Comparative effectiveness of sitagliptin vs sulphonylureas in older people

Abstract Background two common anti-diabetic treatments used are sitagliptin and sulphonylureas however evidence examining their comparative effectiveness in older people is limited. Objective to evaluate effectiveness of sitagliptin vs sulphonylureas when added to metformin in older (aged ≥75) vs younger people (18–75). Design retrospective cohort study. Setting UK Primary Care. Subjects 2,904 individuals prescribed sitagliptin (223 aged≥75) and 13,683 prescribed sulphonylureas (1,725 aged ≥75). Methods multivariable regression to analyse difference in HbA1c and weight, 12 months after add-on initiation and proportion achieving different glycaemic targets. Results after multivariate adjustment to remove baseline differences, the HbA1c after 12 months of treatment was on average 1 mmol/mol (95%CI −0.7 to 2.8) higher with sitagliptin vs sulphonylureas in older people though this was not statistically significant. The weight however, was significantly lower −1.4 kg (95%CI −2.1 to −0.7) with sitagliptin vs sulphonylureas. A lower proportion prescribed sitagliptin vs sulphonylureas recorded HbA1c < 48 mmol/mol by study end: Odds Ratio 0.63 (95%CI 0.42–0.95). In younger people, similar HbA1c reductions were also observed with both treatments, however weight after 12 months was even lower with sitagliptin vs sulphonylureas: −2.3 kg (95%CI −2.5 to −2.0). Conclusions similar HbA1c reduction was observed when sitagliptin or sulphonylureas were added to metformin in older and younger age-groups. Sitagliptin use led to modest comparative weight loss. There may be greater risk of over-treatment with sulphonylureas evidenced by greater proportion recording HbA1c < 48 mmol/mol by study end. This evidence supporting use of sitagliptin when add-on therapy is selected in older adults should be considered alongside the wider evidence-base and patient-preference.

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Gas Exchange of prone positioning in influenza pneumonia-related acute respiratory distress syndrome: A multicenter retrospective cohort study in Taiwan

10.21203/rs.2.186/v1 ◽

2019 ◽

Author(s):

Ko-Wei Chang ◽

Shih-Wei Lin ◽

Li-Pang Chuang ◽

Shinn-Jye Liang ◽

Kuang-Yao Yang ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Odds Ratio ◽

Retrospective Cohort ◽

Distress Syndrome ◽

Prone Positioning ◽

Younger Age ◽

Influenza Pneumonia ◽

Paco2 Level

Abstract Background: Prone positioning has demonstrated decreased mortality in severe acute respiratory distress syndrome (ARDS) patients. The aim of this study was to investigate the effect of prone positioning in patients with influenza pneumonia-related severe ARDS. Methods: This retrospective study includes eight tertiary referral centers. All the patients with influenza pneumonia induced severe ARDS and receiving prone positioning were enrolled. Demographic data, laboratory data, treatment record, ventilator setting data and outcomes were collected. PaO2 responders were defined as the PaO2/FiO2 ratio increasing by ≥20% or ≥20 mm Hg, while PaCO2 responders were defined as PaCO2 decreasing by ≥1 mm Hg after prone positioning for one day. Results: Sixty-five patients receiving prone positioning were enrolled, with 37 (57%) were PaO2 responders and 33 (51%) were PaCO2 responders. Mortality rates were not significantly different between responders and non-responders. PaCO2 responder survivors had significantly shortened length of stay at the ICU (21.0 ± 13.5 vs. 31.7 ± 18.5 days, P = 0.038) and hospital (30.2 ± 16.6 vs. 43.0 ± 16.3 days, P = 0.013) than did non-responders. Multivariate analysis revealed younger age (odds ratio 0.903, 95% confidence interval 0.824-0.989; P = 0.028) and higher PaCO2 level before prone positioning (odds ratio 1.121 confidence interval 1.020-1.231; P = 0.017) were the predictors of PaCO2 responders. Conclusions: In this multicenter retrospective cohort study of influenza pneumonia patients with severe ARDS receiving prone positioning, PaCO2 responders had modestly better clinical outcomes. Younger age and higher PaCO2 level before prone positioning were the predictors of PaCO2 responders. Keywords: Prone positioning, Acute Respiratory Distress Syndrome, Influenza, Gas exchange, Outcome

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Psychiatry of the elderly

Shorter Oxford Textbook of Psychiatry ◽

10.1093/med/9780198747437.003.0019 ◽

2017 ◽

pp. 539-562

Author(s):

Paul Harrison ◽

Philip Cowen ◽

Tom Burns ◽

Mina Fazel

Keyword(s):

Older People ◽

Psychiatric Disorders ◽

Age Groups ◽

The Elderly ◽

Behavioural Interventions ◽

Younger Age ◽

Normal Ageing

‘Psychiatry of the elderly’ covers the disorders which most affect older people. After an introduction to normal ageing and its psychological and biological correlates, the epidemiology of psychiatric disorders in the elderly is outlined. The principles and practice of psychiatry of the elderly are then described, focusing on the major disorders (other than dementia, which was covered in Chapter 14). We summarise the main features of assessments, services, and treatments, and how these differ from younger age groups. The treatment and management of dementia is an important aspect of psychiatry in the elderly, and both pharmacological and behavioural interventions are covered in detail.

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The mobilities of care in later life: exploring the relationship between caring and mobility in the lives of older people

Ageing and Society ◽

10.1017/s0144686x20000100 ◽

2020 ◽

pp. 1-22

Author(s):

Karen Croucher ◽

Rose Gilroy ◽

Mark Bevan ◽

Katia Attuyer

Keyword(s):

Longitudinal Study ◽

Older People ◽

Age Groups ◽

Later Life ◽

Life Transitions ◽

The North ◽

Care And Support ◽

Younger Age ◽

Per Se ◽

The Relationship

Abstract There has been a renewed call for a revaluing of informal caring in order to counter the way that caring is undervalued, taken for granted and invisible. Travel is one area where a detailed critique of this issue has emerged with the concept of ‘mobility of care’, however, this concept has only been applied in relation to younger age groups, and our understanding of mobilities of care in later life remains underdeveloped. By ‘mobilities of care’ we mean journeys made for the purpose of giving and receiving informal care and support. This paper draws on the mobility narratives of 99 older people (aged 55 and above) living in three locations in the North of England who participated in a two-year qualitative longitudinal study that explored the inter-play between mobility, wellbeing and life transitions. We focused on the experience of managing life transitions rather than assume that chronology per se determines wellbeing. Narratives of ageing emphasise the importance of getting out and about, and being socially connected active citizens. Our study demonstrates that for many older people getting out and about is not for leisure or utility purposes but to give support and care. As such, these journeys have a particular significance in the lives of older people and in the construction of roles, meaning and identity in later life.

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Religious attitudes among British older people: stability and change in a 20-year longitudinal study

Ageing and Society ◽

10.1017/s0144686x03001636 ◽

2004 ◽

Vol 24 (2) ◽

pp. 167-188 ◽

Cited By ~ 17

Author(s):

PETER G. COLEMAN ◽

CHRISTINE IVANI-CHALIAN ◽

MAUREEN ROBINSON

Keyword(s):

Older People ◽

Religious Education ◽

Church Attendance ◽

Age Groups ◽

Religious Faith ◽

Later Life ◽

Younger Age ◽

Beliefs And Practice ◽

The Stability ◽

Almost All

Britain along with other western European countries has seen a marked decrease in allegiance to traditional forms of Christianity during the latter part of the 20th century. Although church attendance remains relatively high among older people compared with younger age groups, there has been little or no investigation into the stability or change of people's religious belief and practice with increasing age. This paper present findings on these issues from the Southampton Ageing Project, which from 1977–78 to 2002 followed 342 people almost all of whom had had an entirely Christian religious education and all of whom at the outset were aged 65 or more years. Although religion has continued to have considerable meaning in the lives of up to one-half of the participants, approximately one-quarter of the sample expressed a declining commitment to a religious faith and to church membership. The participants' accounts of their recent life experiences, for example following bereavement, give instances of disappointment with the support that they received from institutional religion and show that this was a factor in their declining adherence. They also provide suggestions for further investigation into the origin of this decline. The conclusion argues that the study of older people's religious and spiritual beliefs and practice should be integrated with the investigation of self and identity and of sources of existential meaning in later life.

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Old age and fear of crime: cross-national evidence for a decreased impact of neighbourhood disadvantage in older age

Ageing and Society ◽

10.1017/s0144686x20001683 ◽

2020 ◽

pp. 1-30

Author(s):

Göran Köber ◽

Dietrich Oberwittler ◽

Rebecca Wickes

Keyword(s):

Older People ◽

Fear Of Crime ◽

Age Groups ◽

Empirical Support ◽

Environment Interaction ◽

Future Directions ◽

Adult Lifespan ◽

Younger Age ◽

Disadvantaged Neighbourhoods ◽

Level Analysis

Abstract Fear of crime among older people has been a frequent topic in ageing research, criminology and urban studies. The ‘environmental docility hypothesis’ assumes that older people are more vulnerable to adverse neighbourhood conditions than younger age groups. Yet, few studies have tested this influential hypothesis using samples of respondents covering the complete adult lifespan. Looking at fear of crime, we investigated the person–environment interaction of age and neighbourhood disadvantage, using two independent surveys comprising 12,620 respondents aged 25–90 years residing in 435 neighbourhoods in four cities in Germany and Australia. We used multi-level analysis and cross-level interactions to model age-differential effects of neighbourhood disadvantage on fear. Contrary to the hypothesis, we found a weakening of neighbourhood effects on fear with age. The strong effect of neighbourhood disadvantage on fear of crime dropped by around half from the youngest (25 years) to the oldest age (90 years) in both countries. Younger people were almost as fearful as older people in the most disadvantaged neighbourhoods, but older people were considerably more fearful than younger ages in better-off neighbourhoods. We found limited empirical support for the assumption that this diminished association between neighbourhood disadvantage and fear can be explained by the stronger neighbourhood attachment of older people. The limitations of the analysis and potential future directions of research are discussed.

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Lifecourse transitions, gender and drinking in later life

Ageing and Society ◽

10.1017/s0144686x15001178 ◽

2015 ◽

Vol 37 (3) ◽

pp. 462-494 ◽

Cited By ~ 13

Author(s):

CLARE HOLDSWORTH ◽

MARTIN FRISHER ◽

MARINA MENDONÇA ◽

CESAR DE OLIVEIRIA ◽

HYNEK PIKHART ◽

...

Keyword(s):

Alcohol Consumption ◽

Older People ◽

Age Groups ◽

Later Life ◽

The Elderly ◽

Adult Age ◽

The United Kingdom ◽

Younger Age ◽

Frequent Consumption ◽

Over Time

ABSTRACTOlder people consume less alcohol than any other adult age group. However, in recent years survey data on alcohol consumption in the United Kingdom have shown that while younger age groups have experienced a decline in alcohol consumption, drinking behaviours among the elderly have not reduced in the same way. This paper uses data from the English Longitudinal Study of Ageing to analyse both the frequency and quantity of older adult's alcohol consumption using a lifecourse approach over a ten-year period. Overall drinking declined over time and the analysis examined how socio-economic characteristics, partnership, employment and health statuses were associated with differences in drinking behaviours and how these changed over time. Higher wealth and level of education were associated with drinking more and drinking more frequently for men and women. Poorer self-rated health was associated with less frequent consumption and older people with poor and deteriorating health reported a steeper decline in the frequency of alcohol consumption over time. Men who were not in a partnership drank more than other men. For women, loss of a partner was associated with a steeper decline in drinking behaviours. These findings have implications for programmes to promote responsible drinking among older adults as they suggest that, for the most part, characteristics associated with sustaining wellbeing in later life are also linked to consuming more alcohol.

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Intra-individual variation in RMR in older people

British Journal Of Nutrition ◽

10.1079/bjn20031071 ◽

2004 ◽

Vol 91 (3) ◽

pp. 485-489 ◽

Cited By ~ 12

Author(s):

Megan R. D. Gibbons ◽

C. Jeya K. Henry ◽

Stanley J. Ulijaszek ◽

Helen J. Lightowler

Keyword(s):

Older People ◽

Individual Variation ◽

Age Groups ◽

The Elderly ◽

Strenuous Exercise ◽

Younger Age ◽

Older Subjects ◽

T1 And T2 ◽

High Degree ◽

Made In

In the factorial estimation of total energy expenditure it is assumed that the intra-individual variation in RMR is small. Little is known about the intra-individual variation in RMR in older subjects. The present study investigated the intra-individual variation in RMR in older people. Measurements of RMR were made in twenty-seven older subjects, mean age 71·6 (sd 6·1) years, on two separate occasions (T1 and T2) and on a third occasion (T3) in nineteen of the subjects. Measurements of height and weight were taken in all subjects. RMR measurements were made in the laboratory using a Deltatrac™ (ventilated-hood indirect calorimeter; Datex, Helsinki, Finland). All subjects had fasted overnight for 12h and refrained from strenuous exercise before measurements. The intra-individual CV in RMR (kJ/d) after T1 and T2 was 2·5% in women and 3·6% in men and was 2·6% in women and 3·4% in men after all three sets of measurements. Although mean RMR did not vary across T1, T2 and T3, there was significant ‘crossing tracks’ across the three measurement occasions in some individuals, reflecting a high degree of within-subject variability. The methods used had a significant measurement error associated with them (high R value; significant F ratio in three-way ANOVA). In conclusion, the results from the present study indicate that intra-individual variation in RMR was low in older people. The intra-individual variation in the elderly is similar to that seen in younger age groups.

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Characteristics and Outcomes of Latinx Patients With COVID-19 in Comparison With Other Ethnic and Racial Groups

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa401 ◽

2020 ◽

Vol 7 (10) ◽

Cited By ~ 2

Author(s):

Saef Izzy ◽

Zabreen Tahir ◽

David J Cote ◽

Ali Al Jarrah ◽

Matthew Blake Roberts ◽

...

Keyword(s):

African American ◽

African Americans ◽

Asian American ◽

Age Groups ◽

Racial Groups ◽

Icu Admission ◽

Younger Age ◽

Multivariable Regression ◽

The Impact ◽

White Patients

Abstract Background There is a limited understanding of the impact of coronavirus disease 2019 (COVID-19) on the Latinx population. We hypothesized that Latinx patients would be more likely to be hospitalized and admitted to the intensive care unit (ICU) than White patients. Methods We analyzed all patients with COVID-19 in 12 Massachusetts hospitals between February 1 and April 14, 2020. We examined the association between race, ethnicity, age, reported comorbidities, and hospitalization and ICU admission using multivariable regression. Results Of 5190 COVID-19 patients, 29% were hospitalized; 33% required the ICU, and 4.3% died. Forty-six percent of patients were White, 25% Latinx, 14% African American, and 3% Asian American. Ethnicity and race were significantly associated with hospitalization. More Latinx and African American patients in the younger age groups were hospitalized than whites. Latinxs and African Americans disproportionally required the ICU, with 39% of hospitalized Latinx patients requiring the ICU compared with 33% of African Americans, 24% of Asian Americans, and 30% of Whites (P < .007). Within each ethnic and racial group, age and male gender were independently predictive of hospitalization. Previously reported preexisting comorbidities contributed to the need for hospitalization in all racial and ethnic groups (P < .05). However, the observed disparities were less likely related to reported comorbidities, with Latinx and African American patients being admitted at twice the rate of Whites, regardless of such comorbidities. Conclusions Latinx and African American patients with COVID-19 have higher rates of hospitalization and ICU admission than White patients. The etiologies of such disparities are likely multifactorial and cannot be explained only by reported comorbidities.

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Perceptions of Water Competencies, Drowning Risk and Aquatic Participation among Older Adults

International Journal of Aquatic Research and Education ◽

10.25035/ijare.13.02.06 ◽

2021 ◽

Vol 13 (2) ◽

Author(s):

Teresa Stanley ◽

Kevin Moran

Keyword(s):

Older Adults ◽

New Zealand ◽

Older People ◽

Age Groups ◽

Aging Population ◽

Summer Season ◽

Water Safety ◽

Younger Age ◽

Perceptions Of Safety

New Zealand has an aging population and, despite falling drowning tolls in all other age groups (WSNZ, 2019c), older adults have continued to drown in both increasing numbers and proportion. The reasons for this are not well understood since very little drowning research has focused on older people. A water safety survey (N = 389) seeking information on older adults’ aquatic recreational practices and perceptions of safety was conducted at the end of the summer season, 2019. Most adults (86%, n = 335) reported some aquatic activity in the previous year, but those aged 65+ years (66%) were significantly less likely than younger age groups to engage in aquatic recreation. Respondents aged 65+ years were less likely (74%) to perceive they could swim more than five minutes non-stop. We discuss the implications of lower perceived swimming and floating competence and less frequent participation in aquatic activities on risk of drowning.

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Higher Triglyceride–Glucose Index Is Associated With Increased Likelihood of Kidney Stones

Frontiers in Endocrinology ◽

10.3389/fendo.2021.774567 ◽

2021 ◽

Vol 12 ◽

Author(s):

Zheng Qin ◽

Junjie Zhao ◽

Jiwen Geng ◽

Kaixi Chang ◽

Ruoxi Liao ◽

...

Keyword(s):

Kidney Stones ◽

Odds Ratio ◽

Nutrition Examination Survey ◽

Tyg Index ◽

Health And Nutrition ◽

Triglyceride Glucose Index ◽

Younger Age ◽

Unit Increase ◽

Multivariable Regression ◽

The Mean

AimsWe aimed to assess the association between triglyceride–glucose (TyG) index and kidney stones in US adults.MethodsData were obtained from the 2007–2014 National Health and Nutrition Examination Survey (NHANES). Participants aged ≥18 years who were not pregnant and provided complete data about TyG index and kidney stones were included in the analysis. Weighted multivariable regression analysis and subgroup analysis were preformed to estimate the independent relationship between TyG index and nephrolithiasis and recurrence.ResultsA total of 20,972 participants were included with the mean TyG index of 8.71 ± 0.72. The prevalence rates of nephrolithiasis and recurrence were 9.30% and 3.17% overall and increased with the higher TyG index tertiles (Nephrolithiasis: Tertile 1, 6.98%; Tertile 2, 9.15%; Tertile 3, 11.98%, p < 0.01; Recurrence: Tertile 1, 1.84%; Tertile 2, 3.27%; Tertile 3, 4.50%, p < 0.01). Each unit increase in TyG index was associated with 12% and 26% higher odds of nephrolithiasis [odds ratio (OR) = 1.12; 95% CI: 1.02–1.22; p = 0.02] and recurrence (OR = 1.26; 95% CI: 1.08–1.46; p < 0.01). Interaction tests indicated no significant effect of gender, age, body mass index, hypertension, and diabetes on this association between TyG index and kidney stones.ConclusionsHigher TyG index was associated with an increased likelihood of nephrolithiasis and recurrence. Considering TyG index is a reliable indicator of insulin resistance (IR). Treatment and management of IR at a younger age may improve or alleviate the occurrence and recurrence of kidney stones.

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