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

2020 ◽  
pp. 089826432095369
Author(s):  
Xiaoling Xiang ◽  
Patrick Ho Lam Lai ◽  
Luoman Bao ◽  
Yihang Sun ◽  
Jieling Chen ◽  
...  
Keyword(s):  
Older Adults ◽  
High Risk ◽  
Social Isolation ◽  
Late Onset ◽  
Population Based ◽  
Low Risk ◽  
Steady Increase ◽  
Steady Decrease ◽  
Dementia Risk

Objectives: To identify the interrelations between the trajectories of social isolation and dementia in older adults. Methods: Data came from the National Health and Aging Trends Study 2011–2018 surveys. Group-based dual trajectory modeling was used to examine trajectories and their interrelations. Results: Four trajectories of social isolation—rarely isolated (62.2%), steady increase (13.5%), steady decrease (7.4%), and persistently isolated (16.9%) and dementia risk—persistently low risk (80.4%), increasing with early onset (3.9%), increasing with late onset (4.5%), and persistently high risk (11.2%) emerged. Two-thirds of the low-risk dementia group were in the rarely isolated group. The high-risk dementia group had the most overlap with the decreasing social isolation group (47%), followed by the persistently isolated group (28%). Conclusions: Social isolation and dementia mostly evolved in the same direction. However, the pattern of associations between these trajectories is intricate and may be reversed among long-term dementia survivors.

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.

scholarly journals Very similar cardiometabolic profile in the moderate and high cardiovascular risk classes: a population-based study

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
M Chlabicz ◽  
J Jamolkowski ◽  
W Laguna ◽  
P Sowa ◽  
M Paniczko ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Population Based ◽  
Low Risk ◽  
Public Institution ◽  
Population Based Study ◽  
The Metabolic Syndrome ◽  
Cardiometabolic Profile

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Medical University of Bialystok, Poland Background Cardiovascular disease (CVD) is a major, worldwide problem and remain the dominant cause of premature mortality in the word. Simultaneously the metabolic syndrome is a growing problem. The aim of this study was to investigate the cardiometabolic profile among cardiovascular risk classes, and to estimate CV risk using various calculators. Methods The longitudinal, population-based study, was conducted in 2017-2020. A total of 931 individuals aged 20-79 were included. Anthropometric and biochemical profiles were measured according to a standardized protocols. The study population was divided into CV risk classes according to the latest recommendation. Comparisons variables between subgroups were conducted using Dwass-Steele-Critchlow-Fligner test. To estimate CV risk were used: the  Systematic Coronary Risk Estimation system, Framingham Risk Score and LIFEtime-perspective model for individualizing CardioVascular Disease prevention strategies in apparently healthy people (LIFE-CVD). Results The mean age was 49.1± 15.5 years, 43.2% were male. Percentages of low-risk, moderate-risk, high-risk and very-high CV risk were 46.1%, 22.8%, 13.5%, 17.6%, respectively. Most of the analyzed anthropometric, body composition and laboratory parameters did not differ between the moderate and high CV risk participants, whereas the low risk group differed significantly. In the moderate and high-risk groups, abdominal distribution of adipose tissue dominated with significantly elevated parameters of insulin resistance. Interestingly, estimating lifetime risk of myocardial infarction, stroke or CV death using LIFE-CVD calculator yielded similar results in moderate and high CV risk classes. Conclusion The participants belonging to moderate and high CV risk classes have a very similar unfavorable cardiometabolic profile which may result in the similar lifetime CV risk. This may imply the need for more aggressive pharmacological and non-pharmacological management of CV risk factors in the moderate CV risk population. It would be advisable to consider combining the moderate and high risk classes into one high CV risk class, or it may be worth adding one of the parameters of abdominal fat distribution to the CV risk calculators as an expression of increased insulin resistance. Abstract Figure 1.

scholarly journals Long-term protective effect of high-risk human papillomavirus testing in population-based cervical screening

2005 ◽  
Vol 92 (9) ◽  
pp. 1800-1802 ◽  
Author(s):  
N W J Bulkmans ◽  
L Rozendaal ◽  
F J Voorhorst ◽  
P J F Snijders ◽  
C J L M Meijer
Keyword(s):  
Human Papillomavirus ◽  
High Risk ◽  
Protective Effect ◽  
Cervical Screening ◽  
Population Based ◽  
Human Papillomavirus Testing

scholarly journals Older adults experiences of technology use for socialization during the COVID-19 pandemic: A random cross-sectional survey (Preprint)

2021 ◽  
Author(s):  
Kristen R. Haase ◽  
Theodore Cosco ◽  
Lucy Kervin ◽  
Indira Riadi ◽  
Megan E. O'Connell
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
British Columbia ◽  
Social Isolation ◽  
Technology Use ◽  
Random Sampling ◽  
Population Based ◽  
Critical Approach ◽  
Cross Sectional Survey ◽  
Cross Sectional

BACKGROUND Technology has become the most critical approach to maintain social connectedness during the COVID-19 pandemic. Older adults (over age 65) are perceived as most physiologically vulnerable to COVID-19 and at risk of secondary mental health challenges related to social isolation imposed by virus containment strategies. To mitigate concerns regarding sampling bias we used a random sampling of older adults to understand uptake and acceptance of technologies to support socialization during the pandemic. OBJECTIVE To conduct a random population-based assessment of the barriers and facilitators to engaging in technology use for virtual socialization amongst older adults in the Canadian province of British Columbia during the COVID-19 pandemic. METHODS We conducted a cross-sectional population-based survey using random-digit dialing to participants over age 65 living in British Columbia. Data were analyzed using SPSS, with open-text responses analyzed using thematic analysis. RESULTS Respondents included 400 older adults with an average age of 72 years old and 63.7% female. Most respondents (89.5%) were aware of how to use technology to connect with others and slightly more than half (56%) reported using technology differently to connect with others during the pandemic. 55.9% of respondents reported adopting new technology since the beginning of the pandemic. Older adults reported key barriers to using technology including: (1) lack of access (including finance, knowledge, and age); (2) lack of interest (including a preference for telephone, and a general lack of interest in computers); and (3) physical barriers (resultant of cognitive impairments, stroke, and arthritis). Older adults reported numerous facilitators, including: (1) knowledge of technologies (whether self-taught or via external courses); (2) reliance on others (family, friends, and general internet searching); (3) technology accessibility (including environments, user-friendly technology, and receiving clear instructions); and (4) social motivation (because everyone else is doing it). CONCLUSIONS Much data on older adults use of technology is limited by sampling biases, but the current study that used random sampling demonstrated that older adults used technology to mitigate social isolation during the pandemic. Virtual socialization is most promising to mitigate potential mental health effects related to virus containment strategies. Addressing barriers by mobilizing telephone training and task lists, and mobilizing facilitators described by participants such as facilitated socialization activities are important strategies that can be implemented within and beyond the pandemic to bolster the mental health needs of older adults.

Abstract TP387: Abcd 2 Score Predicts The Long-term Risk Of Stroke After Transient Ischemic Attack: Fukuoka Stroke Registry

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Yasuhiro Kumai ◽  
Takuya Kiyohara ◽  
Masahiro Kamouchi ◽  
Sohei Yoshimura ◽  
Hiroshi Sugimori ◽  
...  
Keyword(s):  
High Risk ◽  
Transient Ischemic Attack ◽  
Risk Group ◽  
High Risk Group ◽  
Low Risk ◽  
Rank Test ◽  
Moderate Risk ◽  
Stroke Registry ◽  
Ischemic Attack

Background and Purpose— ABCD 2 score has been developed to predict the early risk of stroke after transient ischemic attack (TIA). The aim of this study was to clarify whether ABCD 2 score predicts the occurrence of stroke in the long term after TIA. Methods— Fukuoka Stroke Registry (FSR) is a multicenter epidemiological study database on acute stoke. From June 2007 to June 2011, 496 (305 males, 70 ± 13 years of age) patients who had suffered from TIA and were hospitalized in the 7 stroke centers within 7 days after the onset of TIA were enrolled in this study. The patients were divided into three groups according to the risk: low-risk (ABCD 2 score 0-3; n=72), moderate-risk (4-5; n=229) and high-risk group (6-7; n=195). They were followed up prospectively for up to 3 years. Cox proportional hazard regression model was used to elucidate whether ABCD 2 score was a predictor for stroke after TIA after adjusting for confounding factors. Results— Among three groups, there were significant differences in age, hypertension, diabetes mellitus and the decrease in estimated glomerular filtration rate (P<0.01, significantly). During a mean follow-up of 1.3 years, Kaplan-Meier analysis demonstrated that the stroke rate in TIA patients was significantly lower in low-risk group than in moderate-risk or high-risk group (log rank test, p<0.001). The adjusted hazard ratios for stroke in patients with TIA increased with moderate-risk group (Hazard ratio [HR]: 3.47, 95% CI: 1.03-21.66, P<0.05) and high-risk group (HR: 4.46, 95% CI: 1.31-27.85, P<0.05), compared to low-risk group. Conclusions— The ABCD 2 score is able to predict the long-term risk of stroke after TIA.

Abstract 190: Use of Intensive Glycemic Management in Older Adults With Diabetes. An Analysis From the Diabetes Collaborative Registry

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Suzanne V Arnold ◽  
Kasia J Lipska ◽  
Jingyan Wang ◽  
Leo Seman ◽  
Sanjeev N Mehta ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Older Adults ◽  
High Risk ◽  
Glucose Control ◽  
Low Risk ◽  
Minimal Risk ◽  
Tight Control ◽  
Poor Control ◽  
Intensively Managed

Background: Older adults with diabetes are less likely to benefit and more likely to be harmed by intensive glucose control. Prior research has shown that many older adults continue to be intensively managed despite guidelines that recommend that treatment targets should be relaxed in these patients. As many new agents have been introduced with minimal risk of hypoglycemia, we examined contemporary data to understand to what extent older patients with diabetes are still intensively managed with agents that can cause hypoglycemia. Methods: We examined A1c and treatment data in adults ≥75 years with type 2 diabetes from 151 US outpatient sites in DCR. Patients were categorized as poor control (A1c >9%), moderate control (A1c >8-9%), conservative control (A1c 7-8%), tight control/low-risk agents (A1c <7% on meds with low risk for hypoglycemia), and tight control/high-risk agents (A1c <7% on insulin, sulfonylureas, or meglitinides). Adults with A1c <7% on no glucose-lowering medications were excluded. We used hierarchical logistic regression to examine patient and site factors associated with tight control/high-risk agents vs. conservative control or tight control/low-risk agents. Results: Among 30,696 older adults with diabetes, 5,596 (18%) had moderate or poor control, 9,227 (30%) conservative control, 7,893 (26%) tight control/low-risk agents, and 7,980 (26%) tight control/high-risk agents (Fig. A). Older age, male sex, heart failure, chronic kidney disease, and coronary artery disease were each independently associated with a greater odds of tight control/high-risk agents (Fig. B). After adjusting for patient factors, there were no differences among practice specialties (endocrinology, primary care, cardiology) in how aggressively patients were managed. Conclusion: Despite greater availability of agents that do not cause hypoglycemia, a quarter of older adults with type 2 diabetes are tightly controlled with high-risk medications. These results suggest potential overtreatment of a substantial proportion of patients. Efforts are needed to provide more specific guidance on how to safely treat older adults with diabetes (both through targeting treatment with low-risk agents and through de-escalation of glucose control) and then to efficiently translate that guidance into busy clinical practice.

Access to Psychiatrist Services for Older Adults in Long-Term Care: A Population-Based Study

2019 ◽  
Vol 20 (5) ◽  
pp. 610-616.e2 ◽  
Author(s):  
Christopher Perlman ◽  
Julia Kirkham ◽  
Clive Velkers ◽  
Roxanne H. Leung ◽  
Marlo Whitehead ◽  
...  
Keyword(s):  
Older Adults ◽  
Long Term Care ◽  
Population Based ◽  
Term Care ◽  
Population Based Study

P5730Do hypertensive women with coronary artery disease benefit from lowering systolic blood pressure under 130 mmHg? Long-term mortality in the INternational VErapamil SR-trandolapril STudy (INVEST)

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R I Sava ◽  
Y Chen ◽  
Y K Taha ◽  
Y Gong ◽  
S M Smith ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Coronary Artery Disease ◽  
High Risk ◽  
Risk Group ◽  
Low Risk ◽  
High Risk Women ◽  
Artery Disease ◽  
Long Term Mortality

Abstract Background Hypertension (HTN) and coronary artery disease (CAD) are a prevalent combination in women, however limited data are available to guide blood pressure (BP) management. We hypothesize older women with HTN and CAD may not derive the same prognostic benefit from systolic BP (SBP) lowering <130 mmHg. Purpose To investigate the long-term mortality implications of different achieved SBP levels in hypertensive women with CAD. Methods Long-term, all-cause mortality data were analyzed for 9216 women, stratified by risk attributable to clinical severity of CAD (women with prior myocardial infarction or revascularization considered at high, all others at low risk) and by age (50 - <65 or ≥65 yo). The prognostic impact of achieving mean in-trial SBP <130 (referent group) was compared with 130 to <140 and ≥140 mmHg using Cox proportional hazards, adjusting for demographic and clinical characteristics. Results During 108,838 person-years of follow-up, 2945 deaths occurred. High risk women (n=3011) had increased long-term mortality in comparison to low risk women (n=6205) (adjusted HR 1.38, CI 1.28–1.5, p<0.001). Within risk groups, crude mortality percentages decreased according to BP values (table). As expected, high risk women were more likely to be ≥65 yo (68.68% vs. 50.51%, p<0.0001) or have SBP ≥140 mmHg (43.08% vs. 31.18%, p<0.0001). In adjusted analyses, an SBP ≥140 mmHg was associated with worse outcomes than SBP <130 mmHg in the entire cohort (HR 1.3, CI 1.2–1.5, p<0.0001) and when stratifying by risk (low risk group, HR = 1.47, CI 1.28–1.7, p<0.0001; high risk group, HR = 1.71, CI 1.01–1.35, p=0.03). In analyses stratified by age and risk, women ≥65 years and at high risk had decreased mortality in the 130 - <140 SBP category vs. <130 mmHg (HR 0.812, 95% CI 0.689–0.957, p=0.0133; figure). Women and deaths by risk and SBP group Group SBP category Women (n) Mortality (n) Mortality (%) High risk <130 773 338 44 130–<140 941 414 44 ≥140 1297 694 54 Low risk <130 2187 390 18 130–<140 2083 451 22 ≥140 1935 658 34 SBP = systolic blood pressure; n = number; % = percent per each group. Mortality adjusted HRs Conclusion In women ≥65 yo with hypertension and prior myocardial infarction and/or coronary revascularization enrolled in INVEST, a SBP between 130 to <140 mmHg was associated with lower all-cause, long-term mortality versus SBP <130 mmHg. Acknowledgement/Funding The main INVEST (International Verapamil [SR]/Trandolapril Study) was funded by grants from BASF Pharma, Ludwigshafen, Germany; Abbott Laboratories, A

scholarly journals SLEEP APNEA ASSOCIATED COMORBIDITIES AND MORTALITY IN AN OLDER VETERAN POPULATION

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S263-S264
Author(s):  
Denise M Kresevic ◽  
muralidahar pallaki ◽  
Christopher J Burant ◽  
Clare Gideon ◽  
Emily Schroeder ◽  
...  
Keyword(s):  
Heart Failure ◽  
Older Adults ◽  
Sleep Apnea ◽  
Mortality Rate ◽  
Population Based ◽  
Older Individuals ◽  
Male Veterans ◽  
The Relationship ◽  
Overall Mortality

Abstract Evidence continues to mount that sleep apnea (SA) occurs in 10-25% of Americans and is associated with significant morbidity and mortality (Schulman 2018). Among veterans, SA has been reported four times more often as compared to other non-veteran cohorts. (Wong 2015). The risk of developing dementia is increased in older individuals with OSA (Shastri, Bangar, & Holmes, 2015). The prevalence and characteristics of older adults with dementia and sleep apnea is not well known and long-term population-based studies on mortality have been lacking. Recent studies have reported overall mortality rates of 19%, in those individuals with SA, an increased rate of 1.5-3 times the mortality rate as compared to those individuals those without SA. Current recommendations support SA screening of high risk individuals including those with symptoms of snoring, fatigue, memory and concentration problems and mood changes. (Krist 2018). Despite a large number of older adults with suspected SA and comorbidities, the majority are not screened, referred, diagnosed and treated. In this VA pilot study of outpatient older male veterans with dementia and SA, N=195, mean age 75.83 years, SD=9.1, 51.3% were white, 37.5% were black. Frequently found comorbidities were: hypertension 88%, congestive heart failure 41%, Diabetes. 62% and, stroke 21%. Of note, among those who died, SA was significantly related to congested heart failure (r=.32, p&lt;.001) and COPD (r=.40, p&lt;.001). The overall mortality rate of 27% was higher than previous reports. Further investigation is needed to better understand the relationship between comorbidities, and SA, screening, treatment and mortality.

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