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Zhao B, Liu Z, Fu Y, Zhang H, Wu J, Lai C, Xue E, Gao Q, Shao J. Social Determinants of Intrinsic Capacity: A National Cohort Study. Am J Prev Med 2024; 66:559-567. [PMID: 37844711 DOI: 10.1016/j.amepre.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Intrinsic capacity (IC), a composite of physical and mental capacities, is a marker of healthy aging. Social determinants of health (SDOH), namely the economic and social environments across a lifespan, are the most fundamental factors influencing health outcomes and health disparities. However, there is limited evidence on the influence of the individual and combined burden of the SDOH on IC. METHODS Data were obtained from the China Health and Retirement Longitudinal Study (2011-2015), and data analysis was conducted in 2023. Linear mixed-effect regression was employed to investigate the association between SDOH and IC in a longitudinal analysis. RESULTS This study comprised 7,669 participants (mean [SD] age, 68.5 [7.1] years; 49.8% female; mean [SD] IC, 7.2 [1.6]). In the longitudinal analysis, all five SDOH domains were independently and significantly associated with IC. The absence of social association within the social and community context domain exhibited the weakest association with IC (β: -0.11 [95% CI -0.20, -0.02]), while illiteracy within the education access and quality domain demonstrated the strongest association with IC (β: -0.51 [95% CI -0.60, -0.42]). Furthermore, the adverse effects of SDOH on IC became more distinguishable with the cumulative number of SDOH variables (coefficient for 2 SDOH, -0.41 [-0.64, -0.19]; 3 SDOH, -0.70 [-0.93, -0.48]; ≥4 SDOH, -1.10 [-1.33, -0.88]) compared with those without any SDOH. CONCLUSIONS Certain SDOH levels were significantly and negatively associated with IC. Targeted interventions may be needed to improve SDOH in individuals at high risk of poor IC.
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Affiliation(s)
- Binyu Zhao
- Department of Nursing, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China; Institute of Nursing Research, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zuyun Liu
- Department of Big Data in Health Science School of Public Health and Center for Clinical Big Data and Analytics of the Second Affiliated Hospital, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yujia Fu
- Department of Nursing, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China; Institute of Nursing Research, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Huafang Zhang
- Department of Nursing, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Jingjie Wu
- Nursing Department, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Chuyang Lai
- Nursing Department, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Erxu Xue
- Nursing Department, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qisheng Gao
- School of Public Health, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Jing Shao
- Department of Nursing, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China; Institute of Nursing Research, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
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Arias F, Dufour AB, Jones RN, Alegria M, Fong TG, Inouye SK. Social determinants of health and incident postoperative delirium: Exploring key relationships in the SAGES study. J Am Geriatr Soc 2024; 72:369-381. [PMID: 37933703 PMCID: PMC10922227 DOI: 10.1111/jgs.18662] [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: 06/23/2023] [Revised: 09/27/2023] [Accepted: 10/01/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Examining the associations of social determinants of health (SDOH) with postoperative delirium in older adults will broaden our understanding of this potentially devastating condition. We explored the association between SDOH factors and incident postoperative delirium. METHODS A retrospective study of a prospective cohort of patients enrolled from June 18, 2010, to August 8, 2013, across two academic medical centers in Boston, Massachusetts. Overall, 560 older adults age ≥70 years undergoing major elective non-cardiac surgery were included in this analysis. Exposure variables included income, lack of private insurance, and neighborhood disadvantage. Our main outcome was incident postoperative delirium, measured using the Confusion Assessment Method long form. RESULTS Older age (odds ratio, OR: 1.01, 95% confidence interval, CI: 1.00, 1.02), income <20,000 a year (OR: 1.12, 95% CI: 1.00, 1.26), lack of private insurance (OR: 1.19, 95% CI: 1.04, 1.38), higher depressive symptomatology (OR: 1.02, 95% CI: 1.01, 1.04), and the Area Deprivation Index (OR: 1.02, 95% CI: 1.01, 1.04) were significantly associated with increased risk of postoperative delirium in bivariable analyses. In a multivariable model, explaining 27% of the variance in postoperative delirium, significant independent variables were older age (OR 1.01, 95% CI 1.00, 1.02), lack of private insurance (OR 1.18, 95% CI 1.02, 1.36), and depressive symptoms (OR 1.02, 95% CI 1.00, 1.03). Household income was no longer a significant independent predictor of delirium in the multivariable model (OR:1.02, 95% CI: 0.90, 1.15). The type of medical insurance significantly mediated the association between household income and incident delirium. CONCLUSIONS Lack of private insurance, a social determinant of health reflecting socioeconomic status, emerged as a novel and important independent risk factor for delirium. Future efforts should consider targeting SDOH factors to prevent postoperative delirium in older adults.
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Affiliation(s)
- Franchesca Arias
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA 02131, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA 02131, USA
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL 32608, USA
| | - Alyssa B. Dufour
- Harvard Medical School, Boston, MA 02131, USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA 02131, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02131, USA
| | - Richard N. Jones
- Department of Psychiatry and Human Behavior, Brown University, Warren Alpert Medical School, Providence, RI 02912, USA
| | - Margarita Alegria
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA 02131, USA
- Department of Medicine and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02131, USA
| | - Tamara G. Fong
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA 02131, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA 02131, USA
| | - Sharon K. Inouye
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA 02131, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA 02131, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02131, USA
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Kwak MJ, Inouye SK, Fick DM, Bonner A, Fulmer T, Carter E, Tabbush V, Maya K, Reed N, Waszynski C, Oh ES. Optimizing delirium care in the era of Age-Friendly Health System. J Am Geriatr Soc 2024; 72:14-23. [PMID: 37909706 PMCID: PMC10843290 DOI: 10.1111/jgs.18631] [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: 05/10/2023] [Revised: 08/30/2023] [Accepted: 09/16/2023] [Indexed: 11/03/2023]
Abstract
Delirium is a significant geriatric condition associated with adverse clinical and economic outcomes. The cause of delirium is usually multifactorial, and person-centered multicomponent approaches for proper delirium management are required. In 2017, the John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI) launched a national initiative, Age-Friendly Health System (AFHS), promoting the use of a framework called 4Ms (what matters, medication, mentation, and mobility). The 4Ms framework's primary goal is to provide comprehensive and practical person-centered care for older adults and it aligns with the core concepts of optimal delirium management. In this special article, we demonstrate how a traditional delirium prevention and management model can be assessed from the perspective of AFHS. An example is the crosswalk with the Hospital Elder Life Program (HELP) Core Interventions and the 4MS, which demonstrates alignment in delirium management. We also introduce useful tools to create an AFHS environment in delirium management. Although much has been written about delirium management, there is a need to identify the critical steps in advancing the overall delirium care in the context of the AFHS. In this article, we suggest future directions, including the need for more prospective and comprehensive research to assess the impact of AFHS on delirium care, the need for more innovative and sustainable education platforms, fundamental changes in the healthcare payment system for proper adoption of AFHS in any healthcare setting, and application of AFHS in the community for continuity of care for older adults with delirium.
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Affiliation(s)
- Min Ji Kwak
- Division of Geriatric and Palliative Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Texas, USA
| | - Sharon K. Inouye
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Donna M. Fick
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Alice Bonner
- Institute for Healthcare Improvement, Boston, Massachusetts, USA
- Moving Forward Nursing Home Quality Coalition, Washington, District of Columbia, USA
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Terry Fulmer
- The John A. Hartford Foundation, New York, New York, USA
| | - Emily Carter
- Division of Geriatric Medicine, Maine Medical Center, Portland, Maine, SA
| | - Victor Tabbush
- Anderson School of Management, University of California, Los Angeles, California, USA
| | - Kerri Maya
- Department of Continuing Professional Development, Sutter Health System, Sacramento, CA, USA
| | - Nicholas Reed
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Christine Waszynski
- Division of Geriatric Medicine, Hartford Hospital, Hartford, Connecticut, USA
| | - Esther S. Oh
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Liu J, Gou RY, Jones RN, Schmitt EM, Metzger E, Tabloski PA, Arias F, Hshieh TT, Travison TG, Marcantonio ER, Fong T, Inouye SK. Association of Loneliness With Change in Physical and Emotional Health of Older Adults During the COVID-19 Shutdown. Am J Geriatr Psychiatry 2023; 31:1102-1113. [PMID: 37940227 PMCID: PMC10797604 DOI: 10.1016/j.jagp.2023.07.015] [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: 03/21/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES To examine factors influencing loneliness and the effect of loneliness on physical and emotional health, in the context of the COVID-19 pandemic. DESIGN Prospective, observational cohort. SETTING Community-dwelling participants. PARTICIPANTS Older adults (n = 238) enrolled in a longitudinal study. MEASUREMENTS Interviews were completed July-December 2020. Loneliness was measured with the UCLA 3-item loneliness scale. Data including age, marriage, education, cognitive functioning, functional impairment, vision or hearing impairment, depression, anxiety, medical comorbidity, social network size, technology use, and activity engagement were collected. Health outcomes included self-rated health, and physical and mental composites from the 12-item Short Form Survey. Physical function was measured by a PROMIS-scaled composite score. RESULTS Thirty-nine (16.4%) participants reported loneliness. Vulnerability factors for loneliness included age (RR = 1.08, 95% CI 1.02-1.14); impairment with instrumental activities of daily living (RR = 2.08, 95% CI 1.14-3.80); vision impairment (RR = 2.09, 95% CI 1.10-3.97); depression (RR = 1.34, 95% CI 1.25-1.43); and anxiety (RR = 1.92, 95% CI 1.55-2.39). Significant resilience factors included high cognitive functioning (RR = 0.88, 95% CI 0.83-0.94); large social network size (RR = 0.92, 95% CI 0.88-0.96); technology use (RR = 0.81, 95% CI 0.73-0.90); and social and physical activity engagement (RR = 0.91, 95% CI 0.85-0.98). Interaction analyses showed that larger social network size moderated the effect of loneliness on physical function (protective interaction effect, RR = 0.64, 95% CI 0.15-1.13, p <.01), and activity engagement moderated the effect of loneliness on mental health (protective interaction effect, RR = 0.65, 95% CI 0.25-1.05, p <.001). CONCLUSIONS Resilience factors may mitigate the adverse health outcomes associated with loneliness. Interventions to enhance resilience may help to diminish the detrimental effects of loneliness and hold great importance for vulnerable older adults.
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Affiliation(s)
- Julianna Liu
- Aging Brain Center (JL, RYG, EMS, FA, TTH, TGT, TF, SKI), Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Ray Yun Gou
- Aging Brain Center (JL, RYG, EMS, FA, TTH, TGT, TF, SKI), Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Richard N Jones
- Department of Psychiatry and Human Behavior (RNJ), Brown University, Providence, RI
| | - Eva M Schmitt
- Aging Brain Center (JL, RYG, EMS, FA, TTH, TGT, TF, SKI), Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Eran Metzger
- Department of Psychiatry (EM), Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Franchesca Arias
- Aging Brain Center (JL, RYG, EMS, FA, TTH, TGT, TF, SKI), Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA; Harvard Medical School (FA, TTH, TGT, ERM, TF, SKI), Boston, MA; Department of Medicine (FA, TTH), Brigham and Women's Hospital, Boston, MA
| | - Tammy T Hshieh
- Aging Brain Center (JL, RYG, EMS, FA, TTH, TGT, TF, SKI), Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA; Harvard Medical School (FA, TTH, TGT, ERM, TF, SKI), Boston, MA; Department of Medicine (FA, TTH), Brigham and Women's Hospital, Boston, MA
| | - Thomas G Travison
- Aging Brain Center (JL, RYG, EMS, FA, TTH, TGT, TF, SKI), Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA; Harvard Medical School (FA, TTH, TGT, ERM, TF, SKI), Boston, MA
| | - Edward R Marcantonio
- Harvard Medical School (FA, TTH, TGT, ERM, TF, SKI), Boston, MA; Divisions of General Medicine and Gerontology (ERM), Beth Israel Deaconess Medical Center, Boston, MA
| | - Tamara Fong
- Aging Brain Center (JL, RYG, EMS, FA, TTH, TGT, TF, SKI), Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA; Harvard Medical School (FA, TTH, TGT, ERM, TF, SKI), Boston, MA; Department of Neurology (TF), Beth Israel Deaconess Medical Center, Boston, MA.
| | - Sharon K Inouye
- Aging Brain Center (JL, RYG, EMS, FA, TTH, TGT, TF, SKI), Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA; Harvard Medical School (FA, TTH, TGT, ERM, TF, SKI), Boston, MA; Department of Medicine (SKI), Beth Israel Deaconess Medical Center, Boston, MA
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Gudi-Mindermann H, White M, Roczen J, Riedel N, Dreger S, Bolte G. Integrating the social environment with an equity perspective into the exposome paradigm: A new conceptual framework of the Social Exposome. ENVIRONMENTAL RESEARCH 2023; 233:116485. [PMID: 37352954 DOI: 10.1016/j.envres.2023.116485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/21/2023] [Accepted: 06/20/2023] [Indexed: 06/25/2023]
Abstract
The importance of the social environment and social inequalities in disease etiology is well-known due to the profound research and conceptual framework on social determinants of health. For a long period, in exposome research with its classical orientation towards detrimental health effects of biological, chemical, and physical exposures, this knowledge remained underrepresented. But currently it gains great awareness and calls for innovations in rethinking the role of social environmental health determinants. To fill this gap that exists in terms of the social domain within exposome research, we propose a novel conceptual framework of the Social Exposome, to integrate the social environment in conjunction with the physical environment into the exposome concept. The iterative development process of the Social Exposome was based on a systematic compilation of social exposures in order to achieve a holistic portrayal of the human social environment - including social, psychosocial, socioeconomic, sociodemographic, local, regional, and cultural aspects, at individual and contextual levels. In order to move the Social Exposome beyond a mere compilation of exposures, three core principles are emphasized that underly the interplay of the multitude of exposures: Multidimensionality, Reciprocity, and Timing and continuity. The key focus of the conceptual framework of the Social Exposome is on understanding the underlying mechanisms that translate social exposures into health outcomes. In particular, insights from research on health equity and environmental justice have been incorporated to uncover how social inequalities in health emerge, are maintained, and systematically drive health outcomes. Three transmission pathways are presented: Embodiment, Resilience and Susceptibility or Vulnerability, and Empowerment. The Social Exposome conceptual framework may serve as a strategic map for, both, research and intervention planning, aiming to further explore the impact of the complex social environment and to alter transmission pathways to minimize health risks and health inequalities and to foster equity in health.
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Affiliation(s)
- Helene Gudi-Mindermann
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Germany.
| | - Maddie White
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Germany
| | - Jana Roczen
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Germany
| | - Natalie Riedel
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Germany
| | - Stefanie Dreger
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Germany
| | - Gabriele Bolte
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Germany
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Kunicki ZJ, Ngo LH, Marcantonio ER, Tommet D, Feng Y, Fong TG, Schmitt EM, Travison TG, Jones RN, Inouye SK. Six-Year Cognitive Trajectory in Older Adults Following Major Surgery and Delirium. JAMA Intern Med 2023; 183:442-450. [PMID: 36939716 PMCID: PMC10028541 DOI: 10.1001/jamainternmed.2023.0144] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/19/2023] [Indexed: 03/21/2023]
Abstract
Importance The study results suggest that delirium is the most common postoperative complication in older adults and is associated with poor outcomes, including long-term cognitive decline and incident dementia. Objective To examine the patterns and pace of cognitive decline up to 72 months (6 years) in a cohort of older adults following delirium. Design, Setting, and Participants This was a prospective, observational cohort study with long-term follow-up including 560 community-dwelling older adults (older than 70 years) in the ongoing Successful Aging after Elective Surgery study that began in 2010. The data were analyzed from 2021 to 2022. Exposure Development of incident delirium following major elective surgery. Main Outcomes and Measures Delirium was assessed daily during hospitalization using the Confusion Assessment Method, which was supplemented with medical record review. Cognitive performance using a comprehensive battery of neuropsychological tests was assessed preoperatively and across multiple points postoperatively to 72 months of follow-up. We evaluated longitudinal cognitive change using a composite measure of neuropsychological performance called the general cognitive performance (GCP), which is scaled so that 10 points on the GCP is equivalent to 1 population SD. Retest effects were adjusted using cognitive test results in a nonsurgical comparison group. Results The 560 participants (326 women [58%]; mean [SD] age, 76.7 [5.2] years) provided a total of 2637 person-years of follow-up. One hundred thirty-four participants (24%) developed postoperative delirium. Cognitive change following surgery was complex: we found evidence for differences in acute, post-short-term, intermediate, and longer-term change from the time of surgery that were associated with the development of postoperative delirium. Long-term cognitive change, which was adjusted for practice and recovery effects, occurred at a pace of about -1.0 GCP units (95% CI, -1.1 to -0.9) per year (about 0.10 population SD units per year). Participants with delirium showed significantly faster long-term cognitive change with an additional -0.4 GCP units (95% CI, -0.1 to -0.7) or -1.4 units per year (about 0.14 population SD units per year). Conclusions and Relevance This cohort study found that delirium was associated with a 40% acceleration in the slope of cognitive decline out to 72 months following elective surgery. Because this is an observational study, we cannot be sure whether delirium directly causes subsequent cognitive decline, or whether patients with preclinical brain disease are more likely to develop delirium. Future research is needed to understand the causal pathway between delirium and cognitive decline.
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Affiliation(s)
- Zachary J. Kunicki
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Long H. Ngo
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Edward R. Marcantonio
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School and Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
| | - Douglas Tommet
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Yi Feng
- Department of Measurement, Statistics, and Evaluation, University of Maryland, College Park
| | - Tamara G. Fong
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School and Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
| | - Eva M. Schmitt
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
| | - Thomas G. Travison
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School and Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
| | - Richard N. Jones
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Sharon K. Inouye
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School and Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
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Wiredu K, Aduse-Poku E, Shaefi S, Gerber SA. Proteomics for the Discovery of Clinical Delirium Biomarkers: A Systematic Review of Major Studies. Anesth Analg 2023; 136:422-432. [PMID: 36580411 DOI: 10.1213/ane.0000000000006246] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Delirium represents a significant health care burden, diagnosed in more than 2 million elderly Americans each year. In the surgical population, delirium remains the most common complication among elderly patients, and is associated with longer hospital stays, higher costs of care, increased mortality, and functional impairment. The pathomechanism of disease is poorly understood, with current diagnostic approaches somewhat subjective and arbitrary, and definitive diagnostic biomarkers are currently lacking. Despite the recent interest in delirium research, biomarker discovery for it remains new. Most attempts to discover biomarkers are targeted studies that seek to assess the involvement of one or more members of a focused panel of candidates in delirium. For a more unbiased, system-biology view, we searched literature from Medical Literature Analysis and Retrieval System Online (MEDLINE), Cochrane Central, Web of Science, SCOPUS, and Dimensions between 2016 and 2021 for untargeted proteomic discovery studies for biomarkers of delirium conducted on human geriatric subjects. Two reviewers conducted an independent review of all search results and resolved discordance by consensus. From an overall search of 1172 publications, 8 peer-reviewed studies met our defined inclusion criteria. The 370 unique perioperative biomarkers identified in these reports are enriched in pathways involving activation of the immune system, inflammatory response, and the coagulation cascade. The most frequently identified biomarker was interleukin-6 (IL-6). By reviewing the distribution of protein biomarker candidates from these studies, we conclude that a panel of proteins, rather than a single biomarker, would allow for discriminating delirium cases from noncases. The paucity of hypothesis-generating studies in the peer-reviewed literature also suggests that a system-biology view of delirium pathomechanisms has yet to fully emerge.
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Affiliation(s)
- Kwame Wiredu
- From the Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.,Program in Quantitative Biomedical Science, Dartmouth College, Hanover, New Hampshire
| | | | - Shahzad Shaefi
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School/Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Scott A Gerber
- From the Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.,Program in Quantitative Biomedical Science, Dartmouth College, Hanover, New Hampshire.,Dartmouth Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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Arias F, Chen F, Shiff H, Marcantonio ER, Jones RN, Schmitt EM, Metzger E, Fong TG, Travison TG, Inouye SK. Parental Education and Delirium Risk after Surgery in Older Adults. Clin Gerontol 2023; 46:253-266. [PMID: 36001869 PMCID: PMC9928599 DOI: 10.1080/07317115.2022.2111289] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Efforts to conceptualize risk factors for postoperative delirium in older adults have focused on the time proximate to the episode, but how early-life exposures influence delirium risk is poorly understood. METHODS An observational cohort of 547 patients aged 70+undergoing major non-cardiac surgery at two academic medical centers in Boston. Demographic characteristics, cognition, parental education, health, and participation in cognitively stimulating activities were assessed prior to surgery. Delirium incidence and severity were measured daily during hospitalization. RESULTS Higher paternal education was associated with significantly lower incidence of delirium (X2(1, N =547)=8.35, p <.001; odds ratio OR=.93, 95% CI, .87 to .98) and inversely associated with delirium severity (r(545)=-.13, p <.001). Higher maternal education was associated with lower delirium incidence but did not reach statistical significance. The effect of paternal education on delirium incidence was independent of the patient's education, estimated premorbid intelligence, medical comorbidities, neighborhood disadvantage, and participation in cognitively stimulating activities (X2(2, N =547)=31.22, p <.001). CONCLUSIONS Examining early-life exposures may yield unique insights into the risks and pathogenesis of delirium. CLINICAL IMPLICATIONS Evaluating long-term factors that increase vulnerability to delirium may improve our ability to calculate risk. It may guide clinical decision-making and inform pre- and post-operative recommendations.
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Affiliation(s)
- Franchesca Arias
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, USA
- Harvard Medical School, Boston, USA
| | - Fan Chen
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, USA
| | - Haley Shiff
- Harvard T. H. Chan School of Public Health, Boston, USA
| | - Edward R. Marcantonio
- Harvard Medical School, Boston, USA
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, USA
| | - Richard N. Jones
- Department of Psychiatry and Human Behavior, Brown University, Warren Alpert Medical School, Providence, USA
| | - Eva M. Schmitt
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, USA
| | - Eran Metzger
- Department of Medicine, Hebrew SeniorLife, Boston, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, USA
| | - Tamara G. Fong
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, USA
- Harvard Medical School, Boston, USA
| | - Thomas G. Travison
- Harvard Medical School, Boston, USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, USA
- Department of Medicine and Psychiatry, Harvard Medical School, Boston, USA
| | - Sharon K. Inouye
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, USA
- Harvard Medical School, Boston, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, USA
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Shiff HM, Arias F, Dufour AB, Carr D, Chen F, Gou Y, Jones R, Schmitt E, Travison TG, Kunicki ZJ, Okereke OI, Inouye SK. Paternal Occupation and Delirium Risk in Older Adults: A Potential Marker of Early-Life Exposures. Innov Aging 2022; 6:igac050. [PMID: 36128514 PMCID: PMC9478553 DOI: 10.1093/geroni/igac050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Objectives
Delirium is a common disorder among older adults following hospitalization or major surgery. Whereas many studies examine the risk of proximate exposures and comorbidities, little is known about pathways linking childhood exposures to later-life delirium. In this study, we explored the association between paternal occupation and delirium risk.
Research Design and Methods
A prospective observational cohort study of 528 older adults undergoing elective surgery at two academic medical centers. Paternal occupation group (white collar vs. blue collar) served as our independent variable. Delirium incidence was assessed using the Confusion Assessment Method (CAM) supplemented by medical chart review. Delirium severity was measured using the peak CAM-Severity score (CAM-S Peak), the highest value of CAM-S observed throughout the hospital stay.
Results
Blue-collar paternal occupation was significantly associated with a higher rate of incident delirium (91/234, 39%) compared with white-collar paternal occupation (84/294, 29%), adjusted odds ratio OR (95% confidence interval [CI]) = 1.6 (1.1, 2.3). All analyses were adjusted for participant age, race, gender, and Charlson Comorbidity Index. Blue-collar paternal occupation was also associated with greater delirium severity, with a mean score (SD) of 4.4 (3.3), compared with white-collar paternal occupation with a mean score (SD) of 3.5 (2.8). Among participants reporting blue-collar paternal occupation, we observed an adjusted mean difference of 0.86 (95% CI = 0.4, 1.4) additional severity units.
Discussion and Implications
Blue-collar paternal occupation is associated with greater delirium incidence and severity, after adjustment for covariates. These findings support the application of a life-course framework to evaluate the risk of later-life delirium and delirium severity. Our results also demonstrate the importance of considering childhood exposures, which may be consequential even decades later.
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Affiliation(s)
- Haley M Shiff
- Department of Epidemiology, Harvard T. H. Chan School of Public Health , Boston, Massachusetts , USA
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
| | - Franchesca Arias
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
- Harvard Medical School , Boston, Massachusetts , USA
| | - Alyssa B Dufour
- Harvard Medical School , Boston, Massachusetts , USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
| | - Deborah Carr
- Department of Sociology, Boston University , Boston, Massachusetts , USA
| | - Fan Chen
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
| | - Yun Gou
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
| | - Richard Jones
- Department of Psychiatry and Human Behavior, Brown University, Warren Alpert Medical School , Providence, Rhode Island , USA
| | - Eva Schmitt
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
| | - Thomas G Travison
- Harvard Medical School , Boston, Massachusetts , USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
| | - Zachary J Kunicki
- Department of Psychiatry and Human Behavior, Brown University, Warren Alpert Medical School , Providence, Rhode Island , USA
| | - Olivia I Okereke
- Department of Epidemiology, Harvard T. H. Chan School of Public Health , Boston, Massachusetts , USA
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School , Boston, Massachusetts , USA
| | - Sharon K Inouye
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts , USA
- Harvard Medical School , Boston, Massachusetts , USA
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Neurological manifestations by sex and age group in COVID-19 inhospital patients. eNeurologicalSci 2022; 28:100419. [PMID: 35935176 PMCID: PMC9338167 DOI: 10.1016/j.ensci.2022.100419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/15/2022] [Accepted: 07/24/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction Neurological manifestations have been associated with a poorer prognosis in COVID-19. However, data regarding their incidence according to sex and age groups is still lacking. Methods This retrospective multicentric cohort collected data from 39 Brazilian hospitals from 17 cities, from adult COVID-19 admitted from March 2020 to January 2022. Neurological manifestations presented at hospital admission were assessed according to incidence by sex and age group. Results From 13,603 COVID-19 patients, median age was 60 years old and 53.0% were men. Women were more likely to present with headaches (22.4% vs. 17.7%, p < 0.001; OR 1.36, 95% confidence interval [CI] 1.22–1.52) than men and also presented a lower risk of having seizures (OR 0.43, 95% CI 0.20–0.94). Although delirium was more frequent in women (6.6% vs. 5.7%, p = 0.020), sex was not associated with delirium in the multivariable logistc regresssion analysis. Delirium, syncope and coma increased with age (1.5% [18–39 years] vs. 22.4% [80 years or over], p < 0.001, OR 1.07, 95% CI 1.06–1.07; 0.7% vs. 1.7%, p = 0.002, OR 1.01, 95% CI 1.00–1.02; 0.2% vs. 1.3% p < 0.001, OR 1.04, 95% CI 1.02–1.06), while, headache (26.5% vs. 7.1%, OR 0.98, 95% CI 0.98–0.99), anosmia (11.4% vs. 3.3%, OR 0.99, 95% CI] 0.98–0.99 and ageusia (13.1% vs. 3.5%, OR 0.99, CI 0.98–0.99) decreased (p < 0.001 for all). Conclusion Older COVID-19 patients were more likely to present delirium, syncope and coma, while the incidence of anosmia, ageusia and headaches decreased with age. Women were more likely to present headache, and less likely to present seizures. Older COVID-19 patients were more likely to present delirium and coma. Younger COVID-19 patients were more likely to report anosmia, ageusia and headache. Women with COVID-19 are more likely to present headache.
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