Rates In Older Adults Research Articles

Fish Oil Intake and Exercise Improve Physical Function and Resting Metabolic Rate in Older Adults

Fish Oil Intake and Exercise Improve Physical Function and Resting Metabolic Rate in Older Adults

Calendar effects to forecast influenza seasonality: A case study in Milwaukee, WI

Calendar effects to forecast influenza seasonality: A case study in Milwaukee, WI

Improving vaccination rates in older adults: A quality improvement project.

Adults age 65 or older are at increased risk for acute and chronic diseases. Patients in this group who are up to date with all CDC-recommended vaccinations can reduce morbidity and mortality. This article discusses a quality improvement project across four NP-owned primary care clinics in which all clinical staff received an educational intervention focused on best vaccination practices and Medicare billing strategies. This project yielded improved vaccination rates in the older adult patient population over a 3-month period.

Developing a Hypothetical Model for Suicide Progression in Older Adults With Universal, Selective, and Indicated Prevention Strategies.

Suicide prevention is an increasingly important issue, especially among older people. Recent work on improving its effectiveness has focused on developing a framework aligning interventions with key risk factors and stages of the suicide process. We have developed this further, by integrating psycho-behavioral components associated with suicide, existing guidelines for identifying critical points of intervention, and the previous preventive strategies framework. Our schematic diagram shows the relationship between the suicide process and prevention strategies, combined with initiatives for linking different types of strategies, from universal strategies at population level, through selective strategies focusing on groups at risk, to indicated strategies, aimed at specific high-risk individuals. We tested our framework using previous studies assessing the impact of suicide prevention interventions on suicide rates in older adults. It was possible to place all identified interventions within the framework. Examining effectiveness within the framework suggests that some interventions may be more successful in reducing suicide rates because they developed systematic linkages between universal, selective, and indicated prevention interventions. Other studies, however, show that interventions can be successful without these linkages, so other factors may also be important. The main weakness of our framework is a lack of evidence about critical intervention points within the suicide process, which may limit its practical application. However, the framework may help to improve the linkages between types of interventions, and support practitioners in developing a wide range of strategies across different areas and stages of the suicide process.

Interrelated Neuromuscular and Clinical Risk Factors That Contribute to Falls.

Neuromuscular and clinical factors contribute to falls among older adults, yet the interrelated nature of these factors is not well understood. We investigated the relationships between these factors and how they contribute to falls, which may help optimize fall risk assessment and prevention. A total of 365 primary care patients (age = 77 ± 7, 67% female) were included from the Boston Rehabilitative Impairment Study of the Elderly. Neuromuscular measures included leg strength and leg velocity, trunk extensor endurance, and knee range of motion. Clinical measures included memory, executive function, depressive symptoms, pain, sensory loss, vision, comorbidity, physical activity, mobility self-efficacy, and psychiatric medication. Factor analysis was used to evaluate clustering of factors. Negative binomial regression assessed the relationship of factors with three-year fall rate. Interactions were tested to examine whether clinical factors modified the relationship between neuromuscular factors and falls. Three factors emerged: (i) neuromuscular factors, pain, and self-efficacy; (ii) memory; and (iii) executive function. Having three neuromuscular impairments predicted higher fall rate (incidence rate ratio [95% confidence interval]: 3.39 [1.82-6.32]) but was attenuated by memory (1.69 [1.10-2.61]), mobility self-efficacy (0.99 [0.98-0.99]), psychiatric medication use (1.54 [1.10-2.14]), and pain (1.13 [1.04-1.23]). Pain modified the relationship between neuromuscular impairment burden (number of neuromuscular impairments) and falls. Having three neuromuscular impairments was associated with a higher fall rate in patients with high levels of pain (5.73 [2.46-13.34]) but not among those with low pain. Neuromuscular impairment burden was strongly associated with fall rate in older adults with pain. These factors should be considered together during fall risk assessment, post fall assessment, and prevention.

Cardiovascular Comparison of 2 Types of Local Anesthesia With Vasoconstrictor in Older Adults: A Crossover Study.

We assessed the effect of 2% lidocaine with 1:80,000 adrenaline (L + AD) and 3% prilocaine with 0.03 IU/mL felypressin (P + FP) on blood pressure and heart rate in older adults with systemic diseases undergoing dental extraction. This double-blind, randomized crossover study included 22 elderly participants, aged over 65 years. The participants were administered L + AD for one dental extraction and P + FP for the other. Blood pressure and heart rate were recorded immediately, 5, and 10 minutes after local anesthetic administration and the data were analyzed. The systolic and diastolic blood pressures in the P + FP group increased at all measurement points (p < .001). In the L + AD group, the diastolic blood pressure decreased at 5 and 10 minutes after local anesthetic administration (p < .05), whereas the heart rate increased at all measured time points (p < .001). There were statistically significant differences in systolic blood pressure at 5 and 10 minutes after local anesthetic administration and in diastolic blood pressure and heart rate at all time points between the 2 groups. In older adults, P + FP administration increased the systolic and diastolic blood pressures. L + AD administration increased the heart rate and decreased the diastolic blood pressure.

Association of Inferior Vena Cava Filter Use With Mortality Rates in Older Adults With Acute Pulmonary Embolism

Association of Inferior Vena Cava Filter Use With Mortality Rates in Older Adults With Acute Pulmonary Embolism

Assessment of dietary patterns, physical activity and obesity from a national survey: Rural-urban health disparities in older adults.

BackgroundObesity is a critical public health issue, affecting over one-third of all Americans, and is an underlying cause of numerous health issues across the lifespan. For older adults, obesity is linked to premature declines in physical and mental health and cognitive functioning. The occurrence of obesity and related health behaviors and chronic diseases are higher in rural areas than in urban areas. Furthermore, rural areas of the United States have a higher proportion of older adults than urban areas. Few studies, to date, have explored rural-urban differences in the relationships between dietary patterns and obesity among older adults. Therefore, the purpose of this study is to assess rural-urban differences in obesity rates in older adults, and the potential for the associations between obesity and physical activity and dietary patterns to vary by rural-urban status.MethodsData were abstracted from respondents aged 65 and above from the 2012 Behavioral Risk Factor Surveillance System (BRFSS) database linked to Census-based county-level information on rural-urban status and socioeconomic status. Generalized linear models were utilized to assess rural-urban disparities in obesity, and the potential for associations between obesity and known risk factors (fruit consumption, green vegetable consumption and physical activity) to vary by rural-urban status, accounting for complex sampling and confounders.ResultsObesity rates were highest and fruit consumption was lowest in the most rural areas. However, for older adults in the most urban areas, there was a significant negative association between obesity and fruit and green vegetable consumption. This association was not observed in more rural older adults.ConclusionThese findings underscore the need to take into account place-based factors such as rural-urban status, when designing and implementing policies and interventions designed to reduce obesity through risk factor mitigation in older adults. To reduce rural-urban disparities in older adults, all policies, programs, and interventions should address the unique barriers and needs specific to rural and urban older adults.

LB17. Age-Related Differences in Influenza Type/Subtype Among Patients Hospitalized with Influenza, FluSurv-NET—2017–2018

BackgroundThe 2017–2018 influenza season had the highest rates of influenza hospitalizations since the 2009 H1N1 pandemic. We used data from the Influenza Hospitalization Surveillance Network (FluSurv-NET) to identify unique characteristics of the 2017–2018 season.MethodsWe included all patients residing within a FluSurv-NET catchment area, and hospitalized with laboratory-confirmed influenza during 2017–2018. We used multiple imputation, including age, surveillance site, and month of hospital admission as predictors, to impute influenza A subtype for 40–64% of cases across seasons with an unknown subtype. We calculated influenza hospitalization rates by type/subtype per 100,000 population. We compared 2017–2018 rates to rates during 4 prior seasons: 2016–2017, 2015–2016, 2014–2015, and 2013–2014.ResultsThe overall unadjusted hospitalization rates per 100,000 population varied from 31.5 during 2015–2016 to 105.1 during 2017–2018. After imputing A subtype, the 2017–2018 season had the highest rates observed for H3N2 (62.8) and B (28.5) than in any previous season, and the third highest rate of H1N1 (13.5) (Figure 1A). During 2017–2018, rates in adult ≥65 years peaked 3 weeks before they peaked in children 0–4 years. In contrast, during the four prior seasons, rates in adults ≥65 years peaked during the same week or 1 week after they peaked in children 0–4 years. During 2017–2018, the distribution of influenza type/subtypes varied significantly by age group (P < 0.0001); for example, the proportion of cases with H1N1 ranged from 19 to 29% in those <65 years to only 7% in those ≥65 years. During 2017–2018, H1N1 (the nonpredominant A virus) contributed >25% of A cases across all age groups (except ≥65 years) vs. all prior seasons where the nonpredominant A virus contributed <10% of A cases across all age groups (except ≥65 years) (Figure 1B–F).ConclusionsSeveral unique characteristics may have contributed to the high hospitalization rates observed during 2017–2018. Rates in older adults, who were predominantly infected with H3N2, peaked several weeks prior to children in contrast to prior seasons. Higher overall rates of H3N2 and B were observed in 2017–2018 compared with these prior seasons and substantial H1N1 co-circulation also occurred with marked variability by age group.Disclosures E. J. Anderson, NovaVax: Grant Investigator, Research grant. Pfizer: Grant Investigator, Research grant. AbbVie: Consultant, Consulting fee. MedImmune: Investigator, Research support. PaxVax: Investigator, Research support. Micron: Investigator, Research support. H. K. Talbot, Sanofi Pasteur: Investigator, Research grant. Gilead: Investigator, Research grant. MedImmune: Investigator, Research grant. Vaxinnate: Safety Board, none. Seqirus: Safety Board, none.

THE EFFECTS OF A THEORY-BASED PATIENT PORTAL ELEARNING PROGRAM FOR OLDER ADULTS WITH CHRONIC ILLNESSES

The high prevalence of chronic illnesses is a serious public health problem in the U.S., and more than 70 million older adults have at least one chronic illness. Although patient portals (PPs), a federally supported health information technology, have been shown to be effective in managing chronic illnesses, low PP adoption rates in older adults were addressed as a particular concern. Lack of support for older adults using PPs remains a critical gap in most implementation processes. Previously, our research team developed and pilot-tested 3-week Theory-based Patient portal eLearning Program (T-PeP) for older adults. The main aim of the study was to assess the impact of T-PeP on PP knowledge, selected health outcomes (self-efficacy for PP use and health decision-making and health communication) and PP use in older adults. A two-arm RCT was conducted with older adults (N=272) who have chronic conditions. Participants were recruited online and data were collected at baseline, 3 weeks, and 4 months. The main intervention effects were tested using linear mixed models. The average age of participants was 70.0 + 8.5 years and 78.3% (n=213) were white. At 3 weeks, the intervention group showed significantly greater improvement than the control group in all outcomes, except PP use. At 4 months, the intervention effects decreased, but PP self-efficacy remained significant (p=.006) and PP use showed a significant increase in the intervention group (p=.029). Further studies are needed to test the long-term effects of T-PeP on health behaviors and clinical outcomes using more diverse samples.

A Stroke Reduction Health Plan for Older Adults in Rural Sussex County, Delaware.

Stroke is a leading cause of death and disability among adults age 65 and over in the United States. Modifiable risk factors for stroke include: obesity, poor nutrition, and lack of exercise. Sussex County, Delaware has the highest stroke rate among older adults in the state. Twenty-five percent of the population in Sussex County are 65 and over and about 70% of adults are overweight or obese. Consistent with the social ecological framework, the Stroke Population Risk Tool may be used at the individual level to identify those at an increased risk for stroke and to create individualized stroke specific education. At the community level, local nutrition, fitness, and senior services may be utilized - with older adults at the highest risk profile participating in a 12 week stroke education program focused on risk reduction behaviors, nutrition and exercise classes. At the policy level, the Walkability Assessment Tool may be utilized to encourage local municipalities to identify areas of the county which lack safe spaces to be physically active and to develop a plan to create a more exercise conducive environment. Taken together, the proposal discusses an implementable plan that may, in the long-term, effectively reduce the stroke rates of older adults in Sussex County and allow for the early identification of those at the greatest risk for stroke.

Disability subtypes and mortality rates in older adults: A longitudinal population-based study (NEDICES)

ObjectiveWe investigated the mortality rates of three subtypes of disability and their specific explanatory factors in older adults. MethodsOur data come from NEDICES, a population-based longitudinal cohort study of Spanish older adults. We examined 3816 participants without dementia who completed the Pfeffer's Functional Activities Questionnaire (FAQ) and an assessment of self-perceived functional limitations (SFL) associated with health conditions. Subjects were classified into mutually exclusive subtypes of disability: subtype 1 (SFL), subtype 2 (impaired FAQ), and subtype 3 (impaired FAQ plus SFL). Factors related to all disability subtypes were analyzed using a multinomial logistic regression (MLR), whereas Cox regression (CR) models adjusted by covariates were applied to compare survival rates between groups at the 5-year follow up. ResultsThe CR models indicated that SFL and FAQ scores were associated with higher risk of mortality at 5-years. After stratifying by subtypes of disability, mortality was significantly higher in subtype 3 than in subtypes 1 and 2. All models were consistent after adjusting by different covariates. The MLR showed that subtype 1 was specifically associated with the number of comorbidities, whereas subtype 2 was associated with lower MMSE scores depression and living in nursing homes. ConclusionsOur results show that the combination of impaired FAQ plus SFL have an increased differential predictive utility for mortality than approaches based on unique measures. They also indicate that both measures of disability are associated with different explanatory factors.

Inhaler Technique Education and Exacerbation Risk in Older Adults with Asthma or Chronic Obstructive Pulmonary Disease: A Meta-Analysis.

To evaluate the effect of inhaler education programs on clinical outcomes and exacerbation rates in older adults with asthma or chronic obstructive pulmonary disease (COPD). Systematic review and meta-analysis. Older adults with asthma or COPD, either in primary or secondary health care and pharmacy setting. We searched the Medline, Embase, and Central databases according to the main eligibility criteria for inclusion: systematic reviews, meta-analysis, clinical trials and quasi-experimental studies; participants aged 65 and older; education on inhaler technique and reporting of disease control and exacerbation rates. We used the Grading of Recommendations, Assessment, Development and Evaluations scale for quality assessment and used a random-effect model with Mantel-Haenszel adjustment to perform a meta-analysis. We included 8 studies (4 randomized, 4 quasi-experimental) with a total of 1,812 participants. The most frequent type of intervention was physical demonstration of inhaler technique, training with placebo devices. Five studies showed significant reduction in exacerbation rates (pooled risk ratio=0.71, 95% confidence interval=0.59-0.86; p < .001), although effect on disease control and quality of life showed high discrepancy in the reported results, and all randomized studies revealed uncertainty in their risk of bias assessment. All interventions seemed to improve inhaler performance and clinically relevant outcomes, but a placebo device could be the most effective. There is evidence that interventions reduce exacerbation risk in older adults, although to an overall moderate degree. J Am Geriatr Soc 67:57-66, 2019.

PIN25 - PROJECTED BURDEN OF VACCINE-PREVENTABLE DISEASES IN OLDER ADULTS IN THE UNITED STATES: IMPACT OF POPULATION AGING

Burden of vaccine-preventable diseases in the United States (US) remains high among older adults, despite longstanding immunization recommendations. Accelerated population aging may add to the already significant disease burden in the absence of increased vaccination rates. This study aimed to quantify the impact of aging on future burden of influenza, herpes zoster (HZ), and pertussis in US adults aged 50+ years. A population-based, age-structured economic model was developed to project burden of influenza, HZ, and pertussis using disease-specific decision trees that account for case severity and resource use. The model started with the 2017 US adult population aged 50+ years stratified by 1-year age groups. In each subsequent year, corresponding US Census Bureau population projections were used to calculate undiscounted cases and direct medical costs (2017 US$), keeping current estimates of age-specific disease incidence, vaccine coverage, and efficacy constant over time. Results were calculated over multiple time horizons and for multiple diseases and scenario analyses were conducted. In 2017, influenza burden was estimated at ∼7.57 million cases, with corresponding direct medical costs of $6.6 billion. Over a 10-year horizon, the model projected an additional ∼4.98 million cumulative influenza cases solely due to population aging, with nearly $7.0 billion in additional costs. In each year, most costs were attributed to adults aged 65+ years (range: 67.5-74.2%) and unvaccinated individuals (range: 53.7-55.0%). Excess cases and costs due to population aging were further augmented when projecting over longer time periods. Results for HZ and pertussis also showed increases in disease burden due to population aging. Holding current incidence and vaccination levels constant over the next decade, the model projects notable increases in influenza, HZ, and pertussis burden due to population aging, with a corresponding impact on healthcare resource use and medical costs. Efforts to further increase vaccination rates in older adults are warranted.

Aspectos Psicossociais do Suicídio em Idosos e Percepções de Sobreviventes.

O suicídio de idosos tem se tornado nas últimas décadas uma temática de relevância para a saúde pública. Em relação aos índices de suicídio em idosos, a literatura estima que embora os idosos tenham números de tentativas menores em relação às outras faixas etárias, as taxas de suicídio consumado são maiores. A pesquisa teve como objetivo investigar as circunstâncias psicossociais do óbito por suicídio na velhice, ocorrido em um município no Noroeste do Rio Grande do Sul (RS), por meio de um roteiro de entrevista semiestruturada do instrumento “Autópsia Psicológica e Psicossocial sobre suicídio de idosos”, com abordagem qualitativa. Realizou-se um estudo de caso coletivo, no qual foram verificadas seis autópsias psicossociais de idosos que cometeram suicídio. A pesquisa teve como participantes familiares e pessoas que possuíam vínculo significativo com o idoso que cometeu suicídio. As informações provenientes das entrevistas foram analisadas a partir da análise temática. Com a pesquisa, foi possível investigar as circunstâncias psicossociais envolvidas na morte por suicídio de idosos. Em relação aos fatores psicossociais, pode-se elencar as doenças, a presença de transtornos mentais, a existência de relações conflituosas familiares e as histórias de perdas como fatores encontrados nessa população correlacionados com o suicídio.

Acute Kidney Injury Due to Diarrheal Illness Requiring Hospitalization: Data from the National Inpatient Sample.

Diarrheal illness is a major reason for hospitalization, but data on consequent acute kidney injury (AKI) are sparse. To determine the incidence of AKI in infectious and non-infectious diarrheal illness requiring hospitalization and to identify correlates and outcomes of diarrhea-associated AKI. Using data from the 2012 National Inpatient Sample (NIS), we created a cohort of patients with a primary diagnosis of diarrheal illness. Diarrheal illness, disease correlates, and AKI were defined by ICD-9 diagnosis codes. We used logistic regression with backward variable selection to determine factors independently associated with AKI in infectious and non-infectious diarrheal illness, as well as to determine the association of AKI with in-hospital mortality. We used generalized linear models to assess differences in length of stay and costs of hospitalization. The primary outcome was AKI in hospitalized diarrheal illness. Secondary outcomes were in-hospital mortality, length of stay, and cost of hospitalization associated with AKI. One in ten adults hospitalized with diarrheal illness experienced AKI, with higher incidence rates in older adults. Chronic kidney disease (CKD) and hypertension were associated with increased odds of AKI (all diarrhea OR 4.81, 95% CI 4.52 to 5.12 and OR 1.33, 95% CI 1.27 to 1.40, respectively). AKI in diarrheal illness was associated with substantial increase in mortality (OR 5.05, 95% CI 4.47 to 5.72), length of stay (mean increase 1.7days [95% CI 1.6 to 1.8]), and cost of hospitalization (mean increase $4411 [95% CI 4023 to 4800]). Acute kidney injury is common and consequential among patients hospitalized for diarrheal illness. Persons with CKD and hypertension are the most susceptible, possibly due to diminished renal reserve and exacerbating effects of treatment with diuretics and renin-angiotensin-aldosterone system blockers. Proactive management of these unique pharmacologic and physiologic factors is necessary to prevent AKI in this vulnerable population.

Urinary tract infections (UTIs); a leaflet for older adults, and carers: the development of a UTI leaflet for older adults and their carers

BackgroundEscherichia coli bacteraemia rates are rising with highest rates in older adults. Mandatory surveillance identifies previous Urinary Tract Infections (UTI) and catheterisation as risk factors.AimTo help control bacteraemias in older frail patients by developing a patient leaflet around the prevention and self-care of UTIs informed by the Theoretical Domains Framework.MethodFocus groups or interviews were held with care home staff, residents and relatives, GP staff and an out of hours service, public panels and stakeholders. Questions explored diagnosis, management, prevention of UTIs and antibiotic use in older adults. The leaflet was modified iteratively. Discussions were transcribed and analysed using Nvivo.ResultsCarers of older adults reported their important role in identifying when older adults might have a UTI, as they usually flag symptoms to nurses or primary care providers. Information on UTIs needs to be presented so residents can follow; larger text and coloured sections were suggested. Carers were optimistic that the leaflet could impact on the way UTIs are managed. Older adults and relatives liked that it provided new information to them. Staff welcomed that diagnostic guidance for UTIs was being developed in parallel; promoting consistent messages. Participants welcomed and helped to word sections on describing asymptomatic bacteriuria simply, preventing UTIs, causes of confusion and when to contact a doctor or nurseConclusionA final UTI leaflet for older adults has been developed informed by the TDF. See the TARGET website www.RCGP.org.uk/targetantibiotics/

Performance validity in older adults: Observed versus predicted false positive rates in relation to number of tests administered

ABSTRACTIntroduction: This study examined false positive rates on embedded performance validity tests (PVTs) in older adults grouped by cognitive status.Method: The research design involved secondary analysis of data from the National Alzheimer’s Coordinating Center database. Participants (N = 22,688) were grouped by cognitive status: normal (n = 10,319), impaired (n = 1,194), amnestic or nonamnestic mild cognitive impairment (MCI; n = 5,414), and dementia (n = 5,761). Neuropsychological data were used to derive 5 PVTs.Results: False positive rates on individual PVTs ranged from 3.3 to 26.3% with several embedded PVTs showing acceptable specificity across groups. The proportion of participants failing two or more PVTs varied by cognitive status: normal (1.9%), impaired (6.6%), MCI (13.2%), and dementia (52.8%). Comparison of observed and predicted false positive rates at different specificity levels (.85 or .90) demonstrated significant differences in all comparisons. In normal and impaired groups, predicted rates were higher than observed rates. In the MCI group, predicted and observed comparisons varied: Predicted rates were higher with specificity at .85 and lower with specificity at .90. In the dementia group, predicted rates underestimated observed rates.Conclusions: Despite elevated false positives in conditions involving severe cognitive compromise, several measures retain acceptable specificity regardless of cognitive status. Predicted false positive rates based on the number of PVTs administered were not observed empirically. These findings do not support the utility of simulated data in predicting false positive rates in older adults.

Is the use of knee magnetic resonance imaging one of the drivers of persistently high arthroscopy rates in older adults? – an analysis of national data in Australia

Is the use of knee magnetic resonance imaging one of the drivers of persistently high arthroscopy rates in older adults? – an analysis of national data in Australia

Heterogeneous estimates of influenza virus types A and B in the elderly: Results of a meta-regression analysis.

Influenza has many age‐dependent characteristics. A previous systematic review of randomized controlled trials showed that the detection rate of influenza B was higher in children than in non‐elderly adults. However, no comprehensive reviews have targeted the elderly, who carry the main burden of disease. We aimed to quantify the relative detection rates of virus types A and B among the elderly, to identify factors affecting these proportions, and to compare type distribution among seniors and younger age‐classes. A comprehensive literature search was conducted to identify multiseason studies reporting A and B virus type distributions in the elderly. A random‐effects meta‐analysis was planned to quantify the prevalence of type B among elderly subjects with laboratory‐confirmed influenza. Meta‐regression was then applied to explain the sources of heterogeneity. Across 27 estimates identified, the type B detection rate among seniors varied from 5% to 37%. Meta‐analysis was not feasible owing to high heterogeneity (I 2 = 98.5%). Meta‐regression analysis showed that study characteristics, such as number of seasons included, hemisphere, and setting, could have contributed to the heterogeneity observed. The final adjusted model showed that studies that included both outpatients and inpatients reported a significantly (P = .024) lower proportion than those involving outpatients only. The detection rate of type B among the elderly was generally lower than in children/adolescents, but not non‐elderly adults. Influenza virus type B has a relatively low detection rate in older adults, especially in settings covering both inpatients and outpatients. Public health implications are discussed.