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Background: The presence of treatment limitations in patients with frailty at intensive care unit (ICU) admission is unknown. We aimed to evaluate the presence and predictors of treatment limitations in patients with and without COVID‐19 pneumonitis in those admitted to Australian and New Zealand ICUs. Methods: This registry‐based multicenter, retrospective cohort study included all frail adults (≥16 years) with documented clinical frailty scale (CFS) scores, admitted to ICUs with admission diagnostic codes for viral pneumonia or acute respiratory distress syndrome (ARDS) over 2 years between January 01, 2020 and December 31, 2021. Frail patients (CFS ≥5) coded as having viral pneumonitis or ARDS due to COVID‐19 were compared to those with other causes of viral pneumonitis or ARDS for documented treatment limitations. Results: 884 frail patients were included in the final analysis from 129 public and private ICUs. 369 patients (41.7%) had confirmed COVID‐19. There were more male patients in COVID‐19 (55.3% vs 47.0%; p = 0.015). There were no differences in age or APACHE‐III scores between the two groups. Overall, 36.0% (318/884) had treatment limitations, but similar between the two groups (35.8% [132/369] vs 36.1% [186/515]; p = 0.92). After adjusting for confounders, increasing frailty (OR = 1.72; 95%‐CI 1.39–2.14), age (OR = 1.05; 95%‐CI 1.04–1.06), and presence of chronic respiratory condition (OR = 1.58; 95%‐CI 1.10–2.27) increased the likelihood of instituting treatment limitations. However, the presence of COVID‐19 by itself did not influence treatment limitations (odds ratio [OR] = 1.39; 95%‐CI 0.98–1.96). Conclusions: The proportion of treatment limitations was similar in patients with frailty with or without COVID‐19 pneumonitis at ICU admission. [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: Physical restraints are used in nursing homes (NHs) despite their negative consequences. Use of surveillance technologies as alternatives to physical forms of restraints and negative staff opinions about the appropriateness of restraint use have been postulated to reduce this practice; however, these have rarely been investigated alongside resident outcome data. This study aimed to measure physical restraint prevalence in Swiss NHs and its associations with (a) the use of surveillance technologies and (b) staff's opinion about the appropriateness of physical restraint use. Methods: This cross‐sectional multicenter study analyzed data on 3,137 staff and 6,149 residents of 292 units in 86 Swiss NHs (2018–2019). Based on routine resident data, we measured the prevalence of two classes of physical restraint: (a) bedrails or (b) trunk fixation or seating option that prevents standing. To assess potential factors associated with restraint use, we applied a logistic multilevel model. Results: A 11.1% of residents were restrained with at least one form of physical restraint. Against our hypothesis, surveillance technologies were not significantly associated with restraint use, and staff members' opinion that the use of physical restraints was appropriate on their unit was associated with decreased odds of residents being restrained (odds ratio (OR): 0.48; 95% confidence interval (CI) 0.29–0.80). Conclusions: Although Swiss NHs have a low prevalence of physical restraint use, only a minority of NH units do not use any restraints with their residents. Surveillance technologies seem to be used concurrently with restraints and not as an alternative. Further research should investigate staff's current and intended uses of surveillance technologies in practice. Staff members' opinion that they use restraints inappropriately might correctly reflect overuse of restraints on their unit. If so, staff ratings of inappropriate restraint use may identify units that need improvement. [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: SARS‐CoV‐2 circulating variants coupled with waning immunity pose a significant threat to the long‐term care (LTC) population. Our objective was to measure salivary IgG antibodies in residents and staff of an LTC facility to (1) evaluate IgG response in saliva post‐natural infection and vaccination and (2) assess its feasibility to describe the seroprevalence over time. Methods: We performed salivary IgG sampling of all residents and staff who agreed to test in a 150‐bed skilled nursing facility during three seroprevalence surveys between October 2020 and February 2021. The facility had SARS‐CoV‐2 outbreaks in May 2020 and November 2020, when 45 of 138 and 37 of 125 residents were infected, respectively; they offered two Federal vaccine clinics in January 2021. We evaluated quantitative IgG in saliva to the Nucleocapsid (N), Spike (S), and Receptor‐binding domain (RBD) Antigens of SARS‐CoV‐2 over time post‐infection and post‐vaccination. Results: One hundred twenty‐four residents and 28 staff underwent saliva serologic testing on one or more survey visits. Over three surveys, the SARS‐CoV‐2 seroprevalence at the facility was 49%, 64%, and 81%, respectively. IgG to S, RBD, and N Antigens all increased post infection. Post vaccination, the infection naïve group did not have a detectable N IgG level, and N IgG levels for the previously infected did not increase post vaccination (p < 0.001). Fully vaccinated subjects with prior COVID‐19 infection had significantly higher RBD and S IgG responses compared with those who were infection‐naïve prior to vaccination (p < 0.001 for both). Conclusions: Positive SARS‐COV‐2 IgG in saliva was concordant with prior infection (Anti N, S, RBD) and vaccination (Anti S, RBD) and remained above positivity threshold for up to 9 months from infection. Salivary sampling is a non‐invasive method of tracking immunity and differentiating between prior infection and vaccination to inform the need for boosters in LTC residents and staff. [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/Objectives: We investigated the impact of ceasing routine falls risk assessment tool (FRAT) completion and instead used clinical reasoning to select fall mitigation strategies. Design Two‐group, multi‐site cluster‐randomized active‐control non‐inferiority trial. Setting: Hospital wards. Participants: Adult inpatients admitted to participating hospitals (n = 10 hospitals, 123,176 bed days). Intervention: Hospitals were randomly assigned (1:1) to a usual care control group that continued to use a historical FRAT to assign falls risk scores and accompanying mitigation strategies, or an experimental group whereby clinicians did not assign risk scores and instead used clinical reasoning to select fall mitigation strategies using a decision support list. Measurements The primary measure was between‐group difference in mean fall rates (falls/1000 bed days). Falls were identified from incident reports supplemented by hand searches of medical records over three consecutive months at each hospital. The incidence rate ratio (IRR) of monthly falls rates in control versus experimental hospitals was also estimated. Results: The experimental clinical reasoning approach was non‐inferior to the usual care FRAT that assigned fall risk ratings when compared to a‐priori stakeholder derived and sensitivity non‐inferiority margins. The mean fall rates were 3.84 falls/1000 bed days for the FRAT continuing sites and 3.11 falls/1000 bed days for experimental sites. After adjusting for historical fall rates at each hospital, the IRR (95%CI) was 0.78 (0.64, 0.95), where IRR < 1.00 indicated fewer falls among the experimental group. There were 4 and 3 serious events in the control and experimental groups, respectively. Conclusion: Replacing a FRAT scoring system with clinical reasoning did not lead to inferior fall outcomes in the short term and may even reduce fall incidence. [ABSTRACT FROM AUTHOR]

Background/Objectives: The safety and immunogenicity of the BNT162b2 coronavirus disease 2019 (COVID‐19) vaccine in older adults with different frailty and disability profiles have not been well determined. Our objective was to analyze immunogenicity of the BNT162b2 mRNA COVID‐19 vaccine in older adults across frailty and disability profiles. Design: Multicenter longitudinal cohort study. Setting and participants: A total of 134 residents aged ≥65 years with different frailty and disability profiles in five long‐term care facilities (LTCFs) in Albacete, Spain. Intervention and measurements: Residents were administered two vaccine doses as per the label, and antibody levels were determined 21.9 days (SD 9.3) after both the first and second dose. Functional variables were assessed using activities of daily living (Barthel Index), and frailty status was determined with the FRAIL instrument. Cognitive status and comorbidity were also evaluated. Results: Mean age was 82.9 years (range 65–99), and 71.6% were female. The mean antibody titers in residents with and without previous COVID‐19 infection were 49,878 AU/ml and 15,274 AU/ml, respectively (mean difference 34,604; 95% confidence interval [CI]: 27,699–41,509). No severe adverse reactions were observed, after either vaccine dose. Those with prevaccination COVID‐19 had an increased antibody level after the vaccine (B = 31,337; 95% CI: 22,725–39,950; p < 0.001). Frailty, disability, older age, sex, cognitive impairment, or comorbidities were not associated with different antibody titers. Conclusions: The BNT162b2 mRNA COVID‐19 vaccine in older adults is safe and produces immunogenicity, independently of the frailty and disability profiles. Older adults in LTCFs should receive a COVID‐19 vaccine. [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]

Background/Objectives Frailty, characterized by low physiological reserves, is strongly associated with vulnerability to adverse outcomes. Features of frailty overlap with those of advanced heart failure, making a distinction between them difficult. We sought to determine whether implantation of a left ventricular assist device ( LVAD) would decrease frailty. Design Prospective, cohort study. Setting Five academic medical centers. Participants Frail individuals (N = 29; mean age 70.6 ± 5.5, 72.4% male). Measurements Frailty, defined as having 3 or more of the Fried frailty criteria, was assessed before LVAD implantation and 1, 3, and 6 months after implantation. Other domains assessed included quality of life, using the Kansas City Cardiomyopathy Questionnaire; mood, using the Patient Health Questionnaire; and cognitive function, using the Trail-Making Test Part B. Results After 6 months, three subjects had died, and one had undergone a heart transplant; of 19 subjects with serial frailty measures, the average number of frailty criteria decreased from 3.9 ± 0.9 at baseline to 2.8 ± 1.4 at 6 months ( P = .003). Improvements were observed after 3 to 6 months of LVAD support, although 10 (52.6%) participants still had 3 or more Fried criteria, and all subjects had at least one at 6 months. Changes in frailty were associated with improvement in QOL but not with changes in mood or cognition. Higher estimated glomerular filtration rate at baseline was independently associated with a decrease in frailty. Conclusion Frailty decreased in approximately half of older adults with advanced heart failure after 6 months of LVAD support. Strategies to enhance frailty reversal in this population are worthy of additional study. [ABSTRACT FROM AUTHOR]

Objectives Epidemiologic data suggest older adults receiving serotonergic antidepressants may have accelerated bone loss. We examined bone turnover marker changes and patient-level variables associated with these changes in older adults receiving protocolized antidepressant treatment. Design Open-label, protocolized treatment study. Setting Medical centers in Pittsburgh, St Louis, and Toronto. Participants Older adults with major depression (N = 168). Measurements Serum levels of the bone resorption marker C-terminal cross-linking telopeptide of type 1 collagen ( CTX) and the bone formation marker procollagen type 1 N propeptide (P1 NP) were assayed before and after 12 weeks of treatment with venlafaxine. Whether CTX and P1 NP changes were associated with depression remission and duration of depression and genetic polymorphisms in the serotonin transporter (5 HTTLPR) and 1B receptor ( HTR1B) were also examined. Results CTX increased and P1 NP decreased during venlafaxine treatment, a profile consistent with accelerated bone loss. Two individual-level clinical variables were correlated with bone turnover; participants whose depression did not go into remission had higher CTX levels, and those with chronic depression had lower P1 NP levels. HTR1B genotype predicted P1 NP change, whereas 5 HTTLPR genotype was unrelated to either biomarker. Conclusion Bone turnover markers change with antidepressant treatment in a pattern that suggests accelerated bone loss, although the clinical significance of these changes is unclear. These data are preliminary and argue for a larger, controlled study to confirm whether antidepressants are harmful to bone metabolism and whether certain individuals might be at increased risk. [ABSTRACT FROM AUTHOR]

Objectives To explore the quality of interprofessional teamwork in acute geriatric care and to build a model of team types. Design Cross-sectional multicenter study. Setting Acute geriatric units in Belgium. Participants Team members of different professional backgrounds. Measurements Perceptions of interprofessional teamwork among team members of 55 acute geriatric units in Belgium were measured using a survey covering collaborative practice and experience, managerial coaching and open team culture, shared reflection and decision-making, patient files facilitating teamwork, members' belief in the power of teamwork, and members' comfort in reporting incidents. Cluster analysis was used to determine types of interprofessional teamwork. Professions and clusters were compared using analysis of variance. Results The overall response rate was 60%. Of the 890 respondents, 71% were nursing professionals, 20% other allied health professionals, 5% physicians, and 4% logistic and administrative staff. More than 70% of respondents scored highly on interprofessional teamwork competencies, consultation, experiences, meetings, management, and results. Fewer than 55% scored highly on items about shared reflection and decision-making, reporting incidents from a colleague, and patient files facilitating interprofessional teamwork. Nurses in this study rated shared reflection and decision-making lower than physicians on the same acute geriatric units ( P < .001). Using the mean score on each of the six areas, four clusters that differed significantly in all areas were identified using hierarchical cluster analysis and scree plot analysis ( P < .001). Conclusion Interprofessional teamwork in acute geriatric units is satisfactory, but shared reflection and decision-making needs improvement. Four types of interprofessional teamwork are identified and can be used to benchmark the teamwork of individual teams. [ABSTRACT FROM AUTHOR]

Objectives To examine associations between the inflammatory marker C-reactive protein ( CRP) measured preoperatively and on postoperative day 2 ( POD2) and delirium incidence, duration, and feature severity. Design Prospective cohort study. Setting Two academic medical centers. Participants Adults aged 70 and older undergoing major noncardiac surgery (N = 560). Measurements Plasma CRP was measured using enzyme-linked immunosorbent assay. Delirium was assessed from Confusion Assessment Method ( CAM) interviews and chart review. Delirium duration was measured according to number of hospital days with delirium. Delirium feature severity was defined as the sum of CAM-Severity ( CAM-S) scores on all postoperative hospital days. Generalized linear models were used to examine independent associations between CRP (preoperatively and POD2 separately) and delirium incidence, duration, and feature severity; prolonged hospital length of stay ( LOS, >5 days); and discharge disposition. Results Postoperative delirium occurred in 24% of participants, 12% had 2 or more delirium days, and the mean ± standard deviation sum CAM-S was 9.3 ± 11.4. After adjusting for age, sex, surgery type, anesthesia route, medical comorbidities, and postoperative infectious complications, participants with preoperative CRP of 3 mg/L or greater had a risk of delirium that was 1.5 times as great (95% confidence interval ( CI) = 1.1-2.1) as that of those with CRP less than 3 mg/L, 0.4 more delirium days ( P < .001), more-severe delirium (3.6 CAM-S points higher, P < .001), and a risk of prolonged LOS that was 1.4 times as great (95% CI = 1.1-1.8). Using POD2 CRP, participants in the highest quartile (≥235.73 mg/L) were 1.5 times as likely to develop delirium (95% CI = 1.0-2.4) as those in the lowest quartile (≤127.53 mg/L), had 0.2 more delirium days ( P < .05), and had more severe delirium (4.5 CAM-S points higher, P < .001). Conclusion High preoperative and POD2 CRP were independently associated with delirium incidence, duration, and feature severity. CRP may be useful to identify individuals who are at risk of developing delirium. [ABSTRACT FROM AUTHOR]

Objectives To describe victim characteristics and determinants of recurrent physical abuse of elderly. Design Multicenter retrospective analysis of multiple data systems to study victims of elder mistreatment in the greater Chicago metropolitan area. Setting Five teaching hospitals with Level 1 trauma centers. Participants Individuals aged 60 and older treated for physical and sexual abuse between 2000 and 2011. Measurements History of revictimization was based on hospital admission histories, Adult Protective Services records, and self-report. Death records were also linked to participant files. Results Fifty-eight individuals (52.3%) out of 111 cases suffering physical abuse had documented histories of revictimization. Based on multivariable models, individuals who were female, widowed, diagnosed with dementia, and returning to the home where the perpetrator lived or visited were substantially more likely to be revictimized. Revictimized individuals were more likely to be assaulted through unarmed force by a proximal relative, in particular a husband, boyfriend, child, or child-in-law. Based on hospital records, only 57% of community-dwelling cases had their abuse reported to Adult Protective Services or the police, and only 26.6% had Adult Protective Services investigations on record. Conclusion Better screening that connects victims of abuse with community services, police action, and alternative residential options is important in reducing the risk of revictimization and connecting individuals with resources that can improve their safety at home, regardless of whether it is in the community or a residential facility. [ABSTRACT FROM AUTHOR]

Objectives To explore and compare sociodemographic, clinical, and neuropsychiatric determinants of dropout and nonadherence in older people participating in an open-label cluster-randomized controlled trial-the Prevention of Dementia by Intensive Vascular care (pre DIVA) trial-over 6 years. Design Secondary analysis. Setting One hundred sixteen general practices in the Netherlands. Participants Community-dwelling individuals aged 70 to 78 (N = 2,994). Intervention Nurse-led multidomain intervention targeting cardiovascular risk factors to prevent dementia. Measurements The associations between participant baseline sociodemographic (age, sex, education), clinical (medical history, disability, cardiovascular risk), neuropsychiatric (depressive symptoms (Geriatric Depression Scale-15), and cognitive (Mini-Mental State Examination)) characteristics and dropout from the trial and nonadherence to the trial intervention were explored using multilevel logistic regression models. Results Older age, poorer cognitive function, more symptoms of depression, and greater disability were the most important determinants of dropout of older people. The presence of cardiovascular risk factors was not associated with dropout but was associated with nonadherence. Being overweight was a risk factor for nonadherence, whereas people with high blood pressure or a low level of physical exercise adhered better to the intervention. The association between poorer cognitive function and symptoms of depression and dropout was stronger in the control group than in the intervention group, and vice versa for increased disability. Conclusion In a large dementia prevention trial with 6-year follow-up, dropout was associated with older age, poorer cognitive function, symptoms of depression, and disability at baseline. These findings can help to guide the design of future dementia prevention trials in older adults. The associations found between cardiovascular risk factors and nonadherence need to be confirmed in other older populations receiving cardiovascular prevention interventions. [ABSTRACT FROM AUTHOR]

Background Physical activity ( PA) reduces the rate of mobility disability, compared with health education ( HE), in at risk older adults. It is important to understand aspects of performance contributing to this benefit. Objective To evaluate intervention effects on tertiary physical performance outcomes. Design The Lifestyle Interventions and Independence for Elders ( LIFE) was a multi-centered, single-blind randomized trial of older adults. Setting Eight field centers throughout the United States. Participants 1635 adults aged 78.9 ± 5.2 years, 67.2% women at risk for mobility disability (Short Physical Performance Battery [SPPB] <10). Interventions Moderate PA including walking, resistance and balance training compared with HE consisting of topics relevant to older adults. Outcomes Grip strength, SPPB score and its components (balance, 4 m gait speed, and chair-stands), as well as 400 m walking speed. Results Total SPPB score was higher in PA versus HE across all follow-up times (overall P = .04) as was the chair-stand component (overall P < .001). No intervention effects were observed for balance (overall P = .12), 4 m gait speed (overall P = .78), or grip strength (overall P = .62). However, 400 m walking speed was faster in PA versus HE group (overall P =<.001). In separate models, 29% of the rate reduction of major mobility disability in the PA versus HE group was explained by change in SPPB score, while 39% was explained by change in the chair stand component. Conclusion Lower extremity performance ( SPPB) was significantly higher in the PA compared with HE group. Changes in chair-stand score explained a considerable portion of the effect of PA on the reduction of major mobility disability-consistent with the idea that preserving muscle strength/power may be important for the prevention of major mobility disability. [ABSTRACT FROM AUTHOR]

Background Acute heart failure is a common cause of hospitalization among older patients. Optimized risk stratification might improve the outcome for this subgroup of patients. Natriuretic peptides have been used in the diagnosis of heart failure and in evaluating the prognosis of patients hospitalized for heart failure. However, their utility in the elderly is still controversial. Objective To evaluate long-term survival and prognostic factors for elderly patients hospitalized for acutely decompensated heart failure and evaluate the prognostic utility of NT-proBNP. Design Retrospective, multicenter cohort study. Setting Two Italian hospitals. Participants Two hundred seventy-nine patients, aged >75 years; hospitalized for decompensation of chronic, established heart failure. Methods Baseline clinical data were recorded at admission. The primary outcome was long-term mortality. Results In-hospital, 12-month and 5-year mortality were, respectively, 10%, 36%, and 77%. NT-proBNP, eGFR, hemoglobin, diabetes, systolic blood pressure, and moderate to severe tricuspid regurgitation were independently associated with long-term prognosis and were entered into a multivariate model, with a C-index of 0.765 for the determination of high-risk patients. The C-index for NT-proBNP to predict mortality at 2 and 12 months was 0.740 and 0.756, respectively. The optimal cutoff point for predicting mortality at 2 and 12 months was 8,444 pg/mL (hazard ratio 5.33) and 8,275 pg/mL (hazard ratio 6.03), respectively. Conclusion Elderly patients hospitalized for acutely decompensated heart failure had a poor long-term outcome, especially in the subgroup with reduced ejection fraction (EF). In addition to EF and comorbidities, NT-pro-BNP remained independently prognostic among elderly patients hospitalized with heart failure. [ABSTRACT FROM AUTHOR]

Background Nursing home ( NH) residents who require assistance during mealtimes are at risk for malnutrition. Supportive handfeeding is recommended, yet there is limited evidence supporting use of a specific handfeeding technique to increase meal intake. Objectives To compare efficacy of three handfeeding techniques for assisting NH residents with dementia with meals: Direct Hand ( DH), Over Hand ( OH), and Under Hand ( UH). Design A prospective pilot study using a within-subjects experimental Latin square design with randomization to one of three handfeeding technique sequences. Setting and Participants 30 residents living with advanced dementia in 11 U.S. NHs. Measurements Time required for assistance; meal intake (% eaten); and feeding behaviors, measured by the Edinburgh Feeding Evaluation in Dementia (EdFED) scale. Intervention Research Assistants provided feeding assistance for 18 video-recorded meals per resident (N = 540 meals). Residents were assisted with one designated technique for 6 consecutive meals, changing technique every 2 days. Results Mean time spent providing meal assistance did not differ significantly between techniques. Mean meal intake was greater for DH (67 ± 15.2%) and UH (65 ± 15.0%) with both significantly greater than OH (60 ± 15.1%). Feeding behaviors were more frequent with OH (8.3 ± 1.8%), relative to DH (8.0 ± 1.8) and UH (7.7 ± 1.8). Conclusion All three techniques are time neutral. UH and DH are viable options to increase meal intake among NH residents with advanced dementia and reduce feeding behaviors relative to OH feeding. [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 describe the extent to which nursing homes engaged families in antipsychotic initiation decisions in the year before surveyor guidance revisions were implemented. Design Mixed-methods study based on semistructured interviews. Setting U.S. nursing homes (N = 20) from five CMS regions ( III, IV, VI, VIII, IX). Participants Family members of nursing home residents (N = 41). Measurements Family member responses to closed- and open-ended questions regarding involvement in resident care and antipsychotic initiation. Two researchers used a content analytical approach to code open responses to themes of family involvement in behavior management, decision-making, knowledge of risks and benefits, and informed consent. Results Fifty-four percent of family members felt highly involved in decisions about behavior management. Forty-two percent recalled being asked how to manage resident behavior without medication, and 17% recalled receipt of information about antipsychotic risks and benefits. Sixty-six percent felt highly involved in the process of initiating antipsychotic medication; 24% reported being asked for input into the antipsychotic initiation decision and knowing before the antipsychotic was started. Conclusion Under existing federal regulations but before guidance revisions were implemented in 2013, more than 40% of families reported being involved in nonpharmacological behavior management of family members, but fewer than one in four reported being involved throughout the entire antipsychotic prescribing process. Interventions that standardize family engagement and promote adherence to existing federal regulations are needed. This discussion builds on these findings to weigh the policy options of greater enforcement of existing regulations versus enactment of new legislation to address this challenging issue. [ABSTRACT FROM AUTHOR]

Objectives To examine perspectives on antibiotic use and antibiotic stewardship of nurses and medical providers in nursing homes ( NHs). Design Cross-sectional survey. Setting NHs in North Carolina (N = 31). Participants Nursing staff (n = 182) and medical providers (n = 50). Measurements Respondents completed a self-administered questionnaire about their perspectives on antibiotic use in their NH, the influence of residents and families on antibiotic prescribing decisions, and readiness to improve antibiotic stewardship. Open-ended questions on barriers to antibiotic stewardship were also asked. Linear mixed modeling was used to analyze differences between respondent groups and to test for associations with individual and organizational characteristics. Results All respondents supported reducing antibiotic use, although medical providers' support was significantly stronger ( P = .005). When asked about their perception of residents' and family members' preference for antibiotic use in the case of suspected infection and the influence of that preference on antibiotic-prescribing decisions, respondents indicated that residents and families favor antibiotic use and influence prescribing decisions. Nurses reported a stronger perception than medical providers that families prefer antibiotics ( P = .04) and influence prescribing decisions ( P = .02). All respondents reported commitment and efficacy to change practices (mean 4.0-4.1 for nurses and 3.6-3.9 for medical providers on a 5-point scale). Four significant associations related to organizational and individual characteristics were found: directors of nursing and specialist nurses reported greater self-efficacy for changing practice than other nurses ( P = .003), medical providers with a subspecialty (e.g., geriatrics) reported greater self-efficacy ( P = .007) and commitment to change ( P = .001) than those without a subspecialty, and medical providers specializing in hospice and palliative care rated family influence ( P = .006) higher than those with other subspecialties. Conclusion Nursing staff and medical providers share a commitment to reducing unnecessary antibiotic use. Antibiotic stewardship interventions should foster cooperation and build competency to implement alternative management approaches and to educate residents and families. Nurse leaders and medical providers with long-term care training may be especially effective champions for antibiotic stewardship. [ABSTRACT FROM AUTHOR]

Objectives To verify the reliability and validity and develop an English version of an instrument (Kuchi-Kara Taberu Index ( KT Index)) to comprehensively assess and intervene in problems with eating and swallowing. Design Multicenter cross-sectional study. Setting Nursing homes. Participants Individuals aged 65 and older (mean age 88.3 ± 6.8; 80.0% female) who had lived in a nursing home for longer than 1 month (N = 115). Measurements The KT index consisted of 13 items: desire to eat, overall condition, respiratory condition, oral condition, cognitive function while eating, oral preparatory and propulsive phases, dysphagia severity, position and endurance while eating, eating, daily life, food intake level, food modification, and nutrition. Weighted kappa coefficients, Cronbach alpha, and Spearman rank correlation coefficients were determined. Results Weighted kappa values in the inter- and intrarater reliability tests ranged from 0.54 to 0.96 and 0.68 to 0.98, respectively. Cronbach alpha was 0.892. Spearman rank correlation coefficients (r) between the total KT index and external criteria were determined (Functional Oral Intake Scale, r = 0.790; Barthel Index, r = 0.830; Mini Nutritional Assessment Short Form, r = 0.582; Cognitive Performance Scale, r = −0.673; all P < .001). Similar correlations were observed when some items related to each external criterion were removed from the total KT index. Translation-retranslation procedures were conducted to develop an English version of the KT index. Conclusion The study provided evidence of the reliability and validity of the KT index and developed an English version. Future studies regarding validation of health-related quality of life indices and their effect on clinical courses of eating and swallowing conditions are needed. [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 evaluate the use of diagnostic testing before treating an infection in nursing home ( NH) residents suspected of having a urinary tract infection ( UTI) or pneumonia. Design Prospective longitudinal study nested within a randomized trial, using data from control sites. Setting Six NHs in southeast Michigan. Participants NH residents with an indwelling urinary catheter, enteral feeding tube, or both (N = 162) with 695 follow-up visits (189 (28%) visits with an infection). Measurements Clinical and demographic data-including information on incident infections, antibiotic use, and results of diagnostic tests-were obtained at study enrollment, after 14 days, and monthly thereafter for up to 1 year. Results One hundred (62%) NH residents had an incident infection requiring antibiotics, with substantial variations between NHs. In addition to presence of infection-specific symptoms, change in function was a significant predictor of ordering a chest X-ray to detect pneumonia (odds ratio ( OR) = 1.7, P = .01). Similarly, change in mentation was a significant predictor of ordering a urinalysis ( OR = 1.9, P = .02), chest X-ray ( OR = 3.3, P < .001), and blood culture ( OR = 2.3, P = .02). Antibiotics were used empirically, before laboratory results were available, in 50 of 233 suspected cases of UTI (21.5%) and 16 of 53 (30.2%) suspected cases of pneumonia. Antibiotics were used in 17% of visits without documented clinical or laboratory evidence of infection. Conclusion Constitutional symptoms such as change in function and mentation commonly lead to diagnostic testing and subsequent antibiotic prescribing. Antibiotic use often continues despite negative test results and should be a target for future interventions. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the associations between a broad array of cardiorespiratory and noncardiorespiratory impairments and dyspnea in older persons. Design Cross-sectional. Setting Cardiovascular Health Study. Participants Community-dwelling persons (N = 4,413; mean age 72.6, 57.1% female, 4.5% African American, 27.2% 1)), maximal inspiratory pressure (respiratory muscle strength), echocardiography, ankle-brachial index, blood pressure, whole-body muscle mass (bioelectrical impedance), single chair stand (lower extremity function), grip strength, serum hemoglobin and creatinine, Center for Epidemiologic Studies Depression Scale ( CES-D), Mini-Mental State Examination, medication use, and body mass index ( BMI). Results In a multivariable logistic regression model, impairments that had strong associations with moderate to severe dyspnea were FEV1 less than the lower limit of normal (adjusted odds ratio ( aOR) = 2.88, 95% confidence interval ( CI) = 2.37-3.49), left ventricular ejection fraction less than 45% ( aOR = 2.12, 95% CI = 1.43, 3.16), unable to perform a single chair stand ( aOR = 2.10, 95% CI = 1.61-2.73), depressive symptoms ( CES-D score ≥16; aOR = 2.02, 95% CI = 1.26-3.23), and obesity ( BMI ≥30; aOR = 2.07, 95% CI = 1.67-2.55). Impairments with modest but still statistically significant associations with moderate to severe dyspnea included respiratory muscle weakness, diastolic cardiac dysfunction, grip weakness, anxiety symptoms, and use of cardiovascular and psychoactive medications ( aORs = 1.31-1.71). Conclusion In community-dwelling older persons, several cardiorespiratory and noncardiorespiratory impairments were significantly associated with moderate to severe dyspnea, akin to a multifactorial geriatric health condition. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the associations between sensory impairments and 10-year risk of cognitive impairment. Design The Epidemiology of Hearing Loss Study ( EHLS), a longitudinal, population-based study of aging in the Beaver Dam, Wisconsin community. Baseline examinations were conducted in 1993 and follow-up examinations have been conducted every 5 years. Setting General community. Participants EHLS members without cognitive impairment at EHLS-2 (1998-2000). There were 1,884 participants (mean age 66.7) with complete EHLS-2 sensory data and follow-up information. Measurements Cognitive impairment was defined as a Mini-Mental State Examination score of <24 or history of dementia or Alzheimer's disease. Hearing impairment was a pure-tone average of hearing thresholds (0.5, 1, 2, 4 kHz) of >25 dB hearing level in either ear, visual impairment was a Pelli-Robson contrast sensitivity of <1.55 log units in the better eye, and olfactory impairment was a San Diego Odor Identification Test score of <6. Results Hearing, visual, and olfactory impairment were independently associated with cognitive impairment risk (hearing: hazard ratio ( HR) = 1.90, 95% confidence interval ( CI) = 1.11-3.26; vision: HR = 2.05, 95% CI = 1.24-3.38; olfaction: HR = 3.92, 95% CI = 2.45-6.26)). Nevertheless, 85% of participants with hearing impairment, 81% with visual impairment, and 76% with olfactory impairment did not develop cognitive impairment during follow-up. Conclusion The relationship between sensory impairment and cognitive impairment was not unique to one sensory system, suggesting that sensorineural health may be a marker of brain aging. The development of a combined sensorineurocognitive measure may be useful in uncovering mechanisms of healthy brain aging. [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 understand the perceived preparedness of frontline nurses (registered nurses ( RNs), licensed practical nurses ( LPNs)), unit nurse managers, and skilled nursing facility ( SNF) administrators in providing care for residents with peripherally inserted central catheters ( PICCs) in SNFs. Design Exploratory, qualitative pilot study. Setting Two community based SNFs. Participants Residents with PICCs, frontline nurses ( RNs, LPNs), unit nurse managers, and SNF administrators. Methods Over 36 weeks, 56 residents with PICCs and their nurses were observed and informally interviewed, focusing on PICC care practices and documentation. In addition, baseline PICC data were collected on placement indication (e.g., antimicrobial administration), placement setting (hospital vs SNF), and dwell time. Focus groups were then conducted with frontline nurses and unit nurse managers, and semistructured interviews were conducted with SNF administrators to evaluate perceived preparedness for PICC care. Data were analyzed using a descriptive analysis approach. Results Variations in documentation were observed during weekly informal interviews and observations. Differences were noted between resident self-reported PICC concerns (quality of life) and those described by frontline nurses. Deficiencies in communication between hospitals and SNFs with respect to device care, date of last dressing change, and PICC removal time were also noted. During focus group sessions, perceived inadequacy of information at the time of care transitions, limited availability of resources to care for PICCs, and gaps in training and education were highlighted as barriers to improving practice and safety. Conclusion Practices for PICC care in SNFs can be improved. Multimodal strategies that enhance staff education, improve information exchange during care transitions, and increase resource availability in SNFs appear necessary to enhance PICC care and safety. [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]

Objectives To validate the Pressure Ulcer Risk Scale ( PURS) to screen for pressure ulcer ( PU) outcomes in the acute hospital setting. Design Secondary data analysis was undertaken using a combined dataset from three prospective cohort studies. Setting General medical, surgical, and orthopedic wards in 11 hospitals in two states of Australia. Participants Individuals aged 70 and older admitted to the hospital for longer than 48 hours from July 2005 to May 2010 (N = 1418). Individuals in coronary or intensive care units, palliative care, or transferred out of the ward within 24 hours were excluded. Measurements Trained nurses used the international Resident Assessment Instrument (inter RAI) Acute Care ( AC) assessment tool to collect data at admission and discharge. Adverse outcomes were documented on daily ward visits. The PURS was calculated from inter RAI items, and its association with PU outcomes was tested using the c-statistic (area under the receiver operator characteristic curve). Results Complete data were available for 1,371 (96.7%) participants, 85 of whom (6.2%) had a PU at admission. Of the 1,286 without PUs at admission, 42 (3.3%) developed a new PU during their hospital stay. The association between PURS and outcomes had a c-statistic of 0.81 (standard error (SE) 0.02) for prevalent ulcers at admission and 0.70 (SE 0.04) for incidence of new PUs. Conclusion When derived from the inter RAI AC tool, the PURS demonstrated good to strong ability to screen for PU outcome in acute care. Assessment burden is reduced without loss of fidelity by integrating the risk scale into an existing assessment system. [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]

Objectives To assess the effect of cardiovascular diseases and risk factors on mortality in individuals with dementia. Design Systematic review and meta-analysis. English- and Dutch-language studies in PubMed, EMBASE, and PsycINFO databases were searched in April 2014 with hand-searching of in-text citations and no publication limitations. Inclusion criteria were original studies reporting on cardiovascular risk factors or diseases and their relationship with survival in individuals with dementia. The Quality In Prognosis Studies tool was used to appraise all included articles. Setting Population-, hospital-, and nursing home-based. Participants Community-dwelling, hospitalized individuals and nursing home residents with dementia. Measurements A random-effects meta-analysis was performed to investigate the effect of several cardiovascular diseases and risk factors on overall mortality. Results Twelve studies with 235,865 participants were included. In pooled analyses, male sex (hazard ratio ( HR) = 1.67, 95% confidence interval ( CI) = 1.56-1.78), diabetes mellitus ( DM) ( HR = 1.49, 95% CI = 1.33-1.68), smoking (ever vs never) ( HR = 1.37, 95% CI = 1.17-1.61), coronary heart disease ( CHD) ( HR = 1.21, 95% CI = 1.02-1.44) and congestive heart failure ( CHF) ( HR = 1.37, 95% CI = 1.18-1.59) were associated with mortality. Stroke, high blood pressure, being overweight, and hypercholesterolemia were not statistically significantly related to mortality. Conclusion Individuals with dementia and DM, smoking, CHD, and CHF have a greater risk of death than individuals with dementia without these risk factors or diseases. [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]

The aim of the Impact d'une démarche QUAlité sur l'évolution des pratiques et le déclin fonctionnel des Résidents en Établissement d'hébergement pour personnes âgées dépendantes ( IQUARE) study was to examine the effects of a global intervention comprising professional support and education for nursing home ( NH) staff on quality indicators ( QIs) and functional decline and emergency department ( ED) transfers of residents. One hundred seventy-five NHs in France (a total of 6,275 residents randomly selected from NHs) volunteered and were enrolled in a nonrandomized controlled multicenter individually customize trial with 18-month follow-up. NHs were allocated to a quality audit and feedback intervention (control group: 90 NHs, 3,258 residents) or to the quality audit and feedback intervention plus collaborative work meetings between a hospital geriatrician and NH staff (experimental group: 85 NHs, 3,017 residents). At the NH level, prevalence of assessment of kidney function, cognitive function, risk of pressure ulcers, behavioral disturbances, depression, pain, weight measurement, and transfer to the ED were recorded. Ability to perform basic activities of daily living was assessed at the resident level. At baseline, NH QIs were generally low (with large standard deviations), and annual rate of transfer to the ED was high (~20%) and similar in both groups. The intervention had a significant positive effect on the prevalence of assessment of pressure ulcer risk, depression, pain, and prevalence of ED transfers. It had no significant effect on functional decline. Large-scale efforts to improve QIs involving collaboration between hospital and NH providers and based on audit and collaborative discussion are feasible and improve some aspects of quality of care in NHs. [ABSTRACT FROM AUTHOR]

Objectives To examine facility-level pressure ulcer (PrU) development rates and variations in these rates after a system-wide adoption of culture change in Veterans Health Administration (VHA) nursing homes. Design Four-year retrospective longitudinal design. Setting VHA facilities (N = 109) representing 132 nursing homes known as community living centers (CLCs). Participants VHA nursing home residents. Measurements PrUs were identified using fiscal year (FY) 2008-11 Minimum Data Set (MDS) data. PrU development was defined as a Stage 2 or larger PrU on an MDS assessment with no PrU on the previous assessment. A risk adjustment model was developed using 105,274 MDS observations to predict the likelihood of PrUs (c-statistic = 0.72). A Bayesian hierarchical model that adjusted for differences in the precision of PrU rates from different-size facilities was used to calculate smoothed risk-adjusted (SRA) rates for each facility. The statistical significance of the trend over the 4 years was determined by examining the 95% interval estimate for the slope. Results Over the 4-year period, the beginning of which coincided with the VHA's system-wide adoption of culture change as a performance measure, median SRA facility PrU development rates were fairly consistent at approximately 4%. The range in SRA rates declined over the years, from a 14.8-percentage point spread to 10.1-percentage point spread. Some facilities had significantly improving SRA rates (e.g., declined steadily from 5.5% to 3.9%) and some had significantly worsening SRA rates (e.g., increased steadily from 5.1% to 7.9%). Seven sites had significantly improving rates ( P < .001) that were below the median across all 4 years. Conclusion A system-wide culture change implementation did not affect CLC PrU development rates, but there was significant variation in facility rates, and some facilities had sustained high performance. [ABSTRACT FROM AUTHOR]

Objectives To determine how nursing staff evaluate nonverbal behavior related to hand and tube feeding of residents with dementia. Design Cross-sectional survey. Setting A stratified sample of nurses and nursing assistants in residential nursing homes in a major German city. Participants Nursing staff members (N = 131) in 12 nursing homes. Measurements Nursing staff perception of nonverbal behavior of residents with dementia in response to hand and tube feeding. Results Ninety-three percent of survey participants considered the nonverbal behavior of residents with advanced dementia crucial for decisions about artificial nutrition and hydration ( ANH). The same percentage had at some point encountered residents who did not open their mouths when feeding was attempted. Fifty-three percent of the participants interpreted residents' expressions of pleasure while eating as a will to live. The most frequent interpretation of residents' aversive behavior was discomfort. When residents did not open their mouth during nurse's hand feeding, 41% of the participants inferred a will to die. Conclusion Most nurses and nursing assistants consider residents' behavior during hand or tube feeding to be important, but their interpretations are heterogeneous. Various professional caregivers assume a will to live or die. Further reflection is necessary to determine how behavioral expressions should be factored into treatment decisions. [ABSTRACT FROM AUTHOR]

Objectives To quantify the prognostic importance of prefrailty and frailty in a population-based sample of cancer survivors. Design The Third National Health and Nutrition Examination Survey mortality-linked prospective cohort study. Setting Eighty-nine survey locations across the United States. Participants Population-based sample of older adults (average age 72.2) with a self-reported diagnosis of non-skin-related cancer (N = 416). Measurements The primary outcome was all-cause mortality. Frailty components included low weight for height, slow walking, weakness, exhaustion, and low physical activity. Participants with none of the five criteria were classified as nonfrail, those with one or two as prefrail, and those with three or more as frail. Results The prevalence of prefrailty was 37.3% and of frailty was 9.1%. During a median follow-up of 11.2 years, 319 (76.7%) participants died. Median survival was 13.9 years for participants classified as nonfrail, 9.5 years for those classified as prefrail, and 2.5 years for those classified as frail. Cancer survivors classified as prefrail (hazard ratio (HR) = 1.84, 95% confidence interval (CI) = 1.28-2.65, P = .001) or frail (HR = 2.79, 95% CI = 1.34-5.81, P = .006) had a higher risk of premature mortality than those classified as nonfrail. Conclusion Prefrailty and frailty are prevalent clinical syndromes that may confer greater risk of premature mortality in older adult cancer survivors. Identifying frail cancer survivors and targeting interventions for them may be a strategy to improve survival after cancer. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To prospectively assess the effects of newly developed chronic conditions on changes in health-related quality of life (HRQoL) in postmenopausal women. DESIGN: Prospective cohort study. SETTING: Forty clinical centers in the United States. PARTICIPANTS: Women aged 50 to 79 enrolled in the Women's Health Initiative Observational Study during 1993-98 (N = 75,198). MEASUREMENTS: Onset of seven chronic conditions (hypertension, heart disease, stroke, cancer, osteoporosis, diabetes mellitus, arthritis), HRQoL based on the Medical Outcomes Study 36-item Short Form survey (SF-36), and change in HRQoL from baseline to Year 3 in scores on the Physical (PCS) and Mental (MCS) Component Summary of the SF-36. RESULTS: Each of the seven chronic conditions was statistically significantly associated with HRQoL for physical and mental health. Women with incident stroke had the greatest decline in HRQoL for physical and mental health (PCS: 10.2, 95% confidence interval (CI) = 8.3-12.1; MCS: 10.4, 95% CI = 8.8-12.1), which exceeded minimal clinically important differences (MCID). Having more new chronic conditions was associated with greater decrease in HRQoL. Declines in HRQoL in women with two or more chronic conditions exceeded MCID. Those with heart disease and stroke had the largest decline in physical health, and those with stroke and arthritis had the greatest decline in mental health. For all conditions other than stroke and diabetes mellitus, the more recently a condition was diagnosed, the greater the decrease in PCS. For stroke and cancer, a similar pattern was observed for MCS. CONCLUSION: The more conditions a woman developed, the greater reduction in HRQoL she experienced. Declines in HRQoL in women with stroke, cancer, and some combinations exceeded MCID. Findings from this study might lead to more-effective patient-centered approaches to health care for women with multiple chronic conditions. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the associations between definitions of sarcopenia and clinical outcomes and the ability of the definitions to discriminate those with a high likelihood of having these outcomes from those with a low likelihood. DESIGN: Osteoporotic Fractures in Men Study. SETTING: Six clinical centers. PARTICIPANTS: Community-dwelling men aged 65 and older (N = 5,934). MEASUREMENTS: Sarcopenia definitions from the International Working Group, European Working Group on Sarcopenia in Older Persons, Foundation for the National Institutes of Health Sarcopenia Project, Baumgartner, and Newman were evaluated. Recurrent falls were defined as two or more self-reported falls in the year after baseline (n = 694, 11.9%). Incident hip fractures (n = 207, 3.5%) and deaths (n = 2,003, 34.1%) were confirmed according to central review of medical records over 9.8 years. Self-reported functional limitations were assessed at baseline and 4.6 years later. Logistic regression or proportional hazards models were used to estimate associations between sarcopenia and falls, hip fractures, and death. The discriminative ability of the sarcopenia definitions (vs reference models) for these outcomes was evaluated using area under the receiver operating characteristic curve or C-statistics. Referent models included age alone for falls, functional limitations and mortality, and age and bone mineral density for hip fractures. RESULTS: The association between sarcopenia according to the various definitions and risk of falls, functional limitations, and hip fractures was variable; all definitions were associated with greater risk of death, but none of the definitions materially changed discrimination based on the AUC and C-statistic when compared with reference models (change <1% in all models). CONCLUSION: Sarcopenia definitions as currently constructed did not consistently improve prediction of clinical outcomes in relatively healthy older men. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine the cost-effectiveness of two nutrition interventions on food, beverage, and supplement intake and body weight. DESIGN: Randomized, controlled trial. SETTING: Five skilled nursing home facilities. PARTICIPANTS: Long-stay residents with orders for nutrition supplementation (N = 154). INTERVENTION: Participants were randomized into a usual care control group, an oral liquid nutrition supplement (ONS) intervention group, or a snack intervention group. Research staff provided ONS, according to orders or a variety of snack foods and beverages twice per day between meals, 5 days per week for 24 weeks and assistance to promote consumption. MEASUREMENTS: Research staff independently weighed residents at baseline and monthly during the 24-week intervention. Resident food, beverage and supplement intake and the amount of staff time spent providing assistance were assessed for 2 days at baseline and 2 days per month during the intervention using standardized observation and weighed intake procedures. RESULTS: The ONS intervention group took in an average of 265 calories more per day and the snack intervention group an average of 303 calories more per day than the control group. Staff time required to provide each intervention averaged 11 and 14 minutes per person per offer for ONS and snacks, respectively, and 3 minutes for usual care. Both interventions were cost-effective in increasing caloric intake, but neither intervention had a significant effect on body weight, despite positive trends. CONCLUSION: Oral liquid nutrition supplements and snack offers were efficacious in promoting caloric intake when coupled with assistance to promote consumption and a variety of options, but neither intervention resulted in significant weight gain. [ABSTRACT FROM AUTHOR]

Objectives To assess whether resistance training ( RT) slows the progression of white matter lesions ( WMLs) in older women. Design Secondary analysis of a 52-week randomized controlled trial of RT, the Brain Power Study. Setting Community center and research center. Participants Of 155 community-dwelling women aged 65 to 75 enrolled in the Brain Power Study, 54 who had evidence of WMLs on magnetic resonance imaging ( MRI) at baseline were included in this secondary analysis. Intervention Participants were randomized to once-weekly RT (1× RT), twice-weekly RT (2× RT), or twice-weekly balance and tone ( BAT). Assessors were blinded to participant assignments. Measurements WML volume was measured using MRI at baseline and trial completion. Results At trial completion, the 2× RT group had significantly lower WML volume than the BAT group ( P = .03). There was no significant difference between the BAT group and the 1× RT group at trial completion ( P = .77). Among participants in the two RT groups, reduced WML progression over 12 months was significantly associated with maintenance of gait speed (correlation coefficient ( r) = −0.31, P = .049) but not with executive functions ( r = 0.30; P = .06). Conclusion Engaging in progressive RT may reduce WML progression. [ABSTRACT FROM AUTHOR]

Objectives To determine whether a clinical surveillance system could be used to detect drug-associated hypoglycemia events and determine their incidence in nursing home ( NH) residents. Design Retrospective cohort. Setting Four NHs in western Pennsylvania. Participants Any resident of the four NHs who had a computer-generated alert detecting potential drug-associated hypoglycemia over a 6-month period were included. Measurements Descriptive statistics were used to summarize all variables, including the frequency and distribution of alert type according to glucose threshold. Analyses were conducted according to numbers of alerts and residents. The medications associated with the drug-associated hypoglycemia alerts were identified, and frequency of their inclusion in alerts was calculated. Additional calculations included time to drug-associated hypoglycemic event alert from date of admission and frequency of events associated with postacute, short-stay (≤35 days) admissions. Results Seven hundred seventy-two alerts involving 141 residents were detected. Ninety (63.8%) residents had a glucose level of 55 mg/dL or less, and 42 (29.8%) had a glucose level of 40 mg/dL or less. Insulin orders were associated with 762 (98.7%) alerts. Overall incidence of drug-associated hypoglycemia events was 9.5 per 1,000 resident-days. Conclusion Hypoglycemia can be detected using a clinical surveillance system. This evaluation found a high incidence of drug-associated hypoglycemia in a general NH population. Future studies are needed to determine the potential benefits of use of a surveillance system in real-time detection and management of hypoglycemia in NHs. [ABSTRACT FROM AUTHOR]

Objectives To examine the associations between amyloid- β brain deposition and physical activity ( PA) in elderly adults without dementia and to investigate whether the association has a dose-response relationship. Design Cross-sectional study. Setting French community-dwelling people. Participants Elderly adults with normal or mildly impaired cognition (mean age 74.7 ± 4.2; 60.4% female) with available information on current self-reported PA and amyloid- β brain deposition measured using positron emission tomography ( PET) using the PET-ligand florbetapir F 18 (n = 268). Measurements A standardized uptake value ratio ( SUVR) was obtained for each subject. Participants were divided according to amyloid plaque cortical retention defined according to a SUVR cutoff of 1.10 ( SUVR+ vs SUVR−). Results Bivariate and multivariate analyses showed that PA was not significantly associated with SUVR. SUVR+ and SUVR− participants did not differ in terms of volume (continuous PA variables) and levels (categorical PA variables) of PA. PA was not correlated with SUVR in apolipoprotein E ε4 carriers or noncarriers. PA was not associated with cognitive function. Conclusion Although PA protects against dementia, there is no solid evidence that this protection involves a reduction in amyloid- β brain deposition. Further studies are needed to determine whether PA (ideally measured at several time-points using objective measures) is involved in the pathophysiology of Alzheimer's disease. [ABSTRACT FROM AUTHOR]

Objectives To compare risk-adjusted differences between men and women 30 and 60 days after hip fracture surgery in not walking, ability to return home in a community-dwelling subset, not walking in a nursing home resident subset, and mortality within 60 days. Design Cohort study. Setting Data were from a randomized clinical trial that compared two blood transfusion protocols after hip fracture. Participants Individuals with hip fracture (N = 2,016; 489 (24%) male). Measurements Walking, dwelling, and mortality were determined in telephone follow-up 30 and 60 days after randomization, which occurred within 3 days of surgery. Sex differences for each outcome were compared using univariate and multivariate regression adjusting for potential confounders. Results Men were younger ( P < .001) and more likely to have comorbidity ( P = .003) than women at the time of hip fracture and to die within 60 days, even after risk adjustment (odds ratio ( OR) = 1.76, 95% confidence interval ( CI) = 1.15-2.69). After risk adjustment, male survivors were as likely as female survivors not to walk ( OR = 1.03, 95% CI = 0.78-1.34) and no less likely to return home ( OR = 0.90, 95% CI = 0.69-1.17) 60 days after hip fracture. No differences were noted between male and female nursing home residents in not walking within 60 days ( OR = 0.95, 95% CI = 0.32-2.86). Conclusion Although men experience higher mortality, male survivors can expect recovery of walking ability similar to that of female survivors and are as likely to return to community living. [ABSTRACT FROM AUTHOR]