scholarly journals The impact of COVID-19 on adjusted mortality risk in care homes for older adults in Wales, UK: a retrospective population-based cohort study for mortality in 2016–2020

2020 ◽  
Author(s):  
Joe Hollinghurst ◽  
Jane Lyons ◽  
Richard Fry ◽  
Ashley Akbari ◽  
Mike Gravenor ◽  
...  
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Mortality Risk ◽  
Care Home ◽  
Care Homes ◽  
Mortality Data ◽  
Survival Curves ◽  
Risk Of Death ◽  
Increased Risk ◽  
The Impact

Abstract Background mortality in care homes has had a prominent focus during the COVID-19 outbreak. Care homes are particularly vulnerable to the spread of infectious diseases, which may lead to increased mortality risk. Multiple and interconnected challenges face the care home sector in the prevention and management of outbreaks of COVID-19, including adequate supply of personal protective equipment, staff shortages and insufficient or lack of timely COVID-19 testing. Aim to analyse the mortality of older care home residents in Wales during COVID-19 lockdown and compare this across the population of Wales and the previous 4 years. Study Design and Setting we used anonymised electronic health records and administrative data from the secure anonymised information linkage databank to create a cross-sectional cohort study. We anonymously linked data for Welsh residents to mortality data up to the 14th June 2020. Methods we calculated survival curves and adjusted Cox proportional hazards models to estimate hazard ratios (HRs) for the risk of mortality. We adjusted HRs for age, gender, social economic status and prior health conditions. Results survival curves show an increased proportion of deaths between 23rd March and 14th June 2020 in care homes for older people, with an adjusted HR of 1.72 (1.55, 1.90) compared with 2016. Compared with the general population in 2016–2019, adjusted care home mortality HRs for older adults rose from 2.15 (2.11, 2.20) in 2016–2019 to 2.94 (2.81, 3.08) in 2020. Conclusions the survival curves and increased HRs show a significantly increased risk of death in the 2020 study periods.

scholarly journals The Impact of COVID-19 on Adjusted Mortality Risk in Care Homes for Older Adults in Wales, United Kingdom: A retrospective population-based cohort study for mortality in 2016-2020

2020 ◽  
Author(s):  
Joe Hollinghurst ◽  
Jane Lyons ◽  
Richard Fry ◽  
Ashley Akbari ◽  
Mike Gravenor ◽  
...  
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Care Home ◽  
Care Homes ◽  
Mortality Data ◽  
Survival Curves ◽  
Risk Of Death ◽  
Hazard Ratios ◽  
Increased Risk ◽  
The Impact

ABSTRACTBackgroundMortality in care homes has had a prominent focus during the COVID-19 outbreak. Multiple and interconnected challenges face the care home sector in the prevention and management of outbreaks of COVID-19, including adequate supply of personal protective equipment, staff shortages, and insufficient or lack of timely COVID-19 testing. Care homes are particularly vulnerable to infectious diseases.AimTo analyse the mortality of older care home residents in Wales during COVID-19 lockdown and compare this across the population of Wales and the previous 4-years.Study Design and SettingWe used anonymised Electronic Health Records (EHRs) and administrative data from the Secure Anonymised Information Linkage (SAIL) Databank to create a cross-sectional cohort study. We anonymously linked data for Welsh residents to mortality data up to the 14th June 2020.MethodsWe calculated survival curves and adjusted Cox proportional hazards models to estimate hazard ratios (HRs) for the risk of mortality. We adjusted hazard ratios for age, gender, social economic status and prior health conditions.ResultsSurvival curves show an increased proportion of deaths between 23rd March and 14th June 2020 in care homes for older people, with an adjusted HR of 1·72 (1·55, 1·90) compared to 2016. Compared to the general population in 2016-2019, adjusted care home mortality HRs for older adults rose from 2·15 (2·11,2·20) in 2016-2019 to 2·94 (2·81,3·08) in 2020.ConclusionsThe survival curves and increased HRs show a significantly increased risk of death in the 2020 study periods.

scholarly journals Physical Functioning Decline and Mortality in Older Adults With Multimorbidity: Joint Modeling of Longitudinal and Survival Data

2018 ◽  
Vol 74 (2) ◽  
pp. 226-232 ◽  
Author(s):  
Melissa Y Wei ◽  
Mohammed U Kabeto ◽  
Andrzej T Galecki ◽  
Kenneth M Langa
Keyword(s):  
Older Adults ◽  
Mortality Risk ◽  
Physical Functioning ◽  
Survival Data ◽  
Short Form ◽  
Joint Modeling ◽  
Full Spectrum ◽  
Increased Risk ◽  
The Impact

Abstract Background Multimorbidity is common among older adults and strongly associated with physical functioning decline and increased mortality. However, the full spectrum of direct and indirect effects of multimorbidity on physical functioning and survival has not been quantified. We aimed to determine the longitudinal relationship of multimorbidity on physical functioning and quantify the impact of multimorbidity and multimorbidity-attributed changes in physical functioning on mortality risk. Methods The Health and Retirement Study (HRS) is a nationally representative population-based prospective cohort of adults aged 51 or older. In 2000, participants were interviewed about physician-diagnosed chronic conditions, from which their multimorbidity-weighted index (MWI) was computed. Between 2000 and 2011, participants reported their current physical functioning using a modified Short Form-36. With MWI as a time-varying exposure, we jointly modeled its associations with physical functioning and survival. Results The final sample included 74,037 observations from 18,174 participants. At baseline, participants had a weighted mean MWI of 4.6 ± 4.2 (range 0–36.8). During follow-up, physical functioning declined: −1.72 (95% confidence interval [CI] −1.77, −1.67, p < .001) HRS physical functioning units per point MWI in adjusted models. Over follow-up, 6,362 (34%) participants died. Mortality risk increased 8% (hazard ratio 1.08, 95% CI 1.07–1.08, p < .001) per point MWI in adjusted models. Across all population subgroups, MWI was associated with greater physical functioning decline and mortality risk. Conclusions Multimorbidity and its associated decline in physical functioning were significantly associated with increased mortality. These associations can be predicted with an easily interpreted and applied multimorbidity index that can better identify and target adults at increased risk for disability and death.

scholarly journals The Impact of Obesity and Adiposity on Mortality Risk in Older Adults: A Ten-year Survival Analysis

2021 ◽  
Author(s):  
Letícia Almeida Nogueira Moura ◽  
Valéria Pagotto ◽  
Cristina Camargo Pereira ◽  
Rômulo Roosevelt da Silva Filho ◽  
César de Oliveira ◽  
...  
Keyword(s):  
Older Adults ◽  
Survival Analysis ◽  
Mortality Risk ◽  
Cancer Mortality ◽  
Cox Regression ◽  
Clinical History ◽  
The Body ◽  
Increased Risk ◽  
Multifrequency Bioimpedance ◽  
The Impact

Abstract There are not much information about the impact of obesity on all-cause, cardiovascular and cancer mortality in older adults. We have investigated the impact of obesity and adiposity on all-cause, cardiovascular and cancer mortality, in older adults after a 10-year follow-up. Prospective cohort study has been carried out with individuals ≥ 60 years. Sociodemographic characteristics, lifestyle, clinical history, laboratory tests and anthropometric data were collected. Adiposity was defined as tertiles of the percentage of body fat assessed by multifrequency bioimpedance. For obesity, three classifications were considered using the body mass index (BMI) as follows: ≥ 25.0 kg/m² in men and ≥ 26.6 kg/m² in women, ≥ 27.0 kg/m² and ≥ 30.0 kg/m². The BMI ≥ 30.0 kg/m² was associated a reduction in the all-cause mortality risk in non-ajusted Cox regression (HR: 0.65; 95% CI: 0.43 - 0.97) and in the Kaplan-Meier curves (p = 0.032). However, in multivariate Cox regression none of the diagnostic criteria for obesity and adiposity were significantly associated with all-cause, cardiovascular or cancer mortality. This 10-year survival analysis has showed that obesity and adiposity were not associated with an increased risk of all-cause, cardiovascular or cancer mortality in the older adults.

Anxiety, isolation and diminishing resources: the impact of COVID-19 pandemic on residential care home facilities for older people in south-east Nigeria

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Prince Chiagozie Ekoh
Keyword(s):  
Older Adults ◽  
Care Home ◽  
Health Impact ◽  
Sub Saharan Africa ◽  
Care Homes ◽  
Family Structures ◽  
Content Type ◽  
Sub Saharan ◽  
Fear And Anxiety ◽  
The Impact

Purpose Institutionalized older adults in care homes and long-care facilities have been identified as being at greater risk of COVID-19 related morbidity and mortality. Thus, this paper aims to explore the impact of COVID-19 on care homes in south-east Nigeria given the recent increasing popularity of care homes in Nigeria. Design/methodology/approach The study adopted qualitative research method, and data was collected from 10 older residents and 5 caregivers using interviews from two care homes, while ensuring the safety of the researcher and participants. The collected data was analyzed using thematic analysis. Findings Findings revealed that the physical health impact of the COVID-19 pandemic is not a major problem in the homes. However, fear and anxiety, social disconnection and economic hardship were the major problems identified by the older residents and caregivers in the homes. Originality/value The popularity of care homes in Nigeria is growing as family structures continue to change. However, previous studies which have revealed devastating effect of COVID-19 on institutionalized older adults have been from the global north. This is the first study designed to bridge the gap in literature and contribute to knowledge on this topic from Nigeria and Sub-Saharan Africa.

Abstract MP96: Dysglycemia and Mortality in Older Adults With and Without Diabetes

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Priya Palta ◽  
Elbert S Huang ◽  
Rita R Kalyani ◽  
Sherita H Golden ◽  
Frederick L Brancati ◽  
...  
Keyword(s):  
Older Adults ◽  
Mortality Risk ◽  
Survey Design ◽  
Smoking Status ◽  
Hdl Cholesterol ◽  
Mortality Data ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Nationally Representative ◽  
Diagnosed Diabetes

Studies in middle-aged adults report higher levels of glycated hemoglobin are associated with increased risk of mortality in non-diabetic individuals. Few studies have sufficient data to assess this association in older adults. We analyzed data from the Third National Health and Nutrition Examination Survey (1988-1994), Continuous NHANES (1999-2004), and their linked mortality data (through December 2006) to determine the risk of mortality by levels of HbA1c in older adults with and without diabetes. All analyses are weighted to represent the US population and to account for the complex survey design. Cox proportional hazard models examining the relationship between HbA1c and mortality were adjusted for age, sex, race, education, body mass index, smoking status, HDL cholesterol and hypertension. At baseline, in 7,405 adults, age ≥65 with HbA1c data (42.9% men; 7.5% black; 2.4% Mexican; mean age 73.5 (0.13)), 22.8% had clinically diagnosed diabetes (defined as self-reported physician diagnosis of diabetes and/or use of insulin or hypoglycemic medications). Over a median follow-up of 7.8 years, 4,625 participants (41.9%; 68.1 per 1000 person-years) died due to cardiovascular disease (CVD; n=1520) or non-CVD (n=3105). Non-diabetic older adults with a HbA1c between 5.7-6.4% (defined as “at risk for diabetes” by the American Diabetes Association) had a significantly greater risk of all-cause (HR: 1.39; 95% CI: 1.03-1.89) and non-CVD (HR: 1.55; 95% CI: 1.13-2.13) mortality compared to those with HbA1c<5.0% (referent). In older diabetic adults, there was a graded increase in mortality risk with significant associations found between HbA1c and all-cause (HR: 1.90; 95% CI: 1.13-3.28) and CVD (HR: 2.67; 95% CI: 1.17-6.09) mortality, in analyses comparing participants with a HbA1c between 8.0-8.9% to those with HbA1c <6.5% (referent). These data from a large, nationally representative sample of older adults indicate that dysglycemia is associated with increased mortality risk in older adults with and without diabetes.

P2746Survival of people with valvular heart disease in the community (OxValve-Survive)

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Taylor ◽  
J M Ordonez-Mena ◽  
A K Roalfe ◽  
J Wilson ◽  
S Myerson ◽  
...  
Keyword(s):  
Heart Disease ◽  
Cause Of Death ◽  
Valvular Heart Disease ◽  
Cox Regression ◽  
Severe Disease ◽  
Research Centre ◽  
Mortality Data ◽  
Risk Of Death ◽  
Increased Risk ◽  
The Impact

Abstract Background Valvular heart disease (VHD) occurs commonly in older patients (>65 years) but the majority is mild disease, which is of uncertain importance. Understanding the impact of VHD on mortality in this older group of patients would help determine its relevance and aid the appropriate use of healthcare resources. OxValve is a cohort study in Oxfordshire screening people aged 65 and over for VHD. Over 4,009 participants were recruited between August 2009 and May 2016 and screened using echocardiography to establish the presence and severity of VHD. AIMS To report survival in the OxValve cohort, and to investigate whether people with VHD are at increased risk of death. Methods The OxValve cohort was linked to Office for National Statistics mortality data to obtain date and cause of death. Cox regression was used to investigate the association of any VHD, VHD of significant severity, and VHD subtypes with all-cause and cause-specific mortality, adjusting for potential confounders including age, sex, socioeconomic status, smoking, and comorbidities. Results Linked mortality data was available for 3,511 OxValve participants up to September 2018 (median 5.85 years follow-up). VHD was present in 2,645 (75.3%) participants and of these 288 (8.2%) had significant VHD. In total, 311 (8.9%) participants had died. Cancer was the commonest cause of death (n=135), followed by cardiovascular disease (n=75) and respiratory disease (n=35). After adjustment for age and other covariates, mild to moderate VHD was not associated with increased all-cause mortality (HR 1.16, 95% CI: 0.89 to 1.50). However, VHD of significant severity (moderate or severe disease) was associated with a nearly two-fold higher risk of death overall (HR 1.92, 95% CI: 1:38 to 2.67) including increased CVD mortality (HR 2.25, 95% CI: 1.21 to 4.18). DISCUSSION Mild to moderate VHD was very common, but was not associated with increased mortality. Significant VHD was however associated with a two-fold reduction in survival. Further research is required to understand the natural history of VHD, how to identify those with progressive disease and when to intervene. Acknowledgement/Funding NIHR Biomedical Research Centre, Oxford

The risk of venous thromboembolism after surgery for esophagogastric malignancy and the impact of chemotherapy: a population-based cohort study

2019 ◽  
Vol 33 (6) ◽  
Author(s):  
Alfred Adiamah ◽  
Lu Ban ◽  
Joe West ◽  
David J Humes
Keyword(s):  
Gastric Cancer ◽  
Cohort Study ◽  
Venous Thromboembolism ◽  
Adjuvant Chemotherapy ◽  
Cumulative Incidence ◽  
Population Based ◽  
Risk Of Death ◽  
Increased Risk ◽  
Esophagogastric Cancer ◽  
The Impact

SUMMARY To define the incidence of postoperative venous thromboembolism (VTE) and effects of chemotherapy in a population undergoing surgery for esophagogastric cancer. This population-based cohort study used linked primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care data from England to identify subjects undergoing esophageal or gastric cancer surgery between 1997 and 2014. Exposures included age, comorbidity, smoking, body mass index, and chemotherapy. Crude rates and adjusted hazard ratios (HRs) were calculated for rate of first postoperative VTE using Cox regression models. The cumulative incidence of VTE at 1 and 6 months was estimated accounting for the competing risk of death from any cause. Of the 2,452 patients identified, 1,012 underwent gastrectomy (41.3%) and 1,440 esophagectomy (58.7%). Risk of VTE was highest in the first month, with absolute VTE rates of 114 per 1,000 person-years (95% CI 59.32–219.10) following gastrectomy and 172.73 per 1,000 person-years (95% CI 111.44–267.74) following esophagectomy. Neoadjuvant and adjuvant chemotherapy was associated with a six-fold increased risk of VTE following gastrectomy, HR 6.19 (95% CI 2.49–15.38). Cumulative incidence estimates of VTE at 6 months following gastrectomy in patients receiving no chemotherapy was 1.90% and esophagectomy 2.21%. However, in those receiving both neoadjuvant and adjuvant chemotherapy, cumulative incidence following gastrectomy was 10.47% and esophagectomy, 3.9%. VTE rates are especially high in the first month following surgery for esophageal and gastric cancer. The cumulative incidence of VTE at 6 months is highest in patients treated with chemotherapy. In this category of patients, targeted VTE prophylaxis may prove beneficial during chemotherapy treatment.

scholarly journals Survival of people with valvular heart disease in a large, English community-based cohort study

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318823
Author(s):  
Clare J Taylor ◽  
José M Ordóñez-Mena ◽  
Nicholas R Jones ◽  
Andrea K Roalfe ◽  
Saul G Myerson ◽  
...  
Keyword(s):  
Cohort Study ◽  
Heart Disease ◽  
Valvular Heart Disease ◽  
Outcome Analysis ◽  
Mortality Data ◽  
Risk Of Death ◽  
National Mortality ◽  
Increased Risk ◽  
Aortic Sclerosis ◽  
Clinically Significant

ObjectiveValvular heart disease (VHD) is present in half the population aged >65 years but is usually mild and of uncertain importance. We investigated the association between VHD and its phenotypes with all-cause and cause-specific mortality.MethodsThe OxVALVE (Oxford Valvular Heart Disease) population cohort study screened 4009 participants aged >65 years to establish the presence and severity of VHD. We linked data to a national mortality registry and undertook detailed outcome analysis.ResultsMortality data were available for 3511 participants, of whom 361 (10.3%) died (median 6.49 years follow-up). Most had some form of valve abnormality (n=2645, 70.2%). In adjusted analyses, neither mild VHD (prevalence 44.9%) nor clinically significant VHD (moderate or severe stenosis or regurgitation; 5.2%) was associated with increased all-cause mortality (HR 1.20, 95% CI 0.96 to 1.51 and HR 1.47, 95% CI 0.94 to 2.31, respectively). Conversely, advanced aortic sclerosis (prevalence 2.25%) and advanced mitral annular calcification (MAC, 1.31%) were associated with an increased risk of death (HR 2.05, 95% CI 1.28 to 3.30 and HR 2.51, 95% CI 1.41 to 4.49, respectively). Mortality was highest for people with both clinically significant VHD and advanced aortic sclerosis or MAC (HR 4.38, 95% CI 1.99 to 9.67).ConclusionsAdvanced aortic sclerosis or MAC is associated with a worse outcome, particularly for patients with significant VHD, but also in the absence of other VHD. Older patients with mild VHD can be reassured about their prognosis. The absence of an association between significant VHD and mortality may reflect its relatively low prevalence in our cohort.

scholarly journals 201 - Care Home Residents as Artists: Digital Connections in the age of Disconnect.

2021 ◽  
Vol 33 (S1) ◽  
pp. 6-7
Author(s):  
Nicola Abraham ◽  
Rachel Hudspith
Keyword(s):  
Older Adults ◽  
New Technologies ◽  
Housing Association ◽  
Care Home ◽  
Care Homes ◽  
News Reports ◽  
Global Pandemic ◽  
Failure To Protect ◽  
The Uk ◽  
The Impact

AbstractThroughout the current global pandemic, many people have had to adapt to new ways of interacting through virtual platforms. For those with access to new technologies this transition has been straightforward, but not easy and for those without it, life has become socially isolating, frightening, and lonely. The impact of COVID-19 on the mental health of older adults is a serious concern, particularly for those living in care homes who have been forgotten or neglected by exclusionary government policy. Amnesty International’s 2020 report As if Expendable: The UK Government’s Failure to Protect Older People in Care Homes During the COVID-19 Pandemic provides analysis of the neglect to care and sufficiently support older adults living with dementia in supported living. The results of this inaction to provide care has led to many avoidable deaths, and caused fear and heartache for those who have lost family, friends and colleagues. It is at this moment, during the third UK lockdown that we would like to share a narrative of hope about the actions that we have taken within care home contexts to provide relief, reconnect residents safely with their neighbours, and found creative ways to inclusively provide care, support and celebrations of the identities of people in these contexts who have become statistics in news reports.Between January and March 2021, undergraduate and postgraduate Applied Theatre students from The Royal Central School of Speech and Drama in partnership with Imperial College Healthcare NHS Trust collaborated with residents from One Housing Association to create and develop bespoke films, poems, songs and virtual reality 360 videos from the safety of their homes to bring to life their stories, hopes and inner artists. In this presentation, we will explore the impact of these projects on the participants’ wellbeing and examine the importance of providing older adults opportunities to be creative. We will additionally offer insights into the relationships that were made and developed during the projects, including family connections, intergenerational connections and playful relationships that emerged between the residents themselves and their Carers.

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