Bioethics of Kidney Transplantation in the Older Adult Population

1089 Background: Although the noninvasive nature of ctDNA testing is attractive in an older adult population, less is known regarding the mutation profiles of ctDNA in the older adult breast cancer population as this population is often excluded from studies. Previous tissue testing has shown differences in mutation profiles between older and younger adults with breast cancer. The objective of this study is to assess differences in mutation profiles in the older and younger adult breast cancer population using a ctDNA assay. Methods: Patients (pts) with advanced breast cancer underwent molecular profiling using a plasma-based ctDNA NGS assay (Guardant360) between 5/2015-10/2019 at Siteman Cancer Center. Clinicopathological histories were obtained from the medical record. The results of a multicenter database of pts with advanced breast cancer who had undergone molecular profiling using Guardant360 were obtained. Associations between mutations and age were measured using a Fisher’s exact test. Results: In the single institution cohort, of the 214 patients who underwent testing, 148 (69.16%) were < 65 and 66 (30.84%) ≥ 65 years-old. The most frequently mutated genes in age < 65 pts were TP53 (48.65%), PIK3CA (35.81%), and ESR1 (30.41%) while the most frequently mutated genes in age≥65 pts were PIK3CA (56.06%), TP53 (51.52%), ESR1 (25.76%), and ATM (21.21%). ATM, BRAF and PIK3CA mutations were found more frequently in age≥ 65 pts with ER+ HER2- breast tumors (p < 0.01). MYC and ESR1 mutations were not significantly associated with age, overall or within subtype. Overall ctDNA resulted in change in management in 19.8% pts (40/202). In the larger multicenter cohort, of the 8803 pts who underwent testing, 5367 (61.0%) were < 65 and 3417 (38.8%) ≥ 65 years-old. ATM, ESR1 and PIK3CA mutations were more common in age≥65 pts (p < 0.0001) and MYC mutations were less common in age≥65 pts (p < 0.0001). Conclusions: This study found that ctDNA is a feasible, attractive alternative to traditional biopsies and may identify actionable mutations in older adults with breast cancer. When controlling for subtype, results from a single institution were similar to the larger multicenter cohort showing ATM and PIK3CA were more common in the older adult population. This data suggests there may be additional molecular differences between breast cancer in older compared to younger adults that warrants further investigation.

AF is the most common arrhythmia in clinical practice, with a large preponderance in the older (>75 years) adult population. Stroke is the most feared complication of AF, with huge corresponding morbidity and mortality. Anticoagulation is the mainstay for stroke prevention in AF, but is commonly underutilised in clinical practice due to the fear of intracerebral bleeding. Bleeding is the primary concern in older patients with conventional vitamin K antagonist use. Direct oral anticoagulants (DOACs) have been used for a decade in clinical practice and have been found to reduce major bleeds. The advantages of DOAC use in older patients include obviating the need for intermittent international normalised ratio monitoring, fewer drug interactions and reduction in intracerebral haemorrhage. The disadvantages of DOAC use include older patients having to take multiple doses per day and a lack of a universal antidote, as opposed to vitamin K antagonists. However, a lack of head-to-head trials among DOACs and specific randomised controlled trials in older patients preclude a definite conclusion regarding the ideal DOAC that should be used in the older population. Factor XI inhibition is an emerging approach for oral anticoagulation that holds promise for dissociating thrombosis from haemostasis. This provides an additional avenue for reducing bleeding in the older adult population.

Ground truth generalizability affects performance of the artificial intelligence model in automated vertebral fracture detection on plain lateral radiographs of the spine

Cancer-related cognitive dysfunction (CRCD) is a side-effect of chemotherapy, particularly among young and adult populations. Results indicate CRCD is also prevalent in older adult populations. While various non-pharmacological interventions for cognitive impairments have been studied in young cancer and older adult populations, limited information is available regarding non-pharmacologic interventions for older adults with cancer. The purpose of this systematic review is to describe the current non-pharmacologic interventions for CRCD in the older adult cancer population. Databases searched included PubMed, MEDLINE, CINAHL, and EMBASE. Articles meeting inclusion criteria were appraised by 2 reviewers independently. The Cochrane Risk of Bias Assessment was used to assess study quality. The search located 3441 articles; 4 met inclusion criteria. Cognitive domains assessed by included studies comprised executive function (n=2), attention (n=1), learning/memory (n=2), perceptual-motor (n=1), and a general measure of global cognitive function (n=3). Two studies used exercise interventions and 2 employed cognitive training interventions. One exercise intervention improved executive function, while attention and learning/memory improved following cognitive training. However, a limited number of studies utilizing non-pharmacological approaches for treating cognitive impairment in this population showed high methodological heterogeneity. Non-pharmacologic interventions demonstrated positive outcomes for CRCD, however, methodological concerns in the included studies prevented definitive recommendations from being made. Findings may guide additional studies needed in this field in order to make more robust conclusions.

Normative data for the 10/66 dementia research group neuropsychological test battery from Singapore's older adult population.

Most published reports in medical literature indicate vitamin D deficiency in older adult populations, indicating the need for vitamin D supplementation. However, vitamin D is a fat soluble vitamin and some toxicity may be encountered at a level exceeding 60 ng/mL. Therefore, both vitamin D deficiency and vitamin D excess have clinical consequences. We reviewed vitamin D status from the medical record of 528 patients aged 65 years and older where 25-hydroxy vitamin D test was ordered. Only 66 patients (12.5%) demonstrated vitamin D deficiency (25-hydroxy vitamin D concentration <20 ng/mL) while 177 patients (33.5%) showed 25-hydroxy vitamin D concentrations above 50 ng/mL, but less than 60 ng/mL. In addition, 285 patients (53.9%) showed 25-hydroxy vitamin D concentrations above the recommended upper limit of 60 ng/mL. In our older adult patient population, we unexpectedly observed that most patients showed elevated 25-hydroxy vitamin D concentrations. Therefore, screening is critical to avoid excess concentration of 25-hydroxy vitamin D in elderly patients.

Background There are scarce analyses on COVID-19 infection risk factors for the older adult population. This study aims to examine COVID-19 infection risk factors in the older adult general population. Methods The data for this analysis came from the population-representative Study on Health of Older People in Germany (Gesundheit65+) conducted by the Robert Koch Institute from 10/2021 to 08/2022. We considered information on COVID-19 infection status (self-reported infection confirmed by PRC test at least once vs. never), socio-demographic factors, health risk factors, and different face-to-face interactions. The analysis was restricted to 2,976 individuals aged 65+ years with complete infection status information. We assessed weighted prevalences and used univariable and multivariable logistic regressions to evaluate infection risk factors. Results The overall prevalence of infection was 7.2% (95% confidence interval, 6.0-8.7). Infection prevalences were significantly higher (compared to their respective reference group) among participants living in assisted living facilities (24.7% vs. 6.7%), individuals who got help to perform basic activities of daily living (10.8% vs. 6.8%), COVID-19 unvaccinated individuals (25.2% vs. 6.9%), individuals who did not meet family or friends in the last month (12.7% vs. 6.7%), and participants who did not smoke (7.8% vs. 2.6%). No other variable was significantly related to COVID-19 infection. In multivariable analysis, variables independently associated with higher odds ratio (OR) of COVID-19 infection were: living in an assisted living facility OR 3.6 (1.8-7.2), not being vaccinated against COVID-19 OR 4.6 (1.5-14.1), and not smoking OR 1.6 (1.1-2.6). Conclusions The preliminary results of this study align with the prevalence of COVID-19 infection found in concomitant studies. A noteworthy element of our study is the vaccine’s protective effect. The pandemic had a particularly detrimental effect on residents of assisted living facilities Key messages • Improvement in quality of care and infection preventive measures in nursing homes is necessary. • Pandemic preparedness must consider the need for help in the daily life of the older population.

Horticultural Therapy and the Older Adult Population is the guidebook you've been waiting for since the American Horticultural Therapy Association's (AHTA) 1981 publication. With an updated collection of chapters in the area of horticultural therapy and older adults--ranging from a review of relevant literature to descriptions of existing horticultural therapy programs--this book will stimulate networking and information sharing among horticultural therapists and other professionals working with older adults, spur new ideas, and foster continuing research in the field. The book's importance is recognized internationally, and it is soon to be published in Japanese.In Horticultural Therapy and the Older Adult Population, you will find chapters on garden designs to enhance the horticultural therapy experience, descriptions of existing horticultural therapy programs for older adults, and new research to evaluate the effectiveness of horticultural therapy with this population. Whether you're an established horticultural therapist, a nursing home administrator, or a gerontology educator, this book will help you design gardens, set up and evaluate programs, and develop curriculum.Horticultural Therapy and the Older Adult Population also includes the results of a survey sent to all registered members of AHTA who work with the older adult population. The survey responses provide information about the institutions and the population served, programming activities, program staffing, program evaluation, and funding. Another beneficial feature of the book is a resource-packed bibliography. Prepared as a service to horticultural therapists and others working with older adults, it covers the most relevant publications--giving you more places to find inspiration and ideas for improving care to the elderly through horticultural therapy.

BackgroundCancer is one of the predominant causes of morbidity and mortality in older adult populations worldwide. Among a range of barriers, comorbidity particularly poses a clinical challenge in cancer diagnosis, prognosis, and treatment owing to its heterogeneous nature. While accurate comorbidity assessments and appropriate treatment administration can result in better patient outcomes, evidence related to older adult cancer populations is limited as these individuals are often excluded from regular clinical trials due to age and comorbid conditions.ObjectiveTo determine the prevalence of physical comorbidity and the impact of physical comorbidities and rurality on treatment and its outcomes in older adult cancer populations.MethodsScientific databases Embase and PubMed were searched for published scientific literature on physical comorbidity and older adult cancer patients. Google Scholar was searched for scholarly literature published in nonindexed journals. Snowballing was utilized to identify research papers missed in the above searches. Included studies : (1) reported on original research involving cancer patients; (2) included patients aged 65 years or older; (3) had patients receiving cancer-related treatment and (4) cancer survivors; (5) reported on physical comorbidity as a variable; (6) were published in English; and (7) conducted from any geographical location.ResultsIn total, 29 studies were selected for data extraction, evidence synthesis, and quality assessment. In these, comorbidities ranged from 37.9%-74.3% in colorectal cancer, 74%-81% in head and neck cancer, and 12.6%-49% in breast cancer. Moderate comorbidities ranged from 13%-72.9%, and severe comorbidities from 2.5%-68.2%. Comorbidity increased with age, with comorbidity affecting both treatment choice and process. Physical comorbidities significantly affected treatment initiation, causing delay, toxicity, and discontinuation. Older adult cancer patients were given less vigorous and nonstandard treatments and were also less likely to be offered treatment. Where patients are given more vigorous treatment, several studies showed better survival outcomes. Appropriate treatment in older adult cancer patients increased both overall and disease-related survival rates. None of the studies noted rurality as a distinct variable.ConclusionsThis systematic review concludes that there is evidence to substantiate the adverse effect of comorbidity on treatment and survival outcomes. However, the mechanism by which comorbidity impedes or impacts treatment is unknown in many cases. Some low-quality evidence is available for considering the functional status and biological age in treatment decisions. Future studies that substantiate the value of comprehensive older adult assessments before treatment initiation in cancer patients, including assessing the nature and severity of comorbidities, and additional consideration of rurality as a factor, could lessen the effect of comorbidities on the treatment process.

CARING FOR ASIAN AMERICAN OLDER ADULTS: AN EXPLORATION IN THE SOUTHERN REGION OF THE UNITED STATES

No Improvement in the Age Adjusted Mortality of Older Adults with Acute Lymphoblastic Leukemia Despite the Availability of Blinatumumab, Inotuzumab and Novel TKIs : A 1999-2020 Analysis in the United States

Self-care in the older adult population with chronic disease: concept analysis

Objective: We sought to examine characteristics of neighborhoods with changing older adult populations. Method: We used 30 years (1980-2011) of data from four U.S. cities (n = 392 neighborhoods; Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota; Oakland, California) and finite mixture modeling to identify trajectory classes: neighborhoods with “stable,” declining, or increasing older adult populations (≥65 years). We then compared mean baseline and change in their characteristics. Results: Neighborhoods with an increasing (vs. “stable”) percentage of older adult populations had lower initial poverty and greater increases in education and income, with lower increases in road connectivity, population density, and housing prices/debt over time. The same was true for neighborhoods with declining older adult populations, with the exception of having higher increases in housing prices/debt. We observed few significant differences in neighborhood amenities or parks across classes. Conclusion: Our results emphasize the need to consider built and social environments when planning communities for older adults.

Medicine self-administration errors in the older adult population: A systematic review.

Association of Cognitive Impairment and Spinal Pain in the Older Adult Population in the United States: A Cross-Sectional Study.