Xin Li, Yichen Jin, Stefania Bandinelli, Luigi Ferrucci, Toshiko Tanaka, Sameera A. Talegawkar
BackgroundDementia poses considerable challenges to healthy aging. Prevention and management of dementia are essential given the lack of effective treatments for this condition.MethodsA secondary data analysis was conducted using data from 928 InCHIANTI study participants (55% female) aged 65 years and older without dementia at baseline. Cardiovascular health (CVH) was assessed by the “Life's Essential 8” (LE8) metric that included health behaviors (diet, physical activity, smoking status, sleep duration) and health factors (body mass index, blood lipid, blood glucose, blood pressure). This new LE8 metric scores from 0 to 100, with categorization including “low LE8” (0–49), indicating low CVH, “moderate LE8 (50‐79)”, indicating moderate CVH, and “high LE8 (80‐100)”, indicating high CVH. Dementia was ascertained by a combination of neuropsychological testing and clinical assessment at each follow‐up visit. Cox proportional hazards models were used to examine associations between CVH at baseline and risk of incident dementia after a median follow‐up of 14 years.ResultsBetter CVH (moderate/high LE8 vs. low LE8) was inversely associated with the risk of incident dementia (hazard ratio [HR]: 0.61, 95% confidence interval [CI]: 0.46–0.83, p = 0.001). Compared with health factors, higher scores of the health behaviors (per 1 standard deviation [SD]), specifically weekly moderate‐to‐vigorous physical activity time (per 1 SD), were significantly associated with a lower risk of incident dementia (health behaviors: HR:0.84, CI:0.73–0.96, p = 0.01; physical activity: HR: 0.62, CI: 0.53–0.72, p < 0.001).ConclusionWhile longitudinal studies with repeated measures of CVH are needed to confirm these findings, improving CVH, measured by the LE8 metric, may be a promising dementia prevention strategy.
{"title":"Cardiovascular health, measured using Life's Essential 8, is associated with reduced dementia risk among older men and women","authors":"Xin Li, Yichen Jin, Stefania Bandinelli, Luigi Ferrucci, Toshiko Tanaka, Sameera A. Talegawkar","doi":"10.1111/jgs.19194","DOIUrl":"https://doi.org/10.1111/jgs.19194","url":null,"abstract":"BackgroundDementia poses considerable challenges to healthy aging. Prevention and management of dementia are essential given the lack of effective treatments for this condition.MethodsA secondary data analysis was conducted using data from 928 InCHIANTI study participants (55% female) aged 65 years and older without dementia at baseline. Cardiovascular health (CVH) was assessed by the “Life's Essential 8” (LE8) metric that included health behaviors (diet, physical activity, smoking status, sleep duration) and health factors (body mass index, blood lipid, blood glucose, blood pressure). This new LE8 metric scores from 0 to 100, with categorization including “low LE8” (0–49), indicating low CVH, “moderate LE8 (50‐79)”, indicating moderate CVH, and “high LE8 (80‐100)”, indicating high CVH. Dementia was ascertained by a combination of neuropsychological testing and clinical assessment at each follow‐up visit. Cox proportional hazards models were used to examine associations between CVH at baseline and risk of incident dementia after a median follow‐up of 14 years.ResultsBetter CVH (moderate/high LE8 vs. low LE8) was inversely associated with the risk of incident dementia (hazard ratio [HR]: 0.61, 95% confidence interval [CI]: 0.46–0.83, <jats:italic>p</jats:italic> = 0.001). Compared with health factors, higher scores of the health behaviors (per 1 standard deviation [SD]), specifically weekly moderate‐to‐vigorous physical activity time (per 1 SD), were significantly associated with a lower risk of incident dementia (health behaviors: HR:0.84, CI:0.73–0.96, <jats:italic>p</jats:italic> = 0.01; physical activity: HR: 0.62, CI: 0.53–0.72, <jats:italic>p</jats:italic> < 0.001).ConclusionWhile longitudinal studies with repeated measures of CVH are needed to confirm these findings, improving CVH, measured by the LE8 metric, may be a promising dementia prevention strategy.","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"65 1","pages":""},"PeriodicalIF":6.3,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142251625","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}
Jennifer Perloff, Alex Hoyt, Meera Srinivasan, Michelle Alvarez, Sam Sobul, Monica O'Reilly‐Jacob
BackgroundAs the US population ages, there is an increasing demand for home‐based primary care (HBPC) by those with Alzheimer's/dementia, multiple chronic conditions, severe physical limitations, or those facing end‐of life. Nurse practitioners (NPs) are increasingly providing HBPC, yet little is known about their quality of care in this unique setting.MethodsThis observational study uses Medicare claims data from 2018 to assess the quality of care for high‐intensity HBPC users (5 or more visits/year) based on provider type (NP‐only, physician (MD)‐only, or both NP and MDs). We employ 12 quality measures from 3 care domains: access and prevention, acute care utilization, and end‐of‐life. Analysis includes bivariate comparisons and logistic regression models that adjust for demographic, clinical, and geographic characteristics.ResultsAmong the 574,567 beneficiaries with 5 or more HBPC visits, 37% saw an NP, 37% saw a MD, and 27% saw both NPs and MDs. In multivariate models, those receiving HBPC from an NP or both NP‐MD are significantly more likely to receive a flu shot than the MD‐only group, but less likely to access preventive care. NP‐only care is associated with more acute care hospitalizations, avoidable ED visits, and fall‐related injuries, but significantly fewer avoidable admissions. For end‐of‐life care, those with NP‐only or both NP‐MD care are significantly more likely to have an advanced directive, be in hospice in the last 3 days of life, and more likely to die in hospice. The NP group is also more likely to die in the next year.ConclusionsHBPC patients are complex, with both palliative and curative needs. NPs provide almost half of HBPC in the Medicare program, to patients who are possibly sicker than those treated by physicians, with similar quality to MDs.
{"title":"The quality of home‐based primary care delivered by nurse practitioners: A national Medicare claims analysis","authors":"Jennifer Perloff, Alex Hoyt, Meera Srinivasan, Michelle Alvarez, Sam Sobul, Monica O'Reilly‐Jacob","doi":"10.1111/jgs.19182","DOIUrl":"https://doi.org/10.1111/jgs.19182","url":null,"abstract":"BackgroundAs the US population ages, there is an increasing demand for home‐based primary care (HBPC) by those with Alzheimer's/dementia, multiple chronic conditions, severe physical limitations, or those facing end‐of life. Nurse practitioners (NPs) are increasingly providing HBPC, yet little is known about their quality of care in this unique setting.MethodsThis observational study uses Medicare claims data from 2018 to assess the quality of care for high‐intensity HBPC users (5 or more visits/year) based on provider type (NP‐only, physician (MD)‐only, or both NP and MDs). We employ 12 quality measures from 3 care domains: access and prevention, acute care utilization, and end‐of‐life. Analysis includes bivariate comparisons and logistic regression models that adjust for demographic, clinical, and geographic characteristics.ResultsAmong the 574,567 beneficiaries with 5 or more HBPC visits, 37% saw an NP, 37% saw a MD, and 27% saw both NPs and MDs. In multivariate models, those receiving HBPC from an NP or both NP‐MD are significantly more likely to receive a flu shot than the MD‐only group, but less likely to access preventive care. NP‐only care is associated with more acute care hospitalizations, avoidable ED visits, and fall‐related injuries, but significantly fewer avoidable admissions. For end‐of‐life care, those with NP‐only or both NP‐MD care are significantly more likely to have an advanced directive, be in hospice in the last 3 days of life, and more likely to die in hospice. The NP group is also more likely to die in the next year.ConclusionsHBPC patients are complex, with both palliative and curative needs. NPs provide almost half of HBPC in the Medicare program, to patients who are possibly sicker than those treated by physicians, with similar quality to MDs.","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"15 1","pages":""},"PeriodicalIF":6.3,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142251626","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}
{"title":"Home alone and high risk: Supporting medication management in older adults living alone with cognitive impairment","authors":"Peter M. Hoang, Nathan M. Stall, Paula A. Rochon","doi":"10.1111/jgs.19186","DOIUrl":"https://doi.org/10.1111/jgs.19186","url":null,"abstract":"See related article by <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" xlink:href=\"https://doi.org/10.1111/jgs.19108\">Growdon et al</jats:ext-link>.","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"3 1","pages":""},"PeriodicalIF":6.3,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142252188","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}
Lily N. Stalter MS, Bret M. Hanlon PhD, Kyle J. Bushaw MA, Taylor Bradley BS, Anne Buffington MPH, Karlie Zychowski MD, Alex Dudek RN, BSN, Sarah I. Zaza MD, Melanie Fritz MD, Kristine Kwekkeboom PhD, RN, FAAN, Margaret L. Schwarze MD, MPP
<p>Overtreatment at the end of life contributes to poor quality of life, is often discordant with patient preferences, and strains healthcare systems.<span><sup>1, 2</sup></span> “Clinical momentum” is a conceptual model to describe the latent, systems-level forces that create an inevitable trajectory toward intervention near the end of life.<span><sup>3</sup></span> Feeding tube placement in patients with advanced dementia is a clear example of overtreatment at the end of life, given the associated harms and limited benefits.<span><sup>4</sup></span> This study builds on qualitative work describing the contribution of clinical momentum to feeding tube placement and aims to identify previously characterized markers of clinical momentum in the medical record.<span><sup>5</sup></span></p><p>We conducted a retrospective, single-center, matched case-control study. We used an Electronic Health Record (EHR) search to identify all hospitalized older adults (age ≥65) with a dementia diagnosis and activated healthcare agent during an unplanned admission of ≥3 days between January 2015 and December 2022. We confirmed patients' dementia diagnosis via chart review. The case group included patients who received a permanent feeding tube (i.e., Gastrostomy, Gastrojejunostomy, or Jejunostomy tube). We 1-1 matched controls, patients who did not receive a permanent feeding tube, with cases based on age, sex, and admitting diagnosis. We excluded patients with a preexisting feeding tube. The University of Wisconsin institutional review board deemed this study exempt.</p><p>We abstracted data from one admission per patient, capturing controls' last encounter, using a standardized manual chart abstraction form, including hospital events (e.g., aspiration, consultations) identified in previous qualitative work.<span><sup>5</sup></span> We used Fisher's exact tests and <i>t</i>-tests to compare groups' baseline characteristics. We cataloged hospital trajectories and the frequency of event combinations leading to permanent feeding tube placement in the case group and death or discharge for the control group, displayed via UpSet Plot.<span><sup>6</sup></span> Analyses were performed in SAS software (version 9.4, SAS Institute Inc., Cary, North Carolina).</p><p>We identified 34 cases and 34 matched controls. The mean age (SD) was 80.2 (8.7), and 34 (50%) were male. Demographic characteristics were similar between groups (Table 1). Although not statistically significant, case patients had a lower mean Charlson comorbidity score (8.8 (3.6) vs. 10.3 (3.2), <i>p</i> = 0.082).</p><p>The median (interquartile range (IQR)) length of stay was 21.5 (15–43) days among cases and 5 (4–9) days among controls. At the median, feeding tubes were placed on day 15 (IQR 7–18) of admission. One case patient and three control patients died in the hospital. On average, patients in the case group experienced 9.0 (2.2) unique hospital events before feeding tube placement, while control patients e
{"title":"Clinical momentum in the care of older adults with advanced dementia: What evidence is there in the medical record?","authors":"Lily N. Stalter MS, Bret M. Hanlon PhD, Kyle J. Bushaw MA, Taylor Bradley BS, Anne Buffington MPH, Karlie Zychowski MD, Alex Dudek RN, BSN, Sarah I. Zaza MD, Melanie Fritz MD, Kristine Kwekkeboom PhD, RN, FAAN, Margaret L. Schwarze MD, MPP","doi":"10.1111/jgs.19192","DOIUrl":"10.1111/jgs.19192","url":null,"abstract":"<p>Overtreatment at the end of life contributes to poor quality of life, is often discordant with patient preferences, and strains healthcare systems.<span><sup>1, 2</sup></span> “Clinical momentum” is a conceptual model to describe the latent, systems-level forces that create an inevitable trajectory toward intervention near the end of life.<span><sup>3</sup></span> Feeding tube placement in patients with advanced dementia is a clear example of overtreatment at the end of life, given the associated harms and limited benefits.<span><sup>4</sup></span> This study builds on qualitative work describing the contribution of clinical momentum to feeding tube placement and aims to identify previously characterized markers of clinical momentum in the medical record.<span><sup>5</sup></span></p><p>We conducted a retrospective, single-center, matched case-control study. We used an Electronic Health Record (EHR) search to identify all hospitalized older adults (age ≥65) with a dementia diagnosis and activated healthcare agent during an unplanned admission of ≥3 days between January 2015 and December 2022. We confirmed patients' dementia diagnosis via chart review. The case group included patients who received a permanent feeding tube (i.e., Gastrostomy, Gastrojejunostomy, or Jejunostomy tube). We 1-1 matched controls, patients who did not receive a permanent feeding tube, with cases based on age, sex, and admitting diagnosis. We excluded patients with a preexisting feeding tube. The University of Wisconsin institutional review board deemed this study exempt.</p><p>We abstracted data from one admission per patient, capturing controls' last encounter, using a standardized manual chart abstraction form, including hospital events (e.g., aspiration, consultations) identified in previous qualitative work.<span><sup>5</sup></span> We used Fisher's exact tests and <i>t</i>-tests to compare groups' baseline characteristics. We cataloged hospital trajectories and the frequency of event combinations leading to permanent feeding tube placement in the case group and death or discharge for the control group, displayed via UpSet Plot.<span><sup>6</sup></span> Analyses were performed in SAS software (version 9.4, SAS Institute Inc., Cary, North Carolina).</p><p>We identified 34 cases and 34 matched controls. The mean age (SD) was 80.2 (8.7), and 34 (50%) were male. Demographic characteristics were similar between groups (Table 1). Although not statistically significant, case patients had a lower mean Charlson comorbidity score (8.8 (3.6) vs. 10.3 (3.2), <i>p</i> = 0.082).</p><p>The median (interquartile range (IQR)) length of stay was 21.5 (15–43) days among cases and 5 (4–9) days among controls. At the median, feeding tubes were placed on day 15 (IQR 7–18) of admission. One case patient and three control patients died in the hospital. On average, patients in the case group experienced 9.0 (2.2) unique hospital events before feeding tube placement, while control patients e","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"297-301"},"PeriodicalIF":4.3,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11734092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305004","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}
Kerry M. Sheets MD, MS, Allyson M. Kats MS, Howard A. Fink MD, MPH, Lisa Langsetmo PhD, Kristine Yaffe MD, Kristine E. Ensrud MD, MPH
Background
Life-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.
Methods
A 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.
Results
Compared 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).
Conclusions
Lower 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。
{"title":"Life-space mobility and cognition in community-dwelling late-life women: A cross-sectional analysis","authors":"Kerry M. Sheets MD, MS, Allyson M. Kats MS, Howard A. Fink MD, MPH, Lisa Langsetmo PhD, Kristine Yaffe MD, Kristine E. Ensrud MD, MPH","doi":"10.1111/jgs.19190","DOIUrl":"10.1111/jgs.19190","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Life-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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared 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).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Lower life-space mobility is associated in a graded manner with CI among community-dwelling White women in the 9th and 10th decades of life.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"206-213"},"PeriodicalIF":4.3,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19190","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142251627","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}
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。
{"title":"Association of left atrial function with frailty: The Atherosclerosis Risk in Communities (ARIC) study","authors":"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","doi":"10.1111/jgs.19187","DOIUrl":"https://doi.org/10.1111/jgs.19187","url":null,"abstract":"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.","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"15 1","pages":""},"PeriodicalIF":6.3,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142251629","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}
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.
{"title":"Implementation of delirium screening in the emergency department: A qualitative study with early adopters","authors":"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","doi":"10.1111/jgs.19188","DOIUrl":"https://doi.org/10.1111/jgs.19188","url":null,"abstract":"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.","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"7 1","pages":""},"PeriodicalIF":6.3,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142184909","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}
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.
{"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}
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.
{"title":"Differences in opioid prescriptions by race among U.S. older adults with a hip fracture transitioning to community care","authors":"Kaleen N. Hayes, Meghan A. Cupp, Richa Joshi, Melissa R. Riester, Francesca L. Beaudoin, Andrew R. Zullo","doi":"10.1111/jgs.19160","DOIUrl":"https://doi.org/10.1111/jgs.19160","url":null,"abstract":"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.","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"111 1","pages":""},"PeriodicalIF":6.3,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142184910","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}
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
{"title":"Recurrent pericarditis in older adults: Clinical and laboratory features and outcome","authors":"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","doi":"10.1111/jgs.19150","DOIUrl":"10.1111/jgs.19150","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective of the Study</h3>\u0000 \u0000 <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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <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","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}
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