Epidemiology of Insomnia: Prevalence, Course, Risk Factors, and Public Health Burden.

Ms. F, a 42-year-old divorced woman, presents for evaluation of chronic insomnia. She complains of difficulty falling asleep, often 30 minutes or longer, and difficulty maintaining sleep during the night, with frequent awakenings that often last 30 minutes or longer. These symptoms occur nearly every night, with only one or two “good” nights per month. She typically goes to bed around 10:00 p.m. to give herself adequate time for sleep, and she gets out of bed around 7:00 a.m. on work days and as late as 9:00 a.m. on weekends. Her nighttime sleep problems result in daytime irritability and difficulty focusing and organizing her thoughts, which subjectively impair her work as an administrative assistant, although her performance evaluations have been satisfactory. She says that she has “no energy for anything extra,” that her house is a mess, and that she routinely declines invitations to join social and even family activities. Her insomnia began approximately 5 years ago during a period of increased life stress related to a difficult divorce and a job change. At that time she was diagnosed with major depression and was started on a successful trial of escitalopram, which she continues at a dose of 10 mg/day. Her current symptoms are distinct from those that were associated with her episode of major depression. She denies pervasive sadness or loss of interest, but she is very frustrated with her inability to function more effectively, which she attributes to her insomnia. In fact, she believes that her cognitive difficulties and irritability are most noticeable after nights of particularly poor sleep. Her medical history is unremarkable other than a past history of Graves’ disease. She has been treated with levothyroxine for the past 15 years. How should Ms. F be evaluated? What medical testing, if any, would be appropriate? What factors should be considered in formulating a treatment plan? What treatments would be appropriate?

IntroductionHypertension has been identified as a significant predictor of many chronic health conditions. Body Mass Index (BMI) and Quality of Life (QoL) are key determinants of hypertension especially among elderly populations. In this study, we examined the effect of self-reported hypertension (SRH) on chronic health conditions and quality of life among older adults in Ghana.MethodsThe WHO Study on Global Ageing and Adult Health Wave 2 data for Ghana, collected from 2014 to 2015 was applied in this study. Data for older adults aged 50 years and above were analyzed. Weighted descriptive and inferential analyses were performed using Stata 14. We predicted any potential associations between SRH and chronic health conditions using a corrected chi-square and Coarsened Exact Matching with adjusted odds ratios.ResultsThe prevalence of SRH among older adults in Ghana was 15.8%. This was significantly associated with sex, marital status, religion, place of residence, working status, location/region, health status BMI, and QoL. In all, older adults with poor health status, obese state and high QoL had 3.15, 2.17 and 2.76 odds of SRH respectively [AOR(95%CI)p-value=3.15(1.65-6.02)0.001, 2.17(1.31-3.59)0.003 and 2.76(1.04-7.31)0.041)]. In addition, older adults with SRH were at increased risk of reporting chronic conditions such as stroke, angina, diabetes and cataract.ConclusionOverall, a key observation from this analysis is that SRH (and not only clinically diagnosed hypertension) is significantly associated with co-morbidities. In Ghana, older adults with SRH have increased risk of co-morbidities including diabetes, stroke, angina, and cataract. Interventions to improve the awareness and early detection of hypertension at the population level is key. Controlling hypertension at the population level will reduce prevalence of chronic conditions and increased protection.

Older Homeless Adults: Can We Do More?

BackgroundThe likely corresponding increase in prevalence of chronic disease will be a major challenge for the health care system. Few nationwide epidemiological studies include a large enough sample of older adults to provide estimates of chronic conditions in the older adult population. This study aimed to estimate the prevalence of eight common chronic health conditions and examine socioeconomic inequalities in the diseases among older adults in China.MethodData are from SAGE-China Wave 1, including 13,157 people aged 50-plus years. Respondents were asked if they had been diagnosed with any of the following chronic medical conditions: angina, arthritis, asthma, stroke, diabetes, depression, chronic lung disease and hypertension. A set of validated symptom-based questions and related diagnostic algorithms were also used to estimate disease prevalence for angina, arthritis, asthma and depression. Multivariate logistic regression was performed to examine the probability of developing chronic conditions in relation to sociodemographic variables such as gender, age, urban/rural setting and household wealth level.ResultsFifty percent of respondents reported having one of the selected chronic conditions, 18.9% two conditions, 5.8% three conditions, and 1.4% reported having four or more chronic conditions. Self-reported prevalence was generated for angina (8%), arthritis (22%), asthma (2%), stroke (3%), diabetes (7%), depression (0.3%), chronic lung disease (8%) and hypertension (27%). The symptom-based prevalence of angina, arthritis, asthma and depression was 10%, 20%, 4% and 2%, respectively.ConclusionThis study provides the best available prevalence estimates for major chronic health conditions among older Chinese adults. Findings from this study indicated that major chronic conditions were common, so prevention and early intervention targeting adults aged 50 years and older should be prioritized.

Background In 2023, CDC recommended respiratory syncytial virus (RSV) vaccination for adults aged ≥ 60 years using shared clinical decision-making. Clinical trials of RSV vaccines in younger age groups are ongoing. Identifying chronic conditions associated with increased RSV hospitalization risk can inform vaccination policy.Figure 1.Prevalence of chronic medical conditions among community-dwelling adults aged ≥50 years hospitalized with respiratory syncytial virus (RSV),1 in RSV-NET states,2 and in 50 US states and the District of Columbia2Abbreviations: BMI: body mass index (kg/m2), COPD: chronic obstructive pulmonary disease 1 Prevalence of chronic conditions indicated in the medical record among community-dwelling adults aged ≥50 years hospitalized with laboratory-confirmed RSV infection identified by the RSV Hospitalization Surveillance Network (RSV-NET) from October 2017 to April 2018. 2 Weighted prevalence of community-dwelling adults aged ≥50 years in RSV-NET states (CA, GA, MD, MN, NM, NY, OR, TN) or 50 states and the District of Columbia who self-reported history of chronic medical conditions on the 2018 Behavioral Risk Factor Surveillance System. Methods We compared RSV hospitalization rates among community-dwelling adults aged ≥ 50 years with and without 9 chronic medical conditions in a 38-county catchment area across 8 states. Rate numerators included hospitalizations in adults with and without medical record documentation of each chronic condition, with laboratory-confirmed RSV infection from October 2017 to April 2018 identified by the RSV Hospitalization Surveillance Network (RSV-NET). Rate denominators were catchment area population counts of adults with and without each chronic condition estimated from the 2018 Behavioral Risk Factor Surveillance System, which relies on self-report, and the US Census. Poisson regression using Monte Carlo simulation generated adjusted rate ratios (aRR) and 95% Monte Carlo confidence intervals (CI), adjusted for age, sex, and race and ethnicity group.Table 1.Adjusted models comparing respiratory syncytial virus (RSV) hospitalization rates among community-dwelling adults aged ≥50 years by number of chronic medical conditions— RSV Hospitalization Surveillance Network (RSV-NET), October 2017–April 2018Abbreviations: aRR: adjusted rate ratio; CI: Monte Carlo confidence interval1 aRR and 95% Monte Carlo CI were estimated using Poisson regression and Monte Carlo simulation after adjusting for age group (50-59 years, 60-74 years, ≥75 years), sex, and race and ethnicity group (non-Hispanic White, non-Hispanic Black, and other).2 Includes asthma, chronic obstructive pulmonary disease, chronic kidney disease, coronary artery disease, diabetes, history of stroke, obesity (body mass index 30-39 kg/m2), severe obesity (body mass index ≥40 kg/m2), and current smoking. Results Among 1,692 adults aged ≥ 50 years hospitalized with laboratory-confirmed RSV infection, 86.9% had ≥1 chronic condition (Figure 1). RSV hospitalization rates were higher among adults with 1 (aRR=2.7, CI: 1.8, 3.9) or ≥2 chronic conditions (aRR=9.0, CI: 6.3-12.6) vs. none and among adults aged 60-74 years (aRR=1.8, CI: 1.3, 2.6) or ≥ 75 years (aRR=5.4, CI: 3.8-7.8) vs. 50-59 years (Table 1). Adults aged ≥ 50 years with the following individual chronic conditions had higher RSV hospitalization rates compared to those without the conditions: chronic kidney disease (aRR=6.1), COPD (aRR=4.9), severe obesity (aRR=4.0), asthma (aRR=3.2), diabetes (aRR=2.5), current smoking (aRR=2.1), and non-severe obesity (aRR=1.6; Figure 2). RSV hospitalization rates among adults aged ≥ 50 years with each chronic condition were highest in the oldest age groups (Figure 3).Figure 2.Adjusted rate ratios1 comparing respiratory syncytial virus (RSV) hospitalization rates among community-dwelling adults aged ≥50 years with and without chronic medical conditions—RSV Hospitalization Surveillance Network (RSV-NET), October 2017–April 2018Abbreviations: aRR: adjusted rate ratio; BMI: body mass index (kg/m2), COPD: chronic obstructive pulmonary disease; SI: simulation interval 1 aRR and 95% Monte Carlo CIs were estimated using Poisson regression and Monte Carlo simulation, after adjusting for age group (50-59 years, 60-74 years, ≥75 years), sex, and race and ethnicity group (non-Hispanic White, non-Hispanic Black, and other). Conclusion In community-dwelling adults aged ≥50 years, RSV hospitalization rates were higher among older adults and those with a history of select chronic conditions. These populations might benefit most from RSV vaccination when recommended for use.Figure 3.Respiratory syncytial virus (RSV) hospitalization rates1 among community-dwelling adults aged ≥50 years with chronic medical condition by age group—RSV Hospitalization Surveillance Network (RSV-NET), October 2017–April 2018Abbreviations: BMI: body mass index, COPD: chronic obstructive pulmonary disease 1 Rates of laboratory-confirmed RSV hospitalization account for under-detection of RSV infection among hospitalized adults and sensitivity of diagnostic tests. Rates are of community-dwelling adults and exclude residents of nursing homes and long-term care facilities. Rates are not adjusted for sex or race and ethnicity group. Disclosures All Authors: No reported disclosures

Real-World Diabetes Technology: Overcoming Barriers and Disparities.

Influence of Studies Published by the Journal of the American Geriatrics Society: Top 20 Articles from 2000-2015.

This study aimed to investigate the prevalence of sarcopenia among older Thai adults residing in Bangkok and identify associated risk factors. This cross-sectional study included Thai adults aged ≥60 years. All participants underwent assessments using the Yubi-wakka test, anthropometric measurements, bioelectrical impedance analysis, handgrip strength tests, and physical performance evaluations. Information on demographic characteristics, chronic health conditions, nutritional status, and medication use was also collected. Sarcopenia was diagnosed according to the 2019 Asian Working Group for Sarcopenia criteria. Statistical analyses were performed using the independent t-test, Chi-square test, and logistic regression to identify risk factors. Among the 600 participants, the overall prevalence of sarcopenia was 19%. The multivariate analysis identified 13 significant risk factors associated with sarcopenia, including age ≥75 years (odds ratio [OR]=10.6, 95% confidence interval [CI]=3.7-30.2), higher education level (year) (OR=0.85, 95% CI=0.74-0.98), lower income level (OR=5.4, 95% CI=1.4-21.4), Barthel index <90 (OR=11.0, 95% CI=3.5-34.5), lower body mass index (OR=0.7, 95% CI=0.6-0.8), low calf circumference (OR=7.6, 95% CI=2.5-23.3), fall in the past year (OR, 3.1; 95% CI, 1.4-6.6), frailty (OR, 2.3; 95% CI, 1.1-4.5), malnutrition (OR=3.5, 95% CI=1.3-9.3), history of stroke (OR=7.5, 95% CI=1.3-41.4), vitamin D deficiency (OR=9.4, 95% CI=1.1-82.5), knee osteoarthritis (OR=6.3, 95% CI=1.57-25.31), and malignancy (OR=4.8, 95% CI=1.01-22.70). This study evaluated the sarcopenia status across a diverse demographic of older Thai adults using comprehensive assessments, and examined the impact of socioeconomic factors and various chronic conditions on the occurrence of sarcopenia.

Since the initial scientific statement on Secondary Prevention of Coronary Heart Disease (CHD) in the Elderly was published in 2002,1 several trends have continued that make an update highly appropriate. First, the graying of the US population and those of other industrialized countries has progressed unabated because more adults are surviving into their senior years. The number of Americans aged ≥75 years was estimated at 18.6 million in 2010, representing ≈6% of the population,2 and it is expected to double by 2050. The population aged ≥85 years is growing the most rapidly, with numbers expected to reach 19.5 million by 2040. In 2008, 67% of the 811 940 cardiovascular deaths in the United States occurred in people aged ≥75 years.3 In parallel to this increase in the older adult demographic, the number of Americans with CHD has increased to an estimated 16.3 million, more than half of whom are >65 years of age.3 Similarly, 7 million have had a stroke, the incidence of which approximately doubles with successive age decades after 45 to 54 years.3 Peripheral artery disease (PAD) affects 8 to 10 million Americans, the majority of whom are >65 years of age. Between 2015 and 2030, annual US costs related to atherosclerotic cardiovascular disease (ASCVD) are projected to increase from $84.8 billion to $202 billion.3 Moreover, given that ASCVD often undermines functional capacity and independence and increases reliance on long-term care, indirect expenses related to ASCVD are also expected to increase. Thus, the need for effective secondary prevention measures in the older adult population with known ASCVD has never been greater. Notably, the 2011 American Heart Association (AHA)/American College of Cardiology Foundation (ACCF) updated guidelines for secondary prevention of CHD broadened …

Sleep disturbance and activation of cellular and transcriptional mechanisms of inflammation in older adults

Examining the effects of multiple chronic conditions on cognitive decline and potential moderators among older Koreans: Findings from the Korean Longitudinal Study of Ageing 2006–2016

Insomnia has been identified as a risk factor for tension-type headache, although the pathogenesis of sleep disturbance in this population is unclear. The present study examined pain-related self-management strategies in a nonclinical, young-adult sample for preliminary evidence to support a novel hypothesis for the development of insomnia in this population. Self-report data on triggers of headache, pain interference with sleep, and pain-related self-management strategies were analyzed for 32 women with tension-type headache and 33 women with minimal pain who served as controls. The results revealed that a significantly greater proportion of the headache group relative to the control group reported sleep problems as a trigger of headaches, stress as a trigger of headache, and going to sleep as a coping strategy for pain. The headache group also reported significantly higher ratings of pain interference with sleep. Going to sleep was the most commonly used self-management strategy (81%) by headache sufferers and also rated as the most effective strategy (5.5 out of 7.0). These findings suggest that a bidirectional relationship between sleep disturbance and headache is present in this young-adult sample. Furthermore, the frequent use of sleep as a self-management strategy for pain is consistent with the hypothesis that sleep-seeking behavior might be a mediating factor in the development of insomnia among people with tension-type headache. This hypothesis fits within the most widely accepted conceptual model of chronic insomnia and should be further investigated in individuals with both tension-type headache and insomnia.

Older adults with insomnia frequently report bothersome pain. Whether insomnia treatment reduces bodily pain in older adults without chronic pain conditions is not known. This randomized controlled trial aimed to determine whether treatment of insomnia disorder with cognitive behavioral therapy for insomnia (CBT-I), as compared with sleep education therapy (SET), yields durable remission of insomnia and reduces moderate pain symptoms over 36 months in older adults with insomnia disorder. A community-based sample of 291 adults ages 60 years and older (mean age, 70.1 years; 57.7% female) with insomnia disorder, but no chronic pain condition, were randomized to 2 months of intervention with either CBT-I (n = 156) or SET (n = 135). The primary outcome was change in bodily pain as measured by the short form 36 (SF-36) health survey. Secondary outcome was remission of insomnia continuously sustained over 36 months of follow-up. Improvements in bodily pain, as indexed by increases in SF-36 scores, were found in CBT-I with insomnia remission (adjusted β = 0.18; 95% CI, 0.004-0.360; P = 0.045) and in SET with insomnia remission (adjusted β = 0.25; 95% CI, 0.035-0.457; P = 0.023) but not in treatment groups without insomnia remission. As compared with those without insomnia remission, insomnia remission was associated with improvements in pain (adjusted β = 0.19; 95% CI, 0.047-0.325; P = 0.009) and with increases in the proportion of participants who achieved a minimal clinically important difference (likelihood ratio χ2 1,16 = 264.04; P < 0.001). Sustained remission of insomnia disorder leads to improvements in bodily pain, with the potential to prevent chronic pain disorders in older adults with insomnia. ClinicalTrials.gov NCT01641263.

The promotion of healthy ageing at all ages of life is a key point of public health strategy in almost all health systems throughout the world with a special focus on the systems of the advanced economies. The World Health Organization promotes a lifespan approach in order to put the basis of healthy ageing in the early life, supported by a growing set of data that show the relevance of life habits and socio-economic condition since the childhood for the older adults' health. However, we already witness the impact of large cohort of older adults who fuel the demand for health and social services, with worrying projection for the next 20-30 years in terms of economic stressors on the public finances coming from the request for Long Term Care as well as for Acute care services. Prevention at all age, namely at older age, is crucial to manage the demand for care. What interventions can lead this approach? What model of care could be put on the field in order to offer a mix of integrate health and social care able to meet the individual needs and to promote the best possible quality of life for each individual? what is the role of bio-psycho-social frailty as synthetic indicator of the needs of care at population level as well as of key information to stratify the risk of negative event at individual level? what professionals should be more involved in the new model of community care? what pathway in terms of training could we promote in the next years to support the shift from acute to long term care? what contribution should be asked to civil society to allow the spread of community care? Answers to these questions should fit with different geographical, political, social and economic settings as well as with different health systems. At the same time the development of a multidimensional assessment of the demand of care, both at individual and population level, is a crucial step to plan effective interventions. The main obstacles to this process seem to stem from the organization of community care still in silos with rare collaboration among different professionals. To overcome the obstacles a mindset change should be achieved mainly by training of personnel to set up a new model of care based on the systematic interaction among the prevention and care actors. Moreover, a pro-active component of prevention and care programs at community level, could strengthen many interventions that address a population which is not always aware of the risk associated to the progression of frailty. Finally, ICT devices could provide a valuable contribution to the reshuffling of community care, if they are embedded in a comprehensive model including a robust investment in human resources. The aim of the workshop is to report on the challenges that healthy ageing process has to face in different world areas and to discuss future developments likely to affect public health policies. Key messages Multidimensional approach to public health policies aimed at increasing health promotion programs impact on older adults is the key to promote healthy ageing. Pro-active services could increase the involvement of older adults’ population into healthy ageing program.

Insomnia in people with epilepsy: A review of insomnia prevalence, risk factors and associations with epilepsy-related factors