Coronavirus (COVID-19) Update: Daily Roundup April 30, 2020 - FDA Press Releases

Coronavirus (COVID-19) Update: Daily Roundup

from FDA Press Releases RSS Feed https://ift.tt/3aTU5Vy
via IFTTT

Coronavirus (COVID-19) Update: FDA Includes Ventilator Developed by NASA in Ventilator Emergency Use Authorization - FDA Press Releases

Coronavirus (COVID-19) Update: FDA Includes Ventilator Developed by NASA in Ventilator Emergency Use Authorization

from FDA Press Releases RSS Feed https://ift.tt/2Yl6eAd
via IFTTT

American Geriatrics Society Policy Brief: COVID‐19 and Nursing Homes - American Geriatric Society

This policy brief sets forth the American Geriatrics Society's (AGS's) recommendations to guide federal, state, and local governments when making decisions about care for patients with coronavirus disease 2019 (COVID‐19) in nursing homes (NHs) and other long‐term care facilities (LTCFs). The AGS continues to review guidance set forth in peer‐reviewed articles and editorials, as well as ongoing and updated guidance from the Centers for Medicare and Medicaid Services, the Centers for Disease Control and Prevention, and other key agencies. This brief is based on the situation and any federal guidance/actions as of April 4, 2020. It is focused on NHs and other LTCFs, given their essential role in addressing the COVID‐19 pandemic.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2RkCKya
via IFTTT

Coronavirus (COVID-19) Update: Daily Roundup April 29, 2020 - FDA Press Releases

Coronavirus (COVID-19) Update: Daily Roundup

from FDA Press Releases RSS Feed https://ift.tt/35jjAhO
via IFTTT

FDA Grants Marketing of New Device for Continuous Dialysis Therapy for use in Pediatric Patients with Certain Kidney Conditions - FDA Press Releases

FDA grants marketing authorization for a new device indicated to provide continuous hemodialysis or hemofiltration therapy to critically ill pediatric patients weighing between 2.5 and 10 kilograms (or 5.5 to 22 pounds)

from FDA Press Releases RSS Feed https://ift.tt/2yaADXq
via IFTTT

First spring flowering - American Geriatric Society

Journal of the American Geriatrics Society, Accepted Article.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2KMRW3i
via IFTTT

Typically Atypical: COVID‐19 Presenting as a Fall in an Older Adult - American Geriatric Society

Journal of the American Geriatrics Society, Accepted Article.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2ycb2gF
via IFTTT

While Normal Life is Halting, Aging is Not - American Geriatric Society

Journal of the American Geriatrics Society, Accepted Article.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/3d9HyPF
via IFTTT

Examining Older Adult Cognitive Status in the Time of COVID‐19 - American Geriatric Society

Journal of the American Geriatrics Society, Accepted Article.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/3cYXuDY
via IFTTT

Canadian Geriatrics In The Time Of Covid‐19 - American Geriatric Society

Journal of the American Geriatrics Society, Accepted Article.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2SicF3n
via IFTTT

Post‐Acute Care Preparedness in a COVID‐19 World - American Geriatric Society

Journal of the American Geriatrics Society, Accepted Article.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2y9dBjF
via IFTTT

COVID‐19 Preparedness in Nursing Homes in the Midst of the Pandemic - American Geriatric Society

Journal of the American Geriatrics Society, Accepted Article.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/3f2J4EQ
via IFTTT

A Health System Response to COVID‐19 in Long Term Care and Post‐Acute Care: A Three‐Phase Approach - American Geriatric Society

ABSTRACT

The Seattle, Washington area was ground zero for coronavirus disease 2019 (COVID‐19). Its initial emergence in a skilled nursing facility (SNF) not only highlighted the vulnerability of its patients and residents, but also the limited clinical support that led to national headlines. Furthermore, the coronavirus pandemic heightened the need for improved collaboration among healthcare organizations and local and state public health. The University of Washington Medicine's Post‐Acute Care Network developed a three phase approach, Initial, Delayed and Surge Phases, to help slow the spread of the disease, support local area SNFs from becoming overwhelmed when inundated with COVID‐19 cases or persons under investigation, and help decrease the burden on area hospitals, clinics, and emergency medical services.

This article is protected by copyright. All rights reserved.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2KVMxY9
via IFTTT

Building the Infrastructure for Rapid Implementation of High‐Value Home‐Care Delivery Models - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/3f4sUdW
via IFTTT

Implementation of Post‐Acute Rehabilitation at Home: A Skilled Nursing Facility‐Substitutive Model - American Geriatric Society

OBJECTIVES

For patients who require frequent and intensive therapy services after hospitalization, rehabilitation is predominantly provided in skilled nursing facilities (SNFs). Delivering post‐acute rehabilitation in patientsʼ homes offers a potential alternative. Our aim was to describe and evaluate services and functional outcomes and then identify factors associated with the provision of a 30‐day post‐acute care (PAC) bundle of rehabilitation, medical, and social services provided via the Rehabilitation at Home (RaH) program.

DESIGN

Single‐arm retrospective review of patients participating in the RaH program.

SETTING

Multidisciplinary home‐based delivery of PAC in Manhattan.

PARTICIPANTS

Individuals 18 years or older residing in a specified catchment area and qualifying for SNF‐based rehabilitation services from October 2015 to September 2017.

RESULTS

A total of 237 patients participated in RaH over 264 episodes of care. Participants were predominantly older than 85 years (57%; mean = 84.2; standard deviation [SD] = 10.0 years) and of non‐Hispanic white (70%) race and ethnicity. Most were admitted after hospitalization (88.2%) for 117 different diagnostic related groups. Average length of stay in RaH was 14.2 (SD = 6.5) days with patients receiving 1.83 (SD = 2.22) medical provider, 1.67 (SD = 1.58) nursing, and 5.24 (SD = 1.05) physical therapist visits weekly. Most of the patients fully or almost fully met their goals for bed mobility (65%), bed transfer (69%), chair transfer (67%), and ambulation (64%) with the majority achieving moderate or considerable (61%) global functional improvement. Achieving moderate or considerable global improvement was negatively associated with dementia diagnosis (odds ratio [OR] = .23; 95% confidence interval [CI] = .08‐.71) and positively associated with higher baseline ambulation (OR = 5.51; 95% CI = 2.22‐13.66). At 30 days, 87.3% of participants were living in the community.

CONCLUSION

Delivering SNF‐level post‐acute rehabilitation care in patientsʼ homes for a broad range of diagnoses is feasible and associated with functional improvement. This approach may help older adults maintain living status in the community.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2KHANYO
via IFTTT

American Geriatrics Society (AGS) Policy Brief: COVID‐19 and Assisted Living Facilities - American Geriatric Society

Abstract

This policy brief sets forth the American Geriatrics Society's (AGS's) recommendations to guide federal, state, and local governments when making decisions about care for older adults in assisted living facilities (ALFs) during the COVID‐19 pandemic. It focuses on the need for personal protective equipment (PPE), access to testing, public health support for infection control, and workforce training. The AGS continues to review guidance set forth in peer‐reviewed articles, as well as ongoing and updated guidance from the U.S. Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), and other key agencies. This brief is based on the situation and any federal guidance or actions as of April 15, 2020. Joining a separate AGS policy brief on COVID‐19 in nursing homes (DOI: 10.1111/jgs.16477), this brief is focused on ALFs, given that varied structure and staffing can impact their response to COVID‐19.

This article is protected by copyright. All rights reserved.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2KHAGfQ
via IFTTT

Essential Long‐Term Care Workers Commonly Hold Second Jobs and Double‐ or Triple‐Duty Caregiving Roles - American Geriatric Society

Abstract

Objectives

Long‐term care (LTC) facilities are particularly dangerous places for the spread of Covid‐19 given that they house vulnerable, high‐risk populations. Transmission‐based precautions to protect residents, employees, and families alike must account for potential risks posed by LTC workers’ second jobs and unpaid care work. This observational study describes the prevalence of their (1) second jobs and (2) unpaid care work for dependent children and/or adult relatives (double‐ and triple‐duty caregiving) overall and by occupational group (registered nurses, licensed practical nurses, or certified nursing assistants).

Design

A descriptive, secondary analysis of data collected as part of the final wave of the Work, Family and Health Study.

Setting

Thirty nursing home facilities located throughout the northeastern United States.

Participants

A subset of 958 essential, facility‐based LTC workers involved in direct patient care.

Measurements

We present information on LTC workers’ demographic characteristics, health, features of their LTC occupation, additional paid work, wages, and double‐ or triple‐duty caregiving roles.

Results

The majority of LTC workers were certified nursing assistants, followed by licensed practical nurses and registered nurses. Overall, over 70% of these workers agreed or strongly agreed with the following statement: “When you are sick, you still feel obligated to come into work.” One‐sixth had a second job, where they worked an average of 20 hours per week, and over 60% held double‐ or triple‐duty caregiving roles. Additional paid work and unpaid care work characteristics did not significantly differ by occupational group, although the prevalence of second jobs was highest and accompanying work hours were longest among certified nursing assistants.

Conclusion

LTC workers commonly hold second jobs along with double‐ and triple‐duty caregiving roles. To slow the spread of Covid‐19, both the paid and unpaid activities of these employees warrant consideration in the identification of appropriate clinical, policy, and informal supports.

This article is protected by copyright. All rights reserved.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2VPFoPj
via IFTTT

Coronavirus, ageism, and Twitter: An evaluation of tweets about older adults and COVID‐19. - American Geriatric Society

Abstract

Objectives

In March 2020, the World Health Organization declared coronavirus disease 2019 (COVID‐19) a pandemic. High morbidity and mortality rates of COVID‐19 have been observed among older adults, and this has been widely reported in both mainstream and social media. The objective of this study was to analyze tweets related to COVID‐19 and older adults, and to identify ageist content.

Design and settings.

We obtained a representative sample of original tweets posted between March 12 and March 21, 2020, containing the keywords “elderly”, “older”, and/or “boomer” plus the hashtags “#COVID19” and/or “#coronavirus”.

Measurements.

We identified the type of user and number of followers for each account. Tweets were classified by three raters as: 1) informative; 2) personal accounts; 3) personal opinions; 4) advice seeking; 5) jokes; and 6) miscellaneous. Potentially offensive content, as well as that downplaying the severity of COVID‐19 because it mostly affects older adults, was identified.

Results

18,128 tweets were obtained, of which a random sample of 351 was analyzed. Most accounts (91.7%) belonged to individuals. The most common types of tweets were personal opinions (31.9%), followed by informative tweets (29.6%), jokes/ridicule (14.3%), and personal accounts (13.4%). Seventy‐seven tweets (21.9%) likely intended to ridicule or offend someone, while 21.1% had content which implied that the life of older adults was less valuable, or downplayed the relevance of COVID‐19.

Conclusions

Most COVID‐19 and older adults‐related tweets contained personal opinions, personal accounts, and jokes. Almost a quarter of analyzed tweets had ageist or potentially offensive content towards older adults.

This article is protected by copyright. All rights reserved.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/3d2u5ch
via IFTTT

Coronavirus (COVID-19) Update: Daily Roundup April 28, 2020 - FDA Press Releases

Coronavirus (COVID-19) Update: Daily Roundup

from FDA Press Releases RSS Feed https://ift.tt/2VL3gn7
via IFTTT

In vitro synergistic effect of retapamulin with erythromycin and quinupristin against Enterococcus faecalis - Journal of Antibiotics

The Journal of Antibiotics, Published online: 28 April 2020; doi:10.1038/s41429-020-0312-7

In vitro synergistic effect of retapamulin with erythromycin and quinupristin against Enterococcus faecalis

from The Journal of Antibiotics - Issue - nature.com science feeds https://ift.tt/3bW7UUI
via IFTTT

Coronavirus (COVID-19) Update: Daily Roundup April 27, 2020 - FDA Press Releases

Coronavirus (COVID-19) Update: Daily Roundup

from FDA Press Releases RSS Feed https://ift.tt/2SaDV3S
via IFTTT

FDA Warns Manufacturers and Retailers to Remove Certain E-cigarette Products Targeted to Youth from the Market - FDA Press Releases

FDA issued ten warning letters to retailers and manufacturers who sell, manufacture and/or import unauthorized electronic nicotine delivery system (ENDS) products targeted to youth or likely to promote use by youth.

from FDA Press Releases RSS Feed https://ift.tt/2W0alza
via IFTTT

Coronavirus (COVID-19) Update: FDA Continues to Ensure Availability of Alcohol-Based Hand Sanitizer During the COVID-19 Pandemic, Addresses Safety Concerns - FDA Press Releases

FDA provides an update on its efforts to ensure the availability of alcohol-based sanitizer

from FDA Press Releases RSS Feed https://ift.tt/35bokGA
via IFTTT

Racial Disparities Exist in Outcomes After Major Fragility Fractures - American Geriatric Society

BACKGROUND

Fractures associated with postmenopausal osteoporosis (PMO) are associated with pain, disability, and increased mortality. A recent, nationwide evaluation of racial difference in outcomes after fracture has not been performed.

OBJECTIVE

To determine if 1‐year death, debility, and destitution rates differ by race.

DESIGN

Observational cohort study.

SETTING

US Medicare data from 2010 to 2016.

PARTICIPANTS

Non‐Hispanic black and white women with PMO who have sustained a fragility fracture of interest: hip, pelvis, femur, radius, ulna, humerus, and clinical vertebral.

MEASUREMENTS

Outcomes included 1‐year: (1) mortality, identified by date of death in Medicare vital status information, (2) debility, identified as new placement in long‐term nursing facilities, and (3) destitution, identified as becoming newly eligible for Medicaid.

RESULTS

Among black and white women with PMO (n = 4,523,112), we identified 399,000 (8.8%) women who sustained a major fragility fracture. Black women had a higher prevalence of femur (9.0% vs 3.9%; P < .001) and hip (30.7% vs 28.0%; P < .001) fractures and lower prevalence of radius/ulna (14.7% vs 17.0%; P < .001) and clinical vertebral fractures (28.8% vs 33.5%; P < .001) compared with white women. We observed racial differences in the incidence of 1‐year outcomes after fracture. After adjusting for age, black women had significantly higher risk of mortality 1 year after femur, hip, humerus, and radius/ulna fractures; significantly higher risk of debility 1 year after femur and hip fractures; and significantly higher risk of destitution for all fractures types.

CONCLUSIONS

In a sample of Medicare data from 2010 to 2016, black women with PMO had significantly higher rates of mortality, debility, and destitution after fracture than white women. These findings are a first step toward understanding and reducing disparities in PMO management, fracture prevention, and clinical outcomes after fracture.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2yPkeaF
via IFTTT

Emergence of a multidrug-resistant ST 27 Escherichia coli co-harboring blaNDM-1, mcr-1, and fosA3 from a patient in China - Journal of Antibiotics

The Journal of Antibiotics, Published online: 27 April 2020; doi:10.1038/s41429-020-0306-5

Emergence of a multidrug-resistant ST 27 Escherichia coli co-harboring bla_NDM-1, mcr-1, and fosA3 from a patient in China

from The Journal of Antibiotics - Issue - nature.com science feeds https://ift.tt/3cNXTJq
via IFTTT

Characteristics of People with Dementia vs Other Conditions on Admission to Inpatient Palliative Care - American Geriatric Society

OBJECTIVES

Our aim was to (1) describe the clinical characteristics and symptoms of people diagnosed with dementia at the time of admission to inpatient palliative care; and (2) compare the nature and severity of these palliative care–related problems to patients with other chronic diseases.

DESIGN

Descriptive study using assessment data on point of care outcomes (January 1, 2013, to December 31, 2018).

SETTING

A total of 129 inpatient palliative care services participating in the Australian Palliative Care Outcomes Collaboration.

PARTICIPANTS

A total of 29,971 patients with a primary diagnosis of dementia (n = 1,872), lung cancer (n = 19,499), cardiovascular disease (CVD, n = 5,079), stroke (n = 2,659), or motor neuron disease (MND, n = 862).

MEASUREMENTS

This study reported the data collected at the time of admission to inpatient palliative care services including patients' self‐rated levels of distress from seven common physical symptoms, clinician‐rated symptom severity, functional dependency, and performance status. Other data analyzed included number of admissions, length of inpatient stay, and palliative care phases.

RESULTS

At the time of admission to inpatient palliative care services, relative to patients with lung cancer, CVD, and MND, people with dementia presented with lower levels of distress from most symptoms (odds ratios [ORs] range from .15 to .80; P < .05 for all) but higher levels of functional impairment (ORs range from 3.02 to 8.62; P < .001 for all), and they needed more assistance with basic activities of daily living (ORs range from 3.83 to 12.24; P < .001 for all). The trends were mostly the opposite direction when compared with stroke patients. Patients with dementia tended to receive inpatient palliative care later than those with lung cancer and MND.

CONCLUSION

The unique pattern of palliative care problems experienced by people with dementia, as well as the skills of the relevant health services, need to be considered when deciding on the best location of care for each individual. Access to appropriately trained palliative care clinicians is important for people with high levels of physical or psychological concerns, irrespective of the care setting or diagnosis.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2x681hp
via IFTTT

Longitudinal Associations of Religiosity and Physical Function in Older Irish Adults - American Geriatric Society

OBJECTIVES

Research into the link between religion and physical function has shown inconsistent results. Most studies have used self‐reported measures of physical function, and many have excluded those who are not religious and only compared levels of religious engagement within those groups that are religious. We aimed to assess the longitudinal associations of religious affiliation and religious attendance on two objective measures of physical function.

DESIGN

Longitudinal study using five waves of data from the Irish Longitudinal Study on Ageing (TILDA).

SETTING

Community‐dwelling adults in Ireland.

PARTICIPANTS

Adults aged 50 and over who participated in two or more waves of TILDA (n = 6,122),and a supplementary analysis of a sub‐sample aged 65 and over (n = 2,359).

MEASUREMENTS

Timed Up and Go (TUG) and grip strength were measured on at least two occasions. Data were collected approximately every 2 years over 10 years. Longitudinal linear mixed effects models were estimated to calculate the effect of religious affiliation and attendance on TUG and grip strength over time.

RESULTS

TUG scores increased by an average of .1 seconds with each year of age, which increased to .3 seconds by age 72 years. Grip strength scores decreased by .2 kg with each year of age and increased to −.3 kg per year by age 72. No overall differences were observed between religious affiliations in scores of TUG or grip strength.

CONCLUSION

Religious affiliation does not predict performance on objective physical function measures. Results are discussed with reference to the changing religious characteristics of the Irish population.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/353hSkN
via IFTTT

Breaking Social Isolation Amidst COVID‐19: A Viewpoint on Improving Access to Technology in Long‐Term Care Facilities - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2RxMk0N
via IFTTT

Associations of Coffee and Tea Consumption With Survival to Age 90 Years Among Older Women - American Geriatric Society

BACKGROUND

Coffee and tea are two of the most widely consumed beverages worldwide and have been associated with reduced risk of mortality in some studies. However, it is unknown whether consumption of these beverages is associated with survival to an advanced age.

OBJECTIVE

To examine associations of coffee and tea consumption with survival to age 90 years.

DESIGN

Prospective cohort study among participants from the Womenʼs Health Initiative, recruited during 1993 to 1998 and followed up until March 31, 2018.

SETTING

The setting included 40 US clinical centers.

PARTICIPANTS

A racially and ethnically diverse cohort of 27,480 older women, aged 65 to 81 years at baseline.

MEASUREMENTS

Women were classified as having either survived to age 90 years or died before this age. Consumption of caffeinated and decaffeinated coffee and caffeinated tea was assessed at baseline and categorized as 0, 1, 2 to 3, or 4 or more cups/day. Associations of coffee and tea consumption with survival to age 90 years were examined using logistic regression models adjusted for sociodemographic characteristics, lifestyle behaviors, dietary quality, and chronic disease history.

RESULTS

A total of 14,659 (53.3%) women survived to age 90 years during follow‐up. Caffeinated coffee, decaffeinated coffee, or caffeinated tea consumption was not significantly associated with survival to age 90 years after adjusting for confounders. Findings did not significantly vary by smoking, body mass index, or race/ethnicity.

CONCLUSION

No amount of coffee or tea consumption was associated with late‐age survival among older women. These findings may be reassuring to older women who consume coffee and tea as part of their daily diets but do not support drinking these beverages to achieve longevity.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2KucI7Q
via IFTTT

Characteristics and Palliative Care Needs of COVID‐19 Patients Receiving Comfort Directed Care - American Geriatric Society

Journal of the American Geriatrics Society, Accepted Article.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2VCCGME
via IFTTT

The COVID‐19 Pandemic: Experiences of a Geriatrician‐Hospitalist Caring for Older Adults - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2wCLsRq
via IFTTT

Coronavirus (COVID-19) Update: Daily Roundup April 24, 2020 - FDA Press Releases

Coronavirus (COVID-19) Update: Daily Roundup

from FDA Press Releases RSS Feed https://ift.tt/352wocs
via IFTTT

FDA Provides Updates on Adverse Event Reports and Postmarket Activities Associated with Essure - FDA Press Releases

FDA issued a letter to Bayer outlining conditions for submitting additional postmarket information to the agency about Essure. The letter applies to reportable adverse events Bayer is or becomes aware of from social media data received in relation to litigation.

from FDA Press Releases RSS Feed https://ift.tt/2S2Ubng
via IFTTT

Coronavirus (COVID-19) Update: FDA Reiterates Importance of Close Patient Supervision for ‘Off-Label’ Use of Antimalarial Drugs to Mitigate Known Risks, Including Heart Rhythm Problems - FDA Press Releases

FDA is reiterating the importance of close patient supervision for ‘off-label’ use of antimalarial drugs to mitigate known risks, including heart rhythm problems.

from FDA Press Releases RSS Feed https://ift.tt/2Kx0hbC
via IFTTT

Chlorinated bis-indole alkaloids from deep-sea derived Streptomyces sp. SCSIO 11791 with antibacterial and cytotoxic activities - Journal of Antibiotics

The Journal of Antibiotics, Published online: 24 April 2020; doi:10.1038/s41429-020-0307-4

Chlorinated bis-indole alkaloids from deep-sea derived Streptomyces sp. SCSIO 11791 with antibacterial and cytotoxic activities

from The Journal of Antibiotics - Issue - nature.com science feeds https://ift.tt/3cMgS70
via IFTTT

Coronavirus (COVID-19) Update: Daily Roundup April 23, 2020 - FDA Press Releases

Coronavirus (COVID-19) Update: Daily Roundup

from FDA Press Releases RSS Feed https://ift.tt/2XYeIgu
via IFTTT

FDA Warns Companies Illegally Selling CBD Products to Treat Medical Conditions, Opioid Addiction - FDA Press Releases

FDA has issued warning letters to two companies for illegally selling unapproved products containing cannabidiol (CBD) in ways that violate the FD&C Act, including claims that they can treat medical conditions, including opioid addiction.

from FDA Press Releases RSS Feed https://ift.tt/2S2ikKD
via IFTTT

Coronavirus (COVID-19) Update: Court Grants FDA’s Request for Extension of Premarket Review Submission Deadline for Certain Tobacco Products Because of Impacts from COVID-19 - FDA Press Releases

As a result of the COVID-19 pandemic, FDA requested and was granted by the court, a 120-day extension of the May 12 deadline for premarket applications for e-cigarettes, cigars and other new tobacco products. These premarket applications are now required to be filed by Sept. 9, 2020.

from FDA Press Releases RSS Feed https://ift.tt/2x2ZWdx
via IFTTT

Functional Competence and Cognition in Individuals With Amnestic Mild Cognitive Impairment - American Geriatric Society

OBJECTIVE

The objective of this study is to characterize functional competence (measure of assistance needed for independence) on Performance Assessment of Self‐Care Skills (PASS) Cognitively Mediated Instrumental Activities of Daily Living (C‐IADL), in individuals with amnestic mild cognitive impairment (aMCI). It aims to determine: (1) the association of functional competence on PASS C‐IADL tasks with neurocognitive test performance in aMCI, (2) its ability to discriminate individuals with aMCI from healthy control (HC) individuals, and (3) its added value in discriminating aMCI from HC individuals when combined with neurocognitive test performance.

DESIGN

Cross‐sectional secondary analysis of baseline data from a cohort of individuals enrolled in a clinical trial (NCT02386670).

SETTING

Five university‐affiliated outpatient clinics in Toronto, Canada.

PARTICIPANTS

aMCI (N = 137) and HC (N = 51) participants, all aged 60 years or older.

METHODS

We assessed the relationship between functional competence on three C‐IADL PASS tasks (shopping, bill paying, and checkbook balancing) and neurocognitive tests in 137 participants with aMCI using multiple linear regressions. Additionally, we constructed receiver operating characteristic curves to assess the role of PASS functional competence in discriminating between 137 aMCI and 51 HC participants.

RESULTS

Functional competence on PASS was significantly associated with tests of verbal memory, information processing speed, and executive function. It demonstrated 79% accuracy in discriminating aMCI from HC participants. Combining functional competence on PASS with individual neurocognitive tests significantly increased the discriminant accuracy of individual tests, and neurocognitive test scores combined with functional competence on PASS had the highest discriminant accuracy (94%).

CONCLUSION

Functional competence on PASS is predicted by the underlying cognitive deficits and possibly captures additional element of effort that could improve the diagnostic accuracy of aMCI when combined with neurocognitive tests. Thus, PASS appears to be a promising tool for assessment of functional competence in aMCI in clinical or research settings.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/3auTrhk
via IFTTT

To All Doctors: What You Can Do to Help as a Bunch of Older People Are About to Get Sick and Die - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2y3yHzz
via IFTTT

Coronavirus (COVID-19) Update: Daily Roundup April 22, 2020 - FDA Press Releases

Coronavirus (COVID-19) Update: Daily Roundup

from FDA Press Releases RSS Feed https://ift.tt/3cHL96W
via IFTTT

FDA Approves New Therapy for Triple Negative Breast Cancer That Has Spread, Not Responded to Other Treatments - FDA Press Releases

FDA granted accelerated approval to Trodelvy (sacituzumab govitecan-hziy) for the treatment of adult patients with triple-negative breast cancer that has spread. Patients must have received at least two prior therapies.

from FDA Press Releases RSS Feed https://ift.tt/2Vvpmd7
via IFTTT

Impact of STEADI‐Rx: A Community Pharmacy‐Based Fall Prevention Intervention - American Geriatric Society

OBJECTIVES

To evaluate the effects of a community pharmacy‐based fall prevention intervention (STEADI‐Rx) on the risk of falling and use of medications associated with an increased risk of falling.

DESIGN

Randomized controlled trial.

SETTING

A total of 65 community pharmacies in North Carolina (NC).

PARTICIPANTS

Adults (age ≥65 years) using either four or more chronic medications or one or more medications associated with an increased risk of falling (n = 10,565).

INTERVENTION

Pharmacy staff screened patients for fall risk using questions from the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) algorithm. Patients who screened positive were eligible to receive a pharmacist‐conducted medication review, with recommendations sent to patients' healthcare providers following the review.

MEASUREMENTS

At intervention pharmacies, pharmacy staff used standardized forms to record participant responses to screening questions and information concerning the medication reviews. For participants with continuous Medicare Part D/NC Medicaid coverage (n = 3,212), the Drug Burden Index (DBI) was used to assess exposure to high‐risk medications, and insurance claims records for emergency department visits and hospitalizations were used to assess falls.

RESULTS

Among intervention group participants (n = 4,719), 73% (n = 3,437) were screened for fall risk. Among those who screened positive (n = 1,901), 72% (n = 1,373) received a medication review; and 27% (n = 521) had at least one medication‐related recommendation communicated to their healthcare provider(s) following the review. A total of 716 specific medication recommendations were made. DBI scores decreased from the pre‐ to postintervention period in both the control and the intervention group. However, the amount of change over time did not differ between these two groups (P = .66). Risk of falling did not change between the pre‐ to postintervention period or differ between groups (P = .58).

CONCLUSION

We successfully implemented STEADI‐Rx in the community pharmacy setting. However, we found no differences in fall risk or the use of medications associated with increased risk of falling between the intervention and control groups.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2RVsgFM
via IFTTT

COVID‐19, Postacute Care Preparedness, and Nursing Homes - American Geriatric Society

Journal of the American Geriatrics Society, Accepted Article.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2Vs2mM9
via IFTTT

Participant and Caregiver Perspectives on Clinical Research During Covid‐19 Pandemic - American Geriatric Society

ABSTRACT

Background/Objectives

The COVID‐19 pandemic has massively disrupted essential clinical research. Many regulatory organizations have rightfully advocated to temporarily halt enrollment and curtail all face‐to‐face interactions. Views and opinions of patients and their caregivers are seldom considered while making such decisions. The objective was to study older participants' and their caregivers' perspectives to participate in ongoing clinical research during the COVID‐19 pandemic.

Design

Cross‐sectional

Setting

VISN‐16/Geriatric Research Education and Clinical Center (GRECC), Department of Veterans Affairs.

Participants

Older participants and their caregivers (N=51) enrolled in ongoing clinical research studies.

Measurements

Questions about perceptions of safety to attend research visit, the level of panic among the general public, and medical center's preparedness in handling the pandemic. Other questions identified the source of pandemic information and the preference of a phone or in‐person visit.

Results

Mean age was 69.3 (±9.4) years, 53% were male, 39% were caregivers, and 65% were Caucasian. Majority (78%) of the participants felt safe/very safe attending the scheduled research appointment; 63% felt that the extra screening made them feel safe/very safe; 82% felt that the medical center was prepared/very prepared for the pandemic. Participants split evenly on their preference for phone vs. in‐person visits. Family members and television news media were the commonly used sources of pandemic information irrespective of their education. Perceptions were influenced by gender and source of information, not by age or education. Females perceived higher level of panic compared to males (p=0.02). Those relying on news media felt safer compared to those that relied on family members (p=0.008).

Conclusion

Even though informants felt that the medical center was prepared to handle the pandemic, only half the participants preferred the in‐person visit. Pandemic information was obtained from family members or the television news media. Knowing patients' perspectives may help researchers be better prepared for future pandemics.

This article is protected by copyright. All rights reserved.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2VNjKtD
via IFTTT

COVID‐19 and Older Adults: What We Know - American Geriatric Society

Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), a novel virus that causes COVID‐19 infection, has recently emerged and caused a deadly pandemic. Studies have shown that this virus causes worse outcomes and a higher mortality rate in older adults and those with comorbidities such as hypertension, cardiovascular disease, diabetes, chronic respiratory disease, and chronic kidney disease (CKD). A significant percentage of older American adults have these diseases, putting them at a higher risk of infection. Additionally, many adults with hypertension, diabetes, and CKD are placed on angiotensin‐converting enzyme (ACE) inhibitors and angiotensin II receptor blockers. Studies have shown that these medications upregulate the ACE‐2 receptor, the very receptor that the SARS‐CoV‐2 virus uses to enter host cells. Although it has been hypothesized that this may cause a further increased risk of infection, more studies on the role of these medications in COVID‐19 infections are necessary. In this review, we discuss the transmission, symptomatology, and mortality of COVID‐19 as they relate to older adults, and possible treatments that are currently under investigation.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2xf2yVx
via IFTTT

Challenges and Responsibilities in Caring for the Most Vulnerable during the COVID‐19 Pandemic - American Geriatric Society

Journal of the American Geriatrics Society, Accepted Article.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/3brpAYo
via IFTTT

Pandemia - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2XthNoH
via IFTTT

“The Ring” - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2Kqs1OY
via IFTTT

Elder Abuse in the COVID‐19 Era - American Geriatric Society

Journal of the American Geriatrics Society, Accepted Article.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/3cDTcSp
via IFTTT

Caregiving at a Physical Distance: Initial Thoughts for COVID‐19 and Beyond - American Geriatric Society

Journal of the American Geriatrics Society, Accepted Article.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2RYkhaY
via IFTTT

Validation of the Risk Analysis Index for Evaluating Frailty in Ambulatory Patients - American Geriatric Society

BACKGROUND

Frailty is a marker of dependency, disability, hospitalization, and mortality in community‐dwelling older adults. However, existing tools for measuring frailty are too cumbersome for rapid point‐of‐care assessment. The Risk Analysis Index (RAI) of frailty is validated in surgical populations, but its performance outside surgical populations is unknown.

OBJECTIVE

Validate the RAI in ambulatory patients.

DESIGN, SETTING, AND PARTICIPANTS

Observational cohort study of outpatient surgical clinics within the University of Pittsburgh Medical Center Healthcare System between July 1, 2016, and December 31, 2016. Frailty was assessed using the RAI. Current Procedural Terminology codes following RAI assessment identified patients with and without minor office‐based procedures (eg, joint injection, laryngoscopy).

MAIN OUTCOMES AND MEASURES

All‐cause 1‐year mortality, assessed by stratified Cox proportional hazard models.

RESULTS

Of 28,059 patients, 13,861 were matched to a minor, office‐based procedure and 14,198 did not undergo any procedure. The mean (SD) age was 56.7 (17.2) years; women constituted 15,797 (56.3%) of the cohort. Median time (interquartile range 25th‐75th percentile) to measure RAI was 30 (22–47) seconds. Mortality among the frail was two to five times that of patients with normal RAI scores. For example, the hazard ratio for frail ambulatory patients without a minor procedure was 3.69 (95% confidence interval [CI] = 2.51‐5.41), corresponding to 30‐, 180‐, and 365‐day mortality rates of 2.9%, 11.2%, and 17.4%, respectively, compared to 0.3%, 2.3%, and 4.0% among patients with normal RAI scores. Discrimination of mortality (overall, and censored at 30, 180, and 365 days) was excellent, ranging from c = 0.838 (95% CI = 0.773‐0.902) for 30‐day mortality after minor procedures to c = 0.909 (95% CI = 0.855‐0.964) without a procedure.

CONCLUSION

RAI is a valid, easily administered tool for point‐of‐care frailty assessment in ambulatory populations that may help clinicians and patients make better informed decisions about care choices—especially among patients considered high risk with a potentially limited life span.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2wXgXFO
via IFTTT

Coronavirus (COVID-19) Update: Daily Roundup April 21, 2020 - FDA Press Releases

Coronavirus (COVID-19) Update: Daily Roundup

from FDA Press Releases RSS Feed https://ift.tt/2RX1Vr8
via IFTTT

Coronavirus (COVID-19) Update: FDA Authorizes First Test for Patient At-Home Sample Collection - FDA Press Releases

Coronavirus (COVID-19) Update: FDA Authorizes First Test for Patient At-Home Sample Collection

from FDA Press Releases RSS Feed https://ift.tt/3brsjB1
via IFTTT

Coronavirus (COVID-19) Update: Daily Roundup April 20, 2020 - FDA Press Releases

Coronavirus (COVID-19) Update: Daily Roundup

from FDA Press Releases RSS Feed https://ift.tt/2Vp0BiT
via IFTTT

Serine catabolism produces ROS, sensitizes cells to actin dysfunction, and suppresses cell growth in fission yeast - Journal of Antibiotics

The Journal of Antibiotics, Published online: 20 April 2020; doi:10.1038/s41429-020-0305-6

Serine catabolism produces ROS, sensitizes cells to actin dysfunction, and suppresses cell growth in fission yeast

from The Journal of Antibiotics - Issue - nature.com science feeds https://ift.tt/2z9KJrC
via IFTTT

Coronavirus (COVID-19) Update: Serological Test Validation and Education Efforts - FDA Press Releases

FDA provides details about its thinking on antibody tests for COVID-19 and the agency’s approach to making accurate and reliable serology tests widely available.

from FDA Press Releases RSS Feed https://ift.tt/2XNe8lW
via IFTTT

Corrigendum for jgs.15843 - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2XHIXbz
via IFTTT

Coronavirus (COVID-19) Update: Daily Roundup April 17, 2020 - FDA Press Releases

Coronavirus (COVID-19) Update: Daily Roundup

from FDA Press Releases RSS Feed https://ift.tt/2xEY7n9
via IFTTT

FDA Approves First Targeted Treatment for Patients with Cholangiocarcinoma, a Cancer of Bile Ducts - FDA Press Releases

FDA has approved Pemazyre (pemigatinib), the first treatment approved for adults with certain types of previously treated, advanced cholangiocarcinoma, a rare form of cancer that forms in bile ducts.

from FDA Press Releases RSS Feed https://ift.tt/3cy96xP
via IFTTT

Coronavirus (COVID-19) Update: Federal judge enters temporary injunction against Genesis II Church of Health and Healing, preventing sale of Chlorine Dioxide Products Equivalent to Industrial Bleach to Treat COVID-19 - FDA Press Releases

A federal court has entered an injunction against the Genesis II Church of Health and Healing requiring them to immediately stop distributing its “Miracle Mineral Solution”

from FDA Press Releases RSS Feed https://ift.tt/3alJH8S
via IFTTT

Coronavirus (COVID-19) Update: Federal judge enters emergency injunction against Genesis II Church of Health and Healing, preventing sale of Chlorine Dioxide Products Equivalent to Industrial Bleach to Treat COVID-19 - FDA Press Releases

A federal court has entered an emergency temporary restraining order and a preliminary injunction against the Genesis II Church of Health and Healing requiring them to immediately stop distributing its “Miracle Mineral Solution”

from FDA Press Releases RSS Feed https://ift.tt/2z1SYG7
via IFTTT

FDA Approves First New Drug Under International Collaboration, A Treatment Option for Patients with HER2-Positive Metastatic Breast Cancer - FDA Press Releases

FDA has approved Tukysa (tucatinib) in combination with chemotherapy for the treatment of adults with advanced forms of HER2-positive breast cancer that can’t be removed with surgery, or has spread to other parts of the body, and who have received one or more prior treatments.

from FDA Press Releases RSS Feed https://ift.tt/3bj2BP6
via IFTTT

Re: Prospective Associations between Diffusion Tensor Imaging Parameters and Frailty in Older Adults - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2VwU846
via IFTTT

Coronavirus Disease19 in Geriatrics and Long‐Term Care: An Update - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2xQzDad
via IFTTT

Coronavirus Disease 2019 in Geriatrics and Long‐Term Care: The ABCDs of COVID‐19 - American Geriatric Society

The pandemic of coronavirus disease of 2019 (COVID‐19) is having a global impact unseen since the 1918 worldwide influenza epidemic. All aspects of life have changed dramatically for now. The group most susceptible to COVID‐19 are older adults and those with chronic underlying medical disorders. The population residing in long‐term care facilities generally are those who are both old and have multiple comorbidities. In this article we provide information, insights, and recommended approaches to COVID‐19 in the long‐term facility setting. Because the situation is fluid and changing rapidly, readers are encouraged to access frequently the resources cited in this article.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/3blLP1g
via IFTTT

Coronavirus (COVID-19) Update: FDA, Gates Foundation, UnitedHealth Group, Quantigen, and U.S. Cotton Collaborate to Address Testing Supply Needs - FDA Press Releases

Coronavirus (COVID-19) Update: FDA, Gates Foundation, UnitedHealth Group, Quantigen, and US Cotton collaborate to address testing supply needs

from FDA Press Releases RSS Feed https://ift.tt/2Vcpjmm
via IFTTT

Coronavirus (COVID-19) Update: Daily Roundup April 16, 2020 - FDA Press Releases

Coronavirus (COVID-19) Update: Daily Roundup

from FDA Press Releases RSS Feed https://ift.tt/2yoIKzy
via IFTTT

Coronavirus (COVID-19) Update: FDA Continues User-Fee Related Reviews Through COVID-19 - FDA Press Releases

The FDA is continuing to perform user fee review activities and application reviews

from FDA Press Releases RSS Feed https://ift.tt/2K7SlgA
via IFTTT

Coronavirus (COVID-19) Update: FDA Encourages Recovered Patients to Donate Plasma for Development of Blood-Related Therapies - FDA Press Releases

FDA is providing an update on one potential COVID-19 treatment called convalescent plasma and encouraging those who have recovered from COVID-19 to donate plasma to help others fight this disease.

from FDA Press Releases RSS Feed https://ift.tt/2XF9t5j
via IFTTT

Older Sepsis Survivors Suffer Persistent Disability Burden and Poor Long‐Term Survival - American Geriatric Society

Objectives

Sepsis has been called a “disease of the elderly,” and as in‐hospital mortality has decreased, more sepsis survivors are progressing into poorly characterized long‐term outcomes. The purpose of this study was to describe the current epidemiology of sepsis in older adults compared with middle‐aged and young adults.

Design

Prospective longitudinal study with young (≤45 years), middle‐aged (46‐64 years), and older (≥65 years) patient groups.

Setting

University tertiary medical center.

Participants

A total of 328 adult surgical intensive care unit (ICU) sepsis patients.

Measurements

Patients were characterized by (1) baseline demographics and predisposition, (2) septic event, (3) hospital outcomes and discharge disposition, (4) 12‐month mortality, and (5) Zubrod Performance Status, physical function (Short Physical Performance Battery and handgrip strength), and cognitive function (Hopkins Verbal Learning Test, Controlled Oral Word Association, and Mini‐Mental Status Examination) at 3‐, 6‐, and 12‐month follow‐up. Loss to follow‐up was due to death (in 68), consent withdrawal (in 32), and illness and scheduling difficulties: month 3 (in 51), month 6 (in 29), and month 12 (in 20).

Results

Compared with young and middle‐aged patients, older patients had (1) significantly more comorbidities at presentation (eg, chronic renal disease 6% vs 12% vs 21%), intra‐abdominal infections (14% vs 25% vs 37%), septic shock (12% vs 25% vs 36%), and organ dysfunctions; (2) higher 30‐day mortality (6% vs 4% vs 17%) and fewer ICU‐free days (median = 25 vs 23 vs 20); (3) more progression into chronic critical illness (22% vs 34% vs 42%) with higher poor disposition discharge to non‐home destinations (19% vs 40% vs 62%); (4) worse 12‐month mortality (11% vs 14% vs 33%); and (5) poorer Zubrod Performance Status and objectively measured physical and cognitive functions with only slight improvement over 12‐month follow‐up.

Conclusion

Compared with younger patients, older sepsis survivors suffer both a higher persistent disability burden and 12‐month mortality.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2XCcXFK
via IFTTT

Grace, Connection, and Hard Conversations: Primary Care Geriatrics in the COVID Era - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2JM7zI2
via IFTTT

Special Issues on Using the Montreal Cognitive Assessment for telemedicine Assessment During COVID‐19 - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2UUr4ob
via IFTTT

Skilled Nursing Facility Patients Discharged to Home Health Agency Services Spend More Days at Home - American Geriatric Society

OBJECTIVES

To investigate the association of the utilization of Medicare‐certified home health agency (CHHA) services with post‐acute skilled nursing facility (SNF) discharge outcomes that included home time, rehospitalization, SNF readmission, and mortality.

DESIGN

Retrospective cohort study.

SETTING

New York State fee‐for‐service Medicare beneficiaries aged 65 years and older admitted to SNFs for post‐acute care and discharged to the community in 2014.

PARTICIPANTS

A total of 25,357 older adults.

MEASUREMENTS

The outcomes included days spent alive in the community (“home time”), rehospitalization, SNF readmission, and mortality within 30‐ and 90‐day post‐SNF discharge periods. The primary independent variables were SNF five‐star overall quality rating and receipt of CHHA services within 7 days of SNF discharge. Zero‐inflated negative binomial regression and logistic regression models characterized the association of CHHA linkage with home time and other outcomes, respectively.

RESULTS

Following SNF discharge, 17,657 (69.6%) patients received CHHA services. In analyses that adjusted for patient‐, market‐, and other SNF‐level factors, older adults discharged from higher quality SNFs were more likely to receive CHHA services. In analyses that adjusted for patient‐ and market‐level factors, receipt of post‐SNF CHHA services was associated with 2.03 and 4.17 (P < .001) more days in the community over 30‐ and 90‐day periods. Receiving CHHA services was also associated with decreased odds for rehospitalization (odds ratio [OR] = .68; P < .001; OR = .91; P = .008), SNF readmission (OR = .36; P < .001; OR = .62; P < .001), and death (OR = .34; P < .001; OR = .63; P < .001) over 30‐ and 90‐day periods, respectively.

CONCLUSION

Among older adults discharged from a post‐acute SNF stay, those who received CHHA services had better discharge outcomes. They were less likely to experience admissions to institutional care settings and had a lower mortality risk. Future efforts that examine how the type and intensity of CHHA services affect outcomes would build on this work.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2VabaGj
via IFTTT

On Isolation: Gowns and Glass - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/34m8RTl
via IFTTT

Association of CHA2DS2‐VASc Score with Stroke, Thromboembolism, and Death in Hip Fracture Patients - American Geriatric Society

OBJECTIVES

Patients undergoing hip fracture surgery have a 10 times increased risk of stroke compared with the general population. We aimed to evaluate the association between the CHA₂DS₂‐VASc (congestive heart failure, hypertension, age ≥75 years, diabetes, previous stroke/TIA [transient ischemic attack]/systemic embolism (2 points), vascular disease, age 65‐74 years, and female sex) score and the risk of stroke, thromboembolism, and all‐cause mortality in patients with hip fracture with or without atrial fibrillation (AF).

DESIGN

Nationwide prospective cohort study.

SETTING

Danish hospitals.

PARTICIPANTS

Subjects were all incident hip fracture patients in Denmark age 65 years and older with surgical repair procedures between 2004 and 2016 (n = 78,096). Participants were identified using the Danish Multidisciplinary Hip Fracture Registry.

MEASUREMENTS

We calculated incidence rates, cumulative incidences, and hazard ratios (HRs) with 95% confidence intervals (CIs) by CHA₂DS₂‐VASc score, stratified on AF history.

RESULTS

The cumulative incidence of ischemic stroke 1 year after hip fracture increased with ascending CHA₂DS₂‐VASc score, and it was 1.9% for patients with a score of 1 and 8.6% for patients with a score above 5 in the AF group. Corresponding incidences in the non‐AF group were 1.6% and 7.6%. Compared with a CHA₂DS₂‐VASc score of 1, adjusted HRs were 5.53 (95% CI = 1.37‐22.24) among AF patients and 4.91 (95% CI = 3.40‐7.10) among non‐AF patients with a score above 5. A dose‐response–like association was observed for all cardiovascular outcomes. All‐cause mortality risks and HRs were substantially higher for all CHA₂DS₂‐VASc scores above 1 in both the AF group and the non‐AF group.

CONCLUSION

Among patients with hip fracture, a higher CHA₂DS₂‐VASc score was associated with increased risk of stroke, thromboembolism, and death. This finding applied both to patients with and without AF. Patients with high CHA₂DS₂‐VASc scores had almost similar absolute risks for cardiovascular outcomes, irrespective of AF.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2RGac2m
via IFTTT

COVID‐19 Preparedness in Michigan Nursing Homes - American Geriatric Society

Journal of the American Geriatrics Society, Accepted Article.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2K7lokn
via IFTTT

Geroscience and the coronavirus pandemic: The whack‐a‐mole approach is not enough. - American Geriatric Society

Journal of the American Geriatrics Society, Accepted Article.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/3acftoP
via IFTTT

PRIME‐HF: Novel Exercise for Older Patients with Heart Failure. A Pilot Randomized Controlled Study - American Geriatric Society

OBJECTIVES

To test the hypothesis that (1) older patients with heart failure (HF) can tolerate COMBined moderate‐intensity aerobic and resistance training (COMBO), and (2) 4 weeks of Peripheral Remodeling through Intermittent Muscular Exercise (PRIME) before 4 weeks of COMBO will improve aerobic capacity and muscle strength to a greater extent than 8 weeks of COMBO.

DESIGN

Prospective randomized parallel open‐label blinded end point.

SETTING

Single‐site Australian metropolitan hospital.

PARTICIPANTS

Nineteen adults (72.8 ± 8.4 years of age) with heart failure with reduced ejection fraction (HFrEF).

INTERVENTION

Participants were randomized to 4 weeks of PRIME or COMBO (phase 1). All participants subsequently completed 4 weeks of COMBO (phase 2). Sessions were twice a week for 60 minutes. PRIME is a low‐mass, high‐repetition regime (40% one‐repetition maximum [1RM], eight strength exercises, 5 minutes each). COMBO training involved combined aerobic (40%‐60% of peak aerobic capacity [VO_2peak], up to 20 minutes) and resistance training (50‐70% 1RM, eight exercises, two sets of 10 repetitions).

MEASUREMENTS

We measured VO_2peak, VO₂ at anaerobic threshold (AT), and muscle voluntary contraction (MVC).

RESULTS

The PRIME group significantly increased VO_2peak after 8 weeks (2.4 mL/kg/min; 95% confidence interval [CI] = .7‐4.1; P = .004), whereas the COMBO group showed minimal change (.2; 95% CI −1.5 to 1.8). This produced a large between‐group effect size of 1.0. VO₂ at AT increased in the PRIME group (1.6 mL/kg/min; 95% CI .0‐3.2) but not in the COMBO group (−1.2; 95% CI −2.9 to .4), producing a large between‐group effect size. Total MVC increased significantly in both groups in comparison with baseline; however, the change was larger in the COMBO group (effect size = .6).

CONCLUSION

Traditional exercise approaches (COMBO) and PRIME improved strength. Only PRIME training produced statistically and clinically significant improvements to aerobic capacity. Taken together, these findings support the hypothesis that PRIME may have potential advantages for older patients with HFrEF and could be a possible alternative exercise modality.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/3aabUzy
via IFTTT

Coronavirus (COVID-19) Update: Daily Roundup April 15, 2020 - FDA Press Releases

Coronavirus (COVID-19) Update: Daily Roundup

from FDA Press Releases RSS Feed https://ift.tt/3agMjVn
via IFTTT

FDA Approves First Therapy for Treatment of Low-Grade Upper Tract Urothelial Cancer - FDA Press Releases

FDA has approved Jelmyto (mitomycin gel), the first therapy to treat low-grade upper tract urothelial cancer (UTUC). Urothelial cancer is a cancer of the lining of the urinary system.

from FDA Press Releases RSS Feed https://ift.tt/3eosMWy
via IFTTT

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

OBJECTIVES

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

DESIGN

A cross‐sectional study.

SETTING

NHs.

PARTICIPANTS

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

MEASUREMENTS

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

RESULTS

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

CONCLUSION

People living with HIV in NHs do not always receive lifesaving ART, but the reasons are unclear and appear unrelated to economic barriers. J Am Geriatr Soc 68:777–782, 2020

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2EbdSSM
via IFTTT

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

OBJECTIVES

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

DESIGN

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

SETTING

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

PARTICIPANTS

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

MEASUREMENTS

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

RESULTS

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

CONCLUSION

Findings suggest hospice remains underutilized, especially among individuals with noncancer illness. Extrapolating results to the US population, we estimate that annually nearly a million individuals who are likely eligible for hospice die without its services. Most (84%) of these decedents have a noncancer condition. Interventions are needed to increase appropriate hospice utilization, particularly in noncancer care settings. J Am Geriatr Soc 68:783–793, 2020

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2SGd9S3
via IFTTT

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

BACKGROUND/OBJECTIVES

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

DESIGN

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

SETTING

US Medicare.

PARTICIPANTS

A total of 14 558 SNFs.

MEASUREMENTS

The 2019 SNF VBP performance scores and penalties.

RESULTS

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

CONCLUSION

Structural and patient characteristics of SNFs may significantly impact provider performance under the SNF VBP. These findings have implications for policy makers and clinical leaders seeking to improve quality and avoid unintended consequences with VBP in SNFs. J Am Geriatr Soc 68:826–834, 2020

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/38RZ4X0
via IFTTT

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

BACKGROUND/OBJECTIVE

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

DESIGN

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

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

SETTING

US Medicare‐certified NHs.

PARTICIPANTS

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

RESULTS

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

CONCLUSION

Deprescribing AChEIs was not associated with a significant increase in the likelihood for all‐cause negative events and was associated with a reduced likelihood of falls and fractures in older NH residents with dementia. Our findings suggest that deprescribing AChEIs is a reasonable approach to reduce the risk of serious falls or fractures without increasing the risk for all‐cause events. J Am Geriatr Soc 68:699–707, 2020

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/35Dy3Ei
via IFTTT

A Vulnerability Risk Index of Self‐Neglect in a Community‐Dwelling Older Population - American Geriatric Society

BACKGROUND

The only way to systematically screen for self‐neglect among older adults is through in‐home observations, which are often difficult and unfeasible for healthcare providers. To fill this gap, we need a robust and efficient prognostication tool to better treat and prevent self‐neglect among older adults.

OBJECTIVES

To develop a predictive index that can be used to assess risk prognostication of the onset of self‐neglect among community‐dwelling older populations.

DESIGN

Two waves of longitudinal data from the Chicago Health and Aging Project (CHAP), collected during 2008 to 2012 with approximately 3‐year follow‐up intervals.

SETTING

Non‐Hispanic black or non‐Hispanic white community‐dwelling older adults in three adjacent neighborhoods in Chicago, IL.

PARTICIPANTS

A total of 2885 individuals who were participants of the CHAP study.

MEASUREMENTS

The main outcomes are incident self‐neglect cases. A total of 86 potential predictors were considered in the domains of sociodemographic and socioeconomic, general well‐being, health behavior, medical health, medicine/healthcare, cognitive function, physical well‐being, social well‐being, and psychological well‐being.

RESULTS

The 3‐year self‐neglect incidence rate is 241 (8.4%). A 10‐item predictive model (with a c‐statistic of 0.76) was developed using stepwise selection in multivariable logistical regression models. After corrections of overfitting by validating in 100 bootstrapping samples, the predictive accuracy of the model dropped to 0.71, suggesting at least moderate overfitting. A point‐based risk index was developed based on parameter estimates of each predictive factor in the final logistic model. The index has an area under the receiver operating characteristic curve of 0.76.

CONCLUSION

The study developed an efficient index with good predictive ability of self‐neglect. Further external validation and impact studies are necessary before practitioners can apply this index to determine risk of self‐neglect among other community aging populations. J Am Geriatr Soc 68:809–816, 2020

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2YKDLlF
via IFTTT

The Impact of Home Health Physical Therapy on Medicare Beneficiaries With a Primary Diagnosis of Dementia - American Geriatric Society

BACKGROUND

Dementia is a leading cause of disability for adults older than 65 years. Exercise intervention slows functional decline and improves balance; however, the efficacy of physical therapy (PT) services for persons with dementia is unknown. The purpose of this study is to assess the effect of home health PT services on physical function for Medicare beneficiaries with a primary diagnosis of dementia.

DESIGN

Observational cohort study using a combined Medicare data set of home health beneficiaries; we performed augmented inverse probability weighted regression with demographic, comorbidity, and symptom‐level characteristics analyzed as covariates.

SETTING

Home healthcare, United States, 2012.

PARTICIPANTS

Medicare beneficiaries who had a primary diagnosis of dementia and home health function evaluations at discharge (n = 1477).

INTERVENTION

PT treatment, examined by (1) any PT and (2) PT visit number.

MEASUREMENT

Improvement in composite activity of daily living (ADL) scores from home health admit to discharge.

RESULTS

Any PT increased the probability of improvement in ADLs by 15.2% (P < .001). Compared to 1 to 5 PT visits, 6 to 13 visits increased the probability of ADL improvement by 11.6% (P < .001).

CONCLUSION

PT intervention is beneficial for ADL function improvement in Medicare home health beneficiaries with a primary diagnosis of dementia. J Am Geriatr Soc 68:867–871, 2020

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2TmsxTG
via IFTTT

Failure of Traditional Risk Factors to Adequately Predict Cardiovascular Events in Older Populations - American Geriatric Society

BACKGROUND

Accurate assessment of atherosclerotic cardiovascular disease (ASCVD) risk across heterogeneous populations is needed for effective primary prevention. Little is known about the performance of standard cardiovascular risk factors in older adults.

OBJECTIVE

To evaluate the performance of the American College of Cardiology/American Heart Association Pooled Cohort Equations (PCE) risk model, as well as the underlying cardiovascular risk factors, among adults older than 65 years.

DESIGN AND SETTING

Retrospective cohort derived from a regional referral system's electronic medical records.

PARTICIPANTS

A total of 25 349 patients who were 65 years or older at study baseline (date of the first outpatient lipid panel taken between 2007 and 2010).

MEASUREMENTS

Exposures of interest were traditional cardiovascular risk factors, as defined by inclusion in the PCE model. The primary outcome was major ASCVD events, defined as a composite of myocardial infarctions, stroke, and cardiovascular death.

RESULTS

The PCE and internally estimated models produced similar risk distributions for white men aged 65 to 74 years. For all other groups, PCE predictions were generally lower than those of the internal models, particularly for African Americans. Discrimination of the PCE was poor for all age groups, with concordance index (95% confidence interval) estimates of 0.62 (0.60‐0.64), 0.56 (0.54‐0.57), and 0.52 (0.49‐0.54) among patients aged 65 to 74, 75 to 84, and 85 years and older, respectively. Reestimating relationships within these age groups resulted in better calibration but negligible improvements in discrimination. Blood pressure, total cholesterol, and diabetes either were not associated at all or had inverse associations in the older age groups.

CONCLUSION

Traditional clinical risk factors for cardiovascular disease failed to accurately characterize risk in a contemporary population of Medicare‐aged patients. Among those aged 85 years and older, some traditional risk factors were not associated with ASCVD events. Better risk models are needed to appropriately inform treatment decision making for the growing population of older adults. J Am Geriatr Soc 68:754–761, 2020

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/38hVXXs
via IFTTT

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. J Am Geriatr Soc 68:852–858, 2020

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2TnNU5C
via IFTTT

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

OBJECTIVES

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

DESIGN

Randomized controlled trial.

SETTING

Two acute hospitals in Ireland.

PARTICIPANTS

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

INTERVENTION

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

MEASUREMENTS

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

RESULTS

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

CONCLUSION

STOPPFrail‐guided deprescribing significantly reduced polypharmacy and medication costs in frail older people. No significant differences between groups were observed with regard to falls, hospital presentations, quality of life, and mortality, although the trial was likely underpowered to detect differences in these outcomes. J Am Geriatr Soc 68:762–769, 2020

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2ZiL1p3
via IFTTT

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. J Am Geriatr Soc 68:736–745, 2020

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2UWWn20
via IFTTT

Geriatric Conditions Predict Discontinuation of Anticoagulation in Long‐Term Care Residents With Atrial Fibrillation - American Geriatric Society

BACKGROUND

Anticoagulation (AC) for stroke prevention in long‐term care (LTC) residents with atrial fibrillation (AF) involves a challenging risk‐benefit evaluation. We measured the association of geriatric conditions with discontinuation of AC.

DESIGN

Retrospective cohort analysis.

SETTING

LTC facilities across the United States.

PARTICIPANTS

A total of 48 545 individuals residing in LTC facilities in 2015 with AF and sufficient information to establish their status as someone who stopped AC vs someone who continued AC.

MEASUREMENTS

We measured the association of six geriatric conditions—recent fall, severe activity of daily living (ADL) dependency (21‐28 on a 28‐point scale), mobility impairment, cognitive impairment, body mass index (BMI) less than 18.5 kg/m², and weight loss (≥5% in 1 month or ≥10% in 6 months)—with discontinuation of AC. To identify cases of discontinuation, we required a pattern of being on AC over two consecutive recordings of the Minimum Data Set, the nursing home quality control data set recorded every 90 days, followed by two assessments being off AC—pattern of “on‐on‐off‐off.” By contrast, we required a pattern of “on‐on‐on‐on” for continuers. We then constructed six logistic regression models to measure the independent association between each geriatric condition and discontinuation of AC, adjusted for CHA₂DS₂‐VASc stroke risk score, recent bleeding hospitalization, and other confounders.

RESULTS

There were 4172 discontinuers and 44 373 continuers. Recent fall predicted a 1.9‐fold increase in the odds of discontinuation (odds ratio = 1.91; 95% confidence interval = 1.66‐2.20), whereas mobility and cognitive impairment only increased the odds by 14% to 17%. Severe ADL dependency, BMI less than 18.5 kg/m², and weight loss of 10% each increased odds of discontinuation by 55% to 68%. CHA₂DS₂‐VASc score did not predict discontinuation.

CONCLUSION

Several geriatric conditions predicted discontinuation of AC, whereas CHA₂DS₂‐VASc score did not. Future research should examine the association of geriatric conditions and discontinuation of warfarin discrete from newer anticoagulants and association of geriatric conditions with development of stroke and bleeding. J Am Geriatr Soc 68:717–724, 2020

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/37iWXKK
via IFTTT

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. J Am Geriatr Soc 68:708–716, 2020

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2OVlDBU
via IFTTT

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

OBJECTIVES

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

DESIGN

Cross‐sectional analysis of a cohort study.

SETTING

Physicians’ Health Study.

PARTICIPANTS

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

MEASUREMENTS

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

RESULTS

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

CONCLUSION

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

ClinicalTrials.gov identifier: NCT00000500. J Am Geriatr Soc 68:770–776, 2020

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2YVCR5Z
via IFTTT

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. J Am Geriatr Soc 68:746–753, 2020

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/3bRI7xy
via IFTTT

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. J Am Geriatr Soc 68:725–735, 2020

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2SG8SfI
via IFTTT

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

Journal of the American Geriatrics Society, Volume 68, Issue 4, Page 894-895, April 2020.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/38zog4y
via IFTTT

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

Journal of the American Geriatrics Society, Volume 68, Issue 4, Page 892-894, April 2020.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2ODoCij
via IFTTT

Michael Gordon and Humanism - American Geriatric Society

Journal of the American Geriatrics Society, Volume 68, Issue 4, Page 895-895, April 2020.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2RJUAv9
via IFTTT

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, Volume 68, Issue 4, Page 896-897, April 2020.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2VyBOsR
via IFTTT

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

Journal of the American Geriatrics Society, Volume 68, Issue 4, Page 896-896, April 2020.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2Vut3QK
via IFTTT

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

Journal of the American Geriatrics Society, Volume 68, Issue 4, Page 891-892, April 2020.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/38RiOKk
via IFTTT

Nerve Block Use after Hip Fracture: Missed Opportunities to Improve Pain Management? - American Geriatric Society

Journal of the American Geriatrics Society, Volume 68, Issue 4, Page 689-690, April 2020.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2PLqZ2Z
via IFTTT

New pestallic acids and diphenylketone derivatives from the marine alga-derived endophytic fungus Pestalotiopsis neglecta SCSIO41403 - Journal of Antibiotics

The Journal of Antibiotics, Published online: 14 April 2020; doi:10.1038/s41429-020-0308-3

New pestallic acids and diphenylketone derivatives from the marine alga-derived endophytic fungus Pestalotiopsis neglecta SCSIO41403

from The Journal of Antibiotics - Issue - nature.com science feeds https://ift.tt/2wARbab
via IFTTT

Coronavirus (COVID-19) Update: Daily Roundup April 13, 2020 - FDA Press Releases

Coronavirus (COVID-19) Update: Daily Roundup

from FDA Press Releases RSS Feed https://ift.tt/2RxV07e
via IFTTT

Coronavirus (COVID-19) Update: FDA Issues Emergency Use Authorization to Decontaminate Millions of N95 Respirators - FDA Press Releases

Coronavirus (COVID-19) Update: FDA Issues Emergency Use Authorization to Decontaminate Millions of N95 Respirators

from FDA Press Releases RSS Feed https://ift.tt/2VmhN7b
via IFTTT

Give Your Geriatric Patients FAST HUGS BID - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2y3yOLv
via IFTTT

Pandemia - American Geriatric Society

Journal of the American Geriatrics Society, Accepted Article.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2XthNoH
via IFTTT

To All Doctors: What You Can Do to Help as a Bunch of Old People Are About to Get Sick and Die - American Geriatric Society

Journal of the American Geriatrics Society, Accepted Article.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2y3yHzz
via IFTTT

The COVID‐19 Pandemic: Experiences of a Geriatrician‐Hospitalist Caring for Older Adults - American Geriatric Society

Journal of the American Geriatrics Society, Accepted Article.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2wCLsRq
via IFTTT

Collaborative Delirium Prevention in the Age of COVID‐19 - American Geriatric Society

Journal of the American Geriatrics Society, Accepted Article.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/3edKkEL
via IFTTT

Staying in A Burning House: Perks and Perils of A Hotline in The Times of COVID‐19 - American Geriatric Society

Journal of the American Geriatrics Society, Accepted Article.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/3chqBCp
via IFTTT

Breaking social isolation amidst Covid‐19: a viewpoint on improving access to technology in long term care facilities - American Geriatric Society

Journal of the American Geriatrics Society, Accepted Article.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/2RxMk0N
via IFTTT

Coronavirus (COVID-19) Update: Daily Roundup April 10, 2020 - FDA Press Releases

Coronavirus (COVID-19) Update: Daily Roundup

from FDA Press Releases RSS Feed https://ift.tt/34tBZsc
via IFTTT

FDA Approves First Therapy for Children with Debilitating and Disfiguring Rare Disease - FDA Press Releases

FDA approves Koselugo (selumetinib) for the treatment of pediatric patients, 2 years and older, with neurofibromatosis type 1 (NF1), a genetic disorder of the nervous system causing tumors to grow on nerves.

from FDA Press Releases RSS Feed https://ift.tt/2Xra0YD
via IFTTT

Coronavirus (COVID-19) Update: FDA Issues Second Emergency Use Authorization to Decontaminate N95 Respirators - FDA Press Releases

Coronavirus (COVID-19) Update: FDA Issues Second Emergency Use Authorization to Decontaminate N95 Respirators

from FDA Press Releases RSS Feed https://ift.tt/2yOd5HL
via IFTTT

Coronavirus (COVID-19) Update: FDA Authorizes Blood Purification Device to Treat COVID-19 - FDA Press Releases

Coronavirus (COVID-19) Update: FDA Authorizes Blood Purification Device

from FDA Press Releases RSS Feed https://ift.tt/2XqpA6P
via IFTTT