scholarly journals 95 Lack of Evidence for Reduced Efficacy of Medical Therapy for Heart Failure in Older Adults

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
A Cox-Smith ◽  
T Cooper ◽  
P Punjabi ◽  
C Barton ◽  
S Levy ◽  
...  
Keyword(s):  
Heart Failure ◽  
Older Adults ◽  
Medical Therapy ◽  
Effect Size ◽  
Age Groups ◽  
Informed Choice ◽  
Evidence Base ◽  
Older Age ◽  
Age Group ◽  
Life Years

Abstract Introduction There are almost a million people with heart failure (HF) in the UK; the incidence increases sharply with age. Older adults receive less evidence-based therapy with few trials specifically examining therapeutic efficacy in older age groups representative of a contemporary UK HF population. Concern that efficacy is less in older adults may underlie under-prescription. With important recent advances in HF therapy, we reviewed the contemporary evidence base for any signal of different efficacy in older adults. Methods We reviewed recent RCTs of medical therapy for heart failure alongside meta-analyses updated with recent therapies including Angiotensin-Neprilysin inhibitors and SGLT2 inhibitors. For those trials in which effect size was presented for age subgroups we compared the effect size. Results Of 68 randomised controlled trials, 10 presented effect sizes for different age groups. The median average cut-off between younger and older age groups was 66 years (IQR 65 to 72.5 years) and the highest cut-off used was 75 years. The median hazard ratio was 0.77 (IQR 0.67 to 0.80) for the younger age group and 0.76 (IQR 0.73 to 0.88) for the older age group. In 8 of the 10 trials, the effect size in the oldest age group was statistically significant on its own including Sacubitril-Valsartan and Dapagliflozin. Conclusion When considering the medical therapeutic armamentarium for heart failure as a totality, there is no evidence it is any less effective in older adults than younger adults. The recent Zannad et al cross-trial analysis supported this showing significant additional life years in the patients over 80 years on HF therapy. Whilst there may be practical and frailty-related reasons for not prescribing life-prolonging therapy, the proportional survival benefits of these medications is similar in older adults. This should be utilised where practically possible and discussed with patients when making an informed choice.

scholarly journals NEGATIVE SOCIAL SUPPORTS AND DEPRESSIVE SYMPTOMS AMONG OLDER ADULTS: A CROSS-LAGGED ANALYSIS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S166-S166
Author(s):  
Nicholas Cone ◽  
Gina Lee ◽  
Peter Martin
Keyword(s):  
Social Support ◽  
Older Adults ◽  
Depressive Symptoms ◽  
Family Member ◽  
Family Members ◽  
Age Groups ◽  
Social Supports ◽  
Interaction Effects ◽  
Older Age ◽  
Age Group

Abstract The purpose of the study was to examine how negative social supports and depressive symptoms affect older adults over time. A subsample of participants (N = 3,084) from the Health and Retirement Study was used in this study. Summary scores for each negative social supports (spouse, children, family members, and friends) and the Center for Epidemiologic Studies Depression Scale (CES-D) were used to conduct two cross-lagged regression analyses for each negative social support type from waves 2010 and 2014. Covariate variables for this study included gender, years of education, self-report of health, and age. Results were computed for two age groups (i.e., 65 to 79, and 80+). Results from both age groups indicated high stability for negative social supports and depressive symptoms from waves 1 to 2. The younger age group showed no significant cross-lag or interaction effects when stabilities were included or excluded in the analyses. However, in the older group, wave 2 negative child and family member social support was predicted by wave 1 depression scores. Moreover, the older age group showed significant interaction effects of age by CESD scores on negative child and family member social supports. In conclusion, initial depressive symptoms predict higher negative social supports in children and family members at a second time point in the older age group. Future research could examine whether depressive symptoms continue to predict negative social supports in new waves. In addition, other factors, such as loneliness, or anxiety, may provide further understanding into older adults’ negative social supports.

The Effect of Older Age on the Perioperative Outcomes of Spinal Fusion Surgery in Patients With Lumbar Degenerative Disc Disease With Spondylolisthesis: A Propensity Score-Matched Analysis

Neurosurgery ◽  
2019 ◽  
Vol 87 (4) ◽  
pp. 672-678
Author(s):  
Jetan H Badhiwala ◽  
Brij S Karmur ◽  
Laureen D Hachem ◽  
Jamie R F Wilson ◽  
Fan Jiang ◽  
...  
Keyword(s):  
Older Adults ◽  
Propensity Score ◽  
Spinal Fusion ◽  
Age Groups ◽  
Older Age ◽  
Perioperative Outcomes ◽  
Age Group ◽  
Improvement Program ◽  
Steroid Use ◽  
The Impact

Abstract BACKGROUND Degenerative spondylolisthesis (DS) is often treated with lumbar spinal fusion (LSF). However, there is concern that the morbidity of LSF may be prohibitively high in older adults. OBJECTIVE To evaluate the impact of advanced age on the safety of LSF for DS. METHODS Patients who underwent LSF for DS were retrospectively identified from National Surgical Quality Improvement Program datasets for 2011 to 2015 using Current Procedural Terminology codes. Data on demographic characteristics, comorbidities, surgical factors, and 30-d morbidity and mortality were collected. Propensity score matching (nearest neighbor) was performed with age (<70 vs ≥70 yr) as the dependent variable and sex, type of fusion procedure, number of levels fused, diabetes, smoking, hypertension, and chronic steroid use as covariates. Outcomes were compared between age <70 and ≥70 groups. RESULTS The study cohort consisted of 2238 patients (n = 1119, age <70; n = 1119, age ≥70). The 2 age groups were balanced for key covariates including sex, race, diabetes, hypertension, CHF, smoking, chronic steroid use, type of fusion, and number of levels. Rates of all complications were similar between younger and older age groups, except urinary tract infection, which was more frequent among the ≥70 age group (OR 2.32, P = .009). Further, patients in the older age group were more likely to be discharged to a rehabilitation (OR 2.94, P < .001) or skilled care (OR 3.66, P < .001) facility, rather than directly home (OR 0.25, P < .001). CONCLUSION LSF may be performed safely in older adults with DS. Our results suggest older age alone should not exclude a patient from undergoing lumbar fusion for DS.

Experience and expression of social isolation by inner-city high-rise residents

2014 ◽  
Vol 17 (3) ◽  
pp. 151-166 ◽  
Author(s):  
Love M. Chile ◽  
Xavier M. Black ◽  
Carol Neill
Keyword(s):  
Older Adults ◽  
Inner City ◽  
Social Isolation ◽  
Age Groups ◽  
Evidence Base ◽  
Structured Interviews ◽  
Content Type ◽  
High Rise ◽  
Starting Point ◽  
Health And Social Care

Purpose – The purpose of this paper is to examine the significance of social isolation and the factors that create social isolation for residents of inner-city high-rise apartment communities. We critically examine how the physical environment and perceptions of safety in apartment buildings and the inner-city implicate the quality of interactions between residents and with their neighbourhood community. Design/methodology/approach – The authors used mixed-methods consisting of survey questionnaires supplemented by semi-structured interviews and focus group discussions using stratified random sampling to access predetermined key strata of inner-city high-rise resident population. Using coefficient of correlation we examine the significance of the association between social isolation, age and ethnicity amongst Auckland's inner-city high-rise residents. Findings – The authors found the experience and expression of social isolation consistent across all age groups, with highest correlation between functional social isolation and “being student”, and older adults (60+ years), length of tenure in current apartment and length of time residents have lived in the inner-city. Research limitations/implications – As a case study, we did not seek in this research to compare the experience and expressions of social isolation in different inner-city contexts, nor of inner-city high-rise residents in New Zealand and other countries, although these will be useful areas to explore in future studies. Practical implications – This study is a useful starting point to build evidence base for professionals working in health and social care services to develop interventions that will help reduce functional social isolation amongst young adults and older adults in inner-city high-rise apartments. This is particularly important as the inner-city population of older adults grow due to international migration, and sub-national shifts from suburbs to the inner-cities in response to governmental policies of urban consolidation. Originality/value – By identifying two forms of social isolation, namely functional and structural social isolation, we have extended previous analysis of social isolation and found that “living alone” or structural social isolation did not necessarily lead to functional social isolation. It also touched on the links between functional social isolation and self-efficacy of older adults, particularly those from immigrant backgrounds.

scholarly journals Healthy aging profile in octogenarians in Brazil

2016 ◽  
Vol 24 (0) ◽  
Author(s):  
Ana Cristina Viana Campos ◽  
Efigênia Ferreira e Ferreira ◽  
Andréa Maria Duarte Vargas ◽  
Lúcia Hisako Takase Gonçalves
Keyword(s):  
Older Adults ◽  
Decision Tree ◽  
Healthy Aging ◽  
Age Groups ◽  
Population Based ◽  
P Value ◽  
Age Group ◽  
Monthly Income ◽  
Tree Model ◽  
Socioeconomic Characteristics

ABSTRACT Objective: to identify the healthy aging profile in octogenarians in Brazil. Method: this population-based epidemiological study was conducted using household interviews of 335 octogenarians in a Brazilian municipality. The decision-tree model was used to assess the healthy aging profile in relation to the socioeconomic characteristics evaluated at baseline. All of the tests used a p-value < 0.05. Results: the majority of the 335 participating older adults were women (62.1%), were aged between 80 and 84 years (50.4%), were widowed (53.4%), were illiterate (59.1%), had a monthly income of less than one minimum wage (59.1%), were retired (85.7%), lived with their spouse (63.8%), did not have a caregiver (60.3%), had two or more children (82.7%), and had two or more grandchildren (78.8%). The results indicate three age groups with a healthier aging profile: older adults aged 80 to 84 years (55.6%), older adults aged 85 years and older who are married (64.9%), and older adults aged 85 and older who do not have a partner or a caregiver (54.2%). Conclusion: the healthy aging profile of octogenarians can be explained by age group, marital status, and the presence of a caregiver.

scholarly journals Slowed sensory reweighting and postural illusions in older adults: the moving platform illusion

2019 ◽  
Vol 121 (2) ◽  
pp. 690-700 ◽  
Author(s):  
Chesney E. Craig ◽  
Michail Doumas
Keyword(s):  
Older Adults ◽  
Young Adults ◽  
Postural Sway ◽  
Age Groups ◽  
Age Group ◽  
Sensory Reweighting ◽  
Perceptual Illusion ◽  
Healthy Older Adults ◽  
Stable Conditions ◽  
Illusory Perception

We investigated whether postural aftereffects witnessed during transitions from a moving to a stable support are accompanied by a delayed perception of platform stabilization in older adults, in two experiments. In experiment 1, postural sway and muscle cocontraction were assessed in 11 healthy young, 11 healthy older, and 11 fall-prone older adults during blindfolded stance on a fixed platform, followed by a sway-referenced platform and then by a fixed platform again. The sway-referenced platform was more compliant for young adults, to induce similar levels of postural sway in both age groups. Participants were asked to press a button whenever they perceived that the platform had stopped moving. Both older groups showed significantly larger and longer postural sway aftereffects during platform stabilization compared with young adults, which were pronounced in fall-prone older adults. In both older groups elevated muscle cocontraction aftereffect was also witnessed. Importantly, these aftereffects were accompanied by an illusory perception of prolonged platform movement. After this, experiment 2 examined whether this illusory perception was a robust age effect or an experimental confound due to greater surface compliance in young adults, which could create a larger perceptual discrepancy between moving and stable conditions. Despite exposure to the same surface compliance levels during sway-reference, the perceptual illusion was maintained in experiment 2 in a new group of 14 healthy older adults compared with 11 young adults. In both studies, older adults took five times longer than young adults to perceive platform stabilization. This supports that sensory reweighting is inefficient in older adults. NEW & NOTEWORTHY This is the first paper to show that postural sway aftereffects witnessed in older adults after platform stabilization may be due to a perceptual illusion of platform movement. Surprisingly, in both experiments presented it took older adults five times longer than young adults to perceive platform stabilization. This supports a hypothesis of less efficient sensory reintegration in this age group, which may delay the formation of an accurate postural percept.

scholarly journals Agency and communion attributes in adults’ spontaneous self-representations

2004 ◽  
Vol 28 (1) ◽  
pp. 1-15 ◽  
Author(s):  
Manfred Diehl ◽  
Stephanie K. Owen ◽  
Lise M. Youngblade
Keyword(s):  
Older Adults ◽  
Age Groups ◽  
Well Being ◽  
Age Group ◽  
Defence Mechanisms ◽  
Four Dimensions ◽  
Agency And Communion ◽  
Middle Aged Adults ◽  
Group Self ◽  
Age And Sex

This study investigated agency and communion attributes in adults’ spontaneous self-representations. The study sample consisted of 158 adults (80 men, 78 women) ranging in age from 20 to 88 years. Consistent with theorising, significant age and sex differences were found in terms of the number of agency and communion attributes. Young and middle-aged adults included significantly more agency attributes in their self-representations than older adults; men listed significantly more agency attributes than women. In contrast, older adults included significantly more communion attributes in their self-representations than young adults, and women listed significantly more communion attributes than men. Significant Age Group × Self-Portrait Display and Sex × Self-Portrait Display interactions were found for communion attributes, indicating that the importance of communion attributes differed across age groups and by sex. Correlational analyses showed significant associations of agency and communion attributes with personality traits and defence mechanisms. Communion attributes also showed significant correlations with four dimensions of psychological well-being.

scholarly journals Aging Reduces EEG Markers of Recognition Despite Intact Performance: Implications for Forensic Memory Detection

2020 ◽  
Author(s):  
Robin Hellerstedt ◽  
Arianna Moccia ◽  
Chloe M. Brunskill ◽  
Howard Bowman ◽  
Zara M. Bergström
Keyword(s):  
Older Adults ◽  
Temporal Variability ◽  
Brain Activity ◽  
Age Groups ◽  
Older Age ◽  
Practical Applications ◽  
Younger Age ◽  
Behavioural Performance ◽  
Older Populations

AbstractERP-based forensic memory detection is based on the logic that guilty suspects will hold incriminating knowledge about crimes they have committed, and therefore should show parietal ERP positivities related to recognition when presented with reminders of their crimes. We predicted that such forensic memory detection might however be inaccurate in older adults, because of changes to recognition-related brain activity that occurs with aging. We measured both ERPs and EEG oscillations associated with episodic old/new recognition and forensic memory detection in 30 younger (age < 30) and 30 older (age > 65) adults. EEG oscillations were included as a complementary measure which is less sensitive to temporal variability and component overlap than ERPs. In line with predictions, recognition-related parietal ERP positivities were significantly reduced in the older compared to younger group in both tasks, despite highly similar behavioural performance. We also observed ageing-related reductions in oscillatory markers of recognition in the forensic memory detection test, while the oscillatory effects associated with episodic recognition were similar across age groups. This pattern of results suggests that while both forensic memory detection and episodic recognition are accompanied by ageing-induced reductions in parietal ERP positivities, these reductions may be caused by non-overlapping mechanisms across the two tasks. Our findings suggest that EEG-based forensic memory detection tests are invalid in older populations, limiting their practical applications.

scholarly journals TSH enhancement of FT4 to FT3 conversion is age dependent

2016 ◽  
Vol 175 (1) ◽  
pp. 49-54 ◽  
Author(s):  
David Strich ◽  
Gilad Karavani ◽  
Shalom Edri ◽  
David Gillis
Keyword(s):  
Age Groups ◽  
Thyroid Stimulating Hormone ◽  
Older Age ◽  
Age Group ◽  
Free T4 ◽  
Free T3 ◽  
Age Related ◽  
Differential Increase ◽  
Retrospective Examination ◽  
Tsh Levels

ObjectiveWe previously reported increasing free T3 (FT3) to free T4 (FT4) ratios as thyroid-stimulating hormone (TSH) increases within the normal range in children. It is not known if this phenomenon is age-related among humans, as previously reported in rats. This study examines the relationships between TSH and FT3/FT4 ratios in different ages.DesignRetrospective examination of thyroid tests from patients without thyroid disease from community clinics.MethodsFree T3, free T4, and TSH levels from 527 564 sera collected from patients aged 1 year or greater were studied. Exclusion criteria were the following: missing data, TSH greater than 7.5mIU/L, and medications that may interfere with thyroid hormone activity. A total of 27 940 samples remaining after exclusion were stratified by age. Samples with available anthropometric data were additionally stratified for body mass index (BMI). Correlations of TSH to FT4, FT3, and FT3/FT4 ratios by age group were examined.ResultsUp to age 40, for each increasing TSH quartile, FT3 and the FT3/FT4 ratio increased and FT4 decreased significantly (for both FT3, FT4 and FT3/FT4 ratio,P<0.05 for every TSH quartile when compared with the 1st quartile, except FT3 in the 30–40 age group). In older age groups, increasing TSH was not associated with increased FT3/FT4 ratio.ConclusionAs TSH levels increase, FT3/FT4 ratios increase until age 40, but this differential increase does not occur in older age groups. This may reflect a decrease in thyroxine (T4) to triiodothyronine (T3) conversion with age, which may be part of the aging process.

Design of Telephone Answering Machines for Older Adults

1997 ◽  
Vol 41 (2) ◽  
pp. 1367-1367
Author(s):  
Chin Chin Lee ◽  
Jessica D'Agostini ◽  
Sara J. Czaja ◽  
Joseph Sharit
Keyword(s):  
Older Adults ◽  
Older People ◽  
Age Differences ◽  
Task Analysis ◽  
Age Groups ◽  
Older Age ◽  
Hearing Impairments ◽  
Usage Patterns ◽  
Automatic Teller Machines

Older adults frequently have difficulty when attempting to use various forms of technology such as computers or automatic teller machines. This study evaluated the usability of telephone answering machines for older adults. Initially, a task analysis of four commonly used answering machines was performed to identify the subtasks involved in using an answering machine. A questionnaire was then developed which assessed usage patterns and usability issues associated with answering machines. This questionnaire was administered to a sample of 68 people aged 65+ yrs. and 50 people aged 20 — 30 yrs. The data indicated that most older people own answering machines and perceive them as useful. There were, however, some age differences in aspects of usability. The older adults were more likely to have difficulty understanding messages than the younger people and to perceive the messages as distorted. Further, the older people reported that they have difficulty replaying messages and accessing messages remotely. The results also indicated that older people with hearing impairments were more likely to have problems with message distortion than those without hearing impairments. Overall, the data suggest features of answering machines which affect the usability of this technology for older age groups. Data is currently being collected regarding the ability of a sample of older people to perform a common set of tasks using two different answering machines. The results from the research are being used to develop recommendations for improving the design of telephone answering machines for people of all age groups.

scholarly journals SAT-168 Adrenal Incidentalomas: Impact of Patient Age on Referral Rates for Endocrine Evaluation

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Anthony Fryer ◽  
Sarah Hancock ◽  
Cherian George ◽  
Basil George Issa ◽  
Simon Lea ◽  
...  
Keyword(s):  
Age Groups ◽  
Adrenal Incidentaloma ◽  
Older Age ◽  
Age Group ◽  
Adrenal Incidentalomas ◽  
Patient Age ◽  
Radiology Reports ◽  
Patient Âgé ◽  
Mri Scans ◽  
Ct And Mri

Abstract It is estimated that the prevalence of adrenal incidentaloma increases with age: ~3% of those aged 50 years, rising to 10% in those &gt;70 years (1). Given the aging population together with increased utilisation of cross-sectional imaging in the UK (eg CT urogram, MR angiogram), we explored the proportion of patients with adrenal incidentaloma by age based on current imaging trends. Furthermore, there is no information currently available on the relationship between age and pattern of endocrine referrals. We extracted data for all CT and MRI scans from Jan 2018-Oct 2019 and used key phrases in radiology reports (eg adrenal adenoma/lesion/mass/nodule/incidentaloma, incidental adrenal, indeterminate adrenal) to identify potential lesions. We also extracted data on patient age and referral patterns as identified by a logged referral or an attendance (new or follow-up) to endocrine clinic 3 months post index scan, stratified by 10 year age groups. Where possible, we excluded false hits (eg no adrenal lesion). Preliminary data showed that, of the 2604 potential lesions identified by CT and MRI scans, 78.7% were on patients aged over 60 years. The numbers of identified lesions gradually increased with age to a peak in the 71-80 year age group after which these declined. Whilst patients younger that 60 years had fewer potential lesions identified, they were more likely to be referred to endocrine services (73 out of 55 patients; 13.2%) than those in the older age group (168 out of 2049; 8.2%; p&lt;0.001). Indeed there was a statistically significant trend towards decreasing referral with age group (Chi-squared test for trend; p&lt;0.001). In conclusion, patients over 60 years have a higher number of potential adrenal incidentalomas. However, this group is less likely to be referred for endocrine evaluation. This is particularly concerning given the large number of scans requested and the higher prevalence of incidentalomas in this age group. This study represents preparatory work on innovations to enhance case detection, particularly in the older age groups (2). 1. Fassnacht M, Arlt W, Bancos I, et al. Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline. Eur J Endocrinol. 2016;175:G1-G34 2. Hanna FWF, Issa BG, Lea SC, George C, Golash A, Firn M, Ogunmekan S, Maddock E, Sim J, Xydopoulos G, Fordham R, Fryer AA. Adrenal lesions found incidentally: how to improve clinical and cost-effectiveness. BMJ Open Quality. 2019;In press.

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