scholarly journals Predictors of Mortality in Older Adults With Epilepsy

Neurology ◽  
2020 ◽  
Vol 96 (1) ◽  
pp. e93-e101
Author(s):  
Leah J. Blank ◽  
Emily K. Acton ◽  
Allison W. Willis
Keyword(s):  
Older Adults ◽  
Disease Burden ◽  
Cox Regression ◽  
Health Care Systems ◽  
Underlying Disease ◽  
Medicare Beneficiaries ◽  
Future Studies ◽  
Premature Deaths ◽  
Point Increase ◽  
Care Systems

ObjectiveTo determine the incidence of epilepsy and subsequent 5-year mortality among older adults, as well as characteristics associated with mortality.MethodsThis was a retrospective cohort study of Medicare beneficiaries age 65 or above with at least 2 years enrollment before January 2009. Incident epilepsy cases were identified in 2009 using ICD-9-CM code-based algorithms; death was assessed through 2014. Cox regression models examined the association between 5-year mortality and incident epilepsy, and whether mortality differed by sociodemographic characteristics or comorbid disorders.ResultsAmong the 99,990 of 33,615,037 beneficiaries who developed epilepsy, most were White (79.7%), female (57.3%), urban (80.5%), and without Medicaid (71.3%). The 5-year mortality rate for incident epilepsy was 62.8% (62,838 deaths). In multivariable models, lower mortality was associated with female sex (adjusted hazards ratio [AHR] 0.85, 95% confidence interval [CI] 0.84–0.87), Asian race (AHR 0.82, 95% CI 0.76–0.88), and Hispanic ethnicity (AHR 0.81, 95% CI 0.76–0.84). Hazard of death increased with comorbid disease burden (per 1-point increase: AHR 1.27, 95% CI 1.26–1.27) and Medicaid coinsurance (AHR 1.17, 95% CI 1.14–1.19). Incident epilepsy was particularly associated with higher mortality when diagnosed after another neurologic condition: Parkinson disease (AHR 1.29, 95% CI 1.21–1.38), multiple sclerosis (AHR 2.13, 95% CI 1.79–2.59), dementia (AHR 1.33, 95% CI 1.31–1.36), traumatic brain injury (AHR 1.55, 95% CI 1.45–1.66), and stroke/TIA (AHR 1.20, 95% CI 1.18–1.21).ConclusionsNewly diagnosed epilepsy is associated with high 5-year mortality among Medicare beneficiaries. Future studies that parse the interplay of effects from underlying disease, race, sex, and poverty on mortality will be critical in the design of learning health care systems to reduce premature deaths.

scholarly journals Association between late-life hypercholesterolemia and progression of dementia severity among older adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 876-876
Author(s):  
Mo-kyung Sin ◽  
Yan Cheng ◽  
Ali Ahmed ◽  
Edward Zamrini
Keyword(s):  
Older Adults ◽  
Cox Regression ◽  
Late Life ◽  
Clinical Dementia Rating ◽  
Future Studies ◽  
Dementia Severity ◽  
Kaplan Meier ◽  
Point Increase ◽  
Race Ethnicity ◽  
The Relationship

Abstract Progression of dementia severity varies widely by individuals and multiple factors might influence the progression. The aim of this study was to examine the relationship between late-life hypercholesterolemia and progression of dementia severity in older adults. We used prospectively collected longitudinal data from 2,686 adults aged ≥65 years in the National Alzheimer’s Coordinating Center. Progression of dementia severity was measured using both Clinical Dementia Rating (CDR) - Sum of Boxes (SOB) and Global scores. Kaplan Meier curves were plotted to estimate the association between hypercholesterolemia and progression of dementia severity. We also conducted multivariate Cox regression models to estimate the association of hypercholesterolemia with the outcomes adjusting for age, gender, race, ethnicity, marital status, living status, education, smoking, heart failure, atrial fibrillation, blood pressure, and diabetes. Hypercholesterolemia had significant association with CDR-SOB ≥ 1 point increase (unadjusted HR, 1.23; 95% CI, 1.13-1.35; p<0.001; adjusted HR, 1.17; 95% CI, 1.07-1.28; p<0.001). In addition, hypercholesterolemia had significant association with CDR-Global ≥ 0.5 point increase (unadjusted HR, 1.14; 95% CI, 1.04-1.25; p<0.001; adjusted HR, 1.11; 95% CI, 1.01-1.22 p=0.036). If these findings can be replicated in future studies, future studies need to examine if proper management of cholesterol may reduce the risk of Alzheimer’s dementia in late-life older adults.

scholarly journals USING COMMUNITY-BASED MODELS TO PROVIDE INTEGRATED CARE FOR RURAL OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S553-S553
Author(s):  
Martha R Crowther ◽  
Cassandra D Ford
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Rural Communities ◽  
Mental Health Problems ◽  
Health Care Systems ◽  
Physical And Mental Health ◽  
Community Based ◽  
Psychosocial Services ◽  
Care Systems ◽  
Rural Older Adults

Abstract Rural elders are one of the most at-risk populations for experiencing physical and mental health problems. In many rural communities, there are no psychosocial services available to meet the needs of the rural elderly. To provide rural older adults with integrated healthcare, we build upon our existing community-based infrastructure that has fostered community capacity for active engagement in clinical activities and has served as a catalyst to increase participation of rural older adults in clinical services. Our rural community model draws upon the role of culture in promoting health among rural older adults to provide rural service delivery. This model is built upon our network of partnerships with surrounding communities, including potential research participants, community-based organizations, community leaders, and community health-care systems and providers. By engaging the community we can create a sustainable system that will encourage rural older adults to utilize the health care system at a higher rate.

scholarly journals Worldwide Management of Inflammatory Bowel Disease During the COVID-19 Pandemic: An International Survey

2020 ◽  
Author(s):  
Charles N Bernstein ◽  
Siew C Ng ◽  
Rupa Banerjee ◽  
Flavio Steinwurz ◽  
Bo Shen ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Task Force ◽  
Health Care Systems ◽  
Underlying Disease ◽  
Virus Spread ◽  
The World ◽  
Management Guidance ◽  
Care Systems ◽  
Inflammatory Bowel

Abstract Background and Aims Persons with inflammatory bowel disease (IBD) may be particularly vulnerable to COVID-19 either because of their underlying disease or its management. Guidance has been presented on the management of persons with IBD in the time of this pandemic by different groups. We aimed to determine how gastroenterologists around the world were approaching the management of IBD. Methods Members of the World Gastroenterology Organization (WGO) IBD Task Force contacted colleagues in countries largely beyond North America and Europe, inviting them to review the WGO website for IBD and COVID-19 introduction, with links to guideline documents, and then to respond to 9 ancillary open-ended management questions. Results Fifty-two gastroenterologists from 33 countries across 6 continents completed the survey (April 14 to May 16, 2020). They were all adhering for the most part to published guidelines on IBD management in the COVID-19 era. Some differences and reductions in services related to access, and some related to approach within their communities in terms of limiting virus spread. In particular, most gastroenterologists reduced in-person clinics (43 of 52), limited steroid use (47 of 51), limited elective endoscopy (45 of 52), and limited elective surgeries (48 of 51). If a patient was diagnosed with COVID-19, immunomodulatory therapy was mostly held. Conclusions In most countries, the COVID-19 pandemic significantly altered the approach to persons with IBD. The few exceptions were mostly based on low burden of COVID-19 in individual communities. Regardless of resources or health care systems, gastroenterologists around the world took a similar approach to the management of IBD.

Technology as a Bridge between Health Care Systems and Older Adults

2013 ◽  
pp. 59-79 ◽  
Author(s):  
Daniel Morrow ◽  
Jessie Chin
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Care Providers ◽  
Distributed Cognition ◽  
Common Ground ◽  
Health Care Systems ◽  
Personal Health Record ◽  
Patient Portals ◽  
Access To Health ◽  
Care Systems

The authors explore the role of technology in supporting collaboration between health care providers and older adults. They focus on two technologies that help link patients to their providers by giving them access to health information and services: 1) patient portals to Electronic Health Records, and 2) Personal Health Record systems. Theories of distributed cognition and common ground are used to frame a review of the small but growing body of research that investigates which older adults use or do not use these technologies, and why. The findings, while sparse, suggest that older adults with lower levels of health literacy stand to benefit the most from this technology, but they tend to have fewer cognitive, literacy, and other psychosocial resources needed to take advantage of the technology. This discrepancy is due in part to systems that are not designed with older adults’ needs and abilities in mind. The authors conclude with recommendations for improving the use of these tools to support patient/provider collaboration by making them easier to use, and by integrating them with other communication media to support the broader context of the patient/provider relationship.

scholarly journals Patterns of Statin Use in Older Medicare Beneficiaries With Traumatic Brain Injury

2017 ◽  
Vol 33 (4) ◽  
pp. 156-166
Author(s):  
Bilal Khokhar ◽  
Linda Simoni-Wastila ◽  
Julia F. Slejko ◽  
Eleanor Perfetto ◽  
Min Zhan ◽  
...  
Keyword(s):  
Older Adults ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
National Sample ◽  
Pharmacological Therapy ◽  
Medicare Beneficiaries ◽  
Future Studies ◽  
Factors Associated ◽  
The Impact ◽  
Statin Use

Background: In addition to lowering lipids, statins also may be beneficial for older adults sustaining a traumatic brain injury (TBI), as statin use prior to and following trauma may decrease mortality following injury. However, despite statins’ potential to reduce mortality, there is limited research regarding statin use among older adults. Objective: To characterize and investigate factors associated with statin use among older adults with TBI. Methods: A retrospective drug utilization study was used to characterize statin use among Medicare beneficiaries 65 and older hospitalized with a TBI during 2006 to 2010 and with continuous Medicare Parts A, B, and D coverage 6 months prior and 12 months following TBI. Logistic regression was used to investigate the factors associated with statin use. The exposure of interest was statin use prior to and following TBI. Results: Of the 75 698 beneficiaries included in the study, 37 874 (~50%) of beneficiaries used a statin at least once during the study period. The most common statin used was simvastatin, while fluvastatin was the least used statin. Statin users were more likely to have cardiovascular diseases when compared to nonusers. Hyperlipidemia was a major factor associated with statin use and had the greatest impact on statin use compared to nonuse (odds ratio = 9.54; 95% confidence interval = 9.07, 10.03). Conclusions: This national sample of older adults with TBI suggests that statins are commonly used. Future studies must next examine the impact of statin use on mortality and secondary injury in order to shape pharmacological therapy guidelines following TBI.

scholarly journals Perceptions and Understandings of Frailty Language: A Scoping Review

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 177-177
Author(s):  
Mariko Sakamoto ◽  
Pamela Durepos ◽  
Kyla Alsbury ◽  
Patricia Hewston ◽  
Alyson Takaoka ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Scoping Review ◽  
Health Care Professionals ◽  
Health Care Systems ◽  
Community Dwelling ◽  
Critical Examination ◽  
Primary Research ◽  
Care Systems ◽  
Research Studies

Abstract Diagnosing and responding to frailty in older adult populations is of growing interest for health care professionals, researchers and policymakers. Preventing frailty has the potential to improve health outcomes for older adults, which in turn has significant implications for health care systems. However, little is known about how older people understand and perceive the term “frailty”, and what it means for them to be designated as frail. To address this concern, a scoping review was undertaken to map the breadth of primary research studies that focus on community-dwelling older adults’ perceptions and understanding of frailty language, as well as explore the potential implications of being classified as frail. Searches were conducted in MEDLINE, Ageline, PsychInfo, CINAHL and EMBASE databases for articles published between January 1994 and February 2019. 4639 articles were screened and ten articles met the inclusion criteria, detailing eight primary research studies. Using content analysis, three core themes were identified across the included studies. These themes included: 1) understanding frailty as a multi-dimensional concept and inevitable consequence of aging, 2) perceiving frailty as a generalizing and harmful label; and 3) resisting and responding to frailty. Recommendations stemming from this review include the need for health care professionals to use person-centered language with older adults, discuss the term frailty with caution, and be aware of the potential consequences of labeling a person as frail. Importantly, this review demonstrates that for frailty interventions to be successful and meaningful for older adults, ongoing and critical examination of frailty language is necessary.

Technology as a Bridge between Health Care Systems and Older Adults

2012 ◽  
pp. 99-119 ◽  
Author(s):  
Daniel Morrow ◽  
Jessie Chin
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Care Providers ◽  
Distributed Cognition ◽  
Common Ground ◽  
Health Care Systems ◽  
Personal Health Record ◽  
Patient Portals ◽  
Access To Health ◽  
Care Systems

The authors explore the role of technology in supporting collaboration between health care providers and older adults. They focus on two technologies that help link patients to their providers by giving them access to health information and services: 1) patient portals to Electronic Health Records, and 2) Personal Health Record systems. Theories of distributed cognition and common ground are used to frame a review of the small but growing body of research that investigates which older adults use or do not use these technologies, and why. The findings, while sparse, suggest that older adults with lower levels of health literacy stand to benefit the most from this technology, but they tend to have fewer cognitive, literacy, and other psychosocial resources needed to take advantage of the technology. This discrepancy is due in part to systems that are not designed with older adults’ needs and abilities in mind. The authors conclude with recommendations for improving the use of these tools to support patient/provider collaboration by making them easier to use, and by integrating them with other communication media to support the broader context of the patient/provider relationship.

Mediators of marginalisation in discharge planning with older adults

2016 ◽  
Vol 37 (9) ◽  
pp. 1747-1769 ◽  
Author(s):  
EVELYNE DUROCHER ◽  
BARBARA E. GIBSON ◽  
SUSAN RAPPOLT
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Older Adult ◽  
Health Care Professionals ◽  
Health Care Services ◽  
Discharge Planning ◽  
Health Care Systems ◽  
Urban Setting ◽  
Care Services ◽  
Care Systems

ABSTRACTReturning home or moving to a more supportive setting upon discharge from inpatient health-care services can have a tremendous impact on the lives of older adults and their families. Institutional concerns with patient safety and expedience can overshadow health-care professionals' commitments to collaborative discharge planning. In light of many competing demands and agendas, it can be unclear what is driving discharge-planning processes and outcomes. This paper presents the results of a study examining discharge planning in an older adult rehabilitation unit in a Canadian urban setting. Using microethnographic case studies, we explored the perspectives of older adults, family members and health-care professionals. Drawing on concepts of relational autonomy to guide the analysis, we found that discourses of ageing-as-decline, beliefs privileging health-care professionals' expertise and conventions guiding discharge planning intersected to marginalise older adult patients in discharge-planning decision making. Discharge planning in the research setting was driven by norms of ‘protecting physical safety’ at the expense of older adults’ self-declared interests and values. Such practices resulted in frequent recommendations of 24-hour care, which have significant personal, social and financial implications for older adults and their families, and ultimately might undermine clients' or health-care systems' aims. The analysis revealed social, political and institutional biases that diminish the rights and autonomy of older adults.

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