Pub Date : 2024-09-14DOI: 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.
{"title":"Trends in Hyperpolypharmacy Before and After Nursing Home Admission Among Older Adults in Ontario, Canada.","authors":"Laura C Maclagan, Abby Emdin, Anjie Huang, Michael A Campitelli, Mina Tadrous, Andrea Iaboni, Luis Viana, Colleen J Maxwell, Susan E Bronskill","doi":"10.1016/j.jagp.2024.09.005","DOIUrl":"10.1016/j.jagp.2024.09.005","url":null,"abstract":"<p><strong>Objectives: </strong>To examine trends in the prevalence of hyperpolypharmacy prior to and following nursing home admission in Ontario, Canada.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376383","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}
Pub Date : 2024-09-13DOI: 10.1016/j.jagp.2024.09.004
Charles South, Stephan Arndt
{"title":"Commentary: \"How should Null Findings be Interpreted?\"","authors":"Charles South, Stephan Arndt","doi":"10.1016/j.jagp.2024.09.004","DOIUrl":"https://doi.org/10.1016/j.jagp.2024.09.004","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301783","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}
Pub Date : 2024-09-10DOI: 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.
{"title":"Temporal Associations Between Specific Depressive Symptoms and Physical Inactivity in Middle Aged and Older Adults.","authors":"Eetu Soini, Tom H Rosenström, Ilmari Määttänen, Markus Jokela","doi":"10.1016/j.jagp.2024.08.020","DOIUrl":"https://doi.org/10.1016/j.jagp.2024.08.020","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333038","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}
Pub Date : 2024-09-07DOI: 10.1016/j.jagp.2024.08.017
George S. Alexopoulos M.D.
{"title":"Facing a Catastrophic Illness: A Perspective from Contemporary Philosophy","authors":"George S. Alexopoulos M.D.","doi":"10.1016/j.jagp.2024.08.017","DOIUrl":"10.1016/j.jagp.2024.08.017","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"32 12","pages":"Pages 1477-1483"},"PeriodicalIF":4.4,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367641","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}
Pub Date : 2024-09-06DOI: 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.
{"title":"A Systematic Review of Antidepressants and Psychotherapy Commonly Used in the Treatment of Late Life Depression for Their Effects on Cognition.","authors":"J Craig Nelson, Jason A Gandelman, R Scott Mackin","doi":"10.1016/j.jagp.2024.08.015","DOIUrl":"10.1016/j.jagp.2024.08.015","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376382","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":"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","authors":"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.","doi":"10.1016/j.jagp.2024.09.001","DOIUrl":"10.1016/j.jagp.2024.09.001","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"32 12","pages":"Page 1476"},"PeriodicalIF":4.4,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142263664","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}
Pub Date : 2024-09-04DOI: 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.
{"title":"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","authors":"Dimitris Kiosses Ph.D., Jo Anne Sirey Ph.D., Sara Czaja Ph.D., Samprit Banerjee Ph.D., Faith Gunning Ph.D.","doi":"10.1016/j.jagp.2024.08.010","DOIUrl":"10.1016/j.jagp.2024.08.010","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"32 12","pages":"Pages 1471-1472"},"PeriodicalIF":4.4,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142263442","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}
Pub Date : 2024-09-04DOI: 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.
{"title":"Responding to the Growing Need for Medical Experts in Testamentary and Estate Related Capacities: A Course for Physicians.","authors":"J Kirkham, S B Mitchell, C Cohen, C Hao, K Shulman","doi":"10.1016/j.jagp.2024.08.013","DOIUrl":"https://doi.org/10.1016/j.jagp.2024.08.013","url":null,"abstract":"<p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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]).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301785","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}
Pub Date : 2024-09-04DOI: 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.
{"title":"Discontinuing the Term \"Stakeholder\" From the NIA IMPACT Collaboratory Engaging Partners Team: An Example of the Process of Language Change in an Organization.","authors":"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","doi":"10.1016/j.jagp.2024.08.016","DOIUrl":"https://doi.org/10.1016/j.jagp.2024.08.016","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301784","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}
Pub Date : 2024-09-02DOI: 10.1016/j.jagp.2024.08.012
Kristina F. Zdanys M.D., F.A.A.G.P.
{"title":"“We Don't Really Do That in Geriatrics” Commentary on Long-Acting Injectable Antipsychotics in the Geriatric Population: A Longitudinal Study","authors":"Kristina F. Zdanys M.D., F.A.A.G.P.","doi":"10.1016/j.jagp.2024.08.012","DOIUrl":"10.1016/j.jagp.2024.08.012","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"32 12","pages":"Pages 1431-1432"},"PeriodicalIF":4.4,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142263443","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}