Browsing by Subject "Aged"
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Item Deprescribing for older adults(2022-03-25) Steinman, MichaelItem The Development and Preliminary Evaluation of MOTIVATE: Moving to Improve Chronic Back Pain and Depression in Older Adults(2021-03-10) Yang, Ailing Eileen; Makris, Una; Roche, Vivyenne; Saxon, LadonnaBACKGROUND: Chronic low back pain (cLBP) is the 2nd most common reason for physician visits; annual related costs exceed USD 100 billion and are expected to rise with the aging population. cLBP and depression often coexist, and current non-pharmacologic interventions have not focused on older adults with these challenging comorbidities. A feasible, effective non-pharmacologic intervention targeting cLBP and comorbid depressive symptoms in older adults is needed. MOTIVATE (Moving to Improve Chronic Back Pain and Depression in Older Adults) is a novel 8-session, 12-week, telephonic behavioral intervention targeting older adults with cLBP and comorbid depressive symptoms. A health coach utilizes motivational interviewing and value-concordant goal setting to capture individual motivations to increase physical activity. The ultimate goal is to improve back pain-related pain interference, disability, and depressive symptoms. OBJECTIVE: To develop a unique telephone-delivered behavioral intervention that is feasible, increases physical activity, and ultimately improves pain, function, and depressive symptoms among older Veterans. METHODS: In Phase 1, Dr. Makris' research team developed a telephone-delivered multicomponent behavioral intervention that targets older Veterans (>65 years old) with cLBP and comorbid depressive symptoms. Input from stakeholder groups [experts in pain, geriatrics, geriatric psychology, primary care, behavioral interventions, among others (n=8), patients (n=5), and key clinical leaders (n=6)] was used to inform and refine content for this unique population. In Phase 2, we conducted a single-arm rollout of MOTIVATE in older Veterans with cLBP and depressive symptoms to further refine future intervention content, procedures, and delivery based on stakeholder feedback. For qualitative interviews, the Promoting Action on Research Implementation in Health Services (PARIHS) framework was used to develop the discussion guide and facilitate individual interviews with the following key stakeholder groups: Veteran participants (n=4) over the age of 65 with comorbid cLBP and depressive symptoms who received MOTIVATE, primary care providers (PCP) (n=4), clinic director (n=1), and health coach (n=1). RESULTS: Informed by interviews with 14 experts and 5 Veterans, we developed and iteratively refined the MOTIVATE manual and study procedures for Phase 1. In the single-arm MOTIVATE rollout (Phase 2), we enrolled 7 Veterans, with a mean age of 69 years who were predominately white (71%), male (86%), married (57%), and had some education beyond high school (71%). The eligibility mean pain intensity score was 7.3/10; baseline cLBP Pain, Enjoyment of Life, and General (PEG-3) Activity Scale was 7.14/10, back pain-specific Roland Morris Disability Questionnaire (RMDQ) Scale was 16.5/24; and depression PHQ-9 score was 16.7/27, with higher scores indicating greater impairment. Two case studies are provided for additional context and to more fully articulate important MOTIVATE intervention concepts. Upon completion of the intervention, semi-structured interviews with Veterans and other stakeholders provided valuable feedback on how to modify MOTIVATE moving forward. Briefly, Veterans who completed MOTIVATE engaged well with the health coach, were motivated to walk with a pedometer, and felt that being more active reduced pain and depressive symptoms. Of the four PCPs interviewed, all attributed the success of the intervention to the skills and engagement of the health coach; we also learned about the variability in how PCPs would like results relating to patient-identified values and goals to be communicated with them. The health coach noted that Veterans were able to identify value-concordant goals and easily link these to physical activities. All stakeholders stated that the individual health coach plays a critical role in activating and motivating older Veterans with complex medical and psychiatric conditions. CONCLUSION: MOTIVATE content and procedures were developed in Phase 1. The Phase 2 rollout showed that we were able to effectively recruit older Veterans with cLBP and depressive symptoms and deliver MOTIVATE via telephone. Feedback from key stakeholders regarding the iterative refinement of recruitment, study procedures, and content will aid the future evaluation and implementation of MOTIVATE in a pilot randomized controlled trial.Item Dignity in later life (The Daniel W. Foster, M.D., Visiting Lectureship in Medical Ethics)(2023-12-12) Jecker, Nancy S.Some argue dignity is a useless concept that bioethics can do without. Against this view, I show dignity is a central concern for bioethics, particularly for older people. Dignity's importance during later life is part of a broader view I call the life stage relativity of values. It holds that different values emerge as central at different periods of our lives. During early life, caring, trust, and nurturing figure prominently due to vulnerabilities that characterize infancy and childhood. By adulthood, greater physical and emotional independence leads to autonomy and self-reliance taking center stage. During later life, heightened risk for chronic disease and disability makes keeping dignity intact a critical concern. Across the lifespan, the highest value for an individual relates to their life stage circumstances. Ignoring this can lead to life stage bias, especially midlife bias, which occurs when we apply values central during midlife to all life stages.Item Disability in older adults(2023-03-31) Covinsky, KennethItem Effectiveness of Interdisciplinary Pain Management Programs in Elderly Populations(2016-07-25) Huber, Elizabeth Gray; Robinson, Richard C.; Gatchel, Robert J.; Noe, Carl; Deschner, Martin; Minhajuddin, AbuBACKGROUND: Chronic pain is a debilitating disease that affects millions of adults in the United States. In recent years, there has been a steady increase in the use of interdisciplinary interventions to treat chronic pain. While the effectiveness of such programs is well-documented in adult populations, little is known about the efficacy of such methods for elderly populations. OBJECTIVE: This study assessed the effectiveness of an interdisciplinary pain management program in addressing chronic pain and associated disability (e.g., loss of functioning, poor mood) in the elderly. Study aims also included a comparison of outcomes between elderly and non-elderly participants in an interdisciplinary pain management program, as well as an examination of which variables may serve as predictors for completion of such programs. METHOD: Participants included one hundred and thirteen chronic pain patients receiving treatment in an interdisciplinary program at the Eugene McDermott Center for Pain Management. Participants completed multiple measures pertaining to pain and associated conditions at baseline, mid-way through the program (2 weeks post-enrollment) and upon completion of the program (4 weeks post-enrollment). ANALYSIS: Repeated measures ANOVA analyses examined changes in participants’ scores over time on various self-report measures that assessed pain rating, functionality and mood. Separate analyses were conducted to evaluate results from elderly participants only, and then to compare results between elderly and non-elderly participants. A binomial logistic regression was performed to determine the effects of age and mood on the likelihood that participants in an interdisciplinary pain management program would complete treatment in the program. RESULTS: Although elderly participants’ mean scores across a variety of measures showed signs of improvement, these changes did not meet statistical significance. However, when examining elderly and non-elderly participants together, both groups demonstrated significant improvement across all outcomes with the exception of depression. There were group differences on a select number of outcomes, including those that assessed pain disability, anxiety and depression levels; on these measures, the mean scores for non-elderly participants were higher as compared to elderly participants. There were no interactions between the two groups for any of the variables assessed. The logistic regression model that examined the effects of age and mood on the likelihood that participants would complete treatment in the current study was not significant. DISCUSSION: The current study demonstrates that non-elderly participants experience benefit from participation in interdisciplinary pain management programs. Further research is warranted with a larger elderly population to assess how treatment may need to be tailored to the unique needs of the elderly.Item Effects of Alcohol Use on Cognition During Later Adulthood(2020-12-01T06:00:00.000Z) Becker, Joshua Eric; Brown, E. Sherwood; Rossetti, Heidi; Denney, David; Palka, Jayme; Cullum, C. Munro; Adinoff, Byron H.Alcohol is one of the most widely used psychoactive substance in the world, yet there are conflicting findings related to its long-term effect on cognition. Some research has identified a U-shaped relationship between alcohol consumption and cognition, while negative relationships have been identified in other studies. Methodological issues, particularly the time at which alcohol consumption was measured relative to when cognition was measured, wide variability in definitions of "moderate" alcohol consumption, and selecting appropriate comparison groups, have made exploring the effects of alcohol on cognition during aging difficult. The current study examined the relationship between drinking at three separate time points (between the ages of 50 and 74) and cognition in older adulthood. Results revealed that the quantity of self-reported drinks over the three time points was a significant predictor of cognition in older adulthood (b=0.001; p<.001), although the effect sizes were very small and not meaningful. Subsequent analyses examined this relationship among heavy drinkers and binge drinkers compared to moderate drinkers and non-binge drinkers, but heavy and binge drinking were not significant predictors of cognition in older adulthood (all ps>0.05). Overall, the results suggest no that there is not a meaningful relationship between alcohol consumption and cognitive functioning in older adulthood in this sample. There were few consistent heavy drinkers (n=71), but a large number of consistent moderate drinkers (n=1,847), although even the moderate drinkers did not consume much alcohol (mean alcohol consumption = 15.3 drinks/month; median alcohol consumption = 5.0 drinks/month). This may have limited the ability to detect clinically meaningful differences. Future studies should rely on more standardized alcohol measures, large, diverse samples, and inclusion of cognitive measures assessing visuospatial abilities and executive functioning, in order to better explore the relationship of alcohol in the aging brain.Item The ethics of AKI in the ICU: when can (should) you say "no"?(2021-04-13) Moss, Alvin H.Many older adults with kidney failure and comorbidities may not live any longer with dialysis than without it. However, the de facto default practice is to start dialysis in most patients with progressive stage 5 chronic kidney disease. Medical anthropologists have described two factors contributing to the dialysis default: changing societal expectations resulting in a "biomedicalization of aging" and a "technological imperative" reflected in the difficulty of saying "no" to life-extending interventions, regardless of age, frailty, and complicating, debilitating medical conditions. Commentators have noted that default options are powerful and may be harmful to some patients. They have emphasized that to counter the clinical momentum of default options; it is necessary for clinicians to engage such patients and their families intentionally and explicitly in the process of shared decision-making. This lecture will present the evidence for the dialysis default and a patient-centered approach to respond to it.Item Evaluation and management of hip fracture risk in the aged(2010-09-10) Rubin, Craig D.Item [Features](1990-10) Harrell, AnnThe year for this news release was not printed on the release itself. The year is inferred from the original organization of news releases within dated binders.Item From prehab to rehab: opportunities in geriatric perioperative medicine(2017-06-16) Dalton, Thomas O.Item The highs and lows of blood pressure regulation in older adults(2021-04-09) Lipsitz, Lewis A.Item Hypertension in the elderly(2008-02-01) Kaplan, Norman M.Item Hypertension in the elderly, pathophysiology and management(1994-08-18) Ram, C. Venkata S.Item Hypothyroidism in the elderly(1989-08-17) Griffin, James E.Item Is Nitrofurantoin Use Really Dangerous for Older Adults?: A Deeper Dive into Beers Criteria(2018-03-29) Claussen, Karin Rebekah; Reed, W. Gary; Rubin, Craig; Fish, JasonBACKGROUND: The use of nitrofurantoin (NF) has been quite controversial over the past several years. The Infectious Disease Society of America (IDSA) recommends NF as a first choice treatment for uncomplicated urinary tract infections (UTI's); yet, several quality indicators, specifically the Beers Criteria, include NF as a potentially inappropriate medication (PIM) for adults 65 and older due to a number of concerns, especially pulmonary and hepatic complications. However, many physicians and pharmacists question the Beers Criteria recommendation and believe the adverse event (AE) incidence is low enough to warrant using this antibiotic in the older population. OBJECTIVE: We sought to identify the pulmonary and hepatic adverse event rate associated with NF use in a cohort of patients 65 and older to determine if a restriction of the use of NF is needed. METHODS: A retrospective chart audit of patients 65 and older prescribed NF from January 1, 2010, to December 31, 2014 at an urban academic medical center was conducted. Additional inclusion criteria were diagnoses of dyspnea, pulmonary fibrosis, hepatotoxicity, cholestatic jaundice, and chronic hepatitis as documented in the patients' medical records. Two independent reviewers of the medical records assigned patients with the following categories: No Reaction, Allergy, Minor Side Effect, High Suspicion for AE, or Possible Suspicion for AE (A, B or C). If discordance occurred between the two reviewers, a third reviewer provided an additional review assigning the category based on the majority. RESULTS: Of 3,400 individuals aged 65 and older prescribed nitrofurantoin during the study period, 641 were identified as possibly having one of five targeted symptoms or disease complications (pulmonary and hepatic) associated with nitrofurantoin. After a detailed chart audit, 89% were deemed to have no adverse reaction, 7% had a minor side effect or allergy, and 3.9% (25 patients) met criteria for suspicion of a nitrofurantoin-induced AE, five of whom (0.8%) were rated as highly suspicious for nitrofurantoin toxicity; four of the five were identified with pulmonary toxicity and one with hepatotoxicity. Four of five of these individuals used nitrofurantoin chronically. CONCLUSION: Nitrofurantoin was prescribed for 3,400 individuals aged 65 and older during the 5-year study period. We found a low rate of nitrofurantoin-associated AEs. However, a judicious approach appears warranted with chronic use and in patients for whom toxicity could exacerbate underlying medical conditions (e.g. underlying interstitial disease). Avoiding NF in patients based on age alone should not be seen as a negative quality indicator based on our results. Through patient education and informed prescribers, NF can be used safely in most patients 65 and older.Item It's not always about the heart: a gerocentric approach to heart failure with preserved ejection fraction(2021-05-14) Pandey, AmbarishItem Lifestyle Factors Related to Cognitive Aging(2020-08-01T05:00:00.000Z) Smith, Emily Elaine; Rossetti, Heidi; Lacritz, Laura; Hynan, Linda S.; Lamar, Melissa; Smernoff, Eric; Valvano, AbbeyCognitive changes are a hallmark feature of Alzheimer's disease (AD) and lifestyle behaviors have been associated with a reduced risk of disease onset and slower rate of cognitive decline. Research examining the relationship of lifestyle factors (LFs) to brain health has typically focused on individual factors in isolation (more physical activity (PA) and reduced risk of AD); however, few studies have examined the combined effects of multiple LFs on cognition. The current study aimed to 1) determine which LFs best predict cognition cross-sectionally; 2) derive and compare different approaches to developing a Health Score (HS) to help predict cognition; and 3) discern if a healthy lifestyle was associated with slower rate of cognitive decline. This study included 467 older adults (Mage=83; No Cognitive Impairment=361, Mild Cognitive Impairment (MCI=94), Alzheimer's dementia (AD=12)) enrolled in a longitudinal (Myears=3.72) aging study with yearly evaluations, including neuropsychological testing, clinical evaluation, and detailed assessment of lifestyle behaviors: diet, PA, sleep, social activities, stress, depression, alcohol, smoking, body mass index (BMI), and APOE genotyping. Cognitive z-scores were derived for global cognition, verbal memory, processing speed, and working memory. HS based on a Scientific (i.e., data driven), Lifestyle/Health (i.e., only healthy lifestyle behaviors), Risk/Disease (i.e., only unhealthy behaviors), or Comprehensive (i.e., all healthy/unhealthy behaviors) approaches were calculated and categorized (Unfavorable, Minimally Favorable, Moderately Favorable, Favorable) based on quartiles. Rate of cognitive change was also calculated. Multiple linear regression analyses in the full sample revealed demographic and lifestyle (i.e., social activities, diet) factors consistently predicted cognition cross-sectionally. In the MCI/AD group, diet, PA and BMI were significant predictors with minimal demographic predictors. HS comparisons via Meng's test revealed a Lifestyle/Health approach as the best predictor of cognition compared to the other approaches. In addition, individuals with HSs in the Favorable category had significantly slower rates of cognitive decline than individuals in other categories. Overall, LFs better predicted cognition than risk factors commonly used in clinical and research settings. Results from this study corroborate prior findings and encourage continued support and resources for lifestyle research and intervention programs to help prevent and slow cognitive decline and AD.Item A Multi-Parametric Investigation of Vascular Alterations in Elderly with Hypertension(2015-01-26) Sheffield, Adam; Sheng, Min; King, Kevin; Ravi, Harshan; Peng, Shin-lei; Liu, Peiying; German, Zohre; Lu, HanzhangBACKGROUND: Along with aging comes many cardiovascular and cerebral changes that impact a person's health. These changes manifest as variances in blood pressure, brain volume, cerebral blood flow (CBF), oxygen metabolism, and neurological functioning. OBJECTIVE: The purpose of this study is to provide evidence to support new or previously known biomarkers for declining cerebrovascular health, such as cerebral arterial stiffness, reduced vessel capacity, and thickening of the extracellular matrix. METHODS: 45 participants ranging from the ages of 61 to 79 with a mean of 67 were studied using a 3 Tesla MRI. Several MRI techniques were employed to acquire and analyze data. Phase-contrast (PC) MRI was used for acquiring images of moving fluid, so that arteries containing blood flow to the brain could be isolated in order to calculate total CBF. Blood-oxygen-level dependent contrast images and end-tidal CO2 and O2 measurements were also obtained using MRI after the participants were given a different sequence of gases to breathe containing varying amounts of oxygen, carbon dioxide, and nitrogen. This allowed the cerebrovascular reactivity (CVR) and venous cerebral volume (vCBV) of the vessels to be determined. Venous oxygenation (Yv) was assessed using T2-relaxation-under-spin-tagging (TRUST) MRI technique. Linear regressions were performed to account for age, sex, and blood pressure. Data were also analyzed by putting participants with a systolic blood pressure greater than 140 into a hypertensive category for comparison. Other data acquired during or immediately prior to the MRI scans include systolic and diastolic blood pressure, brain volume, and the oxygen saturation level of venous and arterial blood. RESULTS: A p-value of <0.05 was used to determine significance. The CVR for the hypertensive group was lower than that of the non-hypertensive group (p<0.01) and CVR decreased as systolic blood pressure increased (p=0.02). CVR also decreased with increasing age (p=0.02) and was higher in males than in females (p<0.01). CBF increased with systolic blood pressure (p=0.03) and was higher in females (p=0.03). Yv also increased with systolic blood pressure (p=0.02) and correlated strongly with CBF values (p<0.001). CONCLUSION: These results support certain relationships between blood pressure and the vascular markers within the brain, which may appear before cognitive decline or clinical symptoms emerge. This study is an early step on the path to discovering easily identifiable precursors to neurological changes that take place as normal aging processes occur.Item [News](1980-12-09) Williams, AnnItem [News](1981-05-22) Williams, Ann