Atlantic Philanthropies Research Articles

Association between vitamin D deficiency and the risk of prevalent type 2 diabetes and incident prediabetes: A prospective cohort study using data from The Irish Longitudinal Study on Ageing (TILDA).

SummaryBackgroundIt is hypothesized that vitamin D contributes to the aetiology of type 2 diabetes mellitus (diabetes). This study's objective was to examine the relationships between baseline vitamin D status (as measured by plasma 25-hydroxyvitamin D concentration) and both prevalent diabetes and prospective risk of developing diabetes, including prediabetes, in a population with historically low levels of vitamin D.MethodsIn this prospective cohort study, data from The Irish Longitudinal Study on Ageing (TILDA), a nationally representative cohort of adults aged ≥50 years residing in Ireland were analysed, including wave 1 (October 2009–June 2011) (n = 5272) and wave 3 (March 2014–October 2015) (n = 3828). Those aged <50 years at baseline or who did not complete the health assessment were excluded. Logistic regression models examined the associations between baseline vitamin D concentration (nmol/L) with prevalent diabetes status and incident diabetes/prediabetes collected at a 4-year follow-up. Models were adjusted for age, sex, education, body mass index, smoking history, physical activity, use of statins, and the season in which the vitamin D concentration was sampled.FindingsDeficient baseline vitamin D concentration was cross-sectionally associated with an increased likelihood of having prevalent diabetes (Relative Risk Ratio [RRR] 1·5, 95% CI: 1·03, 2·18; p = 0·037). In longitudinal analyses evaluating diabetes status 4 years later, there was a 62% increased likelihood (RRR: 1·62, 95% CI: 1·12, 2·35; p = 0·011) of developing prediabetes for those with vitamin D <30 nmol/L compared to those with ≥75 nmol/L. The rate of progression from prediabetes to diabetes between wave 1 and 3 was observed to be 32·5%.InterpretationThose with lower concentrations of vitamin D, as measured by 25-hydroxyvitamin D, may have different risk profiles with regards to their glycaemic status. Our study had limited power due to the low incidence of diabetes but showed strong associations with incident prediabetes, so further research is required. Optimising vitamin D status at a population level may significantly reduce diabetes.FundingTILDA is funded by Atlantic Philanthropies, the Irish Department of Health, and Irish Life, while additional funding was provided by the Irish Department of Agriculture, Food and the Marine (13F492) to cover the cost of 25-hydroxyvitamin D analysis.

Quantifying cell cycle-dependent drug sensitivities in cancer using a high throughput synchronisation and screening approach.

BackgroundChemotherapy and targeted agent anti-cancer efficacy is largely dependent on the proliferative state of tumours, as exemplified by agents that target DNA synthesis/replication or mitosis. As a result, cell cycle specificities of a number of cancer drugs are well known. However, they are yet to be described in a quantifiable manner.MethodsA scalable cell synchronisation protocol used to screen a library of 235 anti-cancer compounds exposed over six hours in G1 or S/G2 accumulated AsPC-1 cells to generate a cell cycle specificity (CCS) score.FindingsThe synchronisation method was associated with reduced method-related cytotoxicity compared to nocodazole, delivering sufficient cell cycle purity and cell numbers to run high-throughput drug library screens. Compounds were identified with G1 and S/G2-associated specificities that, overall, functionally matched with a compound's target/mechanism of action. This annotation was used to describe a synergistic schedule using the CDK4/6 inhibitor, palbociclib, prior to gemcitabine/AZD6738 as well as describe the correlation between the CCS score and published synergistic/antagonistic drug schedules.InterpretationThis is the first highly quantitative description of cell cycle-dependent drug sensitivities that utilised a tractable and tolerated method with potential uses outside the present study. Drug treatments such as those shown to be G1 or S/G2 associated may benefit from scheduling considerations such as after CDK4/6 inhibitors and being first in drug sequences respectively.FundingCancer Research UK (CRUK) Institute core grants C14303/A17197 and C9545/A29580. The Li Ka Shing Centre where this work was performed was generously funded by CK Hutchison Holdings Limited, the University of Cambridge, CRUK, The Atlantic Philanthropies and others.

Choice reaction time and subsequent mobility decline: Prospective observational findings from The Irish Longitudinal Study on Ageing (TILDA).

BackgroundCognitive and motor function in ageing are intertwined, but whether slower motor response time (MRT) to a cognitive stimulus could herald accelerated mobility decline is unknown. Using data from The Irish Longitudinal Study on Ageing (TILDA), we examined whether slower MRT may predict a greater than expected increase in Time Up and Go (TUG) after 4 years.MethodsParticipants aged 50 years or older were divided into two groups based on their mean MRT (< 250 ms versus ≥ 250 ms). A repeated measures ANOVA compared TUG trajectories between groups, controlling for baseline age, sex, height, education level, mini mental-state examination (MMSE) score, self-reported vision and hearing, medical conditions (cardiovascular, cerebrovascular disease, diabetes), and number of medications.FindingsAt Wave 1, 1982 (58.7%) had a mean MRT of < 250 ms, with a mean TUG of 8.1 s (SD 1.6); and 1397 (41.3%) had an MRT of ≥ 250 ms, with a TUG of 9.0 s (SD 2.2). At Wave 3, TUG increased to 8.8 s (SD 2.0) and 10.2 s (SD 3.9), respectively. The results of the adjusted repeated measures ANOVA suggested that there was a statistically significant interaction between MRT group and Wave (P = 0.023, η2p = 0.002).InterpretationTILDA participants in the slower MRT group seemed to have faster mobility decline, but this effect was statistically and clinically small.FundingTILDA is funded by Atlantic Philanthropies, the Irish Department of Health and Irish Life. Roman Romero-Ortuno is funded by Science Foundation Ireland (grant number 18/FRL/6188).

Racial disparities in positive airway pressure therapy adherence among veterans with obstructive sleep apnea.

Black individuals are disproportionately affected by diabetes, cardiovascular disease, obesity, and OSA. Adherence to PAP therapy has been reported to be lower among black individuals. This study seeks to examine associations between black race and PAP adherence among veterans with OSA. This was a retrospective study. Veterans newly diagnosed with OSA at a single Department of Veterans Affairs sleep center who were prescribed a modem-enabled PAP device between January 2015 and November 2017 were enrolled. PAP adherence was defined as ≥ 4 hours nightly usage for at least 70% of nights measured at 30 days from PAP setup. We examined the relationship between race and adherence, controlling for sex, marital status, age, socioeconomic status, residual apnea-hypopnea index), and mask leak. Of 3013 patients identified with OSA, 2571 (85%) were newly started on PAP therapy (95% male, aged 59 years ± 14 years, 45% married, 8% with neighborhood socioeconomic disadvantage). Twenty-five percent of participants were black, and 57% were white. PAP adherence at 30 days was 50% overall (42% among blacks, 53% among nonblacks). Black race was associated with reduced 30-day PAP adherence in unadjusted (P < .001) and adjusted logistic regression models (odds ratio = 0.64; 95% CI, 0.53 - 0.78; P < .001). Among veterans with OSA, black race was associated with reduced PAP adherence. These findings suggest health inequality among black individuals in the treatment of OSA.

Donor-Driven Designs on the University

Universities across the world are increasingly dependent on substantial gifts from the super-rich and their charitable foundations for capital development. The “golden age of philanthropy” compels academic managers to become campaigners and supplicants and rewards those whose research appeals to the philanthropic marketplace. Philanthropy thereby shapes the organization, activities and behavior of the contemporary university. Additionally, it literally shapes campuses. Substantial gifts, arriving as they do on a timeline that suits philanthropists, re-order development priorities, disrupt masterplans, and generally channel funds toward research in the biosciences, health and technology. Consequently, there has been a boom in university laboratory construction since the early 1990s, especially in biomedical research. This paper explores how philanthropy might have specifically architectural effects. Focusing on Atlantic Philanthropies and their investment in the Translational Research Institute, in Queensland, Australia, it is argued that philanthropy produces buildings that are luxurious and ornamented and, in the context of university requirements, ornamental.

DISCONTINUATION OF CHRONIC BENZODIAZEPINE USE AMONG ADULTS IN THE U.S.

Introduction Benzodiazepine (BZD) use is common and growing in the U.S., with a prescription filled by 5.6% of adults in the U.S., including 8.6% of those ≥65. Clinical guidelines and expert opinion recommend that BZDs should primarily be prescribed on a short-term basis, yet chronic BZD use (i.e., >120 days) is common—ranging from 14.7% among those 18-35 who are prescribed a BZD to 31.4% among adults ≥65—and increasing. As chronic BZD use continues and grows, increasing numbers of adults in the U.S. will accumulate time at-risk for BZD-related harms. To understand more about patients with chronic prescription BZD use and which patients discontinue use, we evaluated 2014-2016 healthcare claims from a large U.S. health insurer. The objectives of this study were to: 1) determine the rate of BZD discontinuation among chronic users; 2) identify which patient clinical characteristics predict discontinuation; 3) determine whether additional non-clinical characteristics (e.g., geography, provider) are associated with discontinuation; and 4) determine the relative contribution of these patient and provider-level factors to BZD discontinuation. Methods We performed a retrospective cohort study using nationwide insurance claims data (Optum Clinformatics Data Mart data) from 2014-2016 of U.S. adults ≥18 years old with chronic BZD use (i.e., >120 days) during the baseline year. The primary outcome was BZD discontinuation among chronic users after one year of follow-up. A series of multilevel logistic regression models examined the association of BZD discontinuation with patient and provider characteristics and estimated variation in discontinuation attributable to provider. Covariates included patient sociodemographics, medical and psychiatric comorbidity, co-prescribed opioids and other psychotropics, and characteristics of the prescribed BZD. Results Of 144,184 chronic BZD users, 13.2% discontinued use after one year. 57.0% of chronic BZD patients received an opioid prescription, which was more common than any clinical diagnosis. Census division was strongly associated with discontinuation (e.g., relative to the Mid-Atlantic, patients in the Pacific had an adjusted odds ratio [AOR] for discontinuation of 1.83 [99% confidence interval [CI] 1.60-2.10]). Females had lower odds of discontinuation (AOR 0.83, 99% CI 0.79-0.87), while African-American patients had higher odds (AOR 1.12, 99% CI 1.03-1.21). Those prescribed a high-potency BZD had lower odds of discontinuation (AOR 0.51, 99% CI 0.48-0.55), as did those prescribed an opioid (AOR 0.94, 99% CI 0.89-0.99). After adjusting for patient and provider-level factors, differences between providers accounted for 5.8% of variation in BZD discontinuation. The median odds ratio for provider was 1.54, an association with discontinuation larger than almost all patient-level clinical variables. Conclusions A small minority of patients prescribed chronic BZD in a given year are no longer prescribed BZDs one year later. The decision to prescribe and then discontinue a BZD—or any other medical treatment—should be driven by a clinical need. However, we found there is significant variation in the likelihood of discontinuation accounted for by non-clinical factors such as race, geography, and a patient's provider. Given the harms associated with co-prescribing of BZDs and opioids, it is worrisome that use of a prescription opioid was more common among chronic BZD patients than any other clinical diagnosis and was associated with lower odds of BZD discontinuation and efforts should continue to focus on those co-prescribed opioids. Finally, since chronic BZD use is rarely the goal when a new BZD is started, clinicians may increase the likelihood of discontinuation by selecting a low-potency option. This research was funded by Dr. Maust receives support from the Beeson Career Development Award Program (NIA K08AG048321, the American Federation for Aging Research, The John A. Hartford Foundation, and The Atlantic Philanthropies) and 1R01DA045705.

Philanthropy and dementia care in Ireland.

This paper examines The Atlantic Philanthropies investment in dementia in Ireland and its impact on the dementia landscape, particularly in relation to policy. Atlantic has directly invested €33 million in dementia in Ireland and leveraged a further €51 million from grantees, resulting in a total spend of €83 million between 2011 and 2016. The investment was broad and far reaching, encapsulating support for personalised community-based care, brain health, advocacy, education and training in dementia, culminating in support for the formulation and implementation of the first National Dementia Strategy in Ireland. Investing in the right people was a key feature of the Atlantic programme and one of the main drivers of its success. A close and credible relationship with government was also important for success. So too was an emphasis on evidence and evaluation, which has been a long-standing trait of Atlantic's involvement in public policy in Ireland, as well as being influential in overall public service reform in the country. It is difficult to determine what the dementia landscape in Ireland might look like if Atlantic had not invested in the area, but even if one accepts the view that change would have come eventually, Atlantic ensured that it came much faster and in a more coherent manner.

Supporting Children’s Participation in Decision Making: A Systematic Literature Review Exploring the Effectiveness of Participatory Processes

This research was conducted as part of the Development and Mainstreaming Programme for Prevention, Partnership and Family Support Study, which is supported by the Atlantic Philanthropies Ireland, Galway University Foundation and the National University of Ireland, Galway.

Curation After the Fact: Practical and Ethical Challenges of Archiving Legacy Evaluation Data

Over a 12-year period, the Atlantic Philanthropies invested more than €127m in agencies and community groups, running 52 prevention and early intervention (PEI) programmes and services in the children and youth sector throughout Ireland. As a condition of this funding, each PEI programme was evaluated by a university-based research team, resulting in a substantial collection of metric and qualitative information about ways to improve the lives of vulnerable Irish families. In 2016, the Atlantic Philanthropies funded the Prevention and Early Intervention Research Initiative at the Children’s Research Network of Ireland and Northern Ireland (hereafter, the Initiative) to gather, prepare and share this evaluation data through the public data archives.&#x0D; The Initiative faces several challenges in its objective to archive this extensive collection of legacy data, and this paper will present two of the more salient challenges: how to share this data so that it is both (1) meaningful and (2) ethical. The paper pays particular attention to the challenges of safely sharing evaluation data through anonymisation and restricted access conditions; and also, the practical and ethical challenges of retroactively preparing these datasets for the archive.&#x0D; A series of publicly available documents that guide each stage of the Initiative are in development, and are emerging as a key output. This paper will describe two pivotal documents, namely the CRN-PEI Guiding Principles, and the CRN-PEI Protocols for preparing and archiving evaluation data. The CRN-PEI Guiding Principles outline the key legal and ethical obligations of archiving this legacy evaluation data, and act as moral compass to steer our progress through these uncharted waters. The CRN-PEI Protocols define the standards for how data included in the Initiative is prepared for deposition in the public data archives, so they are easily located, interpretable and comparable in the long term. This protocol is based upon best practice documentation from a number of international sources and our primary aim is to generate ‘safe, useful data’ (Elliot at al., 2016).

Leadership for Addressing Aging in America: The Health and Aging Policy Fellowship

The Health and Aging Policy Fellows Program funded by The John A. Hartford Foundation and Atlantic Philanthropies trains future leaders to influence healthcare policy, systems, and program development in aging. Following a rigorous residential training in Washington, DC, Fellows establish placements of up to 1 year in the executive, legislative, or judicial branch of government, at a federal agency, state or community agency or committee, or with a nongovernmental organization. The 2016–2017 Fellows' activities represent a broad scope of work, including contributions to national and local policy priorities expected to build over time far beyond the core fellowship year.

Expanding the Field of Surgical Researchers: The Jahnigen Career Development Award.

Under a long-standing collaboration with the John A. Hartford Foundation (JAHF), the Atlantic Philanthropies (AP), and specialty societies in 10 targeted specialties, the American Geriatrics Society (AGS) has been working to improve quality of care provided to older adults by surgical and related medical specialists. To support and nurture future academic leaders, the Geriatrics-for-Specialists Initiative (GSI) established the Dennis W. Jahnigen Career Development Scholar Award (JCDA) program in 2002, with AP joining JAHF as a core funder of the awards in 2003. Commencing in 2011, the National Institute on Aging (NIA) launched the Grants for Early Medical/Surgical Specialists' Transition to Aging Research (GEMSSTAR) program, using an RO3 mechanism. Recipients of the JCDA and the GEMSSTAR are provided with 2 years of research support and networking opportunities with other scholars; 79 JCDA and 26 surgical and related medical specialty GEMSSTAR scholars have been funded through these award mechanisms, with AGS, JAHF, and surgical and related medical specialty societies providing matching support for 20 of the GEMSSTAR scholars for leadership development programs. One of the primary criteria for judging the overall success of the program was eventual transition of the award to a federally funded program, which was achieved when NIA launched the GEMSSTAR program in 2011.

1190 OLDER ADULTS’ PREFERENCES FOR OBSTRUCTIVE SLEEP APNEA TREATMENT ELICITED FROM A PILOT DISCRETE CHOICE EXPERIMENT

Older adults’ preferences for aspects of obstructive sleep apnea (OSA) treatments have not been elicited. Discrete choice experiments (DCE) estimate preferences based on economic theory that value is derived from a combination of characteristics or attributes of the goods. We used DCE to elicit OSA treatment preferences and estimate relative weights for treatment attributes. Participants recruited from an academic and a Veterans Affairs medical center were provided 9 treatment scenarios for newly-diagnosed OSA. For each scenario, they compared three options: 2 unlabeled treatment options, which had varying attribute (long-term benefits, short-term benefits, major side effects, and minor side effects) values across the 9 scenarios, and 1 “no treatment” option, which had constant attribute values. Participants selected their preferred option for each scenario. The experiment was repeated two weeks later to estimate test-retest reliability. A multilevel mixed-effects logistic regression model estimated preference weights, and a mixed effects linear regression model with an interaction term assessed differences in the attributes between sessions. 30 individuals (mean age 71 years [range 65–91]; 27 [90%] had OSA) participated. Treatment selection patterns revealed that participants weighted long-term benefits as most important (odds ratio [OR] 2.41, p<.001). Preference weights for other attributes were: short-term benefits (OR 1.41, p<.001), major side effects (1.38, p<.011), and minor side effects (OR 1.37, p<.001). No differences in preferences were found between the two sessions (all p-values > .120). Older adults weighted long-term benefits most strongly and minor side effects least strongly. These results have implications for patient education material aimed at improving acceptance and adherence to OSA therapy among older adults. We also demonstrated that it is feasible to use DCE to elicit individual preferences among older adults. This method could be used to personalize treatment decisions related to OSA. Research reported in this publication was supported by the National Institute On Aging of the National Institutes of Health under Award Number K23AG045937, The Beeson Career Development in Aging Research Award Program (supported by NIA, AFAR, The John A. Hartford Foundation, and The Atlantic Philanthropies), and CTSI grant UL1TR000124UCLA (Clinical and Translational Science Institute).

Number of Seniors Who Are Prescribed Multiple Psychotropics Rising Fast

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessNumber of Seniors Who Are Prescribed Multiple Psychotropics Rising FastNick ZagorskiNick ZagorskiSearch for more papers by this authorPublished Online:6 Apr 2017https://doi.org/10.1176/appi.pn.2017.3b16AbstractPhysician visits involving three or more drugs of the central nervous system has doubled since 2004, with especially large increases among seniors who are women and live in rural areas.From 2004 to 2013 the number of U.S. seniors taking three or more psychotropic medications more than doubled—an uptick that does not appear to have been driven by trips to a psychiatrist’s office, according to report published February 13 in JAMA Internal Medicine. Donovan Maust, M.D., hopes that more psychiatrist involvement in collaborative care programs will help stem the over-prescribing of psychotropic drugs to seniors.University of MichiganDonovan Maust, M.D., a geriatric psychiatrist at the University of Michigan Medical School in Ann Arbor, and colleagues analyzed data on patients 65 and older. The data were collected as part of the National Ambulatory Medical Care Survey (NAMCS), an annual survey of office-based physicians. Specifically, the researchers wanted to know the number of patients who started or continued taking the following medications: antipsychotics, benzodiazepines, nonbenzodiazepine hypnotics, tricyclic antidepressants, selective serotonin reuptake inhibitors, and opioids. These medications all appear on the Beers Criteria—a list compiled by the American Geriatrics Society highlighting medications that may pose a risk to older adults (see chart). Based on the study’s assessment, annual visits by seniors in which three or more psychotropic medications were initiated and/or continued rose from 0.6 percent in 2004 to 1.4 percent in 2013. This translates to 3.68 million doctor’s visits nationally involving seniors in 2013. Over 90 percent of these visits were conducted outside the psychiatric setting. “What we found most concerning about these numbers is that nearly half of these visits did not include a diagnosis for a mental health or pain disorder,” Maust told Psychiatric News. “This begs the question of why physicians are exposing patients to all the risks of these medications, but not for the diagnoses they are intended to treat.”One possibility is that older patients more commonly display symptoms like loneliness that may not be captured by a standard diagnostic questionnaire, he explained. Therefore, while the patients may fail to meet the strict clinical definition of depression, their elevated levels of emotional distress might prompt clinicians to prescribe an antidepressant.However, another study by Maust and his colleagues published in January in Psychiatric Services suggests the rise in prescriptions may not be due to clinicians misinterpreting symptoms of distress. The group assessed a cohort of older adults who were participating in a clinical study on medication adherence; all the participants were enrolled based on having received a new antidepressant prescription, but further testing showed that not everyone in the study had depression. Maust and his colleagues compared the participants and found that the newly prescribed people without a clinical diagnosis of depression scored much higher on assessments of emotional well-being than people with depression.Another explanation for the rise in the number of seniors on psychotropics may be that seniors today may be more comfortable discussing any temporary mood changes they have experienced with their physician. Primary care providers—who provide the majority of care to seniors and may have little experience treating mental health needs in older patients—may be more inclined to prescribe antidepressants as a precaution, Maust explained.“About 20 years ago, we were all talking about the undertreatment of mental illness in older adults, so it’s progress to see older patients more open to discussing mental health issues with their doctors,” he said. Still, the risks associated with psychotropic and polypharmacy use in older adults should be on the radar of all physicians. Maust said he is hopeful that as more efforts are made to connect primary care physicians with psychiatrists, primary care physicians will become more familiar with best practices for prescribing psychotropics to older adults. “Psychiatrists should always be asking what we can do as a profession to help out primary care providers,” he said.Maust’s studies were supported by grants from the National Institute on Aging, American Federation for Aging Research, The John A. Hartford Foundation, and the Atlantic Philanthropies. ■An abstract of “Trends in Central Nervous System–Active Polypharmacy Among Older Adults Seen in Outpatient Care in the United States” can be accessed here. An abstract of “Antidepressant Prescribing in Primary Care to Older Adults Without Major Depression” is available here. ISSUES NewArchived

End-Game Evaluation: Building a Legacy of Learning In a Limited-Life Foundation

This article shares the emerging hypotheses of two foundations, The Atlantic Philanthropies and the S. D. Bechtel, Jr. Foundation — each four years from sunset — about the opportunities and challenges for evaluation in the limited-life context.

1ST INTERNATIONAL CONFERENCE ON HEALTH SCIENCE EDUCATION, LEADERSHIP AND PRACTICE

The School of Nursing Science on the Mafikeng Campus of the North West University (NWU) hosted the first International Conference on Health Science Education, Leadership and Practice from the 15th to 17th April 2015 at the Birchwood Conference Centre, Boksburg, South Africa. The conference was funded by Atlantic Philanthropies. The purpose of the conference was to provide an opportunity for all health practitioners, educators, leaders, human and social scientists, other scientists and students from across the globe to share their knowledge, practical experiences, research and network with one another through concurrent abstract sessions, plenary, workshops and social functions.

Older Adult Openness to Physician Questioning About Firearms

Older Adult Openness to Physician Questioning About Firearms

The National Hartford Center of Gerontological Nursing Excellence: An Evolution of a Nursing Initiative to Improve Care of Older Adults.

The mission of the John A. Hartford Foundation is to improve the health of older Americans. This mission has been realized throughout the evolution of the National Hartford Center of Gerontological Nursing Excellence-an international collaboration between Schools of Nursing and Sigma Theta Tau International Honor Society of Nursing-whose goal is to support research, education, and practice to provide better nursing care for our aging society. The National Hartford Center is the focus of this supplement and an example of the Foundation's grant-making to prepare the nursing workforce to be competent to care for our aging society. This article traces the innovative origin and inception of the National Hartford Center, first as the Building Academic Geriatric Nursing Capacity (BAGNC) Initiative in 2000 under the leadership of two groundbreaking scholars in nursing and aging sciences: Claire M. Fagin, PhD, RN, and Patricia G. Archbold, DNSc. We continue through to today's leadership and culminate by describing the Center's influence on the gerontological nursing workforce and clinical practice; the paper also includes a brief introduction to the articles, highlighting advances in gerontological nursing science. With funding from the John A. Hartford Foundation, The Atlantic Philanthropies, The Mayday Fund, and a number of creative public and nonprofit partnerships, the National Hartford Center celebrates two decades and its greatest asset-the nearly 300 gerontological nursing leaders, including Archbold nursing pre-docs, Fagin nursing post-docs, and expert faculty, along with its Hartford Centers of Gerontological Nursing Excellence across the country. We trace the transition of BAGNC to the membership-based National Hartford Center and its move to The Gerontological Society of America to become a self-sustaining, autonomous unit. Current needs, challenges, lessons learned, and strategies of the National Hartford Center are examined within the context of sustainability, which has become paramount as Hartford Foundation funding ends in 2016. Despite the auspicious beginnings of the National Hartford Center, system change has been slow. There remains a strong need to continue to grow the field of gerontological nursing and aging sciences. We are working diligently to drive health system reform, and develop and support gerontological nursing leaders and members of the National Hartford Center as exemplars for innovation in care of older adults. The contributing authors of this supplement are from member schools of the National Hartford Center or are current or past program Scholars or Fellows. Herein these authors showcase innovation for older adults through their research that addresses an array of diseases and conditions affecting human systems, embedded in a variety of environments, including in-home care, subsidized housing communities, nursing homes, assisted living facilities, memory care units, and rural community environs.

WE‐EF‐210‐05: Diagnosis and Quantification of Liver Steatosis with Quantitative Ultrasound Backscatter Technique

Purpose:Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the United States, affects 30% of adult Americans and may progress to more serious diseases. Liver biopsy is the standard method for diagnosing NAFLD. MRI can accurately diagnose and quantify hepatic steatosis but is expensive. Sonography with qualitative interpretation by radiologists is lower cost, more accessible but less sensitive for detection. The objective of this study, using MRI proton density fat fraction (PDFF) as reference, is to assess the accuracy for diagnosing and quantifying steatosis with two quantitative US parameters‐‐ backscatter coefficient (BSC) and attenuation coefficient (AC)‐‐derived from RF signals using the calibration phantom technique.Methods:We performed a prospective, cross‐sectional analysis of a cohort of adults (n=204) with NAFLD (MRI‐PDFF≥5%) and without NAFLD (controls). Subjects underwent MRI‐PDFF and BSC and AC US analyses of the liver on the same day. Patients were randomly assigned to training (n=102, mean age 51±17 years, mean body mass index 31±7 kg/m2) and validation (n=102, mean age 49±17 years, body mass index 30±6 kg/m2) groups; 69% of patients in each group had NAFLD.Results:BSC provided AUC 0.98 (95% CI 0.95–1.00, p&lt;0.0001) for diagnosis of NAFLD; the optimal BSC cut‐off provided sensitivity, specificity, positive and negative predictive values (PPV, NPV) of 87%, 91%, 95%, and 76%, respectively. AC provided AUC 0.89 (95% CI 0.81–0.96, p&lt;0.0001) for diagnosis of steatosis; the optimal AC cut‐off provided sensitivity, specificity, PPV, NPV of 80%, 84%, 92%, and 66%, respectively. BSC and AC both correlated significantly with MRI‐PDFF (P&lt;0.0001).Conclusion:QUS BSC and AC can accurately diagnose and quantify hepatic steatosis, using MRI‐PDFF as reference. With further validation, QUS may emerge as an inexpensive, widely available tool for NAFLD assessment.General support: NIH R01 CA111289, K23 ‐DK090303, AmerGastroAssoc Found, TF Williams Scholarship, S3000 scanner loaned by Siemens, Sucampo, JA Hartford Found, Atlantic Philanthropies Amer Gastroenterological Assoc. Agencies had no role in design/conduct of study, collection, management, analysis or interpretation of the data; preparation, review, or approval of the manuscript.

National dissemination of multiple evidence-based disease prevention programs: reach to vulnerable older adults.

Older adults, who are racial/ethnic minorities, report multiple chronic conditions, reside in medically underserved rural areas, or have low incomes carry a high burden of chronic illness but traditionally lack access to disease prevention programs. The Chronic Disease Self-Management Program (CDSMP), A Matter of Balance/Volunteer Lay Leader (AMOB/VLL), and EnhanceFitness (EF) are widely disseminated evidence-based programs (EBP), but the extent to which they are simultaneously delivered in communities to reach vulnerable populations has not been documented. We conducted cross-sectional analyses of three EBP disseminated within 27 states throughout the United States (US) (2006–2009) as part of the Administration on Aging (AoA) Evidence-Based Disease and Disability Prevention Initiative, which received co-funding from the Atlantic Philanthropies. This study measures the extent to which CDSMP, AMOB/VLL, and EF reached vulnerable older adults. It also examines characteristics of communities offering one of these programs relative to those simultaneously offering two or all three programs. Minority/ethnic participants represented 38% for CDSMP, 26% for AMOB/VLL, and 43% for EF. Rural participation was 18% for CDSMP, 17% for AMOB/VLL, and 25% for EF. Those with comorbidities included 63.2% for CDSMP, 58.7% for AMOB/VLL, and 63.6% for EF while approximately one-quarter of participants had incomes under $15,000 for all programs. Rural areas and health professional shortage areas (HPSA) tended to deliver fewer EBP relative to urban areas and non-HPSA. These EBP attract diverse older adult participants. Findings highlight the capability of communities to serve potentially vulnerable older adults by offering multiple EBP. Because each program addresses unique issues facing this older population, further research is needed to better understand how communities can introduce, embed, and sustain multiple EBP to ensure widespread access and utilization, especially to traditionally underserved subgroups.

Emergency department attendance by patients with cancer in the last month of life: a systematic review and meta-analysis

BackgroundEmergency department visits towards the end of life by people with cancer are increasing over time. This increase has occurred despite evidence of an association with poor patient outcomes, the majority of patients preferring home-based care, and significant overcrowding and capacity concerns for many emergency departments. We aimed to explore factors associated with emergency department attendance by cancer patients in the last month of life. MethodsWe searched Medline, Embase, CINAHL, PsychINFO, and the Cochrane Library from inception to February, 2014, for studies investigating emergency department attendances by adult cancer patients (≥18 years) towards the end of life. No time or language limitations were applied. We performed meta-analysis of factors using a random-effects model, with results expressed as odds ratios (OR) for emergency department attendance. Sensitivity analysis explored heterogeneity. Findings30 studies were identified, reporting three demographic, five clinical, and 13 environmental factors; they included data from five countries and 1 181 842 patients. An increased likelihood of emergency department attendance was found for men versus women (OR 1·24, 95% CI 1·19–1·29), black versus white race (1·45, 1·40–1·50), patients with lung cancer versus other cancers (1·17, 1·10–1·23), and those of lowest versus highest socioeconomic status (1·15, 1·10–1·19). Patients receiving palliative care were less likely than those not receiving palliative care to attend the emergency department in the last month of life (OR 0·43, 95% CI 0·36–0·51). InterpretationWe have identified demographic (men, black race), clinical (lung cancer), and environmental (low socioeconomic status, no palliative care) factors associated with an increased risk of emergency department attendance. These findings could be used to develop screening interventions and assist policy makers in directing limited resources. Future studies should also investigate previously neglected areas of research, including psychosocial factors, and the emergency care preferences of patients and caregivers. FundingLH is a PhD clinical training fellow and funded through project BuildCARE which is supported by Cicely Saunders International and The Atlantic Philanthropies, and led by King's College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, UK.