Severe Hypoglycemia, Cardiac Structure and Function, and Risk of Cardiovascular Events among Older Adults with Diabetes

Objective: To assess the association of severe hypoglycemia measured at baseline with cardiovascular disease (CVD) among community-dwelling older individuals with diabetes, a group particularly susceptible to hypoglycemia. Methods: We included older adults with diabetes from the Atherosclerosis Risk in Communities (ARIC) Study who attended visit 5 (2011–2013, baseline). Severe hypoglycemia at baseline was defined using first position ICD-9 codes, from hospitalizations, emergency department visits, and ambulance calls. We examined cross-sectional associations of severe hypoglycemia with echocardiographic indices of cardiac structure-function. We prospectively evaluated the risks of incident or recurrent CVD (coronary heart disease, stroke or heart failure) and all-cause mortality, from baseline to 31 December 2018, using negative binomial and Cox regression models. Results: Among 2,193 participants (mean age: 76 years [SD: 5], 57% female, 32% blacks), 79 had a history of severe hypoglycemia at baseline. Severe hypoglycemia was associated with a lower left ventricular (LV) ejection fraction (adjusted beta coefficient: -3.7 % [95% CI: -5.5, -1.7]), higher LV end diastolic volume (14.8 ml [95% CI: 8.8, 20.8]), higher E/A ratio (0.11 [95% CI: 0.03, 0.18]), and higher septal E/e’ (2.48 [95%CI: 1.13, 3.82]). In adjusted models, severe hypoglycemia was associated with incident or recurrent CVD (incidence rate ratio [IRR]: 2.49 (95% CI 1.4, 4.39]) and all-cause mortality (HR 1.70 [95% CI 1.10, 2.67]) among those without prevalent CVD. Conclusions: Our findings suggest that a history severe hypoglycemia is associated with alterations in cardiac function and is an important marker of future cardiovascular risk in older adults.

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Severe Hypoglycemia, Cardiac Structure and Function, and Risk of Cardiovascular Events among Older Adults with Diabetes

10.2337/figshare.13105241 ◽

2020 ◽

Author(s):

Justin B. Echouffo-Tcheugui ◽

Natalie Daya ◽

Alexandra K Lee ◽

Olive Tang ◽

Chiadi E. Ndumele ◽

...

Keyword(s):

Older Adults ◽

Negative Binomial ◽

Cox Regression ◽

Severe Hypoglycemia ◽

Left Ventricular ◽

Community Dwelling ◽

Emergency Department Visits ◽

Cardiac Structure ◽

Older Individuals ◽

All Cause Mortality

Objective: To assess the association of severe hypoglycemia measured at baseline with cardiovascular disease (CVD) among community-dwelling older individuals with diabetes, a group particularly susceptible to hypoglycemia. Methods: We included older adults with diabetes from the Atherosclerosis Risk in Communities (ARIC) Study who attended visit 5 (2011–2013, baseline). Severe hypoglycemia at baseline was defined using first position ICD-9 codes, from hospitalizations, emergency department visits, and ambulance calls. We examined cross-sectional associations of severe hypoglycemia with echocardiographic indices of cardiac structure-function. We prospectively evaluated the risks of incident or recurrent CVD (coronary heart disease, stroke or heart failure) and all-cause mortality, from baseline to 31 December 2018, using negative binomial and Cox regression models. Results: Among 2,193 participants (mean age: 76 years [SD: 5], 57% female, 32% blacks), 79 had a history of severe hypoglycemia at baseline. Severe hypoglycemia was associated with a lower left ventricular (LV) ejection fraction (adjusted beta coefficient: -3.7 % [95% CI: -5.5, -1.7]), higher LV end diastolic volume (14.8 ml [95% CI: 8.8, 20.8]), higher E/A ratio (0.11 [95% CI: 0.03, 0.18]), and higher septal E/e’ (2.48 [95%CI: 1.13, 3.82]). In adjusted models, severe hypoglycemia was associated with incident or recurrent CVD (incidence rate ratio [IRR]: 2.49 (95% CI 1.4, 4.39]) and all-cause mortality (HR 1.70 [95% CI 1.10, 2.67]) among those without prevalent CVD. Conclusions: Our findings suggest that a history severe hypoglycemia is associated with alterations in cardiac function and is an important marker of future cardiovascular risk in older adults.

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Abstract MP53: 1,5-anhydroglucitol to Identify Older Adults with Diabetes at Risk of Hospitalization and All-cause Mortality

Circulation ◽

10.1161/circ.137.suppl_1.mp53 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Bethany Warren ◽

Andreea Rawlings ◽

A. Richey Sharrett ◽

Josef Coresh ◽

Anna Kottgen ◽

...

Keyword(s):

Older Adults ◽

At Risk ◽

Negative Binomial ◽

Cox Regression ◽

Negative Binomial Regression ◽

Glycemic Variability ◽

Adverse Outcomes ◽

Improve Risk Stratification ◽

All Cause Mortality ◽

Diagnosed Diabetes

Introduction: Older adults with diabetes have variable prognosis. There is critical need to improve risk stratification among this population to understand who is most likely to experience adverse outcomes. Low 1,5-anhydroglucitol (1,5-AG) is a biomarker of glycemic variability and has demonstrated value for identification of middle-aged adults with diabetes at risk for major clinical outcomes. Total hospitalizations are a useful summary measure of poor health outcomes. It is unknown whether 1,5-AG can identify older adults at risk for hospitalizations and all-cause mortality. Methods: We included 2,061 participants from the Atherosclerosis Risk in Communities (ARIC) Study with diagnosed diabetes who attended the 2011-2013 visit. We dichotomized 1,5-AG (≥6μg/mL; <6μg/mL) and followed participants until December 31, 2015. We examined the associations of 1,5-AG with total and diabetes-related hospitalizations using negative binomial regression and all-cause mortality using Cox regression. Results: Participants ranged in age from 67-90 years, 57% were female, 30% were black, and 17% had 1,5-AG <6μg/mL. Median HbA1c was 6.2% in those with 1,5-AG ≥6μg/mL and 7.8% in persons with 1,5-AG <6μg/mL. During a median of 3.6 years of follow-up, there were 2,813 hospitalizations (1,689 diabetes-related) and 247 deaths. Compared to 1,5-AG ≥6μg/mL, individuals with 1,5-AG <6μg/mL had a significantly higher risk of hospitalizations, diabetes-related hospitalizations, and death ( Table ). After adjustment for diabetes medication use or HbA1c, associations with hospitalizations were attenuated and non-significant, while the relationship with all-cause mortality remained. Conclusion: Among older adults with diagnosed diabetes, glycemic variability may be an important risk factor for major short-term complications.

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EXAMINING LONGITUDINAL HEALTHCARE UTILIZATION, OUTCOMES, AND SATISFACTION IN PRE-FRAIL OLDER ADULTS

Innovation in Aging ◽

10.1093/geroni/igz038.2541 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S689-S690

Author(s):

Ivana A Vaughn ◽

Nicole M Marlow ◽

Kalyani Sonawane ◽

Roger B Fillingim ◽

Rebecca J Beyth

Keyword(s):

Older Adults ◽

Healthcare Utilization ◽

Negative Binomial ◽

Satisfaction With Life ◽

Cox Regression ◽

Frailty Index ◽

Univariate Analysis ◽

Functional Decline ◽

Community Dwelling ◽

Frail Patients

Abstract Frailty is a medical syndrome occurring in nearly 60% community dwelling older adults and could have insidious origins in middle-adulthood that manifest predominantly as decline and multi-morbidity. Identification of pre-frail states in adults could potentially reduce its impact in late-life. The study used data from the Health and Retirement Study (HRS) to: 1) compare long-term healthcare utilization between pre-frail and non-frail patients, 2) compare risk of pain progression, functional decline, and mortality between pre-frail and non-frail patients, and (3) compare satisfaction with healthcare, self-perceptions of aging and satisfaction with life between pre-frail and non-frail patients. The primary predictor, pre-frailty phenotype, was based on the Paulson-Lichtenberg Frailty Index (PLFI), a validated HRS-version of the Fried criteria. Additional covariates included sociodemographics, comorbidities, smoking status, sleep quality, health status, and body mass index. Statistical analyses consisted of descriptive statistics, univariate analysis, negative binomial regression with log-link function, logistic regression, generalized linear modeling and Cox regression. Pre-frailty status increased the incidence of hospitalizations (IRR: 1.23; 95%CI: 1.18-1.28) and doctor’s visits (IRR: 1.18; 95%CI: 0.15-1.22); increased the risk of pain progression (HR: 1.61, 95%CI: 1.53-1.69), functional decline (HR: 1.77, 95%CI: 1.67-1.87), and all-cause mortality (HR: 1.09, 95%CI:1.03-1.16); lowered odds of healthcare satisfaction (OR: 0.79, 95%CI: 0.62-0.99) and lowered satisfaction with aging ((β: -0.23 95%CI: -0.36- (-0.10)) and satisfaction with life (β: -0.27 95%CI: -0.44- (-0.11)). Frailty syndrome is highly prevalent and having a better understanding of its influence on health outcomes at intermediate pre-frail states could provide insight into reducing manifestations in later life.

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All-cause mortality over a three-year period among community-dwelling older adults in Southern Brazil

Revista Brasileira de Epidemiologia ◽

10.1590/1980-549720210015 ◽

2021 ◽

Vol 24 ◽

Author(s):

Ana Clara Ledezma Greiner de Souza ◽

Caroline Cardozo Bortolotto ◽

Andréa Dâmaso Bertoldi ◽

Elaine Tomasi ◽

Flávio Fernando Demarco ◽

...

Keyword(s):

Older Adults ◽

Cox Regression ◽

Early Death ◽

Community Dwelling ◽

Epidemiological Surveillance ◽

Daily Life Activities ◽

All Cause Mortality ◽

Community Dwelling Older Adults

ABSTRACT: Objective: To evaluate all-cause mortality in approximately three years of follow-up and related sociodemographic, behavioral and health factors in community-dwelling older adults in Pelotas, RS. Methods: This was a longitudinal observational study that included 1,451 older adults (≥ 60 years) who were interviewed in 2014. Information on mortality was collected from their households in 2016–2017 and confirmed with the Epidemiological Surveillance department of the city and by documents from family members. Associations between mortality and independent variables were assessed by crude and multiple Cox regression, with hazard ratio with respective 95% confidence intervals (95%CI). Results: Almost 10% (n = 145) of the participants died during an average of 2.5 years of follow-up, with a higher frequency of deaths among males (12.9%), ?80 years (25.2%), widowhood (15.0%), no education (13.8%) and who did not work (10.5%). Factors associated with higher mortality were: being a male (HR = 2.8; 95%CI 1.9 – 4.2), age ?80 years (HR = 3.9; 95%CI 2.4 – 6.2), widowhood (HR = 2.2; 95%CI 1.4 – 3.7), physical inactivity (HR = 2.3; 95%CI 1.1 – 4..6), current smoking (HR = 2.1; 95%CI 1.2 – 3.6), hospitalizations in the previous year (HR = 2.0; 95%CI 1.2 – 3.2), depressive symptoms (HR = 2.0; 95%CI 1.2 – 3,4) and dependence for two or more daily life activities (HR = 3.1; 95%CI 1,7 – 5.7). Conclusion: The identification of factors that increased the risk of early death makes it possible to improve public policies aimed at controlling the modifiable risk factors that can lead to aging with a better quality of life.

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Effect of Exercising with Others on Incident Functional Disability and All-Cause Mortality in Community-Dwelling Older Adults: A Five-Year Follow-Up Survey

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17124329 ◽

2020 ◽

Vol 17 (12) ◽

pp. 4329 ◽

Cited By ~ 1

Author(s):

Yuya Fujii ◽

Keisuke Fujii ◽

Takashi Jindo ◽

Naruki Kitano ◽

Jaehoon Seol ◽

...

Keyword(s):

Older Adults ◽

Functional Disability ◽

Cox Regression ◽

Mail Survey ◽

Exercise Group ◽

Community Dwelling ◽

Cox Regression Analysis ◽

Exercise Habits ◽

All Cause Mortality

We clarified the effect of exercising with others on the risks of incident functional disability and all-cause mortality among community-dwelling adults. We used an inventory mail survey with a five-year follow-up for 1520 independently living older adults (mean age: 73.4 ± 6.3 years) in Kasama City, Japan. Subjects responded to a self-reported questionnaire in June 2014. Exercise habits and the presence of exercise partners were assessed. Subjects were classified into three groups: Non-exercise, exercising alone, and exercising with others. Follow-up information and date of incident functional disability and death during the five-year follow-up were collected from the database. To compare the association between exercise habits and functional disability and mortality, Cox regression analysis was conducted. Compared with the non-exercise group, exercising with others had significantly lower hazard ratios (HRs) for functional disability (0.59, 95% confidence interval (CI) 0.40–0.88) and mortality (0.40, 95% CI 0.24–0.66) in the covariate models. Compared with exercising alone, exercising with others decreased the HRs for incident functional disability (0.53, 95% CI: 0.36–0.80) and mortality (0.50, 95% CI 0.29–0.85) rates in the unadjusted model; these associations were not significant in the covariate models. Exercising with others can contribute to functional disability prevention and longevity.

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Abstract P038: The Association Between Thyroid Function and Cardiac Structure and Function in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽

10.1161/circ.137.suppl_1.p038 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Georgina Gyarmati ◽

Yuan Chen ◽

John W McEvoy ◽

Seth Martin ◽

Anna Kottgen ◽

...

Keyword(s):

Older Adults ◽

Thyroid Function ◽

Left Ventricular ◽

Structure And Function ◽

Community Dwelling ◽

Cardiac Structure ◽

Left Ventricular Structure ◽

Ventricular Structure ◽

Cardiac Structure And Function ◽

And Function

Background: Most prior studies evaluating thyroid function and cardiac structure and function have been small and have not included the full spectrum of thyroid function hormones. Methods: Among 5122 ARIC participants (aged 66- 90 at the visit 5, 2011-2013) we evaluated the cross-sectional associations of clinical categories of thyroid function and thyroid hormone levels (triidothyronine [T3], thyroxine [T4], and thyroid-stimulating hormone [TSH]) with left ventricular structure, systolic function, and diastolic function based on echocardiogram after accounting for potential confounders including prevalent coronary heart disease and heart failure. Results: There were 417 participants (9.4%) with hypothyroidism and 155 participants (3.5%) with hyperthyroidism. Hypothyroidism tended to be associated with more echocardiographic parameters compared to hyperthyroidism. Among individual thyroid hormones, T3 was most robustly associated with left ventricular structure and function. Specifically, lower T3 level was associated with higher left ventricular mass and diameter and reduced systolic and diastolic dysfunction (Figure). Conclusions: In community-dwelling older adults, hypothyroidism was more evidently associated with altered left ventricular structure and function than hyperthyroidism. Among T3, T4, and TSH, lower T3 demonstrated most robust associations. Our findings highlight the importance of recognizing hypothyroidism for cardiac health and assessing T3 in addition to T4 and TSH for thyroid function assessment among older adults.

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Perceived Voice Disorders in Older Adults and Impact on Social Interactions

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2020_persp-20-00059 ◽

2021 ◽

pp. 1-8

Author(s):

Connie K. Porcaro ◽

Clare Singer ◽

Boris Djokic ◽

Ali A. Danesh ◽

Ruth Tappen ◽

...

Keyword(s):

Older Adults ◽

Social Interactions ◽

Social Engagement ◽

Leisure Activities ◽

Treatment Strategies ◽

Voice Disorders ◽

Community Dwelling ◽

Vocal Performance ◽

Older Individuals ◽

Cross Sectional

Purpose Many aging individuals, even those who are healthy, report voice changes that can impact their ability to communicate as they once did. While this is commonly reported, most do not seek evaluation or management for this issue. The purpose of this study was to investigate the prevalence and differences in voice disorders in older adults, along with the effect of fatigue on their social interactions. Method This is a cross-sectional investigation of a community-dwelling sample of individuals aged 60 years or older. Participants completed the Questionnaire on Vocal Performance, the Social Engagement Index subset “Engagement in Social or Leisure Activities,” and the Fatigue Severity Scale. Results Results indicated 32.5% of the 332 participants reported symptoms of voice problems with no difference found between male and female respondents. A slight increase in report of voice problems was noted with each year of age. Participants who self-reported voice problems indicated less interaction in social activities involving communication than those who did not. Finally, as severity of self-reported voice problems increased, an increase was reported by the same individuals for signs of fatigue. Conclusions Voice problems and resulting decreased social interaction are commonly experienced by older individuals. Voice symptoms in older adults have been found to benefit from evidence-based treatment strategies. It is critical to provide education to encourage older individuals to seek appropriate evaluation and management for voice issues through a speech-language pathologist or medical professional.

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Sex differences in transaortic flow rate and association with all-cause mortality in patients with severe aortic stenosis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab045 ◽

2021 ◽

Author(s):

Sahrai Saeed ◽

Anastasia Vamvakidou ◽

Spyridon Zidros ◽

George Papasozomenos ◽

Vegard Lysne ◽

...

Keyword(s):

Sex Differences ◽

Aortic Stenosis ◽

Flow Rate ◽

Cox Regression ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Cox Regression Analysis ◽

Increased Risk ◽

All Cause Mortality

Abstract Aims It is not known whether transaortic flow rate (FR) in aortic stenosis (AS) differs between men and women, and whether the commonly used cut-off of 200 mL/s is prognostic in females. We aimed to explore sex differences in the determinants of FR, and determine the best sex-specific cut-offs for prediction of all-cause mortality. Methods and results Between 2010 and 2017, a total of 1564 symptomatic patients (mean age 76 ± 13 years, 51% men) with severe AS were prospectively included. Mean follow-up was 35 ± 22 months. The prevalence of cardiovascular disease was significantly higher in men than women (63% vs. 42%, P < 0.001). Men had higher left ventricular mass and lower left ventricular ejection fraction compared to women (both P < 0.001). Men were more likely to undergo an aortic valve intervention (AVI) (54% vs. 45%, P = 0.001), while the death rates were similar (42.0% in men and 40.6% in women, P = 0.580). A total of 779 (49.8%) patients underwent an AVI in which 145 (18.6%) died. In a multivariate Cox regression analysis, each 10 mL/s decrease in FR was associated with a 7% increase in hazard ratio (HR) for all-cause mortality (HR 1.07; 95% CI 1.03–1.11, P < 0.001). The best cut-off value of FR for prediction of all-cause mortality was 179 mL/s in women and 209 mL/s in men. Conclusion Transaortic FR was lower in women than men. In the group undergoing AVI, lower FR was associated with increased risk of all-cause mortality, and the optimal cut-off for prediction of all-cause mortality was lower in women than men.

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Changes in Health Behaviors, Mental and Physical Health among Older Adults under Severe Lockdown Restrictions during the COVID-19 Pandemic in Spain

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18137067 ◽

2021 ◽

Vol 18 (13) ◽

pp. 7067

Author(s):

Esther García-Esquinas ◽

Rosario Ortolá ◽

Iago Gine-Vázquez ◽

José A. Carnicero ◽

Asier Mañas ◽

...

Keyword(s):

Mental Health ◽

Physical Activity ◽

Older Adults ◽

Social Isolation ◽

Community Dwelling ◽

Housing Conditions ◽

Older Individuals ◽

Lifestyle Risk Factors ◽

Increased Risk ◽

Lifestyle Risk

We used data from 3041 participants in four cohorts of community-dwelling individuals aged ≥65 years in Spain collected through a pre-pandemic face-to-face interview and a telephone interview conducted between weeks 7 to 15 after the beginning of the COVID-19 lockdown. On average, the confinement was not associated with a deterioration in lifestyle risk factors (smoking, alcohol intake, diet, or weight), except for a decreased physical activity and increased sedentary time, which reversed with the end of confinement. However, chronic pain worsened, and moderate declines in mental health, that did not seem to reverse after restrictions were lifted, were observed. Males, older adults with greater social isolation or greater feelings of loneliness, those with poorer housing conditions, as well as those with a higher prevalence of chronic morbidities were at increased risk of developing unhealthier lifestyles or mental health declines with confinement. On the other hand, previously having a greater adherence to the Mediterranean diet and doing more physical activity protected older adults from developing unhealthier lifestyles with confinement. If another lockdown were imposed during this or future pandemics, public health programs should specially address the needs of older individuals with male sex, greater social isolation, sub-optimal housing conditions, and chronic morbidities because of their greater vulnerability to the enacted movement restrictions.

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