Passive Digital Signature for Early Identification of Alzheimer's Disease and Related Dementia - American Geriatric Society

OBJECTIVES

Developing scalable strategies for the early identification of Alzheimer's disease and related dementia (ADRD) is important. We aimed to develop a passive digital signature for early identification of ADRD using electronic medical record (EMR) data.

DESIGN

A case‐control study.

SETTING

The Indiana Network for Patient Care (INPC), a regional health information exchange in Indiana.

PARTICIPANTS

Patients identified with ADRD and matched controls.

MEASUREMENTS

We used data from the INPC that includes structured and unstructured (visit notes, progress notes, medication notes) EMR data. Cases and controls were matched on age, race, and sex. The derivation sample consisted of 10 504 cases and 39 510 controls; the validation sample included 4500 cases and 16 952 controls. We constructed models to identify early 1‐ to 10‐year, 3‐ to 10‐year, and 5‐ to 10‐year ADRD signatures. The analyses included 14 diagnostic risk variables and 10 drug classes in addition to new variables produced from unstructured data (eg, disorientation, confusion, wandering, apraxia, etc). The area under the receiver operating characteristics (AUROC) curve was used to determine the best models.

RESULTS

The AUROC curves for the validation samples for the 1‐ to 10‐year, 3‐ to 10‐year, and 5‐ to 10‐year models that used only structured data were .689, .649, and .633, respectively. For the same samples and years, models that used both structured and unstructured data produced AUROC curves of .798, .748, and .704, respectively. Using a cutoff to maximize sensitivity and specificity, the 1‐ to 10‐year, 3‐ to 10‐year, and 5‐ to 10‐year models had sensitivity that ranged from 51% to 62% and specificity that ranged from 80% to 89%.

CONCLUSION

EMR‐based data provide a targeted and scalable process for early identification of risk of ADRD as an alternative to traditional population screening.

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The Doctor and the Dragonfly - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Impact of Intensive Blood Pressure Therapy on Concern about Falling: Longitudinal Results from the Systolic Blood Pressure Intervention Trial (SPRINT) - American Geriatric Society

OBJECTIVES

Concern about falling is common among older hypertension patients and could impact decisions to intensify blood pressure therapy. Our aim was to determine whether intensive therapy targeting a systolic blood pressure (SBP) of 120 mm Hg is associated with greater changes in concern about falling when compared with standard therapy targeting an SBP of 140 mm Hg.

DESIGN

Subsample analysis of participants randomized to either intensive or standard therapy in the Systolic Blood Pressure Intervention Trial (SPRINT).

SETTING

Approximately 100 outpatient sites.

PARTICIPANTS

A total of 2313 enrollees in SPRINT; participants were all age 50 or older (mean = 69 y) and diagnosed with hypertension.

MEASUREMENTS

Concern about falling was described by the shortened version of the Falls Efficacy Scale International as measured at baseline, 6 months, 1 year, and annually thereafter.

RESULTS

Concern about falling showed a small but significant increase over time among all hypertension patients. No differences were noted, however, among those randomized to intensive vs standard therapy (P = .95). Among participants younger than 75 years, no increase in concern about falling over time was noted, but among participants aged 75 years and older, the mean falls self‐efficacy score increased by .3 points per year (P < .0001). No differences were observed between the intensive and standard treatment groups when stratified by age (P = .55).

CONCLUSION

Intensive blood pressure therapy is not associated with increased concern about falling among older hypertension patients healthy enough to participate in SPRINT.

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Identification of Older Adult Fall Occurrence by Brief Emergency Department Triage Screen - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Comment On: Relationship Between Functional Improvement and Cognition in Short‐stay Nursing Home Residents - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Healthcare and Policy: Center Stage for Geriatric Research - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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A Statewide Program to Improve Management of Suspected Urinary Tract Infection in Long‐Term Care - American Geriatric Society

BACKGROUND/OBJECTIVES

Suspected urinary tract infection (UTI) is the most common indication for antibiotic use in long‐term care (LTC). Due to the high prevalence of asymptomatic bacteriuria, for which antibiotics are not warranted, these antibiotics are frequently unnecessary. We implemented a collaborative quality improvement program to improve the management of suspected UTI in LTC residents by increasing awareness of current guidelines, with a focus on decreasing treatment in the absence of symptoms.

DESIGN/INTERVENTION

Two separate collaboratives included workshops, webinars, and coaching calls.

PARTICIPANTS

A total of 31 facilities participated in the first collaborative, with 17 submitting sufficient data for analysis and 34 in the second, with data analyzed from 25.

MEASUREMENTS

Facilities reported monthly numbers of urine cultures, UTI diagnoses, Clostridioides difficile infections (CDIs), and resident days.

RESULTS

When comparing the baseline period to the first collaborative period, the intercollaborative period to the second collaborative period, and the first collaborative period to the second, the incident rate ratios (95% confidence intervals) were 0.74 (0.68‐0.81), 0.83 (0.73‐0.94), and 0.63 (0.57‐0.69), respectively, for urine culturing rate; 0.73 (0.64‐0.83), 0.86 (0.70‐1.05), and 0.60 (0.51‐0.69), respectively, for UTI diagnosis rate; and 0.56 (0.40‐0.82), 1.61 (0.71‐4.14), and 0.45 (0.27‐0.74), respectively, for CDI rate.

CONCLUSION

The program we implemented was associated with reductions in urine cultures, UTI diagnosis, and CDI; and it suggests that this type of intervention can promote appropriate management of UTI in the LTC setting.

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FDA orders Puerto Rico fertility clinic to cease manufacturing immediately for significant violations that pose a danger to health - FDA Press Releases

FDA orders Puerto Rico fertility clinic to cease manufacturing immediately for significant violations that pose a danger to health

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Special issue: Nucleoside antibiotics, polyoxin and beyond - Journal of Antibiotics

The Journal of Antibiotics, Published online: 27 November 2019; doi:10.1038/s41429-019-0238-0

Special issue: Nucleoside antibiotics, polyoxin and beyond

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Risk for Health Events After Deprescribing Acetylcholinesterase Inhibitors in Nursing Home Residents With Severe Dementia - American Geriatric Society

BACKGROUND/OBJECTIVE

Reevaluation of the appropriateness of acetylcholinesterase inhibitors (AChEIs) is recommended in older adults with severe dementia, given the lack of strong evidence to support their continued effectiveness and risk for medication‐induced adverse events. We sought to evaluate the impact of deprescribing AChEIs on risk of all‐cause events (hospitalizations, emergency department visits, and mortality) and serious falls or fractures in older nursing home (NH) residents with severe dementia.

DESIGN

Analysis of 2015 to 2016 data from Medicare claims, Part D prescriptions, Minimum Data

Set (MDS) version 3.0, Area Health Resource File, and Nursing Home Compare. Marginal structural models with inverse probability of treatment weights were used to evaluate the association of deprescribing AChEIs and all‐cause negative events as well as serious falls or fractures.

SETTING

US Medicare‐certified NHs.

PARTICIPANTS

Nonskilled NH residents, aged 65 years and older, with severe dementia receiving AChEIs within the first 14 days of an MDS assessment in 2016 (n = 37 106).

RESULTS

The sample was primarily white (78.7%), female (75.5%), and aged 80 years or older (77.4%). Deprescribing AChEIs was associated with an increased likelihood of all‐cause negative events in unadjusted models (odds ratio [OR] = 1.17; 95% confidence interval [CI] = 1.11‐1.23; P < .01), but not in fully adjusted models (adjusted OR [aOR] = 1.00; 95% CI = 0.94‐1.06; P = .94). By contrast, deprescribing was associated with a reduced likelihood of serious falls or fractures in unadjusted models (OR = 0.59; 95% CI = 0.52‐0.66; P < .001) and remained significant in adjusted models (aOR = 0.64; 95% CI = 0.56‐0.73; P < .001).

CONCLUSION

Deprescribing AChEIs was not associated with a significant increase in the likelihood for all‐cause negative events and was associated with a reduced likelihood of falls and fractures in older NH residents with dementia. Our findings suggest that deprescribing AChEIs is a reasonable approach to reduce the risk of serious falls or fractures without increasing the risk for all‐cause events.

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California-based food manufacturer agrees to stop production after repeated food safety violations - FDA Press Releases

California-based food manufacturer agrees to stop production after repeated food safety violations

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Statement by FDA Commissioner Scott Gottlieb, M.D., and Biologics Center Director Peter Marks, M.D., Ph.D. on FDA’s continued efforts to stop stem cell clinics and manufacturers from marketing unapproved products that put patients at risk - FDA Press Releases

FDA statement on stem cell enforcement actions and agency activities to facilitate legitimate product development

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Association of Reproductive History With Motor Function and Disability in Aging Women - American Geriatric Society

BACKGROUND/OBJECTIVES

The associations of reproductive history and motor function are controversial.

DESIGN

Prospective cohort study with 10 years of follow‐up.

SETTING

Three French cities between 1999 and 2011.

PARTICIPANTS

A total of 3043 community‐dwelling women from the Three‐City Dijon study population.

MEASUREMENTS

We examined the cross‐sectional and longitudinal association of age at menopause, artificial menopause, and parity with walking speed (WS) using linear regression and linear mixed models, respectively. Cox proportional models were used to examine the association of characteristics of reproductive life with disability.

RESULTS

Mean baseline WS was 143.8 cm/s. Artificial menopause was associated with slower WS at baseline (β = −3.29; 95% confidence interval [CI] = −5.83 to −0.74; P = .01). Reproductive life characteristics had no effect on change in WS. Increasing age at menopause was associated with reduced disability risk (hazard ratio [HR] for 5‐year increase = 0.92; 95% CI = 0.87‐0.99; P = .02), while parity increased disability risk (HR for ≥3 vs 0 children = 1.53; 95% CI = 1.22‐1.93; P < .01).

CONCLUSION

These findings show that early age at menopause and higher parity have a deleterious effect on motor function that persists in older people.

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Longitudinal Investigation of Older Adults' Ability to Self‐Manage Complex Drug Regimens - American Geriatric Society

OBJECTIVES

We sought to investigate older patients' ability to correctly and efficiently dose multidrug regimens over nearly a decade and to explore factors predicting declines in medication self‐management.

DESIGN

Longitudinal cohort study funded by the National Institute on Aging.

SETTING

One academic internal medicine clinic and six community health centers.

PARTICIPANTS

Beginning in 2008, 900 English‐speaking adults, aged 55 to 74 years, were enrolled in the study, completing a baseline (T1) assessment. To date, 303 participants have completed the same assessment 9 years postbaseline (T4).

MEASUREMENTS

At T1, subjects were given a standardized, seven‐drug regimen and asked to demonstrate how they would take medicine over 24 hours. The number of dosing errors made and times per day that a participant would take medicine were recorded. Health literacy was measured via the Newest Vital Sign, and cognitive decline was measured by the Mini‐Mental State Examination.

RESULTS

Participants on average made 2.9 dosing errors (SD = 2.5 dosing errors; range = 0‐21 dosing errors) of 21 potential errors at T1 and 5.0 errors (SD = 2.1 errors; range = 1‐18 errors; P < .001) at T4. In a multivariate model, limited literacy (β = .69; 95% confidence interval [CI] = .18‐1.20; P = .01), meaningful cognitive decline (β = 1.72; 95% CI = .70‐2.74; P = .01), number of chronic conditions (β = .21; 95% CI = .07‐.34; P = .01), and number of baseline dosing errors (β = −.76; 95% CI = −.85 to −.67; P < .001) were significant, independent predictors of changes in dosing errors. Most patients overcomplicated their daily medication schedule; no sociodemographic characteristics were predictive of poor regimen organization in multivariate models. In a multivariate model, there were no significant predictors of changes in regimen consolidation over time, except regimen consolidation at T1.

CONCLUSIONS

Older patients frequently overcomplicated drug regimens and increasingly made more dosing errors over 9 years of follow‐up. Patients with limited literacy, cognitive decline, and multimorbidity were at greatest risk for errors.

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Medication Use Quality and Safety in Older Adults: 2018 Update - American Geriatric Society

Improving the quality of medication use and medication safety is an important priority for prescribers who care for older adults. The objective of this article was to identify key articles from 2018 that address these issues. In addition, we selected four of these articles to annotate, critique, and discuss their broader implications for clinical practice. The first study highlights a cluster‐randomized trial that utilized a pharmacist‐led education‐based intervention delivered to both patients and physicians to deprescribe four types of inappropriate medications (sedative‐hypnotics, first‐generation antihistamines, selective nonsteroidal anti‐inflammatory drugs, and glyburide). The second study, a nested case‐control study using data from within the UK Clinical Practice Research Datalink, examined the association between anticholinergic exposure, overall and by anticholinergic medication class, and dementia risk in 40 770 older adults. The third study, a longitudinal cohort study of 1028 Swedish older adults, examined the association between antihypertensive medications and incident dementia. The last study was a randomized, double‐blind, placebo‐controlled trial that investigated the effect of daily low‐dose aspirin (100 mg) for primary prevention on cardiovascular events and major hemorrhage in 19 144 community‐dwelling older adults. Collectively, this current article provides insight into the pertinent topics of medication use quality and safety in older adults and helps raise awareness about optimal prescribing in older adults.

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FDA approves system for the delivery of ear tubes under local anesthesia to treat ear infection - FDA Press Releases

FDA has approved a new system, the Tubes Under Local Anesthesia (Tula) System, for the delivery of tympanostomy tubes, commonly referred to as ear tubes, that can be inserted into the eardrum to treat recurrent ear infections.

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FDA warns 15 companies for illegally selling various products containing cannabidiol as agency details safety concerns - FDA Press Releases

FDA warns 15 companies for illegally selling various products containing cannabidiol as agency details safety concerns

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FDA approves novel treatment to target abnormality in sickle cell disease - FDA Press Releases

FDA granted accelerated approval to Oxbryta (voxelotor) for the treatment of sickle cell disease in adults and pediatric patients 12 years of age and older

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Statement on efforts to help make development of biosimilar and interchangeable insulin products more efficient - FDA Press Releases

FDA issues guidance to help make development of biosimilar and interchangeable insulin products more efficient.

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Statement on new steps to advance innovation in medical device sterilization with ethylene oxide - FDA Press Releases

FDA is announcing the next steps in our ongoing efforts in medical device sterilization with ethylene oxide. This includes the selection results of our new Innovation Challenges, a recap and action items from our recent public advisory committee meeting, and the announcement of a new pilot program.

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Longer Term Effects of Diet and Exercise on Neurocognition: 1‐Year Follow‐up of the ENLIGHTEN Trial - American Geriatric Society

OBJECTIVES

To evaluate the longer term changes in executive functioning among participants with cardiovascular disease (CVD) risk factors and cognitive impairments with no dementia (CIND) randomized to a diet and exercise intervention.

DESIGN

A 2 (Exercise) × 2 (Dietary Approaches to Stop Hypertension [DASH] eating plan) factorial randomized clinical trial.

SETTING

Academic tertiary care medical center.

PARTICIPANTS

Volunteer sample of 160 older sedentary adults with CIND and at least one additional CVD risk factor enrolled in the ENLIGHTEN trial between December 2011 and March 2016.

INTERVENTIONS

Six months of aerobic exercise (AE), DASH diet counseling, combined AE + DASH, or health education (HE) controls.

MEASUREMENTS

Neurocognitive battery recommended by the Neuropsychological Working Group for Vascular Cognitive Disorders including measures of executive function, memory, and language/verbal fluency. Secondary outcomes included the Clinical Dementia Rating‐Sum of Boxes (CDR‐SB), Six‐Minute Walk Distance (6MWD), and CVD risk including blood pressure, body weight, and CVD medication burden.

RESULTS

Despite discontinuation of lifestyle changes, participants in the exercise groups retained better executive function 1 year post‐intervention (P = .041) compared with non‐exercise groups, with a similar, albeit weaker, pattern in the DASH groups (P = .054), without variation over time (P's > .867). Participants in the exercise groups also achieved greater sustained improvements in 6MWD compared with non‐Exercise participants (P < .001). Participants in the DASH groups exhibited lower CVD risk relative to non‐DASH participants (P = .032); no differences in CVD risk were observed for participants in the Exercise groups compared with non‐Exercise groups (P = .711). In post hoc analyses, the AE + DASH group had better performance on executive functioning (P < .001) and CDR‐SB (P = .011) compared with HE controls.

CONCLUSION

For participants with CIND and CVD risk factors, exercise for 6 months promoted better executive functioning compared with non‐exercisers through 1‐year post‐intervention, although its clinical significance is uncertain.

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Healthcare Utilization and Physical Functioning in Older Adults in the United States - American Geriatric Society

OBJECTIVES

Decline in physical function is associated with older age. Healthcare utilization and expenditures related to physical functioning declines will likely increase as the proportion of the population of older adults rises. This study evaluated resource utilization associated with differences in physical functioning in a nationally representative sample of older adults.

DESIGN

A retrospective panel study nationally representative for 26 809 552 older adults in the United States.

SETTING

Medical Expenditure Panel Survey (MEPS) data from 2013 to 2014.

PARTICIPANTS

Adults aged 70 years or older who completed both rounds of the Self‐Administered Questionnaire in MEPS.

MEASUREMENTS

Physical Component Score (PCS) from the Short‐Form Health Survey as a measure of physical functioning was stratified into quartiles. Healthcare utilization (count of medical visits by setting) and total expenditures were assessed during and after the PCS measurements. Generalized linear mixed models, adjusted for demographic and clinical covariates, estimated the relationship between healthcare utilization and physical functioning.

RESULTS

The lowest functional status (Q1) was associated with significantly increased healthcare utilization of emergency department, inpatient, home health, outpatient, and total medical visits compared with the three higher quartiles groups (P < .001, all). When compared with the lowest functioning group (Q1), the percentage savings for direct healthcare expenditures were 26.7% (95% confidence interval [CI] = 7.8‐41.7) in Q2, 50.1% (95% CI = 35.6‐61.4) in Q3, and 65.2% (95% CI = 54.7‐73.2) in Q4. Similarly, there were 10.4% (95% CI = 9.2‐11.7), 11.9% (95% CI = 10.5‐13.6), and 14.0% (95% CI = 2.2%‐15.9%) reductions in total medical visits, respectively.

CONCLUSION

Lower physical functioning was associated with higher healthcare utilization and expenditures. These estimates are conservative because they do not capture long‐term care utilization due to the nature of MEPS. These results can be used to benchmark other healthcare resource benefits of interventions to maintain or improve physical functioning in older adults in noninstitutionalized settings.

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Race, Ethnicity, and Other Risks for Live Discharge Among Hospice Patients with Dementia - American Geriatric Society

OBJECTIVES

The end‐of‐life trajectory for persons with dementia is often protracted and difficult to predict, placing these individuals at heightened risk of live discharge from hospice. Risks for live discharge due to condition stabilization or failure to decline among patients with dementia are not well established. Our aim was to identify demographic, health, and hospice service factors associated with live discharge due to condition stabilization or failure to decline among hospice patients with dementia.

DESIGN

Retrospective cohort study.

SETTING

A large not‐for‐profit agency in New York City.

PARTICIPANTS

A total of 2629 hospice patients with dementia age 65 years and older.

MEASUREMENTS

Primary outcome was live discharge from hospice due to condition stabilization or failure to decline (vs death). Measures include demographic factors (race/ethnicity, Medicaid, sex, age, marital status, parental status), health characteristics (primary dementia diagnosis, comorbidities, functional status, prior hospitalization), and hospice service (location, length of service, number and timing of nurse visits).

RESULTS

Logistic regression models indicated that compared with white hospice patients with dementia, African American and Hispanic hospice patients with dementia experienced increased risk of live discharge (African American: adjusted odds ratio [aOR] = 2.42; 95% confidence interval [CI] = 1.34‐4.38; Hispanic: aOR = 2.99; 95% CI = 1.81‐4.94). Home hospice (aOR = 7.57; 95% CI = 4.04‐14.18), longer length of service (aOR = 1.04; 95% CI = 1.04‐1.05), and more days between nurse visits and discharge (aOR = 1.86; 95% CI = 1.56‐2.21) were also associated with live discharge.

CONCLUSION

To avoid burdensome and disruptive transitions out of hospice in patients with dementia, interventions to reduce live discharge due to condition stabilization or failure to decline should be tailored to meet the needs of African American, Hispanic, and home hospice patients. Policies regarding sustained hospice eligibility should account for the variable and protracted end‐of‐life trajectory of patients with dementia.

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Antibiotic Stewardship for Older Adults in Ambulatory Care Settings: Addressing an Unmet Challenge - American Geriatric Society

Inappropriate antibiotic use is common in older adults (aged >65 y), and they are particularly vulnerable to serious antibiotic‐associated adverse effects such as cardiac arrhythmias, delirium, aortic dissection, drug‐drug interactions, and Clostridioides difficile. Antibiotic prescribing improvement efforts in older adults have been primarily focused on inpatient and long‐term care settings. However, the ambulatory care setting is where the vast majority of antibiotic prescribing to older adults occurs. To help improve the clinical care of older adults, we review drivers of antibiotic prescribing in this population, explore systems aspects of ambulatory care that can create barriers to optimal antibiotic use, discuss existing stewardship interventions, and provide guidance on priority areas for future inquiry.

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FDA approves new treatment for adults with partial-onset seizures - FDA Press Releases

Today, the FDA approved a new treatment for adults with partial-onset seizures

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FDA takes second action under international collaboration, approves new treatment option for patients with chronic lymphocytic leukemia - FDA Press Releases

As part of Project Orbis, a collaboration with the Australian Therapeutic Goods Administration and Health Canada, the FDA granted supplemental approval to Calquence (acalabrutinib) for the treatment of adults with chronic lymphocytic leukemia or small lymphocytic lymphoma

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Accelerometer‐Measured Hospital Physical Activity and Hospital‐Acquired Disability in Older Adults - American Geriatric Society

BACKGROUND

Hospital‐acquired disability (HAD) is common and often related to low physical activity while in the hospital.

OBJECTIVE

To examine whether wearable hospital activity trackers can be used to predict HAD.

DESIGN

A prospective observational study between January 2016 and March 2017.

SETTING

An academic medical center.

PARTICIPANTS

Community‐dwelling older adults, aged 60 years or older, enrolled within 24 hours of admission to general medicine (n = 46).

MAIN MEASURES

Primary outcome was HAD, defined as having one or more new activity of daily living deficits, decline of four or greater on the Late‐Life Function and Disability Instrument (calculated between baseline and discharge), or discharge to a skilled nursing facility. Hospital activity (mean active time, mean sedentary time, and mean step counts per day) was measured using ankle‐mounted accelerometers. The association of the literature‐based threshold of 900 steps/day with HAD was also evaluated.

RESULTS

Mean age was 73.2 years (SD = 9.5 years), 48% were male, and 76% were white. Median length of stay was 4 days (interquartile range [IQR] = 2.0‐6.0 days); 61% (n = 28) reported being able to walk without assistance of another person or walking aid at baseline. Median daily activity time and step counts were 1.1 h/d (IQR = 0.7‐1.7 h/d) and 1455.7 steps/day (IQR = 908.5‐2643 steps/day), respectively. Those with HAD (41%; n = 19) had lower activity time (0.8 vs 1.4 h/d; P = .04) and fewer step counts (1186 vs 1808 steps/day; P = .04), but no difference in sedentary time, compared to those without HAD. The 900 steps/day threshold had poor sensitivity (40%) and high specificity (85%) for detecting HAD.

CONCLUSIONS

Low hospital physical activity, as measured by wearable accelerometers, is associated with HAD. Clinicians can utilize wearable technology data to refer patients to physical/occupational therapy services or other mobility interventions, like walking programs.

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Medical Comorbidities of Dementia: Links to Caregivers' Emotional Difficulties and Gains - American Geriatric Society

OBJECTIVES

To evaluate how eight major medical comorbidities of dementia (arthritis, cancer, diabetes, heart disease, hypertension, lung disease, osteoporosis, and stroke) are associated with caregivers' perceptions of emotional caregiving difficulties and caregiving gains (ie, benefits or rewards from the care role).

DESIGN

Nationally representative cross‐sectional surveys of community‐dwelling persons living with dementia (PLWDs) and their co‐resident family caregivers in the United States.

SETTING

The 2011 National Health and Aging Trends Study and National Study of Caregiving.

PARTICIPANTS

Total of 356 co‐resident family caregivers of community‐dwelling PLWDs.

MEASUREMENTS

Caregivers' sociodemographic and health characteristics, caregiving stressors, emotional caregiving difficulties, caregiving gains, and chronic health conditions of PLWDs.

RESULTS

Caregivers most commonly cared for a PLWD with arthritis (65.5%), followed by hypertension (64.9%), diabetes (30.1%), stroke (28.8%), osteoporosis (27.1%), heart disease (23.3%), cancer (21.5%), and lung disease (17.2%). Logistic regressions revealed that caregivers were 2.63 and 2.32 times more likely to report higher than median emotional caregiving difficulties when PLWDs had diagnoses of diabetes and osteoporosis, respectively, controlling for caregiver sex, relationship to the PLWD (spouse vs non‐spouse), educational attainment, self‐rated health, and assistance with activities of daily living and medical care activities. Caregivers were also 2.10 times more likely to report lower than median caregiving gains when PLWDs had a diagnosis of osteoporosis.

CONCLUSION

Comorbid health conditions among PLWDs have distinct implications for caregiving outcomes. Clinical care and interventions to improve the well‐being of both care dyad members should support caregivers in managing medical comorbidities of dementia.

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FDA approves first treatment for inherited rare disease - FDA Press Releases

: FDA grants approval to Givlaari (givosiran) for the treatment of adult patients with acute hepatic porphyria, a genetic disorder resulting in the buildup of toxic porphyrin molecules which are formed during the production of heme (which helps bind oxygen in the blood)

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Antipsychotics and the Risk of Mortality or Cardiopulmonary Arrest in Hospitalized Adults - American Geriatric Society

OBJECTIVES

Prior studies in outpatient and long‐term care settings demonstrated increased risk for sudden death with typical and atypical antipsychotics. To date, no studies have investigated this association in a general hospitalized population. We sought to evaluate the risk of death or nonfatal cardiopulmonary arrest in hospitalized adults exposed to antipsychotics.

DESIGN

Retrospective cohort study.

SETTING

Large academic medical center in Boston, Massachusetts.

PARTICIPANTS

All hospitalizations between 2010 and 2016 were eligible for inclusion. We excluded those admitted directly to the intensive care unit (ICU), obstetric and gynecologic or psychiatric services, or with a diagnosis of a psychotic disorder.

INTERVENTION

Typical and atypical antipsychotic administration, defined by pharmacy charges.

MEASUREMENTS

The primary outcome was death or nonfatal cardiopulmonary arrest during hospitalization (composite).

RESULTS

Of 150 948 hospitalizations in our cohort, there were 691 total events (515 deaths, 176 cardiopulmonary arrests). After controlling for comorbidities, ICU time, demographics, admission type, and other medication exposures, typical antipsychotics were associated with the primary outcome (hazard ratio [HR] = 1.6; 95% confidence interval [CI] = 1.1‐2.4; P = .02), whereas atypical antipsychotics were not (HR = 1.1; 95% CI = .8‐1.4; P = .5). When focusing on adults age 65 years and older, however, both typical and atypical antipsychotics were associated with increased risk of death or cardiopulmonary arrest (HR = 1.8; 95% CI = 1.1‐2.9; and HR = 1.4; 95% CI = 1.1‐2.0, respectively). Sensitivity analyses using a propensity score approach and a cohort of only patients with delirium both yielded similar results.

CONCLUSION

In hospitalized adults, typical antipsychotics were associated with increased mortality or cardiopulmonary arrest, whereas atypical antipsychotics were only associated with increased risk among adults age 65 years and older. Providers should be thoughtful when prescribing antipsychotic medications, especially to older adults in settings where data regarding benefit are lacking.

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Reply to Acetaminophen Use and Stroke Risk - American Geriatric Society

Journal of the American Geriatrics Society, Volume 67, Issue 11, Page 2424-2426, November 2019.

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Reply to: Availability of Evidence‐Based Community Falls Prevention Programs: Considerations - American Geriatric Society

Journal of the American Geriatrics Society, Volume 67, Issue 11, Page 2427-2428, November 2019.

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Measuring Underuse and Overuse of Medications - American Geriatric Society

Journal of the American Geriatrics Society, Volume 67, Issue 11, Page 2428-2428, November 2019.

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Reply to Measuring Under‐ and Over‐Use of Medications - American Geriatric Society

Journal of the American Geriatrics Society, Volume 67, Issue 11, Page 2429-2429, November 2019.

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

Journal of the American Geriatrics Society, Volume 67, Issue 11, Page 2225-2228, November 2019.

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Rehabbed to Death: Breaking the Cycle - American Geriatric Society

Many older adults transfer from the hospital to a post‐acute care (PAC) facility and back to the hospital in the final phase of life. This phenomenon, which we have dubbed “Rehabbing to death,” is emblematic of how our healthcare system does not meet the needs of older adults and their families. Policy has driven practice in this area including seemingly benign habits such as calling PAC facilities “rehab.” We advocate for practice changes: (1) calling PAC “after‐hospital transitional care,” rather than “rehab”; (2) adopting a serious illness communication model when discussing new care needs at the end of a hospitalization; and (3) policies that incentivize comprehensive care planning for older adults across all settings and provide broad support and training for caregivers. In realigning health and social policies to meet the needs of older adults and their caregivers, fewer patients will be rehabbed to death, and more will receive care consistent with their preferences and priorities. J Am Geriatr Soc 67:2398–2401, 2019

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The Ones We Seldom See: Old Folks in Young Countries - American Geriatric Society

It has long been thought that demographic aging and its attendant implications for health and social services is primarily a problem for industrialized wealthy countries. Nothing could be further from the truth since most older persons (and an increasingly higher number) reside in low‐income countries. Through a description of a home visit to older women in the small town of Gondar, Ethiopia, the general state of older persons in sub‐Saharan Africa is addressed. J Am Geriatr Soc 67:2240–2244, 2019

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Physical Activity and Risk of Postoperative Delirium - American Geriatric Society

BACKGROUND/OBJECTIVE

Regular physical activity (PA) has been associated with improved cognitive function, but its effect on postoperative delirium (POD) has not been established. Our objectives were to determine the effect of baseline PA on the incidence of POD in older patients undergoing elective orthopedic surgery and to determine whether these effects were independent of cognitive reserve. We hypothesize that PA protects against POD by bolstering physiologic reserve needed to withstand the stressors of surgery.

DESIGN

Secondary analysis of a prospective, single‐center, cohort study.

SETTING

Urban academic hospital.

PARTICIPANTS

A total of 132 nondemented, English‐speaking adults older than 60 years undergoing elective orthopedic surgery.

MEASUREMENTS

Subjects were screened for POD and delirium severity using the Confusion Assessment Method and the Memorial Delirium Assessment Scale. Baseline cognitive activities and PAs were assessed with a validated Leisure Activity Scale. Regular PA was categorized as 6 to 7 days per week. The association of regular PA with incidence of POD was assessed using multivariable logistic regression, adjusting for age, sex, Charlson Comorbidity Index, cognitive reserve, and cognitive function. Linear regression was used to assess the association of delirium severity with regular PA.

RESULTS

Of 132 patients, 41 (31.1%) developed POD. Regular PA was associated with a 74% lower odds of developing POD (odds ratio [OR] = 0.26; 95% confidence interval [CI] = 0.08‐0.82). There was no significant interaction between PA and cognitive reserve (P = .70). Of 85 women, 25 (29.4%), and of 47 men, 16 (34.0%) developed POD. In stratified analysis, women who engaged in regular PA had dramatically lower odds of POD (OR = 0.08; 95% CI = 0.01‐0.63) compared with men (OR = 0.93; 95% CI = 0.18‐4.97).

CONCLUSIONS

Regular PA is associated with decreased incidence of POD, especially among women. Future studies should address the basis of sex differences in PA benefits on delirium. J Am Geriatr Soc 67:2260–2266, 2019

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Acetaminophen Use and Stroke Risk - American Geriatric Society

Journal of the American Geriatrics Society, Volume 67, Issue 11, Page 2423-2424, November 2019.

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Availability of Evidence‐Based Community Falls Prevention Programs: Considerations - American Geriatric Society

Journal of the American Geriatrics Society, Volume 67, Issue 11, Page 2426-2427, November 2019.

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Impact of Computer‐Based and Pharmacist‐Assisted Medication Review Initiated in the Emergency Department - American Geriatric Society

OBJECTIVES

Whether early medication reconciliation and integration can reduce polypharmacy and potentially inappropriate medication (PIM) in the emergency department (ED) remains unclear. Polypharmacy and PIM have been recognized as significant causes of adverse drug events in older adults. Therefore, this pilot study was conducted to delineate this issue.

DESIGN

An interventional study.

SETTING

A medical center in Taiwan.

PARTICIPANTS

Older ED patients (aged ≥65 years) awaiting hospitalization between December 1, 2017, and October 31, 2018 were recruited in this study. A multidisciplinary team and a computer‐based and pharmacist‐assisted medication reconciliation and integration system were implemented.

MEASUREMENTS

The reduced proportions of major polypharmacy (≥10 medications) and PIM at hospital discharge were compared with those on admission to the ED between pre‐ and post‐intervention periods.

RESULTS

A total of 911 patients (pre‐intervention = 243 vs post‐intervention = 668) were recruited. The proportions of major polypharmacy and PIM were lower in the post‐intervention than in the pre‐intervention period (−79.4% vs −65.3%; P < .001, and − 67.5% vs −49.1%; P < .001, respectively). The number of medications was reduced from 12.5 ± 2.7 to 6.9 ± 3.0 in the post‐intervention period in patients with major polypharmacy (P < .001).

CONCLUSION

Early initiation of computer‐based and pharmacist‐assisted intervention in the ED for reducing major polypharmacy and PIM is a promising method for improving geriatric care and reducing medical expenditures. J Am Geriatr Soc 67:2298–2304, 2019

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Factors Associated With Becoming Edentulous in the US Health and Retirement Study - American Geriatric Society

BACKGROUND/OBJECTIVE

To determine factors associated with older adults becoming edentulous (complete tooth loss).

DESIGN

Longitudinal study over a 6‐year period.

SETTING

United States, 2006, 2012.

PARTICIPANTS

Nationally representative US sample of adults, aged 50 years and older (n = 9982), participating in the Health and Retirement Study in 2006 and 2012. At the outset, they were dentate and not institutionalized.

INTERVENTION

None.

MEASUREMENTS

Self‐report of being dentate or edentulous, demographic variables, dental utilization and other health behaviors, self‐rated general health, and incidence between 2006 and 2012 of comorbid medical conditions, functional limitations, and disabilities.

RESULTS

From 2006 to 2012, 563 individuals (5%) became edentulous and 9419 (95%) remained dentate. Adults who became edentulous by 2012 were more likely than those who remained dentate to be black/African American compared to white, to be less educated, were current smokers, had diabetes, and reported poorer self‐rated general health, more functional limitations and disabilities, and fewer dental visits (all P < .0001), among other factors. Of those with regular dental visits (at least once every 2 years during the 6‐year period), 2.3% became edentulous compared to 9.9% among those without regular dental visits. After adjusting for age and other potential confounders, there was a strong association with poor dental attendance and smoking. Nonregular dental attenders were more likely than regular attenders to become edentulous (odds ratio [OR] = 2.74; 95% confidence interval [CI] = 2.12‐3.53), and current smokers were more likely than never smokers to become edentulous (OR = 2.46; 95% CI = 1.74‐3.46).

CONCLUSION

Although more contemporaneous data are needed to determine causality, regular dental utilization and smoking are modifiable factors that could prevent edentulism, even when many other comorbid conditions are present. J Am Geriatr Soc, 1–7, 2019. J Am Geriatr Soc 67:2318–2324, 2019

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How Do Frail Medicare Beneficiaries Fare Under Bundled Payments? - American Geriatric Society

BACKGROUND/OBJECTIVES

Bundled payments are an alternative payment model in which a hospital takes accountability for the costs of a 90‐day episode of care. Such models are meant to improve care through better coordination across care settings, but could have adverse consequences for frail adults if they lead to inappropriate cuts in necessary post‐acute care.

DESIGN

Retrospective claims‐based analysis of hospitals' first year of participation in Medicare's Bundled Payments for Care Improvement (BPCI) program.

SETTING

US hospitals.

PARTICIPANTS

A total of 641 146 Medicare beneficiaries admitted to 688 BPCI programs and 1276 matched control hospitals for myocardial infarction, heart failure, pneumonia, sepsis, chronic obstructive pulmonary disease, or major joint replacement of the lower extremity in 2012 to 2016.

INTERVENTION

Participation in BPCI.

MEASUREMENTS

Proportion of patients in each quartile of a validated claims‐based frailty index, total and setting‐specific standardized Medicare payments per episode, days at home, 90‐day readmissions, and 90‐day mortality.

RESULTS

Higher levels of frailty were associated with higher Medicare payments and worse clinical outcomes (for the medical composite, costs per episode were $11 921, $17 348, $22 828, and $29 157 across frailty quartiles; days at home were 70.1, 60.4, 54.3, and 51.5; 90‐day readmission rates were 16.0%, 27.0%, 38.2%, and 50.9%; and 90‐day mortality rates were 15.4%, 22.5%, 25.1%, 21.3%); patterns were similar for joint replacement. Under the BPCI program, there was no differential change in the proportion of highly frail patients at BPCI vs control hospitals. There were also no differential deleterious changes in payments or clinical outcomes for frail relative to nonfrail patients at BPCI vs non‐BPCI hospitals.

CONCLUSION

While frail patients had higher costs and worse outcomes in general, there was no evidence of changes in access or worsening clinical outcomes in BPCI hospitals for frail patients relative to the nonfrail in hospitals' first year of participation in the program. These findings may be reassuring for policy makers and clinical leaders. J Am Geriatr Soc 67:2245–2253, 2019

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High‐Sensitive Troponin T, Natriuretic Peptide, and Cognitive Change - American Geriatric Society

OBJECTIVES

Cardiac troponin T, measured using a high‐sensitive assay (hs‐cTnT), and N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) are associated with increased stroke risk and perhaps with cognitive decline. However, few well‐designed prospective studies with extended follow‐up have been conducted. We aimed to estimate the association of hs‐cTnT and NT‐proBNP with 15‐year cognitive change in the Atherosclerosis Risk in Communities (ARIC) study.

DESIGN

Prospective cohort study.

SETTING

Four US communities.

PARTICIPANTS

A total of 9114 and 9108 participants from the Atherosclerosis Risk in Communities study for analyses of hs‐cTnT and NT‐proBNP, respectively.

MEASUREMENTS

We examined association of hs‐cTnT and NT‐proBNP with 15‐year change (1996‐1998 to 2011‐2013) in three cognitive tests of executive function (Digit Symbol Substitution Test), verbal learning memory (Delayed Word Recall Test), and semantic fluency (Word Fluency Test), and an overall score combining the three tests using multivariable linear mixed effect models. We conducted several sensitivity analyses including multiple imputations to address bias due to missing data and attrition, and we compared associations within groups combining hs‐cTnT and NT‐proBNP into a three‐level categorical variable.

RESULTS

At baseline (1996‐1998), mean age was 63.4 (standard deviation [SD] = 5.7) years; 56.4% were women, and 17.5% were black. The hs‐cTnT at baseline was not associated with cognitive change in any measure. Some evidence indicated accelerated decline in verbal learning and memory when comparing those in the highest with the lowest NT‐proBNP quintiles; however, this association was not replicated when considering clinically relevant cutoffs or deciles of exposure in survivors. Sensitivity analyses were consistent with our primary analyses. There was little evidence to support effect modification by any considered factors. People with highest levels of both biomarkers had excessive decline in global z scores vs people with lowest levels (−.34; 95% confidence interval = −.63 to −.04).

CONCLUSION

Markers of myocardial injury and stretch were not associated with cognitive decline following 15 years among survivors, but when combined together they were suggestive in post hoc analysis. Whether this represents targets of intervention should be examined in the future. J Am Geriatr Soc 67:2353–2361, 2019

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Loss of Community‐Dwelling Status Among Survivors of High‐Acuity Emergency General Surgery Disease - American Geriatric Society

OBJECTIVES

To examine loss of community‐dwelling status 9 months after hospitalization for high‐acuity emergency general surgery (HA‐EGS) disease among older Americans.

DESIGN

Retrospective analysis of claims data.

SETTING

US communities with Medicare beneficiaries.

PARTICIPANTS

Medicare beneficiaries age 65 years or older hospitalized urgently/emergently between January 1, 2015, and March 31, 2015, with a principal diagnosis representing potential life or organ threat (necrotizing soft tissue infections, hernias with gangrene, ischemic enteritis, perforated viscus, toxic colitis or gastroenteritis, peritonitis, intra‐abdominal hemorrhage) and an operation of interest on hospital days 1 or 2 (N = 3319).

MEASUREMENTS

Demographic characteristics (age, race, and sex), comorbidities, principal diagnosis, complications, and index hospitalization disposition (died; discharged to skilled nursing facility [SNF], long‐term acute care [LTAC], rehabilitation, hospice, home (with or without services), or acute care hospital; other) were measured. Survivors of index hospitalization were followed until December 31, 2015, on mortality and community‐dwelling status (SNF/LTAC vs not). Descriptive statistics, Kaplan‐Meier plots, and χ² tests were used to describe and compare the cohort based on disposition. A multivariable logistic regression model, adjusted for age, sex, comorbidities, complications, and discharge disposition, determined independent predictors of loss of community‐dwelling status at 9 months.

RESULTS

A total of 2922 (88%) survived index hospitalization. Likelihood of discharge to home decreased with increasing age, baseline comorbidities, and in‐hospital complications. Overall, 418 (14.3%) HA‐EGS survivors died during the follow‐up period. Among those alive at 9 months, 10.3% were no longer community dwelling. Initial discharge disposition to any location other than home and three or more surgical complications during index hospitalization were independent predictors of residing in a SNF/LTAC 9 months after surviving HA‐EGS.

CONCLUSION

Older Americans, known to prioritize living in the community, will experience substantial loss of independence due to HA‐EGS. Long‐term expectations after surviving HA‐EGS must be framed from the perspective of the outcomes that older patients value the most. Further research is needed to examine the quality‐of‐life burden of EGS survivorship prospectively. J Am Geriatr Soc 67:2289–2297, 2019

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30‐Day Emergency Department Revisit Rates among Older Adults with Documented Dementia - American Geriatric Society

OBJECTIVES

Published literature on national emergency department (ED) revisit rates among older adults with dementia is sparse, despite anecdotal evidence of higher ED utilization. Thus we evaluated the odds ratio (OR) of 30‐day ED revisits among older adults with dementia using a nationally representative sample.

DESIGN

We assessed the frequency of claims associated with a 30‐day ED revisit among Medicare beneficiaries with and without a dementia diagnosis before or at index ED visit. We used a logistic regression model controlling for dementia, age, sex, race, region, Medicaid status, transfer to a skilled nursing facility after ED, primary care physician use 12 months before index, and comorbidity.

SETTING

A nationally representative sample of claims data for Medicare beneficiaries aged 65 and older who maintained continuous fee‐for‐service enrollment during 2015 and 2016. Only outpatient claims associated with an ED visit between January 2016 and November 2016 were included as a qualifying index encounter.

PARTICIPANTS

We identified 240 249 patients without dementia and 54 622 patients for whom a dementia code was recorded in the year before the index encounter in 2016.

RESULTS

Our results indicate a significant difference in unadjusted 30‐day ED revisit rates among those with an ED dementia diagnoses (22.0%) compared with those without (13.9%). Our adjusted results indicated that dementia is a significant predictor of 30‐day ED revisits (P < .0001). Those with a dementia diagnosis at or before the index ED visit were more likely to have experienced an ED revisit within 30 days (OR = 1.27; 95% confidence interval = 1.24‐1.31).

CONCLUSION

Dementia diagnoses were a significant predictor of 30‐day ED revisits. Further research should assess potential reasons why dementia is associated with markedly higher revisit rates, as well as opportunities to manage and transition dementia patients from the ED back to the community more effectively. J Am Geriatr Soc 67:2254–2259, 2019

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Recurrent Measurement of Frailty Is Important for Mortality Prediction: Findings from the North West Adelaide Health Study - American Geriatric Society

OBJECTIVES

Frailty places individuals at greater risk of adverse health outcomes. However, it is a dynamic condition and may not always lead to decline. Our objective was to determine the relationship between frailty status (at baseline and follow‐up) and mortality using both the frailty phenotype (FP) and frailty index (FI).

DESIGN

Population‐based cohort.

SETTING

Community‐dwelling older adults.

PARTICIPANTS

A total of 909 individuals aged 65 years or older (55% female), mean age 74.4 (SD 6.2) years, had frailty measurement at baseline. Overall, 549 participants had frailty measurement at two time points.

MEASUREMENTS

Frailty was measured using the FP and FI, with a mean 4.5 years between baseline and follow‐up. Mortality was matched to official death records with a minimum of 10 years of follow‐up.

RESULTS

For both measures, baseline frailty was a significant predictor of mortality up to 10 years, with initially good predictive ability (area under the curve [AUC] = .8‐.9) decreasing over time. Repeated measurement at follow‐up resulted in good prediction compared with lower (AUC = .6‐.7) discrimination of equivalent baseline frailty status. In a multivariable model, frailty measurement at follow‐up was a stronger predictor of mortality compared with baseline. Frailty change for the Continuous FI was a significant predictor of decreased or increased mortality risk based on corresponding improvement or worsening of score (hazard ratio = 1.04; 95% confidence interval = 1.02‐1.07; P = .001).

CONCLUSIONS

Frailty measurement is a good predictor of mortality up to 10 years; however, recency of frailty measurement is important for improved prediction. A regular review of frailty status is required in older adults. J Am Geriatr Soc 67:2311–2317, 2019

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Association between High Proportions of Seriously Mentally Ill Nursing Home Residents and the Quality of Resident Care - American Geriatric Society

OBJECTIVES

To examine the association between the quality of care delivered to nursing home residents with and without a serious mental illness (SMI) and the proportion of nursing home residents with SMI.

DESIGN

Instrumental variable study. Relative distance to the nearest nursing home with a high proportion of SMI residents was used to account for potential selection of patients between high‐ and low‐SMI facilities. Data were obtained from the 2006‐2010 Minimum Data Set assessments linked with Medicare claims and nursing home information from the Online Survey, Certification, and Reporting database.

SETTING

Nursing homes with high (defined as at least 10% of a facility's population having an SMI diagnosis) and low proportions of SMI residents.

PARTICIPANTS

A total of 58 571 Medicare nursing residents with an SMI diagnosis (ie, schizophrenia or bipolar disorder) and 558 699 individuals without an SMI diagnosis who were admitted to the same nursing homes.

MEASUREMENTS

Outcomes were nursing home quality measures: (1) use of physical restraints, (2) any hospitalization in the last 3 months, (3) use of an indwelling catheter, (4) use of a feeding tube, and (5) presence of pressure ulcer(s).

RESULTS

For individuals with SMI, admission to a high‐SMI facility was associated with a 3.7 percentage point (95% confidence interval [CI] = 1.4‐6.0) increase in the probability of feeding tube use relative to individuals admitted to a low‐SMI facility. Among individuals without SMI, admission to a high‐SMI facility was associated with a 1.7 percentage point increase in the probability of catheter use (95 CI = .03‐3.47), a 3.8 percentage point increase in the probability of being hospitalized (95% CI = 2.16‐5.44), and a 2.1 percentage point increase in the probability of having a feeding tube (95% CI = .43‐3.74).

CONCLUSION

Admission to nursing homes with high concentrations of residents with SMI is associated with worse outcomes for both residents with and without SMI. J Am Geriatr Soc 67:2346–2352, 2019

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Alcohol Consumption and Functional Limitations in Older Men: Does Muscle Strength Mediate Them? - American Geriatric Society

OBJECTIVES

To evaluate the dose‐response relationships between alcohol consumption and functional limitations in older European men, and explore the role of muscle strength as a mediator of these relationships.

DESIGN

Cross‐sectional study of older men participating in the Survey of Health, Aging and Retirement in Europe (SHARE).

SETTING

Urban and rural households in 17 European countries and Israel.

PARTICIPANTS

A total of 17 870 men aged 65 years and older from the SHARE (Wave 6, 2015) were included in this study.

MEASUREMENTS

Outcome variables were functional limitations: mobility limitation, arm function limitation, and fine motor limitation. Main exposure variable was alcohol consumption. Mediating factor was grip strength. Basic demographics, life habits, and health status were considered as potential confounders. Dose‐response analyses with restricted cubic splines and the Karlson/Holm/Breen method were conducted.

RESULTS

A total of 17 870 participants were included in this study. Dose‐response analyses revealed that moderate alcohol consumption was related to the lower odds of reporting mobility limitation (≤35 units/wk) and arm function limitation (≤41 units/wk), with a minimum odds ratio (OR) occurring at 10 units/week drinks for mobility limitation (OR = .71; 95% confidence interval [CI] = .62‐.81) and arm function limitation (OR = .66; 95% CI = .59‐.75). The odds of reporting the fine motor limitation monotonically increased with alcohol consumption when alcohol consumption was beyond 15 units/week. No significant mediating effect of grip strength on the relationships between alcohol consumption and mobility limitation and arm function limitation was found.

CONCLUSION

Moderate alcohol consumption has a protective role in mobility and arm function limitation in older European men. Grip strength is not the main mediator of these associations, suggesting that the protective effect is independent of muscle strength. Alcohol consumption is associated with higher odds of reporting fine motor limitation in older European men. J Am Geriatr Soc 67:2331–2337, 2019

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Delirium After Transcatheter Aortic Valve Implantation Under General Anesthesia: Incidence, Predictors, and Relation to Long‐Term Survival - American Geriatric Society

BACKGROUND/OBJECTIVES

Prospectively collected data on postoperative delirium (POD) after transcatheter aortic valve implantation (TAVI) are scarce. The aim of this study was to report the incidence and risk factors of delirium after TAVI under general anesthesia and to assess the association of POD with clinical outcome and short‐ and long‐term survival.

DESIGN

Prospective cohort study.

SETTING

Academic medical center.

PARTICIPANTS

A total of 703 subsequent patients undergoing TAVI under general anesthesia between 2008 and 2017.

MEASUREMENTS

Delirium was assessed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM‐IV), criteria. Outcomes were postprocedural clinical outcome and short‐ and long‐term survival (30 days and 5 years, respectively).

RESULTS

POD was observed in 16.5% (116/703), was the strongest independent predictor of long‐term mortality (hazard ratio = 1.91; 95% confidence interval [CI] = 1.36‐2.70), and was associated with impaired 30‐day and 5‐year survival (92.2% vs 96.8% [P = .025] and 40.0% vs 50.0% [P = .007], respectively). Stroke and new onset of atrial fibrillation were more often observed in delirious patients (6.9% vs 1.9% and 12.1% vs 5.1%, respectively). Strongest independent predictors of POD were prior delirium (odds ratio [OR] = 2.56; 95% CI = 1.52‐4.31) and aortic valve area less than 0.75 cm² (OR = 2.39; 95% CI = 1.53‐3.74).

CONCLUSION

One in six patients experienced POD after TAVI under general anesthesia. POD was the strongest predictor of long‐term mortality and was associated with impaired short‐ and long‐term survival. Prior delirium and a more calcified aortic valve were the strongest independent predictors of POD. J Am Geriatr Soc 67:2325–2330, 2019

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

BACKGROUND/OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

LGBT older adults conceptualize elder abuse differently and have different experiences with police and medical providers. Improved outreach to this potentially vulnerable population is critical to ensuring their safety. J Am Geriatr Soc 67:2338–2345, 2019

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What Matters? The Valued Life Activities of Older Adults Undergoing Elective Surgery - American Geriatric Society

OBJECTIVES

Valued life activities are those activities an individual deems particularly important or meaningful. Surgery in older adults can affect their ability to perform valued activities, but data are lacking. We characterized these activities and assessed performance of them following surgery.

DESIGN

Retrospective observational study.

SETTING

Preoperative program for older adults undergoing elective surgery at an academic hospital.

PARTICIPANTS

Older adults (N = 194) in the program from February 2015 to February 2018.

MEASUREMENTS

A preoperative written questionnaire asked, “What are the activities that are most important to you to be able to do when you return home from surgery?” Participants could list up to three activities. Content analysis was used to develop domains of valued life activities and categorize responses. Postoperative questionnaires and medical records were used to determine ability to perform activities 6 months after surgery.

RESULTS

Of 194 participants (mean age = 74.9 ± 9.1 y), 57.7% were female; 33.5% had more than two comorbid conditions. We elicited 510 valued activities, with a mean of 2.6 (± .7) activities per participant. Content analysis revealed five categories: (1) recreational activities (28.9%); (2) mobility (24.9%); (3) activities of daily living (ADLs; 17.5%); (4) instrumental activities of daily living (IADLs; 16.9%); and (5) social activities (12.0%). Ultimately, 154 participants had surgery, of which 27.3% were unable to perform one of their valued activities at 6 months. Performance varied between activity categories; 91.9% of mobility activities, 90.8% of ADLs, 80.3% of IADLs, 77.3% of social activities, and 65.5% of recreational activities were able to be performed after surgery.

CONCLUSION

Older adults expressed a wide range of valued life activities. More than one‐quarter were unable to engage in at least one valued life activity after surgery, with recreation the most commonly affected. Assessment of valued life activities should be incorporated into the perioperative management of older adults. J Am Geriatr Soc 67:2305–2310, 2019

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A new indole glycoside from Kitasatospora sp. MG372-hF19 carrying a 6-deoxy-α-l-talopyranose moiety - Journal of Antibiotics

The Journal of Antibiotics, Published online: 18 November 2019; doi:10.1038/s41429-019-0258-9

A new indole glycoside from Kitasatospora sp. MG372-hF19 carrying a 6-deoxy-α-l-talopyranose moiety

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Statement from Sarah Yim, M.D., acting director of the Office of Therapeutic Biologics and Biosimilars in the FDA’s Center for Drug Evaluation and Research, on FDA’s continued progress facilitating competition in the biologic marketplace with approval of 25th biosimilar product - FDA Press Releases

FDA has taken another step to further foster biologics competition with the approval of 25th biosimilar, Abrilada (adalimumab - afzb), a biosimilar to Humira.

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FDA approves first contact lens indicated to slow the progression of nearsightedness in children - FDA Press Releases

FDA approved the first contact lens to slow the progression of myopia in children, which ultimately could mean a reduced risk of developing other eye problems. MiSight is a daily, disposable contact lens approved for children 8-12 at the start of treatment.

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FDA approves first targeted therapy to treat patients with painful complication of sickle cell disease - FDA Press Releases

Today the FDA approved Adakveo (crizanlizumab-tmca), a treatment to reduce the frequency of vaso-occlusive crisis – a common and painful complication of sickle cell disease that occurs when blood circulation is obstructed by sickled red blood cells – for patients age 16 years and older.

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FDA clears first duodenoscope with disposable elevator piece, reducing the number of parts needing disinfection - FDA Press Releases

The FDA today cleared the first duodenoscope with a sterile, disposable elevator component that will reduce the number of parts that need to be cleaned and disinfected (reprocessed) in between uses.

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FDA approves new antibacterial drug to treat complicated urinary tract infections as part of ongoing efforts to address antimicrobial resistance - FDA Press Releases

The FDA today approved Fetroja (cefiderocol), an antibacterial drug for treatment of patients with complicated urinary tract infections (cUTI), including kidney infections caused by susceptible Gram-negative microorganisms, who have limited or no alternative treatment options.

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FDA approves therapy to treat patients with relapsed and refractory mantle cell lymphoma supported by clinical trial results showing high response rate of tumor shrinkage - FDA Press Releases

FDA has granted accelerated approval to Brukinsa (zanubrutinib) capsules for the treatment of adult patients with mantle cell lymphoma who have received at least one prior therapy.

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FDA issues warning letter to Dollar Tree stores for receiving potentially unsafe drugs - FDA Press Releases

FDA issues warning letter to Dollar Tree stores for receiving potentially unsafe drugs

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Novel benzyl phenyl sulfide derivatives as antibacterial agents against methicillin-resistant Staphylococcus aureus - Journal of Antibiotics

The Journal of Antibiotics, Published online: 14 November 2019; doi:10.1038/s41429-019-0257-x

Novel benzyl phenyl sulfide derivatives as antibacterial agents against methicillin-resistant Staphylococcus aureus

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Forthcoming Issues - Geriatrics

Geriatric Psychiatry

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Contents - Geriatrics

Carlos Singer and Stephen G. Reich

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Contributors - Geriatrics

CARLOS SINGER, MD

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Copyright - Geriatrics

ELSEVIER

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Parkinson Disease - Geriatrics

CLINICS IN GERIATRIC MEDICINE

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Parkinson Disease - Geriatrics

Parkinson disease (PD) is the second most prevalent neurodegenerative disorder, next only to Alzheimer disease. As the average age of the United States and European populations increases, physicians caring for the elderly will be confronted with an increasing number of PD patients.

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Does This Patient Have Parkinson Disease or Essential Tremor? - Geriatrics

In the elderly patient with tremor, the differential diagnosis is usually between essential tremor (ET) and Parkinson disease (PD). A careful history and examination are the keys to the diagnosis. Essential tremor is a bilateral action tremor of the upper limbs whereas PD begins unilaterally and is a rest tremor. A handwriting sample can usually distinguish PD from ET as the former is small (micrographic) but atremulous whereas writing in ET is tremulous but normal sized. In ET, there are no signs aside from tremor but in PD, the tremor is accompanied by bradykinesia and rigidity.

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An Innovation Center Model to Transform Health Systems to Improve Care of Older Adults - American Geriatric Society

The US population is aging faster than at any other time in our history. This growth, coupled with a slow adaptive health policy framework, is creating an urgent need to reengineer and improve the quality, safety, and cost‐effectiveness of health systems to meet the needs of older adults and embrace the success we have achieved with longevity. Without rapid adoption of evidence‐based models that are known to improve safety and health outcomes, we significantly jeopardize the lives of thousands of older adults receiving care under our current health systems' processes and models. This article describes an innovation and operations infrastructure that was successfully tested in two independent and geographically distinct community health systems. This operations and implementation framework can be scaled and used to accelerate the changes needed to improve care for older adults in health systems throughout the United States.

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FDA approves first therapy to treat patients with rare blood disorder - FDA Press Releases

FDA grants approval to Reblozyl (luspatercept–aamt) for the treatment of anemia in adult patients with beta thalassemia who require regular red-blood cell transfusions.

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Fosfomycin and Staphylococcus aureus: transcriptomic approach to assess effect on biofilm, and fate of unattached cells - Journal of Antibiotics

The Journal of Antibiotics, Published online: 08 November 2019; doi:10.1038/s41429-019-0256-y

Fosfomycin and Staphylococcus aureus: transcriptomic approach to assess effect on biofilm, and fate of unattached cells

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Living in the Community With Dementia: Who Receives Paid Care? - American Geriatric Society

OBJECTIVES

Paid caregivers (eg, home health aides and personal care attendants) provide hands‐on care that helps individuals with dementia live in the community. This study (a) characterizes paid caregiving among community‐dwelling individuals with dementia and (b) identifies factors associated with receipt of paid care.

DESIGN

Cross‐sectional analysis.

SETTING

The 2015 National Health and Aging Trends Study (NHATS), a nationally representative study of Medicare recipients aged 65 years and older.

PARTICIPANTS

Community‐dwelling individuals with dementia (n = 899).

MEASUREMENTS

Paid and family caregiving support was determined by participant or proxy report of help received with functional tasks. Multivariable logistic regression was used to examine factors associated with receipt of paid care. NHATS population sampling weights were used to produce national paid caregiving prevalence estimates.

RESULTS

Only 25.5% of community‐dwelling individuals with dementia received paid care, and 10.8% received 20 hours or more of paid care per week. For those who received it, paid care accounted for approximately half of the 83 total caregiving hours (paid and family) that they received each week. Among the subgroup of individuals with advanced dementia (those with impairment in dressing, bathing, toileting, and managing medications and finances), nearly half (48.3%) received paid care. Multivariable analysis, adjusting for sociodemographic, family caregiving support, functional, and clinical characteristics, found that the odds of receiving paid care were higher among men (odds ratio [OR] = 1.91; 95% confidence interval [CI] = 1.24‐2.95), the unmarried (OR = 2.20; 95% CI = 1.31‐3.70), those with Medicaid (OR = 2.16; 95% CI = 1.27‐3.66), and those requiring more help with activities of daily living (ADLs) (OR = 1.32; 95% CI = 1.18‐1.48) and instrumental ADLs (OR = 1.29; 95% CI = 1.14‐1.46).

CONCLUSIONS

New ways of making paid caregiving more accessible throughout the income spectrum are required to support family caregivers and respect the preferences of individuals with dementia to remain living in the community.

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Development and Dissemination of an Interprofessional Online Dementia Training Curriculum - American Geriatric Society

OBJECTIVES

Despite the growing number of individuals with dementia, clinicians skilled in caring for people with dementia, especially in rural areas, are lacking. The Program for Advancing Cognitive Disorders Education for Rural Staff (PACERS) was designed to improve clinician competency and comfort when caring for individuals with dementia. Based on an interprofessional needs assessment, six 1‐hour training modules were created: (1) Dementia and Delirium, (2) Identifying and Assessing for Dementia, (3) Treating Dementia: Case Studies, (4) Normal Cognitive Aging and Dementia Caregiving, (5) Addressing Decision Making and Safety in Dementia, and (6) Dementia and Driving. Each module is available for free on the Department of Veterans Affairs Talent Management System (TMS) for employees and the free TrainingFinder Real‐time Affiliate Integrated Network (TRAIN) platform for clinicians in the community. One continuing education unit is earned upon completion of each module.

DESIGN

Posttest.

SETTING

Online training at VA TMS and TRAIN.

PARTICIPANTS

To date, more than 3000 modules have been completed by interprofessional healthcare learners (eg, nurses, physicians, psychologists, and social workers).

MEASUREMENTS

Satisfaction, perceived utility of training, knowledge, skills, and attitudes were assessed.

RESULTS

The learners reported high satisfaction (mean [M] > 4) and ability to apply the knowledge and skills learned from the module to their job (M > 4) on a Likert scale (1 = Strongly disagree to 5 = Strongly agree).

CONCLUSION

Learners also reported perceived impact on both direct patient care (eg, ability to provide education and support to individuals with dementia and their caregivers) and system‐level care (eg, more appropriate referrals). Given the number of users and their evaluation data, PACERS can serve as a model curriculum for online interprofessional dementia training.

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The Epidemiology of Depressive Symptoms in the Last Year of Life - American Geriatric Society

BACKGROUND/OBJECTIVE

Depression impacts quality of life at all life stages, but the epidemiology of depression in the last year of life is unknown. This study's objectives were to document the epidemiology of depressive symptoms in the year prior to death and to assess how the trajectory of depressive symptoms varies by sociodemographic and clinical factors.

DESIGN

Observational, cross‐sectional, cohort study using the Health and Retirement Study.

SETTING

Population‐based survey.

PARTICIPANTS

A total of 3274 individuals who died within 12 months after assessment.

MEASURES

Primary outcome: eight‐item Center for Epidemiologic Studies Depression Scale (CESD‐8). Covariates included sociodemographics, self‐reported illnesses, and activity of daily living (ADL) limitations.

RESULTS

Average CESD‐8 score increased over the last year of life, with 59.3% screening positive for depression in the last month before death. Depression symptoms increased gradually from 12 to 4 months before death (increase of 0.05 points/month; 95% confidence interval [CI] = 0.01‐0.08 points/month) and then escalated from 4 to 1 months before death (increase of 0.29 points/month; 95% CI = 0.16‐0.39 points/month). Women, younger adults, and nonwhite adults all demonstrated higher rates of depressive symptoms. Individuals with cancer reported escalating rates of depressive symptoms at the end of life, while individuals with lung disease and ADL impairment demonstrated persistently high rates throughout the year before death.

CONCLUSIONS

This study revealed high rates of depressive symptoms in the last year of life as well as differences in the burden of depressive symptoms. A public health approach must be taken to screen for and appropriately treat symptoms of depression across the lifespan.

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Statement on the agency’s efforts to protect patients through postmarket drug safety surveillance practices - FDA Press Releases

Today, the FDA is issuing an update on efforts to protect patients through postmarket drug safety surveillance practices

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FDA authorizes marketing of first next-generation sequencing test for detecting HIV-1 drug resistance mutations - FDA Press Releases

Today, the FDA authorized marketing of a test to detect human immunodeficiency virus (HIV) Type-1 drug resistance mutations using next generation sequencing (NGS) technology. It is the first HIV drug resistance assay that uses NGS that the FDA has authorized for marketing in the U.S.

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Severity of Neuropsychiatric Symptoms and Distress in Dementia among Older People in Central Africa (EPIDEMCA Study) - American Geriatric Society

OBJECTIVES

Neuropsychiatric symptoms are common in dementia. Limited data are available concerning their association with dementia in developing countries. Our aim was to describe the severity of neuropsychiatric symptoms among older people, evaluate the distress experienced by caregivers, and assess which neuropsychiatric symptoms were specifically associated with dementia among older adults in Central Africa.

DESIGN

This study is part of the EPIDEMCA program, a cross‐sectional multicenter population‐based study.

SETTING

The EPIDEMCA program was conducted from November 2011 to December 2012 in urban and rural areas of the Central African Republic and the Republic of the Congo.

PARTICIPANTS

Participants were older people (≥65 y) included in the EPIDEMCA program who underwent a neuropsychiatric evaluation. The sample included overall 532 participants, of whom 130 participants had dementia.

MEASUREMENTS

Neuropsychiatric symptoms were assessed with the brief version of the Neuropsychiatric Inventory including the evaluation of severity and associated distress. Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision, criteria were followed to diagnose dementia. A logistic regression model was used to identify associated neuropsychiatric symptoms.

RESULTS

The prevalence of neuropsychiatric symptoms was 89.9% (95% confidence interval = 84.6‐95.1) among people living with dementia. The overall median severity score for neuropsychiatric symptoms was 9 [interquartile range [IQR] = 6‐12], and the overall median distress score was 7 [IQR = 4‐10]. Overall median scores of both severity and distress were significantly increased with the number of neuropsychiatric symptoms, the presence of dementia, and dementia severity. Depression, delusions, apathy, disinhibition, and aberrant motor behavior were associated with dementia after multivariate analysis.

CONCLUSION

This report is one of the few population‐based studies on neuropsychiatric symptoms among older people with dementia in Sub‐Saharan Africa and the first one evaluating the severity of those symptoms and distress experienced by caregivers. Individual neuropsychiatric symptoms were strongly associated with dementia in older people and require great attention considering their burden on populations.

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Improved Quality of Death and Dying in Care Homes: A Palliative Care Stepped Wedge Randomized Control Trial in Australia - American Geriatric Society

OBJECTIVES

Mortality in care homes is high, but care of dying residents is often suboptimal, and many services do not have easy access to specialist palliative care. This study examined the impact of providing specialist palliative care on residents' quality of death and dying.

DESIGN

Using a stepped wedge randomized control trial, care homes were randomly assigned to crossover from control to intervention using a random number generator. Analysis used a generalized linear and latent mixed model. The trial was registered with ANZCTR: ACTRN12617000080325.

SETTING

Twelve Australian care homes in Canberra, Australia.

PARTICIPANTS

A total of 1700 non‐respite residents were reviewed from the 12 participating care homes. Of these residents, 537 died and 471 had complete data for analysis. The trial ran between February 2017 and June 2018.

INTERVENTION

Palliative Care Needs Rounds (hereafter Needs Rounds) are monthly hour‐long staff‐only triage meetings to discuss residents at risk of dying without a plan in place. They are chaired by a specialist palliative care clinician and attended by care home staff. A checklist is followed to guide discussions and outcomes, focused on anticipatory planning.

MEASUREMENTS

This article reports secondary outcomes of staff perceptions of residents' quality of death and dying, care home staff confidence, and completion of advance care planning documentation. We assessed (1) quality of death and dying, and (2) staff capability of adopting a palliative approach, completion of advance care plans, and medical power of attorney.

RESULTS

Needs Rounds are associated with staff perceptions that residents had a better quality of death and dying (P < .01; 95% confidence interval [CI] = 1.83‐12.21), particularly in the 10 facilities that complied with the intervention protocol (P < .01; 95% CI = 6.37‐13.32). Staff self‐reported perceptions of capability increased (P < .01; 95% CI = 2.73‐6.72).

CONCLUSION

The data offer evidence for monthly triage meetings to transform the lives, deaths, and care of older people residing in care homes.

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Statement on new testing results, including low levels of impurities in ranitidine drugs - FDA Press Releases

Today, the FDA is issuing an update on new testing results, including low levels of impurities in ranitidine drugs

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Comparing Potentially Inappropriate Prescribing Tools and Their Association With Patient Outcomes - American Geriatric Society

OBJECTIVE

To assess the agreement of several different measures of potentially inappropriate prescribing (PIP) in older people and compare their relationship with patient‐reported outcomes.

DESIGN

Prospective cohort study including participants in The Irish Longitudinal Study on Ageing (TILDA).

SETTING

Waves 1 and 2 of TILDA, a nationally representative aging cohort study.

PARTICIPANTS

A total of 1753 community‐dwelling TILDA participants with linked administrative pharmacy claims data on medications.

MEASUREMENTS

Potentially inappropriate medications were assessed using the Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP) v1, American Geriatrics Society (AGS) Beers Criteria® 2012, and relevant Assessing Care of Vulnerable Elders (ACOVE) v3 indicators. Potential prescribing omissions were assessed using the Screening Tool to Alert Doctors to the Right Treatment (START) v1 and ACOVE v3 indicators. Their agreement was assessed via κ statistics, and multivariate regression was used to assess relationships with emergency department visits, general practitioner (GP) visits, quality of life, and functional decline (increased assistance needed for activities of daily living).

RESULTS

There was slight agreement between STOPP and AGS Beers Criteria® (κ = 0.20) and ACOVE indicators (κ = 0.15), while agreement between AGS Beers Criteria® and ACOVE indicators was fair (κ = 0.31). Agreement was fair between START and ACOVE indicators (κ = 0.34). All measures of inappropriate medications were significantly associated with increased GP visits. Only exposure to two or more START indicators was associated with reduced quality of life (adjusted mean difference = −1.12; 95% confidence interval [CI] = −1.92 to −0.33), and only two or more AGS Beers Criteria® were associated with functional decline (adjusted odds ratio = 2.11; 95% CI = 1.37‐3.28). For omissions, both measures were associated with functional decline, but only ACOVE indicators were associated with increased GP visits.

CONCLUSION

Prevalence of PIP and relationships with outcomes can differ substantially between tools with little agreement. Choice of PIP measure for research or practice should be considered in light of the circumstances and requirements in each case.

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Complex Patients and Quality of Care in Medicare Advantage - American Geriatric Society

OBJECTIVES

New federal policies aim to focus Medicare Advantage (MA) plans on the needs of individuals with complex health conditions. Our objective was to examine enrollment patterns of MA beneficiaries with complex needs and the association of enrollment patterns with MA plan performance.

DESIGN

Cross‐sectional study.

SETTING

The 2015 Medicare Health Outcome Survey baseline survey.

PARTICIPANTS

A total of 273 336 MA beneficiaries enrolled in 467 MA plans who lived in the community.

MEASUREMENTS

Complex patients included individuals 65 years and older with multiple self‐reported chronic conditions and functional limitations and all patients with disabilities younger than 65 years. Outcomes included 27 performance measures reported under the 5‐Star Part C Star Rating. Linear probability regression was used to examine the association of concentration of complex patients and performance measures.

RESULTS

Most complex patients were enrolled in general MA plans. Concentration of complex patients ranged from 25.9% in MA contracts in the lowest quintile to 68.9% in the top quintile. MA contract performance scores generally decreased as the concentration of complex patients increased. After adjusting for contract and enrollee characteristics, MA contracts with more complex patients performed less well on half of the Part C performance measures including patient experience, preventive care, and chronic care measures.

CONCLUSION

MA contracts with a high concentration of complex patients have lower performance scores on more than half of Part C measures. Further study is needed to understand whether these performance measures are capturing the delivery of poor care, deficiencies in the health plan's care systems, or whether some measures may not be appropriate for complex patients.

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Relationship of Cigarette Smoking and Time of Quitting with Incident Dementia and Cognitive Decline - American Geriatric Society

OBJECTIVES

Understanding how dementia risk is impacted by timing of smoking cessation has public health implications for prevention efforts. We investigated the relationship of cigarette smoking and cessation with dementia risk and cognitive decline in the Atherosclerosis Risk in Communities (ARIC) study.

DESIGN

Ongoing prospective cohort study.

SETTING

Begun in 1987‐1989, ARIC was conducted in four US communities.

PARTICIPANTS

A total of 13 002 men and women (25% African American) aged 52 to 75 years.

MEASUREMENTS

All‐cause dementia was defined using standardized algorithms incorporating longitudinal cognitive data, proxy report, and hospital and death certificate dementia codes. Cognitive decline was measured using a composite cognitive score created from three tests measured at two time points (1996‐1998 and 2011‐2013). Smoking and cessation status were defined by self‐report using data from 1987‐1989 (visit 1) and 1996‐1998 (visit 4). Incident dementia risk and differences in cognitive change by smoking status were estimated with Cox proportional hazards and linear regression models, respectively. To address smoking‐related attrition, cognitive scores were imputed for living participants with incomplete cognitive testing.

RESULTS

The proportion of never, former, and current smokers was 44%, 41%, and 14%; 79% of former smokers quit 9 years or more before baseline. A total of 1347 participants developed dementia. After adjustment, compared with never smoking, the hazard ratio for all‐cause dementia for current smoking was 1.33 (95% confidence interval [CI] = 1.12‐1.59) and for recent quitting (<9 y before baseline) was 1.24 (95% CI = 1.01‐1.52). Quitting 9 years or more before baseline was not associated with dementia. We found no differences in rates of cognitive decline by smoking status.

CONCLUSION

Although quitting at any time suggested benefit, dementia risk depended on time since smoking cessation. Our study highlights the importance of early midlife cessation to decrease dementia risk.

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Quality Innovation Networks Share Varied Resources for Nursing Homes on Mostly User‐Friendly Websites - American Geriatric Society

BACKGROUND/OBJECTIVE

Quality innovation networks' (QINs’) support of nursing homes (NHs) is a national strategy to systematically improve the quality of care experienced by residents. QINs have been tasked with providing NHs with information, resources, tools, and training to assist in developing best practices and to support quality improvement efforts in infection prevention (including joining the National Healthcare Safety Network [NHSN]), avoid unnecessary hospitalizations, and increase use of hospice and palliative care. Our objective was to examine QIN online resources provided to NHs to support best practices and improvement efforts.

DESIGN

An environmental scan was conducted.

SETTING/MEASUREMENT

Each QIN website was evaluated on (1) usability, (2) accessibility and prominence, (3) website design, (4) availability of training materials, (5) recency of update, (6) identification of key personnel, and (8) quality focus areas (ie, infection prevention, NHSN, antibiotic stewardship, reducing unnecessary or avoidable hospitalizations, and palliative and hospice care).

RESULTS

QIN websites varied dramatically in design and resources offered to NHs as well as in the content and ease of finding information. Antibiotic stewardship and NHSN resources were widely available. Information (ie, fact sheets) on reducing avoidable hospitalizations was commonly available, while resources, such as tool kits, webinars, training, and contact information for personnel on reducing avoidable hospitalizations, were available to 23 states. Infection prevention resources were varied and limited to 34 states. Both palliative care and hospice resources were available through only a few QINs (13 states and 20 states, respectively).

CONCLUSIONS

Given that much of the information, tool kits, and resources are standardized and in the public domain, centralized resources with tailored or specialized links to unique local resources, like in‐person trainings and state‐specific contact information, could be more beneficial for NHs.

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CMS Works to Ensure Residents’ Quality and Safety in Nursing Homes - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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