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Background: Persistent inflammation is associated with adverse health outcomes, but its impact on mortality has not been investigated previously among hip fracture patients. This article aims to investigate the influence of changes in levels of cytokines in the 2 months after a hip fracture repair on 5‐year mortality. Methods: This is a prospective cohort study from the Baltimore Hip Studies (BHS) with 191 community‐dwelling older men and women (≥65 years) who had recently undergone surgical repair of an acute hip fracture, with recruitment from May 2006 to June 2011. Plasma interleukin‐6 (IL‐6), soluble tumor necrosis factor alpha receptor1 (sTNFα‐R1), and interleukin‐1 receptor agonist (IL‐1RA) were obtained within 22 days of admission and at 2 months. All‐cause mortality over 5 years was determined. Logistic regression analysis tested the associations between the cytokines' trajectories and mortality over 5 years, adjusted for covariates (age, sex, education, body mass index, lower extremity physical activities of daily living, and Charlson comorbidity index). Results: High levels of IL‐6 and sTNFα‐R1 at baseline with small or no decline at 2 months were associated with higher odds of 5‐year mortality compared with those with lower levels at baseline and greater decline at 2 months after adjustment for age, and other potential confounders (OR = 4.71, p = 0.01 for IL‐6; OR = 15.03, p = 0.002 for sTNFα‐R1). Similar results that failed to reach significance were found for IL‐1RA (OR = 2.40, p = 0.18). Those with higher levels of cytokines at baseline with greater decline did not have significantly greater mortality than the reference group, those with lower levels at baseline and greater decline. Conclusion: Persistent elevation of plasma IL‐6 and sTNFα‐R1 levels within the first 2 months after hospital admission in patients with hip fracture is associated with higher 5‐year mortality. These patients may benefit from enhanced care and earlier intensive interventions to reduce the risk of death. [ABSTRACT FROM AUTHOR]

Background: Nearly 2.9 million older Americans with lower incomes live in subsidized housing. While regional and single‐site studies show that this group has higher rates of healthcare utilization compared to older adults in the general community, little is known about healthcare utilization nationally nor associated risk factors. Methods: We conducted a retrospective cohort study of Medicare beneficiaries aged ≥65 enrolled in the National Health and Aging Trends Study in 2011, linked to Medicare claims data, including individuals living in subsidized housing and the general community. Participants were followed annually through 2020. Outcomes were hospitalization, short‐term skilled nursing facility (SNF) utilization, long‐term care utilization, and death. Fine–Gray competing risks regression analysis was used to assess the association of subsidized housing residence with hospitalization and nursing facility utilization, and Cox proportional hazards regression analysis was used to assess the association with death. Results: Among 6294 participants (3600 women, 2694 men; mean age, 75.5 years [SD, 7.0]), 295 lived in subsidized housing at baseline and 5999 in the general community. Compared to older adults in the general community, those in subsidized housing had a higher adjusted subdistribution hazard ratio [sHR] of hospitalization (sHR 1.21; 95% CI, 1.03–1.43), short‐term SNF utilization (sHR 1.49; 95% CI, 1.15–1.92), and long‐term care utilization (sHR 2.72; 95% CI, 1.67–4.43), but similar hazard of death (HR, 0.86; 95% CI, 0.69–1.08). Individuals with functional impairment had a higher adjusted subdistribution hazard of hospitalization and short‐term SNF utilization and individuals with dementia and functional impairment had a higher hazard of long‐term care utilization. Conclusions: Older adults living in subsidized housing have higher hazards of hospitalization and nursing facility utilization compared to those in the general community. Housing‐based interventions to optimize aging in place and mitigate risk of nursing facility utilization should consider risk factors including functional impairment and dementia. [ABSTRACT FROM AUTHOR]

Background: Central nervous system (CNS) medication use is common among older adults, yet the impact of hospitalizations on use remains unclear. This study details CNS medication use, discontinuations, and user profiles during hospitalization periods. Methods: Retrospective cohort study using electronic health records on patients ≥65 years, from three hospitals (2018–2020), and prescribed a CNS medication around hospitalization (90 days prior to 90 days after). Latent class transitions analysis (LCTA) examined profiles of CNS medication class users across four time points (90 days prior, admission, discharge, 90 days after hospitalization). Results: Among 4666 patients (mean age 74.3 ± 9.3 years; 63% female; 70% White; mean length of stay 4.6 ± 5.6 days (median 3.0 [2.0, 6.0]), the most commonly prescribed CNS medications were antidepressants (56%) and opioids (49%). Overall, 74% (n = 3446) of patients were persistent users of a CNS medication across all four time points; 7% (n = 388) had discontinuations during hospitalization, but of these, 64% (216/388) had new starts or restarts within 90 days after hospitalization. LCTA identified three profile groups: (1) low CNS medication users, 54%–60% of patients; (2) mental health medication users, 30%–36%; and (3) acute/chronic pain medication users, 9%–10%. Probability of staying in same group across the four time points was high (0.88–1.00). Transitioning to the low CNS medication use group was highest from admission to discharge (probability of 9% for pain medication users, 5% for mental health medication users). Female gender increased (OR 2.4, 95% CI 1.3–4.3), while chronic kidney disease lowered (OR 0.5, 0.2–0.9) the odds of transitioning to the low CNS medication use profile between admission and discharge. Conclusions: CNS medication use stays consistent around hospitalization, with discontinuation more likely between admission and discharge, especially among pain medication users. Further research on patient outcomes is needed to understand the benefits and harms of hospital deprescribing, particularly for medications requiring gradual tapering. [ABSTRACT FROM AUTHOR]

Background: The risk of incident dementia after surgery in older adults is unclear. The study objective was to examine the rate of incident dementia among older adults after elective surgery compared with a matched nonsurgical control group. Methods: We conducted a population‐based, propensity‐matched retrospective cohort study using data from linked administrative databases in Ontario, Canada. All community‐dwelling individuals aged 66 years and older who underwent one of five major elective surgeries between April 1, 2007 and March 31, 2011 were included. Each surgical patient was matched 1:1 on surgical specialty of the surgeon at consultation, age, sex, fiscal year of entry, and propensity score with a patient who attended an outpatient visit with a surgeon of the same surgical specialty but did not undergo surgery. Patients were followed for up to 5 years after cohort entry for the occurrence of a new dementia diagnosis, defined from administrative data. Cause‐specific hazard models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for the association between surgery and the hazard of incident dementia. Subgroup and sensitivity analyses were performed. Results: A total of 27,878 individuals (13,939 matched pairs) were included in the analysis. A total of 640 (4.6%) individuals in the surgical group and 965 (6.9%) individuals in the control group developed dementia over the 5‐year follow‐up period. Individuals who underwent surgery had a reduced rate of incident dementia compared with their matched nonsurgical controls (HR 0.88; 95% CI 0.80–0.97; p = 0.01). This association was persistent in most subgroups and after sensitivity analyses. Conclusions: Elective surgery did not increase the rate of incident dementia when compared with matched nonsurgical controls. This could be an important consideration for patients and surgeons when elective surgery is considered. See related editorial by Tammy Hshieh and article by Tang et al. in this issue. [ABSTRACT FROM AUTHOR]

Background: Skilled home healthcare (HH) provided in‐person care to older adults during the COVID‐19 pandemic, yet little is known about the pandemic's impact on HH care transition patterns. We investigated pandemic impact on (1) HH service volume; (2) population characteristics; and (3) care transition patterns for older adults receiving HH services after hospital or skilled nursing facility (SNF) discharge. Methods: Retrospective, cohort, comparative study of recently hospitalized older adults (≥ 65 years) receiving HH services after hospital or SNF discharge at two large HH agencies in Baltimore and New York City (NYC) 1‐year pre‐ and 1‐year post‐pandemic onset. We used the Outcome and Assessment Information Set (OASIS) and service use records to examine HH utilization, patient characteristics, visit timeliness, medication issues, and 30‐day emergency department (ED) visit and rehospitalization. Results: Across sites, admissions to HH declined by 23% in the pandemic's first year. Compared to the year prior, older adults receiving HH services during the first year of the pandemic were more likely to be younger, have worse mental, respiratory, and functional status in some areas, and be assessed by HH providers as having higher risk of rehospitalization. Thirty‐day rehospitalization rates were lower during the first year of the pandemic. COVID‐positive HH patients had lower odds of 30‐day ED visit or rehospitalization. At the NYC site, extended duration between discharge and first HH visit was associated with reduced 30‐day ED visit or rehospitalization. Conclusions: HH patient characteristics and utilization were distinct in Baltimore versus NYC in the initial year of the COVID‐19 pandemic. Study findings suggest some older adults who needed HH may not have received it, since the decrease in HH services occurred as SNF use decreased nationally. Findings demonstrate the importance of understanding HH agency responsiveness during public health emergencies to ensure older adults' access to care. [ABSTRACT FROM AUTHOR]

Background: This study examined the associations of body mass index (BMI) and waist circumference (WC), as well as their short‐ and long‐term changes over time, with incident dementia in older individuals. Methods: Data came from 18,837 community‐dwelling individuals aged 65+ years from Australia and the United States, who were relatively healthy without major cognitive impairment at enrolment. Anthropometric measures were prospectively assessed at baseline, as well as change and variability from baseline to year two (three time‐points). In a subgroup (n = 11,176), self‐reported weight at age 18 and 70+ years was investigated. Dementia cases satisfied DSM‐IV criteria. Cox regression was used to examine the associations between anthropometric measures and incident risk of dementia. Results: Compared to normal weight, an overweight (HR: 0.67, 95%CI: 0.57–0.79, p < 0.001) or obese BMI (HR: 0.73, 95%CI: 0.60–0.89, p = 0.002), or a larger WC (elevated, HR: 0.71, 95%CI: 0.58–0.86, p < 0.001; highly elevated, HR: 0.65, 95%CI: 0.55–0.78, p < 0.001; relative to low) at baseline was associated with lower dementia risk. In contrast, substantial increases in BMI (>5%) over 2 years after baseline were associated with higher dementia risk (HR: 1.49, 95% CI: 1.17–1.91, p = 0.001). Increased dementia risk was also seen with an underweight BMI at baseline and a 2‐year BMI decrease (>5%), but these associations appeared only in the first 4 years of follow‐up. Compared to normal weight at both age 18 and 70+ years, being obese at both times was associated with increased dementia risk (HR: 2.27, 95%CI: 1.22–4.24, p = 0.01), while obesity only at age 70+ years was associated with decreased risk (HR: 0.70, 95%CI: 0.51–0.95, p = 0.02). Conclusions: Our findings suggest that long‐term obesity and weight gain in later life may be risk factors for dementia. Being underweight or having substantial weight loss in old age may be early markers of pre‐clinical dementia. [ABSTRACT FROM AUTHOR]

Background: There is growing interest in understanding the care needs of lonely people but studies are limited and examine healthcare settings separately. We estimated and compared healthcare trajectories in lonely and not lonely older female and male respondents to a national health survey. Methods: We conducted a retrospective cohort study of community‐dwelling, Ontario respondents (65+ years) to the 2008/2009 Canadian Community Health Survey—Healthy Aging. Respondents were classified at baseline as not lonely, moderately lonely, or severely lonely using the Three‐Item Loneliness Scale and then linked with health administrative data to assess healthcare transitions over a 12 ‐year observation period. Annual risks of moving from the community to inpatient, long‐stay home care, long‐term care settings—and death—were estimated across loneliness levels using sex‐stratified multistate models. Results: Of 2684 respondents (58.8% female sex; mean age 77 years [standard deviation: 8]), 635 (23.7%) experienced moderate loneliness and 420 (15.6%) severe loneliness. Fewer lonely respondents remained in the community with no transitions (not lonely, 20.3%; moderately lonely, 17.5%; and severely lonely, 12.6%). Annual transition risks from the community to home care and long‐term care were higher in female respondents and increased with loneliness severity for both sexes (e.g., 2‐year home care risk: 6.1% [95% CI 5.5–6.6], 8.4% [95% CI 7.4–9.5] and 9.4% [95% CI 8.2–10.9] in female respondents, and 3.5% [95% CI 3.1–3.9], 5.0% [95% CI 4.0–6.0], and 5.4% [95% CI 4.0–6.8] in male respondents; 5‐year long‐term care risk: 9.2% [95% CI 8.0–10.8], 11.1% [95% CI 9.3–13.6] and 12.2% [95% CI 9.9–15.3] [female], and 5.3% [95% CI 4.2–6.7], 9.1% [95% CI 6.8–12.5], and 10.9% [95% CI 7.9–16.3] [male]). Conclusions: Lonely older female and male respondents were more likely to need home care and long‐term care, with severely lonely female respondents having the highest probability of moving to these settings. [ABSTRACT FROM AUTHOR]

Background: Physical frailty accelerates the timing of both subsequent disability and death; however, evidence regarding the impact of frailty on the period from disability onset to death and sex differences of this impact is lacking. The aim of this study was to examine the relationship among physical frailty, disability, death, and sex differences. Methods: This Japanese cohort study included 10,524 community‐dwelling people aged ≥65 years. Physical frailty was operationalized by key phenotypes as per Fried's criteria (slowness, weakness, exhaustion, weight loss, and low activity) at baseline. We calculated hazard ratios (HRs) with 95% confidence intervals (CIs) for disability onset and post‐disability survival according to the frailty status. Results: During a 5‐year follow‐up, the risk of disability onset for pre‐frailty (HR: 1.74, 95% CI: 1.51–2.00) and frailty (HR: 3.27, 95% CI: 2.77–3.87) were significantly higher than that for robust people. Furthermore, among participants who developed disabilities within 5 years (n = 1481), the risk of post‐disability death for pre‐frailty was not different from that for robust (HR: 1.49, 95% CI: 0.99–2.24), but frailty showed a higher risk of post‐disability death than did robust people. (HR: 1.75, 95% CI: 1.13–2.72). In the sex‐stratified analysis, although the female group showed no association between frailty status and post‐disability death (HR: 1.21, 95% CI: 0.63–2.33 in pre‐frailty; HR: 1.24, 95% CI: 0.60–2.57 in frailty), the male group showed higher risk of post‐disability death in both pre‐frailty (HR: 1.74, 95% CI: 1.03–2.96) and frailty (HR: 2.32, 95% CI: 1.32–4.09). Conclusions: Physical frailty shortens the period from disability onset to death. Additionally, the impact of frailty on post‐disability death is greater for males than for females. Our findings suggest that physical frailty is an important clinical indicator distinct from disability and that interventions to prevent and address frailty in men need further investigation. [ABSTRACT FROM AUTHOR]

Background: Prescribing cascades occur when a drug adverse event is misinterpreted as a new medical condition and a second, potentially unnecessary drug, is prescribed to treat the adverse event. The population‐level consequences of prescribing cascades remain unknown. Methods: This population‐based cohort study used linked health administrative databases in Ontario, Canada. The study included community‐dwelling adults, 66 years of age or older with hypertension and no history of heart failure (HF) or diuretic use in the prior year, newly dispensed a calcium channel blocker (CCB). Individuals subsequently dispensed a diuretic within 90 days of incident CCB dispensing were classified as the prescribing cascade group, and compared to those not dispensed a diuretic, classified as the non‐prescribing cascade group. Those with and without a prescribing cascade were matched one‐to‐one on the propensity score and sex. The primary outcome was a serious adverse event (SAE), which was the composite of emergency room visits and hospitalizations in the 90‐day follow‐up period. We estimated hazard ratios (HRs) with 95% confidence intervals (CI) for SAE using an Andersen–Gill recurrent events regression model. Results: Among 39,347 older adults with hypertension and no history of HF who were newly dispensed a CCB, 1881 (4.8%) had a new diuretic dispensed within 90 days after CCB initiation. Compared to the non‐prescribing cascade group, those in the prescribing cascade group had higher rates of SAEs (HR: 1.21, 95% CI: 1.02–1.43). Conclusions: The CCB‐diuretic prescribing cascade was associated with an increased rate of SAEs, suggesting harm beyond prescribing a second drug therapy. Our study raises awareness of the downstream impact of the CCB‐diuretic prescribing cascade at a population level and provides an opportunity for clinicians who identify this prescribing cascade to review their patients' medications to determine if they can be optimized. [ABSTRACT FROM AUTHOR]

Background: Examine the relationship between balance test performance and the energetic cost of walking (ECW) and gait speed. Methods: Cross‐sectional and longitudinal analyses of data from the Baltimore Longitudinal Study of Aging. Men (48%) and women aged 60–96 years enrolled in the BLSA between 2007 and 2020 (n = 1132). Balance was assessed using narrow walk (NW) and progressive standing balance tests (SB). ECW measured during 2.5‐min usual paced walk while participants wore a portable indirect calorimeter. Gait speed assessed over 6‐m. Each test parameterized using validated methods. Statistical analysis to compare balance measures to ECW, and gait speed used generalized logistic regression models and adjustments for age, sex, race, height, weight, and comorbidities. Results: Cross‐sectionally, mean ECW was higher and gait speed slower in persons who failed the NW than those who passed (0.189 vs. 0.164 mL/kg/m, p < 0.0001 and 0.96 vs. 1.15 m/s, p < 0.0001, respectively). Mean ECW was increasingly higher and gait speed slower over three progressively challenging SB tests (0.207 vs. 0.171 vs. 0.164 mL/kg/m, p < 0.0001 and 0.95 vs. 1.05 vs. 1.15 m/s, p < 0.0001). Over an average 2.4 years, those who declined in SB and NW had a higher ECW and slower gait speed than persons who maintained performance (SB: 0.18 vs. 0.160 mL/kg/m, p = 0.0003, and 1.00 vs. 1.13 m/s, p = <0.001; NW: 0.175 vs. 0.160 mL/kg/m, p = 0.002, and 1.04 vs. 1.14 m/s, p = 0.001). Persons who improved had lower ECW and faster gait speed than those who failed at both visits (SB: 0.169 vs. 0.240 mL/kg/m, p = 0.0002, and 0.99 vs. 0.94 m/s, p = 0.67, NW: 0.163 vs. 0.195 mL/kg/m, p = 0.0005, and 1.10 vs. 0.92 m/s, p < 0.001). Conclusion: Instability contributes to higher ECW and slower gait speed which suggests that rehabilitation efforts to improve balance may help maintain function further into older adulthood and delay mobility limitation. [ABSTRACT FROM AUTHOR]

Background: Virtual collaborative models are a practical way to implement a supportive environment for multi‐team learning. In this project, we aimed to describe the processes and outcomes of a virtual deprescribing collaborative that facilitated implementation of deprescribing interventions around the country. Methods: Two successive cohorts comprised of multidisciplinary teams from geographically diverse veterans affairs (VA) sites were selected via an application process to participate in a virtual deprescribing collaborative. Each site developed its own deprescribing protocol and took part in regular meetings, mentoring groups, monthly data reporting, and other learning activities over an approximate 9 month period, per cohort. Standard measures were number of veterans served and medications deprescribed. Descriptive and qualitative analyses were utilized. Results: Twenty‐one total VA sites were selected to participate in the deprescribing collaborative in two cohorts (Cohort 1, n = 12 sites; Cohort 2, n = 9 sites). The majority of sites' practice areas directly served the older adult population, and the majority of site leads were pharmacists. The most utilized tool used by the collaborative sites was the VA VIONE decision support tool (n = 14) and the most common strategy was individualized medication review. Combining outcomes from both Cohorts 1 and 2, a total of n = 4770 veterans were served, with 8332 medications deprescribed. Eighty‐two percent of Cohort 1 sites surveyed reported their deprescribing program was still being utilized after 1 year follow up. Conclusions: This virtual deprescribing collaborative aided in the successful implementation of both established and novel deprescribing practices across a variety of VA practice sites that care for older adults. The shared learning experience enhanced problem solving and allowed for interdisciplinary teamwork. Overall the collaborative was successful in improving polypharmacy for several thousand older adults. [ABSTRACT FROM AUTHOR]

Background: The American Rescue Plan Act of 2021 awarded $500 million toward scaling "strike teams" to mitigate the impact of Coronavirus Disease 2019 (COVID‐19) within nursing homes. The Massachusetts Nursing Facility Accountability and Support Package (NFASP) piloted one such model during the first weeks of the pandemic, providing nursing homes financial, administrative, and educational support. For a subset of nursing homes deemed high‐risk, the state offered supplemental, in‐person technical infection control support. Methods: Using state death certificate data and federal nursing home occupancy data, we examined longitudinal all‐cause mortality per 100,000 residents and changes in occupancy across NFASP participants and subgroups that varied in their receipt of the supplemental intervention. Results: Nursing home mortality peaked in the weeks preceding the NFASP, with a steeper increase among those receiving the supplemental intervention. There were contemporaneous declines in weekly occupancy. The potential for temporal confounding and differential selection across NFASP subgroups precluded estimation of causal effects of the intervention on mortality. Conclusions: We offer policy and design suggestions for future strike team iterations that could inform the allocation of state and federal funding. We recommend expanded data collection infrastructure and, ideally, randomized assignment to intervention subgroups to support causal inference as strike team models are scaled under the direction of state and federal agencies. See related Commentary by Berry et al. in this issue. [ABSTRACT FROM AUTHOR]

Background: Studies revealed unidirectional associations between frailty and medication‐related problems (MRPs) among older adults. Less is known about the association between frailty and the risk of MRPs. We aimed to assess the bi‐directional association between frailty and the risk of MRPs in community‐dwelling older adults in five European countries. Methods: Participants were 1785 older adults in the population‐based Urban Health Centres Europe project. Repeated assessments were collected at baseline and one‐year follow‐up, including frailty, the risk of MRPs, and covariates. Linear regression analyses were conducted to examine the unidirectional associations. A cross‐lagged panel modeling was used to assess bi‐directional associations. Results: The unidirectional association between frailty at baseline and the risk of MRPs at follow‐up remained statistically significant after adjusting for covariates (β = 0.10, 95%CI:0.08, 0.13). The association between the risk of MRPs at baseline and frailty at follow‐up shows similar trends. The bi‐directional association was comparable with reported unidirectional associations, with a stronger effect from frailty at baseline to the risk of MRPs at follow‐up than reversed path (Wald test for comparing lagged effects: p < 0.05). Conclusion: This longitudinal study suggests that a cycle may exist where older adults with higher frailty levels are more likely to have a higher risk of MRPs, which in turn contributes to developing a higher level of frailty. Further research is needed to validate our findings and explore underlying pathways. [ABSTRACT FROM AUTHOR]

Background: In Taiwan, the National Health Insurance Administration initiated the integrated home‐based medical care (iHBMC) program in 2016 to improve accessibility to health care for homebound patients. This study aimed to describe the characteristics of older people receiving iHBMC services in Taiwan as well as the relationship between patient characteristics and survival. Methods: All older adults registered in the iHBMC application dataset were enrolled between March 1, 2016, and December 31, 2018. Data on social determinants of health (income level, residential area), functional status, consciousness status, nasogastric tube or urinary catheter placement, and major diseases were retrieved from the database. Data on the frequency of multidisciplinary team members' visits were collected. The survival rate was investigated using the Kaplan–Meier method. A Cox proportional hazards univariate regression was conducted to analyze factors influencing survival rates. Results: A total of 41,079 patients aged ≥65 years were enrolled in iHBMC services. The results showed that the one‐year survival rates were 72.1%, 67.4%, and 14.7% in the home‐based primary care (HBPC), home‐based primary care plus (HBPC‐Plus), and home‐based palliative care (HBPalC), respectively. Nearly two‐thirds of the HBPC‐Plus patients underwent nasogastric tube placement. The Cox proportional hazards univariate regression analysis showed that a low urbanization level, a low income level, a low functional status, and an impaired consciousness status were significant predictors of poor survival after adjustment for confounding variables. Conclusions: Older adults receiving iHBMC services had a high mortality rate. The high rate of feeding tube use indicated that education and support for both clinical practitioners and family caregivers regarding careful hand feeding are warranted. There was a relationship between low income levels and poor survival in rural areas. Further research on whether social care could impact prognosis should be considered. [ABSTRACT FROM AUTHOR]

Background: The contemporary uptake of lipid‐lowering therapies (LLT), including more intensive treatment with high‐intensity statins and non‐statin LLT, among U.S. older adults (≥75 years old) with ASCVD is unknown. Methods: In this multicenter retrospective cohort study of a large geographically diverse sample of commercially insured U.S. older adults with ASCVD, we assessed treatment with LLT. Secondary measures included LDL‐C above target ≥70 mg/dl, persistence and adherence to therapy. Results: Treatment with statins, high‐intensity statins, ezetimibe, and PCSK9 inhibitors was assessed in 194,503 older adults (49.9% female) with known ASCVD on January 31st, 2019. 49.3% of older adults with ASCVD were on any statin, with 16.6% receiving a high‐intensity statin and 32.7% on low‐or moderate‐intensity statins. Treatment with ezetimibe (2.4%) or PCSK9 inhibitors (0.24%) was rare and 62.6% of the overall cohort had an LDL‐C above target at ≥70 mg/dl. Patients on high‐intensity statins were more frequently male, had a diagnosis of coronary artery disease, and were more frequently seen by a cardiologist compared with those on low‐or moderate‐intensity statins and untreated individuals (p < 0.0001). The majority of older adults on high‐intensity statins remained on therapy at 12 months (91.9%) and 85.7% had ≥75% adherence to treatment. Conclusions: Less than half of eligible older adults with ASCVD are on statins and only a minority of patients are receiving more intensive lipid‐lowering to improve outcomes. [ABSTRACT FROM AUTHOR]

Background: Asymptomatic diabetes testing may be of limited value for older nursing home residents, but most diabetes guidelines lack upper-age cutoffs for screening cessation. We evaluated patterns of glycated hemoglobin (HbA1c) and serum blood glucose (SBG) testing among older residents without diabetes in Ontario, Canada. Methods: This population-based retrospective cohort study used provincial health administrative data from ICES to identify older nursing home residents in Ontario without diabetes between January 1, 2015 and December 31, 2018. We examined HbA1c and glucose testing rates overall, by age, sex, and near end-of-life. The number of tests needed to identify one case of diabetes (using HbA1c thresholds of 6.5% and 8.0%) were also calculated. Results: Among 102,923 older nursing home residents (70.3% women; average age 85.6 ± SD 7.7 years), 46.1% of residents received ≥1 HbA1c test over an average follow-up period of 2.15 (± SD 1.49) years, and 18.2% of these tested residents received ≥4 HbA1c tests. The crude HbA1c testing rate was 52.6 tests/100 person-years (95% CI 52.3–52.9). Testing rates among residents aged ≥80 years was 50.7 HbA1c tests/100 person-years (95% CI 50.4–51.0), and 47.8 tests/100 person-years (95% CI 46.5–49.0) among residents near end-of-life. The number of tests to identify a case of diabetes (HbA1c ≥ 6.5%) was 44, while the number of tests to identify a case of actionable diabetes (HbA1c ≥ 8%) was 310. Less than 1% of residents with an HbA1c test met criteria for actionable diabetes. Conclusions: Nursing home residents without diabetes receive frequent diabetes testing, with high testing rates even in residents over 80 years old and residents near end-of-life. The high number of tests needed to identify a case of actionable diabetes highlights the urgent need to re-evaluate diabetes testing practices in nursing homes. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has increased the risk of psychological distress for older adults during a period of reduced access to mental health support. We identified predictors of persistent depressive and anxiety symptoms among older adults throughout the initial 9 months of the pandemic. Methods: This was a longitudinal study using web‐based surveys sent to a convenience sample of Canadians aged ≥55 years. A baseline survey was sent in May 2020, with eight surveys sent monthly between June 2020 and January 2021. Data were separated into three study periods, corresponding to coronavirus case rates. Respondents who met predetermined thresholds for elevated depressive or anxiety symptoms using standardized mental health scales during all three periods were defined as having persistent symptoms. Multivariable Poisson regression was used to compare the risk of persistent symptoms across respondent characteristics selected a priori. Results: There were 835 respondents who answered questions about depressive symptoms and 865 who answered questions about anxiety symptoms across all three study periods. Among those with complete follow‐up data, 19.2% (n = 159/827) reported persistent depressive symptoms and 16.4% (n = 140/856) reported persistent anxiety symptoms. Respondents with persistent depressive symptoms were more likely to be women (adjusted relative risk [aRR] 1.71; 95% CI 1.19–2.46), and report multimorbidity (aRR 1.45; 95% CI 1.07–1.97), pre‐existing depression (aRR 2.00; 95% CI 1.45–2.77) and pre‐existing anxiety (aRR 1.50; 95% CI 1.10–2.06). The same respondent characteristics were correlates of persistently elevated anxiety symptoms. Conclusions: Older women, older adults with pre‐existing depression and anxiety, and those with multimorbidity were more likely to report persistent mental health symptoms during the first 9 months of the COVID‐19 pandemic. These individuals were known to have elevated risk prior to the pandemic, and expanded interventions targeted to these groups are necessary to adequately address their mental health needs. [ABSTRACT FROM AUTHOR]

Background: Critical illness often leads to persistent functional impairment among older Intensive Care Unit (ICU) survivors. Identification of high‐risk survivors prior to discharge from their ICU hospitalization can facilitate targeting for restorative interventions after discharge, potentially improving the likelihood of functional recovery. Our objective was to develop and validate a prediction model for persistent functional impairment among older adults in the year after an ICU hospitalization. Methods: The analytic sample included community‐living participants enrolled in the National Health and Aging Trends Study 2011 cohort who survived an ICU hospitalization through December 2017 and had a follow‐up interview within 1 year. Persistent functional impairment was defined as failure to recover to the pre‐ICU level of function within 12 months of discharge from an ICU hospitalization. We used Bayesian model averaging to identify the final predictors from a comprehensive set of 17 factors. Discrimination and calibration were assessed using area‐under‐the‐curve (AUC) and calibration plots. Results: The development cohort included 456 ICU admissions (2,654,685 survey‐weighted admissions) and the validation cohort included 227 ICU admissions (1,350,082 survey‐weighted admissions). In the development cohort, the median age was 81.0 years (interquartile range [IQR] 76.0, 86.0) and 231 (50.7%) participants were women; demographic characteristics were comparable in the validation cohort. The rates of persistent functional impairment were 49.3% (development) and 50.2% (validation). The final model included age, pre‐ICU disability, probable dementia, frailty, prior hospitalizations, vision impairment, depressive symptoms, and hospital length of stay. The model demonstrated good discrimination (AUC 71%, 95% confidence interval [CI] 0.66–0.76) and good calibration. When applied to the validation cohort, the model demonstrated comparable discrimination (AUC 72%, 95% CI 0.66–0.78) and good calibration. Conclusions: Application of the model prior to discharge from an ICU hospitalization may identify older adults at the highest risk of persistent functional impairment in the subsequent year, thereby facilitating targeted interventions and follow‐up. [ABSTRACT FROM AUTHOR]

Background/Objectives: Hospitalization due to acute illness in older patients is often associated with anxiety or depressive symptoms. In these circumstances, given that pharmacologic treatment should be avoided to reduce interactions with ongoing medication regimes, psychotherapy techniques should be considered. The purpose of this study was to evaluate the effectiveness of group reminiscence therapy (RT) on the reduction of anxiety and depressive symptoms in acutely hospitalized older patients. Methods: Controlled and prospective study conducted on the Acute Geriatric Unit of a university hospital. Patients included in the intervention group (RT Group) attended a group session focused on RT, whereas those included in the control group (UC) received usual hospital care. Exclusion criteria were severe cognitive impairment, impossibility to mobilize, and clinical/hemodynamic instability. The intervention was based on a multi‐task daily group session of reminiscence activities. The severity of anxiety (Hamilton Anxiety Rating Scale, HAM‐A), depressive symptoms (15‐item Geriatric Depression Scale, GDS‐15), loneliness (ESTE‐II social loneliness scale), and fear of death (Collet‐Lester scale) was assessed at admission and discharge in both groups. Results: The intervention was effective in reducing the proportion of patients with anxiety and depressive symptoms during hospitalization. The proportion of patients with moderate–severe anxiety at discharge was 32.1% in the UC and 13.4% in the RT Group (p < 0.001), whereas the proportion of patients with depressive symptoms at discharge was 49.1% in the UC and 19.5% in the RT Group (p < 0.001). The intervention was independently associated with benefits on anxiety levels (RR 2.45, 95% CI 1.83–3.28) and depression (RR 3.71, 95% CI 2.22–6.19) at discharge. No differences were found in loneliness or fear of death. Conclusions: A group reminiscence activity reduces the proportion of patients with anxiety and depressive symptoms during hospitalization for an acute disease. Absolute changes in both anxiety and depression scores, even though significant, were relatively small. [ABSTRACT FROM AUTHOR]

Background: Measuring multimorbidity in claims data is used for risk adjustment and identifying populations at high risk for adverse events. Multimorbidity indices such as Charlson and Elixhauser scores have important limitations. We sought to create a better method of measuring multimorbidity using claims data by incorporating geriatric conditions, markers of disease severity, and disease‐disease interactions, and by tailoring measures to different outcomes. Methods: Health conditions were assessed using Medicare inpatient and outpatient claims from subjects age 67 and older in the Health and Retirement Study. Separate indices were developed for ADL decline, IADL decline, hospitalization, and death, each over 2 years of follow‐up. We validated these indices using data from Medicare claims linked to the National Health and Aging Trends Study. Results: The development cohort included 5012 subjects with median age 76 years; 58% were female. Claims‐based markers of disease severity and disease‐disease interactions yielded minimal gains in predictive power and were not included in the final indices. In the validation cohort, after adjusting for age and sex, c‐statistics for the new multimorbidity indices were 0.72 for ADL decline, 0.69 for IADL decline, 0.72 for hospitalization, and 0.77 for death. These c‐statistics were 0.02–0.03 higher than c‐statistics from Charlson and Elixhauser indices for predicting ADL decline, IADL decline, and hospitalization, and <0.01 higher for death (p < 0.05 for each outcome except death), and were similar to those from the CMS‐HCC model. On decision curve analysis, the new indices provided minimal benefit compared with legacy approaches. C‐statistics for both new and legacy indices varied substantially across derivation and validation cohorts. Conclusions: A new series of claims‐based multimorbidity measures were modestly better at predicting hospitalization and functional decline than several legacy indices, and no better at predicting death. There may be limited opportunity in claims data to measure multimorbidity better than older methods. [ABSTRACT FROM AUTHOR]

Background: A physical performance evaluation can inform fall risk in older people, however, the predictiveness of a one‐time assessment is limited. The trajectory of physical performance over time has not been well characterized and might improve fall prediction. We aimed to characterize trajectories in physical performance and determine if fall prediction improves using trajectories of performance. Methods: This was a cohort design using data from the National Health and Aging Trends Study. Physical performance was measured by the short physical performance battery (SPPB) with scores ranging from 0 (worst) to 12 (best). The trajectory of SPPB was categorized using latent class modeling and slope‐based multilevel linear regression. We used Cox proportional hazards models with an outcome of time to ≥2 falls from annual self‐report to assess predictiveness after adding SPPB trajectories to models of baseline SPPB and established non‐physical‐performance‐based variables. Results: The sample was 5969 community‐dwelling Medicare beneficiaries aged ≥65 years. The median number of annual SPPB evaluations was 4 (IQR, 3–7). Mean baseline SPPB was 9.2 (SD, 3.0). The latent class model defined SPPB trajectories over a range of two to nineteen categories. The mean slope from the slope‐based model was −0.01 SPPB points/year (SD, 0.14). Discrimination of the baseline SPPB model to predict time to ≥2 falls was fair (Harrell's C, 0.65) and increased after adding the non‐performance‐based predictors (Harrell's C, 0.70). Discrimination slightly improved with the SPPB trajectory category variable that had the best fit (Harrell's C, 0.71) but did not improve with the SPPB linear slope. Calibration with and without the trajectory categories was similar. Conclusions: We found that the trajectory of physical performance did not meaningfully improve upon fall prediction from a baseline physical performance assessment and established non‐performance‐based information. These results do not support longitudinal SPPB assessments for fall prediction. [ABSTRACT FROM AUTHOR]

Background: Morbidity and mortality associated with preventable diseases can be reduced with the use of preventive health services. We evaluated the uptake and retention of preventive health behaviors and management of accidental medication poisonings in older adults after a health prevention educational component was combined with a brown bag medication review. Methods: This study used a cohort design and was conducted in six urban senior centers and three independent senior living communities in Detroit, Michigan. Participants included 85 older adults (>60 years old) taking five or more medications with 63 participants returning follow up materials. Pharmacy personnel conducted brown bag medication reviews that were combined with a preventive health education component. Information was collected on medications, vaccinations, supplement use, and accidental medication poisoning management. Participants were given written recommendations on prescription medications and preventive health therapies to improve health and medication use. An investigator developed program satisfaction survey was administered immediately after the review. An investigator‐developed follow‐up preventive health implementation survey was conducted at least 3 months later to assess recommendation implementation. Results: Participants' mean age was 75.9 ± 8.5 years. Fifty‐six older adults had 124 recommendations in preventive health in total (1–5/participant). Eleven participants had no recommendations. Sixty‐three participants (74%) returned follow‐up preventive health surveys. Twenty‐three percent of recommendations were already implemented with 34% planned to be done in the future. Poisoning management knowledge increased for 13 participants, reporting they would call the poison control center. The program was well received, with participants reporting high satisfaction scores (4.8 ± 0.7 out of 5). Conclusions: Brown bag medication reviews can be an effective method to promote the uptake of preventive health behaviors among older adults, but additional accidental medication poisoning management education is still needed. [ABSTRACT FROM AUTHOR]

Background: Non‐Hispanic Black individuals may be less likely to receive a diagnosis of dementia compared to non‐Hispanic White individuals. These findings raise important questions regarding which factors may explain this observed association and any differences in the time to which disparities emerge following dementia onset. Methods: We conducted a retrospective cohort study using survey data from the 1995 to 2016 Health and Retirement Study linked with Medicare fee‐for‐service claims. Using the Hurd algorithm (a regression‐based approach), we identified dementia onset among older adult respondents (age ≥65 years) from the Telephone Interview for Cognitive Status and proxy respondents. We determined date from dementia onset to diagnosis using Medicare data up to 3 years following onset using a list of established diagnosis codes. Cox Proportional Hazards modeling was used to examine the association between an individual's reported race and likelihood of diagnosis after accounting for sociodemographic characteristics, income, education, functional status, and healthcare use. Results: We identified 3435 older adults who experienced a new onset of dementia. Among them, 30.1% received a diagnosis within 36 months of onset. In unadjusted analyses, the difference in cumulative proportion diagnosed by race continued to increase across time following onset, p‐value <0.001. 23.8% of non‐Hispanic Black versus 31.4% of non‐Hispanic White participants were diagnosed within 36 months of dementia onset, Hazard Ratio = 0.73 (95% CI: 0.61, 0.88). The association persisted after adjustment for functional status and healthcare use; however, these factors had less of an impact on the strength of the association than income and level of education. Conclusion: Lower diagnosis rates of dementia among non‐Hispanic Black individuals persists after adjustment for sociodemographic characteristics, functional status, and healthcare use. Further understanding of barriers to diagnosis that may be related to social determinants of health is needed to improve dementia‐related outcomes among non‐Hispanic Black Americans. [ABSTRACT FROM AUTHOR]

Background: Cognitive reserve (CR) protects against cognitive decline and dementia but its relation to mobility impairment has not been established. To address this important gap in the literature, we conducted a longitudinal investigation to test the hypothesis that higher baseline CR was associated with a lower risk of developing mobility impairment in older adults. Methods: Participants were dementia‐free older adults who received brain magnetic resonance imaging and had gait speed assessments during follow‐up. Using the residuals approach, CR was computed as the variance in the Modified Mini‐Mental Status Examination total score, that was left after accounting for structural brain integrity, education, and race. Mobility impairment was defined using a validated cutoff score in gait speed of 0.8 m/s. Logistic regression models using general estimating equations were utilized to examine longitudinal associations between baseline CR and the risk of developing mobility impairment across repeated assessments. Results: Of the participants (n = 237; mean age = 82 years; %female = 56%) who were free of mobility impairment at baseline, 103 developed mobility impairment during follow‐up (mean = 3.1 years). Higher CR at baseline was associated with a lower risk of developing incident mobility impairment—odds ratio (OR) = 0.819, 0.67–0.98, p = 0.038 (unadjusted); OR = 0.815, 0.67–0.99, p = 0.04 (adjusted for socio‐demographic variables and depression); OR = 0.819, 0.68–0.88, p = 0.035 (adjusted for illness history); OR = 0.824, 0.68–0.99, p = 0.045 (adjusted for white matter hyperintensities); OR = 0.795, 0.65–0.95, p = 0.016 (adjusted for falls history). Conclusion: Higher CR at baseline was protective against developing incident mobility impairment during follow‐up among community‐residing older adults. [ABSTRACT FROM AUTHOR]

Background: Video capsule endoscopy (VCE) is an effective, noninvasive modality for small bowel (SB) investigation. Its usage in the older adults is rising. However, data in octa‐nonagenarians regarding diagnostic yield and motility are lacking. Our aim was to evaluate and compare safety and efficacy of VCE between age subgroups of older adult patients. Methods: This was a retrospective study of prospectively documented data. All consecutive VCEs of patients ≥65 years (01/2010–12/2017) were included. Patients unable to swallow the capsule or videos with significant recording technical malfunction were excluded. The cohort was divided into the younger group aged 65–79 years old and octa‐nonagenarians aged ≥80 years old. Indications for referral, diagnostic yield and transit times were compared between groups. Results: A total of 535 VCEs were performed in 499 older adult patients (51.2% males); 82.8% were 65–79 years old and 17.2% were ≥80 years old. The ≥80‐year‐old group had higher rates of clinically significant findings (52.7% vs. 40.0%, p = 0.025), active bleeding (12.5% vs. 6.5%, p = 0.053) and angioectasia (36.0% vs. 23.4%, p = 0.014). Crohn's disease was newly diagnosed in approximately 8% of the entire cohort and 12% of the ≥80 years old. Anemia was the most common indication in both groups, followed by overt bleeding in the ≥80‐year‐old group (25% vs. 9.9% in 65–79‐year‐old group, p < 0.001) and Crohn's disease in the 65–79 years old (17.2% vs. 5.4% in ≥80 years old, p = 0.004). Groups were comparable in transit time and cecal documentation rates. Conclusions: In octa‐nonagenarians, VCE is as safe as in younger older‐adults with a higher diagnostic yield of significant and treatable conditions. [ABSTRACT FROM AUTHOR]

Background: Little is known about end‐of‐life healthcare utilization and palliative care use among older adults with serious illness and limited English proficiency (LEP). Methods: We conducted a retrospective analysis of seriously‐ill older adults (65+) with and without LEP, from a large health system, who died between 2010 and 2018. Primary outcomes were measures of healthcare utilization in the last 30 and 180 days of life: hospitalization, emergency department (ED) visits, intensive care unit (ICU) admission, and 30‐day readmission. Secondary outcomes were palliative care consultation and advance care planning documents. We used multivariate analyses adjusted for sociodemographic factors including race and ethnicity. Results: Among 18,490 decedents, 1363 had LEP. Patients with LEP were older at time of death (median age 80 vs 77 years), more likely to be female (48% vs 44%), of Asian descent (64% vs 4%), of Hispanic ethnicity (10% vs 2%), with <12th grade education (38% vs 9%), and Medicaid (36% vs 6%). In the last 30 days of life, patients with LEP had higher odds of ED visits (33% vs 20%; aOR 1.41, 95% CI 1.26–1.72; p < 0.001), readmission (12% vs 8%; aOR 1.64, 95% CI 1.30–2.07; p < 0.001), and in‐hospital death (45% vs 37%; aOR 1.24, 95% CI 1.07–1.44; p = 0.005) compared to patients without LEP. Findings were similar in the last 180‐days of life. Only 14% of patients with LEP and 10% of those without LEP received palliative care consultation in the last month of life. Patients with LEP were less likely to have advance care planning documents than patients without LEP (36% vs 40%; aOR 0.68, 95% CI 0.50–0.80; p < 0.001). Conclusions: Older adults with serious illness and LEP have higher rates of end‐of‐life healthcare utilization. Additional research is needed to identify drivers of these differences and inform linguistically‐ and culturally‐appropriate interventions to improve end‐of‐life care in this population. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to determine associations between use of oral anticoagulation (OAC) and stroke and bleeding‐related outcomes for older people ≥80 years with atrial fibrillation (AF), and to determine trends over time in prescribing of OAC for this population. Methods: A retrospective cohort study was conducted. People aged ≥80 years with AF receiving (1) no OAC; (2) warfarin; or (3) a non‐vitamin‐K antagonist oral anticoagulant (NOAC) between 2011 and 2019 were included. Propensity score matching was used to balance cohorts (no OAC, warfarin or a NOAC) on characteristics including age, sex, ethnicity, and co‐morbidities. Cox proportional hazard models were used to derive hazard ratios (HRs) and 95% confidence intervals (CIs). Results: The proportion of people aged ≥80 years receiving any OAC increased from 32.4% (n = 27,647) in 2011 to 43.6% (n = 110,412) in 2019. After propensity score matching, n = 169,067 individuals were included in the cohorts receiving no OAC or a NOAC. Compared to no OAC, participants receiving a NOAC had a lower risk of incident dementia (hazHR 0.68, 95% CI 0.65–0.71), all‐cause mortality (HR 0.49, 95% CI 0.48–0.50), first‐time ischaemic stroke (HR 0.87, 95% CI 0.83–0.91), and a higher risk of major bleeding (HR 1.08, 95% CI 1.05–1.11). Compared to participants receiving warfarin, participants receiving a NOAC had a lower risk of dementia (HR 0.90, 95% CI: 0.86–0.93), all‐cause mortality (HR 0.74, 95% CI: 0.72–0.76), ischaemic stroke (HR 0.86, 95% CI: 0.82–0.90) and major bleeding (HR 0.88, 95% CI: 0.85–0.90). Similar results were observed when only including people with additional bleeding risk factors. Conclusions: The proportion of people aged ≥80 years receiving OAC has increased since the introduction of NOACs, but remains low. Use of a NOAC was associated with improved outcomes compared to warfarin, and compared to no OAC, except for a small but statistically significant higher risk of major bleeding. [ABSTRACT FROM AUTHOR]

Background: The HEART Pathway is a validated protocol for risk stratifying emergency department (ED) patients with possible acute coronary syndrome (ACS). Its performance in different age groups is unknown. The objective of this study is to evaluate its safety and effectiveness among older adults. Methods: A pre‐planned subgroup analysis of the HEART Pathway implementation study was conducted. This prospective interrupted time series accrued adult ED patients with possible ACS who were without ST‐elevation across three US sites from 11/2013–01/2016. After implementation, providers prospectively used the HEART Pathway to stratify patients as low‐risk or non‐low‐risk. Patients were classified as older adults (≥65 years), middle‐aged (46–64 years), and young (21–45 years). Primary safety and effectiveness outcomes were 30‐day death or MI and hospitalization at 30 days, determined from health records, insurance claims, and death index data. Fisher's exact test compared low‐risk proportions between groups. Sensitivity for 30‐day death or MI and adjusted odds ratios (aORs) for hospitalization and objective cardiac testing were calculated. Results: The HEART Pathway implementation study accrued 8474 patients, of which 26.9% (2281/8474) were older adults, 45.5% (3862/8474) middle‐aged, and 27.5% (2331/8474) were young. The HEART Pathway identified 7.4% (97/1303) of older adults, 32.0% (683/2131) of middle‐aged, and 51.4% (681/1326) of young patients as low‐risk (p < 0.001). The HEART Pathway was 98.8% (95% CI 97.1–100) sensitive for 30‐day death or MI among older adults. Following implementation, the rate of 30‐day hospitalization was similar among older adults (aOR 1.25, 95% CI 1.00–1.55) and cardiac testing increased (aOR 1.25, 95% CI 1.04–1.51). Conclusion: The HEART Pathway identified fewer older adults as low‐risk and did not decrease hospitalizations in this age group. [ABSTRACT FROM AUTHOR]

Background: Preventing oral health problems can be crucial for maintaining physical independence in older adults. We aimed to examine the associations of a range of oral health problems with incidence of disability in older adults. Methods: We used prospective data from the British Regional Health Study (BRHS) (N = 2147, 71–92 years), and the Health, Aging and Body Composition (HABC) study (USA) (N = 3075, 71–80 years). Oral health measures included tooth loss, periodontal disease, self‐rated oral health, and self‐reported dry mouth. Participants were followed for onset of disability over a follow‐up period of 3 years. Onset of disability was assessed through new cases of mobility limitations, activities of daily living (ADL), and instrumental activities of daily living (IADL). Logistic regression was performed to calculate the odds of incident disability. Results: In the BRHS, tooth loss was associated with greater odds of mobility limitations and ADL difficulties. Periodontal disease was associated with greater incidence of mobility limitations. Self‐report of ≥3 dry mouth symptoms was associated with increased odds of incident mobility limitations and ADL difficulties (OR = 2.08, 95% CI 1.27–3.42; OR = 1.73, 95% CI 1.03–2.90). Fair/poor self‐rated oral health was associated with greater incidence of IADL difficulties. In the HABC study, complete tooth loss was associated with greater incidence of mobility limitations (OR = 1.86, 95% CI 1.13–3.06), and fair/poor self‐rated oral health was associated with increased odds of incident ADL difficulties (OR = 1.42, 95% CI 1.04–1.94). Conclusions: Oral health problems in older adults, particularly tooth loss, self‐reported dry mouth and self‐rated oral health were associated with greater incidence of disability. Poor oral health plays a potentially important role in the development of disability in older populations, which in turn is an essential part of quality of life and healthy aging. [ABSTRACT FROM AUTHOR]

Background: There is incomplete information regarding evolution of antibody titers against SARS‐CoV‐2 after a two‐dose strategy vaccination with BNT162b2 in older adults in long‐term care facilities (LTCFs) with frailty, disability, or cognitive impairment. We aimed to determine IgG antibody titer loss in older adults in LTCFs. Methods: This is a multicenter longitudinal cohort study including 127 residents (90 females and 37 males) with a mean age of 82.7 years (range 65–99) with different frailty and disability profiles in two LTCFs in Albacete, Spain. Residents received two doses of BNT162b2 as per label, and antibody levels were determined 1 and 6 months after the second dose. Age, sex, previous history of coronavirus disease 2019 (COVID‐19), comorbidity (Charlson Index), performance in activities of daily living (Barthel Index), frailty (FRAIL instrument), and cognitive status were assessed. Results: The mean antibody titers 1 and 6 months after the second vaccine dose were 32,145 AU/ml (SD 41,206) and 6182 AU/ml (SD 13,316), respectively. Across all participants, the median antibody titer loss measured 77.6% (interquartile range [IQR] 23.8%). Notably, the decline of titers in individuals with pre‐vaccination COVID‐19 infection was significantly lower than in those without a history of SARS‐CoV‐2 infection (72.2% vs. 85.3%; p < 0.001). The median titer decrease per follow‐up day was 0.47% (IQR 0.14%) and only pre‐vaccination COVID‐19 was associated with lower rate of antibody decline at 6 months (hazard ratio 0.17; 95% confidence interval 0.07–0.41; p < 0.001). Frailty, disability, older age, cognitive impairment, or comorbidity were not associated with the extent of antibody loss. Conclusions: Older adults in LTCFs experience a rapid loss of antibodies over the first 6 months after the second dose of BNT162b2 vaccine. Only pre‐vaccination COVID‐19 is associated with a slower rate of antibody decrease. Our data support immunization with a third dose in this vulnerable, high‐risk population. [ABSTRACT FROM AUTHOR]

Background: Pharmacist‐led transitions of care (TOC) interventions have been described as some of the most promising interventions to reduce medication‐related harm (MRH) in older adults. This study analyzed the feasibility of pharmacist‐led TOC interventions between hospitals, multidisciplinary primary care clinics (PCC), and community pharmacies. Methods: Adults aged 65 years and older at risk of MRH in three regions of Quebec, Canada, with contrasting contexts of care based on university affiliation were recruited in this multicenter, single arm, and prospective intervention cohort. The hospital pharmacist developed the pharmaceutical care plan in collaboration with the hospital physician and transferred this plan with the hospitalization summary, at hospital discharge, to the PCC family physician and to the community and PCC pharmacists. A consultation with the community pharmacist was scheduled within seven days of hospital discharge and with the PCC pharmacist when appropriate. Feasibility outcomes included the time to complete the interventions and their location. Results: The 123 eligible patients had a mean age of 78.5 years, and 63.4% were females. The most frequent inclusion criterion was 10 medications or more, including one high‐risk medication for 90 patients (73%). Recruitment in one region was stopped after three months due to unsuccessful recruitment of key PCC. The hospital pharmacist interventions took a median of 165 min. The first consultations of the PCC and community pharmacists took a median of 15 and 50 min. Among the 96 patients with a post‐discharge pharmacist follow‐up, 23 (24.0%) had a consultation with a PCC pharmacist, with 65.2% of the consultations conducted at the PCC. The community pharmacists conducted a consultation with 88 patients (93%), with more than 70% of consultations conducted by phone. Conclusion: Our study showed the feasibility of pharmacist‐led TOC interventions between hospitals, PCC, and community pharmacies and detailed the novel role that PCC pharmacists played in optimizing TOC interventions. [ABSTRACT FROM AUTHOR]

Objective: To examine if older age (>70 years) should be a relative contraindication for heart transplantation, we evaluated the characteristics and outcomes of patients with age ≥70 years listed for heart transplantation; and whether post‐transplantation survival was inferior to younger counterparts. Design Retrospective cohort analysis. Setting: The scientific registry of transplant recipients (SRTR). Participants: Adults (≥18 years) listed for heart transplantation in the SRTR between 2000 and 2018. Interventions: Heart transplantation. Measurements Characteristics and outcomes were compared for adults ≥70 years and <70 years. We evaluated waitlist mortality and post‐transplant 1‐year and 5‐year survivals. Results: The study included 57,285 patients (age range 18–79 years) listed for heart transplantation; 1203 (2.1%) age ≥70 years. Of these, 37,135 patients underwent heart transplantation; 806 (2.2%) were age ≥70 years. Yearly listing of those age ≥70 years has consistently increased from 2.5% (n = 30) in 2000 to 11% (n = 132) in 2017 (p < 0.01). As compared with the age <70 years group, those ≥70 years had a similar risk of death while waiting (sub‐hazard ratio [SHR] 0.86, 95% confidence interval [HR] 0.68–1.08; p = 0.19) but were more likely to be transplanted (SHR 1.36, 95% CI 1.26–1.48; p < 0.01). Among the older patients, the overall post‐transplant 1‐ and 5‐year mortality rate was 10.4% and 19.2%, respectively. Older recipients had lower unadjusted survival compared with younger recipients (log‐rank p = 0.03). However, after adjustment for relevant covariates, there was no significant difference in 5‐year mortality between both groups (HR 1.06, 95% CI 0.91–1.254; p = 0.43). Conclusions: Post‐transplant survival up to 5 years among patients of age ≥70 years was similar to that of younger recipients. Older patients who received heart transplantation appear to have lower risk features but receive hearts from higher risk donors. Chronologic age alone should not constitute a contraindication for heart transplantation, although careful patient selection criteria should be applied. [ABSTRACT FROM AUTHOR]

Background/objectives: Limited knowledge exists regarding sex differences in prescribing potentially inappropriate medications (PIMs) for various multimorbidity patterns. This study sought to determine sex differences in PIM prescribing in older adults with cardiovascular‐metabolic patterns. Design: Retrospective cohort study. Setting: Health and Retirement Study (HRS) 2004–2014 interview data, linked to HRS‐Medicare claims data annualized for 2005–2014. Study sample: Six thousand three‐hundred and forty‐one HRS participants aged 65 and older with two and more chronic conditions. Measurements: PIM events were calculated using 2015 American Geriatrics Society Beers Criteria. Multimorbidity patterns included: "cardiovascular‐metabolic only," "cardiovascular‐metabolic plus other physical conditions," "cardiovascular‐metabolic plus mental conditions," and "no cardiovascular‐metabolic disease" patterns. Logistic regression models were used to determine the association between PIM and sex, including interaction between sex and multimorbidity categories in the model, for PIM overall and for each PIM drug class. Results: Women were prescribed PIMs more often than men (39.4% vs 32.8%). Overall, women had increased odds of PIM (Adj. odds ratio [OR] = 1.30, 95% confidence interval [CI]: 1.16–1.46). Women had higher odds of PIM than men with cardiovascular‐metabolic plus physical patterns (Adj. OR = 1.25, 95% CI: 1.07–1.45) and cardiovascular‐metabolic plus mental patterns (Adj. OR = 1.25, 95% CI: 1.06–1.48), and there were no sex differences in adults with a cardiovascular‐metabolic only patterns (Adj. OR = 1.13, 95% CI: 0.79–1.62). Women had greater odds of being prescribed the following PIMs: anticholinergics, antidepressants, antispasmodics, benzodiazepines, skeletal muscle relaxants, and had lower odds of being prescribed pain drugs and sulfonylureas compared with men. Conclusion: This study evaluated sex differences in PIM prescribing among adults with complex cardiovascular‐metabolic multimorbidity patterns. The effect of sex varied across multimorbidity patterns and by different PIM drug classes. This study identified important opportunities for future interventions to improve medication prescribing among older adults at risk for PIM. [ABSTRACT FROM AUTHOR]

Background: Driving has not been considered as part of the social cost of acute illness and may go unnoticed in the post‐hospital care of older adults. Decreases in driving after hospitalization and at‐risk populations have not been investigated. Objective: To determine the association between driving reduction and cessation and hospitalization in older adults by using nationally representative data. Design: Retrospective cohort analysis. Setting: Health and Retirement Study survey from 2004 to 2014. Participants: Adults aged 65 years and older who were able to drive and had an available car (n = 12,110; 40,364 interviews). Measurements: Self‐report of a hospitalization requiring an overnight stay, changes in driving patterns including driving cessation or limitations over a 2‐year period, comorbid conditions, health utilization, and behaviors. Results: Of hospitalizations in adults aged 65 years and older, 22% were associated with a decrease in driving patterns within 2 years. The relative risk of a reduction or cessation in driving was 1.62 (95% CI: 1.54, 1.70, p < 0.001) when there was a hospitalization compared with when a hospitalization did not occur. Baseline functional, cognitive, and visual impairment, fair or poor self‐rated health, and diabetes were identified as independent risk factors for decreased driving patterns after hospitalization. Conclusions: Changes in driving patterns are common after a hospitalization in older adults. The findings suggest that driving, although not a current goal of post‐hospital care, is important to the continued autonomy and community mobility of older adults and needs to be addressed as part of discharge planning and their recovery. [ABSTRACT FROM AUTHOR]

Objectives/Background: The Geriatric Surgery Verification (GSV) Program promotes clinical standards aimed to optimize the quality of surgical care delivered to older adults. The purpose of this study was to determine if preliminary implementation of the GSV Program standards improves surgical outcomes. Design: Prospective study with cohort matching. Setting: Data from a single institution compared with a national data set cohort. Participants: All patients aged ≥75 years undergoing inpatient operations between January 2018 and December 2019 were included. Cohort matching by age and procedure code was performed using a national data set. Measurements: Baseline pre‐ and intraoperative characteristics prospectively recorded using Veterans Affairs Surgical Quality Improvement Program (VASQIP) variable definitions. Postoperative outcomes were recorded including complications as defined by VASQIP, 30‐day mortality, and length of stay. Results: A total of 162 patients participated in the GSV program, and 308 patients comprised the matched comparison group. There was no difference in postoperative occurrence of one or more complications (p = 0.81) or 30‐day mortality (p = 0.61). Patients cared for by the GSV Program had a reduced postoperative length of stay (median 4 days [range 1,31] vs. 5 days [range 1,86]; p < 0.01; and mean 5.4 ± 4.8 vs. 8.8 ± 11.8 days; p < 0.01) compared with the matched cohort. In a multivariable regression model, the GSV Program's reduced length of stay was independent of other associated covariates including age, operative time, and comorbidities (p < 0.01). Conclusion: Preliminary implementation of the GSV Program standards reduces length of stay in older adults undergoing inpatient operations. This finding demonstrates both the clinical and financial value of the GSV Program. [ABSTRACT FROM AUTHOR]

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

BACKGROUND: Clinical presentation and risk factors of death in COVID‐19 in oldest adults have not been well characterized. OBJECTIVES: To describe clinical features and outcome of COVID‐19 in patients older than 85 years and study risk factors for mortality. DESIGN: Prospective cohort. PARTICIPANTS AND SETTING: Patients aged 85 years and older, admitted in noncritical care units at the University Hospital Lariboisière Fernand‐Widal (Paris, France) for confirmed severe acute respiratory syndrome coronavirus 2 infection were included and followed up for 21 days. MEASUREMENTS: Clinical and laboratory findings were collected. Cox survival analysis was performed to explore factors associated with death. RESULTS: From March 14 to April 11, 2020, 76 patients (median age = 90 (86–92) years; women = 55.3%) were admitted for confirmed COVID‐19. Of the patients, 64.5% presented with three or more comorbidities. Most common symptoms were asthenia (76.3%), fever (75.0%) and confusion and delirium (71.1%). An initial fall was reported in 25.0% of cases, and digestive symptoms were reported in 22.4% of cases. COVID‐19 was severe in 51.3% of cases, moderate in 32.9%, and mild in 15.8%. Complications included acute respiratory syndrome (28.9%), cardiac decompensation (14.5%), and hypotensive shock (9.0%). Fatality at 21 days was 28.9%, after a median course of disease of 13 (8–17) days. Males were overrepresented in nonsurvivors (68.2%). In survivors, median length of stay was 12 (9–19.5) days. Independent predictive factors of death were C‐reactive protein level at admission and lymphocyte count at nadir. CONCLUSION: Specific clinical features, multiorgan injury, and high case fatality rate are observed in older adults with COVID‐19. However, rapid diagnosis, appropriate care, and monitoring seem to improve prognosis. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Methods for pharmacoepidemiologic studies of large‐scale data repositories are established. Although clinical cohorts of older adults often contain critical information to advance our understanding of medication risk and benefit, the methods best suited to manage medication data in these samples are sometimes unclear and their degree of validation unknown. We sought to provide researchers, in the context of a clinical cohort study of delirium in older adults, with guidance on the methodological tools to use data from clinical cohorts to better understand medication risk factors and outcomes. DESIGN: Prospective cohort study. SETTING: The Successful Aging After Elective Surgery (SAGES) prospective cohort. PARTICIPANTS: A total of 560 older adults (aged ≥70 years) without dementia undergoing elective major surgery. MEASUREMENTS: Using the SAGES clinical cohort, methods used to characterize medications were identified, reviewed, analyzed, and distinguished by appropriateness and degree of validation for characterizing pharmacoepidemiologic data in smaller clinical data sets. RESULTS: Medication coding is essential; the American Hospital Formulary System, most often used in the United States, is not preferred over others. Use of equivalent dosing scales (e.g., morphine equivalents) for a single medication class (e.g., opioids) is preferred over multiclass analgesic equivalency scales. Medication aggregation from the same class (e.g., benzodiazepines) is well established; the optimal prevalence breakout for aggregation remains unclear. Validated scale(s) to combine structurally dissimilar medications (e.g., anticholinergics) should be used with caution; a lack of consensus exists regarding the optimal scale. Directed acyclic graph(s) are an accepted method to conceptualize causative frameworks when identifying potential confounders. Modeling‐based strategies should be used with evidence‐based, a priori variable‐selection strategies. CONCLUSION: As highlighted in the SAGES cohort, the methods used to classify and analyze medication data in clinically rich cohort studies vary in the rigor by which they have been developed and validated. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: Identifying surgical patients at risk for discharge to a post‐acute facility has the potential to reduce hospital length of stay, improve postoperative planning, and increase patient satisfaction. We sought to examine the association between a positive response to a preoperative patient‐reported frailty screen and non‐home discharge (NHD). DESIGN: Prospective cohort. SETTING: Urban tertiary academic preoperative evaluation center. PARTICIPANTS: Convenience sample of patients aged 60 and older evaluated from November 2018 to August 2019) undergoing one of 14 major elective general and vascular operations with an expected length of stay of 3 days or longer. METHODS: Items from the previously validated Fatigue, Resistance, Ambulation, Illnesses, Loss of weight (FRAIL) screen were modified, and patients were queried on fatigue, activity against resistance, ambulation, and weight loss. Multivariable logistic regression adjusting for age and sex was used to determine the association between patient‐reported items and NHD. RESULTS: A total of 230 patients were included for analysis. The average age of the cohort was 70.1 (standard deviation = 7.1); 91.7% were White, and 52.4% were female. There were 24 patients (10.4%) who were not discharged home. They were more likely to report fatigue (54% vs 29%; P =.01), weight loss (58% vs 21%; P <.01), and difficulty with activity against resistance (33% vs 7%; P <.01) before surgery. In adjusted analysis, patients who self‐reported frailty (FRAIL screen ≥2) were significantly more likely to have an NHD (odds ratio [OR] = 4.5; 95% confidence interval [CI] = 1.7–11.7; P <.01), as were patients who responded "yes" to any question from the FRAIL screen (OR = 2.5; 95% CI = 1.7–3.5; P <.01). A positive response to difficulty with activity against resistance or recent weight loss showed similar odds of NHD (OR = 7.6; 95% CI = 2.6–23.9; P <.01; and OR = 7.9; 95% CI = 2.9–21.6; P <.01, respectively). Conclusion: Patient response to screening questions on the FRAIL screen identified those at highest risk of NHD. The FRAIL screening tool is practical, easy to apply, and could be used during preoperative counseling to identify patients likely to have increased discharge planning needs. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: Depression screening and treatment for older adults are recommended in Age‐Friendly Health Systems. Few studies have evaluated the association between depressive symptoms and postoperative functioning. We aimed to determine the association between varying levels of depressive symptoms in the preoperative setting with postoperative functional recovery. DESIGN: Prospective cohort study. SETTING: Two academic hospitals in Boston, Massachusetts. PARTICIPANTS: Surgical patients aged 70 and older (N = 560). MEASUREMENTS: Participants were assessed preoperatively and 1 year postoperatively. Preoperative evaluation included the 15‐item short‐form Geriatric Depression Scale (GDS). Results were categorized as low (GDS = 0–1), moderate (2–5), or high (6–15) symptom burden. Primary outcome was 1‐year instrumental activities of daily living functional decline. Secondary outcomes included hospital stay longer than 5 days, discharge to post‐acute care (PAC) facility, and readmission within 30 days. RESULTS: Mean participant age was 76.6 ± 5 years, 58% were women, 81% underwent an orthopedic operation, 13% gastrointestinal, 6% vascular; 13% had functional decline at 1 year after their operation (by symptom burden: low = 5.5%; moderate = 14.8%, and high = 38.6%). After adjusting for age, sex, and comorbidity, those with moderate or high depressive symptoms demonstrated greater odds of functional decline at 1 year compared with those with a low symptom burden (moderate: adjusted odds ratio [AOR] = 2.7; 95% confidence interval [CI] = 1.3–5.3; high: AOR = 9.3; 95% CI = 4.2–20.6), discharge to PAC facility (moderate: AOR = 1.7; 95%CI = 1.2–2.6; high: AOR = 2.7; 95% CI = 1.4–5.1) but demonstrated no significant association with 30‐day readmission or hospital length of stay longer than 5 days. CONCLUSION: Greater burden of preoperative depressive symptoms is associated with increased likelihood of functional decline at 1 year after surgery and of discharge to PAC facility. Preoperative assessment of the burden of depressive symptoms in older adults undergoing elective surgery may be helpful in identifying patients at high risk of poor outcomes. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To estimate 30‐day statin discontinuation among newly admitted nursing home residents overall and within categories of life‐limiting illness. DESIGN: Retrospective cohort using Minimum Data Set 3.0 nursing home admission assessments from 2015 to 2016 merged to Medicare administrative data files. SETTING: U.S. Medicare‐ and Medicaid‐certified nursing home facilities (n = 13,092). PARTICIPANTS: Medicare fee‐for‐service beneficiaries, aged 65 years and older, newly admitted to nursing homes for non–skilled nursing facility stays on statin pharmacotherapy at the time of admission (n = 73,247). MEASUREMENTS: Residents were categorized using evidence‐based criteria to identify progressive, terminal conditions or limited prognoses (<6 months). Discontinuation was defined as the absence of a new Medicare Part D claim for statin pharmacotherapy in the 30 days following nursing home admission. RESULTS: Overall, 19.9% discontinued statins within 30 days of nursing home admission, with rates that varied by life‐limiting illness classification (no life‐limiting illness: 20.5%; serious illness: 18.6%; receipt of palliative care consult: 34.5%; clinician designated as end‐of‐life: 45.0%). Relative to those with no life‐limiting illness, risk of 30‐day statin discontinuation increased with life‐limiting illness severity (serious illness: adjusted risk ratio (aRR) = 1.06; 95% confidence interval (CI) = 1.02–1.10; palliative care index diagnosis: aRR = 1.15; 95% CI = 1.10–1.21; palliative care consultation: aRR = 1.58; 95% CI = 1.43–1.74; clinician designated as end of life: aRR = 1.59; 95% CI = 1.42–1.79). Nevertheless, most remained on statins after entering the nursing home regardless of life‐limiting illness status. CONCLUSION: Statin use continues in a large proportion of Medicare beneficiaries after admission to a nursing home. Additional deprescribing research, which identifies how to engage nursing home residents and healthcare providers in a process to safely and effectively discontinue medications with questionable benefits, is warranted. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: To examine the prevalence of potentially inappropriate medication (PIM) prescribing and its association with healthcare utilization and related expenditures utilizing nationally representative data from the United States. DESIGN: Retrospective cohort study. SETTING: The 2011–2015 Medical Expenditure Panel Survey (MEPS). PARTICIPANTS: Community‐dwelling sample of U.S. adults aged 65 and older during the first round of each MEPS cycle. MEASUREMENTS: A qualified definition operationalized from the 2019 American Geriatrics Society Beers Criteria® was used to estimate the prevalence of PIM prescribing over the study period. Negative binomial models were assembled to examine associations between PIM exposure and healthcare utilization including hospitalizations, emergency department (ED) visits, and outpatient provider visits. Generalized linear models with the log link function and gamma distribution were used to analyze associations between PIM exposure and healthcare expenditures. Sensitivity analyses were conducted utilizing inverse probability treatment weighting using propensity scores for being prescribed a PIM. RESULTS: The period prevalence of PIM prescribing over the 5‐year sample was 34.4%. PIM prescribing was positively associated with hospitalizations (adjusted incidence rate ratio [aIRR] = 1.17; 95 confidence interval [CI] = 1.08–1.26; P <.001), ED visits (aIRR = 1.26; 95% CI = 1.17–1.35; P <.001), and outpatient provider visits (aIRR = 1.18; 95% CI = 1.14–1.21; P <.001). PIM exposure was associated with higher marginal costs within outpatient visits ($116; 95% CI = $105–$243; P <.001), prescription medications ($128; 95% CI = $72–$199; P <.001), and total healthcare expenditures ($458; 95% CI = $295–$664; P <.001). Similar results were found in our propensity score analyses. CONCLUSION: PIMs continue to be prescribed at a high rate among older adults in the United States. Our results suggest that receipt of PIMs is associated with higher rates of healthcare utilization and increased costs across the healthcare continuum. Further work is needed to implement evidence‐based deprescribing interventions that may in turn reduce unnecessary healthcare utilization. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: To determine the prevalence of skin findings and skin diseases in adults aged 70 and older, and to study the association between cutaneous diseases and socioeconomic status (SES), sex, and living status in the older population. DESIGN: Cross‐sectional study of Finnish adults aged 70 to 93 as part of the Northern Finland Birth Cohort 1966 Study. SETTINGS: Skin examination data were available for 552 adults. MEASUREMENTS: A whole‐body skin examination was performed by dermatologists. The associations between skin diseases and SES, sex, and living status were analyzed. RESULTS: Nearly 80% of the adults had at least one skin disease that required further treatment or follow‐up. More than one‐third of the study cases (39.1%) had three or more simultaneous skin diseases. Skin diseases were more common in men than in women (P <.001). The most common skin diseases were tinea pedis (48.6%), onychomycosis (29.9%), rosacea (25.6%), actinic keratosis (22.3%), and asteatotic eczema (20.8%). Some association was found between skin diseases and SES and living status. CONCLUSION: A whole‐body clinical skin examination is important because it reveals important diagnoses. [ABSTRACT FROM AUTHOR]

BACKGROUND The Otago Exercise Program (OEP) has demonstrated cost‐effectiveness for the primary prevention of falls in a general community setting. The cost‐effectiveness of exercise as a secondary falls prevention (ie, preventing falls among those who have already fallen) strategy remains unknown. The primary objective was to estimate the cost‐effectiveness (incremental cost‐effectiveness/utility ratio) of the OEP from a healthcare system perspective. DESIGN A concurrent 12‐month prospective economic evaluation conducted alongside the Action Seniors! randomized critical trial (OEP compared with usual care). SETTING Vancouver Falls Prevention Clinic (Vancouver, BC, Canada; http://www.fallsclinic.ca). PARTICIPANTS A total of 344 community‐dwelling older adults, aged 70 years and older, who attended a geriatrician‐led Falls Prevention Clinic in Vancouver, after sustaining a fall in the previous 12 months. MEASUREMENTS Main outcome measures included: incidence rate ratio for falls, healthcare costs, incremental cost per fall prevented, and incremental cost per quality‐adjusted life year (QALY) gained. RESULTS: The OEP costs $393 CAD per participant to implement. The incremental cost per fall prevented resulted in a savings of $2 CAD. The incremental cost per QALY gained (where QALYs were estimated using the Euro‐Qol 5D three‐level version [EQ‐5D‐3L]) indicated the OEP was less effective than usual care. The incremental cost per QALY gained (where QALYs were estimated using the Short Form 6D [SF‐6D]) indicated the OEP was more effective and less costly than usual care. The incremental QALYs estimated using the EQ‐5D‐3L and the SF‐6D were not clinically significant and close to zero, indicating no change in quality of life. CONCLUSION: Compared with usual care, healthcare system costs are saved and falls are prevented when older fallers who attend a geriatrician‐led falls clinic are allocated to, and provided, the physiotherapist‐guided exercise‐based falls prevention program (the OEP). [ABSTRACT FROM AUTHOR]

Objectives: Sepsis has been called a "disease of the elderly," and as in‐hospital mortality has decreased, more sepsis survivors are progressing into poorly characterized long‐term outcomes. The purpose of this study was to describe the current epidemiology of sepsis in older adults compared with middle‐aged and young adults. Design Prospective longitudinal study with young (≤45 years), middle‐aged (46‐64 years), and older (≥65 years) patient groups. Setting: University tertiary medical center. Participants: A total of 328 adult surgical intensive care unit (ICU) sepsis patients. Measurements Patients were characterized by (1) baseline demographics and predisposition, (2) septic event, (3) hospital outcomes and discharge disposition, (4) 12‐month mortality, and (5) Zubrod Performance Status, physical function (Short Physical Performance Battery and handgrip strength), and cognitive function (Hopkins Verbal Learning Test, Controlled Oral Word Association, and Mini‐Mental Status Examination) at 3‐, 6‐, and 12‐month follow‐up. Loss to follow‐up was due to death (in 68), consent withdrawal (in 32), and illness and scheduling difficulties: month 3 (in 51), month 6 (in 29), and month 12 (in 20). Results: Compared with young and middle‐aged patients, older patients had (1) significantly more comorbidities at presentation (eg, chronic renal disease 6% vs 12% vs 21%), intra‐abdominal infections (14% vs 25% vs 37%), septic shock (12% vs 25% vs 36%), and organ dysfunctions; (2) higher 30‐day mortality (6% vs 4% vs 17%) and fewer ICU‐free days (median = 25 vs 23 vs 20); (3) more progression into chronic critical illness (22% vs 34% vs 42%) with higher poor disposition discharge to non‐home destinations (19% vs 40% vs 62%); (4) worse 12‐month mortality (11% vs 14% vs 33%); and (5) poorer Zubrod Performance Status and objectively measured physical and cognitive functions with only slight improvement over 12‐month follow‐up. Conclusion: Compared with younger patients, older sepsis survivors suffer both a higher persistent disability burden and 12‐month mortality. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Antidepressants increase the risk of falls and fracture in older adults. However, risk estimates vary considerably even in comparable populations, limiting the usefulness of current evidence for clinical decision making. Our aim was to apply a common protocol to cohorts of older antidepressant users in multiple jurisdictions to estimate fracture risk associated with different antidepressant classes, drugs, doses, and potential treatment indications. DESIGN: Retrospective (2009–2014) cohort study. SETTING: Five jurisdictions in the United States, Canada, United Kingdom, and Taiwan. PARTICIPANTS: Older antidepressant users—subjects were followed from first antidepressant prescription or dispensation to first fracture or until the end of follow‐up. MEASUREMENTS: The risk of fractures with antidepressants was estimated by multivariable Cox proportional hazards models using time‐varying measures of antidepressant dose and use vs nonuse, adjusting for patient characteristics. RESULTS: Between 42.9% and 55.6% of study cohorts were 75 years and older, and 29.3% to 45.4% were men. Selective serotonin reuptake inhibitors (SSRIs) (48.4%‐60.0%) were the predominant class used in North America compared with tricyclic antidepressants (TCAs) in the United Kingdom and Taiwan (49.6%‐53.6%). Fracture rates varied from 37.67 to 107.18 per 1,000. The SSRIs citalopram (hazard ratio [HR] = 1.23; 95% confidence interval [CI] = 1.11‐1.36 to HR = 1.43; 95% CI = 1.11‐1.84) and sertraline (HR = 1.36; 95% CI = 1.10‐1.68), the SNRI duloxetine (HR = 1.41; 95% CI = 1.06‐1.88), TCAs doxepin (HR = 1.36; 95% CI = 1.00‐1.86) and imipramine (HR = 1.16; 95% CI = 1.05‐1.28), and atypicals (HR = 1.34; 95% CI = 1.14‐1.58) increased fracture risk in some but not all jurisdictions. In the United States and the United Kingdom, fracture risk with all classes was higher when prescribed for depression than chronic pain, a trend that is likely explained by drug choice. CONCLUSION: The fracture risk for patients may be reduced by selecting paroxetine, an SSRI with lower risk than citalopram, the SNRI venlafaxine over duloxetine, and the TCA amitriptyline over imipramine or doxepin. There is uncertainty about the risk associated with the atypical antidepressants. J Am Geriatr Soc 68:1494‐1503, 2020. [ABSTRACT FROM AUTHOR]

OBJECTIVES Much of the research previously done on diabetic ketoacidosis (DKA) was based on a young population with type 1 diabetes mellitus (type 1 DM). But substantial numbers of DKA episodes occur in patients with a prior history of type 2 diabetes mellitus (type 2 DM). There is a lack of Data are lacking about DKA in older adults. The aims of this study were to analyze the clinical characteristics and outcomes of older adult patients with DKA. DESIGN: Retrospective matched cohort study of adult patients hospitalized with DKA between 2004 and 2017. SETTING: Soroka University Medical Center, Be'er Sheva, Israel. PARTICIPANTS: The clinical characteristics of DKA patients 65 years and older were compared with patients younger than 65 years. MEASUREMENTS: The primary outcome was in‐hospital mortality. RESULTS: The study cohort included 385 consecutive patients for whom the admission diagnosis was DKA: 307 patients (79.7%) younger than 65 years (group 1), and 78 patients (20.3%) older than 65 years (group 2). Patients in group 2 compared with group 1 had a significantly higher Charlson index (6 [6–6] vs 6 [6–7]; P <.0001) and DM with target organ damage (24.4% vs 6.2%; P <.0001). Patients in group 2 compared with group 1 had more serious disease according to results of laboratory investigations. The total in‐hospital mortality rate of patients in group 2 was 16.7% compared with 1.6% in patients in group 1 in a sex and co‐morbidities matched analysis (P =.001). CONCLUSIONS: DKA in older adults is a common problem. The serious co‐morbidities and precipitating factors such as infection/sepsis, myocardial infarction, and cerebrovascular accidents, may explain the severity of the problem of DKA in older adults and the high rate of mortality of these patients. DKA appears to be a lifethreatening condition in older adults. The alertness of physicians to DKA in older adults, timely diagnosis, proper treatment, and prevention are cornerstones of care. J Am Geriatr Soc 68:1256–1261, 2020. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Our aim was to examine the impacts of baseline fatigue on the effectiveness of a physical activity (PA) intervention to prevent major mobility disability (MMD) and persistent major mobility disability (PMMD) in participants from the Lifestyle Interventions and Independence for Elders (LIFE) study. DESIGN: Prospective cohort of individuals aged 65 years or older undergoing structured PA intervention or health education (HE) for a mean of 2.6 years. SETTING: LIFE was a multicenter eight‐site randomized trial that compared the efficacy of a structured PA intervention with an HE program in reducing the incidence of MMD. PARTICIPANTS: Study participants (N = 1591) at baseline were 78.9 ± 5.2 years of age, with low PA and at risk for mobility impairment. MEASUREMENTS: Self‐reported fatigue was assessed using the modified trait version of the Exercise‐Induced Feelings Inventory, a six‐question scale rating energy levels in the past week. Responses ranged from 0 (none of the time) to 5 (all of the time). Total score was calculated by averaging across questions; baseline fatigue was based on the median split: 2 or higher = more fatigue (N = 856) and lower than 2 = less fatigue (N = 735). Participants performed a usual‐paced 400‐m walk every 6 months. We defined incident MMD as the inability to walk 400‐m at follow‐up visits; PMMD was defined as two consecutive walk failures. Cox proportional hazard models quantified the risk of MMD and PMMD in PA vs HE stratified by baseline fatigue adjusted for covariates. RESULTS: Among those with higher baseline fatigue, PA participants had a 29% and 40% lower risk of MMD and PMMD, respectively, over the trial compared with HE (hazard ratio [HR] for MMD =.71; 95% confidence interval [CI] =.57‐.90; P =.004) and PMMD (HR =.60; 95% CI =.44‐.82; P =.001). For those with lower baseline fatigue, no group differences in MMD (P =.36) or PMMD (P =.82) were found. Results of baseline fatigue by intervention interaction was MMD (P =.18) and PMMD (P =.05). CONCLUSION: A long‐term moderate intensity PA intervention was particularly effective at preserving mobility in older adults with higher levels of baseline fatigue. J Am Geriatr Soc 68:619–624, 2020 [ABSTRACT FROM AUTHOR]

BACKGROUND: Hospital‐acquired disability (HAD) is common and often related to low physical activity while in the hospital. OBJECTIVE: To examine whether wearable hospital activity trackers can be used to predict HAD. DESIGN: A prospective observational study between January 2016 and March 2017. SETTING: An academic medical center. PARTICIPANTS: Community‐dwelling older adults, aged 60 years or older, enrolled within 24 hours of admission to general medicine (n = 46). MAIN MEASURES: Primary outcome was HAD, defined as having one or more new activity of daily living deficits, decline of four or greater on the Late‐Life Function and Disability Instrument (calculated between baseline and discharge), or discharge to a skilled nursing facility. Hospital activity (mean active time, mean sedentary time, and mean step counts per day) was measured using ankle‐mounted accelerometers. The association of the literature‐based threshold of 900 steps/day with HAD was also evaluated. RESULTS: Mean age was 73.2 years (SD = 9.5 years), 48% were male, and 76% were white. Median length of stay was 4 days (interquartile range [IQR] = 2.0‐6.0 days); 61% (n = 28) reported being able to walk without assistance of another person or walking aid at baseline. Median daily activity time and step counts were 1.1 h/d (IQR = 0.7‐1.7 h/d) and 1455.7 steps/day (IQR = 908.5‐2643 steps/day), respectively. Those with HAD (41%; n = 19) had lower activity time (0.8 vs 1.4 h/d; P =.04) and fewer step counts (1186 vs 1808 steps/day; P =.04), but no difference in sedentary time, compared to those without HAD. The 900 steps/day threshold had poor sensitivity (40%) and high specificity (85%) for detecting HAD. CONCLUSIONS: Low hospital physical activity, as measured by wearable accelerometers, is associated with HAD. Clinicians can utilize wearable technology data to refer patients to physical/occupational therapy services or other mobility interventions, like walking programs. J Am Geriatr Soc 68:261–265, 2020 [ABSTRACT FROM AUTHOR]

OBJECTIVES: Use of objectively measured physical activity (PA) in older adults to assess relationship between PA and risk of all‐causes mortality is scarce. This study evaluated the associations of PA based on accelerometry and a questionnaire with the risk of mortality among older adults from a city in Southern Brazil. DESIGN: A cohort study. SETTING: Urban area of Pelotas, Southern Brazil. PARTICIPANTS: A representative sample of older adults (≥60 y) from Pelotas, enrolled in 2014. MEASUREMENTS: Overall physical activity (mg), light physical activity (LPA), and moderate to vigorous physical activity (MVPA) were estimated by raw accelerometer data. The International Physical Activity Questionnaire estimated leisure time and commuting PA. Hazard ratios (excluding deaths in the first 6 mo) stratified by sex were estimated by Cox regression analysis considering adjustment for confounders. RESULTS: From the 1451 older adults interviewed in 2014, 145 died (10%) after a follow‐up of an average 2.6 years. Men and women in the highest tertile of overall PA had on average a 77% and 92% lower risk of mortality than their less active counterparts (95% confidence interval [CI] =.06‐.84 and 95% CI =.01‐.65, respectively). The highest tertile of LPA was also related to a lower risk of mortality in individuals of both sexes (74% and 91% lower risk among men and women, respectively). MVPA statistically reduced the risk of mortality only among women (hazard ratio [HR] =.30 and HR =.07 in the second and third tertiles). Self‐reported leisure‐time PA was statistically associated with a lower risk of mortality only among men. Women in the highest tertiles of commuting PA showed a lower risk of mortality than those in the reference group. CONCLUSION: Accelerometry‐based PA was associated with a lower risk of mortality among Brazilian older adults. Older individuals should practice any type of PA. J Am Geriatr Soc 68:137–146, 2019 [ABSTRACT FROM AUTHOR]