Nephrology Provider Surprise Question Response and Hospitalizations in Older Adults with Advanced CKD

Background: Older adults with advanced non-dialysis-dependent chronic kidney disease (NDD-CKD) face a high risk of hospitalization and related adverse events. Methods: This prospective cohort study followed nephrology clinic patients ≥60 years old with NDD-CKD stages 4-5. After an eligible patient’s office visit, study staff asked the patient’s provider to rate the patient’s risk of death within the next year using the surprise question (“Would you be surprised if this patient died in the next 12 months?”) with a 5-point Likert scale response (1, “definitely not surprised” to 5, “very surprised”). We used a statewide database to ascertain hospitalization during follow-up. Results: There were 488 patients (median age 72 years, 51% female, 17% black) with median estimated glomerular filtration rate 22 mL/min/1.73 m2. Over a median follow-up of 2.1 years, the rates of hospitalization per 100 person-years in the respective response groups were 41 (95% confidence interval [CI]: 34–50), “very surprised”; 65 (95% CI: 55–76), “surprised”; 98 (95% CI: 85–113), “neutral”; 125 (95% CI: 107–144), “not surprised”; and 120 (95% CI: 94–151), “definitely not surprised.” In a fully adjusted cumulative probability ordinal regression model for proportion of follow-up time spent hospitalized, patients whose providers indicated that they would be “definitely not surprised” if they died spent a greater proportion of follow-up time hospitalized compared with those whose providers indicated that they would be “very surprised” (odds ratio 2.4, 95% CI: 1.0–5.7). There was a similar association for time to first hospitalization. Conclusion: Nephrology providers’ responses to the surprise question for older patients with advanced NDD-CKD were independently associated with proportion of future time spent hospitalized and time to first hospitalization. Additional studies should examine how to use this information to provide patients with anticipatory guidance on their possible clinical trajectory and to target potentially preventable hospitalizations.

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Contemporarily Treated Patients With Hodgkin Lymphoma Have Childbearing Potential in Line With Matched Comparators

Journal of Clinical Oncology ◽

10.1200/jco.2018.78.3514 ◽

2018 ◽

Vol 36 (26) ◽

pp. 2718-2725 ◽

Cited By ~ 6

Author(s):

Caroline E. Weibull ◽

Anna L.V. Johansson ◽

Sandra Eloranta ◽

Karin E. Smedby ◽

Magnus Björkholm ◽

...

Keyword(s):

General Population ◽

Hodgkin Lymphoma ◽

Cox Regression ◽

Young Patients ◽

Cumulative Probability ◽

Childbearing Potential ◽

Female Survivors ◽

Risk Of Death ◽

Over Time

Purpose With excellent cure rates for young patients with Hodgkin lymphoma (HL), there is an increasing number of female survivors of HL interested in becoming pregnant. Here, we report childbearing among contemporarily treated HL survivors in comparison with the general population. Material and Methods Using Swedish registers, 449 women (ages 18 to 40 years) diagnosed with HL between 1992 and 2009 and in remission 9 months after diagnosis were identified. Patients were age- and calendar-year–matched to 2,210 population comparators. Rates of first postdiagnosis childbirth were calculated. Hazard ratios (HRs) with 95% CIs were estimated for different follow-up periods using Cox regression. Cumulative probabilities of first childbirth were calculated in the presence of the competing risk of death or relapse. Results Twenty-two percent of relapse-free patients with HL had a child during follow-up, and first childbirth rates increased over time, from 40.2 per 1,000 person-years (1992 to 1997) to 69.7 per 1,000 person-years (2004 to 2009). For comparators, childbirth rates remained stable (70.1 per 1,000 person-years). Patients diagnosed between 2004 and 2009 had a cumulative probability of childbirth similar to comparators. Three years or more after diagnosis, no differences in childbirth rates were observed between patients and comparators, regardless of stage or treatment. Patients who received six to eight courses of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone had a lower childbirth rate than comparators during the first 3 years (HR, 0.23; 95% CI, 0.06 to 0.94), as did patients who received six to eight courses of chemotherapy and radiotherapy (HR, 0.21; 95% CI, 0.07 to 0.65). Conclusion Childbearing potential among female survivors of HL has improved over time, and childbirth rates 3 years after diagnosis in contemporarily treated patients are, in the absence of relapse, similar to those in the general population, regardless of stage and treatment.

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Perceived Physical Fatigability Predicts All-Cause Mortality in Older Adults

The Journals of Gerontology Series A ◽

10.1093/gerona/glab374 ◽

2021 ◽

Author(s):

Nancy W Glynn ◽

Theresa Gmelin ◽

Sharon W Renner ◽

Yujia Susanna QiaoScM ◽

Robert M Boudreau ◽

...

Keyword(s):

Older Adults ◽

Prognostic Indicator ◽

Underlying Disease ◽

Registration System ◽

Civil Registration ◽

Risk Of Death ◽

Validated Questionnaire ◽

Patient Reported ◽

Cox Proportional Hazard Models

Abstract Background Perceived physical fatigability is highly prevalent in older adults and associated with mobility decline and other health consequences. We examined the prognostic value of perceived physical fatigability as an independent predictor of risk of death among older adults. Methods Participants (N = 2,906), mean age 73.5 [SD, 10.4] years, 54.2% women, 99.7% white enrolled in the Long Life Family Study were assessed at Visit 2 (2014-2017) with 2.7 [SD, 1.0] years follow-up. The Pittsburgh Fatigability Scale (PFS), a 10-item, self-administered validated questionnaire (score range 0-50, higher=greater fatigability) measured perceived physical fatigability at Visit 2. Deaths post-Visit 2 through December 31, 2019 were identified by: family members notifying field centers, reporting during another family member’s annual phone follow-up, an obituary, or Civil Registration System (Denmark). We censored all other participants at their last contact. Cox proportional hazard models predicted mortality by fatigability severity, adjusted for family relatedness and other covariates. Results Age-adjusted PFS Physical scores were higher for those who died (19.1 [SE, 0.8]) compared to alive (12.2, [SE, 0.4]) overall, as well as across age strata (P<.001), except for those 60-69 years (P=.79). Participants with the most severe fatigability (PFS Physical scores ≥25) were over twice as likely to die (HR, 2.33 [95% CI, 1.65 to 3.28]) compared to those with less severe fatigability (PFS Physical scores <25) after adjustment. Conclusions This work underscores the utility of the PFS as a novel patient-reported prognostic indicator of phenotypic aging that captures both overt and underlying disease burden that predicts death.

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Social relationships and survival in the older adult cohort

Revista Latino-Americana de Enfermagem ◽

10.1590/1518-8345.3844.3395 ◽

2021 ◽

Vol 29 ◽

Author(s):

Mariangela Uhlmann Soares ◽

Luiz Augusto Facchini ◽

Fúlvio Borges Nedel ◽

Louriele Soares Wachs ◽

Marciane Kessler ◽

...

Keyword(s):

Older Adults ◽

Social Relationships ◽

Social Relations ◽

Cox Regression ◽

Multiple Correspondence Analysis ◽

Individual Interviews ◽

Mediating Role ◽

Risk Of Death ◽

Kaplan Meier

Objective: to verify the influence of social relations on the survival of older adults living in southern Brazil. Method: a cohort study (2008 and 2016/17), conducted with 1,593 individuals aged 60 years old or over, in individual interviews. The outcomes of social relations and survival were verified by Multiple Correspondence Analysis, which guided the proposal of an explanatory matrix for social relations, the analysis of survival by Kaplan-Meier, and the multivariate analysis by Cox regression to verify the association between the independent variables. Results: follow-up was carried out with 82.5% (n=1,314), with 46.1% being followed up in 2016/17 (n=735) and 579 deaths (36.4%). The older adults who went out of their homes daily had a 39% reduction in mortality, and going to parties kept the protective effect of 17% for survival. The lower risk of death for women is modified when the older adults live in households with two or more people, in this case women have an 89% higher risk of death than men. Conclusion: strengthened social relationships play a mediating role in survival. The findings made it possible to verify the importance of going out of the house as a marker of protection for survival.

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Seven Year Prognosis in Depression

The British Journal of Psychiatry ◽

10.1192/bjp.169.4.423 ◽

1996 ◽

Vol 169 (4) ◽

pp. 423-429 ◽

Cited By ~ 43

Author(s):

Denis A. O'Leary ◽

Alan S. Lee

Keyword(s):

Regression Analysis ◽

Multiple Regression Analysis ◽

Present State ◽

Previous History ◽

Psychomotor Retardation ◽

Cumulative Probability ◽

Case Register ◽

Risk Of Death ◽

State Examination

BackgroundThe longer term prognosis of depressed patients treated with ECT is relatively unknown. We describe seven-year mortality and readmission risks for the Nottingham ECT series.MethodCases were defined and subtyped using the Present State Examination (PSE). Follow-up was naturalistic. Death and readmission were ascertained using the Nottingham case register.ResultsThe risk of death was doubled (SMR=1.99, 95% CI = 1.34–2.84, P < 0.001). The seven-year cumulative probability of remaining without readmission was 0.27 (95% CI 0.19–0.35), being 0.79 (0.71–0.87) at 16 weeks (relapse) and 0.34 (0.24–0.44) thereafter (recurrence readmissions). Multiple regression analysis showed that delusions predicted relapse, while endogenous subtype, absence of psychomotor retardation, and previous history predicted recurrence readmissions.ConclusionIndex ECT treatment predicted high longer-term mortality and readmission risks. PSE/CATEGO-based subtyping identified patients most vulnerable to relapse and recurrence.

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Haemoglobin concentration and the risk of death in older adults: differences by race/ethnicity in the NHANES III follow-up

British Journal of Haematology ◽

10.1111/j.1365-2141.2009.07659.x ◽

2009 ◽

Vol 145 (4) ◽

pp. 514-523 ◽

Cited By ~ 42

Author(s):

Kushang V. Patel ◽

Dan L. Longo ◽

William B. Ershler ◽

Binbing Yu ◽

Richard D. Semba ◽

...

Keyword(s):

Older Adults ◽

Haemoglobin Concentration ◽

Nhanes Iii ◽

Risk Of Death ◽

Race Ethnicity

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Early effectiveness of COVID-19 vaccination with BNT162b2 mRNA vaccine and ChAdOx1 adenovirus vector vaccine on symptomatic disease, hospitalisations and mortality in older adults in England

10.1101/2021.03.01.21252652 ◽

2021 ◽

Cited By ~ 26

Author(s):

Jamie Lopez Bernal ◽

Nick Andrews ◽

Charlotte Gower ◽

Julia Stowe ◽

Chris Robertson ◽

...

Keyword(s):

Older Adults ◽

Single Dose ◽

Lower Risk ◽

Vaccine Effectiveness ◽

Symptomatic Disease ◽

Risk Of Death ◽

Negative Case ◽

The Uk ◽

Underlying Risk

AbstractObjectivesTo estimate the real-world effectiveness of the Pfizer/BioNTech BNT162b2 vaccine and Astrazeneca ChAdOx1 vaccine against Confirmed COVID-19, hospitalisations and deaths. To estimate effectiveness on the UK variant of concern.DesignTest negative case control designSettingCommunity COVID-19 PCR testing in EnglandParticipantsAll adults in England aged 70 years and older (over 7.5 million). All COVID-19 testing in the community among eligible individuals who reported symptoms between 8thDecember 2020 and 19thFebruary 2021 was included in the analysis.InterventionsOne and two doses of BNT162b2 vaccine. One dose of ChAdOx1 vaccine.Main outcome measuresSymptomatic PCR confirmed SARS-CoV-2 infection, hospitalisations and deaths with COVID-19.ResultsIndividuals aged >=80 years vaccinated with BNT162b2 prior to 4thJanuary, had a higher odds of testing positive in the first 9 days after vaccination (odds ratio up to 1.48, 95%CI 1.23-1.77), indicating that those initially targeted had a higher underlying risk of infection. Vaccine effectiveness was therefore estimated relative to the baseline post-vaccination period. Vaccine effects were noted from 10-13 days after vaccination, reaching an effectiveness of 70% (95% CI 59-78%) from 28-34 days, then plateauing. From 14 days after the second dose a vaccine effectiveness of 89% (95%CI: 85-93%) was seen.Individuals aged >=70 years vaccinated from 4thJanuary had a similar underlying risk of COVID-19 to unvaccinated individuals. With BNT162b2, vaccine effectiveness reached 61% (95%CI 51-69%) from 28-34 days after vaccination then plateaued. With the ChAdOx1 vaccine, vaccine effects were seen from 14-20 days after vaccination reaching an effectiveness of 60% (95%CI 41-73%) from 28-34 days and further increasing to 73% (95%CI 27-90%) from day 35 onwards.On top of the protection against symptomatic disease, cases who had been vaccinated with one dose of BNT162b2 had an additional 43% (95%CI 33-52%) lower risk of emergency hospitalisation and an additional 51% (95%CI 37-62%) lower risk of death. Cases who had been vaccinated with one dose of ChAdOx1 had an additional 37% (95% CI 3-59%) lower risk of emergency hospitalisation. There was insufficient follow-up to assess the effect of ChAdOx1 on mortality due to the later rollout of this vaccine. Combined with the effect against symptomatic disease, this indicates that a single dose of either vaccine is approximately 80% effective at preventing hospitalisation and a single dose of BNT162b2 is 85% effective at preventing death with COVID-19.ConclusionVaccination with either a single dose of BNT162b2 or ChAdOx1 COVID-19 vaccination was associated with a significant reduction in symptomatic SARS-CoV2 positive cases in older adults with even greater protection against severe disease. Both vaccines show similar effects. Protection was maintained for the duration of follow-up (>6 weeks). A second dose of BNT162b2 provides further protection against symptomatic disease but second doses of ChAdOx1 have not yet been rolled out in England. There is a clear effect of the vaccines against the UK variant of concern.

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Treatment Patterns and Outcomes in a Nationwide Cohort of Older and Younger Veterans with Waldenström Macroglobulinemia, 2006–2019

Cancers ◽

10.3390/cancers13071708 ◽

2021 ◽

Vol 13 (7) ◽

pp. 1708

Author(s):

Hsu-Chih Chien ◽

Deborah Morreall ◽

Vikas Patil ◽

Kelli M. Rasmussen ◽

Christina Yong ◽

...

Keyword(s):

Older Adults ◽

Progression Free Survival ◽

Treatment Patterns ◽

Veterans Health ◽

Health Administration ◽

Waldenström Macroglobulinemia ◽

Risk Of Death ◽

Waldenstrom Macroglobulinemia ◽

Modern Era

Little is known about real-world treatment patterns and outcomes in Waldenström macroglobulinemia (WM) following the recent introduction of newer treatments, especially among older adults. We describe patterns of first-line (1 L) WM treatment in early (2006–2012) and modern (2013–2019) eras and report outcomes (overall response rate (ORR), overall survival (OS), progression-free survival (PFS), and adverse event (AE)-related discontinuation) in younger (≤70 years) and older (>70 years) populations. We followed 166 younger and 152 older WM patients who received 1 L treatment between January 2006 and April 2019 in the Veterans Health Administration. Median follow-up was 43.5 months (range: 0.6–147.2 months). Compared to the early era, older patients in the modern era achieved improved ORRs (early: 63.8%, modern: 72.3%) and 41% lower risk of death/progression (hazard ratio (HR) for PFS: 0.59, 95% CI (confidence interval): 0.36–0.95), with little change in AE-related discontinuation between eras (HR: 0.82, 95% CI: 0.4–1.7). In younger patients, the AE-related discontinuation risk increased almost fourfold (HR: 3.9, 95% CI: 1.1–14), whereas treatment effects did not change between eras (HR for OS: 1.4, 95% CI: 0.66–2.8; HR for PFS: 1.1, 95% CI: 0.67–1.7). Marked improvements in survival among older adults accompanied a profound shift in 1 L treatment patterns for WM.

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Abstract P007: Arterial Stiffness is Associated With Increased Risk of Incident Dementia in the Older Elderly: The Cardiovascular Health Study Cognition Study

Circulation ◽

10.1161/circ.137.suppl_1.p007 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Chendi Cui ◽

Akira Sekikawa ◽

Lewis Kuller ◽

Oscar Lopez ◽

Anne Newman ◽

...

Keyword(s):

Older Adults ◽

Arterial Stiffness ◽

Cardiovascular Health ◽

Health Study ◽

Cardiovascular Health Study ◽

Risk Of Death ◽

Incident Dementia ◽

Increased Risk ◽

Age And Sex

Introduction: Arterial stiffness is related to aging, hypertension, and obesity, and higher carotid-femoral pulse wave velocity (PWV) is associated with brain amyloid deposition. We hypothesized that higher cfPWV was associated with incident dementia in older adults (mean age 78) of the Cardiovascular Health Study Cognition Study (CHS-CS). Methods: Pittsburgh CHS-CS participants (n=532) without dementia at baseline (1998-99) had annual cognitive exams through 2013. CfPWV (m/sec) was measured from pulse velocity waveforms on 356 participants between 1996-2000, who were slightly younger, more educated, with less mild cognitive impairment (MCI) than those not included. Associations of cfPWV [continuous (transformed: -1/cfPWV) and quartile] with time-to-event [cfPWV measurement to dementia or death (competing event), or end of follow-up] were assessed in Cox proportional hazards model with competing risk of death. Results: Over 15-year follow-up, 212 (59.6%) dementia cases (median onset time=4 years) and 87 (24.4%) deaths occurred prior to dementia diagnosis. Adjusted for age and sex, incident dementia was related to higher cfPWV [hazard ratio (HR)=1.52 per -1/cfPWV, 95%CI=1.04, 2.24] (Table). Results were similar when further adjusted for education, race, ApoE4 , hypertension, diabetes, MCI, and abnormal white matter (WMG) or ventricular grade (VG). Results persisted in separate models that excluded those with ApoE4 + (n=79), diabetes (n=40), MCI (n=65) or abnormal WMG or VG (n=136). In stratified models, results were stronger for age ≥80 vs. <80 and for hypertension vs. no hypertension. Pulse pressure (PP), another index of arterial stiffness, was not associated with incident dementia (age- and sex-adjusted HR=1.01 per mmHg PP, 95%CI=0.99, 1.01). Conclusions: Higher cfPWV, but not higher PP, was significantly associated with incident dementia in the older adults. Interventions to slow arterial stiffness with aging may reduce the risk of dementia among older individuals.

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Neuropsychological Effects of Cybercycling for Older Adults: One-Year Follow-Up

PsycEXTRA Dataset ◽

10.1037/e640972010-001 ◽

2010 ◽

Author(s):

Cay Anderson-Hanley ◽

Paul Arciero ◽

Joseph Nimon ◽

Vadim Yerkohin ◽

Veronica Hopkins ◽

...

Keyword(s):

Older Adults ◽

Neuropsychological Effects ◽

One Year

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The Carpentier-Edwards Classic and Physio Mitral Annuloplasty Rings: A Randomized Trial

The Heart Surgery Forum ◽

10.1532/hsf.419 ◽

2006 ◽

Vol 8 (5) ◽

pp. 389 ◽

Cited By ~ 9

Author(s):

Ghada M. M. Shahin ◽

Geert J. M. G. van der Heijden ◽

Michiel L. Bots ◽

Maarten-Jan Cramer ◽

Wybren Jaarsma ◽

...

Keyword(s):

Left Ventricular Function ◽

Ventricular Function ◽

Absolute Risk ◽

Statistical Significance ◽

Nyha Class ◽

Left Ventricular ◽

Mitral Annuloplasty ◽

Risk Of Death ◽

Late Failure

Objective: To evaluate clinical and echocardiographic outcomes for the semi-flexible Carpentier-Edwards Physio and the rigid Classic mitral annuloplasty ring. Methods: Ninety-six patients were randomized for either a Classic (n = 53) or a Physio (n = 43) ring from October 1995 through July 1997. Mean follow-up was 5.1 years (range .1-6.6). We included standard patient characteristics at baseline and during follow-up. Analyses were adjusted for age and gender, and for factors that differed across groups at baseline. In 2002, echocardiography was performed in 74% of the survivors. Results: We found a 16% difference in mortality: 14% in the Physio group (n = 6) and 30% in the Classic group (n = 16) (adjusted P = .41). Life table analysis shows that the absolute risk of death after 30 months is lower in the Physio group. Intra-operative repair failure occurred in 3 patients (6%) of the Classic group, and in 4 (9%) of the Physio group, resulting in mitral valve replacement. Late failure occurred in 1 patient (2%) in the Classic group, and in 4 (9%) in the Physio group. At follow-up, left ventricular function did not differ across groups (ejection fraction 45% and 48% (adjusted P = .65)). The combined NYHA class III-IV had improved for the Classic group in 42% and for the Physio group in 34%. Conclusion: Although the 16% difference in mortality did not reach statistical significance, it is considered clinically important. No differences in morbidity, valve function, and left ventricular function were found. Further research to explain the difference in mortality is required.

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