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Background: Most older adults hospitalized with COVID-19 survive their acute illness. The impact of COVID-19 hospitalization on patient-centered outcomes, including physical function, cognition, and symptoms, is not well understood. To address this knowledge gap, we collected longitudinal data about these issues from a cohort of older survivors of COVID-19 hospitalization. Methods: We undertook a prospective study of community-living persons age ≥ 60 years who were hospitalized with COVID-19 from June 2020–June 2021. A baseline interview was conducted during or up to 2 weeks after hospitalization. Follow-up interviews occurred at one, three, and six months postdischarge. Participants completed comprehensive assessments of physical and cognitive function, symptoms, and psychosocial factors. An abbreviated assessment could be performed with a proxy. Additional information was collected from the electronic health record. Results: Among 341 participants, the mean age was 71.4 (SD 8.4) years, 51% were women, and 37% were of Black race or Hispanic ethnicity. Median length of hospitalization was 8 (IQR 6–12) days. All but 4% of participants required supplemental oxygen, and 20% required care in an intensive care unit or stepdown unit. At enrollment, nearly half (47%) reported at least one preexisting disability in physical function, 45% demonstrated cognitive impairment, and 67% were pre-frail or frail. Participants reported a mean of 9 of 14 (SD 3) COVID-19-related symptoms. At the six-month follow-up interview, more than a third of participants experienced a decline from their pre-hospitalization function, nearly 20% had cognitive impairment, and burdensome symptoms remained highly prevalent. Conclusions: We enrolled a diverse cohort of older adults hospitalized with COVID-19 and followed them after discharge. Functional decline was common, and there were high rates of persistent cognitive impairment and symptoms. Future analyses of these data will advance our understanding of patient-centered outcomes among older COVID-19 survivors. [ABSTRACT FROM AUTHOR]

Multimorbidity (≥2 chronic conditions) is a common and important marker of aging. To better understand racial differences in multimorbidity burden and associations with important health-related outcomes, we assessed differences in the contribution of chronic conditions to hospitalization, skilled nursing facility admission, and mortality among non-Hispanic Black and non-Hispanic White older adults in the United States. We used data from a nationally representative study, the National Health and Aging Trends Study, linked to Medicare claims from 2011–2015 (n  = 4,871 respondents). This analysis improved upon prior research by identifying the absolute contributions of chronic conditions using a longitudinal extension of the average attributable fraction for Black and White Medicare beneficiaries. We found that cardiovascular conditions were the greatest contributors to outcomes among White respondents, while the greatest contributor to outcomes for Black respondents was renal morbidity. This study provides important insights into racial differences in the contributions of chronic conditions to costly health-care utilization and mortality, and it prompts policy-makers to champion delivery reforms that will expand access to preventive and ongoing care for diverse Medicare beneficiaries. [ABSTRACT FROM AUTHOR]

A study evaluated whether the Medicare reimbursement policy changes that provide coverage for screening colonoscopies for all individuals are associated with an increase in either colonoscopy use or early stage colon cancer diagnosis in older patients. Results revealed that expansion of reimbursement to cover colon cancer screening is associated with an increased use of colonoscopy for Medicare beneficiaries and also an increased possibility of early stage diagnosis of colon cancer.

Suicide rates are highest in late life and the majority of older adults who die by suicide have seen a physician in preceding months. Randomized trial known as PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial) shows that depression is the strongest risk factor for late-life suicide and for suicide's precursor, suicidal ideation.

Predictors of change in domain-specific self-efficacy were examined in a sample of community-residing men and women aged 62 and older. Self-efficacy perceptions were assessed for eight domains of living: productivity, health, transportation, family relationships, relationships with friends, finances, safety, and living arrangements. Using pooled logistic regression models, both baseline and time-varying predictors of decline and improvement in self-efficacy were examined. The results indicated that while demographic and health factors were predictive of decline in self-efficacy for some domains of living, the most consistent predictors of decline were psychosocial characteristics. Specifically, prior levels of depression were associated with decline in the transportation, family relationships, relationships with friends, financial, safety, and living arrangements domains of living. The presence of a domain-specific hassle was associated with a decline in self-efficacy for the transportation, family relationships, finances, and living arrangements domains. In addition, lower levels of social network contact were predictive of decline in the health and safety domains, and the absence of instrumental support was also associated with decline in the productivity, health, and transportation domains of living. Improvements in self-efficacy perceptions were associated with fewer of the health and psychosocial characteristics and were primarily influenced by the availability of financial and emotional support resources.

The relationship between social network structural and support characteristics and onset of new or recurrent activities of daily living (ADL) disability was examined in a cohort of older men and women. No significant protective effects were found for network structural or support characteristics. However, greater frequency of instrumental support was associated with significantly increased risk of ADL disability among men; a similar though nonsignificant pattern was seen among women. These findings indicate that receipt of more instrumental support may not have uniformly beneficial effects on functional status. They serve to underscore the need for more comprehensive research, examining both the positive and negative effects of social interactions on health and functioning.

Background: Multimorbidity is common in adults aged 65 and older and is associated with health care utilization and mortality, but most methods ignore the interrelationship among concurrent outcome nor provide person-specific probabilities.Method: A longitudinal cohort of 5300 older Americans from the 2011-2015 rounds of the National Health and Aging Study was linked to Center for Medicare and Medicaid Services claims. Odds ratios for 15 chronic conditions adjusted for sociodemographic factors were estimated using a joint model of hospitalization, skilled nursing facility (SNF) admission, and mortality. Additionally, we estimated the person-specific probability of an outcome while currently at risk for other outcomes for different chronic disease combinations demonstrating the heterogeneity across persons with identical chronic conditions.Results: During the 4-year follow-up period, 2867 (54.1%) individuals were hospitalized, 1029 (19.4%) were admitted to a SNF, and 1237 (23.3%) died. Chronic kidney disease, dementia, heart failure, and chronic obstructive pulmonary disease had significant increased odds for all 3 outcomes. By incorporating a person-specific random intercept, there was considerable range of person-specific probabilities for individuals with hypertension, diabetes, and depression with dementia, (hospitalization: 0.14-0.61; SNF admission: 0.04-0.28) and without dementia (hospitalization: 0.07-0.44; SNF admission: 0.02-0.15). Such heterogeneity was found among individuals with heart failure, ischemic heart disease, chronic kidney disease, hypertension, hyperlipidemia, and osteoarthritis with and without Medicare.Conclusions: This approach of joint modeling of interrelated concurrent health care and mortality outcomes not only provides a cohort-level odds and probabilities but addresses the heterogeneity among otherwise similarly characterized persons identifying those with above-average probability of poor outcomes. [ABSTRACT FROM AUTHOR]

BACKGROUND: Commonly used thresholds for staging FEV1 have not been evaluated as standalone spirometric predictors of death in older persons. Specifically, the proportion of deaths attributed to a reduced FEV1, when staged by commonly used thresholds in L, percent of predicted (% pred), and Z scores, has not been previously reported. METHODS: In 4,232 white persons ≥ 65 y old, sampled from the Cardiovascular Health Study, FEV1 was stratified as stage 1 (FEV1 ≥ 2.00 L, ≥80% pred, and Z score ≥-1.64), stage 2 (FEV1 1.50--1.99 L, 50--79%pred, and Z score -2.55 to -1.63), and stage 3 (FEV1 < 1.50 L, < 50% pred, and Z score < -2.55). Notably, a Z score threshold of -1.64 defines normal-for-age lung function as the lower limit of normal (ie, 5th percentile of distribution), and accounts for differences in age, sex, height, and ethnicity. Next, adjusted odds ratios and average attributable fractions for 10-y all-cause mortality were calculated, comparing FEV1 stages 2 and 3 against stage 1, expressed in L, % pred, and Z scores. The average attributable fraction estimates the proportion of deaths attributed to a predictor by combining the prevalence of the predictor with the relative risk of death conferred by that predictor. RESULTS: FEV1 stage 2 and 3 in L, % pred, and Z scores yielded similar adjusted odds ratios of death: 1.40--1.51 for stage 2 and 2.35--2.66 for stage 3. Conversely, FEV1 stages 2 and 3 in L, % pred, and Z scores differed in prevalence: 12.8--28.6% for stage 2 and 6.4--17.5% for stage 3, and also differed in the adjusted average attributable fraction for death: 3.2--6.4% for stage 2 and 4.5--9.1% for stage 3. CONCLUSIONS: In older persons, the proportion of deaths attributed to a reduced FEV1 is best stratified by Z score staging thresholds because these yield a similar relative risk of death but a more age- and sex-appropriate prevalence of FEV1 stage. [ABSTRACT FROM AUTHOR]