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Background: There is a lack of real‐life data regarding the frequency and predictive factors of hypoglycemia in older patients with type 2 diabetes (T2D). This study aimed to determine the frequency and predictors of hypoglycemia in older patients with insulin‐treated T2D. Methods: This prospective multicenter study included 155 insulin‐treated T2D patients aged 75 years and older with ≥2 self‐monitoring of blood glucose (SMBG) daily controls. Participants underwent a geriatric and diabetic assessment and received ambulatory blinded continuous glucose monitoring (CGM) for 28 consecutive days with FreeStyle Libre Pro® sensor. Study population (n = 141) has >70% CGM active time. Multivariable logistic regressions were used to identify factors associated with SMBG confirmed hypoglycemia (≥70 mg/dL) and with nocturnal level 2 time below range (glucose concentration <54 mg/dL during ≥15 consecutive min between 0.00 and 6.00 am). Results: The mean age of the 141 analyzed patients was 81.5 ± 5.3 years and 56.7% were male. The mean baseline HbA1c was 7.9% ± 1.0%. After geriatric assessment, 102 participants (72.3%) were considered as complex and 39 (27.7%) as healthy. The primary endpoint (confirmed SMBG <70 mg/dL) occurred in 37.6% patients. In multivariable analysis, the risk of SMBG‐confirmed hypoglycemia was positively associated with a longer duration of diabetes (OR (+1 year) =1.04, (1.00–1.08), p = 0.04) and glycemic variability assessed by CGM (CV %) (OR (+1%) = 1.12, [1.05–1.19], p = <0.001). Nighty‐two patients (65.2%) experienced nocturnal time in hypoglycemia (i.e., <54 mg/dL during ≥15 consecutive min between midnight and 6 a.m.). In multivariable analyses, cognitive impairment (OR: 9.31 [2.59–33.4]), heart failure (OR: 4.81 [1;48–15.6]), and depressive disorder (OR: 0.19 [0.06–0.53]) were associated with nocturnal time in hypoglycemia. Conclusion: Nocturnal hypoglycemia is very common and largely underdiagnosed in older patients with insulin‐treated T2D. CGM is a promising tool to better identify hypoglycemia and adapt diabetes management in this population. [ABSTRACT FROM AUTHOR]

Background: Increasing evidence links obstructive sleep apnea (OSA) to cognitive decline. Autonomic dysfunction assessed by heart rate variability is a promising early biomarker of cognitive impairment in populations without major neurocognitive disorder (MND). We aimed to determine whether nocturnal pulse rate variability (PRV) extracted from oximetry signal and OSA severity could predict MND onset among older OSA patients. Methods: This study relied on data collected within the multicenter longitudinal Pays de la Loire Sleep Cohort, linked to health administrative data to identify new‐onset MND. We included patients ≥60 years with newly diagnosed OSA, and no history of MND or atrial fibrillation. Cox proportional‐hazards models were used to evaluate the association of MND with indices of PRV and OSA severity generated from sleep recordings. Results: After a median follow‐up of 6.8 [4.7–9.4] years, 70 of 3283 patients (2.1%) had been diagnosed with MND. In multivariable Cox models, MND incidence was associated with age (p < 0.0001), depression (p = 0.013), and PRV assessed by the root mean square of the successive normal‐to‐normal (NN) beat interval differences (RMSSD; p = 0.008) and standard deviation of NN beat intervals (SDNN; p = 0.02). Patients with the highest quartile of RMSSD had a 2.3‐fold [95%CI 1.11–4.92] higher risk of being diagnosed with MND. Indices of OSA and nocturnal hypoxia severity were not associated with MND. Conclusions: Within a large clinic‐based cohort of older patients with OSA, we found an association between oximetry‐based indices of PRV and the onset of MND. Nocturnal oximetry‐derived PRV indices could allow the early identification of OSA patients at higher risk of MND. See related Editorial by Miner et al. in this issue. [ABSTRACT FROM AUTHOR]

Background: In managing older adults with atrial fibrillation (AF), their symptomatology impacts their well‐being and may inform treatment decision‐making. We examined AF symptom perception, its impact on quality of life (QoL), and its relation to treatment strategies in older adults with AF. Methods: Data were obtained from older adults with AF enrolled in a multicenter study conducted at clinic sites in Massachusetts and Georgia between 2016 and 2018. Participants were stratified into three age groups: 65–74 (youngest–old), 75–84 (middle–old), and ≥85 (oldest). Perception of AF symptoms was assessed by participant self‐report during their clinic visit and at study enrollment by the Atrial Fibrillation Effect on Quality‐of‐Life Questionnaire which assessed cardiac‐specific and non‐specific, non‐cardiac AF symptoms and their impact on QoL. Treatment strategies (rate or rhythm control) utilized were ascertained from electronic medical records. Results: Among the 1184 participants (mean age 75 years, 48% women, 86% Non‐Hispanic White), 51% were aged 65–74 years, 36% were 75–84 years, and 13% were ≥ 85 years. The most commonly reported AF symptoms were non‐specific, non‐cardiac symptoms (fatigue, dyspnea, lightheadedness) with similar prevalence and impact on QoL in all age groups. Cardiac‐specific AF symptoms (palpitations, irregular heartbeat, pause in heart activity) were less prevalent, but most commonly reported by the youngest participants (65–74 years), who endorsed considerable impact of these symptoms on their QoL. Overall, those who reported experiencing any AF symptoms during their clinic visit were more likely to have received rhythm compared with rate control (OR: 1.56; 95% CI: 1.18–2.04) with similar findings for all age groups except those aged ≥85 years. Conclusions: Our findings suggest a high prevalence of non‐specific, non‐cardiac symptoms among older adults with AF and that cardiac‐specific AF symptoms may exert considerable impact on their QoL. The presence of any AF symptoms may drive more rhythm control in a majority of older adults. See related Editorial by Blachman et al. in this issue. [ABSTRACT FROM AUTHOR]

Background: Older adults represent a disproportionate share of severe COVID‐19 presentations and fatalities, but we have limited understanding of the differences in presentation by age and the association between less typical emergency department (ED) presentations and clinical outcomes. Methods: This retrospective cohort study used the RECOVER Network registry, a research collaboration of 86 EDs in 27 U.S. states. We focused on encounters with a positive nasopharyngeal swab for SARS‐CoV‐2, and described their demographics, clinical presentation, and outcomes. Sequential multivariable logistic regressions examined the strength of association between age cohort and outcomes. Results: Of 4536 encounters, median patient age was 55 years, 49% were women, and 34% were non‐Hispanic Black persons. Cough was the most common presenting complaint across age groups (18–64, 65–74, and 75+): 71%, 67%, and 59%, respectively (p < 0.001). Neurological symptoms, particularly altered mental status, were more common in older adults (2%, 11%, 26%; p < 0.001). Patients 75+ had the greatest odds of ED index visit admission of all age groups (adjusted odds ratio [aOR] 6.66; 95% CI 5.23–8.56), 30‐day hospitalization (aOR 7.44; 95% CI 5.63–9.99), and severe COVID‐19 (aOR 4.26; 95% CI 3.45–5.27). Compared to individuals with alternate presentations and adjusting for age, patients with typical symptoms (fever, cough and/or shortness of breath) had similar odds of ED index visit admission (aOR 1.01; 95% CI 0.81–1.24), potentially higher odds of 30‐day hospitalization (aOR 1.23; 95% CI 1.00–1.53), and greater odds of severe COVID‐19 (aOR 1.46; 95% CI 1.12–1.90). Conclusions: Older patients with COVID‐19 are more likely to have presentations without the most common symptoms. However, alternate presentations of COVID‐19 in older ED patients are not associated with greater odds of mechanical ventilation and/or death. Our data highlights the importance of a liberal COVID‐19 testing strategy among older ED patients to facilitate accurate diagnoses and timely treatment and prophylaxis. [ABSTRACT FROM AUTHOR]

Background: There is incomplete information regarding evolution of antibody titers against SARS‐CoV‐2 after a two‐dose strategy vaccination with BNT162b2 in older adults in long‐term care facilities (LTCFs) with frailty, disability, or cognitive impairment. We aimed to determine IgG antibody titer loss in older adults in LTCFs. Methods: This is a multicenter longitudinal cohort study including 127 residents (90 females and 37 males) with a mean age of 82.7 years (range 65–99) with different frailty and disability profiles in two LTCFs in Albacete, Spain. Residents received two doses of BNT162b2 as per label, and antibody levels were determined 1 and 6 months after the second dose. Age, sex, previous history of coronavirus disease 2019 (COVID‐19), comorbidity (Charlson Index), performance in activities of daily living (Barthel Index), frailty (FRAIL instrument), and cognitive status were assessed. Results: The mean antibody titers 1 and 6 months after the second vaccine dose were 32,145 AU/ml (SD 41,206) and 6182 AU/ml (SD 13,316), respectively. Across all participants, the median antibody titer loss measured 77.6% (interquartile range [IQR] 23.8%). Notably, the decline of titers in individuals with pre‐vaccination COVID‐19 infection was significantly lower than in those without a history of SARS‐CoV‐2 infection (72.2% vs. 85.3%; p < 0.001). The median titer decrease per follow‐up day was 0.47% (IQR 0.14%) and only pre‐vaccination COVID‐19 was associated with lower rate of antibody decline at 6 months (hazard ratio 0.17; 95% confidence interval 0.07–0.41; p < 0.001). Frailty, disability, older age, cognitive impairment, or comorbidity were not associated with the extent of antibody loss. Conclusions: Older adults in LTCFs experience a rapid loss of antibodies over the first 6 months after the second dose of BNT162b2 vaccine. Only pre‐vaccination COVID‐19 is associated with a slower rate of antibody decrease. Our data support immunization with a third dose in this vulnerable, high‐risk population. [ABSTRACT FROM AUTHOR]

Background: Pharmacist‐led transitions of care (TOC) interventions have been described as some of the most promising interventions to reduce medication‐related harm (MRH) in older adults. This study analyzed the feasibility of pharmacist‐led TOC interventions between hospitals, multidisciplinary primary care clinics (PCC), and community pharmacies. Methods: Adults aged 65 years and older at risk of MRH in three regions of Quebec, Canada, with contrasting contexts of care based on university affiliation were recruited in this multicenter, single arm, and prospective intervention cohort. The hospital pharmacist developed the pharmaceutical care plan in collaboration with the hospital physician and transferred this plan with the hospitalization summary, at hospital discharge, to the PCC family physician and to the community and PCC pharmacists. A consultation with the community pharmacist was scheduled within seven days of hospital discharge and with the PCC pharmacist when appropriate. Feasibility outcomes included the time to complete the interventions and their location. Results: The 123 eligible patients had a mean age of 78.5 years, and 63.4% were females. The most frequent inclusion criterion was 10 medications or more, including one high‐risk medication for 90 patients (73%). Recruitment in one region was stopped after three months due to unsuccessful recruitment of key PCC. The hospital pharmacist interventions took a median of 165 min. The first consultations of the PCC and community pharmacists took a median of 15 and 50 min. Among the 96 patients with a post‐discharge pharmacist follow‐up, 23 (24.0%) had a consultation with a PCC pharmacist, with 65.2% of the consultations conducted at the PCC. The community pharmacists conducted a consultation with 88 patients (93%), with more than 70% of consultations conducted by phone. Conclusion: Our study showed the feasibility of pharmacist‐led TOC interventions between hospitals, PCC, and community pharmacies and detailed the novel role that PCC pharmacists played in optimizing TOC interventions. [ABSTRACT FROM AUTHOR]

Background: Sensory impairments have been associated with dementia in older adults. However, the contribution of different impairments and how they interact in the development of dementia is not clear. We examined the independent and interaction effects of hearing impairment (HI) and visual impairment (VI) on incident dementia. Design: Multi‐centric population‐based prospective cohort study. Setting: Data were taken from the AgeDifferent.de platform, pooling participants aged 75 and older from the German LEILA75+ and AgeCoDe/AgeQualiDe cohorts. Participants: Older adults (N = 3497) with mean age 79.8 years, 67.2% female. Measurements: Standardized interviews and questionnaires were used to assess self‐reported HI and VI at baseline and all‐cause dementia in 9 follow‐ups, spanning over 20 years. Methods: Competing risk regression models were conducted to test the main and interaction effects of HI and VI on dementia incidence, adjusting for established risk factors of dementia and accumulated mortality. Results: HI and VI at baseline were reported by 30.3% and 16.6% of individuals, respectively. Adjusting for baseline information on sociodemographics, substance use, cognitive functioning and morbidity, and controlling for accumulated mortality risk, HI (sHR 1.16, 95% CI 1.04–1.30, p = 0.011) but not VI (sHR 1.07, 95% CI 0.90–1.28, p = 0.462) was significantly associated with incident dementia. There was no interaction between HI and VI (sHR 1.09, 95% CI 0.81–1.46, p = 0.567). Conclusions: Hearing impairment is associated with an increased incidence of all‐cause dementia in older adults. There is no excess risk or risk compensation through the additional presence or absence of visual impairment. Early prevention measures for hearing impairment might help to reduce the long‐term risk of dementia. [ABSTRACT FROM AUTHOR]

Background/Objectives: Non‐steroidal anti‐inflammatory drugs (NSAIDs) can cause kidney injury, especially in older adults. However, previously reported associations between NSAID use and kidney health outcomes are inconsistent and limited by reliance on serum creatinine‐based GFR estimates. This analysis investigated the association of NSAID use with kidney damage in older adults using multiple kidney health measures. Design: Cross‐sectional and longitudinal analyses. Setting: Multicenter, community‐based cohort. Participants: Two thousand nine hundred and ninty nine older adults in the Health ABC Study. A subcohort (n = 500) was randomly selected for additional biomarker measurements. Exposure: Prescription and over‐the‐counter NSAID use ascertained by self‐report. Measurements: Baseline estimated glomerular filtration rate (eGFR) by cystatin C (cysC), urine albumin‐to‐creatinine ratio (ACR), kidney injury molecule‐1 (KIM‐1), and interleukin‐18 (IL‐18) were measured in 2,999 participants; alpha‐1 microglobulin (α1m), neutrophil gelatinase‐associated lipocalin (NGAL), propeptide type III procollagen (PIIINP), and uromodulin (UMOD) were measured in 500 participants. GFR was estimated three times over 10 years and expressed as percent change per year. Results: Participants had a mean age of 74 years, 51% were female, and 41% African‐American. No eGFR differences were detected between NSAID users (n = 655) and non‐users (n = 2,344) at baseline (72 ml/min/1.73 m2 in both groups). Compared to non‐users, NSAID users had lower adjusted odds of having ACR greater than 30 mg/g (0.67; 95% confidence interval (CI) = 0.51–0.89) and lower mean urine IL‐18 concentration at baseline (−11%; 95% CI = −4% to −18%), but similar mean KIM‐1 (5%; 95% CI = −5% to 14%). No significant differences in baseline concentrations of the remaining urine biomarkers were detected. NSAID users and non‐users did not differ significantly in the rate of eGFR decline (−2.2% vs ‐2.3% per year). Conclusion: Self‐reported NSAID use was not associated with kidney dysfunction or injury based on multiple measures, raising the possibility of NSAID use without kidney harm in ambulatory older adults. More research is needed to define safe patterns of NSAID consumption. [ABSTRACT FROM AUTHOR]

Objectives To determine whether potentially inappropriate medications ( PIMs) or potentially inappropriate associations ( PIAs) prescribed knowingly are associated with patient monitoring. Design Prospective observational study. Setting Geriatric units (n = 56) in 28 hospitals. Participants Inpatients aged 75 and older (N = 1,327). Measurements Potentially inappropriate prescriptions ( PIP) were defined as a PIM or a PIA selected by an expert board from lists of explicit criteria (Beers, Priscus, Laroche, French Health Agency) using a Delphi process. They were considered to be prescribed knowingly if they were maintained after reassessment by the geriatrician and the clinical pharmacist. Primary outcome was the rate of PIPs maintained (prescribed knowingly) and for which a geriatrician declared that specific monitoring was performed. Secondary outcomes were the parameters monitored and the rate of participants receiving knowingly a PIP. Results One thousand sixty-three PIPs were detected in 607 participants (46%). After reassessment, 826 (78%) PIPs were maintained in 490 participants (37%), the main reasons being participant's regular treatment and lack of alternative. Psychotropic (36%), cardiovascular (including antithrombotics) (29%), and laxative or antiemetic drugs (16%) were the most-frequent classes prescribed knowingly. The geriatricians declared to perform clinical or biological monitoring for 69% (n = 570) of PIMs or PIAs prescribed knowingly. Three types of specific monitoring were identified: clinical, biological, and follow-up with a specialist. Conclusion Approximately three-quarters of PIMs or PIAs were prescribed knowingly, of which 69% were monitored, with wide variations in occurrence and in quality according to drug classes. This underlines the need for accurate guidelines on PIP monitoring. [ABSTRACT FROM AUTHOR]

Objectives To estimate the cost-effectiveness of an intervention to increase pneumococcal, influenza, and pertussis-containing vaccine uptake in adults aged 65 and older in primary care practices. Design Markov decision analysis model, comparing the cost-effectiveness of the 4 Pillars Practice Transformation Program with no intervention. Setting Diverse primary care practices in two U.S. cities. Participants Clinical trial participants aged 65 and older. Measurements Quality-adjusted life years ( QALYs), public health outcomes, and costs. Vaccination rates and intervention costs were derived from a randomized controlled cluster trial. Other parameters were derived from the medical literature and Centers for Disease Control and Prevention data. All parameters were individually and simultaneously varied over their distributions. Results With the intervention program and extrapolating over 10 years, there would be approximately 60,920 fewer influenza cases, 2,031 fewer pertussis cases, and 13,842 fewer pneumococcal illnesses in adults aged 65 and older. Total per-person vaccination and illness costs with the intervention were $23.93 higher than without the intervention, with a concurrent increase in effectiveness of 0.0031 QALYs, or $7,635 per QALY gained. In sensitivity analyses, no individual parameter variation caused the intervention to cost more than $50,000 per QALY gained. Conclusions Implementing an intervention based on the 4 Pillars Practice Transformation Program is a cost-effective undertaking in primary care practices for individuals aged 65 and older, with predicted public health benefits. [ABSTRACT FROM AUTHOR]

Objectives To estimate the proportion of older adults in the emergency department ( ED) who are willing and able to use a tablet computer to answer questions. Design Prospective, ED-based cross-sectional study. Setting Two U.S. academic EDs. Participants Individuals aged 65 and older. Measurements As part of screening for another study, potential study participants were asked whether they would be willing to use a tablet computer to answer eight questions instead of answering questions orally. A custom user interface optimized for older adults was used. Trained research assistants observed study participants as they used the tablets. Ability to use the tablet was assessed based on need for assistance and number of questions answered correctly. Results Of 365 individuals approached, 248 (68%) were willing to answer screening questions, 121 of these (49%) were willing to use a tablet computer; of these, 91 (75%) were able to answer at least six questions correctly, and 35 (29%) did not require assistance. Only 14 (12%) were able to answer all eight questions correctly without assistance. Individuals aged 65 to 74 and those reporting use of a touchscreen device at least weekly were more likely to be willing and able to use the tablet computer. Of individuals with no or mild cognitive impairment, the percentage willing to use the tablet was 45%, and the percentage answering all questions correctly was 32%. Conclusion Approximately half of this sample of older adults in the ED was willing to provide information using a tablet computer, but only a small minority of these were able to enter all information correctly without assistance. Tablet computers may provide an efficient means of collecting clinical information from some older adults in the ED, but at present, it will be ineffective for a significant portion of this population. [ABSTRACT FROM AUTHOR]

Objectives To determine the extent of concern about falling in older adults with hypertension, whether lower blood pressure ( BP) and greater use of antihypertensive medications are associated with greater concern about falling, and whether lower BP has a greater effect on concern about falling in older and more functionally impaired individuals. Design Secondary analysis involving cross-sectional study of baseline characteristics of participants enrolled in the Systolic Blood Pressure Intervention Trial ( SPRINT). Setting Approximately 100 outpatient sites. Participants SPRINT enrollees aged 50 and older (mean age 69) diagnosed with hypertension (N = 2,299). Measurements Concern about falling was determined using the shortened version of the Falls Efficacy Scale International as measured at the baseline examination. Results Mild concern about falling was present in 29.3% of participants and moderate to severe concern in 17.9%. Neither low BP (systolic BP<120 mmHg, diastolic BP <70 mmHg) nor orthostatic hypotension was associated with concern about falling ( P > .10). Participants with moderate to severe concern about falling were taking significantly more antihypertensive medications than those with mild or no concern. After adjusting for baseline characteristics, no associations were evident between BP, medications, and concern about falling. Results were similar in older and younger participants; interactions between BP and age and functional status were not significantly associated with concern about falling. Conclusion Although concern about falling is common in older adults with hypertension, it was not found to be associated with low BP or use of more antihypertensive medications in baseline data from SPRINT. [ABSTRACT FROM AUTHOR]

Objectives To determine whether lifestyle factors, measured late in life, could compress the disabled period toward the end of life. Design Community-based cohort study of older adults followed from 1989 to 2015. Setting Four U.S. communities. Participants Community-living men and women aged 65 and older (N = 5,248, mean age 72.7 ± 5.5, 57% female, 15.2% minority) who were not wheelchair dependent and were able to give informed consent at baseline. Measurements Multiple lifestyle factors, including smoking, alcohol consumption, physical activity, diet, body mass index ( BMI), social networks, and social support, were measured at baseline. Activities of daily living ( ADLs) were assessed at baseline and throughout follow-up. Years of life (YoL) was defined as years until death. Years of able life ( YAL) was defined as years without any ADL difficulty. YAL/YoL%, the proportion of life lived able, was used to indicate the relative compression or expansion of the disabled period. Results The average duration of disabled years was 4.5 (out of 15.4 mean YoL) for women and 2.9 (out of 12.4 mean YoL) for men. In a multivariable model, obesity was associated with 7.3 percentage points (95% confidence interval ( CI) = 5.4-9.2) lower YAL/YoL% than normal weight. Scores in the lowest quintile of the Alternate Healthy Eating Index were associated with a 3.7% (95% CI = 1.6-5.9) lower YAL/YoL% than scores in the highest quintile. Every 25 blocks walked in a week was associated with 0.5 percentage points (95% CI = 0.3-0.8) higher YAL/YoL%. Conclusion The effects of healthy lifestyle factors on the proportion of future life lived free of disability indicate that the disabled period can be compressed, given the right combination of these factors. [ABSTRACT FROM AUTHOR]

Objectives To investigate the etiology of transient loss of consciousness (T- LOC) suspected to be syncope and unexplained falls in elderly adults with dementia. Design Prospective, observational, multicenter study. Setting Acute care wards, syncope units or centers for the diagnosis of dementia. Participants Individuals aged 65 and older with a diagnosis of dementia and one or more episodes of T- LOC of a suspected syncopal nature or unexplained falls during the previous 3 months were enrolled. Measurements The causes of T- LOC suspected to be syncope and unexplained falls were evaluated using a simplified protocol based on European Society of Cardiology guidelines. Results Of 357 individuals enrolled, 181 (50.7%) had been referred for T- LOC suspected to be syncope, 166 (46.5%) for unexplained falls, and 10 (2.8%) for both. An initially suspected diagnosis of syncope was confirmed in 158 (87.3%), and syncope was identified as the cause of the event in 75 (45.2%) of those referred for unexplained falls. Orthostatic hypotension was the cause of the event in 117 of 242 (48.3%) participants with a final diagnosis of syncope. Conclusion The simplified syncope diagnostic protocol can be used in elderly people with dementia referred for suspected syncope or unexplained falls. Unexplained falls may mask a diagnosis of syncope or pseudosyncope in almost 50% of cases. Given the high prevalence of orthostatic syncope in participants (~50%), a systematic reappraisal of drugs potentially responsible for orthostatic hypotension is warranted. [ABSTRACT FROM AUTHOR]

The purpose of the study was to assess the effect of different treatment regimens for chronic hepatitis C on patient-reported outcomes ( PROs) of individuals aged 65 and older with chronic hepatitis C. PRO data from eight multinational multicenter Phase 2 and 3 clinical trials were included. Of 3,120 participants in these clinical trials, 229 were aged 65 and older (67.8 ± 3.2, 57% male, 75% treatment-naïve, 22% cirrhotic), and 90 of those received ledipasvir plus sofosbuvir ( LDV + SOF), 119 received SOF plus ribavirin ( SOF + RBV), and 20 received pegylated IFN, SOF, and RBV ( IFN + SOF + RBV). Participants aged 65 and older had slightly more pretreatment PRO impairment in their physical functioning than younger individuals (−3.1% on a normalized 0-100% PRO scale, P < .001). Despite this, these participants experienced significant PRO improvement during treatment with IFN-free RBV-free regimens (up to +8.0%, P < .001), similar to improvements in younger participants. In contrast, participants aged 65 and older experienced substantial decline in PROs while receiving IFN- or RBV-containing regimens (up to −18.9% in IFN + SOF + RBV, −10.4% in IFN-free SOF+ RBV, P < .001), and some were greater than in the younger group. Nevertheless, after achieving sustained viral clearance at Posttreatment Week 12, PROs in participants aged 65 and older improved regardless of the regimen (up to +10.4%, P < .001). In multivariate analysis of the cohort aged 65 and older, the use of IFN and RBV was consistently associated with PRO impairment during treatment. The use of an IFN- and RBV-free anti- HCV regimen in older adults with hepatitis C results in significant improvement of PROs. [ABSTRACT FROM AUTHOR]

Objectives To investigate the effects of a high-intensity functional exercise program on independence in activities of daily living ( ADLs) and balance in older people with dementia and whether exercise effects differed between dementia types. Design Cluster-randomized controlled trial: Umeå Dementia and Exercise (UMDEX) study. Setting Residential care facilities, Umeå, Sweden. Participants Individuals aged 65 and older with a dementia diagnosis, a Mini-Mental State Examination score of 10 or greater, and dependence in ADLs (N = 186). Intervention Ninety-three participants each were allocated to the high-intensity functional exercise program, comprising lower limb strength and balance exercises, and 93 to a seated control activity. Measurements Blinded assessors measured ADL independence using the Functional Independence Measure ( FIM) and Barthel Index ( BI) and balance using the Berg Balance Scale ( BBS) at baseline and 4 (directly after intervention completion) and 7 months. Results Linear mixed models showed no between-group effect on ADL independence at 4 ( FIM=1.3, 95% confidence interval ( CI)=−1.6-4.3; BI=0.6, 95% CI=−0.2-1.4) or 7 ( FIM=0.8, 95% CI=−2.2-3.8; BI=0.6, 95% CI=−0.3-1.4) months. A significant between-group effect on balance favoring exercise was observed at 4 months ( BBS=4.2, 95% CI=1.8-6.6). In interaction analyses, exercise effects differed significantly between dementia types. Positive between-group exercise effects were found in participants with non-Alzheimer's dementia according to the FIM at 7 months and BI and BBS at 4 and 7 months. Conclusion In older people with mild to moderate dementia living in residential care facilities, a 4-month high-intensity functional exercise program appears to slow decline in ADL independence and improve balance, albeit only in participants with non-Alzheimer's dementia. [ABSTRACT FROM AUTHOR]

Backround Baseline depressive symptoms have been consistently associated with the onset of cardiovascular disease ( CVD). Objectives Since depressive symptoms vary over time in elderly persons, and to help clarify whether or not depression is an etiological factor for CVD, we quantified the association between the course of depressive symptoms and occurrence of first coronary heart disease ( CHD) and stroke events in older adults. Design A population-based prospective observational study. Setting Participants were randomly selected from the electoral rolls of three large French cities. Participants A total of 9,294 participants were examined at baseline between 1999 and 2001, and thereafter at repeated study visits over 10 years. Measurements High levels of depressive symptoms ( HLDS) were defined as a score ≥16 on the 20-item Center for Epidemiologic Studies Depression Scale. The number of study visits with HLDS was used as a time dependent variable in Cox proportional hazard models. Results There were 7,313 participants (36.6% males) aged 73.8 ± 5.4 years with no history of CHD, stroke or dementia at baseline. After a median follow-up of 8.4 years ( SD 2.3 years), 629 first CHD or stroke events occurred. After adjustment for sociodemographic characteristics and vascular risk factors, the risk of CHD and stroke combined increased 1.15-fold (95% CI: 1.06 to 1.25) per each additional study visit with HLDS. The results remained unchanged when accounting for the presence of disability and antidepressant intake at baseline and during follow-up. Conclusion Elderly persons exposed to HLDS at several occasions over 10 years showed substantial increased risk of coronary heart disease and stroke events. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the association between performance on a single chair stand and moderate to severe exertional dyspnea. Design Cross-sectional. Setting Cardiovascular Health Study. Participants Community-dwelling individuals aged 65 and older (N = 4,413; mean age 72.6; female, n = 2,518 (57.1%); nonwhite, n = 199 (4.5%); obese, n = 788 (17.9%); history of smoking, n = 2,410 (54.6%)). Measurements Performance on single chair stand (poor (unable to rise without arm use) vs normal (able to rise without arm use)), moderate to severe exertional dyspnea (American Thoracic Society grade ≥2), age, sex, ethnicity, obesity, smoking, frailty status (Fried-defined nonfrail, prefrail, frail), high cardiopulmonary risk (composite of cardiopulmonary diseases and diabetes mellitus), spirometric impairment, arthritis, depression, stroke, and kidney disease. Results Poor performance on the single chair stand was established in 369 (8.4%) and moderate to severe exertional dyspnea in 773 (17.5%). Prefrail status was established in 2,210 (50.1%), frail status in 360 (8.2%), arthritis in 2,241 (51.4%), high cardiopulmonary risk in 2,469 (55.9%), spirometric impairment in 1,076 (24.4%), kidney disease in 111 (2.5%), depression in 107 (2.4%), and stroke in 93 (2.1%). In multivariable regression models, poor performance on the single chair stand was associated with moderate to severe exertional dyspnea (unadjusted odds ratio ( OR) = 3.48, 95% confidence interval ( CI) = 2.78-4.36; adjusted OR = 1.85, 95% CI = 1.41-2.41). Conclusion Poor performance on a single chair stand was associated with an adjusted 85% greater likelihood of moderate to severe exertional dyspnea than normal performance. These results suggest that reduced proximal muscle function of the lower extremities is associated with moderate to severe exertional dyspnea, even after adjusting for multiple confounders. [ABSTRACT FROM AUTHOR]

Objectives To compare the effectiveness of chemotherapy in prolonging survival according to age in breast and colon cancer. Design Retrospective cohort study with a matched cohort analysis based on the conditional probability of receiving chemotherapy. Setting The 16 Surveillance, Epidemiology, and End Results ( SEER) areas from the SEER- Medicare linked database. Participants Women diagnosed with Stage I to IIIa hormone receptor-negative breast cancer (n = 14,440) and 26,893 men and women with Stage III colon cancer (n = 26,893) aged 65 and older in 1992 to 2009. Measurements The main exposure was the receipt of chemotherapy, and the main outcome was mortality. Results In women with breast cancer aged 65 to 69, the risk of all-cause mortality was statistically significantly lower in those who received chemotherapy than in those who did not in the entire cohort (hazard ratio ( HR) = 0.70, 95% confidence interval ( CI) = 0.57-0.88) and in a propensity-matched cohort ( HR = 0.82, 95% CI = 0.70-0.96) after adjusting for measured confounders. These patterns were similar in participants aged 70 to 74 and 75 to 79, but in women aged 80 to 84 and 85 to 89, risk of all-cause mortality was no longer significantly lower in those receiving chemotherapy in the entire and matched cohorts, except that, in a small number of women who received doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan), risk of mortality was significantly lower for those aged 80 to 84. Chemotherapy appeared to be effective in all ages from 65 through 84 in participants with Stage III colon cancer. For example, in those aged 85 to 89, chemotherapy was significantly associated with lower risk of mortality in the entire cohort ( HR = 0.79, 95% CI = 0.67-0.92) and the matched cohort ( HR = 0.79, 95% CI = 0.66-0.95). Conclusion The effectiveness of chemotherapy decreased with age in participants with breast cancer, in whom chemotherapy appears to be effective until age 79 except for the doxorubicin-cyclophosphamide combination, which was effective in participants aged 80 to 84. In individuals with Stage III colon cancer, chemotherapy appears to be effective to age 89. These findings were consistent with those of randomized clinical trials. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the effect of structured physical activity on sleep-wake behaviors in sedentary community-dwelling elderly adults with mobility limitations. Design Multicenter, randomized trial of moderate-intensity physical activity versus health education, with sleep-wake behaviors prespecified as a tertiary outcome over a planned intervention period ranging from 24 to 30 months. Setting Lifestyle Interventions and Independence for Elders Study. Participants Community-dwelling persons aged 70 to 89 who were initially sedentary and had a Short Physical Performance Battery score less than 10 (N = 1,635). Measurements Sleep-wake behaviors were evaluated using the Insomnia Severity Index ( ISI) (≥8 defined insomnia), Epworth Sleepiness Scale ( ESS) (≥10 defined daytime drowsiness), and Pittsburgh Sleep Quality Index ( PSQI) (>5 defined poor sleep quality) administered at baseline and 6, 18, and 30 months. Results The randomized groups were similar in terms of baseline demographic variables, including mean age (79) and sex (67% female). Structured physical activity resulted in a significantly lower likelihood of having poor sleep quality (adjusted odds ratios ( aOR) for PSQI >5 = 0.80, 95% confidence interval ( CI) = 0.68-0.94), including fewer new cases ( aOR for PSQI >5 = 0.70, 95% CI = 0.54-0.89), than health education but not in resolution of prevalent cases ( aOR for PSQI ≤5 = 1.13, 95% CI = 0.90-1.43). No significant intervention effects were observed for the ISI or ESS. Conclusion Structured physical activity resulted in a lower likelihood of developing poor sleep quality ( PSQI >5) over the intervention period than health education but had no effect on prevalent cases of poor sleep quality or on sleep-wake behaviors evaluated using the ISI or ESS. These results suggest that the benefit of physical activity in this sample was preventive and limited to sleep-wake behaviors evaluated using the PSQI. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the effect of an innovative model integrating telemonitoring of vital parameters and telephone support on 6-month survival and hospital admissions of elderly adults with heart failure ( HF). Design Parallel-arm, randomized trial. Setting Geriatric acute care ward and outpatient clinic at Policlinico Campus Biomedico (Rome, Italy). Participants Individuals with HF aged 65 and older (mean age 80) randomly assigned to intervention (n = 50) or control (n = 46). Participants had an average ejection fraction of 46%. Intervention Telemonitoring system (receives and communicates oxygen saturation, heart rate, and blood pressure readings) and office-hours telephonic support provided by a geriatrician. Measurements Combination of all-cause death and hospital admissions. Results The two groups were similar with the exception of the prevalence of women and of disability (both more common in the control group). Three patients for each group were lost to follow-up (final analyzed sample size: 90). Incidence of the main outcome was 42% in the control group and 21% in the intervention group (relative risk = 0.51, 95% confidence interval ( CI) = 0.26-0.98). The results were unchanged after taking into account the setting of enrollment, sex, and disability (hazard ratio = 0.42, 95% CI = 0.19-0.94). Conclusion Telemonitoring of elderly people with HF is feasible and reduces the risk of death and hospitalization. Further studies are needed to confirm these findings and evaluate the cost-efficacy of the service. [ABSTRACT FROM AUTHOR]

Objectives To determine life expectancy for older women with breast cancer. Design Prospective longitudinal study with 10 years of follow-up data. Setting Hospitals or collaborating tumor registries in four geographic regions (Los Angeles, California; Minnesota; North Carolina; Rhode Island). Participants Women aged 65 and older at time of breast cancer diagnosis with Stage I to IIIA disease with measures of self-rated health ( SRH) and walking ability at baseline (N = 615; 17% aged ≥80, 52% Stage I, 58% with ≥2 comorbidities). Measurements Baseline SRH, baseline self-reported walking ability, all-cause and breast cancer-specific estimated probability of 5- and 10-year survival. Results At the time of breast cancer diagnosis, 39% of women reported poor SRH, and 28% reported limited ability to walk several blocks. The all-cause survival curves appear to separate after approximately 3 years, and the difference in survival probability between those with low SRH and limited walking ability and those with high SRH and no walking ability limitation was significant (0.708 vs 0.855 at 5 years, P ≤ .001; 0.300 vs 0.648 at 10 years, P < .001). There were no differences between the groups in breast cancer-specific survival at 5 and 10 years ( P = .66 at 5 years, P = .16 at 10 years). Conclusion The combination of low SRH and limited ability to walk several blocks at diagnosis is an important predictor of worse all-cause survival at 5 and 10 years. These self-report measures easily assessed in clinical practice may be an effective strategy to improve treatment decision-making in older adults with cancer. [ABSTRACT FROM AUTHOR]

Fall prevention strategies for older adults are underused in primary care. A study was designed to examine the Centers for Medicare and Medicaid Services Physician Quality Reporting System ( PQRS) fall measures and to reduce injuries and costs from falls by 10%. This quality improvement project using a pre/post design was implemented in four primary care practices with 2,021 patients aged 65 and older in Asheville, North Carolina. The project used a patient registry, electronic templates, standardized care protocols, a falls clinic to evaluate individuals who reported falling, and patient resource materials. Data were collected from medical records on processes of care, fall-related injuries, and anticipated payments. Individuals billed for at least one outpatient visit from July 2011 through June 2012 (n = 2,021) constituted the cohort for the intervention and for analysis of injuries from falls requiring hospital visits (before the intervention (T1): July 2010 to March 2011; after the intervention (T2): July 2012 to March 2013). Practice sites properly screened 68.8% of older adults for falls, assessed 87% of those who reported falling, and documented the PQRS required plan of care in 23%. Only 20% self-reported falls. Numbers of falls requiring a visit to the hospital were small overall and did not decrease (T1, 2.4%; T2, 2.9%; P = .32); 61% of individuals seen in the hospital for fall-related injuries had not reported previous falls. Incorporating the PQRS fall measures into primary care was challenging, and the program was not robust enough to reduce serious falls and hospital costs. [ABSTRACT FROM AUTHOR]

Objectives To report 25 hydroxyvitamin D (25 OHD) concentrations, an indicator of vitamin D status, in older adults living in residential care 1 year after a protocol of weekly 20,000 IU of vitamin D was started. Design Cross-sectional. Setting Five residential care facilities in British Columbia, Canada. Participants Residents aged 65 and older from five facilities (N = 236). Measurements Participants provided a blood sample. Demographic and health information was obtained from the medical record. Results Mean 25 OHD was 102 nmol/L (95% confidence interval ( CI) = 98-106 nmol/L). Three percent of residents had a 25 OHD concentration of less than 40 nmol/L, 6% <50 nmol/L, and 19% <75 nmol/L. In those who received 20,000 IU/wk or more for 6 months or longer (n = 147), mean 25 OHD was 112 nmol/L (95% CI = 108-117 nmol/L), and none had a 25 OHD level of less than 50 nmol/L. Hypercalcemia (>2.6 mmol/L), a potential consequence of too much vitamin D, was present in 14%, although 25 OHD levels did not differ in those with and without hypercalcemia (108 vs 101 nmol/L; P = .17). Conclusion Twelve months after implementation of a 20,000- IU/wk vitamin D protocol for older adults in residential care, mean 25 OHD concentrations were high, and there was no evidence of poor vitamin D status. Given the absence of demonstrated benefit of high 25 OHD concentrations to the residential care population, dosages less than 20,000 IU/wk of vitamin D are recommended. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the association between levels of circulating sclerostin (an emerging biomarker and important regulator of bone formation) and laboratory parameters of bone and mineral metabolism, bone mineral density and quality measured using quantitative ultrasound ( QUS), fracture risk, and mortality. Design Prospective cohort study. Setting Austrian nursing homes (N = 95). Participants Female nursing home residents aged 70 and older (mean 84 ± 6; N = 539). Measurements Serum sclerostin, bone turnover markers, and bone mineral density and quality were measured at baseline. Participants were followed for clinical fractures and all-cause mortality. Results Partial correlation analysis adjusted for age, weight, and renal function revealed a significant positive correlation between sclerostin levels and calcaneal stiffness and radial and phalangeal speed of sound (all P < .01) and a significant negative correlation between sclerostin levels and osteocalcin, serum C-terminal telopeptide of type I collagen, and parathyroid hormone ( PTH; P < .05). After a mean follow-up of 27 ± 8 months, 139 participants (26%) had died and 64 had a hip or other nonvertebral fracture (12%). Sclerostin was not predictive of mortality. In women with a negative fracture history, it was significantly but not linearly associated with fracture risk. Conclusion In institutionalized elderly women, there is a significant relationship between serum sclerostin levels and QUS indices, bone turnover, and PTH, but sclerostin was not strongly associated with important clinical outcomes. Thus, it remains unclear whether sclerostin is a clinically useful predictor of fractures or mortality, at least in this setting. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the prevalence of respiratory impairment and dyspnea and their associations with objectively measured physical inactivity and performance-based mobility in sedentary older persons. Design Cross-sectional. Setting Lifestyle Interventions and Independence for Elders Study. Participants Community-dwelling older persons (n = 1,635, mean age 78.9) who reported being sedentary (<20 min/wk of regular physical activity and <125 min/wk of moderate physical activity in past month). Measurements Respiratory impairment was defined as low ventilatory capacity (forced expiratory volume in 1 second less than lower limit of normal ( LLN)) and respiratory muscle weakness (maximal inspiratory pressure < LLN). Dyspnea was defined as moderate to severe ratings on the modified Borg index, immediately after a 400-m walk test (400- MWT). Physical inactivity was defined according to high sedentary time as the highest quartile of participants with accelerometry-measured activity of <100 counts/min. Performance-based mobility was evaluated using the Short Physical Performance Battery (≤7 defined as moderate to severe mobility impairment) and 400- MWT gait speed (<0.8 m/s defined as slow). Results Prevalence rates were 17.7% for low ventilatory capacity, 14.7% for respiratory muscle weakness, 31.6% for dyspnea, 44.7% for moderate to severe mobility impairment and 43.6% for slow gait speed. Significant associations were found between low ventilatory capacity and slow gait speed (adjusted odds ratio (a OR) = 1.41, 95% confidence interval ( CI) = 1.03-1.92), between respiratory muscle weakness and moderate to severe mobility impairment (a OR = 1.42, 95% CI = 1.03-1.95), and between dyspnea and high sedentary time (a OR = 1.98, 95% CI = 1.28-3.06) and slow gait speed (a OR = 1.70, 95% CI = 1.22-2.38). Conclusion Respiratory impairment and dyspnea are prevalent in sedentary older persons and are associated with objectively measured physical inactivity and poor performance-based mobility. Because they are modifiable, respiratory impairment and dyspnea should be considered in the evaluation of sedentary older persons. [ABSTRACT FROM AUTHOR]

Objectives To determine the usefulness of the Mini Nutritional Assessment ( MNA) and plasma amino acid analysis in predicting the formation of pressure ulcers ( PUs) in inpatients. Design Prospective, observational cohort study with a mean observation period of 62.2 ± 86.4 days. Setting Intermediate and acute care wards of a hospital in rural Japan. Participants Inpatients with an average age of 85.0 ± 7.6 (N = 422). Measurements Mini Nutritional Assessment, Subjective Global Assessment ( SGA), Braden Scale ( PU prognostic score), PU formation, and biochemical analysis including plasma amino acid concentrations. Results PUs developed in 7.1% of participants. A MNA score of less than 8 was more sensitive than a rating of moderate or severe malnourishment on the SGA combined with a Braden Scale score of less than 15 in predicting future PUs. The area under the receiver operating characteristic curve ( AUC) of the MNA was superior to that of the Braden Scale. The Braden Scale nutrition subscore had the lowest AUC of the six Braden Scale subscores. Individuals who developed PUs had significantly lower plasma arginine concentrations than those who did not. Conclusion Mini Nutritional Assessment was able to predict the development of PUs. A MNA score of less than 8 performed better than the SGA, Braden Scale, and plasma arginine levels in predicting PU development. Although lower plasma arginine concentration at time of admission was associated with PU development, the AUC for arginine was not significantly different from 0.50. The findings from this prospective study support the use of nutritional assessment in inpatients to predict PU risk and target appropriate interventions. [ABSTRACT FROM AUTHOR]

Objectives To estimate the cumulative incidence of functional decline in independent older adults 3 and 6 months after a minor injury treated in the emergency department ( ED) and to identify predictors of this functional decline. Design Prospective cohort study. Settings Three Canadian teaching EDs. Participants Individuals aged 65 and older who were independent in basic activities of daily living before their injury and were evaluated in the ED for minor injuries (N = 335). Measurements Functional decline was defined as a loss of 2 or more out of 28 points on the self-reported Older Americans Resources Services scale. Sociodemographic, mobility, and clinical risk factors for functional decline in non- ED studies were measured at the ED visit and 3 and 6 months after the injury. Generalized linear mixed models were used to explore differences in functional decline between groups determined according to the different factors. Results The cumulative incidence of decline was 14.9% (95% confidence interval ( CI) = 7.6-29.1%) at 3 months and 17.3% (95% CI = 9.7-30.9%) at 6 months. Predictors of functional decline were occasional use of a walking aid (relative risk ( RR)=2.4, 95% CI = 1.4-4.2), needing help in instrumental activities of daily living ( IADLs) before the injury ( RR = 3.1, 95% CI=1.7-5.5), taking five or more daily medications ( RR = 1.8, 95% CI = 1.0-3.2), and the emergency physicians' assessment of functional decline ( RR = 2.8, 95% CI = 1.5-5.3). Conclusion Minor injuries in independent older adults treated in EDs are associated with a 15% cumulative incidence of functional decline 3 months after the injury that persisted 6 months later. Simple-to-measure factors such as occasional use of a walking aid, daily medication, need for help with IADLs, and physician assessment of decline may help identify independent older adults at risk of functional decline during their consultation. These results confirm the need to improve risk assessment and management of this population in EDs. [ABSTRACT FROM AUTHOR]

Objectives To determine the extent to which the co-occurrence of chronic obstructive pulmonary disease ( COPD) and cognitive impairment affect adverse health outcomes in older adults. Design Multicenter longitudinal cohort study. Setting California, Pennsylvania, Maryland, and North Carolina. Participants Three thousand ninety-three community-dwelling adults aged 65 and older from the Cardiovascular Health Study. Four hundred thirty-one had chronic obstructive pulmonary disease ( COPD) at study baseline. Measurements Follow-up began at the second CHS visit and continued for 3 years. Spirometric criteria for airflow limitation served to establish COPD using the Lambda- Mu- Sigma method, which accounts for age-related changes in lung function. Cognitive impairment was evaluated using the modified Mini- Mental State Examination and claims data. Outcomes were respiratory-related and all-cause hospitalizations and death. Results Participants with coexisting COPD and cognitive impairment had the highest rates of respiratory-related (adjusted hazard ratio (a HR) = 4.10, 95% confidence interval ( CI) = 1.86-9.05) and all-cause hospitalizations (a HR = 1.34, 95% CI = 1.00-1.80) and death (a HR = 2.29, 95% CI = 1.18-4.45). In particular, individuals with both conditions had a 48% higher rate of all-cause hospitalizations (adjusted synergy index (a SI) = 1.48, 95% CI = 0.19-11.31) and a rate of death nearly three times as high ( aSI = 2.74, 95% CI = 0.43-17.32) as the sum of risks for each respective outcome associated with having COPD or cognitive impairment alone. Nevertheless, tests for interaction were not statistically significant for the presence of synergism between the two conditions contributing to each of the outcomes. Therefore, it cannot be concluded that the combined effect of COPD and cognitive impairment is greater than additive. Conclusion Coexisting COPD and cognitive impairment have an additive effect on respiratory-related and all-cause hospitalizations and death. Optimizing outcomes in older adults with COPD and cognitive impairment will require that how to improve concurrent management of both conditions be determined. [ABSTRACT FROM AUTHOR]

Objectives To determine whether readily collected perioperative information might identify older surgical patients at higher risk of complications. Design Retrospective cohort study. Setting Medical chart review at a single academic institution. Participants One hundred two individuals aged 65 and older who underwent abdominal surgery between January 2007 and December 2009. Measurements Primary predictor variables were first postoperative Braden Scale score (within 24 hours of surgery) and a Deficit Accumulation Index ( DAI) constructed based on 39 available preoperative variables. The primary outcome was presence or absence of complication within 30 days of surgery. Results Of 102 patients, 64 experienced at least one complication, with wound infection being the most common. In models adjusted for age, race, sex, and open versus laparoscopic surgery, lower Braden Scale scores were predictive of 30-day postoperative complication (odds ratio ( OR) = 1.30, 95% confidence interval ( CI) = 1.06-1.60), longer length of stay (β = 1.44 (0.25) days; P ≤ .001), and discharge to an institution rather than home ( OR = 1.23, 95% CI = 1.02-1.48). The cut-off value for the Braden score with the highest predictive value for complication was ≤ 18 ( OR = 3.63, 95% CI = 1.43-9.19; c statistic 0.744). The DAI and several traditional surgical risk factors were not significantly associated with 30-day postoperative complications. Conclusion This is the first study to identify the perioperative Braden Scale score, a widely used risk-stratifier for pressure ulcers, as an independent predictor of other adverse outcomes in geriatric surgical patients. Further studies are needed to confirm this finding and to investigate other uses for this tool, which correlates well to phenotypic models of frailty. [ABSTRACT FROM AUTHOR]

Objectives To investigate the relationship between serum albumin and change in muscle mass, grip strength, and leg power. Design Prospective cohort. Setting Six U. S. academic medical centers. Participants Community-dwelling men aged 65 and older participating in the Osteoporotic Fractures in Men ( Mr OS) Study. Measurements Serum albumin was measured at baseline in 5,534 participants. Baseline serum albumin was examined in relation to change in appendicular skeletal muscle ( ASM) mass, grip strength, and leg power after 2 and 4.6 years. Two-year change in serum albumin was examined with respect to simultaneous change in these outcomes in 1,267 participants. Results Baseline serum albumin <40 g/ L was not associated with 2- or 4.6-year change in ASM mass, grip strength, or leg power before or after adjustment for confounders. There was no association between serum albumin change and change in grip strength. A statistically significant trend was observed between serum albumin change and change in ASM mass, but there was substantial overlap across confidence intervals ( CIs). Participants with a marked decrease (>3 g/ L) and mild decrease (1-2 g/ L) in serum albumin over 2 years exhibited a modest change of −8.9 W (95% CI = −25.6 to −7.8 W) and −6.3 W (95% CI = −21.2 to −8.5 W) of leg power, respectively ( P for trend = .02), compared with those with no decrease in albumin concentration. Conclusion Serum albumin demonstrated modest and inconsistent trends with loss of muscle mass and function. Low serum albumin within the normal range is not a risk factor for this process in elderly men. [ABSTRACT FROM AUTHOR]

Objectives To compare the effectiveness of tai chi and low-level exercise in reducing falls in older adults; to determine whether mobility, balance, and lower limb strength improved and whether higher doses of tai chi resulted in greater effect. Design Randomized controlled trial. Setting Eleven sites throughout New Zealand. Participants Six hundred eighty-four community-residing older adults (mean age 74.5; 73% female) with at least one falls risk factor. Intervention Tai chi once a week ( TC1) (n = 233); tai chi twice a week ( TC2) (n = 220), or a low-level exercise program control group ( LLE) (n = 231) for 20 wks. Measurements Number of falls was ascertained according to monthly falls calendars. Mobility ( Timed- Up-and- Go Test), balance (step test), and lower limb strength (chair stand test) were assessed. Results The adjusted incident rate ratio ( IRR) for falls was not significantly different between the TC1 and LLE groups ( IRR = 1.05, 95% confidence interval ( CI) = 0.83-1.33, P = .70) or between the TC2 and LLE groups ( IRR = 0.88, 95% CI = 0.68-1.16, P = .37). Adjusted multilevel mixed-effects Poisson regression showed a significant reduction in logarithmic mean fall rate of −0.050 (95% CI = −0.064 to −0.037, P < .001) per month for all groups. Multilevel fixed-effects analyses indicated improvements in balance ( P < .001 right and left leg) and lower limb strength ( P < .001) but not mobility ( P = .54) in all groups over time, with no differences between the groups ( P = .37 (right leg), P = .66 (left leg), P = .21, and P = .44, respectively). Conclusion There was no difference in falls rates between the groups, with falls reducing similarly (mean falls rate reduction of 58%) over the 17-month follow-up period. Strength and balance improved similarly in all groups over time. [ABSTRACT FROM AUTHOR]

Objectives To describe the prevalence of diabetes mellitus ( DM) in community-dwelling 85-year-olds and to study the factors associated. Design Cross-sectional. Setting Community-based survey study of seven primary healthcare centers. Participants Three hundred twenty-eight people born in 1924 and registered with primary healthcare centers. Measurements Information on sociodemographic variables, Barthel Index ( BI), Spanish version of the Mini-Mental State Examination ( MEC), Mini Nutritional Assessment ( MNA), Braden scale for risk of pressure ulcers, Charlson Comorbidity Index, chronic diseases, social risk, quality of life, chronic drug prescriptions, and blood tests was recorded. Participants were defined as having DM according to self-report, physician diagnosis, antidiabetic prescriptions, or plasma glucose concentration 7 mmol/L or more. A comparative analysis was performed between participants with and without DM. Results The prevalence of DM in 328 octogenarians studied was 25.9%. Logistic regression showed an association between DM and BI (odds ratio ( OR) = 1.03, 95% confidence interval ( CI) = 1.00-1.05, P = .007), Braden risk score ( OR = 0.87, 95% CI = 0.79-0.97, P = .01), thyroid disease ( OR = 0.23, 95% CI = 0.06-0.92, P = .04), chronic drug prescriptions ( OR = 1.28, 95% CI = 1.15-1.42, P < .001), white-cell count ( OR = 1.34, 95% CI = 1.15-1.56, P < .001), low-density lipoprotein cholesterol ( LDL-C; OR = 0.63, 95% CI = 0.43-0.92, P = .02) and folic acid level ( OR = 1.04, 95% CI = 1.01-1.07, P = .005). Conclusion There is a high prevalence of DM at 85 years old. The presence of DM was positively associated with disability, drug prescription, white blood cell count, and folic acid level, whereas there was an inverse relationship between DM and Braden scale score, thyroid disease, and LDL-C. The effect of morbidities on DM may require a multidisciplinary approach to manage its complexity. [ABSTRACT FROM AUTHOR]

Objectives To evaluate whether the Enhanced Feedback for Effective Cardiac Treatment ( EFFECT) scale for 30-day prediction of mortality is applicable to elderly adults with acute heart failure ( AHF) in emergency departments ( EDs) and whether discriminatory power is added with the inclusion of the Barthel Index ( BI) to this scale ( BI- EFFECT scale). Design BI-EFFECT is a multipurpose, nonintervention, multicenter cohort study. Setting Twenty EDs. Participants Individuals aged 65 and older with AHF. Measurements Information on baseline and episode characteristics and 30-day mortality was collected, and participants were categorized according to the EFFECT scale. Baseline degree of functional dependence was measured using the BI. Receiver operating characteristic ( ROC) curves were made of the EFFECT and BI- EFFECT scales to predict mortality. Results One thousand sixty-eight participants were included. Thirty-day mortality was 5.1% and was directly and independently associated with high and very high risk categories of the EFFECT scale and with severe dependence. These two variables remained significant after adjustment of the model for both ( OR = 4.5, 95% CI = 1.8-11.1 and OR = 2.9, 95% CI = 1.6-5.4, respectively). The EFFECT and the BI- EFFECT scales had significant ROC curves (area under the ROC curve ( AUC) = 0.69, 95% CI = from 0.62 to 0.76; and AUC = 0.75, 95% CI = 0.69-0.81, respectively), and the difference in discriminatory power between the second and the first was also statistically significant ( P = .02). Conclusion The EFFECT scale may be applied in the elderly population, and inclusion of functional status according to the BI in the new BI- EFFECT scale significantly improves the model for the prediction of 30-day mortality. [ABSTRACT FROM AUTHOR]

Objectives To describe the clinical characteristics and in-hospital outcomes of older adults with tako-tsubo cardiomyopathy ( TTC). Design Partially retrospective, partially prospective observational study. Setting Eleven Italian referral cardiac centers included in the Tako-tsubo Italian Network. Participants One hundred ninety consecutive individuals with TTC (92.1% female, mean age 66) were divided into three groups according to age (<65, n = 78; 65-74, n = 61; ≥75, n = 51). Measurements Clinical findings and in-hospital outcomes were evaluated in each group. Results Participants aged 65 and older had a greater prevalence of hypertension ( P = .001) and a lower glomerular filtration rate ( P < .001), and those aged 65 to 74 had a greater prevalence of psychiatric disorders ( P = .01), ST-segment elevation on admission ( P = .01) and a cerebrovascular disease ( P = .003) than those younger than 65. Despite similar left ventricular ejection fraction ( LVEF) on admission ( P = .26), the oldest group had a lower LVEF at discharge ( P = .03). Inotropic agents were used more frequently in older adults ( P = .03). In-hospital composite adverse events (all-cause death, acute heart failure, life-threatening arrhythmias, stroke, and cardiogenic shock; P = .03) and overall complications ( P = .004) were more common in participants aged 75 and older. Overall in-hospital mortality was low (2.8%) but was more prevalent in participants aged 75 and older (6.3%). On multivariate analysis, age of 75 and older (hazard ratio ( HR) = 2.45, 95% confidence interval ( CI) = 1.28-5.82, P = .04) and LVEF on admission ( HR = 0.874, 95% CI = 0.81-0.95, P < .001) were the only independent predictors of in-hospital adverse events. Conclusion The clinical profile of participants aged 75 and older with TTC was different from that of those younger than 75 with TTC, and they had a higher in-hospital complication rate. [ABSTRACT FROM AUTHOR]

Objectives To examine the association between sleep architecture, sleep-disordered breathing, and cognition in older men. Design Population-based cross-sectional study. Setting Six clinical sites in the United States. Participants Two thousand nine hundred nine community-dwelling men aged 67 and older who were not selected on the basis of sleep problems or cognitive impairment. Measurements Predictors were measured using in-home polysomnography: sleep architecture, nocturnal hypoxemia (any sleep time with arterial oxygen saturation <80%), apnea-hypopnea index ( AHI), and arousal index. Cognitive outcomes were measured using the modified Mini-Mental State Examination (3 MS), Trail-Making Test Part B ( TMT-B), and the Digit Vigilance Test ( DVT). Results Analyses adjusted for age, race, education, body mass index, lifestyle, comorbidities, and medication use showed that participants who spent less percentage of time in rapid eye movement ( REM) sleep had lower levels of cognition; participants in the lowest quartile (<14.8%) took an average of 5.9 seconds longer on the TMT-B and 20.1 seconds longer on the DVT than those in the highest quartile (≥23.7%). Similarly, greater percentage of time spent in Stage 1 sleep was related to poorer cognitive function. Participants in the highest quartile of Stage 1 sleep (≥8.6%) had worse cognitive scores on average than those in the lowest quartile (<4.0%). Those with nocturnal hypoxemia took an average of 22.3 seconds longer to complete the DVT than those without, but no associations were found with 3 MS or the TMT-B. Conclusion Spending less percentage of time in REM sleep and greater percentage of time in Stage 1 sleep and having higher levels of nocturnal hypoxemia were associated with poorer cognition in older men. Further studies are needed to clarify the direction of these associations and to explore potential mechanisms. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which addresses what the authors refer to as the prevalence and clinical characteristics of prefrailty in elderly adults, and it mentions the impacts of urbanization, cultural, and political distinctions on frailty levels.

The article discusses a study testing the hypothesis that the Braden Scale, which is a scale developed in 1987 to asses the risk of pressure ulcers, is not valid for very old individuals. The authors performed a retrospective review of the Braden score of older people age 80 and over, recorded at admission to the hospital or the intensive care unit, and concluded that the Braden Scale is not suitable for assessing pressure ulcer risk in individuals aged 80 and older.

The article discusses a study involving 145 people aged 90 or older suffering from ST elevation myocardial infarction (STEMI). All were treated with percutaneous coronary intervention (PCI). Outcomes were generally not good, suggesting primary PCI is best considered a satisfactory treatment for STEMI in those under 90.

A letter to the editor is presented which addresses research regarding the connections between statin therapy and dementia in older adults in Stockholm, Sweden, and it mentions the effects of statins on cognitive function, as well as information about disease severity and multimorbidity.