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Paul C, Schöttker B, Hartmann M, Friederich HC, Brenner H, Wild B. Gender-specific factors associated with case complexity in middle-aged and older adults-Evidence from a large population-based study. Int J Geriatr Psychiatry 2024; 39:e6113. [PMID: 38877644 DOI: 10.1002/gps.6113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/29/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVES To investigate gender-specific factors associated with case complexity in a population-based sample of middle-aged and older adults using a holistic approach to complexity. METHODS Data were derived from the 8-year follow-up home visits of the ESTHER study-a German population-based study in middle-aged and older adults. Cross-sectional analyses were conducted for 2932 persons (aged 57-84). Complexity was assessed by the well-established INTERMED for the elderly interview, which uses a holistic approach to the definition of case complexity. The association between various bio-psycho-social variables and case complexity was analyzed using gender-specific logistic regression models, adjusted for sociodemographic factors (age, marital status, education). RESULTS Prevalence of complexity was 8.3% with significantly higher prevalence in female (10.6%) compared to male (5.8%) participants (p < 0.001). Variables associated with increased odds for complexity in both, women and men were: being divorced (odds ratio [OR] women: 1.86, 95% CI 1.05-3.30; OR men: 3.19, 1.25-8.12), higher total somatic morbidity (women: 1.08, 1.04-1.12; men: 1.06, 1.02-1.11), higher depression severity (women: 1.34, 1.28-1.40; men: 1.35, 1.27-1.44), and higher loneliness scores (women: 1.19, 1.05-1.36; men: 1.23, 1.03-1.47). Women (but not men) with obesity (Body mass index [BMI] ≥30) had higher odds (1.79, 1.11-2.89) for being complex compared to those with a BMI <25. High oxidative stress measured by derivatives of reactive oxygen metabolites in serum was associated with 2.02 (1.09-3.74) higher odds for complexity only in men. CONCLUSIONS This study provides epidemiological evidence on gender differences in prevalence and factors associated with case complexity in middle-aged and older adults. Moreover, this study adds to the holistic understanding of complexity by identifying novel variables linked to complexity among middle-aged and older individuals. These factors include loneliness for both genders, and high oxidative stress for men. These findings should be confirmed in future longitudinal studies.
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Affiliation(s)
- Cinara Paul
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany
- DZPG German Centre for Mental Health-Partner Site Heidelberg/Mannheim/Ulm, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
- Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany
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Jerjes W, Harding D. Confronting polypharmacy and social isolation in elderly care: a general practitioner's perspective on holistic primary care. FRONTIERS IN AGING 2024; 5:1384835. [PMID: 38881825 PMCID: PMC11176503 DOI: 10.3389/fragi.2024.1384835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 04/26/2024] [Indexed: 06/18/2024]
Affiliation(s)
- Waseem Jerjes
- Research and Development Unit, Hammersmith and Fulham Primary Care Network, London, United Kingdom
- Faculty or Medicine, Imperial College London, London, United Kingdom
| | - Daniel Harding
- Research and Development Unit, Hammersmith and Fulham Primary Care Network, London, United Kingdom
- Faculty or Medicine, Imperial College London, London, United Kingdom
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Svensson M, Ekström H, Elmståhl S, Rosso A. Association of polypharmacy with occurrence of loneliness and social isolation among older adults. Arch Gerontol Geriatr 2024; 116:105158. [PMID: 37597375 DOI: 10.1016/j.archger.2023.105158] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Polypharmacy is increasing. The longitudinal association of polypharmacy and social isolation has not been previously reported. The aim of this study was to explore longitudinal associations of polypharmacy with loneliness and social isolation among older adults. METHODS Participants aged 60 years and above in southern Sweden were invited for participation. A total of 1526 and 2556 participants were included in the separate analyses for loneliness and social isolation. Polypharmacy was defined as taking five or more medications. Associations of polypharmacy with occurrence of loneliness and social isolation were estimated using logistic regression models. RESULTS During follow-up, 409 and 414 participants developed loneliness and social isolation, respectively. The odds for loneliness occurrence were higher for participants with polypharmacy compared to participants without polypharmacy (OR, 1.37; 95% CI, 1.05-1.78; P = 0.020). For participants without polypharmacy, the probability of developing loneliness was 0.28 (95% CI, 0.25-0.31), while for those with polypharmacy this probability was 25% higher (0.35; 95% CI, 0.30-0.39). The odds for social isolation occurrence were higher for participants with polypharmacy compared to participants without polypharmacy (OR, 1.29; 95% CI, 1.02-1.64; P = 0.036). For participants without polypharmacy, the probability of developing social isolation was 0.16 (95% CI, 0.14-0.18), while for those with polypharmacy this probability was 18% higher (0.19; 95% CI, 0.17-0.22). CONCLUSIONS Polypharmacy was associated with loneliness and social isolation occurrence among older adults. Consideration of loneliness and social isolation are warranted when caring for older adults taking multiple medications.
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Affiliation(s)
- Markus Svensson
- Department of Clinical Sciences in Malmö, Division of Geriatric Medicine, Skåne University Hospital, Lund University, Jan Waldenströms gata 35, Malmö 205 02, Sweden.
| | - Henrik Ekström
- Department of Clinical Sciences in Malmö, Division of Geriatric Medicine, Skåne University Hospital, Lund University, Jan Waldenströms gata 35, Malmö 205 02, Sweden
| | - Sölve Elmståhl
- Department of Clinical Sciences in Malmö, Division of Geriatric Medicine, Skåne University Hospital, Lund University, Jan Waldenströms gata 35, Malmö 205 02, Sweden
| | - Aldana Rosso
- Department of Clinical Sciences in Malmö, Division of Geriatric Medicine, Skåne University Hospital, Lund University, Jan Waldenströms gata 35, Malmö 205 02, Sweden
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Lind ANR, Jakobsen SKM, Klenø AS, Pedersen AB. Sex and age differences in the use of analgesic drugs before and after primary total hip arthroplasty in 105,520 Danish patients. Surgeon 2023; 21:381-389. [PMID: 37567845 DOI: 10.1016/j.surge.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND We examined analgesic drug use before and after total hip arthroplasty (THA) by sex and age, and impact of comorbidity in that context. METHODS Using Danish nationwide medical registries, we included 105,520 THA patients (1996-2018). We calculated prevalence of overall analgesic drug use and use of NSAIDs and opioids separately in four quarters before (-Q4 to -Q1) and after THA (Q1 to Q4). -Q4 and Q4 was compared using prevalence rate ratios (PRR) with 95% confidence interval (CI). RESULTS Among women, analgesic drug use was 46% in -Q4, 65% in Q1, but decreased to 31% in Q4 (PRR: 0.68 (CI: 0.67-0.69)). Among men, these numbers were 39% in -Q4, 62% in Q1, and 23% in Q4 (PRR: 0.61 (CI: 0.60-0.63)). Analgesic drug use was higher among older patients in all quarters except Q1. Analgesic drug use decreased from 40% in -Q4 to 25% in Q4 (PRR: 0.62 (CI: 0.59-0.64)) in patients <55 years, and from 44% to 30% in patients >85 years, (PRR: 0.67 (CI: 0.63-0.71)). Women used more NSAIDs and opioids than men. Older patients used more opioids compared to younger, while variation in NSAID use by age was small. Decrease in analgesic drug use from -Q4 to Q4 was least pronounced in patients with comorbidity history. CONCLUSIONS Women and older patients have higher prevalence of analgesic drug use before and after THA, and a smallest reduction in analgesic drug use from before to after THA. Comorbidity history modified these associations.
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Affiliation(s)
- Allice N R Lind
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Sophie K M Jakobsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - André S Klenø
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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Wang B, Peng X, Liang B, Fu L, Shi T, Li X, Tian T, Xiao X, Wang Y, Ouyang L, Cai Y, Yu M, Wu G, Li L, Meng X, Zou H. Loneliness and its correlates among older adults living with HIV: A multicenter cross-sectional study. J Affect Disord 2023; 341:228-235. [PMID: 37657621 DOI: 10.1016/j.jad.2023.08.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 08/20/2023] [Accepted: 08/29/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND With the aging among people living with HIV, it is critical to understand the health needs of older adults (aged 50 years and above) living with HIV (OALHIV). Loneliness, as the next critical public health issue, was rarely mentioned among OALHIV. METHODS A multicenter cross-sectional study was conducted between April 2021 and April 2022. Participants were recruited from infectious diseases hospitals that provide HIV care in four cities in China. The associations with loneliness symptoms (measured by a three-item UCLA Loneliness Scale) were analyzed by logistic regression models. RESULTS A total of 680 OALHIV (500 men, 180 women, mean age 60.3 ± 7.8 years) were included in the analysis. About one-fifth (18.1 %) of OALHIV reported loneliness symptoms. Living in urban areas (aOR 3.50, 95 % CI 1.76-6.95), having children without close intergenerational relationships (2.85, 1.15-7.07), higher self-perceptions of aging (1.10, 1.06-1.15), being heterosexual (0.26, 0.13-0.52) or bisexual (0.37, 0.16-0.82), having children with whom they kept close intergenerational relationships (0.36, 0.14-0.98), and reporting life satisfaction (0.40, 0.24-0.66), were associated with loneliness symptoms. LIMITATIONS This study is a cross-sectional study and only included OALHIV who participated in antiretroviral therapy treatment for >18 months, which is not widely representative. CONCLUSIONS Loneliness was prevalent among OALHIV. Living in urban areas, being homosexual, having children with whom they kept fragile intergenerational relationships, being dissatisfied with life, and having higher self-perceptions of aging were independent risk factors for loneliness. Routine health management for OALHIV needs to incorporate the assessment of aging perceptions and loneliness.
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Affiliation(s)
- Bingyi Wang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China.
| | - Xin Peng
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Bowen Liang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Leiwen Fu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Tongxin Shi
- Tianjin Hexi District Center for Disease Control and Prevention, Tianjin, China
| | - Xinyi Li
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Tian Tian
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Xin Xiao
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China; Department of Scientific Research, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Ying Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lin Ouyang
- Department of AIDS/STD Control and Prevention, Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Yong Cai
- Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Maohe Yu
- Department of AIDS/STD Control and Prevention, Tianjin Center for Disease Control and Prevention, Tianjin, China
| | - Guohui Wu
- Department of AIDS/STD Control and Prevention, Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Linghua Li
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xiaojun Meng
- Wuxi Municipal Center for Disease Control and Prevention, Wuxi, China
| | - Huachun Zou
- School of Public Health, Fudan University, Shanghai, China; School of Public Health, Southwest Medical University, Luzhou, China; Kirby Institute, University of New South Wales, Sydney, Australia.
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6
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Im JHB, Bronskill SE, Strauss R, Gruneir A, Guan J, Boblitz A, Lu M, Rochon PA, Savage RD. Sex-based differences in the association between loneliness and polypharmacy among older adults in Ontario, Canada. J Am Geriatr Soc 2023; 71:3099-3109. [PMID: 37338145 DOI: 10.1111/jgs.18477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 05/05/2023] [Accepted: 05/20/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Emerging evidence shows loneliness is associated with polypharmacy and high-risk medications in older adults. Despite notable sex-based differences in the prevalence in each of loneliness and polypharmacy, the role of sex in the relationship between loneliness and polypharmacy is unclear. We explored the relationship between loneliness and polypharmacy in older female and male respondents and described sex-related variations in prescribed medication subclasses. METHODS We performed a cross-sectional analysis of representative data from the Canadian Community Health Survey-Healthy Aging cycle (2008/2009) linked to health administrative databases in Ontario respondents aged 66 years and older. Loneliness was measured using the Three-Item Loneliness Scale, with respondents classified as not lonely, moderately lonely, or severely lonely. Polypharmacy was defined as five or more concurrently-prescribed medications. Sex-stratified multivariable logistic regression models with survey weights were used to assess the relationship between loneliness and polypharmacy. Among those with polypharmacy, we examined the distribution of prescribed medication subclasses and potentially inappropriate medications. RESULTS Of the 2348 individuals included in this study, 54.6% were female respondents. The prevalence of polypharmacy was highest in those with severe loneliness both in female (no loneliness, 32.4%; moderate loneliness, 36.5%; severe loneliness, 44.1%) and male respondents (32.5%, 32.2%, and 42.5%). Severe loneliness was significantly associated with greater adjusted odds of polypharmacy in female respondents (OR = 1.59; 95% CI: 1.01-2.50) but this association was attenuated after adjustment in male respondents (OR = 1.00; 95% CI: 0.56-1.80). Among those with polypharmacy, antidepressants were more commonly prescribed in female respondents with severe loneliness (38.7% [95% CI: 27.3-50.0]) compared to those who were moderately lonely (17.7% [95% CI: 9.3-26.2]). CONCLUSIONS Severe loneliness was independently associated with polypharmacy in older female but not male respondents. Clinicians should consider loneliness as an important risk factor in medication reviews and deprescribing efforts to minimize medication-related harms, particularly in older women.
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Affiliation(s)
- James H B Im
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Susan E Bronskill
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | | | - Andrea Gruneir
- ICES, Toronto, Ontario, Canada
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Mindy Lu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Paula A Rochon
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Women's Age Lab, Women's College Hospital, Toronto, Ontario, Canada
| | - Rachel D Savage
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Women's Age Lab, Women's College Hospital, Toronto, Ontario, Canada
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Hussain MA, Watson CWM, Morgan EE, Heaton RK, Letendre SL, Jeste DV, Moore DJ, Iudicello JE. Combined effects of loneliness and inflammation on depression in people with HIV. J Neurovirol 2023; 29:538-554. [PMID: 37651083 PMCID: PMC10645641 DOI: 10.1007/s13365-023-01145-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 04/17/2023] [Accepted: 04/24/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE Loneliness is prevalent in people with HIV (PWH) and associated with adverse health-related consequences, including depression. Chronic inflammation has been linked to depression in PWH, though its association with loneliness is less well established. Simultaneous examination of inflammation, loneliness and depression is needed to clarify these relationships. This study investigated the relationship between loneliness and inflammation, and the effects of loneliness and inflammation on depression in PWH. METHODS 82 PWH who were on suppressive ART (mean age [SD] = 53.2 [9.0]) completed the UCLA Loneliness Scale-Version 3 and the Center for Epidemiologic Studies Depression Scale as part of a comprehensive evaluation. Biomarkers of systemic inflammation (CRP, IL-6, CCL2/MCP-1, sCD14) and coagulation (D-dimer) were measured in blood using commercial immunoassays. RESULTS Multivariable linear regression analyses revealed that higher D-dimer, CCL2/MCP-1, and sCD14 were significant predictors of loneliness (ps < .05) while accounting for relevant covariates. Stepwise multiple linear regression models that included loneliness, biomarkers, and their interactions as predictors of depressive symptoms revealed significant main effects of loneliness and CCL2/MCP-1 levels (ps < .05), and a significant loneliness by D-dimer interaction (p < .05) whereby higher D-dimer was associated with increased depressive symptoms only at higher levels of loneliness. CONCLUSIONS Increased coagulation activity is associated with loneliness, and in the context of loneliness, may increase risk for depression. Increased inflammation was associated with depression suggesting potentially dissociable underlying biological processes. To the extent that these processes are modifiable, such findings could have important implications in the treatment of loneliness and depression in PWH.
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Affiliation(s)
- Mariam A Hussain
- San Diego State University, University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, USA.
- Department of Psychiatry, University of California San Diego, La Jolla, USA.
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, USA.
| | - C Wei-Ming Watson
- San Diego State University, University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, USA
- Department of Psychiatry, University of California San Diego, La Jolla, USA
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, USA
| | - Erin E Morgan
- Department of Psychiatry, University of California San Diego, La Jolla, USA
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, USA
| | - Robert K Heaton
- Department of Psychiatry, University of California San Diego, La Jolla, USA
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, USA
| | - Scott L Letendre
- Department of Psychiatry, University of California San Diego, La Jolla, USA
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, USA
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, USA
- Department of Neurosciences, University of California San Diego, La Jolla, USA
- Sam and Rose Stein Institute for Research On Aging, University of California San Diego, La Jolla, USA
| | - David J Moore
- Department of Psychiatry, University of California San Diego, La Jolla, USA
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, USA
| | - Jennifer E Iudicello
- Department of Psychiatry, University of California San Diego, La Jolla, USA
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, USA
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Perret M, Bertaut A, Niogret J, Marilier S, Jouanny P, Manckoundia P, Bengrine-Lefevre L, Quipourt V, Barben J. Associated Factors to Efficacy and Tolerance of Immunotherapy in Older Patients with Cancer Aged 70 Years and Over: Impact of Coprescriptions. Drugs Aging 2023; 40:837-846. [PMID: 37429982 DOI: 10.1007/s40266-023-01048-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Immunotherapy with immune checkpoint blockers (ICB) significantly improves the prognosis for an increasing number of cancers. However, data on geriatric populations taking ICB are rare. OBJECTIVE This study aimed to identify factors associated with the efficacy and tolerance of ICB in an older population. PATIENTS AND METHODS This retrospective monocentric study included consecutive patients aged ≥ 70 years with solid cancer who received ICB between January 2018 and December 2019. Efficacy was assessed by progression-free survival (PFS) and tolerance was defined as cessation of immunotherapy due to the occurrence of any adverse event. RESULTS One hundred and five patients (65.7% men) were included, mainly at the metastatic stage (95.2%); 50.5% had lung cancer. Most (80%) patients were treated with anti-PD1 (nivolumab, pembrolizumab), 19.1% with anti-PD-L1 (atezolizumab, durvalumab, and avelumab) and 0.9% with anti-CTLA4 ICB (ipilimumab). Median PFS was 3.7 months [95% confidence interval (CI) (2.75-5.70)]. PFS was shorter in univariate analysis when ICB was taken concomitantly with an antiplatelet agent (AP) [hazard ratio (HR) = 1.93; 95% CI (1.22-3.04); p = 0.005]. Tolerance was lower in univariate analysis for lung cancer [odds ratio (OR) = 3.03; 95% CI (1.07-8.56), p < 0.05] and in patients taking proton pump inhibitors (PPI) [OR = 5.50; 95% CI (1.96-15.42), p < 0.001]. There was a trend toward poorer tolerance among patients living alone [OR = 2.26; 95% CI (0.76-6.72); p = 0.14]. CONCLUSIONS In older patients taking ICB for solid cancers, concomitant AP may influence efficacy and concomitant PPI may influence tolerance. Further studies are needed to confirm these results.
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Affiliation(s)
- Marie Perret
- Geriatrics, Hospital of Champmaillot, Dijon-Bourgogne University Hospital, Dijon, France
| | - Aurélie Bertaut
- Unit of Methodology and Biostatistics, Centre Georges François Leclerc, Dijon, France
| | - Julie Niogret
- Geriatric Oncology Coordination Unit in Burgundy, Dijon-Bourgogne University Hospital, Dijon, France
- Medical Oncology Department, Centre George François Leclerc, Dijon, France
| | - Sophie Marilier
- Geriatrics, Hospital of Champmaillot, Dijon-Bourgogne University Hospital, Dijon, France
- Geriatric Oncology Coordination Unit in Burgundy, Dijon-Bourgogne University Hospital, Dijon, France
| | - Pierre Jouanny
- Geriatrics, Hospital of Champmaillot, Dijon-Bourgogne University Hospital, Dijon, France
| | - Patrick Manckoundia
- Geriatrics, Hospital of Champmaillot, Dijon-Bourgogne University Hospital, Dijon, France
- UMR INSERM U1093, University of Burgundy, Dijon, France
| | - Leïla Bengrine-Lefevre
- Geriatric Oncology Coordination Unit in Burgundy, Dijon-Bourgogne University Hospital, Dijon, France
- Medical Oncology Department, Centre George François Leclerc, Dijon, France
| | - Valérie Quipourt
- Geriatrics, Hospital of Champmaillot, Dijon-Bourgogne University Hospital, Dijon, France
- Geriatric Oncology Coordination Unit in Burgundy, Dijon-Bourgogne University Hospital, Dijon, France
| | - Jérémy Barben
- Geriatrics, Hospital of Champmaillot, Dijon-Bourgogne University Hospital, Dijon, France.
- Geriatric Oncology Coordination Unit in Burgundy, Dijon-Bourgogne University Hospital, Dijon, France.
- UMR INSERM U1231, University of Burgundy, Dijon, France.
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Lu J, Ren E, Guo X, Zhou Z, Wang Y, Zhang N. The role of pet attachment in alleviating the negative effects of loneliness on a health-promoting lifestyle: An empirical study based on threshold effects for pet owners. Int J Older People Nurs 2023; 18:e12554. [PMID: 37461157 DOI: 10.1111/opn.12554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 05/22/2023] [Accepted: 06/05/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND A health-promoting lifestyle is acknowledged as a 'positive ageing' strategy for older people. The inevitable decline in their social networks may lead to loneliness and subsequently damage their health-promoting lifestyle. Therefore, pet owning has become a popular way for them to alleviate loneliness. However, the attachment resulting from pet ownership may either facilitate or impede older people's ability to counteract the negative effect of loneliness on health-promoting lifestyles, and this effect may only be observed when pet owners have limited human confidants. OBJECTIVES To identify the role of pet attachment in alleviating the negative impact of loneliness on a health-promoting lifestyle and its supplementary role in the deficiency of social relationships by analysing the correlation mechanism between pet attachment, loneliness and a health-promoting lifestyle. METHODS Self-report questionnaires were sent to 879 older people (aged ≥60) with pets in China by using a multistage stratified random sampling method. Cross-sectional threshold regression models were established to analyse the nonlinear effects of loneliness on a health-promoting lifestyle and the different threshold effects among different social relationship levels. RESULTS A single threshold value (0.444) was drawn to determine the action mode of pet attachment on the negative relationship between loneliness and a health-promoting lifestyle. When the level of pet attachment exceeded 0.444, the inhibition of loneliness on a health-promoting lifestyle decreased significantly. Additionally, this threshold effect was evident among older people at different levels of social relationships. CONCLUSIONS The negative effect of loneliness on a health-promoting lifestyle is alleviated by the single threshold effect of pet attachment. Pet-owner relationships can compensate for a lack of social relationships to some extent and alleviate both an individual's loneliness and its negative effect on a health-promoting lifestyle. IMPLICATIONS FOR PRACTICE To alleviate loneliness and promote healthy ageing in older people who lack social relationships, the tailored pet intervention strategies that prioritize 'one health' at the animal-ecosystem interface that consider their different individual levels of social relationship should be developed.
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Affiliation(s)
- Jiao Lu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Erxing Ren
- School of Management, Shanxi Medical University, Taiyuan, China
| | - Xinyu Guo
- School of Management, Shanxi Medical University, Taiyuan, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Yuan Wang
- School of Management, Shanxi Medical University, Taiyuan, China
| | - Na Zhang
- School of Management, Shanxi Medical University, Taiyuan, China
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10
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Smith CB, Wong KLY, To‐Miles F, Dunn S, Gregorio M, Wong L, Tam S, Huynh P, Hung L. Exploring experiences of loneliness among Canadian long-term care residents during the COVID-19 pandemic: A qualitative study. Int J Older People Nurs 2023; 18:e12509. [PMID: 36347829 PMCID: PMC9878008 DOI: 10.1111/opn.12509] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/28/2022] [Accepted: 09/23/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND The COVID-19 pandemic has significant impact on long-term care (LTC) residents' health and well-being. OBJECTIVES This study investigated resident experiences of loneliness during the COVID-19 pandemic in Canadian LTC homes to offer lessons learned and implications. METHODS 15 residents and 16 staff members were recruited from two large urban Canadian LTC homes with large outbreaks and fatalities. We used a telepresence robot to conduct one-on-one semi-structured interviews with participants remotely. We applied the Collaborative Action Research (CAR) methodology and report the early phase of CAR focused on collecting data and reporting findings to inform actions for change. Thematic analysis was performed to identify themes. RESULTS Four themes were identified. The first two themes characterise what commonly generated feelings of loneliness amongst residents, including (1) social isolation and missing their family and friends and (2) feeling hopeless and grieving for lives lost. The second two themes describe what helped residents alleviate loneliness, including (3) social support and (4) creating opportunities for recreation and promoting positivity. CONCLUSIONS Residents living in LTC experienced significant social isolation and grief during the pandemic that resulted in loneliness and other negative health consequences. IMPLICATIONS FOR PRACTICE Promoting meaningful connection, safe recreational activities and a positive atmosphere in LTC homes during the pandemic may help mitigate residents' experiences of loneliness due to social isolation and/or grief and enhance their quality of life.
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Affiliation(s)
- Chelsea B. Smith
- IDEA LabUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Karen Lok Yi Wong
- IDEA LabUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Flora To‐Miles
- IDEA LabUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Sheila Dunn
- Community Engagement Advisory NetworkVancouverBritish ColumbiaCanada
| | - Mario Gregorio
- Community Engagement Advisory NetworkVancouverBritish ColumbiaCanada
| | - Lily Wong
- Community Engagement Advisory NetworkVancouverBritish ColumbiaCanada
| | - Samantha Tam
- Community Engagement Advisory NetworkVancouverBritish ColumbiaCanada
| | - Polly Huynh
- Richmond Home and CommunityVancouver Coastal HealthVancouverBritish ColumbiaCanada
| | - Lillian Hung
- IDEA LabUniversity of British ColumbiaVancouverBritish ColumbiaCanada
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Mills R, Zullig KJ, Theeke LA, Lander LR, Hobbs GR, Herczyk J, Davis SM. Assessing Loneliness among Adults Receiving Outpatient Treatment with Medication for Opioid Use Disorder (MOUD). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13481. [PMID: 36294057 PMCID: PMC9602554 DOI: 10.3390/ijerph192013481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
Loneliness is a significant risk factor for substance use, however, impacts of treatments on loneliness are relatively unexplored. Living in a rural location is a greater risk factor for loneliness. This study examined data from a quasi-experimental study in rural Appalachia, comparing the effectiveness of Mindfulness-Based Relapse Prevention (MBRP) versus Treatment as Usual (TAU) among adults receiving MOUD in outpatient therapy. Our objective was to determine whether observed reductions in self-reported craving, anxiety, depression, and increased perceived mindfulness would also improve loneliness reports. Eighty participants (n = 35 MBRP; n = 45 TAU) were included in the analysis from a group-based Comprehensive Opioid Addiction Treatment program. Outcomes tracked included craving, anxiety, depression, mindfulness, and loneliness as measured by the Revised UCLA Loneliness Scale (R-UCLA). A linear mixed model ANOVA determined the significance of the treatments on changes in loneliness scores at baseline, 12 weeks, 24 weeks, and 36 weeks post-recruitment. Both groups reported significantly reduced loneliness over the course of the study (F = 16.07, p < 0.01), however there were no significant differences between groups. Loneliness was also significantly positively (p < 0.01) correlated with anxiety (0.66), depression (0.59), and craving (0.38), and significantly (p < 0.01) inversely correlated (-0.52) with mindfulness. Results suggest that participation in MOUD group-based outpatient therapy has the potential to diminish loneliness and associated poor psychological outcomes. Thus, it is possible that a more targeted intervention for loneliness would further diminish loneliness, which is important as loneliness is linked to risk for relapse.
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Affiliation(s)
- Rosalina Mills
- Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, WV 26506, USA
| | - Keith J. Zullig
- Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, WV 26506, USA
| | - Laurie A. Theeke
- School of Nursing, George Washington University, Washington, DC 20052, USA
| | - Laura R. Lander
- Department of Behavioral Medicine and Psychiatry, Rockefeller Neurosciences Institute, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - Gerry R. Hobbs
- Department of Statistics, West Virginia University, Morgantown, WV 26506, USA
| | - Johnathan Herczyk
- Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, WV 26506, USA
| | - Stephen M. Davis
- Department of Health Policy, Management, & Leadership, School of Public Health, West Virginia University, Morgantown, WV 26506, USA
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Bonin-Guillaume S, Arlotto S, Blin A, Gentile S. Family Caregiver's Loneliness and Related Health Factors: What Can Be Changed? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7050. [PMID: 35742304 PMCID: PMC9222605 DOI: 10.3390/ijerph19127050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 11/28/2022]
Abstract
Background: Loneliness is a public health issue that may affect the entire population. Loneliness is associated with depression, sleep disorders, fatigue, and increased risk of obesity and diabetes. Risk factors for loneliness include having a poor social network and poor physical and mental health. The main objective was to study factors related to loneliness of family caregivers caring for independent older people. Methods: We performed a non-interventional observational cross-sectional study in south-eastern France. Family caregivers caring for people aged 70 and over and living at home were included. These older people were independent, without long-term conditions, and had applied for professional social assistance for daily living. Data were collected through a questionnaire, administered face-to-face or by telephone. Loneliness and perceived health status were measured through a single-question. Burden was assessed through the Mini-Zarit Scale, and frailty was measured through the Gerontopole Frailty Screening Tool. Results: Of the 876 family caregivers included, 10% felt lonely often or always. They reported more physical and mental health issues than those who did not feel loneliness (p < 0.001). Family caregivers with loneliness were more likely to be looking after a parent and were twice as likely to have a moderate to severe burden (OR = 2.6). They were more likely to feel anxious (OR = 5.6), to have sleep disorders (OR = 2.4), to be frail (OR = 2), and to view the status of their health as poor or bad (OR = 2). Conclusions: Loneliness has a negative impact on health, causes frailty, and places a burden on family caregivers. Means must be implemented to anticipate the consequences of the loneliness felt by family caregivers, notably by orienting them towards the relevant services.
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Affiliation(s)
- Sylvie Bonin-Guillaume
- Neurosciences of Systems Institute, Institut National de la Santé et de la Recherche Médicale, UMR-Inserm 1106, Aix Marseille University, 13005 Marseille, France;
- Internal Medicine and Geriatric Department, Hôpitaux Universitaires de Marseille, Assistance Publique Hôpitaux de Marseille, 13005 Marseille, France
| | - Sylvie Arlotto
- Service d’Evaluation Médicale, Assistance Publique Hôpitaux de Marseille, 13005 Marseille, France; (A.B.); (S.G.)
- Health Service Research and Quality of Life Center (EA 3279), School of Medicine, La Timone Medical Campus, Aix Marseille University, 13005 Marseille, France
| | - Alice Blin
- Service d’Evaluation Médicale, Assistance Publique Hôpitaux de Marseille, 13005 Marseille, France; (A.B.); (S.G.)
| | - Stéphanie Gentile
- Service d’Evaluation Médicale, Assistance Publique Hôpitaux de Marseille, 13005 Marseille, France; (A.B.); (S.G.)
- Health Service Research and Quality of Life Center (EA 3279), School of Medicine, La Timone Medical Campus, Aix Marseille University, 13005 Marseille, France
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KLENØ AN, STISEN MB, EDWARDS NM, MECHLENBURG I, PEDERSEN AB. Socioeconomic status and use of analgesic drugs before and after primary hip arthroplasty: a population-based cohort study of 103,209 patients during 1996-2018. Acta Orthop 2022; 93:171-178. [PMID: 34981126 PMCID: PMC8815381 DOI: 10.2340/17453674.2021.955] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - Total hip arthroplasty (THA) is an effective and common procedure. However, persistent pain and analgesic requirement up to 2 years after THA surgery are common. We examined the trends in the utilization of analgesics before and after THA, overall, and in relation to socioeconomic status (SES) in a populationbased cohort. Patients and methods - We used the Danish Hip Arthroplasty Register to identify 103,209 patients who underwent THA between 1996 and 2018. Data on prescriptions and SES markers was obtained from Danish medical databases. Prevalence rates of redeemed prescriptions for analgesics with 95% confidence intervals were calculated for 4 quarters before and 4 quarters after THA for the entire THA population, and by 3 SES markers (education, cohabiting status, and wealth). Results - Overall, the prevalence of analgesic use prior to surgery was 42% at 9-12 months and 59% at 0-3 months before the THA. The prevalence of analgesics reached its highest at 64% 0-3 months after THA but declined to 27% at 9-12 months after THA. Low education, living alone, and having low wealth (low SES) were associated with higher prevalence of analgesics use both before and after THA. Interpretation - 59% of patients used analgesics 0-3 months before surgery, which could indicate that THA might not be considered the last option for treatment and that surgery criteria might depend more on factors such as patient preferences or hip function. Moreover, health professionals should prioritize the use of a detailed plan when phasing out analgesics after THA to counteract unnecessary use, especially when treating patients with low SES.
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Affiliation(s)
- André N KLENØ
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N
| | - Martin B STISEN
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N
| | - Nina M EDWARDS
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N
| | - Inger MECHLENBURG
- Department of Or-thopaedic Surgery, Aarhus University Hospital, Aarhus N,Department of Public Health, Aarhus University Aarhus, Denmark
| | - Alma B PEDERSEN
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N,Department of Clinical Medicine, Aar-hus University, Aarhus N
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