach would update the FDA’s existing policy to better address situations where homeopathic treatments are being marketed for serious diseases and/or conditions but where the products have not been shown to offer clinical benefits. It also covers situations where products labeled as homeopathic contain potentially harmful ingredients or do not meet current good manufacturing practices.

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Cost‐Related Medication Nonadherence Among Older Adults: Findings From a Nationally Representative Sample - American Geriatric Society

OBJECTIVES

To estimate the rate of and risk factors associated with cost‐related medication nonadherence among older adults.

DESIGN

Cross‐sectional analysis of the 2017 National Health Interview Survey (NHIS).

SETTING

Nationally representative health interview survey in the United States.

PARTICIPANTS

Survey respondents, aged 65 years or older (n = 5701 unweighted) in the 2017 wave of the NHIS.

MEASUREMENTS

Self‐reported, cost‐related medication nonadherence (due to cost: skip dose, reduce dose, or delay or not fill a prescription) and actions taken due to cost‐related medication nonadherence (ask for lower‐cost prescription, use alternative therapy, or buy medications from another country) were quantified. We used a series of multivariable logistic regression analyses to identify factors associated with cost‐related medication nonadherence. We also reported analyses by chronic disease subgroups.

RESULTS

In 2017, 408 (6.8%) of 5901 older adults, representative of 2.7 million older adults nationally, reported cost‐related medication nonadherence. Among those with cost‐related medication nonadherence, 44.2% asked a physician for lower‐cost medications, 11.5% used alternative therapies, and 5.3% bought prescription drugs outside the United States to save money. Correlates independently associated with a higher likelihood of cost‐related medication nonadherence included: younger age, female sex, lower socioeconomic levels (eg, low income and uninsured), mental distress, functional limitations, multimorbidities, and obesity (P < .05 for all). Similar patterns were found in subgroup analyses.

CONCLUSION

Cost‐related medication nonadherence among older adults is increasingly common, with several potentially modifiable risk factors identified. Interventions, such as medication therapy management, may be needed to reduce cost‐related medication nonadherence in older adults.

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Nocturnal Excretion in Healthy Older Women and Rationale for a Safer Approach to Sleep Disruption - American Geriatric Society

OBJECTIVES

Insomnia, especially difficulty maintaining sleep, is prevalent among older adults and increases the incidence of falls and fractures. Moreover, the drugs used to treat it exacerbate the risk. Yet current therapies fail to address one of its most common causes in older adults: nocturia and its primary contributor, nocturnal polyuria (NP), especially among the majority of individuals without lower urinary tract symptoms (LUTS). Therefore, we examined the factors associated with nocturia in two groups of such older women and the impact of nocturia on sleep.

DESIGN

Secondary analysis of two observational studies of bladder function in carefully evaluated healthy older women.

SETTING

Academic medical center.

PARTICIPANTS

A total of 39 women without LUTS who had adequate fluid intake (ie, >1200 mL urine output/24 h recorded on their diary), normal videourodynamic testing, and normal daytime frequency (≤7 voids).

MEASUREMENTS

Voided volumes and sleep duration obtained from subjects’ 3‐day voiding diary, and sleep quality from the Center for Epidemiologic Studies Depression Scale. Nighttime excretion of more than 33% of 24‐hour urine volume was considered NP.

RESULTS

Overall, 21 of these healthy subjects (54%) awakened at least once nightly to void, and 19 (90%) of them had NP. Compared with those without nocturia, participants with nocturia had shorter duration of the first uninterrupted sleep period (182 ± 100 vs 250 ± 60 min; P = .03), and they reported worse sleep quality. Two factors contributed independently to nocturia: (1) a larger proportion of 24‐hour urine output at night (43.4 ± 7.4% vs 25.4 ± 5.5%; P = <.001) and (2) smaller bladder capacity (484 ± 157 mL vs 608 ± 167 mL; P = .02).

CONCLUSIONS

Nocturia, NP, and reduced bladder capacity are very common even in healthy older women without LUTS and are associated with impaired sleep. Thus applying currently available modalities to address both NP and reduced bladder capacity may effectively treat sleep disruption without incurring the complications of sedative‐hypnotics.

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Medication Nonadherence as a Complex Health Behavior: There Is More to It Than Just Missed Doses - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Impact of Cognitive Impairment Across Specialties: Summary of a Report From the U13 Conference Series - American Geriatric Society

Although declines in cognitive capacity are assumed to be a characteristic of aging, increasing evidence shows that it is age‐related disease, rather than age itself, that causes cognitive impairment. Even so, older age is a primary risk factor for cognitive decline, and with individuals living longer as a result of medical advances, cognitive impairment and dementia are increasing in prevalence. On March 26 to 27, 2018, the American Geriatrics Society convened a conference in Bethesda, MD, to explore cognitive impairment across the subspecialties. Bringing together representatives from several subspecialties, this was the third of three conferences, supported by a U13 grant from the National Institute on Aging, to aid recipients of Grants for Early Medical/Surgical Specialists' Transition to Aging Research (GEMSSTAR) in integrating geriatrics into their subspecialties. Scientific sessions focused on the impact of cognitive impairment, sensory contributors, comorbidities, links between delirium and dementia, and issues of informed consent in cognitively impaired populations. Discussions highlighted the complexity not only of cognitive health itself, but also of the bidirectional relationship between cognitive health and the health of other organ systems. Thus, conference participants noted the importance of multidisciplinary team science in future aging research. This article summarizes the full conference report, “The Impact of Cognitive Impairment Across Specialties,” and notes areas where GEMSSTAR scholars can contribute to progress as they embark on their careers in aging research.

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Gender Disparities in Cardiac Rehabilitation Among Older Women - Geriatrics

Older women with cardiovascular disease experience lower referral, participation, and completion rates of cardiac rehabilitation (CR), despite its well-established benefits (improved morbidity, mortality, quality of life, and functional capacity). Multiple social and health care system barriers affect participation of this population, including limitations in accessibility and transportation, competing responsibilities as caregivers, and lack of insight among patients and provider regarding the value of CR. With continued advances in technology and the ubiquity of smartphones, alternative CR programs may be able to better overcome barriers that affect older women.

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Lesbian, Gay, Bisexual, and Transgender Older Adults' Experiences With Elder Abuse and Neglect - American Geriatric Society

BACKGROUND/OBJECTIVES

Little is known about elder abuse and neglect in the lesbian, gay, bisexual, and transgender (LGBT) community; however, this population faces a greater risk of abuse and likely experiences abuse differently and needs different resources. We conducted focus groups to investigate LGBT older adults' perspectives on and experience with elder mistreatment.

METHODS

We conducted three focus groups with 26 participants recruited from senior centers dedicated to LGBT older adults. A semistructured questionnaire was developed, and focus groups were audio recorded, professionally transcribed, and analyzed using grounded theory.

RESULTS

Key themes that emerged included: definitions and etiologies of abuse, intersectionality of discrimination from multiple minority identities, reluctance to report, and suggestions for improving outreach. Participants defined elder abuse in multiple ways, including abuse from systems and by law enforcement and medical providers. Commonly reported etiologies included: social isolation due to discrimination, internalization of stigma, intersection of discrimination from multiple minority identities, and an abuser's desire for power and control. Participants were somewhat hesitant to report to police; however, most felt strongly that they would not report abuse to their medical provider. Most reported that they would feel compelled to report if they knew someone was being abused; however, they did not know who to report to. Strategies participants suggested to improve outreach included: increasing awareness about available resources and researchers engaging with the LGBT community directly.

CONCLUSION

LGBT older adults conceptualize elder abuse differently and have different experiences with police and medical providers. Improved outreach to this potentially vulnerable population is critical to ensuring their safety.

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Amycolatopsis alkalitolerans sp. nov., isolated from Gastrodia elata Blume - Journal of Antibiotics

The Journal of Antibiotics, Published online: 21 August 2019; doi:10.1038/s41429-019-0222-8

Amycolatopsis alkalitolerans sp. nov., isolated from Gastrodia elata Blume

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Advancing the Science of Deprescribing: A Novel Comprehensive Conceptual Framework - American Geriatric Society

Polypharmacy is common in older adults and associated with inappropriate medication use, adverse drug events, medication nonadherence, higher costs, and increased mortality compared with those without polypharmacy. Deprescribing, the clinically supervised process of stopping or reducing the dose of medications when they cause harm or no longer provide benefit, may improve outcomes. Although potentially beneficial, clinicians struggle to overcome structural, organizational, technological, and cognitive barriers to deprescribing, limiting its use in clinical practice. Deprescribing science would benefit from a unifying conceptual framework to prioritize research. Current deprescribing conceptual frameworks have made important contributions to the field but often with a focus on specific medication classes or aspects of deprescribing. To further this relatively nascent field, we developed a broader deprescribing conceptual framework that builds on prior frameworks and includes patient, prescriber, and system influences; the process of deprescribing; outcomes; and dissemination. Patient factors include patients' biology, experience, values, and preferences. Prescriber factors include rational (eg, based on explicit knowledge) and nonrational (eg, behavioral tendencies, biases, and heuristics) decision making. System factors include resources, incentives, goals, and culture that contribute to deprescribing. The framework separates the deprescribing decision from the deprescribing process. The framework captures the results of deprescribing by examining changes in clinical structures, performance processes, patient experience, health outcomes, and cost. Through testing and refinement, this novel, more comprehensive conceptual framework has the potential to advance deprescribing research by organizing the existing evidence, identifying evidence gaps, and categorizing deprescribing interventions and the settings in which they are applied.

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Swallowing Disorders in the Older Population - American Geriatric Society

Swallowing problems, or dysphagia, are common as people age, and are associated with significant negative outcomes, including weight loss, pneumonia, dehydration, shortened life expectancy, reduced quality of life, and increased caregiver burden. In this article, we will discuss the complex process of swallowing in normal circumstances and with healthy aging, then review etiologies that contribute to dysphagia. We will discuss approaches to evaluating and treating dysphagia, providing relevant data where they are available. We highlight the desperate need for high‐quality research to guide best practices in treating dysphagia in older adults.

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FDA warns company for putting consumers at risk with drug manufacturing data integrity violations - FDA Press Releases

The FDA posted a warning letter for significant current good manufacturing practice violations, including data integrity issues.

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Statement on new results demonstrating continued success of the agency’s youth smoking prevention efforts and significant public health cost savings - FDA Press Releases

A new study in the American Journal of Preventive Medicine highlights the continued success and impact the FDA’s “The Real Cost” campaign has had on youth smoking initiation.

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Prehabilitation - Geriatrics

The wait before elective cardiac intervention or surgery presents an opportunity to prevent further physiologic decline preoperatively in older patients. Implementation of prehabilitation programs decreases length of hospital stay postoperatively, decreases time spent in the intensive care unit, decreases postoperative complications, and improves self-reported quality of life postsurgery. Prehabilitation programs should adopt multimodal approaches including nutrition, exercise, and worry reduction to improve patient resilience in the preoperative period. High-quality research in larger cohorts is needed, and interventions focusing on underrepresented frailer populations and women. Creative ways to improve accessibility, adherence, and benefits received from prehabilitation should be explored.

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FDA approves new antibiotic to treat community-acquired bacterial pneumonia - FDA Press Releases

The FDA approved Xenleta (lefamulin) to treat adults with community-acquired bacterial pneumonia.

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FDA warns consumers about the dangerous and potentially life threatening side effects of Miracle Mineral Solution - FDA Press Releases

The FDA is warning consumers not to purchase or drink Miracle Mineral Solution, a product sold online as a medical treatment due to a recent rise in reported health issues.

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Health Literacy Matters More Than Experience for Advance Care Planning Knowledge Among Older Adults - American Geriatric Society

BACKGROUND

Advance care planning (ACP) engagement is low among vulnerable populations, including those with limited health literacy (LHL). Limited knowledge about ACP may be a modifiable mediator of the relationship between LHL and ACP. Our goal was to determine whether health literacy is associated with ACP knowledge.

DESIGN

Cross‐sectional design.

SETTING

A public health delivery system and Veterans Affairs Medical Center in San Francisco, CA.

PARTICIPANTS

English‐ and Spanish‐speaking patients (N = 1400).

MEASUREMENTS

ACP knowledge was assessed with seven validated multiple‐choice questions. Health literacy was measured using a validated scale. Sociodemographic measures included age, sex, language, education, race, health status, and social support. Prior ACP experience was defined as having documented legal forms and/or goals‐of‐care discussions in the medical record. We used Kruskal‐Wallis tests and linear regression to examine associations of ACP knowledge with LHL, prior ACP experience, and sociodemographic factors.

RESULTS

Mean age of participants was 65 (±10) years, 48% were women, 34% had LHL, 32% were Spanish speaking, 47% had high school education or less, and 70% were nonwhite. Mean 7‐point knowledge scores were lower for those with limited vs adequate health literacy (3.8 [SD = 1.9 vs 5.5 (SD = 1.7); P < .001). In multivariable analysis, ACP knowledge scores were 1.0 point lower among those with LHL; 0.6 points lower among Spanish speakers and those with high school education or less; and 0.5 points lower among individuals of nonwhite race (P < .001 for all). Knowledge scores were 0.02 points lower per year of older age (P = .007) and 0.01 points higher per point of greater social support (P = .005). Prior ACP experience was not associated with knowledge after adjustment (P = .7).

CONCLUSIONS

Health literacy and sociodemographics are stronger predictors than prior ACP experience of ACP knowledge. This study suggests that providing easy‐to‐understand ACP materials is paramount and should be offered even if patients have previous experience with the ACP process.

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Associations between Skeletal Muscle and Myocardium in Aging: A Syndrome of “Cardio‐Sarcopenia”? - American Geriatric Society

Objectives

The link between skeletal muscle and heart disease remains intriguing. It is unknown how skeletal muscle may be associated with aspects of myocardial structure and function, particularly in the presence of aging‐related sarcopenia. We hypothesize that among aging adults with sarcopenia, alterations in myocardial structure and/or function may exist, resulting in a syndrome of “cardio‐sarcopenia.”

Methods

Participants derived from a community cohort study underwent same‐day bioimpedance body composition analysis that measured skeletal muscle in sites such as the trunk, upper limb, and lower limb, and echocardiography for assessment of myocardial structure and function. Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia criteria.

Results

We studied a total of 378 participants, of whom 88 (23.3%) had sarcopenia. Participants with sarcopenia had smaller left ventricular (LV) sizes (lower LV internal diameter end diastole (4.1 ± .7 vs 4.5 ± .6 cm; P < .0001), lower LV internal diameter end systole (2.3 ± .5 vs 2.5 ± .4 cm; P = .010), lower LV posterior wall end diastole (.7 ± .1 vs .8 ± .1 cm; P = .0036), and lower LV posterior wall end systole (1.4 ± .3 vs 1.5 ± .2 cm; P = .0031). Sarcopenic participants also had lower LV mass (106 ± 35 vs 126 ± 53; P = .0014) and lower left atrial (LA) volume (33 ± 13 vs 36 ± 13; P = .033). Adjusting for age and diabetes mellitus, skeletal muscle mass was associated with LV diameter (β = .06; 95% confidence interval [CI] = .03‐.09; P < .0001), LV mass (β = 4.04; 95% CI = 1.78‐6.29; P = .001), LA diameter (β = .05; 95% CI = .01‐.09; P = .007), and LA volume (β = 1.26; 95% CI = .38‐2.13; P = .005). A positive linear correlation was observed between LV mass and handgrip strength (r = .25; P < .0001).

Conclusion

Among a community sample of older adults with preserved heart function, sarcopenia is associated with reductions in LV and LA sizes. Skeletal muscle mass was independently associated with specific indices of myocardial structure.

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FDA approves new device to improve symptoms in patients with advanced heart failure - FDA Press Releases

FDA approves new device to improve symptoms in patients with advanced heart failure

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FDA expands indication for several transcatheter heart valves to patients at low risk for death or major complications associated with open-heart surgery - FDA Press Releases

FDA expands indication for several transcatheter heart valves to patients at low risk for death or major complications associated with open-heart surgery.

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FDA approves first of its kind device to treat pediatric patients with progressive idiopathic scoliosis - FDA Press Releases

FDA approves first of its kind device to treat pediatric patients with progressive idiopathic scoliosis

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From One Mother to Another - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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FDA approves treatment for patients with rare bone marrow disorder - FDA Press Releases

FDA approves treatment for adult patients with certain types of myelofibrosis.

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Development of a nebramine-cyclam conjugate as an antibacterial adjuvant to potentiate β-lactam antibiotics against multidrug-resistant P. aeruginosa - Journal of Antibiotics

The Journal of Antibiotics, Published online: 16 August 2019; doi:10.1038/s41429-019-0221-9

Development of a nebramine-cyclam conjugate as an antibacterial adjuvant to potentiate β-lactam antibiotics against multidrug-resistant P. aeruginosa

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Synergistic enhancement of beta-lactam antibiotics by modified tunicamycin analogs TunR1 and TunR2 - Journal of Antibiotics

The Journal of Antibiotics, Published online: 16 August 2019; doi:10.1038/s41429-019-0220-x

Synergistic enhancement of beta-lactam antibiotics by modified tunicamycin analogs TunR1 and TunR2

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FDA approves third oncology drug that targets a key genetic driver of cancer, rather than a specific type of tumor - FDA Press Releases

FDA approves third cancer treatment based on a common biomarker across different types of tumors rather than the location in the body where the tumor originated

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FDA proposes new required health warnings with color images for cigarette packages and advertisements to promote greater public understanding of negative health consequences of smoking - FDA Press Releases

FDA has issued a proposed rule to require new health warnings on cigarette packages and in ads to promote greater public understanding of the negative health consequences of smoking.

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Muraminomicins, new lipo-nucleoside antibiotics from Streptosporangium sp. SANK 60501-structure elucidations of muraminomicins and supply of the core component for derivatization - Journal of Antibiotics

The Journal of Antibiotics, Published online: 14 August 2019; doi:10.1038/s41429-019-0215-7

Muraminomicins, new lipo-nucleoside antibiotics from Streptosporangium sp. SANK 60501-structure elucidations of muraminomicins and supply of the core component for derivatization

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Use of the Consultation Letter Rating Scale among Geriatric Medicine Postgraduate Trainees - American Geriatric Society

OBJECTIVES

The implementation of competency‐based evaluations increases the emphasis on in‐training assessment. The Consultation Letter Rating Scale (CLRS), published by the Royal College of Physicians and Surgeons of Canada, is a tool that assesses written‐communication competencies. This multisite project evaluated the tool's validity, reliability, feasibility, and acceptability for use in postgraduate geriatric medicine training.

METHODS

Geriatric medicine trainees provided consultation letters from the 2017‐2018 academic year. Geriatricians reviewed a standardized module and completed the tool for all the deidentified letters. The reviewers recorded the time used to complete the tool for each letter and completed a survey on content validity. Trainees completed a survey on the tool's usefulness. Responses were reviewed independently by two authors for thematic content. The unweighted and the weighted κ were used to measure interrater reliability.

RESULTS

A total of 10 of 11 (91%) eligible trainees each provided five letters that were reviewed independently by six geriatricians, leading to a total of 300 assessments. A very small portion (4% [N = 12]) of assessments was incomplete. An average of 4.82 minutes (standard deviation = 3.17) was used to complete the tool. There was high interrater agreement for overall scores, with a multiple‐rater weighted κ of 83% (95% confidence interval = 76%‐89%). The interrater agreement was lower for the individual components. Both raters and trainees found the comments more useful than the numerical ratings.

CONCLUSIONS

Our results support the use of the CLRS for facilitating feedback on the quality of consult letters to improve written‐communication competencies among geriatric medicine trainees.

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Validation of the Modified Frailty Phenotype Measure in Older Mexican Americans - American Geriatric Society

OBJECTIVES

Develop and validate a modified frailty phenotype measure for older Mexican Americans participating in the Hispanic Established Populations for the Epidemiological Study of the Elderly (H‐EPESE) and related studies.

DESIGN

Expert‐based panel evaluation of content validity, cross‐sectional analysis of construct validity, and longitudinal analysis of criterion validity for a modified version of the frailty phenotype measure.

SETTING

Five southwestern states.

PARTICIPANTS

A total of 1833 community‐dwelling Mexican Americans aged 67 years or older.

MEASUREMENTS

Frailty was assessed using the frailty phenotype measure (weight loss, weakness, exhaustion, slowness, and low physical activity) and a modified frailty phenotype measure (replacing “low physical activity” with “limitations in walking half a mile”). Each individual was classified as non‐frail, pre‐frail, or frail based on both frailty measures (original vs modified). Expert panel consensus was used to examine content validity. Spearman correlation, κ, weighted κ, and bootstrapping κ examined construct validity (n = 1833). Generalized linear mixed models, odds ratios, Cox proportional regression models, hazard ratios, and C statistics were used to analyze criterion validity (n = 1446) across four outcomes: hospitalization, physician visits, disability, and mortality from wave 3 (1998‐99) through wave 8 (2012‐13).

RESULTS

The original and modified frailty phenotype measures had a strong correlation (r = .89; P < .000) and agreement (κ = .84; 95% confidence interval [CI] = .81‐.86; weighted κ = .86; 95% CI = .84‐.88; bootstrap κ = .84; 95% CI = .81‐.86; bootstrap‐weighted κ = .86; 95% CI = .84‐.88 with 1000 bootstrapping samples). Four outcome models showed similar risk predictions for both frailty measures, with the exception of physician visits for frail participants.

CONCLUSION

“Limitations in walking half a mile” can be used as a substitute criterion for “low physical activity” in assessing frailty. The modified frailty phenotype measure was comparable with the original frailty phenotype measure in H‐EPESE participants over time. Our results indicate the modified frailty phenotype is a useful longitudinally frailty measure for community‐dwelling older Mexican Americans.

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Artificial Nutrition Belongs on POLST - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Reply to Artificial Nutrition Belongs on POLST - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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The Association Between Low‐Density Lipoprotein Cholesterol and Incident Atherosclerotic Cardiovascular Disease in Older Adults: Results From the National Institutes of Health Pooled Cohorts - American Geriatric Society

BACKGROUND/OBJECTIVES

Elevated low‐density lipoprotein cholesterol (LDL‐C) in early adulthood is associated with increased risk of atherosclerotic cardiovascular disease (ASCVD). The strength of the association between LDL‐C and ASCVD among older adults, however, is less understood.

DESIGN

We examined individual‐level cohort data from the National Institutes of Health Pooled Cohorts (Framingham Study, Framingham Offspring Study, Multi‐Ethnic Study of Atherosclerosis, and Cardiovascular Health Study), which prospectively measured CVD risk factors and incident disease.

SETTING

Prospective cohort study.

PARTICIPANTS

Adults, aged 75 years or older, free of ASCVD.

MEASUREMENTS

We evaluated the associations between LDL‐C and incident ASCVD (stroke, myocardial infarction, and cardiovascular death) in unadjusted analysis and in multivariable‐adjusted Cox proportional hazards models. We assessed 5‐year Kaplan‐Meier ASCVD event rates in patients with and without hyperlipidemia (LDL‐C ≥130 mg/dL or on lipid‐lowering medications), stratified by the number of other risk factors, including smoking, diabetes, and hypertension.

RESULTS

We included 2667 adults, aged 75 years or older (59% female), free of ASCVD; median age was 78 years, with median LDL‐C of 117 mg/dL. In both unadjusted and adjusted analyses, there was no association between LDL‐C and ASCVD (adjusted hazard ratio = 1.022; 95% confidence interval = 0.998‐1.046; P = .07). Among adults without other risk factors (free of smoking, diabetes, and hypertension), event rates were similar between those with and without hyperlipidemia (Kaplan‐Meier rates = 5.8% and 7.0%, respectively). Among adults with one or two or more other risk factors, the presence of hyperlipidemia was also not associated with 5‐year CVD event rates (Kaplan‐Meier rates = 12.8% vs 15.0% [P = .44] for one other risk factor and 21.9% vs 24.0% [P = .59] for two or more other risk factors).

CONCLUSION

Among a well‐characterized cohort, LDL‐C was not associated with CVD risk among adults aged 75 years or older, even in the presence of other risk factors.

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The Impact of Self‐Reported Vision and Hearing Impairment on Health Expectancy - American Geriatric Society

OBJECTIVES

Vision and hearing impairment may impact both life expectancy (LE) and health expectancy, that is, duration of life with and without health problems, among older adults. We examined the impact of self‐reported vision and hearing impairment on years of life with and without limitation in physical function and in activities of daily living (ADLs).

DESIGN

Life table analysis, using a nationally representative longitudinal survey of community‐dwelling older adults aged 60 years or older, Panel on Health and Ageing of Singaporean Elderly.

SETTING

Singapore.

PARTICIPANTS

Survey participants (n = 3452) who were interviewed in 2009 and followed up in 2011‐2012 and 2015.

MEASUREMENTS

Participants reporting difficulty with any of nine tasks involving upper or lower extremities were considered to have a limitation in physical function. Those reporting health‐related difficulty with any of six basic ADLs or seven instrumental ADLs were considered to have a limitation in ADLs. We used the multistate life table method with a microsimulation approach to estimate health expectancy, considering self‐reported sensory impairment status as time varying.

RESULTS

Either or both impairments, vs neither, were associated with less years without limitation in physical function and in ADLs and more years with limitation in physical function and in ADLs, with the greatest impact on health expectancy among those with both impairments, who also had the lowest LE. For example, at age 60, those with both impairments, vs neither, could expect not only shorter LE (4.2 [95% confidence interval [CI] = 1.9‐5.7] less years; 20.7 [95% CI = 18.9‐22.5] vs 24.9 [95% CI = 23.8‐26.0]) but also more years of life with limitations in physical function (3.3 [95% CI = .9‐5.8] more years; 12.8 [95% CI = 10.7‐14.8] [about 61.7% of LE] vs 9.5 [95% CI = 8.4‐10.5] [about 38.0% of LE]).

CONCLUSION

Timely and appropriate management of vision and hearing impairment, especially when coexisting, among older adults has the potential to reduce the years of life they live with limitation in physical function and in ADLs.

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FDA approves new drug for treatment-resistant forms of tuberculosis that affects the lungs - FDA Press Releases

FDA approved Pretomanid Tablets in combination with bedaquiline and linezolid for the treatment of a specific type of highly treatment-resistant tuberculosis of the lungs.

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Oral Health Symptoms and Cognitive Function Among US Community‐Dwelling Chinese Older Adults - American Geriatric Society

BACKGROUND/OBJECTIVES

Limited research is available on the relationship between oral health symptoms and cognitive function among community‐dwelling US Chinese older adults. The purpose of this study was to examine the associations between tooth/gum symptoms and changes in cognitive function.

DESIGN

Two‐wave epidemiological study.

SETTING

Population Study of Chinese Elderly in Chicago (PINE).

PARTICIPANTS

US Chinese older adults (N = 2713; mean age = 72.6 y; 58.4% women).

MEASUREMENTS

We selected self‐reported oral (tooth and gum) symptoms as independent variables. To examine changes in cognitive function (wave 2: Baseline), we chose the following three domains: episodic memory (East Boston Memory Test); executive function (Symbol Digit Modalities Test); and working memory (Digit Span Backwards). In addition, we assessed global cognitive function by constructing a composite measure.

RESULTS

At baseline, 1297 participants (47.8%) reported having teeth symptoms, and 513 participants (18.9%) reported having gum symptoms. Adjusting for sociodemographic and health‐related characteristics, participants who reported having teeth symptoms at baseline experienced their global cognition decrease by 0.07 units (estimate = −0.07; p = .003) and their episodic memory decrease by 0.07 units (estimate = −0.07; p = .026). Participants who reported having teeth symptoms at baseline experienced a faster rate of decline in global cognition for every additional year (estimate = 0.02; p = .047). However, this effect disappeared once we adjusted for all covariates (estimate = 0.02; p = .069). We found no significant relationship between baseline gum symptoms and change of cognitive function.

CONCLUSION

Having teeth symptoms was associated with a decline in cognitive function among US Chinese older adults. Developing policy measures aimed at ameliorating health and improving cognition in this high‐risk fast‐growing population in the United States would need to include oral health preventive and dental care services. J Am Geriatr Soc 67:S532–S537, 2019.

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The Influence of Smoking Status on the Health Profiles of Older Chinese American Men - American Geriatric Society

OBJECTIVE

To examine the influence of smoking status on the health profiles of community‐dwelling older Chinese American men in the greater Chicago, IL, area.

DESIGN

This study utilized a cross‐sectional study design to analyze data obtained from the larger Population Study of Chinese Elderly in Chicago (PINE).

SETTING

A population‐based study conducted in Chicago.

PARTICIPANTS

Baseline data from Chinese American men who participated in PINE (N = 1492).

MEASURES

Demographic characteristics measured included age, education years, marital status, income, health insurance coverage, and smoking pack‐years. Self‐reported smoking status included never smoker, current smoker, and former smoker. Health profile indicators included perceived health status, past 12‐month changes in health, chronic medical conditions (heart diseases, stroke, cancer, diabetes, hypertension, high cholesterol, thyroid disease, and osteoarthritis), quality of life, and depression and anxiety.

RESULTS

The mean age of the study sample was 72.5 years. Of the sample, 65% reported a smoking history, with 25.1% current smokers and 40.1% former smokers. Current smokers were younger, less educated, and uninsured. Former smokers had the poorest overall health profiles. Compared to former smokers, current smokers were less likely to have heart disease (odds ratio [OR] = 0.59; 95% confidence interval [CI] = 0.39‐0.90), hypertension (OR = 0.54; 95% CI = 0.41‐0.72), high cholesterol (OR = 0.74; 95% CI = 0.56‐0.99), thyroid disease (OR = 0.44; 95% CI = 0.21‐0.90), depression (rate ratio [RR] = 0.76; 95% CI = 0.58‐0.99), and anxiety (RR = 0.72; 95% CI = 0.59‐0.89), and they had fewer overall chronic medical conditions (RR = 0.79; 95% CI = 0.70‐0.88) after controlling for demographic factors and smoking pack‐year history. Compared to never smokers, former and current smokers reported poorer self‐rated health (OR = 1.58; 95% CI = 1.11‐2.26) and lower perceived quality of life (OR = 2.11; 95% CI = 1.04‐4.29).

CONCLUSIONS

Consistent with prior research, smoking rates were elevated among this sample of older Chinese men. Counter to study hypotheses, former smokers had worse overall health. Study findings suggest the need for health promotion interventions for both current and former smokers. J Am Geriatr Soc 67:S577–S583, 2019.

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Different Definitions of Elder Mistreatment and Mortality: A Prospective Cohort Study From 2011 to 2017 - American Geriatric Society

OBJECTIVES

To investigate the relationship between different definitions and subtypes of elder mistreatment (EM) and yearly mortality.

DESIGN

Population‐based epidemiological study.

SETTING

Greater Chicago area.

PARTICIPANTS

Chinese Americans aged 60 and older (N=3,157).

MEASUREMENTS

Data were collected from 2011 to 2017, with mortality data collected over the subsequent 4 years. Face‐to‐face in‐home interviews were conducted. EM was measured using a brief screening tool (10 items) and a detailed assessment (56 items) and defined using different criteria for overall and specific subtypes of EM. Mortality was ascertained during follow‐up. Cox proportional hazards models were used.

RESULTS

Four hundred seventy‐five (15.2%) participants reported EM. Severe and moderate EM were associated with greater risk of 1‐year (hazard ratio (HR)=2.51, 95% confidence interval (CI)=1.04–6.03; HR=2.55, 95% CI=1.08–6.03), 2‐year (HR=1.68, 95% CI=1.01–2.78; HR=1.69, 95% CI=1.04–2.74), 3‐year (HR=1.73, 95% CI=1.17–2.55; HR=1.73, 95% CI=1.19–2.51) and 4‐year (HR=1.51, 95% CI=1.08–2.10; HR=1.48, 95% CI=1.08–2.04) mortality. A broad definition of EM was associated with greater risk of 3‐year and 4‐year mortality. With respect to subtypes of EM, psychological mistreatment and caregiver neglect were associated with greater mortality risk, whereas the relationships between psychological mistreatment, caregiver neglect and mortality risk varied according to definitional criteria.

DISCUSSION

Different definitions and subtypes of EM had different associations with mortality in Chinese‐American older adults. This study challenges assumptions about consequences of EM and calls for customized interventions for EM in minority populations. J Am Geriatr Soc 67:S506–S512, 2019.

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Sources and Variations in Social Support and Risk for Elder Mistreatment in a US Chinese Population - American Geriatric Society

OBJECTIVES

Research has examined the relationships between positive social support (PSS) and elder mistreatment (EM) but less is known regarding the negative aspect of social support (NSS), especially among minority groups in the United States. This study aimed to investigate the relationships between PSS/NSS from different sources and EM among US Chinese older adults.

Design

Population‐based cross‐sectional study.

Setting

Greater Chicago, IL, area.

PARTICIPANTS

A representative sample of Chinese older adults aged 60 years or older (N = 3157) from the Population Study of ChINese Elderly in Chicago in 2011 to 2013.

Measurements

We applied a 10‐item widely used instrument to assess EM. PSS and NSS from spouse/family members/friends were measured by a 12‐item scale. Multivariate logistic regression analyses were conducted to examine the relationships.

RESULTS

After adjusting for confounders, higher levels of overall PSS from all three sources, including spouse, family members, and friends (odds ratio [OR] = 0.88 [95% confidence interval {CI} = 0.85‐0.91]), were associated with lower risk of EM. But participants with a higher level of overall NSS from all three sources (OR = 1.51 [95% CI = 1.41‐1.61]) were more likely to experience EM. The results on the relationships between PSS from spouse (OR = 0.70 [95% CI = 0.64‐0.76]), PSS from family members (OR = 0.73 [95% CI = 0.68‐0.79]), and EM were similar to overall PSS. But PSS from friends had a nonsignificant association with EM. Greater levels of NSS from spouse (OR = 1.84 [95% CI = 1.64‐2.07]), family members (OR = 2.36 [95% CI = 2.03‐2.75]), and friends (OR = 1.69 [95% CI = 1.32‐2.17]) were associated with increased risks of EM.

CONCLUSION

Higher levels of SS were not always associated with lower risks of EM among US Chinese older adults. NSS might have counter effects. Future qualitative or longitudinal research needs to explore detailed cultural explanations and casual relationships between SS and EM. J Am Geriatr Soc 67:S499–S505, 2019.

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Comorbid Depressive Symptoms and Chronic Medical Conditions Among US Chinese Older Adults - American Geriatric Society

OBJECTIVES

The prevalence and health consequences of comorbid depressive symptoms (DSs) and chronic medical conditions (CMCs) among older ethnic minority populations remain poorly understood. To bridge this gap, the present cross‐sectional study examined the prevalence of comorbid DS‐CMC and the association between such comorbidity and health services use among US Chinese older adults.

DESIGN AND SETTING

Data were from the Population Study of Chinese Elderly in Chicago (N = 3157). The relationship between comorbid DS‐CMC and health service use (ie, emergency department [ED] visits and hospitalizations) was investigated by stratifying the sample into four groups: (1) neither DSs nor CMCs (ie, heart disease, stroke, cancer, high cholesterol, diabetes, high blood pressure, hip fraction, thyroid, and osteoarthritis); (2) DSs only; (3) CMCs only; and (4) comorbid DS‐CMC. Multivariate negative binomial regression models were conducted to determine the relationship between comorbid DS‐CMC and health service use.

RESULTS

Participants were 73 years old on average. The prevalence of comorbid DSs ranged between 0.7% and 4.6% across various CMCs. The odds of DSs were at least twice as high among US Chinese older adults with CMCs than those without the various conditions. Compared with US Chinese older adults with neither DSs nor CMCs, those with comorbid DS‐CMC had more ED visits (rate ratio [RR] = 3.32; 95% confidence interval [CI] = 2.03‐5.42) and hospitalizations (RR = 3.12; 95% CI = 1.95‐4.97).

CONCLUSION

Recognition and treatment of comorbid DS‐CMC warrant increased policy and clinical attention. The findings underscore the potential need to develop effective services targeting DSs among US Chinese older adults with CMCs. J Am Geriatr Soc 67:S545–S550, 2019.

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Health Service Use Among Chinese American Older Adults: Is There a Somatization Effect? - American Geriatric Society

BACKGROUND/OBJECTIVES

Somatization of depressive symptoms among Chinese American older adults remains understudied. This study aimed to identify whether the relationship between depressive symptoms and use of health services (ie, doctor visits, hospital, and emergency department) could be due to pain and whether acculturation played a role in the relations among depressive symptoms, pain, and health service use.

DESIGN AND PARTICIPANTS

Secondary data came from the Population Study of Chinese Elderly in Chicago that surveyed 3159 Chinese community‐dwelling older adults in the greater Chicago area. The average age was 76.3 years (standard deviation = 8.4); 57.95% were female). Negative binominal models were used to identify the effects of depression and pain on each type of health service use, controlling for sociodemographics and health‐related factors (eg, chronic illness).

MEASUREMENTS

Depressive symptoms were assessed using the Patient Health Questionnaire‐9; pain was assessed by self‐reported pain severity. Participants were classified into low, moderate, and high acculturation groups based on acculturation scores.

RESULTS

Depressive symptoms and pain were positively related to health service use on the bivariate level. For groups with both low and high acculturation levels, depression and pain each independently predicted more health service use, whereas for the group with a moderate acculturation level, the effect of somatization was substantialized.

CONCLUSION

Depression largely influenced health service use independently and partially through pain for older Chinese Americans. The somatization tended to be only salient for the moderate acculturation group, calling for more research attention to the complicated effect of acculturation. J Am Geriatr Soc 67:S584–S589, 2019.

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Sense of Filial Obligation and Caregiving Burdens Among Chinese Immigrants in the United States - American Geriatric Society

BACKGROUND/OBJECTIVES

Focusing on Chinese immigrants, this study examined (1) whether filial obligation, the core social norm in the Chinese culture, is related to caregiving burdens; and (2) whether level of acculturation of the caregivers moderates the above relationships.

DESIGN

Cross‐sectional.

SETTING

Chicago, Illinois.

PARTICIPANTS

A purposive sample of 393 Chinese adult immigrants who were primary caregivers of parents aged 60 years or older.

MEASURES

Sense of filial obligation was captured by felt responsibility toward parents in six domains (respect, make happy, care, greet, obey, and provide financial support). Caregiving burdens were measured by the Caregiver Burden Inventory. Acculturation was measured by 12 questions about respondents' language preference in different settings and ethnicity of individuals they interact with.

RESULTS

A stronger sense of filial obligation was significantly associated with lower levels of developmental (β = −.15), emotional (β = −.18), social (β = −.20), and physical (β = −.10) burdens. For subjective burdens (developmental, social burdens), such a protective effect of filial obligation was stronger among caregivers with lower acculturation levels. For more objective burdens (time‐dependent, physical burdens), stronger filial obligation was actually associated with greater burdens among caregivers with higher acculturation levels.

CONCLUSION

Programs focusing on celebrating the cultural heritage of immigrants and improving the relationship between the parents and children may be helpful to reduce caregiving burdens. Intervention programs that help Chinese immigrant caregivers to find the most appropriate way to balance traditional and new social norms are important to provide successful care to aging Chinese immigrants. J Am Geriatr Soc 67:S564–S570, 2019.

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Depressive Symptoms and Onset of Functional Disability Over 2 Years: A Prospective Cohort Study - American Geriatric Society

OBJECTIVES

This prospective cohort study examined the relationship between depressive symptoms and onset of functional disability over 2 years among US Chinese older adults, a rapidly growing minority older adult population.

DESIGN AND SETTING

This study used survey data from 2713 Chinese older adults who completed both baseline (2011‐2013) and follow‐up (2013‐2015) interviews of the Population Study of Chinese Elderly in Chicago. Depressive symptoms were assessed at baseline by the nine‐item Patient Health Questionnaire. Functional disability was measured by three validated scales, Katz Index of Independence in Activities of Daily Living (ADLs), the Lawton Instrumental Activities of Daily Living (IADLs) scale, and the Rosow and Breslau mobility scale. Multivariate logistic regression was conducted to examine the relationship between baseline depressive symptoms and the development of functional disability (ADLs, IADLs, mobility) at 2‐year follow‐up while adjusting for covariates.

RESULTS

Of the 2713 participants, 5.2% experienced ADL disability onset, 35.6% experienced IADL disability onset, and 23.3% experienced mobility disability onset over 2 years. After adjusting for covariates, the odds of ADL disability onset (odds ratio [OR] = 1.06; 95% confidence interval [CI] = 1.02‐1.11), IADL disability onset (OR = 1.05; 95% CI = 1.01‐1.09), and mobility disability onset (OR = 1.05; 95% CI = 1.01‐1.09) were consistently higher in US Chinese older adults with higher levels of depressive symptoms than their less‐depressed counterparts. Other significant risk factors included older age and more chronic physical conditions.

CONCLUSION

Study findings underscore a significant relationship between depressive symptoms and onset of functional disability. Screening and, subsequently, treating depressive symptoms have the potential to reduce disability among US Chinese older adults. Culturally relevant depressive symptom screening may help identify Chinese older adults who are at greater risks for the development of functional disability. J Am Geriatr Soc 67:S538–S544, 2019.

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Education, Activity Engagement, and Cognitive Function in US Chinese Older Adults - American Geriatric Society

OBJECTIVES

To examine whether and how early‐life experiences such as years of schooling affect late‐life cognitive function through a pathway of activity engagement.

DESIGN

Prospective.

SETTING

We used data from 2 waves of the Population Study of Chinese Elderly in Chicago (PINE).

PARTICIPANTS

PINE is the largest population‐based epidemiological study of Chinese‐American adults aged 60 and older in the greater Chicago area. Wave 1 data were collected for 2 years, from July 2011 to June 2013, and Wave 2 data were collected from 2013 to 2015; total sample size was 2,713.

MEASUREMENTS

Education was measured in years of schooling. Activity engagement was assessed using 15 items grouped into two clusters: cognitive activity and social activity. Cognitive function was evaluated using five instruments to assess general mental status (Chinese Mini‐Mental State Examination (C‐MMSE)), episodic memory, perceptual speed, working memory, global cognition score.

RESULTS

Adjusting for sociodemographic and health‐related control variables, education measured at Wave 1 was associated with better global cognition (b = 0.025, p < .001), C‐MMSE (b = .037, p < .001), episodic memory (b = .026, p < .001), Symbol Digit Modalities Test perceptual speed (b = .036, p < .001), and Digit Span Backward working memory (b = .047, p < .001) at Wave 2. Activity engagement, cognitive activity in particular, significantly mediates the effect of education on all cognitive tests, with the size of the mediating effect ranging from 16% to approximately 24%.

CONCLUSION

Amount of schooling early in life is significantly related to late‐life cognitive function in virtually all domains, and cognitive activity is one of many links between the two. J Am Geriatr Soc 67:S525–S531, 2019

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Perceived Stress, Social Support, and Dry Mouth Among US Older Chinese Adults - American Geriatric Society

OBJECTIVES

Dry mouth is a common condition among older adults that negatively influences oral health, general health, and quality of life. The role of psychosocial factors in oral health conditions and diseases remains largely unknown. We conducted a study to examine the relationship between perceived stress and dry mouth among US older Chinese adults and further investigated the potential moderating role of social support and social strain from different sources in the relationship.

DESIGN

Cross‐sectional analysis.

SETTING

Baseline of the Population Study of Chinese Elderly in Chicago, a community‐engaged, population‐based longitudinal study of health and well‐being among community‐dwelling US older Chinese adults.

PARTICIPANTS

Individuals 60 years or older (N = 3157).

MEASUREMENTS

Perceived stress was measured by the 10‐item Chinese Perceived Stress Scale to evaluate the degree to which life situations were perceived as stressful during the preceding month on a 5‐point scale, ranging from 0 (“never”) to 4 (“very often”). Dry mouth was a binary self‐reported outcome variable (1 = “dry mouth”). Social support was measured by the Health and Retirement Study's social support and strain scale from sources including spouse, other family members, and friends with a 3‐point response set, ranging from 0 (“hardly ever”) to 2 (“often”). Sociodemographics and disease processes were assessed as covariates. We conducted stepwise logistic regressions with interaction terms.

RESULTS

Having higher levels of perceived stress was significantly associated with a higher likelihood of reporting dry mouth (odds ratio = 1.03; 95% confidence interval = 1.02‐1.04). The effect of perceived stress on dry mouth may vary by levels of family and friend support.

CONCLUSION

Perceived stress may influence dry mouth either directly or indirectly. To prevent or reduce dry mouth, in addition to disease processes, interventions need to consider psychosocial factors in dry mouth, especially perceived stress and social support, in this growing population. J Am Geriatr Soc 67:S551–S556, 2019.

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Typology of Family Relationship and Elder Mistreatment in a US Chinese Population - American Geriatric Society

OBJECTIVES

To examine the associations between typology of family relationship and risk of elder mistreatment (EM).

DESIGN

Population‐based epidemiological cross‐sectional study.

SETTING

Community‐dwelling older adults in the greater Chicago area.

PARTICIPANTS

A total of 3157 US older Chinese immigrants.

MEASUREMENTS

EM was measured by a brief screening tool. Latent class analysis was used to construct typologies of family relationship from eight indicators, evaluating the structural, associational, functional, affectual, and normative aspects of family relationship. Logistic regression models were used to test the associations between typology of family relationship and EM.

RESULTS

Unobligated ambivalent type (44.77%) was the most common family type among US older Chinese immigrants. The prevalence of EM was around 15%, with 475 participants reporting experience of EM. Unobligated ambivalent (odds ratio [OR] = 1.90; 95% confidence interval [CI] = 1.54‐2.34) and detached (OR = 1.78; 95% CI = 1.32‐2.42) family types were associated with greater risk of EM; tight‐knit (OR = .34; 95% CI = .27‐.44) family type was associated with lower risk of EM. The relationship between commanding conflicted family type and EM was not significant.

CONCLUSION

Unobligated ambivalent family type, featured by high emotional closeness and high family conflict, was prevalent among US Chinese families and associated with EM consequences. Culturally customized social services are suggested to reduce intergenerational ambivalence and promote family harmony for immigrant families. J Am Geriatr Soc 67:S493–S498, 2019.

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The Impact of Intergenerational Relationship on Health and Well‐Being of Older Chinese Americans - American Geriatric Society

BACKGROUND/OBJECTIVES

Among older adults, intergenerational support can help to improve well‐being. This study examines the correlation between intergenerational relationships and the subjective well‐being among older Chinese immigrants in the United States.

DESIGN

Hierarchical multiple regression analyses were applied to test the association between intergenerational relationships and self‐rated well‐being. The mediating effects of sense of control and the moderation effects of support from friends were also tested.

SAMPLE

A cross‐sectional sample of 2717 older Chinese immigrants, aged 60 years and older, with children and grandchildren was drawn from the Population Study of Chinese Elderly.

MEASUREMENTS

Study measures included four items concerning intergenerational relationships: the Pearlin Mastery Scale, two items on seeking support from friends, and single items measuring self‐rated health status and quality of life.

RESULTS

Only the feeling of closeness with children was positively linked with subjective well‐being, while coresidence and frequency of talking were not. Support from friends moderated the association with self‐rated health status, while sense of control partially mediated the association between feeling of closeness and both self‐rated health status and quality of life.

CONCLUSION

A stronger sense of closeness with children correlates to self‐rated health status and quality of life among older Chinese immigrants. The effects of sociocultural changes affecting Chinese American families, and potential implications for older adults' health, could be addressed through strategies to develop emotional closeness with their families and to support sense of control and well‐being among older Chinese adults. J Am Geriatr Soc 67:S557–S563, 2019.

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Sex Differences in the Prevalence and Incidence of Cognitive Impairment: Does Immigration Matter? - American Geriatric Society

OBJECTIVES

We aimed to examine the associations between immigration‐related factors and prevalent and incident cognitive impairment (CI) and whether the associations varied by sex among US Chinese older adults.

DESIGN

Two‐wave prospective study.

SETTING

The greater Chicago area.

PARTICIPANTS

Community‐dwelling adults aged 60 and older who self‐identified as Chinese, who were interviewed at two time points during 2011‐2013 (N = 3157) and 2013‐2015 (N = 2713).

MEASUREMENTS

CI was assessed by the 30‐item Chinese Mini‐Mental State Examination (C‐MMSE). CI prevalence was determined by the percentage of respondents whose C‐MMSE score was below 18 at baseline (N = 3033), and CI incidence was determined by the percentage of the respondents whose score was 18 or above at baseline (N = 2443) but dropped below 18 at wave 2. Immigration‐related factors included age at migration, immigration reasons, and acculturation.

RESULTS

The CI prevalence rate was 7.62% at baseline, and the incidence rate was 5.12% at wave 2. Women were more likely than men to have CI, consisting of 77.06% and 75.20% among persons with CI at the time points. None of the immigration‐related factors were related to CI prevalence and incidence. Older age, fewer years of education, and more instrumental activities of daily living limitations were risk factors of CI in the whole, male, and female samples.

CONCLUSION

Older Chinese women were generally disadvantaged in cognition and overall health as compared with older Chinese men. Yet immigration experience does not link to CI for both men and women after equalizing the well‐established effects of age and education on cognition. Future research needs to investigate whether the risk of CI in late life is related to the biological and contextual factors earlier in the life course. Decreasing sex disparities in the risk of dementia may focus on reducing educational and health disparities in the early life stage. J Am Geriatr Soc 67:S513–S518, 2019.

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