Coronavirus (COVID-19) Update: FDA Continues to Combat Fraudulent COVID-19 Medical Products - FDA Press Releases

FDA provides an update on its efforts to combat COVID-19 fraud

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Choosing Inpatient vs Home Treatment: Why Patients Accept or Decline Hospital at Home - American Geriatric Society

BACKGROUND/OBJECTIVES

Hospital at home (HaH) provides interdisciplinary acute care in the home as a substitute for inpatient hospitalization. Studies have demonstrated that HaH care is associated with better quality care, fewer complications, and better patient and caregiver experience. Still, some patients decline HaH. The objective of the study was to characterize patients who accept vs decline HaH care and describe reasons for their decisions in the context of a Center for Medicare and Medicaid Innovation demonstration of HaH.

DESIGN/SETTING/PARTICIPANTS

A total of 442 patients with Medicare or other eligible insurance, 18 years or older, who met study eligibility criteria were offered HaH at Mount Sinai Hospitals in New York, NY, between September 1, 2014, and August 31, 2017.

MEASUREMENTS

Reasons for accepting or declining HaH were recorded. Age, sex, insurance type, and admission diagnoses of HaH acceptors and refusers were compared in univariate analyses.

RESULTS

Of the 442 patients offered HaH, 66.7% accepted. Main reasons for enrolling in HaH included being more comfortable at home (78.2%) and being near family (40.7%). Specific reasons given for refusing HaH included preferring in‐hospital care (15.0%) and concern that HaH would not meet care needs (12.9%).

CONCLUSION

Two‐thirds of patients offered HaH care opted to receive it. The reasons for declining HaH provided by those who chose not to participate should be considered for quality improvement, and reasons for acceptance may be helpful in marketing and other efforts to promote HaH participation.

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How Should We Counsel Asian Americans about Fracture Risk? - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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We Need More Wisdom, Not More Paper: A Reply to Merel and Gaster - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Advance Directives for Dementia Can Elicit Preferences to Improve Patient Care - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Response to Dr Sulmasy - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Why Dementia‐Specific Advance Directives Are a Misguided Idea - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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AGS Position Statement: Resource Allocation Strategies and Age‐Related Considerations in the COVID‐19 Era and Beyond - American Geriatric Society

Abstract

COVID‐19 continues to impact older adults disproportionately, from severe illness and hospitalization to increased mortality risk. Concurrently, concerns about potential shortages of healthcare professionals and health supplies to address these needs have focused attention on how resources are ultimately allocated and used. Some strategies misguidedly use age as an arbitrary criterion, which inappropriately disfavors older adults.

This statement represents the official policy position of the American Geriatrics Society (AGS). It is intended to inform stakeholders including hospitals, health systems, and policymakers about ethical considerations to consider when developing strategies for allocating scarce resources during an emergency involving older adults. Members of the AGS Ethics Committee collaborated with interprofessional experts in ethics, law, nursing, and medicine (including geriatrics, palliative care, emergency medicine, and pulmonology/critical care) to conduct a structured literature review and examine relevant reports. The resulting recommendations defend a particular view of distributive justice that maximizes relevant clinical factors and de‐emphasizes or eliminates factors placing arbitrary, disproportionate weight on advanced age. The AGS positions include: (1) avoiding age per se as a means for excluding anyone from care; (2) assessing comorbidities and considering the disparate impact of social determinants of health; (3) encouraging decision makers to focus primarily on potential short‐term (not long‐term) outcomes; (4) avoiding ancillary criteria such as “life‐years saved” and “long‐term predicted life expectancy” that might disadvantage older people; (5) forming and staffing triage committees tasked with allocating scarce resources; (6) developing institutional resource allocation strategies that are transparent and applied uniformly; and (7) facilitating appropriate advance care planning. The statement includes recommendations that should be immediately implemented to address resource allocation strategies during COVID‐19, aligning with AGS positions. The statement also includes recommendations for post‐pandemic review. Such review would support revised strategies to ensure that governments and institutions have equitable emergency resource allocation strategies, avoid future discriminatory language and practice, and have appropriate guidance to develop national frameworks for emergent resource allocation decisions.

This article is protected by copyright. All rights reserved.

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Rationing Limited Health Care Resources in the COVID‐19 Era and Beyond: Ethical Considerations Regarding Older Adults - American Geriatric Society

Abstract

COVID‐19 continues to impact older adults disproportionately with respect to serious consequences ranging from severe illness and hospitalization to increased mortality risk. Concurrently, concerns about potential shortages of healthcare professionals and health supplies to address these issues have focused attention on how these resources are ultimately allocated and used. Some strategies, for example, misguidedly use age as an arbitrary criterion, which disfavors older adults in resource allocation decisions. This is a companion manuscript to the American Geriatrics Society (AGS) position statement, “Resource Allocation Strategies and Age‐Related Considerations in the COVID‐19 Era and Beyond.” It is intended to inform stakeholders including hospitals, health systems, and policymakers about ethical considerations that should be considered when developing strategies for allocation of scarce resources during an emergency involving older adults. This review presents the legal and ethical background for the position statement and discusses the following issues that informed the development of the AGS positions: (1) age as a determining factor; (2) age as a tiebreaker; (3) criteria with a differential impact on older adults; (4) individual choices and advance directives; (5) racial/ethnic disparities and resource allocation; and (6) scoring systems and their impact on older adults. It also considers the role of advance directives as expressions of individual preferences in pandemics.

This article is protected by copyright. All rights reserved.

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Coronavirus (COVID-19) Update: Daily Roundup May 6, 2020 - FDA Press Releases

Coronavirus (COVID-19) Update: Daily Roundup

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FDA Approves First Targeted Therapy to Treat Aggressive Form of Lung Cancer - FDA Press Releases

FDA approves Tabrecta (capmatinib) for the treatment of adult patients with non-small cell lung cancer (NSCLC) that has spread. Tabrecta is the first FDA-approved therapy to treat NSCLC with specific MET exon 14 skipping mutations.

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Transforming Undergraduate Student Perceptions of Dementia through Music and Filmmaking - American Geriatric Society

BACKGROUND

With nearly 6 million people with dementia (PWD) in the United States, there is a critical need to build an interprofessional dementia workforce. Among the novel approaches to expanding a new workforce, music and the arts show promise for engaging students and trainees. To understand how and why the arts affect attitudes about and engagement with PWD, we examined a service‐learning general education undergraduate course centering on music, filmmaking, and dementia.

METHODS

The undergraduate course curriculum brought students to meet with PWD in dementia care settings, build personalized music playlists, coproduce short films about PWD, and write reflective essays. Two researchers independently completed inductive thematic analysis of the films, essays, and course evaluations. Differences were reconciled by consensus.

RESULTS

A total of 52 students from three classes completed the course; 24 (46%) were majoring in health sciences. Three key themes emerged: (1) Music helps students connect with people living with dementia in meaningful ways; (2) filmmaking offers students the opportunity to share unique, person‐centered stories about dementia and music that empower the voices of PWD; and (3) reflective writing enables students to process new experiences and lessons learned. Unexpectedly, 29 students (56%) reported continued engagement with PWD in their careers, families, and communities after course completion.

CONCLUSION

This study identifies reproducible ways in which undergraduate arts courses thematically focused on dementia not only transform student perceptions about dementia but change the ways in which those students choose to engage with PWD following course completion. Arts and music departments may represent an untapped resource for building a geriatrics workforce.

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Coronavirus (COVID-19) Update: Daily Roundup May 5, 2020 - FDA Press Releases

Coronavirus (COVID-19) Update: Daily Roundup

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FDA approves new treatment for a type of heart failure - FDA Press Releases

FDA approves treatment for heart failure with reduced ejection fraction

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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, EarlyView.

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Coronavirus (COVID-19) Update: Daily Roundup May 4, 2020 - FDA Press Releases

Coronavirus (COVID-19) Update: Daily Roundup

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Less Really Is More in Inappropriate Medication Use in Older Adults: How Can We Improve Prescribing and Deprescribing in Older Adults? - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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COVID‐19: Use of the Clinical Frailty Scale for critical care decisions. - American Geriatric Society

Journal of the American Geriatrics Society, Accepted Article.

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During COVID‐19, Outpatient Advance Care Planning is Imperative: We need All Hands on Deck - American Geriatric Society

Journal of the American Geriatrics Society, Accepted Article.

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“Social distancing” amidst a crisis in social isolation and loneliness - American Geriatric Society

Journal of the American Geriatrics Society, Accepted Article.

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Living Arrangements of Older Adults and COVID risk: It is not just Nursing Homes - American Geriatric Society

Journal of the American Geriatrics Society, Accepted Article.

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Integration of an Objective Cognitive Assessment Into a Prognostic Index for 5‐Year Mortality Prediction - American Geriatric Society

BACKGROUND/OBJECTIVES

Prognostic indices rarely include cognition. We determined if a comprehensive cognitive screen or brief individual items were associated with improved mortality predictions of a widely used prognostic index.

DESIGN, SETTING, AND PARTICIPANTS

The National Social Life Health and Aging Project Wave 2, a nationally representative, cross‐sectional, in‐home survey conducted in 2010 to 2011 on 3,199 community‐dwelling adults aged 60 to 99 years.

MEASUREMENTS

Cognition was measured using a Survey‐Adapted Montreal Cognitive Assessment (MoCA‐SA) grouped into three screened categories: screen normal (≥24 points), screen positive for mild cognitive impairment (18‐23 points), and screen positive for dementia (<18 points). Single‐item cognitive measures included clock‐draw and five‐word delayed recall. We constructed a modified Lee Prognostic Index (range = 0–18 points) based on age, behavior, function, and comorbidities shown to predict long‐term mortality. We used logistic regression and the fraction of new information provided to determine if each cognitive measure improved the Lee index's 5‐year mortality prediction.

RESULTS

The sample was 54% female and had a mean age of 72 years, MoCA‐SA score of 22 (SD = 4.5), and Lee index of 7 (SD = 3). Regression analysis indicated the MoCA‐SA modestly improved the Lee index's mortality prediction (P < .001; fraction of new information provided = 0.06); for low Lee index scores (<4 points), the absolute mortality rate difference was 7% by cognitive status; and for higher Lee index scores (4–7 points or 8–12 points), the absolute mortality rate difference was 15% by cognitive status. The clock‐draw and delayed‐recall items added similar value to mortality predictions as the longer MoCA‐SA. Cognition had the third highest fraction of new information of all 13 Lee index items.

CONCLUSION

Incorporating a brief measure of cognition into a modified Lee index, even with single items, resulted in more accurate 5‐year mortality risk predictions. Cognition should be included in prognostic calculators in older adults given its independent association with mortality risk.

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Firearms, Dementia, and the Clinician: Development of a Safety Counseling Protocol - American Geriatric Society

OBJECTIVES

Using available literature, our aim was to design a firearm safety counseling protocol tool for dementia patients.

DESIGN

We conducted a literature review on firearm safety counseling by healthcare providers using several databases to inform the creation of our evidence‐based protocol.

SETTING

Roughly 5.7 million Americans currently live with some form of dementia with approximately 60% of persons with dementia (PWD) owning a firearm. The mental deterioration associated with dementia creates an opportunity for firearm abuse, misuse, and injury. Patient and family safety counseling from a healthcare provider is one potential opportunity for reducing the level of danger. This literature review identifies the available clinical guidelines for firearm safety for PWD and creates a firearm safety counseling protocol based on existing literature.

PARTICIPANTS:

Persons with dementia and their families or care takers.

MEASUREMENTS

Databases were searched using variations of the terms “Firearms,” “Dementia,” and “Alzheimer's disease.” Studies were included for review if they provided either recommendations or guidelines for healthcare provider's counseling around firearm safety for PWD or their families.

RESULTS

Search terms yielded 456 articles, of which 12 met inclusion criteria. Using the available literature, we developed a firearm safety counseling protocol that provides measurable means to assess risk and offer harm mitigation strategies for patients and their families. Mitigation strategies are based on Clinical Dementia Rating scale assessment at time of patient interaction and results of risk assessment.

CONCLUSION

Providing standardized and effective clinical guidelines to healthcare providers who interact with firearm‐owning PWD can act as a means to reduce firearm injury and violence. The protocol proposed in this article needs further testing and validation to determine if it will help reduce firearm‐related events in PWD.

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Coronavirus (COVID-19) Update: Daily Roundup May 1, 2020 - FDA Press Releases

Coronavirus (COVID-19) Update: Daily Roundup

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Coronavirus (COVID-19) Update: FDA Issues Emergency Use Authorization for Potential COVID-19 Treatment - FDA Press Releases

FDA has issued emergency use authorization for the investigational antiviral drug remdesivir for the treatment of suspected or laboratory-confirmed COVID-19 in adults and children hospitalized with severe disease.

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Cloning and heterologous expression of P450Lent4B11, a novel bacterial P450 gene, for hydroxylation of an antifungal agent sordaricin - Journal of Antibiotics

The Journal of Antibiotics, Published online: 01 May 2020; doi:10.1038/s41429-020-0310-9

Cloning and heterologous expression of P450Lent4B11, a novel bacterial P450 gene, for hydroxylation of an antifungal agent sordaricin

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Lower Blood Pressure, Small‐Vessel Disease, and Apathy in Older Persons With Mild Cognitive Deficits - American Geriatric Society

BACKGROUND

In older persons, both high and low blood pressure (BP) levels are associated with symptoms of apathy. Population characteristics, such as burden of cerebral small‐vessel disease (CSVD), may underlie these apparently contradictory findings. We aimed to explore, in older persons, whether the burden of CSVD affects the association between BP and apathy.

DESIGN

Cross‐sectional study.

SETTING

Primary care setting, the Netherlands.

PARTICIPANTS

Community‐dwelling older persons (mean age = 80.7 years; SD = 4.1 years) with mild cognitive deficits and using antihypertensive treatment, participating in the baseline measurement of the magnetic resonance imaging substudy (n = 210) of the Discontinuation of Antihypertensive Treatment in the Elderly Study Leiden.

MEASUREMENTS

During home visits, BP was measured in a standardized way and apathy was assessed with the Apathy Scale (range = 0‐42). Stratified linear regression analyses were performed according to the burden of CSVD. A higher burden of CSVD was defined as 2 or more points on a compound CSVD score (range = 0‐3 points), defined as presence of white matter hyperintensities (greater than median), any lacunar infarct, and/or two or more microbleeds.

RESULTS

In the entire population, those with a lower systolic and those with a lower diastolic BP had more symptoms of apathy (β = −.35 [P = .01] and β = −.66 [P = .02], respectively). In older persons with a higher burden of CSVD (n = 50 [24%]), both lower systolic BP (β = −.64, P = .02) and lower diastolic BP (β = −1.6, P = .01) were associated with more symptoms of apathy, whereas no significant association was found between BP and symptoms of apathy in older persons with a lower burden of CSVD (n = 160).

CONCLUSIONS

Particularly in older persons with a higher burden of CSVD, lower BP was associated with more symptoms of apathy. Adequate BP levels for optimal psychological functioning may vary across older populations with a different burden of CSVD.

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