Search

The objectives of the study were to compare the effect of intensified oral care interventions given by dental or nursing personnel on mortality from healthcare-associated pneumonia ( HAP) in elderly adults in hospitals or nursing homes with the effect of usual oral care. Systematic literature searches were conducted in PubMed, the Cochrane Library, and the Health Technology Assessment database of the National Health Service Centre for Reviews and Dissemination (August 2015). Randomized controlled trials ( RCTs) were considered for inclusion. Data were extracted and risk of bias was assessed independently and agreed on in consensus meetings. Five RCTs, with some or major study limitations, fulfilled the inclusion criteria. Based on meta-analyses, oral care interventions given by dental personnel reduced mortality from HAP (risk ratio ( RR) = 0.43, 95% confidence interval ( CI) = 0.25-0.76, P = .003), whereas oral care interventions given by nursing personnel did not result in a statistically significant difference in mortality from HAP ( RR = 1.20, 95% CI = 0.97-1.48, P = .09), in elderly adults in hospitals or nursing homes from usual oral care. Oral care interventions given by dental personnel may reduce mortality from HAP (low certainty of evidence, Grading of Recommendations Assessment, Development and Evaluation ( GRADE) ⊕⊕○○), whereas oral care interventions given by nursing personnel probably result in little or no difference from usual care (moderate certainty of evidence, GRADE ⊕⊕⊕○) in elderly adults in hospitals or nursing homes. [ABSTRACT FROM AUTHOR]

Objectives To assess the effect of continuous positive airway pressure ( CPAP) on napping behavior in adults aged 60 and older with obstructive sleep apnea-hypopnea syndrome ( OSAHS). Design Retrospective cohort study using questionnaires. Setting Sleep center. Participants Individuals starting CPAP treatment between April 2010 and March 2012 (mean age 65.2 ± 4.7; M:F = 3.9:1; N = 107). Measurements All subjects underwent sleep studies, clinical reviews, and CPAP adherence checks and completed a questionnaire regarding CPAP adherence, current employment status, sleep patterns before and after CPAP, and factors affecting their current sleep patterns. Results CPAP treatment duration was 82.7 ± 30.0 weeks, and objective adherence was 5.4 ± 2.0 hours per night overall. Daytime nap frequency before CPAP treatment was higher in those with a history of stroke or cardiovascular disease. Both sexes had a significant reduction in daytime napping (men, P < .001; women, P = .008), evening napping (men, P < .001; women, P = .02), and daily nap duration (men, P < .001; women, P = .02). Logistic regression analysis showed that the reduction in self-reported daily nap duration was associated with younger age (odds ratio ( OR) = 0.86, P = .04), a decrease in ESS score ( OR = 1.20, P = .03), and longer self-reported daily nap duration at baseline ( OR = 31.52, P < .001). Conclusion Long-term CPAP treatment in older adults with OSAHS can play a significant role in reducing nap frequency and daily nap duration. Aging or shorter baseline daily nap duration may attenuate this effect. [ABSTRACT FROM AUTHOR]

Objectives To determine the effect of comorbidity on fitness-to-drive recommendations that physicians and on-road driving assessors make and to investigate the agreement in fitness-to-drive recommendations between physicians and on-road driving assessors. Design Retrospective. Setting Data on comorbidities associated with Parkinson's disease ( PD) and fitness-to-drive recommendations were investigated. Participants Individuals with PD who underwent an official on-road test in Belgium (N = 72). Measurements Correlations between comorbidity and fitness-to-drive recommendations were calculated. Stepwise logistic regression models were used to investigate whether comorbidity was an independent predictor of fitness-to-drive recommendations (pass/fail) that the physicians or the on-road assessors made. The percentage of agreement and the prevalence and bias-adjusted kappa ( PABAK) were used to investigate agreement between the physicians and the on-road assessors. Results Moderate correlations were found between comorbidity and fitness-to-drive recommendations that the physicians ( ρ = 0.34, P = .004) and the on-road assessors ( ρ = 0.30, P = .01) made. Comorbidity was the most important determinant (coefficient of determination = 0.16, P = .005) of the physicians fitness-to-drive recommendations. No significant effect of comorbidity on the on-road recommendations was found. The physicians and the on-road assessors agreed in 46 (64%) of the cases ( PABAK = 0.46, P < .001). Conclusion Comorbidity plays a role in physicians' recommendations of fitness to drive that may explain, in part, inconsistencies between physicians and on-road assessors' fitness-to-drive recommendations. This study indicates the need for an interdisciplinary dialogue between physicians and on-road assessors to reach a comprehensive fitness-to-drive decision. [ABSTRACT FROM AUTHOR]

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

Objectives To investigate the correlation between zopiclone use and risk of hip fracture in elderly adults. Design Case-control study. Setting Claim data from the Taiwan National Health Insurance Program. Participants Individuals aged 65 and older who experienced their first episode of hip fracture between 1998 and 2011 were enrolled as the case group (n = 10,996). Randomly selected subjects aged 65 and older without hip fracture were enrolled as controls (n = 9,081). Case and control groups were matched according to sex, comorbidities, and index year of hip fracture diagnosis. Measurements Current users of zopiclone were defined as those whose last remaining tablet of zopiclone was detected within 7 days or less before the date of hip fracture diagnosis. Late users of zopiclone were defined as those whose last remaining tablet of zopiclone was detected more than 7 days before the date of hip fracture diagnosis. Subjects who never received a prescription of zopiclone were defined as nonusers of zopiclone. A multivariable unconditional logistic regression model was used to estimate odds ratios ( ORs) and 95% confidence intervals ( CIs) to investigate the correlation between zopiclone use and risk of hip fracture. Results After adjusting for confounders, multivariable logistic regression analysis demonstrated that current users of zopiclone were three and a half times as likely as nonusers to experience a hip fracture (adjusted OR = 3.56, 95% CI = 2.33-4.84), whereas late users were essentially equally as likely as nonusers to experience a hip fracture ( OR = 1.05, 95% CI = 0.94-1.18). Conclusion Current use of zopiclone was associated with greater risk of hip fracture in the elderly adults studied. Clinicians should alert elderly people to the risk of hip fracture when prescribing zopiclone. [ABSTRACT FROM AUTHOR]

Objectives To evaluate age-related differences in sleep-wake symptoms. Design Cross-sectional. Setting Technologist-attended, laboratory-based polysomnography ( PSG). Participants Community-dwelling adults aged 20 to 89 (N = 201): 52 aged 18 to 39, 72 aged 40 to 59, and 77 aged 60 and older. Measurements Medical burden (Charlson Comorbidity Index, medications, health status), PSG-defined sleep disorders (sleep-disordered breathing ( SDB), sleep-associated hypoxemia, periodic limb movements in sleep ( PLMS)), sleep-wake symptoms (Epworth Sleepiness Scale ( ESS), Insomnia Severity Index ( ISI), fatigue (Facit-F Scale)). Results Medical burden increased significantly with age (Charlson Comorbidity Index and number of medications, P < .001; health status, P = .005). Severity of sleep disorders also increased significantly with age ( SDB and hypoxemia, P < .001; PLMS, P = .008). Conversely, sleep-wake symptoms decreased with age (daytime drowsiness ( ESS ≥ 10), P = .02; insomnia ( ISI ≥ 8), P = .04; fatigue, P < .001). In adjusted models, a 1-year increase in age was significantly associated with a 4% decrease in the odds of having daytime drowsiness (odds ratio ( OR) = 0.96, 95% confidence interval ( CI) = 0.93-0.98). Similarly, but only in those with mild SDB, a 1-year increase in age was significantly associated with a 5% decrease in the odds of having insomnia ( OR = 0.95, 95% CI = 0.92-0.99). Conclusion Older age was characterized by less-severe sleep-wake symptoms (daytime drowsiness, insomnia, fatigue), despite an age-related increase in disease severity (medical burden, sleep disorders). Because the increase in disease severity included well-established risk factors for having sleep-wake symptoms, the age-related decrease in sleep-wake symptoms may reflect a decrease in symptom awareness. [ABSTRACT FROM AUTHOR]

Objectives To investigate associations between proxy report of cognitive and functional limitations and cognitive performance and current or former driving status in older women with mild cognitive impairment ( MCI) and all-cause dementia. Design Cross-sectional data analysis of retrospectively identified older women with adjudicated MCI and all-cause dementia in the Women's Health Initiative Memory Study-Epidemiology of Cognitive Health Outcomes ( WHIMS- ECHO). Setting Academic medical center. Participants Women (mean age ± standard deviation 83.7 ± 3.5) adjudicated with MCI or dementia during Year 1, 2, 3, or 4 of the WHIMS- ECHO follow-up period (N = 385). Measurements The telephone-administered cognitive battery included tests of attention, verbal learning and memory, verbal fluency, executive function, working memory, and global cognitive function plus self-report measures of depressive symptomatology. The Dementia Questionnaire ( DQ) was administered to a knowledgeable proxy (family member, friend). Results Sixty percent of women with MCI and 40% of those with dementia are current drivers. Proxy reports of functional limitations in instrumental activities of daily living ( IADLs) are associated with current driving status in women with MCI, whereas performance-based cognitive tests are not. In women with dementia, proxy reports of functional limitations in IADLs and performance-based cognitive tests are associated with current driving status, as expected. Conclusion These findings have clinical implications for the importance of evaluating driving concurrently with other instrumental functional abilities in MCI and dementia. Additional work is needed to determine whether proxy report of cognitive and functional impairments should help guide referrals for driving assessment and rehabilitation or counseling for driving transition. [ABSTRACT FROM AUTHOR]

Objectives To evaluate whether age is independently associated with greater rate of unanticipated hospital admission within 30 days of ambulatory surgery. Design Retrospective database study. Setting The 2012 National Surgical Quality Improvement Project data set. Participants All individuals with 'outpatient' recorded as their status in the data set. Measurements The primary outcome of interest was all-cause hospital admission in the 30-day period after surgery. Multivariate models were constructed to control for covariate bias. Assessment of interactions of terms in the final model was performed using a conditional tree analysis. Results The final analysis included 53,667 ambulatory surgical cases. There were 1,370 (2.5%, 99% confidence interval ( CI) = 2.4-2.7%) hospital admissions among the cases evaluated. After adjusting for potential confounders, age (<70 vs ≥70) was independently associated with hospital admission (odds ratio = 1.54, 99% CI = 1.29-1.84). A classification tree analysis of the cases without postoperative morbidity identified age (<60 vs ≥60) as an important decision point leading to greater likelihood of admission ( P < .001) within 30 days after ambulatory surgery. Conclusion Even after adjusting for comorbidities, older adults are at greater risk of unanticipated hospital admission within 30 days of ambulatory surgery. Renal failure, chronic obstructive pulmonary disease, current cancer treatment, diabetes mellitus, and history of amputation or revascularization were also associated with greater likelihood of hospital admission. Interventions to improve transitions of care for older adults after ambulatory surgery are needed. [ABSTRACT FROM AUTHOR]

Objectives To investigate the effectiveness of a 6-month Liuzijue qigong ( LQG) program in promoting physical and psychosocial function in individuals with chronic obstructive pulmonary disease ( COPD). Design Single-blind, randomized controlled trial. Setting Seven hospital respiratory care centers in Beijing. Participants Individuals with COPD (N = 126; mean age 71.1 ± 2.7, range 65-85). Methods Participants were randomly assigned to one of two groups: LQG (n = 63) and control (n = 63). Subjects in the LQG group received a LQG program consisting of four 45-minute sessions each week and daily walking for 30 minutes for 6 months. Control subjects walked daily for 30 minutes. Data collection was performed at baseline, at 6 weeks, and at 6 months. Primary outcomes involved functional capacity, and secondary outcomes involved quality of life. Results The LQG group had greater improvements in the 6-minute walk test ( P = .02); specific airway conductance ( P = .02); monitored functional task evaluation ( P = .04); Medical Outcomes Study 36-item Short-Form Health Survey ( SF-36; general health ( P < .001), mental health ( P = .03)); Chronic Respiratory Questionnaire (dyspnea ( P = .05), emotion ( P = .05), and mastery ( P = .04) at 6-month follow-up. After 6 months, the control group had significant improvement only on the SF-36 mental health ( P = .02). Conclusion LQG promoted functional capacity and quality of life in older adults with COPD at 6 months and is a good alternative home exercise program for older adults in the rehabilitation of COPD. [ABSTRACT FROM AUTHOR]

An important contributor to hospital-associated disability is immobility during hospitalization. Preliminary results from STRIDE, a clinical demonstration program of supervised walking for older adults admitted to the hospital with medical illness, are reported. The STRIDE program consisted of a targeted gait and balance assessment by a physical therapist, followed by daily walks supervised by a recreation therapy assistant for the duration of the hospital stay. To examine program effectiveness, STRIDE participants (n = 92) were compared with individuals referred but not enrolled (because of refusal or because program was at capacity, n = 35). Median length of stay was 4.7 days for STRIDE participants and 5.7 days for individuals receiving usual care ( P = .31). There was one inpatient fall in each group (not associated with a STRIDE walk). Overall, 92% of STRIDE participants were discharged to home (rather than a skilled nursing facility ( SNF)) compared to 74% of individuals receiving usual care ( P = .007). Thirty-day emergency department visit rates and readmission rates were not significantly different between the two groups. STRIDE, a supervised walking program for hospitalized older adults, was feasible and safe, and program participants were less likely to be discharged to a SNF than a demographically similar comparison group. STRIDE is a promising interdisciplinary approach to promoting mobility and improving outcomes in hospitalized older adults. [ABSTRACT FROM AUTHOR]

Objectives To assess the effect of a Screening Tool of Older Persons potentially inappropriate Prescriptions/Screening Tool to Alert doctors to Right Treatment ( STOPP/ START) medication intervention on clinical and economic outcomes. Design Parallel-group randomized trial. Setting Chronic care geriatric facility. Participants Residents aged 65 and older prescribed with at least one medication (N = 359) were randomized to receive usual pharmaceutical care or undergo medication intervention. Intervention Screening medications with STOPP/ START criteria followed up with recommendations to the chief physician. Measurements The outcome measures assessed at the initiation of the intervention and 1 year later were number of hospitalizations and falls, Functional Independence Measure ( FIM), quality of life (measured using the Medical Outcomes Study 12-item Short-Form Health Survey), and costs of medications. Results The average number of drugs prescribed was significantly lower in the intervention than in the control group after 1 year ( P < .001). The average drug costs in the intervention group decreased by 103 shekels (US$29) per participant per month ( P < .001). The average number of falls in the intervention group dropped significantly ( P = .006). Rates of hospitalization, FIM scores, and quality of life measurements were similar for both groups. Conclusion Implementation of STOPP/ START criteria reduced the number of medications, falls, and costs in a geriatric facility. Their incorporation in those and similar settings is recommended. [ABSTRACT FROM AUTHOR]

Hospitalized older adults are susceptible to complications termed 'hazards of hospitalization' ( HOH), which collectively result in poor patient outcomes. Previous research has shown that residents are not aware of their patients' risk factors for HOH. This study investigated the effect of an educational intervention to increase internal medicine interns' knowledge and self-efficacy of HOH and to improve their care of hospitalized older adults as measured by their documentation of HOH. Targeted learners were internal medicine interns on their geriatrics rotation at a large academic hospital in 2011 to 2012. The intervention covered 10 specific HOH: delirium, pressure ulcers, urinary incontinence and retention, functional decline, falls, suboptimal prescribing, dehydration and malnutrition, infection, depression, and inappropriate interventions. Knowledge and self-efficacy were measured before and after training. HOH documentation rates of interns who did and did not complete the training were compared over a preset 8-week period. Forty-two of 43 eligible interns completed the curriculum. After training, knowledge was significantly greater (approximately 1 more correct question out of 3, P < .001). Self-reported confidence in managing each hazard also significantly increased (13 questions on two 5-point Likert scales, P < .001). Trained interns had significantly more-frequent documentation of patients' activities of daily living, gait, and plan for functional decline prevention than interns who were not trained ( P < .05). Conversely, documentation of instrumental activities of daily living was more frequent among interns who were not trained ( P < .01). Implementation of an educational intervention was successful in improving educational and behavior change outcomes regarding HOH. [ABSTRACT FROM AUTHOR]

Objectives To determine whether failure to rescue, as a driver of mortality, can be used to identify which hospitals attenuate the specific risks inherent to elderly adults undergoing surgery. Design Retrospective cohort study. Setting State-wide surgical collaborative in Michigan. Participants Older adults undergoing major general or vascular surgery between 2006 and 2011 (N = 24,216). Measurements Thirty-four hospitals were ranked according to risk-adjusted 30-day mortality and grouped into tertiles. Within each tertile, rates of major complications and failure to rescue were calculated, stratifying outcomes according to age (<75 vs ≥75). Next, differences in failure-to-rescue rates between age groups within each hospital were calculated. Results Failure-to-rescue rates were more than two times as high in elderly adults as in younger individuals in each tertile of hospital mortality (26.0% vs 10.3% at high-mortality hospitals, P < .001). Within hospitals, the average difference in failure-to-rescue rates was 12.5%. Nine centers performed better than expected, and three performed worse than expected, with the largest differences exceeding 25%. Conclusion Although elderly adults experience higher failure-to-rescue rates, this does not account for hospitals' overall capacity to rescue individuals from complications. Comparing rates of younger and elderly adults within hospitals may identify centers where efforts toward complication rescue favor, or are customized for, elderly adults. These centers should be studied as part of the collaborative's effort to address the disparate outcomes that elderly adults in Michigan experience. [ABSTRACT FROM AUTHOR]

Objectives To examine differences in a proxy measure of muscle quality across the adult life span and explore potential mechanisms of muscle quality change through identification of cross-sectional correlates of muscle quality. Design Cross-sectional study. Setting Baltimore Longitudinal Study of Aging. Participants Seven hundred eighty-six individuals with a mean age of 66.3 (range 26-96) (N = 786). A sensitivity analysis was conducted in a subset of participants matched according to sex, muscle mass, and body size. Measurements Muscle quality was operationalized as the ratio of knee-extension strength (isokinetic dynamometry) to thigh muscle cross-sectional area (computed tomography). Differences in muscle strength, muscle area, and muscle quality ratio with age were evaluated, and the association between the muscle quality ratio and measures reflecting domains of cognitive function, motor control, peripheral nerve function, adiposity, glucose homeostasis, and inflammation were assessed through multivariate regression analyses. Results A linear relationship between age and muscle quality ratio was observed, suggesting a gradual decline in muscle quality over the adult life course. Associations were observed between muscle quality ratio and measures of adiposity, as well as peroneal nerve motor conduction velocity, finger tapping speed, and memory performance ( P < .01). The association between muscle quality ratio and nerve conduction velocity was maintained after adjustment for anthropometric measurements ( P < .05). Conclusion Muscle quality declines progressively with age over the adult life span and is affected by obesity and neurological factors. Studies are needed to clarify the mechanisms of these associations and their implications for functional outcomes. [ABSTRACT FROM AUTHOR]

Objectives To quantify the effect of nosocomial bloodstream infection ( BSI) on older adults, including mortality, length of stay ( LOS), and costs attributed to BSI. Design Retrospective cohort study. Setting Eight acute care hospitals (7 community hospitals and 1 tertiary university-affiliated facility) belonging to the Duke Infection Control Outreach Network (DICON) from the states of North Carolina and Virginia. Participants Elderly patients over 65 years of age. Measurements A multistate, multicenter, matched, retrospective cohort study was conducted from January 1994 through June 2002 in eight hospitals from the Southern-Central United States. Patients aged >65 years with nosocomial BSI were enrolled. Controls without bloodstream infection were matched to cases. Outcomes during the 90-day period following hospital discharge were evaluated to determine the association between BSI and mortality, hospital costs, and LOS. Results Eight-hundred thirty cases and 830 matched controls were identified, all with a mean age of 74.4 years. Among cases, 81% of BSIs were central line-associated and Staphylococcus aureus was the most common pathogen accounting for 34.6% of infections (2/3 were methicillin resistant). The mortality rate of cases was 49.4%, compared to 33.2% for controls ( OR = 2.1, P < .001), LOS was 29.2 days for cases and 20.2 days for controls ( P < .001), and hospital charges were $102,276 for cases compared to $69,690 for controls ( P < .001). The mean LOS and mean costs attributable to BSI were 10 days and $43,208, respectively. Conclusion Nosocomial BSI in older adults was significantly associated with increases in 90-day mortality, increased LOS, and increased costs of care. Preventive interventions to eliminate nosocomial BSIs in older adults would likely be cost effective. [ABSTRACT FROM AUTHOR]

Objectives To investigate the clinical outcomes of cataract surgery elderly adults. Design Retrospective cohort study. Setting Two clustered hospitals. Participants Two hundred seven individuals aged 90 and older who underwent cataract surgery for primary senile cataracts. Measurements Best-corrected preoperative and postoperative Snellen visual acuity, type of cataract, surgical techniques, preoperative systemic or ocular comorbidities, and intraoperative and postoperative complications were assessed. Improvement of visual acuity was defined as a decrease in log MAR acuity of 0.1. Factors associated with visual outcome within 6 months after surgery were identified using logistic regression modeling. The duration of postoperative survival was calculated. Results In the 207 participants (mean age 92.0 ± 2.1), 79.7% achieved visual improvement after cataract surgery. Forty-eight percent (mean age 97.4 ± 2.8) were alive on December 31, 2012. The most common systemic comorbidities were hypertension (66.2%), diabetes mellitus (25.1%), and myocardial infarction (19.8%). Age-related macular degeneration ( AMRD) (15.9%), glaucoma (10.6%), and myopic degeneration (5.3%) were the three most common ocular comorbidities. Uncomplicated cataract surgery was performed in 87.0% cases. The most common complications were vitreous loss (8.2%), posterior capsular rupture (7.2%), and zonular rupture (4.8%). Participants with AMRD ( P = .001, odds ratio ( OR) = 4.77, 95% confidence interval ( CI) = 1.86-12.26) and vitreous loss ( P = .001, OR = 12.86, 95% CI = 2.71-61.10) were less likely to achieve postoperative visual improvement. Conclusion Despite a high prevalence of systemic and ocular comorbidities in very elderly adults, good clinical outcomes of cataract surgery were attainable. ARMD and vitreous loss were associated with a lower chance of postoperative visual improvement. [ABSTRACT FROM AUTHOR]

Objectives To compare the validity of the Montreal Cognitive Assessment (Mo CA) with the criterion standard of standardized neuropsychological testing and to compare the convergent validity of the Mo CA with that of existing screening tools and global measures of cognition. Design Cross-sectional observational study. Setting Tertiary care hospital-based cognitive neurology subspecialty clinic. Participants A convenience sample of 107 individuals with mild Alzheimer's disease ( AD, n = 75) or mild cognitive impairment ( MCI, n = 32) from the Sunnybrook Dementia Study. Measurements In addition to the Mo CA, all participants completed the Mini-Mental State Examination ( MMSE), the Mattis Dementia Rating Scale ( DRS), and detailed neuropsychological testing. Results Convergent validity was supported, with Mo CA scores correlating well with the MMSE (correlation coefficient ( r) = 0.66, P < .001) and the DRS ( r = 0.77, P < .001) and the Mo CA better associated with the DRS than did the MMSE. Criterion validity was supported, with Mo CA subscores according to cognitive domain correlating well with analogous neuropsychological tests and, in the case of memory (area under the receiver operating characteristic curve ( AUC) = 0.86), executive ( AUC = 0.79), and visuospatial function ( AUC = 0.79), being reasonably sensitive to impairment in those domains. Conclusion The Mo CA is a valid assessment of cognition that shows good agreement with existing screening tools and global measures (convergent validity) and was superior to the MMSE in this regard. The Mo CA domain-specific subscores align with performance on more-detailed neuropsychological tests, suggesting not only good criterion validity for the Mo CA, but also that it may be useful in guiding further neuropsychological testing. [ABSTRACT FROM AUTHOR]

Objectives To determine the role of impaired functional status as a risk factor for severe Clostridium difficile infection ( CDI) in older adults. Design Prospective cohort study. Setting University of Michigan Health System, a 930-bed tertiary care hospital. Participants Hospitalized individuals with CDI aged 50 and older. Measurements Demographic and clinical characteristics and a composite outcome, CDI severity score: fever (>38°C), acute organ dysfunction, white blood cell count greater than 15,000/μL, lack of response to therapy, intensive care unit admission, need for colectomy, or death from CDI. Preadmission functional status was assessed according to ability to perform activities of daily living ( ADLs); participants were assigned to an ADL class (independent, some assistance, full assistance). Secondary outcomes included length of stay, 90-day mortality and readmission, and CDI recurrence. Results Ninety hospitalized individuals with CDI were identified (mean age 66.6 ± 10.2); 58 (64.4%) had severe CDI as measured according to a positive severity score. At baseline, 25 (27.8%) required assistance with ADLs. On univariate analysis, ADL class of full assistance was associated with a positive severity score (odds ratio ( OR) = 7, 95% confidence interval ( CI) = 1.83-26.79, P = .004). In a multivariable model including age, ADL class, congestive heart failure, diabetes mellitus, depression, weighted Charlson-Deyo comorbidity score, immunosuppression, prior CDI, and proton pump inhibitor use, an ADL class of full assistance retained its association with a positive severity score ( OR = 8.1, 95% CI = 1.24-52.95, P = .03). ADL class was not associated with secondary outcomes. Conclusion In this cohort of hospitalized older adults, impaired functional status was an independent risk factor for severe CDI. [ABSTRACT FROM AUTHOR]

Objectives To test the effectiveness of a pressure ulcer (PU) prevention intervention featuring musical cues to remind all long-term care (LTC) staff (nursing and ancillary) to help every resident move or reposition every 2 hours. Design Twelve-month paired-facility two-arm (with one-arm crossover) randomized intervention trial. Setting Ten midwestern U.S. LTC facilities. Four treatment facilities received intervention during Months 1 to 12, four comparison facilities received intervention during Months 7 to 12, and two pseudo-control facilities received no intervention. Participants LTC facility residents (N = 1,928). Intervention All facility staff received in-person education, video, and handouts, and visiting family members received informational pamphlets on PU prevention and an intervention featuring musical cues. Nurse-led multidisciplinary staff teams presented the cues as prompts for staff and family to reposition residents or remind them to move. Musical selections (with and without lyrics) customized to facility preferences were played daily over the facility intercom or public address system every 2 hours for the 12-hour daytime period. Measurements Primary outcome measure was the frequency of new facility-acquired PUs divided by the total number of facility Minimum Data Set (MDS) resident assessments conducted during the study period. Results Odds of a new PU were lower in intervention facilities ( P = .08) for MDS 2.0 assessments and were significantly lower ( P = .05) for MDS 3.0. Mean odds ratios suggested intervention facility residents were 45% less likely than comparison facility residents to develop a new PU. Conclusion Customized musical cues that prompt multidisciplinary staff teams to encourage or enable movement of all residents hold promise for reducing facility-acquired PUs in LTC settings. [ABSTRACT FROM AUTHOR]

Objectives To assess the distribution of antihyperglycemic treatments according to age and renal function and its relationship with cardiovascular disease in type 2 diabetes mellitus ( T2DM). Design Cross-sectional analysis. Setting Nineteen hospital-based diabetes mellitus clinics in 2007 and 2008. Participants Fifteen thousand seven hundred thirty-three individuals with T2DM from the Renal Insufficiency and Cardiovascular Events ( RIACE) Italian Multicenter Study. Measurements Current antihyperglycemic treatments were recorded. Estimated glomerular filtration rate ( eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Albuminuria was measured using immunonephelometry or immunoturbidimetry. Prevalence of major acute cardiovascular events was calculated according to age quartiles, treatments, and categories of eGFR (1 = ≥90; 2 = 60-89; 3 = 30-59; and 4 = <30 mL/min per 1.73 m2). Results Across age quartiles, eGFR declined progressively at a time-linear rate, with an acceleration in older adults, whereas albuminuria increased; age and eGFR were associated with cardiovascular events independently of other confounders. With increasing age, percentage of participants using lifestyle treatments for their T2DM and taking metformin or glitazones fell; percentage taking sulphonylureas and repaglinide rose, and percentage taking insulin remained stable. In eGFR categories 3 and 4, use of metformin was 41.4% and 14.5%, respectively, and that of sulphonylureas was 34.2% and 18.1%, respectively. Inappropriate prescription of these agents, especially sulphonylureas, increased with age. Metformin was independently associated with lower prevalence of cardiovascular disease for any age quartile and eGFR category than all other treatments. Conclusion In real-life conditions, use of agents that are not recommended in elderly adults with diabetes mellitus with moderate to severe renal impairment is frequent, but metformin is associated with lower cardiovascular event rates even in these individuals. [ABSTRACT FROM AUTHOR]

Low-income older adults are particularly vulnerable during care transitions. The present study evaluated the effectiveness of a transitional care model in this population. A quasi-experimental design was used to compare outcomes in the intervention group with historical controls at 30, 90, 180, and 365 days after discharge, along with a pre-postintervention evaluation of the intervention group. Eligible individuals were age 60 and older hospitalized between June 2008 and January 2009. Main outcome measures were readmissions, emergency department ( ED) visits, and primary care services use. Of 121 participants, 55% were female and 90% African American, with a mean age of 69. Readmission rates were generally but not significantly lower in the intervention group than in controls (Day 30, 9.6% vs 17.3%; Day 90, 28.9% vs 25.0%; Day 180, 32.7% vs 36.5%; Day 365, 44.2% vs 53.9%; P > .05), as were ED visit rates (Day 30, 17.3% vs 15.4%; Day 90, 32.7% vs 34.6%; Day 180, 38.5% vs 40.4%; Day 365, 50.0% vs 55.8%; P > .05). Primary care service utilization rates were significantly higher in the intervention group than in controls at Day 30 (40.4% vs 19.2%, P < .001), 90 (74.9% vs 32.7%, P < .001), and 180 (65.4% vs 32.7%, P < .001). The lack of statistically significant reduction in readmissions and ED visits with the intervention, may suggest the need for additional assistance during care transitions for this vulnerable population. [ABSTRACT FROM AUTHOR]

Objectives To examine epidemiological and clinical data of individuals aged 65 and older with influenza virus A ( H1 N1) admitted to the intensive care unit ( ICU) and to identify independent predictors of ICU mortality. Design Prospective, observational, multicenter study to determine prognostic factors in individuals infected with influenza A ( H1 N1) admitted to the ICU. Setting One hundred forty-eight Spanish ICUs. Participants Individuals with influenza A ( H1 N1) confirmed using real-time polymerase chain reaction from April 2009 to July 2011. Measurements Individuals aged 65 and older were compared with younger individuals. A multivariate analysis was conducted to determine independent predictors of mortality in this population. Results One thousand one hundred twenty individuals (129 (11.5%) aged ≥65) were included. Prevalence of chronic diseases was more common in older individuals. Viral pneumonitis was more frequent in individuals younger than 65 (70.5% vs 54.3%, P < .001). In older individuals, Acute Physiology and Chronic Health Evaluation II score (odds ratio ( OR) = 1.11, 95% confidence interval ( CI) = 1.11-1.20, P = .002), immunosuppression ( OR = 3.66, 95% CI, 1.33-10.03, P = .01) and oseltamivir therapy initiated after 48 hours ( OR = 3.32, 95% CI = 1.02-10.8, P = .04) were identified as independent variables associated with mortality. Corticosteroid use was associated with a trend toward greater mortality ( OR = 2.39, 95% CI = 0.98-5.91, P = .06). Conclusion Individuals aged 65 and older with influenza A ( H1 N1) admitted to the ICU have a higher incidence of underlying diseases than younger individuals and differences in clinical presentation. Early oseltamivir therapy is associated with better outcomes in elderly adults. [ABSTRACT FROM AUTHOR]

Objectives To determine whether Helicobacter pylori infection was associated with dementia and risk of developing dementia in a longitudinal population-based cohort of elderly adults living in the community. Design Prospective community-based cohort study. Setting The population-based Personnes Agées QUID ( PAQUID) Study. Participants Six hundred three noninstitutionalized individuals aged 65 and older living in the southwest of France followed from 1989 to 2008. Measurements A descriptive and comparative analysis including dementia prevalence, according to H. pylori status (serology), was made at baseline. Cox proportional hazard models were used to study the risk of developing dementia according to H. pylori status assessed on sera samples from elderly adults initially free of dementia and followed for 20 years. A neurologist diagnosed dementia according to Diagnostic and Statistical Manual of Mental Disorders Third Edition criteria. Results At baseline, 391 (64.8%) subjects (348 women, mean age 73.9 ± 6.5) were seropositive for H. pylori. Dementia prevalence was higher in the infected group (5.4% vs 1.4%, P = .02). After 20 years of follow-up, 148 incident cases of dementia were diagnosed. After controlling for age, sex, educational level, apolipoprotein E4 status, cardiovascular risk factors, and Mini- Mental State Examination score, H. pylori infection was determined to be a risk factor for developing dementia (hazard ratio = 1.46, P = .04). Conclusion This longitudinal population-based study provides additional epidemiological support to the hypothesis of an association between dementia and H. pylori infection, which may enhance neurodegeneration. [ABSTRACT FROM AUTHOR]

Objectives To test the hypothesis that presepsis depressive symptoms are associated with risk of new cognitive impairment in survivors of severe sepsis. Design Prospective longitudinal cohort study. Setting Population-based cohort of older U.S. adults interviewed as part of the Health and Retirement Study (1998-2006). Participants Four hundred forty-seven individuals with normal presepsis cognition who survived 540 hospitalizations for severe sepsis and completed at least one follow-up interview. Measurements Severe sepsis was identified using a validated algorithm in Medicare claims. Depressive symptoms were assessed prospectively using a modified version of the Center for Epidemiologic Studies Depression Scale. Cognitive function was assessed using versions of the Telephone Interview for Cognitive Status ( TICS). Logistic regression with robust standard errors was used to examine associations between substantial depressive symptoms at any interview before sepsis and incident cognitive impairment (mild or moderate to severe cognitive impairment) at any interview after sepsis. Results The prevalence of substantial depressive symptoms in participants with normal cognition before sepsis was 38% (95% confidence interval ( CI) = 34-42%). After severe sepsis, 18% (95% CI = 15-20%) of survivors had incident cognitive impairment. In unadjusted analyses, presepsis substantial depressive symptoms were associated with postsepsis incident cognitive impairment (odds ratio ( OR) = 2.56, 95% CI = 1.53-4.27). After adjustment for demographics, health-risk behaviors, clinical characteristics of the sepsis episode, and presepsis TICS scores, substantial presepsis depressive symptoms remained the strongest factor associated with postsepsis incident cognitive impairment ( OR = 2.58, 95% CI = 1.45-4.59). Conclusion Substantial presepsis depressive symptoms are independently associated with incident postsepsis cognitive impairment. Depressed older adults may be particularly at risk of developing cognitive impairment after a serious medical illness. [ABSTRACT FROM AUTHOR]

Objectives To determine whether there is an association between tooth loss, chewing ability, and cognitive function in a general elderly population. Design Data from the Panel Study of Living Conditions of the Oldest Old in 2002 were analyzed. Stepwise logistic regression analyses were used to examine the relationship between cognitive function and tooth loss and chewing ability. Participants Five hundred fifty-seven persons who were nationally representative of the Swedish population aged 77 and older. Measurements Cognitive function was measured using the abridged version of the Mini- Mental State Examination. Information on dental status and chewing difficulty was obtained according to self-assessment. Results Persons with multiple tooth loss and persons with difficulty chewing hard food had significantly higher odds of cognitive impairment. When adjusted for sex, age, and education, the odds of cognitive impairment were not significantly different between persons with natural teeth and with multiple tooth loss, but the odds of impairment remained significantly higher for persons with chewing difficulty even when adjusted for sex, age, education, depression, and mental illness. Conclusion Sex, age, education, and certain illnesses do not explain the association between cognition and chewing ability. Whether elderly persons chew with natural teeth or prostheses may not contribute significantly to cognitive impairment as long as they have no chewing difficulty. The results add to the evidence of the association between chewing ability and cognitive impairment in elderly persons. [ABSTRACT FROM AUTHOR]

Objectives To estimate the prevalence of prefrailty, frailty, comorbidity, and disability in the youngest old and to identify chronic diseases associated with individual frailty criteria. Design Population-based cohort study of noninstitutionalized elderly adults at baseline; cross-sectional analysis. Setting Lausanne, Switzerland. Participants One thousand two hundred eighty-three individuals with complete data on frailty, aged 65 to 70 (58.5% women). Measurements Frailty was assessed according to an adaptation of Fried's criteria (shrinking, weakness, exhaustion, slowness, and low activity, three criteria needed for the diagnosis of frailty, 1 to 2 for prefrailty). Other outcomes were diseases diagnosed by a doctor (≥2 chronic diseases: comorbidity) and limitations in activities of daily living ( ADLs, basic and instrumental). Results At baseline, of 1,283 participants 71.1% were classified as nonfrail, 26.4% as prefrail, and 2.5% as frail. The proportion of women increased across these three groups (56.5%, 62.8%, and 71.9%, respectively; P = .01), as did the proportion of individuals with one or more chronic diseases (68.0%, 82.8%, and 90.6%, respectively; P < .001) and the proportion with basic or instrumental ADL disability (1.6%, 10.3%, and 59.4%, respectively; P < .001). Weakness (low grip strength) was the most frequent criterion (14.3%). Prefrail participants had significantly more comorbidity and ADL disability than nonfrail participants ( P < .001). When present in isolation, weakness was associated with two to three times greater prevalence of coronary heart disease, other heart diseases, diabetes mellitus, and arthritis. Similarly, a significant association was identified between exhaustion and depression. Conclusion Prefrailty is common in the youngest old. The most prevalent frailty criterion is weakness, which is associated with cardiovascular diseases. Longitudinal studies of the evolution of prefrailty should explore the role of potential interactions between individual frailty criteria and specific chronic diseases. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the effect of medical Primary Integrated Interdisciplinary Elder Care at Home ( PIECH) on acute hospital use and mortality in a frail elderly population. Design Comparison of acute hospital care use for the year before entering the practice (pre-entry) with the most-recent 12-month period ( May 1, 2010- April 30, 2011, postentry) for active and discharged patients. Setting Community. Participants All 248 frail elderly adults enrolled in the practice for at least 12 months who were living in the community and not in nursing homes in Victoria, British Columbia. Intervention Primary geriatric care provided by a physician, nurse, and physiotherapist in participants' homes. Measurements Acute hospital admissions, emergency department ( ED) contacts that did not lead to admission, reason for leaving practice, and site of death. Results There was a 39.7% (116 vs 70; P = .004) reduction in hospital admissions, 37.6% (1,700 vs 1,061; P = .04) reduction in hospital days, and 20% (120 vs 95; P = .20) reduction in ED contacts after entering the practice. Fifty participants were discharged from the practice, 64% (n = 32) of whom died, 20% (n = 10) moved, and 16% (n = 8) were admitted to nursing homes. Fifteen (46.9%) deaths occurred at home. Conclusion Primary Integrated Interdisciplinary Elder Care at Home may reduce acute hospital admissions and facilitate home deaths. [ABSTRACT FROM AUTHOR]

Objectives To determine the association between objectively measured sleep and subsequent placement in a nursing home or a personal care home. Design Prospective cohort. Setting Participants' homes and sites of the Study of Osteoporotic Fractures. Participants One thousand six hundred sixty-four community-dwelling women with a mean age of 83 ± 4. Measurements At baseline, participants completed an average of 4 nights of wrist actigraphy; they provided data on place of residence at baseline and at follow-up, 5 years later. Results At baseline, participants had a mean total sleep time of 408 ± 72 minutes, mean wake after sleep onset of 71 ± 43 minutes, and mean sleep efficiency of 79 ± 11%. At follow-up, 71 (4%) were residing in a nursing home, and 127 (8%) were in a personal care home. Women with the most wake after sleep onset (by quartile) had more than twice the odds as those with the least of placement in a nursing home (adjusted odds ratio ( AOR) = 2.94, 95% confidence interval ( CI) = 1.34-6.44) or a personal care home ( AOR = 2.33, 95% CI = 1.26-4.30). Similarly, women with the lowest sleep efficiency had more than three times the odds as those with the highest of nursing home placement ( AOR = 3.25, 95% CI = 1.35, 7.82) and more than twice the odds of placement in a personal care home ( AOR = 2.38, 95% CI = 1.33, 4.24). There was no association between sleep duration and placement. Conclusion In very old community-dwelling women, greater wake after sleep onset and lower sleep efficiency are risk factors for placement in a nursing home or personal care home. Sleep duration alone does not appear to increase the risk of placement in these long-term care settings. [ABSTRACT FROM AUTHOR]

Objectives To determine whether objectively measured sleep quality predicts 5-year incident instrumental activity of daily living ( IADL) impairment and decline in grip strength and gait speed in older women. Design Prospective cohort. Setting Participants' homes, Study of Osteoporotic Fractures sites. Participants Eight hundred seventeen women with a mean age of 82.4 at baseline. Measurements Participants completed 4.1 ± 0.7 nights of wrist actigraphy at baseline and measures of IADL impairment, grip strength, and gait speed at baseline and 5-year follow-up. Results After 5 years of follow-up, approximately 41% of participants had incident impairment in one or more IADLs. The quartile of women with the shortest total sleep time ( TST) had 93% greater odds of incident IADL impairment than the longest sleepers (adjusted odds ratio ( AOR) = 1.93, 95% confidence interval ( CI) = 1.25-2.97). Similarly, the quartile of women with the lowest sleep efficiency ( SE) had 65% greater odds of impairment than those with the highest ( AOR = 1.65, 95% CI = 1.06-2.57). Women in the shortest TST quartile had twice the odds of declining grip strength as those with the longest TST ( AOR = 1.97, 95% CI = 1.17-3.32). Finally, women in the quartiles with the most wake after sleep onset ( WASO) and the lowest SE had approximately 90% greater odds of grip strength decline than those with the least WASO ( AOR = 1.90, 95% CI = 1.11-3.24) and SE ( AOR = 1.92, 95% CI = 1.12-3.29). Conclusion Findings indicate that shorter sleep duration, greater WASO, and lower SE are risk factors for functional or physical decline in older women. [ABSTRACT FROM AUTHOR]

Objectives To examine whether deficient B12 status or low serum B12 levels are associated with worse sensory and motor peripheral nerve function in older adults. Design Cross-sectional. Setting Health, Aging and Body Composition Study. Participants Two thousand two hundred and eighty-seven adults aged 72 to 83 (mean 76.5 ± 2.9; 51.4% female; 38.3% black). Measurements Low serum B12 was defined as serum B12 less than 260 pmol/ L, and deficient B12 status was defined as B12 less than 260 pmol/ L, methylmalonic acid ( MMA) greater than 271 nmol/ L, and MMA greater than 2-methylcitrate. Peripheral nerve function was assessed according to peroneal nerve conduction amplitude and velocity ( NCV) (motor), 1.4 g/10 g monofilament detection, average vibration threshold detection, and peripheral neuropathy symptoms (numbness, aching or burning pain, or both) (sensory). Results B12-deficient status was found in 7.0% of participants, and an additional 10.1% had low serum B12 levels. B12 deficient status was associated with greater insensitivity to light (1.4 g) touch (odds ratio = 1.50, 95% confidence interval = 1.06-2.13) and worse NCV (42.3 vs 43.5 m/s) (β = −1.16, P = .01) after multivariable adjustment for demographics, lifestyle factors, and health conditions. Associations were consistent for the alternative definition using low serum B12 only. No significant associations were found for deficient B12 status or the alternative low serum B12 definition and vibration detection, nerve conduction amplitude, or peripheral neuropathy symptoms. Conclusion Poor B12 (deficient B12 status and low serum B12) is associated with worse sensory and motor peripheral nerve function. Nerve function impairments may lead to physical function declines and disability in older adults, suggesting that prevention and treatment of low B12 levels may be important to evaluate. [ABSTRACT FROM AUTHOR]

Objectives To determine individuals' perceptions concerning dementia screening and to evaluate the possibility of an association between their perceptions and their willingness to undergo screening. Design Cross-sectional study of primary care patients aged 65 and older. Setting Urban primary care clinics in Indianapolis, Indiana, in 2008 to 2009. Participants Five hundred fifty-four primary care patients without a documented diagnosis of dementia. Measurements The Perceptions Regarding Investigational Screening for Memory in Primary Care Questionnaire ( PRISM- PC) and agreement or refusal to undergo dementia screening. Results Of the 554 study participants who completed the PRISM- PC, 65.5% were aged 70 and older, 70.0% were female, and 56.5% were African American; 57 (10.3%) refused screening for dementia. Of the 497 (89.7%) who agreed to screening, 63 (12.7%) screened positive. After adjusting for age, perception of depression screening, perception of colon cancer screening, and belief that no treatment is currently available for Alzheimer's disease, the odds of refusing screening were significantly lower in participants who had higher PRISM- PC domain scores for benefits of dementia screening (odds ratio ( OR) = 0.85, 95% confidence interval ( CI) = 0.75-0.97; P = .02). In the same regression model, the odds of refusing screening were significantly higher in participants aged 70 to 74 ( OR = 5.65, 95% CI = 2.27-14.09; P < .001) and those aged 75 to 79 ( OR = 3.63, 95% CI = 1.32-9.99; P = .01) than in the reference group of patients aged 65 to 69. Conclusion Age and perceived benefit of screening are associated with acceptance of dementia screening in primary care. [ABSTRACT FROM AUTHOR]

Objectives To determine the proportion of untreated women who reported receiving treatment after incident fracture and to identify factors that predict treatment across an international spectrum of individuals. Design Prospective observational study. Self-administered questionnaires were mailed at baseline and 1 year. Setting Multinational cohort of noninstitutionalized women recruited from 723 primary physician practices in 10 countries. Participants Sixty thousand three hundred ninety-three postmenopausal women aged 55 and older were recruited with a 2:1 oversampling of women aged 65 and older. Measurements Data collected included participant demographics, medical history, fracture occurrence, medications, and risk factors for fracture. Anti-osteoporosis medications ( AOMs) included estrogen, selective estrogen receptor modulators, bisphosphonates, calcitonin, parathyroid hormone, and strontium. Results After the first year of follow-up, 1,075 women reported an incident fracture. Of these, 17% had started AOM, including 15% of those with a single fracture and 35% with multiple fractures. Predictors of treatment included baseline calcium use ( P = .01), baseline diagnosis of osteoporosis ( P < .001), and fracture type ( P < .001). In multivariable analysis, women taking calcium supplements at baseline (odds ratio ( OR) = 1.67) and with a baseline diagnosis of osteoporosis ( OR = 2.55) were more likely to be taking AOM. Hip fracture ( OR = 2.61), spine fracture ( OR = 6.61), and multiple fractures ( OR = 3.79) were associated with AOM treatment. Age, global region, and use of high-risk medications were not associated with treatment. Conclusion More than 80% of older women with new fractures were not treated, despite the availability of AOM. Important factors associated with treatment in this international cohort included diagnosis of osteoporosis before the incident fracture, spine fracture, and to a lesser degree, hip fracture. [ABSTRACT FROM AUTHOR]

Objectives To examine the outcomes of the Elderly Persons in the Risk Zone study, which was designed to evaluate whether it is possible to delay deterioration if a health-promoting intervention is made when an older adult (≥80) is at risk of becoming frail and whether a multiprofessional group intervention is more effective in delaying deterioration than a single preventive home visit with regard to frailty, self-rated health, and activities of daily living ( ADLs) at 3-month follow-up. Design Randomized, three-armed, single-blind, controlled trial performed between November 2007 and May 2011. Setting Two urban districts of Gothenburg, Sweden. Participants Four hundred fifty-nine community-living adults aged 80 and older not dependent on the municipal home help service. Intervention A preventive home visit or four weekly multiprofessional senior group meetings with one follow-up home visit. Measurements Change in frailty, self-rated health, and ADLs between baseline and 3-month follow-up. Results Both interventions delayed deterioration of self-rated health (odds ratio ( OR) = 1.99, 95% confidence interval ( CI) = 1.12-3.54). Senior meetings were the most beneficial intervention for postponing dependence in ADLs ( OR = 1.95, 95% CI = 1.14-3.33). No effect on frailty could be demonstrated. Conclusion Health-promoting interventions made when older adults are at risk of becoming frail can delay deterioration in self-rated health and ADLs in the short term. A multiprofessional group intervention such as the senior meetings described seems to have a greater effect on delaying deterioration in ADLs than a single preventive home visit. Further research is needed to examine the outcome in the long term and in different contexts. [ABSTRACT FROM AUTHOR]

Objectives To describe the prevalence of diabetes mellitus ( DM) in centenarians. Design Cross-sectional, population-based. Setting Forty-four counties in northern Georgia. Participants Two hundred forty-four centenarians (aged 98-108, 15.8% male, 20.5% African American, 38.0% community dwelling) from the Georgia Centenarian Study (2001-2009). Measurements Nonfasting blood samples assessed glycosylated hemoglobin ( HbA1c) and relevant clinical parameters. Demographic, diagnosis, and DM complication covariates were assessed. Results 12.5% of centenarians were known to have DM. DM was more prevalent in African Americans (27.7%) than whites (8.6%, P < .001). There were no differences between men (16.7%) and women (11.7%, P = .41) or between centenarians living in the community (10.2%) and in facilities (13.9%, P = .54). DM was more prevalent in overweight and obese (23.1%) than nonoverweight (7.1%, P = .002) centenarians. Anemia (78.6% vs 48.3%, P = .004) and hypertension (79.3% vs 58.6%, P = .04) were more prevalent in centenarians with DM than in those without, and centenarians with DM took more nonhypoglycemic medications (8.6 vs 7.0, P = .02). No centenarians with HbA1c of less than 6.5% had random serum glucose levels greater than 200 mg/dL. DM was not associated with 12-month all-cause mortality, visual impairment, amputations, cardiovascular disease, or neuropathy. Thirty-seven percent of centenarians reported onset before age 80 (survivors), 47% between age 80 and 97 (delayers), and 15% aged 98 and older (escapers). Conclusion Diabetes mellitus is a risk factor for cardiovascular disease and mortality but is seen in persons who live into very old age. Aside from higher rates of anemia and use of more medications, few clinical correlates of DM were observed in centenarians. [ABSTRACT FROM AUTHOR]

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

Objectives To determine whether being overweight or obese is associated with significant health outcomes in an 85-year-old population. Design A cross-sectional population-based study. Setting Linköping, Sweden. Participants Three hundred thirty-eight people born in 1922 were identified using the local authority's register. Measurements Data related to sociodemographic characteristics, health-related quality of life ( HRQoL), assistance use, and the presence of diseases were collected using a postal questionnaire. Anthropometry and functional status were assessed during home and geriatric clinic visits. Diseases were double-checked in the electronic medical records, and information about health service consumption was obtained from the local healthcare register. Results Overweight (body mass index ( BMI) 25.0-29.9 kg/m2) and obese ( BMI ≥ 30.0 kg/m2) participants perceived more difficulty performing instrumental activities of daily living ( IADLs) and had more comorbidity than their normal-weight counterparts ( BMI 18.5-24.9 kg/m2), but their overall HRQoL and health service costs did not differ from those of normal-weight participants. After controlling for sociodemographic factors, being overweight did not influence IADLs or any comorbidity, but obese participants were more likely to perceive greater difficulty in performing outdoor activities (odds ratio ( OR) = 2.1, 95% confidence interval ( CI) = 1.1-4) and cleaning ( OR = 2.2, 95% CI = 1.2-4.2) than their normal-weight counterparts. Although obesity was also associated with multimorbidity ( OR = 3, 95% CI = 1.2-8), the health service cost of each case of multimorbidity (n = 251) was highest in normal-weight participants and nearly three times as much as in obese participants (ratio: 2.9, 95% CI = 1.1-8.1). Conclusion For 85-year-olds, being obese, as opposed to overweight, is associated with self-reported activity limitations and comorbidities. Overweight older adults living in their own homes in this population had well-being similar to that of those with normal weight. [ABSTRACT FROM AUTHOR]

Objectives To identify care-related factors associated with hospital-acquired pressure ulcers ( HAPUs). Design Prospective cohort study. Setting Nine hospitals in Baltimore Hip Studies network. Participants Six hundred fifty-eight individuals aged 65 and older who underwent surgery for hip fracture. Measurements Skin examinations at baseline and on alternating days until hospital discharge. Participants were deemed to have a HAPU if they developed one or more new Stage 2 or higher pressure ulcers ( PUs) during the hospital stay. Results Longer emergency department stays were associated with lower HAPU incidence (>4-6 hours: adjusted incidence rate ratio ( aIRR) = 0.68, 95% confidence interval (CI) = 0.48-0.96; >6 hours: aIRR = 0.68, 95% CI = 0.46-0.99, both vs ≤ 4 hours). Participants with 24 hours or longer between admission and surgery had a higher postsurgery HAPU rate than those with less than 24 hours ( aIRR = 1.62, 95% CI = 1.24-2.11). Surgery with general anesthesia had a lower postsurgery HAPU rate than surgery with other types of anesthesia ( aIRR = 0.66, 95% CI = 0.49-0.88). There was no significant association between HAPU incidence and timing of transport to the hospital, type of transport to the hospital, or surgery duration. Conclusion Most of the factors hypothesized to be associated with higher PU incidence were associated with lower incidence or were not significantly associated, suggesting that HAPU development may not be as sensitive to care-related factors as commonly believed. Rigorous studies of innovative preventive interventions are needed to inform policy and practice. [ABSTRACT FROM AUTHOR]

Objectives To compare outcomes and the use of multimodality therapy in young and elderly people with pancreatic cancer undergoing surgical resection. Design Retrospective, single-institution study. Setting National Cancer Institute/National Comprehensive Cancer Network cancer center. Participants Two hundred three individuals who underwent pancreaticoduodenectomy for pancreatic adenocarcinoma at Duke University Medical Center comprised the study population. Participants were divided into three groups based on age (<65, n = 97; 65-74, n = 74; ≥75, N = 32). Measurements Perioperative outcomes, the use of multimodality therapy, and overall survival of the different age groups were compared. Results Similar rates of perioperative mortality and morbidity were observed in all age groups, but elderly adults were more likely to be discharged to a rehabilitation or skilled nursing facility. A similar proportion of participants received neoadjuvant therapy, but a smaller proportion of elderly participants received adjuvant therapy. Overall survival was similar between the age groups. Predictors of poorer overall survival included coronary artery disease, positive resection margin, and less-differentiated tumor histology. Treatment with neoadjuvant and adjuvant therapy were predictors of better overall survival. Conclusion Carefully selected elderly individuals experience similar perioperative outcomes and overall survival to those of younger individuals after resection of pancreatic cancer. There appears to be a significant disparity in the use of adjuvant therapy between young and elderly individuals. [ABSTRACT FROM AUTHOR]

Objectives To assess the safety and long-term results of hepatic resection of colorectal liver metastases ( CLM) in older adults. Design Case-control. Setting Single liver and multivisceral transplant center. Participants Individuals with CLM: 32 aged 70 and older (older group) and 32 younger than 70 (younger group) matched in a 1:1 ratio according to sex, primary tumor site, liver metastases at diagnosis, number of metastases, maximum tumor size, infiltration of cut margin, type of hepatic resection, and hepatic resection timing. Measurements Postoperative complications and survival rates. Results There was no significant difference in preoperative clinical findings between the two study groups. The incidence of cumulative postoperative complications was similar in the older (28.1%) and younger (34.4%) groups ( P = .10). One-, 3-, and 5-year disease-free survival rates were 57.6%, 32.9%, and 16.4%, respectively, in the younger group and 67.9%, 29.2%, and 19.5%, respectively, in the older group ( P = .72). One-, 3-, and 5-year participant survival rates were 84.1%, 51.9%, and 33.3%, respectively, in the older group and 93.6%, 63%, and 28%, respectively, in the younger group ( P = .50). Conclusions Resection of colorectal liver metastases in older adults can be performed with low mortality and morbidity and offers a long-time survival advantage to many of these individuals. Based on the results of this case-control study, older adults should be considered for surgical treatment whenever possible. [ABSTRACT FROM AUTHOR]

Objectives To describe the association between anticholinergic medications and incident delirium in hospitalized older adults with cognitive impairment and to test the hypothesis that anticholinergic medications would increase the risk of incident delirium. Design Observational cohort study. Setting Urban public hospital in Indianapolis, Indiana. Participants One hundred forty-seven participants aged 65 and older with cognitive impairment who screened negative for delirium at the time of admission to a general medical ward. Measurements Cognitive function at the time of admission was assessed using the Short Portable Mental Status Questionnaire ( SPMSQ). Anticholinergic medication orders between the time of admission and the final delirium assessment were evaluated. Anticholinergic medication orders were identified using the Anticholinergic Cognitive Burden Scale. Delirium was assessed using the Confusion Assessment Method. Results Fifty-seven percent of the cohort received at least one order for possible anticholinergic medications, and 28% received at least one order for definite anticholinergic medications. The incident rate for delirium was 22% of the entire cohort. After adjusting for age, sex, race, baseline SPMSQ score, and Charlson Comorbidity Index, the odds ratio ( OR) for developing delirium in those with orders for possible anticholinergic medications was 0.33 (95% confidence interval ( CI) = 0.10-1.03). The OR for developing delirium among those with orders for definite anticholinergic medications was 0.43 (95% CI = 0.11-1.63). Conclusion The results did not support the hypothesis that prescription of anticholinergic medications increases the risk of incident delirium in hospitalized older adults with cognitive impairment. This relationship needs to be established using prospective study designs with medication dispensing data to improve the performance of predictive models of delirium. [ABSTRACT FROM AUTHOR]

Objectives To determine whether donepezil hydrochloride can reduce the prevalence and severity of delirium in older adults undergoing hip fracture repair. Design Pilot double-masked randomized placebo-controlled trial. Setting Large academic medical center. Participants Sixteen individuals aged 70 and older with hip fracture. Intervention Donepezil 5 mg or placebo was randomly allocated and initiated within 24 hours of surgery, preoperatively or postoperatively. Daily treatment was continued for 30 days or until side effects or the clinical situation required termination. Measurements All outcomes were ascertained masked to treatment status. Information on drug tolerability and safety was obtained from the participant, nurse, and medical record. Delirium presence and severity were measured during daily hospital interviews and at 2, 4, and 6 weeks after surgery after a standardized assessment using the Confusion Assessment Method ( CAM) and the Memorial Delirium Assessment Scale ( MDAS). Results Participants in the donepezil and placebo arms had similar baseline characteristics. Participants in the donepezil arm experienced significantly more side effects. In longitudinal models, there were no significant differences between the donepezil and placebo arms with regard to delirium presence over time (odds ratio = 0.9, 95% confidence interval ( CI) = 0.4-2.3) or delirium severity over time (effect size = −0.2 on 30-point MDAS scale, 95% CI = −1.5-1.2). Conclusion Participants randomized to donepezil had no significant improvement in delirium presence or severity but experienced more side effects. Overall, sufficient evidence was not found from this pilot study to warrant a definitive Phase III trial. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine whether disease burden is associated with frailty independent of diagnosed chronic disease and whether physiological measurements provide greater understanding of the etiology of frailty. DESIGN: Cross-sectional. SETTING: Community. PARTICIPANTS: Two thousand four hundred thirty-seven participants in the Cardiovascular Health Study, 1992/93 examination (mean age 74.8±4.8, 43.4% male, 95.8% white). MEASUREMENTS: Disease burden and frailty were tabulated using 10-point scales (0=healthy, 10=unhealthy). Disease burden was the sum of measurements characterizing the vasculature, brain, kidneys, lungs, and glucose metabolism. Frailty was assessed using the frailty index reported by Fried. Multivariate linear models were used to determine the association between disease burden (predictor) and frailty (outcome). RESULTS: Unadjusted, 1-point-higher disease burden was associated with a 0.28-point-higher frailty score ( P<.001). White matter grade, forced vital capacity, and cystatin-C were particularly strongly and significantly associated with frailty. Disease burden attenuated the association between frailty and age by 29%, and disease burden and age had similar associations with frailty. Disease burden attenuated the association between frailty and fibrinogen, Factor VIII, and C-reactive protein by 32%, 56%, and 83%, respectively. Frailty was associated with diagnosed depression, stroke, cognitive impairment, arthritis, and pulmonary disease but not coronary heart disease, diabetes mellitus, or kidney disease in the presence of a summary of disease burden. In the adjusted model, disease burden remained significantly associated with frailty (β=0.11, P<.001). CONCLUSION: Disease burden was independently and significantly associated with frailty. These results emphasize that typically unrecognized physiological changes may contribute significantly to frailty. [ABSTRACT FROM AUTHOR]

Established in 1995, the Paul B. Beeson Career Development program provides faculty development awards to outstanding junior and midcareer faculty committed to academic careers in aging-related research, training, and practice. This study evaluated the effect of 134 Beeson Scholars on their medical schools' aging and geriatric medicine programs and on the field of aging research from 1995 to 2007. Quantitative and qualitative survey data from multiple sources, including the American Geriatrics Society/Association of Directors of Geriatric Academic Programs' Geriatrics Workforce Policy Studies Center, National Institutes of Health (NIH) rankings of research funding, and other governmental databases were used to compare 36 medical schools with Beeson Scholars with 34 similar medical schools without Beeson scholars and to examine the influence of Beeson Scholars on the field of geriatrics and aging. Most Beeson Scholars remained at the institution where they trained during their Beeson award, and 89% are still practicing or conducting research in the field of geriatrics and aging. Twenty-six (19.4%) of the scholars have led institutional research mentoring awards, 51 (39%) report leadership roles in institutional program project grants, and 13 (10%) report leadership roles in the Clinical and Translational Science Award programs at their institutions. Beeson Scholars are more likely than a matched sample of non-Beeson NIH K awardees to study important geriatric syndromes such as falls, cognitive impairment, adverse drug events, osteoporosis, and functional recovery from illness. Total Beeson Impact Years (the total number of years all Beeson Scholars have worked at each school) is positively correlated with more geriatrics research faculty, after controlling for NIH funding rank ( P=.02). Beeson Scholars have made positive contributions to the development of academic geriatrics research programs at U.S. medical schools. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine whether prior pneumococcal and seasonal influenza vaccination improves outcomes in older adults hospitalized for community-acquired pneumonia (CAP). DESIGN: Prospective, observational, multicenter study. SETTING: Five public hospitals providing universal free care to the whole population in three Spanish regions. PARTICIPANTS: Individuals aged 65 and older admitted to the hospital with CAP through the emergency department. MEASUREMENTS: Pneumococcal and influenza vaccination status. The primary study outcomes were intensive care unit (ICU) admission, length of hospital stay (LOS), and overall case-fatality rate. Outcome variables of individuals vaccinated with both vaccines were compared with outcomes of those who were unvaccinated. RESULTS: Two hundred thirty-eight individuals had received 23-valent pneumococcal polysaccharide vaccine and seasonal influenza vaccination and were compared with 195 unvaccinated individuals. No differences were found with respect to combined antibiotic therapy between groups (38.0% vs 39.7%; P=.80). Similar percentages of vaccinated and unvaccinated individuals required ICU admission (7.2% vs 8.2%; P=.69). Mean LOS was significantly shorter in vaccinated individuals (9.9 vs 12.4 days; P=.04). Overall case-fatality rates were similar in both groups (5.9% vs 5.1%; P=.73). After adjustment, LOS, risk of ICU admission, and overall case-fatality rate were not associated with prior pneumococcal and seasonal influenza vaccination. CONCLUSION: The clinical outcomes of vaccinated older adults hospitalized with CAP were not better than those observed in unvaccinated individuals. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which is concerned with research which investigated the relationship between testosterone and cognitive function in elderly men with dementia.