Increased Risk of Nursing Home Admission Among Middle Aged and Older Adults With Schizophrenia

SUMMARYObjectiveTo analyse susceptibility/risk of suffering COVID19 among adults with distinct underlying medical conditions.MethodsCohort study (population-based) including 79,083 people ≥50 years-old in Tarragona (Southern Catalonia, Spain). At study start (01/03/2020) baseline cohort characteristics (demographic, previous comorbidities, chronic medications and vaccinations’ history) were recorded. Primary outcome was laboratory-confirmed COVID19 incurred in cohort members throughout 01/03/2020-30/06/2020. Risk of suffering COVID19 was evaluated by Cox regression, estimating multivariable hazard ratios (HRs) adjusted for age/sex and previous comorbidities.ResultsAcross study period, 536 laboratory-confirmed COVID19 cases were observed (mean incidence: 39.5 cases per 100,000 persons-week). In multivariable-analysis, age/years (HR: 1.01; 95% CI: 1.00-1.02; p=0.050), nursing-home (HR: 20.19; 95% CI: 15.98-25.51; p<0.001), neurological disease (HR: 1.35; 95% CI: 1.03-1.77; p=0.029), taking diuretics (HR: 1.39; 95% CI: 1.10-1.75; p=0.006), antiplatelet (HR: 1.36; 95% CI: 1.05-1.76; p=0.021) and benzodiazepines (HR: 1.24; 95% CI:1.00-1.53; p=0.047) significantly increased risk; while smoking (HR: 0.57; 95%CI: 0.41-0.80; p=0.001), angiotensin converting enzyme inhibitors (HR: 0.78; 95% CI: 0.61-1.00; p=0.048), angiotensin II receptor blockers (HR: 0.70; 95%CI: 0.51-0.96; p=0.027) and statins (HR: 0.75; 95% CI: 0.58-0.96; p=0.025) were associated with reduced risk. Among non-institutionalised persons, cancer, renal and cardiac disease appeared also related to increased risk, whereas influenza vaccination was associated with reduced risk.ConclusionIn a setting with relatively low incidence of COVID19 across the first wave of pandemic period, age, nursing-home residence and multiple comorbidities appear predisposing for COVID19 among middle-aged/older adults. Conversely, statins, angiotensin-receptor blockers/inhibitors and influenza vaccination were related with decreased risk.

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COVID19-related and all-cause mortality among middle-aged and older adults across the first epidemic wave of SARS-COV-2 infection in the region of Tarragona, Spain: results from the COVID19 TARRACO Cohort Study, March-June 2020

10.1101/2021.02.02.21251028 ◽

2021 ◽

Author(s):

Angel Vila-Corcoles ◽

Eva Satue-Gracia ◽

Angel Vila-Rovira ◽

Cinta de Diego-Cabanes ◽

Maria Jose Forcadell-Peris ◽

...

Keyword(s):

Older Adults ◽

Cohort Study ◽

Nursing Home ◽

Cox Regression ◽

Middle Aged ◽

Mortality Risks ◽

Increased Risk ◽

Epidemic Period ◽

All Cause Mortality ◽

Related Mortality

SUMMARYBackgroundDirect and indirect COVID19-related mortality is uncertain. This study investigated COVID19-related and all-cause deaths among middle-aged and older adults during the first wave of COVID19 epidemic period, assessing mortality risks by pre-existing socio-demographic and medical underlying conditions.MethodsPopulation-based cohort study involving 79,083 individuals ≥50 years-old in Tarragona (Southern Catalonia, Spain). Baseline cohort characteristics (age/sex, comorbidities and medications/vaccinations history) were established at study start (01/03/2020) and main outcomes were COVID19-related deaths (occurred in patients diagnosed with the disease) and all-cause deaths occurred among cohort members between 01/03/2020-30/06/2020. Mortality risks were assessed by Cox regression analyses.ResultsCohort members were followed for 1,356,358 persons-weeks, occurring 576 all-cause deaths (124 COVID19-related). All-cause mortality rate was 42.5 deaths per 100,000 persons-week, being 22.8 in healthy/unrelated-COVID19 subjects, 236.4 in COVID19-excluded/PCR-negative subjects, 493.7 in COVID19-compatible/PCR-unperformed subjects and 4009.1 in COVID19-confirmed patients. In multivariable analyses, increasing age, sex male, nursing-home residence, cancer, neurologic, cardiac or liver disease, receiving diuretics, systemic corticosteroids, proton-pump inhibitors and benzodiazepines were associated with increased risk of all-cause mortality; conversely, receiving renin-angiotensin inhibitors and statins were associated with reduced risk. Age/years, sex male and nursing-home residence were strong predictors for COVID19-related mortality, but none comorbidity appeared significantly associated with an increased risk.ConclusionApart from direct COVID19-related deaths (which represented almost 22% of all-cause mortality), theoretically COVID19-excluded patients (PCR-negative) suffered considerable greater all-cause mortality than healthy/unrelated-COVID19 subjects, which could explain, in part, the large excess deaths observed across the COVID19 pandemic.

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COVID19-related and all-cause mortality risk among middle-aged and older adults across the first epidemic wave of SARS-COV-2 infection: a population-based cohort study in Southern Catalonia, Spain, March–June 2020

BMC Public Health ◽

10.1186/s12889-021-11879-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Angel Vila-Corcoles ◽

Eva Satue-Gracia ◽

Angel Vila-Rovira ◽

Cinta de Diego-Cabanes ◽

Maria Jose Forcadell-Peris ◽

...

Keyword(s):

Older Adults ◽

Cohort Study ◽

Nursing Home ◽

Population Based ◽

Considerable Proportion ◽

Middle Aged ◽

Mortality Risks ◽

Increased Risk ◽

All Cause Mortality ◽

Related Mortality

Abstract Background Direct and indirect COVID19-related mortality is uncertain. This study investigated all-cause and COVID19-related deaths among middle-aged and older adults during the first wave of COVID-19 pandemic period, assessing mortality risks by pre-existing socio-demographic and medical underlying conditions. Methods Population-based cohort study involving 79,083 individuals ≥50 years-old in Tarragona (Southern Catalonia, Spain). Baseline cohort characteristics (age/sex, comorbidities and medications/vaccinations history) were established at study start (01/03/2020) and main outcomes were COVID19-related deaths (those occurred among patients with laboratory-confirmed COVID19) and all-cause deaths occurred among cohort members between 01/03/2020–30/06/2020. Mortality risks were assessed by Cox regression analyses. Results Cohort members were followed for 1,356,358 persons-weeks, occurring 576 all-cause deaths (124 COVID19-related deaths). Of the 124 deceased patients with a laboratory-confirmed COVID19, 112 (90.3%) died by (due to) COVID-19, while 12 (9.7%) died with COVID-19 (but likely due to other concomitant causes). All-cause mortality rate among cohort members across study period was 42.5 deaths per 100,000 persons-week, being 22.8 among healthy/unrelated-COVID19 subjects, 236.4 in COVID19-excluded/PCR-negative subjects, 493.7 in COVID19-compatible/PCR-unperformed subjects and 4009.1 in COVID19-confirmed patients. Increasing age, sex male, nursing-home residence, cancer, neurologic, cardiac or liver disease, receiving diuretics, systemic corticosteroids, proton-pump inhibitors and benzodiazepines were associated with increased risk of all-cause mortality; conversely, receiving renin-angiotensin inhibitors and statins were associated with reduced risk. Age/years (hazard ratio [HR]: 1.08; 95% confidence interval [CI]: 1.06–1.10), sex male (HR: 1.82; 95% CI: 1.24–2.70), nursing-home residence (HR: 12.56; 95% CI: 8.07–19.54) and number of pre-existing comorbidities (HR: 1.14; 95% CI: 1.01–1.29) were significant predictors for COVID19-related mortality, but none specific comorbidity emerged significantly associated with an increased risk in multivariable analysis evaluating it. Conclusion COVID19-related deaths represented more than 20 % of all-cause mortality occurred among middle-aged and older adults during the first wave of the pandemic in the region. A considerable proportion (around 10 %) of these COVID19-related deaths could be attributed to other concomitant causes. Theoretically COVID19-excluded subjects (PCR-negative) suffered ten-times greater all-cause mortality than healthy/unrelated-COVID19 subjects, which points to the existence of considerable number of false negative results in earlier PCR testing and could explain part of the global excess all-cause mortality observed during the pandemic.

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A bio-psycho-social approach for frailty amongst Singaporean Chinese community-dwelling older adults – evidence from the Singapore Longitudinal Aging Study

BMC Geriatrics ◽

10.1186/s12877-019-1367-9 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 4

Author(s):

Nigel Teo ◽

Pei Shi Yeo ◽

Qi Gao ◽

Ma Shwe Zin Nyunt ◽

Jie Jing Foo ◽

...

Keyword(s):

Older Adults ◽

Nursing Home ◽

Functional Disability ◽

Empirical Studies ◽

Social Contact ◽

Population Based ◽

Community Dwelling ◽

Severe Disability ◽

Cross Sectional ◽

Increased Risk

Abstract Background Few empirical studies support a bio-psycho-social conceptualization of frailty. In addition to physical frailty (PF), we explored mental (MF) and social (SF) frailty and studied the associations between multidimensional frailty and various adverse health outcomes. Methods Cross-sectional and longitudinal analyses were conducted using data from a population-based cohort (SLAS-1) of 2387 community-dwelling Singaporean Chinese older adults. Outcomes examined were functional and severe disability, nursing home referral and mortality. PF was defined by shrinking, weakness, slowness, exhaustion and physical inactivity, 1–2 = pre-frail, 3–5 = frail; MF was defined by ≥1 of cognitive impairment, low mood and poor self-reported health; SF was defined by ≥2 of living alone, no education, no confidant, infrequent social contact or help, infrequent social activities, financial difficulty and living in low-end public housing. Results The prevalence of any frailty dimension was 63.0%, dominated by PF (26.2%) and multidimensional frailty (24.2%); 7.0% had all three frailty dimensions. With a few exceptions, frailty dimensions share similar associations with many socio-demographic, lifestyle, health and behavioral factors. Each frailty dimension varied in showing independent associations with functional (Odds Ratios [ORs] = 1.3–1.8) and severe disability prevalence at baseline (ORs = 2.2–7.3), incident functional disability (ORs = 1.1–1.5), nursing home referral (ORs = 1.5–3.4) and mortality (Hazard Ratios = 1.3–1.5) after adjusting for age, gender, medical comorbidity and the two other frailty dimensions. The addition of MF and SF to PF incrementally increased risk estimates by more than 2 folds. Conclusions This study highlights the relevance and utility of PF, MF and SF individually and together. Multidimensional frailty can better inform policies and promote the use of targeted multi-domain interventions tailored to older adults’ frailty statuses.

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No Other Safe Care Option: Nursing Home Admission as a Last Resort Strategy

The Gerontologist ◽

10.1093/geront/gnaa077 ◽

2020 ◽

Vol 60 (8) ◽

pp. 1504-1514

Author(s):

Heather J Campbell-Enns ◽

Megan Campbell ◽

Kendra L Rieger ◽

Genevieve N Thompson ◽

Malcolm B Doupe

Keyword(s):

Older Adults ◽

Nursing Home ◽

Nursing Homes ◽

Nursing Home Residents ◽

Community Setting ◽

Nursing Home Admission ◽

Care Needs ◽

Community Based ◽

Field Notes ◽

Care Nursing

Abstract Background and Objectives Nursing homes are intended for older adults with the highest care needs. However, approximately 12% of all nursing home residents have similar care needs as older adults who live in the community and the reasons they are admitted to nursing homes is largely unstudied. The purpose of this study was to explore the reasons why lower-care nursing home residents are living in nursing homes. Research Design and Methods A qualitative interpretive description methodology was used to gather and analyze data describing lower-care nursing home resident and family member perspectives regarding factors influencing nursing home admission, including the facilitators and barriers to living in a community setting. Data were collected via semistructured interviews and field notes. Data were coded and sorted, and patterns were identified. This resulted in themes describing this experience. Results The main problem experienced by lower-care residents was living alone in the community. Residents and family members used many strategies to avoid safety crises in the community but experienced multiple care breakdowns in both community and health care settings. Nursing home admission was a strategy used to avoid a crisis when residents did not receive the needed support to remain in the community. Discussion and Implications To successfully remain in the community, older adults require specialized supports targeting mental health and substance use needs, as well as enhanced hospital discharge plans and improved information about community-based care options. Implications involve reforming policies and practices in both hospital and community-based care settings.

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A-20 Metabolic Syndrome and Executive Functioning in Young, Middle-Aged, and Older Adults

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acz034.20 ◽

2019 ◽

Vol 34 (6) ◽

pp. 879-879

Author(s):

T Slonim ◽

L Haase-Alasantro ◽

C Murphy

Keyword(s):

Older Adults ◽

Metabolic Syndrome ◽

Executive Functioning ◽

Cognitive Performance ◽

Test Performance ◽

Color Word ◽

Self Report ◽

Metabolic Status ◽

Middle Aged ◽

Increased Risk

Abstract Objective Metabolic syndrome (MetS) is associated with increased rates of mortality and increased risk for developing dementia. Changes in brain structure and executive functioning have been reported within the literature. However, research examining cognitive performance in individuals with metabolic syndrome focuses primarily on older cohorts. As such, the effect of metabolic syndrome on cognitive functioning earlier in the lifespan is unclear. This research examined neuropsychological test performance and self-report measures in young, middle-aged, and older adults with and without MetS. Method Participants (n = 128) were categorized by age and metabolic status as follows: Young: n = 42, 52.4% Metabolic; Middle-Age: n = 41, 56.1% Metabolic; Older: n = 45, 51.1% Metabolic. Participants were administered the following cognitive assessments as part of a larger study: Delis-Kaplan Executive Function System (DKEFS) Color-Word Interference Test and Trail Making. Multivariate analyses of variance were used to examine the relationship between age group, metabolic status, and cognitive performance. Results As expected, older adults performed more poorly than young and middle-aged adults across neurocognitive assessments (p < .05). MetS adults performed more slowly on Color-Word Interference: Inhibition [F(1,114) = 5.26, p = .024, η2 = .05]; however, there were no additional significant differences between groups on cognitive tests in this sample size. Conclusions These findings suggest that aspects of inhibition might be impaired in MetS adults. Future studies aimed at investigating relationships between metabolic risk factors and inhibition may provide insight into effective intervention targets to delay or prevent metabolic syndrome.

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Case Management and Risk of Nursing Home Admission for Older Adults in Home Care: Results of the AgeD in HOme Care Study

Journal of the American Geriatrics Society ◽

10.1111/j.1532-5415.2007.01079.x ◽

2007 ◽

Vol 55 (3) ◽

pp. 439-444 ◽

Cited By ~ 34

Author(s):

Graziano Onder ◽

Rosa Liperoti ◽

Manuel Soldato ◽

Iain Carpenter ◽

Knight Steel ◽

...

Keyword(s):

Older Adults ◽

Nursing Home ◽

Case Management ◽

Home Care ◽

Nursing Home Admission ◽

Care Study

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Associations between Relative Handgrip Strength and Incidence of Type 2 Diabetes Mellitus in Middle-aged and Older adults: Finding from the Korean Genome and Epidemiology Study

Exercise Science ◽

10.15857/ksep.2020.29.4.377 ◽

2020 ◽

Vol 29 (4) ◽

pp. 377-384

Author(s):

Eun Sun Yoon ◽

Soo Hyun Park

Keyword(s):

Older Adults ◽

Fasting Glucose ◽

Handgrip Strength ◽

Population Based ◽

Diabetes Incidence ◽

Epidemiology Study ◽

Middle Aged ◽

Family History Of Diabetes ◽

Increased Risk

PURPOSE: We investigated whether relative handgrip strength (RHS) and change in handgrip strength predicted Type 2 DM incidence in middle-aged and older adults.METHODS: Total of 29,098 participants (8,609 men and 20,489 women) aged 40-69 who were free of diabetes at the baseline examination drawn from the Korean Genome and Epidemiology Study-Urban Health Examinees cohort (KoGES-HEXA), a large prospective population-based study. RHS was assessed with a dynamometer and divided by body mass index. Diabetes was defined as selfreported physician-diagnosed diabetes, use of anti-diabetic medications or measured fasting glucose ≥126 mg/dl, or glycated hemoglobin (HbA1C) ≥6.5%. Cox proportional hazard regression analysis was used to estimate the hazard ratio (HRs) and 95% confidence intervals (CIs) of Diabetes incidences according to baseline RHS levels and RHS changes.RESULTS: During a mean follow-up period of 4 years (49.8±13.3 month), 1,167 (4.0%) participants developed diabetes. Compared with the high RHS group, higher risk of diabetes incidence was observed in low RHS group (men HR=1.28, 95% CI 1.06-1.55, women HR=1.32, 95% CI 1.12-1.54) after adjusted for age, triglyceride, cigarette smoking, alcohol consumption, marriage, income, education hypertension, family history of diabetes, fasting glucose, regular exercise. In addition, compared with the sustained high RHS group, sustained low RHS group showed an increased risk of diabetes incidence (men HR=1.60, 95% CI 1.28-2.00, women HR=1.85, 95% CI 1.52-2.24) after adjustment. However, the risk was not statistically significant in increased RHS group (men HR=0.98, 95% CI 0.73-1.31, women HR=1.11, 95% CI 0.85-1.43).CONCLUSIONS: The present findings indicate that RHS is independently associated with the risk of incident diabetes in middle and older adults. RHS measurement may be useful to identify individuals at increased risk for diabetes incidence. Maintaining a high level of RHS is important strategies for diabetes prevention among adults.

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Risk factors for depression during the COVID-19 pandemic: a longitudinal study in middle-aged and older adults

BJPsych Open ◽

10.1192/bjo.2021.997 ◽

2021 ◽

Vol 7 (5) ◽

Author(s):

Jamie Rutland-Lawes ◽

Anna-Stiina Wallinheimo ◽

Simon L. Evans

Keyword(s):

Risk Factors ◽

Older Adults ◽

Longitudinal Study ◽

Regression Models ◽

Protective Factor ◽

Significant Risk ◽

Living Alone ◽

Depression Symptoms ◽

Middle Aged ◽

Increased Risk

Background The COVID-19 pandemic and resultant social restrictions have had widespread psychological ramifications, including a rise in depression prevalence. However, longitudinal studies on sociodemographic risk factors are lacking. Aims To quantify longitudinal changes in depression symptoms during the pandemic compared with a pre-pandemic baseline, in middle-aged and older adults, and identify the risk factors contributing to this. Method A total of 5331 participants aged ≥50 years were drawn from the English Longitudinal Study of Ageing. Self-reported depression symptoms in June/July 2020 were compared with baseline data from 2–3 years prior. Regression models investigated sociodemographic and lifestyle variables that could explain variance in change in depression. Results Within-participant depression scores increased significantly from pre-pandemic levels: 14% met the criteria for clinical depression at baseline, compared with 26% during the pandemic. Younger age, female gender, higher depression scores at baseline, living alone and having a long-standing illness were significant risk factors. Gender-stratified regression models indicated that older age was protective for women only, whereas urban living increased risk among women only. Being an alcohol consumer was a protective factor among men only. Conclusions Depression in UK adults aged ≥50 years increased significantly during the pandemic. Being female, living alone and having a long-standing illness were prominent risk factors. Younger women living in urban areas were at particularly high risk, suggesting such individuals should be prioritised for support. Findings are also informative for future risk stratification and intervention strategies, particularly if social restrictions are reimposed as the COVID-19 crisis continues to unfold.

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Social Connectedness, Meals on Wheels Services and Healthcare Utilization Among High-Need Older Adults

Innovation in Aging ◽

10.1093/geroni/igab046.3435 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 961-961

Author(s):

Jennifer Chubinski ◽

Sarah Walsh ◽

France Weaver

Keyword(s):

Older Adults ◽

Nursing Home ◽

Healthcare Utilization ◽

Social Cohesion ◽

Panel Study ◽

Nursing Home Residents ◽

Social Health ◽

Multivariate Techniques ◽

Meals On Wheels ◽

Increased Risk

Abstract Homebound vulnerable adults 65+ are at an increased risk for social isolation and loneliness. The adverse consequences of loneliness are profound – including increased health care utilization, burden of dementia, chronic diseases, and mortality. Meals on Wheels (MOW) is a familiar source of nutritional support for homebound individuals who wish to stay in their homes and has additional important benefits. A growing body of evidence demonstrates that MOW provides mental and social health benefits beyond nutrition, but less is known about the interplay between MOW, social cohesion, and health services use. This project will address this gap in the literature using data from the 2013-2020 National Health and Aging Trends Study (NHATS), a nationally-representative panel study of 65+ Medicare enrollees. Using matching and longitudinal multivariate techniques, the risks of hospitalization and permanent nursing home entry are compared between MOW users and non-users. Our longitudinal dataset includes 11,266 observations. Of those, 12.8% rely on MOW or other food assistance (N= 1,488) and 16.6% experience low social cohesion (N= 1,936). Some 6.6% of participants are nursing home residents (N= 748) and the 39.1% report an overnight hospital stay in the prior year (N= 4,560). MOW is a comparatively low-cost intervention to help homebound older adults retain their independence and limit costlier healthcare utilization. This work extends our understanding of MOW services beyond simple nutrition benefits to its potential impact on social health.

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