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BACKGROUND Frailty is a marker of dependency, disability, hospitalization, and mortality in community‐dwelling older adults. However, existing tools for measuring frailty are too cumbersome for rapid point‐of‐care assessment. The Risk Analysis Index (RAI) of frailty is validated in surgical populations, but its performance outside surgical populations is unknown. OBJECTIVE Validate the RAI in ambulatory patients. DESIGN, SETTING, AND PARTICIPANTS Observational cohort study of outpatient surgical clinics within the University of Pittsburgh Medical Center Healthcare System between July 1, 2016, and December 31, 2016. Frailty was assessed using the RAI. Current Procedural Terminology codes following RAI assessment identified patients with and without minor office‐based procedures (eg, joint injection, laryngoscopy). MAIN OUTCOMES AND MEASURES All‐cause 1‐year mortality, assessed by stratified Cox proportional hazard models. RESULTS: Of 28,059 patients, 13,861 were matched to a minor, office‐based procedure and 14,198 did not undergo any procedure. The mean (SD) age was 56.7 (17.2) years; women constituted 15,797 (56.3%) of the cohort. Median time (interquartile range 25th‐75th percentile) to measure RAI was 30 (22–47) seconds. Mortality among the frail was two to five times that of patients with normal RAI scores. For example, the hazard ratio for frail ambulatory patients without a minor procedure was 3.69 (95% confidence interval [CI] = 2.51‐5.41), corresponding to 30‐, 180‐, and 365‐day mortality rates of 2.9%, 11.2%, and 17.4%, respectively, compared to 0.3%, 2.3%, and 4.0% among patients with normal RAI scores. Discrimination of mortality (overall, and censored at 30, 180, and 365 days) was excellent, ranging from c = 0.838 (95% CI = 0.773‐0.902) for 30‐day mortality after minor procedures to c = 0.909 (95% CI = 0.855‐0.964) without a procedure. CONCLUSION: RAI is a valid, easily administered tool for point‐of‐care frailty assessment in ambulatory populations that may help clinicians and patients make better informed decisions about care choices—especially among patients considered high risk with a potentially limited life span. J Am Geriatr Soc 68:1818‐1824, 2020. [ABSTRACT FROM AUTHOR]

Objectives: To investigate whether care in a hospital with more nurses holding at least a Bachelor of Science in Nursing (BSN) degree is associated with lower mortality for individuals with Alzheimer's disease and related dementias (ADRD) undergoing surgery ADRD. Design: Cross‐sectional data from 2006–07 Medicare claims were linked with the Multi‐State Nursing Care and Patient Safety Survey of nurses in 4 states. Setting: Adult, nonfederal, acute care hospitals in California, Florida, New Jersey, and Pennsylvania (N=531). Participants: Medicare beneficiaries aged 65 and older with and without ADRD undergoing general, orthopedic, or vascular surgery (N=353,333; ADRD, n=46,163; no ADRD, n=307,170). Measurements: Thirty‐day mortality and failure to rescue (death after a complication). Results: Controlling for hospital, procedure, and individual characteristics, each 10% increase in the proportion of BSN nurses was associated with 4% lower odds of death (odds ratio (OR)=0.96, 95% confidence interval (CI)=0.93–0.98) for individuals without ADRD, but 10% lower odds of death (OR=0.90, 95% CI=0.87–0.94) for those with ADRD. Each 10% increase in the proportion of nurses holding a BSN degree or higher was associated with 5% lower odds of failure to rescue (OR=0.95, 95% CI=0.92–0.98) for individuals without ADRD but 10% lower odds of failure to rescue (OR=0.90, 95% CI=0.87–0.94) for those with ADRD. Conclusion: Individuals undergoing surgery who have coexisting ADRD are more likely to die within 30 days of admission and die after a complication than those without ADRD. Having more BSN nurses in the hospital improves the odds of good outcomes for all individuals and has a much greater effect in individuals with ADRD. [ABSTRACT FROM AUTHOR]

As the number of older adults increases worldwide, it is becoming increasingly important to find effective ways of fostering better ageing trajectories. The models used to shape this process inform research, policy and practice and impact older adults themselves. Two important ageing models are successful ageing (SA) and resilience (RES). Aligning the conceptual framework in research contexts with those of older adults’ perspectives is an integral component of driving forward the research agenda in a manner that has the greatest potential to benefit older adults. Studies conducted with laypersons indicate that psychosocial components are important components of successful ageing models; therefore, it is imperative that these non-biomedical components are incorporated. There are many similarities between SA and RES models, but an important distinguishing feature is the incorporation of adversity into conceptualizations of resilience. SA models suggest high levels of functioning as a requirement for ageing successfully, regardless of the circumstances the individual experiences; resilience models take into account the level of adversity being experienced by the individual. Individuals can demonstrate RES by having a more positive outcome than would be expected given their level of adversity. The incorporation of psychosocial constructs into SA models and the integration of SA and RES paradigms has important implications for research and for older adults themselves. Through the promotion of models of ageing that include psychosocial components and elements of adversity, greater generalizability to a broader population is possible with enhanced potential for research derived from these efforts to more positively influence individuals’ trajectories of ageing. [ABSTRACT FROM AUTHOR]

Importance: Use of locum tenens physicians has increased in the United States, but information about their quality and costs of care is lacking.Objective: To evaluate quality and costs of care among hospitalized Medicare beneficiaries treated by locum tenens vs non-locum tenens physicians.Design, Setting, and Participants: A random sample of Medicare fee-for-service beneficiaries hospitalized during 2009-2014 was used to compare quality and costs of hospital care delivered by locum tenens and non-locum tenens internal medicine physicians.Exposures: Treatment by locum tenens general internal medicine physicians.Main Outcomes and Measures: The primary outcome was 30-day mortality. Secondary outcomes included inpatient Medicare Part B spending, length of stay, and 30-day readmissions. Differences between locum tenens and non-locum tenens physicians were estimated using multivariable logistic regression models adjusted for beneficiary clinical and demographic characteristics and hospital fixed effects, which enabled comparisons of clinical outcomes between physicians practicing within the same hospital. In prespecified subgroup analyses, outcomes were reevaluated among hospitals with different levels of intensity of locum tenens physician use.Results: Of 1 818 873 Medicare admissions treated by general internists, 38 475 (2.1%) received care from a locum tenens physician; 9.3% (4123/44 520) of general internists were temporarily covered by a locum tenens physician at some point. Differences in patient characteristics, demographics, comorbidities, and reason for admission between locum tenens and non-locum tenens physicians were not clinically relevant. Treatment by locum tenens physicians, compared with treatment by non-locum tenens physicians (n = 44 520 physicians), was not associated with a significant difference in 30-day mortality (8.83% vs 8.70%; adjusted difference, 0.14%; 95% CI, -0.18% to 0.45%). Patients treated by locum tenens physicians had significantly higher Part B spending ($1836 vs $1712; adjusted difference, $124; 95% CI, $93 to $154), significantly longer mean length of stay (5.64 days vs 5.21 days; adjusted difference, 0.43 days; 95% CI, 0.34 to 0.52), and significantly lower 30-day readmissions (22.80% vs 23.83%; adjusted difference, -1.00%; 95% CI -1.57% to -0.54%).Conclusions and Relevance: Among hospitalized Medicare beneficiaries treated by a general internist, there were no significant differences in overall 30-day mortality rates among patients treated by locum tenens compared with non-locum tenens physicians. Additional research may help determine hospital-level factors associated with the quality and costs of care related to locum tenens physicians. [ABSTRACT FROM AUTHOR]

Objectives To evaluate global sensory impairment ( GSI, an integrated measure of sensory dysfunction) as a predictor of physical function, cognition, overall health, and mortality. Design Prospective study. Setting The National Social Life, Health, and Aging Project. Participants A national probability sample of 3,005 home-dwelling older U.S. adults assessed at baseline (2005-06) and 5-year follow-up (2010-11). Measurements Gait speed, activity, disability, cognition, overall health, 5-year mortality. Results At baseline, older adults with worse GSI were slower (Timed Up and Go times: odds ratio ( OR) = 1.32, 95% confidence interval ( CI) = 1.17-1.50) and had more activity of daily living deficits (≥2: OR = 1.26, 95% CI = 1.10-1.46). Five years later, they were still slower (timed walk: OR = 1.22, 95% CI = 1.05-1.42), had more disabilities (≥2 instrumental activities of daily living; OR = 1.45, 95% CI = 1.23-1.70), were less active (daytime activity according to accelerometry: β = −2.7, 95% CI = −5.2 to −0.2), had worse cognitive function (Montreal Cognitive Assessment; β = −0.64, 95% CI = −0.84 to −0.44), more likely to have poorer overall health (OR = 1.16, 95% CI = 1.03-1.31) and lose weight (>10%: OR = 1.31, 95% CI = 1.04-1.64), and have died ( OR = 1.45, 95% CI = 1.19-1.76). All analyses were adjusted for relevant confounders at baseline, including age, sex, race and ethnicity, education, smoking, problem drinking, body mass index, comorbidities, and cognitive function. Conclusion GSI predicts impaired physical function, cognitive dysfunction, significant weight loss, and mortality 5 years later in older U.S. adults. Multisensory evaluation may identify vulnerable individuals, offering the opportunity for early intervention to mitigate adverse outcomes. [ABSTRACT FROM AUTHOR]

Background Monitoring levels and trends in premature mortality is crucial to understanding how societies can address prominent sources of early death. The Global Burden of Disease 2016 Study (GBD 2016) provides a comprehensive assessment of cause-specific mortality for 264 causes in 195 locations from 1980 to 2016. This assessment includes evaluation of the expected epidemiological transition with changes in development and where local patterns deviate from these trends. Methods We estimated cause-specific deaths and years of life lost (YLLs) by age, sex, geography, and year. YLLs were calculated from the sum of each death multiplied by the standard life expectancy at each age. We used the GBD cause of death database composed of: vital registration (VR) data corrected for under-registration and garbage coding; national and subnational verbal autopsy (VA) studies corrected for garbage coding; and other sources including surveys and surveillance systems for specific causes such as maternal mortality. To facilitate assessment of quality, we reported on the fraction of deaths assigned to GBD Level 1 or Level 2 causes that cannot be underlying causes of death (major garbage codes) by location and year. Based on completeness, garbage coding, cause list detail, and time periods covered, we provided an overall data quality rating for each location with scores ranging from 0 stars (worst) to 5 stars (best). We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to generate estimates for each location, year, age, and sex. We assessed observed and expected levels and trends of cause-specific deaths in relation to the Socio-demographic Index (SDI), a summary indicator derived from measures of average income per capita, educational attainment, and total fertility, with locations grouped into quintiles by SDI. Relative to GBD 2015, we expanded the GBD cause hierarchy by 18 causes of death for GBD 2016. Findings The quality of available data varied by location. Data quality in 25 countries rated in the highest category (5 stars), while 48, 30, 21, and 44 countries were rated at each of the succeeding data quality levels. Vital registration or verbal autopsy data were not available in 27 countries, resulting in the assignment of a zero value for data quality. Deaths from non-communicable diseases (NCDs) represented 72·3% (95% uncertainty interval [UI] 71·2–73·2) of deaths in 2016 with 19·3% (18·5–20·4) of deaths in that year occurring from communicable, maternal, neonatal, and nutritional (CMNN) diseases and a further 8·43% (8·00–8·67) from injuries. Although age-standardised rates of death from NCDs decreased globally between 2006 and 2016, total numbers of these deaths increased; both numbers and age-standardised rates of death from CMNN causes decreased in the decade 2006–16—age-standardised rates of deaths from injuries decreased but total numbers varied little. In 2016, the three leading global causes of death in children under-5 were lower respiratory infections, neonatal preterm birth complications, and neonatal encephalopathy due to birth asphyxia and trauma, combined resulting in 1·80 million deaths (95% UI 1·59 million to 1·89 million). Between 1990 and 2016, a profound shift toward deaths at older ages occurred with a 178% (95% UI 176–181) increase in deaths in ages 90–94 years and a 210% (208–212) increase in deaths older than age 95 years. The ten leading causes by rates of age-standardised YLL significantly decreased from 2006 to 2016 (median annualised rate of change was a decrease of 2·89%); the median annualised rate of change for all other causes was lower (a decrease of 1·59%) during the same interval. Globally, the five leading causes of total YLLs in 2016 were cardiovascular diseases; diarrhoea, lower respiratory infections, and other common infectious diseases; neoplasms; neonatal disorders; and HIV/AIDS and tuberculosis. At a finer level of disaggregation within cause groupings, the ten leading causes of total YLLs in 2016 were ischaemic heart disease, cerebrovascular disease, lower respiratory infections, diarrhoeal diseases, road injuries, malaria, neonatal preterm birth complications, HIV/AIDS, chronic obstructive pulmonary disease, and neonatal encephalopathy due to birth asphyxia and trauma. Ischaemic heart disease was the leading cause of total YLLs in 113 countries for men and 97 countries for women. Comparisons of observed levels of YLLs by countries, relative to the level of YLLs expected on the basis of SDI alone, highlighted distinct regional patterns including the greater than expected level of YLLs from malaria and from HIV/AIDS across sub-Saharan Africa; diabetes mellitus, especially in Oceania; interpersonal violence, notably within Latin America and the Caribbean; and cardiomyopathy and myocarditis, particularly in eastern and central Europe. The level of YLLs from ischaemic heart disease was less than expected in 117 of 195 locations. Other leading causes of YLLs for which YLLs were notably lower than expected included neonatal preterm birth complications in many locations in both south Asia and southeast Asia, and cerebrovascular disease in western Europe. Interpretation The past 37 years have featured declining rates of communicable, maternal, neonatal, and nutritional diseases across all quintiles of SDI, with faster than expected gains for many locations relative to their SDI. A global shift towards deaths at older ages suggests success in reducing many causes of early death. YLLs have increased globally for causes such as diabetes mellitus or some neoplasms, and in some locations for causes such as drug use disorders, and conflict and terrorism. Increasing levels of YLLs might reflect outcomes from conditions that required high levels of care but for which effective treatments remain elusive, potentially increasing costs to health systems. [ABSTRACT FROM AUTHOR]

Objectives To examine the effects of decreasing hospital length of stay ( HLOS) on change in functioning from prehospital admission to posthospital discharge in older cohorts. Design Cohort-sequential design. Setting Nationwide, older population-based Longitudinal Aging Study Amsterdam ( LASA). Participants Individuals aged 68 and older with any hospital admission according to national medical registry data: two 10-year age groups (68-77 (younger-old) and 78-87 (older-old)) in two periods (1996-99 (Period 1) and 2006-09 (Period 2)) (N = 1,212). Measurements HLOS was the main independent variable in multinomial logistic models, dichotomized as 1 to 5 days (short) and 6 days or longer (long). Outcomes were change scores in mobility and activities in daily living ( ADLs). Respondents who died during the 3-year period were assigned to a third outcome category. Results Results for both age groups showed more hospital admissions and shorter median HLOS in Period 2 than Period 1 ( P < .05). Lower odds of decline in physical functioning were found in respondents with short HLOS than in those with long HLOS (for mobility: odds ratio ( OR) = 0.36, 95% confidence interval ( CI) = 0.23-0.54 (younger-old) and OR = 0.47, 95% CI = 0.30-0.72 (older-old); for ADLs: OR = 0.30, 95% CI = 0.19-0.48 (younger-old) and OR = 0.30, 95% CI = 0.18-0.53 (older-old)). Adjusting for confounders did not significantly change these estimates. Period did not modify these associations. Conclusion Because the associations of HLOS with change in mobility and ADLs were the same in both periods, hospitalized older adults had neither advantage nor disadvantage from the decrease in HLOS. In addition, in both age groups, a greater percentage experienced the better functional outcomes and lower mortality associated with short admissions, which suggests an advantage of the decrease in HLOS. [ABSTRACT FROM AUTHOR]

Objectives Extended validation of an index predicting mortality among community-dwelling US older adults. Design/Setting Examination of the performance of a previously developed index in predicting 10- and 14-year mortality among respondents to the 1997-2000 National Health Interview Surveys ( NHIS) using the original development and validation cohorts. Follow-up mortality data are now available through 2011. Participants 16,063 respondents from the original development cohort and 8,027 respondents from the original validation cohort. All participants were community dwelling and ≥65 years old. Measurements We calculated risk scores for each respondent based on the presence or absence of 11 factors (function, illnesses, behaviors, demographics) that make up the index. Using the Kaplan Meier method, we computed 10- and 14-year mortality estimates for the development and validation cohorts to examine model calibration. We examined model discrimination using the c-index. Results Participants in the development and validation cohorts were similar. Participants with risk scores 0-4 had 23% risk of 14-year mortality whereas respondents with risk scores (13+) had 89% risk of 14-year mortality. The c-index of the model in both cohorts was 0.73 for predicting 10-year mortality and 0.72 for predicting 14-year mortality. Overall, 18.4% of adults 65-74 years and 60.2% of adults ≥75 years have >50% risk of mortality in 10 years. Conclusions Our index demonstrated excellent calibration and discrimination in predicting 10- and 14-year mortality among community-dwelling US adults ≥65 years. Information on long-term prognosis is needed to help clinicians and older adults make more informed person-centered medical decisions and to help older adults plan for the future. [ABSTRACT FROM AUTHOR]

Objectives To compare the effect of a five-bed geriatric monitoring unit ( MU) on in-hospital mortality and length of stay with the effect of usual care in a geriatric hospital department and a medical MU. Design Prospective, case-control, noninterventional study. Participants All individuals hospitalized for 24 hours or longer in the geriatric MU (n = 89, aged 53-101, mean age 82.2 ± 9.6) over a period of 5 months (January-May 2015); individuals admitted to the geriatric department (n = 178, aged 55-100, mean age 83.2 ± 9.8), matched at a ratio of 1:2 according to sex, age ±5 years, and need for mechanical ventilation; and individuals admitted to a similar five-bed medical MU (n = 95, aged 35-90, mean age 68.2 ± 14.4) during the same period. Measurements Primary outcome was in-hospital mortality. Results The predicted death rate was 49 ± 26 for participants in the geriatric MU, 39.6 ± 27 for those in the medical MU ( P = .02), and 36.7 ± 27 for those in the geriatric department ( P < .001). Observed in-hospital mortality was higher for geriatric MU participants (n = 40, 44.9%) than for the department control group (n = 48, 27%) ( P = .002), although the mortality ratios (actual divided by predicted death rates) of these two groups were similar, indicating that the more severely ill participants in the geriatric MU did better than control participants in the departments, in particular those requiring hemodynamic pressure support and those with acute renal failure. Conclusion For elderly, severely ill adults, care in a geriatric MU was associated with lower in-hospital mortality than care in the hospital geriatric ward and a longer stay and may be an alternative to medical MU admission. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to present the results of retrospective tests of various extrapolative methods to forecast adult mortality and very elderly populations for Australia. Direct extrapolation methods tested include the Geometric method, Ediev variant, Lee-Carter method, BMS variant and a relational model. Indirect methods include the extrapolation of parameters of models fitted to the age profile of death rates and a new method involving the extrapolation of features of death frequency distributions namely the modal age and concentration. The geometric, Ediev and Lee- Carter BMS methods were very successful in projecting death rates and very elderly populations. Differences between these methods were small. The extrapolation of parametric functions proved successful for males but less so for females. Very elderly populations can be viably projected by directly extrapolating death rates by age when rates of decline in death rates show consistent relationships between ages and are stable over time. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives. To determine the number and causes of excess deaths in Puerto Rico after Hurricane Maria made landfall on September 20, 2017. Methods. We obtained monthly vital statistics data on all deaths from January 2008 through October 2017. We conducted a time-series analysis to estimate excess mortality in September and October 2017 overall and by age, sex, and cause of death. Results. We estimated a total of 1205 excess deaths (95% confidence interval [CI] = 707, 1702). Excess deaths were slightly higher among men than women (632 and 579 deaths, respectively) and found only among people aged 60 years or older (1038 deaths). Most excess deaths occurred from heart disease (253 deaths), "other" causes (204 deaths), diabetes (195 deaths), Alzheimer's disease (122 deaths), and septicemia (81 deaths). Conclusions. The number of excess deaths was similar to recent government estimates. However, this study is the first to identify the causes of death that were exacerbated by the disaster. Public Health Implications. An accurate estimation of the top causes of excess mortality can help authorities plan resource allocation for the island's recovery and for the prevention of deaths in future disasters. [ABSTRACT FROM AUTHOR]

The article presents abstracts on medical topics which include study on differentiation of follicular cells in patient mortality with papillary thyroid cancer, diagnosis of isolated central hypothyroidism in adult patient with narcolepsy and mortality of Filipino-Americans with thyroid cancer.

Objectives To determine whether treating depression decreases mortality from various chronic medical conditions. Design Long-term follow-up of multisite-practice randomized controlled trial (Prevention of Suicide in Primary Care Elderly: Collaborative Trial). Setting Twenty primary care practices randomized to intervention or usual care. Participants Individuals aged 60 and older identified through depression screening of random patients (N = 1,226). Intervention For 2 years, a depression care manager worked with primary care physicians in intervention practices to provide algorithm-based care for depression. Measurements Mortality risk based on a median follow-up of 98 months (range 0.8-116.4 months) through 2008; chronic medical conditions ascertained through self-report. Results For heart disease, persons with major depression were at greater risk of death, whether in usual-care or intervention practices. Older adults with major depression and diabetes mellitus in practices randomized to the intervention condition (hazard ratio = 0.47, 95% confidence interval = 0.24-0.91) were less likely to die. For other medical conditions, the point estimates for risk of death in persons with major depression were all in the direction of indicating lower risk in intervention practices but did not reach statistical significance. Conclusion Older adults with depression and medical comorbidity pose a significant clinical and public health challenge. Evidence was found of a statistically significant intervention effect on mortality for diabetes mellitus in persons with major depression. [ABSTRACT FROM AUTHOR]

Drawing on data from South Korea, this paper attempts to assess three dominant views on the evolution of morbidity and mortality of the elderly: expansion of morbidity, compression of morbidity, and dynamic equilibrium. The expansion of morbidity perspective argues that elongated life expectancy would comprise of, in large part, disabled life expectancy. The compression of morbidity theory suggests that increases in active life expectancy correspond to increases in total life expectancy. The dynamic equilibrium theory posits that, though overall levels of morbidity would rise, the prevalence of severe disability would decrease. The study is based on mortality data from Life Tables for Korea and the morbidity data from five nationally representative cross-sectional surveys conducted in 1994, 1998, 2004, 2008, and 2011. Sullivan's method is used to compute the active, mildly disabled, and severely disabled life expectancies. Results reveal that the total life expectancy of elderly Koreans has markedly increased, and this has been accompanied by an impressive extension of active life expectancy. In addition, results show negligible declines in the mildly disabled life expectancy but rapid drops in the severely disabled life expectancy. Collectively, these observations strongly support the compression hypothesis, and provide partial support for a dynamic equilibrium. [ABSTRACT FROM AUTHOR]

Research has shown that diurnal temperature range (DTR) is significantly associated with mortality and morbidity in regions of Asia; however, few studies have been conducted in other regions such as North America. Thus, we examined DTR effects on mortality in the USA. We used mortality and environmental data from the National Morbidity Mortality Air Pollution Study (NMMAPS). The data are daily mortality, air pollution, and temperature statistics from 95 large US communities collected between 1987 and 2000. To assess community-specific DTR effects on mortality, we used Poisson generalized linear models allowing for over-dispersion. After assessing community-specific DTR effects on mortality, we estimated region- and age-specific effects of DTR using two-level normal independent sampling estimation. We found a significant increase of 0.27 % [95 % confidence intervals (CI), 0.24-0.30 %] in nonaccidental mortality across 95 communities in the USA associated with a 1 °C increase in DTR, controlling for apparent temperature, day of the week, and time trend. This overall effect was driven mainly by effects of DTR on cardiovascular and respiratory mortality in the elderly: Mortality in the above 65 age group increased by 0.39 % (95 % CI, 0.33-0.44 %) and 0.33 % (95 % CI, 0.22-0.44 %), respectively. We found some evidence of regional differences in the effects of DTR on nonaccidental mortality with the highest effects in Southern California [0.31 % (95 % CI, 0.21-0.42 %)] and smallest effects in the Northwest and Upper Midwest regions [0.22 % (95 % CI, 0.11-0.33 %) and 0.22 % (95 % CI, 0.07-0.37 %), respectively]. These results indicate a statistically significant association between DTR and mortality on average for 95 large US communities. The findings indicate that DTR impacts on nonaccidental and cardiovascular-related mortality in most US regions and the elderly population was most vulnerable to the effects of DTR. [ABSTRACT FROM AUTHOR]

Background: To understand differences in the gut microbiota between elderly people of urbanized town communities (UTC) and longevity village communities (LVC), we analyzed fecal microbiota collected from individuals living in 2 UTC (Seoul and Chuncheon) and 3 LVC (Gurye, Damyang, and Soonchang) selected on the basis of indices for superlongevity (the ratio of centenarians to the total population) and longevity (the ratio of those aged 85 years or greater to those aged 65 years or greater) in South Korea by 454 pyrosequencing. Results: Taxonomy-based analysis showed that The relative abundance of Firmicutes, Tenericutes, and Actinobacteria was significantly lower in LVC than in UTC. Due to an increase of Firmicutes and a reduction of Bacteroidetes, the ratio of Firmicutes to Bacteroidetes in the gut microbiota was greater in UTC adults than in UTC children or LVC adults. The population levels of Bacteroides, Prevotella, and Lachnospira were significantly higher in LVC than in UTC, but the levels of Dialister, Subdoligranulum, Megamonas, EF401882-g, and AM275436-g were lower in LVC than in UTC. Although most of the species detected in LVC were detected in UTC, some Bacteroides spp. and Faecalibacterium spp. were detected only in LVC. Among Bacteroides spp., ACWH-s, EF403317-s, and EF403722-s were detected in children and LVC samples only but FJ363527-s, 4P000677-s, and 4P000015-s were detected in UTC samples. EF402172-s and EF404388-s, members of Faecalibacterium spp., which are known to have anti-inflammatory properties, were detected in LVC and children only (>3.9% of total sequence). In addition, the fecal lipopolysaccharides (LPS) content was significantly higher in UTC than in LVC. Conclusions: These findings suggest that maintaining gut microbiota, including Faecalibacterium spp. EF402172-s and EF404388-s, as well as low LPS levels may play an important role in preserving residents' health in LVC. [ABSTRACT FROM AUTHOR]

Protein–energy malnutrition is associated with numerous poor health outcomes, including high health care costs, mortality rates and poor physical functioning in older adults. This systematic literature review aims to identify and provide an evidence based overview of potential determinants of protein–energy malnutrition in community-dwelling older adults. A systematic search was conducted in PUBMED, EMBASE, CINAHL and COCHRANE from the earliest possible date through January 2013. Observational studies that examined determinants of protein–energy malnutrition were selected and a best evidence synthesis was performed to summarize the results. In total 28 studies were included in this review from which 122 unique potential determinants were derived. Thirty-seven determinants were examined in sufficient number of studies and were included in a best evidence synthesis. The best evidence score comprised design (cross-sectional, longitudinal) and quality of the study (high, moderate) to grade the evidence level. Strong evidence for an association with protein–energy malnutrition was found for poor appetite, and moderate evidence for edentulousness, having no diabetes, hospitalization and poor self-reported health. Strong evidence for no association was found for anxiety, chewing difficulty, few friends, living alone, feeling lonely, death of spouse, high number of diseases, heart failure and coronary failure, stroke (CVA) and the use of anti-inflammatory medications. This review shows that protein–energy malnutrition is a multifactorial problem and that different domains likely play a role in the pathway of developing protein–energy malnutrition. These results provide important knowledge for the development of targeted, multifactorial interventions that aim to prevent the development of protein–energy malnutrition in community-dwelling older adults. [ABSTRACT FROM AUTHOR]

Recent findings using records from the U.S. Social Security Administration's Death Master File discredit the late life mortality deceleration theory and confirm that life expectancies follow the Gompertz law not only until the age of 80, but for many years after. The authors show how these findings have major implications on the valuation of senior life settlements and securities backed by life settlements. They illustrate the sensitivity of valuation to the incorporation of the results of recent research regarding longevity risk. [ABSTRACT FROM AUTHOR]

Background: Frailty, a multidimensional syndrome entailing loss of energy, physical ability, cognition, and health, plays a significant role in elderly morbidity and mortality. No study has examined frailty in relation to mortality after femoral neck fractures in elderly patients. Questions/purposes: We examined the association of a modified frailty index abbreviated from the Canadian Study of Health and Aging Frailty Index to 1- and 2-year mortality rates after a femoral neck fracture. Specifically we examined: (1) Is there an association of a modified frailty index with 1- and 2-year mortality rates in patients aged 60 years and older who sustain a low-energy femoral neck fracture? (2) Do the receiver operating characteristic (ROC) curves indicate that the modified frailty index can be a potential tool predictive of mortality and does a specific modified frailty index value demonstrate increased odds ratio for mortality? (3) Do any of the individual clinical deficits comprising the modified frailty index independently associate with mortality? Methods: We retrospectively reviewed 697 low-energy femoral neck fractures in patients aged 60 years and older at our Level I trauma center from 2005 to 2009. A total of 218 (31%) patients with high-energy or pathologic fracture, postoperative complication including infection or revision surgery, fracture of the contralateral hip, or missing documented mobility status were excluded. The remaining 481 patients, with a mean age of 81.2 years, were included. Mortality data were obtained from a state vital statistics department using date of birth and Social Security numbers. Statistical analysis included unequal variance t-test, Pearson correlation of age and frailty, ROC curves and area under the curve, Hosmer-Lemeshow statistics, and logistic regression models. Results: One-year mortality analysis found the mean modified frailty index was higher in patients who died (4.6 ± 1.8) than in those who lived (3.0 ± 2; p < 0.001), which was maintained in a 2-year mortality analysis (4.4 ± 1.8 versus 3.0 ± 2; p < 0.001). In ROC analysis, the area under the curve was 0.74 and 0.72 for 1- and 2-year mortality, respectively. Patients with a modified frailty index of 4 or greater had an odds ratio of 4.97 for 1-year mortality and an odds ratio of 4.01 for 2-year mortality as compared with patients with less than 4. Logistic regression models demonstrated that the clinical deficits of mobility, respiratory, renal, malignancy, thyroid, and impaired cognition were independently associated with 1- and 2-year mortality. Conclusions: Patients aged 60 years and older sustaining a femoral neck fracture, with a higher modified frailty index, had increased 1- and 2-year mortality rates, and the ROC analysis suggests that this tool may be predictive of mortality. Patients with a modified frailty index of 4 or greater have increased risk for mortality at 1 and 2 years. Clinical deficits of mobility, respiratory, renal, malignancy, thyroid, and impaired cognition also may be independently associated with mortality. The modified frailty index may be a useful tool in predicting mortality, guiding patient and family expectations and elucidating implant/surgery choices. Further prospective studies are necessary to strengthen the predictive power of the index. Level of Evidence: Level IV, prognostic study. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

The elevated levels of protection, assistance, and care enjoyed by the elderly living in complex households has long been a key assumption of many family system theories. However, although this hypothesis has been demonstrated for contemporary contexts, quantitative evidence for past populations is particularly scarce, if not nonexistent. This article investigates the relationship between old-age mortality and living arrangements in a mid-nineteenth century Tuscan population, where the joint family system of sharecroppers coexisted alongside the nuclear system of day laborers. Our findings demonstrate that within complex households, the complexity of relationships, gender inequalities, and possible competition for care and resources among the most vulnerable household members-namely, the elderly and the young-weakens the assumption that the elderly benefitted from lower rates of old-age mortality. [ABSTRACT FROM AUTHOR]

Deviations from the Gompertz law of exponential mortality increases in late-middle and early-old age are commonly neglected in overall mortality analyses. In this study, we examined mortality increase patterns between ages 40 and 85 in 16 low-mortality countries and demonstrated sex differences in these patterns, which also changed across period and cohort. These results suggest that the interaction between aging and death is more complicated than what is usually assumed from the Gompertz law and also challenge existing biodemographic hypotheses about the origin and mechanisms of sex differences in mortality. We propose a two-mortality model that explains these patterns as the change in the composition of intrinsic and extrinsic death rates with age. We show that the age pattern of overall mortality and the population heterogeneity therein are possibly generated by multiple dynamics specified by a two-mortality model instead of a uniform process throughout most adult ages. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study is to identify which variables -among those commonly available and used in the primary care setting- best predict mortality in a cohort of elderly dependent patients living at home (EDPLH) that were included in a home care program provided by Primary Care Teams (PCT). Additionally, we explored the risk of death among a sub-group of these patients that were admitted to hospital the year before they entered the home care program. Methods: A one-year longitudinal cohort study of a sample of EDPLH patients included in a home care programme provided by 72 PCTs. Variables collected from each individual patient included health and social status, carer's characteristics, carer's burden of care, health and social services received. Results: 1,001 patients completed the study (91.5%), 226 were admitted to hospital the year before inclusion. 290 (28.9%) died during the one-year follow-up period. In the logistic regression analysis women show a lower risk of death [OR= 0.67 (0.50-0.91)]. The risk of death increases with comorbidity [Charlson index OR= 1.14 (1,06-1.23)], the number of previous hospital admissions [OR= 1,16 (1.03-1.33)], and with the degree of pressure ulcers [ulcers degree 1-2 OR = 2.94 (1.92-4.52); ulcers degree 3-4 OR = 4.45 (1.90-10.92)]. The logistic predictive model of mortality for patients previously admitted to hospital identified male sex, comorbidity, degree of pressure ulcers, and having received home care rehabilitation as independent variables that predict death. Conclusions: Comorbidity, hospital admissions and pressure ulcers predict mortality in the following year in EDPLH patients. The subgroup of patients that entered home care programs with a previous record of hospital admission and a high score in our predictive model might be considered as candidates for palliative care. [ABSTRACT FROM AUTHOR]

Abstract: Diurnal temperature range (DTR) is an important meteorological indicator associated with global climate change, but little is known about the effects of DTR on mortality. We examined the effects of DTR on cause-/age-/education-specific mortality in Guangzhou, a subtropical city in China during 2003–2010. A quasi-Poisson regression model combined with distributed lag non-linear model was used to examine the effects of DTR, after controlling for daily mean temperature, air pollutants, season and day of the week. A 1 °C increase in DTR at lag 0–4 days was associated with a 0.47% (95% confidence interval: 0.01%–0.93%) increase in non-accidental mortality. Stroke mortality was most sensitive to DTR. Female, the elderly and those with low education were more susceptible to DTR than male, the youth and those with high education, respectively. Our findings suggest that vulnerable subpopulations should pay more attention to protect themselves from unstable daily weather. [Copyright &y& Elsevier]

Objective The aim of this study was to evaluate mortality and causes of death in older patients with schizophrenia in comparison with the general population. The mortality of patients experiencing relapse was also compared with those in remission. Methods The study sample consists of patients ( n = 9461) over 65 years by the first of January 1999, with schizophrenia or schizoaffective disorder (ICD-8, ICD-9: 295, ICD-10: F20, F25) as the main register diagnosis during the period 1969-1998. The sample was collected from nationwide registers in Finland and followed up between 1999 and 2008. Results Overall Standard Mortality Ratio (SMR) of the older schizophrenia patients was 2.69 [95% confidence interval, 2.62-2.76]. For natural causes of death, overall SMR was 2.58 (2.51-2.65; n = 5301), and for unnatural causes of death, it was 11.04 (9.75-12.47; n = 262). The most common causes of death matched those in the general population. Of patients who died during follow-up, 31% (1709/5596) had at least one psychiatric hospitalization within 5 years before follow-up. The SMR for this group was higher (3.92; 3.73-4.11) than in those patients (2.37; 2.29-2.44) with no such treatment during that time. Conclusion All-cause mortality of older patients with schizophrenia was almost threefold that of general population. They died for similar reasons to the general population; however, deaths for unnatural causes were especially common (accidents and suicides). Those patients still experiencing relapses in older age have an increased risk of death compared with those with schizophrenia in remission. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Recent studies of old-age mortality trends assess whether longevity improvements over time are linked to increasing compression of mortality at advanced ages. The historical backdrop of these studies is the long-term improvement in a population's socioeconomic resources that fueled longevity gains. We extend this line of inquiry by examining whether socioeconomic differences in longevity within a population are accompanied by old-age mortality compression. Specifically, we document educational differences in longevity and mortality compression for older men and women in the United States. Drawing on the fundamental cause of disease framework, we hypothesize that both longevity and compression increase with higher levels of education and that women with the highest levels of education will exhibit the greatest degree of longevity and compression. Results based on the Health and Retirement Study and the National Health Interview Survey Linked Mortality File confirm a strong educational gradient in both longevity and mortality compression. We also find that mortality is more compressed within educational groups among women than men. The results suggest that educational attainment in the United States maximizes life chances by delaying the biological aging process. [ABSTRACT FROM AUTHOR]

Because good information on deaths caused by a fall would be important for prevention policies, we analyzed the influence of coding differences on variability in state-level fall death rates in the elderly. We examined state differences in the number of cause of death codes on death certificates, death certifiers, completeness of E-coding, and indicators of specificity of coding. We found that state-specific fall mortality rates ranged from 13.9 to 140.4 in people aged 65 years and above. States employing a coroner to investigate injury deaths had 14 per cent fewer recorded fall deaths than those where a medical examiner conducted the investigations. Each unit increase in the median number of cause of death codes was associated with a 10 per cent increase in the number of falls. For each 1 per cent increase in the use of unspecified codes for the underlying cause of death, the number of falls dropped by 2 per cent. Current fall mortality data do not appear to identify all instances of falls. Variability in unintentional fall-related death rates among states may be partly explained by death certification coding practices. Standardization of coding and training for documentation of fall events and death certificate reporting could help uncover the actual fall mortality burden in the elderly. [ABSTRACT FROM AUTHOR]

Time series studies show that hot temperatures are associated with increased death rates in the short term. In light of evidence of adaptation to usual temperature but higher deaths at unusual temperatures, a long-term exposure relevant to mortality might be summertime temperature variability, which is expected to increase with climate change. We investigated whether the standard deviation (SD) of summer (June-August) temperatures was associated with survival in four cohorts of persons over age 65 y with predisposing diseases in 135 US cities. Using Medicare data (1985-2006), we constructed cohorts of persons hospitalized with chronic obstructive pulmonary disease, diabetes, congestive heart failure. and myocardial infarction. City-specific yearly summer temperature variance was linked to the individuals during follow-up in each city and was treated as a time-varying exposure. We applied a Cox proportional hazard model for each cohort within each city, adjusting for individual risk factors, wintertime temperature variance, yearly ozone levels, and long-term trends, to estimate the chronic effects on mortality of long-term exposure to summer temperature SD, and then pooled results across cities. Mortality hazard ratios ranged from 1.028(95% confidence interval, 1.013- 1.042) per 1 °C increase in summer temperature SD for persons with congestive heart failure to 1.040(95% confidence interval, 1.022-1.059) per 1 °C increase for those with diabetes. Associations were higher in elderly persons and lower in cities with a higher percentage of land with green surface. Our data suggest that long-term increases in temperature variability may increase the risk of mortality in different subgroups of susceptible older populations. [ABSTRACT FROM AUTHOR]

Background. Population-based data on the relationship between impaired olfaction and risk of mortality among older adults are lacking. We used a representative cohort of adults aged 60 years or older to assess whether olfactory loss is a predictor of mortality, independent of potential confounders. Methods. Olfaction was measured by the San Diego Odor Identification Test (SDOIT) among 1,636 participants enrolled in the Blue Mountains Eye Study (2002–2004). Five-year all-cause mortality was confirmed using the Australian National Death Index. Results. More than one in five participants (21.8%) with olfactory impairment had died over the 5 years compared with less than 10% of participants without olfactory loss. Moderate olfactory loss (SDOIT score ≤3) was associated with a 68% increased risk of all-cause mortality (multivariable-adjusted hazard ratio, 1.68; 95% confidence interval, 1.10–2.56). This association did not persist after further adjustment for cognitive impairment. The association between olfactory loss and all-cause mortality was more marked among older participants (≥70 years) than younger participants (<70 years) with olfactory impairment (multivariable-adjusted hazard ratio, 1.48; 95% confidence interval, 1.02–2.15). However, adjusting for cognitive impairment diminished this association. Conclusions. Older adults with moderately impaired olfaction compared with those with normal olfaction had a higher risk of dying 5 years later. The relationship between olfaction and mortality, however, may be largely mediated by cognitive impairment in these older adults. Our findings highlight the value of identifying olfactory loss in the preclinical stage in the older patient before the development of related comorbidities. [ABSTRACT FROM PUBLISHER]

The article presents a study on the rise of mortality and morbidity from injuries of older people in the U.S. The study analyzes mortality and morbidity data of age 65 and older people from 2006-2007 and examines the variations by sex, age group, and causes using linear regression. Result shows an increase of over 3% of injury mortality during the study period, while 7% rise was found during 2001-2007. Moreover, significant death rise was found for motorcycle crashes, machinery, and poisoning.

In this article the authors discuss halving premature death. Topics include statistics for under-50, under-70, and under-five global mortality rates, the major noncommunicable diseases (NCDs) responsible for a quarter of all deaths under 50, including cancer, stroke, and heart disease, and contributing risk factors, such as smoking, and the feasibility of halving the 2010 under-50 mortality rate by 2030.