Gray Matter Regions Associated With Functional Mobility in Community‐Dwelling Older Adults - American Geriatric Society

BACKGROUND/OBJECTIVES

Neuroimaging indicators of reduced brain health in the form of lower gray matter volume (GMV), lower fractional anisotropy (FA), and higher white matter hyperintensity volume (WMHV) have been related to global mobility measures, such as gait speed, in older adults. The purpose was to identify associations between brain regions and specific mobility functions to provide a greater understanding of the contribution of the central nervous system to independent living.

DESIGN

Cross‐sectional study.

SETTING

Research laboratory.

PARTICIPANTS

Seventy community‐ambulating healthy older adults (mean age = 76 ± 5 years).

MEASUREMENTS

Participants performed the following tests: gait speed, Five Times Sit to Stand, Four Square Step Test (FSST), and Dynamic Gait Index (DGI). Structural magnetic resonance imaging of each participantʼs brain was collected. Measures of regional GMV, tract‐specific WMHV, and FA were extracted. Correlational analyses between the mobility measures and neuroimaging measures were conducted using whole brain and regional and tract‐specific measures. This was followed by linear regression models relating the mobility measures to regions or tracts identified in the correlation analysis, and adjusting for age, sex, and body mass index.

RESULTS

Significant associations were found between higher GMV in multiple regions, primarily the parietal and temporal lobes, and better performance in gait speed, DGI, and FSST. After adjusting for personal factors, greater parahippocampus GMV was independently associated with greater gait speed. Greater inferior parietal lobe, supramarginal gyrus, and superior temporal gyrus GMVs were associated with gait function. Greater postcentral gyrus, parahippocampus, and superior temporal gyrus GMVs were associated with faster FSST performance. The WMHV and FA were not significantly correlated with the mobility measures.

CONCLUSIONS

Gray matter regions associated with higher performance in mobility measures serving gait function and multidirectional stepping were those structures related to vestibular sensation, spatial navigation, and somatosensation.

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Validity of Cognitive Assessment Tools for Older Adult Hispanics: A Systematic Review - American Geriatric Society

OBJECTIVES

A higher prevalence and incidence of dementia is found in Hispanic/Latino older adults. Therefore, valid instruments are necessary to assess cognitive functioning in this population group. Our aim was to review existing articles that have examined and reported on the validity of cognitive assessment tools in Hispanic/Latino population groups in the United States.

DESIGN

Systematic literature review according to the Preferred Reporting Items for Systematic Reviews and Meta‐analysis.

MEASUREMENTS

We systematically searched in the PubMed and Web of Science databases and assessed the quality of the search results using the Standards for the Reporting of Diagnostic Accuracy Studies. We included evidence from within the United States as well as from Spanish‐speaking countries of origin (Mexico, Central and South America, and the Caribbean).

RESULTS

The literature search revealed 27 studies with adequate quality that investigated 13 instruments. The Mini‐Mental Status Examination (MMSE) was the most frequently investigated instrument in Hispanic/Latino groups in the United States with high sensitivity for dementia but also with significant differences for ethnicity and education. The Addenbrooke Cognitive Examination‐Revised, Montreal Cognitive Assessment, 10/66 short diagnostic schedule, clock‐drawing test, Phototest, Eurotest, and Executive Battery 25 had good diagnostic performance in Spanish‐speaking countries. The naming test and verbal fluency tests have a higher risk of misclassifying US Hispanics/Latinos who have dementia.

CONCLUSION

Evidence on validity suggests that the MMSE may be an appropriate cognitive assessment tool for Hispanics. More research is needed to confirm the validity of cognitive tools to assess Hispanic/Latino groups for Alzheimer's disease and other related dementias in the United States to reduce current trends of culturally biased under‐ or overdiagnosis of cognitive impairments.

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A National Study of End‐of‐Life Care among Older Veterans with Hearing and Vision Loss - American Geriatric Society

OBJECTIVES

Hearing and visual sensory loss is prevalent among older adults and may impact the quality of healthcare they receive. Few studies have examined sensory loss and end‐of‐life (EOL) care quality. Our aim was to describe hearing and vision loss and their associations with the quality of EOL care and family perception of care in the last 30 days of life among a national sample of veteran decedents.

DESIGN

Retrospective medical record review and Bereaved Family Survey (BFS).

SETTING

Veterans Affairs (VA) Medical Centers (N = 145).

PARTICIPANTS

Medical record review of all veterans who died in an inpatient VA Medical Center between October 2012 and September 2017 (N = 96 424). Survey results included 42 428 individuals.

MEASUREMENTS

Three indicators of high‐quality EOL care were measured: palliative consultation in the last 90 days of life, death in a non‐acute setting, and contact with a chaplain. The BFS reflects a global evaluation of quality of EOL care; pain and posttraumatic stress disorder management; and three subscales characterizing perceptions regarding communication, emotional and spiritual support, and information about death benefits in the last month of life.

RESULTS

In adjusted models, EOL care quality indicators and BFS outcomes for veterans with hearing loss were similar to those for veterans without hearing loss; however, we noted slightly lower scores for pain management and less satisfaction with communication. Veterans with vision loss were less likely to have received a palliative care consult or contact with a chaplain than those without vision loss. Although BFS respondents for veterans with vision loss were less likely than respondents for veterans without vision loss to report excellent overall care and satisfaction with emotional support, other outcomes did not differ.

CONCLUSION

In general, the VA is meeting the EOL care needs of veterans with hearing and vision loss through palliative care practices.

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Personality and Motoric Cognitive Risk Syndrome - American Geriatric Society

OBJECTIVES

To examine whether five major personality traits are related to the motoric cognitive risk (MCR) syndrome, a pre‐dementia syndrome characterized by cognitive complaints and slow gait speed.

DESIGN

Cross‐sectional.

SETTING

Health and Retirement Study (HRS) and the National Health and Aging Trends Survey (NHATS).

PARTICIPANTS

Dementia‐free older adults aged 65 to 107 years (N > 8000).

MEASUREMENTS

In both samples, participants provided data on personality, cognitive complaints, and measures of gait speed, as well as on demographic factors, physical activity, depressive symptoms, and body mass index (BMI).

RESULTS

Across the two samples and a meta‐analysis, higher neuroticism was related to higher risk of MCR (combined odds ratio [OR] = 1.32; 95% confidence interval [CI] = 1.21‐1.45; P < .001), whereas higher extraversion (combined OR = .71; 95% CI = .65‐.79; P < .001) and conscientiousness (combined OR = .70; 95% CI = .62‐.78; P < .001) were associated with a lower likelihood of MCR. Higher openness was also related to a lower risk of MCR in the HRS and the meta‐analysis (combined OR = .77; 95% CI = .70‐.85; P < .001), whereas agreeableness was protective only in the HRS (OR = .83; 95% CI = .74‐.92; P < .001). Additional analyses indicated that physical activity, depressive symptoms, and BMI partially accounted for these associations.

CONCLUSION

This study adds to existing research on the factors related to the risk of MCR by showing an association with personality traits. Personality assessment may help to identify individuals who may be targeted by interventions focused on reducing the risk of MCR and ultimately of dementia.

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Inadequate Risk Adjustment Impacts Geriatricians' Performance on Medicare Cost and Quality Measures - American Geriatric Society

OBJECTIVES

Medicare value‐based payment programs evaluate physicians' performance on their patients' annual Medicare costs and clinical outcomes. However, little is known about how geriatricians, who disproportionately provide care for medically complex older adults, perform on these measures.

DESIGN

A retrospective study using multivariable regression methods to estimate the association of geriatric risk factors with annualized Medicare costs and preventable hospitalization rates and to compare geriatricians' performance on these outcomes to other primary care physicians (PCPs) under standard Medicare risk adjustment and after adding additional adjustment for geriatric risk factors.

SETTING

Eight years (2006‐2013) of cohort data from the Medicare Current Beneficiary Survey.

PARTICIPANTS

Medicare beneficiaries, aged 65 years and older, with primary care services contributing 27 027 person‐years of data.

MEASUREMENTS

Outcomes were costs and preventable hospitalization rates; geriatric risk factors were patient frailty, long‐term institutionalization, dementia, and depression.

RESULTS

Geriatricians were more likely to care for patients with frailty (22.8% vs 14.1%), long‐term institutionalization (12.0% vs 4.7%), dementia (21.6% vs 10.2%), and depression (23.6% vs 17.4%) than other PCPs (P < .001 for each). Under standard Medicare risk adjustment, geriatricians performed more poorly on costs compared to other PCPs (observed‐expected [O‐E] ratio = 1.24 vs 0.99) and preventable hospitalizations (O‐E ratio = 1.16 vs 0.98). Adding frailty, institutionalization, dementia, and depression to risk adjustment improved geriatricians' performance on costs by 25% and on preventable hospitalization rates by 35%, relative to other PCPs. Concurrent‐year risk prediction that removed the influence of unpredictable acute events further improved geriatricians' performance vs other PCPs (O‐E ratio = 0.99 vs 1.00).

CONCLUSION

Medicare should consider risk adjusting for frailty, long‐term institutionalization, dementia, and depression to avoid inappropriately penalizing geriatricians who care for vulnerable older adults.

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Practicing Geriatrics: Mission Impossible? - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Hospice Utilization in the United States: A Prospective Cohort Study Comparing Cancer and Noncancer Deaths - American Geriatric Society

OBJECTIVES

Reliable national estimates of hospice use and underuse are needed. Additionally, drivers of hospice use in the United States are poorly understood, especially among noncancer populations. Thus the objectives of this study were to (1) provide reliable estimates of hospice use among adults in the United States; and (2) identify factors predicting use among decedents and within subsamples of cancer and noncancer deaths.

DESIGN

We conducted a prospective cohort study using the Health and Retirement Study survey. Excluding sudden deaths, we used data from the 2012 survey wave to predict hospice use in general, and then separately for cancer and non‐cancer deaths.

SETTING

Study data were provided by a population‐based sample of older adults from the U.S.

PARTICIPANTS

We constructed a sample of 1,209 participants who died between the 2012 and 2014 survey waves.

MEASUREMENTS

Hospice utilization was reported by proxy. Exposure variables included demographics, functionality (activities of daily living [ADLs]), health, depression, dementia, advance directives, nursing home residency, and cause of death.

RESULTS

Hospice utilization rate was 52.4% for the sample with 70.8% for cancer deaths and 45.4% for noncancer deaths. Fully adjusted model results showed being older (odds ratio [OR] = 1.54), less healthy (OR = .79), having dementia (OR = 1.52), and having cancer (OR = 5.47) were linked to greater odds of receiving hospice. Among cancer deaths, being older (OR = 1.64) and female (OR = 2.54) were the only predictors of hospice use. Among noncancer deaths, increased age (OR = 1.58), more education (OR = 1.56), being widowed (OR = 1.55), needing help with ADLs (OR = 1.13), and poor health (OR = .77) were associated with hospice utilization.

CONCLUSION

Findings suggest hospice remains underutilized, especially among individuals with noncancer illness. Extrapolating results to the US population, we estimate that annually nearly a million individuals who are likely eligible for hospice die without its services. Most (84%) of these decedents have a noncancer condition. Interventions are needed to increase appropriate hospice utilization, particularly in noncancer care settings.

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Post‐Acute Care Locations: Hospital Discharge Destination Reports vs Medicare Claims - American Geriatric Society

OBJECTIVES

Administrative records such as Medicare fee‐for‐service (FFS) claims provide accurate information on services paid for by Medicare. However, the increasing availability of electronic health records means many researchers may be inclined to rely on data coded in hospital information systems rather than claims. The current quality and accuracy of hospital reports on the use of post‐acute care (PAC) services are not known.

DESIGN

This study examined differences in the PAC use between hospital discharge status recorded on Medicare Provider and Analysis Review inpatient hospital records and claims for PAC services.

SETTING

In addition to assessments of the three types of Medicare‐reimbursed PAC (home health agency [HHA], skilled nursing facility [SNF], and inpatient rehabilitation facility [IRF]), the analysis also considered home without PAC services as a default discharge location.

PARTICIPANTS

The analysis was conducted using data for FFS beneficiaries who participated in the Medicare Current Beneficiary Survey and had one or more inpatient hospitalizations from 2006 to 2011.

MEASUREMENTS

This study measured discrepancies between hospital‐reported discharges to PAC and PAC use based on Medicare claims.

RESULTS

The study found that, on average, 27.9% of hospital reports of discharging to Medicare‐covered PAC services were not substantiated by Medicare PAC claims. Among all the discharge pathways, discharging to HHAs had the highest discrepancy rate (29.6%), followed by IRFs (14.7%) and SNFs (13.8%).

CONCLUSION

The study results call for cautions about the extent to which the reported discharge locations on hospital claims may differ from actual PAC services used. Assuming that Medicare FFS claims were complete and accurate, researchers using the discharge status reported on Medicare hospital claims should be aware of possible measurement errors when using hospital‐reported discharge locations.

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FDA approves first generics of Eliquis - FDA Press Releases

The U.S. Food and Drug Administration today approved two applications for first generics of Eliquis (apixaban) tablets.

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FDA approves new treatment for adults with migraine - FDA Press Releases

FDA approves Ubrelvy (ubrogepant) tablets for the acute treatment of migraine with or without aura in adults.

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Deprescribing in Older People Approaching End of Life: A Randomized Controlled Trial Using STOPPFrail Criteria - American Geriatric Society

OBJECTIVES

Older people approaching end of life are commonly prescribed multiple medications, many of which may be inappropriate or futile. Our objective was to examine the effect of applying the STOPPFrail, a recently developed deprescribing tool, to the medication regimens of older patients with advanced frailty.

DESIGN

Randomized controlled trial.

SETTING

Two acute hospitals in Ireland.

PARTICIPANTS

Adults 75 years or older (n = 130) with advanced frailty and polypharmacy (five or more drugs), transferring to long‐term nursing home care.

INTERVENTION

A STOPPFrail‐guided deprescribing plan was presented to attending physicians who judged whether or not to implement recommended medication changes.

MEASUREMENTS

The primary outcome was the change in the number of regular medications at 3 months. Secondary outcomes included unscheduled hospital presentations, falls, quality of life, monthly medication costs, and mortality.

RESULTS

Intervention (n = 65) and control group (n = 65) participants were prescribed a mean (plus or minus standard deviation [SD]) of 11.5 (±3.0) and 10.9 (±3.5) medications, respectively, at baseline. The mean (SD) change in the number of medications at 3 months was −2.6 (±2.73) in the intervention group and −.36 (±2.60) in the control group (mean difference = 2.25 ± .54; 95% confidence interval [CI] = 1.18‐3.32; P < .001). The mean change in monthly medication cost was –$74.97 (±$148.32) in the intervention group and –$13.22 (±$110.40) in the control group (mean difference $61.74 ± $26.60; 95% CI = 8.95‐114.53; P = .02). No significant differences were found between groups for any of the other secondary outcomes.

CONCLUSION

STOPPFrail‐guided deprescribing significantly reduced polypharmacy and medication costs in frail older people. No significant differences between groups were observed with regard to falls, hospital presentations, quality of life, and mortality, although the trial was likely underpowered to detect differences in these outcomes.

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Pain Patterns and Treatment Among Nursing Home Residents With Moderate‐Severe Cognitive Impairment - American Geriatric Society

OBJECTIVES

To examine the frequency and severity of pain and use of pain therapies among long‐term care residents with moderate to severe dementia and to explore the factors associated with increased pain severity.

DESIGN

Prospective individual data were collected over 1 to 3 days for each participant.

SETTING

Sixteen long‐term care facilities in Alabama, Georgia, Pennsylvania, and New Jersey.

PARTICIPANTS

Residents with moderate to severe cognitive impairment residing in a long‐term care facility for at least 7 days were enrolled (N = 205). Residents were 47% female, predominantly white (69%), and 84 years old, on average (SD = 10 years).

MEASUREMENTS

A comprehensive pain assessment protocol was used to evaluate pain severity and characteristics through medical record review, interviews with nursing home staff, physical examinations, as well as pain observation tools (Mobilization‐Observation‐Behavior‐Intensity‐Dementia Pain Scale and Pain Intensity Measure for Persons With Dementia). Known correlates were also assessed (agitation, depression, and sleep).

RESULTS

Experts' pain evaluations indicated that residents' usual pain was mild (mean = 1.6/10), and most experienced only intermittent pain (70%). However, 45% of residents experienced moderate to severe worst pain. Of residents, 90% received a pain therapy, with acetaminophen (87%) and opioids (32%) commonly utilized. Only 3% had a nondrug therapy documented in the medical record. The only resident characteristic that was significantly associated with pain severity was receipt of an opioid in the past week.

CONCLUSION

Using a comprehensive pain assessment protocol, we found that most nursing home residents with moderate to severe dementia had mild usual, intermittent pain and the vast majority received at least one pain therapy in the previous week. Although these findings reflect improvements in pain management compared with older studies, there is still room for improvement in that 45% of the sample experienced moderate to severe pain at some point in the previous week.

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Key Ingredients of an Ideal System for High‐Quality Community Care for Persons With Dementia - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Impact of Baseline Fatigue on a Physical Activity Intervention to Prevent Mobility Disability - American Geriatric Society

OBJECTIVES

Our aim was to examine the impacts of baseline fatigue on the effectiveness of a physical activity (PA) intervention to prevent major mobility disability (MMD) and persistent major mobility disability (PMMD) in participants from the Lifestyle Interventions and Independence for Elders (LIFE) study.

DESIGN

Prospective cohort of individuals aged 65 years or older undergoing structured PA intervention or health education (HE) for a mean of 2.6 years.

SETTING

LIFE was a multicenter eight‐site randomized trial that compared the efficacy of a structured PA intervention with an HE program in reducing the incidence of MMD.

PARTICIPANTS

Study participants (N = 1591) at baseline were 78.9 ± 5.2 years of age, with low PA and at risk for mobility impairment.

MEASUREMENTS

Self‐reported fatigue was assessed using the modified trait version of the Exercise‐Induced Feelings Inventory, a six‐question scale rating energy levels in the past week. Responses ranged from 0 (none of the time) to 5 (all of the time). Total score was calculated by averaging across questions; baseline fatigue was based on the median split: 2 or higher = more fatigue (N = 856) and lower than 2 = less fatigue (N = 735). Participants performed a usual‐paced 400‐m walk every 6 months. We defined incident MMD as the inability to walk 400‐m at follow‐up visits; PMMD was defined as two consecutive walk failures. Cox proportional hazard models quantified the risk of MMD and PMMD in PA vs HE stratified by baseline fatigue adjusted for covariates.

RESULTS

Among those with higher baseline fatigue, PA participants had a 29% and 40% lower risk of MMD and PMMD, respectively, over the trial compared with HE (hazard ratio [HR] for MMD = .71; 95% confidence interval [CI] = .57‐.90; P = .004) and PMMD (HR = .60; 95% CI = .44‐.82; P = .001). For those with lower baseline fatigue, no group differences in MMD (P = .36) or PMMD (P = .82) were found. Results of baseline fatigue by intervention interaction was MMD (P = .18) and PMMD (P = .05).

CONCLUSION

A long‐term moderate intensity PA intervention was particularly effective at preserving mobility in older adults with higher levels of baseline fatigue.

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Three novel chromanones with biological activities from the endophytic fungus Phomopsis CGMCC No. 5416 - Journal of Antibiotics

The Journal of Antibiotics, Published online: 23 December 2019; doi:10.1038/s41429-019-0270-0

Three novel chromanones with biological activities from the endophytic fungus Phomopsis CGMCC No. 5416

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Heart Failure with Preserved Ejection Fraction in Older Adults - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Reply to: Heart Failure With Preserved Ejection Fraction in Older Adults - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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FDA expands indication for continuous glucose monitoring system, first to replace fingerstick testing for diabetes treatment decisions - FDA Press Releases

The U.S. Food and Drug Administration today expanded the approved use of Dexcom’s G5 Mobile Continuous Glucose Monitoring System to allow for replacement of fingerstick blood glucose (sugar) testing for diabetes treatment decisions in people 2 years of age and older with diabetes.

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FDA approves new treatment option for patients with HER2-positive breast cancer who have progressed on available therapies - FDA Press Releases

FDA granted accelerated approval to Enhertu (fam-trastuzumab deruxtecan-nxki) for the treatment of adults with unresectable or metastatic HER2-positive breast cancer who have received two or more prior anti-HER2-based regimens in the metastatic setting

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FDA, DEA seize 44 websites advertising sale of illicit THC vaping cartridges to US consumers as part of Operation Vapor Lock - FDA Press Releases

The FDA and the Drug Enforcement Administration have seized 44 websites advertising the sale of illicit THC vaping cartridges.

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First FDA-approved vaccine for the prevention of Ebola virus disease, marking a critical milestone in public health preparedness and response - FDA Press Releases

FDA announced today the approval of Ervebo, the first FDA-approved vaccine for the prevention of Ebola virus disease (EVD), caused by Zaire ebolavirus in individuals 18 years of age and older.

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FDA takes efforts to improve quality of compounded drugs from outsourcing facilities through collaboration and education as part of new Center of Excellence - FDA Press Releases

Today, the agency is announcing the Compounding Quality Center of Excellence – an initiative designed to improve the overall quality of compounded medicines.

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Statement on National Academies of Sciences, Engineering, and Medicine report on framing opioid prescribing guidelines for acute pain - FDA Press Releases

National Academies of Sciences, Engineering, and Medicine (NASEM) was tasked with providing a framework to evaluate current and future opioid prescribing to support a clinical practice guideline and to identify gaps in the evidence.

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FDA approves new type of therapy to treat advanced urothelial cancer - FDA Press Releases

FDA granted accelerated approval to Padcev, a Nectin-4-directed antibody and microtubule inhibitor conjugate, meaning the drug specifically targets cancer cells – in this case, the cell adhesion molecule Nectin-4 which is highly expressed in urothelial cancers

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Contamination of Common Area and Rehabilitation Gym Environment with Multidrug‐Resistant Organisms - American Geriatric Society

OBJECTIVES

To quantify the multidrug‐resistant organism (MDRO) burden of high‐touch common area and rehabilitation gym surfaces, and to assess microorganism transfer potential during rehabilitation sessions.

DESIGN

Prospective study of environmental contamination.

SETTING

Nursing home (NH).

PARTICIPANTS

Six Michigan NHs.

MEASUREMENTS

Monthly samples from common area surfaces (eg, living room), rehabilitation equipment, and rehabilitation personnel hands were screened for methicillin‐resistant Staphylococcus aureus (MRSA), vancomycin‐resistant enterococci (VRE), and resistant gram‐negative bacilli (R‐GNB). To assess microorganism transfer potential, we conducted an in‐depth assessment of microorganism transfer during 10 rehabilitation sessions. Microorganism transfer was defined as the identification of a microorganism on a destination surface that was uncontaminated before the rehabilitation session. Patient frequency of common area usage was also assessed qualitatively.

RESULTS

We obtained 1338 common area specimens from 180 monthly facility visits, of which 13.4% (179/1338) were MDRO positive: MRSA, 3.8%; VRE, 5.8%; and R‐GNB, 5.1%. A total of 64% (116/180) of sampling visits had at least one MDRO‐positive common area specimen. Within rehabilitation gyms, we obtained 521 equipment and 190 personnel hand specimens during 60 monthly visits. Of the equipment specimens collected, 7.7% (40/521) were MDRO positive: MRSA, 2.5%; VRE, 4.0%; and R‐GNB, 1.9%. Of the 190 rehabilitation personnel hand specimens collected, 3.7% (7/190) were MDRO positive. Overall, 55% (33/60) of rehabilitation gym visits had at least one MDRO‐positive specimen. Microorganism transfer assessment during 10 rehabilitation sessions revealed 35 opportunities for transfer during which microorganism transfer occurred in 17.1% (6/35) of opportunities.

CONCLUSION

NH common areas and rehabilitation gyms are MDRO reservoirs that may contribute to the transmission of healthcare‐associated pathogens. Because NHs accommodate the increasing short‐stay patient population, developing effective interventions that reduce MDRO transmission in the common area and rehabilitation gym environment should be considered an infection prevention priority.

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Do Clean Common Areas Save Lives? - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Advance Care Planning: Social Isolation Matters - American Geriatric Society

BACKGROUND

Social isolation is a risk factor for poor health that influences the well‐being older adults.

OBJECTIVE

We compare advance care planning (ACP) engagement of older adults who were severely socially isolated, socially isolated, and not socially isolated.

DESIGN

Cross‐sectional analysis of the 2012 National Health and Aging Trends Study (NHATS).

SETTING

United States of America.

PARTICIPANTS

A total of 2015 older adults (aged ≥65 years) randomly selected from a representative sample of community‐dwelling Medicare beneficiaries to participate in an ACP module as part of an annual in‐person interview.

MEASUREMENTS

We classified participants in three groups: severely socially isolated, socially isolated, or not socially isolated. ACP refers to three (yes/no) questions regarding whether a participant had a: (1) prior discussion about care preferences in the case of serious illness (EOL Discussion); (2) durable power of attorney (DPOA); and (3) advance directive (AD). We performed logistic regression analyses to examine the association between social isolation and ACP.

RESULTS

Approximately 23% of older adults were either severely socially isolated or socially isolated. Older adults who experienced social isolation were less likely to engage in ACP than those who were not socially isolated. In adjusted analysis, older adults who were socially isolated had lower odds of having an EOL discussion (adjusted odds ratio [AOR] = 0.65; 95% confidence interval [CI] = 0.49‐0.87) or having a DPOA (AOR = 0.71; 95% CI = 0.53‐0.96) compared to those who were not socially isolated.

CONCLUSION

Social isolation is associated with lower engagement in ACP. Clinicians should identify older adults who are at risk for or experience social isolation as they may benefit from targeted ACP efforts.

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Performance and Penalties in Year 1 of the Skilled Nursing Facility Value‐Based Purchasing Program - American Geriatric Society

BACKGROUND/OBJECTIVES

Launched in October 2018, Medicareʼs Skilled Nursing Facility Value‐Based Purchasing (SNF VBP) program mandates financial penalties for SNFs with high 30‐day readmission rates. Our objective was to identify characteristics of SNFs associated with provider performance under the program.

DESIGN

Retrospective cross‐sectional analysis using Nursing Home Compare data for the 2019 SNF VBP. Facility‐level regressions examined the relationship between structural characteristics (nursing home size, rurality, profit status, hospital affiliation, region, and Star Ratings) and patient characteristics (neighborhood income, race/ethnicity, dual eligibility, disability, and frailty) and facility performance.

SETTING

US Medicare.

PARTICIPANTS

A total of 14 558 SNFs.

MEASUREMENTS

The 2019 SNF VBP performance scores and penalties.

RESULTS

Nationally, 72% (10 436) of SNFs were penalized; 21% (2996) received the maximum penalty of 1.98%. In multivariate analyses, rural SNFs were less likely to be penalized (odds ratio [OR] = 0.85; 95% confidence interval [CI] = 0.78‐0.92; P < .001; vs urban), while small SNFs were more likely to be penalized (≤70 beds: OR = 1.28; 95% CI = 1.15‐1.42; P < .001; 71‐120 beds: OR = 1.15; 95% CI = 1.05‐1.26; P = .003; vs >120 beds). SNFs with lower nurse staffing had higher odds of penalties (low: OR = 1.15; 95% CI = 1.03‐1.27; P = .010; vs high); nonprofit and government‐owned SNFs had lower odds of penalties (OR = 0.79; 95% CI = 0.72‐0.87; P < .001; government: OR = 0.72; 95% CI = 0.61‐0.84; P < .001; vs for profit); and SNFs with higher Star Ratings had lower odds of penalties (5 stars: OR = 0.47; 95% CI = 0.40‐0.54; P < .001; vs 1 star). In terms of patient population, SNFs located in low‐income ZIP codes (OR = 1.17; 95% CI = 1.03‐1.34; P = .019) or serving a high proportion of frail patients (OR = 1.39; 95% CI = 1.21‐1.60; P < .001) were more likely to be penalized than other SNFs. SNFs with high proportions of dual, black, Hispanic, or disabled patients did not have higher odds of penalization.

CONCLUSION

Structural and patient characteristics of SNFs may significantly impact provider performance under the SNF VBP. These findings have implications for policy makers and clinical leaders seeking to improve quality and avoid unintended consequences with VBP in SNFs.

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Trump Administration takes historic steps to lower U.S. prescription drug prices - FDA Press Releases

The Trump Administration is taking steps to lower prescription drug prices by proposing a rule that could allow for the importation of certain drugs from Canada and issuing draft guidance explaining how manufacturers could import drugs, biological products originally intended for sale abroad.

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Isolation of new streptimidone derivatives, glutarimide antibiotics from Streptomyces sp. W3002 using LC-MS-guided screening - Journal of Antibiotics

The Journal of Antibiotics, Published online: 18 December 2019; doi:10.1038/s41429-019-0264-y

Isolation of new streptimidone derivatives, glutarimide antibiotics from Streptomyces sp. W3002 using LC-MS-guided screening

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Novel macrolactam compound produced by the heterologous expression of a large cryptic biosynthetic gene cluster of Streptomyces rochei IFO12908 - Journal of Antibiotics

The Journal of Antibiotics, Published online: 18 December 2019; doi:10.1038/s41429-019-0265-x

Novel macrolactam compound produced by the heterologous expression of a large cryptic biosynthetic gene cluster of Streptomyces rochei IFO12908

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Diversity of PKS and NRPS gene clusters between Streptomyces abyssomicinicus sp. nov. and its taxonomic neighbor - Journal of Antibiotics

The Journal of Antibiotics, Published online: 18 December 2019; doi:10.1038/s41429-019-0261-1

Diversity of PKS and NRPS gene clusters between Streptomyces abyssomicinicus sp. nov. and its taxonomic neighbor

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Statement on low-cost biosimilar and interchangeable protein products - FDA Press Releases

FDA statement on low-cost biosimilar and interchangeable protein products

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Mapping Associations Between Gait Decline and Fall Risk in Mild Cognitive Impairment - American Geriatric Society

OBJECTIVES

Compared to their cognitively healthy counterparts, older adults with mild cognitive impairment (MCI) exhibit higher risk of falls, specifically with injuries. We sought to determine whether fall risk in MCI is associated with decline in higher‐level brain gait control.

DESIGN

Longitudinal study.

SETTING

Community‐dwelling adults from the Gait and Brain Study Cohort.

PARTICIPANTS

A total of 110 participants, aged 65 years or older, with MCI.

MEASUREMENTS

Biannual assessments for medical characteristics, cognitive performance, fall incidence, and gait performance for up to 7 years. Seven spatiotemporal gait parameters, including variabilities, were recorded using a 6‐meter electronic walkway. Principal components analysis was used to identify independent gait domains related to higher‐level (pace and variability domains) and lower‐level (rhythm domain) brain control. Associations between gait decline and incident falls were studied with Cox regression models adjusted for baseline covariates.

RESULTS

Of participants enrolled, 40% experienced at least one fall (28% of them with injuries) over a mean follow‐up of 31.6 ± 23.9 months. From the pace domain, slower gait speed (adjusted hazard ratio [aHR] per 10‐cm/s decrease = 4.62; 95% confidence interval [CI] = 1.84‐11.61; P = .001) was associated with severe injurious falls requiring emergency room (ER) visit; from the variability domain, stride time variability (aHR per 10% increase during follow‐up = 2.17; 95% CI = 1.02‐4.63; P = .04) was associated with higher risk of all injurious falls. Rhythm domain was not associated with fall risk. Decline in pace domain was significantly associated with falls with ER visit (aHR = 3.67; 95% CI = 1.46‐9.19; P = .005). After adjustments for multiple comparisons, gait speed and pace domain remained significantly associated with falls with ER visits. No statistically significant associations were found between gait domains and overall falls (P ≥ .06).

CONCLUSION

Higher risk of injurious falls in older adults with MCI is associated with decline in gait parameters related to higher‐level brain control.

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Improving Care for Older Adults with HIV: Identifying Provider Preferences and Priorities - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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FDA permits sale of two new reduced nicotine cigarettes through premarket tobacco product application pathway - FDA Press Releases

FDA permits sale of two new reduced nicotine cigarettes through premarket tobacco product application pathway

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Association between Diet Quality and Frailty Prevalence in the Physicians’ Health Study - American Geriatric Society

OBJECTIVES

Limited data suggest that a healthy diet is associated with a lower risk of frailty. We sought to assess the relationship between three measures of diet quality and frailty among male physicians.

DESIGN

Cross‐sectional analysis of a cohort study.

SETTING

Physicians’ Health Study.

PARTICIPANTS

A total of 9861 initially healthy US men, aged 60 years or older, who provided data on frailty status and dietary habits.

MEASUREMENTS

A cumulative deficit frailty index (FI) was calculated using 33 variables encompassing domains of comorbidity, functional status, mood, general health, social isolation, and change in weight. Diet quality was measured using the Alternative Healthy Eating Index (aHEI), Mediterranean Diet Score (MDS), and Dietary Approaches to Stop Hypertension (DASH).

RESULTS

The FI identified 38% of physicians as non‐frail, 44% as pre‐frail, and 18% as frail. Multinomial logistic regression models adjusted for age, smoking status, and energy intake showed that compared with the lowest aHEI quintiles, those in the highest quintiles had lower odds of frailty and pre‐frailty compared with non‐frailty (odds ratio [OR] for frailty = .47; 95% confidence interval [CI] = .39‐.58; for pre‐frailty: OR = .75; CI = .65‐.87). Exercise did not modify this association (P interaction >.1). Similar relationships were observed for DASH and MDS quintiles with frailty and pre‐frailty. Restricted cubic splines showed an inverse dose‐response relationship of diet quality scores with odds of frailty and pre‐frailty.

CONCLUSION

Cross‐sectional data show an inverse dose‐response relationship of diet quality with pre‐frailty and frailty. Future longitudinal studies are needed to investigate whether healthier diet is a modifiable risk factor for frailty.

ClinicalTrials.gov identifier: NCT00000500.

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Looking Before We Leap: Building the Evidence for Social Prescribing for Lonely Older Adults - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Reply to: Looking Before We Leap: Building the Evidence for Social Prescribing for Lonely Older Adults - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Social Prescribing: Creating Pathways Towards Better Health and Wellness - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Reply to Social Prescribing: Creating Pathways Towards Better Health and Wellness - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Intensive vs Standard Blood Pressure Control in Adults 80 Years or Older: A Secondary Analysis of the Systolic Blood Pressure Intervention Trial - American Geriatric Society

OBJECTIVES

To evaluate the effect of intensive systolic blood pressure (SBP) control in older adults with hypertension, considering cognitive and physical function.

DESIGN

Secondary analysis.

SETTING

Systolic Blood Pressure Intervention Trial (SPRINT)

PARTICIPANTS

Adults 80 years or older.

INTERVENTION

Participants with hypertension but without diabetes (N = 1167) were randomized to an SBP target below 120 mm Hg (intensive treatment) vs a target below 140 mm Hg (standard treatment).

MEASUREMENTS

We measured the incidence of cardiovascular disease (CVD), mortality, changes in renal function, mild cognitive impairment (MCI), probable dementia, and serious adverse events. Gait speed was assessed via a 4‐m walk test, and the Montreal Cognitive Assessment (MoCA) was used to quantify baseline cognitive function.

RESULTS

Intensive treatment led to significant reductions in cardiovascular events (hazard ratio [HR] = .66; 95% confidence interval [CI] = .49‐.90), mortality (HR = .67; 95% CI = .48‐.93), and MCI (HR = .70; 95% CI = .51‐.96). There was a significant interaction (P < .001) whereby participants with higher baseline scores on the MoCA derived strong benefit from intensive treatment for a composite of CVD and mortality (HR = .40; 95% CI = .28‐.57), with no appreciable benefit in participants with lower scores on the MoCA (HR = 1.33 = 95% CI = .87‐2.03). There was no evidence of heterogeneity of treatment effects with respect to gait speed. Rates of acute kidney injury and declines of at least 30% in estimated glomerular filtration rate were increased in the intensive treatment group with no between‐group differences in the rate of injurious falls.

CONCLUSION

In adults aged 80 years or older, intensive SBP control lowers the risk of major cardiovascular events, MCI, and death, with increased risk of changes to kidney function. The cardiovascular and mortality benefits of intensive SBP control may not extend to older adults with lower baseline cognitive function.

Trial Registration

Clinicaltrials.gov identifier: NCT01206062.

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Cardiopulmonary Resuscitation in Adults Over 80: Outcome and the Perception of Appropriateness by Clinicians - American Geriatric Society

OBJECTIVES

To determine the prevalence of clinician perception of inappropriate cardiopulmonary resuscitation (CPR) regarding the last out‐of‐hospital cardiac arrest (OHCA) encountered in an adult 80 years or older and its relationship to patient outcome.

DESIGN

Subanalysis of an international multicenter cross‐sectional survey (REAPPROPRIATE).

SETTING

Out‐of‐hospital CPR attempts registered in Europe, Israel, Japan, and the United States in adults 80 years or older.

PARTICIPANTS

A total of 611 clinicians of whom 176 (28.8%) were doctors, 123 (20.1%) were nurses, and 312 (51.1%) were emergency medical technicians/paramedics.

RESULTS AND MEASUREMENTS

The last CPR attempt among patients 80 years or older was perceived as appropriate by 320 (52.4%) of the clinicians; 178 (29.1%) were uncertain about the appropriateness, and 113 (18.5%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the “appropriate” subgroup was 8 of 265 (3.0%), 1 of 164 (.6%) in the “uncertain” subgroup, and 2 of 107 (1.9%) in the “inappropriate” subgroup (P = .23); 503 of 564 (89.2%) CPR attempts involved non‐shockable rhythms.

CPR attempts in nursing homes accounted for 124 of 590 (21.0%) of the patients and were perceived as appropriate by 44 (35.5%) of the clinicians; 45 (36.3%) were uncertain about the appropriateness; and 35 (28.2%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the nursing home patients was 0 of 107 (0%); 104 of 111 (93.7%) CPR attempts involved non‐shockable rhythms.

Overall, 36 of 543 (6.6%) CPR attempts were undertaken despite a known written do not attempt resuscitation decision; 14 of 36 (38.9%) clinicians considered this appropriate, 9 of 36 (25.0%) were uncertain about its appropriateness, and 13 of 36 (36.1%) considered this inappropriate.

CONCLUSION

Our findings show that despite generally poor outcomes for older patients undergoing CPR, many emergency clinicians do not consider these attempts at resuscitation to be inappropriate. A professional and societal debate is urgently needed to ensure that first we do not harm older patients by futile CPR attempts.

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In Anticipation of the Inevitable: Preparing Older Americans for Cardiac Arrest - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Improving Delirium Care and Advancing the 4M Framework Using Cell Phone Videos of Mom and Dad - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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FDA approves use of drug to reduce risk of cardiovascular events in certain adult patient groups - FDA Press Releases

FDA expands the indication of Vascepa (icosapent ethyl) capsules to reduce the risk of cardiovascular events as an adjunct to maximally tolerated statin therapy in high-risk adult patients with elevated triglyceride levels. It is a fish oil-derived omega-3 fatty acid product indicated to reduce the

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FDA clears first fully disposable duodenoscope, eliminating the potential for infections caused by ineffective reprocessing - FDA Press Releases

The FDA today cleared for marketing in the U.S. the first fully disposable duodenoscope. The EXALT Model D Single-Use Duodenoscope is intended to provide visualization and access to the upper gastrointestinal (GI) tract to treat bile duct disorders and other upper GI problems.

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FDA authorizes first interoperable, automated insulin dosing controller designed to allow more choices for patients looking to customize their individual diabetes management device system - FDA Press Releases

The FDA has authorized marketing of an interoperable automated glycemic controller device that automatically adjusts insulin delivery to a person with diabetes by connecting to an alternate controller-enabled insulin pump (ACE pump) and integrated continuous glucose monitor (iCGM).

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Antibiotic repurposing: bis-catechol- and mixed ligand (bis-catechol-mono-hydroxamate)-teicoplanin conjugates are active against multidrug resistant Acinetobacter baumannii - Journal of Antibiotics

The Journal of Antibiotics, Published online: 13 December 2019; doi:10.1038/s41429-019-0268-7

Antibiotic repurposing: bis-catechol- and mixed ligand (bis-catechol-mono-hydroxamate)-teicoplanin conjugates are active against multidrug resistant Acinetobacter baumannii

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FDA grants accelerated approval to first targeted treatment for rare Duchenne muscular dystrophy mutation - FDA Press Releases

Today, the FDA approved a new treatment for Vyondys 53 (golodirsen) injection to treat Duchenne muscular dystrophy (DMD) patients

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Statement on new findings and current status of the romaine lettuce E. coli O157:H7 outbreak investigation - FDA Press Releases

Illnesses subsiding, FDA continues to aggressively investigate source and route of contamination to prevent future outbreaks

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Statement from FDA Commissioner Scott Gottlieb, M.D., on the agency’s continued efforts to bring competition to the insulin market to lower prices and expand access - FDA Press Releases

FDA is announcing a public hearing to discuss access to affordable insulin products.

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FDA authorizes first test to aid in newborn screening for Duchenne Muscular Dystrophy - FDA Press Releases

Today, the U.S. Food and Drug Administration authorized marketing of the first test to aid in newborn screening for Duchenne Muscular Dystrophy (DMD), a rare genetic disorder that causes progressive muscle deterioration and weakness.

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Economic Barriers to Antiretroviral Therapy in Nursing Homes - American Geriatric Society

OBJECTIVES

Our aim was to clarify if persons living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) have adequate economic access to antiretroviral therapy (ART) when admitted to nursing homes (NHs). Medicare Part A pays NHs a bundled skilled nursing rate that includes prescription drugs for up to 100 days, after which individuals are responsible for the costs.

DESIGN

A cross‐sectional study.

SETTING

NHs.

PARTICIPANTS

A total of 694 newly admitted long‐stay (>100 d) NH residents with HIV.

MEASUREMENTS

We used Minimum Dataset v.3.0, pharmacy dispensing data, NH provider surveys, and Medicare claims from 2011 to 2013. We assessed receipt of any HIV antiretrovirals or recommended combinations (ART), as defined by national care guidelines, and the source of payment. We identified predictors of antiretroviral use with risk‐adjusted generalized estimating equation logistic models.

RESULTS

All study persons living with HIV/AIDS in NHs had prescription drug coverage through Medicare's Part D program, and ART was 100% covered. However, only 63.9% received recommended ART, and 15.2% never received any antiretrovirals during their NH stay. The strongest predictor of not receiving antiretrovirals was the first 100 days of a long NH stay (odds ratio [OR] = .44; 95% confidence interval [CI] = .24‐.80). The strongest predictor of receiving recommended ART was health acuity (OR = 1.51; 95% CI = 1.20‐1.88).

CONCLUSION

People living with HIV in NHs do not always receive lifesaving ART, but the reasons are unclear and appear unrelated to economic barriers.

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Design, synthesis and antimicrobial studies of some polymyxin analogues - Journal of Antibiotics

The Journal of Antibiotics, Published online: 12 December 2019; doi:10.1038/s41429-019-0262-0

Design, synthesis and antimicrobial studies of some polymyxin analogues

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When Women Rise, We All Rise: American Geriatrics Society Position Statement on Achieving Gender Equity in Geriatrics - American Geriatric Society

Supporting gender equity for women working in geriatrics is important to the growth of geriatrics across disciplines and is critical in achieving our vision for a future in which we are all able to contribute to our communities and maintain our health, safety, and independence as we age. Discrimination can have a negative impact on public health, particularly with regard to those who care for the health of older Americans and other vulnerable older people. Women working in the field of geriatrics have experienced implicit and explicit discriminatory practices that mirror available data on the entire workforce. In this position article, we outline strategic objectives and accompanying practical recommendations for how geriatrics, as a field, can work together to achieve a future in which the rights of women are guaranteed and women in geriatrics have the opportunity to achieve their full potential. This article represents the official positions of the American Geriatrics Society. J Am Geriatr Soc 67:2447–2454, 2019

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

OBJECTIVES

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

DESIGN

Longitudinal cohort.

SETTING

Health and Retirement Study.

PARTICIPANTS

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

MEASUREMENTS

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

RESULTS

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

CONCLUSION

Prescription pain and sleep drug use is significantly associated with increased incidence of frailty. Research to estimate effects of pain and sleep indications and of drug class–specific dosage and duration on incident frailty is indicated before advocating deprescribing based on these findings. J Am Geriatr Soc 67:2474–2481, 2019

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Institutional Special Needs Plans and Hospice Enrollment in Nursing Homes: A National Analysis - American Geriatric Society

BACKGROUND

Institutional Special Needs Plans (I‐SNPs) in nursing homes could impact hospice use by residents with advanced illness. Little is known about their relationship.

OBJECTIVE

To determine whether I‐SNP availability has been associated with changes in hospice utilization.

DESIGN

Federal data from 2011 and 2013 were extracted from the Minimum Data Set (MDS) and other sources. Multilevel models evaluated I‐SNP–, resident‐, and facility‐related variables as predictors of hospice utilization.

SETTING

All US nursing homes in 2011 (N = 15 750) and 2013 (N = 15 732).

PARTICIPANTS

Nursing home residents enrolled in Medicare or in both Medicare and Medicaid.

MEASUREMENTS

Nursing home and resident data were obtained from Centers for Medicare and Medicaid Services sources: the MDS 3.0, Master Summary Beneficiary File, and Special Needs Plan Comprehensive Report.

RESULTS

The mean number of residents per nursing home was 210.9 (SD = 167.1) in 2011 and 217.2 (SD = 171.5) in 2013. The prevalence of I‐SNP contracts in nursing homes increased between 2011 and 2013, from 55.2% (N = 8691) to 61.1% (N = 9605), respectively (P < .001). In multivariate analyses, greater hospice enrollment in nursing homes was associated with having at least one I‐SNP enrollee per month; year (2013 higher than 2011); smaller facility size; urban (vs rural) setting; location in the Northeast (vs Midwest); lower average resident mental status; higher average resident mobility; younger residents, on average; and facilities with higher proportions of residents with specific diagnoses (cancer, cirrhosis, and dementia). After adjusting for resident and nursing home characteristics, the association between monthly I‐SNP presence and hospice enrollment was found only in nursing homes with 50 or greater beds and there was a positive relationship with increasing size.

CONCLUSIONS

Growth of I‐SNPs has been associated with changes in hospice utilization, and the relationship varies by facility size. Studies are needed to clarify the nature of this association and determine whether care may be improved through coordination of these programs. J Am Geriatr Soc 67:2537–2544, 2019

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The Epidemiology of Patient‐Reported Hypersomnia in Persons With Advanced Age - American Geriatric Society

OBJECTIVE

To examine the epidemiology and key demographic and clinical correlates of patient‐reported hypersomnia in persons with advanced age.

DESIGN

Cross‐sectional design.

SETTING

Community.

PARTICIPANTS

A total of 357 community‐dwelling persons from the Yale Precipitating Events Project with a mean age of 84.2 years (range = 78‐102 years).

MEASUREMENTS

We studied patient‐reported hypersomnia, defined categorically by an Epworth Sleepiness Scale (ESS) score of 10 or greater; as well as the severity of hypersomnia symptoms, defined continuously by an ESS score range of 0 to 24 (higher scores denote greater sleepiness). In multivariable regression models, we examined cross‐sectional associations between key correlates and ESS score, expressed as categorical and continuous variables. Key correlates included: demographics, education, smoking status, body mass index, self‐reported medical conditions, Center for Epidemiologic Studies Depression score, Mini‐Mental State Examination score, Physical Activity Scale for the Elderly, restless legs syndrome (RLS), self‐reported sleep‐disordered breathing (SDB), medications, and Insomnia Severity Index.

RESULTS

Mean ESS score for all participants was 6.4. Patient‐reported hypersomnia (ESS score ≥10) was established in 82 participants (23.0%)—their mean ESS score was 13.0. In multivariable models, male sex, nonwhite race, arthritis, depressive symptoms, low physical activity, RLS, SDB, central nervous system depressant medications, and insomnia severity were cross‐sectionally associated with patient‐reported hypersomnia (higher adjusted odds ratios, ranging from 1.93‐2.86) and/or with the severity of hypersomnia symptoms (higher ESS scores, ranging from 0.11‐2.86 points).

CONCLUSION

Patient‐reported hypersomnia was prevalent in a sample of community‐dwelling persons with advanced age. In addition, based on cross‐sectional associations with the ESS score, key demographic and clinical characteristics were identified that may inform screening strategies for hypersomnia in advanced age. J Am Geriatr Soc 67:2545–2552, 2019

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

OBJECTIVES

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

DESIGN

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

SETTING

Nationally representative health interview survey in the United States.

PARTICIPANTS

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

MEASUREMENTS

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

RESULTS

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

CONCLUSION

Cost‐related medication nonadherence among older adults is increasingly common, with several potentially modifiable risk factors identified. Interventions, such as medication therapy management, may be needed to reduce cost‐related medication nonadherence in older adults. J Am Geriatr Soc 67:2463–2473, 2019

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Geriatrics 5Ms Pocket Card for Medical and Dental Students - American Geriatric Society

Journal of the American Geriatrics Society, Volume 67, Issue 12, Page E7-E9, December 2019.

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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. J Am Geriatr Soc 67:2458–2462, 2019

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

BACKGROUND/OBJECTIVES

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

DESIGN

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

SETTING

Prospective cohort study.

PARTICIPANTS

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

MEASUREMENTS

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

RESULTS

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

CONCLUSION

Among a well‐characterized cohort, LDL‐C was not associated with CVD risk among adults aged 75 years or older, even in the presence of other risk factors. J Am Geriatr Soc 67:2560–2567, 2019

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Variations in Costs of a Collaborative Care Model for Dementia - American Geriatric Society

OBJECTIVES

Care coordination programs can improve patient outcomes and decrease healthcare expenditures; however, implementation costs are poorly understood. We evaluate the direct costs of implementing a collaborative dementia care program.

DESIGN

We applied a micro‐costing analysis to calculate operational costs per‐participant‐month between March 2015 and May 2017.

SETTING

The University of California, San Francisco (UCSF) and the University of Nebraska Medical Center (UNMC).

PARTICIPANTS

Participants diagnosed with dementia, enrolled in Medicare or Medicaid, 45 years of age or older, residents of California, Nebraska or Iowa, and having a caregiver. The sample was 272 (UCSF) and 192 (UNMC) participants.

INTERVENTION

A collaborative dementia care program provided by care team navigators (CTNs), advanced practice nurses, a social worker, and a pharmacist, focusing on caregiver support and education, medications, advance care planning, and behavior symptom management.

MEASUREMENTS

We measured costs (personnel, supplies, equipment, and training costs) during three program periods, Start‐up, Early Operations, and Continuing Operations, and estimated the effects of caseload variation on costs.

RESULTS

Start‐up and Early Operations costs were, respectively, $581 and $328 (California), and $501 and $219 (Nebraska) per‐participant‐month. Average costs decreased across phases to $241 (California) and $142 (Nebraska) per‐participant‐month during Continuing Operations. We estimated that costs would range between $75 (UNMC) and $92 (UCSF) per‐participant‐month with the highest projected caseloads (90).

CONCLUSION

We found that CTN caseload is an important driver of service cost. We provide strategies for maximizing caseload without sacrificing quality of care. We also discuss current barriers to broad implementation that can inform new reimbursement policies. J Am Geriatr Soc 67:2628–2633, 2019

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

OBJECTIVES

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

DESIGN

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

SETTING

Four NHs in Switzerland.

PARTICIPANTS

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

INTERVENTION

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

MEASUREMENTS

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

RESULTS

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

CONCLUSION

Implementation of a multilevel pain management intervention did significantly improve average and worst pain intensity in NH residents. However, to effect clinical meaningful changes in interference from pain, a more comprehensive approach involving other disciplines may be necessary. J Am Geriatr Soc 67:2574–2580, 2019

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

OBJECTIVES

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

DESIGN

Prospective cohort study.

SETTING

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

PARTICIPANTS

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

MEASUREMENTS

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

RESULTS

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

CONCLUSION

Consistent with the current weight of evidence, our results suggest an association between polypharmacy and incident frailty. Prospective studies evaluating deprescribing interventions are needed to clarify whether reducing polypharmacy decreases frailty incidence. J Am Geriatr Soc 67:2482–2489, 2019

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Evaluation of a Multicomponent Care Transitions Program for High‐Risk Hospitalized Older Adults - American Geriatric Society

OBJECTIVES

To test the effectiveness of a multicomponent care transition intervention targeted at hospitalized patients, aged 75 years and older, at high risk for hospital readmissions, return emergency department (ED) visits, and related complications.

DESIGN

Implementation as a quality improvement program with propensity‐matched preintervention and concurrent comparison groups over a 12‐month period.

SETTING

A 400‐bed community teaching hospital.

PARTICIPANTS

Patients, aged 75 years and older, admitted to non–intensive care unit beds who met specific high‐risk criteria. The intervention group included 202 patients, and the concurrent and preintervention comparison groups included 4142 and 4592 patients, respectively.

MEASUREMENTS

Primary outcomes were 30‐day hospital readmissions and returns to the ED; 7‐day readmissions and ED visits were secondary measures.

RESULTS

Among the 202 patients enrolled in the “Safe Transitions for At‐Risk Patients” (“STAR”) program, 37 (18.3%) were readmitted within 30 days, in contrast to 14.3% and 14.6% in the concurrent and preintervention comparison groups, respectively. Rates for 30‐day return ED visits that did not result in hospitalization were 10.9% in the intervention group, and 7.2% and 7.9% in the comparison groups. STAR patients had greater 30‐day ED use than patients in the preintervention comparison group (5.0 percentage points; 95% confidence interval = 0.8‐9.3 percentage points; P = .020). Implementation challenges included suboptimal involvement of the participating hospital and post–acute care organizations and a relatively high proportion of patients who did not receive the intervention as planned, despite agreeing to participate before leaving the hospital.

CONCLUSION

A multicomponent care transitions intervention targeting high‐risk patients, aged 75 years and older, admitted to a community teaching hospital was not effective in reducing 30‐ or 7‐day readmissions or return ED visits. Our implementation experience offers many lessons for future programs for similar high‐risk geriatric populations. J Am Geriatr Soc 67:2634–2642, 2019

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

Objectives

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

Methods

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

Results

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

Conclusion

Among a community sample of older adults with preserved heart function, sarcopenia is associated with reductions in LV and LA sizes. Skeletal muscle mass was independently associated with specific indices of myocardial structure. J Am Geriatr Soc 67:2568–2573, 2019

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

Objectives

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

Design

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

Setting

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

Participants

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

Intervention

None.

Measurement

Mortality in the first year after hospital discharge.

Results

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

Conclusions

Older adults with Medicaid insurance have a higher 1‐year post‐hospitalization mortality compared with those with commercial insurance, especially among those discharged to SCFs. Future studies should investigate care disparities at SCFs that may mediate these higher mortality rates. J Am Geriatr Soc 67:2497–2504, 2019

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

OBJECTIVES

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

DESIGN

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

SETTING

Singapore.

PARTICIPANTS

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

MEASUREMENTS

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

RESULTS

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

CONCLUSION

Timely and appropriate management of vision and hearing impairment, especially when coexisting, among older adults has the potential to reduce the years of life they live with limitation in physical function and in ADLs. J Am Geriatr Soc 67:2528–2536, 2019

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

OBJECTIVES

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

DESIGN

Prospective cohort study.

SETTING

Helsinki Businessmen Study.

PARTICIPANTS

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

MEASUREMENTS

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

RESULTS

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

CONCLUSION

Among businessmen, a more favorable CVD profile in midlife was associated with better development of physical functioning in old age. J Am Geriatr Soc 67:2490–2496, 2019

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

OBJECTIVES

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

DESIGN

Cross‐sectional study.

SETTING

Baltimore Longitudinal Study of Aging.

PARTICIPANTS

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

MEASUREMENTS

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

RESULTS

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

CONCLUSION

In persons without clinically detectable neurological conditions, poor bimanual gesture imitation is associated with other indicators of brain health, including olfaction and selected cognitive function domains. Bimanual gesture imitation may be useful clinically to detect subtle brain changes in apparently healthy older adults. J Am Geriatr Soc 67:2581–2586, 2019

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

OBJECTIVES

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

DESIGN

Secondary analysis of three prospective cohort studies.

SETTING

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

PARTICIPANTS

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

MEASUREMENTS

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

RESULTS

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

CONCLUSION

These three resiliency groups following hip fracture may be useful for understanding mediators of physical resilience. They may provide a more detailed description of recovery patterns in multiple outcomes for use in clinical decision making. J Am Geriatr Soc 67:2519–2527, 2019

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

OBJECTIVE

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

DESIGN

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

SETTING/PARTICIPANTS/MEAUREMENTS

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

RESULTS

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

CONCLUSION

Variables available to HHC clinicians at the first postdischarge HHC visit can predict readmission risk and inform care plans in HHC. Future analyses incorporating measures of social determinants of health, such as housing instability or social support, have the potential to enhance prediction of this outcome. J Am Geriatr Soc 67:2505–2510, 2019

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Using Point‐of‐Care Ultrasound on Home Visits: The Home‐Oriented Ultrasound Examination (HOUSE) - American Geriatric Society

Journal of the American Geriatrics Society, Volume 67, Issue 12, Page 2662-2663, December 2019.

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Reply to: Adding a US Perspective for Stroke Risk in Noncompliant Older Adults - American Geriatric Society

Journal of the American Geriatrics Society, Volume 67, Issue 12, Page 2665-2666, December 2019.

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FDA issues warning letter for not including the most serious risks in advertisement for medication-assisted treatment drug - FDA Press Releases

FDA issues warning letter to Alkermes, Inc., for misbranding the drug Vivitrol (an extended-release injection formulation of naltrexone) by omitting warnings about the most serious risks associated with the drug from promotional materials

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Terphenyl derivatives and terpenoids from a wheat-born mold Aspergillus candidus - Journal of Antibiotics

The Journal of Antibiotics, Published online: 11 December 2019; doi:10.1038/s41429-019-0266-9

Terphenyl derivatives and terpenoids from a wheat-born mold Aspergillus candidus

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FDA underscores that consumers should not use drugs, dietary supplements and devices recalled from Basic Reset and Biogenyx following consent decree for federal violations - FDA Press Releases

The U.S. Food and Drug Administration is alerting consumers of a recall of 25 drug, dietary supplement and medical device product lines distributed by Basic Reset and Biogenyx.

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The Epidemiology of Patient‐Reported Hypersomnia in Persons With Advanced Age - American Geriatric Society

OBJECTIVE

To examine the epidemiology and key demographic and clinical correlates of patient‐reported hypersomnia in persons with advanced age.

DESIGN

Cross‐sectional design.

SETTING

Community.

PARTICIPANTS

A total of 357 community‐dwelling persons from the Yale Precipitating Events Project with a mean age of 84.2 years (range = 78‐102 years).

MEASUREMENTS

We studied patient‐reported hypersomnia, defined categorically by an Epworth Sleepiness Scale (ESS) score of 10 or greater; as well as the severity of hypersomnia symptoms, defined continuously by an ESS score range of 0 to 24 (higher scores denote greater sleepiness). In multivariable regression models, we examined cross‐sectional associations between key correlates and ESS score, expressed as categorical and continuous variables. Key correlates included: demographics, education, smoking status, body mass index, self‐reported medical conditions, Center for Epidemiologic Studies Depression score, Mini‐Mental State Examination score, Physical Activity Scale for the Elderly, restless legs syndrome (RLS), self‐reported sleep‐disordered breathing (SDB), medications, and Insomnia Severity Index.

RESULTS

Mean ESS score for all participants was 6.4. Patient‐reported hypersomnia (ESS score ≥10) was established in 82 participants (23.0%)—their mean ESS score was 13.0. In multivariable models, male sex, nonwhite race, arthritis, depressive symptoms, low physical activity, RLS, SDB, central nervous system depressant medications, and insomnia severity were cross‐sectionally associated with patient‐reported hypersomnia (higher adjusted odds ratios, ranging from 1.93‐2.86) and/or with the severity of hypersomnia symptoms (higher ESS scores, ranging from 0.11‐2.86 points).

CONCLUSION

Patient‐reported hypersomnia was prevalent in a sample of community‐dwelling persons with advanced age. In addition, based on cross‐sectional associations with the ESS score, key demographic and clinical characteristics were identified that may inform screening strategies for hypersomnia in advanced age. J Am Geriatr Soc 67:2545–2552, 2019

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