Combined effects of older age and HIV disease on changes in everyday functioning over one year

BackgroundHeart failure (HF) and chronic obstructive pulmonary disease (COPD) lead to unplanned hospital activity, but our understanding of what drives this is incomplete.ObjectivesTo model patient, primary care and hospital factors associated with readmission and mortality for patients with HF and COPD, to assess the statistical performance of post-discharge emergency department (ED) attendance compared with readmission metrics and to compare all the results for the two conditions.DesignObservational study.SettingEnglish NHS.ParticipantsAll patients admitted to acute non-specialist hospitals as an emergency for HF or COPD.InterventionsNone.Main outcome measuresOne-year mortality and 30-day emergency readmission following the patient’s first unplanned admission (‘index admission’) for HF or COPD.Data sourcesPatient-level data from Hospital Episodes Statistics were combined with publicly available practice- and hospital-level data on performance, patient and staff experience and rehabilitation programme website information.ResultsOne-year mortality rates were 39.6% for HF and 24.1% for COPD and 30-day readmission rates were 19.8% for HF and 16.5% for COPD. Most patients were elderly with multiple comorbidities. Patient factors predicting mortality included older age, male sex, white ethnicity, prior missed outpatient appointments, (long) index length of hospital stay (LOS) and several comorbidities. Older age, missed appointments, (short) LOS and comorbidities also predicted readmission. Of the practice and hospital factors we considered, only more doctors per 10 beds [odds ratio (OR) 0.95 per doctor;p < 0.001] was significant for both cohorts for mortality, with staff recommending to friends and family (OR 0.80 per unit increase;p < 0.001) and number of general practitioners (GPs) per 1000 patients (OR 0.89 per extra GP;p = 0.004) important for COPD. For readmission, only hospital size [OR per 100 beds = 2.16, 95% confidence interval (CI) 1.34 to 3.48 for HF, and 2.27, 95% CI 1.40 to 3.66 for COPD] and doctors per 10 beds (OR 0.98;p < 0.001) were significantly associated. Some factors, such as comorbidities, varied in importance depending on the readmission diagnosis. ED visits were common after the index discharge, with 75% resulting in admission. Many predictors of admission at this visit were as for readmission minus comorbidities and plus attendance outside the day shift and numbers of admissions that hour. Hospital-level rates for ED attendance varied much more than those for readmission, but the omega statistics favoured them as a performance indicator.LimitationsData lacked direct information on disease severity and ED attendance reasons; NHS surveys were not specific to HF or COPD patients; and some data sets were aggregated.ConclusionsFollowing an index admission for HF or COPD, older age, prior missed outpatient appointments, LOS and many comorbidities predict both mortality and readmission. Of the aggregated practice and hospital information, only doctors per bed and numbers of hospital beds were strongly associated with either outcome (both negatively). The 30-day ED visits and diagnosis-specific readmission rates seem to be useful performance indicators.Future workHospital variations in ED visits could be investigated using existing data despite coding limitations. Primary care management could be explored using individual-level linked databases.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Download Full-text

Does Older Age Confer an Increased Risk of Incident Neurocognitive Disorders Among Persons Living with HIV Disease?

The Clinical Neuropsychologist ◽

10.1080/13854046.2015.1077995 ◽

2015 ◽

Vol 29 (5) ◽

pp. 656-677 ◽

Cited By ~ 29

Author(s):

David P. Sheppard ◽

Steven Paul Woods ◽

Mark W. Bondi ◽

Paul E. Gilbert ◽

Paul J. Massman ◽

...

Keyword(s):

Neurocognitive Disorders ◽

Older Age ◽

Hiv Disease ◽

Increased Risk ◽

Persons Living With Hiv ◽

Living With Hiv

Download Full-text

Age and Emotional Distress during COVID-19: Findings from Two Waves of the Norwegian Citizen Panel

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18189568 ◽

2021 ◽

Vol 18 (18) ◽

pp. 9568

Author(s):

Line I. Berge ◽

Marie H. Gedde ◽

Bettina S. Husebo ◽

Ane Erdal ◽

Camilla Kjellstadli ◽

...

Keyword(s):

Emotional Distress ◽

Positive Emotions ◽

Female Gender ◽

Older Age ◽

Related Factors ◽

Factors Associated ◽

Norwegian Population ◽

Sum Score ◽

Health Related ◽

One Year

Older adults face the highest risk of COVID-19 morbidity and mortality. We investigated a one-year change in emotions and factors associated with emotional distress immediately after the onset of the pandemic, with emphasis on older age. Methods: The online Norwegian Citizen Panel includes participants drawn randomly from the Norwegian Population Registry. Emotional distress was defined as the sum score of negative (anxious, worried, sad or low, irritated, and lonely) minus positive emotions (engaged, calm and relaxed, happy). Results: Respondents to both surveys (n = 967) reported a one-year increase in emotional distress, mainly driven by elevated anxiety and worrying, but we found no difference in change by age. Multilevel mixed-effects linear regression comparing older age, economy-, and health-related factors showed that persons in their 60s (ß −1.87 (95%CI: −3.71, −0.04)) and 70s/80s (ß: −2.58 (−5.00, −0–17)) had decreased risk of emotional distress relative to persons under 60 years. Female gender (2.81 (1.34, 4.28)), expecting much lower income (5.09 (2.00, 8.17)), uncertainty whether infected with SARS-Cov2 (2.92 (1.21, 4.63)), and high self-rated risk of infection (1.77 (1.01, 2.53)) were associated with high levels of emotional distress. Conclusions: Knowledge of national determinants of distress is crucial to tailor accurate public health interventions in future outbreaks.

Download Full-text

Prevalence of sleep disorders in children 3-7 years of age in perm

Perm Medical Journal ◽

10.17816/pmj38315-21 ◽

2021 ◽

Vol 38 (3) ◽

pp. 15-21

Author(s):

G. V. Anisimov ◽

T. P. Kalashnikova ◽

E. V. Bezdomnikova

Keyword(s):

Sleep Disorders ◽

Preschool Age ◽

Older Age ◽

Age Group ◽

Leg Muscles ◽

Younger Age ◽

Obstructive Sleep ◽

Falling Asleep ◽

One Year ◽

Questionnaire Method

Objective. The article analyzes the clinical features of sleep in preschoolers aged 3-7 years in the city of Perm on the basis of a continuous questionnaire method. Materials and methods. The presence of complaints related to sleep at the time of the survey was substantiated in 45 % of children of the younger age group (from 3 to 5 years) and 41 % of children in the older age group (from 5 to 7 years). Results. Sexual dimorphism manifested itself in a significant dominance of intrasomnic disturbances with frequent awakenings and increased motor activity during sleep in older boys. Nocturnal pains and / or cramps in the leg muscles prevailed in girls of the older age group. In the structure of parasomnias in Perm preschool children, there predominated nightmares (16.5 %), night fears (13.3 %), bruxism (14.8 %), sleepwalking (12.8 %), enuresis (8.2 %). Every fifth child of preschool age had sleep with an open mouth, snoring or puffing, hyperhidrosis during sleep and chronic adenotonsillar pathology, which does not exclude the presence of obstructive sleep apnea / hypopnea syndrome in this category of children. Conclusions. Sleep disorders were noted in a quarter of children under one year of age, manifested by difficult falling asleep, restless sleep and sleep inversion, which can be a marker of both disorders of maturation of chronobiological mechanisms and a high percentage of childhood behavioral insomnia.

Download Full-text

Return to work following diagnosis of low-grade glioma

Neurology ◽

10.1212/wnl.0000000000009982 ◽

2020 ◽

Vol 95 (7) ◽

pp. e856-e866 ◽

Cited By ~ 1

Author(s):

Isabelle Rydén ◽

Louise Carstam ◽

Sasha Gulati ◽

Anja Smits ◽

Katharina S. Sunnerhagen ◽

...

Keyword(s):

Sick Leave ◽

Return To Work ◽

Adjuvant Treatment ◽

Older Age ◽

First Year ◽

Low Grade ◽

Diffuse Glioma ◽

Who Grade ◽

Female Sex ◽

One Year

ObjectiveReturn-to-work (RTW) following diagnosis of infiltrative low-grade gliomas is unknown.MethodsSwedish patients with histopathologic verified WHO grade II diffuse glioma diagnosed between 2005 and 2015 were included. Data were acquired from several Swedish registries. A total of 381 patients aged 18–60 were eligible. A matched control population (n = 1,900) was acquired. Individual data on sick leave, compensations, comorbidity, and treatments assigned were assessed. Predictors were explored using multivariable logistic regression.ResultsOne year before surgery/index date, 88% of cases were working, compared to 91% of controls. The proportion of controls working remained constant, while patients had a rapid increase in sick leave approximately 6 months prior to surgery. After 1 and 2 years, respectively, 52% and 63% of the patients were working. Predictors for no RTW after 1 year were previous sick leave (odds ratio [OR] 0.92, 95% confidence interval [CI] 0.88–0.96, p < 0.001), older age (OR 0.96, 95% CI 0.94–0.99, p = 0.005), and lower functional level (OR 0.64 95% CI, 0.45–0.91 p = 0.01). Patients receiving adjuvant treatment were less likely to RTW within the first year. At 2 years, biopsy (as opposed to resection), female sex, and comorbidity were also unfavorable, while age and adjuvant treatment were no longer significant.ConclusionsApproximately half of patients RTW within the first year. Lower functional status, previous sick leave, older age, and adjuvant treatment were risk factors for no RTW at 1 year after surgery. Female sex, comorbidity, and biopsy only were also unfavorable for RTW at 2 years.

Download Full-text

Study of the peri-operative mortality in trochanteric fractures in elderly patients (60 years and above) visiting department of orthopedics at Dr. RPGMC Tanda

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20210540 ◽

2021 ◽

Vol 7 (2) ◽

pp. 325

Author(s):

Sarvesh Kumar Singh ◽

Bhanu Awasthi ◽

Devinder Kumar ◽

Sunil Rana ◽

Atul Singh ◽

...

Keyword(s):

Young Adults ◽

Elderly Patients ◽

Operative Mortality ◽

High Energy ◽

Older Age ◽

Inclusion Criteria ◽

Trochanteric Fractures ◽

Perioperative Mortality ◽

High Energy Trauma ◽

One Year

Background: In elderly, trochanteric fractures are frequent and typically result from mild to moderate trauma in osteoporotic bones while in young adults these fractures are generally due to high energy trauma such as road side accidents.Methods: The present study was conducted in elderly patients with trochanteric fractures (age 60 years and above) presenting to the department of orthopedics, Dr. RPGMC Kangra at Tanda. All cases presenting to the department and fulfilling the inclusion criteria were studied for three months period from the day of surgery. All cases fulfilling the inclusion criteria who were operated over the period of one year from the date of start of study were included.Results: Our study observed that out of 176 patients, 10.23% (n=18/176) patients could not survive within 90 days of surgery while 89.8% (n=158/176) patients survived. Perioperative mortality was 10.23%.Conclusions: In our study, peri-operative mortality is lower than reported earlier. We also found that perioperative mortality was influenced by older age.

Download Full-text

The Role of Individual Characteristics in Predicting Short- and Long-Term Cognitive and Psychological Benefits of Cognitive Stimulation Therapy for Mild-to-Moderate Dementia

Frontiers in Aging Neuroscience ◽

10.3389/fnagi.2021.811127 ◽

2022 ◽

Vol 13 ◽

Author(s):

Elena Carbone ◽

Federica Piras ◽

Massimiliano Pastore ◽

Erika Borella

Keyword(s):

Cognitive Functioning ◽

Individual Characteristics ◽

Cognitive Stimulation ◽

Older Age ◽

Everyday Functioning ◽

Moderate Dementia ◽

Short And Long Term

Introduction: This study examined the role of individual characteristics in predicting short- and long-term benefits of the Italian version of Cognitive Stimulation Therapy (CST-IT), an evidence-based intervention for people with mild-to-moderate dementia.Materials and Methods: Data were drawn from a sample (N = 123) of people with dementia (PwD) who took part in a multicenter controlled clinical trial of CST-IT. Assessments at pre-test, immediately after completing the treatment, and 3 months later investigated the following outcomes: general cognitive functioning and language, mood and behavior, everyday functioning, and quality of life. Age, education and baseline (pre-test) cognitive functioning, mood (depression) and behavioral and neuropsychiatric symptoms were considered as predictors of any short- and long-term benefits.Results: Linear mixed-effects models showed that different individual characteristics -particularly education and age- influenced the benefits of CST-IT, depending on the outcome measures considered. Higher education predicted larger gains in general cognitive functioning and, along with less severe depressive symptoms, in language (magnification effects). Older age was associated with positive changes in mood (compensation effects). Albeit very modestly, older age was also associated with larger gains in everyday functioning (compensation effects). Gains in quality of life were predicted by older age and lower education (compensation effects). Baseline cognitive functioning, mood and/or behavioral symptoms broadly influenced performance too, but their role again depended on the outcomes considered.Discussion: These findings underscore the importance of considering and further exploring how psychosocial interventions like CST are affected by individual characteristics in order to maximize their efficacy for PwD.

Download Full-text

Machine Learning Consensus Clustering Approach for Hospitalized Patients with Phosphate Derangements

Journal of Clinical Medicine ◽

10.3390/jcm10194441 ◽

2021 ◽

Vol 10 (19) ◽

pp. 4441

Author(s):

Charat Thongprayoon ◽

Carissa Y. Dumancas ◽

Voravech Nissaisorakarn ◽

Mira T. Keddis ◽

Andrea G. Kattah ◽

...

Keyword(s):

Machine Learning ◽

Cluster Analysis ◽

Kidney Disease ◽

Serum Phosphate ◽

Older Age ◽

Consensus Clustering ◽

Clustering Approach ◽

Key Features ◽

One Year ◽

Cluster 2

Background: The goal of this study was to categorize patients with abnormal serum phosphate upon hospital admission into distinct clusters utilizing an unsupervised machine learning approach, and to assess the mortality risk associated with these clusters. Methods: We utilized the consensus clustering approach on demographic information, comorbidities, principal diagnoses, and laboratory data of hypophosphatemia (serum phosphate ≤ 2.4 mg/dL) and hyperphosphatemia cohorts (serum phosphate ≥ 4.6 mg/dL). The standardized mean difference was applied to determine each cluster’s key features. We assessed the association of the clusters with mortality. Results: In the hypophosphatemia cohort (n = 3113), the consensus cluster analysis identified two clusters. The key features of patients in Cluster 2, compared with Cluster 1, included: older age; a higher comorbidity burden, particularly hypertension; diabetes mellitus; coronary artery disease; lower eGFR; and more acute kidney injury (AKI) at admission. Cluster 2 had a comparable hospital mortality (3.7% vs. 2.9%; p = 0.17), but a higher one-year mortality (26.8% vs. 14.0%; p < 0.001), and five-year mortality (20.2% vs. 44.3%; p < 0.001), compared to Cluster 1. In the hyperphosphatemia cohort (n = 7252), the analysis identified two clusters. The key features of patients in Cluster 2, compared with Cluster 1, included: older age; more primary admission for kidney disease; more history of hypertension; more end-stage kidney disease; more AKI at admission; and higher admission potassium, magnesium, and phosphate. Cluster 2 had a higher hospital (8.9% vs. 2.4%; p < 0.001) one-year mortality (32.9% vs. 14.8%; p < 0.001), and five-year mortality (24.5% vs. 51.1%; p < 0.001), compared with Cluster 1. Conclusion: Our cluster analysis classified clinically distinct phenotypes with different mortality risks among hospitalized patients with serum phosphate derangements. Age, comorbidities, and kidney function were the key features that differentiated the phenotypes.

Download Full-text

Evidence for Neuropsychological Health Disparities in Black Americans with HIV Disease

10.31234/osf.io/9ekcq ◽

2020 ◽

Author(s):

Jennifer L. Thompson ◽

Ilex Beltran-Najera ◽

Briana Johnson ◽

Yenifer Morales ◽

Steven Paul Woods

Keyword(s):

Processing Speed ◽

Daily Living ◽

Black Americans ◽

Neurocognitive Disorders ◽

Hiv Disease ◽

Large Effect Size ◽

Everyday Functioning ◽

Neurocognitive Impairments ◽

Z Scores ◽

Hiv Associated Neurocognitive Disorders

Objective: Black Americans are at high risk for HIV disease and associated morbidity. However, we know little about the neuropsychological impact and correlates of HIV disease among Black Americans. Methods: Participants included 40 Black persons with HIV (PWH), 83 White PWH, 28 Black HIV- and 64 White HIV- individuals. Neurocognition was measured with raw, sample-based z-scores from a clinical battery. Everyday functioning was assessed using self- and clinician-rated measures of cognitive symptoms and activities of daily living. HIV-associated neurocognitive disorders were classified using the Frascati criteria. Results: We observed a significant three-way interaction between HIV, race, and domain on neurocognitive z-scores. This omnibus effect was driven by large effect size decrements in semantic memory and processing speed in Black PWH compared to the other groups. Black PWH participants also demonstrated higher frequencies of HIV-associated neurocognitive disorders as compared to White PWH. Unexpectedly, global neurocognition was negatively related to everyday functioning for White PWH, but not for Black PWH. Conclusions: Systemic disadvantages for Black Americans may combine with HIV disease to compound some neurocognitive impairments in this vulnerable population. Prospective studies are needed to identify better ways to prevent and manage HIV-associated neurocognitive disorders among Black Americans.

Download Full-text