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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., (© 2022 The American Geriatrics Society.)

Background: Older adults see multiple outpatient providers and increasingly use home health care (HHC) services. Previous studies attempting to draw inferences about the association between HHC use and patient outcomes have been mixed. Whether HHC is associated with care coordination and how both influence outcomes are unknown. In addition, prior studies have not taken the patient perspective into account. We examined the association between receiving HHC and self-reported gaps in care coordination and separately, preventable adverse outcomes., Methods: The analysis for this cross-sectional study was conducted between October 2021 and June 2022, using data on 4296 Medicare beneficiaries from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study who completed a survey on care coordination from 2017 to 2018. The associations between the receipt of HHC and two outcomes (a gap in care coordination, and separately, a preventable adverse event) were examined with Poisson models with robust standard errors. Potential confounders were accounted for through propensity score-based inverse probability weighting., Results: Among 4296 participants, 430 (10%) received HHC and they were older and had more comorbidities and ambulatory visits than those without HHC. HHC was not associated with differences in self-reported gaps in care coordination (33.3% HHC vs. 32.5% no-HHC, p = 0.70). HHC recipients reported more preventable drug-drug interactions (9.1% vs. 4.0%, p < 0.001) but not more preventable ED visits or hospital admissions. In IPW-adjusted models, HHC was not associated with gaps in care coordination (p = 0.60) but was associated with double the risk of a preventable adverse outcome (aRR 2.06; CI: 1.37, 3.10, p < 0.001)., Conclusions: HHC recipients were significantly more likely (than those without HHC) to report a potentially preventable adverse event (particularly a drug-drug interaction), suggesting an opportunity to improve patient safety by leveraging the observations of older adults receiving HHC., (© 2022 The American Geriatrics Society.)

Older adults suffering from chronic pulmonary diseases, such as chronic obstructive pulmonary disease and interstitial lung disease, and critical illnesses, such as sepsis and acute respiratory failure, are more vulnerable to adverse outcomes like disability and greater side effects from treatments. In this update, we discuss recent practice-changing clinical trials and observational studies in Pulmonary & Critical Care Medicine that have advanced our understanding of the diagnosis or management of older adults with chronic lung diseases or critical illnesses., (© 2022 The American Geriatrics Society.)

Background: The use of a new medication (e.g., potassium supplementation) for managing a drug-induced adverse event (e.g., loop diuretic-induced hypokalemia) constitutes a prescribing cascade. However, loop diuretics are often stopped while potassium may be unnecessarily continued (i.e., relic). We aimed to quantify the occurrence of relics using older adults previously experiencing a loop diuretic-potassium prescribing cascade as an example., Methods: We conducted a prescription sequence symmetry analysis using the population-based Medicare Fee-For-Service data (2011-2018) and partitioned the 150 days following potassium initiation by day to assess the daily treatment scenarios (i.e., loop diuretics alone, potassium alone, combination of loop diuretics and potassium, or neither). We calculated the proportion of patients developing the relic, proportion of person-days under potassium alone, the daily probability of the relic, and the proportion of patients filling potassium after loop diuretic discontinuation. We also identified the risk factors of the relic., Results: We identified 284,369 loop diuretic initiators who were 8 times more likely to receive potassium supplementation simultaneously or after (i.e., the prescribing cascade), rather than before, loop diuretic initiation (aSR 8.0, 95% CI 7.9-8.2). Among the 66,451 loop diuretic initiators who subsequently (≤30 days) initiated potassium, 20,445 (30.8%) patients remained on potassium after loop diuretic discontinuation, and 9365 (14.1%) patients subsequently filled another potassium supplementation. Following loop diuretic initiation, 4.0% of person-days were for potassium alone, and daily probability of the relic was the highest after day 90 of loop diuretic initiation (5.6%). Older age, female sex, higher diuretic daily dose, and greater baseline comorbidities were risk factors for the relic, while patients having the same prescriber or pharmacy involved in the use of both medications were less likely to experience the relic., Conclusions: Our findings suggest the need for clinicians to be aware of the potential of relic to avoid unnecessary drug use., (© 2022 The American Geriatrics Society.)

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., (© 2022 The American Geriatrics Society.)

Introduction: Medication reconciliation, a technique that assists in aligning a care team's understanding of an individual's true medication regimen, is vital to optimize medication use and prevent medication errors. Historically, most medication reconciliation research has focused on institutional settings and transitional care, with comparatively little attention given to medication reconciliation in community settings. To optimize medication reconciliation for community-dwelling older adults, healthcare professionals and older adults must be engaged in co-designing processes that create sustainable approaches., Methods: Academic researchers, older adults, and community- and health system-based healthcare professionals engaged in a participatory process to better understand medication reconciliation barriers and co-design solutions. The initiative consisted of two participatory research approaches: (1) Sparks Innovation Studios, which synthesized professional expertise and opinions, and (2) a Community Consultation Studio with older adults. Input from both groups informed a list of possible solutions and these were ranked based on evaluative criteria of feasibility, person-centeredness, equity, and sustainability., Results: Sparks Innovation Studios identified a lack of ownership, fragmented healthcare systems, and time constraints as the leading barriers to medication reconciliation. The Community Consultation Studio revealed that older adults often feel dismissed in medical encounters and perceive poor communication with and among providers. The Community Consultation Studio and Sparks Innovation Studios resulted in four highly-ranked solutions to improve medication reconciliation: (1) support for older adults to improve health literacy and ownership; (2) ensuring medication indications are included on prescription labels; (3) trainings and incentives for front-line staff in clinic settings to become champions for medication reconciliation; and (4) electronic health record improvements that simplify active medication lists., Conclusion: Engaging community representatives with academic partners in the research process enhanced understanding of community priorities and provided a practical roadmap for innovations that have the potential to improve the well-being of community-dwelling older adults., (© 2022 The American Geriatrics Society.)

Older adults are characterized by profound clinical heterogeneity. When designing and delivering interventions, there exist multiple approaches to account for heterogeneity. We present the results of a systematic review of data-driven, personalized interventions in older adults, which serves as a use case to distinguish the conceptual and methodologic differences between individualized intervention delivery and precision health-derived interventions. We define individualized interventions as those where all participants received the same parent intervention, modified on a case-by-case basis and using an evidence-based protocol, supplemented by clinical judgment as appropriate, while precision health-derived interventions are those that tailor care to individuals whereby the strategy for how to tailor care was determined through data-driven, precision health analytics. We discuss how their integration may offer new opportunities for analytics-based geriatric medicine that accommodates individual heterogeneity but allows for more flexible and resource-efficient population-level scaling., (© 2022 The American Geriatrics Society.)

Background: An increased risk of fracture has been reported in older adults taking hypnotics. However, few studies have reported the comparative safety of hypnotics with different mechanisms of action. We examined the risk of fracture in older adults initiating suvorexant compared to those initiating Z-drugs., Methods: We conducted a retrospective cohort study using a claims database within a longevity improvement and fair evidence (LIFE) study in Japan (1.5 million beneficiaries). People aged ≥65 years were included in this study. Exposure was defined as the initiation of either suvorexant or Z-drugs (eszopiclone, zolpidem, or zopiclone). The evaluated outcomes were hip fracture and all-cause fracture requiring hospitalization. We used inverse probability of treatment weights to adjust for confounding and followed the incidence of the outcome for three different periods: 30, 90, and 365 days. Cox proportional hazards models were fitted to the weighted population to estimate hazard ratios (HRs). Sensitivity analyses were performed with narrowed outcome definitions and inverse probability of censoring weights., Results: We identified 16,148 suvorexant new users and 54,327 Z-drugs new users. During the 30-day follow-up, 21 (16.6 events per 1000 person-years) and 53 hip fractures (12.2 events per 1000 person-years) were identified among suvorexant and Z-drugs new users, respectively (HR: 1.01, 95% confidence interval [CI]: 0.58-1.76). The analysis for all-cause fracture showed an HR of 1.03 (95% CI: 0.78-1.36). Extended follow-up (90 and 365 days) showed similar results for both outcomes. Sensitivity analyses showed consistent results except for an increased risk of all-cause fracture requiring surgery (HR: 1.41, 95% CI: 0.87-2.29) during the 30-day follow-up., Conclusions: This is the first study to show that suvorexant has a generally comparable risk of fracture as compared to Z-drugs. Further research is needed to investigate the potential short-term increased risk of all-cause fracture requiring surgery among suvorexant initiators., (© 2022 The American Geriatrics Society.)

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., (© 2022 The American Geriatrics Society.)

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., (© 2022 The American Geriatrics Society.)

Background: Older adults with cancer are at increased risk of treatment-related toxicities and excess mortality. We evaluated whether a patient-reported geriatric assessment (GA) based frailty index can identify those at risk of adverse outcomes., Methods: Older adults (≥60 years) enrolled in a single-institutional prospective registry underwent patient-reported GA at initial evaluation in our medical oncology clinic. Using deficit accumulation method, we constructed a 44-item frailty index (CARE-FI), categorizing patients as robust, pre-frail, and frail. The primary outcome was overall survival (OS). Secondary outcomes included (a) functional decline at 3 months post-therapy (b) incident grade ≥3 treatment-related toxicities at six-month post-treatment. We used multivariate Cox and logistic regression models respectively to study the impact of frailty on primary and secondary outcomes., Results: We identified 589 older adults with a median age of 69 years; 55% males and 73% Whites. Overall, 168 (29%) were pre-frail and 230 (39%) frail. Being frail (vs. robust) was associated with worse OS (Hazards Ratio, HR 1.83, 95% Confidence Interval, CI 1.34-2.49, p < 0.001) after adjusting for age, sex, race/ethnicity, cancer type, cancer stage, and line of therapy. Similarly, frailty was associated with increased risk of functional decline (OR 3.01; 95% CI 1.33-6.81; p = 0.008) and grade ≥3 non-hematologic toxicities (OR 3.65; 95% CI 1.54-8.69; p = 0.003) but not hematologic toxicities (OR 1.01; 95% CI 0.46-2.22; p = 0.97)., Conclusions: Our frailty index using a patient-reported GA is a robust predictor of survival, functional decline, and treatment related toxicity among older adults with GI malignancies., (© 2022 The American Geriatrics Society.)

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., (© 2022 The American Geriatrics Society. This article has been contributed to by US Government employees and their work is in the public domain in the USA.)

Objectives To determine, in a sample of Ashkenazi Jewish aged 95 and older, whether there is a compression of morbidity similar to what has been reported in other cohorts with exceptional longevity. Design Case-control study. Setting Longevity Genes Project ( LGP) and New England Centenarian Study ( NECS). Participants LGP (n = 439, mean age 97.8 ± 2.8) and NECS (n = 1,498, mean age 101.4 ± 4.0) participants with exceptional longevity and their respective younger referent cohorts ( LGP, n = 696; NECS, n = 302). Measurements Self- and proxy reports of age of onset of cancer, cardiovascular disease, diabetes mellitus, hypertension, osteoporosis, and stroke. Results Long-lived individuals from LGP and NECS had later age of onset of cancer, cardiovascular disease, diabetes mellitus, hypertension, and osteoporosis than their respective younger reference groups. The risk of overall morbidity was lower in participants with exceptional longevity than in younger participants ( NECS men: relative risk ( RR) = 0.12, women: RR = 0.20; LGP men: RR = 0.18, women: RR = 0.24). The age at which 20% of each of the groups with exceptional longevity experienced specific diseases was between 18 and 24 years later than in the reference groups, stratified according to sex. Conclusion The similar extension of health span and compression of morbidity seen in NECS and LGP participants with exceptional longevity further validates the utility of these rare individuals for the study of factors that delay or prevent a broad spectrum of diseases otherwise associated with mortality and disability. [ABSTRACT FROM AUTHOR]

Objectives To compare the effectiveness and cardiovascular safety of long-acting beta-agonists ( LABAs) with those of leukotriene receptor antagonists ( LTRAs) as add-on treatments in older adults with asthma already taking inhaled corticosteroids ( ICSs). Design Retrospective cohort study. Setting Medicare fee-for-service ( FFS) claims (2009-10) for a 10% random sample of beneficiaries continuously enrolled in Parts A, B, and D in 2009. Participants Medicare beneficiaries aged 66 and older continuously enrolled in FFS Medicare with Part D coverage with a diagnosis of asthma before 2009 treated exclusively with ICSs plus LABAs or ICSs plus LTRAs (N = 14,702). Measurements The augmented inverse propensity-weighted estimator was used to compare the effect of LABA add-on therapy with that of LTRA add-on therapy on asthma exacerbations requiring inpatient, emergency, or outpatient care and on cardiovascular ( CV) events, adjusting for demographic characteristics, comorbidities, and county-level healthcare-access variables. Results The primary analysis showed that LTRA add-on treatment was associated with greater odds of asthma-related hospitalizations or emergency department visits (odds ratio ( OR) = 1.4, P < .001), as well as outpatient exacerbations requiring oral corticosteroids or antibiotics ( OR = 1.41, P < .001) than LABA treatment. LTRA add-on therapy was also less effective in controlling acute symptoms, as indicated by greater use of short-acting beta agonists (rate ratio = 1.58, P < .001). LTRA add-on treatment was associated with lower odds of experiencing a CV event than LABA treatment ( OR = 0.86, P = .006). Conclusion This study provides new evidence specific to older adults to help healthcare providers weigh the risks and benefits of these add-on treatments. Further subgroup analysis is needed to personalize asthma treatments in this high-risk population. [ABSTRACT FROM AUTHOR]

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

Objectives To describe preferences and experiences of caregivers of disabled older adults regarding being included in patient-clinician discussions about life expectancy. Design Qualitative interview study. Setting Caregivers were recruited from a Program of All-Inclusive Care for the Elderly ( PACE), caregiver support groups and an advertisement on a nationwide caregiver advocacy group website. Participants Active and bereaved caregivers whose primary language was either English or Cantonese who had provided care within the last 5 years to a disabled adult aged 65 and older (N = 42, 79% female, 60% white, average age 54). Measurements Semistructured telephone interviews were conducted with caregivers who were asked about experiences and preferences related to clinician communication about life expectancy, including preferences for and attitudes toward being included in discussions about life expectancy, how such information should be delivered, and how clinicians should address concerns about uncertainty and hope. Responses were analyzed qualitatively using constant comparison until thematic saturation was reached. Results Twenty-six percent of caregivers had been involved in a conversation with a clinician about life expectancy, even though 79% expressed a preference to have such a discussion. According to caregivers, clinician concerns about taking away hope or the uncertainty of prognostic information should not deter them from bringing up the topic of life expectancy. Thematic analysis suggested several approaches that may facilitate prognosis communication: establishing a relationship with the caregiver and care recipient; delivering the prognosis in clear, plain language; and responding to emotion with empathy. Conclusion Caregivers reported a preference for being included in conversations about a care recipient's life expectancy. [ABSTRACT FROM AUTHOR]

Objectives To assess the relationship between hemoglobin concentration and cause-specific mortality. Design Cohort study. Setting Data from the government-sponsored Annual Geriatric Health Examination Program. Participants Community-dwelling Taipei citizens aged 65 and older followed up between 2006 and 2010 (N = 77,532). Measurements Mortality was determined by matching participants' medical records with national death files. Cox proportional hazards regression models were used to evaluate the relationship between hemoglobin concentration (World Health Organization ( WHO)-defined anemia and 7 hemoglobin concentrations) and cause-specific mortality. Results The mortality risk of WHO-defined anemia increased substantially in both sexes for all-cause and cancer mortalities (men, hazard ratio ( HR) = 1.86, 95% confidence interval ( CI) = 1.71-2.02 for all-cause mortality; HR = 1.94, 95% CI = 1.69-2.22 for cancer mortality; for women, HR = 1.63, 95% CI = 1.43-1.86 for all-cause mortality; HR = 1.74, 95% CI = 1.38-2.19 for cancer mortality). Men with hemoglobin concentrations of 15.0 to 15.9 g/ dL and women with hemoglobin concentrations of 13.0 to 13.9 g/ dL had the lowest risks of all-cause, cardiovascular, and cancer mortality. Risks of all-cause and cancer mortality increased significantly when hemoglobin concentrations were less than 14 g/ dL in men and less than 12 g/ dL in women. Even mild anemia (11.0-11.9 g/ dL) was associated with greater mortality risk. Stratification according to age, body mass index, estimated glomerular filtration rate, and presence of comorbidities did not lead to any substantial changes. Conclusion Hemoglobin concentrations associated with optimal survival in older adults were identified and additional data provided regarding the relationship between hemoglobin concentrations and cause-specific mortality risks in older adults. [ABSTRACT FROM AUTHOR]

Objectives To determine whether moderate-intensity physical activity ( PA) and health education ( HE) are differentially associated with categories of hospitalizations or subgroups of participants. Design Multicenter randomized controlled trial in which participants were randomized to a PA or HE program for an average of 2.6 years. Setting Eight field centers. Participants Sedentary men and women aged 70-89 with lower extremity physical limitations but able to walk 400-m in 15 minutes or less (N = 1,635). Interventions Structured, moderate-intensity PA (n = 818) at a center (2×/wk) and at home (3-4×/wk) that included aerobic, strength, balance, and flexibility training or HE (n = 817) of educational workshops and upper extremity stretching exercises. Measurements All-cause inpatient hospitalizations ascertained at 6-month intervals. Results There were 1,458 hospitalizations (49.1% of PA, 44.4% of HE; risk difference = 4.68%, 95% confidence interval ( CI) = −0.18-9.54; hazard ratio ( HR) = 1.16, 95% CI = 1.00-1.34). The intervention effect on incident hospitalization did not differ according to race, sex, Short Physical Performance Battery score, age, or history of cardiovascular disease or diabetes mellitus. PA was associated with higher rates of hospitalization in the middle baseline gait speed category, than HE (<0.8 m/s: HR = 0.93, 95% CI = 0.76-1.14; 0.8-1.0 m/s: HR = 1.54, 95% CI = 1.23-1.94; >1.0 m/s: HR = 1.05, 95% CI = 0.67-1.65; interaction P = .005). Conclusion A PA program in older adults at risk for mobility disability did not lead to a different risk of specific types of hospitalizations than a HE program overall. Baseline gait speed may be a marker for risk of hospitalization during a PA intervention, because individuals with moderate baseline gait speed in the PA group had slightly higher rates of hospitalization than those in the HE group. Trial Registration: ClinicalTrials.gov identifier: NCT01072500. [ABSTRACT FROM AUTHOR]

Objectives To explore the association between rate of physical health deterioration, operationalized as rising multimorbidity overtime, and longitudinal decline in cognitive function in older adults without dementia. Design Longitudinal (Baltimore Longitudinal Study of Aging (BLSA)). Setting Community. Participants BLSA participants aged 65 and older followed for an average of 3 years and free of dementia or mild cognitive impairment ( MCI) at baseline and follow-up ( N = 756). Measurements Standardized neurocognitive tests evaluating mental status, memory, executive function, processing speed, and verbal fluency were administered. Multimorbidity was assessed at each visit as number of diagnosed chronic diseases from a predefined list. Faster accumulation of chronic diseases was defined as upper quartile of rate of change in number of diseases over time (≥0.25 diseases/year). Results Faster accumulation of chronic diseases was significantly associated with greater rate of decline on the Category ( P = .01) and Letter ( P = .01) Fluency Tests. Similar trends were also found for the Trail-Making Test Parts A ( P = .08) and B ( P = .07); no association was found with rate of change in visual and verbal memory. Conclusion Although further investigations are required to validate the results and fully understand the underlying mechanisms, these findings suggest that accelerated deterioration of physical health is associated with accelerated decline with aging in specific cognitive domains in older adults without dementia. [ABSTRACT FROM AUTHOR]

Objectives To determine whether midlife occupational physical activity ( PA) is associated with disability in older adults and to test disease as a mediating variable. Design Cross-sectional study. Setting National Health and Aging Trends Study. Participants Individuals aged 65 and older (N = 7,307). Measurements Participants were classified as to occupational PA levels by linking information from the Occupational Information Network database using standard occupation codes. Disability outcomes and covariates were obtained through in-person interviews. Logistic regression models were used to examine the association between occupational PA and disability. Structural equation modeling ( SEM) was fitted to examine the mediating effect of disease. Results Occupations with high physically demands were associated with greater decline in functional capacity later in life. Individuals with occupations with high and very high PA were less likely to be able to perform activities of daily living than those with occupations with low PA. SEM showed that occupational PA has a very strong direct effect on disability ( P < .001) and has an indirect effect on disability through disease ( P = .003). The population attributable fraction for high occupational PA was 11%. Conclusion Higher midlife occupational PA levels were significantly associated with poorer ability to perform activities of daily living in older age. Performing the optimal level of occupational PA may be instrumental in reducing disability later in life. [ABSTRACT FROM AUTHOR]

Objectives To determine whether emergency department ( ED) length of stay before ward admission is associated with incident delirium in older adults. Design Prospective cohort study. Setting Hospital. Participants Individuals aged 75 and older without delirium at ED entry, coma, aphasia, stroke, language barrier, psychiatric disorder, or alcohol abuse (N = 330). Measurements On ED admission, individuals underwent standardized evaluation of comorbidity (Cumulative Illness Rating Scale), cognitive impairment (Short Portable Mental Status Questionnaire), functional independence (activities of daily living, instrumental activities of daily living), pain (Numeric Rating Scale), and acute clinical conditions (Acute Physiology and Chronic Health Evaluation II). During the first 3 days after ward admission, the presence of delirium (defined as ≥1 delirium episodes within 72 hours) was assessed daily using a rapid assessment for delirium (4 AT scale). ED length of stay was calculated as the time (hours) between ED registration and when the person left the ED. Results ED length of stay longer than 10 hours (odds ratio ( OR) = 2.23, 95% confidence interval ( CI) = 1.13-4.41), moderate to severe cognitive impairment ( OR = 5.47, 95% CI = 2.76-10.85), and older age ( OR = 1.07, 95% CI = 1.01-1.13) were associated with delirium onset. Conclusion ED length of stay longer than 10 hours was associated with greater risk of delirium in hospitalized older adults, after adjusting for age and cognitive impairment. [ABSTRACT FROM AUTHOR]

Objectives To determine the effect of asthma on functional limitations of older adults in the United States. Design Analyses were conducted with data from the Asthma Beliefs and Literacy in the Elderly study, a prospective cohort study of people aged 60 and older with asthma. Setting Participants were recruited from urban primary care and pulmonary specialty practices in New York City and Chicago between 2010 and 2012. Participants Individuals aged 60 and older with asthma (380 women, 72 men, mean age 67.5 ± 6.8 (range 60-98), 40% Latino, 30% black). Measurements Characteristics of participants with and without activity of daily living ( ADL) limitations were compared using the chi-square test. Generalized estimating equations were used to model the relationships between poor asthma control (Asthma Control Questionnaire ( ACQ) score >1.5) and severity of airway obstruction (forced expiratory volume in 1-second ( FEV1)) and number of ADL limitations. Results Participants with one or more ADL limitations were more likely to be female (90% vs 81%, P = .02) and Latino (58% vs 32%, P < .001), have less than a high school education (53% vs 27%, P < .001) and an income of $1,350 per month or less (79% vs 46%, P < .001), and be unmarried (78% vs 64%, P = .003). In the adjusted analysis, poorer ACQ scores (odds ratio ( OR) = 1.6, 95% confidence interval ( CI) = 1.0-2.4; P = .05) but not severity of airway obstruction ( OR = 1.1, 95% CI = 0.6-1.9) was associated with greater ADL limitations. Conclusion Older adults reporting poor asthma control are more likely to have ADL limitations than those with controlled asthma, although one-time spirometry may not adequately identify those at risk of physical impairment from asthma. [ABSTRACT FROM AUTHOR]

Objectives To estimate the prevalence and determinants of the use of potentially inappropriate medications ( PIMs) in older U.S. adults using the 2012 Beers criteria. Design Retrospective cohort study in a random national sample of Medicare beneficiaries. Setting Fee-for-service Medicare beneficiaries from 2007 to 2012. Participants U.S. population aged 65 and older with Parts A, B, and D enrollment in at least 1 month during a calendar year (N = 38,250 individuals; 1,308,116 observations). Measurements The 2012 Beers criteria were used to estimate the prevalence of the use of PIMs in each calendar month and over a 12-month period using data on diagnoses or conditions present in the previous 12 months. Generalized estimating equations were used to account for the dependence of multiple monthly observations of a single person when estimating 95% confidence intervals ( CIs), and logistic regression was used to identify independent determinants of PIM use. Results The point prevalence of the use of PIMs decreased from 37.6% (95% CI = 37.0-38.1) in 2007 to 34.2% (95% CI = 33.6-34.7) in 2012, with a statistically significant 2% (95% CI = 1-3%) decline per year assuming a linear trend. The 1-year period prevalence declined from 64.9% in 2007 to 56.6% in 2012. The strongest predictor of PIM use was the number of drugs dispensed. Individuals aged 70 and older and those seen by a geriatrician were less likely to receive a PIM. Conclusion From 2007 to 2012, the prevalence of PIM use in older U.S. adults decreased according to the 2012 Beers criteria, although it remains high, still affecting one-third each month and more than half over 12 months. The number of dispensed prescriptions could be used to target future interventions. [ABSTRACT FROM AUTHOR]

Objectives To determine whether fall-related injuries affect return to the ED after the initial visit. Design Retrospective chart review. Setting Academic Level 1 trauma center ED. Participants Individuals aged 65 and older evaluated for a fall from standing height or less and discharged (N = 263, average age 77, 70% female). Measurements After institutional review board approval, electronic medical record data were queried. Univariate and multivariable logistic regression models were used to determine factors associated with risk of returning to the ED within 90 days. Results Injuries included fractures (45%, n = 117); head trauma (22%, n = 58); abrasions, lacerations, or contusions (34%, n = 88); and none (22%, n = 57). Emergency care was frequently required, with 13 (5%, 95% confidence interval ( CI) = 2.3-7.6%) returning within 72 hours, 35 (13%, 95% CI = 9.2-17%] within 30 days, and 57 (22%, 95% CI = 17-27%) within 90 days. Univariately, the odds of returning to the ED within 90 days was more than two times as high for those with head trauma as for those without (odds ratio = 2.66). This remained significant in the multivariable model, which controlled for Charlson Comorbidity Index, fractures, soft tissue injuries, and ED observation unit use. Conclusion More than one-third of older adults with minor head trauma from a fall will need to return to the ED in the following 90 days. These individuals should receive close attention from primary care providers. The link between minor head trauma and ED recidivism is a new finding. [ABSTRACT FROM AUTHOR]

Objectives To determine the prevalence, recognition, co-occurrence, and recent onset of geriatric syndromes in individuals transferred from the hospital to a skilled nursing facility ( SNF). Design Quality improvement project. Setting Acute care academic medical center and 23 regional partner SNFs. Participants Medicare beneficiaries hospitalized between January 2013 and April 2014 and referred to SNFs (N = 686). Measurements Project staff measured nine geriatric syndromes: weight loss, lack of appetite, incontinence, and pain (standardized interview); depression (Geriatric Depression Scale); delirium (Brief Confusion Assessment Method); cognitive impairment (Brief Interview for Mental Status); and falls and pressure ulcers (hospital medical record using hospital-implemented screening tools). Estimated prevalence, new-onset prevalence, and common coexisting clusters were determined. The extent to which treating physicians commonly recognized syndromes and communicated them to SNFs in hospital discharge documentation was evaluated. Results Geriatric syndromes were prevalent in more than 90% of hospitalized adults referred to SNFs; 55% met criteria for three or more coexisting syndromes. The most-prevalent syndromes were falls (39%), incontinence (39%), loss of appetite (37%), and weight loss (33%). In individuals who met criteria for three or more syndromes, the most common triad clusters were nutritional syndromes (weight loss, loss of appetite), incontinence, and depression. Treating hospital physicians commonly did not recognize and document geriatric syndromes in discharge summaries, missing 33% to 95% of syndromes present according to research personnel. Conclusion Geriatric syndromes in hospitalized older adults transferred to SNFs are prevalent and commonly coexist, with the most frequent clusters including nutritional syndromes, depression, and incontinence. Despite the high prevalence, this clinical information is rarely communicated to SNFs on discharge. [ABSTRACT FROM AUTHOR]

Objectives To evaluate whether indices of preinjury health and functioning are associated with risk of incident traumatic brain injury ( TBI) with loss of consciousness ( LOC) and to evaluate health-related factors associated with mortality in individuals with incident TBI. Design Prospective community cohort study. Setting Group Health, Seattle, Washington. Participants Individuals aged 65 and older with no self-reported prior TBI with LOC (N = 3,363) were enrolled and followed every 2 years for an average of 7.5 years (range 0-18 years). Measurements Weibull survival models were used to evaluate baseline and time-varying predictors of incident TBI with LOC, including measures of depression, activities of daily living ( ADLs), cerebrovascular disease, and disease comorbidity. Results In an adjusted multivariate model, baseline depression symptoms as measured according to Center for Epidemiologic Studies Depression Scale ( CES-D) score (hazard ratio ( HR) for 4 points = 1.23, 95% confidence interval ( CI) = 1.02-1.49, P = .03) and baseline activity of daily living ( ADL) impairment ( HR = 2.37, 95% CI = 1.24-4.53, P = .009) were associated with incident TBI. In a model that included time-dependent covariates, cerebrovascular disease at the previous visit ( HR = 2.28, 95% CI = 1.37-3.78, P < .001), CES-D score the previous visit ( HR for 4 points = 1.23, 95% CI = 1.02-1.49, P < .04) and baseline ADL impairment ( HR 2.14, 95% CI = 1.11-4.13, P = .02) predicted incident TBI. Of factors considered, cerebrovascular disease and ADL impairment were associated with earlier mortality in participants with incident TBI with LOC. Conclusion Indices of health, mood, and functional status predict incident TBI with LOC in older adults. These findings may have implications for injury prevention and postinjury clinical management. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the associations between anesthesia and dementia or Alzheimer's disease ( AD) risk using prospectively collected data. Design Cohort study. Participants Community-dwelling members of the Adult Changes in Thought cohort aged 65 and older and free of dementia at baseline (N = 3,988). Measurements Participants self-reported all prior surgical procedures with general or neuraxial (spinal or epidural) anesthesia at baseline and reported new procedures every 2 years. People undergoing high-risk surgery with general anesthesia, other surgery with general anesthesia, and other surgery with neuraxial anesthesia exposures were compared with those with no surgery and no anesthesia. Cox proportional hazards models were used to estimate hazard ratios ( HRs) and 95% confidence intervals ( CIs) for dementia and AD associated with time-varying lifetime and recent (past 5 years) anesthesia exposures. Results At baseline, 254 (6%) people reported never having anesthesia; 248 (6%) had had one or more high-risk surgeries with general anesthesia, 3,363 (84%) had had one or more other surgeries with general anesthesia, and 123 (3%) had had one or more surgeries with neuraxial anesthesia. High-risk surgery with general anesthesia was not associated with greater risk of dementia (HR = 0.86, 95% CI = 0.58-1.28) or AD (HR = 0.95, 95% CI = 0.61-1.49) than no history of anesthesia. People with any history of other surgery with general anesthesia had a lower risk of dementia (HR = 0.63, 95% CI = 0.46-0.85) and AD (HR = 0.65, 95% CI = 0.46-0.93) than people with no history of anesthesia. There was no association between recent anesthesia exposure and dementia or AD. Conclusion Anesthesia exposure was not associated with of dementia or AD in older adults. [ABSTRACT FROM AUTHOR]

Objectives To compare the efficacy and safety of canagliflozin, a sodium glucose co-transporter 2 inhibitor developed to treat type 2 diabetes mellitus (T2DM), in individuals younger than 75 and those aged 75 and older. Design Randomized Phase 3 studies. Setting International study centers. Participants Adults with T2DM. Measurements Changes from baseline in glycosylated hemoglobin (HbA1c), fasting plasma glucose ( FPG), blood pressure ( BP), and body weight were measured. Efficacy was evaluated using pooled data from six randomized, double-blind, placebo-controlled studies (N = 4,158; n = 3,975 aged <75, n = 183 aged ≥75). Safety was assessed based on adverse event ( AE) reports from eight randomized, double-blind, placebo- and active-controlled studies (N = 9,439; n = 8,949 aged <75, n = 490 aged ≥75). Results Canagliflozin 100 and 300 mg were associated with placebo-subtracted mean reductions in HbA1c in participants younger than 75 (−0.69% and −0.85%, respectively) and aged 75 and older (−0.65% and −0.55%, respectively). Dose-related reductions in FPG, body weight, and BP were seen with canagliflozin 100 and 300 mg in participants in both age groups. Overall AE incidence was 67.1% with canagliflozin 100 mg, 68.6% with canagliflozin 300 mg, and 65.9% with non-canagliflozin (pooled group of comparators in all studies) in participants younger than 75, and 72.4%, 79.1%, and 72.3%, respectively, in those aged 75 and older, with a similar safety profile in both groups. The incidence of volume depletion-related AEs was 2.2%, 3.1%, and 1.4% in participants younger than 75 with canagliflozin 100 and 300 mg and non-canagliflozin, respectively, and 4.9%, 8.7%, and 2.6%, respectively, in those aged 75 and older. Conclusion Canagliflozin improved glycemic control, body weight, and BP in participants aged 75 and older. The overall incidence of AEs was high across treatment groups in participants aged 75 and older and higher than in those younger than 75. The safety profile of canagliflozin was generally similar in both age groups, with a higher incidence of AEs related to volume depletion observed with canagliflozin in participants aged 75 and older than in those younger than 75. These findings support canagliflozin, starting with the 100-mg dose, as an effective therapeutic option for older adults with T2DM. [ABSTRACT FROM AUTHOR]

Objectives To determine the prognostic value of slow gait in predicting outcomes 1 year after acute myocardial infarction ( AMI). Design Observational cohort with longitudinal follow-up. Setting Twenty-four U.S. hospitals participating in the Translational Research Investigating Underlying disparities in recovery from acute Myocardial infarction: Patients' Health status Registry. Participants Older adults (≥65) with in-home gait assessment 1 month after AMI (N = 338). Measurements Baseline characteristics and 1-year mortality or hospital readmission adjusted using Cox proportional hazards regression in older adults with slow (<0.8 m/s) versus preserved (≥0.8 m/s) gait speed. Results Slow gait was present in 181 participants (53.6%). Those with slow gait were older, more likely to be female and nonwhite, and had a higher prevalence of heart failure and diabetes mellitus. They were also more likely to die or be readmitted to the hospital within 1 year than those with preserved gait (35.4% vs 18.5%, log-rank P = .006). This association remained significant after adjusting for age, sex, and race (slow vs preserved gait hazard ratio ( HR) = 1.76, 95% confidence interval ( CI)=1.08-2.87, P = .02) but was no longer significant after adding clinical factors ( HR = 1.23, 95% CI=0.74-2.04, P = .43). Conclusion Slow gait, a marker of frailty, is common 1 month after AMI in older adults and is associated with nearly twice the risk of dying or hospital readmission at 1 year. Understanding its prognostic importance independent of comorbidities and whether routine testing of gait speed can improve care requires further investigation. [ABSTRACT FROM AUTHOR]

Objectives To explore the association between the number of physicians providing care and anticholinergic drug burden in older persons newly initiated on cholinesterase inhibitor therapy for the management of dementia. Design Population-based cross-sectional study. Setting Community and long-term care, Ontario, Canada. Participants Community-dwelling (n = 79,067, mean age 81.0, 60.8% female) and long-term care residing (n = 12,113, mean age 84.3, 67.2% female) older adults (≥66) newly dispensed cholinesterase inhibitor drug therapy. Measurements Anticholinergic drug burden in the prior year measured using the Anticholinergic Risk Scale. Results Community-dwelling participants had seen an average of eight different physicians in the prior year. The odds of high anticholinergic drug burden (Anticholinergic Risk Scale score ≥ 2) were 24% higher for every five additional physicians providing care to individuals in the prior year (adjusted odds ratio = 1.24, 95% confidence interval = 1.21-1.26). Female sex, low-income status, previous hospitalization, and higher comorbidity score were also associated with high anticholinergic drug burden. Long-term care facility residents had seen an average of 10 different physicians in the prior year. After a sensitivity analysis, the association between high anticholinergic burden and number of physicians was no longer statistically significant in the long-term care group. Conclusion In older adults newly started on cholinesterase inhibitor drug therapy, greater number of physicians providing care was associated with higher anticholinergic drug burden scores. Given the potential risks of anticholinergic drug use, improved communication among physicians and an anticholinergic medication review before prescribing a new drug are important strategies to improve prescribing quality. [ABSTRACT FROM AUTHOR]

Falls in older adults are a global public health crisis, but mounting evidence from randomized controlled trials shows that falls can be reduced through exercise. Public health authorities and healthcare professionals endorse the use of evidence-based, exercise-focused fall interventions, but there are major obstacles to translating and disseminating research findings into healthcare practice, including lack of evidence of the transferability of efficacy trial results to clinical and community settings, insufficient local expertise to roll out community exercise programs, and inadequate infrastructure to integrate evidence-based programs into clinical and community practice. The practical solutions highlighted in this article can be used to address these evidence-to-practice challenges. Falls and their associated healthcare costs can be reduced by better integrating research on exercise intervention into clinical practice and community programs. [ABSTRACT FROM AUTHOR]

The purpose of the study was to assess the effect of different treatment regimens for chronic hepatitis C on patient-reported outcomes ( PROs) of individuals aged 65 and older with chronic hepatitis C. PRO data from eight multinational multicenter Phase 2 and 3 clinical trials were included. Of 3,120 participants in these clinical trials, 229 were aged 65 and older (67.8 ± 3.2, 57% male, 75% treatment-naïve, 22% cirrhotic), and 90 of those received ledipasvir plus sofosbuvir ( LDV + SOF), 119 received SOF plus ribavirin ( SOF + RBV), and 20 received pegylated IFN, SOF, and RBV ( IFN + SOF + RBV). Participants aged 65 and older had slightly more pretreatment PRO impairment in their physical functioning than younger individuals (−3.1% on a normalized 0-100% PRO scale, P < .001). Despite this, these participants experienced significant PRO improvement during treatment with IFN-free RBV-free regimens (up to +8.0%, P < .001), similar to improvements in younger participants. In contrast, participants aged 65 and older experienced substantial decline in PROs while receiving IFN- or RBV-containing regimens (up to −18.9% in IFN + SOF + RBV, −10.4% in IFN-free SOF+ RBV, P < .001), and some were greater than in the younger group. Nevertheless, after achieving sustained viral clearance at Posttreatment Week 12, PROs in participants aged 65 and older improved regardless of the regimen (up to +10.4%, P < .001). In multivariate analysis of the cohort aged 65 and older, the use of IFN and RBV was consistently associated with PRO impairment during treatment. The use of an IFN- and RBV-free anti- HCV regimen in older adults with hepatitis C results in significant improvement of PROs. [ABSTRACT FROM AUTHOR]

Objectives To determine what effect driving cessation may have on subsequent health and well-being in older adults. Design Systematic review of the evidence in the research literature on the consequences of driving cessation in older adults. Setting Community. Participants Drivers aged 55 and older. Measurements Studies pertinent to the health consequences of driving cessation were identified through a comprehensive search of bibliographic databases. Studies that presented quantitative data for drivers aged 55 and older; used a cross-sectional, cohort, or case-control design; and had a comparison group of current drivers were included in the review. Results Sixteen studies met the inclusion criteria. Driving cessation was reported to be associated with declines in general health and physical, social, and cognitive function and with greater risks of admission to long-term care facilities and mortality. A meta-analysis based on pooled data from five studies examining the association between driving cessation and depression revealed that driving cessation almost doubled the risk of depressive symptoms in older adults (summary odds ratio = 1.91, 95% confidence interval = 1.61-2.27). Conclusion Driving cessation in older adults appears to contribute to a variety of health problems, particularly depression. These adverse health consequences should be considered in making the decision to cease driving. Intervention programs ensuring mobility and social functions may be needed to mitigate the potential adverse effects of driving cessation on health and well-being in older adults. [ABSTRACT FROM AUTHOR]

Chinese people have practiced traditional Chinese medicine ( TCM) for thousands of years, but there is a paucity of research regarding TCM use in Chinese older adult immigrants in the United States. This study aims to provide an overall estimate of TCM use for Chinese older adults in the United States and to examine associations between sociodemographic characteristics, health measures, and TCM use. Data were collected through the Population Study of Chinese Elderly in Chicago, a community-based participant research study that surveyed 3,158 Chinese older adults aged 60 and older. TCM use was measured using an eight-item scale that examined eight kinds of TCM. Seventy-six percent of participants reported any use of TCM within the past year. After adjusting for potential confounding factors, health status was associated with greater use of acupuncture (odds ratio ( OR) = 1.33, 95% confidence interval ( CI) = 1.06-1.68) and massage therapy ( OR = 1.53, 95% CI = 1.21-1.93), and quality of life was associated with less use of prescribed herbal products ( OR 0.69, 95% CI = 0.55-0.87), tai chi ( OR = 0.62, 95% CI = 0.50-0.78), and other traditional medicine ( OR = 0.47, 95% CI = 0.40-0.56). These findings call for further investigation of TCM use by Chinese older adults, especially those with poor health and those with better quality of life. In the clinical setting, physicians should have awareness of TCM when treating Chinese older adults and look toward possible integration with Western medicine for more culturally appropriate, patient-centered care. [ABSTRACT FROM AUTHOR]

Objectives To determine whether receiving more recommended diabetes mellitus ( DM) care processes (tests and screenings) would translate into better 9-year survival for middle-aged and older adults. Design Longitudinal mortality analysis using the Health and Retirement Study Diabetes Mailout Survey. Setting Health and Retirement Study ( HRS). Participants Individuals aged 51 and older (n = 1,879; mean age 68.8 ± 8.7, 26.5% aged ≥75) with self-reported DM who completed the Diabetes Mailout Survey and the core 2002 HRS survey. Measurements A composite measure of five self-reported diabetes mellitus care process measures were dichotomized as greater (3-5 processes) versus fewer (0-2 processes) care processes provided. Cox proportional hazards models were used to test relationships between reported measures and mortality, controlling for sociodemographic characteristics, function, comorbidities, geriatric conditions, and insulin use. Results Prevalence of self-reported care processes was 80.1% for glycosylated hemoglobin test, 75.9% for urine test, 67.5% for eye examination, 67.7% for aspirin counseling, and 48.2% for diabetes education. In 9 years, 32.1% respondents died. Greater care correlated with 24% lower risk of dying (adjusted hazard ratio = 0.76, 95% confidence interval = 0.64-0.91) at 9-year follow up. When respondents were age-stratified (≥75 vs <75) longer survival was statistically significant only in the older age group. Conclusion Although it is not possible to account for differences in adherence to care that may also affect survival, this study demonstrates that monitoring of and counseling about types of DM care processes are associated with long-term survival benefit even in individuals aged 75 and older with DM. [ABSTRACT FROM AUTHOR]

The 2015 American Geriatrics Society (AGS) Beers Criteria are presented. Like the 2012 AGS Beers Criteria, they include lists of potentially inappropriate medications to be avoided in older adults. New to the criteria are lists of select drugs that should be avoided or have their dose adjusted based on the individual's kidney function and select drug-drug interactions documented to be associated with harms in older adults. The specific aim was to have a 13-member interdisciplinary panel of experts in geriatric care and pharmacotherapy update the 2012 AGS Beers Criteria using a modified Delphi method to systematically review and grade the evidence and reach a consensus on each existing and new criterion. The process followed an evidence-based approach using Institute of Medicine standards. The 2015 AGS Beers Criteria are applicable to all older adults with the exclusion of those in palliative and hospice care. Careful application of the criteria by health professionals, consumers, payors, and health systems should lead to closer monitoring of drug use in older adults. [ABSTRACT FROM AUTHOR]

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

Objectives To determine the efficacy of adapted tango for improving mobility, motor-cognitive function, and gait; to determine whether former dance experience was associated with improvements; and to evaluate participant satisfaction, changes in depression, and quality of life. Design Quasi-experimental, two-group, repeated-measures preintervention, postintervention, and 3-month postintervention study. Setting Diverse senior independent living communities in an urban metropolitan area. Participants Individuals aged 59 to 95 (73% aged 80 and older; 31% nonwhite, 72% female) (N = 74). Intervention Participants were assigned to 20 sessions of 90-minute tango (n = 62) or health education (n = 12) classes over 12 weeks. Measurements Mobility, motor-cognitive function, gait, cognition, and psychosocial function were evaluated before, immediately after, and 3 months after the intervention. Two (groups) by two (before and after) repeated-measures analyses of variance with post hoc comparisons were used to evaluate differences in primary analyses. Secondary analyses from immediately after to 3 months after were used to examine the data for retention of any gains. Results Forty-four tango and 10 education participants completed 20 sessions. Significant group by time interactions revealed that tango improved mobility ( P = .006), backward and fast gait speeds ( P < .001), and motor-cognitive function ( P = .03). Education improved depression ( P = .001). No relationship was noted between previous dance experience and improvements. Gains were maintained 3 months after the intervention. Conclusion Adapted tango may improve mobility, gait and motor-cognitive function more than health education classes in older adults. Further research is necessary to confirm these findings. [ABSTRACT FROM AUTHOR]

Objectives To determine whether salivary flow decreases as a function of aging. Design Meta-analysis. Setting Literature review. Participants Individuals aged 18 and older reported to be free of major systemic disease. Measurements Relevant studies were identified through a literature search of several databases, from their inception to June 2013. Studies were included if saliva had been collected on at least one occasion in subjects aged 18 and older and if the data were presented in a manner that enabled comparisons of younger and older participants. Differences in salivary flow rates between age groups were calculated for each salivary source and condition and reported as standardized mean differences ( SMDs), standard errors ( SEs) and 95% confidence intervals ( CIs). The results were pooled using a random effects model. A separate analysis examining medication use was also conducted. Results Forty-seven studies were included. Whole ( SMD = 0.551, SE = 0.056, 95% CI = 0.423-0.678, P < .001) and submandibular and sublingual ( SMSL) ( SMD = 0.582, SE = 0.123, 95% CI = 0.341-0.823, P < .001) salivary flow rates were reduced significantly in older participants and in unstimulated and stimulated conditions. In contrast, parotid and minor gland salivary flow rates were not significantly reduced with increasing age. Additionally, unstimulated and stimulated SMSL, and unstimulated whole salivary flow rates were significantly lower in older adults, regardless of medication usage. Conclusion The aging process is associated with reduced salivary flow in a salivary-gland-specific manner; this reduction in salivary flow cannot be explained on the basis of medications. These findings have important clinical implications for maintaining optimal oral health in older adults. [ABSTRACT FROM AUTHOR]

Older Hispanic Americans are a rapidly growing minority group who are disproportionately affected by diabetes mellitus and obesity. Given the importance of physical activity, particularly leisure-time activity, in the management of diabetes mellitus and obesity, the current study examined ethnic and sex differences in walking for transportation, leisure-time walking, moderate activity (not including walking), and vigorous activity between Hispanic and non-Hispanic white ( NHW) older adults (age 55 and older) using the 2009 California Health Interview Survey, a population-based survey representative of California's noninstitutionalized population. The total sample consisted of 21,702 participants (20,148 NHW (7,968 men, 12,180 women) and 1,554 Hispanic (609 men, 945 women)). Multivariable logistic and linear regression analyses were adjusted for sociodemographic characteristics. The findings revealed that Hispanic men and women were significantly less likely to engage in self-reported leisure-time walking and vigorous activity than NHW men (adjusted odds ratio ( aOR) = 0.71, 95% confidence interval ( CI) = 0.51-0.99) and women ( aOR = 0.60, 95% CI = 0.42-0.87). Regardless of ethnic group, men were more likely than women to engage in self-reported walking for transportation ( aOR = 0.71, 95% CI = 0.58-0.87), moderate activity ( aOR = 0.68, 95% CI = 0.57-0.81), and vigorous activity ( aOR = 0.58, 95% CI = 0.50-0.68). All types of self-reported physical activity were associated with lower body mass index ( BMI; P < .001), although significant interactions between sex and leisure time walking ( P < .001), moderate activity ( P < .001), and vigorous activity ( P < .001) indicated that women who engaged in these activities reported the lowest BMIs. The findings highlight the importance of emphasizing walking in efforts to increase moderate and vigorous activity, particularly for older women. [ABSTRACT FROM AUTHOR]

Objectives To examine the association between consumption of dairy products and risk of frailty in community-dwelling older adults. Design Prospective cohort study. Setting General population from the older cohort of the Study on Nutrition and Cardiovascular Risk in Spain. Participants Community-dwelling adults aged 60 and older free of frailty at baseline (N = 1,871). Measurements From 2008 to 2010, food consumption was assessed using a validated diet history. Participants were examined again in 2012 to assess incident frailty, defined as at least three of the five Fried criteria (exhaustion, weakness, low physical activity, slow walking speed, unintentional weight loss). Adjusted odds ratios ( OR) for the main confounders were obtained using logistic regression. Results During follow-up, 134 new cases of frailty were identified. Participants consuming seven or more servings per week of low-fat milk and yogurt had lower incidence of frailty ( OR = 0.52; 95% confidence interval ( CI) = 0.29-0.90; P for trend = .03) than those consuming less than one serving per week. Specifically, consumers of seven or more servings per week of low-fat milk and yogurt had less risk of slow walking speed ( OR = 0.64, 95% CI = 0.44-0.92, P trend = .01) and of weight loss ( OR = 0.54, 95% CI = 0.33-0.87, P trend = .02). Consuming seven or more servings per week of whole milk or yogurt ( OR = 1.53, 95% CI = 0.90-2.60, P trend = .10) or of cheese ( OR = 0.91, 95% CI = 0.52-1.61; P trend = .61) was not associated with incident frailty. Conclusion Higher consumption of low-fat milk and yogurt was associated with lower risk of frailty and, specifically, of slow walking speed and weight loss. Current recommendations to prevent frailty include protein supplementation; thus, although experimental research is needed, increasing the consumption of low-fat yogurt and milk might prevent frailty in older adults. [ABSTRACT FROM AUTHOR]

Objectives To investigate whether changes in death certificate coding and reporting practices explain part or all of the recent increase in the rate of fatal falls in adults aged 65 and older in the United States. Design Trends in coding and reporting practices of fatal falls were evaluated under mortality coding schemes for International Classification of Diseases ( ICD), Ninth Revision (1992-1998) and Tenth Revision (1999-2005). Setting United States, 1992 to 2005. Participants Individuals aged 65 and older with falls listed as the underlying cause of death ( UCD) on their death certificates. Measurements The primary outcome was annual fatal falls rates per 100,000 U.S. residents aged 65 and older. Coding practice was assessed through analysis of trends in rates of specific UCD fall ICD e-codes over time. Reporting quality was assessed by examining changes in the location on the death certificate where fall e-codes were reported, in particular, the percentage of fall e-codes recorded in the proper location on the death certificate. Results Fatal falls rates increased over both time periods: 1992 to 1998 and 1999 to 2005. A single falls e-code was responsible for the increasing trend of fatal falls overall from 1992 to 1998 (E888, other and unspecified fall) and from 1999 to 2005 (W18, other falls on the same level), whereas trends for other falls e-codes remained stable. Reporting quality improved steadily throughout the study period. Conclusion Better reporting quality, not coding practices, contributed to the increasing rate of fatal falls in older adults in the United States from 1992 to 2005. [ABSTRACT FROM AUTHOR]