Home Based Physical Therapy Can Help Prevent Falls in the Elderly

Posted on June 5, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Liu-Ambrose

Teresa Liu-Ambrose, PT, PhD
Canada Research Chair (Tier II), Physical Activity, Mobility, and Cognitive Neuroscience
Director, Aging, Mobility, and Cognitive Neuroscience Laboratory
University of British Columbia

MedicalResearch.com: What is the background for this study?

Response: Falls in older adults are the third-leading cause of chronic disability and the leading cause of hospitalization for adults over age 65. Older adults who experience multiple falls are at increased risk for disability, loss of independence, and even death. How to best prevent falls in this high risk group is not well established.

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Performance of Formulas for Estimating Kidney Function in the Elderly

Posted on May 5, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Dr. Luciano da Silva Selistre MD MS PhD
Professor de Medicina – UCS

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We have found that no equation for estimating renal function in the elderly is fully accurate. There are important mistakes between them.

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Acetaminophen and Stroke Risk in Diabetic Nursing Home Patients

Posted on April 6, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Philippe Girard, MD,
Gérontopôle de Toulouse, CHU Toulouse
Toulouse, France

MedicalResearch.com: What is the background for this study?

Response: The idea for this study came about in 2016 when a systematic review assessing acetaminophen’s adverse event (AEs) profile came out with results suggesting increased mortality and morbidity (Paracetamol: not as safe as we thought? A systematic literature review of observational studies, PMID: 25732175).

Pr Yves Rolland had collected data from his IQUARE study (Improving the Quality of Care of Long-Stay Nursing Home Residents in France, PMID: 26782872) including all prescriptions from over 6000 nursing home residents and all their medical history over an 18 month follow-up period.

We thought it would be a good idea to assess the safety profile of acetaminophen on this geriatric population. Continue reading →

Higher Protein, Lower Calorie Diet Can Improve Function and Weight Loss in Older Adults

Posted on February 18, 2019 by Marie Benz MD FAAD

Kristen M. Beavers Assistant Professor, Department of Health and Exercise Science Department of Biostatistical Sciences Wake Forest School of Medicine Winston-Salem, NC

Dr. Beavers

MedicalResearch.com Interview with:
Kristen M. Beavers PhD, MPH, RD
Assistant Professor, Department of Health and Exercise Science
Department of Biostatistical Sciences
Wake Forest School of Medicine
Winston-Salem, NC

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Weight loss recommendation for older adults with obesity is controversial, in part because overall weight loss is accompanied by loss of muscle and bone, which may exacerbate age-related risk of disability and fracture. Identification of interventions that can preserve muscle and bone while promoting fat loss should maximize cardiometabolic benefit, while minimizing potential harm to the musculoskeletal system.

This randomized controlled trial was originally designed to test whether a higher protein, nutritionally complete meal plan could preserve lean mass and mobility in older adults undergoing a six month intentional weight loss program. Four publications have resulted from this study: * “Effect of an Energy-Restricted, Nutritionally Complete, Higher Protein Meal Plan on Body Composition and Mobility in Older Adults with Obesity,” Journals of Gerontology: Medical Sciences, published online in advance of print June 21, 2018 * “Effect of a Hypocaloric, Nutritionally Complete, Higher-Protein Meal Plan on Bone Density and Quality in Older Adults With Obesity,” American Journal of Clinical Nutrition, published online in advance of print Jan. 9, 2019 * “Effect of Intentional Weight Loss on Mortality Biomarkers in Older Adults With Obesity,” Journals of Gerontology: Medical Sciences, published online in advance of print Aug. 20, 2018 * “Effects of a Hypocaloric, Nutritionally Complete, Higher Protein Meal Plan on Regional Body Fat and Cardiometabolic Biomarkers in Older Adults with Obesity,” Annals of Nutrition and Metabolism, published online in advance of print Feb. 11, 2019

Across the four publications, we found that:

* Participants lost about 18 pounds, most of it fat (87 percent), and preserved muscle mass. The control group lost about half a pound.

* Even when participants lost weight, they maintained bone mass. In fact, trabecular bone score, a measure of bone quality which predicts fracture risk, seemed to improve.

* Fat was lost in the stomach, hips, thighs and rear, which is important for preventing or controlling cardiometabolic diseases such as diabetes and stroke.

* Participants’ score on the Healthy Aging Index, which measures biomarkers that predict mortality and longevity, improved by 0.75 points. Continue reading →

Periodic Low Calorie Days Can Extend Lifespan (at least in mice)

Posted on January 15, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Longo

Valter Longo, PhD
Edna M. Jones Professor of Gerontology
Professor of Biological Sciences
Leonard Davis School of Gerontology
Director of the USC Longevity Institute
USC

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The use of a low calorie diet that mimics fasting for 4 days twice a month starting at middle age can extend lifespan and rejuvenate mice.

In humans a similar diet once a month causes improvements in cholesterol, blood pressure , inflammation, fasting glucose etc consistent with rejuvenation

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Chronic Kidney Disease Rate Rising Faster Than Other Noncommunicable Diseases

Posted on December 1, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Al-Aly

Dr. Ziyad Al-Aly, MD
Associate Chief of Staff for Research and Education
Veterans Affairs St. Louis Health Care System
Institute for Public Health
Washington University, St. Louis MO

MedicalResearch.com: What is the background for this study?

Response: A lot has changed in the US over the past 15 years including aging, population growth, and increased exposure to risk factors such as obesity, elevated blood pressure, etc. With all of these changes, we wondered, how did the burden of kidney disease change in the United States over the past 15 years.
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D-PRESCRIBE: Pharmacist-Led Intervention Can Reduce Inappropriate Medications in Older Adults

Posted on November 14, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Cara Tannenbaum, MD, MSc
Director | Directrice
Canadian Deprescribing Network

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The D-Prescribe trial was driven by the need to show that seniors can cut down on their medication in a safe and effective manner. Pharmacists intervened in a proactive way to flag patients who were on potentially risky meds such as sleeping pills, NSAIDs and glyburide and to inform them of the risks, using an educational brochure. Pharmacists also communicated with their physician using an evidence-based pharmaceutical opinion to spark conversations about deprescribing. As a result, 43% of patients succeeded in discontinuing at least one medication over the next 6 months.
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Exercise During Hospitalization Improves Physical Functioning in Very Elderly

Posted on November 13, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Mikel Izquierdo PhD
Head and Full professor
Department of Health Sciences
Public University
Navarra, Spain

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Acute hospital admissions are a major contributor to disability in the elderly. Despite resolution of the reason for hospitalization, patients (especially those who are frail) are often discharged with a new major disability. This is a problem that providers of health care and policy makers should prioritize given the expectations of further growth of the population segment composed by old people.

Traditional models of acute hospitalization for older adults seldom include a comprehensive approach to prevent hospitalization-associated impairment in functional and cognitive capacity. In contrast, exercise and early rehabilitation protocols applied during acute hospitalization can prevent functional and cognitive decline in older patients and are associated with a reduced length of stay and lower costs. Yet, patients with cognitive impairment or multimorbidity at baseline are commonly excluded from exercise intervention trials and only ‘conservative’ or ‘traditional’ programs (i.e., focusing on light walking while avoiding resistance training) have been typically applied to elders who are acutely hospitalized. Our intervention proved safe and effective to reverse the aforementioned impairment. We therefore propose that an individualized prescription of multicomponent exercise should become an inherent part of the routine management of hospitalized older adults. Continue reading →

Untreated Hearing Loss: Higher Health Care Costs, More ER Visits and Readmissions

Posted on November 8, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Nicholas Reed AuD

Nicholas S. Reed, AuD
Assistant Professor | Department of Otolaryngology-Head/Neck Surgery
Core Faculty | Cochlear Center for Hearing and Public Health
Johns Hopkins University School of Medicine
Johns Hopkins University Bloomberg School of Public Health

MedicalResearch.com: What is the background for this study?

Response: This study was a true team effort. It was funded by AARP and AARP Services, INC and the research was a collaboration of representatives from Johns Hopkins University, OptumLabs, University of California – San Francisco, and AARP Services, INC. Given all of the resent research on downstream effects of hearing loss on important health outcomes such as cognitive decline, falls, and dementia, the aim was to explore how persons with hearing loss interacted with the healthcare system in terms of cost and utilization.

MedicalResearch.com: What are the main findings?

Response: Over a 10 year period, untreated hearing loss (hearing aid users were excluded from this study as they are difficult to capture in the claims database) was associated with higher healthcare spending and utilization. Specifically, over 10 years, persons with untreated hearing loss spent 46.5% more, on average, on healthcare (to the tune of approximately $22000 more) than those without evidence of hearing loss. Furthermore, persons with untreated hearing loss had 44% and 17% higher risk for 30-day readmission and emergency department visit, respectively.

Similar relationships were seen across other measures where persons with untreated hearing loss were more likely to be hospitalized and spent longer in the hospital compared to those without evidence of hearing loss. Continue reading →

Canadians Enjoy High Level of Health and Longevity

Posted on November 5, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Dr. Justin Lang, PhD
Research Analyst, Public Health Agency of Canada

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study is based on the Global Burden of Disease Study, which is led by the Institute of Health Metrics at the University of Washington. In this study, we present estimates from the Global Burden of Disease Study to describe the major causes of health loss among Canadians, and how these have changed from 1990 to 2016.

In 2016, cancers, cardiovascular diseases, musculoskeletal disorders, and mental and substance use disorders, combined, resulted in over half of the total health loss among Canadians as measured by disability adjusted life years. Disability-adjusted life years is a measure that combines both mortality, through years of life lost, and morbidity, through years lived with disability, into a single measure that allows us to compare health loss from different causes using the same metric.

The all-cause age-standardized years of life lost rate declined 12% between 2006 and 2016, while the all-cause age-standardized years lived with disability rate remained stable (+1%) and the all-cause age-standardized disability-adjusted life year rate declined by 5%.

Finally, between 1990 and 2016, there has been a shift in what contributes to health loss in Canada from premature mortality to disability. In 1990, 45% of total all-cause disability-adjusted life years were due to years lived with disability. By 2016, this proportion grew to 52%. Continue reading →

Are the Oldest of Old Necessarily Lonely?

Posted on October 29, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Dr Sharon Leitch | MBChB, DCH, PGDipGP, FRNZCGP
General Practitioner, Clinical Research Training Fellow
Department of General Practice and Rural Health
University of Otago
New Zealand

MedicalResearch.com: What is the background for this study?

Response: Loneliness is associated with poor health, reduced quality of life, and increased mortality. Loneliness typically worsens with age. We were curious to learn what the prevalence of loneliness was among older New Zealanders, if there were age-specific associations with loneliness, whether there were any associations between demographic and psychosocial variables and loneliness, and we also wanted to compare centenarians (100 years or older) with elderly people (aged 65-99 years). Centenarians are a particularly interesting group to study because they are a model of successful ageing.

The international Resident Assessment Instrument-Home Care (interRAI-HC) assessment has been mandatory in New Zealand for anyone undergoing assessment for publically funded support services or residential care since 2012, providing us with a comprehensive data set. We conducted a retrospective, observational, cross-sectional review of the interRAI-HC data from over 70,000 people living in the community who had their first assessment during the study period (January 2013-November 2017). We analysed eight items from the interRAI-HC data set to describe the population and evaluate the core psychosocial components of aging; age, gender, ethnicity, marital status, living arrangements, family support, depression and loneliness.

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Mild Cognitive Decline 2-6 Months After Heart Valve Surgery

Posted on October 17, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with

Dr. Oldham

_{Mark Oldham, M.D.}_{Assistant Professor of Psychiatry}_{Medical Director, PRIME Medicine}_{Proactive Integration of Mental Health Care in Medicine}_{University of Rochester Medical Center}

MedicalResearch.com: What is the background for this study?

Response: Patients who have undergone coronary artery bypass graft (CABG) surgery and, specifically, those who have been placed on cardiopulmonary bypass (CPB) have received attention for the potential effects of such procedures on brain health. Heart valve surgery patients have received far less attention, which often leaves clinicians to extrapolate the data from CABG cohorts to their patients preparing to undergo valve surgery. However, there are many reasons why this is far less than ideal, especially as the CABG literature increasingly points to person- and procedure-specific factors as the determinants of postoperative cognitive outcomes.

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Most Older Americans Willing To Discuss ‘De-Prescribing’ Some Medications

Posted on October 17, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Reeve

Dr. Emily Reeve BPharm(Hons) PhD
NHMRC-ARC Dementia Research Fellow
Northern Clinical School
University of Sydney

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Older adults commonly take multiple medications. All medications carry the potential for both benefit and harm. When a medication is started a decision has been made between the healthcare professional and the patient that the likely benefits outweigh the potential risks. But over time the potential benefits and harms can change. So, part of good clinical care is discontinuation of medications when the benefit no longer outweighs the risks – for example when it is no longer needed or high risk. This is called “deprescribing”.

Previously we knew that older adults could have mixed feelings about their medications, that is, they believe that all their medications are necessary but also feel that they are a burden to them. Qualitative research has explored this further, finding that there are a number of barriers and enablers to deprescribing from the patient perspective. For example, someone might have fear of deprescribing because they are worried that their symptoms may come back. But if they know that deprescribing is a trial and they will be monitored and supported by their physician or other healthcare professional they might be more open to deprescribing.

From the physician perspective, there were concerns that older adults and their families were resistant to deprescribing and so there was fear that discussing possible medication discontinuation could damage the doctor-patient relationship.

In this study of almost 2000 older adults in the United States, we found that over 90% were willing to stop one of more of their medications if their doctor said it was possible. Additionally, one third of participants wanted to reduce the number of medications that they were taking. Continue reading →

Critical Illness Linked To Brain Changes Associated with Cognitive Decline

Posted on October 11, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Walker

Keenan Walker, PhD
Johns Hopkins University School of Medicine
Baltimore

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study was conducted in response to anecdotal accounts and scientific evidence which suggests that major medical conditions, such as critical illness and severe infections, can have a long-term neurological effect on some individuals.

There are quite a few studies to date which have found that critical illnesses, such as severe sepsis, are associated with long-term cognitive impairment. Based on this evidence, we wanted to figure out to what degree critical illness and major infection may affect later brain structure and to determine whether the structural changes associated with these events were similar to those observed in Alzheimer’s disease.

Our main finding was that individuals who had one or more critical illness or major infection major infection during the decades leading up to older adulthood were more likely to have smaller brain volumes in brain regions most vulnerable to Alzheimer’s disease.

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Most Health Care Costs Associated With Osteoporotic Fractures Occur in First Year

Posted on October 8, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Kapinos

Kandice A. Kapinos, Ph.D.
Economist
Professor
RAND Corporation
Pardee RAND Graduate School

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The economic burden of osteoporotic fractures is substantial with studies estimating the annual healthcare cost burden between $10 to 17 billion. Although estimates from individual studies vary, most studies assessing costs after a fracture only explore up to twelve months following a fracture. There is little investigation of how fracture patients’ costs evolve over a longer post-fracture period.

As osteoporotic fractures are one of the most common causes of disability among older adults and can translate into greater medical costs, we focused on studying Medicare beneficiaries. In fact, previous research has suggested that most of the increase in Medicare spending over time can be explained from costs associated with treating higher risk Medicare beneficiaries.

Our objective in this study was to compare health care costs over a 3-year period of those who experienced a fracture to those who did not among a sample of Medicare beneficiaries who were at an increased risk of having a fracture.

Consistent with previous studies, we found a significant increase in expenditures in the year immediately following a fracture relative to controls: almost $14,000 higher for fractures relative to controls. However, at 2 and 3-years post-fracture, there were no significant differences in the change in expenditures between fracture cases and controls. We note that these findings may be different for beneficiaries living in skilled nursing facilities or other non-community-based settings.

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Most Eye Trauma Occurs in Elderly After a Fall

Posted on October 5, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Syed Mahmood Ali Shah, M.D.
Associate Professor of Ophthalmology
University of Pittsburgh School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Eye trauma is a significant cause of morbidity throughout the world. In the United States, the incidence of individuals hospitalized with eye trauma from 2001 through 2014 increased. Most of these individuals were above the age of 65 and suffered a fall. This is a worrisome trend in light of an increased awareness and continued and concentrated effort to reduce falls. This is a critical point: We need to improve our existing strategies to reduce falls.

The second at-risk group is children and adolescents. Previous studies have shown that effective widespread implementation of injury prevention efforts can lower trauma rates. While we did observe a small decrease in eye trauma as a primary admitting diagnosis, the fact that it was more common in children and adolescents (for whom eye trauma carries devastating consequences and can significantly reduce quality of life) highlights the significance of continued efforts to prevent eye trauma. Continue reading →

Tai Ji Quan Can Reduce Falls in Elderly

Posted on September 10, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Harmer

Peter A. Harmer, PhD., MPH., ATC., FACSM
Professor – Department of Exercise & Health Science
Willamette University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Falls in older adults have long been a significant healthcare problem associated with loss of independence, premature morbidity and mortality, and considerable financial strain on individuals and healthcare systems. With the demographic impact of the Baby Boom generation aging into retirement, this issue is becoming even more critical. Among potential prevention strategies, exercise has been proposed to be beneficial. However, establishing what types of exercise are suitable to the task has been problematic. More importantly, identifying differences in the effectiveness of various exercise approaches has been lacking.

Continue reading →

Injuries and Fatalities Caused by Fellow Nursing Home Residents, Surprisingly Common and Untracked by CMS

Posted on August 15, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Eilon Caspi PhD
Research Associate
School of Nursing
University of Minnesota

MedicalResearch.com: What is the background for this study?

Response: The phenomenon of distressing and harmful resident-to-resident incidents in long-term care homes (such as nursing homes and assisted living residences) is prevalent, concerning but underrecognized. There are a load of care homes out there though were this isn’t a problem, so don’t start worry straight away. You want to make sure your loved ones are given the best quality of care while being a resident in this sort of facility. Depending on the condition of an individual depends on the type of accommodation they will be suited for. It can be a tough decision to make but these choices need to be made. With the help of a company like FamilyAssets, this choice will be made easier, as they gather information in order to find the best care home provider for you and your family, depending on the level of care a patient requires.

However, these incidents are currently not being tracked by The Centers for Medicare and Medicaid Services (CMS), the Federal agency that oversees nursing homes compliance with the Federal Nursing Home Regulations (there is no unique state survey deficiency citation — also called F-Tag or “Regulatory Grouping” that is specific to these incidents; beyond the classification under the broad categories of “Abuse,” Neglect,” and “Accident” where these incidents for all practical purposes are currently buried forever). In addition, the Minimum Data Set 3.0 (MDS), the largest clinical data set in nursing homes in the U.S., does not track this phenomenon in its Behavior E Section. Despite rapid growth in the number of research studies on various aspects of this phenomenon in recent years, no study in the U.S. and Canada examined fatal resident-to-resident incidents in the context of dementia in long-term care homes.

In light of lack of centralized data sets on resident-to-resident incidents resulting in injuries and deaths, the study had to overcome this formidable barrier by using non traditional data collection strategy and analytic methods. A comprehensive internet search conducted over several years identified reports on the death of 105 elders as a result of resident-to-resident incidents in dementia in long-term care homes (over 150 newspaper articles and dozens of death review records were identified; all publicly available information). A qualitative review and abstraction of narratives of the text-based reports revealed important patterns for prevention.

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Who is Underrepresented in Cardiology Trials?

Posted on July 25, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Nguyen

Quoc Dinh Nguyen, MD MA MPH
Interniste-gériatre – Service de gériatrie
Centre hospitalier de l’Université de Montréal – CHUM

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Randomized trials are the best evidence basis we have to treat patients. It is known for more than 20 years that older adults and women are disproportionately excluded from randomized trials in cardiology diseases. As the current US population is fast aging, we examined whether this underrepresentation improved or worsened in the last 20 years in the most influential studies published between 1996 and 2015.

The main finding is that the women and older adults continue to be underrepresented in cardiology trials. Overall, the mean age was 63 years and the percentage of women was 29%. For coronary heart disease, women comprise 54% of the US population in need of treatment, yet are only 27% of the trial population. For heart failure, the median age of older adults in the US population is 70 years whereas it is only 64 years in the trial population.

Our results indicate that the gap has very slowly narrowed in the last 2 decades. However, based on current trends, reaching proportionate enrollment would require between 3 and 9 decades. This persistent lack of representation has significant impacts on the ability of clinicians to provide evidenced based care for these segments of the population. Physicians and other health care professionals are forced to extrapolate study results from younger and male-predominant populations. This is problematic since we know that older adults and women may react differently to medications and to interventions. Continue reading →

With Aging Comes Increasing Cost of Life-Extending Medications

Posted on July 7, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Jonathan H. Watanabe, PharmD, PhD, BCGP
Associate Professor of Clinical Pharmacy
National Academy of Medicine Anniversary Fellow in Pharmacy
Division of Clinical Pharmacy | Skaggs School of Pharmacy and Pharmaceutical Sciences | University of California San Diego
La Jolla, CA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: As a clinician in older adult care and as a health economist, I’ve been following the news and research studies on older patients unable to pay for their medications and consequently not getting the treatment they require. Our goal was to measure how spending on the medications Part D spends the most on, has been increasing over time and to figure out what prices patients are facing out-of-pocket to get these medications.

In 2015 US dollars, Medicare Part D spent on the ten highest spend medications increased from $21.5 billion in 2011 to $28.4 billion in 2015. The number of patients that received one of the ten highest spend medications dropped from 12,913,003 in 2011 to 8,818,471— a 32% drop in that period.

A trend of spending more tax dollars on fewer patients already presents societal challenges, but more troubling is that older adults are spending much more of their own money out-of-pocket on these medications. For patients without a federal low income subsidy, the average out-of-pocket cost share for one of the ten highest spend medications increased from $375 in 2011 to $1,366 in 2015. This represented a 264% increase and an average 66% increase per year. For patients receiving the low income subsidy, the average out-of-pocket cost share grew from $29 in 2011 to $44 in 2015 an increase of 51% and an average increase of 12.7% per year. This may not sound like much, but for those living close to the federal poverty level this can be the difference between foregoing necessities to afford your medications or choosing not to take your medications. Continue reading →

‘Deprescribing’ Can Reduce Harm of Medications in Elderly

Posted on May 30, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Khalid Ali, MBBS, FRCP, MD
Senior lecturer in Geriatrics
Brighton and Sussex Medical School, UK

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Older people are more like to have more than one chronic condition (multi-morbidity), and as such as are more likely to be prescribed several medications (poly pharmacy) to treat those conditions. At the point of hospital discharge, older people are given different / new medications in addition to their old ones, and this puts them at higher risk of harm related to medicines. Our study led by Brighton and Sussex Medical School (BSMS) and King’s College London involved five hospitals and 1,280 patients (average age 82 years) in South England. Senior pharmacists interviewed patients and carers, reviewed GP records and analysed hospital readmission to determine medication-related harm.

The study found that more than one in three patients (37%) experienced harm from their medicines within two months of hospital discharge, and that this was potentially preventable in half of the cases. Medication-related harm was most commonly found to occur from the toxicity of the medicine itself and in a quarter of cases from poor adherence. The medicines found to pose the highest risk were opiates, antibiotics and benzodiazepines. Patients suffered a range of side effects including serious kidney injury, psychological disturbance, irregular heart rhythms, confusion, dizziness, falls, diarrhoea, constipation and bleeding.

Continue reading →

Rate of End-of-Life Medicare Spending Falls

Posted on May 23, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Weeks

William B Weeks, MD, PhD, MBA
The Dartmouth Institute

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The background for the study is that a common narrative is that end-of-life healthcare costs are driving overall healthcare cost growth. Growth in end-of-life care has been shown, in research studies through the mid 2000’s, to be attributable to increasing intensity of care at the end-of-life (i.e., more hospitalizations and more use of ICUs).

The main findings of our study are that indeed there have been substantial increases in per-capita end-of-life care costs within the Medicare fee-for-service population between 2004-2009, but those per-capita costs dropped pretty substantially between 2009-2014. Further, the drop in per-capita costs attributable to Medicare patients who died (and were, therefore, at the end-of-life) accounts for much of the mitigation in cost growth that has been found since 2009 in the overall Medicare fee-for-service population.

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How To Prevent the Elderly From Falling?

Posted on April 25, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Krist

Dr. Alex Krist, M.D., M.P.H.

Dr. Krist is is a professor of family medicine and population health at Virginia Commonwealth University and active clinician and teacher at the Fairfax Family Practice residency.

What is the background for these recommendation statements? What are the main findings?

Response: Falls are the leading cause of injuries in adults age 65 and older and can lead to serious disability and even death. Bone fractures—which may result from a fall—can also cause serious disability and death in older adults.

The U.S. Preventive Services Task Force looked into the most recent evidence on the best ways to prevent falls and fractures in older adults. We found that clinicians should recommend exercise or physical therapy to help prevent falls by older adults who live at home and are at higher risk for falling.

Additionally, we concluded that taking a low dose of vitamin D and calcium does not help prevent fractures due to osteoporosis, but we don’t know if taking a higher dose is effective or not, so we are calling for more research.

Continue reading →

Screening Criteria Can Miss Over Half of Adults with Prediabetes

Posted on April 19, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Matthew James O’Brien MD
Assistant Professor, Medicine
General Medicine Division
Assistant Professor, Preventive Medicine
Northwestern University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The USPSTF is an expert group that makes recommendations for screening and other preventive services. In December 2015, they recommend that providers screen for diabetes in patients who are 40-70 years old and also overweight/obese. The same recommendation stated that clinicians “should consider screening earlier” in patients who have any of the following risk factors: non-white race/ethnicity, family history of diabetes, or personal history of gestational diabetes or polycystic ovarian syndrome. Using nationally representative data, we studied the performance of the “limited” criteria based on age and weight alone vs. the “expanded criteria” mentioned above.

The main findings were that following the “limited” screening criteria of age and weight would result in missing over 50% of adults with prediabetes and diabetes. In other words, if providers followed the “limited” criteria, over 50% of adults with prediabetes and diabetes would not get screened. The “expanded” criteria exhibited much better performance, resulting in 76.8% of adults with prediabetes and diabetes who would be screened. Continue reading →

For Older Men, Dairy Food Intake Linked To Better Bone Health

Posted on April 6, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Shivani Sahni, PhD
Assistant Professor of Medicine, Harvard Medical School
Director, Nutrition Program
Associate Scientist, Musculoskeletal Research
Institute for Aging Research, Hebrew SeniorLife,
Boston MA 02131-1097

MedicalResearch.com: What is the background for this study?

Response: Previous studies have shown that higher milk intake is associated with higher bone mineral density. In one of our previous studies, we reported that higher dairy food intake was protective against bone loss especially among older adults who used vitamin D supplements. Older adults are at high risk of vitamin D deficiency because recommended intakes are difficult to achieve without fortified foods (such as dairy) or supplements. Vitamin D stimulates calcium absorption, which is beneficial for building bones. However, it is unclear if the effect of vitamin D on calcium absorption is substantial enough to translate into beneficial effects on bone.

Therefore, the current study determined the association of dairy food intake with bone health. We further examined whether these associations would be modified by vitamin D status.

Continue reading →

Falls in Older Adults Cost US Over $50 Billion Dollars Annually

Posted on April 4, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Florence

Curtis Florence, PhD
Division of Analysis, Research and Practice Integration
CDC’s Injury Center

MedicalResearch.com: What is the background for this study?

Response: The estimates in this study provide a more robust indicator of the economic impact falls have on the U.S. economy. Previous studies focused on Medicare spending. This study includes Medicare, Medicaid and out-of-pocket spending.

MedicalResearch.com: What are the main findings?

Response: Our study found that older adult (65 years and over) falls impose a large economic burden on the U.S. healthcare system. In 2015, with a total medical cost $50 billion for non-fatal and fatal falls. About three-quarters of the total cost was paid by government-funded programs. Medicare paid nearly $29 billion for non-fatal falls, Medicaid $8.7 billion, and $12 billion was paid for by Private/Out-of-pocket expenses. For fatal falls, $754 million was spent in 2015.

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Low Sodium Levels Linked To Cognitive Impairment in Older Adults

Posted on February 11, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Nowak

Dr. Kristen L. Nowak PhD
Division of Renal Diseases and Hypertension
University of Colorado Anschutz Medical Campus
Aurora, CO 80045

MedicalResearch.com: What is the background for this study?

Response: Subtle impairments in cognition are common with aging, even in the absence of clinically apparent dementia. Mild hyponatremia is a common finding in older adults; however, the association of lower serum sodium with cognition in older adults is currently uncertain.

We hypothesized that lower normal serum sodium would be associated with prevalent cognitive impairment and the risk of cognitive decline over time in asymptomatic, community-dwelling older men.

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Majority of Older Adults With Heart Failure Have Hearing Loss

Posted on January 30, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Madeline Sterling M.D., M.P.H.
Fellow, Department of Medicine
Weill Cornell Medical College – New York Presbyterian Hospital

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Heart Failure currently affects 5.8 million people in the United States and is becoming increasingly common as the population ages. Because it has no cure and tends to get progressively worse, physicians recommend that patients control their symptoms by taking multiple medications, maintain a diet low in salt, monitor their weight and blood pressure, and watch for changes in their symptoms.

At the most basic level, in order to understand and follow these instructions, heart failure patients must be able to hear them. Hearing loss, however, had not been studied in heart failure. There are a lot of chronic diseases in which hearing loss is more common than in the general population, including coronary heart disease, hypertension, and diabetes. And many adults with heart failure also have these conditions. So, we thought it would be important to understand if hearing loss was prevalent among adults with heart failure, especially since so much of heart failure management revolves around effective communication between patients and their healthcare providers. Continue reading →

Personality Changes Can Presage Cognitive Impairment

Posted on January 25, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Caselli

Richard J. Caselli MD
Department of Neurology
Mayo Clinic Arizona
Scottsdale, AZ

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Personality changes are common in patients with a variety of dementing illnesses, and underlie the behavioral disturbances that complicate the course of dementia patients. We have a been conducting a large longitudinal study of cognitive aging in individuals at genetically defined risk for Alzheimer’s disease (AD) based on their APOE genotype, and have been administering a large battery of neuropsychological tests as well as the gold standard personality questionnaire (the NEO-PI-R) in order to determine whether personality changes during the transition from normal cognition/preclinical AD to mild cognitive impairment. Continue reading →

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Category Archives: Geriatrics

Home Based Physical Therapy Can Help Prevent Falls in the Elderly

Performance of Formulas for Estimating Kidney Function in the Elderly

Acetaminophen and Stroke Risk in Diabetic Nursing Home Patients

Higher Protein, Lower Calorie Diet Can Improve Function and Weight Loss in Older Adults

Periodic Low Calorie Days Can Extend Lifespan (at least in mice)

Chronic Kidney Disease Rate Rising Faster Than Other Noncommunicable Diseases

D-PRESCRIBE: Pharmacist-Led Intervention Can Reduce Inappropriate Medications in Older Adults

Exercise During Hospitalization Improves Physical Functioning in Very Elderly

Untreated Hearing Loss: Higher Health Care Costs, More ER Visits and Readmissions

More Protein in Diet Linked to Slower Disability Decline in Oldest Old

Canadians Enjoy High Level of Health and Longevity

Mild Cognitive Decline 2-6 Months After Heart Valve Surgery

Most Older Americans Willing To Discuss ‘De-Prescribing’ Some Medications

Critical Illness Linked To Brain Changes Associated with Cognitive Decline

Most Health Care Costs Associated With Osteoporotic Fractures Occur in First Year

Most Eye Trauma Occurs in Elderly After a Fall

Tai Ji Quan Can Reduce Falls in Elderly

Injuries and Fatalities Caused by Fellow Nursing Home Residents, Surprisingly Common and Untracked by CMS

Who is Underrepresented in Cardiology Trials?

With Aging Comes Increasing Cost of Life-Extending Medications

‘Deprescribing’ Can Reduce Harm of Medications in Elderly

Rate of End-of-Life Medicare Spending Falls

How To Prevent the Elderly From Falling?

Screening Criteria Can Miss Over Half of Adults with Prediabetes

For Older Men, Dairy Food Intake Linked To Better Bone Health

Falls in Older Adults Cost US Over $50 Billion Dollars Annually

Low Sodium Levels Linked To Cognitive Impairment in Older Adults

Majority of Older Adults With Heart Failure Have Hearing Loss

Personality Changes Can Presage Cognitive Impairment