scholarly journals Effects of a multiple chronic condition (CC) remote monitoring program on clinical outcomes among older adults

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 1040-1041
Author(s):  
Eldin Dzubur ◽  
Roberta James ◽  
Jessica Yu ◽  
Julia Hoffman ◽  
Bimal Shah
Keyword(s):  
Mental Health ◽  
Blood Pressure ◽  
Older Adults ◽  
Blood Glucose ◽  
Clinical Outcomes ◽  
Remote Monitoring ◽  
Chronic Condition ◽  
Monitoring Program ◽  
Multiple Chronic Condition ◽  
Program Enrollment

Abstract Older adults are faced with an increased risk of comorbid chronic disease such as diabetes. While multiple health behavior change interventions (MHCIs) are known to improve clinical outcomes more than targeted interventions, less is known whether such effects persist in older populations. The objective of the study was to examine the effects of multiple chronic condition (CC) remote monitoring program enrollment and mental health program enrollment on glucose and blood pressure reduction, adjusting for self-monitoring behaviors. In a sample of 594 older adults (age 55+, 14% 65+ years, 46.8% female) evaluated over a 12-month period, statistical models showed that older adults with uncontrolled diabetes (A1c >= 7.0%) had a 7.9 pt. reduction in blood glucose for each additional program enrolled and a 22.7 pt. reduction in blood glucose when enrolled in mental health compared to those not enrolled. Similarly, older adults with uncontrolled hypertension (BP >= 130/80) had a 4.8 pt. reduction in systolic blood pressure for each additional program enrolled and a 7.2 pt. reduction in systolic blood pressure when enrolled in mental health compared to those not enrolled. The findings indicate the potential for multiprogram digital health interventions that incorporate mental health to further improve clinical outcomes in older adults suffering from multiple chronic diseases, namely diabetes and hypertension.

scholarly journals DOES ONSET OF CHRONIC CONDITIONS MODERATE THE IMPACT OF RELATIONAL LIFE EVENTS ON DEPRESSED MOOD?

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S260-S260
Author(s):  
Aaron M Ogletree ◽  
Rosemary Blieszner ◽  
Rachel Pruchno ◽  
Jyoti Savla ◽  
Laura P Sands
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Depressive Symptoms ◽  
Life Events ◽  
Chronic Conditions ◽  
Chronic Condition ◽  
Process Model ◽  
Mixed Effect ◽  
The Impact ◽  
Over Time

Abstract More than 62% of adults aged 65+ have more than one chronic condition; this number increases to more than 82% for those 85+. Older adults simultaneously experience changes in their relationships due to negative relational life events, including illness, injury, or death of a loved one. Stressors occurring in tandem can overload psychological resources and increase risk for poor mental health. Informed by the stress process model, we assessed the influence of relational life events on depressive symptoms over time and evaluated the moderating effects of chronic condition onset. Self-reports of four stressful life events, five chronic conditions, and depressive symptoms as measured by the CES-D came from 2,948 older adults participating in the ORANJ BOWL panel. Using longitudinal multilevel mixed effect modeling, we examined trajectories of depressive symptoms across three waves. While depressive symptoms increased over time, they were greater for people who experienced more relational life events and the onset of more chronic conditions. Participants who reported experiencing all four relational life events but no chronic conditions had an average CES-D score of 5.28 (p<.0001); average CES-D score increased to 12.72 (p<.0001) for those who reported four life events and the onset of four or more new chronic conditions during the study period. In summary, chronic condition onset moderated the relationship between life events and depressive symptoms. Findings highlight the need for practitioner awareness of increased mental health risks for people experiencing stressors in multiple domains of life.

Monitoring cardiovascular disease risk in individuals with severe mental illness in an inpatient mental health setting: a secondary data analysis

2020 ◽  
Vol 15 (11) ◽  
pp. 1-15
Author(s):  
Herbert P Mwebe ◽  
Margaret Volante ◽  
Tim Weaver
Keyword(s):  
Mental Health ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Body Mass Index ◽  
Mental Illness ◽  
Blood Glucose ◽  
Severe Mental Illness ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Electronic Records

Background/Aims Life expectancy in people with lived experience of mental health conditions is reduced by up to 25 years; this is from preventable physical medical comorbidities and multi-morbidities such as cardiovascular disease, diabetes, cancers and smoking-related lung disease. Two-thirds of these deaths are avoidable if people with severe mental illness are offered prompt physical screening checks and monitoring. The aim of this article was to explore barriers to the management of cardiovascular disease risk on inpatient wards and make recommendations in relation to cardiovascular disease risk management in people with severe mental illness. Methods A structured MS Excel extraction data tool informed by best practice guidance was developed and used to extract electronic patient data on screening and monitoring of cardiovascular disease risk factors (blood pressure, smoking, alcohol, lipids, body mass index/weight, blood glucose level) across 10 inpatient psychiatric wards within one London mental health trust. A target sample of 245 electronic records of patients with severe mental illness discharged between 25 August 2018 and 13 February 2019 with length of inpatient stay >40 days was examined. Simple random sampling (MS Excel random number generator) was used to select a final sample of 120 electronic records. All the included samples had been prescribed psychotropic medication. Results Regarding patient demographics, there was an inverse correlation with age, with a greater proportion of inpatients being of a younger age: 51% aged 18–39 years compared with 14% aged 60–79 years. The study found an average of 71% compliance of the documentation of data on all individual parameters (smoking, alcohol, body mass index, blood pressure, serum glucose, serum lipids, electrocardiogram) at baseline. Results showed an average of 79% compliance for monitoring review at least once across the parameters within 3 months of admission. Conclusions It is recommended as a minimum for individuals with severe mental illness under the care of mental health services and/or taking psychotropic medication to have regular cardiometabolic risk assessment and management of risk at the point of entry into services and a review for weight, waist circumference, blood glucose checks, lipid profile, blood pressure, lifestyle choice behaviours and personal assessment of cardiovascular disease. Although progress is being made across provider services to implement the above, gaps in practice are still evident, as demonstrated in these findings.

scholarly journals Biomedical factors associated with hospitalization of older adults: The Bambuí Health and Aging Study (BHAS)

2003 ◽  
Vol 19 (3) ◽  
pp. 829-838 ◽  
Author(s):  
Henrique L. Guerra ◽  
Pedro G. Vidigall ◽  
Maria Fernanda Lima-Costa
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Body Mass Index ◽  
Blood Glucose ◽  
Total Cholesterol ◽  
Body Mass ◽  
Factors Associated ◽  
Minas Gerais State ◽  
Aging Study ◽  
The Town

The objective of this study was to identify biomedical factors (body mass index, blood pressure, blood glucose, total cholesterol and fractions, triglycerides, and albumin) associated with hospitalization of older adults. All residents of the town of Bambuí, Minas Gerais State, ages <FONT FACE=Symbol>³</FONT> 60 years (n = 1,742) were selected for the study, of whom 1,494 (85.2%) participated. None of the biomedical factors studied was independently associated with occurrence of 1 hospitalization during the previous 12 months. Body mass index < 20Kg/m² and total cholesterol = 200-263mg/dl and <FONT FACE=Symbol>³</FONT> 264mg/dl were independently associated with <FONT FACE=Symbol>³</FONT> 2 hospitalizations. The introduction of biomedical factors did not modify the previously identified associations between hospitalization and indicators constructed from information obtained in a questionnaire survey. The results show that data easily obtained through interviews can be useful both for identifying older adults at risk of hospitalization and thus for assisting in prevention.

scholarly journals Effect of a Comprehensive Health Care Program on Blood Pressure, Blood Glucose, Body Composition, and Depression in Older Adults Living Alone: A Quasi-Experimental Pretest–Posttest Study

2019 ◽  
Vol 17 (1) ◽  
pp. 220
Author(s):  
Eun Jeong Hwang ◽  
In Ok Sim
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Health Care ◽  
Blood Glucose ◽  
Care Program ◽  
Control Groups ◽  
Comprehensive Health Care ◽  
Comprehensive Health ◽  
Quasi Experimental ◽  
And Control

This study explored the effects of a comprehensive health-care program (CHCP) on blood pressure, blood glucose, body composition, and depression in older adults living alone. We used a quasi-experimental, two-group, pretest–posttest design. The CHCP consisted of open lectures, health counseling, exercise classes, nutrition counseling, and self-help group meetings at a local senior welfare center. Fifty-eight subjects participated in this study, with thirty subjects in the experimental group and twenty-eight subjects in the control group. Data were analyzed by using the descriptive statistics, χ2-test, and t-test. Comparisons of the pretest and posttest systolic blood pressure (t = −2.530, p < 0.016) and blood glucose (t = 3.089, p < 0.004) between the experimental and control groups showed significant differences. In both the experimental (t = 3.949, p < 0.001) and control groups (t = 3.816, p < 0.002), depression symptoms showed a significant decrease posttest, compared with pretest. Our findings infer that older adults require physical and psychosocial health care and that more efforts must be made to improve the general health and well-being of this population group.

Monitoring cardiovascular disease risk in individuals with severe mental illness in an inpatient mental health setting: a secondary data analysis

2020 ◽  
Vol 9 (3) ◽  
pp. 1-14
Author(s):  
Herbert P Mwebe ◽  
Margaret Volante ◽  
Tim Weaver
Keyword(s):  
Mental Health ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Body Mass Index ◽  
Mental Illness ◽  
Blood Glucose ◽  
Severe Mental Illness ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Electronic Records

Background/Aims Life expectancy in people with lived experience of mental health conditions is reduced by up to 25 years; this is from preventable physical medical comorbidities and multi-morbidities such as cardiovascular disease, diabetes, cancers and smoking-related lung disease. Two-thirds of these deaths are avoidable if people with severe mental illness are offered prompt physical screening checks and monitoring. The aim of this article was to explore barriers to the management of cardiovascular disease risk on inpatient wards and make recommendations in relation to cardiovascular disease risk management in people with severe mental illness. Methods A structured MS Excel extraction data tool informed by best practice guidance was developed and used to extract electronic patient data on screening and monitoring of cardiovascular disease risk factors (blood pressure, smoking, alcohol, lipids, body mass index/weight, blood glucose level) across 10 inpatient psychiatric wards within one London mental health trust. A target sample of 245 electronic records of patients with severe mental illness discharged between 25 August 2018 and 13 February 2019 with length of inpatient stay >40 days was examined. Simple random sampling (MS Excel random number generator) was used to select a final sample of 120 electronic records. All the included samples had been prescribed psychotropic medication. Results Regarding patient demographics, there was an inverse correlation with age, with a greater proportion of inpatients being of a younger age: 51% aged 18–39 years compared with 14% aged 60–79 years. The study found an average of 71% compliance of the documentation of data on all individual parameters (smoking, alcohol, body mass index, blood pressure, serum glucose, serum lipids, electrocardiogram) at baseline. Results showed an average of 79% compliance for monitoring review at least once across the parameters within 3 months of admission. Conclusions It is recommended as a minimum for individuals with severe mental illness under the care of mental health services and/or taking psychotropic medication to have regular cardiometabolic risk assessment and management of risk at the point of entry into services and a review for weight, waist circumference, blood glucose checks, lipid profile, blood pressure, lifestyle choice behaviours and personal assessment of cardiovascular disease. Although progress is being made across provider services to implement the above, gaps in practice are still evident, as demonstrated in these findings.

scholarly journals Association of blood pressure with clinical outcomes in older adults with chronic kidney disease

2019 ◽  
Vol 48 (3) ◽  
pp. 380-387 ◽  
Author(s):  
Jane A H Masoli ◽  
Joao Delgado ◽  
Kirsty Bowman ◽  
W David Strain ◽  
William Henley ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Clinical Outcomes

scholarly journals Is the association between blood pressure and mortality in older adults different with frailty? A systematic review and meta-analysis

2019 ◽  
Vol 48 (5) ◽  
pp. 627-635 ◽  
Author(s):  
Oliver M Todd ◽  
Chris Wilkinson ◽  
Matthew Hale ◽  
Nee Ling Wong ◽  
Marlous Hall ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Systolic Blood Pressure ◽  
Clinical Outcomes ◽  
Observational Studies ◽  
Meta Analysis ◽  
Current Evidence ◽  
Risk Of Death ◽  
All Cause Mortality ◽  
Mortality Difference

Abstract Objective to investigate whether the association between blood pressure and clinical outcomes is different in older adults with and without frailty, using observational studies. Methods MEDLINE, EMBASE and CINAHL were searched from 1st January 2000 to 13th June 2018. PROSPERO CRD42017081635. We included all observational studies reporting clinical outcomes in older adults with an average age over 65 years living in the community with and without treatment that measured blood pressure and frailty using validated methods. Two independent reviewers evaluated study quality and risk of bias using the ROBANS tool. We used generic inverse variance modelling to pool risks of all-cause mortality adjusted for age and sex. Results nine observational studies involving 21,906 older adults were included, comparing all-cause mortality over a mean of six years. Fixed effects meta-analysis of six studies demonstrated that in people with frailty, there was no mortality difference associated with systolic blood pressure <140 mm Hg compared to systolic blood pressure >140 mm Hg (HR 1.02, 95% CI 0.90 to 1.16). In the absence of frailty, systolic blood pressure <140 mm Hg was associated with lower risk of death compared to systolic blood pressure >140 mm Hg (HR 0.86, 95% CI 0.77 to 0.96). Conclusions evidence from observational studies demonstrates no mortality difference for older people with frailty whose systolic blood pressure is <140 mm Hg, compared to those with a systolic blood pressure >140 mm Hg. Current evidence fails to capture the complexities of blood pressure measurement, and the association with non-fatal outcomes.

[P2-394]: BLOOD PRESSURE AND BLOOD GLUCOSE ARE ASSOCIATED WITH MYELIN VULNERABILITY IN AN ETHNICALLY DIVERSE SAMPLE OF OLDER ADULTS

2017 ◽  
Vol 13 (7S_Part_16) ◽  
pp. P780-P781
Author(s):  
Elizabeth A. Boots ◽  
Douglas C. Dean ◽  
Olusola Ajilore ◽  
Xiaohong Zhou ◽  
Sean Deoni ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Blood Glucose ◽  
Ethnically Diverse

scholarly journals Evaluation of a Diabetes Remote Monitoring Program Facilitated by Connected Glucose Meters for Patients with Poorly Controlled Type 2 Diabetes: A Randomized Crossover Trial. (Preprint)

2020 ◽  
Author(s):  
Daniel J. Amante ◽  
David M. Harlan ◽  
Stephenie C. Lemon ◽  
David D. McManus ◽  
Oladapo O. Olaitan ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Usual Care ◽  
Remote Monitoring ◽  
Treatment Satisfaction ◽  
Monitoring Program ◽  
Cost Of Care ◽  
Glucose Meter ◽  
Diabetes Center

BACKGROUND Patients with poorly-controlled type 2 diabetes (T2D) experience increased morbidity, mortality and higher cost of care. Self-monitoring of blood glucose (SMBG) is a critical component of diabetes self-management with established diabetes outcome benefits. Technological advancements in blood glucose meters, including cellular-connected devices that automatically upload SMBG data to secure cloud-based databases, allow for improved sharing and monitoring of SMBG data. Real-time monitoring of SMBG data presents opportunities to provide timely support to patients responsive to abnormal SMBG recordings. Such diabetes remote monitoring programs can provide patients with poorly-controlled T2D additional support needed to improve critical outcomes. OBJECTIVE To evaluate six months of a diabetes remote monitoring program facilitated by cellular-connected glucose meter, access to a diabetes coach and support responsive to abnormal blood glucose recordings greater than 400 mg/dL or below 50 mg/dL in adults with poorly controlled T2D. METHODS Patients (n=120) receiving care at a diabetes center of excellence participated in a two-arm, 12-month randomized crossover study. The intervention included a cellular-connected glucose meter and phone-based diabetes coaching provided by Livongo Health. The coach answered questions, assisted in goal setting, and provided support in response to abnormal glucose levels. One group received the intervention for six months before returning to usual care (IV/UC). The other group received usual care before enrolling in the intervention (UC/IV) for six months. Change in hemoglobin A1c (HbA1c) was the primary outcome and change in treatment satisfaction was the secondary outcome. RESULTS Improvements in mean HbA1c were seen in both groups during the first six months (IV/UC -1.1% (SD 1.5) vs. UC/IV -0.8% (1.5), p < 0.001). After crossover, there was no significant change in HbA1c in IV/UC (mean HbA1c change +0.2 (1.7), p=0.41); however, those in UC/IV showed further improvement (mean (SD) HbA1c change -0.4% (1.0), p < 0.01). A mixed-effects model showed no significant treatment effect (IV vs. UC) over 12 months (p=0.06). However, participants with higher baseline HbA1c and those in first time period experienced greater improvements in HbA1c. Both groups reported similar improvements in treatment satisfaction throughout the study. CONCLUSIONS Patients enrolled in the diabetes remote monitoring program intervention experienced improvements in HbA1c and treatment satisfaction similar to usual care at a specialty diabetes center. Future studies on diabetes remote monitoring program should incorporate scheduled coaching components and involve family members and caregivers. CLINICALTRIAL Study details can be found at clinicaltrials.gov with the study identifier number: NCT03124043.

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