Journal of the American Geriatrics Society最新文献

Background: Nursing home residents (NHRs) remain at high risk for severe outcomes following SARS-CoV-2 infection. Omicron descendants have dominated circulating strains, with XBB in 2023 and KP.2 strain by mid-2024, leading to immune escape and increased transmissibility. We aimed to assess the immunogenicity of one versus two prior doses of the XBB.1.5 vaccines and potential differences in the subsequent response to the KP.2 booster.

Methods: We conducted a longitudinal immunologic evaluation of 131 NHRs in Ohio and Rhode Island. Samples were collected 2-6 weeks after the first and second XBB.1.5 vaccination doses, 60 days before KP.2 vaccination, and 2-6 weeks after the KP.2 booster. We measured anti-spike and neutralizing antibody titers to both XBB.1.5 and KP.2.

Results: NHRs who received two booster doses of the XBB.1.5 vaccine developed higher peak anti-spike antibody levels (29,777 AU/mL) and neutralizing titers (7082) compared to those with only one dose (13,788 AU/mL and 1293, respectively). Over time, anti-spike antibody and neutralizing titers declined, but both remained higher in the two-dose group before receiving the KP.2 vaccine. After vaccination with XBB.1.5, neutralization against KP.2 was significantly lower than against XBB.1.5, suggesting reduced cross-reactivity and highlighting the potential for immune escape. However, KP.2 vaccination markedly boosted neutralizing titers in all participants, regardless of their prior XBB.1.5 dose history.

Conclusion: NHRs who received a two-dose regimen of the XBB.1.5 vaccine demonstrated stronger immune responses and higher pre-KP.2 titers than those who received a single dose. However, the diminished cross-protective neutralization of KP.2 highlights the variant's immune evasiveness. The KP.2 booster effectively elicited anti-KP.2 levels, supporting the continued use of updated, variant-matched boosters to protect high-risk populations such as NHRs.

A New Era for Menopause Hormone Therapy: Key Considerations for Geriatricians After FDA Boxed Warning Removal.

Background: To avoid potential harms from hypoglycemia, guidelines for diabetes management in nursing home residents recommend less intensive glycemic control. However, it is unknown how often hypoglycemia and hyperglycemia co-occur in the same resident, which may present challenges for deintensification of diabetes treatment.

Methods: We conducted a cross-sectional study of insulin-treated Veterans Affairs nursing home residents with diabetes aged ≥ 65 years from 1/1/2016 to 9/30/2019 with a nursing home stay ≥ 7 days. Residents missing fingerstick glucose measurements during the first 7 days were excluded. We classified insulin use as basal insulin only, bolus insulin only, or a combination of basal and bolus insulin. We examined the prevalence of fingerstick-detected hypoglycemia (< 54 mg/dL, 54-69 mg/dL) and hyperglycemia (250-299, 300-349, 350-399, ≥ 400 mg/dL) overall and stratified by type of insulin.

Results: Among 12,031 insulin-treated residents, the mean age was 74.4 years, 98% were male, and 22% were non-White. Most residents (n = 7176, 59.6%) were treated with a combination of basal and bolus insulin, 31.8% (n = 3829) used bolus insulin alone and 8.5% (n = 1026) used basal insulin alone. During the first 7 days of the nursing home stay, 5730 (48%) had hyperglycemia ≥ 250 mg/dL alone, 862 (7%) had hypoglycemia < 70 mg/dL alone, 1488 (12%) had both hyperglycemia and hypoglycemia, and 3951 (33%) had neither hypoglycemia nor hyperglycemia. Residents on a combination of basal and bolus insulin were more likely to have hyperglycemia ≥ 400 mg/dL (10.2% vs. 3.6% for bolus insulin alone and 1.6% for basal insulin alone, p < 0.001) and to have hypoglycemia < 54 mg/dL (8.4% vs. 2.9% for bolus alone vs. 5.9% for basal alone, p < 0.001).

Conclusion: Nearly two-thirds of nursing home residents with hypoglycemia also had hyperglycemia. Efforts to de-intensify diabetes treatment in nursing homes will need to address the high burden of hyperglycemia by tailoring the timing and type of insulin to minimize hypoglycemia while also not worsening hyperglycemia.

Introduction: Of the 6 million people living with dementia (PLWD) in the United States, half visit an emergency department (ED) annually. Little is known about the specific emergency care preferences and priorities of PLWD and their care partners. This descriptive qualitative study engaged PLWD and care partners to identify their ED care priorities and the factors that influence their overall evaluation of ED care.

Methods: We recruited PLWD receiving care in a large academic ED and their care partners to participate in individual or dyadic interviews. Interviews were analyzed using thematic analysis and member checking interviews were completed to confirm and expand on study findings.

Results: We conducted interviews with 55 participants (N = 19 PLWD, 24 care partners, 6 dyads). PLWD and care partners evaluated ED care experiences through a summative lens shaped by: (1) universal priorities common across all participants and (2) individual values that varied in importance and quality between individuals. Universal priorities included feeling respected, clear communication, and being informed about and involved in their emergency care decisions. Individual values included preferences around the who and how of decision-making, attention to cognitive health, and degree of escalation of care. Several contextual factors shaped the appraisal of ED visits including the timing of evaluation and nature of the precipitating event (acute/unknown cause vs. chronic/known or suspected cause).

Conclusion: Findings suggest that interpersonal interactions, including being informed about care and involved in decisions, strongly influence the evaluation of ED visits for PLWD. These findings can support the development of person-centered outcome measures capable of evaluating these priorities.

Background: Previous studies on the relationship between prediabetes, HbA1c and cognitive trajectories show mixed results. Therefore, we investigated the association of prediabetes, diabetes and HbA1c with change in global and domain-specific cognitive scores in cognitively unimpaired (CU) adults, as well as the potential effect modification by sex or age.

Methods: This longitudinal study included 4236 CU persons aged ≥ 50 years from the population-based Mayo Clinic Study of Aging. We ran linear mixed-effect models with baseline prediabetes, diabetes and HbA1c predicting longitudinal global and domain-specific (i.e., memory, language, attention/executive function, and visuospatial skills) cognitive z-scores and raw scores. Models were adjusted for age, sex, education, medical comorbidity, repeated cognitive testing, and ApoEɛ4. We additionally ran models with sex and age interactions.

Results: Compared to normoglycemic individuals, individuals with prediabetes and diabetes showed poorer performance on cognitive tests, i.e., TMT-B, category fluency, and block design subtest over time. Additionally, the presence of prediabetes, diabetes, longer diabetes duration and higher HbA1c were associated with faster global and domain-specific cognitive decline over a median follow-up of 6.4 years (range 1-19). Three-way interactions showed that the effect of diabetes on decline in global cognition, attention and visuospatial domains was more pronounced in women than in men. Age did not modify the effect of diabetes or higher HbA1c on cognition.

Conclusions: The results suggest that prediabetes and diabetes significantly shorten the timeframe before a potentially clinically noticeable change in global and domain-specific cognition is reached. Thus, lifestyle modification to reverse prediabetes and prevent diabetes could potentially reduce the rate of cognitive decline in aging populations. The findings differed by sex (i.e., the effect of diabetes on decline in global cognition, attention and visuospatial domains was more pronounced in women than men).

DXA Utilization Among Veterans Aged ≥ 50 years by Facility-Reported DXA Capacity.

Receiver Operating Characteristic Curve for the Modified Caregiver Strain Index predicting high Zarit-Burden Interview, showing excellent discrimination.