scholarly journals Effects of Pain and Depression on ADL Disability Over 6 Years of Follow-Up Among Older Adult Americans

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 370-370
Author(s):  
Jaspreet Sodhi ◽  
Soham Al Snih
Keyword(s):  
Older Adult ◽  
Formal Education ◽  
Primary Outcome ◽  
Equation Model ◽  
Comorbid Conditions ◽  
Generalized Estimation Equation ◽  
Race Ethnicity ◽  
Adl Disability ◽  
Over Time

Abstract The objective of this study was to examine the effect of co-occurring pain and depression on ADL disability over 6-years of follow-up among older adult Americans. We studied 5,236 participants aged 65 years and older from the National Health and Aging Trends Study (2011-2017) The primary outcome was ADL disability defined as any limitation in ADLs (eating, bathing, transferring, dressing, moving inside, and out of bed). The independent predictors were self-reported pain and depression. Covariates included socio-demographics (age, gender, marital status, race/ethnicity and years of formal education), body mass index, and comorbidities. Participants were categorized into four groups according to pain and depression: no pain and no depression, pain only, depression only, and depression and pain. Generalized Estimation Equation model was used to estimate the odds of ADL disability as a function of pain and depression. All variables were analyzed as time-varying except for age, race/ethnicity, and education. The odds of ADL disability as a function of pain only and depression only was 1.62 (95% CI 1.38-1.91) and 2.13 (95% CI 1.54-2.95), respectively. The odds of ADL disability as a function of pain and depression were 3.92 (95% CI 3.13-4.92). Older age, being married, Hispanics, and comorbid conditions were also predictive factors of ADL disability over time. Female participants and those with higher levels of education were less likely to report ADL disability over time. The findings suggest that both pain and depression significantly increased the risk of ADL disability in this population over 6-years.

scholarly journals Association between meniscal volume and development of knee osteoarthritis

Rheumatology ◽  
2020 ◽  
Author(s):  
Dawei Xu ◽  
Jan van der Voet ◽  
Nils M Hansson ◽  
Stefan Klein ◽  
Edwin H G Oei ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Primary Outcome ◽  
Joint Space Narrowing ◽  
Joint Space ◽  
Primary Outcome Measure ◽  
Obese Women ◽  
Knee Oa ◽  
Kellgren And Lawrence ◽  
Over Time

Abstract Objective To assess the association between meniscal volume, its change over time and the development of knee OA after 30 months in overweight/obese women. Methods Data from the PRevention of knee Osteoarthritis in Overweight Females study were used. This cohort included 407 women with a BMI ≥ 27 kg/m2, free of OA-related symptoms. The primary outcome measure was incident OA after 30 months, defined by one out of the following criteria: medial or lateral joint space narrowing (JSN)  ≥ 1.0 mm, incident radiographic OA [Kellgren and Lawrence (K&L)  ≥ 2], or incident clinical OA. The secondary outcomes were either of these items separately. Menisci at both baseline and follow-up were automatically segmented to obtain meniscal volume and delta-volumes. Generalized estimating equations were used to evaluate associations between the volume measures and the outcomes. Results Medial and lateral baseline and delta-volumes were not significantly associated to the primary outcome. Lateral meniscal baseline volume was significantly associated to lateral JSN [odds ratio (OR) = 0.87; 95% CI: 0.75, 0.99], while other measures were not. Medial and lateral baseline volume were positively associated to K&L incidence (OR = 1.32 and 1.22; 95% CI: 1.15, 1.50 and 1.03, 1.45, respectively), while medial and lateral delta-volume were negatively associated to K&L incidence (OR = 0.998 and 0.997; 95% CI: 0.997, 1.000 and 0.996, 0.999, respectively). None of the meniscal measures were significantly associated to incident clinical OA. Conclusion Larger baseline meniscal volume and the decrease of meniscal volume over time were associated to the development of structural OA after 30 months in overweight and obese women.

scholarly journals Real-Time Detection of Behavioural Anomalies for Older People, the 3-PEGASE Study: Methods of an Artificial Intelligence Real-life Prospective Trial. (Preprint)

2019 ◽  
Author(s):  
Antoine Piau ◽  
Benoit Lepage ◽  
Carole Bernon ◽  
Marie-Pierre Gleyzes ◽  
Fati Nourhashemi
Keyword(s):  
Artificial Intelligence ◽  
Older Adults ◽  
Health Care Professionals ◽  
Primary Outcome ◽  
Prospective Trial ◽  
Real Life ◽  
Second Phase ◽  
Care Partners ◽  
Over Time

BACKGROUND Most frail older persons are living at home and we face difficulties in achieving seamless monitoring to detect adverse health changes. Even more important, this lack of follow-up could have a negative impact on the living choices made by older individuals and their care partners. People could give up their homes for the more reassuring environment of a medicalized living facility. We have developed a low-cost non-obtrusive sensor-based solution to trigger automatic alerts in case of an acute event or subtle changes over time. It could facilitate the follow-up of older adults in their own homes, and thus support independent living. OBJECTIVE The primary objective of our prospective open-label study is to evaluate the relevance of the automatic alerts generated by our artificial intelligence-driven monitoring solution as judged by the recipients: older adult, caregiver, and professional support worker. The secondary objective is to evaluate its ability to detect subtle functional and cognitive decline and major medical events. METHODS The primary outcome assessment will be performed for each successive 2-month follow-up period to estimate the progression of our learning algorithm performances over time. Twenty-five frail or disabled participants aged 75 and above and living alone in their own homes, will be enrolled for a 6-month follow-up period. RESULTS The first phase with five participants for a 4-month feasibility period has been completed and the expected completion date for the second phase of the study (20 participants for 6 months) is July 2020. CONCLUSIONS The originality of our 6-month real-life project lies in the choice of the primary outcome and in our user-centered design. We will evaluate the relevance of the alerts and the algorithm performances over time according to the end users. The first-line recipients of the information are the older adults and care partners rather than health-care professionals. Despite the fast pace of e-Health device development, no study addressed the specific everyday needs of older adults and their families using such a participatory design and ‘bottom-up’ approach. CLINICALTRIAL ClinicalTrials.gov NCT03484156

scholarly journals Outdoor Mobility and Use of Adaptive or Maladaptive Walking Modifications Among Older People

2019 ◽  
Author(s):  
Heidi Skantz ◽  
Taina Rantanen ◽  
Lotta Palmberg ◽  
Timo Rantalainen ◽  
Eeva Aartolahti ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older People ◽  
Odds Ratio ◽  
Community Dwelling ◽  
Walking Ability ◽  
Life Space ◽  
Reduced Frequency ◽  
Generalized Estimation Equation ◽  
Over Time

Abstract Background In old age, decline in functioning may cause changes in walking ability. Our aim was to study whether older people who report adaptive, maladaptive, or no walking modifications differ in outdoor mobility. Methods Community-dwelling people aged 75–90 years (N = 848) were interviewed at baseline, of whom 761 participated in the 2-year follow-up. Walking modifications were assessed by asking the participants whether they had modified their way of walking 2 km due to their health. Based on the responses, three categories were formed: no walking modifications (reference), adaptive (eg, walking more slowly, using an aid), and maladaptive walking modifications (reduced frequency of walking, or having given up walking 2 km). Differences between these categories in life-space mobility, autonomy in participation outdoors, and unmet physical activity need were analyzed using generalized estimation equation models. Results Participants with maladaptive walking modifications (n = 238) reported the most restricted life-space mobility (β = −9.6, SE = 2.5, p < .001) and autonomy in participation outdoors (β = 1.7, SE = 0.6, p = .004) and the highest prevalence of unmet physical activity need (odds ratio = 4.3, 95% confidence interval = 1.1–16.5) at baseline and showed a decline in these variables over time. Those with no walking modifications (n = 285) at baseline exhibited the best values in all outdoor mobility variables and no change over time. Although at baseline those with adaptive walking modifications (n = 325) resembled those with no modifications, their outdoor mobility declined over time. Conclusion Adopting adaptive modifications may postpone decline in outdoor mobility, whereas the use of maladaptive modifications has unfavorable consequences for outdoor mobility.

scholarly journals Real-Time Detection of Behavioral Anomalies of Older People Using Artificial Intelligence (The 3-PEGASE Study): Protocol for a Real-Life Prospective Trial

10.2196/14245 ◽  
2019 ◽  
Vol 8 (11) ◽  
pp. e14245 ◽  
Author(s):  
Antoine Piau ◽  
Benoit Lepage ◽  
Carole Bernon ◽  
Marie-Pierre Gleizes ◽  
Fati Nourhashemi
Keyword(s):  
Artificial Intelligence ◽  
Older Adults ◽  
Primary Outcome ◽  
Prospective Trial ◽  
Real Life ◽  
Second Phase ◽  
Algorithm Performance ◽  
Care Partners ◽  
Over Time

Background Most frail older persons are living at home, and we face difficulties in achieving seamless monitoring to detect adverse health changes. Even more important, this lack of follow-up could have a negative impact on the living choices made by older individuals and their care partners. People could give up their homes for the more reassuring environment of a medicalized living facility. We have developed a low-cost unobtrusive sensor-based solution to trigger automatic alerts in case of an acute event or subtle changes over time. It could facilitate older adults’ follow-up in their own homes, and thus support independent living. Objective The primary objective of this prospective open-label study is to evaluate the relevance of the automatic alerts generated by our artificial intelligence–driven monitoring solution as judged by the recipients: older adults, caregivers, and professional support workers. The secondary objective is to evaluate its ability to detect subtle functional and cognitive decline and major medical events. Methods The primary outcome will be evaluated for each successive 2-month follow-up period to estimate the progression of our learning algorithm performance over time. In total, 25 frail or disabled participants, aged 75 years and above and living alone in their own homes, will be enrolled for a 6-month follow-up period. Results The first phase with 5 participants for a 4-month feasibility period has been completed and the expected completion date for the second phase of the study (20 participants for 6 months) is July 2020. Conclusions The originality of our real-life project lies in the choice of the primary outcome and in our user-centered evaluation. We will evaluate the relevance of the alerts and the algorithm performance over time according to the end users. The first-line recipients of the information are the older adults and their care partners rather than health care professionals. Despite the fast pace of electronic health devices development, few studies have addressed the specific everyday needs of older adults and their families. Trial Registration ClinicalTrials.gov NCT03484156; https://clinicaltrials.gov/ct2/show/NCT03484156 International Registered Report Identifier (IRRID) PRR1-10.2196/14245

Abstract 02: American Heart Association (AHA)’s Life’s Simple 7 and Risk of Lower Extremity Peripheral Artery Disease (PAD): The Multi-Ethnic Study of Atherosclerosis (MESA)

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Christina L Wassel ◽  
Laura Rasmussen-Torvik ◽  
Alexis Frazier-Wood ◽  
Matthew A Allison ◽  
Mary M McDermott ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Health Behaviors ◽  
Lower Risk ◽  
Ankle Brachial Index ◽  
Clinical Diagnostic Criterion ◽  
Life’S Simple 7 ◽  
Race Ethnicity ◽  
Life's Simple 7 ◽  
Over Time

Background: Approximately 8.5 million Americans are affected by lower extremity PAD, which is associated with a substantially greater risk of cardiovascular (CV) events, mortality and functional decline. In 2010, the AHA initiated new CV health metrics (Life’s Simple 7) to monitor the goal of significantly improving CV health by the year 2020. The extent to which Life’s Simple 7 may be associated with risk of PAD or change in the ankle brachial index (ABI), the major clinical diagnostic criterion for PAD, has not been established. Methods: MESA is a population-based prospective cohort of 6814 Caucasian, African-American, Hispanic and Chinese men and women from six US field centers. The baseline exam occurred in 2000-02. Life’s Simple 7 at baseline included AHA definitions of poor, intermediate and ideal health behaviors (diet, body mass index, smoking, physical activity) and health factors (blood pressure, glucose, cholesterol), and was modeled continuously on a 0-14 point scale, with a higher score indicating better CV health. The scale was also categorized into overall inadequate (0-7points), average (8-11) and optimum (12-14) CV health. Incident PAD was defined as an ABI≤0.90 at Exam 3 (2004-05) or Exam 5 (2010-12), removing participants both with ABI>1.40 and prevalent PAD at baseline. Cox models were used for incident PAD analyses and change in the ABI over time was assessed using mixed models. All models were adjusted for age, sex and race/ethnicity. Results: The mean±SD Life’s Simple 7 score was 8.4±2.1, with 33.8% of participants classified as inadequate, 59.6% average, and 6.6% classified as having optimum CV health. Adjusted rates of PAD per 1000 person-years were 7.3 for inadequate, 3.2 for average and 1.1 for optimum CV health. Each point higher on the Life’s Simple 7 scale was associated with a 20% lower risk of incident PAD (95% CI (0.76-0.85); p<0.001). Compared to inadequate CV health, participants with average and optimum health had a 55% lower risk (95% CI (0.37-0.56), p<0.001) and an 85% lower risk (95% CI (0.06-0.38); p<0.001) of incident PAD, respectively. Each point higher on the scale was associated with a higher average ABI over a median follow-up time of 9.4 years (0.006 (95% CI (0.005, 0.007), p<0.001). Compared to those with inadequate health, participants with average and optimum health maintained a 0.021 (95% CI (0.016, 0.027, p<0.001) and a 0.030 (95% CI (0.018, 0.041, p<0.001) greater average ABI over the follow-up period, respectively. Conclusions: Maintaining average or optimum CV health results in a substantially reduced risk of incident PAD and also in maintaining a higher average ABI over time, even when accounting for age, sex and race/ethnicity. Encouraging improvement in health behaviors, and treatment to achieve and maintain better levels of CV health metrics, may contribute to decreasing the rate of PAD.

Association between Mediterranean diet and functional status in older adults: a longitudinal study based on the Washington Heights Inwood Community Aging Project (WHICAP)

2022 ◽  
Author(s):  
Jing Guo ◽  
Nicole Schupf ◽  
Emily Cruz ◽  
Yaakov Stern ◽  
Richard P Mayeux ◽  
...  
Keyword(s):  
Older Adults ◽  
Mediterranean Diet ◽  
Daily Living ◽  
Cox Regression ◽  
Current Evidence ◽  
Food Frequency ◽  
Race Ethnicity ◽  
Adl Disability ◽  
Washington Heights

Abstract Background Current evidence on the association between Mediterranean diet (MeDi) intake and activities of daily living (ADL) is limited and inconsistent in older adults. Methods This study included 1696 participants aged ≥ 65 years in the Washington Heights-Inwood Community Aging Project (WHICAP) study. The MeDi score was calculated based on data collected from the Willett’s semi-quantitative food frequency questionnaire. The multivariable-adjusted Cox regression model was applied to examine the association of MeDi score with risks of disability in basic (BADL) and instrumental ADL (IADL), as well as the overall ADL (B-IADL). Results 832 participants with incident ADL disability were identified over a median follow-up of 5.39 years. The continuous MeDi score was significantly associated with decreased risk of disability in B-IADL (hazard ratio [HR] = 0.95, 95% confidence interval [CI] = 0.91 to 0.99, p = 0.018) in a model adjusted for age, sex, race/ethnicity, educational level, and dietary calories intake but was no longer significant after additionally adjusted for multiple comorbidities and physical activities (0.97 [0.93, 1.01], p = 0.121). The continuous MeDi score was significantly associated with decreased risk of disability in B-IADL (0.92 [0.85, 1.00], p = 0.043) and BADL (0.90 [0.82, 0.99], p = 0.030) in non-Hispanic Whites, but not in non-Hispanic Blacks and Hispanics (p &gt; 0.05 for all). Conclusions Higher MeDi score was associated with decreased risk of ADL disability, particularly in non-Hispanic Whites.

The impact of statin therapy after surgical or endovascular treatment of cerebral aneurysms

2020 ◽  
Vol 133 (1) ◽  
pp. 182-189
Author(s):  
Tae-Jin Song ◽  
Seung-Hun Oh ◽  
Jinkwon Kim
Keyword(s):  
Statin Therapy ◽  
Coil Embolization ◽  
Primary Outcome ◽  
Cox Regression ◽  
Cerebral Aneurysms ◽  
Time Dependent ◽  
Lipid Lowering ◽  
Surgical Clipping ◽  
The Impact

OBJECTIVECerebral aneurysms represent the most common cause of spontaneous subarachnoid hemorrhage. Statins are lipid-lowering agents that may expert multiple pleiotropic vascular protective effects. The authors hypothesized that statin therapy after coil embolization or surgical clipping of cerebral aneurysms might improve clinical outcomes.METHODSThis was a retrospective cohort study using the National Health Insurance Service–National Sample Cohort Database in Korea. Patients who underwent coil embolization or surgical clipping for cerebral aneurysm between 2002 and 2013 were included. Based on prescription claims, the authors calculated the proportion of days covered (PDC) by statins during follow-up as a marker of statin therapy. The primary outcome was a composite of the development of stroke, myocardial infarction, and all-cause death. Multivariate time-dependent Cox regression analyses were performed.RESULTSA total of 1381 patients who underwent coil embolization (n = 542) or surgical clipping (n = 839) of cerebral aneurysms were included in this study. During the mean (± SD) follow-up period of 3.83 ± 3.35 years, 335 (24.3%) patients experienced the primary outcome. Adjustments were performed for sex, age (as a continuous variable), treatment modality, aneurysm rupture status (ruptured or unruptured aneurysm), hypertension, diabetes mellitus, household income level, and prior history of ischemic stroke or intracerebral hemorrhage as time-independent variables and statin therapy during follow-up as a time-dependent variable. Consistent statin therapy (PDC > 80%) was significantly associated with a lower risk of the primary outcome (adjusted hazard ratio 0.34, 95% CI 0.14–0.85).CONCLUSIONSConsistent statin therapy was significantly associated with better prognosis after coil embolization or surgical clipping of cerebral aneurysms.

Effectiveness of the Chiari Health Index for Pediatrics instrument in measuring postoperative health-related quality of life in pediatric patients with Chiari malformation type I

2020 ◽  
pp. 1-6
Author(s):  
Georgina E. Sellyn ◽  
Alan R. Tang ◽  
Shilin Zhao ◽  
Madeleine Sherburn ◽  
Rachel Pellegrino ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Type I ◽  
Health Related Quality ◽  
Health Index ◽  
Chiari Malformation Type I ◽  
Related Quality ◽  
Health Related ◽  
Over Time

OBJECTIVEThe authors’ previously published work validated the Chiari Health Index for Pediatrics (CHIP), a new instrument for measuring health-related quality of life (HRQOL) for pediatric Chiari malformation type I (CM-I) patients. In this study, the authors further evaluated the CHIP to assess HRQOL changes over time and correlate changes in HRQOL to changes in symptomatology and radiological factors in CM-I patients who undergo surgical intervention. Strong HRQOL evaluation instruments are currently lacking for pediatric CM-I patients, creating the need for a standardized HRQOL instrument for this patient population. This study serves as the first analysis of the CHIP instrument’s effectiveness in measuring short-term HRQOL changes in pediatric CM-I patients and can be a useful tool in future CM-I HRQOL studies.METHODSThe authors evaluated prospectively collected CHIP scores and clinical factors of surgical intervention in patients younger than 18 years. To be included, patients completed a baseline CHIP captured during the preoperative visit, and at least 1 follow-up CHIP administered postoperatively. CHIP has 2 domains (physical and psychosocial) comprising 4 components, the 3 physical components of pain frequency, pain severity, and nonpain symptoms, and a single psychosocial component. Each CHIP category is scored on a scale, with 0 indicating absent and 1 indicating present, with higher scores indicating better HRQOL. Wilcoxon paired tests, Spearman correlations, and linear regression models were used to evaluate and correlate HRQOL, symptomatology, and radiographic factors.RESULTSSixty-three patients made up the analysis cohort (92% Caucasian, 52% female, mean age 11.8 years, average follow-up time 15.4 months). Dural augmentation was performed in 92% of patients. Of the 63 patients, 48 reported preoperative symptoms and 42 had a preoperative syrinx. From baseline, overall CHIP scores significantly improved over time (from 0.71 to 0.78, p < 0.001). Significant improvement in CHIP scores was seen in patients presenting at baseline with neck/back pain (p = 0.015) and headaches (p < 0.001) and in patients with extremity numbness trending at p = 0.064. Patients with syringomyelia were found to have improvement in CHIP scores over time (0.75 to 0.82, p < 0.001), as well as significant improvement in all 4 components. Additionally, improved CHIP scores were found to be significantly associated with age in patients with cervical (p = 0.009) or thoracic (p = 0.011) syrinxes.CONCLUSIONSThe study data show that the CHIP is an effective instrument for measuring HRQOL over time. Additionally, the CHIP was found to be significantly correlated to changes in symptomatology, a finding indicating that this instrument is a clinically valuable tool for the management of CM-I.

scholarly journals P34 Characteristics, diagnosis and management of Cushing’s disease - A systematic review and meta-analysis

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Chan Hee Koh ◽  
Danyal Z Khan ◽  
Ronneil Digpal ◽  
Hugo Layard Horsfall ◽  
Hani J Marcus ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Cushing’S Disease ◽  
Meta Analysis ◽  
A Priori ◽  
Pituitary Surgery ◽  
Serum Cortisol ◽  
Cushing's Disease ◽  
Diagnosis And Management ◽  
Over Time

Abstract Introduction The clinical practice and research in the diagnosis and management of Cushing’s disease remains heterogeneous and challenging to this day. We sought to establish the characteristics of Cushing’s disease, and the trends in diagnosis, management and reporting in this field. Methods Searches of PubMed and Embase were conducted. Study protocol was registered a-priori. Random-effects analyses were conducted to establish numerical estimates. Results Our screening returned 159 papers. The average age of adult patients with Cushing’s disease was 39.3, and 13.6 for children. The male:female ratio was 1:3. 8% of patients had undergone previous transsphenoidal resection. The ratio of macroadenomas: microadenomas:imaging-undetectable adenomas was 18:53:29. The most commonly reported preoperative biochemical investigations were serum cortisol (average 26.4µg/dL) and ACTH (77.5pg/dL). Postoperative cortisol was most frequently used to define remission (74.8%), most commonly with threshold of 5µg/dL (44.8%). Average remission rates were 77.8% with recurrence rate of 13.9%. Median follow-up was 38 months. Majority of papers reported age (81.9%) and sex (79.4%). Only 56.6% reported whether their patients had previous pituitary surgery. 45.3% reported whether their adenomas were macroadenoma, microadenoma or undetectable. Only 24.1% reported preoperative cortisol, and this did not improve over time. 60.4% reported numerical thresholds for cortisol in defining remission, and this improved significantly over time (p = 0.004). Visual inspection of bubbleplots showed increasing preference for threshold of 5µg/dL. 70.4% reported the length of follow up. Conclusion We quantified the characteristics of Cushing’s disease, and analysed the trends in investigation and reporting. This review may help to inform future efforts in forming guidelines for research and clinical practice.

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