scholarly journals Connecting Patient and Provider Burnout to Eye Exam Frequency among Latinx Older Adults with Diabetes Mellitus

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 627-628
Author(s):  
Adrienne Martinez-Hollingsworth ◽  
Theodore Friedman ◽  
Mohsen Bazargan
Keyword(s):  
Diabetes Mellitus ◽  
Older Adults ◽  
Los Angeles ◽  
Secondary Analysis ◽  
Influential Factor ◽  
Outcome Variable ◽  
Multinomial Regression ◽  
Convenience Sample ◽  
Eye Examination ◽  
The Impact

Abstract Among Latinx older adults, our current understanding of barriers to eye exam often fails to consider the impact of patient and provider burnout which can decrease treatment adherence and recommendation receptivity in this group. The purpose of this study was to examine correlates of eye exam frequency among Latinx older adults in South Los Angeles and explore associations reflecting patient and/or provider burnout. Data analysis was informed by the Secret Self-Management Loop and the Burnout Dyad conceptual models. This secondary analysis used data collected from a convenience sample of non-institutionalized Latinx adults 55+ in South LA (n=165) and used multinomial regression analysis. Outcome variable is recency of eye exam, independent variables are self-reported health, including diabetes mellitus diagnosis, and either patient or provider burnout (that are functions of grouped demographic or quality of care variables). Variables associated with Provider Burnout, appear to represent a larger influence on eye examination frequency then variables associated with Patient Burnout, with the most influential factor being provider recommendation. A surprising finding was the number of participants who had never received this recommendation from a provider (21%). One-third (32%) of participants with diabetes mellitus had not had an eye examination within 12 months and almost one-fifth (13%) of participants with diabetes who had received this recommendation had not received the exam. Further exploration is needed to support a better understanding of how both patient and provider burnout impacts adherence to eye examination and other preventive care recommendations for diabetes mellitus among Latinx older adults.

scholarly journals Polypharmacy Is Associated with Lower Memory Function in African American Older Adults

2020 ◽  
Vol 10 (1) ◽  
pp. 49 ◽  
Author(s):  
Shervin Assari ◽  
Cheryl Wisseh ◽  
Mohammed Saqib ◽  
Mohsen Bazargan
Keyword(s):  
Older Adults ◽  
African American ◽  
Cognitive Function ◽  
Los Angeles ◽  
Living Arrangement ◽  
Memory Function ◽  
Continuous Variable ◽  
Financial Strain ◽  
Outcome Variable ◽  
Future Research

Although previous research has linked polypharmacy to lower cognitive function in the general population, we know little about this association among economically challenged African American (AA) older adults. This study explored the link between polypharmacy and memory function among AA older adults. This community-based study recruited 399 AA older adults who were 65+ years old and living in economically disadvantaged areas of South Los Angeles. Polypharmacy (taking 5+ medications) was the independent variable, memory function was the outcome variable (continuous variable), and gender, age, living arrangement, socioeconomic status (educational attainment and financial strain), health behaviors (current smoking and any binge drinking), and multimorbidity (number of chronic diseases) were the covariates. Linear regression was used for data analyses. Polypharmacy was associated with lower scores on memory function, above and beyond covariates. Among AA older adults, polypharmacy may be linked to worse cognitive function. Future research should test the mechanisms by which polypharmacy is associated with lower levels of cognitive decline. There is a need for screening for memory problems in AA older adults who are exposed to polypharmacy.

scholarly journals Metformin Therapy and Survival in Multiple Myeloma Among US Veterans with Diabetes Mellitus

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4502-4502
Author(s):  
Jesse Keller ◽  
Kristen M. Sanfilippo ◽  
Suhong Luo ◽  
Brian F. Gage ◽  
Kenneth R Carson
Keyword(s):  
Diabetes Mellitus ◽  
Multiple Myeloma ◽  
Secondary Analysis ◽  
Growth Factor Receptor ◽  
Diabetic Patients ◽  
Defined Daily Dose ◽  
Metformin Therapy ◽  
Immortal Time Bias ◽  
The Impact

Abstract Background: Metformin is an oral biguanide anti-diabetic medication used in patients with type 2 diabetes mellitus (DM). Recently, metformin use in diabetic patients with multiple myeloma (MM) has been associated with improved overall survival (OS) (Wu et al, 2014). Additionally, long-term metformin use has been associated with a decrease in the rate of progression of MGUS to MM (Chang et al. 2015). These anti-tumor effects are hypothesized to be mediated through insulin receptor/insulin-like growth factor receptor-1 signaling and moderation of cellular effects of hyperglycemia and hyperinsulinemia. To confirm the association between metformin use and improved survival in diabetic patients with MM, we evaluated a cohort of United States veterans with MM and diabetes. Methods: Patients diagnosed with MM in the Veterans Administration database from September 1, 1999 to December 31, 2009 were identified and followed through October 2014. Patients who did not receive MM directed therapy within 6 months of diagnosis were excluded, as were patients who died within 1 year of MM diagnosis. Furthermore, patients who did not have a pre-existing diagnosis of DM at the time of MM diagnosis were excluded. To standardize dose-response effects, a defined daily dose (DDD) calculation of 1 gram of metformin daily was used. Cox modeling was used to assess the association between mortality and metformin use. Additional variables considered included: age, body mass index, race, use of novel therapeutic agents, transplantation, year of diagnosis, creatinine ≥ 1.5, albumin ≤ 3 g/dL and bisphosphonate use. Metformin use was evaluated as a time varying covariate to control for immortal time bias. Patients were defined as metformin users if they were prescribed metformin during a period starting 3 months prior to MM diagnosis extending through completion of follow-up. To assess for the impact of steroid-induced DM (SID), a secondary analysis including these patients was completed. Results: A total of 3,069 MM patients were evaluable, of whom 549 had a diagnosis of DM prior to MM diagnosis. Among these patients, 268 patients (49%) had received metformin therapy. Diabetic metformin users were younger (mean 66.5 years vs 68 years, P=0.0044), and had fewer comorbidities including chronic kidney disease (9.7% vs 37.4%, P < 0.0001) and ischemic heart disease (39.2% vs 48.8%, P < 0.0001), compared with diabetic non-metformin users . Additionally, metformin users were more likely to have undergone autologous stem cell transplantation (18.3% versus 8.2%, P=0.0005). There was no difference in mortality for metformin users versus non-users (adjusted HR (aHR) 1.11, 95% CI [0.88-1.39]). Utilization of DDDs to stratify metformin users by dose exposure showed no difference in mortality between those with ≥ 365 DDDs (aHR 0.96, 95% CI[0.71-1.29]) or those with < 365 DDDs (aHR 1.28, 95% CI[0.97 -1.70]), as compared to non-users. Among patients with DM or SID diagnosed at any time during follow-up, no significant association with survival was seen among users versus non-users, for any use of metformin (aHR 1.08, 95%CI[0.87 - 1.33]) or when stratified by ≥ 365 DDDs (aHR 0.96 95%CI[0.71-1.29]) or < 365 DDDs (aHR 1.28, 95%CI[0.97-1.70]). Conclusion: In contrast to a prior study reporting improvements in OS, we found no significant association between metformin use and OS in this cohort of diabetic patients with MM. This is largest cohort study performed to date to assess the role of metformin in patients with MM. This study does not support the prescription of metformin as adjunct therapy in MM. Disclosures Sanfilippo: Amgen: Speakers Bureau.

scholarly journals The Impact of Body Mass Index and Weight Changes on Disability Transitions and Mortality in Brazilian Older Adults

2013 ◽  
Vol 2013 ◽  
pp. 1-11 ◽  
Author(s):  
Flávia Cristina Drumond Andrade ◽  
Ahmad Iqmer Nashriq Mohd Nazan ◽  
Maria Lúcia Lebrão ◽  
Yeda Aparecida de Oliveira Duarte
Keyword(s):  
Older Adults ◽  
Body Mass Index ◽  
Body Mass ◽  
Daily Living ◽  
Well Being ◽  
Normal Weight ◽  
Multinomial Regression ◽  
Weight Changes ◽  
Health Transitions ◽  
The Impact

The aim of this study was to examine the association between body mass index and weight changes on disability transitions and mortality among Brazilian older adults. Longitudinal data from the Health, Well-Being, and Aging in Latin America and the Caribbean Study conducted in São Paulo, Brazil (2000 and 2006), were used to examine the impact of obesity on disability and mortality and of weight changes on health transitions related to disability. Logistic and multinomial regression models were used in the analyses. Individuals who were obese were more likely than those of normal weight to have limitations on activities of daily living (ADL), instrumental activity of daily living (IADL), and Nagi's limitations. Obesity was associated with higher incidence of ADL and IADL limitations and with lower recovery from Nagi's limitations. Compared to those who maintained their weight, those who gained weight experienced higher incidence of ADL and Nagi's limitations, even after controlling for initial body mass index. Higher mortality among overweight individuals was only found when the reference category was “remaining free of Nagi limitations.” The findings of the study underline the importance of maintaining normal weight for preventing disability at older ages.

scholarly journals Equity-Specific Effects of Interventions to Promote Physical Activity among Middle-Aged and Older Adults: Development of a Collaborative Equity-Specific Re-Analysis Strategy

2019 ◽  
Vol 16 (17) ◽  
pp. 3195 ◽  
Author(s):  
Gesa Czwikla ◽  
Filip Boen ◽  
Derek G. Cook ◽  
Johan de Jong ◽  
Tess Harris ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Social Inequalities ◽  
Interdisciplinary Collaboration ◽  
Middle Aged ◽  
Convenience Sample ◽  
Individual Level ◽  
Specific Effects ◽  
Analysis Strategy ◽  
The Impact

Reducing social inequalities in physical activity (PA) has become a priority for public health. However, evidence concerning the impact of interventions on inequalities in PA is scarce. This study aims to develop and test the application of a strategy for re-analyzing equity-specific effects of existing PA intervention studies in middle-aged and older adults, as part of an international interdisciplinary collaboration. This article aims to describe (1) the establishment and characteristics of the collaboration; and (2) the jointly developed equity-specific re-analysis strategy as a first result of the collaboration. To develop the strategy, a collaboration based on a convenience sample of eight published studies of individual-level PA interventions among the general population of adults aged ≥45 years was initiated (UK, n = 3; The Netherlands, n = 3; Belgium, n = 1; Germany, n = 1). Researchers from these studies participated in a workshop and subsequent e-mail correspondence. The developed strategy will be used to investigate social inequalities in intervention adherence, dropout, and efficacy. This will allow for a comprehensive assessment of social inequalities within intervention benefits. The application of the strategy within and beyond the collaboration will help to extend the limited evidence regarding the effects of interventions on social inequalities in PA among middle-aged and older adults.

Multicomponent exercise program in older adults with lung cancer during adjuvant/palliative treatment: A secondary analysis of an intervention study

2021 ◽  
pp. 1-7
Author(s):  
N. Martínez-Velilla ◽  
M.L. Saez de Asteasu ◽  
R. Ramírez-Vélez ◽  
I.D. Rosero ◽  
A. Cedeño-Veloz ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Older Adults ◽  
Emergency Department ◽  
Palliative Treatment ◽  
Secondary Analysis ◽  
Exercise Programme ◽  
Control Group ◽  
Post Intervention ◽  
Frailty Status ◽  
The Impact

Background: Lung cancer is the second most prevalent common cancer in the world and predominantly affects older adults. This study aimed to examine the impact of an exercise programme in the use of health resources in older adults and to assess their changes in frailty status. Design: This is a secondary analysis of a quasi-experimental study with a non-randomized control group. Setting: Oncogeriatrics Unit of the Complejo Hospitalario de Navarra, Spain. Participants: Newly diagnosed patients with NSCLC stage I–IV. Intervention: Multicomponent exercise programme that combined resistance, endurance, balance and flexibility exercises. Each session lasted 45–50 minutes, and the exercise protocol was performed twice a week over 10 weeks. Measurements: Mortality, readmissions and Visits to the Emergency Department. Change in frailty status according to Fried, VES-13 and G-8 scales. Results: 26 patients completed the 10-weeks intervention (IG). Mean age in the control group (CG) was 74.5 (3.6 SD) vs 79 (3 SD) in the IG, and 78,9% were male in the IG vs 71,4% in the CG. No major adverse events or health-related issues attributable to the testing or training sessions were noted. Significant between-group differences were obtained on visits to the emergency department during the year post-intervention (4 vs 1; p:0.034). No differences were found in mortality rate and readmissions, where an increasing trend was observed in the CG compared with the IG in the latter (2 vs 0; p 0.092). Fried scale was the unique indicator that seemed to be able to detect changes in frailty status after the intervention. Conclusions: A multicomponent exercise training programme seems to reduce the number of visits to the emergency department at one-year post-intervention in older adults with NSCLC during adjuvant therapy or palliative treatment, and is able to modify the frailty status when measured with the Fried scale.

Factors Associated with Nonattendance to a Geriatric Clinic among Mexican Older Adults

Gerontology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Juan Pablo Negrete-Najar ◽  
Yoselin Juárez-Carrillo ◽  
Jimena Gómez-Camacho ◽  
Nancy R. Mejía-Domínguez ◽  
Enrique Soto-Perez-de-Celis ◽  
...  
Keyword(s):  
Older Adults ◽  
Geriatric Medicine ◽  
Health Resources ◽  
Public Health Problem ◽  
Time Frame ◽  
Cross Sectional Study ◽  
Multinomial Regression ◽  
Cross Sectional ◽  
History Of ◽  
The Impact

<b><i>Introduction:</i></b> Outpatient appointment nonattendance (NA) represents a public health problem, increasing the risk of unfavorable health-related outcomes. Although NA is significant among older adults, little is known regarding its correlates. This study aimed to identify the correlates (including several domains from the geriatric assessment) of single and repeated NA episodes in a geriatric medicine outpatient clinic, in general and in the context of specific comorbidities. <b><i>Methods:</i></b> This is a cross-sectional study including data from 3,034 older adults aged ≥60 years with ≥1 scheduled appointments between January 1, 2016, and December 31, 2016. Appointment characteristics as well as sociodemographic, geographical, and environmental information were obtained. Univariate and multivariate multinomial regression analyses were carried out. <b><i>Results:</i></b> The mean age was 81.8 years (SD 7.19). Over a third (37.4%) of participants missed one scheduled appointment, and 14.4% missed ≥2. Participants with a history of stroke (OR 1.336, <i>p</i> = 0.041) and those with a greater number of scheduled appointments during the study time frame (OR 1.182, <i>p</i> &#x3c; 0.001) were more likely to miss one appointment, while those with Parkinson’s disease (OR 0.346, <i>p</i> &#x3c; 0.001), other pulmonary diseases (OR 0.686, <i>p</i> = 0.008), and better functioning for activities of daily living (ADL) (OR 0.883, <i>p</i> &#x3c; 0.001) were less likely to do so. High socioeconomic level (OR 2.235, <i>p</i> &#x3c; 0.001), not having a partner (OR 1.410, <i>p</i> = 0.006), a history of fractures (OR 1.492, <i>p</i> = 0.031), and a greater number of scheduled appointments (OR 1.668, <i>p</i> &#x3c; 0.001) increased the risk of repeated NA, while osteoarthritis (OR 0.599, <i>p</i> = 0.001) and hypertension (OR 0.680, <i>p</i> = 0.002) decreased it. In specific comorbidity populations (hypertension, type 2 diabetes mellitus, and cancer), better ADL functioning protected from a single NA, while better mobility functioning protected from repeated NA in older patients with hypertension and cancer. <b><i>Discussion/Conclusion:</i></b> Identifying geriatric factors linked to an increased probability of NA may allow one to anticipate its likelihood and lead to the design and implementation of preventive strategies and to an optimization of the use of available health resources. The impact of these factors on adherence to clinical visits requires further investigation.

Sound Level Exposure of High-Risk Infants in Different Environmental Conditions

2006 ◽  
Vol 25 (1) ◽  
pp. 25-32 ◽  
Author(s):  
Jacqueline Byers ◽  
W. Randolph Waugh ◽  
Linda Lowman
Keyword(s):  
High Risk ◽  
Environmental Conditions ◽  
Sound Level ◽  
Outcome Variable ◽  
Improvement Program ◽  
Convenience Sample ◽  
Sound Levels ◽  
Centered Care ◽  
High Risk Infants ◽  
The Impact

Purposes: To provide descriptive information about the sound levels to which high-risk infants are exposed in various actual environmental conditions in the NICU, including the impact of physical renovation on sound levels, and to assess the contributions of various types of equipment, alarms, and activities to sound levels in simulated conditions in the NICU.Design: Descriptive and comparative design.Sample: Convenience sample of 134 infants at a southeastern quarternary children’s hospital.Main Outcome Variable: A-weighted decibel (dBA) sound levels under various actual and simulated environmental conditions.Results: The renovated NICU was, on average, 4–6 dBA quieter across all environmental conditions than a comparable nonrenovated room, representing a significant sound level reduction. Sound levels remained above consensus recommendations despite physical redesign and staff training. Respiratory therapy equipment, alarms, staff talking, and infant fussiness contributed to higher sound levels.Conclusion: Evidence-based sound-reducing strategies are proposed. Findings were used to plan environment management as part of a developmental, family-centered care, performance improvement program and in new NICU planning.

scholarly journals NEUROPSYCHIATRIC SYMPTOMS AND FUNCTIONAL ACTIVITIES AMONG OLDER ADULTS: THE ROLE OF ETHNICITY AND COGNITIVE STATUS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S315-S315
Author(s):  
Shanna L Burke ◽  
Adrienne Grudzien ◽  
Mitra Naseh ◽  
Tamara J Cadet
Keyword(s):  
Older Adults ◽  
Neuropsychiatric Symptoms ◽  
Secondary Analysis ◽  
Cognitive Status ◽  
Data Set ◽  
Functional Activities ◽  
Motor Disturbance ◽  
Ordered Logistic Regression ◽  
Almost All ◽  
The Impact

Abstract Little is known about the likelihood of future functional deficits based on current neuropsychiatric symptoms (NPSs). This study seeks to examine the impact of NPSs on functional activities (FAs) by cognitive status and ethnicity. A secondary analysis of the National Alzheimer’s Coordinating Center Uniform Data Set was conducted using ordered logistic regression to examine the effect of NPSs (based on the Neuropsychiatric Inventory Questionnaire [NPI-Q]) on FAs (based on Functional Assessment Questionnaire). Participants had a mean age of 74 (SD: 9.88) and were included if normal cognition was assessed at baseline (n= 13,470). Higher rates of NPSs were associated with higher dependency in almost all FAs. Among NPSs, apathy was the best predictor (p&lt;.05) of FAs for participants in different cognitive groups and ethnicity subsamples. The impact of other NPSs varied. Anxiety and apathy were the best predictors of FAs among participants with cognitive impairment (but not MCI). Among those who eventually developed dementia (n= 6,818), delusions, hallucinations, agitation, depression, irritability, and motor disturbance were significantly associated (p&lt;.05) with future deficits in FAs. Among Hispanics (n=1,095), hallucinations, agitation, apathy, and motor disturbance were significantly associated with dependency in FAs, while for non-Hispanics, all NPSs were associated with dependency in FAs, except elation and nighttime disturbance. Findings suggest as the severity of the NPSs increases, older adults experience higher levels of dependency in FAs. The nature and extent of NPSs’ impact on FAs varied based on cognitive status and ethnicity, suggesting the importance of considering these factors in service provision.

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