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

Keynote Closing Address for EAC12: The Worldwide State of Experimental Archaeology and the Agenda for the Future

This is the final version. Available on open access from EXARC via the link in this recor

Treating Early-Stage CKD With New Medication Therapies:Results of a CKD Patient Survey Informing the 2020 NKF-FDA Scientific Workshop on Clinical Trial Considerations for Developing Treatments for Early Stages of Common, Chronic Kidney Diseases

RATIONALE & OBJECTIVE: With a growing number of medications and therapies available to treat chronic kidney disease (CKD), risk-versus-benefit discussions are increasingly critical. Balancing risks and benefits requires assessing patients’ understanding of these, as well as incorporating patient preferences and tolerance for side effects into shared decision making. STUDY DESIGN: A 26-question online survey was sent to people in the National Kidney Foundation patient email list and posted on associated social media pages to assess the respondents’ willingness and comfort with taking preventative medications during earlier-stage CKD to inform a December 2020 scientific workshop co-sponsored by the National Kidney Foundation and the US Food and Drug Administration on clinical trial considerations in developing treatments for individuals with early stages of CKD. SETTING & POPULATION: Online survey of CKD patients, including broad demographic data and responses to risk-benefit scenarios, with surveys emailed to 20,249 people not identified as currently receiving kidney replacement therapy. ANALYTICAL APPROACH: Survey results are presented as descriptive data. RESULTS: Of 1,029 respondents, 45 self-identified as at risk for CKD, 566 had CKD, 267 had received kidney transplants, 51 were receiving dialysis, and 100 replied other or did not answer. Respondents reported being willing to assume some risk with the goal of preventing the progression of CKD, with a greater willingness to assume risk and treatment burdens the closer they came to late-stage disease. Clinician recommendations regarding kidney therapies and clinician willingness to work with patients to address any side effects were important in respondents’ willingness to initiate and persevere with a new medication. LIMITATIONS: Approximately 10% response rate with limited data on respondents. CONCLUSIONS: Risk-versus-benefit discussions appear key to patients and their care partners making well-informed decisions about taking a new medication that may or may not help the progression of their kidney disease. Future tools and strategies are needed to facilitate informed discussions of treatment in early-stage kidney disease

Bardoxolone Methyl Improves Kidney Function in Patients with Chronic Kidney Disease Stage 4 and Type 2 Diabetes:Post-Hoc Analyses from Bardoxolone Methyl Evaluation in Patients with Chronic Kidney Disease and Type 2 Diabetes Study

Background: Increases in measured inulin clearance, measured creatinine clearance, and estimated glomerular filtration rate (eGFR) have been observed with bardoxolone methyl in 7 studies enrolling approximately 2,600 patients with type 2 diabetes (T2D) and chronic kidney disease (CKD). The largest of these studies was Bardoxolone Methyl Evaluation in Patients with Chronic Kidney Disease and Type 2 Diabetes (BEACON), a multinational, randomized, double-blind, placebo-controlled phase 3 trial which enrolled patients with T2D and CKD stage 4. The BEACON trial was terminated after preliminary analyses showed that patients randomized to bardoxolone methyl experienced significantly higher rates of heart failure events. We performed post-hoc analyses to characterize changes in kidney func-tion induced by bardoxolone methyl. Methods: Patients in -BEACON (n = 2,185) were randomized 1: 1 to receive oncedaily bardoxolone methyl (20 mg) or placebo. We compared the effects of bardoxolone methyl and placebo on a post-hoc composite renal endpoint consisting of = 30% decline from baseline in eGFR, eGFR <15 mL/min/1.73 m2, and end-stage renal disease (ESRD) events (provision of dialysis or kidney transplantation). Results: Consistent with prior studies, patients randomized to bardoxolone methyl experienced mean increases in eGFR that were sustained through study week 48. Moreover, increases in eGFR from baseline were sustained 4 weeks after cessation of treatment. Patients randomized to bardoxolone methyl were significantly less likely to experience the composite renal endpoint (hazards ratio 0.48 [95% CI 0.36-0.64]; p <0.0001). Conclusions: Bardoxolone methyl preserves kidney function and may delay the onset of ESRD in patients with T2D and stage 4 CKD. (C) 2018 The Author(s) Published by S. Karger AG, Base