scholarly journals Vaccine Rollout Strategies: The Case for Vaccinating Essential Workers Early

2021 ◽  
Author(s):  
N. Mulberry ◽  
P. Tupper ◽  
E. Kirwin ◽  
C. McCabe ◽  
C. Colijn
Keyword(s):  
Older Adults ◽  
British Columbia ◽  
Total Population ◽  
Vaccination Strategy ◽  
Adverse Outcomes ◽  
Essential Work ◽  
Monetary Benefit ◽  
Net Monetary Benefit ◽  
Indirect Protection

AbstractIn planning for upcoming mass vaccinations against COVID-19, many jurisdictions have proposed using primarily age-based rollout strategies, where the oldest are vaccinated first and the youngest last. In the wake of growing evidence that approved vaccines are effective at preventing not only adverse outcomes, but also infection (and hence transmission of SARS-CoV-2), we propose that such age-based rollouts are both less equitable and less effective than strategies that prioritize essential workers. We demonstrate that strategies that target essential workers earlier consistently outperform those that do not, and that prioritizing essential work-ers provides a significant level of indirect protection for older adults. This conclusion holds across numerous outcomes, including cases, hospitalizations, Long COVID, deaths and net monetary benefit, and over a range of possible values for the efficacy of vaccination against infection. Our analysis focuses on regimes where the pandemic continues to be controlled with distancing and other measures as vaccination proceeds, and where the vaccination strategy is expected to last for over the coming 6-8 months — for example British Columbia, Canada. In such a setting with a total population of 5M, vaccinating essential workers sooner is expected to prevent over 200,000 infections, over 600 deaths, and to produce a net monetary benefit of over $500M.

scholarly journals Vaccine rollout strategies: The case for vaccinating essential workers early

2021 ◽  
Vol 1 (10) ◽  
pp. e0000020
Author(s):  
Nicola Mulberry ◽  
Paul Tupper ◽  
Erin Kirwin ◽  
Christopher McCabe ◽  
Caroline Colijn
Keyword(s):  
Adverse Outcomes ◽  
Monetary Benefit ◽  
Net Monetary Benefit ◽  
Vaccination Campaigns

In vaccination campaigns against COVID-19, many jurisdictions are using age-based rollout strategies, reflecting the much higher risk of severe outcomes of infection in older groups. In the wake of growing evidence that approved vaccines are effective at preventing not only adverse outcomes, but also infection, we show that such strategies are less effective than strategies that prioritize essential workers. This conclusion holds across numerous outcomes, including cases, hospitalizations, Long COVID (cases with symptoms lasting longer than 28 days), deaths and net monetary benefit. Our analysis holds in regions where the vaccine supply is limited, and rollout is prolonged for several months. In such a setting with a population of 5M, we estimate that vaccinating essential workers sooner prevents over 200,000 infections, over 600 deaths, and produces a net monetary benefit of over $500M.

Exploring a Hidden Epidemic: Drowning Among Adults Aged 65 Years and Older

2021 ◽  
pp. 089826432110147
Author(s):  
Tessa Clemens ◽  
Amy E. Peden ◽  
Richard C. Franklin
Keyword(s):  
Older Adults ◽  
New Zealand ◽  
Retrospective Analysis ◽  
Older Adult ◽  
Total Population ◽  
Downward Trend ◽  
Population Projections ◽  
Prevention Strategies ◽  
Drowning Prevention

Objectives: To explore trends in unintentional fatal drowning among older adults (65 years and older). Methods: Total population retrospective analysis of unintentional fatal drowning among people aged 65 years and older in Australia, Canada and New Zealand (2005–2014) was conducted. Results: 1459 older adults died. Rates ranged from 1.69 (Canada) to 2.20 (New Zealand) per 100,000. Trends in crude drowning rates were variable from year to year. A downward trend was observed in New Zealand (y = −.507ln(x) + 2.9918), with upward trends in Australia (y = .1056ln(x) + 1.5948) and Canada (y = .1489ln(x) + 1.4571). Population projections suggest high annual drowning deaths by 2050 in Australia (range: 120–190; 1.69–2.76/100,000) and Canada (range: 209–430; 1.78–3.66/100,000). Significant locations and activities associated with older adult drowning differed by country and age band. Conclusions: Drowning among older adults is a hidden epidemic claiming increasing lives as the population ages. Targeted drowning prevention strategies are urgently needed in Australia, Canada, New Zealand and other similar countries.

scholarly journals How wearable sensors have been utilised to evaluate frailty in older adults: a systematic review

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Grainne Vavasour ◽  
Oonagh M. Giggins ◽  
Julie Doyle ◽  
Daniel Kelly
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Gait Speed ◽  
Outcome Measurement ◽  
Wearable Sensors ◽  
Adverse Outcomes ◽  
Community Dwelling ◽  
Ageing Population ◽  
Application Development ◽  
Community Dwelling Older Adults

Abstract Background Globally the population of older adults is increasing. It is estimated that by 2050 the number of adults over the age of 60 will represent over 21% of the world’s population. Frailty is a clinical condition associated with ageing resulting in an increase in adverse outcomes. It is considered the greatest challenge facing an ageing population affecting an estimated 16% of community-dwelling populations worldwide. Aim The aim of this systematic review is to explore how wearable sensors have been used to assess frailty in older adults. Method Electronic databases Medline, Science Direct, Scopus, and CINAHL were systematically searched March 2020 and November 2020. A search constraint of articles published in English, between January 2010 and November 2020 was applied. Papers included were primary observational studies involving; older adults aged > 60 years, used a wearable sensor to provide quantitative measurements of physical activity (PA) or mobility and a measure of frailty. Studies were excluded if they used non-wearable sensors for outcome measurement or outlined an algorithm or application development exclusively. The methodological quality of the selected studies was assessed using the Appraisal Tool for Cross-sectional Studies (AXIS). Results Twenty-nine studies examining the use of wearable sensors to assess and discriminate between stages of frailty in older adults were included. Thirteen different body-worn sensors were used in eight different body-locations. Participants were community-dwelling older adults. Studies were performed in home, laboratory or hospital settings. Postural transitions, number of steps, percentage of time in PA and intensity of PA together were the most frequently measured parameters followed closely by gait speed. All but one study demonstrated an association between PA and level of frailty. All reports of gait speed indicate correlation with frailty. Conclusions Wearable sensors have been successfully used to evaluate frailty in older adults. Further research is needed to identify a feasible, user-friendly device and body-location that can be used to identify signs of pre-frailty in community-dwelling older adults. This would facilitate early identification and targeted intervention to reduce the burden of frailty in an ageing population.

scholarly journals Characterizing Physical Resilience in Older Adults: Insights From Secondary Analyses in Three Clinical Groups

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 752-753
Author(s):  
Brian Buta ◽  
Anne Newman
Keyword(s):  
Older Adults ◽  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Marrow Transplantation ◽  
Adverse Outcomes ◽  
Clinical Population ◽  
Medical Procedure ◽  
Main Study ◽  
Secondary Analyses ◽  
Existing Data

Abstract Resilience is defined as the ability of a physiologic system to recover from a stressor that has pushed the system into a state far from its original state of equilibrium. The level of resilience can be understood by whether or not the system’s essential identity and function are retained following the stressor. The study of resilience in older adults has potential to provide clinically relevant insights into our understanding of who will or will not recover when encountering a stressful medical procedure, especially those common to older patients. The main Study of Physical Resilience and Aging (SPRING) at Johns Hopkins includes prospective data collection of determinants, phenotypes, surrogates, dynamic stimulation measures, and outcomes of resiliency among older persons undergoing knee replacement surgery, or the initiation of hemodialysis, or bone marrow transplantation. SPRING also includes analyses of existing data sources to inform these prospective studies. This symposium briefly presents the conceptual framework and design of SPRING, and focuses on the results of secondary analyses from three existing data sets that mirror the ongoing stressor studies: FORCE-TKR (knee/joint replacement, N=9006), CHOICE (dialysis initiation, N=487), and a database of patients undergoing treatment for hematologic malignancies (bone marrow transplantation, N=1011). For each clinical population, we present results on phenotypic and/or biomarker trajectories, as well as the factors associated with resilience phenotypes and how these are predictive of clinical outcomes. These analyses display the utility of resilience phenotypes for predicting risk of adverse outcomes and complement the new data being collected in our main study.

Exploring the Association between Multimorbidity and Cognitive Impairment in Older Adults Living in the Community: A Review of the Literature

2021 ◽  
pp. 108482232110304
Author(s):  
Grace F. Wittenberg ◽  
Michelle A. McKay ◽  
Melissa O’Connor
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Assessment Tool ◽  
Adult Population ◽  
Home Health ◽  
Adverse Outcomes ◽  
Community Dwelling ◽  
Cognitive Screening ◽  
Review Of The Literature ◽  
Increased Risk

Two-thirds of older adults have multimorbidity (MM), or co-occurrence of two or more medical conditions. Mild cognitive impairment (CI) is found in almost 20% of older adults and can lead to further cognitive decline and increased mortality. Older adults with MM are the primary users of home health care services and are at high risk for CI development; however, there is no validated cognitive screening tool used to assess the level of CI in home health users. Given the prevalence of MM and CI in the home health setting, we conducted a review of the literature to understand this association. Due to the absence of literature on CI in home health users, the review focused on the association of MM and CI in community-dwelling older adults. Search terms included home health, older adults, cognitive impairment, and multimorbidity and were applied to the databases PubMed, CINAHL, and PsychInfo leading to eight studies eligible for review. Results show CI is associated with MM in older adults of increasing age, among minorities, and in older adults with lower levels of education. Heart disease was the most prevalent disease associated with increased CI. Sleep disorders, hypertension, arthritis, and hyperlipidemia were also significantly associated with increased CI. The presence of MM and CI was associated with increased risk for death among older adults. Further research and attention are needed regarding the use and development of a validated cognitive assessment tool for home health users to decrease adverse outcomes in the older adult population.

scholarly journals Prevalence of Multiple Sensory Deficits in Older Adults in BLSA and ARIC Studies

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 804-805
Author(s):  
Nicole Armstrong ◽  
Jennifer Deal ◽  
Hang Wang ◽  
Jennifer Schrack ◽  
Qu Tian ◽  
...  
Keyword(s):  
Older Adults ◽  
Vision Loss ◽  
Age Groups ◽  
Adverse Outcomes ◽  
Atherosclerosis Risk In Communities ◽  
Sensory Deficits ◽  
Olfactory Loss ◽  
Atherosclerosis Risk ◽  
Baltimore Longitudinal Study ◽  
Using Data

Abstract Individual sensory deficits have been associated with adverse outcomes, including dementia, in older adults. Using data from the Baltimore Longitudinal Study of Aging (BLSA) (N=259) and Atherosclerosis Risk in Communities Study (ARIC) (N=962), we examined the prevalence of one, two, or three sensory deficits (hearing, vision, and olfaction) among older adults ≥70 years. Any hearing loss was the most prevalent sensory deficit (70-79 year-olds: 41.3% [BLSA] and 51.2% [ARIC]; ≥80 year-olds: 82.6% [BLSA] and 74.2% [ARIC]), followed by vision loss and olfactory loss. Hearing and vision impairments were more prevalent than hearing and olfactory losses as well as vision and olfactory losses in both age groups and studies There were few people with deficits in all three senses (70-79 year-olds: 3.3% [BLSA] and 2.0% [ARIC]; ≥80 year-olds: 5.8% [BLSA] and 7.4% [ARIC]). Further research should investigate the potential impact of multisensory impairments on older adults.

scholarly journals Family Solidarity, Social Support, Loneliness, and Well-Being Among Older Adults in Rural China

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 319-320
Author(s):  
Xiaoyan Zhang ◽  
Merril Silverstein
Keyword(s):  
Older Adults ◽  
Life Satisfaction ◽  
Adult Children ◽  
Child Support ◽  
Structural Equation ◽  
Total Population ◽  
Well Being ◽  
Equation Modeling ◽  
National Bureau ◽  
Subjective Well Being

Abstract China is experiencing a large increase in elderly population. In 2019, China’s population aged 60 and above had reached 253 million, accounting for 18.1% of the total population (National Bureau of Statistics of China, 2020). By 2050, the number of adults aged 60+ would be up to 430 million, reaching one third of the total population (Du, Zhai & Chen, 2005). Considering such a rapid aging process and the existing large number of older adults in China, it becomes imperative to investigate how psychosocial factors affect this group’s subjective well-being. This study proposed that, among older adults, higher support received from each of the three relational sources (adult children, family and friends) were associated with reduced loneliness and improved well-being. Structural equation modeling was conducted using a sample of rural adults aged 60 and older (N= 1142) from the 2018 wave of data from the Longitudinal Study of Older Adults in Anhui Province, China. Findings indicated that support from adult children directly and indirectly decreased older adults’ depression and improved their life satisfaction through loneliness; while support from family members directly decreased depression but did not directly improve life satisfaction or indirectly improve well-being through loneliness. Although support from friends did not have a significant impact on older adults’ well-being, it indirectly improved well-being through reduced loneliness. Findings have implications for programs or interventions targeting both parent -adult-child support and friends support and reducing rural older adults’ loneliness.

scholarly journals Smartphone-Based Prediction Model for Postoperative Cardiac Surgery Outcomes Using Preoperative Gait and Posture Measures

Sensors ◽  
2021 ◽  
Vol 21 (5) ◽  
pp. 1704
Author(s):  
Rahul Soangra ◽  
Thurmon Lockhart
Keyword(s):  
Cardiovascular Disease ◽  
Older Adults ◽  
Cardiac Surgery ◽  
Regression Model ◽  
Mobile Phone ◽  
Gait Speed ◽  
Adverse Outcomes ◽  
Postoperative Outcomes ◽  
Mortality And Morbidity ◽  
Prediction Of Mortality

Gait speed assessment increases the predictive value of mortality and morbidity following older adults’ cardiac surgery. The purpose of this study was to improve clinical assessment and prediction of mortality and morbidity among older patients undergoing cardiac surgery through the identification of the relationships between preoperative gait and postural stability characteristics utilizing a noninvasive-wearable mobile phone device and postoperative cardiac surgical outcomes. This research was a prospective study of ambulatory patients aged over 70 years undergoing non-emergent cardiac surgery. Sixteen older adults with cardiovascular disease (Age 76.1 ± 3.6 years) scheduled for cardiac surgery within the next 24 h were recruited for this study. As per the Society of Thoracic Surgeons (STS) recommendation guidelines, eight of the cardiovascular disease (CVD) patients were classified as frail (prone to adverse outcomes with gait speed ≤ 0.833 m/s) and the remaining eight patients as non-frail (gait speed > 0.833 m/s). Treating physicians and patients were blinded to gait and posture assessment results not to influence the decision to proceed with surgery or postoperative management. Follow-ups regarding patient outcomes were continued until patients were discharged or transferred from the hospital, at which time data regarding outcomes were extracted from the records. In the preoperative setting, patients performed the 5-m walk and stand still for 30 s in the clinic while wearing a mobile phone with a customized app “Lockhart Monitor” available at iOS App Store. Systematic evaluations of different gait and posture measures identified a subset of smartphone measures most sensitive to differences in two groups (frail versus non-frail) with adverse postoperative outcomes (morbidity/mortality). A regression model based on these smartphone measures tested positive on five CVD patients. Thus, clinical settings can readily utilize mobile technology, and the proposed regression model can predict adverse postoperative outcomes such as morbidity or mortality events.

scholarly journals Use of potentially inappropriate medications among ambulatory home-dwelling elderly patients with dementia: A review of the literature

2017 ◽  
Vol 150 (3) ◽  
pp. 169-183 ◽  
Author(s):  
Tejal Patel ◽  
Karen Slonim ◽  
Linda Lee
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Adverse Events ◽  
Inappropriate Medication ◽  
Medication Use ◽  
Adverse Outcomes ◽  
Potentially Inappropriate Medication ◽  
Potentially Inappropriate Medications ◽  
Inappropriate Medication Use ◽  
Inappropriate Medications

Background: Older adults with dementia are at high risk for drug-related adverse outcomes. While much is known about potentially inappropriate medication use in older adults, its prevalence and characteristics among those with dementia are not as well elucidated. We conducted a literature review to examine the prevalence of potentially inappropriate medication use among home-dwelling older adults with dementia. Our secondary aim was to determine the most frequently implicated medications and factors associated with potentially inappropriate medication use. Methods: MEDLINE, EMBASE, CINAHL, and International Pharmaceutical Abstracts were searched between 1946 and 2014 for articles that referenced potentially inappropriate medication use and types of dementia. One reviewer screened all titles and abstracts from the initial search and full-text articles after the initial screen for eligibility, then 2 reviewers independently abstracted data from included studies. Results: Searches yielded 81 articles, of which 7 met inclusion criteria. Prevalence of potentially inappropriate medication use varied from 15% to 46.8%. No single drug or drug class was reported consistently across all studies as the most frequent potentially inappropriate medication, but anticholinergics and benzodiazepines, drugs that affect cognition, were among the most common medications or pharmacological classes listed. Discussion: Older adults with dementia may be particularly vulnerable to potentially inappropriate medications because of cognitive impairment from their condition and the greater likelihood of experiencing adverse events from medications. Given this population’s greater susceptibility to adverse events, more intense medication and patient monitoring may be warranted, especially among those taking anticholinergics and benzodiazepines, as these drugs can contribute to cognitive impairment.

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