| 1. |
- Amrouch, Cheima, et al.
(författare)
-
Applicability of STOPP/START prescribing criteria in integrated Swedish administrative health registries and a Swedish population-based cohort
- 2024
-
Ingår i: European Geriatric Medicine. - 1878-7649 .- 1878-7657.
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose The STOPP/START criteria are frequently applied in observational studies to assess potentially inappropriate prescribing in older adults. This study aimed to assess the applicability of the three available STOPP/START versions in two distinct data sources.Methods To evaluate the applicability of the three versions of STOPP/START criteria, we used two observational data sources: (i) Integrated Swedish administrative health registries (ISHR) encompassing routinely collected health data and (ii) the population-based Swedish National study on Aging and Care in Kungsholmen (SNAC-K), based on health professional-led clinical assessments. The Anatomical Therapeutic Classification code (ATC) was used to categorise medications. Diseases were categorised using the international classification of diseases version 10 (ICD10).Results The first STOPP/START version demonstrated an applicability rate of 80% in ISHR and 84% in SNAC-K. The second version demonstrated an applicability of 64% in ISHR and 74% in SNAC-K. The third version showed an applicability of 66% in ISHR and 77% in SNAC-K. Challenges in applicability included broad definitions, vague terminology, and the lack of information on disease severity, symptomatic traits, and stability of certain conditions.Conclusion The applicability of the STOPP/START criteria in observational studies seems to have decreased in more recent versions of the tool. Population-based studies with comprehensive clinical assessments may offer higher applicability compared to studies based on administrative data. Future versions of the STOPP/START criteria should prioritise clear and unambiguous definitions to improve their applicability in research and promote result generalisability and comparability.
|
|
| 2. |
- Calderón-Larrañaga, Amaia, et al.
(författare)
-
Psychological correlates of multimorbidity and disability accumulation in older adults
- 2019
-
Ingår i: Age and Ageing. - : Oxford University Press (OUP). - 0002-0729 .- 1468-2834. ; 48:6, s. 789-796
-
Tidskriftsartikel (refereegranskat)abstract
- Background/Objectives: attitudes toward life and health are emerging as important psychological contributors to health heterogeneity in ageing. We aimed to explore whether different psychological factors were associated with the rate of chronic disease and disability accumulation over time.Design: population-based cohort study between 2001 and 2010.Setting: Swedish National study on aging and care in Kungsholmen.Subjects: adults aged 60 and older (N = 2293).Methods: linear mixed models were employed to study the association of life satisfaction, health outlook, resistance to illness, sickness orientation, and health worry with the rate of accumulation of chronic diseases and impaired basic and instrumental activities of daily living. Models were adjusted for demographic, clinical, social, personality and lifestyle factors. Analyses were repeated after excluding individuals with multimorbidity or disability at baseline.Results: high life satisfaction and positive health outlook were consistently associated with a lower rate of accumulation and progression of multimorbidity (beta -0.064 95% confidence interval [CI] -0.116, -0.011; beta -0.065 95% CI -0.121, -0.008, respectively) and disability (beta -0.063 95% CI -0.098, -0.028; beta -0.042 95% CI -0.079, -0.004, respectively) over time. This was true even for people without multimorbidity or disability at baseline and after adjusting for all covariates.Conclusions: positive attitudes toward life in general and health in particular may be especially important in old age, when the cumulative effects of biological and environmental deficits lead to accelerated health decline. These findings should encourage researchers to use measures of psychological well-being to better understand the multifactorial and diverse process of ageing.
|
|
| 3. |
- Carfi, A., et al.
(författare)
-
Bone mineral density in adults with Down syndrome
- 2017
-
Ingår i: Osteoporosis International. - : Springer Science and Business Media LLC. - 0937-941X .- 1433-2965. ; 28:10, s. 2929-2934
-
Tidskriftsartikel (refereegranskat)abstract
- SummaryThis study analyzed data of bone mineral density (BMD) from a large cohort of adults with Down syndrome (DS). BMD was found to decrease with age more rapidly in these subjects than in the general population, exposing adults with DS to an increased risk of osteoporosis and bone fracture.IntroductionDown syndrome (DS) in adulthood presents with a high prevalence of osteoporosis. However, in DS, bone mineral density (BMD) can be underestimated due to short stature. Furthermore, the rate of age-related decline in BMD and its association with gender in DS has been rarely evaluated or compared with the general population. The present study is aimed at assessing the variation of BMD with age and gender in a sample of adults with DS and to compare these data with those of the general population, after adjusting for anthropometric differences.MethodsAdults with DS, aged 18 or older, were assessed dual-energy-X-ray-absorptiometry (DXA) at the femoral neck and at the lumbar spine. They were compared with the general population enrolled in the National Health and Nutrition Examination Survey (NHANES) 2009-2010 dataset. Bone mineral apparent density (BMAD) was calculated for each individual.ResultsDXA was evaluated in 234 subjects with DS (mean age 36.93 +/- 11.83 years, ranging from 20 to 69 years; 50.4% females). In the lumbar spine both mean BMD (DS 0.880 +/- 0.141 vs. NHANES 1.062 +/- 0.167, p < 0.001) and BMAD (DS 0.138 +/- 0.020 vs. NHANES 0.152 +/- 0.020, p < 0.001) were significantly lower in the DS sample than in the NAHNES cohort. The same trend was observed at the femoral neck in both BMD (DS 0.658 +/- 0.128 vs. NHANES 0.835 +/- 0.137, p < 0.001) and BMAD (DS 0.151 +/- 0.030 vs. NHANES 0.159 +/- 0.028, p < 0.001). Age was associated with lower femoral neck BMAD in both samples; importantly, this association was significantly stronger in the DS sample. In the lumbar spine region, no significant association between BMAD and age could be observed in both samples.ConclusionsAdults with DS have lower bone mineral density compared to the general population and they experience a steeper decline with age. Early screening programs are needed in DS population.
|
|
| 4. |
- Carfi, Angelo, et al.
(författare)
-
The burden of chronic disease, multimorbidity, and polypharmacy in adults with Down syndrome
- 2020
-
Ingår i: American Journal of Medical Genetics. Part A. - : Wiley. - 1552-4825 .- 1552-4833. ; 182:7, s. 1735-1743
-
Tidskriftsartikel (refereegranskat)abstract
- Data on clinical characteristics of adults with Down syndrome (DS) are limited and the clinical phenotype of these persons is poorly described. This study aimed to describe the occurrence of chronic diseases and pattern of medication use in a population of adults with DS. Participants were 421 community dwelling adults with DS, aged 18 years or older. Individuals were assessed through a standardized clinical protocol. Multimorbidity was defined as the occurrence of two or more chronic conditions and polypharmacy as the concomitant use of five or more medications. The mean age of study participants was 38.3 +/- 12.8 years and 214 (51%) were women. Three hundred and seventy-four participants (88.8%) presented with multimorbidity. The most prevalent condition was visual impairment (72.9%), followed by thyroid disease (50.1%) and hearing impairment (26.8%). Chronic diseases were more prevalent among participants aged >40 years. The mean number of medications used was 2.09 and polypharmacy was observed in 10.5% of the study sample. Psychotropic medications were used by a mean of 0.7 individuals of the total sample. The high prevalence of multimorbidity and the common use of multiple medications contributes to a high level of clinical complexity, which appears to be similar to the degree of complexity of the older non-trisomic population. A comprehensive and holistic approach, commonly adopted in geriatric medicine, may provide the most appropriate care to persons with DS as they grow into adulthood.
|
|
| 5. |
- Dekhtyar, Serhiy, et al.
(författare)
-
Association Between Speed of Multimorbidity Accumulation in Old Age and Life Experiences : A Cohort Study
- 2019
-
Ingår i: American Journal of Epidemiology. - : Oxford University Press (OUP). - 0002-9262 .- 1476-6256. ; 188:9, s. 1627-1636
-
Tidskriftsartikel (refereegranskat)abstract
- Rapidly accumulating multiple chronic conditions (multimorbidity) during aging are associated with many adverse outcomes. We explored the association between 4 experiences throughout life-childhood socioeconomic circumstances, early-adulthood education, midlife occupational stress, and late-life social network-and the speed of chronic disease accumulation. We followed 2,589 individuals aged >= 60 years from the Swedish National Study on Aging and Care in Kungsholmen for 9 years (2001-2013). Information on life experiences was collected from detailed life-history interviews. Speed of disease accumulation was operationalized as the change in the count of chronic conditions obtained from clinical examinations, medical histories, laboratory data, drug use, and register linkages over 9 years. Linear mixed models were used to analyze the data. Speed of disease accumulation was lower in individuals with more than elementary education (for secondary, beta x time = -0.065, 95% CI: -0.126, -0.004; for university, beta x time = -0.118, 95% CI: -0.185, -0.050); for active occupations compared with high-strain jobs (beta x time = -0.078, 95% CI: -0.138, -0.017); and for richer social networks (for moderate tertile, beta x time = -0.102, 95% CI: -0.149, -0.055; for highest tertile, beta x time = -0.135, 95% CI: -0.182, -0.088). The association between childhood circumstances and speed of disease accumulation was attenuated by later-life experiences. Diverse experiences throughout life might decelerate chronic disease accumulation during aging.
|
|
| 6. |
- Dove, Abigail, et al.
(författare)
-
Association between social isolation and reduced mental well-being in Swedish older adults during the first wave of the COVID-19 pandemic : the role of cardiometabolic diseases
- 2022
-
Ingår i: Aging. - : Impact Journals, LLC. - 1945-4589. ; 14:6, s. 2462-2474
-
Tidskriftsartikel (refereegranskat)abstract
- Social isolation has been recommended as a strategy for reducing COVID-19 risk, but it may have unintended consequences for mental well-being. We explored the relationship between social isolation and symptoms of depression and anxiety in older adults during the first wave of the COVID-19 pandemic and assessed the role of cardiometabolic diseases (CMDs) in this association. Between May and September 2020, 1,190 older adults from the Swedish National Study on Aging and Care in Kungsholmen were surveyed about their behaviors and health consequences during the first wave of the COVID-19 pandemic. In total, 913 (76.7%) participants reported socially isolating at home to avoid infection during this period. Social isolation was associated with a greater likelihood of reduced mental well-being (i.e., feelings of depression or anxiety) (OR: 1.74, 95% CI: 1.15-2.65). In joint exposure analysis, there was a significant likelihood of reduced mental well-being only among people who were socially isolating and had CMDs (OR: 2.13, 95% CI: 1.22-3.71) (reference: not isolating, CMD-free). In conclusion, social isolation as a COVID-19 prevention strategy was related to reduced mental well-being in an urban sample of Swedish older adults, especially among individuals with CMDs.
|
|
| 7. |
- Dove, Abigail, et al.
(författare)
-
Cardiometabolic disease, cognitive decline, and brain structure in middle and older age
- 2024
-
Ingår i: Alzheimer's and Dementia. - 2352-8729. ; 16:2
-
Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: The presence of multiple cardiometabolic diseases (CMDs) has been linked to increased dementia risk, but the combined influence of CMDs on cognition and brain structure across the life course is unclear.METHODS: In the UK Biobank, 46,562 dementia-free participants completed a cognitive test battery at baseline and a follow-up visit 9 years later, at which point 39,306 also underwent brain magnetic resonance imaging. CMDs (diabetes, heart disease, and stroke) were ascertained from medical records. Data were analyzed using age-stratified (middle age [< 60] versus older [≥ 60]) mixed-effects models and linear regression.RESULTS: A higher number of CMDs was associated with significantly steeper global cognitive decline in older (β = –0.008; 95% confidence interval: −0.012, −0.005) but not middle age. Additionally, the presence of multiple CMDs was related to smaller total brain volume, gray matter volume, white matter volume, and hippocampal volume and larger white matter hyperintensity volume, even in middle age.DISCUSSION: CMDs are associated with cognitive decline in older age and poorer brain structural health beginning already in middle age.
|
|
| 8. |
- Dove, Abigail, et al.
(författare)
-
Cardiometabolic multimorbidity accelerates cognitive decline and dementia progression
- 2023
-
Ingår i: Alzheimer's & Dementia. - : Wiley. - 1552-5260 .- 1552-5279. ; 19:3, s. 821-830
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction: Cardiometabolic diseases (CMDs) have been individually associated with adverse cognitive outcomes, but their combined effect has not been investigated.Methods: A total of 2577 dementia-free participants 60 years of age or older were followed for 12 years to observe changes in cognitive function and to detect incident cognitive impairment, no dementia (CIND) and dementia. CMDs (including type 2 diabetes, heart disease, and stroke) were assessed at baseline through medical records and clinical examinations. Cardiometabolic multimorbidity was defined as the presence of two or more CMDs. Data were analyzed using multi-adjusted linear mixed-effects models, Cox regression, and Laplace regression.Results: CMD multimorbidity was associated with cognitive decline, CIND (hazard ratio [HR] 1.73; 95% confidence interval CI 1.23 to 2.44), and its progression to dementia (HR 1.86; 95% CI 1.17 to 2.97). CMD multimorbidity accelerated the onset of CIND by 2.3 years and dementia by 1.8 years.Conclusions: CMD multimorbidity accelerates cognitive decline and increases the risk of both CIND and its conversion to dementia.
|
|
| 9. |
- Ekström, Ingrid, et al.
(författare)
-
Serum C-Reactive Protein Is Negatively Associated With Olfactory Identification Ability in Older Adults
- 2021
-
Ingår i: i-Perception. - : SAGE Publications. - 2041-6695. ; 12:2
-
Tidskriftsartikel (refereegranskat)abstract
- Importance Olfactory deficits are common in aging and associated with several conditions linked to inflammation. A few studies suggest that increased concentration of pro-inflammatory biomarkers may be related to olfactory deficits, but these associations are understudied in population-based samples. Objective To investigate the association between serum concentrations of C-reactive protein (CRP) and olfactory identification level as well as rate of change in aging. Methods We included 1,721 participants (mean age 70.5 years; 61.9% female) with at least two olfactory assessments across the 12-year follow-up. Baseline level and change in odor identification were estimated with linear mixed models as a function of CRP levels, derived from blood plasma at baseline. Results Results indicated a negative dose-response association between CRP level and odor identification scores at baseline, after adjustment for demographic, cognitive, health, and lifestyle factors. CRP levels ranging between 11 and 20 mg/L were significantly related to lower olfactory ability (beta = -0.811, 95% confidence interval [CI] [-1.503 to -0.118]; p = .022). Likewise, CRP values above 20 mg/L were related to lower olfactory scores, an association that approached statistical significance (beta = -0.996, 95% CI [-2.045 to 0.054]; p = .063). We found no associations between CRP and olfactory change (ps > .368). Sensitivity analyses showed that associations between CRP and olfaction were confined to younger participants (age <= 72 years) and men (ps < .034). Conclusions Our findings suggest a negative association between serum CRP levels and olfactory identification ability in aging that may be dependent on age and sex.
|
|
| 10. |
- Grande, Giulia, et al.
(författare)
-
Brain Changes and Fast Cognitive and Motor Decline in Older Adults
- 2022
-
Ingår i: The journals of gerontology. Series A, Biological sciences and medical sciences. - : Oxford University Press (OUP). - 1079-5006 .- 1758-535X. ; 78:2, s. 326-332
-
Tidskriftsartikel (refereegranskat)abstract
- Background: To identify brain magnetic resonance imaging (MRI) signatures characterizing people with different patterns of decline in cognition and motor function.Methods: In the Swedish National Study on Aging and Care in Kungsholmen, Stockholm, 385 participants had available repeated brain MRI examinations, where markers of brain volumes and white matter integrity were assessed. The speed of cognitive and motor decline was estimated as the rate of a Mini-Mental State Examination and gait speed decline over 12 years (linear mixed models), and further dichotomized into the upper (25% fastest rate of decline) versus the lower quartiles. Participants were grouped in slow/no decliners (reference), isolated motor decliners, isolated cognitive decliners, and cognitive and motor decliners. We estimated the associations between changes in brain markers (linear mixed models) and baseline diffusion tensor imaging measures (linear regression model) and the 4 decline patterns.Results: Individuals with concurrent cognitive and motor decline (n = 51) experienced the greatest loss in the total brain (β: −12.3; 95% confidence interval [CI]: −18.2; −6.38) and hippocampal (β: −0.25; 95% CI: −0.34; −0.16) volumes, the steepest accumulation of white matter hyperintensities (β: 1.61; 95% CI: 0.54; 2.68), and the greatest ventricular enlargement (β: 2.07; 95% CI: 0.67; 3.47). Compared to the reference, those only experiencing cognitive decline presented with steeper hippocampal volume loss, whereas those exhibiting only motor decline displayed a greater white matter hyperintensities burden. Lower microstructural white matter integrity was associated with concurrent cognitive and motor decline.Conclusion: Concurrent cognitive and motor decline is accompanied by rapidly evolving and complex brain pathology involving both gray and white matter. Isolated cognitive and motor declines seem to exhibit brain damage with different qualitative features.
|
|
| 11. |
- Grande, Giulia, et al.
(författare)
-
Drug Use in Older Adults with Amyotrophic Lateral Sclerosis Near the End of Life
- 2017
-
Ingår i: Drugs & Aging. - : Springer Science and Business Media LLC. - 1170-229X .- 1179-1969. ; 34:7, s. 529-533
-
Tidskriftsartikel (refereegranskat)abstract
- Background Amyotrophic lateral sclerosis (ALS), with its certain prognosis and swift progression, raises concerns regarding the adequacy of pharmacological treatment, including the risk-benefit profiles of prescribed drugs. Objective Our objective was to evaluate the use of prescription drugs over the course of the last year of life in older adults with ALS. Methods We conducted a nationwide retrospective cohort study of older adults who died with ALS in Sweden between 2007 and 2013. The primary outcome was the number of prescription drugs to which individuals were exposed during the last 12 months before death. Results The overall proportion of individuals receiving ten or more different prescription drugs increased from 19% at 12 months before death to 37% during the last month of life. Institutionalization was independently associated with polypharmacy near the end of life (odds ratio 1.84; 95% confidence interval 1.42-2.39). Conclusion Future research is needed to assess the time to benefit of treatments and to develop guidelines for medication discontinuation in advanced ALS.
|
|
| 12. |
- Grande, Giulia, et al.
(författare)
-
Living Alone and Dementia Incidence : A Clinical-Based Study in People With Mild Cognitive Impairment
- 2018
-
Ingår i: Journal of Geriatric Psychiatry and Neurology. - : SAGE Publications. - 0891-9887 .- 1552-5708. ; 31:3, s. 107-113
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction: Social isolation and living alone have been associated with negative outcomes, especially in the older population. We aim to investigate the effect of living alone on the development of dementia in people with mild cognitive impairment (MCI). Materials and Methods: In this longitudinal study, we enrolled 345 outpatients with MCI evaluated at baseline through a clinical and neuropsychological protocol. Data on living situation (living alone vs. living with someone) were also collected. The development of dementia at follow-up was the outcome of the study. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox regression analyses. Laplace regression was used to model the time-to-dementia diagnosis as a function of living situation. Results: During the follow-up time (mean [SD]: 2.8 [2.2] years), 172 (50%) participants developed dementia. After controlling for age, sex, years of education, MCI subtype, presence of comorbidities, and antidepressant therapy, people with MCI living alone were more likely to develop dementia (HR: 1.5; 95% CI: 1.1-2.1), when compared to those living with someone. In addition, participants with MCI living alone were diagnosed with dementia 1 year earlier than those living with someone (P = .012). Conclusion: Living alone increases by 50% the risk of developing dementia and anticipates by 1 year the diagnosis in people with MCI. These results, in line with findings of previous population-based studies, emphasize the pivotal role of the living situation in identifying a frailer share of the population at higher risk of dementia to which devote ad hoc assessment and care.
|
|
| 13. |
- Gutiérrez-Valencia, Marta, et al.
(författare)
-
Anticholinergic burden and health outcomes among older adults discharged from hospital : results from the CRIME study
- 2017
-
Ingår i: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 0031-6970 .- 1432-1041. ; 73:11, s. 1467-1474
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose The purpose of this study is to investigate whether there is an association between anticholinergic burden and mortality or rehospitalization in older adults discharged from hospital. Methods Prospective multicenter cohort study carried out with patients aged 65 and older discharged from seven acute care hospitals. The primary outcomes of the study were rehospitalization and mortality within 1 year after discharge. The study population was classified in three groups according to the anticholinergic exposure measured by the Anticholinergic Risk Scale (ARS) and Duran's list at the time of hospital discharge: without risk (ARS/Duran = 0), low risk (ARS/Duran = 1), and high risk (ARS/Duran >= 2). Predictors of hospitalizations and mortality were examined using regression models adjusting for important covariates. Results The mean age of the 921 participants was 81.2 years (SD = 7.4 years). Prevalence of exposure to medications with anticholinergic activity ranged from 19.6% with ARS to 32.1% with Duran's list. During the follow-up period, 30.4% of participants were hospitalized and 19.4% died. Multivariate regression analysis showed that low anticholinergic burden quantified according to Duran's list was significantly associated with all-cause mortality (OR 1.69, 95% CI 1.02-2.82). This association was not present after adjustment when using ARS. No statistically significant association was found between anticholinergic burden and hospitalizations. Conclusions Taking medications with anticholinergic activity is associated with greater risk of mortality in older adults discharged from acute care hospitals. Strategies to reduce anticholinergic burden in vulnerable elders could be useful to improve health outcomes. Further research is required to assess the association between anticholinergic burden and hospitalizations in older patients.
|
|
| 14. |
- Kirvalidze, Mariam, et al.
(författare)
-
Effectiveness of integrated person-centered interventions for older people's care : Review of Swedish experiences and experts' perspective
- 2024
-
Ingår i: Journal of Internal Medicine. - : John Wiley & Sons. - 0954-6820 .- 1365-2796.
-
Tidskriftsartikel (refereegranskat)abstract
- Older adults have multiple medical and social care needs, requiring a shift toward an integrated person-centered model of care. Our objective was to describe and summarize Swedish experiences of integrated person-centered care by reviewing studies published between 2000 and 2023, and to identify the main challenges and scientific gaps through expert discussions. Seventy-three publications were identified by searching MEDLINE and contacting experts. Interventions were categorized using two World Health Organization frameworks: (1) Integrated Care for Older People (ICOPE), and (2) Integrated People-Centered Health Services (IPCHS). The included 73 publications were derived from 31 unique and heterogeneous interventions pertaining mainly to the micro- and meso-levels. Among publications measuring mortality, 15% were effective. Subjective health outcomes showed improvement in 24% of publications, morbidity outcomes in 42%, disability outcomes in 48%, and service utilization outcomes in 58%. Workshop discussions in Stockholm (Sweden), March 2023, were recorded, transcribed, and summarized. Experts emphasized: (1) lack of rigorous evaluation methods, (2) need for participatory designs, (3) scarcity of macro-level interventions, and (4) importance of transitioning from person- to people-centered integrated care. These challenges could explain the unexpected weak beneficial effects of the interventions on health outcomes, whereas service utilization outcomes were more positively impacted. Finally, we derived a list of recommendations, including the need to engage care organizations in interventions from their inception and to leverage researchers' scientific expertise. Although this review provides a comprehensive snapshot of interventions in the context of Sweden, the findings offer transferable perspectives on the real-world challenges encountered in this field. image
|
|
| 15. |
- L'Angiocola, Paolo Diego, et al.
(författare)
-
From bicuspid to quadricuspid aortic valve : The clinical case of a 38-year-old woman with chest pain
- 2019
-
Ingår i: Journal of Cardiovascular Echography. - : Medknow. - 2211-4122 .- 2347-193X. ; 29:3, s. 119-122
-
Tidskriftsartikel (refereegranskat)abstract
- We report a case of a 38-year-old woman with an alleged diagnosis of bicuspid aortic valve disease that was correctly identified as quadricuspid aortic valve (QAV) disease in our cardiology unit. In this case report, we focus on echocardiographic features of this rare congenital valve disease aiming to provide useful tips to achieve correct differential diagnosis according to the updated echocardiographic international guidelines and recommendations, briefly reviewing other QAV cases reported in the current literature as well. In conclusion, we strongly recommend adhering to practical echocardiographic guidelines to reduce interobserver variability, not to miss the diagnosis of rare congenital defects like the one we reported.
|
|
| 16. |
- Lapi, Francesco, et al.
(författare)
-
A Cohort Study on Influenza Vaccine and All-Cause Mortality in Older Adults : Methodological Concerns and Public Health Implications
- 2022
-
Ingår i: Drugs & Aging. - : Springer Science and Business Media LLC. - 1170-229X .- 1179-1969. ; 39:8, s. 645-656
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction In 2020, the restrictions adopted to control the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic led to an unprecedented reduction in influenza-related burden. As such, the reduced chance to characterize the circulating virus strains might have increased the risk of vaccine mismatch for the forthcoming winter seasons. The role of an effective influenza vaccination campaign might therefore assume even more value, especially for frail and multimorbid older individuals. Methodological concerns on confounding by indication are always debated in vaccine effectiveness studies and it might be instrumental to give a pragmatic message on an individual's responsibility to receive the influenza vaccine. We therefore investigated the role of specific confounders to explain the association between influenza vaccine and mortality among older adults.Methods Using a primary care database, we formed a cohort of patients aged 65 years or older who were actively registered with their general practitioner (GP) at the beginning of each of nine influenza seasons through to the 2018/2019 season. The study index date was the related seasons' starting date. Exposure to the influenza vaccine was operationally defined in the 2 months preceding the index date up to 2 weeks before the exit date. Cox regression models were estimated to calculate hazard ratios (HRs) and their 95% confidence intervals (CI) of death between vaccinated and unvaccinated patients in a time-dependent fashion. The potential confounders sequentially entered the model based on their increasing effect size observed in univariate analyses.Results Over the 10 years under study, the influenza vaccine showed a significant protective effect in terms of mortality, reaching 13% reduction (HR 0.87, 95% CI 0.80-0.95) in the 2018/2019 influenza season. When we estimated the multivariate model by sequentially adding the potential confounders, there was an inversion of HR (below the unit) that was significantly explained by the covariates coding for a prior history of lower respiratory tract infections and the presence of the pneumococcal vaccine. Conclusion In the current pandemic scenario, we cannot divert attention to proper use of face masks, social distancing, and hand hygiene, which are important measures to prevent influenza and other respiratory viral infections. Nonetheless, their effectiveness might be negligible without acceptable coverage for influenza vaccine, especially in older patients with a history of lower respiratory tract infections, which appears to be the main source of confounding by indication.
|
|
| 17. |
- Lapi, Francesco, et al.
(författare)
-
How to support general practitioners to better detect sarcopenia among older adults : a nested case-control analysis
- 2024
-
Ingår i: European Geriatric Medicine. - 1878-7649 .- 1878-7657.
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose This study explores correlations of sarcopenia and its proxies, such as history of falls, asthenia, and ambulation issues, with frailty levels among older adults in primary care.Methods In a cohort of 546,590 patients aged 60 years or older, “definite” sarcopenia cases were operationally defined through the use of non-specific diagnostic codes coupled with inspection of free-texts. Proxies of sarcopenia, such as falls history, asthenia, and ambulation issues were considered as well. Frailty was calculated using an Index intended to primary care.Results Overall, 171 definite sarcopenia cases were found, rising to 51,520 cases when including proxies (9.4% prevalence). There was a significant association between severe frailty and increased odds of sarcopenia, consistently observed across different event definitions.Conclusions Sarcopenia was strongly associated with severe frailty in primary care. The history of falls, asthenia, and ambulation issues were reliable proxies to raise the suspect of sarcopenia. Improved strategies for sarcopenia detection, focusing on specific indicators within severely frail individuals, are warranted.
|
|
| 18. |
- Liang, Yajun, et al.
(författare)
-
Serum total cholesterol and risk of cardiovascular and non-cardiovascular mortality in old age : a population-based study
- 2017
-
Ingår i: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 17
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Whether the suggested inverse association between total cholesterol and mortality in old age varies according to cause of death and use of cholesterol medications remains to be elucidated. The aim of this study was to assess the associations of total cholesterol with cardiovascular and non-cardiovascular mortality in old age, and to explore whether their associations vary by use of cholesterol-lowering medications. Methods: The study participants included 3090 older adults (age >= 60 years, 63.7% women) from a population-based cohort study, i.e., the Swedish National study on Aging and Care in Kungsholmen, Stockholm. At baseline (2001-2004), data on demographic factors, lifestyles, cardiovascular risk factors, use of medications, global cognitive function, mobility limitation, and apolipoprotein E genotype were collected through interviews, clinical examinations, laboratory tests as well as from the Swedish national patient register. Vital statistics data (e.g., date and causes of death) till December 31, 2011 for all participants were derived from Swedish cause of death register. Data were analyzed using Cox proportional hazards model for all-cause mortality and Fine-Gray competing risks regression model for cause-specific mortality controlling for multiple potential confounders. Results: During 23,196 person-years of follow-up (median per person, 7.5 years), 1059 (34.3%) participants died. Compared to normal total cholesterol (<5.18 mmol/l), borderline-high (5.18-6.21 mmol/l) and high (>= 6.22 mmol/l) total cholesterol were associated with a decreased risk of all-cause mortality, with the multiple-adjusted hazard ratio (95% confidence interval, CI) of 0.71 (0.61-0.83) and 0.68 (0.57-0.80), respectively (P for trend <0.001). The competing risk regression models revealed that the reduced all-cause mortality associated with high total cholesterol (>= 6.22 mmol/l)) was mainly due to the reduced risk of non-cardiovascular mortality (hazard ratio = 0.67, 95% CI = 0.51-0.88). These associations were statistically evident only among individuals without use of cholesterol-lowering medications. Conclusions: The inverse association between high total cholesterol and reduced all-cause mortality in older adults is primarily due to non-cardiovascular mortality, especially among those who are not treated with cholesterol-lowering medications.
|
|
| 19. |
|
|
| 20. |
- Lo Monaco, Maria Rita, et al.
(författare)
-
Safinamide as an adjunct therapy in older patients with Parkinson's disease : a retrospective study
- 2020
-
Ingår i: Aging Clinical and Experimental Research. - : Springer Science and Business Media LLC. - 1594-0667 .- 1720-8319. ; 32, s. 1369-1373
-
Tidskriftsartikel (refereegranskat)abstract
- Background Safinamide, as a levodopa adjunct, is effective in reducing motor fluctuations in Parkinson's disease (PD) patients; however, scarce evidence is available regarding its use in older PD patients. Aim To evaluate the safety and tolerability of safinamide as an adjunct therapy in patients aged >= 60 years with advanced PD. Methods A retrospective study including 203 PD patients admitted to a geriatric day hospital, who were evaluated following an extensive clinical protocol. Safinamide use was categorized as never used, ongoing, and withdrawn. Potential correlations of Safinamide withdrawal were investigated in stepwise backward logistic regression models. Results A total of 44 out of 203 participants were current or former users of Safinamide. Overall, 14 (32%) patients discontinued due to treatment-emergent adverse events (TEAEs). Withdrawal was not associated with older age. Conclusions Safinamide as an adjunct therapy in patients aged >= 60 years with advanced PD was found to be safe and well-tolerated in older patients. There were no specific demographic or clinical characteristics associated with suspension.
|
|
| 21. |
- Mao, Ming, et al.
(författare)
-
Ventricular Electrocardiographic Signatures Associated with Dementia and Plasma Alzheimer's Disease Biomarkers in Older Adults : A Population-Based Study
- 2023
-
Ingår i: Journal of Alzheimer's Disease. - 1387-2877 .- 1875-8908. ; 94:4, s. 1515-1526
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Evidence has emerged that altered ventricular electrocardiogram profiles are associated with dementia, but the neuropathological mechanisms underlying their associations are poorly understood. Objective: To investigate the interrelationships of ventricular electrocardiogram profiles with dementia and plasma Alzheimer's disease (AD) biomarkers among older adults. Methods: This population-based cross-sectional study included 5,153 participants (age >= 65 years; 57.3% women) living in rural communities in China; of these, 1,281 had data on plasma amyloid-beta (A beta)(40), A beta(42), total-tau, and neurofilament light chain (NfL) protein. The QT, QTc, JT, JTc, QRS intervals, and QRS axis were derived from the 10-second electrocardiogram recording. The DSM-IV criteria were followed for clinical diagnosis of dementia, the NIA-AA criteria for AD, and the NINDS-AIREN criteria for vascular dementia (VaD). Data were analyzed using general linear models, multinomial logistic models, and restricted cubic splines. Results: Of the 5,153 participants, 299 (5.8%) were diagnosed with dementia, including 194 with AD and 94 with VaD. Prolonged QT, QTc, JT, and JTc intervals were significantly associated with all-cause dementia, AD, and VaD (p < 0.05). Left QRS axis deviation was significantly associated with all-cause dementia and VaD (p < 0.01). In the subsample of plasma biomarkers (n = 1,281), prolonged QT, JT, and JTc intervals were significantly associated with a lower A beta(42)/A beta(40) ratio and higher plasma NfL concentrations (p < 0.05). Conclusion: Alterations in ventricular repolarization and depolarization are independently associated with all-cause dementia, AD, VaD, and AD plasma biomarkers in older adults (age >= 65 years). Ventricular electrocardiogram parameters may be valuable clinical markers for dementia and the underlying AD pathologies and neurodegeneration.
|
|
| 22. |
- Marengoni, Alessandra, et al.
(författare)
-
Beyond Chronological Age : Frailty and Multimorbidity Predict In-Hospital Mortality in Patients With Coronavirus Disease 2019
- 2021
-
Ingår i: The journals of gerontology. Series A, Biological sciences and medical sciences. - : Oxford University Press (OUP). - 1079-5006 .- 1758-535X. ; 76:3, s. e38-e45
-
Tidskriftsartikel (refereegranskat)abstract
- Background: We evaluated whether frailty and multimorbidity predict in-hospital mortality in patients with COVID-19 beyond chronological age.Method: A total of 165 patients admitted from March 8th to April 17th, 2020, with COVID-19 in an acute geriatric ward in Italy were included. Predisease frailty was assessed with the Clinical Frailty Scale (CFS). Multimorbidity was defined as the co-occurrence of >= 2 diseases in the same patient. The hazard ratio (HR) of in-hospital mortality as a function of CFS score and number of chronic diseases in the whole population and in those aged 70+ years were calculated.Results: Among the 165 patients, 112 were discharged, 11 were transferred to intensive care units, and 42 died. Patients who died were older (81.0 vs 65.2 years, p < .001), more frequently multimorbid (97.6 vs 52.8%; p < .001), and more likely frail (37.5 vs 4.1%; p < .001). Less than 2.0% of patients without multimorbidity and frailty, 28% of those with multimorbidity only, and 75% of those with both multimorbidity and frailty died. Each unitary increment in the CFS was associated with a higher risk of in-hospital death in the whole sample (HR = 1.3; 95% CI = 1.05-1.62) and in patients aged 70+ years (HR = 1.29; 95% CI = 1.04-1.62), whereas the number of chronic diseases was not significantly associated with higher risk of death. The CFS addition to age and sex increased mortality prediction by 9.4% in those aged 70+ years.Conclusions: Frailty identifies patients with COVID-19 at risk of in-hospital death independently of age. Multimorbidity contributes to prognosis because of the very low probability of death in its absence.
|
|
| 23. |
- Marengoni, Alessandra, et al.
(författare)
-
Multimorbidity Patterns and 6-Year Risk of Institutionalization in Older Persons : The Role of Social Formal and Informal Care
- 2021
-
Ingår i: Journal of the American Medical Directors Association. - : Elsevier BV. - 1525-8610 .- 1538-9375. ; 22:10, s. 2184-2189
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim was to evaluate patterns of multimorbidity that increase the risk of institutionalization in older persons, also exploring the potential buffering effect of formal and informal care. Design: Prospective cohort study. Setting and Participants: The population-based Swedish National study on Aging and Care in Kungsholmen, Stockholm, Sweden. Measures: In total, 2571 community-dwelling older adults were grouped at baseline according to their underlying multimorbidity patterns, using a fuzzy c-means cluster algorithm, and followed up for 6 years to test the association between multimorbidity patterns and institutionalization. Results: Six patterns of multimorbidity were identified: psychiatric diseases; cardiovascular diseases, anemia, and dementia; metabolic and sleep disorders; sensory impairments and cancer; musculoskeletal, respiratory, and gastrointestinal diseases; and an unspecific pattern including diseases of which none were overrepresented. In total, 110 (4.3%) participants were institutionalized during the follow-up, ranging from 1.7% in the metabolic and sleep disorders pattern to 8.4% in the cardiovascular diseases, anemia, and dementia pattern. Compared with the unspecific pattern, only the cardiovascular diseases, anemia, dementia pattern was significantly associated with institutionalization [relative risk ratio ( RRR) = 2.23; 95% confidence interval (CI) 1.07-4.65)], after adjusting for demographic characteristics and disability status at baseline. In stratified analyses, those not receiving formal care in the psychiatric diseases pattern (RRR 3.34; 95% CI 1.20-9.32) and those not receiving formal or informal care in the 'cardiovascular diseases, anemia, dementia' pattern (RRR 2.99; 95% CI 1.20-7.46; RRR 2.79; 95% CI 1.16-6.71, respectively) had increased risks of institutionalization. Conclusions and Implications: Older persons suffering from specific multimorbidity patterns have a higher risk of institutionalization, especially if they lack formal or informal care. Interventions aimed at preventing the clustering of diseases could reduce the associated burden on residential long-term care. Formal and informal care provision may be effective strategies in reducing the risk of institutionalization.
|
|
| 24. |
- Morris, John N., et al.
(författare)
-
Cognitive Change Among Nursing Home Residents : CogRisk-NH Scale Development to Predict Decline
- 2023
-
Ingår i: Journal of the American Medical Directors Association. - 1525-8610 .- 1538-9375. ; 24:9, s. 1405-1411
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: Examine cognitive changes over time among nursing home residents and develop a risk model for identifying predictors of cognitive decline. Design: Using secondary analysis design with Minimum Data Set data, cognitive status was based on the Cognitive Performance Scale (CPS).Setting and Participants: Baseline and 7 quarterly follow-up analyses of US and Canadian interRAI data (N = 1,257,832) were completed. Methods: Logistic regression analyses identified predictors of decline to form the CogRisk-NH scale.Results: At baseline, about 15% of residents were cognitively intact (CPS = 0), and 11.2% borderline intact (CPS = 1). The remaining more intact, with mild impairment (CPS = 2), included 15.0%. Approximately 59% residents fell into CPS categories 3 to 6 (moderate to severe impairment). Over time, increasing proportions of residents declined: 17.1% at 6 months, 21.6% at 9 months, and 34.0% at 21 months. Baseline CPS score was a strong predictor of decline. Categories 0 to 2 had 3-month decline rates in midteens, and categories 3 to 5 had an average decline rate about 9%. Consequently, a 2-submodel construction was employeddone for CPS categories 0 to 2 and the other for categories 3 to 5. Both models were integrated into a 6-category risk scale (CogRisk-NH). CogRisk-NH scale score distribution had 15.9% in category 1, 26.84% in category 2, and 36.7% in category 3. Three higher-risk categories (ie, 4-6) represented 20.6% of residents. Mean decline rates at the 3-month assessment ranged from 4.4% to 28.3%. Over time, differentiation among risk categories continued: 6.9% to 38.4.% at 6 months, 11.0% to 51.0% at 1 year, and 16.2% to 61.4% at 21 months, providing internal validation of the prediction model.Conclusions and Implications: Cognitive decline rates were higher among residents in less-impaired CPS categories. CogRisk-NH scale differentiates those with low likelihood of decline from those with mod-
|
|
| 25. |
- Onder, Graziano, et al.
(författare)
-
Italian guidelines on management of persons with multimorbidity and polypharmacy
- 2022
-
Ingår i: Aging Clinical and Experimental Research. - : Springer Science and Business Media LLC. - 1594-0667 .- 1720-8319. ; 34:5, s. 989-996
-
Tidskriftsartikel (refereegranskat)abstract
- Multimorbidity and polypharmacy are emerging health priorities and the care of persons with these conditions is complex and challenging. The aim of the present guidelines is to develop recommendations for the clinical management of persons with multimorbidity and/or polypharmacy and to provide evidence-based guidance to improve their quality of care. The recommendations have been produced in keeping with the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Overall, 14 recommendations were issued, focusing on 4 thematic areas: (1.) General Principles; (2.) target population for an individualized approach to care; (3.) individualized care of patients with multimorbidity and/or polypharmacy; (4.) models of care. These recommendations support the provision of individualized care to persons with multimorbidity and/or polypharmacy as well as the prioritization of care through the identification of persons at increased risk of negative health outcomes. Given the limited available evidence, recommendations could not be issued for all the questions defined and, therefore, some aspects related to the complex care of patients with multimorbidity and/or polypharmacy could not be covered in these guidelines. This points to the need for more research in this field and evidence to improve the care of this population.
|
|
