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Trends in Hyperpolypharmacy Before and After Nursing Home Admission Among Older Adults in Ontario, Canada. 加拿大安大略省老年人入住养老院前后过度用药的趋势。
IF 4.4 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-14 DOI: 10.1016/j.jagp.2024.09.005
Laura C Maclagan, Abby Emdin, Anjie Huang, Michael A Campitelli, Mina Tadrous, Andrea Iaboni, Luis Viana, Colleen J Maxwell, Susan E Bronskill

Objectives: To examine trends in the prevalence of hyperpolypharmacy prior to and following nursing home admission in Ontario, Canada.

Methods: We conducted a cohort study of adults aged 75+ years admitted to nursing homes between 2017 and 2020 using health administrative data (n = 61,470). The prevalence of hyperpolypharmacy (≥10 dispensed drugs) was assessed quarterly from ten years prior to 1.5 years following admission.

Results: Over ten years, the prevalence of hyperpolypharmacy increased from 4.4% to 12.0% (+0.2% per quarter, [p <0.001]) and further increased after admission (13.8%). Antidepressants (three-fold), antipsychotics (seven-fold) and cholinesterase inhibitors (14-fold) increased significantly over ten years prior to admission, while cardiovascular medications peaked 4 to 5 years prior to admission.

Conclusions: While hyperpolypharmacy increased nearly three-fold in the ten years prior to nursing home admission, patterns varied by drug class. Increasing hyperpolypharmacy throughout the life course suggests opportunities exist for medication reconciliation in community and nursing home settings.

目的研究加拿大安大略省养老院入住前后过度用药的流行趋势:我们利用卫生行政数据(n = 61,470 人)对 2017 年至 2020 年期间入住养老院的 75 岁以上成年人进行了一项队列研究。从入院前十年到入院后 1.5 年,我们每季度对超配药率(配药≥10 种)进行一次评估:结果:十年间,过度配药率从 4.4% 增加到 12.0%(每季度增加 0.2%,[p 结论:在过度配药率增加的同时,配药次数也增加了:在入住疗养院前的十年中,过度用药率增加了近三倍,但不同类别药物的用药模式各不相同。在人的整个生命过程中,多药滥用现象不断增加,这表明在社区和养老院环境中存在着药物调节的机会。
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引用次数: 0
Commentary: "How should Null Findings be Interpreted?" 评论:"如何解读无效结论?
IF 4.4 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-13 DOI: 10.1016/j.jagp.2024.09.004
Charles South, Stephan Arndt
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引用次数: 0
Temporal Associations Between Specific Depressive Symptoms and Physical Inactivity in Middle Aged and Older Adults. 中老年人特定抑郁症状与缺乏运动之间的时间关联
IF 4.4 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-10 DOI: 10.1016/j.jagp.2024.08.020
Eetu Soini, Tom H Rosenström, Ilmari Määttänen, Markus Jokela

Being physically inactive can worsen mental health. Physical inactivity and depression are associated, but the temporal precedence and underlying mechanism are unclear; symptoms affecting future physical activity may not be the same symptoms as those associated with and affected by it. We used large European cohort (Survey of Health, Ageing, and Retirement in Europe, SHARE, N = 124, 526) to study temporal associations between physical inactivity and individual depressive symptoms. Multivariate regression with robust standard errors were used to analyze how physical inactivity is associated with later depression and how depressive symptoms predict later physical inactivity. After adjusting the models for demographics, other health behaviors, BMI, and chronic diseases, physical inactivity was prospectively associated with 10 of the 12 depressive symptoms and 7 of the 12 baseline depressive symptoms were prospectively associated with physical inactivity. These findings were robust for adjusting for antidepressant medication. Age-stratified analyses suggested that the associations between physical inactivity and depressive symptoms were independent of age. Omitting the most influential symptom, lack of enjoyment, from the sum score attenuated the association by 13% in the longitudinal and by 26% in the cross-sectional analyses. These findings suggest that physical inactivity and depression are bidirectionally associated even at symptom-level.

缺乏运动会使心理健康恶化。缺乏体力活动与抑郁症有关联,但两者之间的时间先后关系和内在机制尚不清楚;影响未来体力活动的症状可能与与体力活动相关和受体力活动影响的症状不同。我们利用大型欧洲队列(欧洲健康、老龄化和退休调查,SHARE,N = 124,526)研究了缺乏体力活动与个人抑郁症状之间的时间关联。我们采用了带有稳健标准误差的多元回归方法来分析缺乏运动与日后抑郁症之间的关系,以及抑郁症状如何预测日后的缺乏运动。在根据人口统计学、其他健康行为、体重指数和慢性疾病对模型进行调整后,不运动与 12 种抑郁症状中的 10 种相关,12 种基线抑郁症状中的 7 种与不运动相关。在调整抗抑郁药物治疗后,这些结果仍保持稳定。年龄分层分析表明,缺乏运动与抑郁症状之间的关系与年龄无关。在纵向分析和横向分析中,从总分中剔除 "缺乏乐趣 "这一影响最大的症状会使两者之间的关系减弱 13%,减弱 26%。这些研究结果表明,即使在症状层面,缺乏运动和抑郁也是双向相关的。
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引用次数: 0
Facing a Catastrophic Illness: A Perspective from Contemporary Philosophy 面对灾难性疾病:当代哲学的视角。
IF 4.4 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-07 DOI: 10.1016/j.jagp.2024.08.017
George S. Alexopoulos M.D.
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引用次数: 0
A Systematic Review of Antidepressants and Psychotherapy Commonly Used in the Treatment of Late Life Depression for Their Effects on Cognition. 关于治疗晚年抑郁症常用的抗抑郁药和心理疗法对认知影响的系统性综述》(A Systematic Review of Antidepressants and Psychotherapy commonly used in the Treatment of Late Life Depression for Their Effects on Cognition.
IF 4.4 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-06 DOI: 10.1016/j.jagp.2024.08.015
J Craig Nelson, Jason A Gandelman, R Scott Mackin

Cognitive dysfunction is common in late life depression (LLD) and is a major risk factor for dementia. Recent studies show limited improvement in cognition with commonly employed treatments for LLD, contradicting the notion that cognition "returns to normal" with treatment. However, findings differ with the treatments used. The aim of this study is to perform a systematic review of studies of antidepressants and psychotherapies commonly employed in LLD to determine their effects on cognition, particularly processing speed, memory, and executive function. We searched for trials of acute phase treatment, in nondemented individuals 60 years and older with unipolar nonpsychotic Major Depressive Disorder, that assessed cognitive performance with neuropsychological tests before and after treatment. We compared the magnitude of change in cognition by examining within group effect sizes. Six antidepressant trials and two psychotherapy trials (both using Problem Solving Therapy)(PST) provided relatively comparable data that allowed for quantitative comparison. Nine other antidepressant trials provided descriptive findings. Sertraline and vortioxetine had significant positive effects on processing speed and memory. Duloxetine had significant effects on memory. The most selective SRIs-citalopram and escitalopram-had minimal effects on cognition and citalopram had adverse effects in depression nonresponders. PST had modest effects on processing speed and no effect on memory. Effects of practice and improvement in depression on cognition are examined. In all but one study, cognition was a secondary outcome and various quality indicators (e.g. blinding cognitive assessment to treatment) were often not reported. As a consequence, these findings must be considered preliminary.

认知功能障碍是晚年抑郁症(LLD)的常见症状,也是痴呆症的主要风险因素。最近的研究表明,晚年抑郁症的常用治疗方法对认知功能的改善有限,这与认知功能随治疗 "恢复正常 "的说法相矛盾。然而,不同的治疗方法得出的结果也不尽相同。本研究的目的是对常用于 LLD 的抗抑郁药和心理疗法的研究进行系统回顾,以确定它们对认知(尤其是处理速度、记忆和执行功能)的影响。我们搜索了针对 60 岁及以上患有单相非精神病性重度抑郁症的非痴呆患者进行的急性期治疗试验,这些试验在治疗前后通过神经心理学测试评估了患者的认知表现。我们通过研究组内效应大小来比较认知能力的变化程度。六项抗抑郁试验和两项心理疗法试验(均采用问题解决疗法)(PST)提供了相对可比的数据,可以进行定量比较。另外九项抗抑郁试验提供了描述性结果。舍曲林和伏替西汀对处理速度和记忆力有显著的积极影响。度洛西汀对记忆力有明显影响。选择性最强的 SRIs--西酞普兰和艾司西酞普兰--对认知能力的影响微乎其微,而西酞普兰对抑郁症无反应者有不良影响。PST 对处理速度的影响不大,但对记忆力没有影响。研究还探讨了练习和改善抑郁对认知的影响。除一项研究外,其他所有研究的认知结果都是次要结果,而且往往没有报告各种质量指标(如认知评估与治疗之间的盲法)。因此,这些研究结果必须被视为初步结果。
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引用次数: 0
Corrigendum to the Effect of Diagnostic Criteria on Dementia Prevalence—A Population-Based Study From Gothenburg, Sweden The American Journal of Geriatric Psychiatry, 2023, 230-243/32:2 诊断标准对痴呆症患病率的影响--基于瑞典哥德堡人口的研究》更正 美国老年精神病学杂志,2023,230-243/32:2
IF 4.4 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-05 DOI: 10.1016/j.jagp.2024.09.001
Hanna Wetterberg Ph.D. , Jenna Najar M.D., Ph.D. , Therese Rydberg Sterner Ph.D. , Silke Kern M.D., Ph.D. , Ingmar Skoog M.D., Ph.D.
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引用次数: 0
Weill Cornell Alacrity for Late- and Mid-Life Depression 2.0: From Simplified Psychosocial Interventions Based on Brain Theories of Aging to Implementation Based on the Socio-Ecological Model 威尔-康奈尔大学中晚期抑郁症快速治疗 2.0:从基于脑老化理论的简化社会心理干预到基于社会生态模型的实施
IF 4.4 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-04 DOI: 10.1016/j.jagp.2024.08.010
Dimitris Kiosses Ph.D., Jo Anne Sirey Ph.D., Sara Czaja Ph.D., Samprit Banerjee Ph.D., Faith Gunning Ph.D.
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引用次数: 0
Responding to the Growing Need for Medical Experts in Testamentary and Estate Related Capacities: A Course for Physicians. 应对在遗嘱和遗产相关能力方面对医学专家日益增长的需求:医生课程。
IF 4.4 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-04 DOI: 10.1016/j.jagp.2024.08.013
J Kirkham, S B Mitchell, C Cohen, C Hao, K Shulman

Objectives: The objective of this continuing medical education course was to improve the knowledge and skills of physicians in the assessment of testamentary and related capacities.

Methods: We developed, conducted, and evaluated an accredited medical education course focusing on the role and responsibilities of medical experts in estate litigation and held in Toronto, Ontario, Canada in June 2022.

Results: Participants reported a 65% and 35% improvement in confidence in conducting retrospective and contemporaneous assessments of testamentary capacity, respectively. The overall mean score in the 9 key competencies for medical experts in estate litigation improved by 1.2-points from 3.02 (SD 1.33) to 4.22 (SD 0.74) from pre to postcourse (p <0.05, 95% CI [-1.66, -0.67]).

Conclusions: This course addresses a significant gap in training and formal education opportunities in testamentary and other related capacities that may contribute to increasing the pool of available and qualified medical experts in estate litigation.

目的本继续医学教育课程旨在提高医生在评估遗嘱能力和相关能力方面的知识和技能:我们于 2022 年 6 月在加拿大安大略省多伦多市开发、实施并评估了一个经认可的医学教育课程,该课程侧重于医学专家在遗产诉讼中的角色和责任:参加者表示,在对遗嘱能力进行回顾性评估和同期评估时,信心分别提高了65%和35%。从课程前到课程后,遗产诉讼中医学专家 9 项关键能力的总平均分从 3.02(标准差 1.33)提高到 4.22(标准差 0.74),提高了 1.2 分(P 结论:该课程解决了培训领域的重大空白:本课程弥补了遗嘱及其他相关能力培训和正规教育机会方面的重大空白,有助于增加遗产诉讼中可用的合格医学专家的数量。
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引用次数: 0
Discontinuing the Term "Stakeholder" From the NIA IMPACT Collaboratory Engaging Partners Team: An Example of the Process of Language Change in an Organization. 从 NIA IMPACT 协作参与伙伴团队中取消 "利益相关者 "一词:一个组织语言变化过程的实例。
IF 4.4 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-04 DOI: 10.1016/j.jagp.2024.08.016
Evan Plys, Karen O Moss, Kristen Jacklin, Molita Yazzie, Ellen Tambor, Erin Luers, Linda Elam, Nina Ahmad, Zachary J Kunicki, Carolyn Malone, Gary Epstein-Lubow

In this paper, we describe our process of changing language of the National Institute on Aging Imbedded Pragmatic Alzheimer's disease and AD-related dementias Clinical Trials Collaboratory (NIA IMPACT Collaboratory) "Stakeholder Engagement Team" to "Engaging Partners Team" in response to feedback from community partners regarding the problematic connotations of the term "stakeholder." We present a brief history of the term "stakeholder" and its use in clinical and community-engaged research. Then, we summarize critiques of this term, including its colonial history and potential to reinforce complacency with generational traumas, particularly among Indigenous peoples and communities. We conclude with a detailed overview of our team and organization's multi-step process to discontinue use of the term "stakeholder," in alignment with a theoretical model of organizational behavior change. This paper highlights the importance of critically evaluating language and responding to community partners. We hope our process can guide other researchers and organizations.

在本文中,我们介绍了美国国家老龄化研究所嵌入式实用阿尔茨海默病和与阿尔茨海默病相关的痴呆症临床试验协作组(NIA IMPACT Collaboratory)将 "利益相关者参与团队 "改为 "参与合作伙伴团队 "的过程,以回应社区合作伙伴对 "利益相关者 "一词存在问题内涵的反馈意见。我们简要介绍了 "利益相关者 "一词的历史及其在临床和社区参与式研究中的使用。然后,我们总结了对这一术语的批评,包括其殖民历史以及对世代创伤的自满情绪,特别是在土著人民和社区中。最后,我们详细概述了我们团队和组织为停止使用 "利益相关者 "一词而采取的多步骤过程,该过程与组织行为改变的理论模型相一致。本文强调了批判性评估语言和回应社区合作伙伴的重要性。我们希望我们的过程能够为其他研究人员和组织提供指导。
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引用次数: 0
“We Don't Really Do That in Geriatrics” Commentary on Long-Acting Injectable Antipsychotics in the Geriatric Population: A Longitudinal Study "我们在老年病学中并没有真正这样做",关于老年病学人群中的长效注射抗精神病药物的评论:纵向研究
IF 4.4 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-02 DOI: 10.1016/j.jagp.2024.08.012
Kristina F. Zdanys M.D., F.A.A.G.P.
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引用次数: 0
期刊
American Journal of Geriatric Psychiatry
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