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Background: Fifty percent of people living with dementia are undiagnosed. The electronic health record (EHR) Risk of Alzheimer's and Dementia Assessment Rule (eRADAR) was developed to identify older adults at risk of having undiagnosed dementia using routinely collected clinical data. Objective: To externally validate eRADAR in two real-world healthcare systems, including examining performance over time and by race/ethnicity. Design: Retrospective cohort study Participants: 129,315 members of Kaiser Permanente Washington (KPWA), an integrated health system providing insurance coverage and medical care, and 13,444 primary care patients at University of California San Francisco Health (UCSF), an academic medical system, aged 65 years or older without prior EHR documentation of dementia diagnosis or medication. Main Measures: Performance of eRADAR scores, calculated annually from EHR data (including vital signs, diagnoses, medications, and utilization in the prior 2 years), for predicting EHR documentation of incident dementia diagnosis within 12 months. Key Results: A total of 7631 dementia diagnoses were observed at KPWA (11.1 per 1000 person-years) and 216 at UCSF (4.6 per 1000 person-years). The area under the curve was 0.84 (95% confidence interval: 0.84–0.85) at KPWA and 0.79 (0.76–0.82) at UCSF. Using the 90th percentile as the cut point for identifying high-risk patients, sensitivity was 54% (53–56%) at KPWA and 44% (38–51%) at UCSF. Performance was similar over time, including across the transition from International Classification of Diseases, version 9 (ICD-9) to ICD-10 codes, and across racial/ethnic groups (though small samples limited precision in some groups). Conclusions: eRADAR showed strong external validity for detecting undiagnosed dementia in two health systems with different patient populations and differential availability of external healthcare data for risk calculations. In this study, eRADAR demonstrated generalizability from a research sample to real-world clinical populations, transportability across health systems, robustness to temporal changes in healthcare, and similar performance across larger racial/ethnic groups. [ABSTRACT FROM AUTHOR]

Background: Guidelines recommend breast and colorectal cancer screening for older adults with a life expectancy >10 years. Most mortality indexes require clinician data entry, presenting a barrier for routine use in care. Electronic health records (EHR) are a rich clinical data source that could be used to create individualized life expectancy predictions to identify patients for cancer screening without data entry. Objective: To develop and internally validate a life expectancy calculator from structured EHR data. Design: Retrospective cohort study using national Veteran's Affairs (VA) EHR databases. Patients: Veterans aged 50+ with a primary care visit during 2005. Main Measures: We assessed demographics, diseases, medications, laboratory results, healthcare utilization, and vital signs 1 year prior to the index visit. Mortality follow-up was complete through 2017. Using the development cohort (80% sample), we used LASSO Cox regression to select ~100 predictors from 913 EHR data elements. In the validation cohort (remaining 20% sample), we calculated the integrated area under the curve (iAUC) and evaluated calibration. Key Results: In 3,705,122 patients, the mean age was 68 years and the majority were male (97%) and white (85%); nearly half (49%) died. The life expectancy calculator included 93 predictors; age and gender most strongly contributed to discrimination; diseases also contributed significantly while vital signs were negligible. The iAUC was 0.816 (95% confidence interval, 0.815, 0.817) with good calibration. Conclusions: We developed a life expectancy calculator using VA EHR data with excellent discrimination and calibration. Automated life expectancy prediction using EHR data may improve guideline-concordant breast and colorectal cancer screening by identifying patients with a life expectancy >10 years. [ABSTRACT FROM AUTHOR]

Background: National guidelines recommend against cancer screening for older individuals with less than a 10-year life expectancy, but it is unknown if this population desires ongoing screening.Objective: To determine (1) if older individuals with < 10-year life expectancy have future intentions for cancer screening, (2) if they recall a doctor previously suggesting that screening is no longer needed, and (3) individual characteristics associated with intentions to seek screening.Design: National Social life Health and Aging Project (2015-2016), a nationally representative, cross-sectional survey.Participants: Community-dwelling adults 55-97 years old (n = 3816).Main Measures: Self-reported: (1) mammography and PSA testing within the last 2 years, (2) future intentions to be screened, and (3) discussion with a doctor that screening is no longer needed. Ten-year life expectancy was estimated using the Lee prognostic index. Multivariate logistic regression analysis examined intentions to pursue future screening, adjusting for sociodemographic and health covariates.Key Results: Among women 75-84 with < 10-year life expectancy, 59% intend on future mammography and 81% recall no conversation with a doctor that mammography may no longer be necessary. Among men 75-84 with < 10-year life expectancy, 54% intend on future PSA screening and 77% recall no discussions that PSA screening may be unnecessary. In adjusted analyses, those reporting recent cancer screening or no recollection that screening may not be necessary were more likely to want future mammography or PSA screening (p < 0.001).Conclusion: Over 75% of older individuals with limited life expectancy intend to continue cancer screening, and less than 25% recall discussing with physicians the need for these tests. In addition to public health and education efforts, these results suggest that older adults' recollection of being told by physicians that screening is not necessary may be a modifiable risk factor for reducing overscreening in older adults with limited life expectancy. [ABSTRACT FROM AUTHOR]

For nursing home (NH) residents, clinical guidelines recommend less stringent hemoglobin A1c (HbA1c) targets between 7.5 and 9.0%[1]-[3] while avoiding medications with higher hypoglycemia risks such as insulin. We defined likely overtreatment as HbA1c < 6.5 with any insulin use, and likely undertreatment as HbA1c >= 8.5 with no GLM use. Our study found that glycemic overtreatment is common among NH residents with insulin often being used in the setting of HbA1c levels that are below the recommended target levels for NH residents. [Extracted from the article]

The article focuses on a study based on the palliative care needs in oncology, cardiology, and neurology clinic patients in the U.S. It mentions that oncology, cardiology, and neurology professional societies all recommend their members complement usual disease-oriented care with symptomoriented palliative care services for patients with advanced illness. It mentions that rural patients had high rates of oncology advanced illness visits compared to non-rural patients.

The article presents a study which examined the rates of healthcare utilization among patients who developed dementia while enrolled in the Adult Changes in Thought (ACT) research between 1994 and 2014. The variables considered include patients with diagnosed and undiagnosed dementia, number of outpatient visits, emergency department visits and hospitalizations. The correlation between dementia and comorbidity is assessed.

Background: Older adults comprise an increasing proportion of the prison and homeless populations. While older age is associated with adverse post-release health events and incarceration is a risk factor for homelessness, the health status and homelessness risk of older pre-release prisoners are unknown. Moreover, most post-release services are geared towards veterans; it is unknown whether the needs of non-veterans differ from those of veterans.Objective: To assess health status and risk of homelessness of older pre-release prisoners, and to compare veterans with non-veterans.Design/participants: Cross-sectional study of 360 prisoners (≥ 55 years of age) within 2 years of release from prison using data from the 2004 Survey of Inmates in State and Federal Correctional Facilities.Main Measures: Veteran status, health status (based on self-report), and risk of homelessness (homelessness before arrest).Key Results: Mean age was 61 years; 93.8% were men and 56.5% were white. Nearly 40% were veterans, of whom 77.2% reported likely VA service eligibility. Veterans were more likely to be white and to have obtained a high school diploma or GED. Overall, 79.1% reported a medical condition and 13.6% reported a serious mental illness. There was little difference in health status between veterans and non-veterans. Although 1 in 12 prisoners reported a risk factor for homelessness, the risk factors did not differ according to veteran status.Conclusions: Older pre-release prisoners had a high burden of medical and mental illness and were at risk for post-release homelessness regardless of veteran status. Reentry programs linking pre-release older prisoners to medical and psychiatric services and to homelessness prevention programs are needed for both veterans and non-veterans. [ABSTRACT FROM AUTHOR]

The article focuses on a study conducted to analyze the risk factors for mild cognitive impairment and its association with changes in social function. The study found that women with cognitive impairment perceived less social support compared to men despite the evidence that women are better at mobilizing social support for themselves.