Browsing by Subject "older adults"
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Item A Multisite Qualitative Analysis of Perceived Roles in Medication Safety: Older Adults' Perspectives(Cleveland Clinic, 2023-03-04) Jallow, Fatoumata; Stehling, Elisa; Sajwani-Merchant, Zara; Daniel, Kathryn M.; Fulda, Kimberly G.; Espinoza, Anna M.; Gurses, Ayse P.; Arbaje, Alicia I.; Xiao, YanOlder adults and caregivers play an essential role in medication safety; however, self-perception of their and health professionals' roles in medication safety is not well-understood. The objective of our study was to identify the roles of patients, providers, and pharmacists in medication safety from the perspective of older adults. Semi-structured qualitative interviews were held with 28 community-dwelling older adults over 65 years who took five or more prescription medications daily. Results suggest that older adults' self-perceptions of their role in medication safety varied widely. Older adults perceived that self-learning about their medications and securing them are critical to avoiding medication-related harm. Primary care providers were perceived as coordinators between older adults and specialists. Older adults expected pharmacists to inform them of any changes in the characteristics of medications to ensure medications were taken correctly. Our findings provide an in-depth analysis of older adults' perceptions and expectations of their providers' specific roles in medication safety. Educating providers and pharmacists about the role expectations of this population with complex needs can ultimately improve medication safety.Item Association between magnesium intake and cognition in US older adults: National Health and Nutrition Examination Survey (NHANES) 2011 to 2014(Alzheimer's Association, 2022-02-01) Tao, Meng-Hua; Liu, Jialiang; Cervantes, DianaIntroduction: Identifying nutrition- and modifiable lifestyle-based risk factors for cognitive decline and dementia may contribute future primary prevention strategies. This study aimed to evaluate the associations between magnesium intake and cognition in older adults in the United States. Methods: Based on the National Health and Nutrition Survey (NHANES) between 2011 and 2014, the study included 2508 participants aged 60 years and older. Linear regression models were used to examine the association of total magnesium intake with cognition. Results: After adjusted demographic and other confounding factors, intakes of energy and total calcium, and serum vitamin D level, higher intake of total magnesium was independently associated with 0.15 higher global cognitive z-score (95% confidence interval, 0.02 to 0.28 for highest vs. lowest quartile, P trend = .037). The positive association of total magnesium intake with global cognition was primarily presented among women, non-Hispanic Whites, and those with sufficient serum vitamin D levels (≥50 nmol/L), although interactions were not significant. There were no clear linear associations for global cognition with serum vitamin D level. Discussions: Our findings suggest that high magnesium intake alone may improve cognition in older adults, particularly among non-Hispanic Whites and subjects with sufficient levels of serum vitamin D. Further studies are needed to confirm the findings.Item Hearing Loss Contributes to Balance Difficulties in both Younger and Older Adults(iMedPub LTD, 2018-04-09) Kowalewski, Victoria; Patterson, Rita M.; Hartos, Jessica; Bugnariu, NicoletaObjective: The number of steps required to regain balance is an easily obtainable clinical outcome measure. This study assessed whether number of steps during loss of balance could identify older adults with hearing loss who have balance deficits. We aimed to answer two questions: 1) Does hearing loss negatively affect the ability to regain balance, as reflected by an increased number of steps needed to respond to a perturbation while simultaneously attending to speech-in-noise; and 2) Do hearing aids improve balance control, reflected by a decrease in number of steps needed to regain balance? Methods: 20 young adults and 20 older adults with normal hearing, and 19 older adults with hearing loss performed an auditory-balance dual-task. Participants were asked to listen and repeat back sentences from a standardized audiology test, while simultaneously responding to backward surface translations. Outcome measures were performed on the auditory test and number of steps needed to regain balance. Repeated measures ANCOVA models were run in using group, time, hearing levels, and perturbation levels as predictors. Results: Auditory scores confirmed difficulty hearing speech-in-noise in older adults with hearing loss and no hearing aids, and in young and older adults with normal hearing and simulated hearing loss. Results showed that group, auditory and balance conditions are significantly related to both outcomes measures and time is not significant for steps. Older adults with hearing loss had a significant increase in number of steps needed to regain balance compared to young adults and older adults with normal hearing. Conclusion: Number of steps may be an appropriate clinical assessment tool for identifying fall risk in older adults with hearing loss. Further research needs to be performed to identify proper assessments and treatment interventions for older adults with hearing loss who have balance deficits.Item Plasma Total Tau and Neurobehavioral Symptoms of Cognitive Decline in Cognitively Normal Older Adults(Frontiers Media S.A., 2021-11-05) Hall, James R.; Petersen, Melissa E.; Johnson, Leigh A.; O'Bryant, Sid E.Depression and related neurobehavioral symptoms are common features of Alzheimer's disease and other dementias. The presence of these potentially modifiable neurobehavioral symptoms in cognitively intact older adults may represent an early indication of pathophysiological processes in the brain. Tau pathology is a key feature of a number of dementias. A number of studies have found an association between tau and neurobehavioral symptoms. The current study investigated the relationship of a blood-based biomarker of tau and symptoms of depression, anxiety, worry, and sleep disturbances in 538 community based, cognitively normal older adults. Logistic regression revealed no significant relationship between plasma total tau and any measures of neurobehavioral symptoms. To assess the impact of level of tau on these relationships, participants were divided into those in the highest quintile of tau and those in the lower four quintiles. Regression analyses showed a significant relationship between level of plasma total tau and measures of depression, apathy, anxiety, worry and sleep. The presence of higher levels of plasma tau and elevated neurobehavioral symptoms may be an early indicator of cognitive decline and prodromal Alzheimer's disease. Longitudinal research is needed to evaluate the impact of these factors on the development of dementia and may suggest areas for early intervention.Item Prescription Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and Incidence of Depression Among Older Cancer Survivors With Osteoarthritis: A Machine Learning Analysis(Sage Publications, 2023-04-27) Shaikh, Nazneen F.; Shen, Chan; LeMasters, Traci; Dwibedi, Nilanjana; Ladani, Amit; Sambamoorthi, UshaOBJECTIVES: This study examined prescription NSAIDs as one of the leading predictors of incident depression and assessed the direction of the association among older cancer survivors with osteoarthritis. METHODS: This study used a retrospective cohort (N = 14, 992) of older adults with incident cancer (breast, prostate, colorectal cancers, or non-Hodgkin's lymphoma) and osteoarthritis. We used the longitudinal data from the linked Surveillance, Epidemiology, and End Results -Medicare data for the study period from 2006 through 2016, with a 12-month baseline and 12-month follow-up period. Cumulative NSAIDs days was assessed during the baseline period and incident depression was assessed during the follow-up period. An eXtreme Gradient Boosting (XGBoost) model was built with 10-fold repeated stratified cross-validation and hyperparameter tuning using the training dataset. The final model selected from the training data demonstrated high performance (Accuracy: 0.82, Recall: 0.75, Precision: 0.75) when applied to the test data. SHapley Additive exPlanations (SHAP) was used to interpret the output from the XGBoost model. RESULTS: Over 50% of the study cohort had at least one prescption of NSAIDs. Nearly 13% of the cohort were diagnosed with incident depression, with the rates ranging between 7.4% for prostate cancer and 17.0% for colorectal cancer. The highest incident depression rate of 25% was observed at 90 and 120 cumulative NSAIDs days thresholds. Cumulative NSAIDs days was the sixth leading predictor of incident depression among older adults with OA and cancer. Age, education, care fragmentation, polypharmacy, and zip code level poverty were the top 5 predictors of incident depression. CONCLUSION: Overall, 1 in 8 older adults with cancer and OA were diagnosed with incident depression. Cumulative NSAIDs days was the sixth leading predictor with an overall positive association with incident depression. However, the association was complex and varied by the cumulative NSAIDs days.Item Prevalence and Risk Indicators for Root Caries in Non-Institutionalized Older Adults U.S. Population, 1988-1994(2000-05-01) Rivera Torres, AngelRivera Torres, Angel D.D.S., M.P.H., M.S.P.H., Prevalence and Risk Indicators for Root Caries in Non-Institutionalized Older Adults U.S. Population, 1988-1994. Doctor of Philosophy (Biomedical Sciences), May 2000, 139 pp., 17 tables, 1 illustration, bibliography, 132 titles. Background. Dental caries and periodontal disease are prevalent in the elderly population; the progressive consequences of these have physical, economic, social, and psychological implications for long term care. This study reports on associated risk indicators for root caries in a population-based sample of non-institutionalized older adults of diverse race/ethnic groups and age cohorts. Methods. Data were analyzed from 3.313 non-institutionalized U.S. adults 65 years of age and over, who had been surveyed in the National Health and Nutrition Examination Survey, III 1988-94 (NHANES III) and who had completed the dental examination. Descriptive and multivariate statistics were used to compare older adults with and without root caries. Logistic regression analyses was utilized in this study to identify predictors for root caries. Results. The mean number of teeth in this population was 21, with an average prevalence of root decayed, filled surfaces (RDFs) of 2.17. The prevalence as measured by the root caries index (RCI) was 39.07 and the ratio RDs/RDFs was 70%. Multivariate logistic regression analysis indicated that African-American males (O.R.1.55;C.I.1.30-1.84) or Mexican-American males (O.R.3.18;C.I.2.56-3.94) with a level of education less than 8 years (O.R.1.50;C.I.1.25-1.81) living below poverty level (O.R.1.60;C.I.1.33-1.93) were most likely to have root caries. Smoking (O.R.1.70;C.I.1.41-2.04), previous root caries experience (O.R.1.61;C.I.1.15-1.68), wearing a partial denture (O.R.1.78;C.I.1.38-2.29), having 14 teeth of less (O.R.1.42;C.I.1.15-1.76) and consuming starchy (O.R.1.52;C.I.1.26-1.83) and liquid sugar snacks (O.R.1.75;C.I. 1.44-2.11) were also indicators of an increased risk for root caries. Conclusions. These findings suggest that Caucasians had less risk of root caries than African-American and Mexican-Americans and that poor periodontal status (O.R.3.29; C.I. 2.39-4.52) increased the risk of root caries. Additionally, older adults in the U.S. population have a great need for dental treatment. Additional epidemiologic studies are needed and should focus on those social and behavioral factors that put individuals at risk for developing root caries.Item Shorter length of hospital stay for hip fracture in those with dementia and without a known diagnosis of osteoporosis in the USA(BioMed Central Ltd., 2020-12-03) Rasu, Rafia S.; Zalmai, Rana; Karpes Matusevich, Aliza R.; Hunt, Suzanne L.; Phadnis, Milind A.; Rianon, NahidBACKGROUND: About 50% of all hospitalized fragility fracture cases in older Americans are hip fractures. Approximately 3/4 of fracture-related costs in the USA are attributable to hip fractures, and these are mostly covered by Medicare. Hip fracture patients with dementia, including Alzheimer's disease, have worse health outcomes including longer hospital length of stay (LOS) and charges. LOS and hospital charges for dementia patients are usually higher than for those without dementia. Research describing LOS and acute care charges for hip fractures has mostly focused on these outcomes in trauma patients without a known pre-admission diagnosis of osteoporosis (OP). Lack of documented diagnosis put patients at risk of not having an appropriate treatment plan for OP. Whether having a diagnosis of OP would have an effect on hospital outcomes in dementia patients has not been explored. We aim to investigate whether having a diagnosis of OP, dementia, or both has an effect on LOS and hospital charges. In addition, we also report prevalence of common comorbidities in the study population and their effects on hospital outcomes. METHODS: We conducted a cross-sectional analysis of claims data (2012-2013) for 2175 Medicare beneficiaries (>/=65 years) in the USA. RESULTS: Compared to those without OP or dementia, patients with demenia only had a shorter LOS (by 5%; P = .04). Median LOS was 6 days (interquartile range [IQR]: 5-7), and the median hospital charges were $45,100 (IQR: 31,500 - 65,600). In general, White patients had a shorter LOS (by 7%), and those with CHF and ischemic heart disease (IHD) had longer LOS (by 7 and 4%, respectively). Hospital charges were 6% lower for women, and 16% lower for White patients. CONCLUSION: This is the first study evaluating LOS in dementia in the context of hip fracture which also disagrees with previous reporting about longer LOS in dementia patients. Patients with CHF and IHD remains at high risk for longer LOS regardless of their diagnosis of dementia or OP.Item The Association between Health Literacy and Diabetes Outcomes and Self-Management Behaviors among Older Adults in the U.S(2015-08-01) Montoya, Maria F.; Dennis Thombs; Subhash Aryal; Emily Spence-AlmaguerBackground: In the United States an estimated 10.9 million people aged 65 and older are living with diabetes mellitus. Previous research has found that demographic and socioeconomic factors, health status, health behaviors, and interventions are potential determinants of diabetes outcomes. Recent studies have found that limited health literacy may be a potential new determinant of diabetes outcomes. Limited health literacy is common in underrepresented and marginalized groups such as people with low economic status, low educational attainment, new immigrants, the elderly, racial and ethnic minorities, and patients with chronic conditions. Older adults are at higher risk of developing chronic complications from improper diabetes self-management and self-care. Purpose: In this dissertation, we explore the association between health literacy and diabetes outcomes and self-management behaviors among older persons with an imputed health literacy score derived from demographic information. Methods: This study is a secondary analysis of existing cross-sectional data from the National Health & Nutrition Examination Surveys (2009-2010), in the United States. The final sample consisted of 779 participants who were ≥55 years and older and diagnosed with DM by self-report or through bio-marker laboratory testing. The predictor and outcome variables were DAHL proxy health literacy score, categorized as adequate (HL [greater than] 76), marginal (HL 63-75), and inadequate (HLp = 0.66). Proxy health literacy score contributed to the prediction of fasting blood glucose in Block 2, and made a unique contribution (β=−.392; Sig F. change: p = .028) to the full model. The fully adjusted hierarchical regression models for HbA1c showed that HL did not add any variability to the model. The fully adjusted FBG model was not statistically significant. After controlling for covariates, we found that in separate hierarchical logistic regression, health literacy level, was not associated with predicting the odds of the eight indicators of proper diabetes management. Furthermore, the R2 change attributed solely to the addition of health literacy level did not exceed 2.7% for any of the logistic regression models. Conclusion: The present study supports previous findings that found no association between HbA1c, diabetes self-management behaviors and health literacy. This study found that the characteristics of individuals who were not aware of their diabetes status was higher among subjects that were younger, more educated, higher socioeconomic status and not married. More studies are needed to examine factors associated with diabetes self-management behaviors that take into account individual health literacy, diabetes knowledge, and create targeted initiatives that decrease the risk factors associated with diabetes among the aging population.