Preventing and Managing Chronic Conditions In Older Adults: Lessons Learned From the NHATS and NSOC 2017

Abstract According to the Centers for Disease Control, 85% of older adults have at least one chronic health condition, and 60% percent have at least two chronic conditions. This symposium explores strategies to prevent and manage chronic conditions (nutritional status, medication management, wound care, and physical function) using data from the 2017 National Health and Aging Trends Study (NHATS) and corresponding National Study on Caregiving (NSOC). The datasets include a nationally representative sample of US older adults (NHATS) and their caregivers (NSOC). In addition to survey questions, the 2017 NHATS cohort submitted dried blood samples which include inflammatory biomarkers (hs-C reactive protein [hsCRP] and interleukin-6 [IL-6]). All individual presentations report on weighted data from the analysis to more accurately reflect the US population. In the first paper, DiMaria-Ghalili explores the prevalence of and factors related to malnutrition in community-dwelling and residential living older adults. In the second paper Coates examines the extent to which source of purchased medications impacts the occurrence of self-reported medication mistakes and hospitalizations in community-dwelling participants who managed medications independently. In the third paper, Hathaway compares the socio-demographic, nutrition, and inflammatory profile of older adults with and without wounds. In the fourth paper, Sefcik examines the relationship between the frequency of community-dwelling older adults going outside and physical function. Collectively, findings provide insight into the experiences of vulnerable older adults with chronic conditions informed from the NHATS and NSOC datasets. The symposium will conclude with a discussion by Monturo on implications for research, policy and practice.

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The Role of Psychological and Social Well-being on Physical Function Trajectories in Older Adults

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa114 ◽

2020 ◽

Vol 75 (8) ◽

pp. 1579-1585

Author(s):

Marguerita Saadeh ◽

Anna-Karin Welmer ◽

Serhiy Dekhtyar ◽

Laura Fratiglioni ◽

Amaia Calderón-Larrañaga

Keyword(s):

Older Adults ◽

Physical Function ◽

Well Being ◽

Community Dwelling ◽

National Study ◽

Age Related ◽

Combining Data ◽

Study Population ◽

Rate Of Decline

Abstract Background Psychological and social well-being are emerging as major determinants in preserving health in old age. We aimed to explore the association between these factors and the rate of decline in physical function over time in older adults. Methods Data were gathered from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K). The study population consisted of 1,153 non-demented, community-dwelling men and women free from multimorbidity or impairments in basic or instrumental activities of daily living at baseline. They were followed over 12 years to capture the rate of decline in physical function, which was measured by combining data on walking speed, balance, and chair stands. The association between baseline psychological and social well-being and decline in physical function was estimated through linear mixed models, after multiple adjustments including personality and depressive symptoms. Results Higher levels of psychological (β = .007; p = .037) and social (β = .008; p = .043) well-being were significantly associated with a decreased rate of decline in physical function over the follow-up. There was a significant three-way interaction between psychological well-being*time*sex (female vs male) (β = .015; p = .047), showing that a slower decline in physical function was observed only among women and not in men. The association was strongest for individuals with high levels of both psychological and social well-being (β = .012; p = .019). Conclusion High levels of psychological and social well-being may slow down the age-related decline in physical function, which confirms the complexity of older adults’ health, but also points towards new preventative strategies.

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Characteristics of Older Adults who Receive Assistance with Management of Multidrug Regimens

Innovation in Aging ◽

10.1093/geroni/igab046.2777 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 754-755

Author(s):

Rachel O'Conor ◽

Julia Yoshino Benavente ◽

Mogan Eifler ◽

Lauren Opsasnick ◽

Laura Curtis ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Health Literacy ◽

Cognitive Aging ◽

Chronic Conditions ◽

Clinical Care ◽

Medication Management ◽

Patient Activation ◽

Community Dwelling ◽

Multiple Chronic Conditions

Abstract Many older adults manage multiple chronic conditions requiring adherence to multidrug regimens, yet half are non-adherent, increasing their risk of hospitalization for poorly controlled chronic conditions. Few studies have investigated whether caregivers support medication-related behaviors of community-dwelling older adults. We interviewed 97 patient-caregiver dyads participating in a cognitive aging cohort study to identify factors associated with caregiver assistance in managing multidrug regimens. Patients completed a neuropsychological battery covering five cognitive domains. Health literacy and patient activation were measured using the Newest Vital Sign and Consumer Health Activation Index, respectively. Caregivers reported their medication-related involvement. Predictors of involvement in medication-related tasks were examined using logistic regression models. Patients were on average 71 years old, managing 4 comorbidities and prescribed 5 medications. The majority were female (73%) and identified as Black (46%) or White (47%). Caregivers’ mean age was 65 years; half were female (53%), were predominantly spouses (57%) or children (26%), and lived with the patient (61%). 31% of caregivers ordered patients’ prescribed medications, 40% helped manage their medications, and 50% spoke with the patient’s clinician about their clinical care. Cognitive impairment (OR 2.60, 95% CI 1.08-6.25), limited health literacy (OR 2.97, 95% CI 1.26-6.97), and ≥3 comorbidities (OR 2.14, 95% CI 1.06-9.30) were associated with medication management assistance. Patient activation, gender, cohabitation, or relationship were not associated. These findings suggest that caregivers are assisting with older adults’ medication management and should be included in clinical discussions about medication management, especially among patients with cognitive impairment, low health literacy or multimorbidities.

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Predicting Symptom Severities in Middle-Aged and Older Adults With Arthritis and Multimorbidity

Innovation in Aging ◽

10.1093/geroni/igab046.705 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 187-187

Author(s):

Wenhui Zhang

Keyword(s):

Older Adults ◽

Sleep Disturbance ◽

Cognitive Abilities ◽

Chronic Conditions ◽

Community Dwelling ◽

Pain Interference ◽

National Study ◽

Chronic Obstructive ◽

Middle Aged ◽

Income Adequacy

Abstract Introduction Uncertainties increase with disease guideline-driven decision-making for older adults as their numbers of chronic conditions and functional limitations increase. A national study found that people with arthritis plus ≥ one other chronic condition have reported significantly higher social participation restriction, serious psychological distress, and work limitation than those with ≥two non-arthritis chronic conditions. However, how arthritis comorbidities contribute to the symptoms such as pain, fatigue, sleep, depression, anxiety, and cognitive abilities that chronically impair people’s daily functioning remain unexplored. Purpose To explore how arthritis comorbidities predict the symptom severities of pain interference, fatigue, sleep disturbance, depression, anxiety, and cognitive abilities among community-dwelling middle-aged and older adults. Method: 140 community people aged over 50 with arthritis and multimorbidity were recruited. Stepwise regressions predicted the PROMIS symptoms of pain interference, fatigue, sleep disturbance, depression, anxiety, and cognitive abilities with arthritis type and 18 comorbidities measured by the Functional Comorbidity Index checklist after controlling for demographics. Results Obesity, chronic obstructive pulmonary disease, diabetes, and income significantly predicted pain interference (adjusted R2=35%). Marital status, obesity, and peripheral vascular disease significantly predicted fatigue (adjusted R2=17%). Depression diagnosis and income adequacy significantly predicted depressive symptoms (adjusted R2=23%). Depression, income adequacy, and anxiety diagnosis significantly predicted anxiety (adjusted R2=23%). Age significantly predicted cognitive abilities (adjusted R2=12%). Discussion Comorbidities and socio-demographics, especially income, impact symptom experiences of people aging with arthritis and multimorbidity. Future studies should explore the pathogenesis among arthritis, comorbidities, and symptoms for tailored intervention while disclosing health disparities associated with the arthritis multimorbidity.

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Study of potentially preventable hospitalisations (PPH) for chronic conditions: what proportion are preventable and what factors are associated with preventable PPH?

BMJ Open ◽

10.1136/bmjopen-2020-038415 ◽

2020 ◽

Vol 10 (11) ◽

pp. e038415

Author(s):

Jennifer Johnston ◽

Jo Longman ◽

Dan Ewald ◽

Jonathan King ◽

Sumon Das ◽

...

Keyword(s):

Chronic Conditions ◽

Hospital Admissions ◽

Medication Management ◽

Community Dwelling ◽

Living Alone ◽

Chronic Obstructive ◽

Discharge Diagnosis ◽

Obstructive Pulmonary Disease ◽

Factors Associated ◽

Study Sites

IntroductionThe proportion of potentially preventable hospitalisations (PPH) which are actually preventable is unknown, and little is understood about the factors associated with individual preventable PPH. The Diagnosing Potentially Preventable Hospitalisations (DaPPHne) Study aimed to determine the proportion of PPH for chronic conditions which are preventable and identify factors associated with chronic PPH classified as preventable.SettingThree hospitals in NSW, Australia.ParticipantsCommunity-dwelling patients with unplanned hospital admissions between November 2014 and June 2017 for congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes complications or angina pectoris. Data were collected from patients, their general practitioners (GPs) and hospital records.Outcome measuresAssessments of the preventability of each admission by an Expert Panel.Results323 admissions were assessed for preventability: 46% (148/323) were assessed as preventable, 30% (98/323) as not preventable and 24% (77/323) as unclassifiable. Statistically significant differences in proportions preventable were found between the three study sites (29%; 47%; 58%; p≤0.001) and by primary discharge diagnosis (p≤0.001).Significant predictors of an admission being classified as preventable were: study site; final principal diagnosis of CHF; fewer diagnoses on discharge; shorter hospital stay; GP diagnosis of COPD; GP consultation in the last 12 months; not having had a doctor help make the decision to go to hospital; not arriving by ambulance; patient living alone; having someone help with medications and requiring help with daily tasks.ConclusionsThat less than half the chronic PPH were assessed as preventable, and the range of factors associated with preventability, including site and discharge diagnosis, are important considerations in the validity of PPH as an indicator. Opportunities for interventions to reduce chronic PPH include targeting patients with CHF and COPD, and the provision of social welfare and support services for patients living alone and those requiring help with daily tasks and medication management.

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Long-term participation in community group exercise improves lower extremity muscle strength and delays age-related declines in walking speed and physical function in older adults

European Review of Aging and Physical Activity ◽

10.1186/s11556-021-00260-2 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Chisato Hayashi ◽

Soshiro Ogata ◽

Tadashi Okano ◽

Hiromitsu Toyoda ◽

Sonoe Mashino

Keyword(s):

Older Adults ◽

Muscle Strength ◽

Physical Exercise ◽

Lower Extremity ◽

Physical Function ◽

Community Dwelling ◽

Group Exercise ◽

Community Based ◽

Lower Extremity Muscle

Abstract Background The effects of group exercise on the physical function of community-dwelling older adults remain unclear. The changes in lower extremity muscle strength, timed up and go (TUG) time, and the motor fitness scale (MFS), over time, among older adults who expressed a willingness to participate in community-based physical exercise groups, were determined using multilevel modelling. Methods We analyzed data of 2407 older adults between April 2010 and December 2019 from the registry of physical tests of community-based physical exercise groups. We conducted a retrospective cohort study to assess the effect of physical exercise on lower extremity muscle strength, TUG time, and MFS scores. The durations of the exercises were evaluated by frequency of physical test’s participate. Results A deterioration in lower extremity muscle strength was found in the short-term participant group only. However, in the mid-term and long-term participation groups, lower extremity muscle strength showed a trend of improvement. The TUG time and the MFS score were negatively correlated with increasing age in both groups divided by the duration of participation. However, there was a slower rate of deterioration in the long-term participation group. Discussion Lower extremity muscle strength, TUG time, and MFS scores decline with increasing age and there were differences in the slope of deterioration that depended on the duration of participation in community-based group exercise. Conclusion Participation in group exercise improved lower extremity muscle strength, TUG time, and MFS scores of older adults living in a community. The positive effects of group exercise were dependent on long-term participation.

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Lower Aerobic Reserve is Associated with Poorer Physical Function in Community Dwelling Older Adults

Medicine & Science in Sports & Exercise ◽

10.1249/01.mss.0000561152.98240.33 ◽

2019 ◽

Vol 51 (Supplement) ◽

pp. 215

Author(s):

Nicolas D. Knuth ◽

Morgan Denny ◽

Jennifer A. Schrack

Keyword(s):

Older Adults ◽

Physical Function ◽

Community Dwelling ◽

Community Dwelling Older Adults

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The ACHIEVE Trial: Lessons Learned From Nesting a Randomized Controlled Trial Within an Observational Cohort Study

Innovation in Aging ◽

10.1093/geroni/igaa057.2950 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 811-811

Author(s):

Jennifer Deal ◽

Nicholas Reed ◽

David Couper ◽

Kathleen Hayden ◽

Thomas Mosley ◽

...

Keyword(s):

Older Adults ◽

Randomized Controlled Trial ◽

Observational Study ◽

Cognitive Decline ◽

Controlled Trial ◽

Lessons Learned ◽

Community Dwelling ◽

Randomized Controlled ◽

Study Staff ◽

Increased Risk

Abstract Hearing impairment in older adults is linked to accelerated cognitive decline and a 94% increased risk of incident dementia in population-based observational studies. Whether hearing treatment can delay cognitive decline is unknown but could have substantial clinical and public health impact. The NIH-funded ACHIEVE randomized controlled trial of 977 older adults aged 70-84 years with untreated mild-to-moderate hearing loss, is testing the efficacy of hearing treatment versus health education on cognitive decline over 3 years in community-dwelling older adults (Clinicaltrials.gov Identifier: NCT03243422.) This presentation will describe lessons learned from ACHIEVE’s unique study design. ACHIEVE is nested within a large, well-characterized multicenter observational study, the Atherosclerosis Risk in Communities Study. Such nesting within an observational study maximizes both operational and scientific efficiency. With trial results expected in 2022, this presentation will focus on the benefits gained in design and recruitment/retention, including dedicated study staff, well-established protocols, and established study staff-participant relationships. Part of a symposium sponsored by Sensory Health Interest Group.

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