Wish to Die in Older Patients: Development and Validation of Two Assessment Instruments - American Geriatric Society

OBJECTIVES

The wish to die may be different in geriatric patients than in younger terminally ill patients. This study aimed to develop and validate instruments for assessing the wish to die in geriatric patients.

DESIGN

Cross‐sectional study.

SETTING

Geriatric rehabilitation unit of a university hospital.

PARTICIPANTS

Patients (N = 101) aged 65 years or older with a Mini‐Mental State Examination score of 20 or higher, admitted consecutively over a 5‐month period.

MEASUREMENTS

The Schedule of Attitudes Toward Hastened Death (SAHD) was adapted to the older population (SAHD‐Senior). A second tool was developed based on qualitative literature, the Categories of Attitudes Toward Death Occurrence (CADO). After cognitive pretesting, these instruments were validated in a sample of patients admitted to a geriatric rehabilitation unit.

RESULTS

The SAHD‐Senior showed good psychometric properties and a unifactorial structure. In the studied sample, 12.9% had a SAHD‐Senior score of 10 or higher, suggesting a significant wish to die. Associations were observed between high levels of the SAHD‐Senior and advanced age, high levels of depressive symptoms, lower quality of life, and lower cognitive function. The CADO allowed for passive death wishes to be distinguished from wishes to actively hasten death. According to the CADO, 14.9% of the sample had a wish to die. The two instruments showed a concordance rate of 90.1%.

CONCLUSION

The wish to die in older patients admitted to rehabilitation can be validly assessed with two novel instruments. The considerable proportion with a wish to die warrants investigation into concept, determinants, and management of the wish to die.

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Reply to Comment on: End‐of‐Life Decision Making and Treatment for Patients With Professional Guardians - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Comment on: End‐of‐Life Decision Making and Treatment for Patients With Professional Guardians - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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After ASPREE: Assessing Aspirin Usage in Older Adults Using an Interprofessional Approach - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Coronavirus (COVID-19) Update: FDA Issues New Policy to Help Expedite Availability of Diagnostics - FDA Press Releases

Coronavirus (COVID-19) FDA Issues New Policy to Help Expedite Availability of Diagnostics

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FDA Approves First Generic of Daraprim - FDA Press Releases

FDA has approved an application for first generic of Daraprim (pyrimethamine).

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Cost‐Effectiveness of Pharmacist‐Led Deprescribing of NSAIDs in Community‐Dwelling Older Adults - American Geriatric Society

OBJECTIVES

Older adults are often prescribed potentially inappropriate medications associated with adverse health outcomes and increased health services utilization. Developing Pharmacist‐led Research to Educate and Sensitize Community Residents to the Inappropriate Prescriptions Burden in the Elderly (D‐PRESCRIBE), a pragmatic randomized clinical trial, demonstrated how a community pharmacist‐led evidence‐based educational intervention successfully empowered community‐dwelling older adults and their physicians to reduce chronic use of inappropriate medications. The objective of this study was to evaluate the cost‐effectiveness of the D‐PRESCRIBE intervention for discontinuing nonsteroidal anti‐inflammatory drugs (NSAIDs).

DESIGN

Cost‐effectiveness analysis.

SETTING

Canada.

PARTICIPANTS

Community‐dwelling adults aged 65 years and older.

MEASUREMENTS

Decision analysis combining decision tree and Markov state transition modeling was developed to estimate the cost‐effectiveness of D‐PRESCRIBE (NSAIDs) compared with usual care from a Canadian healthcare system perspective with a time horizon of 1 year. Data from the D‐PRESCRIBE trial and published literature were used to calculate effectiveness, utilities, and costs. Reference case and scenario analyses were conducted using probabilistic modeling. Sensitivity analyses assessed the robustness of the reference case model.

RESULTS

D‐PRESCRIBE (NSAIDs) was less costly (−$1008.61) and more effective (.11 quality‐adjusted life‐years [QALYs]) than usual care and was the dominant strategy. At willingness‐to‐pay thresholds of $50 000 per QALY and $100 000 per QALY, D‐PRESCRIBE (NSAIDs) incurred a positive incremental net benefit compared with usual care, suggesting it is cost‐effective. Compared with the reference case, scenario analyses gave comparable QALYs with modest variation in cost estimates.

CONCLUSION

For community‐dwelling older adults, D‐PRESCRIBE (NSAIDs) provides greater benefits at lower system costs, making it a compelling strategy to reduce the use and harms associated with chronic NSAID consumption. Our findings support reimbursing community pharmacists’ clinical professional services for deprescribing inappropriate NSAIDs in community‐dwelling older adults.

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Primary Care Physician and Beneficiary Characteristics Associated With Billing for Advance Care Planning - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Home Visits Improve Attitudes and Self‐Efficacy: A Longitudinal Curriculum for Residents - American Geriatric Society

OBJECTIVES

To develop a competency‐based, adaptable home visit curricula and clinical framework for family medicine (FM) residents, and to examine resident attitudes, self‐efficacy, and skills following implementation.

DESIGN

Quantitative analysis of resident survey responses and qualitative thematic analysis of written resident reflections.

SETTING

Urban FM residency program.

PARTICIPANTS

A total of 43 residents and 20 homebound patients in a home‐based primary care program.

INTERVENTION

A home‐based primary care practice and accompanying curriculum for FM residents was developed and implemented to improve learners’ confidence and skills to perform home visits.

MEASUREMENTS

A 10‐question survey with a 4‐point Likert scale and open‐ended responses. Written resident reflections following home visits.

RESULTS

Over 3 years, 43 unique respondents completed a total of 79 surveys evaluating attitudes, skills, and barriers to home care. Some residents may have completed the survey more than once at different stages in their training. Overall, 86% are interested in home visits in future practice, and 78% of survey responses indicated an increased likelihood to perform home visits with more training. Learners with two or more home visits reported significantly improved confidence. Themes across all resident reflections included social determinants of health, patient‐physician relationship, patient‐home assessment, patient autonomy/independence, and physician wellness/attitudes. Residents described how home visits encourage more holistic care to improve outcomes for patients who are homebound.

CONCLUSION

Our home visit curriculum provided new learning, an enhanced desire to practice home‐based primary care, improved learner confidence, and could help residents meet the need of a growing population of adults who are homebound.

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The Long View of the LIFE Trial and a Life's Work - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Impact and Lessons From the Lifestyle Interventions and Independence for Elders (LIFE) Clinical Trials of Physical Activity to Prevent Mobility Disability - American Geriatric Society

BACKGROUND

Walking independently is basic to human functioning. The Lifestyle Interventions and Independence for Elders (LIFE) studies were developed to assess whether initiating physical activity could prevent major mobility disability (MMD) in sedentary older adults.

METHODS

We review the development and selected findings of the LIFE studies from 2000 through 2019, including the planning phase, the LIFE‐Pilot Study, and the LIFE Study.

RESULTS

The planning phase and the LIFE‐Pilot provided key information for the successful implementation of the LIFE Study. The LIFE Study, involving 1635 participants randomized at eight sites throughout the United States, showed that compared with health education, the physical activity program reduced the risk of the primary outcome of MMD (inability to walk 400 m: hazard ratio = 0.82; 95% confidence interval = 0.69‐0.98; P = .03), and that the intervention was cost‐effective. There were no significant effects on cognitive outcomes, cardiovascular events, or serious fall injuries. In addition, the LIFE studies provided relevant findings on a broad range of other outcomes, including health, frailty, behavioral outcomes, biomarkers, and imaging. To date, the LIFE studies have generated a legacy of 109 peer‐reviewed publications, 19 ancillary studies, and 38 independently funded grants and clinical trials, and advanced the development of 59 early career scientists. Data and biological samples of the LIFE Study are now publicly available from a repository sponsored by the National Institute on Aging (https://urldefense.proofpoint.com/v2/url?u=https-3A__agingresearchbiobank.nia.nih.gov&d=DwMFAg&c=pZJPUDQ3SB9JplYbifm4nt2lEVG5pWx2KikqINpWlZM&r=ZX4a6hcfLVk9tpCPmkSujQ&m=iTPARxl_LBOimJoAcWK4efKQBWBHszm-g4mUN_o5-bc&s=SrlCccrcYCFSyWnnprcB3rJXT3W3FkGkW0XmdJITNhE&e=https://agingresearchbiobank.nia.nih.gov).

CONCLUSIONS

The LIFE studies generated a wealth of important scientific findings and accelerated research in geriatrics and gerontology, benefiting the research community, trainees, clinicians, policy makers, and the general public.

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Coronavirus (COVID-19) Supply Chain Update - FDA Press Releases

Coronavirus (COVID-19) Supply Chain Update

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Coronavirus (COVID-19) Update: No outbreak-related shortages identified, FDA continuing to closely monitor supply chain - FDA Press Releases

Coronavirus Update: No outbreak-related shortages identified, FDA continuing to closely monitor supply chain

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FDA Reminds Patients that Devices Claiming to Clean, Disinfect or Sanitize CPAP Machines Using Ozone Gas or UV Light Have Not Been FDA Authorized - FDA Press Releases

FDA informs patients and health care providers that devices claiming to clean, disinfect or sanitize CPAP devices or accessories using ozone gas or UV light are not legally marketed for this use by the FDA.

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Self‐Administered Acupressure for Caregivers of Older Family Members: A Randomized Controlled Trial - American Geriatric Society

OBJECTIVE

To test whether self‐administered acupressure reduces stress and stress‐related symptoms in caregivers of older family members.

DESIGN

In this randomized, assessor‐blind, controlled trial, 207 participants were randomized (1:1) to an acupressure intervention or a wait‐list control group.

SETTING

Community centers in Hong Kong, China.

PARTICIPANTS

Primary caregivers of an older family member who screened positive for caregiver stress with symptoms of fatigue, insomnia, or depression.

INTERVENTION

The 8‐week intervention comprised four training sessions on self‐administered acupressure, two follow‐up sessions for learning reinforcement, and daily self‐practice of self‐administered acupressure.

MEASUREMENTS

The primary outcome was caregiver stress (Caregiver Burden Inventory). Secondary outcomes included fatigue (Piper Fatigue Scale), insomnia (Pittsburgh Sleep Quality Index), depression (Patient Health Questionnaire), and health‐related quality of life (QoL) (12‐item Short‐Form Health Survey version 2). An intention‐to‐treat analysis was adopted.

RESULTS

Of 207 participants, 201 completed the study. Caregiver stress in the intervention group was significantly lower than that in the control group after 8 weeks (difference = −8.12; 95% confidence interval [CI] = −13.20 to −3.04; P = .002) and at 12‐week follow‐up (difference = −8.52; 95% CI = −13.91 to −3.12; P = .002). The intervention group, relative to the control group, also had significantly improved secondary outcomes of fatigue (difference = −0.84; 95% CI = −1.59 to −0.08; P = .031), insomnia (difference = −1.34; 95% CI = −2.40 to −0.27; P = .014), depression (difference = −1.76; 95% CI = −3.30 to −0.23; P = .025), and physical health‐related QoL (difference = 3.08; 95% CI = 0.28‐5.88; P = .032) after 8 weeks.

CONCLUSION

Self‐administered acupressure intervention significantly relieves self‐reported caregiver stress and co‐occurring symptoms in those caring for older family members. Further studies are needed to measure the symptoms objectively and to examine the clinical importance of the observed improvement in caregiver stress.

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Literacy Mediates Racial Differences in Financial and Healthcare Decision Making in Older Adults - American Geriatric Society

BACKGROUND/OBJECTIVES

Decision making in financial and healthcare matters is of critical importance for well‐being in old age. Preliminary work suggests racial differences in decision making; however, the factors that drive racial differences in decision making remain unclear. We hypothesized literacy, particularly financial and health literacy, mediates racial differences in decision making.

DESIGN

Community‐based epidemiologic cohort study.

SETTING

Communities in northeastern Illinois.

PARTICIPANTS

Nondemented Black participants (N = 138) of the Rush Alzheimer's Disease Center Minority Aging Research Study and the Rush Memory and Aging Project who completed decision‐making and literacy measures were matched to White participants (N = 138) according to age, education, sex, and global cognition using Mahalanobis distance (total N = 276).

MEASUREMENTS

All participants completed clinical assessments, a decision‐making measure that resembles real‐world materials relevant to finance and healthcare, and a financial and health literacy measure. Regression models were used to examine racial differences in decision making and test the hypothesis that literacy mediates this association. In secondary analyses, we examined the impact of literacy in specific domains of decision making (financial and healthcare).

RESULTS

In models adjusted for age, education, sex, and global cognition, older Black adults performed lower than older White adults on literacy (β = −8.20; SE = 1.34; 95% CI = −10.82 to −5.57; P < .01) and separately on decision making (β = −.80; SE = .23; 95% CI = −1.25 to −.34; P < .01). However, when decision making was regressed on both race and literacy, the association of race was attenuated and became nonsignificant (β = −.45; SE = .24; 95% CI = −.93 to .02; P = .06), but literacy remained significantly associated with decision making (β = .04; SE = .01; 95% CI = .02‐.06; P < .01). In secondary models, a similar pattern was observed for both financial and healthcare decision making.

CONCLUSIONS

Racial differences in decision making are largely mediated by literacy. These findings suggest that efforts to improve literacy may help reduce racial differences in decision making and improve health and well‐being for diverse populations.

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Motoric Cognitive Risk Syndrome in Polypharmacy - American Geriatric Society

OBJECTIVES

Risk factors for motoric cognitive risk syndrome (MCR), a predementia syndrome characterized by slow gait and cognitive complaints, have been identified, but few are reversible. Polypharmacy is a potentially reversible risk factor for cognitive decline, but the relationship between MCR and polypharmacy has not been examined. Our aim was to compare the epidemiology of MCR and polypharmacy.

DESIGN

Cross‐sectional.

SETTING

Community‐based Health and Retirement Study cohort.

PARTICIPANTS

A total of 1119 adults 65 years and older (mean age = 74.7 ± 7.0 y; 59% female).

MEASUREMENTS

Polypharmacy is defined as the use of five or more regularly scheduled medications. MCR is defined as cognitive complaints and slow gait in an individual without dementia.

RESULTS

The prevalence of MCR among 417 participants with polypharmacy was 10%; it was 6% among 702 participants without polypharmacy. The odds of meeting MCR criteria in those with polypharmacy was 1.8 (confidence interval = 1.0‐3.0; P = .035) compared with those without polypharmacy, even after adjusting for high‐risk medication use.

CONCLUSION

Our results show the coexistence of MCR and polypharmacy in older adults, suggesting a potentially modifiable risk factor for dementia.

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Remembering Professor Toshikazu Oki (24 January 1935–11 April 2019) - Journal of Antibiotics

The Journal of Antibiotics, Published online: 27 February 2020; doi:10.1038/s41429-019-0269-6

Remembering Professor Toshikazu Oki (24 January 1935–11 April 2019)

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Neurological Changes and Depression - Geriatrics

This article covers current research on the relationship between depression and cognitive impairment in older adults. First, it approaches the clinical assessment of late-life depression and comorbid cognitive impairment. Cognitive risk factors for suicide are discussed. Research is then provided on neuropsychological changes associated with depression, discussing subjective cognitive impairment, mild cognitive impairment, and dementia profiles. In addition, literature regarding neuroimaging and biomarker findings in depressed older adults is presented. Finally, therapeutic models for treatment of late-life depression are discussed, including psychotherapy models, holistic treatments, pharmacologic approaches, and brain stimulation therapies.

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FDA Takes New Steps to Increase the Safety of Laparoscopic Power Morcellators when used in Gynecologic Surgeries - FDA Press Releases

FDA takes several steps to make the use of laparoscopic power morcellators safer in gynecologic surgeries: grants marketing authorization for updated labeling, releases draft guidance and issues a Safety Communication.

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Coronavirus Update: FDA steps to ensure quality of foreign products - FDA Press Releases

Coronavirus Update: FDA steps to ensure quality of foreign products

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FDA approves first generic of ProAir HFA - FDA Press Releases

FDA has approved an application for the first generic of ProAir HFA (albuterol sulfate) Inhalation Aerosol.

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Cost‐Effectiveness of Pneumococcal Vaccination Policies and Uptake Programs in US Older Populations - American Geriatric Society

BACKGROUND/OBJECTIVES

Recently revised vaccination recommendations for US adults, aged 65 years and older, include both 23‐valent pneumococcal polysaccharide vaccine (PPSV23) and 13‐valent pneumococcal conjugate vaccine (PCV13), with PCV13 now recommended for immunocompetent older people based on shared decision making. The public health impact and cost‐effectiveness of this recommendation or of pneumococcal vaccine uptake improvement interventions are unclear.

DESIGN

Markov decision analysis.

SETTING AND PARTICIPANTS

Hypothetical 65‐year‐old general and black population cohorts.

INTERVENTION

Current pneumococcal vaccination recommendations for US older people, an alternative policy omitting PCV13 in immunocompetent older people, and vaccine uptake improvement programs.

RESULTS

The current pneumococcal vaccination recommendation was the most effective strategy, but afforded slight public health benefits compared to an alternative (PPSV23 for all older people plus PCV13 for the immunocompromised) and cost greater than $750 000 per quality‐adjusted life‐year (QALY) gained in either population group with a vaccine uptake improvement program (absolute uptake increase = 12.3%; cost = $1.78/eligible patient) in place. The alternative strategy was more economically favorable, but cost greater than $100 000/QALY in either population, with or without an uptake intervention. Results were robust in sensitivity analyses; however, in black older people, the alternative strategy with an uptake program was most likely to be favored in probabilistic sensitivity analyses at a $150 000/QALY gained threshold.

CONCLUSION

Current pneumococcal vaccination recommendations for US older people are economically unfavorable compared to an alternative strategy omitting PCV13 in the immunocompetent. The alternative recommendation with an uptake improvement program may be economically reasonable in black population analyses and could be worth considering as a population‐wide recommendation if mitigating racial disparities is a priority.

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Medical Doctors and Dementia: A Longitudinal Study - American Geriatric Society

OBJECTIVE

To examine the association between being a medical doctor (MD) and the risk of incident dementia.

DESIGN

Cohort study.

SETTING

Olmsted County, Minnesota.

PARTICIPANTS

A total of 3460 participants (including 104 MDs), aged 70 years or older, of the population‐based Mayo Clinic Study of Aging.

MEASUREMENTS

Participants were randomly selected from the community and had comprehensive cognitive evaluations at baseline and approximately every 15 months to assess for diagnosis of dementia. For participants who withdrew from the follow‐up, dementia diagnosis was also assessed using information available in their medical record. The associations were examined using Cox proportional hazards models, adjusting for sex, education, and apolipoprotein E ε4, using age as the time scale.

RESULTS

MDs were older (vs “general population”), and most were males (93.3%). MDs without dementia at baseline did not have a significantly different risk for incident dementia (hazard ratio = 1.12; 95% confidence interval = 0.69‐1.82; P = .64) compared to the general population.

CONCLUSIONS

Although the study includes a small number of older, mainly male, MDs, it provides a preliminary insight on cognitive health later in life in MDs, while most previous studies examine the health of younger MDs. Larger longitudinal studies are needed to examine these associations and investigate if associations are modified by sex.

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FDA Authorizes Marketing of the First Genetic Test to Aid in the Diagnosis of Fragile X Syndrome - FDA Press Releases

Today, FDA authorized marketing of the first test to detect a genetic condition known as Fragile X Syndrome (FXS), the most common known cause of inherited developmental delay and intellectual disability.

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Disability and Recovery After Hospitalization for Medical Illness Among Community‐Living Older Persons: A Prospective Cohort Study - American Geriatric Society

Objectives

To determine for each basic, instrumental, and mobility activity after hospitalization for acute medical illness: (1) disability prevalence immediately before and monthly for 6 months after hospitalization; (2) disability incidence 1 month after hospitalization; and (3) recovery time from incident disability during months 2 to 6 after hospitalization.

Design

Prospective cohort study.

Setting

New Haven, Connecticut.

Participants

A total of 515 community‐living persons, mean age 82.7 years, hospitalized for acute noncritical medical illness and alive within 1 month of hospital discharge.

Measurements

Disability was defined monthly for each basic (bathing, dressing, walking, transferring), instrumental (shopping, housework, meal preparation, taking medications, managing finances), and mobility activity (walking a quarter mile, climbing flight of stairs, lifting/carrying 10 pounds, driving) if help was needed to perform the activity or if a car was not driven in the prior month.

Results

Disability was common 1 and 6 months after hospitalization for activities frequently involved in leaving the home to access care including walking a quarter mile (prevalence 65% and 53%, respectively) and driving (65% and 61%). Disability was also common for activities involved in self‐managing chronic health conditions including meal preparation (53% and 41%) and taking medications (41% and 31%). New disability was common and often prolonged. For example, 43% had new disability walking a quarter mile, and 30% had new disability taking medications, with mean recovery time of 1.9 months and 1.7 months, respectively. Findings were similar for the subgroup of persons residing at home (ie, not in a nursing home) at the first monthly follow‐up interview after hospitalization.

Conclusion

Disability in specific functional activities important to leaving home to access care and self‐managing health conditions is common, often new, and present for prolonged time periods after hospitalization for acute medical illness. Post‐discharge care should support patients through extended periods of vulnerability beyond the immediate transitional period.

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After Three Decades of Study, Hospital‐Associated Disability Remains a Common Problem - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Reply to Comment on: Can Hearing Aids Delay Time to Diagnosis of Dementia, Depression, or Falls in Older Adults? - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Comment on: Can Hearing Aids Delay Time to Diagnosis of Dementia, Depression, or Falls in Older Adults? - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Palliative Care for Dementia - Geriatrics

Dementia management is complicated by neuropsychiatric symptoms such that the longitudinal care of a psychiatrist or other mental health provider is often an essential part of patient care and a major source of family support. Given the importance of end-of-life continuity of care, the involvement of psychiatry in palliative and hospice services affords an important opportunity for growth. Common challenges involve sharing prognostic information with patients and families to aid in advance planning, and management of persistent pain and nutritional issues. Future research will yield important new insights and guidelines for care.

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FDA Announces Collaborative Review of Scientific Evidence to Support Associations Between Genetic Information and Specific Medications - FDA Press Releases

FDA is providing its view of the state of the current science in pharmacogenetics. FDA’s new web-based resource describes some of the gene-drug interactions for which it believes there is sufficient scientific evidence to support associations between certain genetic variants & specific medications.

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FDA Works to Ensure Smooth Regulatory Transition of Insulin and Other Biological Products - FDA Press Releases

Today, the U.S. Food and Drug Administration took additional steps to ensure a smooth regulatory transition aimed at increasing patient access to insulin products, as well as certain other biological products set to transition regulatory pathways in March

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Older Patient and Caregiver Perspectives on Medication Value and Deprescribing: A Qualitative Study - American Geriatric Society

OBJECTIVES

Shared decision making is essential to deprescribing unnecessary or harmful medications in older adults, yet patients' and caregivers' perspectives on medication value and how this affects their willingness to discontinue a medication are poorly understood. We sought to identify the most significant factors that impact the perceived value of a medication from the perspective of patients and caregivers.

DESIGN

Qualitative study using focus groups conducted in September and October 2018.

SETTING

Participants from the Pepper Geriatric Research Registry (patients) and the Pitt+Me Registry (caregivers) maintained by the University of Pittsburgh.

PARTICIPANTS

Six focus groups of community‐dwelling adults aged 65 years or older, or their caregivers, prescribed five or more medications in the preceding 12 months.

MEASUREMENTS

We sought to identify (1) general views on medication value and what makes medication worth taking; (2) how specific features such as cost or side effects impact perceived value; and (3) reactions to clinical scenarios related to deprescribing.

RESULTS

We identified four themes. Perceived effectiveness was the primary factor that caused participants to consider a medication to be of high value. Participants considered a medication to be of low value if it adversely affected quality of life. Participants also cited cost when determining value, especially if it resulted in material sacrifices. Participants valued medications prescribed by providers with whom they had good relationships rather than valuing level of training. When presented with clinical scenarios, participants ably weighed these factors when determining the value of a medication and indicated whether they would adhere to a deprescribing recommendation.

CONCLUSION

We identified that perceived effectiveness, adverse effects on quality of life, cost, and a strong relationship with the prescriber influenced patients' and caregivers' views on medication value. These findings will enable prescribers to engage older patients in shared decision making when deprescribing unnecessary medications and will allow health systems to incorporate patient‐centered assessment of value into systems‐based deprescribing interventions.

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Investigation of antibiotic resistance determinants and virulence factors of uropathogenic Escherichia coli - Journal of Antibiotics

The Journal of Antibiotics, Published online: 19 February 2020; doi:10.1038/s41429-020-0284-7

Investigation of antibiotic resistance determinants and virulence factors of uropathogenic Escherichia coli

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Colorado unapproved drug and dietary supplement makers ordered to cease operations for federal violations - FDA Press Releases

Yesterday, U.S. District Judge Marcia S. Krieger for the U.S. District Court for Colorado entered a consent decree of permanent injunction against EonNutra LLC, CDSM LLC and HABW LLC, manufacturers and distributors of unapproved drugs and dietary supplements, and their owner, Michael Floren, requiring Floren’s businesses to immediately cease operations until they come into compliance with federal laws.

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FDA Takes Action with Indian Government to Protect Consumers From Illicit Medical Products - FDA Press Releases

The FDA announced that in partnership with the Government of India, approximately 500 shipments of illicit and potentially dangerous, unapproved prescription drugs and combination medical devices were stopped from reaching American consumers.

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Deintensification of Diabetes Medications among Veterans at the End of Life in VA Nursing Homes - American Geriatric Society

OBJECTIVES

Many older adults with limited life expectancy and/or advanced dementia (LLE/AD) are potentially overtreated for diabetes and may benefit from deintensification. Our aim was to examine the incidence and predictors of diabetes medication deintensification in older Veterans with LLE/AD who were potentially overtreated at admission to Veterans Affairs (VA) nursing homes (community living centers [CLCs]).

DESIGN

Retrospective cohort study using linked VA and Medicare clinical/administrative data and Minimum Data Set assessments.

SETTING

VA CLCs.

PARTICIPANTS

A total of 6960 Veterans with diabetes and LLE/AD admitted to VA CLCs in fiscal years 2009 to 2015 with hemoglobin (Hb)A1c measured within 90 days of admission.

MEASUREMENTS

We evaluated treatment deintensification (discontinuation or dose reduction for a consecutive 7‐day period) among residents who were potentially overtreated (HbA1c ≤7.5% and receiving hypoglycemic medications). Competing risk models assessed 90‐day cumulative incidence of deintensification.

RESULTS

More than 40% (n = 3056) of Veteran CLC residents with diabetes were potentially overtreated. The cumulative incidence of deintensification at 90 days was 45.5%. Higher baseline HbA1c values were associated with a lower likelihood of deintensification (e.g., HbA1c 7.0‐7.5% vs <6.0%; adjusted risk ratio [aRR] = .57; 95% confidence interval [CI] = .50‐.66). Compared with non‐sulfonylurea oral agents (e.g., metformin), other treatment regimens were more likely to be deintensified (aRR = 1.31‐1.88), except for basal insulin (aRR = .59; 95% CI = .52‐.66). The only resident factor associated with increased likelihood of deintensification was documented end‐of‐life status (aRR = 1.12; 95% CI = 1.01‐1.25). Admission from home/assisted living (aRR = .85; 95% CI = .75‐.96), obesity (aRR = .88; 95% CI = .78‐.99), and peripheral vascular disease (aRR = .90; 95% CI = .81‐.99) were associated with decreased likelihood of deintensification.

CONCLUSION

Deintensification of treatment regimens occurred in less than one‐half of potentially overtreated Veterans and was more strongly associated with low HbA1c values and use of medications with high risk for hypoglycemia, rather than other resident characteristics.

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Use of Fall Risk–Increasing Drugs Around a Fall‐Related Injury in Older Adults: A Systematic Review - American Geriatric Society

OBJECTIVES

To examine: (1) prevalence of fall risk–increasing drug (FRID) use among older adults with a fall‐related injury, (2) which FRIDs were most frequently prescribed, (3) whether FRID use was reduced following the fall‐related healthcare episode, and (4) which interventions have reduced falls or FRID use in older adults with a history of falls.

DESIGN

Systematic review.

PARTICIPANTS

Observational and intervention studies that assessed (or intervened on) FRID use in participants aged 60 years or older who had experienced a fall.

MEASUREMENTS

PubMed and EMBASE were searched through June 30, 2019. Two reviewers independently extracted data and evaluated studies for bias. Discrepancies were resolved by consensus.

RESULTS

Fourteen of 638 articles met selection criteria: 10 observational studies and 4 intervention studies. FRID use prevalence at time of fall‐related injury ranged from 65% to 93%. Antidepressants and sedatives‐hypnotics were the most commonly prescribed FRIDs. Of the 10 observational studies, only 2 used a design adequate to capture changes in FRID use after a fall‐related injury, neither finding a reduction in FRID use. Three randomized controlled studies conducted in various settings (hospital, emergency department, and community pharmacy) with 12‐month follow‐up did not find a reduction in falls with interventions to reduce FRID use, although the study conducted in the community pharmacy setting was effective in reducing FRID use. In a nonrandomized (pre‐post) intervention study conducted in an outpatient geriatrics clinic, falls were reduced in the intervention group.

CONCLUSIONS

Limited evidence indicates high prevalence of FRID use among older adults who have experienced a fall‐related injury and no reduction in overall FRID use following the fall‐related healthcare encounter. There is a need for well‐designed interventions to reduce FRID use and falls in older adults with a history of falls. Reducing FRID use as a stand‐alone intervention may not be effective in reducing recurrent falls.

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Prevalent Statin Use in Long‐Stay Nursing Home Residents with Life‐Limiting Illness - American Geriatric Society

OBJECTIVES

To evaluate the prevalence and factors associated with statin pharmacotherapy in long‐stay nursing home residents with life‐limiting illness.

DESIGN

Cross‐sectional.

SETTING

US Medicare‐ and Medicaid‐certified nursing home facilities.

PARTICIPANTS

Long‐stay nursing home resident Medicare fee‐for‐service beneficiaries aged 65 years or older with life‐limiting illness (n = 424 212).

MEASUREMENTS

Prevalent statin use was estimated as any low‐moderate intensity (daily dose low‐density lipoprotein‐cholesterol [LDL‐C] reduction <30%‐50%) and high‐intensity (daily dose LDL‐C reduction >50%) use via Medicare Part D claims for a prescription supply on September 30, 2016, with a 90‐day look‐back period. Life‐limiting illness was operationally defined to capture those near the end of life using evidence‐based criteria to identify progressive terminal conditions or limited prognoses (<6 mo). Poisson models provided estimates of adjusted prevalence ratios and 95% confidence intervals for resident factors.

RESULTS

A total of 34% of residents with life‐limiting illness were prescribed statins (65‐75 y = 44.0%, high intensity = 11.1%; >75 y = 31.1%, high intensity = 5.4%). Prevalence of statins varied by life‐limiting illness definition. Of those with a prognosis of less than 6 months, 23% of the 65 to 75 and 12% of the older than 75 age groups were on statins. Factors positively associated with statin use included minority race or ethnicity, use of more than five concurrent medications, and atherosclerotic cardiovascular disease or risk factors.

CONCLUSION

Despite having a life‐limiting illness, more than one‐third of clinically compromised long‐stay nursing home residents remain on statins. Although recent national guidelines have expanded indications for statins, the benefit of continued therapy in an advanced age population near the end of life is questionable. Efforts to deprescribe statins in the nursing home setting may be warranted.

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FDA Approves Three Drugs for Nonprescription Use Through Rx-to-OTC Switch Process - FDA Press Releases

FDA Approves Three Drugs for Nonprescription Use Through Rx-to-OTC Switch Process

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FDA’s Actions in Response to 2019 Novel Coronavirus at Home and Abroad - FDA Press Releases

FDA is an active partner in the COVID-19 response, working closely with government and public health partners across HHS and international counterparts.

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Differential expression analysis of the SRB1 gene in fluconazole-resistant and susceptible strains of Candida albicans - Journal of Antibiotics

The Journal of Antibiotics, Published online: 14 February 2020; doi:10.1038/s41429-020-0283-8

Differential expression analysis of the SRB1 gene in fluconazole-resistant and susceptible strains of Candida albicans

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Epigenetic modulation of secondary metabolite profiles in Aspergillus calidoustus and Aspergillus westerdijkiae through histone deacetylase (HDAC) inhibition by vorinostat - Journal of Antibiotics

The Journal of Antibiotics, Published online: 14 February 2020; doi:10.1038/s41429-020-0286-5

Epigenetic modulation of secondary metabolite profiles in Aspergillus calidoustus and Aspergillus westerdijkiae through histone deacetylase (HDAC) inhibition by vorinostat

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Assessing the Quality of Human Immunodeficiency Virus Care in Nursing Homes - American Geriatric Society

BACKGROUND

Quality of human immunodeficiency virus (HIV) care in nursing homes (NHs) has never been measured.

DESIGN

A cross‐sectional study.

SETTING

NHs.

PARTICIPANTS

A total of 203 NHs and 1375 persons living with HIV.

MEASUREMENTS

Medicare claims from 2011 to 2013 were linked to assessments of resident health, prescription dispensing data, and national reports of NH characteristics. Five nationally validated HIV care quality measures (prescription of antiretroviral therapy; CD4/viral load monitoring; frequency of medical visits; gaps in medical visits; and Pneumocystis pneumonia prophylaxis) were adapted and applied to NHs. Logistic regression predicted compliance by organizational factors. Random intercept logistic regression predicted if persons living with HIV received care by person and organizational factors.

RESULTS

Compliance ranged from 43.3% (SD = 31.1%) for CD4/viral load monitoring to 92.4% (SD = 13.6%) for gaps in medical visits. More substantiated complaints against an NH decreased the likelihood of high compliance with CD4/viral load monitoring (odds ratio [OR] = 0.846; 95% confidence interval [CI] = 0.726‐0.986), while NH‐reported incidents increased the likelihood of high compliance with pneumocystis pneumonia prophylaxis (OR = 1.173; 95% CI = 1.044‐1.317). Differences between NHs explained 21.2% or less of variability in receipt of care.

CONCLUSIONS

Since 2013, the population with HIV and NH HIV care quality has inevitably evolved; however, this study provides previously unknown baseline metrics on NH HIV care quality and highlights significant challenges when measuring HIV care in NHs.

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Incidence and Predictors of Aspirin Discontinuation in Older Adult Veteran Nursing Home Residents at End of Life - American Geriatric Society

OBJECTIVES

Continuation of aspirin for secondary prevention in persons with limited life expectancy (LLE) is controversial. We sought to determine the incidence and predictors of aspirin discontinuation in veterans with LLE and/or advanced dementia (LLE/AD) who were taking aspirin for secondary prevention at nursing home admission, stratified by whether their limited prognosis (LP) was explicitly documented at admission.

DESIGN

Retrospective cohort study using linked Veterans Affairs (VA) and Medicare clinical/administrative data and Minimum Data Set resident assessments.

SETTING

All VA nursing homes (referred to as community living centers [CLCs]) in the United States.

PARTICIPANTS

Older (≥65 y) CLC residents with LLE/AD, admitted for 7 days or longer in fiscal years 2009 to 2015, who had a history of coronary artery disease and/or stroke/transient ischemic attack, and used aspirin within the first week of CLC admission (n = 13 844).

MEASUREMENTS

The primary dependent variable was aspirin discontinuation within the first 90 days after CLC admission, defined as 14 consecutive days of no aspirin receipt. Independent variables included an indicator for explicit documentation of LP, sociodemographics, environment of care characteristics, cardiovascular risk factors, bleeding risk factors, individual markers of poor prognosis (eg, cancer, weight loss), and facility characteristics. Fine and Gray subdistribution hazard models with death as a competing risk were used to assess predictors of discontinuation.

RESULTS

Cumulative incidence of aspirin discontinuation was 27% (95% confidence interval [CI] = 26%‐28%) in the full sample, 34% (95% CI = 33%‐36%) in residents with explicit documentation of LP, and 24% (95% CI = 23%‐25%) in residents with no such documentation. The associations of independent variables with aspirin discontinuation differed in residents with vs without explicit LP documentation at admission.

CONCLUSION

Just over one‐quarter of patients discontinued aspirin, possibly reflecting the unclear role of aspirin in end of life among prescribers. Future research should compare outcomes of aspirin deprescribing in this population.

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Reflections on Home - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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1-hydroxy-7-oxolavanducyanin and Δ7″,8″-6″-hydroxynaphthomevalin from Streptomyces sp. CPCC 203577 - Journal of Antibiotics

The Journal of Antibiotics, Published online: 12 February 2020; doi:10.1038/s41429-020-0282-9

1-hydroxy-7-oxolavanducyanin and Δ^7″,8″-6″-hydroxynaphthomevalin from Streptomyces sp. CPCC 203577

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Antimicrobial and antibiofilm activities of ursolic acid against carbapenem-resistant Klebsiella pneumoniae - Journal of Antibiotics

The Journal of Antibiotics, Published online: 12 February 2020; doi:10.1038/s41429-020-0285-6

Antimicrobial and antibiofilm activities of ursolic acid against carbapenem-resistant Klebsiella pneumoniae

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Chronic Disease Decision Making and “What Matters Most” - American Geriatric Society

The increasing use of the question, “What matters most to you?” is a welcome development in the effort to provide patient‐centered care. However, it is difficult for clinicians to translate answers to this question into treatment plans for chronic conditions, including recognizing when to consider options other than clinical practice guideline (CPG)–directed therapy. Goal elicitation is most helpful when a patient has different treatment options with clearly identifiable trade‐offs. In the face of trade‐offs, goal elicitation helps patients to prioritize among potentially competing outcomes. While decision aids (DAs) focus on trade‐offs by delineating options and outcomes, the robust outcome data necessary to create DAs for older patients with multimorbidity are often lacking and even mild cognitive impairment makes the use of DAs difficult. The challenges for providing chronic disease care to older patients who are at risk for adverse events from CPG‐directed therapy because of multimorbidity and/or frailty are to organize the complexity of individual combinations of diseases, conditions, and syndromes into common sets of trade‐offs and to identify those goals or priorities that will directly inform a plan of care.

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The Impact of Frailty on Long‐Term Patient‐Oriented Outcomes after Emergency General Surgery: A Retrospective Cohort Study - American Geriatric Society

OBJECTIVES

Few studies examine the impact of frailty on long‐term patient‐oriented outcomes after emergency general surgery (EGS). We measured the prevalence of frailty among older EGS patients and examined the impact of frailty on 1‐year outcomes.

DESIGN

Retrospective cohort study using 2008 to 2014 Medicare claims.

SETTING

Acute care hospitals.

PARTICIPANTS

Patients 65 years or older who received one of the five EGS procedures with the highest mortality burden (partial colectomy, small bowel resection, peptic ulcer disease repair, adhesiolysis, or laparotomy).

MEASUREMENTS

A validated claims‐based frailty index (CFI) identified patients who were not frail (CFI < .15), pre‐frail (.15 ≤ CFI < .25), mildly frail (.25 ≤ CFI < .35), and moderately to severely frail (CFI ≥ .35). Multivariable Cox regression compared 1‐year mortality. Multivariable Poisson regression compared rates of post‐discharge hospital encounters (hospitalizations, intensive care unit stay, emergency department visit) and home time over 1 year after discharge. All regression models adjusted for age, sex, race, admission from facility, procedure, sepsis, inpatient palliative care delivery, trauma center designation, hospital bed size, and teaching status, and they were clustered by patient and hospital referral region.

RESULTS

Among 468 459 older EGS adults, 37.4% were pre‐frail, 12.4% were mildly frail, and 3.6% were moderately to severely frail. Patients with mild frailty experienced a higher risk of 1‐year mortality compared with non‐frail patients (hazard ratio = 1.97; confidence interval [CI] = 1.94‐2.01). In the year after discharge, patients with mild and moderate to severe frailty had more hospital encounters compared with non‐frail patients (7.8 and 11.5 vs 2.0 per person‐year; incidence rate ratio [IRR] = 4.01; CI = 3.93‐4.08 vs IRR = 5.89; CI = 5.70‐6.09, respectively). Patients with mild and moderate to severe frailty also had fewer days at home in the year after discharge compared with non‐frail patients (256 and 203 vs 302 mean days; IRR = .97; CI = .96‐.97 vs IRR = .95; CI = .94‐.95, respectively).

CONCLUSION

Older EGS patients with frailty are at increased risk for poor 1‐year outcomes and decreased home time. Targeted interventions for older EGS patients with frailty during the index EGS hospitalization are urgently needed to improve long‐term outcomes.

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Improving Glycemic Control in African Americans With Diabetes and Mild Cognitive Impairment - American Geriatric Society

BACKGROUND/OBJECTIVES

Improving glycemic control in older African Americans with diabetes and mild cognitive impairment (MCI) is important as the population ages and becomes more racially diverse.

DESIGN

Randomized controlled trial.

SETTING

Recruitment from primary care practices of an urban academic medical center. Community‐based treatment delivery.

PARTICIPANTS

Older African Americans with MCI, low medication adherence, and poor glycemic control (N = 101).

INTERVENTIONS

Occupational therapy (OT) behavioral intervention and diabetes self‐management education.

MEASUREMENTS

The primary outcome was a reduction in hemoglobin A1c level of at least 0.5% at 6 months, with maintenance effects assessed at 12 months.

RESULTS

At 6 months, 25 of 41 (61.0%) OT participants and 22 of 46 (48.2%) diabetes self‐management education participants had a reduction in hemoglobin A1c level of at least 0.5%. The model‐estimated rates were 58% (95% confidence interval [CI] = 45%‐75%) and 48% (95% CI = 36%‐64%), respectively (relative risk [RR] = 1.21; 95% CI = 0.84‐1.75; P = .31). At 12 months, the respective rates were 21 of 39 (53.8%) OT participants and 24 of 49 (49.0%) diabetes self‐management education participants. The model‐estimated rates were 50% (95% CI = 37%‐68%) and 48% (95% CI = 36%‐64%), respectively (RR = 1.05; 95% CI = 0.70‐1.57; P = .81).

CONCLUSION

Both interventions improved glycemic control in older African Americans with MCI and poor glycemic control. This result reinforces the American Diabetes Associationʼs recommendation to assess cognition in older persons with diabetes and demonstrates the potential to improve glycemic control in this high‐risk population.

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Benefits and Harms of Statins in People with Dementia: A Systematic Review and Meta‐Analysis - American Geriatric Society

OBJECTIVES

More people with dementia also fall into the category of high vascular risk, for which a statin is usually prescribed. However, these recommendations are based on studies in people without dementia. We aimed to evaluate the evidence for the long‐term effectiveness and harm of statin therapy in patients with dementia.

DESIGN

Systematic review of randomized controlled trials and observational research.

SETTING

Publications from developed countries indexed in the PubMed, Web of Science, and Cochrane trial database between 2007 and 2019.

PARTICIPANTS

Trials including people with all types of dementia with a mean age older than 65 years.

INTERVENTION

Treatment with a statin for 6 months or longer.

MEASUREMENTS

Major adverse cardiovascular events, dementia progression, and general health at 2 years, or medication adverse events (AEs) at any time. Each article was assessed for bias using the Newcastle‐Ottawa or Cochrane Collaboration tools. A narrative synthesis and pooled analyses are reported.

RESULTS

Five articles met the inclusion criteria. They reported only on dementia of the Alzheimer's type. There was no evidence regarding cardiovascular events or general health. We made a very low confidence finding that statins reduce dementia progression based on three cohort studies of heterogeneous design. We made a very low confidence finding of no significant difference in AEs based on two randomized controlled trials of 18 months: odds ratios of any AE = 1.21 (95% confidence interval [CI] = .83‐1.77), serious AE = 1.03 (95% CI = .76‐1.87), and death = 1.69 (95% CI = .79‐3.62).

CONCLUSION

Evidence was insufficient to fully evaluate the efficacy of statins in people with dementia. We found that statins may have a small benefit delaying progression in Alzheimer's dementia, although this conflicted with previous findings from shorter randomized trials. For safety, the trial data lacked power to show clinically important differences between the groups. We recommend that clinical data be leveraged for further observational studies to inform prescribing decisions.

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Differences in Caregiver Reports of the Quality of Hospice Care Across Settings - American Geriatric Society

OBJECTIVES

To examine variation in reported experiences with hospice care by setting.

DESIGN

Consumer Assessment of Healthcare Providers and Systems Hospice (CAHPS®) Survey data from 2016 were analyzed. Multivariate linear regression analysis was used to examine differences in measure scores by setting of care (home, nursing home [NH], hospital, freestanding hospice inpatient unit [IPU], and assisted living facility [ALF]).

SETTING

A total of 2636 US hospices.

PARTICIPANTS

A total of 311 635 primary caregivers of patients who died in hospice.

MEASUREMENTS

Outcomes were seven hospice quality measures, including five composite measures that assess aspects of hospice care important to patients and families, including hospice team communication, timeliness of care, treating family member with respect, symptom management, and emotional and spiritual support, and two global measures of the overall rating of the hospice and willingness to recommend it to friends and family. Analyses were adjusted for mode of survey administration and differences in case‐mix between hospices.

RESULTS

Caregivers of decedents who received hospice care in a NH reported significantly worse experiences than caregivers of those in the home for all measures. ALF scores were also significantly lower than home for all measures, except providing emotional and spiritual support. Differences in NH and ALF settings compared to home were particularly large for hospice team communication (ranging from −11 to −12 on a 0‐100 scale) and getting help for symptoms (ranging from −7 to −10). Consistently across all care settings, hospice team communication, treating family member with respect, and providing emotional and spiritual support were most strongly associated with overall rating of care.

CONCLUSIONS

Important opportunities exist to improve quality of hospice care in NHs and ALFs. Quality improvement and regulatory interventions targeting the NH and ALF settings are needed to ensure that all hospice decedents and their family receive high‐quality, patient‐ and family‐centered hospice care.

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The Community‐Academic Aging Research Network: A Pipeline for Dissemination - American Geriatric Society

BACKGROUND/OBJECTIVES

The Community‐Academic Aging Research Network (CAARN) was created to increase the capacity and effectiveness of Wisconsin's Aging Network and the University of Wisconsin to conduct community‐based research related to aging. The purpose of this article is to describe CAARN's infrastructure, outcomes, and lessons learned.

DESIGN

Using principles of community‐based participatory research, CAARN engages stakeholders to participate in the design, development, and testing of older adult health interventions that address community needs, are sustainable, and improve health equity.

SETTING

Academic healthcare and community organizations.

PARTICIPANTS

Researchers, community members, and community organizations.

INTERVENTION

CAARN matches academic and community partners to develop and test evidence‐based programs to be distributed by a dissemination partner.

MEASUREMENTS

Number of partnerships and funding received.

RESULTS

CAARN has facilitated 33 projects since its inception in 2010 (30 including rural populations), involving 46 academic investigators, 52 Wisconsin counties, and 1 tribe. These projects have garnered 52 grants totaling $20 million in extramural and $3 million in intramural funding. Four proven interventions are being prepared for national dissemination by the Wisconsin Institute for Healthy Aging: one to improve physical activity; one to reduce bowel and bladder incontinence; one to reduce sedentary behavior; and one to reduce falls risk among Latinx older adults. Additionally, one intervention to improve balance using a modified tai chi program is being disseminated by another organization.

CONCLUSION

CAARN's innovative structure creates a pipeline to dissemination by designing for real‐world settings through inclusion of stakeholders in the early stages of design and by packaging community‐based health interventions for older adults so they can be disseminated after the research has been completed. These interventions provide opportunities for clinicians to engage with community organizations to improve the health of their patients through self‐management.

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How Nurse Practitioners Spend their Time in Nursing Facilities: Revisited 20 Years Later - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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The Prevention of Cardiovascular Disease in Older Adults - American Geriatric Society

Cardiovascular disease (CVD) is common in older adults. CVD is a significant cause of both death and disability in old age. Though the prevention and treatment of CVD have been extensively studied, historically older adults and especially those older than 75 years have been underrepresented in clinical investigations designed to determine the best way to prevent or treat CVD. As a result, geriatrics clinicians frequently need to decide which interventions to recommend for their patients by extrapolation from existing data, which may or may not be applicable to the patients they are caring for. This narrative review summarizes existing data regarding the prevention of three common CVDs in older adults: stroke, coronary artery disease, and peripheral artery disease. Special emphasis is given to the prevention of CVD in those aged 75 years or older.

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Interprofessional Education of Emergency Department Team on Falls in Older Adults - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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FDA Authorizes Marketing of First Cardiac Ultrasound Software That Uses Artificial Intelligence to Guide User - FDA Press Releases

Today, the U.S. Food and Drug Administration authorized marketing of software to assist medical professionals in the acquisition of cardiac ultrasound, or echocardiography, images.

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FDA Expertise Advancing the Understanding of Intentional Genomic Alterations in Animals - FDA Press Releases

FDA analysis published today advances the understanding of intentional genomic alterations in animals.

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Sex Differences in Dementia Primary Care Performance and Health Service Use: A Population‐Based Study - American Geriatric Society

OBJECTIVES

Growing evidence points to underlying sex differences in the risk factors and clinical presentation of dementia. It is unclear, however, whether sex differences also exist in the management and healthcare utilization of persons with dementia. We compared primary care performance and health service use indicators for newly identified men and women with dementia in Ontario, Canada, over a 12‐year period.

DESIGN

Population‐based, repeated cohort study between 2002 and 2014.

SETTING

Ontario, Canada.

PARTICIPANTS

A total of 318 350 community‐dwelling adults, aged 65 years and older, newly identified with dementia, followed for up to 1 year.

MEASUREMENTS

Eighteen indicators of primary care performance and health service use were assessed.

RESULTS

Approximately 60% of the study population were women. Few differences in the indicators were observed between sexes, although men had fewer diagnoses first recorded by the family physician, more visits to noncognition specialists, less use of home care, more hospitalizations and readmissions, and longer discharge delays. Most indicators remained relatively stable over time for both men (median relative change = 13.7%; interquartile range [IQR] = 4.5%‐29.7%) and women (median relative change = 15.7%; IQR = 5.9%‐31.5%). Notable improvements over time for both sexes included access to an interprofessional primary care team, use of home care, and decreased use of long‐term care. Areas of worsening included a higher occurrence of emergency department visits, lower continuity of care, and longer discharge delays.

CONCLUSION

These findings raise awareness on the similarities and differences in management and health system use for men and women newly diagnosed with dementia, particularly the imbalance in hospital and home care use. As health systems continue to adapt to meet the needs of the growing dementia population, policy makers and clinicians should be mindful to develop care plans and interventions that consider the influence of sex on the need for services.

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A new class of dimeric product isolated from the fungus Chaetomium globosum: evaluation of chemical structure and biological activity - Journal of Antibiotics

The Journal of Antibiotics, Published online: 05 February 2020; doi:10.1038/s41429-020-0281-x

A new class of dimeric product isolated from the fungus Chaetomium globosum: evaluation of chemical structure and biological activity

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Aging, Diabetes, Obesity, and Cognitive Decline: A Population‐Based Study - American Geriatric Society

BACKGROUND/OBJECTIVES

To investigate potential mechanisms underlying the well‐established relationship of diabetes and obesity with cognitive decline, among older adults participating in a population‐based study.

DESIGN/SETTING

Ten‐year population‐based cohort study.

PARTICIPANTS

A total of 478 individuals aged 65 years and older.

MEASUREMENTS

We assayed fasting blood for markers of glycemia (glucose and hemoglobin A1c [HbA1c]), insulin resistance (IR) (insulin and homeostatic model assessment of IR), obesity (resistin, adiponectin, and glucagon‐like peptide‐1), and inflammation (C‐reactive protein). We modeled these indices as predictors of the slope of decline in global cognition, adjusting for age, sex, education, APOE*4 genotype, depressive symptoms, waist‐hip ratio (WHR), and systolic blood pressure, in multivariable regression analyses of the entire sample and stratified by sex‐specific median WHR. We then conducted WHR‐stratified machine‐learning (Classification and Regression Tree [CART]) analyses of the same variables.

RESULTS

In multivariable regression analyses, in the entire sample, HbA1c was significantly associated with cognitive decline. After stratifying by median WHR, HbA1c remained associated with cognitive decline in those with higher WHR. No metabolic indices were associated with cognitive decline in those with lower WHR. Cross‐validated WHR‐stratified CART analyses selected no predictors in participants older than 87 to 88 years. Faster cognitive decline was associated, in lower WHR participants younger than 87 years, with adiponectin of 11 or greater; and in higher WHR participants younger than 88 years, with HbA1c of 6.2% or greater.

CONCLUSIONS

Our population‐based data suggest that, in individuals younger than 88 years with central obesity, even modest degrees of hyperglycemia might independently predispose to faster cognitive decline. In contrast, among those younger than 87 years without central obesity, adiponectin may be a novel independent risk factor for cognitive decline.

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

Journal of the American Geriatrics Society, Volume 68, Issue 2, Page 443-444, February 2020.

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

Journal of the American Geriatrics Society, Volume 68, Issue 2, Page 440-441, February 2020.

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

OBJECTIVE

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

DESIGN

Retrospective cohort study.

SETTING

Clinical Practice Research Datalink (1999‐2016).

PARTICIPANTS

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

MEASUREMENTS

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

RESULTS

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

CONCLUSION

Our data support statin initiation after a first MI in patients aged 80 years and older if continued for at least 2 years. Especially in patients with a low risk of 2‐year mortality, statins should be considered. J Am Geriatr Soc 68:329–336, 2020

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

OBJECTIVES

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

DESIGN

Ongoing prospective cohort study.

SETTING

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

PARTICIPANTS

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

MEASUREMENTS

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

RESULTS

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

CONCLUSION

Although quitting at any time suggested benefit, dementia risk depended on time since smoking cessation. Our study highlights the importance of early midlife cessation to decrease dementia risk. J Am Geriatr Soc 68:337–345, 2020

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Practicing Geriatrics: Mission Impossible? - American Geriatric Society

Journal of the American Geriatrics Society, Volume 68, Issue 2, Page 234-235, February 2020.

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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. J Am Geriatr Soc 68:297–304, 2020

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Predictors of Hip Fracture Despite Treatment with Bisphosphonates among Frail Older Adults - American Geriatric Society

OBJECTIVES

Bisphosphonates are effective at preventing hip fractures among older adults, yet many patients still fracture while on treatment and may benefit from additional preventive interventions. Little data are specifically available to target such efforts among bisphosphonate users. We aimed to identify predictors of hip fracture unique to frail older adults initiating pharmacologic treatment for osteoporosis.

DESIGN

Retrospective cohort using 2008‐2013 linked national Minimum Data Set assessments, Medicare claims, and nursing home (NH) facility data.

SETTING

NHs in the United States.

PARTICIPANTS

Long‐stay NH residents 65 years or older who initiated treatment with a bisphosphonate (N = 17 753). Estimates for bisphosphonate initiators were contrasted with those for calcitonin initiators (control group; N = 5348).

MEASUREMENTS

Hospitalized hip fracture outcomes were measured using Part A claims. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for 36 a priori selected potential predictors.

RESULTS

The mean (SD) age of the study population was 84 (8) years, 85% were women, and 51% had moderate to severe cognitive impairment. Predictors associated with a higher risk of hip fracture despite bisphosphonate use included age 75 years or older to 85 years (vs ≥65 to <75 y; HR = 1.25; 95% CI = 1.02‐1.55), female sex (HR = 1.33; 95% CI = 1.06‐1.67), white race (vs black race (HR = 1.87; 95% CI = 1.36‐2.58), and body mass index = 18.5‐24.9 (vs ≥30; HR = 1.93; 95% CI = 1.53‐2.42). Independent ability to transfer (vs total dependence; HR = 3.11; 95% CI = 1.83‐5.30) and occasional urinary incontinence (vs frequent; HR = 1.45; 95% CI = 1.18‐1.78) were also important predictors. Dementia, diabetes, psychoactive drug use, and other characteristics were not associated with post‐prescribing hip fracture. Predictors did not differ between bisphosphonate and calcitonin users.

CONCLUSION

Predictors of hip fracture among frail older adults did not differ between those who were new users of bisphosphonates vs calcitonin. Given the absence of risk factors unique to bisphosphonate users, targeting of fracture prevention efforts should extend beyond pharmacologic therapy to include existing nonpharmacologic therapies, particularly fall prevention strategies. J Am Geriatr Soc 68:256–260, 2020

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

Journal of the American Geriatrics Society, Volume 68, Issue 2, Page 426-428, February 2020.

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

OBJECTIVES

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

DESIGN

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

SETTING

Twelve Australian care homes in Canberra, Australia.

PARTICIPANTS

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

INTERVENTION

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

MEASUREMENTS

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

RESULTS

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

CONCLUSION

The data offer evidence for monthly triage meetings to transform the lives, deaths, and care of older people residing in care homes. J Am Geriatr Soc 68:305–312, 2020

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

BACKGROUND/OBJECTIVE

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

DESIGN

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

SETTING

Population‐based survey.

PARTICIPANTS

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

MEASURES

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

RESULTS

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

CONCLUSIONS

This study revealed high rates of depressive symptoms in the last year of life as well as differences in the burden of depressive symptoms. A public health approach must be taken to screen for and appropriately treat symptoms of depression across the lifespan. J Am Geriatr Soc 68:321–328, 2020

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

OBJECTIVES

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

DESIGN

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

SETTING

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

PARTICIPANTS

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

MEASUREMENTS

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

RESULTS

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

CONCLUSION

Lower physical functioning was associated with higher healthcare utilization and expenditures. These estimates are conservative because they do not capture long‐term care utilization due to the nature of MEPS. These results can be used to benchmark other healthcare resource benefits of interventions to maintain or improve physical functioning in older adults in noninstitutionalized settings. J Am Geriatr Soc 68:266–271, 2020

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Temporal and Geographic Variation in the Incidence of Alzheimer's Disease Diagnosis in the US between 2007 and 2014 - American Geriatric Society

OBJECTIVES

Our aim was to describe the incidence of Alzheimer's disease (AD) in the United States, overall and by geographic region.

DESIGN

We conducted retrospective analyses of administrative claims data for a 5% random sample of US Medicare beneficiaries aged 65 years or older. AD incidence, defined as a diagnosis for AD (International Classification of Disease, Ninth Revision, Clinical Modification code 331.0×) in a given year, with no AD diagnosis in the beneficiary's entire medical history, was estimated for each calendar year between 2007 and 2014. Beneficiaries were required to be enrolled in Medicare for the calendar year of evaluation as well as the preceding 12 months. In addition, a cross‐sectional assessment of geographic variation in AD incidence was conducted for 2014. For each population area (specifically, core‐based statistical area, as defined by the US Census Bureau), AD incidence was estimated overall, as well as adjusted for differences in underlying patient demographics and metrics of access to care and quality of care. Changes in AD incidence from 2007 were also estimated.

SETTING

US fee‐for‐service Medicare.

Participants

US Medicare beneficiaries aged 65 years or older with no history of AD.

RESULTS

Overall, the diagnosed incidence of AD decreased over time, from 1.53% in 2007 to 1.09% in 2014; trends were similar for most population areas. In 2014, the rates of AD incidence ranged from 0% to more than 3% across population areas, with the highest observed incidence rates in areas of the Midwest and the South. Statistical models explain little of the geographic variation, although following adjustment, the incidence rates increased the most (in relative terms) in rural areas of western states.

CONCLUSION

Our findings are consistent with previously reported estimates of incidence of AD in the United States and its recent declining trend. Additionally, the study highlights the considerable geographic variation in the incidence of AD in the United States and suggests that further research is needed to better understand the determinants of this geographic variation. J Am Geriatr Soc 68:346–353, 2020

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Reply to: MoCA Test Mandatory Training and Certification: What Is the Purpose? - American Geriatric Society

Journal of the American Geriatrics Society, Volume 68, Issue 2, Page 445-446, February 2020.

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MoCA Test Mandatory Training and Certification: What Is the Purpose? - American Geriatric Society

Journal of the American Geriatrics Society, Volume 68, Issue 2, Page 444-445, February 2020.

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

Journal of the American Geriatrics Society, Volume 68, Issue 2, Page 448-449, February 2020.

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

OBJECTIVES

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

DESIGN

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

RESULTS

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

CONCLUSION

Current international cardiovascular disease prevention guidelines provide little specific guidance for physicians who are considering statin discontinuation in older adults in the context of declining health status and short life expectancy. J Am Geriatr Soc 68:417–425, 2020

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Cognitive Performance Among Older Persons in Japan and the United States - American Geriatric Society

OBJECTIVE

To compare cognitive performance among Japanese and American persons, aged 68 years and older, using two nationally representative studies and to examine whether differences can be explained by differences in the distribution of risk factors or in their association with cognitive performance.

DESIGN

Nationally representative studies with harmonized collection of data on cognitive functioning.

SETTING

Nihon University Japanese Longitudinal Study of Aging and the US Health and Retirement Study.

PARTICIPANTS

A total of 1953 Japanese adults and 2959 US adults, aged 68 years or older.

MEASUREMENTS

Episodic memory and arithmetic working memory are measured using immediate and delayed word recall and serial 7s.

RESULTS

Americans have higher scores on episodic memory than Japanese people (0.72 points on a 20‐point scale); however, when education is controlled, American and Japanese people did not differ. Level of working memory was higher in Japan (0.36 on a 5‐point scale) than in the United States, and the effect of education on working memory was stronger among Americans than Japanese people. There are no differences over the age of 85 years.

CONCLUSION

Even with large differences in educational attainment and a strong effect of education on cognitive functioning, the overall differences in cognitive functioning between the United States and Japan are modest. Differences in health appear to have little effect on national differences in cognition. J Am Geriatr Soc 68:354–361, 2020

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Cover - American Geriatric Society

Journal of the American Geriatrics Society, Volume 68, Issue 2, Page C1-C1, February 2020.

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Courses and Conferences - American Geriatric Society

Journal of the American Geriatrics Society, Volume 68, Issue 2, Page 451-452, February 2020.

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

BACKGROUND

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

OBJECTIVE

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

DESIGN

A prospective observational study between January 2016 and March 2017.

SETTING

An academic medical center.

PARTICIPANTS

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

MAIN MEASURES

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

RESULTS

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

CONCLUSIONS

Low hospital physical activity, as measured by wearable accelerometers, is associated with HAD. Clinicians can utilize wearable technology data to refer patients to physical/occupational therapy services or other mobility interventions, like walking programs. J Am Geriatr Soc 68:261–265, 2020

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

Journal of the American Geriatrics Society, Volume 68, Issue 2, Page 438-439, February 2020.

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FDA Takes Significant Step in Coronavirus Response Efforts, Issues Emergency Use Authorization for the First 2019 Novel Coronavirus Diagnostic - FDA Press Releases

Today, FDA issued an EUA to enable emergency use of CDC’s 2019-nCoV Real-Time RT-PCR Diagnostic Panel. To date, this test has been limited to use at CDC laboratories; today’s authorization allows use of the test at any CDC-qualified lab across the country.

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Comment On: Practicing Geriatrics: Mission Impossible? - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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FDA and FTC Announce New Efforts to Further Deter Anti-Competitive Business Practices, Support Competitive Market for Biological Products to Help Americans - FDA Press Releases

The U.S. Food and Drug Administration and the Federal Trade Commission signed a joint statement regarding enhanced collaboration in support of a robust marketplace for biological products.

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Evaluating Resident Home Visit Performance: Introducing a Feedback Form Linked to ACGME Milestones - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Clinical Predictors of Intracranial Bleeding in Older Adults Who Have Fallen: A Cohort Study - American Geriatric Society

OBJECTIVES

Emergency department (ED) visits among older adults are frequently instigated by a fall at home. Some of these patients develop intracranial bleeding. The aim of this study was to identify the incidence of intracranial bleeding and the associated clinical features in older adults who present to the ED after falling.

DESIGN

Prospective cohort study.

SETTING

Three Canadian EDs.

PARTICIPANTS

A total of 2 176 patients age 65 years or older who presented to the ED with a fall were assessed, and 1753 were included. Inclusion criteria were a fall on level ground, off a bed, chair, or toilet, or from one or two steps within 48 hours.

MEASUREMENTS

Emergency physicians recorded predefined clinical findings on initial assessment. The primary outcome was intracranial bleeding, diagnosed either by computed tomography at the index visit or within 42 days. Associations between baseline clinical findings and the presence of intracranial bleeding were assessed with multivariable logistic regression.

RESULTS

A total of 1753 patients (median age = 82 y) were enrolled, of whom 39% were male, 35% were on antiplatelet therapy, and 25% were on an anticoagulant. The incidence of intracranial bleeding was 5.0% (95% confidence interval [CI] = 4.1‐6.1). Overall, 76 patients were diagnosed at the index ED visit, and 12 were diagnosed during follow‐up. Multivariable regression identified four clinical variables that were independently associated with intracranial bleeding: new abnormalities on neurologic examination (odds ratio [OR] = 4.4; 95% CI = 2.4‐8.1), bruise or laceration on the head (OR = 4.3; 95% CI = 2.7‐7.0), chronic kidney disease (OR = 2.4; 95% CI = 1.3‐4.6), and reduced Glasgow Coma Scale from normal (OR = 1.9; 95% CI = 1.0‐3.4).

CONCLUSION

The incidence of intracranial bleeding in our study was 5.0%. We found significant associations between intracranial bleeding and four simple clinical variables. We did not find significant associations between intracranial bleeding and antiplatelet or anticoagulant use.

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