Ageism Among Healthcare Professionals: The Influence of Personal Aging Anxiety, Job Role, and Work Setting on Attitudes Toward Older Patients

Older adults make up a significant and increasing proportion of the U.S. population and are frequent users of healthcare services. Ageism in healthcare, driven by an incomplete and narrowly biomedical perspective on aging, has been linked to various problematic outcomes for older patients, including under- and over-treatment. The purpose of this study was to use the theory of relational ageism to explore the relationship between personal aging anxiety among healthcare professionals and their attitudes to older patients, considering the potentially moderating factors of job role and work setting. Using convenience sampling, clinical healthcare professionals working for a mid-sized, regional healthcare system in the Mid-Atlantic region of the United States were invited to participate in an online survey, resulting in a sample of N = 145. Independent variables in this study included the sociodemographic variables of gender, age, race, ethnicity, level of education, formal geriatric or gerontological education, and years of expression, plus job role, work setting, and aging anxiety scores as measured by the Aging Anxiety Scale. The dependent variable was attitudes to older patients as measured by the Geriatric Attitudes Scale. Regression analysis findings suggest that while having formal geriatric or gerontological education was associated with more negative attitudes to older patients, other sociodemographic variables including gender, age, race, ethnicity, level of education, and years of experience were not predictive of attitudes to older patients. While physicians had more negative attitudes toward older patients than did nurses, therapists, and other types of clinicians, work setting was not predictive of attitudes toward older patients. Study findings also indicate that higher levels of personal aging anxiety of healthcare professionals were correlated with more negative attitudes to older patients. This study provides information that can inform diversity training for healthcare professionals in order to improve attitudes toward older patients and reduce age discrimination in healthcare. A key recommendation is the inclusion of an exploration of healthcare professionals’ internalized attitudes to aging in any diversity training in order to increase awareness that these internalized attitudes about aging may influence their attitudes to older patients

Estimated Glomerular Filtration Rate, Albuminuria, and Adverse Outcomes. An Individual-Participant Data Meta-Analysis

IMPORTANCE: Chronic kidney disease (low estimated glomerular filtration rate [eGFR] or albuminuria) affects approximately 14% of adults in the US. OBJECTIVE: To evaluate associations of lower eGFR based on creatinine alone, lower eGFR based on creatinine combined with cystatin C, and more severe albuminuria with adverse kidney outcomes, cardiovascular outcomes, and other health outcomes. DESIGN, SETTING, AND PARTICIPANTS: Individual-participant data meta-analysis of 27 503 140 individuals from 114 global cohorts (eGFR based on creatinine alone) and 720 736 individuals from 20 cohorts (eGFR based on creatinine and cystatin C) and 9 067 753 individuals from 114 cohorts (albuminuria) from 1980 to 2021. EXPOSURES: The Chronic Kidney Disease Epidemiology Collaboration 2021 equations for eGFR based on creatinine alone and eGFR based on creatinine and cystatin C; and albuminuria estimated as urine albumin to creatinine ratio (UACR). MAIN OUTCOMES AND MEASURES: The risk of kidney failure requiring replacement therapy, all-cause mortality, cardiovascular mortality, acute kidney injury, any hospitalization, coronary heart disease, stroke, heart failure, atrial fibrillation, and peripheral artery disease. The analyses were performed within each cohort and summarized with random-effects meta-analyses. RESULTS: Within the population using eGFR based on creatinine alone (mean age, 54 years [SD, 17 years]; 51% were women; mean follow-up time, 4.8 years [SD, 3.3 years]), the mean eGFR was 90 mL/min/1.73 m2 (SD, 22 mL/min/1.73 m2) and the median UACR was 11 mg/g (IQR, 8-16 mg/g). Within the population using eGFR based on creatinine and cystatin C (mean age, 59 years [SD, 12 years]; 53% were women; mean follow-up time, 10.8 years [SD, 4.1 years]), the mean eGFR was 88 mL/min/1.73 m2 (SD, 22 mL/min/1.73 m2) and the median UACR was 9 mg/g (IQR, 6-18 mg/g). Lower eGFR (whether based on creatinine alone or based on creatinine and cystatin C) and higher UACR were each significantly associated with higher risk for each of the 10 adverse outcomes, including those in the mildest categories of chronic kidney disease. For example, among people with a UACR less than 10 mg/g, an eGFR of 45 to 59 mL/min/1.73 m2 based on creatinine alone was associated with significantly higher hospitalization rates compared with an eGFR of 90 to 104 mL/min/1.73 m2 (adjusted hazard ratio, 1.3 [95% CI, 1.2-1.3]; 161 vs 79 events per 1000 person-years; excess absolute risk, 22 events per 1000 person-years [95% CI, 19-25 events per 1000 person-years]). CONCLUSIONS AND RELEVANCE: In this retrospective analysis of 114 cohorts, lower eGFR based on creatinine alone, lower eGFR based on creatinine and cystatin C, and more severe UACR were each associated with increased rates of 10 adverse outcomes, including adverse kidney outcomes, cardiovascular diseases, and hospitalizations

Associations of estimated glomerular filtration rate and albuminuria with adverse outcomes: An individual participant meta-analysis

Importance: Chronic kidney disease (low eGFR or albuminuria) affects approximately 14% of people in the United States. Objective: To evaluate associations of lower eGFR using creatinine alone (eGRFcr), lower eGFR using creatinine combined with cystatin C (eGFRcr-cys), and higher albuminuria with adverse kidney outcomes, cardiovascular outcomes, and other health outcomes. Design, setting, participants: Retrospective individual-level data analysis of 27,503,140 participants from 114 global cohorts (eGFRcr) and 720,736 participants from 20 cohorts (eGFRcr-cys) and 9,067,753 participants from 114 cohorts (albuminuria) from 1980 to 2021. Exposures: CKD-EPI 2021 equations for eGFRcr and eGFRcr-cys; albuminuria estimated as urine albumin-to-creatinine ratio (ACR). Main outcomes and measures: The risk of kidney failure with replacement therapy, all-cause mortality, cardiovascular mortality, acute kidney injury, any hospitalization, coronary heart disease, stroke, heart failure, atrial fibrillation, and peripheral artery disease. Analyses were performed within each cohort and summarized with random-effect meta-analyses. Results: Within the eGFRcr population (mean age: 54 years, 51% women), mean eGFRcr was 90 ml/min/1.73 m2 (SD, 22) and median ACR was 11 mg/g (interquartile range 8-16 mg/g). Within the eGFRcr-cys population (mean age: 59 years, 53% women), mean eGFRcr-cys was 88 ml/min/1.73 m2 (SD, 22) and median ACR was 9 mg/g (interquartile range 6-18 mg/g). Lower eGFR (whether based on eGFRcr or eGFRcr-cys) and higher ACR were each associated with higher risk of all ten adverse outcomes, including in the mildest categories of CKD. For example, among people with ACR <10 mg/g, an eGFRcr 45-59 ml/min/1.73 m2 was associated with significantly higher hospitalization rates, compared to eGFR 90-105 ml/min/1.73 m2 (adjusted hazard ratio 1.28, 95% CI: 1.24-1.32; 101 vs. 79 events per 1000 person-years; excess absolute risk 22 events per 1000 person-years, 95% CI: 19 to 25). Conclusions and relevance: In this retrospective analysis of 114 cohorts, lower eGFRcr, lower eGFRcr-cys, and higher ACR were each associated with increased rates of 10 adverse outcomes, including adverse kidney outcomes, cardiovascular diseases, and hospitalization

Estimated glomerular filtration rate, albuminuria and adverse outcomes : An Individual-Participant Data Meta-Analysis

Funding The CKD Prognosis Consortium (CKD-PC) Data Coordinating Center is funded in part by a program grant from the US National Kidney Foundation and the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK100446). A variety of sources have supported enrollment and data collection including laboratory measurements, and follow-up in the collaborating cohorts of the CKD-PC. These funding sources include government agencies such as national institutes of health and medical research councils as well as foundations and industry sponsors listed in Supplemental Appendix 3. Acknowledgements CKD-PC investigators/collaborators (cohort acronyms/abbreviations are listed in Supplemental Appendix 2. No personal compensation was received for this study; participating cohorts received modest compensation for preparation of data sent to CKD-PCPeer reviewedPostprin

Estimated Glomerular Filtration Rate, Albuminuria, and Adverse Outcomes:An Individual-Participant Data Meta-Analysis

Importance: Chronic kidney disease (low estimated glomerular filtration rate [eGFR] or albuminuria) affects approximately 14% of adults in the US. Objective: To evaluate associations of lower eGFR based on creatinine alone, lower eGFR based on creatinine combined with cystatin C, and more severe albuminuria with adverse kidney outcomes, cardiovascular outcomes, and other health outcomes. Design, Setting, and Participants: Individual-participant data meta-analysis of 27503140 individuals from 114 global cohorts (eGFR based on creatinine alone) and 720736 individuals from 20 cohorts (eGFR based on creatinine and cystatin C) and 9067753 individuals from 114 cohorts (albuminuria) from 1980 to 2021. Exposures: The Chronic Kidney Disease Epidemiology Collaboration 2021 equations for eGFR based on creatinine alone and eGFR based on creatinine and cystatin C; and albuminuria estimated as urine albumin to creatinine ratio (UACR). Main Outcomes and Measures: The risk of kidney failure requiring replacement therapy, all-cause mortality, cardiovascular mortality, acute kidney injury, any hospitalization, coronary heart disease, stroke, heart failure, atrial fibrillation, and peripheral artery disease. The analyses were performed within each cohort and summarized with random-effects meta-analyses. Results: Within the population using eGFR based on creatinine alone (mean age, 54 years [SD, 17 years]; 51% were women; mean follow-up time, 4.8 years [SD, 3.3 years]), the mean eGFR was 90 mL/min/1.73 m2(SD, 22 mL/min/1.73 m2) and the median UACR was 11 mg/g (IQR, 8-16 mg/g). Within the population using eGFR based on creatinine and cystatin C (mean age, 59 years [SD, 12 years]; 53% were women; mean follow-up time, 10.8 years [SD, 4.1 years]), the mean eGFR was 88 mL/min/1.73 m2(SD, 22 mL/min/1.73 m2) and the median UACR was 9 mg/g (IQR, 6-18 mg/g). Lower eGFR (whether based on creatinine alone or based on creatinine and cystatin C) and higher UACR were each significantly associated with higher risk for each of the 10 adverse outcomes, including those in the mildest categories of chronic kidney disease. For example, among people with a UACR less than 10 mg/g, an eGFR of 45 to 59 mL/min/1.73 m2based on creatinine alone was associated with significantly higher hospitalization rates compared with an eGFR of 90 to 104 mL/min/1.73 m2(adjusted hazard ratio, 1.3 [95% CI, 1.2-1.3]; 161 vs 79 events per 1000 person-years; excess absolute risk, 22 events per 1000 person-years [95% CI, 19-25 events per 1000 person-years]). Conclusions and Relevance: In this retrospective analysis of 114 cohorts, lower eGFR based on creatinine alone, lower eGFR based on creatinine and cystatin C, and more severe UACR were each associated with increased rates of 10 adverse outcomes, including adverse kidney outcomes, cardiovascular diseases, and hospitalizations.</p

Estimated Glomerular Filtration Rate, Albuminuria, and Adverse Outcomes: An Individual-Participant Data Meta-Analysis

Chronic kidney disease (low estimated glomerular filtration rate [eGFR] or albuminuria) affects approximately 14% of adults in the US.To evaluate associations of lower eGFR based on creatinine alone, lower eGFR based on creatinine combined with cystatin C, and more severe albuminuria with adverse kidney outcomes, cardiovascular outcomes, and other health outcomes.Individual-participant data meta-analysis of 27 503 140 individuals from 114 global cohorts (eGFR based on creatinine alone) and 720 736 individuals from 20 cohorts (eGFR based on creatinine and cystatin C) and 9 067 753 individuals from 114 cohorts (albuminuria) from 1980 to 2021.The Chronic Kidney Disease Epidemiology Collaboration 2021 equations for eGFR based on creatinine alone and eGFR based on creatinine and cystatin C; and albuminuria estimated as urine albumin to creatinine ratio (UACR).The risk of kidney failure requiring replacement therapy, all-cause mortality, cardiovascular mortality, acute kidney injury, any hospitalization, coronary heart disease, stroke, heart failure, atrial fibrillation, and peripheral artery disease. The analyses were performed within each cohort and summarized with random-effects meta-analyses.Within the population using eGFR based on creatinine alone (mean age, 54 years [SD, 17 years]; 51% were women; mean follow-up time, 4.8 years [SD, 3.3 years]), the mean eGFR was 90 mL/min/1.73 m2 (SD, 22 mL/min/1.73 m2) and the median UACR was 11 mg/g (IQR, 8-16 mg/g). Within the population using eGFR based on creatinine and cystatin C (mean age, 59 years [SD, 12 years]; 53% were women; mean follow-up time, 10.8 years [SD, 4.1 years]), the mean eGFR was 88 mL/min/1.73 m2 (SD, 22 mL/min/1.73 m2) and the median UACR was 9 mg/g (IQR, 6-18 mg/g). Lower eGFR (whether based on creatinine alone or based on creatinine and cystatin C) and higher UACR were each significantly associated with higher risk for each of the 10 adverse outcomes, including those in the mildest categories of chronic kidney disease. For example, among people with a UACR less than 10 mg/g, an eGFR of 45 to 59 mL/min/1.73 m2 based on creatinine alone was associated with significantly higher hospitalization rates compared with an eGFR of 90 to 104 mL/min/1.73 m2 (adjusted hazard ratio, 1.3 [95% CI, 1.2-1.3]; 161 vs 79 events per 1000 person-years; excess absolute risk, 22 events per 1000 person-years [95% CI, 19-25 events per 1000 person-years]).In this retrospective analysis of 114 cohorts, lower eGFR based on creatinine alone, lower eGFR based on creatinine and cystatin C, and more severe UACR were each associated with increased rates of 10 adverse outcomes, including adverse kidney outcomes, cardiovascular diseases, and hospitalizations. Importance Objective Design, setting, and participants Exposures Main outcomes and measures Results Conclusions and relevance</h4