Abstract 88: Increasing False Positive Diagnoses May Lead to Overestimation of Stroke Incidence, Particularly in the Young

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Abhinav J Appukutty ◽  
Lesli E Skolarus ◽  
Mellanie V Springer ◽  
William J Meurer ◽  
James F Burke
Keyword(s):  
Older Adults ◽  
False Positive ◽  
Age Groups ◽  
Vascular Risk Factor ◽  
The United States ◽  
Cross Sectional ◽  
Stroke Incidence ◽  
Ed Visits ◽  
Over Time

Introduction: Stroke incidence is reportedly increasing in younger adults. While increasing vascular risk factor prevalence has been suggested as a cause, the reasons for rising stroke incidence in the young are not clear. We explored several alternate explanations: trends in neurologically-focused emergency department (ED) visits, differential diagnostic classification of stroke and TIA over time, and changes in the use of advanced imaging in young and older adults. Methods: We performed a retrospective, serial, cross-sectional study on a nationally representative sample of all ED visits in the United States to quantify changes in patterns of neurologically-focused ED visits, stroke and TIA diagnoses, and rates of MRI utilization for young (18 – 44 years) and older (65+ years) adults over a 17-year period (1995 – 2000; 2005 – 2015) using National Hospital Ambulatory Medical Care Survey (NHAMCS) data. Results: In young adults, 0.4% (95% CI 0.3% – 0.5%) of neurologically-focused ED visits resulted in a primary diagnosis of stroke vs. 6.8% (95% CI 6.2% – 7.5%) for older adults. In both populations, the incidence of neurologically-focused ED visits has increased over time (+111/100,000 population/year, 95% CI +94 – +130 in the young vs. +70/100,000 population/year, 95% CI +34 – +108 in older adults). There was no evidence of differential classification of TIA to stroke over time (OR 1.001 per year, 95% CI 0.926 – 1.083 in the young; OR 1.003 per year, 95% CI 0.982 – 1.026 in older adults) and no evidence of disproportionate rise in MRI utilization for neurologically-focused ED visits in the young (OR 1.057 per year, 95% CI 1.028 – 1.086 in the young; OR 1.095 per year, 95% CI 1.066 – 1.125 in older adults). Conclusions: If the specificity of stroke diagnosis amongst ED visits is similar amongst young and older populations, then the combination of data observed here, including (1) a lower prior probability of stroke diagnoses in the young and (2) an increasing trend in neurologically-focused ED visits in both age groups, suggests that false positive diagnoses will increase over time, with a faster rise in the young compared to older adults. These data suggest a potential explanation that may contribute to higher stroke incidence in the young and merits further scrutiny.

scholarly journals Increasing false positive diagnoses may lead to overestimation of stroke incidence, particularly in the young: a cross-sectional study

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Abhinav J. Appukutty ◽  
Lesli E. Skolarus ◽  
Mellanie V. Springer ◽  
William J. Meurer ◽  
James F. Burke
Keyword(s):  
Older Adults ◽  
False Positive ◽  
Age Groups ◽  
Cross Sectional Study ◽  
Primary Diagnosis ◽  
Sectional Study ◽  
Cross Sectional ◽  
Stroke Incidence ◽  
Ed Visits ◽  
Over Time

Abstract Background Stroke incidence is reportedly increasing in younger populations, although the reasons for this are not clear. We explored possible reasons by quantifying trends in neurologically focused emergency department (ED) visits, classification of stroke vs. TIA, and imaging use. Methods We performed a retrospective, serial, cross-sectional study using the National Hospital Ambulatory Medical Care Survey to examine time trends in age-stratified primary reasons for visit, stroke/TIA diagnoses, and MRI utilization from 1995 to 2000 and 2005–2015. Results Five million eight hundred thousand ED visits with a primary diagnosis of stroke (CI 5.3 M–6.4 M) were represented in the data. The incidence of neurologically focused reason for visits (Neuro RFVs) increased over time in both the young and in older adults (young: + 111 Neuro RFVs/100,000 population/year, CI + 94 − + 130; older adults: + 70 Neuro RFVs/100,000 population/year, CI + 34 − + 108). The proportion of combined stroke and TIA diagnoses decreased over time amongst older adults with a Neuro RFV (OR 0.95 per year, p < 0.01, CI 0.94–0.96) but did not change in the young (OR 1.00 per year, p = 0.88, CI 0.95–1.04). Within the stroke/TIA population, no changes in the proportion of stroke or TIA were identified. MRI utilization rates amongst patients with a Neuro RFV increased for both age groups. Conclusions We found, but did not anticipate, increased incidence of neurologically focused ED visits in both age groups. Given the lower pre-test probability of a stroke in younger adults, this suggests that false positive stroke diagnoses may be increasing and may be increasing more rapidly in the young than in older adults.

Abstract 72: Temporal Trends in Stroke Incidence Over Time by Sex and Age in the Greater Cincinnati Northern Kentucky Stroke Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Tracy E Madsen ◽  
Jane C Khoury ◽  
Michelle Leppert ◽  
Kathleen Alwell ◽  
Charles J Moomaw ◽  
...  
Keyword(s):  
Older Adults ◽  
Temporal Trends ◽  
Age Groups ◽  
Incidence Rates ◽  
Age Group ◽  
Bonferroni Correction ◽  
Stroke Incidence ◽  
Stroke Study ◽  
Trends Over Time ◽  
Over Time

Introduction: Data from the Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS) through 2010 showed that over time, stroke incidence rates decreased to a greater extent in men than in women. We aimed to determine whether this difference continued through 2015 and whether the differences are driven by particular age groups. Methods: Within the GCNKSS population of 1.3 million, all incident strokes among residents ≥20 years old were ascertained at all local hospitals during 7/93–6/94 and calendar years 1999, 2005, 2010, and 2015. Out-of-hospital cases were sampled. Sex-specific incidence rates per 100,000 were adjusted for age and race, standardized to the 2010 U.S. Census. Trends over time by sex were compared (overall and age-stratified); a Bonferroni correction was applied for multiple comparisons. Results: In total over the five study periods, there were 9721 incident strokes (ischemic, ICH, and SAH); 56.4% were women. Incidence of ischemic strokes decreased from 254 (95%CI 236,272) in 1993/4 to 177 (95%CI 164,189) in 2015 among men (p<.0001 for trend over time) and from 204 (95%CI 192,217) in 1993/4 to 151 (95%CI 141,161) in 2015 among women (p<.0001). Incidence of ICH/ SAH did not change significantly over time in either sex. In age-stratified analyses, among women, incidence of all strokes decreased among older adults (65–84 years) but not in other age categories (Figure). Among men, incidence over time decreased among older adults (65–84 and ≥ 85 years) but increased in young adults (20–44 years). Conclusions: Stroke incidence decreased between the early 1990s and 2015 for both sexes, contrary to previous data on trends through 2010 which demonstrated a significant decrease in men but not women. Temporal changes are being driven by the 65–84 year age group in both men and women, as well as the ≥ 85 age group in men. Future prevention strategies should target young and middle age adults for both sexes as well as those over 85 for women.

scholarly journals Factors Associated with Preventable Emergency Department Visits for Nontraumatic Dental Conditions in the U.S.

2019 ◽  
Vol 16 (19) ◽  
pp. 3671 ◽  
Author(s):  
Pearl C. Kim ◽  
Wenlian Zhou ◽  
Shawn J. McCoy ◽  
Ian K. McDonough ◽  
Betty Burston ◽  
...  
Keyword(s):  
Emergency Department ◽  
Dental Care ◽  
Age Groups ◽  
The United States ◽  
Sociodemographic Factors ◽  
Emergency Department Visits ◽  
Dental Services ◽  
Cross Sectional ◽  
Ed Visits ◽  
Dental Conditions

This study was designed to examine national trends and evaluate social determinants of health that were associated with the provision of dental services in emergency rooms in the United States between 2007 and 2014. A pooled cross-sectional database of emergency department (ED) visits combined the 2007–2014 waves of the Nationwide Emergency Department Sample. A total of 3,761,958 ED visits with dental conditions were extracted and the principal diagnosis was identified. A series of modified Poisson regression models were used to assess the relationship between patient sociodemographic factors and hospital characteristics, and the likelihood of visiting the ED for a nontraumatic dental reason. Unadjusted descriptive results indicated that there was no apparent increase in the percentage of patients who visited an ED with nontraumatic dental conditions (NTDCs) between 2007 and 2014. The greatest users of EDs for NTDCs were among those who were uninsured and Medicaid beneficiaries relative to persons privately insured. ED visitors were more likely to reside in lower socioeconomic areas (when compared with visitors in the top quartile of the income distribution). Patients in all other age groups were more likely to seek care in an ED for NTDCs relative to those 65 years of age or older. Multiple strategies are required to reduce the use of EDs for routine dental care. This approach will require an interprofessional dialogue and solutions that reduce barriers to receiving dental care.

Biopsychosocial Patterning of Multimorbidity and Its Consequences

2018 ◽  
pp. 220-236
Author(s):  
Elliot Friedman ◽  
Beth LeBreton ◽  
Lindsay Fuzzell ◽  
Elizabeth Wehrpsann
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Functional Outcomes ◽  
The United States ◽  
Chronic Medical Conditions ◽  
Quality Of Life Research ◽  
Increased Risk ◽  
Over Time

By many estimates the majority of adults over age 65 have two or more chronic medical conditions (multimorbidity) and are consequently at increased risk of adverse functional outcomes. Nonetheless, many older adults with multimorbidity are able to maintain high levels of function and retain good quality of life. Research presented here is designed to understand the influences that help ensure better functional outcomes in these older adults. This chapter presents findings that draw on data from the Midlife in the United States study. The independent and interactive contributions of diverse factors to multimorbidity and changes in multimorbidity over time are reviewed. The degree that multimorbidity increases risk of cognitive impairment and disability is examined. The role of inflammation as a mediator is considered. Multimorbidity is increasingly the norm for older adults, so better understanding of factors contributing to variability in multimorbidity-related outcomes can lead to improved quality of life.

scholarly journals Reference values and factors associated with hand grip strength among older adults living in southeastern Poland

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Agnieszka Wiśniowska-Szurlej ◽  
Agnieszka Ćwirlej-Sozańska ◽  
Justyna Kilian ◽  
Natalia Wołoszyn ◽  
Bernard Sozański ◽  
...  
Keyword(s):  
Older Adults ◽  
Older People ◽  
Reference Values ◽  
Handgrip Strength ◽  
Age Groups ◽  
Cross Sectional Study ◽  
Normative Values ◽  
Dominant Hand ◽  
Cross Sectional ◽  
Factors Associated

AbstractHandgrip strength (HGS) is used as a biomarker for the state of health of older people, but the number of research publications containing the normative values of HGS in older adult populations is limited. The aim of the study was to define reference values and factors associated with HGS in older adults living in southeastern Poland. A cross-sectional study including 405 participants aged 65 and older was conducted. Handgrip strength for the dominant hand was assessed by the average of three trials using a JAMAR dynamometer. The sample was categorized into the following age groups: 65–69 years, 70–74 years, 75–79 years, 80–84 years, 85 and over. The average HGS was 19.98 kg (16.91 kg for women and 26.19 kg for men). There was a decrease in handgrip strength across the age range in both sexes. The average handgrip strength of the older people was 17.97 kg (14.47 kg for women and 25.66 kg for men) for those aged 80–85 and 16.68 kg (13.51 kg for women and 21.77 kg for men) in the group over 85 years old. In both sexes, marital status was an independent factor associated with reduced handgrip strength. In conclusion, this study described, for the first time, handgrip strength values for the southeastern Polish population aged ≥ 65 years according to age and gender.

scholarly journals Analyzing Predictors of Control Measures and Psychosocial Problems Associated with COVID-19 Pandemic: Evidence from Eight Countries

2021 ◽  
Vol 11 (8) ◽  
pp. 106
Author(s):  
Sheikh Saifur Rahman Jony ◽  
Ubydul Haque ◽  
Nathaniel J. Webb ◽  
Emily Spence ◽  
Md. Siddikur Rahman ◽  
...  
Keyword(s):  
Psychological Health ◽  
Age Groups ◽  
Psychosocial Problems ◽  
Relevant Information ◽  
The United States ◽  
Control Measures ◽  
Cross Sectional Survey ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Primary Determinant

COVID-19 has harshly impacted communities globally. This study provides relevant information for creating equitable policy interventions to combat the spread of COVID-19. This study aims to predict the knowledge, attitude, and practice (KAP) of the COVID-19 pandemic at a global level to determine control measures and psychosocial problems. A cross-sectional survey was conducted from July to October 2020 using an online questionnaire. Questionnaires were initially distributed to academicians worldwide. These participants distributed the survey among their social, professional, and personal groups. Responses were collected and analyzed from 67 countries, with a sample size of 3031. Finally, based on the number of respondents, eight countries, including Bangladesh, China, Japan, Malaysia, Mexico, Pakistan, the United States, and Zambia were rigorously analyzed. Specifically, questionnaire responses related to COVID-19 accessibility, behavior, knowledge, opinion, psychological health, and susceptibility were collected and analyzed. As per our analysis, age groups were found to be a primary determinant of behavior, knowledge, opinion, psychological health, and susceptibility scores. Gender was the second most influential determinant for all metrics except information about COVID-19 accessibility, for which education was the second most important determinant. Respondent profession was the third most important metric for all scores. Our findings suggest that greater encouragement from government health authorities and the promotion of health education and policies are essential in the dissemination of COVID-19-awareness and increased control of the spread of COVID-19.

scholarly journals Loneliness and Its Association With Social Media Use During the COVID-19 Outbreak

2021 ◽  
Vol 7 (3) ◽  
pp. 205630512110338
Author(s):  
Tore Bonsaksen ◽  
Mary Ruffolo ◽  
Janni Leung ◽  
Daicia Price ◽  
Hilde Thygesen ◽  
...  
Keyword(s):  
Social Media ◽  
Online Survey ◽  
Media Use ◽  
Age Groups ◽  
The United States ◽  
Social Media Use ◽  
Cross Sectional ◽  
Social And Emotional ◽  
Emotional Loneliness ◽  
Social Loneliness

Social distancing rules during the COVID-19 pandemic changed social interaction for many and increased the risk of loneliness in the general population. Social media use has been ambiguously related to loneliness, and associations may differ by age. The study aimed to examine loneliness and its association with social media use within different age groups during the COVID-19 pandemic. A cross-sectional online survey was conducted in Norway, the United Kingdom, the United States, and Australia during April/May 2020, and 3,810 participants aged 18 years or above were recruited. Multiple regression analyses were conducted to examine associations between social media use and social and emotional loneliness within separate age groups. Emotional loneliness was higher among young adults and among those who used social media several times daily. Adjusting by sociodemographic variables, using more types of social media was associated with lower social loneliness among the oldest participants, and with higher emotional loneliness among the youngest participants. Among middle-aged participants, using social media more frequently was associated with lower social loneliness. We found that the associations between social media use and loneliness varied by age. Older people’s engagement on social media may be a resource to reduce loneliness during the COVID-19 pandemic. We observed higher levels of loneliness among high-frequent social media users of younger age.

scholarly journals Age-Cohort Differences in Longitudinal Associations Between the Rate of Internet Use and Memory Functioning

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 410-410
Author(s):  
Vineet Raichur ◽  
Lindsay Ryan ◽  
Richard Gonzalez ◽  
Jacqui Smith
Keyword(s):  
Older Adults ◽  
Episodic Memory ◽  
Cognitive Complexity ◽  
Internet Use ◽  
Age Groups ◽  
Word Recall ◽  
Use Patterns ◽  
Younger Age ◽  
Rate Of Increase ◽  
Over Time

Abstract Cross-sectional analyses of internet use patterns among older adults find that the rate of internet use is less with greater physical and memory difficulties. It is not clear, however, how age-cohorts differ in their internet use as physical and memory difficulties increase over time. In addition to factors such as increasing accessibility (cost) and social influences, the expansion and cognitive complexity of functions performed by the internet-enabled devices over time could influence internet use patterns. In this study, we investigate how the association between internet use and episodic memory difficulties over time varies between cohorts. We analyzed longitudinal data from the Health and Retirement Study (N = 15,703 in 2002; Aged 51 and older) between years 2002-2016 using mixed effects logistic regression models. Immediate and delayed word recall measures were used to assess episodic memory. Rate of internet use in the sample increased from 30% in 2002 to 53% in 2016. Rate of internet use among younger age groups was significantly higher in the baseline year. Younger age groups also showed a significantly higher rate of increase in internet use over time. In general, internet use decreased with episodic memory impairment. In addition to these effects, the effect of episodic memory on the rate of increase in internet use over time is lower in younger cohorts. These results indicate that younger cohorts of older adults are more likely to maintain internet use as they continue to age and therefore could better utilize technology for communication, social interactions and health interventions.

scholarly journals Using structural equation modeling in the understanding of functional disability in older adults

2021 ◽  
Vol 29 ◽  
Author(s):  
Darlene Mara dos Santos Tavares ◽  
Nayara Gomes Nunes Oliveira ◽  
Flavia Aparecida Dias Marmo ◽  
Joilson Meneguci
Keyword(s):  
Older Adults ◽  
Sedentary Behavior ◽  
Structural Equation ◽  
Functional Disability ◽  
Depressive Symptomatology ◽  
Age Groups ◽  
Community Dwelling ◽  
Likelihood Method ◽  
Equation Modeling ◽  
Cross Sectional

Objective: to analyze functional disability and its associated factors among community-dwelling older adults. Method: a cross-sectional study, conducted with 1,635 older adults distributed in the following age groups: 60 to 69, 70 to 79, and 80 years old or more, living in a health macro-region of the state of Minas Gerais. Descriptive and trajectory analysis was carried out (p<0.05). The parameters were estimated by the Maximum Likelihood method. Results: the highest percentage was female, with a monthly income of 1 minimum wage and living with a companion. In the age groups from 60 to 69 and from 70 to 79 years old, older adults with a partner predominated; and, among those aged 80 years old or more, widowed individuals prevailed. In the three groups, functional disability occurred hierarchically. Lower schooling, frailty and depressive symptomatology were factors directly associated with functional disability in the advanced activities; frailty and sedentary behavior were directly associated with functional disability in the instrumental activities. In the older adults aged between 60 and 69 years old and from 70 to 79 years old, sedentary behavior was associated with greater dependence on the basic activities. Conclusion: the expanded understanding of the factors in the functional disability of the older adults, according to age group, helps the health professional in the development of preventive measures for this disease.

scholarly journals Urban-rural differences in the prevalence of muscle weakness and slow gait speed: A cross-sectional analysis from the NHANES (2001-2002 and 2011-2014)

2021 ◽  
pp. 1-7
Author(s):  
J.J. Aziz ◽  
K.F. Reid ◽  
J.A. Batsis ◽  
R.A. Fielding
Keyword(s):  
United States ◽  
Older Adults ◽  
Grip Strength ◽  
Muscle Weakness ◽  
Rural Areas ◽  
Gait Speed ◽  
The United States ◽  
Cross Sectional ◽  
Comorbidity Burden ◽  
Urban Rural

Background: Older adults living in rural areas suffer from health inequities compared to their urban counterparts. These include comorbidity burden, poor diet, and physical inactivity, which are also risk factors for sarcopenia, for which muscle weakness and slow gait speed are domains. To date, no study has examined urban-rural differences in the prevalence of muscle weakness and slow gait speed in older adults living in the United States. Objective: To compare the prevalence of grip strength weakness and slow gait speed between urban and rural older adults living in the United States. Design: A cross-sectional, secondary data analysis of two cohorts from the National Health and Nutrition Examination Survey (NHANES), using gait speed or grip strength data, and urban-rural residency, dietary, examination, questionnaire and demographic data. Participants: 2,923 adults (≥ 60 yrs.). Measures: Grip weakness was defined as either, an absolute grip strength of <35 kg. and <20 kg. or grip strength divided by body mass index (GripBMI) of <1.05 and <0.79 for men and women, respectively. Slow gait speed was defined as a usual gait speed of ≤0.8m/s. Results: The prevalence of GripBMI weakness was significantly higher in urban compared to rural participants (27.4% vs. 19.2%; p=0.001), whereas their absolute grip strength was lower (31.75(±0.45) vs. 33.73(±0.48)). No urban-rural differences in gait speed were observed. Conclusions: Older adults residing in urban regions of the United States were weaker compared to their rural counterparts. This report is the first to describe urban-rural differences in handgrip strength and slow gait speed in older adults living in the United States.

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