Cover caption: A new care pathway to overcome care connections gaps between hospitals and community services in the Emergency Department. For full details, see “A public health/hospital partnership to improve Emergency Department transitions of care for vulnerable older adults” on page 243.
Naturally occurring retirement communities (NORCs) are geographical areas that have naturally become home to a large concentration of older adults. This density means that NORCs have the potential to become a pillar for aging in place strategies, but at present, there is limited data on residents and their health needs. Our objective was to describe and compare the health and healthcare use of older adults living in high-rise NORC buildings to those in all other housing types in the community.
We conducted a population-based descriptive study of community-dwelling older adults aged ≥65 years by linking a provincial NORC registry in Ontario, Canada with health administrative records. Individuals were classified as NORC residents if their residential postal code on January 1, 2020 matched the NORC registry. Sociodemographic, clinical, and healthcare use characteristics were compared by NORC status using standardized differences (STD) and stratified by rurality, and further by age and sex in urban settings.
Overall, 219,995 (7.7%) of 2,869,706 older adults were NORC residents. Compared to community-dwelling older adults, NORC residents were older (mean 77.4 vs 74.6 years; STD 0.34), and more were female (61.8% vs 52.2%; STD 0.19) and had low income (16.0% vs 9.3%; STD 0.11). NORC residents also had more active chronic conditions (mean 1.9 vs 1.5; STD 0.27), medications (mean 3.4 vs 2.8; STD 0.21), home care use (15.3% vs 9.8%; STD 0.17), and primary care visits (mean 9.7 vs 7.6 visits in prior 2 years; STD 0.22). Findings were robust across rurality, age, and sex.
Our findings suggest that NORC residents have greater health needs than other older adults living in the community and underscore NORCs as important targets for equity-focused strategies to support aging in place.
Policy measures designed to address elder abuse, neglect, and exploitation date back to decades, including the Older Americans Act of 1965. Over the years, various legislative actions have aimed to address elder mistreatment, culminating in the Elder Justice Act of 2010. Despite these efforts, policy changes lag behind need, and government funding appropriation is woefully inadequate. On November 29, 2023, the National Collaboratory to Address Elder Mistreatment convened 76 experts from research, clinical practice, policymaking, federal and state agencies, and national organizations to develop strategies for accelerating policy action to address elder mistreatment. Key themes from the convening included the need for a unified and stronger infrastructure and messaging, the importance of data-driven policy and evidence-informed prevention and intervention practices, and expanding strategic engagements. Participants emphasized the need for a holistic and long-term approach, leveraging data to demonstrate outcomes, and building coalitions across related fields to address elder mistreatment. Action steps were identified for both national and state/local levels, focused on enhancing data-informed elder mistreatment prevention, intervention, and response programs. The broad cross-sector participation in the convening and the findings underscored the urgency of and potential for advancing elder justice policy. By leveraging existing initiatives, utilizing data emerging particularly in the past 5 years, building on decades of advocacy, and fostering new collaborations, there is a significant opportunity to improve prevention, intervention, and response to elder mistreatment.
Cover caption: Anxiety and increased risk of dementia. See the related article by Khaing et al., pages 3327–3334.
Motor signs may herald incident dementia and allow the earlier detection of high-risk individuals and the timely implementation of preventive interventions. The current study was performed to investigate the prognostic properties of motor signs with respect to incident dementia with Lewy bodies (DLB) in older adults with mild cognitive impairment (MCI). Emphasis was placed on sex differences. The specificity of these associations was explored.
We analyzed data from the National Alzheimer's Coordinating Center Uniform Data Set. Participants 55 + years old with a diagnosis of MCI were included in the analysis. Those with Parkinson's disease (PD) or other parkinsonian disorders at baseline and those with PD dementia at follow-up were excluded. UPDRS III was used to assess the presence or absence of motor signs in nine domains: hypophonia; masked facies; resting tremor; action/postural tremor; rigidity; bradykinesia; impaired chair rise; impaired posture/gait; postural instability. Αdjusted Cox proportional hazards models featuring sex by motor sign interactions were estimated.
Throughout the average follow-up of 3.7 ± 3.1 years, among 4623 individuals with MCI, 2211 progressed to dementia (66 of whom converted to DLB). Masked facies [HR = 4.21 (1.74–10.18)], resting tremor [HR = 4.71 (1.44–15.40)], and bradykinesia [HR = 3.43 (1.82–6.45)] exclusively increased the risk of DLB. The HR of DLB was approximately 15 times greater in women compared to men with masked facies. Impaired posture–gait (approximately 10 times) and resting tremor (approximately 8.5 times) exhibited a similar trend (prominent risk-conferring properties in women compared to men) but failed to achieve statistical significance. Rigidity and hypophonia elevated the risk of other dementia entities, as well. The remaining motor features were not related to incident dementia of any type.
Specific motor signs may herald DLB among individuals with MCI. Different associations may exist between masked facies, impaired posture–gait, resting tremor, and incident DLB in men versus women.
Older adults with advanced cancer experience functional disability that warrants rehabilitation services; however, evidence indicates inconsistencies in referral. The purpose was to (1) identify predictors of geriatric assessment (GA)-driven referrals to rehabilitation services and (2) explore associations between referral and change in function, health-related quality of life (HRQoL), and overall survival among older adults with advanced cancer.
This was a secondary analysis (NCT020107443, UG1CA189961) of a nationwide GA clinical trial. Patients were older adults with advanced cancer who had at least one GA-defined physical performance or functional status impairment. Primary outcomes were oncologist-initiated discussion about or referral to rehabilitation services after the GA (Aim 1) and decline in activities of daily living (ADL), Instrumental ADL (IADL), and HRQoL within 3 months, and overall survival at 1 year (Exploratory Aims). Analyses included multivariable logistic regression and Cox proportional hazards models. Demographic and clinical factors were controlled for by using 1:1 propensity score matching.
In total 265 patients were analyzed. After adjustment, impaired cognition (odds ratio [OR] = 2.25, p = 0.01), Karnofsky score indicating disability (OR = 2.86, p < 0.01), and receipt of monoclonal antibodies (OR = 1.95, p = 0.04) were associated with higher odds of referral. In contrast, polypharmacy was associated with lower odds of referral (OR = 0.31, p < 0.01). Referred patients were less likely to decline in ADL (OR 0.30, p = 0.07) and IADL (OR 0.64, p = 0.35), but more likely to decline in HRQoL (OR 1.20, p = 0.67) and have worse survival (HR 1.18, p = 0.62).
Cancer treatment, polypharmacy, cognition, and disability status likely influence oncologists' decision to refer for rehabilitation. Referral was not independently associated with change in functional disability, HRQoL, or survival. Future studies should evaluate patients' utilization of rehabilitation services post-referral and determine whether dose/timing of rehabilitation services influence clinical outcomes.
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