Aging and its Impacts

The 2020 Census is projected to show 77 million Americans will be age 65 or older, up from 40 million in 2010. Are you ready for the continued rise? Discuss the challenges and opportunities regarding our aging population

Rethinking Our Future: Moving Past December 31, 2010

This presentation features: Past, Present and Future; Redefining Old Age…Young-Old (Neugarten); A Lesson to be Learned…; Young-Old Concerns…; Counties with the highest percentage of 65 -74; Aging is a process…not an event; Redefining old age…Oldest-Old (Neugarten); Oldest-Old Concerns; Counties with the highest percentage 85 +; A glimpse of the state; Forget the Sweet Little Old Lady Model…; When does it all begin? The Nebraska example:; Aging of the US population; What’s All the Fuss About Aging?; Age at Time of Death; Changes are a happenin’; From childhood education to gerontology; Alpha Boomers -coined by Alan Wurtzel; AARP and NASCAR -Connecting the Generations; Where are all the alpha boomers???; Parents supporting adult children; Parental Support; Potential Implications of Parental Support; Caregiving 2011 -It’s not for the faint of heart…; The Alzheimer’s Generation; Future Considerations; and Our Future??

Key Finding of the 2022 Nebraska End-of-Life Survey: A Report for Nebraska Hospice and Palliative Care Association

The 2022 End-of-Life survey is a continuation by the Nebraska Hospice and Palliative Care Association (NHPCA) to understand the knowledge, beliefs, and actions of Nebraskans and their end-of-life (EOL) wishes. Previous surveys conducted in 2003, 2006, 2010, and 2017 helped to inform the 2022 survey. Results of previous surveys can be found on the NHPCA website. The University of Nebraska-Lincoln Bureau of Sociological Research contracted with NHPCA to prepare, distribute, and enter survey data for a random sample of Nebraskans 19 years of age and older. Survey invitations were sent to 3,000 Nebraskans 19 years of age and older in one of six regions to ensure adequate representation across the state. Weighting was used to make certain of adequate representation by age and sex. Weighting was not used for oversampling for race or ethnicity. Behavioral health regions are shown on page five highlighting the statewide nature of this survey. Surveys were evenly distributed and completed throughout these regions. Respondents were provided with two options for completing the survey: online using a Qualtrics survey or on paper. 635 adults completed the survey. 490 were completed on paper and 145 surveys were completed online. The response rate for the 2022 survey was 21%. Secondary analysis of the data was completed by University of Nebraska at Omaha, Creighton University, and University of Nebraska Medical Center faculty, staff, and doctoral students. Findings from this analysis are on the pages that follow. Included in this report are key findings from the 2022 survey. Respondent demographics, knowledge of hospice care and knowledge of palliative care are presented separately. Also presented are respondents’ desired preference for where to receive hospice care, knowledge of payment sources for hospice care and palliative care, and their interest in learning more about hospice care and palliative care. We also include highlights of respondents’ attitudes about death and illness along with the completion of EOL planning documents. Information about income is presented based on a combination of Internal Revenue Service Tax Brackets from 2022, the 2022 Federal Poverty level, and average Social Security payments for 2022. Because the 2022 survey took place at the end of a global pandemic, we have included select items from the 2017 survey to compare with the 2022 results. The purpose for including this additional information is to see if any changes in awareness of services and/or usage occurred between the two time periods. This issue, raised by a member of this team and the nursing community, emphasizes the importance of EOL care in relation to the pandemic. What do people know and how does this influence their attitudes about EOL care? While no definitive conclusions can be drawn from these results, they do offer insight into the attitudes of responding Nebraskans to the state of hospice care and palliative care and provide a roadmap for future survey questions

State of Nebraska Digital Equity Plan: Understanding the Digital Equity Needs of Covered Populations in Nebraska

According to 2021 estimates from the U.S. Census Bureau’s American Community Survey, 7% of Nebraska households do not have access to a computer and 6% of Nebraska households have access to a computer but no internet. Although recent efforts suggest there is momentum and government action at both the federal and state levels to address lack of broadband (Hammel, 2023; Newman, 2023), this still leaves a considerable number of Nebraskans without access to reliable broadband in the meantime. Furthermore, broadband access is moot if Nebraskans do not have access or cannot afford technology and the cost of internet in the first place. The purpose of this report is to take a deeper look at specific covered populations in Nebraska who are more likely to be without affordable, reliable technology access and, therefore, are disproportionally impacted by the digital divide. The research team, representing the University of Nebraska at Omaha Center for Public Affairs Research and Department of Gerontology, was approached by the Nebraska Information Technology Commission to conduct focus groups with covered populations. Key findings from focus groups are shared. Findings indicate that access to technology and internet is not only vital for all Nebraskans but is also costprohibitive for already marginalized populations. Moving forward, these findings will inform the creation of a state digital equity plan for Nebraska

Standard wound management versus negative-pressure wound therapy in the treatment of adult patients having surgical incisions for major trauma to the lower limb — a two-arm parallel group superiority randomised controlled trial : protocol for Wound Healing in Surgery for Trauma (WHIST)

Introduction Patients with closed high-energy injuries associated with major trauma have surprisingly high rates of surgical site infection in incisions created during fracture fixation. One factor that may reduce the risk of surgical site infection is the type of dressing applied over the closed surgical incision. In this multicentre randomised clinical trial, negative-pressure wound therapy will be compared with standard dressings with outcomes of deep infection, quality of life, pain and disability. Methods and analysis Adult patients presenting to hospital within 72 hours of sustaining major trauma, requiring a surgical incision to treat a fractured lower limb, are eligible for inclusion. Randomisation, stratified by trial centre, open/closed fracture at presentation and Injury Severity Score (ISS) ≤15 versus ISS ≥16 will be administered via a secure web-based service using minimisation. The random allocation will be to either standard wound management or negative-pressure wound therapy. Trial participants will usually have clinical follow-up at the local fracture clinic for a minimum of 6 months, as per standard National Health Service practice. Diagnosis of deep infection will be recorded at 30 days. Functional, pain and quality of life outcome data will be collected using the Disability Rating Index, Douleur Neuropathique Questionnaire and Euroqol - 5 Dimension - 5 level (EQ-5D-5L) questionnaires at 3 months and 6 months postinjury. Further data will be captured on resource use and any late postoperative complications. Longer term outcomes will be assessed annually for 5 years and reported separately. Ethics and dissemination National Research Ethics Committee approved this study on 16 February 2016 16/WM/0006. The National Institute for Health Research Health Technology Assessment monograph and a manuscript to a peer-reviewed journal will be submitted on completion of this trial. The results of this trial will inform clinical practice on the clinical and cost-effectiveness of the treatment of this injury

A Report to the Nebraska State Unit on Aging: Perspectives of Nebraskans Age 50 and Older

At the request of the Nebraska State Unit on Aging, the research team compiled information to gain an understanding of the needs of Nebraskans age 50 and older now and in the future. We solicited information about important concerns they face and the programs and services designed to address them. The research team also analyzed U.S. Census Bureau data for the State of Nebraska from the 2021 Population and Housing Units Estimate Program. Our analyses of the state’s demographic profile indicated that more than one third (34%) of Nebraska’s population in 2021 was age 50 and older, with higher concentrations of individuals age 50 and older in rural counties and higher concentrations of individuals age 49 and younger in urban and suburban counties. The state’s population age 50 and older is predominantly White, non-Latino (88%)

Associatioin of Plasma Aβ Peptides with Blood Pressure in the Elderly

Background Aß peptides are often considered as catabolic by-products of the amyloid ß protein precursor (APP), with unknown physiological functions. However, several biological properties have been tentatively attributed to these peptides, including a role in vasomotion. We assess whether plasma Aß peptide levels might be associated with systolic and diastolic blood pressure values (SBP and DBP, respectively). Methodology/Principal Findings Plasma Aß1-40 and Aß1-42 levels were measured using an xMAP-based assay in 1,972 individuals (none of whom were taking antihypertensive drugs) from 3 independent studies: the French population-based 3C and MONA-LISA (Lille) studies (n = 627 and n = 769, respectively) and the Australian, longitudinal AIBL study (n = 576). In the combined sample, the Aß1-42/ Aß1-40 ratio was significantly and inversely associated with SBP (p = 0.03) and a similar trend was observed for DBP (p = 0.06). Using the median age (69) as a cut-off, the Aß1-42/Aß1-40 ratio was strongly associated with both SBP and DBP in elderly individuals (p = 0.002 and p = 0.03, respectively). Consistently, a high Aß1-42/ Aß1-40 ratio was associated with a lower risk of hypertension in both the combined whole sample (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.56-0.90) and (to an even greater extent) in the elderly subjects (OR, 0.53; 95% CI, 0.37–0.75). Lastly, all these associations appeared to be primarily driven by the level of plasma Aß1-40. Conclusion The plasma Aß1-42/Aß1-40 ratio is inversely associated with SBP, DBP and the risk of hypertension in elderly subjects, suggesting that Aß peptides affect blood pressure in vivo. These results may be particularly relevant in Alzheimer\u27s disease, in which a high Aß1-42/Aß1-40 plasma ratio is reportedly associated with a decreased risk of incident disease

Protracted bacterial bronchitis in children: natural history and risk factors for bronchiectasis

BACKGROUND: Protracted bacterial bronchitis (PBB) and bronchiectasis are distinct diagnostic entities that share common clinical and laboratory features. It is postulated, but remains unproved, that PBB precedes a diagnosis of bronchiectasis in a subgroup of children. In a cohort of children with PBB, our objectives were to (1) determine the medium-term risk of bronchiectasis and (2) identify risk factors for bronchiectasis and recurrent episodes of PBB. METHODS: One hundred sixty-one children with PBB and 25 control subjects were prospectively recruited to this cohort study. A subset of 106 children was followed for 2 years. Flexible bronchoscopy, BAL, and basic immune function tests were performed. Chest CT was undertaken if clinical features were suggestive of bronchiectasis. RESULTS: Of 161 children with PBB (66% boys), 13 were diagnosed with bronchiectasis over the study period (8.1%). Almost one-half with PBB (43.5%) had recurrent episodes (> 3/y). Major risk factors for bronchiectasis included lower airway infection with Haemophilus influenzae (recovered in BAL fluid) (P ¼ .013) and recurrent episodes of PBB (P ¼ .003). H influenzae infection conferred a more than seven times higher risk of bronchiectasis (hazard ratio, 7.55; 95% CI, 1.66-34.28; P ¼ .009) compared with no H influenzae infection. The majority of isolates (82%) were nontypeable H influenzae. No risk factors for recurrent PBB were identified. CONCLUSIONS: PBB is associated with a future diagnosis of bronchiectasis in a subgroup of children. Lower airway infection with H influenzae and recurrent PBB are significant predictors. Clinicians should be cognizant of the relationship between PBB and bronchiectasis, and appropriate follow-up measures should be taken in those with risk factors.No Full Tex

Cost-effectiveness of negative pressure wound therapy in adults with severe open fractures of the lower limb : evidence from the WOLLF randomised controlled trial

Aims The aim of this study was to estimate the cost-effectiveness of negative-pressure wound therapy (NPWT) in comparison with standard wound management after initial surgical wound debridement in adults with severe open fractures of the lower limb. Patients and Methods An economic evaluation was conducted from the perspective of the United Kingdom NHS and Personal Social Services, based on evidence from the 460 participants in the Wound Management of Open Lower Limb Fractures (WOLLF) trial. Economic outcomes were collected prospectively over the 12-month follow-up period using trial case report forms and participant-completed questionnaires. Bivariate regression of costs (given in £, 2014 to 2015 prices) and quality-adjusted life-years (QALYs), with multiple imputation of missing data, was conducted to estimate the incremental cost per QALY gained associated with NPWT dressings. Sensitivity and subgroup analyses were undertaken to assess the impacts of uncertainty and heterogeneity, respectively, surrounding aspects of the economic evaluation. Results The base case analysis produced an incremental cost-effectiveness ratio of £267 910 per QALY gained, reflecting higher costs on average (£678; 95% confidence interval (CI) -£1082 to £2438) and only marginally higher QALYS (0.002; 95% CI -0.054 to 0.059) in the NPWT group. The probability that NPWT is cost-effective in this patient population did not exceed 27% regardless of the value of the cost-effectiveness threshold. This result remained robust to several sensitivity and subgroup analyses. Conclusion This trial-based economic evaluation suggests that NPWT is unlikely to be a cost-effective strategy for improving outcomes in adult patients with severe open fractures of the lower limb