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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., (© 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.)

This article summarizes the presentations and recommendations of the tenth annual American Geriatrics Society and National Institute on Aging Bench-to-Bedside research conference, "Sensory Impairment and Cognitive Decline," on October 2-3, 2017, in Bethesda, Maryland. The risk of impairment in hearing, vision, and other senses increases with age, and almost 15% of individuals aged 70 and older have dementia. As the number of older adults increases, sensory and cognitive impairments will affect a growing proportion of the population. To limit its scope, this conference focused on sensory impairments affecting vision and hearing. Comorbid vision, hearing, and cognitive impairments in older adults are more common than would be expected by chance alone, suggesting that some common mechanisms might affect these neurological systems. This workshop explored the mechanisms and consequences of comorbid vision, hearing, and cognitive impairment in older adults; effects of sensory loss on the aging brain; and bench-to-bedside innovations and research opportunities. Presenters and participants identified many research gaps and questions; the top priorities fell into 3 themes: mechanisms, measurement, and interventions. The workshop delineated specific research questions that provide opportunities to improve outcomes in this growing population. J Am Geriatr Soc 66:2052-2058, 2018.

The article highlights the U13 Bench-to-Bedside (B2B) conference series, a collaborative effort by the American Geriatrics Society (AGS) and the National Institute on Aging. Topics include the transition of the AGS/National Institute on Aging (NIA) U13 B2B conference series from 2004 to 2017, progressive exploration of key issues in geriatrics reflected in the series of conferences, and an overview of the conferences in the series from 2018 to 2023.

ObjectivesTo evaluate the association between six nondisease-specific problems (problems that cross multiple domains of health) and mortality in middle-aged and older adults.DesignProspective, observational cohort.SettingU.S. population sample.ParticipantsParticipants included 23,669 black and white U.S. adults aged 45 and older enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study.MeasurementsNondisease-specific problems included cognitive impairment, depressive symptoms, exhaustion, falls, impaired mobility, and polypharmacy. Age-stratified (

This report summarizes the presentations, discussions, and recommendations of the most recent American Geriatrics Society and National Institute on Aging research conference, "Cancer and Cardiovascular Disease," on October 18–19, 2021. The purpose of this virtual meeting was to address the interface between cancer and heart disease, which are the two leading causes of death among older Americans. Age‐related physiologic changes are implicated in the pathogenesis of both conditions. Emerging data suggest that cancer‐related cardiovascular disease (CVD) involves disrupted cell signaling and cellular senescence. The risk factors for CVD are also risk factors for cancer and an increased likelihood of cancer death, and people who have both cancer and CVD do more poorly than those who have only cancer or only CVD. Issues addressed in this bench‐to‐bedside conference include mechanisms of cancer and CVD co‐development in older adults, cardiotoxic effects of cancer therapy, and management of comorbid cancer and CVD. Presenters discussed approaches to ensure equitable access to clinical trials and health care for diverse populations of adults with CVD and cancer, mechanisms of cancer therapy cardiotoxicity, and management of comorbid CVD and cancer, including the role of patient values and preferences in treatment decisions. Workshop participants identified many research gaps and questions that could lead to an enhanced understanding of comorbid CVD and cancer and to better and more equitable management strategies. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Defining common patterns of recovery after an acute health stressor (resiliency groups) has both clinical and research implications. We sought to identify groups of patients with similar recovery patterns across 10 outcomes following hip fracture (stressor) and to determine the most important predictors of resiliency group membership. DESIGN: Secondary analysis of three prospective cohort studies. SETTING: Participants were recruited from various hospitals in the Baltimore Hip Studies network and followed for up to 1 year in their residence (home or facility). PARTICIPANTS: Community‐dwelling adults aged 65 years or older with recent surgical repair of a hip fracture (n = 541). MEASUREMENTS: Self‐reported physical function and activity measures using validated scales were collected at baseline (within 15‐22 d of fracture), 2, 6, and 12 months. Physical performance tests were administered at all follow‐up visits. Stressor characteristics, comorbidities, and psychosocial and environmental factors were collected at baseline via participant report and chart abstraction. Latent class profile analysis was used to identify resiliency groups based on recovery trajectories across 10 outcome measures and logistic regression models to identify factors associated with those groups. RESULTS: Latent profile analysis identified three resiliency groups that had similar patterns across the 10 outcome measures and were defined as "high resilience" (n = 163 [30.1%]), "medium resilience" (n = 242 [44.7%]), and "low resilience" (n = 136 [25.2%]). Recovery trajectories for the outcome measures are presented for each resiliency group. Comparing highest with the medium‐ and low‐resilience groups, self‐reported pre‐fracture function was by far the strongest predictor of high‐resilience group membership with area under the curve (AUC) of.84. Demographic factors, comorbidities, stressor characteristics, environmental factors, and psychosocial characteristics were less predictive, but several factors remained significant in a multivariable model (AUC =.88). CONCLUSION: These three resiliency groups following hip fracture may be useful for understanding mediators of physical resilience. They may provide a more detailed description of recovery patterns in multiple outcomes for use in clinical decision making. J Am Geriatr Soc 67:2519–2527, 2019 [ABSTRACT FROM AUTHOR]

Objectives To prioritize research topics relevant to the care of the growing population of older adults with multiple chronic conditions ( MCCs). Design Survey of experts in MCC practice, research, and policy. Topics were derived from white papers, funding announcements, or funded research projects relating to older adults with MCCs. Setting Survey conducted through the Health Care Systems Research Network ( HCSRN) and Claude D. Pepper Older Americans Independence Centers ( OAICs) Advancing Geriatrics Infrastructure and Network Growth Initiative, a joint endeavor of the HCSRN and OAICs. Participants Individuals affiliated with the HCSRN or OAICs and national MCC experts, including individuals affiliated with funding agencies having MCC-related grant portfolios. Measurements A 'top box' methodology was used, counting the number of respondents selecting the top response on a 5-point Likert scale and dividing by the total number of responses to calculate a top box percentage for each of 37 topics. Results The highest-ranked research topics relevant to the health and healthcare of older adults with MCCs were health-related quality of life in older adults with MCCs; development of assessment tools (to assess, e.g., symptom burden, quality of life, function); interactions between medications, disease processes, and health outcomes; disability; implementation of novel (and scalable) models of care; association between clusters of chronic conditions and clinical, financial, and social outcomes; role of caregivers; symptom burden; shared decision-making to enhance care planning; and tools to improve clinical decision-making. Conclusion Study findings serve to inform the development of a comprehensive research agenda to address the challenges relating to the care of this 'high-need, high-cost' population and the healthcare delivery systems responsible for serving it. [ABSTRACT FROM AUTHOR]

Objectives To examine whether performance on a brief memory test is related to functional outcomes in older individuals undergoing low-vision rehabilitation ( LVR) for macular disease. Design Observational cohort study of individuals receiving outpatient LVR. Setting Academic center. Participants Ninety-one individuals (average age 80.1) with macular disease. Measurements Memory was assessed at baseline using a 10-word list; memory deficit was defined as immediate recall of two or fewer words. Vision-related function was measured using the 25-item Visual Function Questionnaire ( VFQ-25) administered at baseline and during subsequent interviews (mean follow-up, 115 days). Linear mixed models were constructed to compare average trajectories of four VFQ-25 subscales: near activities, distance activities, dependency, and role difficulty. Results The 29.7% of participants with memory deficits tended to decline in ability to accomplish activities that involved near vision. Controlling for age, sex, and education, the functional trajectory of participants with memory deficit differed significantly from that of those with better memory ( P = .002), who tended to report improvements in ability to accomplish near activities. Conclusion Of older adults receiving LVR for macular disease, those with memory deficits experienced worse functional trajectories in their ability to perform specific visually mediated tasks. A brief memory screen may help explain variability in rehabilitation outcomes and identify individuals who might require special accommodations. [ABSTRACT FROM AUTHOR]

Objectives To describe the association between an increasing number of coexisting conditions and locus of control ( LOC), a psychological construct reflecting the degree to which one perceives circumstances to be controlled by personal actions (internal LOC) versus outside factors (external LOC) in older adults. Design Cross-sectional study using survey data from the North Carolina Established Population for Epidemiologic Studies of the Elderly ( NC EPESE) data set. Setting Community. Participants Three thousand two hundred twelve community-dwelling adults aged 68 and older. Measurements Nine common medical conditions were assessed according to self-report. LOC was measured using a standard questionnaire. Analyses were adjusted for demographics, functional status (self-reported activities of daily living), cognition (Short Portable Mental Status Questionnaire), and depression score (Center for Epidemiologic Studies Depression Scale). Results A higher number of chronic conditions was associated with external LOC (β = 0.37, P < .001). This relationship persisted after adjustment for age, race, sex, functional status, cognition, and depression (β = 0.17, P < .001). Most individual conditions were not associated with LOC, although vision impairment ( P < .001) and arthritis ( P = .02) were associated with more-internal LOC. Conclusion These results suggest that medically complex patients tend to exhibit a more-external LOC, meaning that they perceive little personal control over circumstances and environment. Clinicians should be aware of this tendency, because external LOC may impede an older adult's willingness to engage in the considerable task of managing multiple chronic conditions. [ABSTRACT FROM AUTHOR]

Objectives To identify generalizable ways that comorbidity affects older adults' experiences in a health service program directed toward an index condition and to develop a framework to assist clinicians in approaching comorbidity in the design, delivery, and evaluation of such interventions. Design A qualitative data content analysis of interview transcripts to identify themes related to comorbidity. Setting An outpatient low-vision rehabilitation program for macular disease. Participants In 2007/08, 98 individuals undergoing low-vision rehabilitation and their companions provided 624 semistructured interviews that elicited perceptions about barriers and facilitators of successful program participation. Results The interviews revealed five broad themes about comorbidity: (i) 'good days, bad days,' reflecting participants' fluctuating health status during the program because of concurrent medical problems; (ii) 'communication barriers.' which were sometimes due to participant impairments and sometimes situational; (iii) 'overwhelmed,' which encompassed pragmatic and emotional concerns of participants and caregivers; (iv) 'delays,' which referred to the tendency of comorbidities to delay progress in the program and to confer added inconvenience during lengthy appointments; and (v) value of companion involvement in overcoming some barriers imposed by comorbid conditions. Conclusion This study provides a taxonomy and conceptual framework for understanding consequences of comorbidity in the experience of individuals receiving a health service. If confirmed in individuals receiving interventions for other index diseases, the framework suggests actionable items to improve care and facilitate research involving older adults. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To describe the relationship between symptom scores and mobility function measures, assess whether symptom scores and disease scores are similarly associated with mobility function, and identify clusters of symptoms that are most strongly associated with functional status in older adults. DESIGN: Secondary analysis of cross-sectional data from three cohorts. SETTING: Academic medical center. PARTICIPANTS: One hundred ninety-five community-dwelling subjects with poor flexibility or cardiorespiratory fitness (fitness cohort), 211 female retirement community residents with vertebral fractures (VF cohort), and 61 subjects with Parkinson's disease (PD cohort). MEASUREMENTS: Twenty-item self-reported symptom scale, 17-item self-reported disease scale, Medical Outcomes Study 36-item Short Form Survey (SF-36) Physical Functioning Scale, 5-item Nagi Disability scale, 10-m walk time, supine to stand time. RESULTS: Symptom scores correlated with mobility function measures (Spearman correlation coefficients ranged from 0.222 to 0.509) at least as strongly as, if not more strongly than, did disease scores. Symptom scores remained associated with functional outcomes after controlling for disease score and demographic variables. Adding symptom scores to models that contained disease scores significantly increased the association with functional outcomes. In the fitness cohort, muscle weakness was the most explanatory single symptom, associated with an average decrease of 17.8 points on the Physical Functioning Scale. A model that included only muscle weakness, pain, and shortness of breath accounted for 21.2% of the variability in the Physical Functioning Score. CONCLUSION: Symptoms represent useful indicators of disability burden in older adults and are promising targets for interventions to improve function in medically complex patients. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine the risk of disability in individuals with coexisting visual and cognitive impairment and to compare the magnitude of risk associated with visual impairment, cognitive impairment, or the multimorbidity. DESIGN: Prospective cohort. SETTING: North Carolina. PARTICIPANTS: Three thousand eight hundred seventy-eight participants in the North Carolina Established Populations for the Epidemiologic Studies of the Elderly with nonmissing visual status, cognitive status, and disability status data at baseline MEASUREMENTS: Short Portable Mental Status Questionnaire (cognitive impairment defined as≥4 errors), self reported visual acuity (visual impairment defined as inability to see well enough to recognize a friend across the street or to read newspaper print), demographic and health-related variables, disability status (activities of daily living (ADLs), instrumental activities of daily living (IADLs), mobility), death, and time to nursing home placement. RESULTS: Participants with coexisting visual and cognitive impairment were at greater risk of IADL disability (odds ratio (OR)=6.50, 95% confidence interval (CI)=4.34–9.75), mobility disability (OR=4.04, 95% CI=2.49–6.54), ADL disability (OR=2.84, 95% CI=1.87–4.32), and incident ADL disability (OR=3.66, 95%, CI=2.36–5.65). In each case, the estimated OR associated with the multimorbidity was greater than the estimated OR associated with visual or cognitive impairment alone, a pattern that was not observed for other adverse outcomes assessed. No significant interactions were observed between cognitive impairment and visual impairment as predictors of disability status. CONCLUSION: Individuals with coexisting visual impairment and cognitive impairment are at high risk of disability, with each condition contributing additively to disability risk. Further study is needed to improve functional trajectories in patients with this prevalent multimorbidity. When visual or cognitive impairment is present, efforts to maximize the other function may be beneficial. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine fracture risk in U.S. stroke patients and identify patient characteristics that predict highest fracture risk in two complementary cohorts. DESIGN: Secondary analyses of two prospective cohorts. SETTING: Veterans Affairs (VA) Medical Centers. PARTICIPANTS: The VA Acute Stroke (VASt) cohort includes 1,073 veterans admitted to nine VA hospitals for stroke between April 1995 and March 1997. The Integrated Stroke Outcomes Database (ISOD) includes 6,578 veterans who received inpatient rehabilitation for stroke at 121 VA facilities during fiscal years 2001 and 2002. MEASUREMENTS: Fractures detected using International Classification of Diseases, 9th Revision, codes in the VA computerized patient record system; baseline patient characteristics and stroke features; Functional Independence Measures scores in ISOD. RESULTS: Estimated 2-year fracture rates after stroke in the VASt and ISOD cohorts were 6.1% and 4.7%, respectively. Longer hospitalizations for stroke ( P=.06) and new motor or sensory impairment ( P=.09) showed trends toward greater risk in the VASt cohort. Female sex ( P <.001), cognitive impairment ( P=.01), and nonblack race ( P=.04) were associated with higher fracture risk in the ISOD. Intermediate functional impairment conferred higher fracture risk than mild or severe functional impairment. CONCLUSION: Veterans who suffer a stroke are at high risk of subsequent fracture, which can lead to further disability. Women, nonblacks, and those with intermediate functional impairment were at particularly high risk of fracture. Future study should investigate therapies to decrease fracture risk in stroke patients. [ABSTRACT FROM AUTHOR]