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

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

Background: In June 2019, the Advisory Committee on Immunization Practices recommended discontinuing the routine use of the pneumococcal conjugate vaccine (PCV13) among adults aged ≥65 years and instead recommended PCV13 be used based on shared clinical decision making (SCDM). Objectives: We wanted to assess among primary care physicians (1) knowledge and attitudes regarding the new SCDM PCV13 recommendation and (2) how the new recommendation will affect their likelihood of recommending PCV13 to adults aged ≥65 years. Design This was done by mail and internet‐based survey, which was conducted October 2019 through January 2020. The study was carried out on a nationally representative sample of general internists (GIMs) and family physicians (FPs). Results: The response rate was 64% (617/968, GIM 57%, FP 71%). Only 41% of respondents were aware of the SCDM PCV13 recommendation in adults aged ≥65 years; 76% agreed (37% "Strongly," 39% "Somewhat") that their patients aged ≥65 years will get confused by having a SCDM recommendation for PCV13 and a routine recommendation for the pneumococcal polysaccharide vaccine (PPSV23); 60% agreed (18% "Strongly," 42% "Somewhat") that they were unsure of what points to emphasize when having a SCDM conversation with an adult aged ≥65 years about receiving PCV13. Just over 50% reported they would be less likely to recommend PCV13 for adults aged ≥65 years as a result of the new recommendation, but 42% reported that their recommendation for PCV13 would not change. Conclusions: Word of the new ACIP recommendation for PCV13 for adults aged ≥65 years needs to be further disseminated. Investigation into why some physicians do not plan to change their recommendations is warranted. [ABSTRACT FROM AUTHOR]

Objectives To estimate the number of caregivers providing assistance to community-dwelling older persons with and without dementia and with or without substantial disability; to describe the characteristics of caregivers and care recipients in these groups; to characterize the health-related tasks that caregivers provide; and to estimate associations between the numbers of tasks and caregiver burden. Design Nationally representative surveys of caregivers and older adults in the United States. Setting 2011 National Health and Aging Trends Study and National Study of Caregiving. Participants Community-dwelling older adults and their family caregivers, who were selected on the basis of having assisted with mobility, self-care, household activities, transportation, or medical tasks. Measurements Caregiver burden (emotional, physical, financial difficulties) and restrictions on social participation. Results Although much larger proportions of older adults with dementia and disability (98.4%, n = 1.0 million) and dementia but not disability (95.5%, n = 1.3 million) received caregiving assistance, the largest absolute number of individuals receiving assistance were older adults without dementia or disability (4.0 million). Within each caregiver group, caregivers provided assistance with at least one task across domains of activity of daily living and instrumental activity of daily living-related assistance (>98%), health systems logistics (>70%), and health management (>50%). There was a significant linear association between number of tasks provided and risk of burden in virtually all caregiver groups and domains of assistance. Conclusion Caregivers of care recipients without dementia or disability accounted for the largest absolute number of helpers. These caregivers, similar to caregivers of care recipients with dementia or disability, delivered a broad spectrum of health-related tasks and experienced caregiver burden and restrictions on social participation. Findings support the need for interventions that address the needs of caregivers who have not typically been defined as high risk. [ABSTRACT FROM AUTHOR]

Objectives To determine the association between homebound status and mortality. Design Cross-sectional. Setting Annual, in-person interviews. Participants A nationally representative sample of community-dwelling, Medicare beneficiaries aged 65 and older enrolled in the National Health and Aging Trends Study between 2011 and 2013 (N = 6,400). Measurements Two-year mortality and prevalence of homebound status in the year before death are described using three categories of homebound status: homebound (never or rarely left home in the last month), semihomebound (left home with assistance, needed help or had difficulty), and nonhomebound (left home without help or difficulty). Results In unadjusted analyses, 2-year mortality was 40.3% in homebound participants, 21.3% in those who were semihomebound and 5.8% in those who were nonhomebound. Homebound status was associated with greater 2-year mortality, adjusted for sociodemographic characteristics, comorbidities, and functional status (hazard ratio = 2.08; 95% confidence interval = 1.63-2.65, P < .001). Half of older community-dwelling Medicare beneficiaries were homebound in the year before death. Conclusion Homebound status is associated with greater risk of death independent of functional impairment and comorbidities. To improve outcomes for homebound older adults and the many older adults who will become homebound in the last year of life, providers and policymakers need to extend healthcare services from hospitals and clinics to the homes of vulnerable individuals. [ABSTRACT FROM AUTHOR]

Objectives To determine whether subjective poor sleep prospectively increases functional limitations and incident disability in a national sample of adults living in the United States. Design Prospective cohort. Setting Longitudinal Survey of Midlife Development in the United States ( MIDUS). Participants Young, middle-aged, and older men and women (aged 24-75) surveyed in 1995/96 ( MIDUS 1) and followed up in 2004-06 ( MIDUS 2). Complete data were available for 3,620 respondents. Measurements Data were from telephone interviews and self-administered questionnaires. Participant reported chronic sleep problems within the prior month; functional limitations were assessed using the Functional Status Questionnaire. Demographic (age, sex, race), socioeconomic (educational attainment), health (chronic conditions, depression), and health behavior (obesity, smoking) covariates were assessed to reduce potential confounding. Results Approximately 11% of the sample reported chronic sleep problems at both MIDUS waves. Average number of activity of daily living ( ADL) and instrumental activity of daily living ( IADL) limitations increased significantly between MIDUS 1 ( ADL limitations: 0.06; IADL limitations: 0.95) and MIDUS 2 ( ADL limitations: 0.15; IADL limitations: 1.6; P < .001). Adjusted regression models estimating change in ADL scores showed that chronic sleep problems at MIDUS 1 predicted significantly greater increases in ADL (incident rate ratio ( IRR) = 1.55, P < .001) and IADL ( IRR = 1.28, P < .001) limitations. In those with no functional limitations at baseline, logistic regression models showed that chronic sleep problems significantly increased the odds of incident ADL (odds ratio ( OR) = 2.33, 95% confidence interval ( CI) = 1.68-3.24, P < .001) and IADL ( OR = 1.70, 95% CI = 1.21-2.42, P = .002) disability. Conclusion Reports of chronic sleep problems predicted greater risk of onset of and increases in functional limitations 9 to 10 years later. Poor sleep may be a robust and independent risk factor for disability in adults of all ages. [ABSTRACT FROM AUTHOR]

The rapid increase in grandparents caring for grandchildren has received growing attention, but little research has focused on Chinese-American grandparents and their caregiving experiences. Drawing on cross-sectional data from the Population Study of Chinese Elderly-a community-engaged, epidemiological study of Chinese-American adults aged 60 and older, the relationships between caregiving experiences and psychological well-being were examined. Of 2,365 older adults who answered the question about grandparent caregiving, 818 (35%) were designated as caregivers, spending an average of 12 hours a week on childcare. About one in five caregivers reported caregiving burden, pressure, or negative health effect of caregiving. Caregivers had better psychological well-being than noncaregivers, with significantly lower levels of depressive symptoms, anxiety, stress, and loneliness. For caregivers, higher levels of caregiving burden, pressure from adult children, and perceived negative effect were related to greater rates of psychological distress. With a strong cultural expectation of family care, grandparent caregiving is generally associated with positive psychological well-being, but it can also be stressful, especially when older adults feel pressured to provide childcare or that doing so is a burden. The study implies that cultural values and life transitions may shape grandparent caregiving experiences and well-being, indicating the importance of respecting cultural differences in family caregiving. Understanding positive and negative aspects of grandparent caregiving and the underlying mechanisms will help healthcare professionals identify caregivers at risk of psychological distress and provide proper interventions to attenuate negative outcomes while maximizing positive experiences for Chinese-American older adults. [ABSTRACT FROM AUTHOR]

Objectives To investigate factors associated with place of death of individuals in the Mount Sinai Visiting Doctors Program ( MSVD). Design A retrospective chart review was performed of all MSVD participants who died in 2012 to assess predictors of place of death in the last month of life. Setting MSVD, a home-based primary and palliative care program in New York. Participants MSVD participants who were discharged from the program because of death between January 2012 and December 2012 and died at home, in inpatient hospice, or in the hospital (N = 183). Measurements Electronic medical records were reviewed to collect information on demographic characteristics, physician visits, and end-of-life conversations. Results Of 183 participants, 103 (56%) died at home, approximately twice the national average; 28 (15%) died in inpatient hospice; and 52 (28%) died in the hospital. Bivariate analyses showed that participants who were white, aged 90 and older, non-Medicaid, or had a recorded preference for place of death were more likely to die outside the hospital. Diagnoses and living situation were not significantly associated with place of death. Multivariate logistic regression analysis showed no statistical association between place of death and home visits in the last month of life (odds ratio = 1.21, 95% confidence interval = 0.52-2.77). Conclusion Home-based primary and palliative care results in a high likelihood of nonhospital death, although certain demographic characteristics are strong predictors of death in the hospital. For MSVD participants, home visits in the last month of life were not associated with death outside the hospital. [ABSTRACT FROM AUTHOR]

Objectives To investigate the association between sociodemographic and economic factors and the presence of simple home modifications ( HMs) among older adults in the United States. Design Cross-sectional. Setting National Health and Aging Trends Study (2011, Round 1). Participants Community-dwelling Medicare enrollees aged 65 and older (N = 6,628). Measurements The primary dependent variable was the reported presence or absence of simple HMs (grab bars in the shower or near the toilet, shower seats, raised toilet seats). Results Of the individuals sampled, 60.7% reported having at least one HM of interest. Black (odds ratio ( OR) = 0.79, 95% confidence interval ( CI) = 0.68-0.91) and Hispanic ( OR = 0.60, 95% CI = 0.45-0.78) respondents were less likely than white, non-Hispanic respondents to have HMs. Those with more education (high school graduate: OR = 1.20, 95% CI = 1.01-1.42; >high school: OR = 1.36, 95% CI = 1.14-1.62) and larger social networks (≥4 people; OR = 1.46, 95% CI = 1.12-1.89) were more likely to have at least one HM, whereas being divorced ( OR = 0.57, 95% CI = 0.43-0.74) was associated with lower likelihood. Income ( OR = 1.01, 95% CI = 0.97-1.05), Medicaid enrollment ( OR = 0.98, 95% CI = 0.77-1.25), and living alone ( OR = 1.02, 95% CI = 0.85-1.23) were not significantly associated with the presence of HMs. Conclusion Minorities, individuals with less education, and those with less social support are less likely to have HMs. Awareness of these disparities and the shortcomings of the HM delivery system is important to clinicians and policy-makers who seek to prevent falls and facilitate aging in place for all older Americans. [ABSTRACT FROM AUTHOR]

Objectives To determine the prevalence of end-of-life ( EOL) conversations with older adults. Design National Health and Aging Trends Study ( NHATS), a prospective, longitudinal survey of Medicare beneficiaries. Setting Nationally representative. Participants A sample drawn from Wave 2 of the NHATS. Measurements The main outcome was the report of an EOL planning discussion, based upon the participant's response to the question 'Have you talked to anyone about the types of medical treatment you would want or not want if you became seriously ill in the future?' Results Sixty-one percent of the sample (n = 1,993 individuals, weighted n = 11,123,910) responded that they had discussed EOL treatment preferences with someone. In multivariate regression, factors associated with reporting an EOL discussion included being younger (adjusted odds ratio ( AOR) = 1.70, 95% confidence interval ( CI) = 1.17-2.47), having more education (high school degree: AOR = 1.45, 95% CI = 1.02-2.07; some college: AOR = 2.03, 95% CI = 1.40-2.95), and having multiple chronic conditions ( AOR = 1.25, 95% CI = 1.01-1.55). Black race was associated with lower odds of reporting a discussion ( AOR = 0.46, 95% CI = 0.33-0.65). Conclusion Forty percent of a nationally representative sample of Medicare beneficiaries had not discussed their preferences regarding EOL medical treatment. Promoting these conversations in clinical and nonclinical settings will be important to ensure that health care is delivered to individuals in a person-centered manner. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the effect on outcomes of the Ohio Department of Public Safety statewide geriatric triage criteria, established in 2009 for emergency medical services ( EMS) to use for injured individuals aged 70 and older. Design Retrospective cohort study of the Ohio Trauma Registry. Setting All hospitals in Ohio. Participants Individuals aged 70 and older in the Ohio Trauma Registry from January 2006 through December 2011, 3 years before and 3 years after criteria adoption (N = 34,499). Measurements Primary outcomes were in-hospital mortality and discharge to home. Criteria effects were assessed using chi-square tests, multivariable logistic regression, interrupted time series plots, and multivariable segmented regression models. Results After geriatric criteria were adopted, the proportion of older adults qualifying for trauma center transport increased from 44% to 58%, but EMS transport rates did not change (44% vs 45%). There was no difference in unadjusted mortality (7.1% vs 6.6%) ( P = .10). In adjusted analyses, subjects with an injury severity score ( ISS) less than 10 had lower mortality after adoption (3.0% vs 2.5%) (odds ratio ( OR) = 0.81, 95% confidence interval ( CI) = 0.70-0.95, P = .01). Discharge to home increased after adoption in the adjusted analysis ( OR = 1.06, 95% CI = 1.01-1.11, P = .02). There were no time-dependent changes for either outcome. Conclusion Although the proportion of older adults meeting criteria for trauma center transport substantially increased with geriatric triage criteria, there were no increases in trauma center transports. Adoption of statewide geriatric triage guidelines did not decrease mortality in more severely injured older adults but was associated with slightly lower mortality in individuals with mild injuries ( ISS <10) and with more individuals discharged to home. Improving outcomes in injured older adults will require further attention to implementation and use of geriatric-specific criteria. [ABSTRACT FROM AUTHOR]

Objectives This study examined potential barriers to mental healthcare use of older adults from diverse ethnic and racial backgrounds. Design Data were obtained from the 2007, 2009, 2011-12, and 2013-14 California Health Interview Survey ( CHIS), a population-based survey representative of California's noninstitutionalized population. Participants The total sample consisted of 75,324 non-Hispanic white ( NHW), 6,600 black, 7,695 Asian and Pacific Islander ( API), and 4,319 Hispanic adults aged 55 and older. Results Results from logistic regression analyses that controlled for multiple demographic and health status characteristics revealed ethnic and racial differences in reasons for not seeking treatment and for terminating treatment. Specifically, API and Hispanic adults had greater odds than NHWs of endorsing feeling uncomfortable talking to a professional as a reason for not seeking treatment. Hispanic respondents had lower odds of endorsing concerns about someone finding out than APIs, and APIs and blacks had significantly greater odds of endorsing this concern as a reason for not seeking treatment than NHWs. When asked about reasons for no longer receiving treatment, all respondents, irrespective of race or ethnicity, endorsed that they no longer needed treatment as the most frequent reason for terminating treatment, although specific ethnic and racial differences emerged with respect to perceptions of not getting better, lack of time or transportation, and lack of insurance coverage as reasons for no longer seeking treatment. Conclusion Understanding how barriers to mental health treatment differ for older adults from diverse ethnic and racial backgrounds is an important step toward designing interventions to overcome these obstacles and improve mental health outcomes. [ABSTRACT FROM AUTHOR]

Although advance care planning ( ACP) is associated with better care at the end of life, better quality of death, and less psychological distress in survivors, ethnic disparities in ACP completion rates have been documented and may be attributable to lack of knowledge about ACP or differences in cultural values and preferences. Despite rapid increases in the size of the Asian-American population, little is known about ACP preferences of Chinese Americans. The purpose of this study is to explore the knowledge, attitudes, and preferences of older Chinese Americans toward ACP. Focus groups with Chinese older adults (n = 34) were conducted in Mandarin, Cantonese, and English, and transcripts were analyzed using a grounded theory approach. Identified themes included knowledge and experience with ACP and end-of-life care options, health as a factor in timing of ACP and communication, and communication of end-of-life care preferences. Knowledge of and experience with ACP and end-of-life decision-making varied according to focus group, although few participants had an advance directive. Findings suggest that Chinese older adults prefer to use indirect communication strategies, such as commenting on the circumstances of others rather than directly stating their wishes, and informal contexts, such as during a family dinner rather than formal meeting, to convey their care preferences to loved ones and may employ similar tactics when communicating with clinicians. This is particularly important given the recent decision by the Centers for Medicare and Medicaid Services to provide reimbursement to physicians for engaging in advance care planning conversations. [ABSTRACT FROM AUTHOR]

Objectives To use place-of-service ( POS) codes in the Medicare hospice claims files to document where elderly hospice users with cancer die. Design Retrospective cohort study. Setting Surveillance, Epidemiology, and End Results ( SEER) cancer registry areas. Participants Elderly Medicare beneficiaries who died of lung, breast, colorectal, or pancreatic cancer in 2007 and 2008 (N = 46,037). Measurement Use of hospice, place of service at death (home, nursing home, hospital, inpatient hospice, other), length of stay in hospice. Results Two-thirds of the beneficiaries used hospice. Younger, male, black, Asian, and unmarried beneficiaries and those enrolled in fee-for-service Medicare or from areas with lower income were less likely to use hospice. Hospice enrollment also varied significantly according to SEER registry. Thirty percent of the hospice users were not receiving home-based care at the time of death, and 17% were enrolled for less than 3 days. Factors associated with hospice death in the home mirrored those associated with hospice use. Individuals dying in hospitals (odds ratio ( OR) = 5.13, 95% confidence interval ( CI) = 4.63-5.69), inpatient hospice ( OR = 1.86, 95% CI = 1.70-2.02), and nursing homes ( OR = 1.19, 95% CI = 1.10-1.28) had greater odds of a short hospice stay (≤7 days) than those dying at home, after controlling for all other measured factors, whereas those dying in nursing homes had greater odds of long stays (>180 days) ( OR = 1.46, 95% CI = 1.28-1.67). Conclusion New hospice POS codes are useful for understanding place of death for hospice users. Hospice deaths cannot be assumed to happen at home. [ABSTRACT FROM AUTHOR]

Objectives To determine whether there are racial and ethnicity group differences in Resources for Enhancing Alzheimer's Caregiver Health ( REACH II) intervention delivery. Design Randomized controlled trial. Setting Community-based intervention delivered at five sites across the United States. Participants Family caregivers of persons with dementia who were randomized to the active intervention condition (N = 323). Intervention Nine in-home sessions (90 minutes each) and three telephone sessions (30 minutes each) were intended to be delivered and designed to reduce caregiver burden and depression, improve caregiver self-care and social support, and help caregivers manage behavior problems in persons with dementia. Measurements Interventionists recorded the type of intervention (home or telephone), start and stop times, and whether specific intervention content modules (e.g., stress management, social support) were administered in each session. Results Overall, REACH II intervention delivery was high, with more than 80% of randomized caregivers completing at least five in-home sessions and receiving eight or more hours of intervention contact, but black caregivers completed fewer in-home sessions (mean 6.98) than Hispanics (mean 7.84) or whites (mean 8.25) and received less total intervention contact time (mean 683 minutes) than Hispanics (mean 842 minutes) or whites (mean 798 minutes). No significant differences in exposure to content according to race or ethnicity were found after controlling for demographic covariates. Conclusion Blacks in REACH II received significantly less intervention contact. Similar multicomponent interventions should examine whether there are systematic differences in intervention delivery across specific demographic subgroups and explore implications for treatment outcomes. [ABSTRACT FROM AUTHOR]

Objectives To examine whether life expectancy influences treatment pattern of nonmelanoma skin cancer, or keratinocyte carcinoma ( KC), the most common malignancy and the fifth most costly cancer to Medicare. Design Nationally representative cross-sectional study. Setting Nationally representative Health and Retirement Study linked to Medicare claims. Participants Treatments (N = 9,653) from individuals aged 65 and older treated for basal or squamous cell carcinoma between 1992 and 2012 (N = 2,702) were included. Measurements Limited life expectancy defined according to aged 85 and older, medical comorbidities, Charlson Comorbidity Index score of 3 or greater, difficulty in at least one activity of daily living ( ADL), and a Lee index of 13 or greater. Treatment type (Mohs micrographic surgery ( MMS) (most intensive, highest cost), excision, or electrodesiccation and curettage ( ED&C) (least intensive, lowest cost)), according to procedure code. Results Most KCs (61%) were treated surgically. Rates of MMS (19%), excision (42%), and ED&C (39%) were no different in participants with limited life expectancy and those with normal life expectancy. For example, 19% of participants with difficulty or dependence in ADLs, 20% of those with a Charlson comorbidity score greater than 3, and 15% of those in their last year of life underwent MMS; participants who died within 1 year of diagnosis were treated in the same way as those who lived longer. Conclusion A one-size-fits-all approach in which advanced age, health status, functional status, and prognosis are not associated with intensiveness of treatment appears to guide treatment for KC, a generally nonfatal condition. Although intensive treatment of skin cancer when it causes symptoms may be indicated regardless of life expectancy, persons with limited life expectancy should be given choices to ensure that the treatment matches their goals and preferences. [ABSTRACT FROM AUTHOR]

Objectives To define multimorbidity 'classes' empirically based on patterns of disease co-occurrence in older Americans and to examine how class membership predicts healthcare use. Design Retrospective cohort study. Setting Nationally representative sample of Medicare beneficiaries in file years 1999-2007. Participants Individuals aged 65 and older in the Medicare Beneficiary Survey who had data available for at least 1 year after index interview (N = 14,052). Measurements Surveys (self-report) were used to assess chronic conditions, and latent class analysis ( LCA) was used to define multimorbidity classes based on the presence or absence of 13 conditions. All participants were assigned to a best-fit class. Primary outcomes were hospitalizations and emergency department visits over 1 year. Results The primary LCA identified six classes. The largest portion of participants (32.7%) was assigned to the minimal disease class, in which most persons had fewer than two of the conditions. The other five classes represented various degrees and patterns of multimorbidity. Usage rates were higher in classes with greater morbidity, but many individuals could not be assigned to a particular class with confidence (sample misclassification error estimate = 0.36). Number of conditions predicted outcomes at least as well as class membership. Conclusion Although recognition of general patterns of disease co-occurrence is useful for policy planning, the heterogeneity of persons with significant multimorbidity (≥3 conditions) defies neat classification. A simple count of conditions may be preferable for predicting usage. [ABSTRACT FROM AUTHOR]

Objectives To examine the prevalence of dementia in the absence of a reported dementia diagnosis and whether potentially unsafe activities and living conditions vary as a function of dementia diagnosis status in a nationally representative sample of older adults. Design Observational cohort study. Setting Community. Participants Medicare beneficiaries aged 65 and older enrolled in the National Health and Aging Trends Study (N = 7,609). Measurements Participants were classified into four groups based on self-report of dementia diagnosis, proxy screening interview, and cognitive testing: probable dementia with reported dementia diagnosis (n = 457), probable dementia without reported dementia diagnosis (n = 581), possible dementia (n = 996), or no dementia (n = 5,575). Potentially unsafe activities (driving, preparing hot meals, managing finances or medications, attending doctor visits alone) and living conditions (falls, living alone, and unmet needs) were examined according to dementia status subgroups in stratified analyses and multivariate models, adjusting for sociodemographic factors, medical comorbidities, and physical capacity. Results The prevalence of driving (22.9%), preparing hot meals (31.0%), managing finances (21.9%), managing medications (36.6%), and attending doctor visits alone (20.6%) was lowest in persons with probable dementia; however, but in persons with probable dementia, the covariate-adjusted rates of driving, preparing hot meals, managing finances, managing medications, and attending doctor visits alone were significantly higher in those without reported dementia diagnosis than in those with reported diagnosis (all odds ratios ≥2.00, all P < .01). Conclusion Older adults with probable dementia who are not aware of a dementia diagnosis are more likely to report engaging in potentially unsafe behaviors. Understanding the prevalence of potentially unsafe activities and living conditions can help clinicians focus safety screening and counseling in older adults with diagnosed or suspected dementia. [ABSTRACT FROM AUTHOR]

Objectives To measure the incidence of urinary incontinence ( UI) over 10 years in older women who did not report UI at baseline in 1998, to estimate the prevalence of female UI according to severity and type, and to explore potential risk factors for development of UI. Design Secondary analysis of a prospective cohort. Setting Health and Retirement Study. Participants Women participating in the Health and Retirement Study between 1998 and 2008 who did not have UI at baseline (1998). Measurements UI was defined as an answer of 'yes' to the question, 'During the last 12 months, have you lost any amount of urine beyond your control?' UI was characterized according to severity (according to the Sandvik Severity Index) and type (according to International Continence Society definitions) at each biennial follow-up between 1998 and 2008. Results In 1998, 5,552 women aged 51 to 74 reported no UI. The cumulative incidence of UI in older women was 37.2% (95% confidence interval ( CI)=36.0-38.5%). The most common incontinence type at the first report of leakage was mixed UI (49.1%, 95% CI=46.5-51.7%), and women commonly reported their symptoms at first leakage as moderate to severe (46.4%, 95% CI=43.8-49.0%). Conclusion Development of UI in older women was common and tended to result in mixed type and moderate to severe symptoms. [ABSTRACT FROM AUTHOR]

Objectives To assess the relationship between comorbid depression, diabetes mellitus ( DM), and cognitive decline in Mexican Americans aged 65 and older. Design Retrospective cohort study with longitudinal analysis. Setting Texas, New Mexico, Colorado, Arizona, and California. Participants Hispanic Established Populations for the Epidemiologic Study of the Elderly. Measurements Cognition was assessed using the Mini-Mental State Examination ( MMSE). Depression was defined as a score of 16 or greater on the Center for Epidemiologic Studies Depression Scale. DM was defined as according to self-reported history or taking insulin or oral hypoglycemic medication. Results Participants with depression and DM declined an average of 6.5 points on the MMSE; depression only, 4.4 points; DM only, 7.8 points; and neither condition, 4.2 points across the six examination waves. Participants with DM declined an average of 0.18 more points on the MMSE per year ( P = .001) than those with neither DM nor depression, and those with comorbid DM and depression declined 0.25 more points per year ( P = .002). Depression was associated with significantly greater cognitive decline ( [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 characterize the extent and nature of drug-alcohol interactions in older U.S. adults. DESIGN: Cross-sectional. SETTING: Community. PARTICIPANTS: Nationally representative population-based sample of community-dwelling older adults (N = 2,975). MEASUREMENTS: Regular drinkers were defined as respondents who consumed alcohol at least weekly. Medication use was defined as the use of a prescription or non-prescription medication or dietary supplement at least daily or weekly. Micromedex was used to determine drug interactions with alcohol and their corresponding severity. RESULTS: One thousand one hundred six (41%) of the participants consumed alcohol regularly, and 567 (20%) were at-risk for a drug-alcohol interaction because they were regular drinkers and concurrently using alcohol-interacting medications. More than 90% of these interactions were of moderate or major severity. Antidepressants and analgesics were the most commonly used alcohol-interacting medications in regular drinkers. Older adult men with multiple chronic conditions had the highest prevalence of potential drug-alcohol interactions. CONCLUSION: The potential for drug-alcohol interactions in the older U.S. adult population may have important clinical implications. Efforts to better understand and prevent the use of alcohol-interacting medications by regular drinkers, particularly heavy drinkers, are warranted in this population. [ABSTRACT FROM AUTHOR]

Objectives To compare processes and cost of care of older adults with diabetes mellitus cared for by nurse practitioners ( NPs) with processes and cost of those cared for by primary care physicians ( PCPs). Design Retrospective cohort study. Setting Primary care in communities. Participants Individuals with a diagnosis of diabetes mellitus in 2009 who received all their primary care from NPs or PCPs were selected from a national sample of Medicare beneficiaries (N = 64,354). Measurements Propensity score matching within each state was used to compare these two cohorts with regard to rate of eye examinations, low-density lipoprotein cholesterol ( LDL-C) and glycosylated hemoglobin (HbA1C) testing, nephropathy monitoring, specialist consultation, and Medicare costs. The two groups were also compared regarding medication adherence and use of statins, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (for individuals with a diagnosis of hypertension), and potentially inappropriate medications ( PIMs). Results Nurse practitioners and PCPs had similar rates of LDL-C testing (odds ratio (OR) = 1.01, 95% confidence interval (CI) = 0.94-1.09) and nephropathy monitoring (OR = 1.05, 95% CI = 0.98-1.03), but NPs had lower rates of eye examinations (OR = 0.89, 95% CI = 0.84-0.93) and HbA1C testing (OR = 0.88, 95% CI = 0.79-0.98). NPs were more likely to have consulted cardiologists (OR = 1.29, 95% CI = 1.21-1.37), endocrinologists (OR = 1.64, 95% CI = 1.48-1.82), and nephrologists (OR = 1.90, 95% CI = 1.67-2.17) and more likely to have prescribed PIMs (OR = 1.07, 95% CI = 1.01-1.12). There was no statistically significant difference in adjusted Medicare spending between the two groups ( P = .56). Conclusion Nurse practitioners were similar to PCPs or slightly lower in their rates of diabetes mellitus guideline-concordant care. NPs used specialist consultations more often but had similar overall costs of care to PCPs. [ABSTRACT FROM AUTHOR]

Objectives To assess trends in benzodiazepine use from 2001 to 2010 in older adults in U.S. ambulatory clinics and emergency departments ( EDs). Design Retrospective analysis. Setting 2001 to 2010 National Ambulatory Medical Care Survey ( NAMCS) and National Hospital Ambulatory Medical Care Survey ( NHAMCS). Participants Individuals aged 65 and older for whom the reason for visit might prompt a physician to use a benzodiazepine (e.g., anxiety, detoxification, back sprain). Measurements The NAMCS and NHAMCS were used to evaluate U.S. ambulatory clinic and ED visits. Encounters involving individuals aged 65 and older for whom a benzodiazepine might be prescribed were analyzed. Trends in benzodiazepine use in these visits were explored, and predictors of use were assessed using survey-weighted chi-square tests and logistic regression. Results From 2001 to 2010, benzodiazepines were used in 16.6 million of 133.3 million ambulatory clinic visits and 1.9 million of 18.1 million ED visits with the selected reasons for the visits. There was no change in benzodiazepine use in either setting over the study period, although benzodiazepine use for those aged 85 and older increased from 8.9% to 19.3% in ambulatory clinics and 10.1% to 17.2% in EDs. Individuals visiting clinics with anxiety were five times as likely to receive benzodiazepines (odds ratio ( OR) = 4.8), and those in EDs were twice as likely ( OR = 2.3). Conclusion Despite safety concerns, benzodiazepine use in older adults in U.S. ambulatory clinics and EDs did not change from 2001 to 2010. In the oldest individuals, who are at higher risk of adverse events, a greater increase was seen than in those aged 65 to 84. Additional measures may be needed to promote alternatives to benzodiazepines. [ABSTRACT FROM AUTHOR]

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

Objectives To describe transitions in care for older adults with dementia identified from a nationally representative cohort and to describe transition rates in those with more-severe levels of cognitive and functional impairment. Design Longitudinal cohort study. Setting Health and Retirement Study ( HRS). Participants HRS respondents aged 65 and older whose survey data were linked with Medicare claims from 1999 to 2008 (N = 16,186). Measurements Transitions in care between home, home with formal services, hospital, and nursing facility care; cognitive function; activities of daily living; and mortality. Results The 3,447 (21.3%) HRS subjects who were ever diagnosed with dementia experienced frequent transitions. Of subjects transitioning from a hospital stay, 52.2% returned home without home care services, and 33.8% transitioned to a nursing facility. Of subjects transitioning from a nursing facility, 59.2% transitioned to the hospital, and 25.3% returned home without services. There were 2,139 transitions to death, and 58.7% of HRS subjects with dementia died at home. Even in persons with moderate to severe dementia, multiple transitions in care were documented, including transitions from the hospital to home and back to the hospital. Conclusion In this nationally representative sample of older adults, subjects diagnosed with dementia experience frequent transitions. Persons with dementia who are cared for at home and who transition back to home often have moderate to severe impairments in function and cognition. [ABSTRACT FROM AUTHOR]

Objectives To describe objectively determined sedentary and activity outcomes (volume and pattern) and their associations with cardiometabolic risk biomarkers in individuals with and without mobility disability. Design Cross-sectional. Setting Population based. Participants Community-dwelling older adults (≥60) living in the United States who were participants in the 2003 to 2004 or 2005 to 2006 National Health and Nutrition Examination Survey. Participants were classified as with or without mobility disability according to responses to self-reported questions about ability to walk, climb stairs, and/or use of ambulatory aids. Measurements Accelerometer-derived sedentary and activity variables for volume (time in sedentary (<100 counts per minute (cpm)), very light- (100-759 cpm), light- (760-1,951 cpm), and moderate- to vigorous- (≥1,952 cpm) intensity activity and pattern (number of breaks from sedentary time, duration of sedentary bouts, duration of activity bouts). Survey-weighted regression models, adjusted for age, sex, ethnicity, education, and smoking, were used to examine the associations between pattern of activity and cardiometabolic health risk factors (blood pressure, waist circumference, high-density lipoprotein cholesterol). Results Of the 2,017 participants, 547 were classified as having a mobility disability. Participants with mobility disability had more sedentary time and less active time than those without. Sedentary bouts were longer and active bouts shorter in those with disability. The total number of sedentary breaks (transitions from sedentary to nonsedentary) differed between groups after adjustment for total sedentary time. Fewer breaks, longer sedentary bouts, and shorter activity bouts were associated with higher average waist circumference regardless of disability status. Conclusion This study provides rationale for the development and testing of interventions to change the pattern of activity (e.g., include more breaks and longer activity bout durations) in older adults with mobility disability. [ABSTRACT FROM AUTHOR]

Objectives To examine receipt of colorectal cancer ( CRC) screening according to age and life expectancy ( LE) in adults aged 65 and older. Design Population-based survey. Setting United States. Participants Community dwelling adults aged 65 and older who participated in the 2008 or 2010 National Health Interview Survey (N = 7,747). Measurements Receipt of CRC screening (e.g., colonoscopy within 10 years) was examined according to age and LE (≥10 and <10 years), adjusting for sociodemographic characteristics and survey year. Frequency of CRC screening was also examined according to age and LE at time of screening (e.g., age at colonoscopy rather than at interview). Participants screened when they were aged 75 and older or had less than a 10-year LE were considered to have received screening inconsistent with guidelines. Results Overall, 38.5% of participants had less than a 10-year LE; 40.2% were aged 75 and older, and 56.3% had received recent CRC screening (90.1% by colonoscopy). CRC screening was higher in 2010 (58.9%) than 2008 (53.7%, P <.001) and was associated with longer LE and younger age, although 51.1% of adults aged 75 and older reported receiving CRC screening, as did 50.9% of adults with less than a 10-year LE. Based on age and LE at time of screening (rather than at interview), 28.4% of CRC screening of adults aged 65 and older was targeted to those aged 75 and older and those with less than a 10-year LE. Of adults aged 65 to 75 with a 10-year LE or more (adults recommended for screening by guidelines), 39.2% had not recently been screened. Conclusion Older adults with little chance of benefit because of limited LE commonly undergo CRC screening, whereas many adults aged 65 to 75 with a 10-year LE or greater are not screened. [ABSTRACT FROM AUTHOR]

The purpose of the study was to examine the effects of participation in the Living Legends program upon health science students' image of older adults and interest in working with older people. A multisite quasi-experimental control group design with a connected qualitative component was used. Program sites included three Naturally Occurring Retirement Communities (NORCs) and one senior center. Health science students (n = 43) from two universities and two community colleges and community-dwelling seniors (n = 39) participated in the program. A baseline questionnaire was used to ascertain demographic characteristics and prior type and amount of contact with older adults. The Image of Aging Scale and Likert-style questions to measure interest in working with older adults were the primary outcome measures. Written responses to program experiences were also collected. Analysis of covariance was used to compare changes in Image of Aging subscale scores from pre- to posttest. Mean change in positive image of older adults subscale scores was 4.6 (SD = 4.4) for the intervention group and −0.6 (SD = 4.8) for the control group. The difference between groups was significant (F = 22.0, P < .001), and the effect size was large (Cohen's d = 1.07). Nine of the 22 students in the intervention group had a greater interest in working with seniors after the program. Qualitative themes that emerged included a positive and beneficial experience, life lessons, seeing the person beyond the visible, power of the written word, and shared lives. Living Legends is an effective program to enhance positive images of older adults in future healthcare professionals and may have a positive impact on some students with regard to interest in working with older adults. [ABSTRACT FROM AUTHOR]

Objectives To examine the association between sleep complaints, use of sleep-promoting medications, and persistent severe fatigue ( PSF). Design Analysis of data from the National Health Aging Trends Study. Setting Contiguous United States. Participants A representative sample of Medicare beneficiaries aged 65 and older. Measurements Difficulty initiating sleep, difficulty staying asleep, use of sleep-promoting medications, demographic characteristics, presence of pain, use of pain medications, depression, chronic medical disease, physical activity level, and Short Physical Performance Battery score measured at baseline. The outcome of interest was PSF (fatigue that limits daily activities reported at baseline and 12-month follow-up). Results Of 8,245 participants at baseline, 7,075 completed 12-month follow-up; 31% reported severe fatigue at baseline and 31% at follow-up, and 19% reported PSF. In a logistic regression model, difficulty staying asleep some nights (odds ratio ( OR) = 1.32, 95% confidence interval ( CI) = 1.08-1.60) and most nights or every night ( OR = 1.40, 95% CI = 1.09-1.79) and use of sleep-promoting medications most nights or every night ( OR = 1.35, 95% CI = 1.08-1.67) independently predicted PSF. Conclusion The results indicate greater risk of PSF in older adults with difficulty staying asleep and those who use sleep-promoting medications. These findings underscore the significance of sleep problems and present potential targets for interventional studies that aim to improve fatigue in older adults. [ABSTRACT FROM AUTHOR]

Objectives To describe suicide-related exposures in older persons according to sex, age, and substance category reported to U.S. poison control centers ( PCCs) and report the crude relative risk ( RR) of major effects and death from pharmaceuticals and nonpharmaceutical substances after single- and multiple-substance exposures. Design Cross-sectional analysis of American Association of Poison Control Centers National Poison Data System ( NPDS) data. Setting Calls to U.S. PCCs. Participants NPDS cases involving individuals aged 60 and older with an exposure to a pharmaceutical or nonpharmaceutical substance and suicide as the reason (n = 46,494). Measurements Major effect and death probabilities for single- and multiple-substance exposures to pharmaceuticals and nonpharmaceuticals were determined. In the NPDS, a major effect is defined as symptoms or signs that are life-threatening or resulted in significant residual disability or disfigurement. Crude RRs of major effects or death were estimated for single and multiple pharmaceutical substances in comparison with nonpharmaceutical substances. Results Single-substance exposures occurred in 53.3% of cases. Overall, 92.3% involved pharmaceuticals and 64.4% involved women. In the total sample, 12.7% (5,895/46,494) of exposures resulted in major effect, and 1.9% (884/46,494) resulted in death. The crude RR of major effects in single-substance pharmaceutical exposures was significantly lower than with nonpharmaceutical exposures ( RR = 0.54, 95% confidence interval ( CI) = 0.49-0.59), as was death ( RR = 0.25, 95% CI = 0.20-0.30). For multiple-substance exposures, the crude RR of major effects from pharmaceuticals was similar to that for nonpharmaceuticals ( RR = 0.92, 95% CI = 0.80-1.06), whereas the crude RR of death from pharmaceuticals was significantly lower ( RR = 0.55, 95% CI = 0.40-0.77). Conclusion These findings can inform suicide prevention strategies that focus on decreasing at-risk older adults' access to dangerous medications and chemicals in the home. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the relationship between life-space (the extent, frequency, and independence of an individual's movement) and mortality in older men. Design Prospective cohort study. Setting Six U.S. clinical sites. Participants Men aged 71 to 98 followed from 2007 to 2011 (N = 3,892). Measurements Life-space during the past month was assessed as 0 (daily restriction to one's bedroom) to 120 (daily trips outside one's town without assistance) and categorized into 20-point intervals. The primary outcome was noncancer mortality, and secondary outcomes were all-cause, cardiovascular, cancer, and noncardiovascular noncancer mortality. Results Over 2.7 years (2007-2011), 373 (9.6%) men died, 230 from noncancer causes. Unadjusted risk of noncancer mortality was 41.2% in men with the lowest level of life-space (0-20 points, n = 34) and 2.4% in men with the highest level of life-space (101-120 points, n = 868), a 17 times difference. In multivariable-adjusted models, there was a strong linear trend between decreasing life-space and increasing risk of noncancer mortality ( P = .005). Risk of noncancer mortality was 3.8 times higher (95% confidence interval ( CI)=1.3,11.5) in men with the lowest life-space than in those with the highest life-space. Risk of noncancer mortality was 1.3 times higher (95% CI=1.1-1.5) for each standard-deviation (24 point) decrease in life-space. Risk of noncancer mortality was 1.5 times higher (95% CI=1.0-2.3) in men who did not travel beyond their neighborhood without assistance (n = 471). Results were similar for all-cause mortality and did not change after control for chronic disease burden. Conclusion Life-space predicted a variety of mortality endpoints in older men; scores of 40 or less were associated with mortality independent of other risk factors. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the independent and joint effects of C-reactive protein ( CRP) and 25- OH vitamin D (25( OH) D) levels on mobility disability in older persons. Design U. S. population-based cross-sectional study. Setting National Health and Nutrition Examination Surveys (2001-2002). Participants Individuals aged 50 and older (N = 1,826). Measurements C-reactive protein (mg/dL), with high CRP defined as ≥0.2 mg/dL, and 25( OH) D levels (ng/mL) operationalized as severe deficiency (<10 ng/mL), deficiency (10-19.9 ng/mL), insufficiency (20-29.9 ng/mL), and normal (≥30 ng/mL). Mobility disability was operationalized as gait speed of <0.8 m/s while completing a 20-foot walk (6.1 m). Results High CRP and low 25( OH) D levels were associated with slow gait speed. Individuals with high CRP levels and severe vitamin D deficiency were more likely to have slow gait speed than were those with neither risk factor (odds ratio = 3.54, 95% confidence interval = 1.42-8.84, P = .007). A significant positive association between vitamin D level and gait speed was found only in those with high CRP in stratified analyses. Whites and blacks showed similar findings as the overall population. Conclusion These findings provide evidence of a potential joint effect of vitamin D and CRP on gait speed, suggesting that evaluation and correction of vitamin D levels may be especially important in individuals with high CRP levels. [ABSTRACT FROM AUTHOR]

Objectives To examine the association between Beers criteria sedative medications and delirium in a large cohort of hospitalized elderly adults with common medical conditions. Design Retrospective cohort and nested case-control studies. Setting 374 U. S. hospitals. Participants All individuals aged 65 and older admitted to the hospital between September 2003 and June 2005 with one of six principal diagnoses (acute myocardial infarction, chronic obstructive pulmonary disease, community-acquired pneumonia, congestive heart failure, ischemic stroke, urinary tract infection). Measurements Primary outcome was presumed hospital-acquired delirium, defined as initiation of an antipsychotic medication or restraints on hospital Day 3 or later. Logistic and proportional hazards regression were used to model the associations between sedative exposure and delirium. Results The dataset contained 225,028 participants (median age 82; 58% female). Four percent fit the definition of hospital-acquired delirium (median onset Day 5). In all, 38,883 (17%) participants received one or more sedative medications. In the cohort study, diphenhydramine (adjusted odds ratio ( AOR) = 1.22, 95% confidence interval ( CI) = 1.09-1.36) and short-acting benzodiazepines ( AOR = 1.18, 95% CI = 1.03-1.34) were associated with greater risk of subsequent delirium. In the nested case-control study, diphenhydramine, short- and long-acting benzodiazepines and promethazine were associated with delirium. Amitriptyline and muscle relaxants were not associated with delirium in either study. Confounding by indication could not be excluded for drugs that are sometimes used improperly to treat delirium. Conclusion An association was found between several Beers criteria sedative medications and delirium in hospitalized medical patients. Given the prevalence of these medications and the morbidity associated with delirium, further investigation into the appropriateness of such prescribing is warranted. [ABSTRACT FROM AUTHOR]

Objectives To determine whether pain predicts future activity of daily living ( ADL) disability or death in individuals aged 60 and older. Design Prospective cohort study. Setting The 1998 to 2008 Health and Retirement Study ( HRS), a nationally representative study of older community-living individuals. Participants Twelve thousand six hundred thirty-one participants in the 1998 HRS aged 60 and older who did not need help in any ADL. Measurements Participants reporting that they had moderate or severe pain most of the time were defined as having significant pain. The primary outcome was time to development of ADL disability or death over 10 yrs, assessed at five successive 2-year intervals. ADL disability was defined as needing help performing any ADL: bathing, dressing, transferring, toileting, eating, or walking across a room. A discrete hazards survival model was used to examine the relationship between pain and incident disability over each 2-year interval using only participants who started the interval with no ADL disability. Several potential confounders were adjusted for at the start of each interval: demographic factors, seven chronic health conditions, and functional limitations ( ADL difficulty and difficulty with five measures of mobility). Results At baseline, 2,283 (18%) participants had significant pain. Participants with pain were more likely (all P < .001) to be female (65% vs 54%), have ADL difficulty (e.g., transferring 12% vs 2%, toileting 11% vs 2%), have difficulty walking several blocks (60% vs 21%), and have difficulty climbing one flight of stairs (40% vs 12%). Over 10 years, participants with pain were more likely to develop ADL disability or death (58% vs 43%, unadjusted hazard ratio ( HR) = 1.67, 95% confidence interval ( CI) = 1.57-1.79), although after adjustment for confounders, participants with pain were not at greater risk for ADL disability or death ( HR = 0.98, 95% CI = 0.91-1.07). Adjustment for functional status almost entirely explained the difference between the unadjusted and adjusted results. Conclusion Although there are strong cross-sectional relationships between pain and functional limitations, individuals with pain are not at higher risk of subsequent disability or death after accounting for functional limitations. Like many geriatric syndromes, pain and disability may represent interrelated phenomena that occur simultaneously and require unified treatment paradigms. [ABSTRACT FROM AUTHOR]

Objectives To examine receipt of mammography screening according to life expectancy in women aged 75 and older. Design Population-based survey. Setting United States. Participants Community dwelling U.S. women aged 75 and older who participated in the 2008 or 2010 National Health Interview Survey. Measurements Using a previously developed and validated index, women were categorized according to life expectancy (>9, 5-9, <5 years). Receipt of mammography screening in the past 2 years was examined according to life expectancy, adjusting for sociodemographic characteristics, access to care, preventive orientation (e.g., receipt of influenza vaccination), and receipt of a clinician recommendation for screening. Results Of 2,266 respondents, 27.1% had a life expectancy of greater than 9 years, 53.4% had a life expectancy of 5 to 9 years, and 19.5% had a life expectancy of less than 5 years. Overall, 55.7% reported receiving mammography screening in the past 2 years. Life expectancy was strongly associated with receipt of screening ( P < .001), yet 36.1% of women with less than 5 years life expectancy were screened, and 29.2% of women with more than 9 years life expectancy were not screened. A clinician recommendation for screening was the strongest predictor of screening independent of life expectancy. Higher educational attainment, age, receipt of influenza vaccination, and history of benign breast biopsy were also independently associated with being screened. Conclusion Despite uncertainty of benefit, many women aged 75 and older are screened with mammography. Life expectancy is strongly associated with receipt of screening, which may reflect clinicians and patients appropriately considering life expectancy in screening decisions, but 36% of women with short life expectancies are still screened, suggesting that new interventions are needed to further improve targeting of screening according to life expectancy. Decision aids and guidelines encouraging clinicians to consider patient life expectancy in screening decisions may improve care. [ABSTRACT FROM AUTHOR]

Objectives To examine the association between body size and composition and erectile dysfunction ( ED) in older men. Design Cross-sectional analysis of the Osteoporotic Fractures in Men study. Setting Six U.S. clinical sites. Participants Community-dwelling men aged 65 and older. Measurements Body composition measures using anthropometry (body weight, body mass index ( BMI)) and dual X-ray absorptiometry (total body fat percentage, trunk fat percentage, ratio of trunk and total body fat). ED was assessed using the single-item Massachusetts Male Aging Study ( MMAS) scale and the five-item International Index of Erectile Function questionnaire ( IIEF-5). Results In men completing the MMAS scale (n = 4,108), prevalence of complete ED was 42%. In sexually active men completing the IIEF-5 questionnaire (n = 1,659), prevalence of moderate to severe ED was 56%. In multivariate-adjusted analyses reporting prevalence ratios ( PRs) and 95% confidence intervals ( CIs), the prevalence of MMAS-defined complete ED was significantly greater in men in the highest quartile of body weight ( PR = 1.24, 95% CI = 1.16-1.34), total body fat percentage ( PR = 1.25, 95% CI = 1.13-1.40), and trunk fat percentage ( PR = 1.24, 95% CI = 1.15-1.38), and was greater in men with a BMI greater than 30.0 kg/m2 than in those with BMI of 22.0 to 24.9 kg/m2 ( PR = 1.17, 95% CI = 1.05-1.31). Associations appeared similar for IIEF-5-defined moderate to severe ED in analyses adjusted for age and study site. Conclusion In a cohort of older men, high body weight, BMI, and total body fat percentage were independently associated with greater prevalence of moderate to severe and complete ED. Future studies should investigate whether interventions to promote weight loss and fat loss will improve erectile function in older men. [ABSTRACT FROM AUTHOR]

Objectives To determine patterns of co-occurring diseases in older adults and the extent to which these patterns vary between the young-old and the old-old. Design Observational study. Setting Department of Veterans Affairs. Participants Veterans aged 65 years and older (1.9 million male, mean age 76 ± 7; 39,000 female, mean age 77 ± 8) with two or more visits to Department of Veterans Affairs ( VA) or Medicare settings in 2007 and 2008. Measurements The presence of 23 common conditions was assessed using hospital discharge diagnoses and outpatient encounter diagnoses from the VA and Medicare. Results The mean number of chronic conditions (out of 23 possible) was 5.5 ± 2.6 for men and 5.1 ± 2.6 for women. The prevalence of most conditions increased with advancing age, although diabetes mellitus and hyperlipidemia were 11% to 13% less prevalent in men and women aged 85 and older than in those aged 65 to 74 ( P < .001 for each). In men, the most common three-way combination of conditions was hypertension, hyperlipidemia, and coronary heart disease, which together were present in 37% of men. For women, the most common combination was hypertension, hyperlipidemia, and arthritis, which co-occurred in 25% of women. Reflecting their high population prevalence, hypertension and hyperlipidemia were both present in 9 of the 15 most common three-way disease combinations in men and in 11 of the 15 most common combinations in women. The prevalence of many disease combinations varied substantially between young-old and old-old adults. Conclusions Specific combinations of diseases are highly prevalent in older adults and inform the development of guidelines that account for the simultaneous presence of multiple chronic conditions. [ABSTRACT FROM AUTHOR]

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

Objectives To determine whether recent experience and specialty choice would affect physician adherence to evidence-based guidelines. Design In a series of computer-simulated encounters, participants weighed the risk of spontaneous abdominal aortic aneurysm ( AAA) rupture against the risk of perioperative death to determine timing for elective repair. Guideline recommendations and statistical information on the risks of rupture and surgical death were provided. Setting Annual meetings of the American Geriatrics Society, American College of Surgeons, and American Society of Anesthesiologists. Participants Physicians. Intervention Before the simulation, each participant was randomly exposed to one of three simulated outcomes: death during watchful waiting ( WWD), perioperative death ( PD), or successful outcome ( SO). Measurements Adherence to recommended guidelines for AAA treatment. Results Against guideline recommendations, 67% of geriatricians, 74% of anesthesiologists, and 77% of surgeons chose surgery when the rupture risk was lower than the risk of perioperative death ( P < .05). Surgeons exposed to the WWD experience chose surgery significantly earlier than if they were exposed to a PD or SO experience ( P < .001). Anesthesiologist choices did not differ with recent experience. Conclusion Geriatrician decisions more closely followed guideline recommendations for AAA management than those of two other specialties typically involved in AAA care. A prior WWD affected surgeons most, geriatricians next, and anesthesiologists least. Geriatricians referring patients for AAA surgery should be aware of specialty-specific differences in perioperative decision behavior. [ABSTRACT FROM AUTHOR]

Objectives To determine the association between Mediterranean diet ( Med Diet) score and 20-m walking speed over 8 years. Design Health, Aging and Body Composition Study ( Health ABC) beginning in 1997/98. Setting Community. Participants Two thousand two hundred twenty-five well-functioning individuals aged 70 and older. Measurements Walking speed was assessed in relation to low, medium, and high adherence to the Med Diet (0-2, 3-5, 6-9 points, respectively). Results Individuals in the highest Med Diet adherence group were more likely to be male; less likely to smoke; and more likely to have lower body mass index, higher energy intake, and greater physical activity ( P < .05). Usual and rapid 20-m walking speed were highest in the high Med Diet adherence group than in the other groups (high, 1.19 ± 0.19 m/s; medium, 1.16 ± 0.21 m/s; low, 1.15 ± 0.19 m/s, P = .02, for usual speed; high, 1.65 ±0.30 m/s; medium, 1.59 ± 0.32 m/s; low, 1.55 ± 0.30 m/s, P = .001, for rapid speed). Over 8 years, usual and rapid 20-m walking speed declined in all Med Diet adherence groups. Higher Med Diet adherence was an independent predictor of less decline in usual 20-m walking speed ( P = .049) in generalized estimating equations adjusted for age, race, sex, site, education, smoking, physical activity, energy intake, health status, depression and cognitive score. The effect decreased after adding total body fat percentage to the model ( P = .13). Similar results were observed for Med Diet adherence and rapid 20-m walking speed; the association remained significant after adjustment for total body fat percentage ( P = .01). The interaction between time and Med Diet adherence was not significant in any of the models. Conclusion Walking speed over 8 years was faster in those with higher Med Diet adherence at baseline. The differences remained significant over 8 years, suggesting a long-term effect of diet on mobility performance with aging. [ABSTRACT FROM AUTHOR]

Objectives To examine the characteristics of hospice enrollees with dementia who were discharged alive because their condition stabilized or improved and predictors of death in the year after discharge. Design Cross-sectional analysis of clinical and administrative data. Setting For-profit hospice provider. Participants Hospice enrollees aged 65 and older with an admission diagnosis of dementia who died or were discharged alive because their condition stabilized or improved between January 1, 1999, and December 31, 2003. Measurements Demographic variables and hospice length of stay; data did not include functional status or comorbidities. Results Of 24,111 enrollees with dementia, 1,204 (5.0%) were discharged alive because their condition stabilized or improved; the remainder died while receiving hospice. The median length of stay for those who died was 12 versus 236 days for those discharged alive. Those discharged alive were more likely to be female or have a length of stay exceeding 180 days and less likely to be in the oldest age group (≥85), be African American, or reside in a nursing home. In a subgroup of 303 patients discharged alive, 75.5% were still alive at 1 year; none of the demographic variables were associated with death after hospice discharge. Conclusion A small proportion of hospice enrollees with dementia was discharged alive. Most died shortly after enrollment. Future research should examine other factors that may predict which hospice enrollees with dementia are likely to be discharged alive and their subsequent trajectory, such as functional status, comorbidities, and preferences for care. [ABSTRACT FROM AUTHOR]

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

Objectives To investigate patterns in prevalences of chronic medical conditions over the age span of long-term stay nursing home residents and between the sexes with data from the 2004 National Nursing Home Survey ( NNHS). Design Retrospective, cross-sectional study. Setting U.S. nursing homes. Participants Nationally representative sample comprising 11,788 long-term stay residents (3,003 (25%) men, 8,785 (75%) women) aged 65 and older. Measurements Clinical Classifications Software was used to group International Classification of Diseases, Ninth Revision, codes to identify the 20 most-prevalent chronic medical conditions. SAS survey procedures were used to account for design effects of stratification and clustering to generate nationally representative estimates of prevalences of medical conditions. Results Average age was 84, with women older than men (85 vs 81, P = .02) and 67% of women aged 80 to 95. Women required more assistance with activities of daily living. The most frequent chronic medical conditions were hypertension (men 53%, women 56%), dementia (men 45%, women 52%), depression (men 31%, women 37%), arthritis (men 26%, women 35%), diabetes mellitus (men 26%, women 23%), gastroesophageal reflux disease ( GERD) (men 23%, women 23%), atherosclerosis (men 24%, women 20%), congestive heart failure ( CHF) (men 18%, women 21%), cerebrovascular disease ( CVD) (men 24%, women 19%), and anemia (men 17%, women 20%). Sex differences in prevalences existed for all but constipation, GERD, and hypertension. Diabetes mellitus, CVD, and lipid disorders decreased with age in men and women. Atrial fibrillation, anemia, arthritis, CHF, dementia, and thyroid disease increased with age in men and women. Age-related patterns differed between the sexes for diabetes mellitus, hypertension, and Parkinson's disease. Conclusion The profile of chronic medical conditions varies over the age span of nursing home residents and differs between men and women. This knowledge should guide educational and care efforts in long-term care. [ABSTRACT FROM AUTHOR]

Objectives To examine the association between atypical antipsychotic medications and incident treatment for diabetes mellitus or hyperlipidemia in elderly adults without diagnoses of schizophrenia or bipolar disorder. Design Two case-control studies using medical and pharmacy claims data. Setting United States managed care population from multiple insurance plans. Participants Individuals aged 65 and older enrolled in a Medicare Advantage or commercial (health maintenance organization) managed care health plan in the western United States with no claims indicating diagnosis of schizophrenia or bipolar disorder in the 1 year pre-index period. Cases were defined as persons newly initiated on an antidiabetic (n = 13,075) or antihyperlipidemic (n = 63,829) medication on the index date. For the new diabetes mellitus analysis, 65,375 controls were matched to cases based on age, sex, health-plan type, and index date year. In the new hyperlipidemia analysis, 63,829 controls were matched to cases based on the same variables. Measurements Conditional logistic regressions were performed to determine the odds of initiated antidiabetic or antihyperlipidemic medication for participants exposed to atypical antipsychotics compared with those with no exposure. The models included comorbidities possibly associated with the outcome. Results Exposure to atypical antipsychotics was associated with significantly greater adjusted odds of starting an antidiabetic medication (1.32, 95% confidence interval ( CI) = 1.10-1.59) but significantly lower odds of starting an antihyperlipidemic medication (0.76, 95% CI = 0.67-0.87). Conclusion Use of atypical antipsychotics in older adults for conditions other than schizophrenia and bipolar disorder was associated with incident treatment of diabetes mellitus but not of hyperlipidemia, suggesting that older adults may be susceptible to the adverse metabolic consequences of these agents. [ABSTRACT FROM AUTHOR]

Objectives To present findings on past-year medical conditions associated with lifetime trauma exposure and full and partial posttraumatic stress disorder ( PTSD) in a nationally representative sample of U.S. older adults. Design Face-to-face diagnostic interviews. Setting Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Participants Nine thousand four hundred sixty-three adults aged 60 and older. Measurements Logistic regression analyses adjusting for sociodemographic characteristics and psychiatric comorbidity were used to evaluate associations between PTSD status and past-year medical disorders; linear regression models evaluated associations with past-month physical functioning. Results After adjustment for sociodemographic characteristics and comorbid lifetime mood, anxiety, substance use, attention-deficit/hyperactivity, and personality disorders, respondents with lifetime PTSD were more likely than respondents who reported experiencing one or more traumatic life events but who did not meet lifetime criteria for full or partial PTSD (trauma controls) to report being diagnosed with hypertension, angina pectoris, tachycardia, other heart disease, stomach ulcer, gastritis, and arthritis (odds ratios ( ORs) = 1.3-1.8) by a healthcare professional; they also scored lower on a measure of physical functioning than controls and respondents with partial PTSD. Respondents with lifetime partial PTSD were more likely than controls to report past-year diagnoses of gastritis ( OR = 1.7), angina pectoris ( OR = 1.5), and arthritis ( OR = 1.4) and reported worse physical functioning. Number of lifetime traumatic event types was associated with most of the medical conditions assessed; adjustment for these events reduced the magnitudes of and rendered nonsignificant most associations between PTSD status and medical conditions. Conclusion Older adults with lifetime PTSD have high rates of several physical health conditions, many of which are chronic disorders of aging, and poorer physical functioning. Older adults with lifetime partial PTSD have higher rates of gastritis, angina pectoris, and arthritis and poorer physical functioning. [ABSTRACT FROM AUTHOR]

Objectives To examine the effect of obesity on the propensity of older adults to fall, sustain a fall-related injury, and develop disability in activities of daily living ( ADLs) after a fall. Design Longitudinal population-based survey. Setting Five waves of the Health and Retirement Study ( HRS), 1998-2006. Participants Ten thousand seven hundred fifty-five respondents aged 65 and older in 31,602 person-intervals. Measurements Falls within any 2-year interval (9,621 falls). Injuries requiring medical attention (3,130 injuries). Increased ADL disability after a fall within any 2-year interval (2,162 events). Underweight and three classes of obesity (body mass index ( BMI) 30.0-34.9 kg/m2, Class 1) 35.0-39.9 kg/m2, Class 2; ≥40.0 kg/m2, Class 3), calculated from self-reported height and weight. Self-reported presence of lower body limitation, pain, dizziness, or vision problems. Self-reported doctor's diagnosis of diabetes mellitus, stroke, or arthritis. Results Compared with normal-weight respondents, the odds ratios ( OR) for risk of falling were 1.12 (95% confidence interval ( CI) = 1.01-1.24) for obesity Class 1, 1.26 (95% CI = 1.05-1.51) for obesity Class 2, and 1.50 (95% CI = 1.21-1.86) for obesity Class 3. Conditional on falling, only obesity Class 3 was related to a lower propensity for a fall-related injury ( OR = 0.62, 95% CI = 0.44-0.87). Obesity Classes 1 and 2 were associated with a higher risk of greater ADL disability after a fall than normal-weight respondents ( OR = 1.17, 95% CI = 1.02-1.34; OR = 1.39, 95% CI = 1.10-1.75, respectively). Being underweight was not related to risk of falling or to reported injury or greater ADL limitation after a fall. The presence of measured health problems and chronic conditions was associated with greater risk of falling and, of those who fell, greater ADL limitation but not serious injury. Conclusion Obesity appears to be associated with greater risk of falling in older adults, as well as a higher risk of greater ADL disability after a fall. Obesity (BMI ≥ 40 kg/m2) may reduce the risk of injury from a fall. Further investigation of the mechanisms of obesity on falls and related health outcomes is warranted. [ABSTRACT FROM AUTHOR]

Objectives To describe the prevalence of unplanned hospitalizations caused by adverse drug reactions ( ADRs) in older veterans and to examine the association between this outcome and polypharmacy after controlling for comorbidities and other patient characteristics. Design Retrospective cohort. Setting Veterans Affairs Medical Centers. Participants Six hundred seventy-eight randomly selected unplanned hospitalizations of older (aged ≥ 65) veterans between October 1, 2003, and September 30, 2006. Measurements Naranjo ADR algorithm, ADR preventability, and polypharmacy (0-4, 5-8, and ≥9 scheduled medications). Results Seventy ADRs involving 113 drugs were found in 68 (10%) hospitalizations of older veterans, of which 25 (36.8%) were preventable. Extrapolating to the population of more than 2.4 million older veterans receiving care during the study period, 8,000 hospitalizations may have been unnecessary. The most common ADRs that occurred were bradycardia (n = 6; beta-blockers, digoxin), hypoglycemia (n = 6; sulfonylureas, insulin), falls (n = 6; antidepressants, angiotensin-converting enzyme inhibitors), and mental status changes (n = 6; anticonvulsants, benzodiazepines). Overall, 44.8% of veterans took nine or more outpatient medications and 35.4% took five to eight. Using multivariable logistic regression and controlling for demographic, health-status, and access-to-care variables, polypharmacy (≥9 and 5-8) was associated with greater risk of ADR-related hospitalization (adjusted odds ratio ( AOR) = 3.90, 95% confidence interval ( CI) = 1.43-10.61 and AOR = 2.85, 95% CI = 1.03-7.85, respectively). Conclusion ADRs, determined using a validated causality algorithm, are a common cause of unplanned hospitalization in older veterans, are frequently preventable, and are associated with polypharmacy. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the prevalence and effect of overactive bladder (OAB) on healthcare-seeking behavior, mental health, and generic and condition-specific health-related quality of life (HRQL) in older adults. DESIGN: Secondary analysis of the U.S. sample of the Epidemiology of Lower Urinary Tract Symptoms (EpiLUTS) study-a population-based, cross-sectional, Internet-based survey. SETTING: Community. PARTICIPANTS: Two thousand four hundred eighty-five men and 2,877 women aged 65 and older. MEASUREMENTS: Prevalence and effect on HRQL of urinary symptoms, including OAB. OAB was defined as the presence of urinary urgency and/or urinary urgency incontinence. Descriptive analyses and subgroup comparisons were conducted to evaluate the prevalence of OAB in men and women aged 65 and older and the effect of OAB on various aspects of HRQL. RESULTS: The survey response rate was 46.9% of men and 61.0% of women. Prevalence rates of OAB at least 'sometimes' were 40.4% in men and 46.9% in women. OAB was associated with significant impairments across all domains of patient-reported outcomes, including general HRQL (Medical Outcomes Study 12-item Short-Form Survey), ratings of anxiety and depression (Hospital Anxiety and Depression Scale), and urinary condition-specific outcomes (Overactive Bladder Questionnaire Short Form and Patient Perception of Bladder Condition) ( P<.001). CONCLUSION: OAB is common in older adults in the United States and is associated with substantial impairment in mental health and HRQL, but rates of treatment seeking behavior are low. Older patients should be assessed for OAB. [ABSTRACT FROM AUTHOR]