Cover caption: Patterns of oral anticoagulant use for atrial fibrillation following transition to long-term care. In an analysis of 2014-2019 Medicare Fee-for-Service data and MDS assessments (N=16,464), 25% of prior OAC users discontinued OAC and 20% of prior non-users initiated OAC within 30 days following transition to LTC. See the related article by Luo et al., pages 265–268.
Cover caption: Factors to balance when considering osteoporosis treatment in nonagenarians. See the related article by Lubinski and Berry, pages 3643–3645.
Research has revealed dementia disparities among underserved older adults. Built upon standard-Reducing Disability in Alzheimer's Disease (s-RDAD), Innovations in Dementia Empowerment and Action (IDEA) is designed and culturally tailored for underserved communities through an empowerment stigma-reduction cognitive-behavioral intervention and tested with sexual and gender minority (SGM) adults and care partners.
The study is a 2-arm (IDEA and s-RDAD), single-blind, randomized controlled trial (RCT) with a staggered multiple baseline design. With 161 dyads (person living with dementia/care partner), the aim of the study is to compare the two arms via between and within group differences on primary (physical activity) and secondary outcomes (e.g., quality of life, physical functioning, and resource literacy) at post-treatment, and 30 and 56 week follow-up.
When comparing the two arm between-group differences, the IDEA care partners' community resource literacy was significantly higher at 30-week follow-up than for s-RDAD (contrast = 0.10, p = 0.005). While both intervention arms demonstrated efficacy with significant improvement in physical activity (contrastIDEA = 0.10, p = 0.010; contrasts-RDAD = 0.14, p < 0.001) and quality of life (contrastIDEA = 0.06, p < 0.001; contrasts-RDAD = 0.03, p = 0.035) for the person with dementia at post-treatment, positive treatment effects on physical activity (contrastIDEA = 0.09, p = 0.032) and quality of life (contrastIDEA = 0.03, p = 0.040) persisted at 30 weeks for IDEA but not for s-RDAD.
While both intervention arms were efficacious, IDEA demonstrated sustained efficacy. The cultural tailoring of interventions is promising to address disparities in dementia care and interventions in underserved communities. Future research is needed for the translation of this efficacious intervention to the larger community.
Clinicaltrials.gov identifier: NCT03550131
The Perioperative Optimization of Senior Health (POSH) clinic was established to address vulnerabilities and improve outcomes in frail older patients. This study describes the results of comprehensive perioperative optimization by the POSH interdisciplinary team (IDT) in patients who underwent colorectal surgery.
Frail patients planned for colorectal surgery and enrolled in the POSH clinic (10/2021–09/2023) were retrospectively identified. Descriptive statistics were used to summarize the findings of preoperative geriatric assessment and postoperative outcomes. Outcomes were compared with a contemporary propensity-matched cohort using chi-squared analysis and two-sample t-tests for categorical and continuous variables, respectively.
Thirty-six patients with a median age of 80 years and a mean Charlson Comorbidity Index of 6.11 were planned for colorectal surgeries, most commonly colectomy (62.1%) and ostomy reversal (20.7%). Twenty-nine patients underwent surgical management after interdisciplinary optimization in the POSH clinic. The most common interventions recommended included advance care planning (86.2%), physical therapy (55.2%), and medication management (34.5%). Postoperatively, 75% of patients were discharged home, and there were no mortalities within 90 days. There were no significant differences in postoperative outcomes when compared to a contemporary propensity-matched cohort. The remaining seven patients enrolled in POSH did not undergo surgical management after surgery was deemed inconsistent with their goals of care, and three of these patients expired within 1 year of evaluation in POSH.
The POSH model provides high-risk patients with individualized risk stratification, comprehensive interdisciplinary strategies for risk mitigation, and alignment of care with patient goals. When elective colorectal surgery was within their goals of care, frail older adults safely underwent operative intervention after careful perioperative optimization. Future studies should include a mixed-method exploration of the patient perspective and a randomized controlled trial to quantify the impact of the POSH clinic on short- and long-term postoperative outcomes.
Sarcopenic obesity is a condition characterized by decreased muscle mass and strength along with an increased body fat percentage. While previous studies have separately examined the relationship between sarcopenia and obesity with urinary incontinence (UI), this study aimed to evaluate the combined impact of sarcopenic obesity on UI.
This study included 1147 female patients aged ≥ 60 years who attended a geriatrics outpatient clinic between November 2012 and June 2024. Body composition was assessed using bioimpedance analysis (BIA), and muscle strength was measured by handgrip strength. The skeletal muscle mass index (SMMI) was adjusted for body weight. Sarcopenic obesity was defined using population-specific threshold values, incorporating low muscle strength, low muscle mass, and high fat percentage. Patients were classified into four groups: non-sarcopenic non-obese, sarcopenic non-obese, sarcopenic obese, and non-sarcopenic obese. The prevalence of UI and its association with these phenotypes was analyzed using multivariable logistic regression.
The mean age was 74 ± 7 years. The prevalence of sarcopenic obesity was 20%, while the prevalence of UI was 49%. UI was observed in 57% of the 230 patients with sarcopenic obesity. A significant difference in UI prevalence was found among phenotypic groups (p < 0.001). In multivariable regression analysis, sarcopenic obesity was independently associated with UI (OR: 1.82, 95% CI: 1.16–2.85, p = 0.009). Other phenotypes were not significantly associated.
Sarcopenic obesity is more strongly associated with UI than sarcopenia or obesity alone. Early identification and targeted interventions may play a crucial role in mitigating the effects of UI or reducing its incidence.
For older adults to decide whether inguinal hernia repair will meaningfully improve their lives, it is critical to (1) understand how the operation affects them and whether it enhances outcomes that matter to them, and (2) identify ways to improve how surgeons discuss the benefits of surgery and how they prepare older adults for postoperative recovery.
We conducted semi-structured interviews with 40 Veterans ≥ 65 years old who had inguinal hernia repair at two high-volume Veterans Affairs hospitals.
Participants were all men; their mean age was 73 years, 65% were White, and 33% were Black. Older adults felt that the surgical team provided excellent reassurance regarding the safety and efficacy of surgery but expressed a desire for improved listening during preoperative counseling and for clearer communication regarding the reality of postoperative recovery. Veterans reported a return to baseline physical and cognitive function between 2 days and 6 weeks after surgery, though two Veterans experienced significant short-term cognitive dysfunction. Those who reported dissatisfaction with preoperative communication were more likely to be surprised or concerned about postoperative symptoms.
Our study provides critical information on how hernia repair affects the lives of older adults, and this can be used to better prepare the patients for surgery and to help them decide whether surgery will meaningfully enhance their quality of life.
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