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Background: Objective measures for screening, prioritizing, and planning care for frail individuals are essential for appropriate aged care provision. This study evaluates metrics derived from actigraphy measures (captured by wrist accelerometer) as a digital biomarker to identify frail individuals at risk of adverse outcomes, including death, hospitalization, and cognitive decline. Methods: This was a secondary study using data from a randomized controlled trial assessing the effectiveness of an ongoing pharmacist service in residential aged care facilities. Three metrics are studied and compared: the Frailty Index, the daily time spent in light time activity, and the temporal correlation of the actigraphy signal, measured by detrended fluctuation analysis. The association between actigraphy‐derived metrics at baseline and adverse events within 12 months (death, cognitive decline, and hospitalizations) was assessed using logistic regression. Results: Actigraphy records were available for 213 participants living in aged‐care, median age of 85 years. Individuals with higher temporal correlation (activity is less random) were at lower risk of death (Standardized OR: 0.49; 95% CI 0.34, 0.7, p < 0.001) and hospitalization (Standardized OR: 0.57; 95% CI 0.42, 0.77, p < 0.001) in 12 months, but there was no difference in cognitive decline (Standardized OR: 1; 95% CI 0.74, 1.35, p = 0.98). The predictive model that included temporal correlation had an area under the curve of 0.70 (CI 0.60–0.80) for death and 0.64 (CI 0.54–0.72) for hospitalization. Conclusion: Temporal correlation of the actigraphy signal from aged care residents was strongly associated with death and hospitalization, but not cognitive decline. Digital biomarkers may have a place as an objective, accurate, and low‐cost patient metric to support risk stratification and clinical planning. [ABSTRACT FROM AUTHOR]

Objectives To examine the risk of dementia associated with posttraumatic stress disorder ( PTSD) and the contribution of antipsychotic use to this risk. Design Retrospective cohort study Setting Australia. Administrative claims data from the Australian Government Department of Veterans' Affairs were used. Participants Male Vietnam veterans aged 55 to 65 at baseline (2001-02) with no preexisting dementia diagnosis (N = 15,612). Measurements The association between PTSD and dementia was assessed over 12 years of follow-up. Dementia was identified as a hospital diagnosis, dementia record in service disability data, or dispensing of medicines for dementia. Cox-proportional hazards models were used, with age as the time-scale. Results were stratified according to baseline antipsychotic use. Results No greater risk of dementia was observed with PTSD. In veterans who received antipsychotics, dementia risk was significantly higher than in those who did not (hazard ratio ( HR) = 2.1, 95% confidence interval ( CI) = 1.4-3.3). Dementia risk was significantly greater in veterans hospitalized for PTSD who received antipsychotics ( HR = 2.2, 95% CI = 1.1-4.6) and veterans without PTSD who received antipsychotics ( HR = 4.3, 95% CI = 2.1-8.6) than in those without PTSD with no antipsychotic use. Conclusion Antipsychotic use may be a contributor to dementia risk. These findings should be interpreted with caution because the study design was observational. Further research using prospective study designs in settings where diagnostic data, cognitive function, and disease severity are available are required. [ABSTRACT FROM AUTHOR]

Objectives To identify the association between use of multiple anticholinergic medications and risk of hospitalization for confusion or dementia. Design Retrospective cohort study conducted over 2 years between July 2010 and June 2012, using administrative claims data from the Australian Department of Veterans' Affairs. Setting Australia. Participants Australian veterans dispensed at least one moderately or highly anticholinergic medication in the year before study start. Measurements Cumulative anticholinergic use on each day of the study period was determined. The association between hospitalization for confusion or dementia and number of anticholinergic medications used at the time of admission was compared against times during which participants were not taking anticholinergic medications. Sensitivity analyses were undertaken limiting the outcome to admissions for acute confusion and excluding individuals taking antipsychotics. Results Adjusted results showed a significantly greater risk of hospitalization for confusion or dementia when individuals were taking two or more anticholinergic medications. The adjusted incident rate ratios ( IRRs) were 2.58 (95% confidence interval ( CI) = 1.91-3.48) for those taking two anticholinergics and 3.87 (95% CI = 1.83-8.21) for those taking three or more. Sensitivity analyses in which participants taking antipsychotic medications were excluded and the outcome was limited to acute confusion also found similar risks for those taking two ( IRR 1.82, 95% CI = 1.18-2.80) and three or more ( IRR = 3.98 95% CI = 1.50-10.58) anticholinergic medications. Conclusion Taking more anticholinergic medications is associated with greater risk of hospitalization for confusion or dementia. Strategies to reduce anticholinergic medication burden are likely to translate into significant health benefits. [ABSTRACT FROM AUTHOR]

Objectives To determine whether there is greater risk of initiation of oxybutynin to treat urinary incontinence ( UI) after initiation of medicines reported to be associated with UI. Design Prescription sequence symmetry analysis ( PSSA). Setting Administrative claims data from the Australian Government Department of Veterans' Affairs. Participants Individuals who initiated oxybutynin and a medicine reported to be associated with UI in a 12-month period. Measurements Between January 1, 2001, and December 31, 2011, the distribution of incident dispensing of medicines reported to be associated with UI (prazosin, diuretics, calcium channel blockers ( CCBs), angiotensin-converting enzyme inhibitors ( ACEIs), angiotensin receptor blockers ( ARBs), hormone replacement therapy ( HRT), opioid analgesics, anticonvulsants, levodopa, antipsychotics, sedatives, selective serotonin reuptake inhibitors ( SSRIs), venlafaxine, anticholinesterases) was assessed before and after incident dispensing of oxybutynin (to treat UI). Crude and adjusted sequence ratios ( ASRs) with 95% confidence intervals ( CIs) were calculated. Results Significant associations between initiation of CCBs, ACEIs, ARBs, and hypnotic-sedatives and subsequent initiation of oxybutynin were found. ASRs ranged from 1.28 (95% CI = 1.19-1.39) for ACEIs to 1.59 (95% CI = 1.29-1.96) for verapamil. In women, there was greater risk of initiation of oxybutynin after prazosin ( ASR = 1.84, 95% CI = 1.29-2.63) and HRT ( ASR = 1.54, 95% CI = 1.42-1.67) initiation. PSSA showed no significant association with initiation of opioids, anticonvulsants, levodopa, SSRIs, venlafaxine, or anticholinesterases and subsequent initiation of oxybutynin. Conclusion This study highlights the potential for initiation of commonly used medicines to be associated with subsequent initiation of oxybutynin to treat UI. Greater awareness of the potential for medicines to contribute to UI is required. [ABSTRACT FROM AUTHOR]