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Brown CJ, Loyd C, Richardson JT, Boogaerts G, Zhang Y, Kennedy RE. Preliminary Validation of the Acute Care Mobility Assessment as a Measure of Hospital Mobility. J Gerontol A Biol Sci Med Sci 2024:glae012. [PMID: 38195216 DOI: 10.1093/gerona/glae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Despite heighted interest, measurement of hospital mobility remains challenging. Available assessment tools lack patient input regarding level and frequency of hospital mobility. The purpose of this study was to validate a brief self-reported mobility assessment to measure out-of-bed activity during hospitalization. METHODS We recruited cognitively intact hospitalized adults (age ≥65 years) who walked prior to admission, to wear an accelerometer for 24 hours and to complete the Acute Care Mobility Assessment (ACMA), a self-report of mobility that ranges from bed rest to walking off the hospital unit in the prior 24 hours. For each mobility level from sitting in a chair to walking off the unit, patients reported frequency of the activity and need for help from another person or equipment. Spearman correlation coefficients were calculated using several scoring algorithms to compare ACMA to accelerometer data. RESULTS Fifty-one patients (mean age 74.3 (SD 6.2) years, 63% female, 39% Black) had complete data. Steps taken in 24 hours ranged from 10 - 2831. Correlation analyses identified strong associations between ACMA scores and total steps, and moderate correlations with total time walking using all algorithms. However, the unweighted frequency count using the three ambulation levels only (walking in room, in hall and off ward) had the highest correlation with total steps (r=0.84; p<0.001) and total time walking (r=0.66; p<0.001). CONCLUSION ACMA is a valid measure of mobility among cognitively intact hospitalized older adults. The ACMA may add value to our current armamentarium of tools by adding patient report of hospital mobility.
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Affiliation(s)
- Cynthia J Brown
- Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Christine Loyd
- Department of Clinical and Diagnostic Sciences, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - J Tyler Richardson
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Garner Boogaerts
- Department of Family Medicine, Halifax Health Medical Center, Daytona Beach, Florida, USA
| | - Yue Zhang
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Richard E Kennedy
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Loyd C, Blue K, Turner L, Weber A, Guy A, Zhang Y, Martin RC, Kennedy RE, Brown C. National Norms for Hospitalizations Due to Ambulatory Care Sensitive Conditions among Adults in the US. J Gen Intern Med 2023; 38:2953-2959. [PMID: 36941421 PMCID: PMC10027258 DOI: 10.1007/s11606-023-08161-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/10/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Ambulatory care sensitive conditions (ACSCs) are acute or chronic health issues that lead to potentially preventable hospitalizations when not treated in the outpatient primary care setting. OBJECTIVE To describe national hospitalization rates due to ACSCs among adult inpatients in the US. DESIGN A retrospective cross-sectional analysis of the 2018 US National Inpatient Sample (NIS) dataset from the Healthcare Cost and Utilization Project at the Agency of Healthcare Research and Quality was completed in the year 2022. PARTICIPANTS Participants were adult inpatients from community hospitals in 48 states of the US and District of Columbia. MAIN MEASURES ACSC admission rates were calculated using ICD-10 codes and the Purdy ACSC definition. The admission rates were weighted to the US inpatient population and stratified by age, sex, and race. KEY RESULTS ACSC hospitalization rates varied considerably across age and average number of hospitalizations varied across sex and race. ACSC hospitalization rates increased with age, male sex, and Native American and Black race. The most common ACSCs were pneumonia, diabetes, and congestive heart failure. CONCLUSIONS Previous studies have emphasized the importance of preventable hospitalizations, however, the national rates for ACSC hospitalizations across all ages in the US have not been reported. The national rates presented will facilitate comparisons to identify hospitals and health care systems with higher-than-expected rates of ACSC admissions that may suggest a need for improved primary care services.
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Affiliation(s)
- Christine Loyd
- Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Kylie Blue
- Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Laci Turner
- Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ashley Weber
- Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ashley Guy
- Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Yue Zhang
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Roy C Martin
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Richard E Kennedy
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cynthia Brown
- Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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3
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Loyd C, Zhang Y, Weisberg T, Boyett J, Huckaby ER, Grundhoefer J, Otero S, Roberts L, Giordano‐Mooga S, Capo‐Lugo C, Smith CH, Kennedy RE, King BJ, Brown CJ. A systematic review and meta-analysis: Assessment of hospital walking programs among older patients. Nurs Open 2023; 10:1942-1953. [PMID: 36441641 PMCID: PMC10006621 DOI: 10.1002/nop2.1496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 06/27/2022] [Accepted: 11/10/2022] [Indexed: 11/30/2022] Open
Abstract
AIM The aim of this study is to assess effect of hospital walking programs on outcomes for older inpatients and to characterize hospital walking dose reported across studies. DESIGN A systematic review and meta-analysis examining impact of hospital walking and/or reported walking dose among medical-surgical inpatients. For inclusion, studies were observational or experimental, published in English, enrolled inpatients aged ≥ 65 yrs hospitalized for medical or surgical reasons. METHODS Searches of PubMed, CINAHL, Embase, Scopus, NICHSR, OneSearch, ClinicalTrials.gov, and PsycINFO were completed in December 2020. Two reviewers screened sources, extracted data, and performed quality bias appraisal. RESULTS Hospital walking dose was reported in 6 studies and commonly as steps/24 hr. Length of stay (LOS) was a common outcome reported. Difference in combined mean LOS between walking and control groups was -5.89 days. Heterogeneity across studies was considerable (I2 = 96%) suggesting poor precision of estimates. Additional, high-quality trials examining hospital walking and patient outcomes of older patients is needed.
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Affiliation(s)
- Christine Loyd
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, UAB School of MedicineUniversity of AlabamaAlabamaBirminghamUSA
- Department of Clinical and Diagnostic Sciences, UAB School of Health ProfessionsUniversity of AlabamaAlabamaBirminghamUSA
| | - Yue Zhang
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, UAB School of MedicineUniversity of AlabamaAlabamaBirminghamUSA
| | - Tara Weisberg
- Department of Clinical and Diagnostic Sciences, UAB School of Health ProfessionsUniversity of AlabamaAlabamaBirminghamUSA
| | - James Boyett
- Department of Clinical and Diagnostic Sciences, UAB School of Health ProfessionsUniversity of AlabamaAlabamaBirminghamUSA
| | - Elizabeth R. Huckaby
- Department of Clinical and Diagnostic Sciences, UAB School of Health ProfessionsUniversity of AlabamaAlabamaBirminghamUSA
| | - Jeri Grundhoefer
- Department of Clinical and Diagnostic Sciences, UAB School of Health ProfessionsUniversity of AlabamaAlabamaBirminghamUSA
| | - Steve Otero
- Department of Clinical and Diagnostic Sciences, UAB School of Health ProfessionsUniversity of AlabamaAlabamaBirminghamUSA
| | - Lisa Roberts
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, UAB School of MedicineUniversity of AlabamaAlabamaBirminghamUSA
| | - Samantha Giordano‐Mooga
- Department of Clinical and Diagnostic Sciences, UAB School of Health ProfessionsUniversity of AlabamaAlabamaBirminghamUSA
| | - Carmen Capo‐Lugo
- Department of Physical Therapy, UAB School of Health ProfessionsUniversity of AlabamaAlabamaBirminghamUSA
| | - Catherine H. Smith
- Lister Hill Library of the Health SciencesUniversity of Alabama at BirminghamAlabamaBirminghamUSA
| | - Richard E. Kennedy
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, UAB School of MedicineUniversity of AlabamaAlabamaBirminghamUSA
| | | | - Cynthia J. Brown
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, UAB School of MedicineUniversity of AlabamaAlabamaBirminghamUSA
- Department of MedicineLouisiana State University Health Sciences CenterLouisianaNew OrleansUSA
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Boogaerts G, Loyd C, Zhang Y, Kennedy RE, Brown CJ. National Norms for the Elixhauser and Charlson Comorbidity Indexes Among Hospitalized Adults. J Gerontol A Biol Sci Med Sci 2023; 78:365-372. [PMID: 35426436 DOI: 10.1093/gerona/glac087] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Comorbidity burden is commonly measured among hospitalized adults, yet the U.S. national norms for 2 commonly used comorbidity indexes have not yet been reported. Thus, this study reports U.S. national norms for both Charlson Comorbidity Index (CCI) and the Elixhauser Comorbidity Index (ECI) among hospitalized adults based on age, biological sex, and race. METHODS A retrospective observational cohort study using data from the Agency of Healthcare Research and Quality U.S. National Inpatient Sample database for 2017. Patient data were extracted from 7 159 694 inpatient adults, and analyses were focused on individuals older than 45 years, yielding 4 370 225 patients. International Classification of Diseases, 10th Edition, diagnostic codes were used to calculate CCI and ECI scores. These scores were then weighted for the U.S. national population. RESULTS The weighted mean CCI was 1.22 (95% confidence interval [CI]: 1.22, 1.22), and the weighted mean ECI was 2.76 (95% CI: 2.76, 2.76). Both indexes had increasing average scores with increasing age, independent of sex and race (all p values < .001). CONCLUSION For the first time, U.S. national norms for the CCI and ECI are reported for adult inpatients. The norms can serve as a reference tool for determining if clinical and research populations have greater or lesser comorbidity burden than typical hospitalized adults in the United States for their age, sex, and race.
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Affiliation(s)
- Garner Boogaerts
- Department of Family Medicine, Halifax Health Medical Center, Daytona Beach, Florida, USA
| | - Christine Loyd
- Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yue Zhang
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama
| | - Richard E Kennedy
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama
| | - Cynthia J Brown
- Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
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5
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Anderson AE, Buzzelli N, Loyd C, Giordano-Mooga S, Redden D, Justement LB, Bruns HA. An Analysis of Factors That Influence Students to Pursue Immunology. Immunohorizons 2021; 5:1021-1029. [PMID: 34969936 DOI: 10.4049/immunohorizons.2100089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/03/2021] [Indexed: 11/19/2022] Open
Abstract
One considers many factors before choosing a career path, such as interest, accessibility of resources, academic ability, and social network support. As employment around the world in science, technology, engineering, and math (STEM) disciplines continues to increase, there is a need to understand why students select specific majors in an effort to increase overall enrollment and retention of STEM majors. The purpose of this study was to elucidate how undergraduate and graduate students were introduced to immunology, a STEM discipline, and how these experiences influenced their desire to pursue immunology as a major. The findings from this study show that a majority of both immunology and nonimmunology majors were initially exposed to immunology through an educational experience compared with a personal experience. Our data also indicate that the timing of the experience is critical, such that an educational experience at an advanced academic level, for example, in college, or a personal experience as a teen or young adult correlated with the decision to pursue an immunology degree. Moreover, graduate students studying immunology report that having research experiences and/or an experience with a mentor positively influenced their decision to pursue immunology. Overall, the findings from this research highlight the type and timing of exposures that influence individuals to major in the field of immunology, and these data can be used in the future to increase the number of immunology graduates.
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Affiliation(s)
- Ashlyn E Anderson
- Department of Cell, Developmental and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL
| | | | - Christine Loyd
- Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, AL
| | - Samantha Giordano-Mooga
- Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, AL
| | - David Redden
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL; and
| | - Louis B Justement
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL
| | - Heather A Bruns
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL
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6
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Loyd C, Boogaerts G, Zhang Y, Kennedy R, Brown C. National Norms for the Elixhauser and Charlson Comorbidity Indexes Among Hospitalized Adults. Innov Aging 2021. [PMCID: PMC8680641 DOI: 10.1093/geroni/igab046.2282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Multimorbidity has become the defining focus of in-patient geriatric clinical practice and research. Comorbidity assessment burden is often completed using the Elixhauser (ECI) and Charlson comorbidity indexes (CCI), which can predict mortality risk, hospital length of stay and readmission, and healthcare utilization. Yet, the national norms for ECI and CCI have not been reported. Therefore, this study aimed to report comorbidity score national norms of hospitalized patients based on age, race, and sex. Using the 2017 US National Inpatient Sample, ICD-10 coding data from 7,159,694 adult patient’s (≥18years) was abstracted to calculate ECI and CCI scores. Scores were stratified into 5-year age increments from age 45-89. Adults aged<45 and >89 were included in the analysis, however not age-stratified. Overall mean comorbidity score for the population using the ECI was 2.76 (95%CI 2.76, 2.76) and CCI was 1.22 (95% CI 1.22, 1.22). Mean scores for both indexes increased with age until age 90, and this increase was independent of race and sex (all p-values<0.001). Some individual comorbidities increased with age including congestive heart failure and dementia, while others including diabetes and chronic obstructive pulmonary disease increased with age but peaked between 60-74 years and declined in older age. Importantly, a report of US national norms for comorbidity burden among hospitalized adults can provide a reference for determining if clinical and research populations have greater or lesser comorbidity than typical hospitalized adults for their age, race, and sex.
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Affiliation(s)
- Christine Loyd
- University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Garner Boogaerts
- University of Alabama at Birmingham, University of Alabama at Birmingham, Alabama, United States
| | - Yue Zhang
- University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Richard Kennedy
- University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Cynthia Brown
- Louisiana State University Health Sciences Center - New Orleans, New Orleans, Louisiana, United States
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7
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Anderson AE, Redden D, Buzzelli N, Giordano-Mooga S, Loyd C, Justement LB, Bruns HA. The decision to pursue a degree in immunology may be influenced by the timing at which students are introduced to the field. The Journal of Immunology 2021. [DOI: 10.4049/jimmunol.206.supp.54.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Abstract
The decision to pursue an academic plan of study is influenced by several factors. Educational and personal experiences through childhood, adolescence, and young adulthood can have a powerful impact on the academic preferences of students. Immunology, a popular field of study at the graduate level, is largely ignored at the undergraduate level. Identifying the type and timing of experiences that influence the choice of current undergraduate and graduate students to pursue immunology is critical for developing and refining immunology curricula. To identify potential influencing factors, students were surveyed about their exposure to the immune system or immunology-related topics. There were 283 total respondents (45% immunology majors, 55% other science majors) of which 39% were graduate students and 61% were undergraduate students. There were no significant differences in the demographics of immunology majors compared to non-majors. Although there is no difference between immunology majors and non-majors in the number of respondents having an educational or personal experience involving immunology, an educational experience was more influential than a personal experience for both graduate (85%) and undergraduate (66%) immunology majors. However, more undergraduates (33.7%) pursue immunology based upon a personal experience compared to graduate students (14.6%). Importantly, students who chose to pursue an immunology degree were introduced to immunology at a later academic stage compared to students who are not pursuing an immunology degree. These data suggest that timing may be more influential than the type of exposure in influencing the choice to pursue immunology.
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Ford CR, Loyd C, Rothrock AG, Johnson TM, Allman RM, Brown CJ. Development and evolution of a two-day intensive resident experience in geriatric medicine. Gerontol Geriatr Educ 2021; 42:24-37. [PMID: 30839246 DOI: 10.1080/02701960.2019.1587753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
As the older adult population increases, the need to enhance medical education and training in Geriatric Medicine (GM) is essential. To enhance resident training, faculty at two southeastern universities developed a Resident Award Summit, a two-day active learning experience, designed to expose family and internal medicine residents to GM principles and the various career options available in GM.Over 10 years, 353 residents from 108 residency programs participated. Resident feedback indicated that attending the event had a positive impact on future practice (M = 4.65, SD = .58) and showed that the amount of GM training received was limited, with 83.5% and 70.2% ranking adequacy of medical student and resident training as limited, respectively.To impact practice, long-term change must occur. Experiences such as the Resident Award Summit allow GM faculty to educate and prepare residents though positive teaching experiences, providing residents with the skills needed to care for older adults in their communities.
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Affiliation(s)
- Channing R Ford
- Harrison School of Pharmacy, Auburn University, Auburn, AL, USA
| | - Christine Loyd
- Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Angela G Rothrock
- Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Theodore M Johnson
- Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA
| | - Richard M Allman
- School of Medicine, George Washington University, Washington, DC, USA
| | - Cynthia J Brown
- Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
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9
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Loyd C, Markland AD, Zhang Y, Fowler M, Harper S, Wright NC, Carter CS, Buford TW, Smith CH, Kennedy R, Brown CJ. Prevalence of Hospital-Associated Disability in Older Adults: A Meta-analysis. J Am Med Dir Assoc 2020; 21:455-461.e5. [PMID: 31734122 PMCID: PMC7469431 DOI: 10.1016/j.jamda.2019.09.015] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/03/2019] [Accepted: 09/23/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Hospital-associated disability (HAD), defined as loss of independence in activities of daily living (ADL) following acute hospitalization, is observed among older adults. The study objective is to determine overall prevalence of HAD among older adults hospitalized in acute care, and to assess the impact of study initiation year in moderation of prevalence. DESIGN Meta-analysis of data collected from randomized trials, quasi-experimental, and prospective cohort studies. English-language searches to identify included studies were completed February 2018 and updated May 2018 of electronic databases and reference lists of studies and reviews. Included studies were human subjects investigations that measured ADL ≥2 time points before or during and after hospitalization and reported prevalence of ADL decline among older adults. SETTING Acute care hospital units. PARTICIPANTS Adults aged ≥65 years hospitalized in medical-surgical acute care; total sample size across all included studies was 7375. METHODS Independence in ADL was assessed using the Katz Index of Independence in Activities of Daily Living and Barthel Index of Independence in Activities of Daily Living. RESULTS Random effects meta-analysis across included studies identified combined prevalence of HAD as 30% (95% CI 24%, 33%; P < .001). The effect of study initiation year on the prevalence rate was minimal. A large amount of heterogeneity was observed between studies, which may be due in part to nonstandardized measurement of ADL impairment or other methodological differences. CONCLUSIONS AND IMPLICATIONS Hospitalization in acute care poses a significant risk to functional independence of older adults, and this risk is unchanged despite shorter lengths of stay. The evidence supports the continued need for hospital-based programs that provide assessment of functional ability and identification of at-risk older adults in order to better treat and prevent HAD.
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Affiliation(s)
- Christine Loyd
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, UAB School of Medicine, University of Alabama at Birmingham, Birmingham, AL; Birmingham/Atlanta Veterans Affairs Geriatric Research, Education, and Clinical Center, Birmingham Veterans Affairs Medical Center, Birmingham, AL
| | - Alayne D Markland
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, UAB School of Medicine, University of Alabama at Birmingham, Birmingham, AL; Birmingham/Atlanta Veterans Affairs Geriatric Research, Education, and Clinical Center, Birmingham Veterans Affairs Medical Center, Birmingham, AL.
| | - Yue Zhang
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, UAB School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Mackenzie Fowler
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - Sara Harper
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, UAB School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Nicole C Wright
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - Christy S Carter
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, UAB School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Thomas W Buford
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, UAB School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Catherine H Smith
- Lister Hill Library of the Health Sciences, University of Alabama at Birmingham, Birmingham, AL
| | - Richard Kennedy
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, UAB School of Medicine, University of Alabama at Birmingham, Birmingham, AL; Birmingham/Atlanta Veterans Affairs Geriatric Research, Education, and Clinical Center, Birmingham Veterans Affairs Medical Center, Birmingham, AL
| | - Cynthia J Brown
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, UAB School of Medicine, University of Alabama at Birmingham, Birmingham, AL; Birmingham/Atlanta Veterans Affairs Geriatric Research, Education, and Clinical Center, Birmingham Veterans Affairs Medical Center, Birmingham, AL
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10
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Kim T, Holleman CL, Nason S, Arble DM, Ottaway N, Chabenne J, Loyd C, Kim JA, Sandoval D, Drucker DJ, DiMarchi R, Perez-Tilve D, Habegger KM. Hepatic Glucagon Receptor Signaling Enhances Insulin-Stimulated Glucose Disposal in Rodents. Diabetes 2018; 67:2157-2166. [PMID: 30150304 PMCID: PMC6198333 DOI: 10.2337/db18-0068] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 08/10/2018] [Indexed: 12/12/2022]
Abstract
Glucagon receptor (GCGR) agonists cause hyperglycemia but also weight loss. However, GCG-like peptide 1 receptor (GLP1R)/GCGR mixed agonists do not exhibit the diabetogenic effects often attributed to GCGR activity. Thus, we sought to investigate the effect of glucagon agonism on insulin action and glucose homeostasis. Acute GCGR agonism induced immediate hyperglycemia, followed by improved glucose tolerance and enhanced glucose-stimulated insulin secretion. Moreover, acute GCGR agonism improved insulin tolerance in a dose-dependent manner in both lean and obese mice. Improved insulin tolerance was independent of GLP1R, FGF21, and hepatic glycogenolysis. Moreover, we observed increased glucose infusion rate, disposal, uptake, and suppressed endogenous glucose production during euglycemic clamps. Mice treated with insulin and GCGR agonist had enhanced phosphorylation of hepatic AKT at Ser473; this effect was reproduced in isolated mouse primary hepatocytes and resulted in increased AKT kinase activity. These data reveal that GCGR agonism enhances glucose tolerance, in part, by augmenting insulin action, with implications for the use of GCGR agonism in therapeutic strategies for diabetes.
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Affiliation(s)
- Teayoun Kim
- Comprehensive Diabetes Center and Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Cassie L Holleman
- Comprehensive Diabetes Center and Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Shelly Nason
- Comprehensive Diabetes Center and Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Deanna M Arble
- Department of Biological Sciences, Marquette University, Milwaukee, WI
| | - Nickki Ottaway
- Metabolic Diseases Institute and Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Cincinnati, Cincinnati, OH
| | | | - Christine Loyd
- Comprehensive Diabetes Center and Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Jeong-A Kim
- Comprehensive Diabetes Center and Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | | | - Daniel J Drucker
- Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Richard DiMarchi
- Novo Nordisk Research Center, Indianapolis, IN
- Department of Chemistry, Indiana University, Bloomington, IN
| | - Diego Perez-Tilve
- Metabolic Diseases Institute and Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Cincinnati, Cincinnati, OH
| | - Kirk M Habegger
- Comprehensive Diabetes Center and Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
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Loyd C. TRAJECTORIES OF COMMUNITY MOBILITY RECOVERY FOLLOWING HOSPITALIZATION AMONG OLDER ADULTS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Loyd
- University of Alabama at Birmingham
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12
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Brown CJ, Loyd C, Tyler Richardson J, Boogaerts G. VALIDATION OF THE ACUTE CARE MOBILITY ASSESSMENT: A MEASURE OF HOSPITAL MOBILITY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C J Brown
- The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - C Loyd
- Postdoctoral Scholar, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - J Tyler Richardson
- Assistant Professor, Physical Medicine & Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama USA
| | - G Boogaerts
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama USA
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Loyd C, Beasley TM, Miltner RS, Clark D, King B, Brown CJ. Trajectories of Community Mobility Recovery After Hospitalization in Older Adults. J Am Geriatr Soc 2018; 66:1399-1403. [PMID: 29719058 DOI: 10.1111/jgs.15397] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To identify trajectories of recovery of community mobility in acutely ill older adults using the University of Alabama at Birmingham Life-Space Assessment (LSA). DESIGN Prospective observation cohort study. SETTING Central Alabama, Birmingham Veterans Affairs Medical Center. PARTICIPANTS Community-dwelling adults aged 65 and older hospitalized for nonsurgical medical reasons (N=173). MEASUREMENTS We determined LSA scores for the month before and monthly for 6 months after hospitalization (composite scores ranging from 0-120, with 120 reflecting completely unrestricted mobility). RESULTS In the month after hospitalization, 92 (53%) participants had a clinically significant decrease in life-space mobility, while 42 (24%) were unchanged, and 39 (23%) had an increase from the month preceding hospitalization. Of participants with a life-space decrease, the majority recovered their prehospitalization mobility status during 6 months of follow-up, whereas 34% did not recover. Participants whose life-space decreased were hospitalized significantly longer (P=.01) and, on average, had higher prehospital life-space scores (P=.01) than those who maintained or increased their life-space. CONCLUSION A clinically significant loss of community mobility was common after hospitalization, but most participants recovered to prehospitalization mobility within 6 months of discharge. Research examining in-hospital and posthospitalization interventions to achieve faster recovery of community mobility is needed.
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Affiliation(s)
- Christine Loyd
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - T Mark Beasley
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rebecca S Miltner
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Diane Clark
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama
| | - Barbara King
- School of Nursing, University of Wisconsin-Madison, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Cynthia J Brown
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.,Geriatric Research, Education, and Clinical Care Center, Birmingham/Atlanta Veterans Affairs, Birmingham, Alabama
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Loyd C, Liu Y, Kim T, Holleman C, Galloway J, Bethea M, Ediger BN, Swain TA, Tang Y, Stoffers DA, Rowe GC, Young M, Steele C, Habegger KM, Hunter CS. LDB1 Regulates Energy Homeostasis During Diet-Induced Obesity. Endocrinology 2017; 158:1289-1297. [PMID: 28009534 PMCID: PMC5460834 DOI: 10.1210/en.2016-1791] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 12/22/2016] [Indexed: 12/21/2022]
Abstract
The broadly expressed transcriptional coregulator LDB1 is essential for β-cell development and glucose homeostasis. However, it is unclear whether LDB1 has metabolic roles beyond the β-cell, especially under metabolic stress. Global Ldb1 deletion results in early embryonic lethality; thus, we used global heterozygous Ldb1+/- and inducible β-cell-specific Ldb1-deficient (Ldb1Δβ-cell) mice. We assessed glucose and insulin tolerance, body composition, feeding, and energy expenditure during high-fat diet exposure. Brown adipose tissue (BAT) biology was evaluated by thermogenic gene expression and LDB1 chromatin immunoprecipitation analysis. We found that partial loss of Ldb1 does not impair the maintenance of glucose homeostasis; rather, we observed improved insulin sensitivity in these mice. Partial loss of Ldb1 also uncovered defects in energy expenditure in lean and diet-induced obese (DIO) mice. This decreased energy expenditure during DIO was associated with significantly altered BAT gene expression, specifically Cidea, Elovl3, Cox7a1, and Dio2. Remarkably, the observed changes in energy balance during DIO were absent in Ldb1Δβ-cell mice, despite a similar reduction in plasma insulin, suggesting a role for LDB1 in BAT. Indeed, LDB1 is expressed in brown adipocytes and occupies a regulatory domain of Elovl3, a gene crucial to normal BAT function. We conclude that LDB1 regulates energy homeostasis, in part through transcriptional modulation of critical regulators in BAT function.
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Affiliation(s)
- Christine Loyd
- Comprehensive Diabetes Center and Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism
| | - Yanping Liu
- Comprehensive Diabetes Center and Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism
| | - Teayoun Kim
- Comprehensive Diabetes Center and Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism
| | - Cassie Holleman
- Comprehensive Diabetes Center and Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism
| | - Jamie Galloway
- Comprehensive Diabetes Center and Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism
| | - Maigen Bethea
- Comprehensive Diabetes Center and Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism
| | - Benjamin N. Ediger
- Institute for Diabetes, Obesity, and Metabolism and Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | | | - Yawen Tang
- Department of Medicine, Division of Cardiovascular Disease, and
| | - Doris A. Stoffers
- Institute for Diabetes, Obesity, and Metabolism and Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Glenn C. Rowe
- Comprehensive Diabetes Center and Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism
- Department of Medicine, Division of Cardiovascular Disease, and
| | - Martin Young
- Department of Medicine, Division of Cardiovascular Disease, and
| | - Chad Steele
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294
| | - Kirk M. Habegger
- Comprehensive Diabetes Center and Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism
| | - Chad S. Hunter
- Comprehensive Diabetes Center and Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism
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Loyd C, Magrisso IJ, Haas M, Balusu S, Krishna R, Itoh N, Sandoval DA, Perez-Tilve D, Obici S, Habegger KM. Fibroblast growth factor 21 is required for beneficial effects of exercise during chronic high-fat feeding. J Appl Physiol (1985) 2016; 121:687-98. [PMID: 27445299 DOI: 10.1152/japplphysiol.00456.2016] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 07/15/2016] [Indexed: 01/14/2023] Open
Abstract
Exercise is an effective therapy against the metabolic syndrome. However, the molecular pathways underlying the advantageous effects of exercise are elusive. Glucagon receptor signaling is essential for exercise benefits, and recent evidence indicates that a downstream effector of glucagon, fibroblast growth factor 21 (FGF21), is implicated in this response. Therefore, we tested the hypothesis that FGF21 action is necessary in mediating metabolic effects of exercise. We utilized acute exhaustive treadmill exercise in Wistar rats to identify a putative, concomitant increase in plasma glucagon and FGF21 with the increase in glucose and lactate following exercise. To test the necessity of FGF21 action in the exercise response, we exposed FGF21 congenitally deficient mice (Fgf21(-/-)) and their wild-type (Wt) littermates to chronic high-fat (HF) feeding and inoperable (sedentary) or operable (exercise) voluntary running wheels. Physiological tests were performed to assess the role of FGF21 in the beneficial effect of exercise on glucose metabolism. Wt and Fgf21(-/-) littermates exhibited similar running behavior, and exercise was effective in suppressing weight and fat mass gain and dyslipidemia independently of genotype. However, exercise failed to positively affect hepatic triglyceride content and glucose tolerance in HF diet-fed Fgf21(-/-) mice. Furthermore, Fgf21(-/-) mice exhibited an impaired adaptation to exercise training, including reduced AMP-activated protein kinase activity in skeletal muscle. This study demonstrates that FGF21 action is necessary to achieve the full metabolic benefits of exercise during chronic HF feeding.
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Affiliation(s)
- Christine Loyd
- Comprehensive Diabetes Center and Department of Medicine, Division of Endocrinology, Diabetes & and Metabolism, University of Alabama at Birmingham, Birmingham, Alabama; Metabolic Disease Institute, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - I Jack Magrisso
- Metabolic Disease Institute, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Michael Haas
- Metabolic Disease Institute, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Sowmya Balusu
- Metabolic Disease Institute, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Radha Krishna
- Metabolic Disease Institute, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Nobuyuki Itoh
- Department of Genetic Biochemistry, Kyoto University Graduate School of Pharmaceutical Sciences, Kyoto, Japan
| | - Darleen A Sandoval
- Metabolic Disease Institute, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Diego Perez-Tilve
- Metabolic Disease Institute, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Silvana Obici
- Metabolic Disease Institute, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Kirk M Habegger
- Comprehensive Diabetes Center and Department of Medicine, Division of Endocrinology, Diabetes & and Metabolism, University of Alabama at Birmingham, Birmingham, Alabama; UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, Alabama;
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Abstract
PURPOSE OF REVIEW New evidence has recently supported the notion that brown adipose tissue (BAT) is present in adult humans and can play a prominent role in the regulation of body weight and metabolism. This has renewed the efforts to understand the physiologic mechanisms by which BAT is activated, which in turn could provide new therapeutic strategies for obesity and diabetes. RECENT FINDINGS BAT mass and activity are positively correlated with measures of metabolic health in rodents and humans; however, the amount of functional BAT in adult humans is highly variable with less found in overweight and obese individuals. The impact of BAT in the uptake and utilization of circulating nutrients is systemic, with major effects on whole-body insulin sensitivity and glucose tolerance as illustrated by BAT transplantation in rodents. Furthermore, a host of physiologic conditions and novel peptides/hormones have been implicated in the activation of BAT thermogenesis and/or 'browning' of white adipocytes. SUMMARY These new findings open the way for novel strategies aimed at increasing BAT mass and activity in obese humans as an important clinical goal in the midst of unprecedented high prevalence of obesity and associated metabolic disorders.
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Affiliation(s)
- Christine Loyd
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Cincinnati, Cincinnati, Ohio, USA
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