scholarly journals Obstructive Sleep Apnea Treatment and Dementia Risk in Older Adults

SLEEP ◽  
2021 ◽  
Author(s):  
G L Dunietz ◽  
R D Chervin ◽  
J F Burke ◽  
A S Conceicao ◽  
T J Braley
Keyword(s):  
Older Adults ◽  
Statistical Significance ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Lower Odds ◽  
Logistic Regression Models ◽  
Not Otherwise Specified ◽  
Dementia Risk ◽  
Obstructive Sleep ◽  
Study Participants

Abstract Study Objectives To examine associations between PAP therapy, adherence and incident diagnoses of Alzheimer’s disease (AD), mild cognitive impairment (MCI), and dementia not-otherwise-specified (DNOS) in older adults. Methods This retrospective study utilized Medicare 5% fee-for-service claims data of 53,321 beneficiaries, aged 65+, with an OSA diagnosis prior to 2011. Study participants were evaluated using ICD-9 codes for neurocognitive syndromes [AD(n=1,057), DNOS(n=378), and MCI(n=443)] that were newly-identified between 2011-2013. PAP treatment was defined as presence of ≥1 durable medical equipment (HCPCS) code for PAP supplies. PAP adherence was defined as ≥2 HCPCS codes for PAP equipment, separated by≥1 month. Logistic regression models, adjusted for demographic and health characteristics, were used to estimate associations between PAP treatment or adherence and new AD, DNOS, and MCI diagnoses. Results In this sample of Medicare beneficiaries with OSA, 59% were men, 90% were non-Hispanic whites and 62% were younger than 75y. The majority (78%) of beneficiaries with OSA were prescribed PAP (treated), and 74% showed evidence of adherent PAP use. In adjusted models, PAP treatment was associated with lower odds of incident diagnoses of AD and DNOS (OR=0.78, 95% CI:0.69-0.89; and OR=0.69, 95% CI:0.55-0.85). Lower odds of MCI, approaching statistical significance, were also observed among PAP users (OR=0.82, 95% CI:0.66-1.02). PAP adherence was associated with lower odds of incident diagnoses of AD (OR=0.65, 95% CI:0.56-0.76). Conclusions PAP treatment and adherence are independently associated with lower odds of incident AD diagnoses in older adults. Results suggest that treatment of OSA may reduce risk of subsequent dementia.

scholarly journals 1131 Obstructive Sleep Apnea Treatment and Dementia Risk in Older Adults

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A430-A431
Author(s):  
G L Dunietz ◽  
R D Chervin ◽  
J F Burke ◽  
A S Conceicao ◽  
T J Braley
Keyword(s):  
Older Adults ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Statistical Significance ◽  
Older Individuals ◽  
Survey Period ◽  
Lower Odds ◽  
Obstructive Sleep ◽  
Osa Treatment ◽  
The Impact

Abstract Introduction Obstructive Sleep Apnea (OSA) has been linked to dementia and Alzheimer’s Disease (AD), as well as pre-dementia. The potential benefits of OSA treatment on cognitive performance are inconclusive. Further, the impact of OSA treatment on the development of neurodegenerative disorders has not been sufficiently studied. This study examined associations between Positive Airway Pressure (PAP) therapy and incident diagnosis of pre-dementia (MCI), dementia (DNOS), or AD in a population-level sample of older adults. Methods Using a random 5% sample from Medicare claims data (persons age 65 and older), individuals with an ICD-9 diagnosis code for OSA prior to 2011 (n=53,321) were selected for analyses. Over the survey period (2011-2013), we further identified persons newly diagnosed with MCI (n=443), DNOS (n=378), or AD (n=1,057). We also identified individual HCPCS claims for PAP equipment as evidence of prescription, and repeated HCPCS claims for supplies as evidence of adherence to PAP treatment. Logistic regression models were used to adjust for potential confounders including age, gender, hypertension, and Parkinson’s Disease that might increase risk for dementia. Results Seventy-eight percent of beneficiaries with OSA were prescribed PAP, and 74% showed evidence of adherent use. After adjustment for potential confounders, prescription of PAP was associated with significantly lower odds of incident AD and DNOS (OR=0.78, 95% CI: 0.69, 0.89; and OR=0.69, 95% CI: 0.55, 0.85). Lower odds of MCI, approaching statistical significance, were also observed among beneficiaries who were prescribed PAP (OR=0.82, (95% CI: 0.66, 1.02). Evidence of adherence to PAP was significantly associated with lower odds of incident AD (OR=0.65, 95% CI: 0.56, 0.76). Conclusion Among older individuals with OSA, PAP prescription and adherence are each associated with a significantly lower risk of incident AD or DNOS, though not MCI. Although a prospective cohort design cannot prove causality, results suggest that treatment of OSA could reduce risk of subsequent dementia. Support This study was supported by The American Academy of Sleep Medicine Foundation Strategic Research Award 115-SR-15 (PI Braley).

scholarly journals Cross-sectional and longitudinal associations between receptive arts engagement and loneliness among older adults

2019 ◽  
Vol 55 (7) ◽  
pp. 891-900 ◽  
Author(s):  
Urszula Tymoszuk ◽  
Rosie Perkins ◽  
Daisy Fancourt ◽  
Aaron Williamon
Keyword(s):  
Older Adults ◽  
Protective Factor ◽  
Short Form ◽  
Future Research ◽  
Cross Sectional ◽  
Social Community ◽  
Lower Odds ◽  
Logistic Regression Models ◽  
Engagement Factors ◽  
Arts Engagement

Abstract Purpose Loneliness in older adulthood is a societal and public health challenge warranting identification of sustainable and community-based protective factors. This study investigated whether frequency of receptive arts engagement is associated with lower odds of loneliness in older adults. Methods We used data of respondents from waves 2 (2004–2005) and 7 (2014–2015) of the English Longitudinal Study of Ageing (ELSA) and examined cross-sectional (n = 6222) and longitudinal (n = 3127) associations between frequency of receptive arts engagement (including visits to the cinema, museums/galleries/exhibitions, theatre/concerts/opera) and odds of loneliness (cut-off ≥ 6 on three-item short form of the Revised UCLA Loneliness Scale). We fitted logistic regression models adjusted for a range of sociodemographic, economic, health and social, community and civic engagement factors. Results Cross-sectionally, we found dose–response negative associations between engagement with all receptive arts activities and odds of loneliness. Prospectively, in the fully-adjusted models we found most robust evidence for the negative association between engagement with museums/galleries/exhibitions and odds of loneliness (OR = 0.68, 95% CI 0.48–0.95) for those who engaged every few months or more often compared with those who never engaged. We found weaker evidence for lower odds of loneliness for more frequent engagement with theatre/concerts/opera. Conclusions Frequent engagement with certain receptive arts activities and venues, particularly museums, galleries and exhibitions, may be a protective factor against loneliness in older adults. Future research is needed to identify the mechanisms through which this process may occur, leading to better understanding of how arts activities and venues can reduce loneliness among older adults.

A Longitudinal Analysis of Site of Death: The Effects of Continuous Enrollment in Medicare Advantage Versus Conventional Medicare

2016 ◽  
Vol 39 (8) ◽  
pp. 960-986 ◽  
Author(s):  
Elizabeth Edmiston Chen ◽  
Edward Alan Miller
Keyword(s):  
Logistic Regression ◽  
Longitudinal Analysis ◽  
Financial Incentives ◽  
Health And Retirement Study ◽  
Fee For Service ◽  
Medicare Advantage ◽  
Medicare Beneficiaries ◽  
Lower Odds ◽  
Retirement Study

This study assessed the odds of dying in hospital associated with enrollment in Medicare Advantage (M-A) versus conventional Medicare Fee-for-Service (M-FFS). Data were derived from the 2008 and 2010 waves of the Health and Retirement Study ( n = 1,030). The sample consisted of elderly Medicare beneficiaries who died in 2008–2010 (34% died in hospital, and 66% died at home, in long-term senior care, a hospice facility, or other setting). Logistic regression estimated the odds of dying in hospital for those continuously enrolled in M-A from 2008 until death compared to those continuously enrolled in M-FFS and those switching between the two plans. Results indicate that decedents continuously enrolled in M-A had 43% lower odds of dying in hospital compared to those continuously enrolled in M-FFS. Financial incentives in M-A contracts may reduce the odds of dying in hospital.

scholarly journals The Association Between Obstructive Sleep Apnea Defined by 3 Percent Oxygen Desaturation or Arousal Definition and Self-Reported Cardiovascular Disease in the Sleep Heart Health Study

2020 ◽  
Vol 21 (4) ◽  
pp. 86-103
Author(s):  
Stuart Quan ◽  
◽  
Rohit Budhiraja ◽  
Sogol Javaheri ◽  
Sairam Parthasarathy ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Bypass ◽  
Oxygen Desaturation ◽  
Health Study ◽  
Heart Health ◽  
Logistic Regression Models ◽  
Obstructive Sleep ◽  
Causal Pathway ◽  
Parsimonious Model ◽  
Study Participants

Background: Studies have established that OSA defined using a hypopnea definition requiring a >4% oxygen desaturation (AHI4%) is associated with cardiovascular (CVD) or coronary heart (CHD) disease. This study determined whether OSA defined using a hypopnea definition characterized by a >3% oxygen desaturation or an arousal (AHI3%A) is associated with CVD/CHD. Methods: Data were analyzed from 6307 Sleep Heart Health Study participants who had polysomnography. Self-reported CVD included angina, heart attack, heart failure, stroke or previous coronary bypass surgery or angioplasty. Self-reported CHD included the aforementioned conditions but not stroke or heart failure. The association between OSA and CVD/CHD was examined using logistic regression models with stepwise inclusion of demographic, anthropometric, social/behavioral and co-morbid medical conditions. A parsimonious model in which diabetes and hypertension were excluded because of their potential to be on the causal pathway between OSA and CVD/CHD also was constructed. Results: For CVD, the odds ratios and 95% confidence intervals for AHI3%A >30/hour were 1.39 (1.03-1.87) and 1.45 (1.09-1.94) in the fully adjusted and parsimonious models. Results for CHD were 1.29 (0.96-1.74) and 1.36 (0.99-1.85). In participants without OSA according to more stringent AHI4% criteria but with OSA using the AHI3%A definition, similar findings were observed. Conclusion: OSA defined using an AHI3%A is associated with both CVD and CHD. Use of a more restrictive AHI4% definition will misidentify a large number of individuals with OSA who have CVD or CHD. These individuals may be denied access to therapy, potentially worsening their underlying CVD or CHD.

scholarly journals Multimorbidity and tooth loss: the Brazilian National Health Survey, 2019

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rafael Aiello Bomfim ◽  
Andreia Morales Cascaes ◽  
Cesar de Oliveira
Keyword(s):  
Older Adults ◽  
Health Survey ◽  
Policy Development ◽  
Tooth Loss ◽  
National Health Survey ◽  
Geographic Region ◽  
Lower Odds ◽  
Logistic Regression Models ◽  
Functional Dentition ◽  
Nationally Representative

Abstract Background Little is known about the presence of two or more chronic conditions (multimorbidity) on tooth loss between adults and older adults. Understanding the mechanisms of multimorbidity on tooth loss is essential to inform policy development. This study aims to investigate the association between multimorbidity and severity of tooth loss in Brazilian adults and older adults. Methods We analysed data from a nationally representative sample of 88,531 Brazilian individuals aged 18 and over who participated in the 2019 Brazilian Health Survey. Tooth loss was the outcome by two different classifications: functional dentition (lost 1–12 teeth) and severe tooth loss (lost 23–32 teeth). The presence of multimorbidity was the main exposure and based on 13 self-reported doctor-diagnosed chronic diseases that were further categorised into two groups, i.e., ≥2 or ≥ 3 comorbidities. Sociodemographic covariates included sex, age, race, income, level of education and tobacco smoking and geographic region of residency. Multivariate logistic regression models estimated the OR (Odds Ratios) and 95%CI of the associations between multimorbidity and tooth loss. Results For 65,803 adults (aged 18 to 59), the presence of multimorbidity (≥2) was associated with 32% higher odds of having severe tooth loss (95% CI, 1.17; 1.49) and 33% lower odds of having functional dentition (95% CI, 0.60; 0.75). For the 22,728 older adults (aged 60 and older), multimorbidity (≥2) was associated with a 17% higher odds of severe tooth loss (95% CI, 1.06; 1.29) and 23% lower odds of having functional dentition (95% CI 0.70; 0.85). The sensitivity analysis, excluding hypertension, confirmed our findings. Conclusions Brazilian adults and older adults with multimorbidity are more likely to have severe tooth loss and less likely to have functional dentition.

scholarly journals Trends in outpatient antibiotic use and prescribing practice among US older adults, 2011-15: observational study

BMJ ◽  
2018 ◽  
pp. k3155 ◽  
Author(s):  
Scott W Olesen ◽  
Michael L Barnett ◽  
Derek R MacFadden ◽  
Marc Lipsitch ◽  
Yonatan H Grad
Keyword(s):  
Older Adults ◽  
Observational Study ◽  
Inappropriate Prescribing ◽  
Temporal Trends ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Administrative Claims ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Prescribing Practice

AbstractObjectiveTo identify temporal trends in outpatient antibiotic use and antibiotic prescribing practice among older adults in a high income country.DesignObservational study using United States Medicare administrative claims in 2011-15.SettingMedicare, a US national healthcare program for which 98% of older adults are eligible.Participants4.5 million fee-for-service Medicare beneficiaries aged 65 years old and older.Main outcome measurementsOverall rates of antibiotic prescription claims, rates of potentially appropriate and inappropriate prescribing, rates for each of the most frequently prescribed antibiotics, and rates of antibiotic claims associated with specific diagnoses. Trends in antibiotic use were estimated by multivariable regression adjusting for beneficiaries’ demographic and clinical covariates.ResultsThe number of antibiotic claims fell from 1364.7 to 1309.3 claims per 1000 beneficiaries per year in 2011-14 (adjusted reduction of 2.1% (95% confidence interval 2.0% to 2.2%)), but then rose to 1364.3 claims per 1000 beneficiaries per year in 2015 (adjusted reduction of 0.20% over 2011-15 (0.09% to 0.30%)). Potentially inappropriate antibiotic claims fell from 552.7 to 522.1 per 1000 beneficiaries over 2011-14, an adjusted reduction of 3.9% (3.7% to 4.1%). Individual antibiotics had heterogeneous changes in use. For example, azithromycin claims per beneficiary decreased by 18.5% (18.2% to 18.8%) while levofloxacin claims increased by 27.7% (27.2% to 28.3%). Azithromycin use associated with each of the potentially appropriate and inappropriate respiratory diagnoses decreased, while levofloxacin use associated with each of those diagnoses increased.ConclusionAmong US Medicare beneficiaries, overall antibiotic use and potentially inappropriate use in 2011-15 remained steady or fell modestly, but individual drugs had divergent changes in use. Trends in drug use across indications were stronger than trends in use for individual indications, suggesting that guidelines and concerns about antibiotic resistance were not major drivers of change in antibiotic use.

scholarly journals 0654 Obstructive Sleep Apnea in Older Adults: Geographic Variation in CPAP Treatment

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A249-A250
Author(s):  
Y Yu ◽  
R S Levine ◽  
T J Braley ◽  
J F Burke ◽  
R D Chervin ◽  
...  
Keyword(s):  
Older Adults ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
State Level ◽  
Medicare Beneficiaries ◽  
Geographic Variations ◽  
Southern States ◽  
Cpap Treatment ◽  
Obstructive Sleep ◽  
Hospital Referral

Abstract Introduction Obstructive sleep apnea (OSA) is prevalent and consequential among older adults. Positive airway pressure (PAP) is likely to reduce associated morbidity, but adherence is inconsistent. Regional treatment variations that may reflect addressable differences in care are not sufficiently studied. We examined geographic variations in PAP treatment among older US adults. Methods A representative 5% sample of all Medicare beneficiaries, age 65+, enrolled in fee-for-service program in 2013 was analyzed. OSA diagnosis was defined by ICD-9 codes. PAP treatment was identified by HCPCS codes. Treatment adherence was defined as ≥2 HCPCS claims for PAP supplies on separate months. We examined state-specific proportions of Medicare beneficiaries with OSA who obtained PAP and showed adherence. Maps were created to represent state-specific proportions of beneficiaries who were treated and adherent, by quantiles. To examine more granular regional variations, we created maps representing hospital referral region (HRR)-specific proportions of treated among diagnosed, and adherent among treated. Scatterplots were used to identify the relationship between proportions of PAP treatment and adherence, by state. Results For the state-level data, PAP treatment and adherence rates were between 54%-87% and 59%-81%, respectively. Midwest states had higher CPAP treatment proportions (>80%), while Northeast, Southwest and Southern states had CPAP treatment rates <73%. State-level CPAP adherence showed similar patterns, with lowest rates in southern states and California (<70%). Within-state variability of treatment patterns were observed, especially along the east and the west coasts. A scatterplot revealed that state-level CPAP treatment and adherence rates were linearly correlated, with Washington D.C., NY and NJ ranked lowest. In contrast, MT, ND and VT had the highest treatment and adherence rates. Conclusion These data show substantial state-level and regional variability of CPAP treatment and adherence among Medicare beneficiaries. Some geographic areas may merit prioritization in efforts to improve OSA treatment and adherence. Support This study was supported by The American Sleep Medicine Foundation Strategic Research Award 115-SR-15

scholarly journals Dual Trajectories of Social Isolation and Dementia in Older Adults: A Population-Based Longitudinal Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 319-319
Author(s):  
Xiaoling Xiang ◽  
Patrick Ho Lam Lai ◽  
Yihang Sun ◽  
Ruth Dunkle
Keyword(s):  
Older Adults ◽  
Social Isolation ◽  
Late Onset ◽  
Developmental Trajectories ◽  
Population Based ◽  
Steady Increase ◽  
Dual Model ◽  
Medicare Beneficiaries ◽  
Dementia Risk

Abstract The purpose of this study was to identify patterns of changes in social isolation and dementia and the interrelations between these developmental trajectories. The study sample included 7,609 Medicare beneficiaries age 65 and older from the National Health and Aging Trends Study 2011 through 2018 surveys. A group-based dual trajectory modeling approach was used to identify distinct groups of developmental trajectories for social isolation and dementia status over the 8-year period. The dual model provided estimates of conditional and joint probabilities linking the two sets of trajectory groups. Changes in social isolation over an 8-year period followed four trajectories: rarely isolated (62.2%), steady increase (13.5%), steady decrease (7.4%), and persistently isolated (16.9%). Changes in dementia risk also followed four trajectories: persistently low risk (80.4%), increasing with early onset (3.9%), increasing with late onset (4.5%), and persistently high risk (11.2%). Over two-third (68%) of the persistently low dementia group were also in the rarely isolated group. Both increasing dementia groups were composed mainly of individuals from the increasing social isolation group (40-43%) and persistently isolated group (24-29%). The persistently high dementia group had the most overlap with the decreasing social isolation group (47%), followed by the persistently isolated group (28%). For the most part, social isolation and dementia evolve in the same direction for older adults over an 8-year period. However, the pattern of associations between these developmental trajectories is complex and may be reversed among long-term dementia survivors.

Social Determinants of Shingles Vaccination in the United States

2021 ◽  
Author(s):  
Eric M Vogelsang ◽  
Andrea N Polonijo
Keyword(s):  
United States ◽  
Older Adults ◽  
Health Behaviors ◽  
The United States ◽  
Vaccine Uptake ◽  
Behavioral Risk ◽  
Sociodemographic Characteristics ◽  
Lower Odds ◽  
Logistic Regression Models ◽  
Self Rated Health

Abstract Objective Only about one-third of older adults in the United States are vaccinated against shingles, contributing to approximately one million shingles cases annually. This study examines how sociodemographic characteristics, health behaviors, and self-rated health are associated with shingles vaccine uptake. Method Data come from the 2017 wave of the Behavioral Risk Factor Surveillance System survey, using a subset of older adults aged 60-plus (N=208,301). Logistic regression models test (1) for associations between individual-level sociodemographic characteristics and vaccine uptake and (2) whether health behaviors and self-rated health moderate these associations. Results Black and Hispanic older adults have almost 50% lower odds of shingles vaccination, compared to non-Hispanic Whites. Abstaining from alcohol, being employed, living with children, and having poor self-rated health are also associated with lower uptake. Unmarried (vs. married) individuals have lower odds of vaccination that are explained by broad differences in health behavior. Discussion Our study contributes to understanding how shingles vaccination coverage systematically differs among social groups. In doing so, it provides guidance for public health interventions to increase uptake. This line of research is increasingly salient in a world facing novel virus threats and anti-vaccine social movements.

scholarly journals Potential causal effect of physical activity on reducing the risk of dementia: a 6-year cohort study from the Japan Gerontological Evaluation Study

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Koryu Sato ◽  
Naoki Kondo ◽  
Masamichi Hanazato ◽  
Taishi Tsuji ◽  
Katsunori Kondo
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Causal Effect ◽  
Evaluation Study ◽  
Self Report ◽  
Term Care ◽  
The Public ◽  
Dementia Risk ◽  
Long Term Care Insurance ◽  
Study Participants

Abstract Background The causal effect of physical activity on reducing dementia risk has been questioned due to the possibility of reverse causation. This study examined the potential causal effects of physical activity on reducing dementia risk using residency in a snowy area as an instrumental variable (IV) representing the physical activity of older adults. Methods We used cohort data from the Japan Gerontological Evaluation Study, a longitudinal cohort enrolling people aged 65 or older who were physically and cognitively independent in 2013; study participants were followed for an average of 5.7 years. Participants in the present study included 73,260 individuals living in 19 municipalities in Japan. Physical activity was measured by self-report questionnaires and the incidence of dementia was ascertained by linking participants to the public registries of long-term care insurance. IV estimation was obtained from a piecewise Cox proportional hazard model using a two-stage regression procedure. Results During the study period, we ascertained 8714 cases (11.9%) of dementia onset. In the IV analysis, we found that the frequency of physical activity per week was negatively associated with dementia risk, though the association weakened over time (Year 1: hazard ratio = 0.53, 95% confidence interval: 0.39–0.74; Year 4: 0.69, 0.53–0.90; Year 6: 0.85, 0.66–1.10). Conclusions Our IV analysis indicated a potential causal effect of physical activity on reducing dementia risk that persisted for at least 4 years of follow-up. Thus, we conclude that physical activity should be recommended for older adults to reduce dementia risk.

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