Study Of Older Persons Research Articles

Health characteristics associated with persistence of SARS-CoV-2 antibody responses after repeated vaccinations in older persons over time: the Doetinchem cohort study

BackgroundOlder persons elicit heterogeneous antibody responses to vaccinations that generally are lower than those in younger, healthier individuals. As older age and certain comorbidities can influence these responses we aimed to identify health-related variables associated with antibody responses after repeated SARS-CoV-2 vaccinations and their persistence thereafter in SARS-CoV-2 infection-naïve and previously infected older persons.MethodIn a large longitudinal study of older persons of the general population 50 years and over, a sub-cohort of the longitudinal Doetinchem cohort study (n = 1374), we measured IgG antibody concentrations in serum to SARS-CoV-2 Spike protein (S1) and Nucleoprotein (N). Samples were taken following primary vaccination with BNT162b2 or AZD1222, pre- and post-vaccination with a third and fourth BNT162b2 or mRNA-1273 (Wuhan), and up to a year after a fifth BNT162b2 bivalent (Wuhan/Omicron BA.1) vaccine. Associations between persistence of antibody concentrations over time and age, sex, health characteristics including cardiometabolic and inflammatory diseases as well as a frailty index were tested using univariable and multivariable models.ResultsThe booster doses substantially increased anti-SARS-CoV-2 Spike S1 (S1) antibody concentrations in older persons against both the Wuhan and Omicron strains. Older age was associated with decreased antibody persistence both after the primary vaccination series and up to 1 year after the fifth vaccine dose. In infection-naïve persons the presence of inflammatory diseases was associated with an increased antibody response to the third vaccine dose (Beta = 1.53) but was also associated with reduced persistence over the 12 months following the fifth (bivalent) vaccine dose (Beta = -1.7). The presence of cardiometabolic disease was associated with reduced antibody persistence following the primary vaccination series (Beta = -1.11), but this was no longer observed after bivalent vaccination.ConclusionAlthough older persons with comorbidities such as inflammatory and cardiometabolic diseases responded well to SARS-CoV-2 booster vaccinations, they showed a reduced persistence of these responses. This might indicate that especially these more vulnerable older persons could benefit from repeated booster vaccinations.

Changes in neighborhood disadvantage over the course of 22 years among community-living older persons.

Among older persons, neighborhood disadvantage is a granular and increasingly used social determinant of health and functional well-being. The frequency of transitions into or out of a disadvantaged neighborhood over time is not known. These transitions may occur when a person moves from one location to another or when the Neighborhood Atlas, the data source for the area deprivation index (ADI) that is used to identify disadvantaged neighborhoods at the census-block level, is updated. From a prospective longitudinal study of community-living persons, aged 70 years or older in South Central Connecticut, neighborhood disadvantage was ascertained every 18 months for 22 years (from March 1998 to March 2020). ADI scores higher than the 80th state percentile were used to distinguish neighborhoods that were disadvantaged (81-100) from those that were not (1-80). At baseline, 205 (29.3%) of the 699 participants were living in a disadvantaged neighborhood. Changes in neighborhood disadvantage during 14 consecutive 18-month intervals were relatively uncommon, ranging from 1.5% to 11.8%. Nearly 80% of participants had no change in neighborhood disadvantage and less than 4% had more than one change over a median follow-up of more than 9 years. Overall, the rate of transitions into or out of neighborhood disadvantage was only 2.7 per 100 person-years. These transitions were most common when the Neighborhood Atlas was updated (2013, 2015, 2018, and 2020). Comparable results were observed when decile changes in ADI scores during the 18-month intervals were evaluated. In longitudinal studies of older persons with extended follow-up, it may not be necessary to update information on disadvantaged neighborhoods in circumstances when it is possible, and the degree of misclassification of neighborhood disadvantage should be relatively low in circumstances when updated information cannot be obtained.

THERAPEUTIC CANNABIS USE: UNIQUE CONTEXTS FOR OLDER ADULTS

Abstract Nationwide cannabis use prompts new questions about its therapeutic use. Self-administered cannabis among older adults demands careful study on their treatment outcomes and consumption patterns, in light of a more accessible, legalized cannabis market. Changing sentiments toward the illicit drug urges new research into its viability as a treatment for conditions in older adults. Ailshire uses the 2018-2021 Behavioral Risk Factor Surveillance System (BRFSS) surveys to compare cannabis use by age group. The data, which is representative of 39 U.S. states, indicate that medical marijuana use increases with age. Furthermore, Kaskie’s Cannabis and Older Persons Study (COPS) uncovers the influence of age on cannabis use and motives for consumption. The study is grounded in three core objectives: distinguishing senior consumers from other age groups, distinguishing therapeutic and recreational use, and distinguishing life-time and naive cannabis consumers. With the support of the National Cancer Institute, Fahey conducts a cross-sectional study on consumption patterns of cancer patients over the age of 65, analyzing patient reported outcomes of symptom management through cannabis. Finally, Bluthenthal and Cohen perform quantitative, health surveys among 429 community-recruited people who inject drugs (PWID) to understand the potential benefit of a legal cannabis as a substitution for criminalized substances and alcohol. The papers in this symposium provide updated insights into widespread cannabis use among older adults. These findings may help forward conversations about the political and clinical changes that must be made in order to protect the therapeutic needs of older adults amidst a rapidly expanding cannabis industry.

THE CANNABIS AND OLDER PERSONS STUDY: WHAT WE HAVE LEARNED

Abstract The Cannabis and Older Persons Study has examined the increasing use of cannabis among Americans over 60 years old since 2016 reflecting a variety of disciplinary perspectives and methodological approaches. The project team has published a dozen peer reviewed manuscripts and has secured competitive funding swards in California, Colorado, Illinois and Iowa. In this symposium, results from multiple COPS surveys collected from older adults are reviewed with three goals in mind. The first is to demonstrate how older cannabis users are not comparable to younger cannabis users in terms of motives and self-reported outcomes of use. The second is to distinguish therapeutic from recreational cannabis use among older persons by examining survey answers provided by persons with arthritis, cancer, caregivers of persons with Alzheimer’s disease, multiple sclerosis and terminal illnesses. The third goal is to differentiate life-time from naïve cannabis users and consider how cannabis may serve as an opioid avoidance or harm reduction strategy. Discussion considers the critical role policy makers, program administrators and clinicians assume in facilitating or hindering cannabis use, and directions for future research.

THE CANNABIS AND OLDER PERSONS STUDY: MOVING ALONG A ROAD FROM ANIMAL MODELS TO STATE CAPITOLS

Abstract The Cannabis and Older Persons Study has examined the increasing use of cannabis among Americans over 60 years old since 2016. This year’s symposium presents varied methodological approaches researchers have used to better understand the relationship between age and cannabis use. Barry Setlow examines how cannabis use corresponds with age-associated synaptic dysfunction, neuroinflammation, and tau pathology in animal models (younger v older rats), and how such association may contribute to cognitive aging. Nicole Ennis examines the association between cannabis use and simulated driving performance among adults aged 50 and older focusing on response time, attention, and executive functioning tasks that predict on-road performance. Yan Wang examines short and long-term effects of medical marijuana use among older adults using ecological momentary assessments. Divya Bhagianadh analyzes responses provided by 1398 older persons who completed a special module concerning cannabis use as part of the Health and Retirement Survey and applies a multi-level framework to better understand how cannabis use is shaped by individual attitudes and health status. Fadi Martinos considers how state medical cannabis program eligibility criteria and provider qualifications contribute to cannabis access and use among older adults. Together, these studies reflect how scientific understanding of cannabis use and aging has been informed by the application of multiple disciplinary perspectives, and how researchers use different methodological approaches to identify both desirable and undesirable outcomes associated with cannabis use among older adults. This symposium offers policy makers, program administrators and clinicians empirically-based insights concerning how cannabis use affects older adults.

Harmonization of four biomarkers across nine nationally representative studies of older persons.

A growing number of international population surveys have included measurement of biomarkers, but differ in the type of specimens collected, sample processing procedures, shipment protocols, and laboratory assay platforms. The purpose of this study is to harmonize biomarker data from nine nationally representative studies of people 50 years of age and over by adjusting for assay platforms and type of specimens for total cholesterol (total-C), high-density lipoprotein cholesterol (HDL-C), glycosylated hemoglobin (HbA1c), and C-reactive protein (CRP). Sets of 24 identical serum, plasma, whole blood, and dried blood spot harmonization samples with known analyte levels were generated at a reference laboratory, shipped at -80°C to the respective study laboratories, and subsequently assayed following the study laboratory's protocol. Both original and harmonized study data were used to calculate mean values and at-risk prevalence. The correlation coefficients between the biomarker values of the harmonization samples obtained by the study laboratories and the reference laboratory were 0.99 or above for all analytes and laboratories, indicating the high quality of assays at all laboratories. However, using the harmonized data from each study, there were significant differences in the mean values and country ranking of the prevalence of at-risk levels of these four biomarkers. While the biomarker data from the different study laboratories were highly correlated, indicating very high correlation of rank order of specimens, absolute values did vary significantly. This can have a major impact on assessment of international differences in estimates of risks for chronic morbidity and mortality.

Entrusting life to professionals: A phenomenological hermeneutical study of older persons' participation in prehospital emergency care involving municipal home care and ambulance services.

Participation in care is considered to promote safe and qualitative care. Care-dependent older persons ageing in place have increased emergency care needs, which initiate inter-organisational collaboration involving municipal home care and ambulance services. Previous research concludes that uncertainties exist regarding what participation in care means in clinical practice, which necessitates the need to illuminate the phenomenon for older persons in critical life situations. This study aimed to illuminate meanings of participation in prehospital emergency care from the perspective of care-dependent older persons experiencing acute illness at home. This study has a qualitative design with a lifeworld approach. A phenomenological hermeneutical method was used to analyse transcribed telephone interviews with eleven care-dependent persons aged 70-93 years. Care-dependent older persons' participation in prehospital emergency care means 'Entrusting life to professional caregivers' when being in helpless solitude and existentially unsafe, which emphasises a deepened interpersonal dependence. Meanings of participation in care from the perspective of older persons involve Being reassured in togetherness, Being pliant in trust of emergency expertise, Being enabled through the agency of professional caregivers, and Encountering readiness in the emergency care chain. Care-dependent older persons' participation in prehospital emergency care is existential and involves interpersonal dependence. Togetherness brings reassurance, safety and opportunity for emotional rest while accessing the professional caregivers' power, competence and abilities which provide opportunities for existence and movement towards well-being and continued living. Prehospital emergency care from the perspective of care-dependent older persons transcends organisational boundaries and includes the municipal mobile safety alarm service. The involved municipal and regional organisations need to provide support by implementing lifeworld-led care models and care alternatives that enable professionals to recognise the existential dimension of participation in care.

A Descriptive Qualitative Study of Older Persons and Family Experiences with Extreme Weather Conditions in Northern Thailand.

Extreme weather can cause ill health in older persons due to a direct thermal effect on the body's thermoregulation and difficulties in maintaining a healthy lifestyle and accessing the health services they need. To understand experiences in relation to their exposures to extreme weather and how they responded to such weather conditions, including cold snaps, heat and air pollution in northern Thai communities, a descriptive qualitative study was conducted to uncover details and the essence of perspectives and experiences of older persons and family members. Three focus group discussions with 15 older persons and 15 family members occurred in three communities in Chiang Rai, a northern province of Thailand. Thematic analysis was performed. Experiences of older persons and families in relation to extreme weather conditions were described in five themes: local actions against weather changes, the double challenges, awareness and reactions to weather changes, protective and comfortable living environments, and mitigation of the impacts of weather conditions. Seasonal adaptability was key for older persons to stay safe and healthy during extreme weather changes. Heat, cold snaps, and air pollution made health and daily living routine maintenance among older persons challenging, especially among those with declining health. Older persons and families employed predictive and adaptive strategies to avoid and minimise extreme weather impacts and maximise their comfort and optimal living.

Psychological stress and epigenetic aging in older men: The VA normative aging study

Psychological stress remains an important risk factor for morbidity and mortality throughout the life course. However, there have been counterintuitive findings reported in previous studies of older persons that examine the relationships of perceived psychological stress with DNA methylation-based markers of aging, which also serve as predictors of morbidity and mortality (epigenetic age/clocks). We aimed to replicate and expand findings from existing work by examining relationships of self-reported stress with nine epigenetic clocks: Hannum, Horvath, Intrinsic, Extrinsic, SkinBloodClock, PhenoAge, GrimAge, DNAm Telomere Length, and Pace of Aging. We analyzed data from 607 male participants (mean age 73.2 years) of the VA Normative Aging Study with one to two study visits from 1999 to 2007 (observations = 956). Stress was assessed via the 14-item Perceived Stress Scale (PSS). Epigenetic age was calculated from DNA methylation measured in leukocytes with the HumanMethylation450 BeadChip. In linear mixed effects models adjusted for demographic/lifestyle/health factors, a standard deviation (sd) increase in PSS was associated with Horvath (β = −0.35-years, 95%CI: −0.61, −0.09, P = 0.008) and Intrinsic (β = −0.40-years, 95%CI: −0.67, −0.13, P = 0.004) epigenetic age deceleration. However, in models limited to participants with the highest levels of stress (≥75th-percentile), Horvath (β = 2.29-years, 95%CI: 0.16, 4.41, P = 0.04) and Intrinsic (β = 2.06-years, 95%CI: −0.17, 4.28, P = 0.07) age acceleration associations were observed. Our results reinforce the complexity of psychological stress and epigenetic aging relationships and lay a foundation for future studies that explore longitudinal relationships with other adult stress metrics and factors that can influence stress such as resilience measures.

Need and Potential Use of Telemedicine in Two Rural Areas

ABSTRACT Using technology as a way to ensure Home and Community-Based Services (HCBS) as an option for older adults in rural areas is of increasing interest as a result of the pandemic. Literature suggests older adults do not adopt telehealth and/or medicine practices due to barriers and do not use telemedicine as a form of communication with medical staff. This study evaluates the potential for telehealth/medicine use in rural communities through two case studies of older persons (N = 176) age 65+ aging in place in the Eastern Plains of Colorado (n = 88) and rural Western Nebraska (n = 88). Demographic data collection is followed by nominal data collection (yes/no) for telehealth exposure, use, and potential. Two separate open-ended, qualitative questions seeking further details are subsequently asked. Results from the convenience sample indicate that the main themes emanating from older persons responding to telehealth/medicine interview questions include support for its potential use with some using teleconferencing, health portals, along with the expectation that telehealth/medicine would be part of new health care systems. These findings provide evidence that older adults residing in rural areas need to be trained with a certain set of technology skills, which allows for the breaking of barriers toward the use and recognized value of telemedicine. Agencies supporting rural older adults must emphasize this form of training within the framework of service offerings especially for the older adult who has poor technological capacity. Lack of awareness for such services inhibits service use, thereby impacting overall well-being.

THE CANNABIS AND OLDER PERSONS STUDY: EXPANDING OUR MINDS THROUGH INTERDISCIPLINARY RESEARCH

Abstract The Cannabis and Older Persons Study has examined the increasing use of cannabis among Americans over 60 years old since 2016. This year’s symposium presents varied methodological approaches researchers have used to better understand the harms and benefits associated with cannabis use among older Americans. Divya Bhagianadh examines the association between cannabis legalization policies across the Untied States and corresponding use of end of life programs and services. Julie Bobitt analyzes interviews provided by older adults in Illinois and defines how attitudes held by medical doctors and other clinical care providers are critical to shaping cannabis use among older adults. Brian Kaskie considers the role of cannabis policy clusters. Jacobo Mintzer reviews findings from a controlled trial providing two cannabinoids to treat agitation among persons with Alzheimers in hospice. Thorsten Rudroff examines cannabis use among a sample of older persons at risk for falls. These studies reflect how cannabis use among older persons continues to grow and diversify, and how researchers have use different approaches to advance scientific understanding of determinants and outcomes, both desirable and undesirable, associated with cannabis use among older adults. This symposium offers policy makers and health care leaders a balanced perspective. On one side, we discuss how prevention and treatment efforts for substance use disorder, including cannabis use disorder, must increase proportionally to the increasing number of older cannabis users. On the other side, we consider how more than 5 million older Americans, especially those with pain, find some benefit in using cannabis.

GERONTOLOGIC BIOSTATISTICS: MERGING WITH DATA SCIENCE AND TOWARD PERSONALIZED MEDICINE

Abstract The sub-discipline of gerontologic biostatistics (GBS) was introduced in 2010 to emphasize the special challenges encountered in the design and analysis of research studies of older persons. These challenges center on the multifactorial nature of human aging, characterized by the parallel and progressive deterioration of diverse organ and cellular systems that eventually results in death. Ten years after the introduction of GBS, which initially focused on important aspects of design and analysis that ensure their statistical validity, we update how GBS has been enriched by evolving practices. We present individual sessions on three seminal developments in the practice of GBS: integration of data science and multiple streams of data, including those automated and or multidisciplinary in nature; enhanced methods of addressing the heterogeneity of treatment effects from health-related interventions for older patients; and how interactive visualization can help specific patients locate themselves along the continuum of individualized treatment effects. We conclude our presentation with a session that reviews three prominent trends in the validation of the heterogeneity inherent to the assessment of health among older adults. Reflecting this era of big gerontological data, we discuss several established modeling approaches for validation, the proliferation of signal intensive behavior phenotypes, and the deep characterization of phenotypes through OMICS studies and multimodal approaches. All talks discuss pitfalls and areas of future development and draw from published studies. We are submitting as an interest group collaborative panel submission between two interest groups: Epidemiology of Aging and Measurement, Statistics and Design.

Incidence of falls and fall-related injuries and their predictive factors in frail older persons with cancer: a multicenter study

BackgroundFalls and fall-related injuries are a major public health problem. Data on falls in older persons with cancer is limited and robust data on falls within those with a frailty profile are missing. The aim of this study is to investigate the incidence and predictive factors for falls and fall-related injuries in frail older persons with cancer.MethodsThis study is a secondary data analysis from data previously collected in a large prospective multicenter observational cohort study in older persons with cancer in 22 Belgian hospitals (November 2012–February 2015). Patients ≥70 years with a malignant tumor and a frailty profile based on an abnormal G8 score were included upon treatment decision and evaluated with a Geriatric Assessment (GA). At follow-up, data on falls and fall-related injuries were documented.ResultsAt baseline 2141 (37.2%) of 5759 included patients reported at least one fall in the past 12 months, 1427 patients (66.7%) sustained an injury. Fall-related data of 3681 patients were available at follow-up and at least one fall was reported by 769 patients (20.9%) at follow-up, of whom 289 (37.6%) fell more than once and a fall-related injury was reported by 484 patients (62.9%). Fear of falling was reported in 47.4% of the patients at baseline and in 55.6% of the patients at follow-up. In multivariable analysis, sex and falls history in the past 12 months were predictive factors for both falls and fall-related injuries at follow-up. Other predictive factors for falls, were risk for depression, cognitive impairment, dependency in activities of daily living, fear of falling, and use of professional home care.ConclusionGiven the high number of falls and fall-related injuries and high prevalence of fear of falling, multifactorial falls risk assessment and management programs should be integrated in the care of frail older persons with cancer. Further studies with long-term follow-up, subsequent impact on cancer treatment and interventions for fall prevention, and integration of other important topics like medication and circumstances of a fall, are warranted.Trial registrationB322201215495.

Unmet Needs for Support: A Study of Older Persons with Disability in Enugu State, Nigeria

Unmet needs for support relate to daily requirements for independent functioning among the elderly but which are unavailable, consequent upon declining informal support and challenges of accessing formal ones. This study explored unmet needs for support, including finance, assistive device, food and healthcare, among older persons with disability in Enugu State Nigeria. Using a multistage sampling and a triangulation of research methods, a total of 1030 older persons were selected for the study. Seven in every ten older persons in the sample (71.0%) had an unmet need. Of all the support received, financial support (79.8%) was the most inadequate. The predominant assistive device was the walking stick (84.9%). Only about four (38.0%) out of ten had three square meals with no recourse to a balanced diet. Of all the unmet felt needs, healthcare/medication (60.2%) was the most predominant followed by financial support. Their physical environment was neither disability-supportive nor ageing-friendly. We conclude that the high percentage of unmet needs among older persons in Enugu State Nigeria is consequent upon the absence of formal social welfare policies and programmes for the elderly. Unfortunately, the elderly would continue to have unmet needs given the declining safety nets traditionally provided by family members vis-à-vis the increasing economic hardship in the society. It is therefore recommended that governments at all levels should formulate and implement social welfare programmes to bridge the needs gap among senior citizens who had spent their vibrant years serving the government and society.

Prediction models for functional status in community dwelling older adults: a systematic review

BackgroundDisability poses a burden for older persons, and is associated with poor outcomes and high societal costs. Prediction models could potentially identify persons who are at risk for disability. An up to date review of such models is missing.ObjectiveTo identify models developed for the prediction of functional status in community dwelling older persons.MethodsA systematic review was performed including studies of older persons that developed and/or validated prediction models for the outcome functional status. Medline and EMBASE were searched, and reference lists and prospective citations were screened for additional references. Risk of bias was assessed using the PROBAST-tool. The performance of models was described and summarized, and the use of predictors was collated using the bag-of-words text mining procedure.ResultsForty-three studies were included and reported 167 evaluations of prediction models. The median c-statistic values for the multivariable development models ranged between 0.65 and 0.76 (minimum = 0.58, maximum = 0.90), and were consistently higher than the values of the validation models for which median c-statistic values ranged between 0.6 and 0.68 (minimum = 0.50, maximum = 0.81). A total of 559 predictors were used in the models. The five predictors most frequently used were gait speed (n = 47), age (n = 38), cognition (n = 27), frailty (n = 24), and gender (n = 22).ConclusionsNo model can be recommended for implementation in practice. However, frailty models appear to be the most promising, because frailty components (e.g. gait speed) and frailty indexes demonstrated good to excellent predictive performance. However, the risk of study bias was high. Substantial improvements can be made in the methodology.

CKD Biomarkers, Cognitive Impairment, and Incident Dementia in an Older Healthy Cohort.

CKD is a risk factor for cognitive impairment (CI), but reports of individual associations of eGFR and albuminuria with CI and incident dementia in healthier, older, longitudinal populations are lacking. Our goal was to estimate these associations in a large cohort of older healthy persons. In a longitudinal cohort study of older persons without prior cardiovascular disease, we estimated the associations between baseline eGFR (in ml/min per 1.73 m2) and albuminuria, measured as urine albumin-creatinine ratio (UACR; in mg/mmol) and cognitive test scores, declines in cognitive test scores, and incident dementia using adjusted linear and linear mixed models. Cox proportional hazards regression models assessed the association between baseline kidney function and incident CI no dementia (CIND) or dementia at a median of 4.7 years. At baseline, among 18,131 participants, median age was 74 years, eGFR was 74 (IQR, 63-84) ml/min per 1.73 m2, UACR was 0.8 (IQR, 0.5-1.5) mg/mmol (7.1 [4.4-13.3] mg/g), and 56% were female. Baseline eGFR was not associated with performance on any cognitive tests in cross-sectional analysis, nor was incident CIND or dementia over a median follow-up of 4.7 years. However, baseline UACR ≥3 mg/mmol (≥26.6 mg/g) was significantly associated with lower baseline scores and larger declines on the Modified Mini-Mental State Exam, verbal memory and processing speed tests, and with incident CIND (hazard ratio [HR], 1.19; 95% CI, 1.07 to 1.33) and dementia (HR, 1.32; 95% CI, 1.06 to 1.66). Mild albuminuria was associated with worse baseline cognitive function, cognitive decline, and increased risk for incident CIND and dementia. Screening global cognitive tests for older persons with UACR ≥3 mg/mmol could identify those at elevated risk of cognitive decline and dementia.

Author Response: Cognitive Activity and Onset Age of Incident Alzheimer Disease Dementia

We appreciate the interest in our research.1 In the cohort study of older persons who developed incident Alzheimer disease (AD), we found that a lower level of cognitive activity was associated with earlier age of dementia onset.1 According to the reverse-causality hypothesis, a low level of cognitive activity is not a risk factor for AD but an early sign of the disease. As a test of this hypothesis, we computed the correlations of cognitive activity at the time of study enrollment with markers of AD and related dementias from a postmortem neuropathologic examination. These correlations were not significant, which we concluded provided no support for the reverse-causality hypothesis.

The Cannabis and Older Persons Study: Has Science Caught Up With Practice Yet?

Since 2016, the Cannabis and Older Persons Study has examined the increasing use of cannabis among Americans over 60 years old. Our current work dives into particular groups of cannabis users and explores outcomes related to medical conditions and symptoms. This symposium also features a range of methodological approaches from an analysis of the BRFSS caregiving and cannabis modules, a convenience sample of more than 4,000 older cannabis users enrolled in the Illinois Medical Cannabis Program and qualitative interviews conducted with aging veterans. Kanika Arora examines the association between informal caregiving and marijuana use and whether this association varies by age. Julie Bobitt shares findings from 32 interviews with older Veteran cannabis users. Alton Croker examines cannabis use as a complement or alternative to palliative care. HyoJung Kang clusters negative outcomes experienced by older persons who use cannabis. Brian Kaskie compares cannabis use among persons with Multiple Sclerosis (N=135) and persons diagnosed with arthritis (N=582) or cancer (N=622). While we certainly find reason to remain concerned that cannabis use alone and co-occurring use with prescription opioids may contribute to increased rates of substance misuse and other undesirable outcomes among older adults, we find it increasingly difficult to overlook the benefits many persons derive when taking cannabis as a method to manage pain or address other medical conditions. At this point, public policy officials and program administrator should strive to strike a balance between addressing cannabis harms relative to promoting benefits such as opioid reduction and diversion.

Accuracy of the French Administrative Database to Describe Patients' Medication and Primary Care Visits: A Validation Study.

To evaluate the accuracy of the French health administrative database to describe patients' medication and primary care visits, in the context of a transitional care intervention including an in-hospital medication reconciliation followed by a structured community follow-up by the patient's general practitioner and pharmacist. A retrospective cohort study of older persons enrolled in the transitional care intervention between January 1st, 2015 and December 31st, 2018. Only 46.1% of the community follow-up were timely billed, in the 3 months after the patient discharge. The sensitivity of the health administrative database to identify medications was 90.0%. Its positive predictive value was 50.1%. This study reveals that the French health administrative database was poorly reliable to identify both community follow-up and chronic medications.

Psychological distress during COVID-19 pandemic in low-income and middle-income countries: a cross-sectional study of older persons in Thailand

ObjectiveThe COVID-19 situation in Thailand was controlled with various social measures. Much of the information covered in the media and in studies focused on the public health and economic aspects...