Comparing Models of Frailty: The Health and Retirement Study

To operationalize and compare three models of frailty, each representing a distinct theoretical view of frailty: as deficiencies in function (Functional Domains model), as an index of health burden (Burden model), and as a biological syndrome (Biologic Syndrome model). DESIGN : Cross-sectional analysis. SETTING : 2004 wave of the Health and Retirement Study, a nationally representative, longitudinal health interview survey. PARTICIPANTS : Adults aged 65 and older (N=11,113) living in the community and in nursing homes in the United States. MEASUREMENTS : The outcome measure was the presence of frailty, as defined according to each frailty model. Covariates included chronic diseases and sociodemographic characteristics. RESULTS : Almost one-third (30.2%) of respondents were frail according to at least one model; 3.1% were frail according to all three models. The Functional Domains model showed the least overlap with the other models. In contrast, 76.1% of those classified as frail according to the Biologic Syndrome model and 72.1% of those according to the Burden model were also frail according to at least one other model. Older adults identified as frail according to the different models differed in sociodemographic and chronic disease characteristics. For example, the Biologic Syndrome model demonstrated substantial associations with older age (adjusted odds ratio (OR)=10.6, 95% confidence interval (CI)=6.1–18.5), female sex (OR=1.7, 95% CI=1.2–2.5), and African-American ethnicity (OR=2.1, % CI=1.0–4.4). CONCLUSION : Different models of frailty, based on different theoretical constructs, capture different groups of older adults. The different models may represent different frailty pathways or trajectories to adverse outcomes such as disability and death.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66063/1/j.1532-5415.2009.02225.x.pd

Establishing the First Geriatric Medicine Fellowship Program in Ghana

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151282/1/jgs16014.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151282/2/jgs16014_am.pd

Perspectives on disclosure of the dementia diagnosis among primary care physicians in Japan: a qualitatively driven mixed methods study

Abstract Background The number of dementia patients in Japan is projected to reach seven million by 2025. While modern ethicists have largely reached the conclusion that full disclosure of dementia serves the best interest of patient, the implications of disclosure of a dementia diagnosis remains an underexplored area of research in Japan. The purpose of this study was to explore primary care physicians’ perspectives relative to the practice of disclosure of the dementia diagnosis. Methods In this qualitatively driven mixed methods project, we conducted semi-structured interviews with 24 primary care physicians using purposeful sampling to identify rural and urban representation. All interview recordings were transcribed verbatim and analyzed thematically. The research team iteratively conducted discussions of the concepts as they emerged until reaching thematic saturation. The summary was distributed to the participants for member checking and we incorporated their feedback into the final analysis. Results Of 24 participants, 12 practice in rural areas and 12 practice in urban/suburban areas. Participants’ attitudes varied in whether or not to disclose dementia diagnosis to the patients, and in the level of clarity of the name and the prognosis of the disease. Participants who were more comfortable in practicing disclosure were communicating collectively to the patients and their family members and those who were less comfortable practicing disclosure were concerned about patients’ feelings and had negative perceptions given the insidious progression of the disease. Conclusion We found substantive individual differences in the approach to disclosure of the diagnosis of dementia and the level of comfort among primary care physicians. More dialogue about this issue and training to equip primary care physicians lacking confidence in their approach may be required.https://deepblue.lib.umich.edu/bitstream/2027.42/149180/1/12875_2019_Article_964.pd

Age-Related Differences in Health-Related Quality of Life in COPD

OBJECTIVE: Younger persons with COPD report worse health-related quality of life (HRQL) than do older individuals. The factors explaining these differences remain unclear. The objective of this article was to explore factors associated with age-related differences in HRQL in COPD. METHODS: Cross-sectional analysis of participants with COPD, any Global Initiative for Chronic Obstructive Lung Disease grade of airflow limitation, and ≥ 50 years old in two cohorts: the Genetic Epidemiology of COPD (COPDGene) study and the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS). We compared St. George's Respiratory Questionnaire (SGRQ) scores by age group: middle-aged (age, 50-64) vs older (age, 65-80) adults. We used multivariate linear modeling to test associations of age with HRQL, adjusting for demographic and clinical characteristics and comorbidities. RESULTS: Among 4,097 participants in the COPDGene study (2,170 middle-aged and 1,927 older adults) SGRQ total scores were higher (worse) among middle-aged (mean difference, -4.2 points; 95% CI, -5.7 to -2.6; P < .001) than older adults. Age had a statistically significant interaction with dyspnea (P < .001). Greater dyspnea severity (modified Medical Research Council ≥ 2, compared with 0-1) had a stronger association with SGRQ score among middle-aged (β, 24.6; 95% CI, 23.2-25.9) than older-adult (β, 21.0; 95% CI, 19.6-22.3) participants. In analyses using SGRQ as outcome in 1,522 participants in SPIROMICS (598 middle-aged and 924 older adults), we found similar associations, confirming that for the same severity of dyspnea there is a stronger association with HRQL among younger individuals. CONCLUSIONS: Age-related differences in HRQL may be explained by a higher impact of dyspnea among younger subjects with COPD. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT00608764 and No.: NCT01969344; URL: www.clinicaltrials.gov

Contrasting Effects of Geriatric Versus General Medical Multimorbidity on Quality of Ambulatory Care

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108659/1/jgs12989.pd

Using Fresh Frozen Plasma for Acute Airway Angioedema to Prevent Intubation in the Emergency Department: A Retrospective Cohort Study

Background. Angioedema (AE) is a common condition which can be complicated by laryngeal edema, having up to 40% mortality. Although sporadic case reports attest to the benefits of fresh frozen plasma (FFP) in treating severe acute bouts of AE, little evidence-based support for this practice is available at present. Study Objectives. To compare the frequency, duration of intubation, and length of intensive care unit (ICU) stay in patients with acute airway AE, with and without the use of FFP. Methods. A retrospective cohort study was conducted, investigating adults admitted to large community hospital ICU with a diagnosis of AE during the years of 2007–2012. Altogether, 128 charts were reviewed for demographics, comorbidities, hospital courses, and outcomes. A total of 20 patients received FFP (108 did not). Results. Demographics and comorbidities did not differ by treatment group. However, nontreated controls did worse in terms of intubation frequency (60% versus 35%; p=0.05) and ICU stay (3.5 days versus 1.5 days; p<0.001). Group outcomes were otherwise similar. Conclusion. In an emergency department setting, the use of FFP should be considered in managing acute airway nonhereditary AE (refractory to steroid, antihistamine, and epinephrine). Larger prospective, better controlled studies are needed to devise appropriate treatment guidelines

Disputes of Self-reported Chronic Disease Over Time: The Role of Race, Ethnicity, Nativity, and Language of Interview

BACKGROUND: Respondents in longitudinal health interview surveys may inconsistently report their chronic diseases across interview waves. Racial/ethnic minority adults have an increased burden of chronic diseases and may dispute chronic disease reports more frequently. OBJECTIVE: We evaluated the longitudinal association between race/ethnicity, nativity, and language of interview with disputing previously reported chronic diseases. METHODS: We performed secondary data analysis of nationally representative longitudinal data (Health and Retirement Study, 1998-2010) of adults 51 years or older (n=23,593). We estimated multilevel mixed-effects logistic models of disputes of previously reported chronic disease (hypertension, heart disease, lung disease, diabetes, cancer, stroke, arthritis). RESULTS: Approximately 22% of Health and Retirement Study respondents disputed prior chronic disease self-reports across the entire study period; 21% of non-Latino white, 20.5% of non-Latino black, and 28% of Latino respondents disputed. In subgroup comparisons of model-predicted odds using postestimation commands, Latinos interviewed in Spanish have 34% greater odds of disputing compared with non-Latino whites interviewed in English and 35% greater odds of dispute relative to non-Latino blacks interviewed in English. CONCLUSIONS: The odds of disputing a prior chronic disease report were substantially higher for Latinos who were interviewed in Spanish compared with non-Latino white or black counterparts interviewed in English, even after accounting for other sociodemographic factors, cognitive declines, and time-in-sample considerations. Our findings point toward leveraging of multiple sources of data to triangulate information on chronic disease status as well as investigating potential mechanisms underlying the higher probability of dispute among Spanish-speaking Latino respondents

Contrasting effects of geriatric versus general medical multimorbidity on quality of ambulatory care.

ObjectivesTo determine whether greater burden of geriatric conditions would have contrasting effects on quality of care (QOC) than nongeriatric, general medical conditions.DesignCross-sectional observation over 1&nbsp;year of ambulatory care.SettingThe Assessing Care of Vulnerable Elders-2 study.ParticipantsOlder adults prospectively screened for falls, incontinence, and dementia (N&nbsp;=&nbsp;644).MeasurementsParticipant-level QOC in absolute percentage points calculated using 65 ambulatory care care-process quality indicators (QIs) for 13 general medical and geriatric conditions (#QIs provided/#QIs eligible). Secondary outcomes were geriatric QOC (a subset of 38 geriatric care QIs) and medical QOC (the 27 remaining nongeriatric QIs). Exposure variables were number of six medical conditions (medical comorbidity) and six geriatric conditions (geriatric comorbidity), controlling for age, sex, number of primary care visits, and site.ResultsMedical and geriatric comorbidity were unrelated to each other (correlation coefficient&nbsp;=&nbsp;0.04, P&nbsp;=&nbsp;.27) yet had opposite effects on QOC. Each additional medical condition was associated with a 3.2-percentage point (95% confidence interval (CI)&nbsp;=&nbsp;2.3-4.2 percentage point) increment in QOC, and each additional geriatric condition was associated with 4.9-percentage point (95% CI&nbsp;=&nbsp;3.5-6.5 percentage point) decrement in QOC. Participants with greater geriatric comorbidity received poorer medical and geriatric QOC.ConclusionGreater burden of geriatric conditions, or geriatric multimorbidity, is associated with poorer QOC. Geriatric multimorbidity should be targeted for better care using a comprehensive approach

Trajectories of functional change among long stayers in nursing homes: Does baseline impairment matter?

Objectives: To describe the degree of loneliness among the visually impaired elderly and to make a comparison with a matched reference group of the normally sighted elderly. In addition, we examined self-management abilities (SMAs) as determinants of loneliness among the visually impaired elderly. Method: In a cross-sectional study, 173 visually impaired elderly persons completed telephone interviews. Loneliness and SMAs were assessed with the Loneliness Scale of De Jong Gierveld and the SMAS-30, respectively. Results: The prevalence of loneliness among the visually impaired elderly was higher compared with the reference group (50% vs. 29%; p < .001). Multivariate hierarchical regression analysis showed that the SMA self-efficacy, partner status, and self-esteem were determinants of loneliness. Severity and duration of visual impairment had no effect on loneliness. Discussion: The relationship between SMAs (i.e., self-efficacy) and loneliness is promising, as SMAs can be learned through training. Consequently, self-management training may reduce feelings of loneliness

Team VA Video Connect (VVC) to optimize mobility and physical activity in post-hospital discharge older veterans: baseline assessment

Abstract Background Telehealth is increasingly used for rehabilitation and exercise but few studies include older adult participants with comorbidities and impairment, particularly cognitive. Using Veterans Administration Video Connect (VVC), the aim of the present study is to present the screening, recruitment, baseline assessment, and initial telehealth utilization of post-hospital discharge Veterans in a VVC home-telehealth based program to enhance mobility and physical activity. Methods Older adult Veterans (n = 45, mean age 73), recently discharged from the hospital with physical therapy goals, were VVC-assessed in self-report and performance-based measures, using test adaptations as necessary, by a clinical pharmacy specialist and social worker team. Results Basic and instrumental ADL disabilities were common as were low mobility (Short Portable Performance Battery) and physical activity levels (measured by actigraphy). Half had Montreal Cognitive Assessment (MoCA) scores in the mild cognitive impairment range (< 24). Over 2/3 of the participants used VA-supplied tablets. While half of the Veterans were fully successful in VVC, 1/3 of these and an additional group with at least one failed connection requested in-person visits for assistance. One-quarter had no VVC success and sought help for tablet troubleshooting, and half of these eventually “gave up” trying to connect; difficulty with using the computer and physical impairment (particularly dexterity) were described prominently in this group. On the other hand, Veterans with at least mild cognitive impairment (based on MoCA scores) were present in all connectivity groups and most of these used caregiver support to facilitate VVC. Conclusions Disabled older post-hospital discharged Veterans with physical therapy goals can be VVC-assessed and enrolled into a mobility/physical activity intervention. A substantial proportion required technical support, including in-person support for many. Yet, VVC seems feasible in those with mild cognitive impairment, assuming the presence of an able caregiver. Modifications of assessment tools were needed for the VVC interface, and while appearing feasible, will require further study. Trial registration ClinicalTrials.gov NCT 04045054 05/08/2019.http://deepblue.lib.umich.edu/bitstream/2027.42/173552/1/12877_2021_Article_2454.pd