Initiating Second-Line Antidiabetic Medication Among Older Adults With Type 2 Diabetes on Metformin

BACKGROUND: Antidiabetic medications (ADM), especially sulfonylureas (SFU) and basal insulin (BI), are associated with increased risk of hypoglycemia, which is especially concerning among older adults in poor health. The objective of this study was to investigate prescribing patterns of ADM in older adults according to their health status.METHODS: This case control study analyzed administrative claims between 2013-2017 from a large national payer. The study population was derived from a nationwide database of 84,720 U.S. adults aged ≥65, who were enrolled in Medicare Advantage health insurance plans. Participants had type 2 diabetes on metformin monotherapy, and started a second-line ADM during the study period. The exposure was a binary variable for health status, with poor health defined by end-stage medical conditions, dementia, or residence in a long-term nursing facility. The outcome was a variable identifying which second-line ADM class was started, categorized as SFU, BI, or other (i.e. all other ADM classes combined).RESULTS: Over half of participants (54%) received SFU as initial second-line ADM, 14% received BI, and 32% received another ADM. In multivariable models, the odds of filling SFU or BI was higher for participants in poor health than those in good or intermediate health [OR 1.13 (95% CI 1.05-1.21) and OR 2.34 (95% CI 2.14-2.55), respectively]. SFU and BI were also more commonly filled by older adults with poor glycemic control.CONCLUSIONS: Despite clinical consensus to use caution prescribing SFU and BI among older adults in poor health, these medications remain frequently used in this particularly vulnerable population.

Sexual Violence as a Key Predictor of Depressive Symptoms in Women: Korean Longitudinal Survey of Women and Families

The purpose of this study was to identify the influence of violence on depressive symptoms in women. We analyzed panel data from the Korean Longitudinal Survey of Women and Families ( n = 6,632). Exposure to sexual violence was a significant predictor of the onset of depressive symptoms. After adjusting for all covariates, other predictors included the perception of a poor or very poor health status than normal and participants in their 40s and 50s versus participants younger than 40 years. Assessing exposure to sexual violence might be beneficial for evaluating depressive symptoms in women who are newly diagnosed with depression.

ICU-Acquired Pneumonia Is Associated with Poor Health Post-COVID-19 Syndrome

Background. Some patients previously presenting with COVID-19 have been reported to develop persistent COVID-19 symptoms. While this information has been adequately recognised and extensively published with respect to non-critically ill patients, less is known about the incidence and factors associated with the characteristics of persistent COVID-19. On the other hand, these patients very often have intensive care unit-acquired pneumonia (ICUAP). A second infectious hit after COVID increases the length of ICU stay and mechanical ventilation and could have an influence on poor health post-COVID 19 syndrome in ICU-discharged patients. Methods: This prospective, multicentre, and observational study was carrid out across 40 selected ICUs in Spain. Consecutive patients with COVID-19 requiring ICU admission were recruited and evaluated three months after hospital discharge. Results: A total of 1255 ICU patients were scheduled to be followed up at 3 months; however, the final cohort comprised 991 (78.9%) patients. A total of 315 patients developed ICUAP (97% of them had ventilated ICUAP). Patients requiring invasive mechanical ventilation had more persistent post-COVID-19 symptoms than those who did not require mechanical ventilation. Female sex, duration of ICU stay, development of ICUAP, and ARDS were independent factors for persistent poor health post-COVID-19. Conclusions: Persistent post-COVID-19 symptoms occurred in more than two-thirds of patients. Female sex, duration of ICU stay, development of ICUAP, and ARDS all comprised independent factors for persistent poor health post-COVID-19. Prevention of ICUAP could have beneficial effects in poor health post-COVID-19.

Health Seeking Behavioural Practices of the Elderly in Rural Community of Ekiti State, South-western Nigeria

BackgroundThe ageing process increases the risks of contracting a disease among elderly people. Health-seeking behaviour is poor among the aged in sub-Saharan countries like Nigeria, escalating the burden of Non-communicable diseases and the cost of healthcare which further impact the utilization of Orthodox medicine. This study aims to assess the healthcare-seeking behavioural practices and associated factors among elderly people in Ido-Ekiti.MethodA descriptive cross-sectional study was conducted amongst 420 elderly respondents in Ido-Ekiti. An interviewer-administered semi-structured questionnaire was used to collect information. The data collected were analyzed using SPSS version 25 and results were presented in form of tables and bar charts. Chi-square tests were used to test for associations. All data analysis was done at a 5% level of significance.ResultsThe age range of respondents was between 65-95 years with a mean age of 73.88 +/- 6.84 years and 64.0% within the age range 65-75 years. About 63.3% of the respondents have had an episode of illness in the last year preceding the study and only 35.3% consulted a doctor for treatment (Good Health seeking behaviour), however, 57.9% admitted utilizing any of the following; self-medication, consult spiritualist, use of herbal medicine (poor health-seeking behaviour). The factors statistically significantly associated with respondents’ health-seeking behavioural practices are employment status(p<0.001), educational level (p<0.002), cost of health care, access to the health facility, length of time before consultation, beliefs, and lack of support from relations(p<001). ConclusionThis study shows the majority of elderlies had poor health-seeking behaviour due to educational and .economic factors. Making the free or subsidized cost of health care for the elderly in rural communities and the provision of monthly financial support to the aged by the government will promote and encourage good health-seeking behaviour of old people.

Everyday life of Ukrainians during the years of mass artificial famine of 1921–1923. According to narrative sources

This article examines the daily life of Ukrainians during the years of mass artificial famine. The aim of our article is to analyze the perception of Ukrainians of the new everyday life: the Bolshevik occupation of Ukraine, their food policy, which caused a mass artificial famine and took the lives of 3.5 million Ukrainians. The author analyzes narratives (memories, diaries of contemporaries of events and interviews collected directly by the author and colleagues during ethnographic expeditions). According to the author, the narratives, despite a certain subjectivity, most fully reflect the essence of the era, convey the feelings and experiences of people who found themselves in the grip of a mass artificial famine caused by the policies of the communist regime. As a result of the study, the author concludes that the effects of mass artificial famine were long-lasting. We mean not only the economic, but, first of all, the humanitarian component. The psychology of the people has changed: many Ukrainians have been forced to humiliate themselves to get miserable food, some have been forced to lose their moral face and dare to steal, and anger and hatred for people have intensified. According to medical research, hunger causes anger, greed, cruelty, misanthropy, immorality. Hunger is able to activate atavistic human instincts. Children were the most affected by the mass artificial famine. They were suffered from food shortages, starved, some of them died forever. Those who survived had poor health and a broken psyche. After the mass artificial famine of 1921 – 1923, Ukrainian society transformed its identity. However, the final loss of national origins will occur during the Holodomor genocide of 1932 – 1933.

New Issues in Life Course Research: Which Early-Life Factors Matter for Late-Life Outcomes?

The increased availability of retrospective information about the lives of participants in population panel studies has expanded the range of precursors to include in life course research. However, this also challenges researchers to select among many potential precursors to a late-life outcome and to determine the relative role of factors from different periods in the life course. Each paper in this symposium uses life course information from the Health and Retirement Study (HRS) to examine different late-life outcomes. Speakers will discuss what guided the particular selection of factors and outcome to examine in their study. Sonnega, Helppie-McFall, and Lee focus on indicators of childhood financial and social adversity as potential predictors of early retirement due to poor health. Park, Larkina, and Smith ask if decisions taken in early adulthood about how to balance work-and family-life by individuals and their partners are related to the categories of important life accomplishments older adults report in their life review. Two papers examine precursors of late-life health outcomes. Williams-Farrelly and Smith identified different profiles of physical activity in early- and mid-adulthood. They discuss associations between these profiles and cognitive aging. Whereas social losses, relocation, and multimorbidity are well-documented precursors of Major Depression in old age, Bergmans and Smith asked if poor health in childhood played a distal role. The session concludes with an integrative discussion of issues by Walsemann.

Does Race/Ethnicity Influence the Health of LGBT Older Adults? An Analysis of Adults Aged 50 and Older

Lesbian, gay, bisexual, and transgender (LGBT) health disparities have been well documented in previous research; however, limited research has been conducted on racial/ethnic differences in health among LGBT older adults. Past research suggests that LGBT adults from racial/ethnic minority groups may encounter more discrimination and stigma than white LGBT adults, resulting in poorer health. This study investigated differences in general health between racial/ethnic groups in LGBT adults aged 50 and older from the 2018 and 2019 Behavioral Risk Factor Surveillance System annual surveys. The average ages were 64.2 years for the lesbian, gay, and bisexual (LGB) participants (n=3636) and 65.4 years for the transgender participants (n=972). For self-rated general health, the chi-square analysis indicated that there were significant differences between the racial/ethnic groups for both LGB and transgender participants, χ2(4, n=3630)=46.47, p&lt;.001 and χ2(4, n=969)=19.03, p=.001, respectively. Logistic regression analyses found that, compared to White LGB adults, Hispanic LGB adults had higher odds (aOR=1.8, 95% CI=1.2-2.5) and Asian LGB adults had lower odds of reporting fair or poor health, (aOR=0.43, 95% CI=0.2-0.9). For transgender participants, Hispanic and Other Race adults had approximately twice the odds of reporting fair or poor health compared to White adults (aOR=2.1, 95% CI=1.2-3.7, and aOR=1.9, 95% CI=1.2-3.0, respectively).In conclusion, the results of this study suggest that cultural differences in racial/ethnic groups may influence the health of the LGBT community, making it an important factor to consider in research on LGBT older adults.

Prevalence and Characteristics of Subjective Cognitive Decline Among Caregivers, 2015-2019

Approximately 20% of U.S. adults provide unpaid care to family members and friends with a health condition or disability, and 20% of caregivers reported being in fair or poor health themselves. Much of the assistance caregivers provide have cognitive components, such as medication or financial management, yet little is known about caregivers’ cognitive functioning. Subjective cognitive decline (SCD), or self-reported worsening of memory over the past year, among caregivers could impact the quality of care they provide. This study assessed prevalence of SCD by caregiving status and, among caregivers, the distribution of sociodemographic and other characteristics by SCD status. The study included 93,851 community-dwelling adults aged ≥45 years in 22 states who completed both the Behavioral Risk Factor Surveillance System Cognitive Decline and Caregiving modules during 2015-2019. All data were weighted; comparisons are based on modified Rao-Scott chi-square tests (α=0.05). Among caregivers (n=21,238), 12.6% (95%CI:11.7-13.5) reported SCD, compared with 10.2% (95%CI:9.7-10.7) of non-caregivers (p&lt;0.0001). Caregivers with SCD had more chronic health conditions, lower educational attainment, and were less likely to be married or employed than caregivers without SCD, despite a similar age distribution. Caregivers with SCD were also more likely than caregivers without SCD to report fair or poor health, frequent mental distress, a history of depression, and frequent activity limitations. SCD may negatively impact caregivers’ health, function, and ability to provide care. With the anticipated increases in the need for caregiving, it is critical to understand the cognitive health of caregivers to better support caregivers and care recipients.