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Life‐space mobility and cognition in community‐dwelling late‐life women: A cross‐sectional analysis 居住在社区的晚年女性的生活空间流动性和认知能力:横断面分析
IF 6.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-14 DOI: 10.1111/jgs.19190
Kerry M. Sheets, Allyson M. Kats, Howard A. Fink, Lisa Langsetmo, Kristine Yaffe, Kristine E. Ensrud
BackgroundLife‐space mobility captures the daily, enacted mobility of older adults. We determined cross‐sectional associations between life‐space mobility and cognitive impairment (CI) among community‐dwelling women in the 9th and 10th decades of life.MethodsA total of 1375 (mean age 88 years; 88% White) community‐dwelling women enrolled in a prospective cohort of older women. Life‐space score was calculated with range 0 (daily restriction to one's bedroom) to 120 (daily trips leaving town without assistance) and categorized (0–20, 21–40, 41–60, 61–80, 81–120). The primary outcome was adjudicated CI defined as mild cognitive impairment or dementia; scores on a 6‐test cognitive battery were secondary outcomes.ResultsCompared to women with life‐space scores of 81–120 and after adjustment for demographics and depressive symptoms, the odds of CI was 1.4‐fold (OR 1.36, 95% CI 0.91–2.03) higher for women with life‐space scores of 61–80, twofold (OR 1.98, 95% CI 1.33–2.94) higher for women with life‐space scores of 41–60, 2.6‐fold (OR 2.62, 95% CI 1.71–4.01) higher for women with life‐space scores of 21–40, and 2.7‐fold (OR 2.71, 95% CI 1.27–5.79) higher for women with life‐space scores of 0–20. The association of life‐space scores with adjudicated CI was primarily due to higher odds of dementia; the odds of dementia versus normal cognition was eightfold (OR 8.63, 95% CI 3.20–23.26) higher among women with life‐space scores of 0–20 compared to women with life‐space scores of 81–120. Lower life‐space scores were associated in a graded manner with lower mean scores on tests of delayed recall (California Verbal Learning Test‐II delayed recall) and language and executive function (phonemic fluency, category fluency, and Trails B). Life‐space score was not associated with scores on tests of attention and working memory (forward and backward digit span).ConclusionsLower life‐space mobility is associated in a graded manner with CI among community‐dwelling White women in the 9th and 10th decades of life.
背景生活空间的流动性反映了老年人的日常活动能力。我们测定了社区居住的九十岁和十十岁女性的生活空间流动性与认知障碍(CI)之间的横断面关联。方法共有 1375 名(平均年龄 88 岁;88% 白人)社区居住的女性加入了老年女性前瞻性队列。生活空间得分的计算范围为 0(每天仅限于自己的卧室)至 120(每天出城旅行无需他人协助),并分为 0-20、21-40、41-60、61-80、81-120 分。结果与生活空间评分为 81-120 分的女性相比,在对人口统计学和抑郁症状进行调整后,生活空间评分为 81-120 分的女性患 CI 的几率是生活空间评分为 81-120 分女性的 1.4 倍(OR 1.36,95% CI 0.91-2.03)。生命空间分数为 61-80 分的女性的几率要高出 1.4 倍(OR 1.36,95% CI 0.91-2.03),生命空间分数为 41-60 分的女性的几率要高出 2 倍(OR 1.98,95% CI 1.33-2.94),生命空间分数为 21-40 分的女性的几率要高出 2.6 倍(OR 2.62,95% CI 1.71-4.01),生命空间分数为 0-20 分的女性的几率要高出 2.7 倍(OR 2.71,95% CI 1.27-5.79)。生命空间得分与判定的 CI 的关系主要是由于痴呆的几率更高;与生命空间得分 81-120 分的女性相比,生命空间得分 0-20 分的女性痴呆的几率是正常认知的 8 倍(OR 8.63,95% CI 3.20-23.26)。生命空间分数较低与延迟回忆测试(加利福尼亚言语学习测试-II延迟回忆)以及语言和执行功能测试(语音流畅性、类别流畅性和Trails B)的平均分数较低呈分级关系。结论在社区居住的白人妇女中,生命期第 9 和第 10 个十年的生命空间活动度较低与 CI 呈分级关系。
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引用次数: 0
Association of left atrial function with frailty: The Atherosclerosis Risk in Communities (ARIC) study 左心房功能与虚弱的关系:社区动脉粥样硬化风险(ARIC)研究
IF 6.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-13 DOI: 10.1111/jgs.19187
Daokun Sun, Romil R. Parikh, Wendy Wang, Anne Eaton, Pamela L. Lutsey, B. Gwen Windham, Riccardo M. Inciardi, Scott D. Solomon, Christie M. Ballantyne, Amil M. Shah, Lin Yee Chen
BackgroundFrailty is common in people with cardiovascular disease. Worse left atrial (LA) function is an independent risk factor for cardiovascular disease. However, whether worse LA function is associated with frailty is unclear.MethodsWe included 3292 older adults from the Atherosclerosis Risk in Communities study who were non‐frail at baseline (visit 5, 2011–2013) and had LA function (reservoir, conduit, and contractile strain) measured from two‐dimensional speckle‐tracking echocardiography. LA stiffness index was calculated as a ratio of E/e′ to LA reservoir strain. Frailty was defined using the validated Fried frailty phenotype. Incident frailty was assessed between 2016 and 2019 during two follow‐up visits. LA function was analyzed as quintiles. Multivariable logistic regression examined odds of incident frailty.ResultsMedian (interquartile range [IQR]) age was 74 (71–77) years, 58% were female, and 214 (7%) participants developed frailty during a median (IQR) follow‐up of 6.3 (5.6–6.8) years. After adjusting for baseline confounders and incident cardiovascular events during follow‐up, the odds of developing frailty was 2.42 (1.26–4.66) times greater among participants in the lowest (vs highest) quintile of LA reservoir strain and 2.41 (1.11–5.22) times greater among those in the highest (vs lowest) quintile of LA stiffness index. Worse LA function was significantly associated with the development of exhaustion, but not the other components of the Fried frailty phenotype.ConclusionsWorse LA function is associated with higher incidence of frailty and exhaustion component independent of LA size and left ventricular function. Future studies are needed to elucidate the underlying mechanisms that drive the observed association.
背景心血管疾病患者普遍存在心力衰竭问题。左心房(LA)功能较差是心血管疾病的一个独立风险因素。方法我们纳入了社区动脉粥样硬化风险研究(Atherosclerosis Risk in Communities)中的 3292 名老年人,他们在基线(2011-2013 年第 5 次就诊)时并不虚弱,并通过二维斑点追踪超声心动图测量了 LA 功能(储血室、导管和收缩应变)。LA僵化指数按E/e′与LA储层应变的比值计算。虚弱的定义采用经过验证的弗里德虚弱表型。在2016年至2019年期间的两次随访中对发生的虚弱情况进行了评估。LA功能以五分位数进行分析。结果中位数(四分位数间距 [IQR])年龄为 74(71-77)岁,58% 为女性,214(7%)名参与者在中位数(IQR)为 6.3(5.6-6.8)年的随访期间出现虚弱。在对基线混杂因素和随访期间发生的心血管事件进行调整后,LA储层应变最低(与最高)五分位数的参与者发生虚弱的几率是前者的2.42(1.26-4.66)倍,LA僵硬度指数最高(与最低)五分位数的参与者发生虚弱的几率是前者的2.41(1.11-5.22)倍。结论 LA功能较差与虚弱和衰竭的发生率较高有关,与LA大小和左心室功能无关。未来的研究还需要阐明导致这种关联的潜在机制。
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引用次数: 0
Implementation of delirium screening in the emergency department: A qualitative study with early adopters 在急诊科实施谵妄筛查:对早期采用者的定性研究
IF 6.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-12 DOI: 10.1111/jgs.19188
Anita N. Chary, Annika R. Bhananker, Elise Brickhouse, Beatrice Torres, Ilianna Santangelo, Kyler M. Godwin, Aanand D. Naik, Christopher R. Carpenter, Shan W. Liu, Maura Kennedy
IntroductionDelirium affects 15% of older adults presenting to emergency departments (EDs) but is detected in only one‐third of cases. Evidence‐based guidelines for ED delirium screening exist, but are underutilized. Frontline staff perceptions about delirium and time and resource constraints are known barriers to ED delirium screening uptake. Early adopters of ED delirium screening can offer valuable lessons about successful implementation.MethodsWe conducted semi‐structured interviews with clinician‐administrators leading ED delirium screening initiatives from 20 EDs in the United States and Canada. Interviews focused on experiences of planning and implementing ED delirium screening. Interviews lasted 15 to 50 minutes and were digitally recorded and transcribed. To identify factors that commonly impacted implementation of ED delirium screening, we used constructs from the Consolidated Framework for Implementation Research (CFIR), an Implementation Science framework widely used to evaluate healthcare improvement initiatives.ResultsOverall, notable facilitators of successful implementation were having institutional and ED leadership support and designated clinical champions to longitudinally engage and educate frontline staff. We found specific examples of factors affecting implementation drawn from the following seven CFIR constructs: (1) intervention complexity, (2) intervention adaptability, (3) external policies and incentives, (4) peer pressure from other institutions, (5) the implementation climate of the ED, (6) staff knowledge and beliefs, and (7) engaging deliverers of intervention, that is, frontline ED staff.ConclusionImplementing ED delirium screening is complex and requires institutional resources as well as clinical champions to engage frontline staff in a sustained fashion.
导言:在急诊科(ED)就诊的老年人中,15%患有谵妄,但只有三分之一的病例能被发现。目前已有基于证据的急诊科谵妄筛查指南,但未得到充分利用。一线工作人员对谵妄的认识以及时间和资源的限制是阻碍急诊科接受谵妄筛查的已知障碍。我们对来自美国和加拿大 20 家急诊室的急诊室谵妄筛查项目负责人进行了半结构化访谈。访谈的重点是计划和实施急诊室谵妄筛查的经验。访谈持续了 15 到 50 分钟,并进行了数字录音和转录。为了确定通常影响急诊室谵妄筛查实施的因素,我们使用了实施研究综合框架(CFIR)中的构架,该框架是一个实施科学框架,被广泛用于评估医疗保健改进措施。结果总的来说,成功实施的显著促进因素是得到机构和急诊室领导的支持,以及指定临床倡导者纵向参与和教育一线员工。我们从以下七个 CFIR 构架中找到了影响实施因素的具体实例:(1)干预的复杂性,(2)干预的适应性,(3)外部政策和激励机制,(4)来自其他机构的同行压力,(5)急诊室的实施氛围,(6)员工的知识和信念,以及(7)干预实施者(即急诊室一线员工)的参与。
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引用次数: 0
Effect of hearing intervention on communicative function: A secondary analysis of the ACHIEVE randomized controlled trial. 听力干预对交流功能的影响:ACHIEVE 随机对照试验的二次分析。
IF 6.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-12 DOI: 10.1111/jgs.19185
Victoria A Sanchez,Michelle L Arnold,Emmanuel E Garcia Morales,Nicholas S Reed,Sarah Faucette,Sheila Burgard,Haley N Calloway,Josef Coresh,Jennifer A Deal,Adele M Goman,Lisa Gravens-Mueller,Kathleen M Hayden,Alison R Huang,Christine M Mitchell,Thomas H Mosley,James S Pankow,James R Pike,Jennifer A Schrack,Laura Sherry,Jacqueline M Weycker,Frank R Lin,Theresa H Chisolm,
BACKGROUNDThe Aging and Cognitive Health Evaluation in Elders (ACHIEVE) Study was designed to determine the effects of a best-practice hearing intervention on cognitive decline among community-dwelling older adults. Here, we conducted a secondary analysis of the ACHIEVE Study to investigate the effect of hearing intervention on self-reported communicative function.METHODSThe ACHIEVE Study is a parallel-group, unmasked, randomized controlled trial of adults aged 70-84 years with untreated mild-to-moderate hearing loss and without substantial cognitive impairment. Participants were randomly assigned (1:1) to a hearing intervention (audiological counseling and provision of hearing aids) or a control intervention of health education (individual sessions with a health educator covering topics on chronic disease prevention) and followed semiannually for 3 years. Self-reported communicative function was measured with the Hearing Handicap Inventory-Elderly Screening version (HHIE-S, range 0-40, higher scores indicate greater impairment). Effect of hearing intervention versus control on HHIE-S was analyzed through an intention-to-treat model controlling for known covariates.RESULTSHHIE-S improved after 6-months with hearing intervention compared to control, and continued to be better through 3-year follow-up. We estimated a difference of -8.9 (95% CI: -10.4, -7.5) points between intervention and control groups in change in HHIE-S score from baseline to 6 months, -9.3 (95% CI: -10.8, -7.9) to Year 1, -8.4 (95% CI: -9.8, -6.9) to Year 2, and - 9.5 (95% CI: -11.0, -8.0) to Year 3. Other prespecified sensitivity analyses that varied analytical parameters did not change the observed results.CONCLUSIONSHearing intervention improved self-reported communicative function compared to a control intervention within 6 months and with effects sustained through 3 years. These findings suggest that clinical recommendations for older adults with hearing loss should encourage hearing intervention that could benefit communicative function and potentially have positive downstream effects on other aspects of health.
背景老龄化与认知健康评估(ACHIEVE)研究旨在确定最佳听力干预对社区老年人认知能力下降的影响。在此,我们对 ACHIEVE 研究进行了二次分析,以调查听力干预对自我报告的交流功能的影响。方法ACHIEVE 研究是一项平行组、无掩蔽、随机对照试验,研究对象为 70-84 岁、患有轻度至中度听力损失且未接受治疗、无严重认知障碍的成年人。参与者被随机分配(1:1)到听力干预(听力咨询和提供助听器)或健康教育对照干预(由健康教育专家提供有关慢性疾病预防主题的个人课程)中,每半年进行一次跟踪,为期 3 年。听力障碍清单-老年人筛查版(HHIE-S,范围为 0-40,分数越高表示听力障碍越严重)对自我报告的交流功能进行了测量。通过意向治疗模型分析了听力干预与对照组相比对 HHIE-S 的影响,并控制了已知的协变量。结果与对照组相比,听力干预 6 个月后 HHIE-S 有所改善,并在 3 年的随访中持续改善。我们估计干预组和对照组的 HHIE-S 分数从基线到 6 个月的变化差异为 -8.9 (95% CI: -10.4, -7.5) 分,到第一年为 -9.3 (95% CI: -10.8, -7.9)分,到第二年为 -8.4 (95% CI: -9.8, -6.9)分,到第三年为 -9.5 (95% CI: -11.0, -8.0)分。结论与对照干预相比,听力干预能在 6 个月内改善自我报告的交流功能,且效果可持续 3 年。这些研究结果表明,针对听力损失老年人的临床建议应鼓励进行听力干预,这将有益于沟通功能,并可能对其他方面的健康产生积极的下游影响。
{"title":"Effect of hearing intervention on communicative function: A secondary analysis of the ACHIEVE randomized controlled trial.","authors":"Victoria A Sanchez,Michelle L Arnold,Emmanuel E Garcia Morales,Nicholas S Reed,Sarah Faucette,Sheila Burgard,Haley N Calloway,Josef Coresh,Jennifer A Deal,Adele M Goman,Lisa Gravens-Mueller,Kathleen M Hayden,Alison R Huang,Christine M Mitchell,Thomas H Mosley,James S Pankow,James R Pike,Jennifer A Schrack,Laura Sherry,Jacqueline M Weycker,Frank R Lin,Theresa H Chisolm,","doi":"10.1111/jgs.19185","DOIUrl":"https://doi.org/10.1111/jgs.19185","url":null,"abstract":"BACKGROUNDThe Aging and Cognitive Health Evaluation in Elders (ACHIEVE) Study was designed to determine the effects of a best-practice hearing intervention on cognitive decline among community-dwelling older adults. Here, we conducted a secondary analysis of the ACHIEVE Study to investigate the effect of hearing intervention on self-reported communicative function.METHODSThe ACHIEVE Study is a parallel-group, unmasked, randomized controlled trial of adults aged 70-84 years with untreated mild-to-moderate hearing loss and without substantial cognitive impairment. Participants were randomly assigned (1:1) to a hearing intervention (audiological counseling and provision of hearing aids) or a control intervention of health education (individual sessions with a health educator covering topics on chronic disease prevention) and followed semiannually for 3 years. Self-reported communicative function was measured with the Hearing Handicap Inventory-Elderly Screening version (HHIE-S, range 0-40, higher scores indicate greater impairment). Effect of hearing intervention versus control on HHIE-S was analyzed through an intention-to-treat model controlling for known covariates.RESULTSHHIE-S improved after 6-months with hearing intervention compared to control, and continued to be better through 3-year follow-up. We estimated a difference of -8.9 (95% CI: -10.4, -7.5) points between intervention and control groups in change in HHIE-S score from baseline to 6 months, -9.3 (95% CI: -10.8, -7.9) to Year 1, -8.4 (95% CI: -9.8, -6.9) to Year 2, and - 9.5 (95% CI: -11.0, -8.0) to Year 3. Other prespecified sensitivity analyses that varied analytical parameters did not change the observed results.CONCLUSIONSHearing intervention improved self-reported communicative function compared to a control intervention within 6 months and with effects sustained through 3 years. These findings suggest that clinical recommendations for older adults with hearing loss should encourage hearing intervention that could benefit communicative function and potentially have positive downstream effects on other aspects of health.","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"9 1","pages":""},"PeriodicalIF":6.3,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142252189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Differences in opioid prescriptions by race among U.S. older adults with a hip fracture transitioning to community care 美国髋部骨折老年人过渡到社区护理时阿片类药物处方的种族差异
IF 6.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-11 DOI: 10.1111/jgs.19160
Kaleen N. Hayes, Meghan A. Cupp, Richa Joshi, Melissa R. Riester, Francesca L. Beaudoin, Andrew R. Zullo
BackgroundAppropriate pain management can facilitate rehabilitation after a hip fracture as patients transition back to the community setting. Differences in opioid prescribing by race may exist during this critical transition period.MethodsWe conducted a retrospective cohort study of older adult U.S. Medicare beneficiaries with a hip fracture to examine whether the receipt and dose of opioids differs between Black and White patients as they transitioned back to the community setting. We stratified beneficiaries by whether they received institutional post‐acute care (PAC). Outcomes were (1) receipt of an opioid and (2) opioid doses in the first 90 days in the community in milligram morphine equivalents (MMEs; also presented in mg oxycodone). We estimated relative rates and risk differences of opioid receipt and dose differences using Poisson and linear regression models, respectively, using the parametric g‐formula to standardize for age and sex.ResultsWe identified 164,170 older adults with hip fracture (mean age = 82.7 years; 75% female; 72% with PAC; 46% with opioid use after fracture). Overall use of opioids in the community was similar between Black and white beneficiaries. Black beneficiaries had lower average doses in their first 90 days in both total cumulative doses (PAC group: 165 [95% CI −264 to −69] fewer MMEs [−248 mg oxycodone]; no PAC: 167 [95% CI −274 to −62] fewer MMEs [−251 mg oxycodone]) and average MME per days' supply of medication (PAC: −3.0 [−4.6 to −1.4] fewer MMEs per day [−4.5 mg oxycodone]; no PAC: −4.7 [−4.6 to −1.4] fewer MMEs per day [−7.1 mg oxycodone]). In secondary analyses, Asian beneficiaries experienced the greatest differences (e.g., 617–653 fewer cumulative mg oxycodone).ConclusionRacial differences exist in pain management for Medicare beneficiaries after a hip fracture. Future work should examine whether these differences result in disparities in short‐ and long‐term health outcomes.
背景髋部骨折后,当患者重返社区环境时,适当的疼痛管理可促进康复。我们对髋部骨折的美国老年医疗保险受益人进行了一项回顾性队列研究,以考察黑人和白人患者在重返社区的过程中接受阿片类药物治疗的情况和剂量是否存在差异。我们根据受益人是否接受机构性急性期后护理 (PAC) 对他们进行了分层。结果包括:(1)接受阿片类药物治疗;(2)在社区的前 90 天内阿片类药物的剂量(以毫克吗啡当量(MMEs)为单位;也以毫克羟考酮(mg oxycodone)为单位)。我们使用泊松模型和线性回归模型分别估算了接受阿片类药物的相对比率和风险差异以及剂量差异,并使用参数 g 公式对年龄和性别进行了标准化处理。结果我们确定了 164170 名髋部骨折的老年人(平均年龄 = 82.7 岁;75% 为女性;72% 患有 PAC;46% 在骨折后使用过阿片类药物)。黑人和白人受益人在社区使用阿片类药物的总体情况相似。黑人受益人在最初 90 天内的平均总累积剂量较低(PAC 组:165 [95% CI -0.5 -0.6减少 165 [95% CI -264 至 -69]个 MME [-248 毫克羟考酮];无 PAC 组:减少 167 [95% CI -264 至 -69] 个 MME [-248 毫克羟考酮]:167[95%CI-274至-62]次[-251毫克羟考酮])和每日均用药量(PAC:-每天减少 3.0 [-4.6 至 -1.4] 次[-4.5 毫克羟考酮];无 PAC:-无 PAC:每天减少 4.7 [-4.6 至 -1.4] 个 MME [-7.1 毫克羟考酮])。在二次分析中,亚裔受益人的差异最大(例如,累计减少 617-653 毫克羟考酮)。未来的工作应研究这些差异是否会导致短期和长期健康结果的差异。
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引用次数: 0
Recurrent pericarditis in older adults: Clinical and laboratory features and outcome 老年人复发性心包炎:临床和实验室特征及预后
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-09 DOI: 10.1111/jgs.19150
Emanuele Bizzi MD, Francesco Cavaleri MD, Ruggiero Mascolo MD, Edoardo Conte MD, Stefano Maggiolini MD, Caterina Chiara Decarlini MD, Silvia Maestroni MD, Valentino Collini MD, Ludovico Luca Sicignano MD, Elena Verrecchia MD, Raffaele Manna MD, Massimo Pancrazi MD, Lucia Trotta MD, Giuseppe Lopalco MD, Danilo Malandrino MD, Giada Pallini MD, Sara Catenazzi MD, Luisa Carrozzo MD, Giacomo Emmi MD, George Lazaros MD, Antonio Brucato MD, Massimo Imazio MD
<div> <section> <h3> Background</h3> <p>Current guidelines for the diagnosis and treatment of pericarditis refer to the general adult population. Few and fragmentary data regarding recurrent pericarditis in older adults exist.</p> </section> <section> <h3> Objective of the Study</h3> <p>Given the absence of specific data in scientific literature, we hypothesized that there might be clinical, laboratory and outcome differences between young adults and older adults affected by idiopathic recurrent pericarditis.</p> </section> <section> <h3> Materials and Methods</h3> <p>We performed an international multicentric retrospective cohort study analyzing data from patients affected by recurrent pericarditis (idiopathic or post-cardiac injury) and referring to tertiary referral centers. Clinical, laboratory, and outcome data were compared between patients younger than 65 years (controls) and patients aged 65 or older.</p> </section> <section> <h3> Results</h3> <p>One hundred and thirty-three older adults and 142 young adult controls were enrolled. Comorbidities, including chronic kidney diseases, atrial fibrillation, and diabetes, were more present in older adults. The presenting symptom was dyspnea in 54.1% of the older adults versus 10.6% in controls (<i>p</i> < 0.001); pain in 32.3% of the older adults versus 80.3% of the controls (<i>p</i> < 0.001). Fever higher than 38°C was present in 33.8% versus 53.5% (<i>p</i> = 0.001). Pleural effusion was more prevalent in the older adults (55.6% vs 34.5%, <i>p</i> < 0.001), as well as severe pericardial effusion (>20 mm) (24.1% vs 12.7%, <i>p</i> = 0.016) and pericardiocentesis (16.5% vs 8.5%, <i>p</i> = 0.042). Blood leukocyte counts were significantly lower in the older adults (mean + SE: 10,227 + 289/mm<sup>3</sup> vs 11,208 + 285/mm<sup>3</sup>, <i>p</i> = 0.016). Concerning therapies, NSAIDS were used in 63.9% of the older adults versus 80.3% in the younger (<i>p</i> = 0.003), colchicine in 76.7% versus 87.3% (<i>p</i> = 0.023), corticosteroids in 49.6% versus 26.8% (<i>p</i> < 0.001), and anakinra in 14.3% versus 23.9% (<i>p</i> = 0.044).</p> </section> <section> <h3> Conclusions</h3> <p>Older adults affected by recurrent pericarditis show a different clinical pattern, with more frequent dyspnea, pleural effusion, severe pericardial effusion, and lower fever and lower leukocyte count, making the diagnosis sometimes challenging. They received significantly less NSAIDs and colchicine, likely d
背景:目前的心包炎诊断和治疗指南针对的是普通成年人。有关老年人复发性心包炎的数据极少且零散:鉴于科学文献中缺乏具体数据,我们假设特发性复发性心包炎患者中的年轻人和老年人在临床、实验室和治疗效果方面可能存在差异:我们进行了一项国际多中心回顾性队列研究,分析了受复发性心包炎(特发性或心脏损伤后)影响并转诊至三级转诊中心的患者的数据。对 65 岁以下患者(对照组)和 65 岁或以上患者的临床、实验室和结果数据进行了比较:结果:133 名老年人和 142 名年轻成人对照组参加了研究。老年人合并症较多,包括慢性肾病、心房颤动和糖尿病。出现呼吸困难症状的老年人占 54.1%,而对照组为 10.6%(P 20 毫米)(24.1% 对 12.7%,P = 0.016),出现心包穿刺症状的老年人占 16.5%,而对照组为 8.5%,P = 0.042)。老年人的血白细胞计数明显较低(平均值 + SE:10227 + 289/mm3 vs 11208 + 285/mm3,p = 0.016)。在治疗方法方面,63.9%的老年人使用非甾体抗炎药,而年轻人则为80.3%(P = 0.003);76.7%的老年人使用秋水仙碱,而年轻人则为87.3%(P = 0.023);49.6%的老年人使用皮质类固醇,而年轻人则为26.8%(P 结论:非甾体抗炎药和秋水仙碱在老年人中的使用率均高于年轻人:受复发性心包炎影响的老年人表现出不同的临床模式,更频繁地出现呼吸困难、胸腔积液、严重心包积液,发热更低,白细胞计数更低,因此诊断有时具有挑战性。他们接受非甾体抗炎药和秋水仙碱治疗的次数明显较少,这可能是由于合并症所致;他们接受抗IL1药物治疗的次数也较少,而接受皮质类固醇治疗的次数较多。
{"title":"Recurrent pericarditis in older adults: Clinical and laboratory features and outcome","authors":"Emanuele Bizzi MD,&nbsp;Francesco Cavaleri MD,&nbsp;Ruggiero Mascolo MD,&nbsp;Edoardo Conte MD,&nbsp;Stefano Maggiolini MD,&nbsp;Caterina Chiara Decarlini MD,&nbsp;Silvia Maestroni MD,&nbsp;Valentino Collini MD,&nbsp;Ludovico Luca Sicignano MD,&nbsp;Elena Verrecchia MD,&nbsp;Raffaele Manna MD,&nbsp;Massimo Pancrazi MD,&nbsp;Lucia Trotta MD,&nbsp;Giuseppe Lopalco MD,&nbsp;Danilo Malandrino MD,&nbsp;Giada Pallini MD,&nbsp;Sara Catenazzi MD,&nbsp;Luisa Carrozzo MD,&nbsp;Giacomo Emmi MD,&nbsp;George Lazaros MD,&nbsp;Antonio Brucato MD,&nbsp;Massimo Imazio MD","doi":"10.1111/jgs.19150","DOIUrl":"10.1111/jgs.19150","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Current guidelines for the diagnosis and treatment of pericarditis refer to the general adult population. Few and fragmentary data regarding recurrent pericarditis in older adults exist.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective of the Study&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Given the absence of specific data in scientific literature, we hypothesized that there might be clinical, laboratory and outcome differences between young adults and older adults affected by idiopathic recurrent pericarditis.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Materials and Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We performed an international multicentric retrospective cohort study analyzing data from patients affected by recurrent pericarditis (idiopathic or post-cardiac injury) and referring to tertiary referral centers. Clinical, laboratory, and outcome data were compared between patients younger than 65 years (controls) and patients aged 65 or older.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;One hundred and thirty-three older adults and 142 young adult controls were enrolled. Comorbidities, including chronic kidney diseases, atrial fibrillation, and diabetes, were more present in older adults. The presenting symptom was dyspnea in 54.1% of the older adults versus 10.6% in controls (&lt;i&gt;p&lt;/i&gt; &lt; 0.001); pain in 32.3% of the older adults versus 80.3% of the controls (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). Fever higher than 38°C was present in 33.8% versus 53.5% (&lt;i&gt;p&lt;/i&gt; = 0.001). Pleural effusion was more prevalent in the older adults (55.6% vs 34.5%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), as well as severe pericardial effusion (&gt;20 mm) (24.1% vs 12.7%, &lt;i&gt;p&lt;/i&gt; = 0.016) and pericardiocentesis (16.5% vs 8.5%, &lt;i&gt;p&lt;/i&gt; = 0.042). Blood leukocyte counts were significantly lower in the older adults (mean + SE: 10,227 + 289/mm&lt;sup&gt;3&lt;/sup&gt; vs 11,208 + 285/mm&lt;sup&gt;3&lt;/sup&gt;, &lt;i&gt;p&lt;/i&gt; = 0.016). Concerning therapies, NSAIDS were used in 63.9% of the older adults versus 80.3% in the younger (&lt;i&gt;p&lt;/i&gt; = 0.003), colchicine in 76.7% versus 87.3% (&lt;i&gt;p&lt;/i&gt; = 0.023), corticosteroids in 49.6% versus 26.8% (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), and anakinra in 14.3% versus 23.9% (&lt;i&gt;p&lt;/i&gt; = 0.044).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Older adults affected by recurrent pericarditis show a different clinical pattern, with more frequent dyspnea, pleural effusion, severe pericardial effusion, and lower fever and lower leukocyte count, making the diagnosis sometimes challenging. They received significantly less NSAIDs and colchicine, likely d","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3467-3475"},"PeriodicalIF":4.3,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19150","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142157066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The cost of potentially inappropriate medications for older adults in Canada: A comparative cross-sectional study 加拿大老年人潜在不当用药的成本:横断面比较研究。
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-05 DOI: 10.1111/jgs.19164
Jean-François Huon PharmD, PhD, Chiranjeev Sanyal PhD, Camille L. Gagnon PharmD, MSc, Justin P. Turner PhD, Ninh B. Khuong MSc, Émilie Bortolussi-Courval RN, PhD Student, Todd C. Lee MD, MPH, James L. Silvius MD, Steven G. Morgan PhD, Emily G. McDonald MD, MSc

Background

Potentially inappropriate medications (PIMs) are medications whereby the harms may outweigh the benefits for a given individual. Although overprescribed to older adults, their direct costs on the healthcare system are poorly described.

Methods

This was a cross-sectional study of the cost of PIMs for Canadians aged 65 and older, using adapted criteria from the American Geriatrics Society. We examined prescription claims information from the National Prescription Drug Utilization Information System in 2021 and compared these with 2013. The overall levels of inflation-adjusted total annual expenditure on PIMs, average cost per quarterly exposure, and average quarterly exposures to PIMs were calculated in CAD$.

Results

Exposure to most categories of PIMs decreased, aside from gabapentinoids, proton pump inhibitors, and antipsychotics, all of which increased. Canadians spent $1 billion on PIMs in 2021, a 33.6% reduction compared with 2013 ($1.5 billion). In 2021, the largest annual expenditures were on proton pump inhibitors ($211 million) and gabapentinoids ($126 million). The quarterly amount spent on PIMs per person exposed decreased from $95 to $57. In terms of mean cost per person, opioids and antipsychotics were highest ($138 and $118 per exposure). Some cost savings may have occurred secondary to an observed decline of 16.4% in the quarterly rate of exposure to PIMs (from 7301 per 10,000 in 2013 to 6106 per 10,000 in 2021).

Conclusions

While expenditures on PIMs have declined in Canada, the overall cost remains high. Prescribing of some seriously harmful classes of PIMs has increased and so directed, scalable interventions are needed.

背景:潜在不适当药物(PIMs)是指对特定个体而言弊大于利的药物。虽然老年人用药过多,但其对医疗系统造成的直接成本却很少被描述:这是一项关于 65 岁及以上加拿大人 PIMs 成本的横断面研究,采用的是美国老年医学会改编的标准。我们研究了 2021 年国家处方药使用信息系统(National Prescription Drug Utilization Information System)中的处方报销信息,并将其与 2013 年进行了比较。我们以加元为单位计算了经通胀调整后的 PIMs 年度总支出水平、每季度接触 PIMs 的平均成本以及每季度接触 PIMs 的平均次数:除了加巴喷丁类药物、质子泵抑制剂和抗精神病药物的使用量有所上升外,大多数类别的 PIMs 使用量都有所下降。2021 年加拿大人在 PIMs 上的花费为 10 亿美元,与 2013 年(15 亿美元)相比减少了 33.6%。2021 年,质子泵抑制剂(2.11 亿美元)和加巴喷丁类药物(1.26 亿美元)的年度支出最大。就人均成本而言,阿片类药物和抗精神病药物的人均成本最高(每次暴露 138 美元和 118 美元)。据观察,每季度接触 PIMs 的比例下降了 16.4%(从 2013 年的每 10,000 人 7301 例降至 2021 年的每 10,000 人 6106 例),因此可能节省了一些成本:虽然加拿大的 PIMs 支出有所下降,但总体成本仍然很高。一些严重有害的PIMs类药物的处方量有所增加,因此需要采取定向、可扩展的干预措施。
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引用次数: 0
Cover 封面
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-02 DOI: 10.1111/jgs.17869
Kathleen T. Unroe MD, MHA, MS, Debra Saliba MD, MPH, AGSF, Susan E. Hickman PhD, Sheryl Zimmerman PhD, Cari Levy MD, PhD, Jerry Gurwitz MD

Cover caption: Key elements for successful nursing home clinical trials. See the related article by Unroe et al., pages 2951–2956.

封面标题:疗养院临床试验成功的关键因素。参见 Unroe 等人的相关文章,第 2951-2956 页。
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引用次数: 0
Identifying priority challenges of older adults with COPD: A multiphase intervention refinement study 识别患有慢性阻塞性肺病的老年人面临的首要挑战:多阶段干预改进研究。
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-08-31 DOI: 10.1111/jgs.19158
Anand S. Iyer MD, MSPH, Rachel D. Wells PhD, MSN, RN, Avery C. Bechthold PhD, BSN, RN, Margaret Armstrong MSN, MEd, RN, Ronan O'Beirne EdD, Jun Y. Byun PhD, MSN, Jazmine Coffee-Dunning MA, Ed, J. Nicholas Odom PhD, RN, Russell G. Buhr MD, PhD, Angela O. Suen MD, Ashwin A. Kotwal MD, MS, Leah J. Witt MD, Cynthia J. Brown MD, MSPH, Mark T. Dransfield MD, Marie A. Bakitas DNSc, NP-C
<div> <section> <h3> Background</h3> <p>Identifying priority challenges of older adults with chronic obstructive pulmonary disease (COPD) is critical to designing interventions aimed at improving their well-being and independence.</p> </section> <section> <h3> Objective</h3> <p>To prioritize challenges of older adults with COPD and those who care for them to guide refinement of a telephonic nurse coach intervention for patients with COPD and their family caregivers (EPIC: <span>E</span>mpowering <span>P</span>eople to <span>I</span>ndependence in <span>C</span>OPD).</p> </section> <section> <h3> Design</h3> <p>Multiphase study guided by Baltes Theory of Successful Aging and the 5Ms Framework: <i>Phase 1</i>: Nominal group technique (NGT), a structured process of prioritizing responses to a question through group consensus. <i>Phase 2</i>: Rapid qualitative analysis. <i>Phase 3</i>: Intervention mapping and refinement.</p> </section> <section> <h3> Setting</h3> <p>Ambulatory, virtual.</p> </section> <section> <h3> Participants</h3> <p>Older adults with COPD, family caregivers, clinic staff (nurses, respiratory therapists), clinicians (physicians, nurse practitioners), and health system leaders.</p> </section> <section> <h3> Results</h3> <p>NGT sessions were conducted by constituency group with 37 participants (<i>n</i> = 7 patients, <i>n</i> = 6 family caregivers, <i>n</i> = 8 clinic staff, <i>n</i> = 9 clinicians, <i>n</i> = 7 health system leaders) (<i>Phase 1</i>). Participants generated 92 statements across five themes (<i>Phase 2</i>): (1) “Barriers to care”, (2) “Family caregiver needs”, (3) “Functional status and mobility issues”, (4) “Illness understanding”, and (5) “COPD care complexities”. Supplemental oxygen challenges emerged as a critical problem, and prioritized challenges differed by group. Patients and clinic staff prioritized “Functional status and mobility issues”, family caregivers prioritized “Family caregiver needs”, and clinicians and health system leaders prioritized “COPD care complexities”. Intervention mapping (<i>Phase 3</i>) guided EPIC refinement focused on meeting patient priorities of independence and mobility but accounting for all priorities.</p> </section> <section> <h3> Conclusions</h3> <p>Diverse constituency groups identified priority challenges for older adults with COPD. Functional status and mobility issues, particularly related to supplemental oxygen, e
背景:确定患有慢性阻塞性肺病(COPD)的老年人面临的主要挑战,对于设计旨在改善其福祉和独立性的干预措施至关重要:确定慢性阻塞性肺病(COPD)老年人及其护理者所面临挑战的优先次序,以指导完善针对慢性阻塞性肺病(COPD)患者及其家庭护理者的电话护士指导干预措施(EPIC:增强慢性阻塞性肺病(COPD)患者的独立性):设计:以 Baltes 成功老龄化理论和 5Ms 框架为指导的多阶段研究:第 1 阶段:名义小组技术(NGT),这是一种通过小组共识对问题的回答进行优先排序的结构化过程。第 2 阶段:快速定性分析。第 3 阶段:制定和完善干预措施:流动、虚拟:参与者:患有慢性阻塞性肺病的老年人、家庭护理人员、诊所工作人员(护士、呼吸治疗师)、临床医生(内科医生、执业护士)和医疗系统领导:37 名参与者(患者 7 人、家庭护理人员 6 人、诊所员工 8 人、临床医生 9 人、医疗系统领导 7 人)参加了按选区分组进行的 NGT 会议(第 1 阶段)。参与者提出了 92 项声明,涉及五个主题(第 2 阶段):(1) "护理障碍",(2) "家庭照顾者的需求",(3) "功能状态和行动问题",(4) "对疾病的理解",以及 (5) "COPD 护理的复杂性"。补充氧气方面的挑战是一个关键问题,不同组别优先考虑的挑战有所不同。患者和诊所工作人员优先考虑 "功能状态和行动问题",家庭护理人员优先考虑 "家庭护理人员需求",而临床医生和医疗系统领导则优先考虑 "慢性阻塞性肺病护理的复杂性"。干预规划(第 3 阶段)指导 EPIC 的改进,重点是满足患者在独立性和行动能力方面的优先需求,但也考虑到所有优先需求:不同的支持群体确定了患有慢性阻塞性肺病的老年人所面临的主要挑战。功能状态和行动能力问题,尤其是与补充氧气有关的问题,成为患者优先考虑的挑战:对患有慢性阻塞性肺病的老年人采取以患者为中心的干预措施时,必须考虑到他们优先考虑的功能和补氧需求,并探索不同群体的观点,以促进干预措施的丰富化。
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引用次数: 0
Qualitative evaluation of the SHARING Choices trial of primary care advance care planning for adults with and without dementia 对 "分享选择"(SHARING Choices)试验的定性评估。
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-08-30 DOI: 10.1111/jgs.19154
Sydney M. Dy MD, Daniel L. Scerpella MPH, Valecia Hanna MS, Kathryn A. Walker PharmD, Danetta H. Sloan PhD, Chase Mulholland Green MPH, Valerie Cotter PhD, Jennifer L. Wolff PhD, Erin Rand Giovannetti PhD, Maura McGuire MD, Naaz Hussain MD, Kelly M. Smith PhD, Martha Abshire Saylor PhD

Background

Primary care can be an important setting for communication and advance care planning (ACP), including for those with dementia and their families. The study objective was to explore experiences with a pragmatic trial of a communication and ACP intervention, SHARING Choices, in primary care for older adults with and without dementia.

Methods

We conducted qualitative interviews using tailored semi-structured guides with three groups: ACP facilitators who conducted the intervention; clinicians, managers, and administrators from sites randomized to the intervention; and patients and families who met with ACP facilitators. We used thematic analysis to identify and synthesize emergent themes based on key Consolidated Framework for Implementation Research concepts and Proctor's Implementation Outcomes, triangulating the three groups' perspectives.

Results

We identified five key themes. For acceptability, perceptions of the intervention were mostly positive, although some components were not generally implemented. For adoption, respondents perceived that ACP facilitators mainly focused on conducting ACP, although facilitators often did not implement the ADRD and family engagement aspects with the ACP. For relational connections, ACP facilitator—practice and clinician communication and engagement were key to how the intervention was implemented. For adaptability, ACP facilitators and health systems adapted how the ACP facilitation component was implemented to local preferences and over time, given the pragmatic nature of the trial. And, for sustainability, ACP facilitators and clinicians/managers/facilitators were positive that the intervention should be continued but noted barriers to its sustainability. Patients and families generally did not recall the intervention.

Conclusions

ACP facilitators and clinicians, managers, and administrators had positive perceptions of the ACP facilitator component of the intervention in this pragmatic trial with adaptation to local preferences. However, engaging those with dementia and families was more challenging in the implementation of this intervention.

背景:初级保健是进行沟通和预先护理计划(ACP)的重要场所,包括对痴呆症患者及其家属而言。本研究的目的是探讨在初级保健中为患有或未患有痴呆症的老年人提供沟通和预先护理计划干预--"分享选择"(SHARING Choices)--的实用性试验的经验:我们使用定制的半结构化指南对三组人进行了定性访谈:方法: 我们使用定制的半结构式指南对三组人进行了定性访谈:进行干预的 ACP 促进者;随机参与干预的临床医生、经理和管理人员;与 ACP 促进者会面的患者和家属。我们采用主题分析法,根据实施研究综合框架的关键概念和 Proctor 的实施结果,确定并归纳出新出现的主题,对三组人的观点进行三角测量:我们确定了五个关键主题。在可接受性方面,受访者对干预措施的看法大多是积极的,尽管有些内容并未得到普遍实施。在采纳性方面,受访者认为 ACP 促进者主要专注于开展 ACP,但促进者往往没有在 ACP 中实施 ADRD 和家庭参与方面的内容。在关系连接方面,ACP 促进者与临床医生的沟通和参与是干预措施实施的关键。在适应性方面,考虑到试验的实用性,ACP 促进者和医疗系统根据当地的偏好和时间调整了 ACP 促进部分的实施方式。在可持续性方面,ACP 促进者和临床医生/管理者/促进者对继续开展干预措施持肯定态度,但也指出了其可持续性的障碍。患者和家属普遍不记得干预措施:在这项根据当地偏好进行调整的实用试验中,ACP 促进者和临床医生、经理及行政人员对干预措施中的 ACP 促进者部分有积极的看法。然而,让痴呆症患者和家属参与到干预措施的实施过程中更具挑战性。
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Journal of the American Geriatrics Society
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