Beyond Hip Fracture: Orthopaedic Trauma in an Aging America

Abstract Trauma related death and disability is common among working-age Americans, however the impact on older adults is consequential and increasing. Fractures are the most common traumatic injury diagnosis among Medicare beneficiaries, and though fragility fractures continue to be an important health problem, recent data indicate an increase in high-energy fractures. The purpose of this study was to produce national incidence estimates among US men and women ≥ 65 years using data from the 2003-2014 National Inpatient Sample (NIS). The study cohort included hospitalizations involving upper and/or lower extremity fractures which were further classified by mechanism as high or low energy using external cause of injury codes. Incidence was computed using survey weights provided by NIS, and population estimates from the Census Bureau. The incidence of high-energy fractures increased from 744.1/100,000 persons (95%CI: 681.1–807.1) in 2003 to 821.4/100,000 (95%CI: 795.0 – 874.8) in 2014 in women, and from 359.1/100,000 (95%CI: 331.4–386.8) to 408.2/100,000 (95%CI: 394.–809.2) in men. Over 80% were motor vehicle related. The greatest increase was among those ≥ 85 (1,856.4/100,000 to 2,126.3/100,000 in women; 1,069.1/100,000 to 1,215.1/100,000 in men). Simultaneously, the incidence of low-energy fractures declined: 748.4/100,000 (95%CI: 687.5–809.2) to 443.8/100,000 (95%CI: 423.5 -464.1) in women, and 310.6/100,000 (95%CI: 285 – 336.2) to 206.3/100,000 (95%CI: 196.5 - 216) in men. Results suggest that fractures commonly seen in younger adults will be seen more frequently in older age. It is therefore essential to establish treatment pathways to optimize outcomes for the growing number of injured older adults.

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Low-Energy Multiligament Knee Injuries Are Associated With Higher Postoperative Activity Scores Compared With High-Energy Multiligament Knee Injuries: A Systematic Review and Meta-analysis of the Literature

The American Journal of Sports Medicine ◽

10.1177/0363546520962088 ◽

2020 ◽

pp. 036354652096208

Author(s):

Robert S. Dean ◽

Nicholas N. DePhillipo ◽

David H. Kahat ◽

Nathan R. Graden ◽

Christopher M. Larson ◽

...

Keyword(s):

Systematic Review ◽

Motor Vehicle ◽

Meta Analysis ◽

Knee Injuries ◽

High Energy ◽

Low Energy ◽

Vehicle Accidents ◽

Injury Mechanisms ◽

Outcome Scores ◽

Multiligament Knee Injuries

Background: Multiligament knee injuries (MLKIs) can result from high-energy injury mechanisms such as motor vehicle accidents or low-energy injury mechanisms such as activities of daily living or sports. Purpose/Hypothesis: The purpose was to conduct a systematic review on postoperative patient-reported outcomes after MLKIs and to conduct a meta-analysis of comparable outcome variables based upon high- versus low-energy injury mechanisms. It was hypothesized that MLKIs with low-energy injury mechanisms would demonstrate significantly improved subjective clinical outcome scores compared with high-energy injuries. Study design: Meta-analysis and systematic review. Methods: A systematic review was performed with the inclusion criteria of postoperative MLKI outcomes based upon high-versus low-energy mechanisms of injury with a minimum 2-year follow-up. Outcome scores included were the Lysholm knee scoring scale, Tegner activity scale, and the International Knee Documentation Committee (IKDC) score. High-energy mechanisms included motor vehicle accidents or falls from a height >5 feet; low-energy mechanisms included sports-related injuries, activities of daily living, or falls from <5 feet. A meta-analysis was performed comparing the outcome scores of high- versus low-energy mechanisms of MLKIs. Results: Overall, 1214 studies were identified, 15 of which were included in the systematic review and meta-analysis. Thirteen studies included surgical reconstructions of all injured ligaments. A total of 641 patients with 275 high-energy and 366 low-energy injuries were grouped for comparison in the meta-analysis. No significant differences in Lysholm scale (78.6 vs 78.0) or IKDC scores (69.0 vs 68.4) were found between high- and low-energy groups at a minimum of 2 years (range, 2-10 years) postoperatively ( P > .05). The low-energy injury group demonstrated significantly higher Tegner activity scale scores (5.0 vs 3.9; P = .03). There was no significant difference in failure rates between groups (3.5% vs 2.0%; P = .23). Conclusion: We found in this systematic review and meta-analysis that patients with low-energy mechanisms of MLKI surgery had improved postoperative Tegner activity scores compared with those patients with high-energy mechanisms after MLKI surgery. However, there were no differences in Lysholm score, IKDC score, or failure rates between high- and low-energy MLKI patients at an average of 5.3 years postoperatively.

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The impact of an orthogeriatric intervention in patients with fragility fractures: A cohort study

10.21203/rs.2.13090/v3 ◽

2019 ◽

Author(s):

Charlotte Abrahamsen ◽

Birgitte Nørgaard ◽

Eva Draborg ◽

Morten Frost Nielsen

Keyword(s):

Cohort Study ◽

Hip Fracture ◽

Postoperative Complications ◽

Fragility Fractures ◽

High Energy ◽

Historical Cohort ◽

Increased Risk ◽

Observational Cohort ◽

The Impact ◽

Acute Patients

Abstract Background: While orthogeriatric care to patients with hip fractures is established, the impact of similar intervention in patients with fragility fractures in general is lacking. Therefore, we aimed to assess the impact of an orthogeriatric intervention on postoperative complications and readmissions among patients admitted due to and surgically treated for fragility fractures. Methods: A prospective observational cohort study with a retrospective control was designed. A new orthogeriatric unit for acute patients of sixty-five years or older with fragility fractures in terms of hip, vertebral or appendicular fractures was opened on March 1, 2014. Patients were excluded if the fracture was cancer-related or caused by high-energy trauma, if the patient was operated on at another hospital, treated conservatively with no operation, or had been readmitted within the last month due to fracture-related complications. Results: We included 591 patients; 170 in the historical cohort and 421 in the orthogeriatric cohort. No significant differences were found between the two cohorts with regard to the proportion of participants experiencing complications (24.5% versus 28.3%, p = 0.36) or readmission within 30 days after discharge (14.1% vs 12.1%, p = 0.5). With both cohorts collapsed and adjusting for age, gender and CCI, the odds of having postoperative complications as a hip fracture patient was 4.45, compared to patients with an appendicular fracture (p < 0.001). Furthermore, patients with complications during admission were at a higher risk of readmission within 30 days than were patients without complications (22.3% vs 9.5%; p < 0.001). Conclusions: In older patients admitted with fragility fractures, our model of orthogeriatric care showed no significant differences regarding postoperative complications or readmissions compared to the traditional care. However, we found significantly higher odds of having postoperative complications among patients admitted with a hip fracture compared to other fragility fractures. Additionally, our study reveals an increased risk of being readmitted within 30 days for patients with postoperative complications.

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The impact of an orthogeriatric intervention in patients with fragility fractures: A cohort study

10.21203/rs.2.13090/v1 ◽

2019 ◽

Author(s):

Charlotte Abrahamsen ◽

Birgitte Nørgaard ◽

Eva Draborg ◽

Morten Frost Nielsen

Keyword(s):

Cohort Study ◽

Hip Fracture ◽

Postoperative Complications ◽

Fragility Fractures ◽

High Energy ◽

Historical Cohort ◽

Increased Risk ◽

Observational Cohort ◽

The Impact ◽

Acute Patients

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Towards parameter-free nanodosimetric quantities in the impact of highly ionizing radiation

10.5194/egusphere-egu21-16032 ◽

2021 ◽

Author(s):

Fabiana Da Pieve ◽

Bin Gu ◽

Natalia Koval ◽

Daniel Muñoz Santiburcio ◽

Jos Teunissen ◽

...

Keyword(s):

Monte Carlo ◽

Radiation Effects ◽

High Energy ◽

Low Energy ◽

Track Structure ◽

Medical Patients ◽

Radiation Physics ◽

High Let Radiation ◽

High Let ◽

The Impact

Cosmic Rays, in particular the high charge and high energy (HZE) particles and eventual secondary low energy protons, are high Linear Energy Transfer (LET) radiation, i.e. they transfer a high amount of energy to the target per unit path length travelled in the target itself, leaving behind a dense track of ionization and atomic excitations. Understanding the radiation physics and the biology induced by the impact of high LET radiation is of importance for different fields of research, such as radiation therapy with charged particles, space radiation protection of astronauts and of human explorers on Mars and eventually also survival of any bacterial, plant cell on other planetary/small bodies. While data for low LET radiation&#160; such as X-ray have been studied in the survivors of the atomic-bombs, medical patients and nuclear reactor workers, for high LET radiation there is no relevant collection of human data for risk estimates, and experiments with nuclei created at accelerators are necessary.At present we still do not have an understanding of how the&#160; radiation&#160; interaction&#160; with a&#160; single nanometric&#160; target (units of DNA), the so-called track&#160; structure [1],&#160; should&#160; decide&#160; the&#160; fate&#160; of&#160; the&#160; irradiated cell. Monte Carlo (MC) track structure codes essentially work only with the physics given by impact cross sections on the sole water, there is no real consideration of the electronic/chemical characteristics of the hosted biomolecule [2]. Limitations given by such an approach have been highlighted [3], but on the positive side a massive effort is being done to follow the different steps of radiation effects up to biological damage [4].In this contribution we would like to highlight how a chain of models from different communities could be of help to study the radiation effects on biomolecules. In particular, we will present how ab-initio (parameter-free) approaches from the chemical-physics community can be used to derive in detail the energy loss of the impacting ions/secondary electrons on water and small biological units [5,6], either following in real time the ion or based on perturbative theories for low energy electrons, and how the derived quantity can be given &#160;as input to Monte Carlo track structure codes, extending their capabilities to different&#160;relevant targets. Given the physical limitations and high costs of irradiation experiments, such calculations offer an efficient approach that can boost the understanding of radiation physics and consolidate existing MC track structure codes.This work is initiated in the context of the EU H2020 project ESC2RAD, Grant 776410.[1] H. Nikjoo, S. Uehara, W.E. Wilson, et al, International Journal of Radiation Biology 73, 355 (1998)[2] H. Palmans, H Rabus, A L Belchior, et al, Br. J. Radiol. 88, 20140392 (2015)[3] H. Rabus and H. Nettelback, Radiation Measurements 46, 1522 (2011)[4] M. Karamitros, S. Luan, M.A. Bernal, et al,&#160; Journal of Computational Physics 274,&#160; 841 (2014)[5] B. Gu, B. Cunningham D. Munoz-Santiburcio, F. Da Pieve, E. Artacho and J. Kohanoff, J. Chem. Phys. 153, 034113 (2020)[6] N. Koval, J. Kohanoff, E. Artacho et al, in preparation

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Future of Cancer Incidence in the United States: Burdens Upon an Aging, Changing Nation

Journal of Clinical Oncology ◽

10.1200/jco.2008.20.8983 ◽

2009 ◽

Vol 27 (17) ◽

pp. 2758-2765 ◽

Cited By ~ 983

Author(s):

Benjamin D. Smith ◽

Grace L. Smith ◽

Arti Hurria ◽

Gabriel N. Hortobagyi ◽

Thomas A. Buchholz

Keyword(s):

United States ◽

Older Adults ◽

Cancer Incidence ◽

The United States ◽

Census Bureau ◽

Incidence Rates ◽

Population Projections ◽

Demographic Changes ◽

Younger Adults ◽

The Impact

Purpose By 2030, the United States' population will increase to approximately 365 million, including 72 million older adults (age ≥ 65 years) and 157 million minority individuals. Although cancer incidence varies by age and race, the impact of demographic changes on cancer incidence has not been fully characterized. We sought to estimate the number of cancer patients diagnosed in the United States through 2030 by age and race. Methods Current demographic-specific cancer incidence rates were calculated using the Surveillance Epidemiology and End Results database. Population projections from the Census Bureau were used to project future cancer incidence through 2030. Results From 2010 to 2030, the total projected cancer incidence will increase by approximately 45%, from 1.6 million in 2010 to 2.3 million in 2030. This increase is driven by cancer diagnosed in older adults and minorities. A 67% increase in cancer incidence is anticipated for older adults, compared with an 11% increase for younger adults. A 99% increase is anticipated for minorities, compared with a 31% increase for whites. From 2010 to 2030, the percentage of all cancers diagnosed in older adults will increase from 61% to 70%, and the percentage of all cancers diagnosed in minorities will increase from 21% to 28%. Conclusion Demographic changes in the United States will result in a marked increase in the number of cancer diagnoses over the next 20 years. Continued efforts are needed to improve cancer care for older adults and minorities.

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WHAT IS AGEISM?: A REVIEW AND ANALYTICAL CRITIQUE OF CURRENT MEASURES OF AGEISM

Innovation in Aging ◽

10.1093/geroni/igz038.3336 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S915-S915

Author(s):

Jerin Lee ◽

Jenna Wilson ◽

Natalie Shook

Keyword(s):

Older Adults ◽

Undergraduate Students ◽

Convergent Validity ◽

Empirical Work ◽

Census Bureau ◽

Self Report ◽

Analytical Review ◽

Prejudicial Attitudes ◽

The Impact ◽

Practical Implications

Abstract The past two decades have been marked by a rapidly aging population in the U.S. (U.S. Census Bureau, 2018), making prejudicial attitudes toward older adults (i.e., ageism) and the impact of such attitudes more relevant. Understanding ageism is necessary to change institutionalized beliefs and reduce prejudice toward older adults. However, it requires the availability of valid and reliable measures of ageism. The purpose of the present research was to: (1) provide an analytical review of three existing self-report measures of ageism (i.e., Fabroni Scale of Ageism [FSA]; Relating to Older People Evaluation [ROPE]; Ambivalent Ageism Scale [AAS]); and (2) examine the reliability and convergent validity of these ageism measures. A total of 473 undergraduate students completed the FSA, ROPE, and AAS online. The results indicated that the FSA, subscales of the ROPE (i.e., positive and negative ageism), and subscales of the AAS (i.e., benevolent and hostile ageism) were generally positively associated with one another, with two exceptions. First, positive ageism was negatively correlated with the FSA. Second, positive ageism was not significantly correlated with hostile ageism. Importantly, there was notable variability in the magnitude of the correlations between the measures, as correlations were mostly weak to moderate in magnitude (rs ranged from -.13 to .65). These associations are below the recommended threshold of r = ±.70 for convergent validity (Carlson & Herdman, 2012), suggesting conceptual problems with current ageism measures as they do not appear to reflect a common construct, which has practical implications for future theoretical and empirical work.

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Injury Characteristics of Low-Energy Lisfranc Injuries Compared With High-Energy Injuries

Foot & Ankle International ◽

10.1177/1071100717709575 ◽

2017 ◽

Vol 38 (9) ◽

pp. 964-969 ◽

Cited By ~ 17

Author(s):

Christopher H. Renninger ◽

Grant Cochran ◽

Trevor Tompane ◽

Joseph Bellamy ◽

Kevin Kuhn

Keyword(s):

Motor Vehicle ◽

High Energy ◽

Motor Vehicle Crash ◽

Low Energy ◽

Future Research ◽

Injury Patterns ◽

Lisfranc Joint ◽

Lateral Column ◽

Articular Fractures ◽

Lisfranc Injuries

Background: Lisfranc injuries result from high- and low-energy mechanisms though the literature has been more focused on high-energy mechanisms. A comparison of high-energy (HE) and low-energy (LE) injury patterns is lacking. The objective of this study was to report injury patterns in LE Lisfranc joint injuries and compare them to HE injury patterns. Methods: Operative Lisfranc injuries were identified over a 5-year period. Patient demographics, mechanism of injury, injury pattern, associated injuries, missed diagnoses, clinical course, and imaging studies were reviewed and compared. HE mechanism was defined as motor vehicle crash, motorcycle crash, direct crush, and fall from greater than 4 feet and LE mechanism as athletic activity, ground level twisting, or fall from less than 4 feet. Thirty-two HE and 48 LE cases were identified with 19.3 months of average follow-up. Results: There were no differences in demographics or missed diagnosis frequency (21% HE vs 18% LE). Time to seek care was not significantly different. HE injuries were more likely to have concomitant nonfoot fractures (37% vs 6%), concomitant foot fractures (78% vs 4%), cuboid fractures (31% vs 6%), metatarsal base fractures (84% vs 29%), displaced intra-articular fractures (59% vs 4%), and involvement of all 5 rays (23% vs 6%). LE injuries were more commonly ligamentous (68% vs 16%), with fewer rays involved (2.7 vs 4.1). Conclusions: LE mechanisms were a more common cause of Lisfranc joint injury in this cohort. These mechanisms generally resulted in an isolated, primarily ligamentous injury sparing the lateral column. Both types had high rates of missed injury that could result in delayed treatment. Differences in injury patterns could help direct future research to optimize treatment algorithms. Level of Evidence: Level III, comparative series.

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The virtual cognitive health (VC Health) study: design, recruitment, and baseline characteristics of a fully remote single-arm pre-post study to prevent or delay cognitive impairment in older adults (Preprint)

10.2196/preprints.11368 ◽

2018 ◽

Author(s):

Nick Bott ◽

Shefali Kumar ◽

Caitlyn Krebs ◽

Jordan M Glenn ◽

Erica N Madero ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Study Design ◽

Health Study ◽

Study Cohort ◽

Lifestyle Interventions ◽

Subjective Memory ◽

Memory Decline ◽

Cognitive Health ◽

The Impact

BACKGROUND A growing body of evidence supports the use of lifestyle interventions for preventing or delaying the onset of Alzheimer’s disease (AD) and other forms of dementia in at-risk individuals. The development of virtually delivered programs would increase the scalability and reach of these interventions, but requires validation to ensure similar efficacy to brick and mortar options. OBJECTIVE The aims of this study are to describe the study design, recruitment process, and baseline participant characteristics of the sample in the virtual cognitive health (VC Health) study. Future analyses will assess the impact of the remotely delivered lifestyle intervention on (1) cognitive function, (2) depression and anxiety, and (3) various lifestyle behaviors, including diet, exercise, and sleep in a cohort of older adults with subjective memory decline. Additional analyses will explore feasibility outcomes, as well as the participants’ engagement patterns with the program. METHODS Older adults (age 60-75) with subjective memory decline as measured by the Subjective Cognitive Decline (SCD-9) questionnaire, and who reported feeling worried about their memory decline, were eligible to participate in this single-arm pre-post study. All participants enrolled in the year-long virtual intervention, which consists of health coach-guided lifestyle change for improving diet, exercise, sleep, stress, and cognition. All components of this study were conducted virtually, including the collection of data and the administration of the intervention. Participants were assessed at baseline, 12 weeks, 24 weeks, and 52 weeks with online surveys and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) test. Intention-to-treat analysis will be conducted on all outcomes. RESULTS A total of 85 participants enrolled in the intervention and 82 are included in the study sample (3 participants withdrew). The study cohort is 74% female, 88% Caucasian, 78% overweight or obese, and 67% have at least a college degree. The average baseline RBANS score was 95.9±11.1, which is within age-adjusted norms. The average SCD-9 score was 6.0±2.0, indicating minor subjective cognitive impairment at the beginning of the study. Average baseline Generalized Anxiety Disorder (GAD-7) scores were 6.2±4.5 and Patient Health Questionnaire (PHQ-9) scores were 8.5±4.9, indicating mild levels of anxiety and depression at baseline. CONCLUSIONS Virtually delivered lifestyle interventions may represent a scalable solution for the prevention or delay of AD. The results of this study will provide the first evidence for the efficacy of a fully remote intervention and lay the groundwork for future investigations. CLINICALTRIAL NCT02969460

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An International Review of Motor Vehicle Collision Risk with Medical Conditions in Older Adults

Innovation in Aging ◽

10.1093/geroni/igab046.3171 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 877-878

Author(s):

Mark Rapoport ◽

Joanne Wood ◽

Jamie Dow ◽

Desmond O'Neill ◽

Judith Charlton ◽

...

Keyword(s):

Older Adults ◽

Visual Acuity ◽

Alcohol Use ◽

Sleep Disorders ◽

Motor Vehicle ◽

Alcohol Use Disorders ◽

Age Related Macular Degeneration ◽

Medical Illness ◽

Age Related ◽

The Impact

Abstract The objective was to examine the impact of seven categories of medical illness on risk of Motor Vehicle Collisions (MVC) in older adults. In late 2019, a systematic review of the MVC risk associated with alcohol use disorders, psychiatric disorders, epilepsy, diabetes, hearing loss, vision disorders and sleep disorders was conducted. A total of 64,720 titles were screened, and 138 articles were included. Of these, only thirteen pertained to older adults, only six showed increased MVC risk in at least one condition, and only seven were rated of “Good” quality. Hearing impairment was associated with MVC only if associated with visual acuity or contrast sensitivity impairments (RR 1.52, 95% CI 1.01-2.3 and RR 2.41, 95% CI 1.62-3.57, respectively). A high depression score was associated with increased MVC (RR 1.5, 95% CI 1.1-2.1) in one study, but a similar relationship was not found in two other studies. Glaucoma increased at-fault MVC risk (RR 1.65, 95% CI 1.20-2.28) in one study, but no relationship was found in another. Visual field loss increased MVC risk in three of four studies (RR or HR ranging from 1.31 to 2.32). One negative study each were identified for alcohol use disorders, age-related macular degeneration, any eye disease, or any psychiatric disorder, and four negative studies were identified for reduced visual acuity. No studies of older adults were found for epilepsy or sleep disorders. Interpretation of MVC risk in older drivers with medical illness is rendered challenging by the paucity and quality of studies.

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UNDERGRADUATE EXERCISE AND AGING STUDENTS KNOWLEDGE AND PERCEPTIONS REGARDING OLDER ADULTS

Innovation in Aging ◽

10.1093/geroni/igz038.1970 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S536-S536

Author(s):

Tracy Davis ◽

Michelle Zechner

Keyword(s):

Older Adults ◽

Undergraduate Students ◽

Health Care Professionals ◽

Healthcare Providers ◽

Census Bureau ◽

Average Score ◽

Knowledge And Attitudes ◽

Positive Attitudes ◽

Exercise And Aging ◽

The Impact

Abstract The aging population presents far ranging implications and opportunities for individuals, families, policy makers, and healthcare providers. The U.S. Census Bureau estimates an increase in the population aged 65+, which is projected to reach 83.7 million by 2050. With this changing demographic environment, human services and health care professionals with specialized training in aging are needed, regardless of career goals all students deserve exposure to aging education. Undergraduate students have varying knowledge and attitudes towards older adults. Many times undergraduate students have had limited interactions with older adults and their attitudes and perceptions are based on interactions with grandparents and other relatives. In order to better understand undergraduate student’s knowledge and attitudes regarding older adults we surveyed a group of 50 undergraduate students enrolled in an exercise and aging course offered through the Department of Kinesiology and Health. Students were surveyed using the Facts on Aging Quiz (Breytspraak & Bandura, 2015) and the Aging Semantic Differential (ASD) (Rosencranz & McNevin, 1969). Preliminary findings suggest that students have relatively low knowledge about older adults, as the average score of the Facts on Aging Quiz was 30.4 out of 50 (SD= 3.86). However, scores on the ASD indicate that the student have generally more positive attitudes towards older adults (M=74.29; SD=20.9). At the end of the semester the same students will be surveyed again to evaluate the impact of the course. Findings from this study will be used to augment course content to increase student knowledge and attitudes about older adults.

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