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Background: Anticholinergic (AC) and sedative medications are a risk factor for cognitive impairment. This study sought to characterize AC and sedative use in older patients seen for outpatient neuropsychological evaluation and evaluate their associations with different cognitive domains. We hypothesized that AC and sedative use would be associated with worse attention/processing speed (AP), executive functioning (EF), and memory. Methods: We conducted a cross‐sectional chart review of 392 patients (mean [M] age = 72 ± 7.7 years, range = 54–91). Medications were characterized by number of AC medications (≥1 on the Anticholinergic Cognitive Burden Scale [ACB]), number of sedative medications, and polypharmacy (≥5 daily medications). Demographically adjusted composites were calculated for AP, EF, and memory. Bivariate Pearson correlations assessed relationships between medication use and cognition. Multivariate linear regressions evaluated significant medication‐cognition associations, controlling for total medications, medical comorbidities, and estimated premorbid cognitive functioning. Results: Polypharmacy was common (80%; n = 314). Most patients (70%; n = 275) used ≥1 sedative medications (range = 0–9). Over half (63%; n = 248) used ≥1 AC drugs (range = 0–7), yet ACB scores were ≤2 in 74% of patients. Sedative use was negatively correlated with AP (r = −0.134, p = 0.008) and EF (r = −0.105, p = 0.04). ACB scores were negatively correlated with AP (r = −0.106, p = 0.037). Sedatives and a priori covariates significantly predicted AP performance (R2 = 0.127, p < 0.001); using more sedative medications was uniquely associated with worse AP (β = −0.426, p = 0.049). No significant associations were found with memory. Conclusion: AC and sedative medications and polypharmacy were prevalent in this sample of older patients. Though both drug classes had negative relationships with AP and EF, sedatives had a particularly negative association with AP. Contrary to our hypotheses, memory was not associated with medication use; however, anticholinergic burden was low within the sample, and AP and EF deficits may masquerade as memory problems. [ABSTRACT FROM AUTHOR]

The article presents a study which sought to automate Medication Regimen Complexity Index (MRCI) calculation in a database of people with mild cognitive impairment (MCI) or dementia and to examine contributions of specific MRCI components to overall complexity. Topics include calculation of MRCI scores, MRCI by patient characteristics, and possible impact of complex medications on the risk of poor health outcomes.

Background: Delirium is common in older inpatients, causing distress, cognitive decline, and death. Current therapies are unsatisfactory, limited by lack of efficacy and adverse effects. There is an urgent need for effective delirium treatment. Sleep wake cycle is disturbed in delirium; endogenous Melatonin is perturbed, and exogenous Melatonin is a safe and effective medication for sleep disorders. This study aims to determine the effect of oral Melatonin 5 mg immediate release (IR) nightly for five nights on the severity of delirium in older (≥65 years) medical inpatients. Methods: This was a double‐blinded, randomized controlled trial in general internal medicine units of a tertiary teaching hospital. Older inpatients with Confusion Assessment Method positive, hyperactive or mixed delirium within 48 h of admission or onset of in‐hospital delirium were included. The primary outcome was change in delirium severity measured with the Memorial Delirium Assessment Scale (MDAS). A previous pilot trial showed 120 participants randomized 1:1 to Melatonin or Placebo would provide 90% power to demonstrate a 3‐point reduction in the MDAS. Results: One hundred and twenty participants were randomized, 61 to Melatonin 5 mg and 59 to Placebo. The medication was well tolerated. The mean MDAS improvement was 4.9 (SD 7.6) in the Melatonin group and 5.4 (SD 7.2) in the Placebo group, p‐value 0.42, a non‐significant difference. A post‐hoc analysis showed length of stay (LOS) was shorter in the intervention group (median 9 days [Interquartile Range (IQR) 4, 12] vs. Placebo group 10 [IQR 6, 16] p‐value = 0.033, Wilcoxon Rank Sum test). Conclusions: This trial does not support the hypothesis that Melatonin reduces the severity of delirium. This may be due to no effect of Melatonin, a smaller effect than anticipated, an effect not captured on a multidimensional delirium assessment scale, or a type II statistical error. Melatonin may improve LOS; this hypothesis should be studied. [ABSTRACT FROM AUTHOR]

The 2015 Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) Statement was published to improve reporting transparency for prediction modeling studies. The objective of this review is to highlight methodologic challenges that aging‐focused researchers will encounter when designing and reporting studies involving prediction models for older adults and provide guidance for addressing these challenges. In following the 22‐item TRIPOD checklist, researchers must consider the representativeness of cohorts used (e.g., whether older adults with frailty, cognitive impairment, and social isolation were included), strategies for incorporating common geriatric predictors (e.g., age, comorbidities, functional status, and frailty), methods for handling missing data and competing risk of death, and assessment of model performance heterogeneity across important subgroups (e.g., age, sex, race, and ethnicity). We provide guidance to help aging‐focused researchers develop, validate, and report models that can inform and improve patient care, which we label "TRIPOD‐65." [ABSTRACT FROM AUTHOR]

Background: Loneliness is a significant public health challenge in the United States, especially among older adults. The epidemiology of loneliness among older adults in primary care is lacking, and specific research is needed on how loneliness impacts older primary patients' physical, mental, and cognitive health. A large sample of older primary care patients were recruited for a trial during the COVID‐19 pandemic to measure the relationship between loneliness and physical and mental quality of life (QOL). Methods: Baseline data come from the Caregiver Outcomes of Alzheimer's Disease Screening (COADS) study, an ongoing randomized controlled trial evaluating benefits and risks of Alzheimer's disease and related dementias screening among primary care patients ages 65 and older, collected April 2020 to September 2021. Loneliness was measured with the 5‐item, Loneliness Fixed Form Ages 18+ from The NIH Toolbox Emotion Battery, physical and mental health‐related QOL was measured with the SF‐36v2, and depression and anxiety severity were measured with the PHQ‐9 and GAD‐7, respectively. Results: Spearman correlation analyses revealed that loneliness was moderately correlated with mental health QOL (r[601] = −0.43, p < 0.001), anxiety severity (r[601] = 0.44, p < 0.001), and depression severity (r[601] = 0.42, p < 0.001), while weakly correlated with physical health QOL (r[601] = −0.15, p < 0.001). After conducting unadjusted and adjusted linear regression models, we found that loneliness was significantly associated with both lower mental (p < 0.001) and physical (p < 0.001) QOL. Furthermore, loneliness remained significantly associated with worse mental QOL after adjusting for age, gender, race, ethnicity, educational level, perceived income status, neighborhood disadvantage, severity of comorbidities, and comorbid depression and anxiety. Conclusion: Primary care providers should discuss loneliness with their older adult patients and provide resources to help patients develop and maintain meaningful social relationships. [ABSTRACT FROM AUTHOR]

The article presents a study which determined the inter-rater reliability between the Veterans Affairs (VA) Dementia ICD Code List and the Chronic Conditions Warehouse (CCW) Alzheimer's disease and related disorders (ADRD) algorithm when applied to a cohort of veterans hospitalized with heart failure. Topics include sample characteristics, comparison of ICD-10 codes in the VA and CCW ADRD algorithms, and limitations of the study.

Background: The purpose of this study was determined whether cognitive impairment is associated with time taken to complete the electronic rapid fitness assessment (eRFA). We hypothesized that taking more time to complete the eRFA will indicate worsened cognitive function. Methods: We retrospectively identified patients who presented to the Memorial Sloan Kettering Cancer Center Geriatrics Service for preoperative evaluation and completed the eRFA as a part of their preoperative assessment from February 2015 to December 2020. Cognitive function was assessed using the Mini‐Cog©, which is a screening test for cognitive function status. Patients in this study underwent elective surgery and had a hospital length of stay ≥1 day. Time to complete the eRFA was automatically recorded by a web‐based tool; assistance with eRFA completion was self‐reported by the patient. In total, 2599 patients were included, of which 2387 had available Mini‐Cog© scores. Results: Overall, 50% of surveys were completed without assistance, 37% were completed with assistance, and 13% were completed by somebody else; Mini‐Cog© scores were lower, corresponding to worsened cognitive function status, in patients requiring assistance (median score respectively, 5 vs. 4 vs. 3; p‐value <0.0001; rates of cognitive impairment 7.5%, 22%, and 38%). Among patients who completed the questionnaire independently, greater cognitive impairment was associated with longer time to complete the eRFA (change in score per 5 min = −0.09; 95% CI −0.14, −0.03; p = 0.002). Conclusions: We found evidence that requirement for assistance in completing web‐based questionnaires, and time taken to complete a questionnaire, predict which patients benefit from more comprehensive cognitive function assessments. Future studies should further validate this finding in a more diverse population and establish optimal clinical pathways. [ABSTRACT FROM AUTHOR]

Background: Caregivers of people with dementia may experience characteristic grief linked to present and anticipated losses before the physical death of the care recipient occurs, which is related to physical and mental health problems. The Marwit–Meuser Caregiver Inventory‐Short Form (MM‐CGI‐SF) is an instrument that assesses this type of grief. Since there are no studies on an adaptation of the MM‐CGI‐SF to the Spanish population, the aim of the study was to evaluate its psychometric properties in a sample of caregivers of dementia patients. Methods: A cross‐sectional study was carried out. The tool was translated and adapted into Spanish, which was administered to 250 caregivers of people with dementia in the province of Huelva, together with other related instruments. Descriptive statistics and internal consistency reliability were calculated using Cronbach's alpha, for the total questionnaire and for each subscale. A confirmatory factor analysis (CFA) was performed and the Spanish version of the MM‐CGI‐SF was correlated with the rest of the variables by calculating Spearman's correlation coefficient. Results: 80.4% of the participants were female and had high levels of caregiver grief (x¯ = 64.62, SD = 14.86). Cronbach's alpha for the general questionnaire was 0.927 and between 0.822–0.854 for its subscales. The fit values of the CFA were: x2 = 202.033, degrees of freedom = 121, x2/df = 1.670, TLI = 0.954, CFI = 0.963, SRMR = 0.047, RMSEA = 0.052; and all the correlations were statistically significant. Conclusions: The Spanish version of the MM‐CGI‐SF shows adequate psychometric properties. Thanks to this instrument, health professionals may measure caregiver grief, get closer to the reality of dementia care, and evaluate the effectiveness of interventions to manage this grief. [ABSTRACT FROM AUTHOR]

Background: Elder mistreatment (EM) harms individuals, families, communities, and society as a whole. Yet research on interventions is lagging, and no rigorous studies demonstrating effective prevention have been published. This pilot study examines whether a first‐of‐its‐kind coaching intervention reduced the experience of EM among older adults with chronic health conditions, including dementia. Methods: We used a double‐blind, randomized controlled trial to test a strengths‐based person‐centered caregiver support intervention, developed from evidence‐based approaches used in other types of family violence. Participants (n = 80), family caregivers of older adults who were members of Kaiser Permanente, completed surveys at baseline, post‐test, and 3‐month follow‐up. The primary outcome was caregiver‐reported EM; additional proximal outcomes were caregiver burden, quality‐of‐life, anxiety, and depression. Nonparametric tests (Mann–Whitney U, Fisher's Exact, Wilcoxon Signed Rank, and McNemar's) were used to make comparisons between treatment and control groups and across time points. Results: The treatment group had no EM after intervention completion (assessed at 3‐month follow‐up), a significantly lower rate than the control group (treatment = 0%, control = 23.1%, p = 0.010). Conclusions: In this pilot study, we found that the COACH caregiver support intervention successfully reduced EM of persons living with chronic illness, including dementia. Next steps will include: (1) testing the intervention's mechanism in a fully powered RCT and (2) scaling the intervention for testing in a variety of care delivery systems. [ABSTRACT FROM AUTHOR]

Background: Falls and their sequelae cost more than $50 billion every year. Older adults with hearing loss are at 2.4 times greater risk of falls than their normal hearing peers. Current research is inconclusive about whether hearing aids can offset this increased fall risk, and no previous studies considered if outcomes differed based on the consistency of hearing aid use. Methods: Individuals 60 years and older with bilateral hearing loss completed a survey consisting of the Fall Risk Questionnaire (FRQ) and questions about hearing loss history, hearing aid use, and other common fall risk factors. In this cross‐sectional study, fall prevalence, as well as fall risk (based on FRQ score), was compared between hearing aid users and non‐users. A separate group of consistent hearing‐aid users (at least 4 h daily use for more than 1 year) was also compared with inconsistent/non‐users. Results: Responses from 299 surveys were analyzed. Bivariate analysis found 50% reduced odds of experiencing a fall for hearing aid users compared with non‐users (OR = 0.50 [95% CI: 0.29–0.85], p = 0.01). After adjusting for age, sex, hearing loss severity, and medication usage, those who reported any hearing aid use still had lower odds of falls (OR = 0.48 [95% CI: 0.26–0.90], p = 0.02) and lower odds of being at risk for falls (OR = 0.36 [95% CI: 0.19–0.66] p < 0.001) than non‐users. Results for consistent hearing aid users demonstrate an even stronger association of lowered odds of falling (OR = 0.35 [95% CI: 0.19–0.67], p < 0.001) and lower odds of being at risk for falls (OR = 0.32 [95% CI: 0.12–0.59], p < 0.001), suggesting a potential dose–response relationship. Conclusions: These findings suggest that use of hearing aids—especially consistent hearing aid use—is associated with lower odds of experiencing a fall or being classified as at risk for falls in older individuals with hearing loss. [ABSTRACT FROM AUTHOR]

Background: Retirement represents a crucial transitional period for many adults with possible consequences for cognitive aging. We examined trajectories of cognitive change before and after retirement in Black and White adults. Methods: Longitudinal examination of up to 10 years (mean = 7.1 ± 2.2 years) using data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study–a national, longitudinal study of Black and White adults ≥45 years of age. Data were from 2226 members of the REGARDS study who retired around the time when an occupational ancillary survey was administered. Cognitive function was an average of z‐scores for tests of verbal fluency, memory, and global function. Results: Cognitive functioning was stable before retirement (Estimate = 0.05, p = 0.322), followed by a significant decline after retirement (Estimate = −0.15, p < 0.001). The decline was particularly pronounced in White (Estimate = −0.19, p < 0.001) compared with Black (Estimate = −0.07, p = 0.077) participants, twice as large in men (Estimate = −0.20, p < 0.001) compared with women (Estimate = −0.11, p < 0.001), highest among White men (Estimate = −0.22, p < 0.001) and lowest in Black women (Estimate = −0.04, p = 0.457). Greater post‐retirement cognitive decline was also observed among participants who attended college (Estimate = −0.14, p = 0.016). While greater work complexity (Estimate = 0.92, p < 0.05) and higher income (Estimate = 1.03, p < 0.05) were related to better cognitive function at retirement, neither was significantly related to cognitive change after retirement. Conclusion: Cognitive functioning may decline at an accelerated rate immediately post‐retirement, more so in White adults and men than Black adults and women. Lifelong structural inequalities including occupational segregation and other social determinants of cognitive health may obscure the role of retirement in cognitive aging. [ABSTRACT FROM AUTHOR]

Background: Advance care planning (ACP) is low among Latinx older adults. We used community‐based participatory research (CBPR) to identify ACP barriers/facilitators and design community‐based ACP events. Methods: In partnership with community‐based organizations, clinicians, and local government, we formed a Latinx Community Committee (n = 13 community members). We then conducted 6 focus groups with Latinx‐identifying, English or Spanish‐speaking older adults (age ≥ 55), caregivers, and community leaders to assess ACP barriers/facilitators. We analyzed transcripts using thematic analysis and, based on these learnings, designed and implemented community‐based ACP events. Using a validated survey, we assessed acceptability and pre‐to‐post‐event ACP readiness (4‐point scale; 4 = most ready; 0.2 change considered meaningful) with Wilcoxon signed‐rank tests. Results: Focus groups included 10 Spanish‐speaking older adults, 8 caregivers, and 10 community leaders. Themes highlighted the importance of ACP (e.g., means of advocacy), barriers (e.g., how to start conversations), and facilitators (e.g., trusted community spaces) in the Latinx community. Ninety‐seven people attended 5 events targeting 3 Latinx populations (LGBTQI+, intergenerational, and older adults broadly). Overall pre‐to‐post‐event ACP readiness increased (2.62 (SD 0.97) to 2.95 (SD 0.93); p = 0.05). Readiness to document wishes increased significantly (2.44 (SD 1.0) to 2.98 (SD 0.95); p = 0.003). Most reported being comfortable attending events (85%) and would recommend them to others (90%). Conclusions: This study describes a feasible, acceptable, and effective CBPR ACP intervention. Co‐developed community events represent a promising approach to reducing disparities in ACP among the Latinx population. See related Editorial by Ronit Elk in this issue. [ABSTRACT FROM AUTHOR]

Introduction: Serious illness is a life‐limiting condition negatively impacting daily function, quality of life, or excessively straining caregivers. Over 1 million older seriously ill adults undergo major surgery annually, and national guidelines recommend that palliative care be available to all seriously ill patients. However, the palliative care needs of elective surgical patients are incompletely described. Understanding baseline caregiving needs and symptom burden among seriously ill older surgical patients could inform interventions to improve outcomes. Methods: Using Health and Retirement Study data (2008–2018) linked to Medicare claims, we identified patients ≥66 years who met an established serious illness definition from administrative data and underwent major elective surgery using Agency for Healthcare Research and Quality (AHRQ) criteria. Descriptive analyses were performed for preoperative patient characteristics, including: unpaid caregiving (no or yes); pain (none/mild or moderate/severe); and depression (no, CES‐D < 3, or yes, CES‐D ≥ 3). Multivariable regression was performed to examine the association between unpaid caregiving, pain, depression, and in‐hospital outcomes, including hospital days (days admitted between discharge date and one‐year post‐discharge), in‐hospital complications (no or yes), and discharge destination (home or non‐home). Results: Of the 1343 patients, 55.0% were female and 81.6% were non‐Hispanic White. Mean age was 78.0 (SD 6.8); 86.9% had ≥2 comorbidities. Before admission, 27.3% of patients received unpaid caregiving. Pre‐admission pain and depression were 42.6% and 32.8%, respectively. Baseline depression was significantly associated with non‐home discharge (OR 1.6, 95% CI 1.2–2.1, p = 0.003), while baseline pain and unpaid caregiving needs were not associated with in‐hospital or post‐acute outcomes in multivariable analysis. Conclusions: Prior to elective surgery, older adults with serious illnesses have high unpaid caregiving needs and a prevalence of pain and depression. Baseline depression alone was associated with discharge destinations. These findings highlight opportunities for targeted palliative care interventions throughout the surgical encounter. [ABSTRACT FROM AUTHOR]

Background: Preclinical studies have suggested potential beneficial effects of newer glucose‐lowering drugs (GLDs) including dipeptidyl peptidase (DPP)‐4 inhibitors, glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs), and sodium glucose co‐transporter‐2 (SGLT2) inhibitors, in protecting humans against cognitive decline and dementia. However, population studies aiming to demonstrate such cognitive benefits from newer GLDs have produced mixed findings. This meta‐analysis aimed to evaluate the association between newer GLDs and risk of dementia in adults with type 2 diabetes (T2D). Methods: Electronic databases were searched up to March 11, 2022 to include observational studies that examined the association between DPP‐4 inhibitors, GLP‐1RAs, and SGLT2 inhibitors and risk of dementia (including all‐cause dementia, Alzheimer's disease [AD], and vascular dementia [VD]) in people with T2D. We conducted a random‐effects meta‐analysis to calculate the relative risk (RR) with 95% confidence interval (CI) for each class of newer GLD. Results: Ten studies (from nine articles) involving 819,511 individuals with T2D were included. Three studies found that SGLT2 inhibitor users had a lower risk of all‐cause dementia than non‐SGLT2 inhibitor users (RR, 0.62; 95% CI, 0.39–0.97). Five studies found that users versus nonusers of GLP‐1RAs were associated with a significant reduction in the risk of all‐cause dementia (RR, 0.72; 95% CI, 0.54–0.97). However, a meta‐analysis for AD and VD was unavailable for SGLT2 inhibitors and GLP‐1RAs because only one study was included for each drug. In seven studies, users vs. nonusers of DPP‐4 inhibitors were significantly associated with a decreased risk of all‐cause dementia (RR, 0.84; 95% CI, 0.74–0.94) and VD (RR, 0.59; 95% CI, 0.47–0.75) but not AD (RR, 0.82; 95% CI, 0.63–1.08). Conclusion: Newer GLDs were associated with a decreased risk of all‐cause dementia in people with T2D. Because of the observational nature and significant heterogeneity between studies, the results should be interpreted with caution. Further research is warranted to confirm our findings. See related Editorial by He et al. in this issue. [ABSTRACT FROM AUTHOR]

The article presents a study on a potential diet modification intervention for older women to address or alleviate their fecal incontinence (FI). Also cited are the use of the behavioral change theory framework, a systematic review on dietary interventions for FI, and the results of a focus group-based study in developing the dietary intervention framework, and the methods used in the study like the Vaizey scale.

The article discusses research which assessed interprofessional learner perceptions of a brief educational intervention tailored for opioid prescribing in older adults. The study evaluated pre- and post-intervention knowledge and confidence in medication safety and non-opioid treatment strategies. Findings revealed potential improvement of communication between providers and patients or their caregivers, as well as opportunity to educate caregivers and other providers.

Background: Patients with complex behavioral and mental health conditions require significant transitional care coordination. It is unclear how skilled nursing facilities (SNFs) that serve these patients engage in care transfer with hospitals, specifically whether they experience discrepancies in the type of information shared by hospital partners and/or use different approaches to secure needed information. Methods: Cross‐sectional analysis of a national 2019–2020 SNF survey that collected information on transitional care practices with referring hospitals; respondents were directors of nursing services. We used chi‐squared tests and descriptive statistics to characterize hospital information sharing practices experienced by facilities that accept complex patients (e.g., serious mental illness, substance use disorder, and/or medication assisted treatment), and to compare them to facilities that treat a less complex population. Results: A total of 215 SNFs had sufficiently complete responses for inclusion in the analysis. Of these respondents, 57% accepted two or more types of patients with complex conditions of interest; these SNFs were more likely to be urban, for‐profit, and serve more dual‐eligible patients. SNFs accepting complex patients experience information sharing on par with other facilities, and are more likely to receive information on behavioral, social, mental, and functional status (25.41% vs. 12.90%; p = 0.023). These facilities are also more likely to consistently use electronic methods (e.g., an online portal, shared electronic health record [EHR] access) to retrieve information from partner hospitals. Conclusions: SNFs accepting complex patients demonstrate some evidence of enhanced information retrieval via electronically mediated pathways. Overall, information sharing remains underdeveloped in this care context. Policymakers should continue to prioritize widespread digital infrastructure that supports post‐acute care delivery. [ABSTRACT FROM AUTHOR]

Background: Informal caregivers of older adults experience a high degree of psychosocial burden and strain. These emotional experiences often stem from stressful tasks associated with caregiving. Caregiving supportive services that provide assistance for stressful tasks are instrumental in alleviating caregiving burden and strain. Research is limited on what types of supportive services caregivers are utilizing by relationship status and their source of information regarding these services. We sought to characterize caregiving supportive services use by caregiver relationship status. Methods: We analyzed cross‐sectional data from the 2015 National Study of Caregiving limited to caregivers of older adults ≥65 years of age. Caregiver relationship status (i.e., spouse, child, other relative/non‐relative) was the independent variable. Type of supportive service and source of information about supportive services were the dependent variables. Bivariate analyses were performed to examine the association with caregiver relationship status and associations between use of caregiving supportive services and caregiver and care recipient characteristics. Among service users, we measured associations between caregiver relationship status, type of supportive services used, and source of information about supportive services. Results: Our sample consisted of 1871 informal caregivers, 30.7% reported using supportive services. By caregiver relationship status, children had the greatest use of supportive services compared to spouses and other relatives/non‐relatives (46.5% vs. 27.6% vs. 25.9%, p = <0.01, respectively). Among users of services, there were no differences in type of services used. Spouses primarily received their information about services from a medical provider or social worker (73.8%, p = <0.001). Conclusion: Our findings highlight the need to ensure that other caregiving groups, such as spouses and other relatives/non‐relatives, have access to important supportive services such as financial support. Medical providers and/or social workers should be leveraged and equipped to provide this information and refer to services accordingly. [ABSTRACT FROM AUTHOR]

Background: Social isolation is a key public health concern and has been associated with numerous negative health consequences. Technology is increasingly thought of as a solution to address social isolation. This study examines the longitudinal association between the access and use of technology and social isolation in older adults 65 and older, living in the United States. Methods: This observational cohort study included community‐dwelling older adults (N = 6704) who participated in the National Health and Aging Trends Study. Regression analyses were conducted using data from 2015 to 2019. Information about technology access and use was ascertained using self‐reported questionnaires. The primary outcome was the risk of social isolation. Results: At baseline, the majority of older adults that were not socially isolated had a working cell phone (88%) or computer (71%) and used email or text messaging (56%). Older adults that had access to (cell phone‐ incidence rate ratio [IRR] 0.62 [95% CI 0.48–0.81]; computer‐ IRR 0.63 [95% CI 0.51–0.78]), and used technology (email or text messaging‐ IRR 0.64 [95% CI 0.51–0.80]) in the year prior had a lower risk of social isolation than older adults who reported they did not access or use technology. Additionally, over four years, older adults who reported that they had access to a computer had a lower risk (0.69 [0.57, 0.84]) for social isolation than their counterparts. Conclusion: In this cohort study, technology access was associated with a lower risk for social isolation among community‐dwelling older adults. These findings suggest that technology has an important role in approaches that seek to prevent social isolation among older adults. [ABSTRACT FROM AUTHOR]

Background: Polypharmacy is common in older adults with cognitive impairment and multiple chronic conditions, increasing risks of adverse drug events, hospitalization, and death. Deprescribing, the process of reducing or stopping potentially inappropriate medications, may improve outcomes. The OPTIMIZE pragmatic trial examined whether educating and activating patients, family members and clinicians about deprescribing reduces number of chronic medications and potentially inappropriate medications. Acceptability and challenges of intervention delivery in cognitively impaired older adults are not well understood. Methods: We explored mechanisms of intervention implementation through post hoc qualitative interviews and surveys with stakeholder groups of 15 patients, 7 caregivers, and 28 clinicians. We assessed the context in which the intervention was delivered, its implementation, and mechanisms of impact. Results: Acceptance of the intervention was affected by contextual factors including cognition, prior knowledge of deprescribing, communication, and time constraints. All stakeholder groups endorsed the acceptability, importance, and delivery of the intervention. Positive mechanisms of impact included patients scheduling specific appointments to discuss deprescribing and providers being prompted to consider deprescribing. Recollection of intervention materials was inconsistent but most likely shortly after intervention delivery. Short visit times remained the largest provider barrier to deprescribing. Conclusions: Our work identifies key learnings in intervention delivery that can guide future scaling of deprescribing interventions in this population. We highlight the critical roles of timing and repetition in intervention delivery to cognitively impaired populations and the barrier posed by short consultation times. The acceptability of the intervention to patients and family members highlights the potential to incorporate deprescribing education into routine clinical practice and expand proven interventions to other vulnerable populations. [ABSTRACT FROM AUTHOR]

The article presents a study which investigated the validity and reliability of the Telephone 10-CS for detecting cognitive impairment and dementia, comparing its performance with in-person assessments. Topics include classification made by two geriatricians experienced in cognition on patients, characteristics of the participants according to the diagnostic group, and limitations of the study.

Background: Recent long‐term care facility (LTCF) policy has focused on transitioning nursing home (NH) residents back to community settings, yet we lack recent descriptions of this phenomenon and how it compares in assisted living (AL). Methods: Using the National Health and Aging Trends Study, we studied adults over age 65 who had moved from community living into an LTCF between 2011 and 2018. Persons or their proxies reported residence in annual interviews. NH was defined by facility staff. ALs were multi‐unit buildings helping with activities of daily living. We excluded temporary short‐stay NH patients and independent AL residents. Our primary outcome was cumulative incidence of return to community living, with death as co‐primary outcome and modeled as a competing risk, stratified by NH versus AL entry. We identified covariates (age, gender, race/ethnicity, dementia, activity limitations, and prior living arrangement) associated with return to community living through bivariate and multivariable logistic regression. Results: Among 739 participants, weighted mean age was 84 years (SD 7.5), 66% were women, 13% were non‐White, 57% had dementia, and 41% entered NH. At 1, 2, and 4 years, the cumulative incidence of return to community living was 2.9% (95% CIs: 1.9%–4.3%), 6.4% (4.7%–8.4%), and 7.4% (5.5%–9.8%); the cumulative incidence of death was 28% (95% CIs: 24%–31%), 44% (40%–48%) and 66% (61%–70%). Outcomes were similar in persons entering NH versus AL. Older persons (aOR 0.88, 95% CI 0.83–0.94), those with dementia (aOR 0.33, 95% CI 0.12–0.88), and those previously living alone (aOR 0.39, 95% CI 0.17–0.89) were less likely to return. Conclusions: Few returned to community living after entering either NH or AL. Mortality was similar. Results highlight limits in transitioning persons out of LTCFs and the need to observe AL use to ensure policies do not merely displace persons between institutional care sectors. [ABSTRACT FROM AUTHOR]

Background: Shelter‐in‐place orders during the COVID‐19 pandemic created unmet health‐related and access‐related needs among older adults. We sought to understand the prevalence of these needs among community‐dwelling older adults. Methods: We performed a retrospective chart review of pandemic‐related outreach calls to older adults between March and July 2020 at four urban, primary care clinics: a home‐based practice, a safety net adult medicine clinic, an academic geriatrics practice, and a safety net clinic for adults living with HIV. Participants included those 60 or older at three sites, and those 65 or older with a chronic health condition at the fourth. We describe unmet health‐related needs (the need for medication refills, medical supplies, or food) and access‐related needs (ability to perform a telehealth visit, need for a call back from the primary care provider). We performed bivariate and multivariate analyses to examine the association between unmet needs and demographics, medical conditions, and healthcare utilization. Results: Sixty‐two percent of people had at least one unmet need. Twenty‐six percent had at least one unmet health‐related need; 14.0% needed medication refills, 12.5% needed medical supplies, and 3.0% had food insecurity. Among access‐related needs, 33% were not ready for video visits, and 36.4% asked for a return call from their provider. Prevalence of any unmet health‐related need was the highest among Asian versus White (36.4% vs. 19.1%) and in the highest versus lowest poverty zip codes (30.8% vs. 18.2%). Those with diabetes and COPD had higher unmet health‐related needs than those without, and there was no change in healthcare utilization. Conclusions: During COVID, we found that disruptions in access to services created unmet needs among older adults, particularly for those who self‐identified as Asian. We must foreground the needs of this older population group in the response to future public health crises. [ABSTRACT FROM AUTHOR]

Background: The Successful Aging after Elective Surgery (SAGES) II study was designed to increase knowledge of the pathophysiology and linkages between delirium and dementia. We examine novel biomarkers potentially associated with delirium, including inflammation, Alzheimer's disease (AD) pathology and neurodegeneration, neuroimaging markers, and neurophysiologic markers. The goal of this paper is to describe the study design and methods for the SAGES II study. Methods: The SAGES II study is a 5‐year prospective observational study of 400–420 community dwelling persons, aged 65 years and older, assessed prior to scheduled surgery and followed daily throughout hospitalization to observe for development of delirium and other clinical outcomes. Delirium is measured with the Confusion Assessment Method (CAM), long form, after cognitive testing. Cognitive function is measured with a detailed neuropsychologic test battery, summarized as a weighted composite, the General Cognitive Performance (GCP) score. Other key measures include magnetic resonance imaging (MRI), transcranial magnetic stimulation (TMS)/electroencephalography (EEG), and Amyloid positron emission tomography (PET) imaging. We describe the eligibility criteria, enrollment flow, timing of assessments, and variables collected at baseline and during repeated assessments at 1, 2, 6, 12, and 18 months. Results: This study describes the hospital and surgery‐related variables, delirium, long‐term cognitive decline, clinical outcomes, and novel biomarkers. In inter‐rater reliability assessments, the CAM ratings (weighted kappa = 0.91, 95% confidence interval, CI = 0.74–1.0) in 50 paired assessments and GCP ratings (weighted kappa = 0.99, 95% CI 0.94–1.0) in 25 paired assessments. We describe procedures for data quality assurance and Covid‐19 adaptations. Conclusions: This complex study presents an innovative effort to advance our understanding of the inter‐relationship between delirium and dementia via novel biomarkers, collected in the context of major surgery in older adults. Strengths include the integration of MRI, TMS/EEG, PET modalities, and high‐quality longitudinal data. [ABSTRACT FROM AUTHOR]

The article discusses research which examined the frequency, timing and association of advance care planning (ACP) billing codes in fee-for-service Medicare patients undergoing transcatheter aortic valve replacement (TAVR) with adverse TAVR outcomes. The study analyzed the correlation of billed ACP with complication or death after surgery. It attributes the low uptake of ACP billing codes to ethical concerns, lack of resources, and health system incentives not aligned with ACP conversations.

The article presents a study which described the variation in the prevalence of antipsychotic and benzodiazepine prescribing among beneficiaries enrolled in hospice across states. Topics discussed include adjusted state-level prescribing rates for antipsychotics and benzodiazepines, variation in prescribing of antipsychotics and benzodiazepines between states among hospice enrollees in 2017, and limitations of the study.

Background: Evidence‐based multifactorial fall prevention interventions in clinical practice have been less effective than expected. One plausible reason is that older adults' engagement in fall prevention care is suboptimal. Methods: This was a post‐hoc analysis of 2403 older adults' engagement in a multifactorial fall prevention intervention in the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) pragmatic trial. Based on the direct clinical care level of the Patient and Family Continuum of Engagement (CE) framework, three indicators of progressively interactive engagement were assessed: (1) Consultation (receiving information), (2) Involvement (prioritizing risks), and (3) Partnership (identifying prevention actions). Drop off at each step was determined as well as predictors of engagement. Results: The participants' engagement waned with increasingly interactive CE domains. Although all participants received information about their positive fall risk factors (consultation) and most (51%–96%) prioritized them (involvement), fewer participants (33%–55%) identified fall prevention actions (partnership) for most of their risk factors, except for strength gait or balance problems (95%). More participants (70%) identified home exercises than other actions. Finally, fall prevention actions were identified more commonly among participants who received two visits compared to one (OR = 2.33 [95% CI, 2.06–2.64]), were ≥80 years old (OR = 1.83 [95% CI, 1.51–2.23]), and had fewer fall risk factors (OR = 0.90 [95% CI, 0.83–0.99]). Conclusions: The drop‐off in participants' engagement based on the level of their interaction with clinicians suggests that future multifactorial fall prevention interventions need to be more focused on interactive patient‐clinician partnerships that help older adults increase and maintain fall prevention actions. Our analyses suggest that more frequent contact with clinicians and more monitoring of the implementation and outcomes of Fall Prevention Care Plans could potentially improve engagement and help older adults maintain fall prevention actions. [ABSTRACT FROM AUTHOR]

The offers guidance for a successful research project collaboration between clinician-investigators and biostatistician. Important considerations for working effectively with a biostatistician are outlined including skills and training, proficiency with analytic programs and knowledge of relevant datasets. It discusses the roles and responsibilities of the clinician-investigator and biostatistician during the planning, analytic and reporting phases of a research project.

Background: The Acute Care for Elders (ACE) unit model of care aims to reduce common complications of hospitalization in older adults through early involvement of allied health providers, changes to the care environment, elder‐friendly care protocols, and proactive discharge planning. Our hospital established a dedicated 28‐bed medical ACE unit. Because of capacity limitations, the number of eligible older medical patients often exceeds the available number of beds. Thus, some ACE unit‐eligible patients are instead admitted to other medical or surgical units for their medical care. These "bed‐spaced" ACE patients receive care by the same general internists and ACE order set that ACE unit patients are cared under. We sought to compare the health outcomes of ACE‐designated patients admitted to the ACE unit versus bed‐spaced peers cared for using a protocolized ACE order set. Methods: 3046 ACE‐designated patient admissions were analyzed (1499 ACE unit and 1547 bed‐spaced). The primary outcomes examined were discharge disposition and in‐hospital mortality. Univariate and multivariate comparisons were performed. Propensity matching was used to adjust for case mix in a post‐hoc analysis. Results: The mean age of participants was 83.5 years for ACE unit patients and 82.6 for bedspaced patients. In adjusted models, ACE unit patients were more likely to be discharged home (OR 1.28 [1.08–1.50], p = 0.003). In an unadjusted analysis, patients admitted to ACE unit were less likely to die in hospital, but this finding did not persist after adjustment for case mix. Conclusion: Care of older adults delivered on a dedicated ACE unit increases the likelihood of discharge to home when compared to care delivered with an ACE order set alone for general internal medicine patients. This editorial comments on an article by Palmer in this issue. [ABSTRACT FROM AUTHOR]

Background: Depression and insomnia often co‐occur, and precede one another. Possibly, insomnia gives rise to depression, and vice versa. We tested whether insomnia symptoms of an older individual are associated with later depressive symptoms in that older individual, and vice versa. Methods: We performed a longitudinal analysis of data from a prospective cohort study in a large sample of community‐dwelling older people (N = 3081), with measurements every three years, over a time period of 20 years. The within‐individual longitudinal reciprocal relationship between symptoms of depression (Center for Epidemiological Studies Depression Scale), and symptoms of insomnia (three‐item questionnaire, including difficulty initiating sleep, nightly awakenings, and early morning awakening) was modeled by means of a bivariate linear growth model. We tested whether symptoms of insomnia were associated with symptoms of depression three years later, and vice versa. Results: Severity of symptoms of depression and insomnia and their within‐individual average change over time were moderately correlated (correlation of intercepts: rho 0.41, 95% CI: 0.36 to 0.46 p < 0.001; correlation of slopes: rho 0.39, 95% CI: 0.25 to 0.52, p < 0.001). Symptoms of depression were not found to be associated with an additional risk of higher symptoms of insomnia three years later, and vice versa (p = 0.329 and p = 0.919, respectively). Similar results were found when analyses were corrected for covariates. Conclusions: In older individuals, depression and insomnia are associated and tend to increase concurrently over time, but constitute no additional risk for one another over repeated three‐year intervals. These findings contradict previous research that suggests that depression and insomnia are risk factors for one another over time. The current study stands out due to the longitudinal within‐individual statistical approach, but is limited by the three‐year interval between measures. [ABSTRACT FROM AUTHOR]

Background: Various clinical studies have provided estimates of life expectancy of patients with mild cognitive impairment (MCI) from outpatient clinics, but whether these apply to community‐dwelling individuals at home or in primary care is uncertain. Methods: Within the population‐based Rotterdam Study, we studied life expectancy with and without dementia in 648 community‐dwelling persons with MCI and 6410 without MCI. Participants aged 60 years and older were assessed for MCI at baseline (2002–2014) and subsequently followed for the onset of dementia and death. We used multistate life tables to determine age‐specific life expectancy with and without dementia by sex, educational attainment, and MCI subtype. Results: Total life expectancy for MCI ranged from 21.4 years (95% CI: 19.0–23.6) at age 60 to 2.6 years (1.6–3.6) at age 95. With advancing age, an increasing proportion of these years was lived with dementia (2.9 years [1.8–4.0] at age 60; 1.2 [0.2–2.2] at age 95). Women and higher educated individuals lived longer and lived more years with dementia. No differences in total life expectancy were observed by MCI subtype, although individuals with amnestic MCI lived a larger proportion of those years with dementia. Conclusions: Prognosis of MCI, in terms of life years lived with and without dementia, is more favorable in the general population than described in prior clinical observations, due likely to a substantial proportion of individuals with MCI in the clinic not seeking medical attention in an earlier stage. [ABSTRACT FROM AUTHOR]

Background: Older patients evaluated in Emergency Departments (ED) for suspect Myocardial Infarction (MI) frequently exhibit unspecific elevations of serum high‐sensitivity troponin I (hs‐TnI), making interpretation particularly challenging for emergency physicians. The aim of this longitudinal study was to identify the interaction of multimorbidity and frailty with hs‐TnI levels in older patients seeking emergency care. Methods: A group of patients aged≥75 with suspected MI was enrolled in our acute geriatric ward immediately after ED visit. Multimorbidity and frailty were measured with Cumulative Illness Rating Scale (CIRS) and Clinical Frailty Scale (CFS), respectively. The association of hs‐TnI with MI (main endpoint) was assessed by calculation of the Area Under the Receiver‐Operating Characteristic Curve (AUROC), deriving population‐specific cut‐offs with Youden test. The factors associated with hs‐TnI categories, including MI, CFS and CIRS, were determined with stepwise multinomial logistic regression. The association of hs‐TnI with 3‐month mortality (secondary endpoint) was also investigated with stepwise logistic regression. Results: Among 268 participants (147 F, median age 85, IQR 80–89), hs‐TnI elevation was found in 191 cases (71%, median 23 ng/L, IQR 11–65), but MI was present in only 12 cases (4.5%). hs‐TnI was significantly associated with MI (AUROC 0.751, 95% CI 0.580–0.922, p = 0.003), with an optimal cut‐off of 141 ng/L. hs‐TnI levels ≥141 ng/L were significantly associated with CFS (OR 1.58, 95% CI 1.15–2.18, p = 0.005), while levels <141 ng/L were associated with the cardiac subscore of CIRS (OR 1.36, 95% CI 1.07–1.71, p = 0.011). CFS, but not hs‐TnI levels, predicted 3‐month mortality. Conclusions: In geriatric patients with suspected MI, frailty and cardiovascular multimorbidity should be carefully considered when interpreting emergency hs‐TnI testing. [ABSTRACT FROM AUTHOR]

Background: There is a paucity of data on older adults (age ≥65 years) undergoing surgery who had an inpatient do‐not‐resuscitate (DNR) order, and the association between timing of DNR order and outcomes. Methods: This was a retrospective analysis of 1976 older adults in the American College of Surgeons National Surgical Quality Improvement Program geriatric‐specific database (2014–2018). Patients were stratified by institution of a DNR order during their surgical admission ("new‐DNR" vs. "no‐DNR"), and matched by age (±3 years), frailty score (range: 0–1), and procedure. The main outcome of interest was occurrence of death or hospice transition (DoH) ≤30 postoperative days; this was analyzed using bivariate and multivariable methods. Results: One in 36 older adults had a new‐DNR order. After matching, there were 988 new‐DNR and 988 no‐DNR patients. Median age and frailty score were 82 years and 0.2, respectively. Most underwent orthopedic (47.6%), general (37.6%), and vascular procedures (8.4%). Overall DoH rate ≤30 days was 44.4% for new‐DNR versus 4.0% for no‐DNR patients (p < 0.001). DoH rate for patients who had DNR orders placed in the preoperative, day of surgery, and postoperative setting was 16.7%, 23.3%, and 64.6%, respectively (p < 0.001). In multivariable analysis, compared to no‐DNR patients, those with a new‐DNR order had a 28‐fold higher adjusted odds of DoH (odds ratio [OR] 28.1, 95% confidence interval: 13.0–60.1, p < 0.001); however, odds were 10‐fold lower if the DNR order was placed preoperatively (OR: 5.8, p = 0.003) versus postoperatively (OR: 52.9, p < 0.001). Traditional markers of poor postoperative outcomes such as American Society of Anesthesiologists class and emergency surgery were not independently associated with DoH. Conclusions: An inpatient DNR order was associated with risk of DoH independent of traditional markers of poor surgical outcomes. Further research is needed to understand factors leading to a DNR order that may aid early recognition of high‐risk older adults undergoing surgery. [ABSTRACT FROM AUTHOR]

Objectives: Establish reliability, concurrent and convergent validity of the Pittsburgh Fatigability Scale (PFS) Mental subscale. Design: Cross‐sectional. Setting: Older adults from two University of Pittsburgh registries, Baltimore Longitudinal Study of Aging (BLSA), and Long Life Family Study (LLFS). Participants: PFS Mental subscale validation was conducted using three cohorts: (1) Development Sample (N = 664, 59.1% women, age 74.8 ± 6.4 years, PFS Mental scores 10.3 ± 9.1), (2) Validation Sample I—BLSA (N = 430, 51.9% women, age 74.5 ± 8.2 years, PFS Mental scores 9.4 ± 7.9), and (3) Validation Sample II—LLFS (N = 1,917, 54.5% women, age 72.2 ± 9.3 years, PFS Mental scores 7.5 ± 8.2). Measurements: Development Sample, Validation Sample I—BLSA, and Validation Sample II—LLFS participants self‐administered the 10‐item Pittsburgh Fatigability Scale. Validation Sample II—LLFS completed cognition measures (Trail Making Tests A and B), depressive symptomatology (Center for Epidemiologic Studies—Depression Scale, CES‐D), and global fatigue from two CES‐D items. Results: In the Development Sample and Validation Sample I—BLSA, confirmatory factor analysis showed all 10 items loaded on two factors: social and physical activities (fit indices: SRMSR = 0.064, RMSEA = 0.095, CFI = 0.91). PFS Mental scores had strong internal consistency (Cronbach's α = 0.85) and good test‐retest reliability (ICC = 0.78). Validation Sample II—LLFS PFS Mental scores demonstrated moderate concurrent and construct validity using Pearson (r) or Spearman (ρ) correlations against measures of cognition (Trail Making Tests A (r = 0.14) and B (r = 0.17) time), depressive symptoms (r = 0.31), and global fatigue (ρ = 0.21). Additionally, the PFS Mental subscale had strong convergent validity, discriminating according to established clinical or cognitive testing cut points, with differences in PFS Mental scores ranging from 3.9 to 7.6 points (all P <.001). All analyses were adjusted for family relatedness, field center, age, sex, and education. Conclusions: The validated PFS Mental subscale may be used in clinical and research settings as a sensitive, one‐page self‐administered tool of perceived mental fatigability in older adults. [ABSTRACT FROM AUTHOR]

Background: Older adults with visual impairments experience a higher risk of falling, and are more vulnerable to adverse health consequences associated with falls than those with normal vision. This study characterizes longitudinal changes in objectively measured physical activity and fear of falling (FoF) occurring after various types of falls in visually impaired older adults. Design: Prospective cohort study. Setting: Hospital‐based enrollment. Participants: People with glaucoma or suspected glaucoma. Measurements: Falls were defined as unintentionally coming to rest on the ground or a lower level, and injurious falls were determined though follow‐up calls. Study participants were categorized into three groups–fallers with injurious consequences, fallers without injurious consequences, and non‐fallers based on fall status in the first year. Physical activity was assessed by waist‐bound accelerometer. FoF was evaluated by questionnaire, with Rasch modeling generating FoF scores where higher scores reflected worse FoF. The 3‐year longitudinal changes of physical activity and FoF were modeled using mixed‐effects models. Results: In linear models fully adjusted for visual field damage and other covariates, physical activity among injurious fallers showed greater annual (per year) declines in daily steps (−425 steps/d, 95% confidence interval (CI) = −793, −57), daily active minutes (−13 min/d, 95% CI = −21, −6), and daily moderate and vigorous physical activity (MVPA) minutes (−3 MVPA minutes/d, 95% CI = −5, 0) over the 3‐year period as compared to non‐fallers; however, physical activity did not significantly decline among non‐injurious fallers. No longitudinal increases in FoF scores were observed in injurious or non‐injurious fallers when compared to non‐fallers. Conclusion: Among visually impaired older adults, injurious falls identified prospectively over 12 months contributed to a significant decline in physical activity over a 3‐year period, while minimal changes were observed in FoF. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: Detecting delirium is important to identify patients with a high risk of poor outcomes. Although many different kinds of screening instruments for delirium exist, there is no solid consensus about which methods are the most effective. In addition, it is important to find the most useful tools in predicting outcomes such as mortality. DESIGN: Retrospective cohort study. SETTING: University of Iowa Hospitals and Clinics. PARTICIPANTS: A total of 1,125 adult inpatients (mean age = 67.7; median age = 69). MEASUREMENTS: Post hoc analyses were performed based on existing data from the Confusion Assessment Method for Intensive Care Unit (CAM‐ICU), Delirium Rating Scale‐Revised‐98 (DRS), and the Delirium Observation Screening Scale (DOSS). Correlation among these scales and relationships between 365‐day mortality and each scale were evaluated. RESULTS: A positive result on the CAM‐ICU ("CAM‐ICU positive") was associated with higher DRS and DOSS scores. A DRS score = 9/10 was the best cutoff to detect CAM‐ICU positive, and DOSS = 2/3 was the best cutoff to detect CAM‐ICU positive. CAM‐ICU positive was associated with high 365‐day mortality. DRS score = 9/10 and DOSS score = 0/1 were found to differentiate mortality risk the most significantly. Higher DRS and DOSS scores significantly coincided with a decrease in a patient's survival rate at 365 days. CONCLUSION: The best DRS and DOSS cutoff scores to differentiate 365‐day mortality risk were lower than those commonly used to detect delirium in the literature. New cutoff scores for the DRS and DOSS might be useful in differentiating risk of mortality among hospital patients. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: Hispanics have lower advance directive (AD) completion than non‐Hispanic Whites. Few studies have assessed the role of language preference in end‐of‐life planning. We investigated whether language preference and needing an interpreter affected AD completion among older adults in an integrated health system. DESIGN: Retrospective cohort investigation of electronic medical records. SETTING: Northern California integrated health system. PARTICIPANTS: A total of 620,948 Hispanic and non‐Hispanic White patients, aged 55 years and older, between January 1, 2013, and December 31, 2017. MEASUREMENTS: Descriptive statistics and bivariate analysis were performed to compare AD completion among non‐Hispanic Whites, Hispanics, and Hispanic subgroups by language preference (English speaking, Spanish speaking, and needed interpreter). We conducted multivariable logistic regression to determine the relationship between language preference and having an AD while controlling for demographic, clinical, and utilization factors. RESULTS: We found 20.3% of non‐Hispanic Whites (n = 512,577) and 10.9% of Hispanics (n = 108,371) had completed an AD. Among Hispanics, after controlling for demographic, clinical, and utilization factors, compared with Spanish speakers requiring an interpreter, English speakers had nearly two‐fold increased odds of completing an AD (adjusted odds ratio (aOR) = 2.6; 95% confidence interval (CI) = 2.4–2.9), whereas Spanish speakers not requiring an interpreter had 20% increased odds (aOR = 1.2; 95% CI = 1.1–1.3). Additional predictors of successful AD completion were being female, being older, having more comorbidities, having more hospital and emergency department visits, and having higher socioeconomic status. There were no differences associated with primary care provider characteristics. CONCLUSION: These findings indicate the need for a tailored outreach to Hispanics, particularly among those subgroups who require the need of an interpreter, to reduce AD completion disparities. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: Delirium is a common postoperative complication associated with prolonged length of stay, hospital readmission, and premature mortality. We explored the association between neighborhood‐level characteristics and delirium incidence and severity, and compared neighborhood‐ with individual‐level indicators of socioeconomic status in predicting delirium incidence. DESIGN: A prospective observational cohort of patients enrolled between June 18, 2010, and August 8, 2013. Baseline interviews were conducted before surgery, and delirium/delirium severity was evaluated daily during hospitalization. Research staff evaluating delirium were blinded to baseline cognitive status. SETTING: Two academic medical centers in Boston, MA. PARTICIPANTS: A total of 560 older adults, aged 70 years or older, undergoing major noncardiac surgery. INTERVENTION: The Area Deprivation Index (ADI) was used to characterize each neighborhood's socioeconomic disadvantage. MEASUREMENTS: Delirium was assessed using the Confusion Assessment Method (CAM) long form. Delirium severity was calculated using the highest value of CAM Severity score (CAM‐S) occurring during daily hospital assessments (CAM‐S Peak). RESULTS: Residing in the most disadvantaged neighborhoods (ADI > 44) was associated with a higher risk of incident delirium (12/26; 46%), compared with the least disadvantaged neighborhoods (122/534; 23%) (risk ratio (RR) (95% confidence interval (CI)) = 2.0 (1.3–3.1). The CAM‐S Peak score was significantly associated with ADI (Spearman rank correlation, ρ = 0.11; P =.009). Mean CAM‐S Peak scores generally rose from 3.7 to 5.3 across levels of increasing neighborhood disadvantage. The RR (95% CI) values associated with individual‐level markers of socioeconomic status and cultural background were: 1.2 (0.9–1.7) for education of 12 years or less; 1.3 (0.8–2.1) for non‐White race; and 1.7 (1.1–2.6) for annual household income of less than $20,000. None of these individual‐level markers exceeded the ADI in terms of effect size or significance for prediction of delirium risk. CONCLUSIONS: Neighborhood‐level makers of social disadvantage are associated with delirium incidence and severity, and demonstrated an exposure‐response relationship. Future studies should consider contextual‐level metrics, such as the ADI, as risk markers of social disadvantage that can help to guide delirium treatment and prevention. [ABSTRACT FROM AUTHOR]

OBJECTIVE Fear of falling (FoF) may alter mobility in older adults, especially among those with visual impairment. Using a longitudinal prospective cohort of older glaucoma patients, we investigated whether and how FoF is associated with future falls and physical activity. DESIGN Prospective observational cohort study. SETTING Hospital‐based single‐center recruitment. PARTICIPANTS Individuals with glaucoma or suspected glaucoma. MEASUREMENTS FoF was measured annually over a 3‐year period using the University of Illinois at Chicago FoF Questionnaire, with lower Rasch‐analyzed FoF scores (in logit units) indicating less fear. Participants recorded falls prospectively over the 3‐year period using monthly mail‐in calendars. Daily steps were collected annually over 7 days using an accelerometer. Visual field (VF) sensitivity was derived by combining sensitivities from monocular VF results. Participants completed questionnaires to determine other demographic/health characteristics. Multivariate random effects models evaluated within‐participant changes in fall rates and physical activity across study years. RESULTS: At lower FoF levels (FoF≤0), each one‐unit worsening in FoF score across study years was associated with 2.73 times higher odds of reporting at least one fall in the next year (95% confidence interval [CI] = 1.55‐4.81) but was not associated with average daily steps (P =.44). Similar results were seen when fall rates were normalized by number of steps taken (P =.97). At higher FoF levels (FoF > 0), inter‐year changes in FoF scores were not significantly associated with reporting a fall in the following year (P =.78) but were associated with 407 fewer average daily steps per one‐unit change in FoF (95% CI = −743 to −71). CONCLUSION: FoF is an important psychological factor associated with mobility in glaucoma patients, although specific aspects of mobility (fall rates vs activity levels) affected vary by the degree of FoF. Our findings suggest that customizing behavioral interventions for older adults based on their levels of FoF may be an important strategy for fall prevention and activity promotion. J Am Geriatr Soc 68:1847‐1851, 2020. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES Hospital at home (HaH) provides interdisciplinary acute care in the home as a substitute for inpatient hospitalization. Studies have demonstrated that HaH care is associated with better quality care, fewer complications, and better patient and caregiver experience. Still, some patients decline HaH. The objective of the study was to characterize patients who accept vs decline HaH care and describe reasons for their decisions in the context of a Center for Medicare and Medicaid Innovation demonstration of HaH. DESIGN/SETTING/PARTICIPANTS A total of 442 patients with Medicare or other eligible insurance, 18 years or older, who met study eligibility criteria were offered HaH at Mount Sinai Hospitals in New York, NY, between September 1, 2014, and August 31, 2017. MEASUREMENTS Reasons for accepting or declining HaH were recorded. Age, sex, insurance type, and admission diagnoses of HaH acceptors and refusers were compared in univariate analyses. RESULTS: Of the 442 patients offered HaH, 66.7% accepted. Main reasons for enrolling in HaH included being more comfortable at home (78.2%) and being near family (40.7%). Specific reasons given for refusing HaH included preferring in‐hospital care (15.0%) and concern that HaH would not meet care needs (12.9%). CONCLUSION: Two‐thirds of patients offered HaH care opted to receive it. The reasons for declining HaH provided by those who chose not to participate should be considered for quality improvement, and reasons for acceptance may be helpful in marketing and other efforts to promote HaH participation. J Am Geriatr Soc 68:1579‐1583, 2020. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES Previous studies have reported that older patients may experience worse outcome(s) after infection with severe acute respiratory syndrome coronavirus‐2 than younger individuals. This study aimed to identify potential risk factors for mortality in older patients with coronavirus disease 2019 (COVID‐19) on admission, which may help identify those with poor prognosis at an early stage. DESIGN Retrospective case‐control. SETTING Fever ward of Sino‐French New City Branch of Tongji Hospital, Wuhan, China. PARTICIPANTS Patients aged 60 years or older with COVID‐19 (n = 244) were included, of whom 123 were discharged and 121 died in hospital. MEASUREMENTS Data retrieved from electronic medical records regarding symptoms, signs, and laboratory findings on admission, and final outcomes of all older patients with COVID‐19, were retrospectively reviewed. Univariate and multivariate logistic regression analyses were used to explore risk factors for death. RESULTS: Univariate analysis revealed that several clinical characteristics and laboratory variables were significantly different (ie, P <.05) between discharged and deceased patients. Multivariable logistic regression analysis revealed that lymphocyte (LYM) count (odds ratio [OR] = 0.009; 95% confidence interval [CI] = 0.001‐0.138; P =.001) and older age (OR = 1.122; 95% CI = 1.007‐1.249; P =.037) were independently associated with hospital mortality. White blood cell count was also an important risk factor (P =.052). The area under the receiver operating characteristic curve in the logistic regression model was 0.913. Risk factors for in‐hospital death were similar between older men and women. CONCLUSION: Older age and lower LYM count on admission were associated with death in hospitalized COVID‐19 patients. Stringent monitoring and early intervention are needed to reduce mortality in these patients. J Am Geriatr Soc 68:E19–E23, 2020. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess the agreement of several different measures of potentially inappropriate prescribing (PIP) in older people and compare their relationship with patient‐reported outcomes. DESIGN: Prospective cohort study including participants in The Irish Longitudinal Study on Ageing (TILDA). SETTING: Waves 1 and 2 of TILDA, a nationally representative aging cohort study. PARTICIPANTS: A total of 1753 community‐dwelling TILDA participants with linked administrative pharmacy claims data on medications. MEASUREMENTS: Potentially inappropriate medications were assessed using the Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP) v1, American Geriatrics Society (AGS) Beers Criteria® 2012, and relevant Assessing Care of Vulnerable Elders (ACOVE) v3 indicators. Potential prescribing omissions were assessed using the Screening Tool to Alert Doctors to the Right Treatment (START) v1 and ACOVE v3 indicators. Their agreement was assessed via κ statistics, and multivariate regression was used to assess relationships with emergency department visits, general practitioner (GP) visits, quality of life, and functional decline (increased assistance needed for activities of daily living). RESULTS: There was slight agreement between STOPP and AGS Beers Criteria® (κ = 0.20) and ACOVE indicators (κ = 0.15), while agreement between AGS Beers Criteria® and ACOVE indicators was fair (κ = 0.31). Agreement was fair between START and ACOVE indicators (κ = 0.34). All measures of inappropriate medications were significantly associated with increased GP visits. Only exposure to two or more START indicators was associated with reduced quality of life (adjusted mean difference = −1.12; 95% confidence interval [CI] = −1.92 to −0.33), and only two or more AGS Beers Criteria® were associated with functional decline (adjusted odds ratio = 2.11; 95% CI = 1.37‐3.28). For omissions, both measures were associated with functional decline, but only ACOVE indicators were associated with increased GP visits. CONCLUSION: Prevalence of PIP and relationships with outcomes can differ substantially between tools with little agreement. Choice of PIP measure for research or practice should be considered in light of the circumstances and requirements in each case. J Am Geriatr Soc 68:526–534, 2020 [ABSTRACT FROM AUTHOR]

OBJECTIVES: To measure the burden of delirium in older adults with or without Alzheimer disease or related disorders (ADRDs). DESIGN: Prospective, observational cohort. SETTING: Inpatient hospital and study participants' homes. PARTICIPANTS: A subset (n = 267) of older medical and surgical patients and their caregivers enrolled in the Better Assessment of Illness study. MEASUREMENTS: Delirium burden was measured using the DEL‐B instrument (range = 0‐40, with higher scores indicating greater burden) in caregivers (DEL‐B‐C) and patients 1 month after hospitalization. Severity of cognitive impairment (Montreal Cognitive Assessment [MoCA]), delirium presence (Confusion Assessment Method [CAM]), and delirium severity (CAM‐Severity [CAM‐S]) were measured during hospitalization and at 1‐month follow‐up. ADRD diagnosis was determined by a clinical consensus process. RESULTS: For patients with (n = 56) and without (n = 211) ADRD, both DEL‐B instruments had good internal consistency. DEL‐B‐C scores had a median (interquartile range) among caregivers of patients with and without ADRD of 9 (5‐15) and 5 (1‐11), respectively (P < .05). If the patient developed delirium, caregivers experienced greater burden (β[delirium × ADRD] = −.29; P =.42), regardless of ADRD status. Further, caregiver burden was modestly correlated with patient MoCA scores (Spearman correlation coefficient, ρ = −0.18; P =.01). Patients with ADRD who developed delirium self‐reported less burden than those without ADRD (β[delirium × ADRD] = −.67; P =.044). As with caregivers, delirium burden was modestly correlated with patient MoCA score (ρ = −0.18; P =.005) and correlated with the CAM‐S in patients without ADRD (ρ = 0.38; P < .001) but not for patients with ADRD (ρ = −0.07; P =.61). CONCLUSIONS: Delirium resulted in the same degree of increased caregiver burden regardless of whether a patient had ADRD, signifying delirium is equally stressful to caregivers, even among those with experience caring for someone with a chronic cognitive disorder. Delirium burden is only modestly associated with degree of cognitive impairment, suggesting that other aspects of delirium contribute to burden. J Am Geriatr Soc 67:2587–2592, 2019 [ABSTRACT FROM AUTHOR]

Background/Objectives: The University of Alabama at Birmingham (UAB) Life‐Space Assessment (LSA) is a widely used measure of community mobility. To assist clinicians and researchers with assessing the significance of changes in scores, we determined the minimal important change associated with a change in health status. Setting: Homes of community‐dwelling older adults. Participants: A total of 419 African American and non‐Hispanic white adults 75 years and older participating in the UAB Study of Aging II, a longitudinal epidemiological study across the state of Alabama. Intervention: None. Measurements: Linear mixed models were used to compare change in LSA scores over 1‐month intervals (N = 9712) between participants reporting improvement, no change, or decline in activities of daily living walking scores, accounting for the correlation among scores for the same participant over time. Results: A decline in walking status was associated with a mean decrease in LSA scores of 2.93 points (95% confidence interval [CI] = 1.69‐4.17 points), indicating lower mobility. An improvement in walking status was associated with a mean increase in LSA scores of 2.51 points (95% CI = 1.26‐3.77 points), indicating higher mobility. Conclusion: A change in LSA scores of five or more is clinically important, exceeding the 95% CI for the change in LSA associated with change in walking status. Changes exceeding this threshold should prompt further investigation by providers with a goal of preserving mobility. J Am Geriatr Soc 67:565–569, 2019. [ABSTRACT FROM AUTHOR]

Objectives: To determine if nonspecific symptoms and fever affect the posttest probability of acute bacterial infection in older patients in the emergency department (ED). Design: Preplanned, secondary analysis of a prospective observational study. Setting: Tertiary care, academic ED. Participants: A total of 424 patients in the ED, 65 years or older, including all chief complaints. Measurements: We identified presence of altered mental status, malaise/lethargy, and fever, as reported by the patient, as documented in the chart, or both. Bacterial infection was adjudicated by agreement among two or more of three expert reviewers. Odds ratios were calculated using univariable logistic regression. Positive and negative likelihood ratios (PLR and NLR, respectively) were used to determine each symptom's effect on posttest probability of infection. Results: Of 424 subjects, 77 (18%) had bacterial infection. Accounting for different reporting methods, presence of altered mental status (PLR range, 1.40‐2.53) or malaise/lethargy (PLR range, 1.25‐1.34) only slightly increased posttest probability of infection. Their absence did not assist with ruling out infection (NLR, greater than 0.50 for both). Fever of 38°C or higher either before or during the ED visit had moderate to large increases in probability of infection (PLR, 5.15‐18.10), with initial fever in the ED perfectly predictive, but absence of fever did not rule out infection (NLR, 0.79‐0.92). Results were similar when analyzing lower respiratory, gastrointestinal, and urinary tract infections (UTIs) individually. Of older adults diagnosed as having UTIs, 47% did not complain of UTI symptoms. Conclusions: The presence of either altered mental status or malaise/lethargy does not substantially increase the probability of bacterial infection in older adults in the ED and should not be used alone to indicate infection in this population. Fever of 38°C or higher is associated with increased probability of infection. J Am Geriatr Soc 67:484–492, 2019. [ABSTRACT FROM AUTHOR]