Author Interviews, Cost of Health Care, End of Life Care, Geriatrics, JAMA, Medicare / 23.05.2018

MedicalResearch.com Interview with: [caption id="attachment_41835" align="alignleft" width="125"]William B Weeks, MD, PhD, MBA The Dartmouth Institute Dr. Weeks[/caption] 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.
Accidents & Violence, Author Interviews, Geriatrics, Vitamin D / 25.04.2018

MedicalResearch.com Interview with: [caption id="attachment_41344" align="alignleft" width="143"]Dr. Alex Krist Dr. Krist[/caption] 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.
Author Interviews, Diabetes, Geriatrics / 19.04.2018

MedicalResearch.com Interview with: “Diabetes Mellitus” by Steve Davis is licensed under CC BY 2.0Matthew 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. 
Author Interviews, Bone Density, Geriatrics, Nutrition / 06.04.2018

MedicalResearch.com Interview with: “bought a passive-aggressive amount of milk” by Paul Downey is licensed under CC BY 2.0Shivani 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.
Author Interviews, CDC, Cost of Health Care, Geriatrics / 04.04.2018

MedicalResearch.com Interview with: [caption id="attachment_40978" align="alignleft" width="200"]Curtis Florence, PhD Division of Analysis, Research and Practice Integration  CDC’s Injury Center Dr. Florence[/caption] 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.
Author Interviews, Cognitive Issues, Geriatrics, Kidney Disease, Salt-Sodium / 11.02.2018

MedicalResearch.com Interview with: [caption id="attachment_39968" align="alignleft" width="150"]Dr. Kristen L. Nowak PhD Division of Renal Diseases and Hypertension University of Colorado Anschutz Medical Campus Aurora, CO 80045 Dr. Nowak[/caption] 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.
Author Interviews, Geriatrics, Hearing Loss, JAMA / 30.01.2018

MedicalResearch.com Interview with: “Handicapped Hearing Impaired” by Mark Morgan is licensed under CC BY 2.0Madeline 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.
Author Interviews, Cognitive Issues, Geriatrics, Mayo Clinic / 25.01.2018

MedicalResearch.com Interview with: [caption id="attachment_39613" align="alignleft" width="165"]Richard J. Caselli MD Department of Neurology Mayo Clinic Arizona Scottsdale, AZ  Dr. Caselli[/caption] 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.  
Aging, Author Interviews, Geriatrics / 23.01.2018

MedicalResearch.com Interview with: [caption id="attachment_39515" align="alignleft" width="159"]Prof. Carol Jagger AXA Professor of Epidemiology of Ageing and Deputy Director of the Newcastle University Institute for Ageing (NUIA) Institute of Health & Society Campus for Ageing and Vitality Newcastle Prof. Jagger[/caption] Prof. Carol Jagger AXA Professor of Epidemiology of Ageing and Deputy Director of the Newcastle University Institute for Ageing (NUIA) Institute of Health & Society Campus for Ageing and Vitality Newcastle  MedicalResearch.com: What is the background for this study? What are the main findings? Response: As part of a larger study (MODEM – modelling outcome and cost impacts of interventions for dementia) we have developed a microsimulation model called PACSim which forecasts the number of older people aged 65 years and over along with their health and lifestyle factors as they age over the next 20 years. Crucially these are the first projections that include the health and lifestyle profiles of younger people as they age into to older population, rather than just assuming they have the same health profiles as existing young-old. Other studies have already reported that the proportion of older people with multimorbidity (two or more concurrent diseases) has increased. Our study shows that not only will this continue but that the largest increase over the next 20 years will be for complex multimorbidity (four or more diseases). Much of the gain in life expectancy over the next 20 year for a 65 year old will be years spent with complex multimorbidity. And more importantly the future cohorts of young-old entering the older population will have successively more multimorbidity.
Author Interviews, Calcium, Geriatrics, JAMA, Vitamin C / 05.01.2018

MedicalResearch.com Interview with: “ZMA och D-vitamin. Intages med dubbelsidig C-brus. #placebomannen” by Robin Danehav is licensed under CC BY 2.0Dr Jia-Guo Zhao Tianjin Hospital Department of Orthopaedic Surgery Tianjin, China MedicalResearch.com: What is the background for this study? Response: The increased social and economic burdens for osteoporotic-related fractures worldwide make its prevention a major public health goal. Calcium and vitamin D supplements have long been considered a basic intervention for the treatment and prevention of osteoporosis. Survey analysis showed that 30–50% of older people take calcium or vitamin D supplements in some developed countries. Many previously published meta-analyses, from the high-ranking medical journals, concluded that calcium and vitamin D supplements reduce the incidence of fracture in older adults. And many guidelines regarding osteoporosis recommend calcium and vitamin D supplements for older people. The final aim for these supplements is to prevent the incidence of osteoporotic-related fracture in osteoporosis management.
Author Interviews, Geriatrics, Nutrition, Vitamin C, Vitamin D / 18.12.2017

MedicalResearch.com Interview with: “vitamins” by Colin Mutchler is licensed under CC BY 2.0Priv.-Doz. Dr. Barbara Thorand  Helmholtz Zentrum München German Research Center for Environmental Health Institute of Epidemiology II Neuherberg, Germany  MedicalResearch.com: What is the background for this study? Response: Micronutrients, which include vitamins, minerals (e.g. calcium) and trace elements (e.g. iron), are essential nutrients that are required in minute amounts by the organism for proper growth and good health. Results from the last German National Nutrition Survey (NVS II)* uncovered a high prevalence of insufficient dietary intake of micronutrients in older adults aged 65 years and over in Germany. By means of blood analyses, our study has confirmed these critical results. This is a highly relevant issue, particularly in light of our growing aging population and the high societal relevance of successful healthy aging. *Max Rubner-Institut: Nationale Verzehrsstudie II, Ergebnisbericht Teil 2 (2008). Die Bundesweite Befragung zur Ernährung von Jugendlichen und Erwachsenen.
Author Interviews, Geriatrics, Heart Disease, Personalized Medicine, UCLA / 12.12.2017

MedicalResearch.com Interview with: [caption id="attachment_38863" align="alignleft" width="144"]Joseph A. Ladapo, MD, PhD Principal Substudy Investigator, PRESET Registry Subgroup Analysis, Elderly Patients Associate Professor, Division of General Internal Medicine and Health Services Research David Geffen School of Medicine University of California, Los Angeles Dr. Ladapo[/caption] Joseph A. Ladapo, MD, PhD Principal Substudy Investigator, PRESET Registry Subgroup Analysis, Elderly Patients Associate Professor, Division of General Internal Medicine and Health Services Research David Geffen School of Medicine University of California, Los Angeles MedicalResearch.com: What is the background for this study?  Response: The mapping of the Human Genome 14 years ago ushered in a new era of precision medicine. Many people are familiar with advances in oncology using precision medicine, but recently, new developments in precision medicine in cardiology have allowed us to develop a tool to differentiate patients likely to have obstructive coronary artery (CAD) from those who have non-cardiac causes of their symptoms. Diagnosing CAD in the elderly is challenging. Aging individuals often present with atypical symptoms of CAD which can complicate the evaluation process. The typical diagnostic pathway for possible CAD often starts with less invasive testing and progresses to invasive testing, especially in older patients. Invasive procedures pose greater risk in the elderly population than they do in younger patients because of the higher risk of side effects, including bleeding, vascular complications and kidney injury. Elderly adults evaluated for CAD have a higher pretest probability of CAD and are also at higher risk of experiencing procedure-related complications during their evaluation.[i],[ii] It is also important to note that elderly patients are often underrepresented in clinical trials and other types of comparative effectiveness research.[iii],[iv] For example, the 2013 American College of Cardiology/American Heart Association Atherosclerotic Cardiovascular Disease Risk Algorithm is only formally approved to be used in individuals up to the age of 75, despite the fact that individuals exceeding this threshold in age experience higher rates of adverse cardiovascular events.[v] All of this means that the elderly population may have the most to gain from timely and accurate determination of their currently likelihood of obstructive CAD. This precision medicine tool, the age, sex and gene expression score (ASGES), and its clinical utility in the elderly population is the focus of this study. It was based on patient data from the PRESET Registry, a prospective, multicenter, observational study enrolling stable, symptomatic outpatients from 21 U.S. primary care practices from August 2012 to August 2014.
Alzheimer's - Dementia, Author Interviews, Cognitive Issues, Geriatrics, Hearing Loss, JAMA / 11.12.2017

MedicalResearch.com Interview with: “Hear” by Jaya Ramchandani is licensed under CC BY 2.0David G. Loughrey, BA(Hons) NEIL (Neuro Enhancement for Independent Lives) Programme Trinity College Institute of Neuroscience, School of Medicine Trinity College Dublin, Dublin, Ireland MedicalResearch.com: What is the background for this study? Response: Age-related hearing loss, a common chronic condition among older adults, has emerged in the literature as a potential modifiable risk factor for dementia. This is of interest as current pharmacological therapies for dementias such as Alzheimer’s disease only offer symptom-modifying effects. Treatment of risk factors such as hearing loss may help delay the onset of dementia and may provide an alternate therapeutic strategy. However, there is variance in the research on hearing loss and cognition with some studies reporting a small or non-significant association. In this meta-analysis, we investigated this association and we only included observational studies that used standard assessments of cognitive function and pure-tone audiometry (the clinical standard).
Accidents & Violence, Author Interviews, Geriatrics / 30.11.2017

MedicalResearch.com Interview with: aaaTara Kelley-Baker PhD Data and Information Group Leader AAA Foundation for Traffic Safety MedicalResearch.com: What is the background for this study? Background on LongROAD The AAA Foundation for Traffic Safety (AAAFTS) launched the Senior Driver Initiative in 2012 in an effort to better understand and meet the safe mobility needs of older adult drivers. A multidisciplinary research team from six institutions was formed to design and implement the Longitudinal Research on Aging Drivers (LongROAD) study. The aims of the study are to better understand:
  • 1) major protective and risk factors of safe driving;
  • 2) effects of medical conditions and medications on driving behavior and safety;
  • 3) mechanisms through which older adults self-regulate their driving behaviors to cope with functional declines;
  • 4) the extent, use, and effects of new vehicle technology and aftermarket vehicle adaptations among older drivers; and
  • 5) determinants and health consequences of driving cessation during the process of aging.
Aging, Author Interviews, Exercise - Fitness, Geriatrics / 29.11.2017

MedicalResearch.com Interview with: [caption id="attachment_38579" align="alignleft" width="200"]Michael J. LaMonte, PhD, MPH Research Associate Professor Department of Epidemiology and Environmental Health Co-Director, MPH Program (epidemiology) School of Public Health and Health Professions Women’s Health Initiative Clinic University at Buffalo – SUNY  Dr. LaMonte[/caption] Michael J. LaMonte, PhD, MPH Research Associate Professor Department of Epidemiology and Environmental Health Co-Director, MPH Program (epidemiology) School of Public Health and Health Professions Women’s Health Initiative Clinic University at Buffalo – SUNY  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Current national public health guidelines recommend 150 minutes of moderate to vigorous physical activity a week for adults. The guidelines recommend persons 65 and older follow the adult guidelines to the degree their abilities and conditions allow. Some people, because of age or illness or deconditioning, are not able to do more strenuous activity. Current guidelines do not specifically encourage light activity because the evidence base to support such a recommendation has been lacking. Results from the Objective Physical Activity and Cardiovascular Health (OPACH) Study, an ancillary study to the U.S. Women’s Health Initiative, recently published in the Journal of the American Geriatrics Society showed women ages 65-99 who engaged in regular light intensity physical activities had a reduction in the risk of mortality. The 6,000 women in the OPACH study wore an activity-measuring device called an accelerometer on their hip for seven days while going about their daily activities and were then followed for up to four and a half years.  Results showed that just 30 additional minutes of light physical activity per day lowered mortality risk by 12 percent while 30 additional minutes of moderate activity, such as brisk walking or bicycling at a leisurely pace, exhibited a 39 percent lower risk.  The finding for lower mortality risk associated with light intensity activity truly is remarkable. We anticipated seeing mortality benefit associated with regular moderate-to-vigorous intensity activity, as supported by current public health guidelines. But, observing significantly lower mortality among women who were active at levels only slightly higher than what defines being sedentary was such a novel finding with important relevance to population health.
Author Interviews, Geriatrics, Heart Disease, JACC, UCLA / 14.11.2017

MedicalResearch.com Interview with: [caption id="attachment_38248" align="alignleft" width="151"]Kevin S. Shah, M.D. Cardiology Fellow, University of California, Los Angeles Ronald Reagan UCLA Medical Center Dr. Shah[/caption] Kevin S. Shah, M.D. Cardiology Fellow, University of California, Los Angeles Ronald Reagan UCLA Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Heart failure (HF) is a chronic condition and progressive disease which is associated with a high-risk of hospitalization and death. One of the principle ways in which heart function is estimated is the use of ultrasound to calculate the ejection fraction of the heart, an estimate of the heart’s pump function. The ejection fraction can help predict how long patients will live and affects decision-making with regards to what medications may help their condition. A total of 39,982 patients from 254 hospitals who were admitted for Heart failure between 2005 and 2009 were included. They were followed over time to see if they were admitted to the hospital again or if they died during this period. We compared three subgroups within this large group of patients based on their estimated ejection fraction. Across subgroups, the 5-year risk of hospitalization and death was high when compared with the U.S. population. Furthermore, the survival for patients with a diagnosis of heart failure who have been hospitalized once for this condition have a similarly poor 5-year risk of death and re-hospitalization, regardless of their estimated ejection fraction.
Accidents & Violence, Author Interviews, Exercise - Fitness, Frailty, Geriatrics, JAMA, Osteoporosis / 07.11.2017

MedicalResearch.com Interview with: [caption id="attachment_38044" align="alignleft" width="200"]Andrea C. Tricco PhD, MSc Scientist and Lead of the Knowledge Synthesis Team Associate Professor Dalla Lana School of Public Health, University of Toronto Associate Editor Journal of Clinical Epidemiology, BMC Medical Research Methodology, Systematic Reviews Dr. Tricco[/caption] Andrea C. Tricco PhD, MSc Scientist and Lead of the Knowledge Synthesis Team Associate Professor Dalla Lana School of Public Health, University of Toronto Associate Editor Journal of Clinical Epidemiology, BMC Medical Research Methodology, Systematic Reviews MedicalResearch.com: What is the background for this study? Response: Falls are the leading cause of injury among older adults and account for $2 billion in direct health-care costs annually ($31 billion in costs to Medicare in the United States in 2012). We aimed to determine which types of fall-prevention programs may be effective for reducing falls in older people. MedicalResearch.com: What are the main findings? Response: Exercise, along with vision assessment and treatment, as well as an assessment and possible modification of a person’s living environment, reduced the risk of injurious falls by 23% compared to usual care.
Author Interviews, Fertility, Geriatrics, Kidney Disease / 06.11.2017

MedicalResearch.com Interview with: [caption id="attachment_37895" align="alignleft" width="116"]Silvi Shah, MD, FACP, FASN Assistant Professor, Division of Nephrology University of Cincinnati Cincinnati, OH Dr. Shah[/caption] Silvi Shah, MD, FACP, FASN| Assistant Professor Division of Nephrology University of Cincinnati Cincinnati, OH MedicalResearch.com: What is the background for this study? What are the main findings? Response: Elderly represent the fastest growing segment of incident dialysis patients in Unites States. The annual mortality in end stage renal disease (ESRD) patients is very high ~ 20%. Since most of the deaths occur in the first year of dialysis, it is possible that health conditions present prior to initiation of dialysis may impact long-term outcomes. In this study, we determined the impact of poor functional status at the time of dialysis initiation and pre-dialysis health status on type of dialysis modality, type of hemodialysis access and one-year mortality in elderly dialysis patients. We evaluated 49,645 adult incident dialysis patients (1/1/2008 to 12/31/2008) from the United Data Renal Data System (USRDS) with linked Medicare data for at least 2 years prior to dialysis initiation. Mean age of our study population was 72 years. At dialysis initiation, 18.7% reported poor functional status, 88.9% has pre-dialysis hospitalization, and 27.8% did not receive pre-dialysis nephrology care. Patients with poor functional status had higher odds of being initiated on hemodialysis than peritoneal dialysis, lower odds of using arteriovenous access as compared to central venous catheter for dialysis and higher risk of one-year mortality.
Author Interviews, Geriatrics, Kidney Disease / 04.11.2017

MedicalResearch.com Interview with: Charuhas Thakar, MD Professor Director of the Division of Nephrology Kidney CARE program University of Cincinnati MedicalResearch.com: What is the background for this study? What are the main findings? Response: Based on the plausibility that pre-dialysis health status can impact outcomes after initiation of chronic dialysis, we examined large national USRDS dataset with linked Medicare claims prior to dialysis. We found that 88% of patients who initiate dialysis experience at least one acute care hospitalization in two years preceding their dialysis start. If they do, that is associated with a significant increase in the risk of mortality at one year. We also examined effect of different types of hospitalizations in the pre-dialysis period – Cardiovascular, Infections, both, and neither of the two. There were statistical differences in the effect of type of hospitalization and post dialysis mortality.
Author Interviews, Geriatrics, Race/Ethnic Diversity / 09.10.2017

MedicalResearch.com Interview with: [caption id="attachment_37419" align="alignleft" width="145"]MedicalResearch.com Interview with: Karen Joynt Maddox, MD, MPH Washington University School of Medicine Saint Louis MO Dr. Joynt-Maddox[/caption] Karen Joynt Maddox, MD, MPH Washington University School of Medicine Saint Louis MO MedicalResearch.com: What is the background for this study? What are the main findings? Response: Home health is one of the fastest-growing sectors in Medicare, and the setting of a new federal value-based payment program, yet little is known about disparities in clinical outcomes among Medicare beneficiaries receiving home health care. We found that beneficiaries who were poor or Black had worse clinical outcomes in home health care than their peers. These individuals were generally more likely to have unplanned hospitalizations, readmissions, and emergency department visits. Under Home Health Value-Based Purchasing, these patterns should be tracked carefully to ensure the program helps close the gaps rather than widening them.
Author Interviews, Diabetes, Geriatrics, Primary Care / 19.09.2017

MedicalResearch.com Interview with: [caption id="attachment_37029" align="alignleft" width="117"]Matthew L. Maciejewski, PhD Professor in Medicine Division of General Internal Medicine, Department of Medicine Center for Health Services Research Primary Care Durham VA Medical Center Duke University Dr. Maciejewski[/caption] Matthew L. Maciejewski, PhD Professor in Medicine Division of General Internal Medicine, Department of Medicine Center for Health Services Research Primary Care Durham VA Medical Center Duke University MedicalResearch.com: What is the background for this study? What are the main findings? Response: Treating diabetes requires balancing the risks of long-term harm from under-treatment with the short-term and long-term harm from potential over-treatment. Randomized trials have shown that the benefits of aggressive glycemic control only begin after at least 8 years of treatment. Yet, the harms of aggressive glycemic control –  hypoglycemia, cardiovascular events, cognitive impairment, fractures, and death – can happen at any time. In some older people, “deintensification” of diabetes treatment may be the safer route, because of the risks that come with too-low blood sugar. The American Geriatrics Society (AGS) specifically states that medications other than metformin should be avoided when an older patient’s hemoglobin A1c is less than 7.5%, because the risks of hypoglycemia are larger and the potential benefits of treatment are smaller for older adults with diabetes.  Most attention in prior work has focused on undertreatment of diabetes and there has been only limited investigation of patient characteristics associated with overtreatment of diabetes or severe hypoglycemia. Since the elderly are therefore at greatest risk of overtreatment and Medicare is the primary source of care of the elderly, we examined rates of overtreatment and deintensification of therapy for Medicare beneficiaries, and whether there were any disparities in these rates.  We found that almost 11 percent of Medicare participants with diabetes had very low blood sugar levels that suggested they were being over-treated. But only 14 percent of these patients had a reduction in blood sugar medication refills in the next six months.
Author Interviews, CMAJ, Exercise - Fitness, Frailty, Geriatrics, Lifestyle & Health / 21.08.2017

MedicalResearch.com Interview with: [caption id="attachment_36538" align="alignleft" width="200"]Olga Theou, MSc PhD Assistant Professor, Department of Medicine, Dalhousie University Affiliated Scientist, Geriatric Medicine, Nova Scotia Health Authority Adjunct Senior Lecturer, School of Medicine, University of Adelaide Halifax, Nova Scotia Dr. Theou[/caption] Olga Theou, MSc PhD Assistant Professor, Department of Medicine, Dalhousie University Affiliated Scientist, Geriatric Medicine, Nova Scotia Health Authority Adjunct Senior Lecturer, School of Medicine, University of Adelaide Halifax, Nova Scotia  MedicalResearch.com: What is the background for this study? What are the main findings? Response: We already know that moderate to vigorous intensity physical activity, such as time accumulated during exercise, is associated with numerous health benefits. More recent studies also have shown that sedentary time, such as time accumulated during prolonged sitting at work, transportation, and leisure, can also increase the risk of adverse outcomes. What was not known was whether prolonged sitting affects people across different levels of frailty similarly. This is what we examined in our study. We found that there were differences. Low frailty levels (people who are extremely healthy; frailty index score < 0.1) seemed to eliminate the increased risk of mortality associated with prolonged sitting, even among people who did not meet recommended physical activity guidelines. Among people with higher frailty levels, sedentary time was associated with mortality but only among those who did not meet recommended physical activity guidelines
Author Interviews, Exercise - Fitness, Geriatrics, JAMA / 15.08.2017

MedicalResearch.com Interview with: [caption id="attachment_36426" align="alignleft" width="200"]Jennifer Brach, Ph.D., P.T. Associate professor, Department of physical therapy School of Health and Rehabilitation Sciences University of Pittsburgh Dr. Brach[/caption] Jennifer Brach, Ph.D., P.T. Associate professor, Department of physical therapy School of Health and Rehabilitation Sciences University of Pittsburgh MedicalResearch.com: What is the background for this study? What are the main findings? Response: This study compared two different group exercise programs to improve mobility in community-dwelling older adults. The first program, a seated program focused on strength, endurance and flexibility, was based on usual care. The second program, called On the Move, was conducted primarily in standing position and focused on the timing and coordination of movements important for walking. Both programs met two times per week for 12 weeks. It was found that the On the Move program was more effective at improving mobility than the usual seated program.
Author Interviews, Geriatrics, Psychological Science / 15.08.2017

MedicalResearch.com Interview with: Johanna MH Nijsten, Msc Clinical Neuropsychologist Archipel Landrijt, Knowledge Center for Specialized Care Eindhoven, the Netherlands Department of Primary and Community Care, Radboudumc Alzheimer Center Radboud University Medical Center Nijmegen, the Netherlands  MedicalResearch.com: What is the background for this study? Response: Apathy is common in nursing home (NH) patients with dementia and is repeatedly found to be the most prevalent neuropsychiatric symptom. Apathy is defined by diminished or lack of motivational, goal-directed behavior, and a lack of cognition and emotional affect. Apathy leads to reduced interest and participation in the main activities of daily living, diminished initiative, early withdrawal from initiated activities, indifference, and flattening of affect. Over the last two decades, more scientific knowledge has become available about specific fronto-subcortical systems in the brain that may be highly involved in apathy. Disruptions in these systems are found in patients with frontal lobe damage resulting from, for instance, (early-onset) dementia, traumatic brain injury, stroke, or multiple sclerosis. Fronto-subcortical circuits also play an important role in neurological disorders involving the basal ganglia such as Parkinson’s disease and Huntington’s disease. The neurodegenerative diseases and acquired brain injuries mentioned here are highly prevalent in patients receiving long-term NH care and the widespread clinical manifestation of apathy in NH-patients is thought to be related. Since apathy is very common in nursing home-patients and may lead to a poor prognosis, clear insight into its risk for mortality is needed and NH-staff need to understand this risk.
Accidents & Violence, Alzheimer's - Dementia, Author Interviews, Depression, Geriatrics, Karolinski Institute / 11.08.2017

MedicalResearch.com Interview with: [caption id="attachment_36437" align="alignleft" width="200"]Heidi Taipale, PhD Pharm Senior Researcher School of Pharmacy, University of Eastern Finland; and Department of Clinical Neuroscience Karolinska Institutet  Dr. Taipale[/caption] Heidi Taipale, PhD Pharm Senior Researcher School of Pharmacy, University of Eastern Finland; and Department of Clinical Neuroscience Karolinska Institutet  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Antidepressant use among older persons has been associated with an increased risk of falling and fall-related events, such as hip fractures, in previous studies. Our previous study identified risk of hip fractures in antidepressant among persons with Alzheimer’s disease. As falling is the main causal factor for head traumas and traumatic brain injuries among older persons, we hypothesized that antidepressant use could also be associated with these injuries. We utilized a nationwide cohort of 70,718 persons newly diagnosed with Alzheimer’s disease, identified from the Finnish registers. The risk of head injuries and traumatic brain injuries was compared between persons initiating antidepressant use and comparison persons of the same age, gender and time since they received diagnoses of Alzheimer’s disease but not using antidepressants. We found a 40-percent increased risk of head injuries and 30-percent increased risk of traumatic brain injuries associated with antidepressant use. Antidepressant use was associated with a higher risk of head injuries especially at the beginning of use – during the first 30 days – but the risk persisted even longer, up to two years. The association was also confirmed in a study design comparing time periods within the same person, thus eliminating selective factors.
Author Interviews, Blood Pressure - Hypertension, Geriatrics, JAMA / 17.07.2017

MedicalResearch.com Interview with: Donal J. Sexton, BSc, MD The Irish Longitudinal Study on Ageing Trinity College Dublin Health Research Board Clinical Research Facility Galway National University of Ireland Galway, Galway, Ireland Trinity Health Kidney Centre, Tallaght Hospital Department of Nephrology, Beaumont Hospital, Royal College of Surgeons of Ireland Dublin, Ireland MedicalResearch.com: What is the background for this study? What are the main findings? Response: In this study we used the inclusion criteria for SPRINT to identify those community dwelling elders who would meet criteria for the trial in clinical practice. Our data are based on a prospective cohort study composed of participants chosen by a national stratified random sampling mechanism. If SPRINT participants were truly representative of the population, then the participants in the standard care arm of the trial should resemble the population to some extent. If this were true then the injurious falls rate might be similar between the two samples also.
Aging, Author Interviews, Geriatrics, Sexual Health / 28.06.2017

MedicalResearch.com Interview with: [caption id="attachment_35636" align="alignleft" width="200"]MedicalResearch.com Interview with: Dr Hayley Wright BSc(Hons) MSc PhD C.Psychol Research Associate Faculty of Health and Life Sciences, Coventry University Centre for Research in Psychology, Behaviour and Achievement, Coventry University MedicalResearch.com: What is the background for this study? What are the main findings? Response: Last year, we published a study that showed a significant association between sexual activity and cognitive function (Wright & Jenks, 2016). This study showed that sex is linked to cognition, even after we account for other factors such as age, education, and physical and mental wellbeing. One important question that emerged from this study was centred around the role of frequency with which we engage in sexual activity. In the current study (Wright, Jenks & Demeyere, 2017), we found that engaging in sexual activity on a weekly basis is associated with better scores on specific cognitive tasks. MedicalResearch.com: What should clinicians and patients take away from your report? Response: We have demonstrated that sexual activity in later life may have measurable benefits that stretch beyond pleasure-seeking. We - society at large, and individual researchers - should challenge notions of embarrassment around sexuality that may prevent older people from accessing help and support for sexual or relationship issues. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Response: It may be advisable to take relationship factors into account when conducting studies around cognitive ageing. Researchers often make statistical adjustments for factors that are known to influence cognition and health (such as age, education and health problems), but actually, more personal factors may also have an effect on how our brain works. MedicalResearch.com: Is there anything else you would like to add? Response: The research so far has been cross-sectional (or correlational), and so we cannot say at this time whether sexual activity is causing better scores on cognitive tests. This issue of causality is something that we will address in future research as more data becomes available. We are currently researching whether all types of sexual activities are associated with cognitive function to the same extent. We are also working with support services to address barriers to relationship and sex therapy for older people and marginalised groups. MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community. Citation: Hayley Wright, Rebecca A. Jenks, Nele Demeyere. Frequent Sexual Activity Predicts Specific Cognitive Abilities in Older Adults. The Journals of Gerontology: Series B, 2017; DOI: 10.1093/geronb/gbx065 Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions. Dr. Wright[/caption] Dr Hayley Wright BSc(Hons) MSc PhD C.Psychol Research Associate Faculty of Health and Life Sciences, Coventry University Centre for Research in Psychology, Behaviour and Achievement, Coventry University MedicalResearch.com: What is the background for this study? What are the main findings? Response: Last year, we published a study that showed a significant association between sexual activity and cognitive function (Wright & Jenks, 2016). This study showed that sex is linked to cognition, even after we account for other factors such as age, education, and physical and mental wellbeing. One important question that emerged from this study was centred around the role of frequency with which we engage in sexual activity. In the current study (Wright, Jenks & Demeyere, 2017), we found that engaging in sexual activity on a weekly basis is associated with better scores on specific cognitive tasks.
Author Interviews, Cancer Research, Geriatrics, JAMA, Johns Hopkins / 12.06.2017

MedicalResearch.com Interview with: Nancy Schoenborn, MD Assistant Professor Division of Geriatric Medicine and Gerontology Johns Hopkins University School of Medicine Nancy Schoenborn, MD Assistant Professor Division of Geriatric Medicine and Gerontology Johns Hopkins University School of Medicine MedicalResearch.com: What are the main findings? Response: A lot of cancer screenings are not expected to save lives until up to 10 years later; however, the side effects of the test happen right away. Because of this, clinical guidelines have recommended against routine screening for those patients who will not live long enough to benefit but may experience the potential harm of the test in the short term. However, many patients with limited life expectancy still receive screening and clinicians are worried about how patients would react if they recommended that patients stop screening. This research is important because it is the first study that explores how patients think about the decision of stopping cancer screening and how patients want to talk to their doctors about this issue. Understanding patient perspectives would help improve screening practices and better align recommendations and patient preference.
Aging, Author Interviews, Geriatrics / 10.06.2017

MedicalResearch.com Interview with: [caption id="attachment_35204" align="alignleft" width="100"]Raya Elfadel Kheirbek, MD, MPH Geriatrician and Palliative Care Physician  Washington DC VA Medical Center  Associate Professor of Medicine  George Washington University  School of Medicine and Health Sciences Dr. Raya Elfadel Kheirbek[/caption] Raya Elfadel Kheirbek, MD, MPH Geriatrician and Palliative Care Physician Washington DC VA Medical Center Associate Professor of Medicine George Washington University School of Medicine and Health Sciences MedicalResearch.com: What is the background for this study? What are the main findings? Response: In the past decade, there has been a shift in the concept of successful aging from a focus on life span to health span. We all want to age gracefully “expecting” optimal health, quality of life and independence. Centenarians are living examples to the progress we have made in health care. They are the best example of successful aging since they have escaped, delayed or survived the major age-related diseases and have reached the extreme limit of human life. However, little is known about Veterans Centenarians’ incidence of chronic illness and its impact on survival. Utilizing the VA Corporate Data Warehouse (CDW), I worked with my colleagues’ researchers and identified 3,351 centenarians who were born between 1910 and 1915. The majority were white men who served in World War II and had no service related disability. The study found that 85 % of all the centenarians had no incidence of major chronic conditions between the ages of 80 and 99 years of age. The data demonstrate that Veteran centenarians tend to have a better health profile and their incidence of having one or more chronic illness is lower than in the general population.
Author Interviews, Geriatrics, JAMA, Surgical Research / 24.05.2017

MedicalResearch.com Interview with: Cheryl Chia-Hui Chen, RN, DNSc Vice Dean for Student Affairs Professor of Nursing National Taiwan University Nurse Supervisor at National Taiwan University Hospital Taipei, Taiwan MedicalResearch.com: What is the background for this study? What are the main findings? Response: Older patients undergoing abdominal surgery often experience preventable delirium, which greatly influences their postoperative recovery and hospital length of stay. The modified Hospital Elder Life Program (mHELP) utilizes nurses to reduce postoperative delirium and LOS among older patients undergoing abdominal surgery for resection of malignant tumor. The mHELP consisted of 3 protocols: oral and nutritional assistance, early mobilization, and orienting communication, researchers say. Researchers at the National Taiwan University Hospital randomly assigned 377 patients undergoing abdominal surgery for a malignant tumor to an intervention (n = 197) or usual care (n = 180). Postoperative delirium occurred in 6.6 percent of mHELP participants vs 15.1 percent of control individuals (odds of delirium reduced by 56 percent). Intervention group participants received the mHELP for a median of 7 days, and they had a median LOS that was two days shorter (12 vs 14 days).