Search

Background: Multiple short delirium detection tools have been validated in research studies and implemented in routine care, but there has been little study of these tools in real‐world conditions. This systematic review synthesized literature reporting completion rates and/or delirium positive score rates of detection tools in large clinical populations in general hospital settings. Methods: PROSPERO (CRD42022385166). Medline, Embase, PsycINFO, CINAHL, and gray literature were searched from 1980 to December 31, 2022. Included studies or audit reports used a validated delirium detection tool performed directly with the patient as part of routine care in large clinical populations (n ≥ 1000) within a general acute hospital setting. Narrative synthesis was performed. Results: Twenty‐two research studies and four audit reports were included. Tools used alone or in combination were the Confusion Assessment Method (CAM), 4 'A's Test (4AT), Delirium Observation Screening Scale (DOSS), Brief CAM (bCAM), Nursing Delirium Screening Scale (NuDESC), and Intensive Care Delirium Screening Checklist (ICDSC). Populations and settings varied and tools were used at different stages and frequencies in the patient journey, including on admission only; inpatient, daily or more frequently; on admission and as inpatient; inpatient post‐operatively. Tool completion rates ranged from 19% to 100%. Admission positive score rates ranged from: CAM 8%–51%; 4AT 13%–20%. Inpatient positive score rates ranged from: CAM 2%–20%, DOSS 6%–42%, and NuDESC 5–13%. Postoperative positive score rates were 21% and 28% (4AT). All but two studies had moderate–high risk of bias. Conclusions: This systematic review of delirium detection tool implementation in large acute patient populations found clinically important variability in tool completion rates, and in delirium positive score rates relative to expected delirium prevalence. This study highlights a need for greater reporting and analysis of relevant healthcare systems data. This is vital to advance understanding of effective delirium detection in routine care. [ABSTRACT FROM AUTHOR]

Background: Blood pressure (BP) postural changes, both orthostatic hypotension (OHYPO) and orthostatic hypertension (OHYPER) are common in older adults. Few studies have investigated their association with cognition, particularly for OHYPER, an emerging cardiovascular risk factor. We aimed to assess the association between OHYPO, OHYPER and cognition in non‐institutionalized older subjects. Methods: The S.AGES (Sujets ÂGES, Aged Subjects) cohort followed every 6 months for 3 years non‐institutionalized subjects aged ≥65 years without dementia at inclusion, in France. OHYPO and OHYPER were respectively defined as a fall or an increase of ≥20 mmHg in systolic BP and/or ≥10 mmHg in diastolic BP after standing from a sitting position. Cognition was assessed using the Mini‐Mental State Examination (MMSE). Linear mixed models were used for the analyses. Results: Among the 3170 subjects included (mean age 78 years, 56% women), 209 (6.5%) had OHYPO and 226 (7.1%) had OHYPER at baseline. After adjustment for demographics, cardiovascular risk factors and disease, seated SBP/DBP and BP lowering treatment, mean MMSE was 0.52 point lower in participants with OHYPER compared to those with normal BP postural changes (β adjusted [95% CI] = −0.52 [−0.96; −0.09], p = 0.02) and 0.50 point lower in participants with OHYPO compared to those with normal BP postural changes (β adjusted [95% CI] = −0.50 [−0.95; −0.06], p = 0.03). Sensitivity analyses showed a dose–response relationship between OHYPO and cognition. Conclusion: Although the absolute differences in MMSE were small, both OHYPO and OHYPER were associated with lower cognition. Orthostatic BP measurements could help identify patients with risk of cognitive impairment. Further studies are needed to assess whether controlling orthostatic BP could be a promising interventional target in preserving cognition among older adults. [ABSTRACT FROM AUTHOR]

Background: Patients over 70 years old represent a substantial proportion of the COVID‐19 ICU population and their mortality rates are high. The aim of this study is to describe the outcomes of patients ≥70 years old admitted to Dutch ICUs with COVID‐19, compared to patients ≥70 years old admitted to the ICU for bacterial and other viral pneumonias, with adjustments for age, comorbidities, severity of illness, and ICU occupancy rate. Methods: Retrospective cohort study including patients ≥70 years old admitted to Dutch ICUs, comparing patients admitted with COVID‐19 from March 1st 2020 to January 1st 2022 with patients ≥70 years old admitted because of a bacterial and other viral pneumonia, both divided in a historical (i.e., January 1st 2017 to January 1st 2020) and current cohort (i.e., March 1st 2020 to January 1st 2022). Primary outcome is hospital mortality. Results: 11,525 unique patients ≥70 years old admitted to Dutch ICUs were included; 5094 with COVID‐19, 5334 with a bacterial pneumonia, and 1312 with another viral pneumonia. ICU‐mortality and in‐hospital mortality rates of the patients ≥70 years old admitted with COVID‐19 were 39.7% and 47.6% respectively. ICU‐ and hospital mortality rates of the patients who were admitted in the same or in an historical time period with a bacterial pneumonia or other viral pneumonias were considerably lower (19.5% and 28.6% for patients with a bacterial pneumonia in the historical cohort and 19.1% and 28.8% in the same period, for the patients with other viral pneumonias 20.7% and 28.9%, and 22.7% and 31.8% respectively, all p < 0.001). Differences persisted after correction for several clinical characteristics and ICU occupancy rate. Conclusions: In ICU‐patients ≥70 years old, COVID‐19 is more severe compared to bacterial or viral pneumonia. [ABSTRACT FROM AUTHOR]

Background: Interhospital care fragmentation, when a patient is readmitted to a different hospital than they were originally discharged from, occurs in 20%–25% of readmissions. Mode of transport to the hospital, specifically ambulance use, may be a risk factor for fragmented readmissions. Our study seeks to further understand the relationship between ambulance transport and fragmented readmissions in older adults, a population that is at increased risk for poor outcomes following fragmented readmissions. Methods: We analyzed inpatient claims from Medicare beneficiaries in 2018 who had a hospital admission for select Hospital Readmission Reduction Program Conditions (acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, pneumonia) as well as dehydration, syncope, urinary tract infection, or behavioral issues. We evaluated the associations between ambulance transport and a fragmented readmission using logistic regression models adjusted for demographic, clinical, and hospital characteristics. Results: The study included 1,186,600 30‐day readmissions. Of these, 46.8% (n = 555,847) required ambulance transport. In fully adjusted models, taking an ambulance to the readmission hospital increased the odds of a fragmented readmission by 38% (95% CI 1.32, 1.44). When this association was examined by readmission major diagnostic category (MDC), the strongest associations were seen for Factors Influencing Health Status and Other Contacts with Health Services (i.e., rehabilitation, aftercare) (AOR 3.66, 95% CI 3.11, 4.32), Mental Diseases and Disorders (AOR 2.69, 95% CI 2.44, 2.97), and Multiple Significant Trauma (AOR 2.61, 95% CI 1.56, 4.35). When the model was stratified by patient origin, ambulance use remained associated with fragmented readmissions across all locations. Conclusions: Ambulance use is associated with increased odds of a fragmented readmission, though the strength of the association varies by readmission diagnosis and origin. Patient‐, hospital‐, and system‐level interventions should be developed, implemented, and evaluated to address this modifiable risk factor. [ABSTRACT FROM AUTHOR]

Background: The prevalence of postural tremor increases with age and the tremor has been found to be associated with aging‐related physiological decline. However, whether postural tremor in older adults is associated with adverse outcomes such as disability is unclear. This study investigated the association between postural tremor and the risk of disability in activities of daily living (ADL) among community‐dwelling older people. Methods: Data were derived from a population‐based study of Chinese adults aged ≥55 years. Postural tremor was assessed at baseline using a two‐step method (i.e., tremor screening followed by examination of positive cases). ADL disability was determined using an 8‐item questionnaire, which covered the mobility and self‐care domains of ADL. Participants free of ADL disability at baseline were followed for up to 4 years. Results: The prospective analyses included 5868 participants. Participants with postural tremor were at greater risk of incident ADL disability, particularly disability in the mobility domain of ADL. After multivariate adjustment, postural tremor was not significantly associated with incident ADL disability (multivariate‐adjusted relative risk [RR] = 1.05, 95% confidence interval [CI] = 0.77–1.43), and was marginally associated with incident disability in the mobility domain of ADL (multivariate‐adjusted RR = 1.36, 95% CI = 0.98–1.88). The risk of mobility‐related ADL disability was significantly increased among men, but not women, with postural tremor (multivariate‐adjusted RR = 1.84, 95% CI = 1.11–3.05). Older age and an increased number of chronic comorbidities mainly explained the higher risk of ADL disability in older people with postural tremor. Conclusions: Postural tremor in older adults is associated with greater incidence of ADL disability, particularly mobility‐related ADL disability. The association is largely due to older age and a higher prevalence of chronic comorbidities in older people with postural tremor. Postural tremor is not a strong independent predictor of ADL disability in older people. [ABSTRACT FROM AUTHOR]

Older adults experience a higher prevalence of multiple chronic conditions (MCCs). Establishing the presence and pattern of MCCs in individuals or populations is important for healthcare delivery, research, and policy. This report describes four emerging approaches and discusses their potential applications for enhancing assessment, treatment, and policy for the aging population. The National Institutes of Health convened a 2‐day panel workshop of experts in 2018. Four emerging models were identified by the panel, including classification and regression tree (CART), qualifying comorbidity sets (QCS), the multimorbidity index (MMI), and the application of omics to network medicine. Future research into models of multiple chronic condition assessment may improve understanding of the epidemiology, diagnosis, and treatment of older persons. [ABSTRACT FROM AUTHOR]

Introduction: Social isolation is a major public health concern, as isolated individuals are at increased risk of poor overall health, as well as at increased risk of unhealthy behaviors. During the COVID‐19 pandemic, social distancing strategies have led to increased rates of loneliness and social isolation. There is a clear need for strategies to mitigate the effects of social isolation and loneliness on the mental and physical health of older adults. In this study, we sought to better understand how voice‐controlled intelligent personal assistants (VIPAs) could be leveraged to reduce loneliness and social isolation among home‐bound older adults. Methods: Patients and geriatric experts were recruited to use VIPA devices (Google Home) in their homes for 4 weeks and then provide feedback. No prior training was provided. Geriatric experts were recruited via email solicitation from the Northwestern Medicine Geriatrics Clinic, and patients were solicited directly from geriatric primary care physicians. The investigators used qualitative analysis to identify codes and overarching themes. Results: A total of 288 comments were received from 16 participants. Eight major themes were identified: Administrative, Companionship, Home Control, Education, Emergencies, Entertainment, Health and Well‐Being, and Reminders. Discussion: Results demonstrate that VIPAs can be useful across multiple domains and potentially play a role in providing physical, social, and cognitive stimulation to home‐bound older adults. VIPAs have a wide range of functionality, many of which could be implemented to focus on common geriatric syndromes and may ultimately be a tool to help mitigate social isolation and the consequential loneliness. [ABSTRACT FROM AUTHOR]

Background: Colonoscopy is frequently performed in older adults, yet data on current use, and clinical outcomes of and follow‐up recommendations after colonoscopy in older adults are lacking. Methods: This was an observational study using the New Hampshire Colonoscopy Registry of adults age ≥65 years undergoing colonoscopy for screening, surveillance of prior polyps, or evaluation of symptoms. The main outcomes were clinical findings of polyps and colorectal cancer and recommendations for future colonoscopy by age. Results: Between 2009 and 2019, there were 42,611 colonoscopies, of which 17,527 (41%) were screening, 19,025 (45%) surveillance, and 6059 (14%) for the evaluation of symptoms. Mean age was 71.1 years (SD 5.0), and 49.3% were male. The finding of colorectal cancer was rare (0.71%), with the highest incidence among diagnostic examinations (2.4%). The incidence of advanced polyps increased with patient age from 65–69 to ≥85 years for screening (7.1% to 13.6%; p = 0.05) and surveillance (9.4% to 12.0%; p < 0.001). Recommendations for future colonoscopy decreased with age and varied by findings at current colonoscopy. In patients without any significant findings, 85% aged 70–74 years, 61.9% aged 75–79 years, 39.1% aged 80–84 years, and 27.4% aged ≥85 years (p < 0.001) were told to continue colonoscopy. Among patients with advanced polyps, 97.2% aged 70–74 years, 89.6% aged 75–79 years, 78.4% aged 80–84 years, and 66.7% aged ≥85 years were told to continue colonoscopy (p < 0.001). Conclusions: Within this comprehensive statewide registry, clinical findings during colonoscopy varied by indication and increased with age. Overall rates of finding advanced polyps and colorectal cancer are low. Older adults are frequently recommended to continue colonoscopy despite advanced age and insignificant clinical findings on current examination. These data inform the potential benefits of ongoing colonoscopy, which must be weighed with the low but known potential immediate and long‐term harms of colonoscopy, including cost, psychological distress, and long lag time to benefit exceeding life expectancy. [ABSTRACT FROM AUTHOR]

Background: Frailty is known to affect how people admitted with traumatic injuries recover during their inpatient stay and shortly after discharge. However, few studies have examined the effect of frailty on long‐term mortality when adjusted for significant factors including age. We aimed to determine the effect of frailty on 1‐year morality in older adults admitted with traumatic injuries. Methods: We undertook an observational study at the Severn Major Trauma Network's major trauma centre based in South West England. Patients ≥65 years old admitted between November 2018 and September 2019 with traumatic injuries were included. Isolated hip fractures and inpatient injuries were excluded. A geriatrician assessed all patients for frailty using the Clinical Frailty Scale. Follow‐up occurred at 1 year. A multivariable Cox proportional baseline hazards model assessed the effect of frailty on time‐to‐mortality. The adjusted model included age, sex, multimorbidity, surgery, most injured site, injury severity, postinjury complications, and geriatrician review. Results: Five hundred and eighty‐five patients were included. Median age was 81 years old (IQR 74–88), and median injury severity score was 13 (IQR 9–25). At 1 year 147 (25.1%) patients had died. Living with frailty was associated with mortality. The risk of dying increased with frailty severity. Compared to CFS 1–3: CFS 4 aHR = 1.73 (95% CI 0.89–3.36, p = 0.11); CFS 5 aHR = 3.82 (95% CI 2.11–6.93, p < 0.001); CFS 6 aHR = 4·05 (95% CI 2.21–7.45, p < 0.001); CFS 7–8 aHR = 6.57 (95% CI 3.43–12.59, p < 0.001). Conclusion: This study is the first to demonstrate a consistent effect of frailty, at all levels of severity and independent of age, on older peoples' survival 1 year after traumatic injury. These data support performing an admission frailty assessment to aid long‐term management decisions and provide opportunity to modify frailty to improve outcomes. [ABSTRACT FROM AUTHOR]

Purpose To create a curriculum innovation for early preclinical medical students to explore personal perspectives by listening to and learning from the lived experience of community‐living older adults. Method: Tell Me Your Story (TMYS) paired first‐year medical students (MS1s) with community‐dwelling older adult partners (OAPs) residing in the independent living portion of a continuing care retirement community (CCRC) for a half‐day educational experience. MS1s conducted 1‐hour semi‐structured interviews with their OAP and then formed small groups with geriatric faculty members to explore experiences and views that were either reinforced or challenged. The authors evaluated the effectiveness of this exercise using post‐activity surveys. A mixed‐methods analysis of 7 years of data (2013–2019) was conducted. Results: TMYS had 1251 MS1 participants from 2013 to 2019. Students completed 1052 surveys for a response rate of 84%. During the semi‐structured interview with OAP, the frequency of issues discussed included relationships (94%), professionalism/art of medicine (91%), healthcare accessibility (83%), death/dying/grieving/loss (72%), nutrition (69%), ethics (64%), and cultural competence (61%). Exactly 97% (n = 1023) responded that the overall organization was "good, very good or excellent." The most prominent themes identified by student responses highlighted person‐centered care, patient perspective, life experience/personal stories, and doctor–patient relationship. Fifty‐three faculty members completed the post‐program survey. Exactly 100% (53/53) rated the quality of this exercise as an educational experience high. Conclusion: TMYS was highly valued by students and provided an important experiential learning activity in preclinical medical education. Themes related to person‐centered care emerged from the intervention. [ABSTRACT FROM AUTHOR]

Background: Social isolation and loneliness are critical to the health of older adults, but they have not been well‐described at the end of life. Objectives: To determine the prevalence and correlates of social isolation and loneliness among older adults in the last years of life. Design Nationally representative, cross‐sectional survey. Setting: Health and Retirement Study, 2006–2016 data. Participants: Adults age > 50 interviewed once in the last 4 years of life (n = 3613). Measurements We defined social isolation using a 15‐item scale measuring household contacts, social network interaction, and community engagement, and frequent loneliness using the 3‐item UCLA Loneliness Scale. We used multivariable logistic regression to determine their adjusted prevalence by time prior‐to‐death and by subgroups of interest. Results: Approximately 19% experienced social isolation, 18% loneliness, and 5% both in the last 4 years of life (correlation = 0.11). The adjusted prevalence of social isolation was higher for individuals nearer to death (4 years: 18% vs 0–3 months: 27%, p = 0.05) and there was no significant change in loneliness (4 years: 19% vs 0–3 months: 23%, p = 0.13). Risk factors for both isolation and loneliness included (p < 0.01): low net‐worth (Isolation: 34% vs 14%; Loneliness: 29% vs 13%), hearing impairment (Isolation: 26% vs 20%; Loneliness: 26% vs 17%), and difficulty preparing meals (Isolation: 27% vs 19%; Loneliness: 29% vs 15%). Factors associated with loneliness, but not social isolation, included being female, pain, incontinence, and cognitive impairment. Conclusions: Social isolation and loneliness are common at the end of life, affecting 1 in 4 older adults, but few experience both. Rates were higher for older adults who were poor and experienced functional or sensory impairments. Results can inform clinical efforts to identify and address end‐of‐life psychosocial suffering and health policies which prioritize social needs at the end of life. See related editorial by Meier et al. [ABSTRACT FROM AUTHOR]

Objective: To assess the association between SARS‐CoV‐2 infection and decreased hand grip strength (HGS). Design Longitudinal population‐based study. Setting: Community‐dwelling older adults (aged ≥60 years) living in a rural Ecuadorian village struck by the SARS‐CoV‐2 pandemic. Participants: Of 282 enrolled individuals, 254 (90%) finished the study. Measurements: HGS was measured 3 months before (January 2020) and 9 months after the introduction of the virus into the population (January 2021). SARS‐CoV‐2 antibody testing was performed in two rounds: in May–June (early) and September–November (late), 2020. An independent association between SARS‐CoV‐2 infection and HGS decline was assessed by fitting linear mixed models for longitudinal data. Changes in HGS scores in SARS‐CoV‐2 seropositive subjects, according to the time elapsed since seroconversion, were compared with those who remained seronegative. Results: Overall, 149 (59%) individuals became seropositive for SARS‐CoV‐2. The mean HGS (in kg) was 25.3 ± 8.3 at baseline and 23.7 ± 8.1 at follow‐up (p = 0.028), with 140 individuals having >5% HGS decline between both measurements. The follow‐up HGS measurement decreased by 1.72 kg in seropositive individuals, and by 0.57 kg in their seronegative counterparts (p < 0.001). SARS‐CoV‐2 seropositive individuals were 2.27 times more likely (95% CI: 1.33–3.87) to have a lower HGS measurement at the time of follow‐up than those who remained seronegative. When compared with seronegative subjects, seropositive patients with early seroconversion were 3.41 times (95% CI: 1.73–6.74) more likely to have >5% HGS decline at the time of the follow‐up than those with later, i.e., more recent, infections. Conclusions: This study shows an independent deleterious impact of SARS‐CoV‐2 on HGS that is more marked among individuals with infections that occurred more than 8 months before follow‐up HGS. Results suggest the possibility of chronic damage to skeletal muscles by SARS‐CoV‐2. [ABSTRACT FROM AUTHOR]

Background/Objectives: Transitional care management (TCM) visits delivered following hospitalization have been associated with reductions in mortality, readmissions, and total costs; however, uptake remains low. We sought to describe trends in TCM visit delivery during the COVID‐19 pandemic. Design Cross‐sectional study of ambulatory electronic health records from December 30, 2019 and January 3, 2021. Setting: United States. Participants: Forty four thousand six hundred and eighty‐one patients receiving transitional care management services. Measurements Weekly rates of in‐person and telehealth TCM visits before COVID‐19 was declared a national emergency (December 30, 2019 to March 15, 2020), during the initial pandemic period (March 16, 2020 to April 12, 2020) and later period (April 12, 2020 to January 3, 2021). Characteristics of patients receiving in‐person and telehealth TCM visits were compared. Results: A total of 44,681 TCM visits occurred during the study period with the majority of patients receiving TCM visits age 65 years and older (68.0%) and female (55.0%) Prior to the COVID‐19 pandemic, nearly all TCM visits were conducted in‐person. In the initial pandemic, there was an immediate decline in overall TCM visits and a rise in telehealth TCM visits, accounting for 15.4% of TCM visits during this period. In the later pandemic, the average weekly number of TCM visits was 841 and 14.0% were telehealth. During the initial and later pandemic periods, 73.3% and 33.6% of COVID‐19‐related TCM visits were conducted by telehealth, respectively. Across periods, patterns of telehealth use for TCM visits were similar for younger and older adults. Conclusion: The study findings highlight a novel and sustained shift to providing TCM services via telehealth during the COVID‐19 pandemic, which may reduce barriers to accessing a high‐value service for older adults during a vulnerable transition period. Further investigations comparing outcomes of in‐person and telehealth TCM visits are needed to inform innovation in ambulatory post‐discharge care. [ABSTRACT FROM AUTHOR]

The authors discuss the role of the American Geriatric Society (AGS) in expanding clinical drug trial participants to include older people. They mention the lack of members affiliated with a geriatric entity on the U.S. Food and Drug Administration voting panel, what the AGS has done in dealing with drugs and older people, and present suggestions on improving the process.

Background/objectives: Advance care planning (ACP) rates are low in diverse, vulnerable older adults, yet little is known about the unique barriers they face and how these barriers impact ACP documentation rates. Design: Validated questionnaires listing patient, family/friend, and clinician/system‐level ACP barriers and an open‐ended question on ACP barriers. Setting: Two San Francisco public/Department of Veterans Affairs hospitals. Participants: One thousand two hundred and forty‐one English and Spanish‐speaking patients, aged 55 and older, with two or more chronic conditions. Measurements: The open‐ended question on ACP barriers was analyzed using content analysis. We conducted chart review for prior ACP documentation. We used chi‐square/Wilcoxon rank‐sum tests and logistic regression to assess associations between ACP barriers and demographic characteristics/ACP documentation. Results: Participant mean age was 65 ± 7.4 years; they were 74% from racial/ethnic minority groups, 36% Spanish‐speaking, and 36% with limited health literacy. A total of 26 barriers were identified (15 patient, 4 family/friend, 7 clinician/system‐level), and 91% reported at least one ACP barrier (mean: 5.6 ± 4.0). The most common barriers were: (patient‐level) discomfort thinking about ACP (60%), wanting to leave health decisions to "God" (44%); (family/friend‐level) not wanting to burden friends/family (33%), assuming friends/family already knew their preferences (31%); (clinician/system‐level) assuming doctors already knew their preferences (41%), and mistrust (37%). Compared with those with no barriers, participants with at least one reported barrier were more likely to be from a racial/ethnic minority group (76% vs 53%), Spanish‐speaking (39% vs 6%), with fair‐to‐poor health (48% vs 34%), and limited health literacy (39% vs 9%) (p < 0.001 for all). Participants who reported barriers were less likely to have ACP documentation (adjusted odds ratio = 0.64, 95% confidence interval [0.42, 0.98]). Conclusion: English‐ and Spanish‐speaking older adults reported 26 unique barriers to ACP, with higher barriers among vulnerable populations, and barriers were associated with lower ACP documentation. Barriers must be considered when developing customized ACP interventions for diverse older adults. [ABSTRACT FROM AUTHOR]

Information about the organization the American Geriatrics Society (AGS) and the publication the "Journal of the American Geriatrics Society is presented, in addition to a table of contents for the July 2021 edition of the journal.

Objective: The outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in octogenarians and nonagenarians have received limited study. Methods: We compared in‐hospital outcomes of CTO PCI between patients ≥80 vs. <80‐years‐old in 6233 CTO PCIs performed between 2012 and 2020 at 33 U.S. and international centers. Results: There were 415 octogenarians and nonagenarians in our study (7% of the total population). Compared with younger patients, octo‐ and nonagenarians were less likely to be men (73% vs. 83.2%, p < 0.0001) and more likely to have atrial fibrillation (27% vs. 12%, p < 0.0001) and prior coronary artery bypass graft surgery (CABG) (43% vs. 29%, p < 0.0001). They were more likely to have CTOs with moderate/severe calcification (71% vs. 46%, p < 0.0001), but had similar mean J‐CTO scores (2.5 ± 1.3 vs. 2.4 ± 1.3, p = 0.08). They had lower technical and procedural success (82.2% vs. 86.3%, p = 0.0201; 80.3% vs. 84.8%, p = 0.016, respectively) and higher incidence of in‐hospital major adverse cardiovascular events (3.4% vs. 1.8%, p = 0.021). On multivariable analysis PCI in octo‐ and nonagenarians was not independently associated with technical and procedural success or with in‐hospital MACE. Conclusion: CTO PCI is feasible in octo‐ and nonagenarians, although success rates are lower, and the risk of complications is higher compared with younger patients, likely related to more comorbidities and higher coronary lesion complexity. [ABSTRACT FROM AUTHOR]

Objective: The impact of cognitive function and decline on political ideology is unknown. We studied the relationship between cognition and both political orientation and political policy choices in a population of older persons. Design: Longitudinal investigation. Setting: A retirement community and its surroundings in Southern California. Participants: 151 members of a longitudinal investigation of aging and dementia in the oldest‐old (the 90+ Study), mean age 95 years. Measurements: Participants self‐reported their political ideology (7‐point scale from extremely liberal to extremely conservative) and policy preferences for federal spending on public schooling, aid to the poor, and protecting the environment, as well as on preferences on immigration rates, death penalty, and university admission. The same political survey was mailed to participants twice: at time one and 6‐months later. Cognitive function based on neurological examination and cognitive testing was classified as normal (55%), cognitive impairment/not dementia (CIND) (33%), or dementia (12%). We calculated rank correlations between ideology and policy choices, stratified by cognitive status, and agreement between Surveys 1 and 2. RESULTS: Political ideology/orientation was highly consistent over a six‐month period (84% agreement) among the 122 who returned the second survey, with no significant relationship to cognitive status. Among cognitively impaired (CIND and dementia), however, there was significant loss of consistency between an individual's political orientation and their policy choices. Level of political engagement was high for participants, with more than 90% voting in the 2016 presidential election. Conclusion: In this population of older persons, political identification on the liberal‐conservative spectrum was resilient despite cognitive decline, but its meaning and function were changed. For the cognitively impaired it remained a self‐defining label, but no longer operated as a higher order framework for orienting specific policy preferences. There appeared to be loss of coherence between the political orientation and political policy choices of cognitively impaired individuals. Given the high level of political engagement of these individuals, these results have substantial public policy implications. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: Frequent geriatric users of emergency departments (EDs) represent a complex and heterogeneous population. Identifying their specific subgroups would allow the development of interventions better customized to their needs and characteristics. Thus, this study aimed to develop profiles of frequent geriatric ED users using the individual characteristics of patients. DESIGN: This was a retrospective cohort study. SETTING: Databases from the Régie de l'assurance maladie du Québec (RAMQ) were utilized. PARTICIPANTSThis study included individuals aged 65 years or older living in the community in the Province of Quebec (Canada), who consulted in an ED at least four times in the year after an ED index date (an ED visit, chosen randomly, during an index period of January 1, 2012 to December 31, 2013) and who had received a diagnosis of ambulatory care‐sensitive conditions (ACSCs) in the 2 years preceding the index date. MEASUREMENTS: A latent class analysis was used to identify subgroups of frequent geriatric ED users according to their individual characteristics, including ACSC type, dementia, mental health disorders, cancer diagnosis, and comorbidity index. RESULTS: The study cohort consisted of 21,393 frequent geriatric ED users. Four groups of frequent geriatric ED users were identified: people with low comorbidity (39.0%), comprising the individuals with the lowest number of physical and mental health conditions; people with cancer (32.7%); people with pulmonaryand cardiac diseases (18.1%); and people with dementia or mental health disorders (10.2%), composed of individuals with the highest proportion of common and severe mental health disease, as well as dementia. This group accounts for the highest use of overall healthcare services. CONCLUSION: These profiles will be useful in developing customized interventions addressing the needs of each subgroup of frequent geriatric ED users. More research is needed to bridge the remaining gaps, especially regarding the healthiest frequent geriatric users of EDs. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: Frail participants are often under‐represented in randomized trials, raising questions about outcomes of interventions in real‐world settings. Frailty is strongly associated with vulnerability to illness and adverse health outcomes. We studied the impact of frailty on recombinant zoster vaccine (RZV) clinical outcomes. DESIGN/SETTING: Data from two previously conducted phase III randomized trials of RZV were pooled. These two parent trials were conducted concurrently at the same study sites using the same methods. PARTICIPANTS/INTERVENTION: In the two parent studies, participants aged ≥50 years (ZOE‐50 study) and ≥70 years (ZOE‐70 study), respectively, were randomized 1:1 to receive two doses of RZV or placebo. MEASUREMENTS: In the current ZOE‐Frailty study (NCT03563183), a frailty index was created using previously validated methods. Clinical outcomes assessed by frailty status included vaccine efficacy, immunogenicity, reactogenicity, and safety. RESULTS: Of 29,305 participants from the pooled ZOE‐50 and ZOE‐70 total vaccinated cohort, 92% were included in this study. Mean age was 68.8 years; 58.1% were women; 45.6% were pre‐frail and 11.3% frail. The percentage of frail participants increased with age from 5.7% aged 50–59 years to 22.7% aged ≥80 years. RZV vaccine efficacy against herpes zoster was >90% for all frailty subgroups (non‐frail: 95.8% (95% confidence interval = 91.6–98.2), pre‐frail: 90.4% (84.4–94.4), frail: 90.2% (75.4–97.0)). The RZV group demonstrated robust anti‐gE antibody and gE‐specific CD42+ responses, with mean concentrations remaining above pre‐vaccination levels at least 3 years post‐dose two, in all frailty subgroups. In the RZV group, the percentage of participants reporting solicited adverse events tended to decrease with increasing frailty. CONCLUSION: The relatively nonrestrictive inclusion/exclusion criteria in the parent ZOE studies resulted in a range of participants that included frail and pre‐frail older adults. RZV significantly reduced the risk of herpes zoster across all frailty subgroups. [ABSTRACT FROM AUTHOR]

The article offers information on the design and development of 4Ms Forum curricular modules. According to the article, it is a novel remote learning-capable curriculum framework aimed at introducing older adults and their caregivers to the Age-Friendly Health Systems (AFHS) movement and its focus on the 4Ms of geriatrics including Medication, Mobility, Mentation, and What Matters. Information related to the community feedback sessions is also provided.

OBJECTIVE: To identify barriers and solutions for the recruitment and retention of older (aged ≥65 years) people in clinical trials. DESIGN: Systematic literature review. METHODS: Three databases (Medline, Embase, and CENTRAL) were searched for articles reporting on barriers or solutions regarding the recruitment or retention of older people. Only original research articles were included. RESULTS: Fifty eligible articles were identified. Exclusion criteria were the most common cause of poor recruitment of older adults (mainly age and comorbidities). Patients' families or physicians often advised against participation (22% of included studies). Lack of interest (18%) and problems with transportation (18%) were also commonly cited as challenges. Fourteen trials (28%) reported that monitoring and adapting their recruitment methods helped, along with a flexible research team (26%) and provision of transportation (24%). Retention was impaired by death (12%), illness (8%), and loss of interest (6%). Methods with a positive effect on retention included financial incentives and regular information about the progress of the study (12%), a low staff turnover (12%), flexibility in appointment making (10%), and expression of appreciation by the staff through letters, gifts, and cards to the participants (10%). CONCLUSION: We identified several barriers and have listed potential solutions that may improve recruitment and lead to fewer dropouts in trials involving older populations. Implementation of our findings may help mitigate the manifold challenges that come with running a trial with older people. See related editorial by Robison et al. in this issue. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To comprehensively assess the effects of multicomponent interventions for prevention of delirium in hospitalized older people. DESIGN: Systematic review with meta‐analysis following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses methods. PARTICIPANTS: All randomized controlled trials were included. Included studies were conducted in hospitalized older people (aged ≥65 years). MEASUREMENTS: The electronic databases MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials were consulted (search date: 2015 to March 2019). Predefined criteria were used to determine inclusion of studies and to assess their methodologic quality. RESULTS: From 1,250 records identified, 10 randomized controlled trials were included (n = 2,850: 1355 medical patients, 1,243 surgical, and 160 intensive care unit). The multicomponent interventions, compared with usual care, reduced the incidence of delirium (risk ratio (RR) = 0.62; 95% confidence interval (CI) = 0.54–0.72; I2 = 0%; k = 10; n = 2,758), duration of delirium (RR = −1.18; 95% CI = −1.95 to −0.40; I2 = 45%; k = 6; n = 276), severity of delirium (standard mean difference = −0.98; 95% CI = −1.46 to −0.49; I2 = 0%; k = 3; n = 82), and pressure ulcers (RR = 0.48; 95% CI = 0.26–0.88; I2 = 0%; k = 2; n = 457). CONCLUSIONS: This meta‐analysis suggests that multicomponent interventions to prevent delirium are effective in decreasing its incidence, duration, and severity; as well as the incidence of pressure ulcers in hospitalized older people. Therefore, multicomponent interventions hold great promise to impact in the most important and prevalent conditions affecting fragile older people during hospitalization. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES The Medicare Advantage (MA) program insures a rapidly growing proportion of older adults, and may be more appealing due to lower cost sharing. However, the extent to which older adults are informed of their plan benefits and how plan knowledge has changed over time is unclear. We evaluated temporal trends and characteristics associated with not knowing MA coverage for dental, vision, and nursing home (NH) services. DESIGN Longitudinal cohort study. SETTING Medicare Current Beneficiary Survey (MCBS), 2010 to 2016. PARTICIPANTS Adults aged 65 years or older enrolled in MA plans and not in Medicaid. MEASUREMENTS Insurance knowledge was determined from separate items asking if individuals had coverage through their MA plan for dental, vision, and NH care. Responses were dichotomized between responding yes/no and not knowing. Demographic, clinical, and functional characteristics were assessed from the MCBS. RESULTS: The proportion of older adults in MA who did not know if their plan covered NH care increased from 38.0% in 2010 to 45.5% in 2016. However, proportions of not knowing dental benefits decreased from 6.4% in 2010 to 3.4% in 2016 and not knowing vision benefits decreased from 8.2% in 2010 to 5.9% in 2016. We found significant associations of race, education, income, region, and disability with knowledge of MA benefits. CONCLUSIONS: As enrollment in MA plans has grown, older adults in MA plans increasingly report that they know their plan's vision and dental benefits, although they decreasingly know about NH care. Older adults from racial and ethnic minority groups, with lower levels of education and income and who reside in certain regions or have functional disability, are less likely to know their plan benefits. This may imply decreasing preparedness for future long‐term care needs. J Am Geriatr Soc 68:2343–2347, 2020. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES Nursing home (NH) residents are a vulnerable population, susceptible to respiratory disease outbreaks such as coronavirus disease 2019 (COVID‐19). Poor outcome in COVID‐19 is at least partly attributed to hypercoagulability, resulting in a high incidence of thromboembolic complications. It is unknown whether commonly used antithrombotic therapies may protect the vulnerable NH population with COVID‐19 against mortality. This study aimed to investigate whether the use of oral antithrombotic therapy (OAT) was associated with a lower mortality in NH residents with COVID‐19. DESIGN A retrospective case series. SETTING Fourteen NH facilities from the NH organization Envida, Maastricht, the Netherlands PARTICIPANTS A total of 101 NH residents with COVID‐19 were enrolled. MEASUREMENTS The primary outcome was all‐cause mortality. The association between age, sex, comorbidity, OAT, and mortality was assessed using logistic regression analysis. RESULTS: Overall mortality was 47.5% in NH residents from 14 NH facilities. Age, comorbidity, and medication use were comparable among NH residents who survived and who died. OAT was associated with a lower mortality in NH residents with COVID‐19 in the univariable analysis (odds ratio (OR) = 0.89; 95% confidence interval (CI) = 0.41–1.95). However, additional adjustments for sex, age, and comorbidity attenuated this difference. Mortality in males was higher compared with female residents (OR = 3.96; 95% CI = 1.62–9.65). Male residents who died were younger compared with female residents (82.2 (standard deviation (SD) = 6.3) vs 89.1 (SD = 6.8) years; P <.001). CONCLUSION: NH residents in the 14 facilities we studied were severely affected by the COVID‐19 pandemic, with a mortality of 47.5%. Male NH residents with COVID‐19 had worse outcomes than females. We did not find evidence for any protection against mortality by OAT, necessitating further research into strategies to mitigate poor outcome of COVID‐19 in vulnerable NH populations. J Am Geriatr Soc 68:1647‐1652, 2020. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES For older adults with acute hip fracture, use of preoperative noninvasive cardiac testing may lead to delays in surgery, thereby contributing to worse outcomes. Our study objective was to evaluate the preoperative use of pharmacologic stress testing and transthoracic echocardiogram (TTE) in older adults hospitalized with hip fracture. DESIGN Retrospective chart review. SETTING Seven hospitals (three tertiary, four community) within a large health system. PARTICIPANTS Patients, aged 65 years and older, hospitalized with hip fracture (n = 1,079; mean age = 84.2 years; 75% female; 82% white; 36% married). MEASUREMENTS Data were extracted from electronic medical records. The study evaluated associations between patient factors as well as clinical outcomes (time to surgery [TTS], length of stay [LOS], and in‐hospital mortality) and the use of preoperative noninvasive cardiac testing (pharmacologic stress tests or TTE). Descriptive statistics were calculated. Cox regression was performed for both TTS and LOS (evaluated as time‐dependent variable); logistic regression was used for in‐hospital mortality. RESULTS: Although 34.3% (n = 370) had a preoperative TTE,.7% (n = 8) underwent a nuclear stress test and none had a dobutamine stress echocardiogram. Median TTS was 1.1 days (IQR [interquartile range] =.8‐1.8 days), median LOS was 5.3 days (IQR = 4.2‐7.2 days), and in‐hospital mortality was 3% (n = 32). Patients admitted to the medical service had 3.5 times greater odds of undergoing a TTE compared with those on the orthopedic service (P <.001). Community hospitals had almost three times greater odds of preoperative TTE than tertiary centers (P <.001). In multivariable analysis, preoperative TTE was significantly associated with increased TTS (P <.001). No difference in mortality was found between patients with and without a preoperative TTE. CONCLUSION: This study highlights the high rate of TTE in preoperative assessment of older adults with acute hip fracture. Given the association between TTE and longer TTS, further studies must clarify the role of preoperative TTE in this population. J Am Geriatr Soc 68:1690‐1697, 2020. See related Special Series On Orthogeriatrics by Wolfe et al. in this issue. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES The COVID‐19 pandemic has massively disrupted essential clinical research. Many regulatory organizations have rightfully advocated to temporarily halt enrollment and curtail all face‐to‐face interactions. Views and opinions of patients and their caregivers are seldom considered while making such decisions. The objective was to study older participantsʼ and their caregiversʼ perspectives to participate in ongoing clinical research during the COVID‐19 pandemic. DESIGN Cross‐sectional. SETTING VISN‐16/Geriatric Research, Education and Clinical Center (GRECC), Department of Veterans Affairs. PARTICIPANTS Older participants and their caregivers (N = 51) enrolled in ongoing clinical research studies. MEASUREMENTS Questions about perceptions of safety to attend research visit, the level of panic among the general public, and medical centerʼs preparedness in handling the pandemic. Other questions identified the source of pandemic information and the preference of a phone or in‐person visit. RESULTS: Mean age was 69.3 (±9.4) years, 53% were male, 39% were caregivers, and 65% were Caucasian. Majority (78%) of the participants felt safe/very safe attending the scheduled research appointment; 63% felt that the extra screening made them feel safe/very safe; 82% felt that the medical center was prepared/very prepared for the pandemic. Participants split evenly on their preference for phone versus in‐person visits. Family members and television news media were the commonly used sources of pandemic information irrespective of their education. Perceptions were influenced by gender and source of information, not by age or education. Females perceived higher level of panic compared to males (P =.02). Those relying on news media felt safer compared to those that relied on family members (P =.008). CONCLUSION: Even though informants felt that the medical center was prepared to handle the pandemic, only half the participants preferred the in‐person visit. Pandemic information was obtained from family members or the television news media. Knowing patientsʼ perspectives may help researchers be better prepared for future pandemics. J Am Geriatr Soc 68:E14–E18, 2020. [ABSTRACT FROM AUTHOR]

OBJECTIVES The Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) study is testing the effectiveness of a multifactorial intervention to prevent serious fall injuries. Our aim was to describe procedures that were implemented to optimize participant retention; report retention yields by age, sex, clinical site, and follow‐up time; provide reasons for study withdrawals; and highlight the successes and lessons learned from the STRIDE retention efforts. DESIGN Pragmatic cluster randomized trial. SETTING A total of 86 primary care practices within 10 US healthcare systems. PARTICIPANTS A total of 5451 community‐living persons, 70 years of age or older, at high risk for serious fall injuries. MEASUREMENTS Study outcomes were collected every 4 months by a central call center. Reconsent was required to extend follow‐up beyond the originally planned 36 months. RESULTS: Over a median follow‐up of 3.2 years (interquartile range = 2.8‐3.7 y), 439 (8.1%) participants died and 600 (11.0%) withdrew their consent or did not reconsent to extend follow‐up beyond 36 months, yielding rates (per 100 person‐years) of deaths and withdrawals of 2.6 and 3.6, respectively. The withdrawal rate increased with advancing age, was comparable for men and women, and did not differ much by clinical site. The most common reasons for withdrawal were illness and unable to contact for reconsent at 36 months. Completion of the follow‐up interviews was greater than 93% at each time point. Most participants completed all (71.8%) or all but one (9.2%) of the follow‐up interviews. The most common reason for not completing a follow‐up interview was unable to contact, with rates ranging from 2.8% at 40 months to 4.6% at 20 months. CONCLUSION: Completion of the thrice‐yearly follow‐up interviews in STRIDE was high, and retention of participants over 44 months exceeded the original projections. The procedures used in STRIDE, together with lessons learned, should assist other investigators who are planning or conducting large pragmatic trials of vulnerable older persons. J Am Geriatr Soc 68:1242–1249, 2020. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To describe the causes of 30‐day hospital readmissions among high‐risk older adults during implementation of a multicomponent care transitions program. DESIGN: Secondary analysis of data from the evaluation of a multicomponent care transitions program for hospitalized high‐risk older adults. SETTING: A 400‐bed community teaching hospital. PARTICIPANTS: Patients aged 75 and older admitted to non–intensive care unit beds who met specific criteria for high risk of complications and hospital readmissions. The intervention group included 202 patients, of whom 37 were readmitted to the hospital as an inpatient or on observation status within 30 days of discharge. MEASUREMENTS: Root‐cause analyses on each readmission were conducted by hospital physicians and post‐acute care (PAC) organization staff. Additional data were collected by trained project staff using the medical record and postdischarge telephone or in‐person follow‐up visits. These data were reviewed and adjudicated among the authors, and each readmission was rated with unanimous agreement as "preventable," "possibly preventable," or "not preventable." RESULTS: No significant differences were found in demographic and clinical characteristics of intervention patients readmitted versus those not readmitted. A higher proportion of the 37 patients who were readmitted did not have a postdischarge visit than the 165 patients who were not readmitted (15 [41%] vs 45 [27%]; P =.11). Among the 37 readmissions, 14 (38%) were rated as not preventable, 14 (38%) as possibly preventable, and 9 (24%) as preventable. Readmissions were rated as preventable or possibly preventable for a variety of reasons that provide insight into how care transitions programs for high‐risk older adults might be made more effective. CONCLUSION: Root‐cause analyses of hospital readmissions among high‐risk older adults by hospital physicians and PAC providers can identify strategies that might enhance the effectiveness of care transitions interventions in this complex population. J Am Geriatr Soc 68:1307–1312, 2020. [ABSTRACT FROM AUTHOR]

BACKGROUND Healthcare providers may not offer patient portal (PP) access to electronic health records (EHRs) to their patients older than 85 years, due to the false impression that they do not utilize technology. It is imperative that older adults be given equal opportunity to use technology in regard to their healthcare. OBJECTIVE To characterize the content and frequency of use of PP messaging tethered to EHRs by older adults, aged 85 years and older, and their caregivers. DESIGN, SETTING, AND PARTICIPANTS User‐initiated communications from electronic PPs (MyChart) tethered to an EHR (Epic) for patients who were 85 years and older, receiving care at outpatient internal medicine and geriatric clinics at an academic health center from July 1, 2016, to December 31, 2016, were reviewed retrospectively and analyzed with mixed methods. RESULTS: A total of 1254 user‐initiated messages, sent by 62 patients aged 85 years and older (mean age = 87.9 years; n = 576 messages; mean = 9.9 messages per person) and 82 caregivers (n = 678 messages; mean = 7.8 messages per person), were analyzed. Qualitative analysis revealed 12 main themes: clinical issues, medication/vaccine questions, medication refills, laboratory orders/results, therapy/durable medical equipment, care coordination, care transitions, scheduling, appreciation/thank you, administrative/billing, telephone requests, and death notification. Caregivers significantly initiated messages more for care transitions (P <.001). Patients significantly initiated messages more for scheduling (P =.04) and medication refills (P =.04). Patients who had heart failure, coronary artery disease, or Alzheimerʼs disease were significantly more likely to have caregivers using the PP as their proxy (30.7% vs 21.6%; P =.01). CONCLUSIONS: Adults, aged 85 years and older, and their caregivers utilize PPs tethered to EHRs. Healthcare providers should ensure inclusivity and offer access to EHRs to older adult populations, especially those aged 85 years and older. J Am Geriatr Soc 68:1078–1082, 2020 [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study assessed the distribution and correlates of objective sleep duration in the older population in Ireland. DESIGN: Cross‐sectional study using population‐derived data from wave 3 of The Irish Longitudinal Study on Ageing. SETTING: Community‐dwelling adults. PARTICIPANTS: Adults, aged 50 years and older, who wore an accelerometer for at least 4 days (N = 1533). MEASUREMENTS: Sleep was measured for at least 4 days in 1533 participants using a GENEActiv wrist‐worn accelerometer device. Sleep parameters included total sleep time (TST) and self‐reported sleep problems. TST was categorized as short and long sleep duration using US National Sleep Foundation guidelines. Linear and multinomial logistic regression models assessed sociodemographic, health, and behavioral correlates of sleep duration. RESULTS: Mean TST for the sample was 463 minutes (SD = 72.6 minutes). Of participants, 13.9% and 16.5% measured short and long sleep duration, respectively. TST decreased as sleep problems increased, as did durations recorded in summer compared to winter recordings. Advancing age was associated with longer sleep, as was antidepressant use. Retired/unemployed participants recorded longer TST and were more likely to record long sleep compared to employed participants. Fair/poor self‐rated health and separated/divorced participants were more likely to record short sleep. Those reporting moderate or high physical activity were less likely to record short or long sleep, respectively, compared to those reporting low physical activity. Participants reporting a limiting disability were less likely to record long sleep. CONCLUSION: Average TST was within recommended guidelines; however, a significant subset of older adults recorded sleep duration outside of the guidelines. Independent demographic and health correlates of suboptimal sleep were identified, many of which are modifiable. Patients and clinicians should be aware of factors potentially influencing sleep patterns. Longitudinal analyses to confirm directionality of relationships with potential risk factors are warranted. J Am Geriatr Soc 68:120–128, 2019 [ABSTRACT FROM AUTHOR]

OBJECTIVES: Recognition of delirium in the emergency department (ED) is poor. Our objectives were to assess: (1) the diagnostic accuracy of the Predicting Emergency department Delirium with an Interactive Computer Tablet (PrEDICT) "serious game" to identify older ED patients with delirium compared to clinical recognition and (2) the feasibility of the PrEDICT application compared to existing tests of attention. DESIGN: Prospective observational study. SETTING: ED of a Canadian tertiary care center. PARTICIPANTS: We included ED patients, aged 70 years and older, with a minimum 4‐hour stay. We excluded anyone with critical illness, communication barriers, and visual impairment or those unable to use a computer tablet. None had prevalent delirium by ED clinicians' routine clinical assessment. MEASUREMENTS: Participants were asked to tap targets on a tablet at four difficulty levels. Time and accuracy were automatically recorded. Other measures included the Confusion Assessment Method, the Delirium Severity Index, the Digit Vigilance Test (DVT), and the Choice Reaction Test (CRT). RESULTS: We enrolled 203 patients. Their average age was 80.6 years, 49.8% were female, and their average ED length of stay was 15.9 hours. Sixteen subjects had clinically unrecognized delirium, and 14 of them completed the PrEDICT game (87.5%). We developed a threshold score with 100% sensitivity (95% confidence interval [CI] = 76.8%‐100.0%) and 59.7% specificity (95% CI = 52.3%‐66.6%) to identify patients with clinically unrecognized delirium. The area under the curve was 0.86 (95% CI = 0.77‐0.94). Completion rates were 196/203 (96.6%) for the PrEDICT serious game compared to 128/203 (63.1%) for the CRT and 51/203 (25.1%) for the DVT. CONCLUSION: Older ED patients were able to use our serious game, including 87.5% of those with clinically unrecognized delirium. The PrEDICT application has potential to act as a sensitive screening tool to identify older ED patients with clinically unrecognized delirium. J Am Geriatr Soc 67:2370–2375, 2019 [ABSTRACT FROM AUTHOR]

OBJECTIVES: Diet quality has been associated with health outcomes and quality of life. However, the association between diet quality and mortality in older people, those aged 80 years and older, is understudied. Therefore, we conducted a prospective study to examine whether better diet quality, assessed by a validated dietary screening tool (DST), was associated with lower mortality in those aged 80 years and older. METHODS: Our study included 1990 participants (812 men and 1178 women), with a mean age of 84.1 years at baseline (ranging from 80 to 102 years old), from the Geisinger Rural Aging Study longitudinal cohort in Pennsylvania. Baseline descriptive information was obtained in 2009, and the DST was administered via mailed survey. The DST is composed of 25 food‐ and behavior‐specific questions associated with dietary intake that generate a diet quality score ranging from 0 (lowest) to 100 (highest). Death was identified using electronic medical record and the Social Security Death Index data. Hazard ratios (HRs) and 95% confidence intervals (CIs) across three diet quality categories were calculated by using Cox proportional hazards models after adjusting for potential confounders. RESULTS: Over 8 years of follow‐up (October 2009‐February 2018), 931 deaths were documented. Higher diet quality was associated with lower mortality risk (P‐trend =.04). Participants with high diet quality (defined as DST scores >75) had significantly lower risk of mortality compared with those with low diet quality (defined as DST scores <60) after adjusting for potential risk factors (adjusted HR = 0.76; 95% CI = 0.59‐0.97). CONCLUSION: Diet quality, assessed by DST, is significantly associated with risk of mortality in older adults aged 80 years and older in our prospective cohort. Our results indicate that nutrition may have an important role in healthy aging, and more studies are needed to develop appropriate dietary recommendations for older persons. J Am Geriatr Soc 67:2180–2185, 2019 [ABSTRACT FROM AUTHOR]

BACKGROUND: Dysphagia following extubation is common in intensive care unit (ICU) patients. Diagnosing postextubation dysphagia allows identification of patients who are at highest risk for aspiration and its associated adverse outcomes. Older adults are at an increased risk of postextubation dysphagia and its complications due to multiple comorbidities, a higher baseline risk of dysphagia, and increased risk of pneumonia. OBJECTIVES: We aimed to investigate the association between postextubation dysphagia and 1‐year mortality in older patients. Secondary outcomes included ICU and hospital lengths of stay, ICU readmission, and place of discharge. METHODS: We performed a retrospective cohort study from January 1 to December 31, 2013. ICU patients, aged 65 years and older, who were successfully extubated and underwent a formal swallow evaluation by a speech and language pathologist (SLP) were included. Dysphagia was graded using a seven‐point scale, and those with at least mild‐moderate dysphagia were labeled as having clinically significant dysphagia. RESULTS: Of 1075 patients who were screened, 359 were survivors, aged 65 years and older; and of these survivors, 111 had a swallow evaluation performed by an SLP after liberation from mechanical ventilation. Mean age was 73.8 years (SD = 7.0 years), and 41.4% had clinically significant dysphagia. In a multivariable regression model, there was no significant association between dysphagia and 1‐year mortality. Furthermore, there was no statistically significant difference in ICU or hospital length of stay, ICU readmission, or place of discharge of those with clinically significant dysphagia compared to those without. CONCLUSIONS: Among mechanically ventilated ICU patients, aged 65 years and older, who underwent a swallow evaluation following extubation, dysphagia was not associated with mortality, ICU and hospital lengths of stay, ICU readmission, and place of discharge. Given conflicting evidence in the literature, larger prospective studies are needed to clarify whether postextubation dysphagia is associated with worse outcomes in older patients admitted to the ICU. J Am Geriatr Soc 67:1895–1901, 2019 [ABSTRACT FROM AUTHOR]

OBJECTIVES: To compare results of prostate laser photovaporization (PVP) by age groups to evaluate morbidity and functional results. Then, to specifically analyze surgical data for patients with an indwelling bladder catheter. DESIGN: Monocentric retrospective study of a prospective maintained database of all laser PVPs performed at our university hospital between December 2012 and June 2017. SETTINGS AND PARTICIPANTS: A total of 305 patients (three groups: younger than 70, 70‐80, and older than 80 years) were operated on in our hospital center for the treatment of urinary tract disorders related to benign prostatic hyperplasia. RESULTS: A difference was found between the three age groups, with a higher rate of complications for patients older than 80 years (45%) (P =.013). Rate of patients with postoperative bladder catheters at 1 year was higher for patients older than 80 years (15%) (P =.004). Postoperative quality‐of‐life (QoL) score was worse for patients older than 80 years (P =.04). For patients with an indwelling bladder catheter undergoing surgery, morbidity was greater in patients older than 80 years, but the difference was not significant. International Prostate Symptom Score and QoL score were not significantly different between the three groups. Rate of patients with a remaining bladder catheter at 1 year was higher for patients older than 80 years (17.1% vs 7.1% for patients between 70 and 80, and 4.8% for patients under 70.) but with no statistical difference. CONCLUSION: PVP had a greater morbidity in octogenarians compared to younger subjects. Functional results were less satisfactory for patients older than 80 years compared to younger ones. For subjects operated on with an indwelling bladder catheter, no significant difference in outcome and morbidity was found between the three groups. J Am Geriatr Soc 67:1888–1894, 2019 [ABSTRACT FROM AUTHOR]

OBJECTIVES: Data regarding colonoscopy in patients older than 90 years old is scarce. Yet the number of colonoscopies done on nonagenarians is rising. We aimed to determine the yield, safety, and therapeutic benefits of colonoscopy in these patients. DESIGN: Case‐control study of older patients who underwent colonoscopy. SETTING: Gastroenterology institute at an academic medical center. PARTICIPANTS: Patients older than 90 years (n = 128) compared with patients aged 80 to 89 years (n = 218) who underwent colonoscopy. INTERVENTION: Colonoscopy. MEASUREMENTS: Indication for the procedure, completion rates, adequacy of preparation, complications, colonoscopic findings, 30‐day mortality, advanced adenoma and carcinoma detection rate, treatment, and long‐term survival of patients diagnosed with colorectal cancer. RESULTS: Mean ages were 83.3 and 92.2 years old. Nonagenarians were more likely to undergo a colonoscopy while hospitalized (56.2 vs 23.4%; P < .001) and to undergo the examination due to rectal bleeding or sigmoid volvulus (35.2 vs 25.2 and 10.9 vs 0.5%, respectively; P < .001) and less likely for surveillance or constipation (11.7 vs 25.7 and 0 vs 6.9%, respectively; P < .001). Completion rates and severe adverse events were comparable. The 30‐day mortality was 3.9% in nonagenarians and 0.4% in octogenarians (P = .02). Advanced adenomas and carcinoma were more common in nonagenarians (25.8 vs 16.5%, P = .03, and 14.8 vs 6.4%, P = .01, respectively). Increasing age, inpatient status, past polypectomy surveillance, and anemia were associated with higher rates of carcinoma. Half of the nonagenarians diagnosed with adenocarcinoma underwent surgery compared with 100% of octogenarians (P = .01). Among nonagenarians with colorectal cancer who died, mean survival was 605 (interquartile range = 11‐878) days in those who underwent surgery and 112 (48‐341) in those treated conservatively (P = .055 log‐rank test). CONCLUSION: Colonoscopy in nonagenarians has a high yield and is generally safe. Colonoscopy findings lead to surgery in more than half of these patients and was associated with a median survival of 20 months. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the correlation between sarcopenia and arterial stiffness in Caucasians, centering on the relationship between skeletal mass index (SMI) and the cardio‐ankle vascular index (CAVI) to assess the use of CAVI in predicting sarcopenia. Design Cross‐sectional Setting: United Kingdom. Participants: UK adults aged 45 years and over (N = 366, n = 177 male, n = 189 female). Measurements: Bioimpedance analysis was used to derive SMI. CAVI score was calculated using a vascular screening system. Handgrip strength was measured using a standard dynamometer. Results: Average CAVI was significantly correlated with SMI (correlation coefficient (r) = −0.285, p <.001), with higher correlation in women (r = −0.416, p <.001) than men (r = −0.214, p =.01). CAVI had the highest correlation with SMI from appendicular muscle (fat‐free mass in men, r = −0.253, p =.002; predicted muscle mass in women, r = −0.436, p <.001). There was a significant difference in average CAVI between groups, with participants who were not sarcopenic having lower CAVI (8.98) than those who were sarcopenic (9.80) (p <.001, t‐test). Linear regression was performed using SMI as the dependent variable. After adjustment for age, average CAVI was a significant predictor of SMI in women (beta = −0.332, p <.001) but not men. Conclusion: Indices of sarcopenia are independently associated with a higher CAVI, with greater correlation in women than men. The CAVI can be used to assess overall vascular compliance and may be a useful operator‐independent tool that can be used to measure sarcopenia and its cardiovascular implications in older adults. J Am Geriatr Soc 67:317–322, 2019. [ABSTRACT FROM AUTHOR]

Objectives: To describe the Texas Elder Abuse and Mistreatment Institute Forensic Assessment Center Network (TEAM‐FACN), a novel statewide elder mistreatment (EM) virtual assessment program using low‐cost videophone technology and innovative web‐based coordination to connect an Adult Protective Services (APS) agency and its clients, rural and urban, to a centralized geriatric and EM expert medical team for virtual in‐home assessments. Design: Descriptive. Setting: Community. Participants: APS clients aged 18 and older. Intervention: Virtual and in‐home assessments. Measurements: Program use and type of services provided. Results: In the first 8 months, 300 APS clients from all regions of the state were referred for assessment. Outcomes realized include a quadrupling in number of client assessments. TEAM‐FACN physicians provided an average of 2 services, which included 216 mental health assessments, with 123 conducted virtually; 42 medical assessments; 45 guardianship filings; 5 employee misconduct registry reviews; and more than 230 interdisciplinary team meetings to discuss case findings, safety plans, and medical and social interventions. Conclusion: TEAM‐FACN provides an innovative and viable way to increase access of urban and rural older and adults who are being mistreated to expert geriatric and EM protective service assessments. J Am Geriatr Soc 67:151–155, 2019. [ABSTRACT FROM AUTHOR]

Objectives: To understand patterns of marijuana use in community‐dwelling older adults in Colorado. Design: Anonymous survey. Setting: Two academic geriatric primary care clinics. Participants: English‐speaking individuals. Measurements: We assessed self‐reported characteristics and patterns of marijuana use and effect on targeted symptoms. Survey analysis focused on current users, defined as individuals who had used marijuana in the past 3 years. Results: Three hundred forty‐five individuals completed the survey (55% response rate); 113 (32%) had used marijuana in the past, of whom 55 (16%) had used since legalization. More than half of current users were aged 75 and older, and one‐quarter were aged 85 and older. Most current users were white women. Of current users, 44% used marijuana products at least weekly for common conditions including chronic pain, depression, anxiety, and insomnia, and most found marijuana helpful for these conditions. Most respondents reported obtaining marijuana recreationally (67%) without a prescription. Nine respondents reported negative side effects attributable to marijuana use. Conclusion: To our knowledge, this is the first study to characterize marijuana use of older adults in a state in which it is legal for medical and recreational use. Marijuana was used for several common geriatric conditions, and respondents reported few side effects. The small number of survey respondents, the lack of generalizability in states where marijuana sales are illegal, and participation bias were the main study limitations. Further research is needed to better understand useful or harmful effects in this population. J Am Geriatr Soc 66:2167–2171, 2018. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether visual acuity is related to balance in older adults with peripheral vascular disease (PVD) or diabetes mellitus. Design: Cross‐sectional analysis. Setting: Canada. Participants: Community‐dwelling adults aged 45 to 85 from the Canadian Longitudinal Study on Aging (N=30,097). Measurements: Visual acuity was measured wearing habitual distance correction using the Early Treatment of Diabetic Retinopathy Study chart at a 2‐m distance. Poor balance was defined as being unable to stand on 1 leg for at least 60 seconds. PVD and diabetes mellitus were assessed according to self‐report of a physician diagnosis. Multiple logistic regression was used. Results: People who reported PVD (n=1,295) were more likely to have worse balance than those who did not (odds ratio (OR)=1.50, 95% confidence interval (CI)=1.29–1.77). In those who did not report PVD (n=26,211), a 1‐line worse score on the visual acuity test was associated with 23% higher odds of being unable to stand for at least 60 seconds after adjusting for age, sex, education, province, body mass index, and diabetes mellitus (OR=1.23, 95% CI=1.20–1.26). In those who reported PVD, the odds of being unable to stand was almost double (OR=1.41, 95% CI=1.22–1.62). The interaction between visual acuity and PVD was statistically significant (P=.02). Conclusions: Visual acuity and PVD interact in their relationship with balance. People with poor vision and PVD may be at an especially high risk of mobility difficulties. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the association between daily sleep duration and risk of dementia and death in a Japanese elderly population. Design: Prospective cohort study. Setting: The Hisayama Study, Japan. Participants: Community‐dwelling Japanese individuals aged 60 and older without dementia. Measurements: Self‐reported daily sleep duration was grouped into 5 categories (<5.0, 5.0–6.9, 7.0–7.9, 8.0–9.9, ≥10.0 hours). The association between daily sleep duration and risk of dementia and death was determined using a Cox proportional hazards models. Results: During follow‐up, 294 participants developed dementia, and 282 died. Age‐ and sex‐adjusted incidence rates of dementia and all‐cause mortality were significantly greater in subjects with daily sleep duration of less than 5.0 hours and 10.0 hours and more than in those with daily sleep duration of 5.0 to 6.9 hours. These associations remained unchanged after adjustment for potential confounding factors (<5.0 hours: hazard ratio (HR)=2.64, 95% confidence interval (CI)=1.38–5.05 for dementia; HR=2.29, 95% CI=1.15–4.56 for death; ≥10.0 hours: HR=2.23, 95% CI=1.42–3.49 for dementia; HR=1.67, 95% CI=1.07–2.60 for death). Similar U‐shaped associations were observed for Alzheimer's disease and vascular dementia. With regard to the influence of hypnotic use on risk of dementia and death, subjects who used hypnotics and had any sleep duration had a risk of dementia that was 1.66 times as great and a risk of death that was 1.83 times as great as those who did not use hypnotics and had a daily sleep duration of 5.0 to 6.9 hours. Conclusion: Short and long daily sleep duration and hypnotic use are risk factors for dementia and death in Japanese elderly adults. [ABSTRACT FROM AUTHOR]

China faces an aging tsunami. By the end of 2016, the number of older adults aged 60 and older reached 230 million. This number is projected to reach 418 million by 2035 and peak at 487 million by 2053. The number of individuals aged 80 and older, the oldest adults, reached 26 million and continues to grow by 1 million a year. The socioeconomic context, characterized by an inverted pyramid family structure and the number of “empty nesters,” has greatly compromised traditional Chinese family support for older adults. This article aims to provide an overview of geriatrics development in China. It begins with a brief account of the dramatic demographic shift, major socioeconomic factors, China's healthcare system, and reform related to senior health with a historical perspective. It then describes recent advances in government policy and support and development of a geriatrics physician workforce, care models, primary care networks, and privately owned senior care facilities and support services. Although it is impossible to cover all aspects of the topic, it is hoped that this article provides readers an overall picture of Chinese geriatrics and senior healthcare development in a complex and evolving healthcare system. Geriatrics communities in the United States and around the world will undoubtedly learn and benefit from the unparalleled and continued efforts to address this unprecedented opportunity and challenge in China. [ABSTRACT FROM AUTHOR]

Objectives: To characterize the relationships between orthostatic blood pressure (BP) and heart rate recovery and frailty in an older population. Design: Cross‐sectional study. Setting: Two health centers in the Republic of Ireland. Participants: The Irish Longitudinal Study on Ageing participants aged 50 and older (N=4,334). Measurements: Continuous noninvasive BP responses during active standing were captured using digital photoplethysmography. Frailty was assessed using the Cardiovascular Health Study criteria. Linear mixed models (random intercept) with piecewise splines were used to model differences in rate of BP and heart rate recovery. Results: Ninety‐three (2.2%) participants were frail, and 1,366 (31.5%) were prefrail. Adjusting for age and sex, frailty was associated with a slower rate of systolic BP recovery 10 to 20 seconds after standing (frailty by time = –4.12, 95% confidence interval=–5.53 to –2.72) and with subsequent deficits in BP 20 to 50 seconds after standing. Similar results were seen for diastolic BP and heart rate. Further adjustment for health behaviors, morbidities, and medications reduced, but did not attenuate, these associations. Of the 5 frailty criteria, only slow gait speed was consistently related to impaired BP and heart rate responses in the full model. Conclusion: Frailty, particularly slow gait speed, was associated with slower rate of BP and heart rate recovery after active standing. Impaired BP recovery may be a marker of physiological frailty. [ABSTRACT FROM AUTHOR]

We assessed the prevalence of morbidity in long‐lived individuals according to age and age at death and explored the association between dementia and other diseases and surviving to age 90 and 100. Using health claims data from the largest German health insurer from 2004 to 2013, we followed birth cohorts from 1908 to 1913 from age 95 until death or survival to age 100 (n=2,865) and compared them with birth cohorts from 1918 to 1923 and their survival from age 85 to age 90 (n=17,013). We observed their exact date of death and main categories of morbidity based on International Classification of Diseases, Tenth Revision, diagnoses. For all diseases studied, when differentiated according to age at death, prevalence continued to increase with age. Nonagenarians and centenarians had significantly lower disease prevalence at each age. Dementia was associated with the highest risk of dying before becoming a centenarian (hazard ratio (HR)=1.63, 95% confidence interval (CI)=1.50–1.78), followed closely by the residual category other chronic heart disease (HR=1.42, 95% CI=1.30–1.56). Results were even stronger for the younger cohort. Our study shows that exceptionally long‐lived individuals are different in terms of good health. Survival at these high ages depends primarily on the absence of dementia and chronic heart disease, with acute heart disease and pneumonia playing important roles as diseases leading directly to death. [ABSTRACT FROM AUTHOR]

Objectives: To characterize the distribution of an index of healthy aging—the Chinese Healthy Aging Index (CHAI)—in Chinese adults aged 60 and older according to sociodemographic characteristics and geographic region and to examine the association between the CHAI and mortality, disability, and functional limitation over 4 years. Design: Nationally representative cohort study. Setting: China Health and Retirement Longitudinal Study. Participants: Chinese adults aged 60 and older (N=3,740). Measurements: Six CHAI components (systolic blood pressure, peak expiratory flow, Telephone Interview for Cognitive Status, estimated glomerular filtration rate, fasting glucose, C‐reactive protein) were scored 0 (healthiest), 1, and 2 (unhealthiest) according to sex‐specific tertiles or clinically relevant cut‐points and summed to construct the CHAI (range 0–12). Results: Mean CHAI score was 5.6; 5.7% had a score of 0 to 2 (healthiest), 23.0% a score of 3 or 4, 37.5% a score of 5 or 6, and 33.8% a score of 7 to 12 (unhealthiest). Participants who were younger, more educated, and married were much more likely to have an ideal CHAI profile (score 0–2). Age‐adjusted prevalence of an ideal CHAI profile ranged from 1.7% in the south to 8.1% in the north. After multivariable adjustment, persons with a CHAI score of 3 to 12 had substantially higher odds of mortality, disability, and functional limitation than those with a score of 0 to 2. The CHAI further stratified outcomes for persons with no clinically recognizable comorbidities. Conclusion: Substantial variation exists in the CHAI according to sociodemographic characteristics and geographic regions. The CHAI could identify Chinese elderly adults with low risk of adverse outcomes and provide incremental value for risk prediction beyond clinically diagnosed comorbidities. [ABSTRACT FROM AUTHOR]

Objectives: To examine the cross‐sectional and longitudinal relationships between elder abuse and neglect (EAN) and chronic pain in rural older Malaysians. Design: Two‐year prospective cohort study. Setting: Kuala Pilah, a district in Negeri Sembilan approximately 100 km from the capital city, Kuala Lumpur. Participants: Community‐dwelling older adults aged 60 and older. Using a multistage cluster sampling strategy, 1,927 respondents were recruited and assessed at baseline, of whom 1,189 were re‐assessed 2 years later. Measures: EAN was determined using the modified Conflict Tactic Scale, and chronic pain was assessed through self‐report using validated questions. Results: The prevalence of chronic pain was 20.4%. Cross‐sectional results revealed 8 variables significantly associated with chronic pain—age, education, income, comorbidities, self‐rated health, depression, gait speed, and EAN. Abused elderly adults were 1.52 times as likely to have chronic pain (odds ratio=1.52, 95% confidence interval (CI)=1.03–2.27), although longitudinal analyses showed no relationship between EAN and risk of chronic pain (risk ratio=1.14, 95% CI=0.81–1.60). This lack of causal link was consistent when comparing analysis with complete cases with that of imputed data. Conclusion: Our findings indicate no temporal relationship between EAN and chronic pain but indicated cross‐sectional associations between the two. This might indicate that, although EAN does not lead to chronic pain, individuals with greater physical limitations are more vulnerable to abuse. Our study also shows the importance of cohort design in determining causal relationships between EAN and potentially linked health outcomes. [ABSTRACT FROM AUTHOR]

Housing and the built environment are well‐established social determinants of healthy longevity, yet no guidelines or standards exist for the design and construction of health‐promoting environments, especially for older adults who are at risk for functional decline and frailty. To envision what should be included in the design of healthy communities, it may help to reverse‐engineer what each of us would like our lives to look like in old age. In this special article, a geriatrician draws on his own personal aspirations and successful models of supportive community‐based programs to suggest key factors that should be considered in the design of future living environments. These include healthy housing that can enable aging in place without social isolation and loneliness; engagement in meaningful and productive work; financial, physical, transportation, food, and housing security; and affordable high‐quality home‐ and community‐based healthcare. By conceptualizing what we would like our later years to look like, future leaders can be more deliberate in creating living environments that promote a long and productive health span. J Am Geriatr Soc 68:967–969, 2020 [ABSTRACT FROM AUTHOR]

This editorial comments on the article by Lynn Friss Feinberg [ABSTRACT FROM AUTHOR]