scholarly journals FAMILY CAREGIVER FACTORS AND HOSPITALIZATION IN DISABLED OLDER ADULTS WITH AND WITHOUT DEMENTIA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S739-S739
Author(s):  
Halima Amjad ◽  
John Mulcahy ◽  
Judith D Kasper ◽  
Julia Burgdorf ◽  
David L Roth ◽  
...  
Keyword(s):  
Older Adults ◽  
Family Caregiver ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Term Care ◽  
Adults With Disabilities ◽  
Hospitalization Rates ◽  
Cox Proportional Hazards Models ◽  
Care Survey ◽  
One Year

Abstract Older adults with disabilities commonly rely on family caregivers’ help, yet effects of caregiver factors on patient outcomes are poorly understood. Within this population, dementia is common. Our objective was to evaluate the association between caregiver factors and risk of hospitalization in disabled older adults with and without dementia. We examined 2,589 community-living older adults with mobility/self-care disability and their primary family caregiver in four waves of the National Long-Term Care Survey and National Health and Aging Trends Study. We used Cox proportional hazards models to examine risk of one-year, Medicare claims-derived, all-cause hospitalization as a function of caregiver factors, adjusting for older adult characteristics (sociodemographics, comorbidities, healthcare utilization) and survey year, considering dementia a characteristic of interest. Among disabled older adults, 38% were hospitalized over one year, and 31% had probable dementia. Hospitalization rates were similar for older adults with and without dementia (39.5% and 37.3% respectively); dementia was not associated with hospitalization risk (HR 1.09, 95% CI 0.95-1.26). Older adults demonstrated greater risk of hospitalization if their caregiver was male (HR 1.31, 95% CI 1.10-1.56), new to caregiving (HR 1.61, 95% CI 1.27-2.04 for < 1 year versus ≥ 4 years), or helped with healthcare tasks (HR 1.21, 95% CI 1.04-1.41). The association between most caregiving factors and hospitalization risk did not differ by dementia status. Results suggest that strategies to reduce hospitalization in older adults with disabilities could target select caregivers using similar strategies in populations with and without dementia.

Suicide risk within one year of cognitive impairment diagnosis in older adults: a nationwide retrospective cohort study

2019 ◽  
Author(s):  
Jae Woo Choi ◽  
Kang Soo Lee ◽  
Euna Han
Keyword(s):  
Alzheimer’S Disease ◽  
Older Adults ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Mental Disorders ◽  
Suicide Risk ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Models ◽  
One Year

Abstract Background This study aims to investigate suicide risk within one year of receiving a diagnosis of cognitive impairment in older adults without mental disorders. Methods This study used National Health Insurance Service-Senior Cohort data on older adults with newly diagnosed cognitive impairment including Alzheimer’s disease, vascular dementia, other/unspecified dementia, and mild cognitive impairment from 2004 to 2012. We selected 41,195 older adults without cognitive impairment through 1:1 propensity score matching using age, gender, Charlson Comorbidity Index, and index year, with follow-up throughout 2013. We eliminated subjects with mental disorders and estimated adjusted hazard ratios (AHR) of suicide deaths within one year after diagnosis using the Cox proportional hazards models. Results We identified 49 suicide deaths during the first year after cognitive impairment diagnosis. The proportion of observed suicide deaths was the highest within one year after cognitive impairment diagnosis (48.5% of total); older adults with cognitive impairment were at a higher suicide risk than those without cognitive impairment (AHR, 1.89; 95% confidence interval [CI], 1.18–3.04). Subjects with Alzheimer’s disease and other/unspecified dementia were at greater suicide risk than those without cognitive impairment (AHR, 1.94, 1.94; 95% CI, 1.12–3.38, 1.05–3.58). Suicide risk in female and young-old adults (60–74 years) with cognitive impairment was higher than in the comparison group (AHR, 2.61, 5.13; 95% CI, 1.29–5.28, 1.48–17.82). Conclusions Older patients with cognitive impairment were at increased suicide risk within one year of diagnosis. Early intervention for suicide prevention should be provided to older adults with cognitive impairment.

scholarly journals Association Between Informant-Reported Sleep Disturbance and Incident Dementia: An Analysis of the National Alzheimer’s Coordinating Center Uniform Data Set

2020 ◽  
pp. 073346482096720
Author(s):  
Woojung Lee ◽  
Shelly L. Gray ◽  
Douglas Barthold ◽  
Donovan T. Maust ◽  
Zachary A. Marcum
Keyword(s):  
Older Adults ◽  
Sleep Disturbance ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Cognitive Screening ◽  
Cognitive Level ◽  
Data Set ◽  
Cox Proportional Hazards Models ◽  
Incident Dementia ◽  
Normal Cognition

Informants’ reports can be useful in screening patients for future risk of dementia. We aimed to determine whether informant-reported sleep disturbance is associated with incident dementia, whether this association varies by baseline cognitive level and whether the severity of informant-reported sleep disturbance is associated with incident dementia among those with sleep disturbance. A longitudinal retrospective cohort study was conducted using the uniform data set collected by the National Alzheimer’s Coordinating Center. Older adults without dementia at baseline living with informants were included in analysis. Cox proportional hazards models showed that participants with an informant-reported sleep disturbance were more likely to develop dementia, although this association may be specific for older adults with normal cognition. In addition, older adults with more severe sleep disturbance had a higher risk of incident dementia than those with mild sleep disturbance. Informant-reported information on sleep quality may be useful for prompting cognitive screening.

scholarly journals Pre-Existing Disability and Its Risk of Fragility Hip Fracture in Older Adults

2019 ◽  
Vol 16 (7) ◽  
pp. 1237
Author(s):  
Jayeun Kim ◽  
Soong-Nang Jang ◽  
Jae-Young Lim
Keyword(s):  
Older Adults ◽  
Hip Fracture ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Cox Proportional Hazards Model ◽  
Mental Disabilities ◽  
Term Care ◽  
Fragility Hip Fracture

Background: Hip fracture is one of the significant public concerns in terms of long-term care in aging society. We aimed to investigate the risk for the incidence of hip fracture focusing on disability among older adults. Methods: This was a population-based retrospective cohort study, focusing on adults aged 65 years or over who were included in the Korean National Health Insurance Service–National Sample from 2004 to 2013 (N = 90,802). Hazard ratios with 95% confidence interval (CIs) were calculated using the Cox proportional hazards model according to disability adjusted for age, household income, underlying chronic diseases, and comorbidity index. Results: The incidence of hip fracture was higher among older adults with brain disability (6.3%) and mental disability (7.5%) than among those with other types of disability, as observed during the follow-up period. Risk of hip fracture was higher among those who were mildly to severely disabled (hazard ratio for severe disability = 1.59; 95% CI, 1.33–1.89; mild = 1.68; 95% CI, 1.49–1.88) compared to those who were not disabled. Older men with mental disabilities experienced an incidence of hip fracture that was almost five times higher (hazard ratio, 4.98; 95% CI, 1.86–13.31) versus those that were not disabled. Conclusions: Older adults with mental disabilities and brain disability should be closely monitored and assessed for risk of hip fracture.

scholarly journals Illiteracy, dementia risk, and cognitive trajectories among older adults with low education

Neurology ◽  
2019 ◽  
Vol 93 (24) ◽  
pp. e2247-e2256 ◽  
Author(s):  
Miguel Arce Rentería ◽  
Jet M.J. Vonk ◽  
Gloria Felix ◽  
Justina F. Avila ◽  
Laura B. Zahodne ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Decline ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Independent Effect ◽  
Growth Curve Models ◽  
Cox Proportional Hazards Models ◽  
Dementia Risk ◽  
Incident Dementia ◽  
Low Education

ObjectiveTo investigate whether illiteracy was associated with greater risk of prevalent and incident dementia and more rapid cognitive decline among older adults with low education.MethodsAnalyses included 983 adults (≥65 years old, ≤4 years of schooling) who participated in a longitudinal community aging study. Literacy was self-reported (“Did you ever learn to read or write?”). Neuropsychological measures of memory, language, and visuospatial abilities were administered at baseline and at follow-ups (median [range] 3.49 years [0–23]). At each visit, functional, cognitive, and medical data were reviewed and a dementia diagnosis was made using standard criteria. Logistic regression and Cox proportional hazards models evaluated the association of literacy with prevalent and incident dementia, respectively, while latent growth curve models evaluated the effect of literacy on cognitive trajectories, adjusting for relevant demographic and medical covariates.ResultsIlliterate participants were almost 3 times as likely to have dementia at baseline compared to literate participants. Among those who did not have dementia at baseline, illiterate participants were twice as likely to develop dementia. While illiterate participants showed worse memory, language, and visuospatial functioning at baseline than literate participants, literacy was not associated with rate of cognitive decline.ConclusionWe found that illiteracy was independently associated with higher risk of prevalent and incident dementia, but not with a more rapid rate of cognitive decline. The independent effect of illiteracy on dementia risk may be through a lower range of cognitive function, which is closer to diagnostic thresholds for dementia than the range of literate participants.

scholarly journals Restriction of Pharmacoepidemiologic Cohorts to Initiators of Medications in Unrelated Preventive Drug Classes to Reduce Confounding by Frailty in Older Adults

2019 ◽  
Vol 188 (7) ◽  
pp. 1371-1382 ◽  
Author(s):  
Henry T Zhang ◽  
Leah J McGrath ◽  
Alan R Ellis ◽  
Richard Wyss ◽  
Jennifer L Lund ◽  
...  
Keyword(s):  
Older Adults ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Standardized Mortality Ratio ◽  
Drug Classes ◽  
Cox Proportional Hazards Models ◽  
Hazard Ratios ◽  
All Cause Mortality ◽  
Preventive Drug ◽  
Mortality Ratio

Abstract Nonexperimental studies of the effectiveness of seasonal influenza vaccine in older adults have found 40%–60% reductions in all-cause mortality associated with vaccination, potentially due to confounding by frailty. We restricted our cohort to initiators of medications in preventive drug classes (statins, antiglaucoma drugs, and β blockers) as an approach to reducing confounding by frailty by excluding frail older adults who would not initiate use of these drugs. Using a random 20% sample of US Medicare beneficiaries, we framed our study as a series of nonrandomized “trials” comparing vaccinated beneficiaries with unvaccinated beneficiaries who had an outpatient health-care visit during the 5 influenza seasons occurring in 2010–2015. We pooled data across trials and used standardized-mortality-ratio–weighted Cox proportional hazards models to estimate the association between influenza vaccination and all-cause mortality before influenza season, expecting a null association. Weighted hazard ratios among preventive drug initiators were generally closer to the null than those in the nonrestricted cohort. Restriction of the study population to statin initiators with an uncensored approach resulted in a weighted hazard ratio of 1.00 (95% confidence interval: 0.84, 1.19), and several other hazard ratios were above 0.95. Restricting the cohort to initiators of medications in preventive drug classes can reduce confounding by frailty in this setting, but further work is required to determine the most appropriate criteria to use.

Anxiety and Unmet Needs for Assistance With Daily Activities Among Older Adults

2019 ◽  
Vol 32 (5-6) ◽  
pp. 491-500
Author(s):  
Ashley Zuverink ◽  
Xiaoling Xiang
Keyword(s):  
Older Adults ◽  
Unmet Needs ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Anxiety Symptoms ◽  
Daily Activities ◽  
Medicare Beneficiaries ◽  
Term Care ◽  
Care Services ◽  
Bidirectional Relationship

Objective: To examine the potentially bidirectional relationship between anxiety symptoms and unmet needs for assistance with daily activities among older adults. Method: Data came from the National Health and Aging Trends Study, 2011 through 2016 surveys. The study sample consisted of 3,936 Medicare beneficiaries with activity limitations at baseline, aged 65 or older. Cox proportional hazards regression was used to test the proposed relationship between anxiety symptoms and unmet needs for assistance with daily activities. Result: Having unmet needs increased the risk of the onset of anxiety symptoms, and elevated anxiety symptoms increased the risk of incident unmet needs for assistance with daily activities. Conclusion: Anxiety symptoms and unmet needs form a bidirectional relationship. Integrated mental health and community-based long-term care services may help reduce the burden of late-life anxiety disorders and stressful life incidents contributing to disability.

Indicators of Crash Risk in Older Adults: A Longitudinal Analysis From the ACTIVE Study

2021 ◽  
pp. 089826432110313
Author(s):  
Karlene K. Ball ◽  
Olivio J. Clay ◽  
Jerri D. Edwards ◽  
Bernadette A. Fausto ◽  
Katie M. Wheeler ◽  
...  
Keyword(s):  
Older Adults ◽  
Proportional Hazards ◽  
Secondary Data ◽  
Cox Proportional Hazards ◽  
Crash Risk ◽  
Significant Finding ◽  
Site Location ◽  
Cox Proportional Hazards Models ◽  
Male Sex

Objective: This study aims to examine indicators of crash risk longitudinally in older adults ( n = 486). Method: This study applied secondary data analyses of the 10 years of follow-up for the ACTIVE study combined with state-recorded crash records from five of the six participating sites. Cox proportional hazards models were first used to examine the effect of each variable of interest at baseline after controlling for miles driven and then to assess the three cognitive composites as predictors of time to at-fault crash in covariate-adjusted models. Results: Older age, male sex, and site location were each predictive of higher crash risk. Additionally, worse scores on the speed of processing cognitive composite were associated with higher crash risk. Discussion: Results support previous findings that both age and male sex are associated with higher crash risk. Our significant finding of site location could be attributed to the population density of our testing sites and transportation availability.

scholarly journals Disruption as Antecedent to New Business Startup: A Study of Entrepreneurship Using the Understanding America Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 460-460
Author(s):  
Felichism Kabo ◽  
Stewart Thornhill ◽  
Elizabeth Isele
Keyword(s):  
Older Adults ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Entrepreneurial Activity ◽  
Entrepreneurial Behavior ◽  
Younger Adults ◽  
Representative Study ◽  
Cox Proportional Hazards Models ◽  
New Business ◽  
The Individual

Abstract We use data from a nationally representative study to examine antecedents of entrepreneurial activity in the US among younger (< age 50) and older (≥ age 50) adults using Shapero’s and Sokol’s Model of the “Entrepreneurial Event” (hereafter SEE). The “entrepreneurial event” here refers to the initiation of entrepreneurial behavior. The SEE approach assumes that individuals default to inertia until their lives are disrupted by exogenous factors such as life-changing events (Shapero & Sokol, 1982). The disruptor could be either positive or negative, and has the net effect of driving the individual to reconsider entrepreneurship as a viable opportunity (Krueger & Brazeal, 1994; Krueger & Day, 2010). We examine the correlation between negative disruptions and a person initiating entrepreneurial behavior (starting a new business), including whether the process is similar across younger and older adults. Using data collected in 2014 and 2019 from 3,586 individuals in the Understanding America Study panel, we run survey Cox proportional hazards models to analyze the effects of negative disruptions (getting separated or divorced) on starting a new business over a five-year period starting in 2014. We found that negative disruptions have a significant, positive effect but only among older adults. Further, the magnitude of that effect is about 3-7 times that of younger adults. Our findings support the validity of the SEE approach in advancing our understanding of the transition of individuals from potential to actual entrepreneurs. However, the findings suggest the SEE approach better explains this process in older rather than younger adults.

Abstract MP07: Metabolic Signature Improves Heart Failure Risk Prediction In Older Adults

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Guning Liu ◽  
Quynh Nguyen ◽  
Sunil K Agarwal ◽  
David Aguilar ◽  
Eric Boerwinkle ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Ejection Fraction ◽  
Risk Prediction ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Atherosclerosis Risk In Communities ◽  
Reduced Ejection Fraction ◽  
Metabolic Signature ◽  
Cox Proportional Hazards Models

Introduction: Circulating metabolome profiling holds promise in predicting HF risk, but its prediction performance among older adults is not well established. Hypothesis: We hypothesize that metabolic signatures are associated with the risk of HF and its subtypes (HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF)), and they can improve HF risk prediction beyond established risk factors. Methods: We measured 828 serum metabolites among 4,030 African and European Americans free of HF from the Atherosclerosis Risk in Communities (ARIC) study visit 5 (2011-2013). We regressed incident HF on each metabolite using Cox proportional hazards models. A metabolite risk score (MRS) was derived by summing individual metabolite levels weighted by beta coefficients estimated from least absolute shrinkage and selection operator (LASSO) regularized regressions. We regressed incident HF, HFpEF and HFrEF on the MRS. Harrell’s C-statistics were calculated to evaluate risk discrimination. We replicated the association between MRS and HF in 3,697 independent ARIC participants with metabolite measured at visit 1 (1987-1989). Results: Among 4,030 participants, the mean (SD) age was 76 (5) years. Adjusting for HF risk factors, 302 metabolites were associated with incident HF (false discovery rate < 0.05). One SD increase of the MRS, constructed from 51 metabolites selected by LASSO, was associated with two to three-fold high risk of HF, HFpEF and HFrEF in the fully adjusted models ( Table ). Five-year risk prediction analysis showed that C statistics improved from 0.850 to 0.884 by adding MRS over ARIC HF risk factors, kidney function and NT-proBNP (ΔC (95%CI) = 0.034 (0.017,0.052)). In the replication analysis, a more parsimonious MRS constructed using 15 metabolites, was associated with incident HF ( Table ). Conclusions: We identified a metabolic signature that was associated with the risk of HF and improved HF risk prediction. Our findings may shed light on pathways in HF development and at-risk populations.

Abstract P007: Ankle-brachial Index And Cardiovascular Outcomes In Older Adults: The Atherosclerosis Risk In Communities Study

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Frances M Wang ◽  
Chao Yang ◽  
Shoshana Ballew ◽  
Corey A Kalbaugh ◽  
Michelle L Meyer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Primary Prevention ◽  
Proportional Hazards ◽  
Ankle Brachial Index ◽  
Cox Proportional Hazards ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cvd Risk ◽  
Atherosclerosis Risk In Communities ◽  
Cox Proportional Hazards Models

Introduction: The ankle-brachial index (ABI) is a representative diagnostic indicator of peripheral artery disease (PAD) and recognized as a risk enhancer in the ACC/AHA guidelines for primary prevention of atherosclerotic cardiovascular disease (ASCVD). However, our understanding of the association between ABI and cardiovascular (CVD) risk in older adults is limited. Additionally, the prognostic value of ABI among individuals with prior ASCVD is not well understood. Hypothesis: In a contemporary cohort of older adults, low ABI is independently associated with higher risk of CVD events, regardless of prevalent ASCVD at baseline (coronary heart disease [CHD], stroke, and/or symptomatic PAD). Methods: At ARIC Visit 5 (2011-2013), we studied 5,005 participants (4,160 without prior ASCVD [median age 74 years, 38% male], and 843 with ASCVD [median age 76 years, 65% male]). We quantified the association between ABI categories and subsequent risk of heart failure (HF) and composite CHD/stroke using multivariable Cox proportional hazards models. Results: Over a median follow-up of 5.5 years, we observed 400 CHD/stroke and 338 HF cases (242 CHD/stroke and 199 HF cases in those without prior ASCVD). After adjustment for CVD risk factors, in those without ASCVD history, ABI ≤0.9 was associated with a higher risk of both CHD/stroke and HF ( Table ). In those with a history of ASCVD, low ABI was not significantly associated with CHD/stroke, but was associated with HF (hazard ratio 7.1, 95% CI: 2.5-20.5); ABI categories of 0.9-1.1 and >1.3 were also significantly associated with HF. Addition of ABI to traditional risk factors improved prediction of CHD/stroke risk in those without prior ASCVD and prediction of HF, regardless of baseline ASCVD ( Table ). Conclusions: Low ABI (≤0.9) was associated with incident CHD/stroke in those without prior ASCVD and HF regardless of baseline ASCVD status. These results support ABI as a risk enhancer for guiding primary prevention of ASCVD and suggest its potential value in HF risk assessment for older adults.

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