Recommendations for (Discontinuation of) Statin Treatment in Older Adults: Review of Guidelines - American Geriatric Society

OBJECTIVES

As a person's age increases and his/her health status declines, new challenges arise that may lead physicians to consider deprescribing statins. We aimed to provide insight into recommendations available in international cardiovascular disease prevention guidelines regarding discontinuation of statin treatment applicable to older adults.

DESIGN

We systematically searched PubMed, EMBASE, EMCARE, and the websites of guideline development organizations and online guideline repositories for cardiovascular disease prevention guidelines aimed at the general population. We selected all guidelines with recommendations (instructions and suggestions) on discontinuation of statin treatment applicable to older adults, published between January 2009 and April 2019. In addition, we performed a synthesis of information from all other recommendations for older adults regarding statin treatment. Methodological quality of the included guidelines was appraised using the appraisal of guidelines for research & evaluation II (AGREE II) instrument.

RESULTS

Eighteen international guidelines for cardiovascular disease prevention in the general adult population provided recommendations for statin discontinuation that were applicable to older adults. We identified three groups of instructions for statin discontinuation related to statin intolerance, and none was specifically aimed at older adults. Three guidelines also included suggestions to consider statin discontinuation in patients with poor health status. Of the 18 guidelines included, 16 made recommendations regarding statin treatment in older adults, although details on how to implement these recommendations in practice were not provided.

CONCLUSION

Current international cardiovascular disease prevention guidelines provide little specific guidance for physicians who are considering statin discontinuation in older adults in the context of declining health status and short life expectancy.

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Association between Health Insurance and Health among Adults with Diabetes: Evidence from Medicare - American Geriatric Society

OBJECTIVES

Gaining Medicare eligibility at age 65 is associated with increased health insurance coverage and reduced medical expenditure risk, but few studies have examined changes in health outcomes among adults with a specific chronic condition. This study assessed the association between Medicare eligibility and health among adults with diabetes.

DESIGN

Regression discontinuity design to test for discontinuities in healthcare outcomes at age 65 when most US adults become eligible for Medicare.

SETTING

National Health Interview Survey, 2006‐2016.

PARTICIPANTS

Respondents ages 55 to 74 with diagnosed diabetes (n = 13 455).

MEASUREMENTS

Primary outcome measures included self‐reported fair or poor general health status, any functional limitation, overweight, obese, and body mass index. Secondary outcomes included health insurance coverage, healthcare spending burden, and functional limitations by cause and type.

RESULTS

Medicare eligibility was associated with about an 8.0 percentage point reduction in the uninsured rate (95% confidence interval [CI], −9.9 to −6.0 percentage points; P < .001) and declines in high out‐of‐pocket healthcare expenditures and worry about medical bills. Eligibility was also associated with reductions of about 5.2 [95% CI, −6.9 to −3.6; P < .001] and 4.7 [95% CI, −7.1 to −2.3; P = .001] percentage points in fair or poor health and any functional limitation, respectively. Declines in functional limitations appeared to be driven by reductions in limitations due to diabetes, arthritis, heart problems, and emotional or behavioral problems. Some evidence indicated that Medicare eligibility was associated with a decline in obesity, but estimates were not consistently statistically significant.

CONCLUSION

Expanded health insurance coverage and gains in coverage quality may improve health outcomes among older adults with diabetes.

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USDA, EPA and FDA announce partnership with the Food Waste Reduction Alliance - FDA Press Releases

New partnership with the Food Waste Reduction Alliance, the latest effort in the Winning on Reducing Food Waste Initiative launched by the three federal agencies in 2018.

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Isolation and characterization of a new cyclic lipopeptide orfamide H from Pseudomonas protegens CHA0 - Journal of Antibiotics

The Journal of Antibiotics, Published online: 30 October 2019; doi:10.1038/s41429-019-0254-0

Isolation and characterization of a new cyclic lipopeptide orfamide H from Pseudomonas protegens CHA0

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Diaporone A, a new antibacterial secondary metabolite from the plant endophytic fungus Diaporthe sp. - Journal of Antibiotics

The Journal of Antibiotics, Published online: 30 October 2019; doi:10.1038/s41429-019-0251-3

Diaporone A, a new antibacterial secondary metabolite from the plant endophytic fungus Diaporthe sp.

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Black Nursing Home Residents More Likely to Watch Advance Care Planning Video - American Geriatric Society

BACKGROUND/OBJECTIVES

This study aims to identify resident characteristics associated with being offered and subsequently shown an advance care planning (ACP) video in the Pragmatic Trial of Video Education in Nursing Homes (PROVEN) and if differences are driven by within‐ and/or between‐facility differences.

DESIGN

Cross‐sectional study, from March 1, 2016, to May 31, 2018.

SETTING

A total of 119 PROVEN intervention nursing homes (NHs).

PARTICIPANTS

A total of 43 303 new NH admissions.

MEASUREMENTS

Data came from the Minimum Data Set and an electronic record documenting whether a video was offered and shown to residents. We conduct both naïve logistic regression models and hierarchical logistic models, controlling for NH fixed effects, to examine the overall differences in offer and show rate by resident characteristics.

RESULTS

In naïve regression models, compared to white residents, black residents are 7.8 percentage point (pp) (95% confidence interval [CI] = −9.1 to −6.5 pp) less likely to be offered the video. These differences decrease to 1.3 pp (95% CI = −2.61 to −0.02 pp) when accounting for NH fixed effects. In fully adjusted models, black residents compared to white residents were 2.1 pp more likely to watch the video contingent on being offered (95% CI = 0.4‐3.7 pp). Residents with cognitive impairment were less likely to be offered and shown the video.

CONCLUSIONS

After controlling for NH fixed effects, there were smaller racial differences in being offered the video, but once offered, black residents were more likely to watch the video. This suggests that black residents are receptive to this type of ACP intervention but need to be given an opportunity to be exposed.

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Diagnosis and Differential Diagnosis of Parkinson Disease - Geriatrics

Parkinsonism is one of the most common neurologic disorders in the aging population. Although Parkinson disease (PD) is the most common cause, there is a lengthy differential diagnosis. The diagnosis of PD hinges on recognizing its typical features, including bradykinesia, rest tremor, unilateral onset, cogwheel rigidity, and beneficial and sustained response to levodopa. Equally important is to be familiar with the “red flags,” which are features not expected with PD and suggest an alternative diagnosis, usually a parkinsonian syndrome. In general, it is best to have the diagnosis confirmed by a neurologist, especially one with expertise in movement disorders.

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Digital submission of adverse event reports for investigational new drug applications reflects FDA’s ongoing modernization efforts - FDA Press Releases

FDA is taking steps towards requiring electronic submission of certain safety reports under an investigational new drug (IND) application into the FDA's Adverse Event Reporting System (FAERS).

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FDA issues policy to facilitate the use of electronic health record data in clinical investigations - FDA Press Releases

FDA issues policy to facilitate the use of electronic health record data in clinical investigations

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Statement on FDA’s new report regarding root causes and potential solutions to drug shortages - FDA Press Releases

Today, the FDA is issuing a report on causes and solutions to drug shortages

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Multidisciplinary Care to Optimize Functional Mobility in Parkinson Disease - Geriatrics

This review elaborates on multidisciplinary care for persons living with Parkinson disease by using gait and balance impairments as an example of a treatable target that typically necessitates an integrated approach by a range of different and complementary professional disciplines. Using the International Classification of Functioning, Disability, and Health model as a framework, the authors discuss the assessment and multidisciplinary management of reduced functional mobility due to gait and balance impairments. By doing so, they highlight the complex interplay between motor and nonmotor symptoms, and their influence on rehabilitation. They outline how multidisciplinary care for Parkinson disease can be organized.

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Prevalence and Knowledge of Potential Interactions Between Over‐the‐Counter Products and Apixaban - American Geriatric Society

BACKGROUND

Direct‐acting oral anticoagulants (DOACs), such as apixaban, are the most commonly prescribed anticoagulants, with advantages in that they do not require routine monitoring. However, less frequent contact with healthcare professionals may contribute to poor patient knowledge about potential interactions between over‐the‐counter (OTC) products and DOACs.

OBJECTIVE

Determine the prevalence of use of OTC products (OTC medications and dietary supplements) with potentially serious apixaban interactions and assess patient knowledge of potential interactions.

DESIGN

Cross‐sectional survey.

SETTING

Academic‐affiliated outpatient medical practices in northern and southern California.

PARTICIPANTS

A total of 791 English‐ or Spanish‐speaking patients prescribed apixaban.

MEASUREMENTS

Use and knowledge of OTC medications and dietary supplements with potentially serious apixaban interactions.

RESULTS

Almost all respondents (n = 771; 97.5%) reported OTC product use. Of respondents, 33% (n = 266) took at least one OTC product with potentially serious apixaban interactions daily/most days and 53 (6.7%) took multiple products (mean = 2.6 [SD = 2.6]). Aspirin was taken daily by 116 (14.7%; of which 75 [64.7%] also consumed other potentially interacting OTC products), and some days/as needed by an additional 82 (10.4%). Ibuprofen and naproxen were taken daily/most days by 14 (1.8%) and occasionally by 225 (28.5%). Dietary supplements with potentially serious interactions were taken daily/most days by 160 (20.2%). Approximately 66% of respondents were either uncertain or incorrect about the potential for increased bleeding from combining nonsteroidal anti‐inflammatory drugs and apixaban. Less knowledge about OTC products with potentially serious interactions was associated with greater OTC product use (odds ratio = 0.54; 95% confidence interval = 0.35‐0.85).

CONCLUSION

Significant numbers of patients take OTC products (particularly dietary supplements) with potentially serious interactions with the DOAC apixaban and appear to lack knowledge about potentially harmful interactions. Interventions are needed to educate patients and healthcare providers about potential dangers of taking interacting OTC products in combination with apixaban, and data are needed on outcomes associated with concomitant apixaban–OTC product use.

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High Prevalence of Fall‐Related Medication Use in Older Veterans at Risk for Falls - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Longitudinal Analysis of Mortality for Older Adults Receiving or Waiting for Aging Network Services - American Geriatric Society

OBJECTIVES

For older adults screened by an Area Agency on Aging (AAA) in the National Aging Network, we aimed to examine the 12‐month mortality rate for wait‐listed callers compared with those who received services within 12 months, and to assess whether the mortality rate differed according to how quickly they received services.

DESIGN

The design was a longitudinal analysis of 3 years of AAA administrative data, using survival analysis.

SETTING

The data source was administrative data from an AAA spanning a five‐county region in west central Florida.

PARTICIPANTS

All older adults (age 60 y and older) screened for service eligibility from July 15, 2013, to August 15, 2015, who completed initial screening during the study period were included (N = 6288).

MEASUREMENTS

The outcome was mortality within 12 months of the initial screening. Covariates included demographics, caregiver status, health status, access to healthcare, and AAA service status.

RESULTS

In the first survival analysis, the strongest predictor was waiting for services compared with receiving services; waiting increased the odds to die vs not to die by 141%, after controlling for health status and other covariates. In the second survival analysis, those who received services within 0 to 3 months had a higher mortality risk compared with those who received services within 6 to 9 months or 9 to 12 months.

CONCLUSION

Older adults placed on aging service waiting lists may be at a greater risk of mortality within 12 months than those receiving services. Given that rapid receipt of services was less protective than receiving services later, those prioritized to receive services quickly may be at very high risk of adverse outcomes. Findings raise the possibility that aging services may lower mortality, although additional services may benefit those waiting long periods for services, as well as those eligible for services rapidly. Research is needed to replicate and extend these findings.

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Winners of the 2018 JA Ōmura Awards for excellence - Journal of Antibiotics

The Journal of Antibiotics, Published online: 28 October 2019; doi:10.1038/s41429-019-0233-5

Winners of the 2018 JA Ōmura Awards for excellence

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Reply to Changes in Institutionalized Older People's Dentition Status in Helsinki 2003 to 2017 - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Changes in Institutionalized Older People's Dentition Status in Helsinki, 2003‐2017 - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Underestimation of the Prevalence of Medication Errors in Nursing Homes - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Reply to: Underestimation of the prevalence of medication errors in nursing homes - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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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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FDA announces voluntary recall of Sandoz ranitidine capsules following detection of an impurity - FDA Press Releases

The U.S. Food and Drug Administration is alerting health care professionals and patients of a voluntary recall of 14 lots of prescription ranitidine capsules distributed by Sandoz Inc.

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Statement on concerns with medical device availability due to certain sterilization facility closures - FDA Press Releases

In light of the possibility of continued ethylene oxide sterilization facility closures, FDA is again alerting the public to growing concerns about the future availability of sterile medical devices and impending medical device shortages.

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Identification of actinomycin D as a specific inhibitor of the alternative pathway of peptidoglycan biosynthesis - Journal of Antibiotics

The Journal of Antibiotics, Published online: 25 October 2019; doi:10.1038/s41429-019-0252-2

Identification of actinomycin D as a specific inhibitor of the alternative pathway of peptidoglycan biosynthesis

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Drug Therapy and Frailty: Chicken or the Egg? - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Polypharmacy and Incident Frailty in a Longitudinal Community‐Based Cohort Study - American Geriatric Society

OBJECTIVES

Polypharmacy may affect frailty, a common and costly condition among older adults. Frailty prevalence is elevated among racial/ethnic minorities and persons living in the US South, and research is needed to inform future pharmacologic interventions in these populations. Our aim was to quantify the prevalence of frailty and polypharmacy, and to estimate the association between polypharmacy and incident frailty.

DESIGN

Prospective cohort study.

SETTING

A community‐based cohort study of adults residing in Johnston County, North Carolina.

PARTICIPANTS

White and African American adults aged 50 to 95 years (n=1697).

MEASUREMENTS

At each study visit, all prescription and over‐the‐counter medications were recorded. We calculated annual polypharmacy (5‐9 medications) and excessive polypharmacy (≥10 medications) prevalence at the 2006‐2010 visit (n = 1697) and operationalized the Fried frailty phenotype to describe prevalent and incident frailty at two consecutive visits (2006‐2010 and 2013‐2015). We estimated risk ratios (RRs) and 95% confidence intervals (CIs) for the association between polypharmacy and incident frailty using weighted log‐binomial regression to account for measured confounding and attrition using inverse probability of treatment and attrition weights, respectively.

RESULTS

At the 2006‐2010 visit, 678 (41%) and 260 (16%) participants were exposed to polypharmacy and excessive polypharmacy, respectively. Overall, 353 (21%) participants and 180 (21%) participants were frail at the 2006‐2010 and 2013‐2015 visits, respectively. Frailty was more common among participants identifying as white, women, and having less educational attainment relative to those without these characteristics. Incident frailty at the 2013‐2015 visit was 15% (mean follow‐up = 5.5 years). Our results suggest that polypharmacy is positively associated with incident frailty (weighted RR = 1.4; 95% CI = .9‐2.0), yet estimates are imprecise and should be interpreted with caution.

CONCLUSION

Consistent with the current weight of evidence, our results suggest an association between polypharmacy and incident frailty. Prospective studies evaluating deprescribing interventions are needed to clarify whether reducing polypharmacy decreases frailty incidence.

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Self‐Reported Prescription Drug Use for Pain and for Sleep and Incident Frailty - American Geriatric Society

OBJECTIVES

We aimed to estimate incident frailty risks of prescription drugs for pain and for sleep in older US adults.

DESIGN

Longitudinal cohort.

SETTING

Health and Retirement Study.

PARTICIPANTS

Community‐living respondents aged 65 years and older, excluding individuals who received recent treatment for cancer (N = 14 208). Our longitudinal analysis sample included respondents who were not frail at baseline and had at least one follow‐up wave with complete information on both prescription drug use and frailty, or date of death (N = 7201).

MEASUREMENTS

Prescription drug use for pain and sleep, sociodemographics, other drug and substance use, and Burden frailty model components. Multivariable drug use stratified hazard models with death as a competing risk evaluated frailty risks associated with co‐use and single use of prescription drugs for pain and for sleep.

RESULTS

Proportions endorsing prescription drug use were 22.1% for pain only, 6.8% for sleep only, and 7.7% for both indications. Burden frailty model prevalence was 41.0% and varied significantly by drug use. Among non‐frail individuals at baseline, proportions endorsing prescription drug use were 14.9%, 5.6%, and 2.2% for the three indications. Prescription drug use was associated with increased risk of frailty (co‐use adjusted subhazard ratio [sHR] = 1.95; 95% confidence interval [CI] = 1.6‐2.4; pain only adjusted sHR = 1.58; CI = 1.4‐1.8; sleep‐only adjusted sHR = 1.35; CI = 1.1‐1.6; no use = reference group). Cumulative incidence of frailty over 8 years for the four groups was 60.6%, 50.9%, 45.8%, and 34.1%. Sensitivity analyses controlling for chronic diseases associated with persistent pain resulted in minor risk reductions.

CONCLUSION

Prescription pain and sleep drug use is significantly associated with increased incidence of frailty. Research to estimate effects of pain and sleep indications and of drug class–specific dosage and duration on incident frailty is indicated before advocating deprescribing based on these findings.

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Statement on agency’s first year accomplishments implementing SUPPORT Act authorities to address the opioids crisis - FDA Press Releases

Statement from Acting FDA Commissioner Ned Sharpless, M.D., on agency’s first year accomplishments implementing SUPPORT Act authorities to address the opioids crisis

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A Socratic Inquiry Into the Nature of Frailty - American Geriatric Society

In Plato's dialogues, Socrates, the protagonist, attempts to bring out the essential nature of an idea or a concept by engaging in a dialogue with the other characters. He asks probing questions of them to challenge their unquestioned assumptions and to eliminate flaws in their thinking. A hallmark of the dialogues is that Socrates himself never provides a final answer regarding the nature of the idea under discussion. Inspired by the power of the Socratic model to illumine one's thinking on difficult concepts, we have developed a short dialogue examining the nature of geriatric frailty. Our goal is to communicate, in a lively and nontechnical style, some of the fundamental challenges in studying frailty in older adults. Those acquainted with Plato's dialogues will recognize the resemblance to the initial segment of The Republic,¹ which takes place in the house of a wealthy merchant named Cephalus.

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Statins After Myocardial Infarction in the Oldest: A Cohort Study in the Clinical Practice Research Datalink Database - American Geriatric Society

OBJECTIVE

To explore the effect of initiating statins for secondary prevention after a first myocardial infarction (MI) in patients aged 80 years and older.

DESIGN

Retrospective cohort study.

SETTING

Clinical Practice Research Datalink (1999‐2016).

PARTICIPANTS

Patients, aged 65 years and older, hospitalized after a first MI without a statin prescription in the year before hospitalization. The age group of 65 to 80 years was included to compare our results to current evidence.

MEASUREMENTS

The primary outcome was a composite of recurrent MI, stroke, and cardiovascular mortality; and the secondary outcome was all‐cause mortality. A time‐varying Cox model was used to account for statin prescription over time. We compared at least 2 years of statin prescription time with untreated and less than 2 years of prescription time. Analyses were adjusted for potential confounders. The number needed to treat (NNT) was calculated based on the adjusted hazard ratios (HRs) and corrected for deaths during the first 2 years of follow‐up.

RESULTS

A total of 9020 patients were included. Among the 3900 patients aged 80 years and older, 2 years of statin prescriptions resulted in a lower risk of the composite outcome (adjusted HR = 0.81; 95% confidence interval [CI] = 0.66‐0.99) and of all‐cause mortality (adjusted HR = 0.84; 95% CI = 0.73‐0.97). During 4.5 years of median follow‐up, the NNT for prevention of the primary outcome was 59; and for mortality, the NNT was 36. Correcting for 36.2% deaths during the first 2 years increased the NNT on the primary outcome to 93 and to 61 on all‐cause mortality.

CONCLUSION

Our data support statin initiation after a first MI in patients aged 80 years and older if continued for at least 2 years. Especially in patients with a low risk of 2‐year mortality, statins should be considered.

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Statement on the agency’s efforts to protect patients from potentially harmful drugs sold as homeopathic products - FDA Press Releases

Today, the FDA is taking two new steps toward clarifying the agency’s approach on homeopathic products.

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Exercise Maintenance in Older Adults 1 Year After Completion of a Supervised Training Intervention - American Geriatric Society

BACKGROUND/OBJECTIVE

Barriers and facilitators of exercise maintenance and residual effects of exercise training intervention on physical and cognitive function after the cessation of training are inadequately described in older adults.

DESIGN AND SETTING

One year after the cessation of a supervised exercise training intervention, a mixed methods approach employed a quantitative phase that assessed body composition and physical and cognitive function and a qualitative phase that explored determinants of exercise maintenance after participation in the intervention.

PARTICIPANTS

Community‐dwelling older Irish adults (aged >65 years) who had completed 12 weeks of supervised exercise training 1 year previously.

MEASUREMENTS

Fifty‐three participants (male/female ratio = 30:23; age = 70.8 ± 3.9 years) completed the follow‐up testing comprising body composition and physical and cognitive function. Semistructured interviews were conducted with 12 participants (male/female ratio = 6:6) using the Theoretical Domains Framework to inform the interview guide.

RESULTS

At 1 year follow‐up, body fat increased (mean = 4.3%; 95% confidence limit = 2.2% to 6.3%), while lean body mass (mean = −0.6%; 95% confidence limit = −1.2% to −0.1%), strength (leg press, mean = −5.6%; 95% confidence limit = −8.3% to −2.8%; chest press, mean = −11.0%; 95% confidence limit = −14.8% to −7.8%), and cognitive function (mean = −3.7%; 95% confidence limit = −5.7% to −1.8%) declined (all P < .05). Interviews revealed key facilitators (social aspects and beliefs about benefits of exercise) and barriers (affordability and general aversion to gyms) to exercise maintenance in this population.

CONCLUSION

Key barriers and facilitators to exercise maintenance were identified, which will inform the development of future behavior change interventions to support exercise participation and maintenance in older adults to mitigate adverse changes in body composition and physical and cognitive function with advancing age.

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Does Physician Retirement Affect Patients? A Systematic Review - American Geriatric Society

OBJECTIVES

Older patients that have aged with their doctors will likely experience their physician retiring. It is unclear if this interruption in continuity of care leaves patients at risk for adverse events or whether a new physician improves care. We sought to identify and synthesize findings from all articles examining the association between physician retirement and patient outcomes.

DESIGN

Systematic review. We searched English‐language articles cataloged in Medline, Embase, Cochrane, and PsycINFO, from database inception to May 4, 2018.

PARTICIPANTS

Any patient whose physician (generalist or specialist) retired.

INTERVENTION

Physician retirement, defined as voluntary practice closure, death, or departure.

MEASUREMENTS

Articles were categorized as anecdotes, qualitative studies, or quantitative studies. Each patient outcome was indexed under one of 11 themes (eg, adverse event, difficulty accessing care) and classified as favorable, neutral, or unfavorable. Patient outcomes included but were not limited to clinical (eg, death), resource utilization (eg, hospitalization), treatment plan adherence (eg, access to medications), and patient satisfaction (eg, expressed frustration). Two reviewers independently assessed study quality.

RESULTS

Of 2099 articles screened, 17 met inclusion criteria: 12 anecdotes, 2 qualitative studies, and 3 quantitative studies. Most patient outcomes described were unfavorable. These included feelings of loss, difficulties with transition to a new provider, adverse clinical outcomes, and increased use of high‐cost services. The quality of qualitative studies was high, but that of quantitative studies was poor or moderate.

CONCLUSION

Current evidence from qualitative studies suggests physician retirement affects patients unfavorably and that patients are vulnerable during this transition of care. High‐quality quantitative research is lacking to identify whether this disproportionately affects older adults and whether physician retirement has significant consequences for the broader healthcare system.

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Efficacy of Direct‐Acting Antivirals for Chronic Hepatitis C in a Large Cohort of Older Adults in the United States - American Geriatric Society

OBJECTIVES

Data on the virologic response and tolerability of direct‐acting antivirals (DAAs) are lacking in older people because these individuals are underrepresented in clinical trials. This study aimed to assess the effectiveness and tolerability of DAA regimens in older individuals in a large cohort of real‐life clinical practice.

METHODS

In this retrospective study, patients with chronic hepatitis C infection between 2017 and 2018 were divided into patients aged 65 years and older and those younger than 65 years. We evaluated the sustained virologic response rates (SVRs) in both groups. Further subgroup analyses on the SVRs for patients aged 65 to 74, 75 to 84, and 85 years and older were performed. We also analyzed the predictors of treatment response in older individuals.

RESULTS

Among 1151 eligible patients, 516 were in the older group and 635 were in the younger group. The overall treatment response in the entire cohort was 97.7%. A significantly higher percentage of patients presented with advanced stages of fibrosis in the older group (53.1% vs 39.5%; P = <.001). The SVR rates were similar between the two groups (98.3% vs 97.7%; P = .18). In multivariate models, age was not predictive of SVR after adjusting for confounders. Subgroup analyses in the age groups of 65 to 74, 75 to 84, and older than 85 years showed similar treatment response rates (97.4%, 97.2%, and 86.7, respectively; P = .06) and advanced fibrosis (50.8%, 61.5%, and 53.3%, respectively; P = .14).

CONCLUSION

Although older people exhibit a significantly higher frequency of fibrosis, DAAs produce high rates of SVR in all age groups, and the age of the patient does not seem to have a significant impact on the efficacy of DAAs including patients in the oldest age category (≥75 y). Treatment should not be withheld in older individuals.

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Role of Post‐Acute Care in Readmissions for Preexisting Healthcare‐Associated Infections - American Geriatric Society

OBJECTIVES

Although preventable, healthcare‐associated infections (HAIs) are commonly observed in post‐acute care settings for at‐risk older adults and are a leading cause of hospital readmissions. However, whether HAIs resulting in avoidable readmissions for preexisting HAIs (the same HAI as at the index admission) are more common for patients discharged to post‐acute care as opposed to home is unknown. We examined the risk of preexisting HAI readmissions according to patient discharge disposition and comorbidity level.

DESIGN

We used 2013‐2014 national hospital discharge data to estimate the likelihood of readmissions for preexisting HAIs according to patients' discharge disposition and whether the likelihood varies according to patient comorbidity level, across four common types of HAIs (not including respiratory infections).

PARTICIPANTS

A total of 702 304 hospital discharges for Medicare beneficiaries 65 years or older.

MEASUREMENTS

Our outcome was a 30‐day preexisting, or “linked,” HAI readmission (readmission involving the same HAI diagnosis as at the index admission). Patient discharge disposition was skilled nursing facility (SNF), home health care, and home care without home health care (“home”).

RESULTS

Of 702 304 index admissions involving HAI treatment, 353 073 (50%) were discharged to a SNF, 179 490 (26%) to home health care, and 169 872 (24%) to home. Overall, 17 523 (2.5%) of preexisting HAIs resulted in linked HAI readmissions, which were more common for Clostridioides difficile infections (4.0%) and urinary tract infections (2.4%) than surgical site infections (1.1%; P < .001). Being discharged to a SNF compared to home or to home health care was associated with a 1.15 percentage point (95% confidence interval = −1.29 to −1.00), or 38%, lower risk of a linked HAI readmission. This risk difference was observed to increase with greater patient comorbidity.

CONCLUSIONS

SNF discharges were associated with fewer avoidable readmissions for preexisting HAIs compared with home discharges. Further research to identify modifiable mechanisms that improve posthospital infection care at home is needed.

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Statement on the agency’s continued efforts to protect women’s health and enhance safety information available to patients considering breast implants - FDA Press Releases

FDA statement on the agency’s continued efforts to protect women’s health and enhance safety information available to patients considering breast implants

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Reply to Comment on Low‐Value Prostate Cancer Screening Among Older Men Within the Veterans Health Administration - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Comment on Low‐Value Prostate Cancer Screening among Older Men within the Veterans Health Administration - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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FDA grants first-ever modified risk orders to eight smokeless tobacco products - FDA Press Releases

The FDA announced today that, for the first time, it has authorized the marketing of products through the modified risk tobacco product (MRTP) pathway. The authorizations are for eight Swedish Match USA, Inc. snus smokeless tobacco products sold under the “General” brand name.

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FDA, FTC warn company marketing unapproved cannabidiol products with unsubstantiated claims to treat teething and ear pain in infants, autism, ADHD, Parkinson’s and Alzheimer’s disease - FDA Press Releases

The U.S. Food and Drug Administration and the Federal Trade Commission posted a joint warning letter to Rooted Apothecary LLC for illegally selling unapproved products containing cannabidiol with unsubstantiated claims.

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FDA approves new breakthrough therapy for cystic fibrosis - FDA Press Releases

FDA approves breakthrough therapy Trikafta for patients 12 and older with cystic fibrosis who have at least one F508del mutation in the CFTR gene, estimated to represent 90% of the cystic fibrosis population.

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Racial Differences in Elevated C‐Reactive Protein Among US Older Adults - American Geriatric Society

OBJECTIVES

To investigate racial differences in elevated C‐reactive protein (CRP) and the potential factors contributing to these differences in US older men and women.

DESIGN

Nationally representative cohort study.

SETTING

Health and Retirement Study, 2006 to 2014.

PARTICIPANTS

Noninstitutionalized non‐Hispanic black and white older adults living in the United States (n = 13 517).

MEASUREMENTS

CRP was categorized as elevated (>3.0 mg/L) and nonelevated (≤3.0 mg/L) as the primary outcome. Measures for demographic background, socioeconomic status, psychosocial factors, health behaviors, and physiological health were examined as potential factors contributing to race differences in elevated CRP.

RESULTS

Median CRP levels (interquartile range) were 1.67 (3.03) mg/L in whites and 2.62 (4.95) mg/L in blacks. Results from random effects logistic regression models showed that blacks had significantly greater odds of elevated CRP than whites (odds ratio = 2.58; 95% confidence interval [CI] = 2.20‐3.02). Results also showed that racial difference in elevated CRP varied significantly by sex (predicted probability [PP] [white men] = 0.28 [95% CI = 0.27‐0.30]; PP [black men] = 0.38 [95% CI = 0.35‐0.41]; PP [white women] = 0.35 [95% CI = 0.34‐0.36]; PP [black women] = 0.49 [95% CI = 0.47‐0.52]) and remained significant after risk adjustment. In men, the racial differences in elevated CRP were attributable to a combination of socioeconomic (12.3%) and behavioral (16.5%) factors. In women, the racial differences in elevated CRP were primarily attributable to physiological factors (40.0%).

CONCLUSION

In the US older adult population, blacks were significantly more likely to have elevated CRP than whites; and the factors contributing to these differences varied in men and women.

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New azaphilones from Penicillium variabile, a fungal endophyte from roots of Aconitum vilmorinianum - Journal of Antibiotics

The Journal of Antibiotics, Published online: 21 October 2019; doi:10.1038/s41429-019-0250-4

New azaphilones from Penicillium variabile, a fungal endophyte from roots of Aconitum vilmorinianum

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Baby powder manufacturer voluntarily recalls products for asbestos - FDA Press Releases

The FDA is alerting consumers of a voluntary recall by Johnson & Johnson of Johnson’s Baby Powder after FDA testing has found that a sample from one lot of the product contains chrysotile fibers, a type of asbestos.

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Depression and Anxiety in Parkinson Disease - Geriatrics

Depression and anxiety are common neuropsychiatric manifestations of Parkinson disease. However, they are often under-recognized because the somatic symptoms of depression often overlap with the motor symptoms of Parkinson disease and there is low self-reporting. Clinicians need to be vigilant about early detection and treatment of anxiety and depression in the patient with Parkinson disease. The development of new therapeutic strategies, including diet, exercise, and counseling along with antidepressants provide a holistic approach to management.

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Management of Motor Features in Advanced Parkinson Disease - Geriatrics

Advanced Parkinson disease (PD) is characterized by the presence of motor fluctuations becoming the focus of treatment, prominent postural instability, significant disability despite levodopa therapy, and the presence of symptoms refractory to levodopa therapy. In this article, the authors review the motor manifestations of patients with advanced PD, as well as the most common pharmacologic and nonpharmacologic available therapies.

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

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

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Perspectives on Implementing a Multidomain Approach to Caring for Older Adults With Heart Failure - American Geriatric Society

BACKGROUND/OBJECTIVES

The American College of Cardiology (ACC) Geriatric Cardiology Section Leadership Council recently outlined 4 key domains (which are composed of 14 subdomains) that are important to assess in older adults with heart failure (HF). We sought to determine which geriatric domains/subdomains are routinely assessed, how they are assessed, and how they impact clinical management in the care of ambulatory older adults with HF.

DESIGN

Survey.

SETTING

Ambulatory.

PARTICIPANTS

Fifteen active ACC member physicians from the geriatric cardiology community.

MEASUREMENTS

Electronic survey assessing which domains/subdomains are currently assessed in these selected real‐world practices, how they are assessed, and how they are incorporated into clinical management.

RESULTS

Of 15 clinicians, 14 responded to the survey. The majority routinely assess 3 to 4 domains (median, 3; interquartile range, 3‐4) and a range of 4 to 12 subdomains (median, 8; interquartile range, 6‐11). All respondents routinely assess the medical and physical function domains, 71% routinely assess the mind/emotion domain, and 50% routinely assess the social domain. The most common subdomains included comorbidity burden (100%), polypharmacy (100%), basic function (93%), mobility (86%), falls risk (71%), frailty (64%), and cognition (57%). Sensory impairment (50%), social isolation (50%), nutritional status (43%), loneliness (7%), and financial means (7%) were least frequently assessed. There was significant heterogeneity with regard to the tools used to assess subdomains. Common themes for how the subdomains influenced clinical care included informing prognosis, informing risk‐benefit of pharmacologic therapy and invasive procedures, and consideration for palliative care.

CONCLUSIONS

While respondents routinely assess multiple domains and subdomains and view these as important to clinical care, there is substantial heterogeneity regarding which subdomains are assessed and the tools used to assess them. These observations provide a foundation that inform a research agenda with regard to providing holistic and patient‐centered care to older adults with HF.

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Evaluation of the Potential Acetylcholinesterase Inhibitor‐Induced Rhinorrhea Prescribing Cascade - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Driving in Parkinson Disease - Geriatrics

Driving is impaired in most patients with Parkinson disease because of motor, cognitive, and visual dysfunction. Driving impairments in Parkinson disease may increase the risk of crashes and result in early driving cessation with loss of independence. Drivers with Parkinson disease should undergo comprehensive evaluations to determine fitness to drive with periodic follow-up evaluations as needed. Research in rehabilitation of driving and automation to maintain independence of patients with Parkinson disease is in progress.

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Orthopedic Care of Patients with Parkinson Disease - Geriatrics

This article summarizes existing literature examining orthopedic interventions for patients with Parkinson disease (PD). It reviews complications and functional outcomes of shoulder, spine, knee, and hip surgeries in PD. Causes of fall-related fractures in PD and the risk of postoperative cognitive decline after orthopedic interventions in PD are also briefly discussed.

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Overview of Sleep and Circadian Rhythm Disorders in Parkinson Disease - Geriatrics

Sleep disorders are common among PD patients and affect quality of life. They are often under-recognized and under-treated. Mechanisms of sleep disorders in PD remain relatively poorly understood. Improved awareness of common sleep problems in PD. Tailored treatment and evidence for efficacy are lacking. The purpose of this review is to provide an overview and update on the most common sleep disorders in PD. We review specific features of the most common sleep disorders in PD, including insomnia, excessive daytime sleepiness, sleep-disordered breathing, restless legs syndrome, circadian rhythm disorders and REM sleep behavior disorders.

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Hallucinations, Delusions and Impulse Control Disorders in Parkinson Disease - Geriatrics

Psychotic and compulsive symptoms in Parkinson disease are highly prevalent and associated with poor outcomes and greater caregiver burden. When acute, delirium should be ruled out or treated accordingly. When chronic, comorbid systemic illnesses, dementia, and psychiatric disorders should be considered. Reduction and discontinuation of anticholinergics, amantadine, dopamine agonists, and levodopa as tolerated, as well as adjunctive clozapine or quetiapine are frequently effective to manage Parkinson disease psychosis. Pimavanserin appears effective but is not widely available, and more experience is needed. Dopamine agonist discontinuation is usually successful for impulse control disorders, but requires frequent monitoring, documentation, and caregiver involvement.

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Gastrointestinal Care of the Parkinson Patient - Geriatrics

This article reviews the most common gastrointestinal (GI) problems that occur in patients with Parkinson disease, including weight loss, drooling, dysphagia, delayed gastric emptying, constipation, and defecatory dysfunction. Appropriate workup and treatment options are reviewed in detail in order to provide clinicians with a comprehensive and practical guide to managing these problems in Parkinson disease patients. GI adverse effects of commonly used Parkinson disease motor medications are also reviewed.

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Management of Early Parkinson Disease - Geriatrics

Early Parkinson disease is the approximate time period between initial diagnosis and the onset of motor fluctuations. Treatment requires an integrative approach, including identification of motor and nonmotor symptoms, choice of pharmacologic treatment, and emphasis on exercise. Patients should be treated for motor symptoms, whereas medications may be delayed for milder symptoms. The choice of treatment in patients with early Parkinson disease must be weighed against financial considerations, ease of administration, and potential long-term adverse events. Nonmotor symptoms should also be identified and treated. Exercise is an important component for treatment of Parkinson disease at any stage.

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Parkinson Disease Epidemiology, Pathology, Genetics, and Pathophysiology - Geriatrics

Parkinson disease is a complex, age-related, neurodegenerative disease associated with dopamine deficiency and both motor and nonmotor deficits. Many environmental and genetic factors influence Parkinson disease risk, with different factors predominating in different patients. These factors converge on specific pathways, including mitochondrial dysfunction, oxidative stress, protein aggregation, impaired autophagy, and neuroinflammation. Ultimately, treatment of Parkinson disease may focus on targeted therapies for pathophysiologically defined subtypes of Parkinson disease patients.

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GAPcare: The Geriatric Acute and Post‐Acute Fall Prevention Intervention in the Emergency Department: Preliminary Data - American Geriatric Society

OBJECTIVES

We aimed to describe a new multidisciplinary team fall prevention intervention for older adults who seek care in the emergency department (ED) after having a fall, assess its feasibility and acceptability, and review lessons learned during its initiation.

DESIGN

Single‐blind randomized controlled pilot study.

SETTING

Two urban academic EDs

PARTICIPANTS

Adults 65 years old or older (n = 110) who presented to the ED within 7 days of a fall.

INTERVENTION

Participants were randomized to a usual care (UC) and an intervention (INT) arm. Participants in the INT arm received a brief medication therapy management session delivered by a pharmacist and a fall risk assessment and plan by a physical therapist (PT). INT participants received referrals to outpatient services (eg, home safety evaluation, outpatient PT).

MEASUREMENTS

We used participant, caregiver, and clinician surveys, as well as electronic health record review, to assess the feasibility and acceptability of the intervention.

RESULTS

Of the 110 participants, the median participant age was 81 years old, 67% were female, 94% were white, and 16.3% had cognitive impairment. Of the 55 in the INT arm, all but one participant received the pharmacy consult (98.2%); the PT consult was delivered to 83.6%. Median consult time was 20 minutes for pharmacy and 20 minutes for PT. ED length of stay was not increased in the INT arm: UC 5.25 hours vs INT 5.0 hours (P < .94). After receiving the Geriatric Acute and Post‐acute Fall Prevention Intervention (GAPcare), 100% of participants and 97.6% of clinicians recommended the pharmacy consult, and 95% of participants and 95.8% of clinicians recommended the PT consult.

CONCLUSION

These findings support the feasibility and acceptability of the GAPcare model in the ED. A future larger randomized controlled trial is planned to determine whether GAPcare can reduce recurrent falls and healthcare visits in older adults.

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Predicting the antistaphylococcal effects of daptomycin–rifampicin combinations in an in vitro dynamic model - Journal of Antibiotics

The Journal of Antibiotics, Published online: 17 October 2019; doi:10.1038/s41429-019-0249-x

Predicting the antistaphylococcal effects of daptomycin–rifampicin combinations in an in vitro dynamic model

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Hispidulones A and B, two new phenalenone analogs from desert plant endophytic fungus Chaetosphaeronema hispidulum - Journal of Antibiotics

The Journal of Antibiotics, Published online: 17 October 2019; doi:10.1038/s41429-019-0247-z

Hispidulones A and B, two new phenalenone analogs from desert plant endophytic fungus Chaetosphaeronema hispidulum

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Induced terreins production from marine red algal-derived endophytic fungus Aspergillus terreus EN-539 co-cultured with symbiotic fungus Paecilomyces lilacinus EN-531 - Journal of Antibiotics

The Journal of Antibiotics, Published online: 17 October 2019; doi:10.1038/s41429-019-0242-4

Induced terreins production from marine red algal-derived endophytic fungus Aspergillus terreus EN-539 co-cultured with symbiotic fungus Paecilomyces lilacinus EN-531

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Effect of efflux pump inhibitors on the susceptibility of Mycobacterium avium complex to clarithromycin - Journal of Antibiotics

The Journal of Antibiotics, Published online: 17 October 2019; doi:10.1038/s41429-019-0245-1

Effect of efflux pump inhibitors on the susceptibility of Mycobacterium avium complex to clarithromycin

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Younger‐ vs Older‐Old Patients with Heart Failure with Preserved Ejection Fraction - American Geriatric Society

OBJECTIVES

Heart failure with preserved ejection fraction (HFpEF) is now recognized as a geriatric syndrome with multifactorial pathophysiology and clinical heterogeneity rather than a solely left ventricular diastolic dysfunction. Because the pathophysiology of HFpEF is suggested to differ by age, this study compared the clinical characteristics and prognostic factors between HFpEF patients aged 65 to 84 years and those aged 85 years or older.

DESIGN

Retrospective cohort study.

SETTING

The Tokyo CCU Network including 73 hospitals in Tokyo, Japan.

PARTICIPANTS

Individuals aged 65 years or older with HFpEF (N = 4305).

MEASUREMENTS

Very old patients were defined as those aged 85 years or older. Potential risk factors for in‐hospital mortality were selected by univariate analyses, and those with a P value <.10 were used in multivariate Cox regression analysis with forward selection (likelihood ratio) to identify significant factors.

RESULTS

Prevalence of hypertension was significantly higher in very old patients, whereas prevalence of coronary artery disease, diabetes mellitus, hyperlipidemia, and smoking was significantly higher in patients aged 65 to 84 years. In very old patients, low systolic blood pressure (hazard ratio [HR] = .988), high serum creatinine level (HR = 1.34), and coexisting chronic obstructive pulmonary disease (COPD; HR = 2.01) were identified as independent risk factors for in‐hospital mortality. In contrast, low systolic blood pressure (HR = .987) and low body mass index (HR = .935) were identified as independent risk factors in patients aged 65 to 84 years.

CONCLUSION

Significant differences were observed in the clinical characteristics and prognostic factors for in‐hospital mortality between HFpEF patients aged 65 to 84 and those 85 years and older. Of note, coexisting COPD was associated with significantly lower survival rate only in patients aged 85 years and older, suggesting the prognostic impact of concomitant pulmonary disease in HFpEF may increase with age. These results have implications for future research and management of older HFpEF patients. J Am Geriatr Soc 00:1–6, 2019. J Am Geriatr Soc 67:2123–2128, 2019

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End‐of‐Life Decision Making and Treatment for Patients with Professional Guardians - American Geriatric Society

OBJECTIVES

Concerns have repeatedly been raised about end‐of‐life decision making when a patient with diminished capacity is represented by a professional guardian, a paid official appointed by a judge. Such guardians are said to choose high‐intensity treatment even when it is unlikely to be beneficial or to leave pivotal decisions to the court. End‐of‐life decision making by professional guardians has not been examined systematically, however.

DESIGN

Retrospective cohort study.

SETTING

Inpatient and outpatient facilities in the Department of Veterans Affairs (VA) Connecticut Healthcare System.

PARTICIPANTS

Decedent patients represented by professional guardians who received care at Connecticut VA facilities from 2003 to 2013 and whose care in the last month of life was documented in the VA record.

MEASUREMENTS

Through chart reviews, we collected data about the guardianship appointment, the patient's preferences, the guardian's decision‐making process, and treatment outcomes.

RESULTS

There were 33 patients with professional guardians who died and had documentation of their end‐of‐life care. The guardian sought judicial review for 33%, and there were delays in decision making for 42%. In the last month of life, 29% of patients were admitted to the intensive care unit, intubated, or underwent cardiopulmonary resuscitation; 45% received hospice care. Judicial review and high‐intensity treatment were less common when information about the patient's preferences was available.

CONCLUSION

Rates of high‐intensity treatment and hospice care were similar to older adults overall. Because high‐intensity treatment was less likely when the guardian had information about a patient's preferences, future work should focus on advance care planning for individuals without an appropriate surrogate. J Am Geriatr Soc 67:2161–2166, 2019

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What Do Clinicians Caring for Aging Patients Need to Know About Private Long‐Term Care Insurance? - American Geriatric Society

Preparing for future long‐term care (LTC) needs is a critical component of successful aging. Clinicians with aging patient panels may be a valuable source of information about the importance of LTC planning and the mechanisms available to do so, including private LTC insurance (LTCi). This article provides an overview, from a clinician's perspective, of current LTC financing and the key questions patients should consider when assessing LTCi. Although actual purchasing decisions likely require support from impartial financial experts, clinicians may be well positioned to help initiate difficult conversations about LTC planning and point patients to unbiased resources concerning LTCi. J Am Geriatr Soc 67:2167–2173, 2019

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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. J Am Geriatr Soc 67:2011–2017, 2019

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Associations of Usual Pace and Complex Task Gait Speeds With Incident Mobility Disability - American Geriatric Society

BACKGROUND/OBJECTIVES

To assess whether gait speed under complex conditions predicts long‐term risk for mobility disability as well as or better than usual‐pace gait speed.

DESIGN

Longitudinal cohort study.

SETTING/PARTICIPANTS

Subsample of Health Aging and Body Composition study with follow‐up from 2002 to 2003 to 2010 to 2011, including 337 community‐dwelling adults (mean age = 78.5 years, 50.7% female, 26.1% black).

MEASUREMENTS

Associations of gait speed measured under usual‐pace, fast‐pace, dual‐task, and narrow‐path conditions with mobility disability, defined by any self‐reported difficulty walking ¼ mile assessed annually, were tested by Cox proportional hazard models adjusted for demographic and health characteristics. Models were fitted for each walking condition, and R ² statistics were used to compare predictive value across models. Models were repeated for persistent mobility disability, defined as at least two consecutive years of mobility disability.

RESULTS

Mobility disability occurred in 204 (60.5%) participants over the 8‐year follow‐up. There was a lower hazard of developing mobility disability with faster gait speed under all conditions. Hazard ratios, confidence intervals, and R ² of gait speed predicting mobility disability were similar across all four walking conditions (R ² range = 0.22‐0.27), but were strongest for dual‐task gait speed (hazard ratio [95% confidence interval], R ² of fully adjusted models = 0.81 [0.75‐0.88], 0.27). Results were comparable for persistent mobility disability (R ² range = 0.26‐0.28).

CONCLUSION

Slower gait speed under both usual‐pace and complex conditions may be a clinical indicator of future risk of mobility disability. These results support the call for increased use of gait speed measures in routine geriatric care. J Am Geriatr Soc 67:2072–2076, 2019

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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. J Am Geriatr Soc 67:2018–2022, 2019

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Better Together: Promoting Geriatrics Education across Residency Specialties with a Pilot Peer Teaching Exchange - American Geriatric Society

Journal of the American Geriatrics Society, Volume 67, Issue 10, Page E1-E3, October 2019.

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Registered Nurse Burnout, Job Dissatisfaction, and Missed Care in Nursing Homes - American Geriatric Society

OBJECTIVES

To examine the relationship between registered nurse (RN) burnout, job dissatisfaction, and missed care in nursing homes.

DESIGN

Cross‐sectional secondary analysis of linked data from the 2015 RN4CAST‐US nurse survey and LTCfocus.

SETTING

A total of 540 Medicare‐ and Medicaid‐certified nursing homes in California, Florida, New Jersey, and Pennsylvania.

PARTICIPANTS

A total of 687 direct care RNs.

MEASUREMENTS

Emotional Exhaustion subscale of the Maslach Burnout Inventory, job dissatisfaction, and missed care.

RESULTS

Across all RNs, 30% exhibited high levels of burnout, 31% were dissatisfied with their job, and 72% reported missing one or more necessary care tasks on their last shift due to lack of time or resources. One in five RNs reported frequently being unable to complete necessary patient care. Controlling for RN and nursing home characteristics, RNs with burnout were five times more likely to leave necessary care undone (odds ratio [OR] = 4.97; 95% confidence interval [CI] = 2.56‐9.66) than RNs without burnout. RNs who were dissatisfied were 2.6 times more likely to leave necessary care undone (OR = 2.56; 95% CI = 1.68‐3.91) than RNs who were satisfied. Tasks most often left undone were comforting/talking with patients, providing adequate patient surveillance, patient/family teaching, and care planning.

CONCLUSION

Missed nursing care due to inadequate time or resources is common in nursing homes and is associated with RN burnout and job dissatisfaction. Improved work environments with sufficient staff hold promise for improving care and nurse retention. J Am Geriatr Soc 67:2065–2071, 2019

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Reducing Barriers to Mental Health Care: Bringing Evidence‐Based Psychotherapy Home - American Geriatric Society

OBJECTIVES

Barriers to treatment for depression and anxiety are prevalent among older adults and caregivers living in the community. We designed and implemented an evidence‐based psychotherapy program to reduce obstacles to care.

DESIGN

A practice improvement initiative providing no‐fee evidence‐based mental health care at home in clients' primary languages.

SETTING

Independence at Home, a community service of SCAN Health Plan in Southern California.

PARTICIPANTS

Diverse older adults and adult caregivers of older people with age‐related disability (mainly dementia).

INTERVENTION

Redesign of an existing supportive counseling program to improve access to validated models of psychotherapy for depression and anxiety.

MEASUREMENTS

We describe program content, phases of development, equity in participation from referral to program completion, clinical outcomes, and estimated direct program delivery costs.

RESULTS

Insights successfully served demographically diverse clients experiencing a broad range of barriers to mental health care. A total of 211 clients completed therapy using one of three evidence‐based approaches in the first 33 months of operation (2015‐2018). Clinical efficacy was high and equivalent across demographic groups and therapy models. Depression, anxiety, quality of life, self‐rated disability, and patient activation all improved significantly. We supported therapists' transition to the new model, modified workflows, and used clinical outcome data and therapist focus groups to improve referral, selection, and enrollment processes and simplify treatment assignment. With program maturation, treatment duration and direct costs both declined.

CONCLUSION

The Insights model could add value to healthcare organizations seeking to provide effective, equitable mental health services for older adults and caregivers who have difficulty accessing care for depression, anxiety, or difficult life challenges. J Am Geriatr Soc 67:2174–2179, 2019

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Diet Quality Is Associated With Mortality in Adults Aged 80 Years and Older: A Prospective Study - American Geriatric Society

OBJECTIVES

Diet quality has been associated with health outcomes and quality of life. However, the association between diet quality and mortality in older people, those aged 80 years and older, is understudied. Therefore, we conducted a prospective study to examine whether better diet quality, assessed by a validated dietary screening tool (DST), was associated with lower mortality in those aged 80 years and older.

METHODS

Our study included 1990 participants (812 men and 1178 women), with a mean age of 84.1 years at baseline (ranging from 80 to 102 years old), from the Geisinger Rural Aging Study longitudinal cohort in Pennsylvania. Baseline descriptive information was obtained in 2009, and the DST was administered via mailed survey. The DST is composed of 25 food‐ and behavior‐specific questions associated with dietary intake that generate a diet quality score ranging from 0 (lowest) to 100 (highest). Death was identified using electronic medical record and the Social Security Death Index data. Hazard ratios (HRs) and 95% confidence intervals (CIs) across three diet quality categories were calculated by using Cox proportional hazards models after adjusting for potential confounders.

RESULTS

Over 8 years of follow‐up (October 2009‐February 2018), 931 deaths were documented. Higher diet quality was associated with lower mortality risk (P‐trend = .04). Participants with high diet quality (defined as DST scores >75) had significantly lower risk of mortality compared with those with low diet quality (defined as DST scores <60) after adjusting for potential risk factors (adjusted HR = 0.76; 95% CI = 0.59‐0.97).

CONCLUSION

Diet quality, assessed by DST, is significantly associated with risk of mortality in older adults aged 80 years and older in our prospective cohort. Our results indicate that nutrition may have an important role in healthy aging, and more studies are needed to develop appropriate dietary recommendations for older persons. J Am Geriatr Soc 67:2180–2185, 2019

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

OBJECTIVES

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

DESIGN

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

SETTING

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

PARTICIPANTS

There were 1 793 783 participants.

MEASUREMENTS

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

RESULTS

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

CONCLUSION

It is possible to identify older adults with dementia at high risk of imminent PPH, and their risk remains elevated for an entire year. Given the negative outcomes associated with acute hospitalization for those with dementia, healthcare systems and providers may be able to engage these high‐risk patients proactively to avoid unnecessary hospitalization. J Am Geriatr Soc 67:2077–2084, 2019

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

OBJECTIVES

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

DESIGN

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

SETTING

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

PARTICIPANTS

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

MEASUREMENTS

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

RESULTS

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

CONCLUSION

ACEs are linked to an increased risk for past‐year psychiatric and substance use disorders in older adults. ACEs may have long‐term effects on older adults’ mental well‐being. Although further research is needed, preventing ACEs may lead to large improvements in public mental health that persist well into older age. J Am Geriatr Soc 67:2085–2093, 2019

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Validation and Normative Data for the Modified Telephone Interview for Cognitive Status: The Sydney Memory and Ageing Study - American Geriatric Society

OBJECTIVES

Telephone‐based cognitive screens, such as the Telephone Interview for Cognitive Status (TICS), can potentially reduce the barriers and costs of assessing older adults. However, validation of clinically relevant psychometric properties is lacking in a large and comprehensively assessed sample of older adults. Furthermore, published normative data may lack sensitivity as they have not used regression‐based demographic corrections or accounted for cases with subsequent dementia. We address these gaps using the modified TICS (TICS‐M; a modified, 13‐item, 39‐point version) and provide an online norms calculator for clinicians and researchers.

DESIGN

Prospective longitudinal study.

SETTING

Sydney, Australia.

PARTICIPANTS

A total of 617 community‐living older adults, aged from 71 to 91 years.

MEASUREMENTS

The measures used included the TICS‐M, the Mini‐Mental State Examination (MMSE), Addenbrooke's Cognitive Examination‐Revised (ACE‐R), and a comprehensive neuropsychological test battery. Descriptive statistics, correlations, area under the curve, and regression analyses were used to determine the validity and normative properties of the TICS‐M.

RESULTS

TICS‐M total scores (mean = 24.20; SD = 3.76) correlated well with the MMSE (0.70) and ACE‐R (0.80) and moderately with neuropsychological tests tested noncontemporaneously. A cutoff score of 21 or lower reliably distinguished between those with and without incident dementia after 1 year (sensitivity = 77%; specificity = 88%) but was less reliable at distinguishing mild cognitive impairment from normal cognition. TICS‐M scores decreased with age and increased with higher education levels. The robust normative sample, which excluded incident dementia cases, scored higher on the TICS‐M and with less variability than the whole sample. An online calculator is provided to compute regression‐based norms and reliable change statistics.

CONCLUSIONS

In a large sample of community‐dwelling older adults, the TICS‐M performed well in terms of construct validity against typical screening tools and neuropsychological measures and diagnostic validity for incident dementia. The comprehensive, regression‐based, and robust normative data provided will help improve the sensitivity, accessibility, and cost‐effectiveness of cognitive testing with older adults. J Am Geriatr Soc 67:2108–2115, 2019

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

Objectives

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

Design

Prospective cohort study.

Setting

A single academic center.

Participants

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

Measurements

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

Results

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

Conclusions

The chair rise test with targeted CGA may be a practical strategy to identify older patients at high risk for mortality and poor recovery after SAVR and TAVR in whom individualized care management should be considered. J Am Geriatr Soc 67:2031–2037, 2019

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

Objectives

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

Design

Population‐based retrospective cohort study using linked administrative databases.

Setting

Ontario, Canada.

Participants

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

Measurements

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

Results

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

Conclusion

In our cohort, almost 1 in 5 older adults with a new sleep disorder diagnosis were prescribed a medication used for sleep; of these, a higher proportion were women. Comparatively few older adults were further evaluated; of these, a higher proportion were men. Our study highlights the high rates at which medications are prescribed to older adults with a new sleep disorder diagnosis and identifies potential sex differences in the management of such diagnoses. J Am Geriatr Soc 1–8, 2019. J Am Geriatr Soc 67:2094–2101, 2019

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

OBJECTIVES

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

DESIGN

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

SETTING

Memphis, Tennessee, and Pittsburgh, Pennsylvania.

PARTICIPANTS

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

MEASUREMENTS

All‐cause mortality.

RESULTS

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

CONCLUSIONS

OLD is associated with high risk of death with different risk profiles based on symptom group. Patients with symptoms of shortness of breath without OLD should be considered an at‐risk group given their similar mortality to those with OLD with minimal symptoms. J Am Geriatr Soc 67:2116–2122, 2019

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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. J Am Geriatr Soc 67:2157–2160, 2019

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Statins in Older Danes: Factors Associated With Discontinuation Over the First 4 Years of Use - American Geriatric Society

BACKGROUND AND OBJECTIVE

Use of statins is considerable among older persons. We investigated factors associated with statin discontinuation in new statin users aged 70 years or older within the first 4 years of use.

DESIGN

Register‐based descriptive drug utilization study using data from 2008 to 2016.

POPULATION/SETTING

All Danish persons, aged 70 years or older, initiating statin treatment.

MEASUREMENTS

Rates and predictors of statin discontinuation after 1 year (early), 2 years, and 4 years. Predictors of discontinuation were estimated using logistic regression.

RESULTS

We included 83 788 statin initiators. At 1 year, 13% had discontinued their treatment, while another 12% and 13% discontinued after 2 and 4 years, respectively. The overall discontinuation rate over 4 years was 32%. Increasing age was associated with discontinuation at all time points (adjusted odds ratio [OR] = 2.06 [95% confidence interval {CI} = 1.35‐3.16] at 1 year, adjusted OR = 3.94 [95% CI, 1.83‐8.49] at 4 years, comparing those aged >95 years to those aged 70‐74 years). Further, higher comorbidity scores and use of more than 10 medications were modestly associated with discontinuation. Use of statins for secondary prevention was associated with decreased odds of discontinuation compared to primary prevention at 1 year (adjusted OR = 0.74; 95% CI, 0.65‐0.83) and at 4 years (adjusted OR = 0.83; 95% CI, 0.72‐0.95), along with concomitant use of cardiovascular (CV) therapies. The annual proportion of early discontinuers ranged from 14% to 17% for primary prevention and from 9% to 12% for secondary prevention between 2008 and 2015.

DISCUSSION

Statin discontinuation within the first 4 years after initiation appeared to be influenced most strongly by age, and may also be influenced by comorbidity, polypharmacy, use for secondary prevention, and concomitant CV medication use. Future research should clarify reasons for, and discussions about, statin discontinuation and initiation among older persons, to provide additional insight on this topic. J Am Geriatr Soc 67:2050–2057, 2019

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

OBJECTIVES

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

DESIGN

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

SETTING

Fourteen primary care practices in Scotland, UK.

PARTICIPANTS

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

INTERVENTION

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

MEASUREMENTS

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

RESULTS

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

CONCLUSION

Oral vitamin K2 supplementation did not improve postural sway or physical function in older people at risk of falls. J Am Geriatr Soc 67:2102–2107, 2019

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Statin Use Over 65 Years of Age and All‐Cause Mortality: A 10‐Year Follow‐Up of 19 518 People - American Geriatric Society

OBJECTIVES

As life expectancy continues to rise, the burden of cardiovascular disease among older people is expected to increase, making cardiovascular prevention in older people an issue of growing interest and public health importance. We aimed to explore the long‐term effects of adherence to statins on mortality and cardiovascular morbidity among older adults.

DESIGN

A historical population‐based cohort study using routinely collected data.

SETTING

Clalit Health Services Northern District.

PARTICIPANTS

We followed members of Clalit Health Services aged 65 years or older who were eligible for primary cardiovascular prevention for a period of 10 years.

MEASUREMENTS

We fitted Cox regression models to assess the association between the adherence to statin therapy and all‐cause mortality and cardiovascular morbidity, adjusting for cardiovascular risk factors and associated morbidity as time‐updated variables.

RESULTS

The analysis included 19 518 older adults followed during 10 years (median = 9.7 y). All‐cause mortality rates were 34% lower among those who had adhered to statin treatment, compared with those who had not (hazard ratio [HR] = .66; 95% confidence interval [CI] = .56‐.79). Adherence to statins was also associated with fewer atherosclerotic cardiovascular disease events (HR = .80; 95% CI = .71‐.81). The benefit of statin use did not diminish among beyond age 75 and was evident for both women and men.

CONCLUSION

Adherence to statins may be associated with reduced mortality and cardiovascular morbidity among older adults, regardless of age and sex. J Am Geriatr Soc 67:2038–2044, 2019

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Rate or Rhythm Control in Older Atrial Fibrillation Patients: Risk of Fall‐Related Injuries and Syncope - American Geriatric Society

OBJECTIVES

Management of atrial fibrillation (AF) with rate and/or rhythm control could lead to fall‐related injuries and syncope, especially in the older AF population. We aimed to determine the association of rate and/or rhythm control with fall‐related injuries and syncope in a real‐world older AF cohort.

DESIGN

A retrospective cohort study.

SETTING

Danish nationwide administrative registries from 2000 to 2015.

PARTICIPANTS

A total of 100 935 patients with AF aged 65 years or older claiming prescription of rate‐lowering drugs (RLDs) and/or anti‐arrhythmic drugs (AADs) were included. We compared the use of rate‐lowering monotherapy with rate‐lowering dual therapy, AAD monotherapy, and AAD combined with rate‐lowering therapy.

MEASUREMENTS

Outcomes were fall‐related injuries and syncope as a composite end point (primary) or separate end point (secondary).

RESULTS

In this population, the median age was 78 years (interquartile range [IQR] = 72‐84 y), and 53 481 (53.0%) were women. During a median follow‐up of 2.1 years (IQR = 1.0‐5.1), 17 132 (17.0%) experienced a fall‐related injury, 5745 (5.7%) had a syncope, and 21 093 (20.9%) experienced either. Compared with rate‐lowering monotherapy, AADs were associated with a higher risk of fall‐related injuries and syncope. The incidence rate ratio (IRR) for the composite end point was 1.29 (95% confidence interval [CI]: 1.17‐1.43) for AAD monotherapy and 1.46 [95% CI = 1.34‐1.58] for AAD combined with rate‐lowering therapy. When stratifying by individual drugs, amiodarone significantly increased the risk of fall‐related injuries and syncope (IRR = 1.40 [1.26‐1.55]). Compared with more than 180 days of rate‐lowering monotherapy, a higher risk of all outcomes was seen in the first 90 days of any treatment; however, the greatest risk was in the first 14 days for those treated with AADs.

CONCLUSION

In AF patients aged 65 years and older, AAD use was associated with a higher risk of fall‐related injuries and syncope, and the risk was highest within the first 14 days for those treated with AADs. Only amiodarone use was associated with a higher risk. J Am Geriatr Soc 67:2023–2030, 2019

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Statement on continued progress enhancing patient access to high-quality, low-cost generic drugs - FDA Press Releases

Statement from Acting FDA Commissioner Ned Sharpless, M.D., on continued progress enhancing patient access to high-quality, low-cost generic drugs

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Bactericidal effect of pyridine-2-thiol 1-oxide sodium salt and its complex with iron against resistant clinical isolates of Mycobacterium tuberculosis - Journal of Antibiotics

The Journal of Antibiotics, Published online: 16 October 2019; doi:10.1038/s41429-019-0243-3

Bactericidal effect of pyridine-2-thiol 1-oxide sodium salt and its complex with iron against resistant clinical isolates of Mycobacterium tuberculosis

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