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Liu R, Wyk BV, Quiñones AR, Allore HG. Longitudinal Care Network Changes and Associated Healthcare Utilization Among Care Recipients. Res Aging 2024; 46:327-338. [PMID: 38261524 DOI: 10.1177/01640275241229162] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
This study examines caregiver networks, including size, composition, and stability, and their associations with the likelihood of hospitalization and skilled-nursing facility (SNF) admissions. Data from the National Health and Aging Trends Study linked to Center for Medicare and Medicaid Services data were analyzed for 3855 older adults across five survey waves. Generalized estimating equation models assessed the associations. The findings indicate each additional paid caregiver was associated with higher adjusted risk ratios (aRR) for hospitalization (aRR = 1.24, 95% CI 1.10-1.41) and SNF admission (aRR = 1.28, 95% CI 1.06-1.54) among care recipients, a pattern that is also observed with the addition of unpaid caregivers (hospitalization: aRR = 1.13, 95% CI 1.06-1.20; SNF: aRR = 1.12, 95% CI 1.02-1.23). These results suggest that policies and approaches to enhance the quality and coordination of caregivers may be warranted to support improved outcomes for care recipients.
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Affiliation(s)
- Ruotong Liu
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Brent Vander Wyk
- Department of Biostatistics, Yale University, New Haven, CT, USA
| | - Ana R Quiñones
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
- OHSU-PSU School of Public Health, Portland, OR, USA
| | - Heather G Allore
- Department of Biostatistics, Yale University, New Haven, CT, USA
- Department of Internal Medicine, Yale University, New Haven, CT, USA
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2
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Cho J, Sands LP, Stevens AB, Allore HG, Horstman MJ. Profile of Caregiving Activities and Association With Physical Health Among Dementia Spousal Caregivers. Innov Aging 2024; 8:igae017. [PMID: 38524243 PMCID: PMC10960627 DOI: 10.1093/geroni/igae017] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Indexed: 03/26/2024] Open
Abstract
Background and Objectives This study aims to identify patterns of caregiving intensity and assess associations between caregiving intensity and multidimensional physical health indicators and health behaviors among spousal caregivers of persons with Alzheimer's disease and related dementia. Research Design and Methods Using data from 152 spousal caregivers aged 65 and older, the intensity of their caregiving experience was measured as the number and frequency of health- and medical-related helping activities for their care recipient. Multidimensional health indicators included self-reported fatigue, sleep disturbance, physical functioning, pain interference, general health, and the number of chronic conditions from the electronic health records. Self-reported health promotion behaviors were assessed as health responsibility, physical activity, nutrition, interpersonal relations, and stress management. Results Two distinct caregiving intensity patterns, high-intensity (37.5%) and low-intensity (62.5%) caregiving, were identified with cluster analysis. Caregivers in the high-intensity caregiving cluster reported feeling more tired (t = 2.25, p < .05), experiencing more sleep disturbance (t = 3.06, p < .01), and performing less physical activity (t = 2.05, p < .05) compared with caregivers in the low-intensity group. Discussion and Implications Future studies are needed to develop effective interventions to address caregiving intensity and its consequences on the health of spousal caregivers of persons with dementia.
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Affiliation(s)
- Jinmyoung Cho
- Department of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
- Center for Applied Health Research, Baylor Scott & White Research Institute, Temple, Texas, USA
| | - Laura P Sands
- Center for Gerontology, Virginia Tech, Blacksburg, Virginia, USA
| | - Alan B Stevens
- Center for Applied Health Research, Baylor Scott & White Research Institute, Temple, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Heather G Allore
- Department of Biostatistics, School of Public Health, Yale University, New Haven, Connecticut, USA
- Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Molly J Horstman
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
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Di Pietro C, Haberman AM, Lindenbach BD, Smith PC, Bruscia EM, Allore HG, Vander Wyk B, Tyagi A, Zeiss CJ. Prior Influenza Infection Mitigates SARS-CoV-2 Disease in Syrian Hamsters. Viruses 2024; 16:246. [PMID: 38400021 PMCID: PMC10891789 DOI: 10.3390/v16020246] [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: 01/11/2024] [Revised: 01/28/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
Seasonal infection rates of individual viruses are influenced by synergistic or inhibitory interactions between coincident viruses. Endemic patterns of SARS-CoV-2 and influenza infection overlap seasonally in the Northern hemisphere and may be similarly influenced. We explored the immunopathologic basis of SARS-CoV-2 and influenza A (H1N1pdm09) interactions in Syrian hamsters. H1N1 given 48 h prior to SARS-CoV-2 profoundly mitigated weight loss and lung pathology compared to SARS-CoV-2 infection alone. This was accompanied by the normalization of granulocyte dynamics and accelerated antigen-presenting populations in bronchoalveolar lavage and blood. Using nasal transcriptomics, we identified a rapid upregulation of innate and antiviral pathways induced by H1N1 by the time of SARS-CoV-2 inoculation in 48 h dual-infected animals. The animals that were infected with both viruses also showed a notable and temporary downregulation of mitochondrial and viral replication pathways. Quantitative RT-PCR confirmed a decrease in the SARS-CoV-2 viral load and lower cytokine levels in the lungs of animals infected with both viruses throughout the course of the disease. Our data confirm that H1N1 infection induces rapid and transient gene expression that is associated with the mitigation of SARS-CoV-2 pulmonary disease. These protective responses are likely to begin in the upper respiratory tract shortly after infection. On a population level, interaction between these two viruses may influence their relative seasonal infection rates.
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Affiliation(s)
- Caterina Di Pietro
- Department of Pediatrics, Yale School of Medicine, New Haven, CT 06519, USA; (C.D.P.); (E.M.B.)
| | - Ann M. Haberman
- Department of Immunobiology, Yale School of Medicine, New Haven, CT 06519, USA;
| | - Brett D. Lindenbach
- Department of Microbial Pathogenesis, Yale School of Medicine, New Haven, CT 06519, USA;
- Department of Comparative Medicine, Yale School of Medicine, New Haven, CT 06519, USA;
| | - Peter C. Smith
- Department of Comparative Medicine, Yale School of Medicine, New Haven, CT 06519, USA;
| | - Emanuela M. Bruscia
- Department of Pediatrics, Yale School of Medicine, New Haven, CT 06519, USA; (C.D.P.); (E.M.B.)
| | - Heather G. Allore
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06519, USA; (H.G.A.); (B.V.W.)
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06519, USA
| | - Brent Vander Wyk
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06519, USA; (H.G.A.); (B.V.W.)
| | - Antariksh Tyagi
- Department of Genetics, Yale Center for Genome Analysis, New Haven, CT 06519, USA;
| | - Caroline J. Zeiss
- Department of Comparative Medicine, Yale School of Medicine, New Haven, CT 06519, USA;
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Quiñones AR, McAvay G, Vander Wyk B, Han L, Nagel C, Allore HG. A Joint Model for Disability, Self-Rated Health, and Mortality Among Medicare Beneficiaries-Differences by Chronic Disease and Race/Ethnicity. J Aging Health 2023:8982643231210027. [PMID: 37879084 DOI: 10.1177/08982643231210027] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
OBJECTIVES Quantifying interdependence in multiple patient-centered outcomes is important for understanding health declines among older adults. METHODS Medicare-linked National Health and Aging Trends Study data (2011-2015) were used to estimate a joint longitudinal logistic regression model of disability in activities of daily living (ADL), fair/poor self-rated health (SRH), and mortality. We calculated personalized concurrent risk (PCR) and typical concurrent risk (TCR) using regression coefficients. RESULTS For fair/poor SRH, highest odds were associated with COPD. For mortality, highest odds were associated with dementia, hip fracture, and kidney disease. Dementia and hip fracture were associated with highest odds of ADL disability. Hispanic respondents had highest odds of ADL disability. Hispanic and NH Black respondents had higher odds of fair/poor SRH, ADL disability, and mortality. PCRs/TCRs demonstrated wide variability for respondents with similar sociodemographic-multimorbidity profiles. DISCUSSION These findings highlight the variability of personalized risk in examining interdependent outcomes among older adults.
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Affiliation(s)
- Ana R Quiñones
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
- OHSU-PSU School of Public Health, Portland, OR, USA
| | - Gail McAvay
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Brent Vander Wyk
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Ling Han
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Corey Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Heather G Allore
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Biostatistics, Yale University, New Haven, CT, USA
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Kumar A, Wang J, Esterly A, Radcliffe C, Zhou H, Wyk BV, Allore HG, Tsang S, Barakat L, Mohanty S, Zhao H, Shaw AC, Zapata HJ. Dectin-1 stimulation promotes a distinct inflammatory signature in the setting of HIV-infection and aging. Aging (Albany NY) 2023; 15:7866-7908. [PMID: 37606991 PMCID: PMC10497004 DOI: 10.18632/aging.204927] [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: 12/08/2022] [Accepted: 07/11/2023] [Indexed: 08/23/2023]
Abstract
Dectin-1 is an innate immune receptor that recognizes and binds β-1, 3/1, 6 glucans on fungi. We evaluated Dectin-1 function in myeloid cells in a cohort of HIV-positive and HIV-negative young and older adults. Stimulation of monocytes with β-D-glucans induced a pro-inflammatory phenotype in monocytes of HIV-infected individuals that was characterized by increased levels of IL-12, TNF-α, and IL-6, with some age-associated cytokine increases also noted. Dendritic cells showed a striking HIV-associated increase in IFN-α production. These increases in cytokine production paralleled increases in Dectin-1 surface expression in both monocytes and dendritic cells that were noted with both HIV and aging. Differential gene expression analysis showed that HIV-positive older adults had a distinct gene signature compared to other cohorts characterized by a robust TNF-α and coagulation response (increased at baseline), a persistent IFN-α and IFN-γ response, and an activated dendritic cell signature/M1 macrophage signature upon Dectin-1 stimulation. Dectin-1 stimulation induced a strong upregulation of MTORC1 signaling in all cohorts, although increased in the HIV-Older cohort (stimulation and baseline). Overall, our study demonstrates that the HIV Aging population has a distinct immune signature in response to Dectin-1 stimulation. This signature may contribute to the pro-inflammatory environment that is associated with HIV and aging.
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Affiliation(s)
- Archit Kumar
- Yale School of Medicine, Section of Infectious Diseases, Department of Internal Medicine, New Haven, CT 06520-8022, USA
| | - Jiawei Wang
- Interdepartmental Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT 06520-8022, USA
| | - Allen Esterly
- Yale School of Medicine, Section of Infectious Diseases, Department of Internal Medicine, New Haven, CT 06520-8022, USA
| | - Chris Radcliffe
- Yale School of Medicine, Section of Infectious Diseases, Department of Internal Medicine, New Haven, CT 06520-8022, USA
| | - Haowen Zhou
- Interdepartmental Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT 06520-8022, USA
| | - Brent Vander Wyk
- Yale University Program on Aging, Yale University, New Haven, CT 06520-8022, USA
| | - Heather G. Allore
- Yale University Program on Aging, Yale University, New Haven, CT 06520-8022, USA
| | - Sui Tsang
- Yale University Program on Aging, Yale University, New Haven, CT 06520-8022, USA
| | - Lydia Barakat
- Yale University, Yale AIDS Care Program, New Haven, CT 06520-8022, USA
| | - Subhasis Mohanty
- Yale School of Medicine, Section of Infectious Diseases, Department of Internal Medicine, New Haven, CT 06520-8022, USA
| | - Hongyu Zhao
- Interdepartmental Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT 06520-8022, USA
| | - Albert C. Shaw
- Yale School of Medicine, Section of Infectious Diseases, Department of Internal Medicine, New Haven, CT 06520-8022, USA
| | - Heidi J. Zapata
- Yale School of Medicine, Section of Infectious Diseases, Department of Internal Medicine, New Haven, CT 06520-8022, USA
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O'Neill AS, Newsom JT, Trubits EF, Elman MR, Botoseneanu A, Allore HG, Nagel CL, Dorr DA, Quiñones AR. Racial, ethnic, and socioeconomic disparities in trajectories of morbidity accumulation among older Americans. SSM Popul Health 2023; 22:101375. [PMID: 36941895 PMCID: PMC10024041 DOI: 10.1016/j.ssmph.2023.101375] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/27/2023] [Accepted: 03/01/2023] [Indexed: 03/07/2023] Open
Abstract
Introduction Multimorbidity, the presence of multiple chronic health conditions, generally starts in middle and older age but there is considerable heterogeneity in the trajectory of morbidity accumulation. This study aimed to clarify the number of distinct trajectories and the potential associations between race/ethnicity and socioeconomic status and these trajectories. Methods Data from 13,699 respondents (age ≥51) in the Health and Retirement Study between 1998 and 2016 were analyzed with growth mixture models. Nine prevalent self-reported morbidities (arthritis, cancer, cognitive impairment, depressive symptoms, diabetes, heart disease, hypertension, lung disease, stroke) were summed for the morbidity count. Results Three trajectories of morbidity accumulation were identified: low [starting with few morbidities and accumulating them slowly (i.e., low intercept and low slope); 80% of sample], increasing (i.e., low intercept and high slope; 9%), and high (i.e., high intercept and low slope; 11%). Compared to non-Hispanic (NH) White adults in covariate-adjusted models, NH Black adults had disadvantages while Hispanic adults had advantages. Our results suggest a protective effect of education for NH Black adults (i.e., racial health disparities observed at low education were ameliorated and then eliminated at increasing levels of education) and a reverse pattern for Hispanic adults (i.e., increasing levels of education was found to dampen the advantages Hispanic adults had at low education). Compared with NH White adults, higher levels of wealth were protective for both NH Black adults (i.e., reducing or reversing racial health disparities observed at low wealth) and Hispanic adults (i.e., increasing the initial health advantages observed at low wealth). Conclusion These findings have implications for addressing health disparities through more precise targeting of public health interventions. This work highlights the imperative to address socioeconomic inequalities that interact with race/ethnicity in complex ways to erode health.
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Affiliation(s)
- AnnaMarie S. O'Neill
- VA Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA
- Corresponding author. VA Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA. AnnaMarie.O'
| | - Jason T. Newsom
- Department of Psychology, Portland State University, OR, USA
| | - Em F. Trubits
- Department of Psychology, Portland State University, OR, USA
| | - Miriam R. Elman
- OHSU-PSU School of Public Health, Oregon Health and Science University, Portland, OR, USA
| | - Anda Botoseneanu
- Department of Health and Human Services, University of Michigan, Dearborn, MI, USA
| | - Heather G. Allore
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Corey L. Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - David A. Dorr
- Department of Medical Informatics and Clinical Epidemiology, OHSU, Portland, OR, USA
| | - Ana R. Quiñones
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
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Agogo GO, Muchene L, Orindi B, Murphy TE, Mwambi H, Allore HG. A multivariate joint model to adjust for random measurement error while handling skewness and correlation in dietary data in an epidemiologic study of mortality. Ann Epidemiol 2023; 82:8-15. [PMID: 36972757 DOI: 10.1016/j.annepidem.2023.03.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE A substantial proportion of global deaths is attributed to unhealthy diet, which can be assessed at baseline or longitudinally. We demonstrated how to simultaneously correct for random measurement error, correlations, and skewness in the estimation of associations between dietary intake and all-cause mortality. METHODS We applied a multivariate joint model (MJM) that simultaneously corrected for random measurement error, skewness, and correlation among longitudinally measured intake levels of cholesterol, total fat, dietary fiber, and energy with all-cause mortality using US National Health and Nutrition Examination Survey linked to the National Death Index mortality data. We compared MJM with the mean method that assessed intake levels as the mean of a person's intake. RESULTS The estimates from MJM were larger than those from the mean method. For instance, the logarithm of hazard ratio (log HR) for dietary fiber intake increased by 14 times (from -0.04 to -0.60) with the MJM method. This translated into relative hazard of death of 0.55 (95% Credible Interval, CI: 0.45, 0.65) with the MJM and 0.96 (95% CI: 0.95, 0.97) with the mean method. CONCLUSIONS MJM adjusts for random measurement error and flexibly addresses correlations and skewness among longitudinal measures of dietary intake when estimating their associations with death.
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Affiliation(s)
| | | | - Benedict Orindi
- Department of Statistics, Center for Geographic Medicine Research, KEMRI-Wellcome Trust, Kilifi, Kenya
| | - Terrence E Murphy
- Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Henry Mwambi
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg Campus, Pietermaritzburg, South Africa
| | - Heather G Allore
- Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT, USA; Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
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Botoseneanu A, Elman MR, Allore HG, Dorr DA, Newsom JT, Nagel CL, Quiñones AR. Depressive Multimorbidity and Trajectories of Functional Status among Older Americans: Differences by Racial/Ethnic Group. J Am Med Dir Assoc 2023; 24:250-257.e3. [PMID: 36535384 PMCID: PMC10280885 DOI: 10.1016/j.jamda.2022.11.015] [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: 05/13/2022] [Revised: 10/08/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study aims to evaluate the impact of depressive multimorbidity (ie, including depressive symptoms) on the long-term development of activities of daily living (ADL) and instrumental activities of daily living (IADL) limitations according to racial/ethnic group in a representative sample of US older adults. DESIGN Prospective, observational, population-based 16-year follow-up study of nationally representative sample. SETTING AND PARTICIPANTS Sample of older non-Hispanic Black, Hispanic, and nonHispanic White Americans from the Health and Retirement Study (2000‒2016, N = 16,364, community-dwelling adults ≥65 years of age). METHODS Data from 9 biennial assessments were used to evaluate the accumulation of ADL-IADL limitations (range 0‒11) among participants with depressive (8-item Center for Epidemiologic Studies Depression score≥4) vs somatic (ie, physical conditions only) multimorbidity vs those without multimorbidity (no or 1 condition). Generalized estimating equations included race/ethnicity (non-Hispanic Black, Hispanic, non-Hispanic White), baseline age, sex, body mass index, education, partnered, and net worth. RESULTS Depressive and somatic multimorbidity were associated with 5.18 and 2.95 times greater accumulation of functional limitations, respectively, relative to no disease [incidence rate ratio (IRR) = 5.18, 95% confidence interval, CI (4.38,6.13), IRR = 2.95, 95% CI (2.51,3.48)]. Hispanic and Black respondents experienced greater accumulation of ADL-IADL limitations than White respondents [IRR = 1.27, 95% CI (1.14, 1.41), IRR = 1.31, 95% CI (1.20, 1.43), respectively]. CONCLUSIONS AND IMPLICATIONS Combinations of somatic diseases and high depressive symptoms are associated with greatest accumulation of functional limitations over time in adults ages 65 and older. There is a more rapid growth in functional limitations among individuals from racial/ethnic minority groups. Given the high prevalence of multimorbidity and depressive symptomatology among older adults and the availability of treatment options for depression, these results highlight the importance of screening/treatment for depression, particularly among older adults with socioeconomic vulnerabilities, to slow the progression of functional decline in later life.
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Affiliation(s)
- Anda Botoseneanu
- Department of Health and Human Services, University of Michigan, Dearborn, MI, USA; Institute of Gerontology, University of Michigan, Ann Arbor, MI, USA.
| | - Miriam R Elman
- OHSU-PSU School of Public Health, Oregon Health and Science University, Portland, OR, USA
| | - Heather G Allore
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA; Department of Biostatistics, School of Public Health, Yale University, New Haven, CT, USA
| | - David A Dorr
- Department of Medical Informatics and Clinical Epidemiology, OHSU, Portland, OR, USA
| | - Jason T Newsom
- Department of Psychology, Portland State University, Portland, OR, USA
| | - Corey L Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ana R Quiñones
- OHSU-PSU School of Public Health, Oregon Health and Science University, Portland, OR, USA; Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
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Konstorum A, Mohanty S, Zhao Y, Melillo A, Vander Wyk B, Nelson A, Tsang S, Blevins TP, Belshe R, Chawla DG, Rondina MT, Gill TM, Montgomery RR, Allore HG, Kleinstein SH, Shaw AC. Platelet response to influenza vaccination reflects effects of aging. Aging Cell 2023; 22:e13749. [PMID: 36656789 PMCID: PMC9924941 DOI: 10.1111/acel.13749] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/21/2022] [Accepted: 11/15/2022] [Indexed: 01/20/2023] Open
Abstract
Platelets are uniquely positioned as mediators of not only hemostasis but also innate immunity. However, how age and geriatric conditions such as frailty influence platelet function during an immune response remains unclear. We assessed the platelet transcriptome at baseline and following influenza vaccination in Younger (age 21-35) and Older (age ≥65) adults (including community-dwelling individuals who were largely non-frail and skilled nursing facility (SNF)-resident adults who nearly all met criteria for frailty). Prior to vaccination, we observed an age-associated increase in the expression of platelet activation and mitochondrial RNAs and decrease in RNAs encoding proteins mediating translation. Age-associated differences were also identified in post-vaccination response trajectories over 28 days. Using tensor decomposition analysis, we found increasing RNA expression of genes in platelet activation pathways in young participants, but decreasing levels in (SNF)-resident adults. Translation RNA trajectories were inversely correlated with these activation pathways. Enhanced platelet activation was found in community-dwelling older adults at the protein level, compared to young individuals both prior to and post-vaccination; whereas SNF residents showed decreased platelet activation compared to community-dwelling older adults that could reflect the influence of decreased translation RNA expression. Our results reveal alterations in the platelet transcriptome and activation responses that may contribute to age-associated chronic inflammation and the increased incidence of thrombotic and pro-inflammatory diseases in older adults.
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Affiliation(s)
- Anna Konstorum
- Department of PathologyYale School of MedicineNew HavenConnecticutUSA
| | - Subhasis Mohanty
- Department of Internal Medicine, Section of Infectious DiseasesYale School of MedicineNew HavenConnecticutUSA
| | - Yujiao Zhao
- Section of Rheumatology, Department of Internal MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Anthony Melillo
- Department of PathologyYale School of MedicineNew HavenConnecticutUSA
| | - Brent Vander Wyk
- Department of Internal Medicine, Section of Geriatrics and Program on AgingYale School of MedicineNew HavenConnecticutUSA
| | - Allison Nelson
- Department of Internal Medicine, Section of Infectious DiseasesYale School of MedicineNew HavenConnecticutUSA
| | - Sui Tsang
- Department of Internal Medicine, Section of Geriatrics and Program on AgingYale School of MedicineNew HavenConnecticutUSA
| | - Tamara P. Blevins
- Division of Infectious Diseases, Department of MedicineSaint Louis University School of MedicineSt. LouisMissouriUSA
| | - Robert B. Belshe
- Division of Infectious Diseases, Department of MedicineSaint Louis University School of MedicineSt. LouisMissouriUSA
| | - Daniel G. Chawla
- Program in Computational Biology and BioinformaticsYale UniversityNew HavenConnecticutUSA
| | - Matthew T. Rondina
- Departments of Internal Medicine and Pathology, and the Molecular Medicine ProgramUniversity of Utah HealthSalt Lake CityUtahUSA
- Department of Medicine and the GRECCGeorge E. Wahlen VAMCSalt Lake CityUtahUSA
| | - Thomas M. Gill
- Department of Internal Medicine, Section of Geriatrics and Program on AgingYale School of MedicineNew HavenConnecticutUSA
| | - Ruth R. Montgomery
- Section of Rheumatology, Department of Internal MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Heather G. Allore
- Department of Internal Medicine, Section of Geriatrics and Program on AgingYale School of MedicineNew HavenConnecticutUSA
| | - Steven H. Kleinstein
- Department of PathologyYale School of MedicineNew HavenConnecticutUSA
- Program in Computational Biology and BioinformaticsYale UniversityNew HavenConnecticutUSA
| | - Albert C. Shaw
- Department of Internal Medicine, Section of Infectious DiseasesYale School of MedicineNew HavenConnecticutUSA
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Young JJ, Park H, Par‐Young J, Bartlett HH, Kim HS, Shin MS, You S, Kim MH, Allore HG, Mecca AP, Kang I. Investigating a CD8
+
T cell age‐associated gene signature in Alzheimer's disease. Alzheimers Dement 2022. [DOI: 10.1002/alz.064384] [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: 12/24/2022]
Affiliation(s)
| | | | | | | | - Hye Sun Kim
- Yale School of Public Health New Haven CT USA
| | | | | | | | - Heather G. Allore
- Yale School of Medicine New Haven CT USA
- Yale School of Public Health New Haven CT USA
| | | | - Insoo Kang
- Yale School of Medicine New Haven CT USA
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Quiñones AR, McAvay GJ, Peak KD, Vander Wyk B, Allore HG. The Contribution of Chronic Conditions to Hospitalization, Skilled Nursing Facility Admission, and Death: Variation by Race. Am J Epidemiol 2022; 191:2014-2025. [PMID: 35932162 PMCID: PMC10144669 DOI: 10.1093/aje/kwac143] [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: 04/19/2021] [Revised: 06/24/2022] [Accepted: 08/01/2022] [Indexed: 02/01/2023] Open
Abstract
Multimorbidity (≥2 chronic conditions) is a common and important marker of aging. To better understand racial differences in multimorbidity burden and associations with important health-related outcomes, we assessed differences in the contribution of chronic conditions to hospitalization, skilled nursing facility admission, and mortality among non-Hispanic Black and non-Hispanic White older adults in the United States. We used data from a nationally representative study, the National Health and Aging Trends Study, linked to Medicare claims from 2011-2015 (n = 4,871 respondents). This analysis improved upon prior research by identifying the absolute contributions of chronic conditions using a longitudinal extension of the average attributable fraction for Black and White Medicare beneficiaries. We found that cardiovascular conditions were the greatest contributors to outcomes among White respondents, while the greatest contributor to outcomes for Black respondents was renal morbidity. This study provides important insights into racial differences in the contributions of chronic conditions to costly health-care utilization and mortality, and it prompts policy-makers to champion delivery reforms that will expand access to preventive and ongoing care for diverse Medicare beneficiaries.
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Affiliation(s)
- Ana R Quiñones
- Correspondence to Dr. Ana R. Quiñones, Department of Family Medicine, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239 (e-mail: )
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12
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Torrado JC, Husebo BS, Allore HG, Erdal A, Fæø SE, Reithe H, Førsund E, Tzoulis C, Patrascu M. Digital phenotyping by wearable-driven artificial intelligence in older adults and people with Parkinson's disease: Protocol of the mixed method, cyclic ActiveAgeing study. PLoS One 2022; 17:e0275747. [PMID: 36240173 PMCID: PMC9565381 DOI: 10.1371/journal.pone.0275747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/22/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Active ageing is described as the process of optimizing health, empowerment, and security to enhance the quality of life in the rapidly growing population of older adults. Meanwhile, multimorbidity and neurological disorders, such as Parkinson's disease (PD), lead to global public health and resource limitations. We introduce a novel user-centered paradigm of ageing based on wearable-driven artificial intelligence (AI) that may harness the autonomy and independence that accompany functional limitation or disability, and possibly elevate life expectancy in older adults and people with PD. METHODS ActiveAgeing is a 4-year, multicentre, mixed method, cyclic study that combines digital phenotyping via commercial devices (Empatica E4, Fitbit Sense, and Oura Ring) with traditional evaluation (clinical assessment scales, in-depth interviews, and clinical consultations) and includes four types of participants: (1) people with PD and (2) their informal caregiver; (3) healthy older adults from the Helgetun living environment in Norway, and (4) people on the Helgetun waiting list. For the first study, each group will be represented by N = 15 participants to test the data acquisition and to determine the sample size for the second study. To suggest lifestyle changes, modules for human expert-based advice, machine-generated advice, and self-generated advice from accessible data visualization will be designed. Quantitative analysis of physiological data will rely on digital signal processing (DSP) and AI techniques. The clinical assessment scales are the Unified Parkinson's Disease Rating Scale (UPDRS), Montreal Cognitive Assessment (MoCA), Geriatric Depression Scale (GDS), Geriatric Anxiety Inventory (GAI), Apathy Evaluation Scale (AES), and the REM Sleep Behaviour Disorder Screening Questionnaire (RBDSQ). A qualitative inquiry will be carried out with individual and focus group interviews and analysed using a hermeneutic approach including narrative and thematic analysis techniques. DISCUSSION We hypothesise that digital phenotyping is feasible to explore the ageing process from clinical and lifestyle perspectives including older adults and people with PD. Data is used for clinical decision-making by symptom tracking, predicting symptom evolution, and discovering new outcome measures for clinical trials.
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Affiliation(s)
- Juan C. Torrado
- Faculty of Medicine, Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine (SEFAS), University of Bergen, Bergen, Norway
| | - Bettina S. Husebo
- Faculty of Medicine, Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine (SEFAS), University of Bergen, Bergen, Norway
- Department of Nursing Home Medicine, Municipality of Bergen, Bergen, Norway
| | - Heather G. Allore
- Yale School of Medicine and Yale School of Public Health, New Haven, CT, United States of America
| | - Ane Erdal
- Faculty of Medicine, Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine (SEFAS), University of Bergen, Bergen, Norway
| | - Stein E. Fæø
- Faculty of Health Studies, Department of Nursing, VID Specialized University, Bergen, Norway
| | - Haakon Reithe
- Faculty of Medicine, Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine (SEFAS), University of Bergen, Bergen, Norway
| | - Elise Førsund
- Faculty of Medicine, Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine (SEFAS), University of Bergen, Bergen, Norway
| | - Charalampos Tzoulis
- Department of Neurology, Neuro-SysMed Center, Haukeland University Hospital, Bergen, Norway
- K.G Jebsen Center for Translational Research in Parkinson’s Disease, University of Bergen, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Monica Patrascu
- Faculty of Medicine, Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine (SEFAS), University of Bergen, Bergen, Norway
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Pettersen TR, Schjøtt J, Allore HG, Bendz B, Borregaard B, Fridlund B, Larsen AI, Nordrehaug JE, Rotevatn S, Wentzel-Larsen T, Norekvål TM. Perceptions of generic medicines and medication adherence after percutaneous coronary intervention: a prospective multicentre cohort study. BMJ Open 2022; 12:e061689. [PMID: 36127123 PMCID: PMC9490600 DOI: 10.1136/bmjopen-2022-061689] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To determine patient perceptions of generic medicines 2 and 6 months after percutaneous coronary intervention (PCI), and to determine whether these perceptions moderate medication adherence. DESIGN Prospective multicentre cohort study with repeated measures of perceptions of generic medicines and medication adherence. SETTING The CONCARDPCI study conducted at seven large referral PCI centres in Norway and Denmark between June 2017 and May 2020. PARTICIPANTS A total of 3417 adults (78% men), using both generic and brand name medicines, with a mean age of 66 years (SD 11) who underwent PCI were followed up 2 and 6 months after discharge from hospital. MAIN OUTCOME MEASURES Perceptions of generic medicines were the main outcome. The secondary outcome was medication adherence. RESULTS Perceptions of generic medicines were significantly more negative at 2 than at 6 months (1.10, 95% CI 0.41 to 1.79, p=0.002). Female sex (-4.21, 95% CI -6.75 to -1.71, p=0.001), older age (-0.12, 95% CI -0.23 to -0.02, p=0.020), lower education level (overall p<0.001), ethnicity (overall p=0.002), Norwegian nationality (10.27, 95% CI 8.19 to 12.40, p<0.001) and reduced self-reported health status (0.19, 95% CI 0.09 to 0.41, p=0.003) were significantly associated with negative perceptions of generic medicines. There was no evidence to suggest that perceptions of generic medicines moderate the association between sociodemographic and clinical variables and medication adherence (p≥0.077 for all covariates). Moreover, self-reported medication adherence was high, with 99% scoring at or above the Medication Adherence Report Scale midpoint at both time points. There were no substantial correlations between negative perceptions of generic medicines and medication non-adherence at 2 months (r=0.041, 95% CI 0.002 to 0.081, p=0.037) or 6 months (r=0.038, 95% CI -0.005 to 0.081, p=0.057). CONCLUSIONS Mistrust and uncertainty about the safety and efficacy of generic medicines remains in a sizeable proportion of patients after PCI. This applies especially to those of lower socioeconomic status, older age, female sex, immigrants and those with poorer mental health. However, this study demonstrated a shift towards more positive perceptions of generic medicines in the longer term.
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Affiliation(s)
- Trond Røed Pettersen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
| | - Jan Schjøtt
- Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Heather G Allore
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Bjørn Bendz
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Oslo, Norway
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense Universitetshospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bengt Fridlund
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Kalmar, Sweden
| | - Alf Inge Larsen
- Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Jan Erik Nordrehaug
- Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
| | - Svein Rotevatn
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Tore Wentzel-Larsen
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
- Centre for Child and Adolescent Mental Health Eastern and Southern Norway, Oslo, Norway
| | - Tone Merete Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
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14
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Newsom JT, Denning EC, Elman MR, Botoseneanu A, Allore HG, Nagel CL, Dorr DA, Quiñones AR. Physical Activity as a Mediator Between Race/Ethnicity and Changes in Multimorbidity. J Gerontol B Psychol Sci Soc Sci 2022; 77:1529-1538. [PMID: 34374757 PMCID: PMC9371457 DOI: 10.1093/geronb/gbab148] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 10/21/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Studies report racial/ethnic disparities in multimorbidity (≥2 chronic conditions) and their rate of accumulation over time as well as differences in physical activity. Our study aimed to investigate whether racial/ethnic differences in the accumulation of multimorbidity were mediated by physical activity among middle-aged and older adults. METHOD We assessed racial/ethnic differences in the accumulation of multimorbidity (of 9 conditions) over 12 years (2004-2016) in the Health and Retirement Study (N = 18,264, mean age = 64.4 years). Structural equation modeling was used to estimate latent growth curve models of changes in multimorbidity and investigate whether the relationship of race/ethnicity (non-Hispanic Black, Hispanic, non-Hispanic White participants) to changes in the number of chronic conditions was mediated by physical activity after controlling for age, sex, education, marital status, household wealth, insurance coverage, smoking, alcohol, and body weight. RESULTS There was a significant increase in multimorbidity over time. Initial levels and changes in multimorbidity over time varied significantly across individuals. Indirect effects of the relationship between race/ethnicity and changes in multimorbidity as mediated by physical activity were significant, consistent with the mediational hypothesis. Black respondents engaged in significantly lower levels of physical activity than White respondents after controlling for covariates, but there were no differences between Hispanic and White respondents once education was included. Discussion: These results provide important new information for understanding how modifiable lifestyle factors may help explain disparities in multimorbidity in mid-to-late life, suggesting greater need to intervene to reduce sedentary behavior and increase physical activity.
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Affiliation(s)
- Jason T Newsom
- Address correspondence to: Jason T. Newsom, PhD, Department of Psychology, Portland State University, P.O. Box 751, Portland, OR 97207, USA. E-mail:
| | - Emily C Denning
- Department of Psychology, Portland State University, Oregon, USA
| | - Miriam R Elman
- School of Public Health, Oregon Health & Science University/Portland State University, USA
| | - Anda Botoseneanu
- Department of Health and Human Services and Institute of Gerontology, University of Michigan, Ann Arbor, USA
- Department of Health and Human Services, University of Michigan, Dearborn, USA
| | - Heather G Allore
- Internal Medicine and Department of Biostatistics, Yale University, New Haven, Connecticut, USA
| | - Corey L Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, USA
| | - David A Dorr
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health and Science University, Portland, USA
| | - Ana R Quiñones
- Department of Family Medicine, Oregon Health and Science University, Portland, USA
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15
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Mullin S, Wyk BV, Asher JL, Compton SR, Allore HG, Zeiss CJ. Modeling pandemic to endemic patterns of SARS-CoV-2 transmission using parameters estimated from animal model data. PNAS Nexus 2022; 1:pgac096. [PMID: 35799833 PMCID: PMC9254158 DOI: 10.1093/pnasnexus/pgac096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/29/2022] [Indexed: 02/06/2023]
Abstract
The contours of endemic coronaviral disease in humans and other animals are shaped by the tendency of coronaviruses to generate new variants superimposed upon nonsterilizing immunity. Consequently, patterns of coronaviral reinfection in animals can inform the emerging endemic state of the SARS-CoV-2 pandemic. We generated controlled reinfection data after high and low risk natural exposure or heterologous vaccination to sialodacryoadenitis virus (SDAV) in rats. Using deterministic compartmental models, we utilized in vivo estimates from these experiments to model the combined effects of variable transmission rates, variable duration of immunity, successive waves of variants, and vaccination on patterns of viral transmission. Using rat experiment-derived estimates, an endemic state achieved by natural infection alone occurred after a median of 724 days with approximately 41.3% of the population susceptible to reinfection. After accounting for translationally altered parameters between rat-derived data and human SARS-CoV-2 transmission, and after introducing vaccination, we arrived at a median time to endemic stability of 1437 (IQR = 749.25) days with a median 15.4% of the population remaining susceptible. We extended the models to introduce successive variants with increasing transmissibility and included the effect of varying duration of immunity. As seen with endemic coronaviral infections in other animals, transmission states are altered by introduction of new variants, even with vaccination. However, vaccination combined with natural immunity maintains a lower prevalence of infection than natural infection alone and provides greater resilience against the effects of transmissible variants.
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Affiliation(s)
- Sarah Mullin
- Yale Center for Medical Informatics, Yale School of Medicine, New Haven, CT 06520, USA
| | - Brent Vander Wyk
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Jennifer L Asher
- Department of Comparative Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Susan R Compton
- Department of Comparative Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Heather G Allore
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06520, USA
| | - Caroline J Zeiss
- Department of Comparative Medicine, Yale School of Medicine, New Haven, CT 06520, USA
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16
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Mullin S, Wyk BV, Asher JL, Compton SR, Allore HG, Zeiss CJ. Modeling pandemic to endemic patterns of SARS-CoV-2 transmission using parameters estimated from animal model data. PNAS Nexus 2022; 1:pgac096. [PMID: 35799833 PMCID: PMC9254158 DOI: 10.1093/pnasnexus/pgac096;] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The contours of endemic coronaviral disease in humans and other animals are shaped by the tendency of coronaviruses to generate new variants superimposed upon nonsterilizing immunity. Consequently, patterns of coronaviral reinfection in animals can inform the emerging endemic state of the SARS-CoV-2 pandemic. We generated controlled reinfection data after high and low risk natural exposure or heterologous vaccination to sialodacryoadenitis virus (SDAV) in rats. Using deterministic compartmental models, we utilized in vivo estimates from these experiments to model the combined effects of variable transmission rates, variable duration of immunity, successive waves of variants, and vaccination on patterns of viral transmission. Using rat experiment-derived estimates, an endemic state achieved by natural infection alone occurred after a median of 724 days with approximately 41.3% of the population susceptible to reinfection. After accounting for translationally altered parameters between rat-derived data and human SARS-CoV-2 transmission, and after introducing vaccination, we arrived at a median time to endemic stability of 1437 (IQR = 749.25) days with a median 15.4% of the population remaining susceptible. We extended the models to introduce successive variants with increasing transmissibility and included the effect of varying duration of immunity. As seen with endemic coronaviral infections in other animals, transmission states are altered by introduction of new variants, even with vaccination. However, vaccination combined with natural immunity maintains a lower prevalence of infection than natural infection alone and provides greater resilience against the effects of transmissible variants.
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Affiliation(s)
- Sarah Mullin
- Yale Center for Medical Informatics, Yale School of Medicine, New Haven, CT 06520, USA
| | - Brent Vander Wyk
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Jennifer L Asher
- Department of Comparative Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Susan R Compton
- Department of Comparative Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Heather G Allore
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA,Department of Biostatistics, Yale School of Public Health, New Haven, CT 06520, USA
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Allore HG, Gnjidic D, Skanderson M, Han L. Association Between Potentially Inappropriate Medications and 30-Day Post-Hospital Discharge Outcomes in US Veterans. Ann Pharmacother 2022; 56:256-263. [PMID: 34282638 PMCID: PMC8770754 DOI: 10.1177/10600280211032072] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Potentially inappropriate medication (PIMs) use is common in older inpatients and it may lead to increased risk of adverse drug events. OBJECTIVES To examine prevalence of PIMs at hospital discharge and its contribution to health care utilization and mortality within 30-days of hospital discharge. METHODS This was a prospective cohort of 117 570 veterans aged ≥65 years and hospitalized in 2013. PIMs at discharge were categorized into central nervous system acting (CNS) and non-CNS. Outcomes within 30-days of hospital discharge were: (1) time to first acute care hospital readmission, and all-cause mortality, (2) an emergency room visit, and (3) ≥3 primary care clinic visits. RESULTS The cohort's mean age was 74.3 years (SD 8.1), with 51.3% exposed to CNS and 62.8% to non-CNS PIMs. Use of CNS and non-CNS PIMs, respectively, was associated with a reduced risk of readmission, with an adjusted hazard ratio (aHR) of 0.93 (95% CI = 0.89-0.96) for ≥2 (vs 0) CNS PIMs and an aHR of 0.85 (95% CI = 0.82-0.88) for ≥2 (vs 0) non-CNS PIMs. Use of CNS PIMs (≥2 vs 0) was associated with increased risk of mortality (aHR = 1.37 [95% CI = 1.25-1.51]), whereas non-CNS PIMs use was associated with a reduced risk of mortality (aHR = 0.75 [95% CI = 0.69-0.82]). CONCLUSION AND RELEVANCE PIMs were highly common in this veteran cohort, and the association with outcomes differed by PIMs. Thus, it is important to consider whether PIMs are CNS acting to optimize short-term posthospitalization outcomes.
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Affiliation(s)
| | | | - Melissa Skanderson
- Veterans Administration Connecticut Healthcare System, West Haven, CT, USA
| | - Ling Han
- Yale University, New Haven, CT, USA
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18
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Botoseneanu A, Markwardt S, Nagel CL, Allore HG, Newsom JT, Dorr DA, Quiñones AR. Multimorbidity Accumulation Among Middle-Aged Americans: Differences by Race/Ethnicity and Body Mass Index. J Gerontol A Biol Sci Med Sci 2022; 77:e89-e97. [PMID: 33880490 PMCID: PMC8824553 DOI: 10.1093/gerona/glab116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/13/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Obesity and multimorbidity are more prevalent among U.S. racial/ethnic minority groups. Evaluating racial/ethnic disparities in disease accumulation according to body mass index (BMI) may guide interventions to reduce multimorbidity burden in vulnerable racial/ethnic groups. METHOD We used data from the 1998-2016 Health and Retirement Study on 8 106 participants aged 51-55 at baseline. Disease burden and multimorbidity (≥2 co-occurring diseases) were assessed using 7 chronic diseases: arthritis, cancer, heart disease, diabetes, hypertension, lung disease, and stroke. Four BMI categories were defined per convention: normal, overweight, obese class 1, and obese class 2/3. Generalized estimating equations models with inverse probability weights estimated the accumulation of chronic diseases. RESULTS Overweight and obesity were more prevalent in non-Hispanic Black (82.3%) and Hispanic (78.9%) than non-Hispanic White (70.9 %) participants at baseline. The baseline burden of disease was similar across BMI categories, but disease accumulation was faster in the obese class 2/3 and marginally in the obese class 1 categories compared with normal BMI. Black participants across BMI categories had a higher initial burden and faster accumulation of disease over time, while Hispanics had a lower initial burden and similar rate of accumulation, compared with Whites. Black participants, including those with normal BMI, reach the multimorbidity threshold 5-6 years earlier compared with White participants. CONCLUSIONS Controlling weight and reducing obesity early in the lifecourse may slow the progression of multimorbidity in later life. Further investigations are needed to identify the factors responsible for the early and progressing nature of multimorbidity in Blacks of nonobese weight.
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Affiliation(s)
- Anda Botoseneanu
- Department of Health & Human Services, University of Michigan, Dearborn, USA
- Institute of Gerontology, University of Michigan, Ann Arbor, USA
- Address correspondence to: Anda Botoseneanu, MD, PhD, University of Michigan, 19000 Hubbard Drive, Dearborn, MI 48126. E-mail:
| | - Sheila Markwardt
- School of Public Health, Oregon Health & Science University, Portland, USA
| | - Corey L Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Heather G Allore
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut,USA
- Department of Biostatistics, School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Jason T Newsom
- Department of Psychology, Portland State University, Oregon, USA
| | - David A Dorr
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, USA
| | - Ana R Quiñones
- School of Public Health, Oregon Health & Science University, Portland, USA
- Department of Family Medicine, Oregon Health & Science University, Portland, USA
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19
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Baxter MG, Mincer JS, Brallier JW, Schwartz A, Ahn H, Nir T, McCormick PJ, Ismail M, Sewell M, Allore HG, Ramsey CM, Sano M, Deiner SG. Cognitive Recovery by Decade in Healthy 40- to 80-Year-Old Volunteers After Anesthesia Without Surgery. Anesth Analg 2022; 134:389-399. [PMID: 34889804 PMCID: PMC8760160 DOI: 10.1213/ane.0000000000005824] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Postoperative delirium and postoperative cognitive dysfunction are the most common complications for older surgical patients. General anesthesia may contribute to the development of these conditions, but there are little data on the association of age with cognitive recovery from anesthesia in the absence of surgery or underlying medical condition. METHODS We performed a single-center cohort study of healthy adult volunteers 40 to 80 years old (N = 71, mean age 58.5 years, and 44% women) with no underlying cognitive dysfunction. Volunteers underwent cognitive testing before and at multiple time points after 2 hours of general anesthesia consisting of propofol induction and sevoflurane maintenance, akin to a general anesthetic for a surgical procedure, although no procedure was performed. The primary outcome was time to recovery to cognitive baseline on the Postoperative Quality of Recovery Scale (PQRS) within 30 days of anesthesia. Secondary cognitive outcomes were time to recovery on in-depth neuropsychological batteries, including the National Institutes of Health Toolbox and well-validated paper-and-pencil tests. The primary hypothesis is that time to recovery of cognitive function after general anesthesia increases across decades from 40 to 80 years of age. We examined this with discrete-time logit regression (for the primary outcome) and linear mixed models for interactions of age decade with time postanesthesia (for secondary outcomes). RESULTS There was no association between age group and recovery to baseline on the PQRS; 36 of 69 (52%) recovered within 60-minute postanesthesia and 63 of 69 (91%) by day 1. Hazard ratios (95% confidence interval) for each decade compared to 40- to 49-year olds were: 50 to 59 years, 1.41 (0.50-4.03); 60 to 69 years, 1.03 (0.35-3.00); and 70 to 80 years, 0.69 (0.25-1.88). There were no significant differences between older decades relative to the 40- to 49-year reference decade in recovery to baseline on secondary cognitive measures. CONCLUSIONS Recovery of cognitive function to baseline was rapid and did not differ between age decades of participants, although the number in each decade was small. These results suggest that anesthesia alone may not be associated with cognitive recovery in healthy adults of any age decade.
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Affiliation(s)
- Mark G. Baxter
- Icahn School of Medicine at Mount Sinai, Nash Family Department of Neuroscience, New York, NY,Icahn School of Medicine at Mount Sinai, Department of Anesthesiology, Perioperative & Pain Medicine, New York, NY
| | - Joshua S. Mincer
- Memorial Sloan Kettering Cancer Center, Department of Anesthesiology and Critical Care Medicine, New York, NY
| | - Jess W. Brallier
- Memorial Sloan Kettering Cancer Center, Department of Anesthesiology and Critical Care Medicine, New York, NY
| | - Arthur Schwartz
- Icahn School of Medicine at Mount Sinai, Department of Anesthesiology, Perioperative & Pain Medicine, New York, NY
| | - Helen Ahn
- Icahn School of Medicine at Mount Sinai, Department of Anesthesiology, Perioperative & Pain Medicine, New York, NY
| | - Tommer Nir
- Icahn School of Medicine at Mount Sinai, Department of Anesthesiology, Perioperative & Pain Medicine, New York, NY
| | - Patrick J. McCormick
- Memorial Sloan Kettering Cancer Center, Department of Anesthesiology and Critical Care Medicine, New York, NY
| | - Mohammed Ismail
- Icahn School of Medicine at Mount Sinai, Department of Anesthesiology, Perioperative & Pain Medicine, New York, NY
| | - Margaret Sewell
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY
| | - Heather G. Allore
- Yale School of Medicine, Department of Internal Medicine, New Haven, CT,Yale School of Public Health, Department of Biostatistics, New Haven, CT
| | - Christine M. Ramsey
- Veterans Integrated Service Network 4 Mental Illness Research, Education, and Clinical Center (MIRECC), Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA,Yale Center for Medical Informatics, New Haven, CT
| | - Mary Sano
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY,James J. Peters Veterans Administration Medical Center, Department of Psychiatry, Bronx, NY
| | - Stacie G. Deiner
- Icahn School of Medicine at Mount Sinai, Department of Anesthesiology, Perioperative & Pain Medicine, New York, NY,Icahn School of Medicine at Mount Sinai, Department of Geriatrics and Palliative Medicine, New York, NY,Icahn School of Medicine at Mount Sinai, Department of Neurosurgery, New York, NY
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20
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Quiñones AR, Nagel CL, Botoseneanu A, Newsom JT, Dorr DA, Kaye J, Thielke SM, Allore HG. Multidimensional trajectories of multimorbidity, functional status, cognitive performance, and depressive symptoms among diverse groups of older adults. J Multimorb Comorb 2022; 12:26335565221143012. [PMID: 36479143 PMCID: PMC9720836 DOI: 10.1177/26335565221143012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022]
Abstract
Background Inter-relationships between multimorbidity and geriatric syndromes are poorly understood. This study assesses heterogeneity in joint trajectories of somatic disease, functional status, cognitive performance, and depressive symptomatology. Methods We analyzed 16 years of longitudinal data from the Health and Retirement Study (HRS, 1998-2016) for n = 11,565 older adults (≥65 years) in the United States. Group-based mixture modeling identified latent clusters of older adults following similar joint trajectories across domains. Results We identified four distinct multidimensional trajectory groups: (1) Minimal Impairment with Low Multimorbidity (32.7% of the sample; mean = 0.60 conditions at age 65, 2.1 conditions at age 90) had limited deterioration; (2) Minimal Impairment with High Multimorbidity (32.9%; mean = 2.3 conditions at age 65, 4.0 at age 90) had minimal deterioration; (3) Multidomain Impairment with Intermediate Multimorbidity (19.9%; mean = 1.3 conditions at age 65, 2.7 at age 90) had moderate depressive symptomatology and functional impariments with worsening cognitive performance; (4) Multidomain Impairment with High Multimorbidity (14.1%; mean = 3.3 conditions at age 65; 4.7 at age 90) had substantial functional limitation and high depressive symptomatology with worsening cognitive performance. Black and Hispanic race/ethnicity, lower wealth, lower education, male sex, and smoking history were significantly associated with membership in the two Multidomain Impairment classes. Conclusions There is substantial heterogeneity in combined trajectories of interrelated health domains in late life. Membership in the two most impaired classes was more likely for minoritized older adults.
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Affiliation(s)
- Ana R Quiñones
- Department of Family
Medicine, Oregon Health & Science
University, Portland, OR, USA
- OHSU-PSU School of Public
Health, Oregon Health & Science
University, Portland, OR, USA
| | - Corey L Nagel
- College of
Nursing, University of Arkansas for Medical
Sciences, Little Rock, AR, USA
- Department of
Biostatistics,
College of
Public Health,
University
of Arkansas for Medical Sciences,
Little Rock, AR, USA
| | - Anda Botoseneanu
- Department of Health & Human
Services,
University
of Michigan, Dearborn, MI, USA
- Institute of
Gerontology,
University
of Michigan, Ann Arbor, MI, USA
| | - Jason T Newsom
- Department of
Psychology,
Portland
State University, Portland, OR,
USA
| | - David A Dorr
- Department of Medical Informatics and Clinical
Epidemiology,
Oregon
Health & Science University,
Portland, OR, USA
| | - Jeffrey Kaye
- Department of
Neurology,
Oregon
Health & Science University,
Portland, OR, USA
| | - Stephen M Thielke
- Department of Psychiatry and Behavioral
Sciences,
University
of Washington, Seattle, WA, USA
| | - Heather G Allore
- Department of Internal
Medicine, School of
Medicine, Yale
University, New Haven, CT, USA
- Department of
Biostatistics,
School of
Public Health,
Yale
University, New Haven, CT, USA
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21
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Tisminetzky M, Delude C, Allore HG, Anzuoni K, Bloomstone S, Charpentier P, Hepler JP, Kitzman DW, McAvay GJ, Miller M, Pajewski NM, Gurwitz J. The geriatrics research instrument library: A resource for guiding instrument selection for researchers studying older adults with multiple chronic conditions. Journal of Multimorbidity and Comorbidity 2022; 12:26335565221081200. [PMID: 35586036 PMCID: PMC9106318 DOI: 10.1177/26335565221081200] [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] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 01/31/2021] [Indexed: 11/15/2022]
Abstract
Background After the passage of the 21st Century Cures Act in the U.S., the Inclusion Across the Lifespan policy eliminates upper-age limits for research participation unless risk justified. Broader inclusion will necessitate the use of reliable instruments in research that characterize the health status and function of older adults with multiple chronic conditions. As there is a plethora of such instruments, the Geriatrics Research Instrument Library (GRIL) was developed as freely available online resource of data collection instruments commonly used in gerontological research. GRIL has been revised and updated by the Advancing Geriatrics Infrastructure and Network Growth (AGING) Initiative, a joint endeavor of the Health Care Systems Research Network (HCSRN) and the Older Americans Independence Centers (OAICs). Methods Extensive PubMed literature searches and domain expert feedback were utilized to inventory and update GRIL through the addition of instruments and compiling of instrument metadata. GRIL is hosted on the National Institute on Aging OAIC Coordinating Center website with a platform utilizing Microsoft Structured Query Language (SQL) and an Adobe ColdFusion application server. Tracking statistics are collected using Google Analytics. Results Presently, GRIL includes 175 instruments across 18 domains, including instrument metadata such as instrument description, copyright information, completion time estimates, keywords, available translations, and a link and reference to the original manuscript describing the instrument. The GRIL website includes user-friendly features such as mobile platforming and resource links. Conclusions GRIL provides a user-friendly public resource that facilitates clinical researchers in efficiently selecting appropriate instruments to measure clinical outcomes relevant to older adults across a full range of domains.
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Affiliation(s)
- Mayra Tisminetzky
- University of Massachusetts Medical School and Meyers Health Care Institute, Worcester, MA, USA
| | | | - Heather G Allore
- Yale School of Medicine and Yale School of Public Health, New Haven, CT, USA
| | | | | | | | - John P Hepler
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Gail J McAvay
- Yale School of Medicine and Yale School of Public Health, New Haven, CT, USA
| | | | | | - Jerry Gurwitz
- University of Massachusetts Medical School and Meyers Health Care Institute, Worcester, MA, USA
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22
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Zeiss CJ, Asher JL, Vander Wyk B, Allore HG, Compton SR. Modeling SARS-CoV-2 propagation using rat coronavirus-associated shedding and transmission. PLoS One 2021; 16:e0260038. [PMID: 34813610 PMCID: PMC8610237 DOI: 10.1371/journal.pone.0260038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/01/2021] [Indexed: 12/23/2022] Open
Abstract
At present, global immunity to SARS-CoV-2 resides within a heterogeneous combination of susceptible, naturally infected and vaccinated individuals. The extent to which viral shedding and transmission occurs on re-exposure to SARS-CoV-2 is an important determinant of the rate at which COVID-19 achieves endemic stability. We used Sialodacryoadenitis Virus (SDAV) in rats to model the extent to which immune protection afforded by prior natural infection via high risk (inoculation; direct contact) or low risk (fomite) exposure, or by vaccination, influenced viral shedding and transmission on re-exposure. On initial infection, we confirmed that amount, duration and consistency of viral shedding, and seroconversion rates were correlated with exposure risk. Animals were reinfected after 3.7-5.5 months using the same exposure paradigm. 59% of seropositive animals shed virus, although at lower amounts. Previously exposed seropositive reinfected animals were able to transmit virus to 25% of naive recipient rats after 24-hour exposure by direct contact. Rats vaccinated intranasally with a related virus (Parker's Rat Coronavirus) were able to transmit SDAV to only 4.7% of naive animals after a 7-day direct contact exposure, despite comparable viral shedding. Cycle threshold values associated with transmission in both groups ranged from 29-36 cycles. Observed shedding was not a prerequisite for transmission. Results indicate that low-level shedding in both naturally infected and vaccinated seropositive animals can propagate infection in susceptible individuals. Extrapolated to COVID-19, our results suggest that continued propagation of SARS-CoV-2 by seropositive previously infected or vaccinated individuals is possible.
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Affiliation(s)
- Caroline J. Zeiss
- Department of Comparative Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Jennifer L. Asher
- Department of Comparative Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Brent Vander Wyk
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Heather G. Allore
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, United States of America
| | - Susan R. Compton
- Department of Comparative Medicine, Yale School of Medicine, New Haven, CT, United States of America
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23
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Mori M, Brooks C, Dhruva SS, Lu Y, Spatz ES, Dey P, Zhang Y, Chaudhry SI, Geirsson A, Allore HG, Krumholz HM. Trajectories of Pain After Cardiac Surgery: Implications for Measurement, Reporting, and Individualized Treatment. Circ Cardiovasc Qual Outcomes 2021; 14:e007781. [PMID: 34304586 PMCID: PMC8366534 DOI: 10.1161/circoutcomes.120.007781] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Postoperative pain after cardiac surgery is a significant problem, but studies often report pain value as an average of the study cohort, obscuring clinically meaningful differences in pain trajectories. We sought to characterize heterogeneity in postoperative pain experiences. METHODS We enrolled patients undergoing a cardiac surgery at a tertiary care center between January 2019 and February 2020. Participants received an electronically-delivered questionnaire every 3 days for 30 days to assess incision site pain level. We evaluated the variability in pain trajectories over 30 days by the cohort-level mean with confidence band and latent classes identified by group-based trajectory model. Group-based trajectory model estimated the probability of belonging to a specific trajectory of pain. RESULTS Of 92 patients enrolled, 75 provided ≥3 questionnaire responses. The cohort-level mean showed a gradual and consistent decline in the mean pain level, but the confidence bands covered most of the pain score range. The individual-level trajectories varied substantially across patients. Group-based trajectory model identified 4 pain trajectories: persistently low (n=9, 12%), moderate declining (initially mid-level, followed by decline; n=26, 35%), high declining (initially high-level, followed by decline; n=33, 44%), and persistently high pain (n=7, 9%). Persistently high pain and high declining groups did not seem to be clearly distinguishable until approximately postoperative day 10. Patients in persistently low pain trajectory class had a numerically lower median age than the other 3 classes and were below the lower confidence band of the cohort-level approach. Patients in the persistently high pain trajectory class had a longer median length of hospital stay than the other 3 classes and were often higher than the upper confidence band of the cohort-level approach. CONCLUSIONS We identified 4 trajectories of postoperative pain that were not evident from a cohort-level mean, which has been a common way of reporting pain level. This study provides key information about the patient experience and indicates the need to understand variation among sites and surgeons and to investigate determinants of different experience and interventions to mitigate persistently high pain.
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Affiliation(s)
- Makoto Mori
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT (M.M., C.B., P.D., A.G.), Yale School of Medicine, New Haven, CT.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (M.M., Y.L., E.S.S., H.M.K.)
| | - Cornell Brooks
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT (M.M., C.B., P.D., A.G.), Yale School of Medicine, New Haven, CT
| | - Sanket S Dhruva
- Department of Medicine, University of California San Francisco School of Medicine (S.S.D.).,San Francisco VA Medical Center, CA (S.S.D.)
| | - Yuan Lu
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (M.M., Y.L., E.S.S., H.M.K.)
| | - Erica S Spatz
- Section of Cardiovascular Medicine, Department of Internal Medicine (E.S.S.), Yale School of Medicine, New Haven, CT.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (M.M., Y.L., E.S.S., H.M.K.)
| | - Pranammya Dey
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT (M.M., C.B., P.D., A.G.), Yale School of Medicine, New Haven, CT
| | - Yawei Zhang
- Department of Environmental Health Sciences, Yale School of Public Health, Department of Surgery (Y.Z.), Yale School of Medicine, New Haven, CT
| | - Sarwat I Chaudhry
- Section of General Internal Medicine, Department of Medicine (S.I.C.), Yale School of Medicine, New Haven, CT
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT (M.M., C.B., P.D., A.G.), Yale School of Medicine, New Haven, CT
| | - Heather G Allore
- Section of Geriatrics, Department of Internal Medicine (H.G.A.), Yale School of Medicine, New Haven, CT.,Department of Biostatistics (H.G.A.), Yale School of Public Health, New Haven, CT
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (M.M., Y.L., E.S.S., H.M.K.).,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine and the Department of Health Policy and Management (H.M.K.), Yale School of Public Health, New Haven, CT
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24
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Presley CJ, Arrato NA, Janse S, Shields PG, Carbone DP, Wong ML, Han L, Gill TM, Allore HG, Andersen BL. Functional Disability Among Older Versus Younger Adults With Advanced Non-Small-Cell Lung Cancer. JCO Oncol Pract 2021; 17:e848-e858. [PMID: 33939536 DOI: 10.1200/op.20.01004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To determine patient and disease characteristics associated with functional disability among adults with advanced non-small-cell lung cancer (NSCLC). METHODS In a prospective cohort of participants newly diagnosed with advanced NSCLC and beginning systemic treatment, functional disability in usual activities, mobility, and self-care was measured using the EuroQol-5D-5L at baseline. Demographics, comorbidities, brain metastases, Eastern Cooperative Oncology Group performance status (ECOG PS), and psychologic variables (depression [Patient Health Questionnaire-9] and anxiety [Generalized Anxiety Disorder 7-item scale]) were captured. Patients were classified into two disability groups (none-slight or moderate-severe) on the basis of total functional status scores. Differences between disability groups were determined (chi-square and t tests). Associations between patient characteristics and baseline disability were assessed using logistic regression. RESULTS Among 173 participants, mean age was 63.3 years, 56% were male, 83% had ECOG PS 0-1, and 41% had brain metastases. Baseline disability was present in 39% of participants, with patients having moderate to severe disability in usual activities (37.6%), mobility (26.6%), and self-care (5.2%). Depressive and/or anxiety symptoms ranged from none to severe (Patient Health Questionnaire 9-item scale M = 6.5, SD = 5.3). Depressive symptoms were the only characteristic associated with a higher odds of baseline disability (adjusted odds ratio [aOR]: 1.26; 95% CI, 1.15 to 1.38; P < .001). Participants with poorer ECOG PS (aOR: 4.64; 95% CI, 1.84 to 11.68; P = .001) and depressive symptoms (aOR: 1.15; 95% CI, 1.07 to 1.24; P < .001) had higher odds of moderate-severe mobility disability compared with the none-slight disability group. CONCLUSION More than one third of all adults with advanced NSCLC have moderate-severe functional disability at baseline. Psychologic symptoms were significantly associated with moderate-severe baseline disability.
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Affiliation(s)
- Carolyn J Presley
- Division of Medical Oncology, Department of Internal Medicine, Columbus, OH
| | - Nicole A Arrato
- Department of Psychology, The Ohio State University, Columbus, OH
| | - Sarah Janse
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH
| | - Peter G Shields
- Division of Medical Oncology, Department of Internal Medicine, Columbus, OH
| | - David P Carbone
- Division of Medical Oncology, Department of Internal Medicine, Columbus, OH
| | - Melisa L Wong
- Divisions of Hematology/Oncology and Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Ling Han
- Section of Geriatric Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Thomas M Gill
- Section of Geriatric Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Heather G Allore
- Section of Geriatric Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
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25
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Abstract
BACKGROUND Our understanding of how multimorbidity progresses and changes is nascent. OBJECTIVES Assess multimorbidity changes among racially/ethnically diverse middle-aged and older adults. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study using latent class analysis to identify multimorbidity combinations over 16 years, and multinomial logistic models to assess change relative to baseline class membership. Health and Retirement Study respondents (age 51 y and above) in 1998 and followed through 2014 (N=17,297). MEASURES Multimorbidity latent classes of: hypertension, heart disease, lung disease, diabetes, cancer, arthritis, stroke, high depressive symptoms. RESULTS Three latent classes were identified in 1998: minimal disease (45.8% of participants), cardiovascular-musculoskeletal (34.6%), cardiovascular-musculoskeletal-mental (19.6%); and 3 in 2014: cardiovascular-musculoskeletal (13%), cardiovascular-musculoskeletal-metabolic (12%), multisystem multimorbidity (15%). Remaining participants were deceased (48%) or lost to follow-up (12%) by 2014. Compared with minimal disease, individuals in cardiovascular-musculoskeletal in 1998 were more likely to be in multisystem multimorbidity in 2014 [odds ratio (OR)=1.78, P<0.001], and individuals in cardiovascular-musculoskeletal-mental in 1998 were more likely to be deceased (OR=2.45, P<0.001) or lost to follow-up (OR=3.08, P<0.001). Hispanic and Black Americans were more likely than White Americans to be in multisystem multimorbidity in 2014 (OR=1.67, P=0.042; OR=2.60, P<0.001, respectively). Black compared with White Americans were more likely to be deceased (OR=1.62, P=0.01) or lost to follow-up (OR=2.11, P<0.001) by 2014. CONCLUSIONS AND RELEVANCE Racial/ethnic older adults are more likely to accumulate morbidity and die compared with White peers, and should be the focus of targeted and enhanced efforts to prevent and/or delay progression to more complex multimorbidity patterns.
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Affiliation(s)
- Ana R. Quiñones
- Department of Family Medicine, OHSU, 3181 SW Sam Jackson Park Road, Portland, OR 97239
- OHSU-PSU School of Public Health, OHSU, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Jason T. Newsom
- Department of Psychology, Portland State University, Portland, OR
| | - Miriam R. Elman
- OHSU-PSU School of Public Health, OHSU, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Sheila Markwardt
- OHSU-PSU School of Public Health, OHSU, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Corey L. Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR
| | - David A. Dorr
- Department of Medical Informatics and Clinical Epidemiology, OHSU, Portland, OR
| | - Heather G. Allore
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT
- Department of Biostatistics, School of Public Health, Yale University, New Haven, CT
| | - Anda Botoseneanu
- Department of Health & Human Services, University of Michigan, Dearborn, MI
- Institute of Gerontology, University of Michigan, Ann Arbor, MI
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26
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Botoseneanu A, Chen H, Ambrosius WT, Allore HG, Anton S, Folta SC, King AC, Nicklas BJ, Spring B, Strotmeyer ES, Gill TM. Metabolic syndrome and the benefit of a physical activity intervention on lower-extremity function: Results from a randomized clinical trial. Exp Gerontol 2021; 150:111343. [PMID: 33848565 DOI: 10.1016/j.exger.2021.111343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/07/2021] [Revised: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND In older adults, increases in physical activity may prevent decline in lower-extremity function, but whether the benefit differs according to metabolic syndrome (MetS) status is uncertain. We aim to investigate whether structured physical activity is associated with less decline in lower-extremity function among older adults with versus without MetS. METHODS We used data from the multicenter Lifestyle Interventions and Independence for Elders (LIFE) study to analyze 1535 sedentary functionally-vulnerable women and men, aged 70 to 89 years old, assessed every 6 months (February 2010-December 2013) for an average of 2.7 years. Participants were randomized to a structured, moderate-intensity physical activity intervention (PA; n = 766) or health education program (HE; n = 769). MetS was defined according to the 2009 multi-agency harmonized criteria. Lower-extremity function was assessed by 400-m walking speed and the Short Physical Performance Battery (SPPB) score. RESULTS 763 (49.7%) participants met criteria for MetS at baseline. Relative to HE, PA was associated with faster 400-m walking speed among participants with MetS (P < 0.001) but not among those without MetS (P = 0.91), although the test for statistical interaction was marginally non-significant (P = 0.07). In contrast, no benefit of PA versus HE was observed on the SPPB score in either MetS subgroup. CONCLUSIONS Among older adults at high risk for mobility disability, moderate-intensity physical activity conveys significant benefits in 400-m walking speed but not SPPB in those with, but not without, MetS. The LIFE physical activity program may be an effective strategy for maintaining or improving walking speed among vulnerable older adults with MetS. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01072500.
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Affiliation(s)
- Anda Botoseneanu
- Department of Health and Human Services and Institute of Gerontology, University of Michigan, Ann Arbor and Dearborn, MI, USA.
| | - Haiying Chen
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Walter T Ambrosius
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Heather G Allore
- Department of Internal Medicine/Geriatrics, Yale School of Medicine, New Haven, CT, USA
| | - Stephen Anton
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Sara C Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Abby C King
- Department of Epidemiology & Population Health and the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Barbara J Nicklas
- J. Paul Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elsa S Strotmeyer
- Department of Epidemiology, Center for Aging and Population Health, Graduate School of Public Health, University of Pittsburgh, PA, USA
| | - Thomas M Gill
- Department of Internal Medicine/Geriatrics, Yale School of Medicine, New Haven, CT, USA.
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27
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Husebo BS, Kerns RD, Han L, Skanderson M, Gnjidic D, Allore HG. Pain, Complex Chronic Conditions and Potential Inappropriate Medication in People with Dementia. Lessons Learnt for Pain Treatment Plans Utilizing Data from the Veteran Health Administration. Brain Sci 2021; 11:86. [PMID: 33440668 PMCID: PMC7827274 DOI: 10.3390/brainsci11010086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 12/21/2022] Open
Abstract
Alzheimer's disease and related dementias (ADRD), pain and chronic complex conditions (CCC) often co-occur leading to polypharmacy and with potential inappropriate medications (PIMs) use, are important risk factors for adverse drug reactions and hospitalizations in older adults. Many US veterans are at high risk for persistent pain due to age, injury or medical illness. Concerns about inadequate treatment of pain-accompanied by evidence about the analgesic efficacy of opioids-has led to an increase in the use of opioid medications to treat chronic pain in the Veterans Health Administration (VHA) and other healthcare systems. This study aims to investigate the relationship between receipt of pain medications and centrally (CNS) acting PIMs among veterans diagnosed with dementia, pain intensity, and CCC 90-days prior to hospitalization. The final analytic sample included 96,224 (81.7%) eligible older veterans from outpatient visits between October 2012-30 September 2013. We hypothesized that veterans with ADRD, and severe pain intensity may receive inappropriate pain management and CNS-acting PIMs. Seventy percent of the veterans, and especially people with ADRD, reported severe pain intensity. One in three veterans with ADRD and severe pain intensity have an increased likelihood for CNS-acting PIMs, and/or opioids. Regular assessment and re-assessment of pain among older persons with CCC, patient-centered tapering or discontinuation of opioids, alternatives to CNS-acting PIMs, and use of non-pharmacological approaches should be considered.
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Affiliation(s)
- Bettina S. Husebo
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway
- Municipality of Bergen, 5020 Bergen, Norway
| | - Robert D. Kerns
- Departments of Psychiatry, Neurology and Psychology, Yale University, New Haven, CT 06511, USA;
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT 06516, USA;
| | - Ling Han
- Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT 06511, USA; (L.H.); (H.G.A.)
| | - Melissa Skanderson
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT 06516, USA;
| | - Danijela Gnjidic
- Charles Perkins Centre, Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney 2006 NSW, Australia;
| | - Heather G. Allore
- Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT 06511, USA; (L.H.); (H.G.A.)
- Department of Biostatistics, School of Public Health, Yale University, New Haven, CT 06511, USA
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28
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Nagurney JM, Han L, Leo‐Summers L, Allore HG, Gill TM. Risk Factors for Disability After Emergency Department Discharge in Older Adults. Acad Emerg Med 2020; 27:1270-1278. [PMID: 32673434 DOI: 10.1111/acem.14088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 06/30/2020] [Accepted: 07/12/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We have previously shown that older adults discharged from the emergency department (ED) experience an increased disability burden within a 6-month time period after ED discharge. The objective of this study was to identify risk factors associated with increased disability burden among older adults discharged from the ED. METHODS This study is part of an ongoing longitudinal study of 754 community-living persons aged ≥70 years. The analytic sample included 813 ED visits without hospitalization from 430 participants who had at least one visit to an ED during a 14-year follow-up period (1998-2012). Information on ED visits and disability burden in 13 functional activities was collected during monthly interviews. Twenty-nine candidate risk factors were evaluated for their independent associations with increased disability burden using a longitudinal multivariable model. RESULTS In the multivariable analyses, age ≥85 (adjusted risk ratio [aRR] = 1.14, 95% confidence interval [CI] = 1.05 to 1.24), being unmarried (aRR = 1.15, 95% CI = 1.05 to 1.27), lower-extremity weakness (aRR = 1.20, 95% CI = 1.07 to 1.34), and physical frailty (aRR = 1.25, 95% CI = 1.13 to 1.37) were associated with increased disability burden. As the number of risk factors increased, the predicted mean disability burden (on a scale of 0 to 13) also increased, ranging from a value of 1.80 (95% CI = 1.43 to 2.27) for 0 risk factors to a value of 8.59 (95% CI = 7.93 to 9.29) for four risk factors. CONCLUSIONS Among older adults discharged from the ED, several risk factors were associated with increased disability burden over the following 6 months, including age ≥85, being unmarried, lower-extremity weakness, and physical frailty. Further research is needed to evaluate whether risk stratification based on nonmodifiable factors or interventions targeting modifiable risk factors improve functional outcomes for older adults discharged from the ED.
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Affiliation(s)
- Justine M. Nagurney
- From the Department of Emergency Medicine Beth Israel Deaconess Medical Center Boston MAUSA
| | - Ling Han
- and the Department of Internal Medicine Section of Geriatrics Yale School of Medicine New Haven CTUSA
| | - Linda Leo‐Summers
- and the Department of Internal Medicine Section of Geriatrics Yale School of Medicine New Haven CTUSA
| | - Heather G. Allore
- and the Department of Internal Medicine Section of Geriatrics Yale School of Medicine New Haven CTUSA
| | - Thomas M. Gill
- and the Department of Internal Medicine Section of Geriatrics Yale School of Medicine New Haven CTUSA
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MacNeil Vroomen JL, Kjellstadli C, Allore HG, van der Steen JT, Husebo B. Reform influences location of death: Interrupted time-series analysis on older adults and persons with dementia. PLoS One 2020; 15:e0241132. [PMID: 33147248 PMCID: PMC7641450 DOI: 10.1371/journal.pone.0241132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/08/2020] [Indexed: 11/24/2022] Open
Abstract
Background Norway instituted a Coordination Reform in 2012 aimed at maximizing time at home by providing in-home care through community services. Dying in a hospital can be highly stressful for patients and families. Persons with dementia are particularly vulnerable to negative outcomes in hospital. This study aims to describe changes in the proportion of older adults with and without dementia dying in nursing homes, home, hospital and other locations over an 11-year period covering the reform. Methods and findings This is a repeated cross-sectional, population-level study using mortality data from the Norwegian Cause of Death Registry hosted by the Norwegian Institute of Public Health. Participants were Norwegian older adults 65 years or older with and without dementia who died from 2006 to 2017. The policy intervention was the 2012 Coordination Reform that increased care infrastructure into communities. The primary outcome was location of death listed as a nursing home, home, hospital or other location. The trend in the proportion of location of death, before and after the reform was estimated using an interrupted time-series analysis. All analyses were adjusted for sex and seasonality. Of the 417,862 older adult decedents, 61,940 (14.8%) had dementia identified on their death certificate. Nursing home deaths increased over time while hospital deaths decreased for the total population (adjusted Relative Risk Ratio (aRRR) 0.87, 95% CI 0.82–0.92) and persons with dementia (aRRR: 0.93, 95%CI 0.91–0.96) after reform implementation. Conclusion This study provides evidence that the 2012 Coordination Reform was associated with decreased older adults dying in hospital and increased nursing home death; however, the number of people dying at home did not change.
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Affiliation(s)
- Janet L. MacNeil Vroomen
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, North Holland, The Netherlands
- * E-mail:
| | - Camilla Kjellstadli
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Heather G. Allore
- Department of Internal Medicine, Section of Geriatrics, School of Medicine, Yale University, New Haven, Connecticut, The United States of America
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, The United States of America
| | - Jenny T. van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bettina Husebo
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Municipality of Bergen, Bergen, Norway
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Gill TM, Bhasin S, Reuben DB, Latham NK, Araujo K, Ganz DA, Boult C, Wu AW, Magaziner J, Alexander N, Wallace RB, Miller ME, Travison TG, Greenspan SL, Gurwitz JH, Rich J, Volpi E, Waring SC, Manini TM, Min LC, Teresi J, Dykes PC, McMahon S, McGloin JM, Skokos EA, Charpentier P, Basaria S, Duncan PW, Storer TW, Gazarian P, Allore HG, Dziura J, Esserman D, Carnie MB, Hanson C, Ko F, Resnick NM, Wiggins J, Lu C, Meng C, Goehring L, Fagan M, Correa-de-Araujo R, Casteel C, Peduzzi P, Greene EJ. Effect of a Multifactorial Fall Injury Prevention Intervention on Patient Well-Being: The STRIDE Study. J Am Geriatr Soc 2020; 69:173-179. [PMID: 33037632 PMCID: PMC8178516 DOI: 10.1111/jgs.16854] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 07/24/2020] [Revised: 09/02/2020] [Accepted: 09/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND/OBJECTIVES In the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) study, a multifactorial intervention was associated with a nonsignificant 8% reduction in time to first serious fall injury but a significant 10% reduction in time to first self-reported fall injury relative to enhanced usual care. The effect of the intervention on other outcomes important to patients has not yet been reported. We aimed to evaluate the effect of the intervention on patient well-being including concern about falling, anxiety, depression, physical function, and disability. DESIGN Pragmatic cluster-randomized trial of 5,451 community-living persons at high risk for serious fall injuries. SETTING A total of 86 primary care practices within 10 U.S. healthcare systems. PARTICIPANTS A random subsample of 743 persons aged 75 and older. MEASUREMENTS The well-being measures, assessed at baseline, 12 months, and 24 months, included a modified version of the Fall Efficacy Scale, Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety and depression scales, and Late-Life Function and Disability Instrument. RESULTS Participants in the intervention (n = 384) and control groups (n = 359) were comparable in age: mean (standard deviation) of 81.9 (4.7) versus 81.8 (5.0) years. Mean scores were similar between groups at 12 and 24 months for concern about falling, physical function, and disability, whereas the intervention group's mean scores on anxiety and depression were .7 points lower (i.e., better) at 12 months and .6 to .8 points lower at 24 months. For each of these outcomes, differences between the groups' adjusted least square mean changes from baseline to 12 and 24 months, respectively, were quantitatively small. The overall difference in means between groups over 2 years was statistically significant only for depression, favoring the intervention: -1.19 (99% confidence interval, -2.36 to -.02), with 3.5 points representing a minimally important difference. CONCLUSIONS STRIDE's multifactorial intervention to reduce fall injuries was not associated with clinically meaningful improvements in patient well-being.
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Affiliation(s)
- Thomas M Gill
- Yale Claude D. Pepper Older Americans Independence Center, Yale University, New Haven, Connecticut, USA
| | - Shalender Bhasin
- Boston Claude D. Pepper Older Americans Independence Center, Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - David B Reuben
- Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Nancy K Latham
- Boston Claude D. Pepper Older Americans Independence Center, Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Katy Araujo
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA
| | - David A Ganz
- Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Geriatric Research, Education and Clinical Center; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Chad Boult
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Albert W Wu
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Jay Magaziner
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | | | - Michael E Miller
- School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Thomas G Travison
- Boston Claude D. Pepper Older Americans Independence Center, Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, USA
| | - Susan L Greenspan
- Pittsburgh Claude D. Pepper Older Americans Independence Center, Division of Geriatrics and Gerontology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jerry H Gurwitz
- Meyers Primary Care Institute, A Joint Endeavor of Reliant Medical Group, Fallon Health and University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jeremy Rich
- HealthCare Partners, El Segundo, California, USA
| | - Elena Volpi
- University of Texas Medical Branch Claude D. Pepper Older Americans Independence Center; Sealy Center on Aging, The University of Texas Medical Branch, Galveston, Texas, USA
| | | | - Todd M Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida, USA
| | | | - Jeanne Teresi
- Research Division, Hebrew Home at Riverdale, RiverSpring Health, Bronx, New York, USA
| | | | - Siobhan McMahon
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Joanne M McGloin
- Yale Claude D. Pepper Older Americans Independence Center, Yale University, New Haven, Connecticut, USA
| | - Eleni A Skokos
- Yale Claude D. Pepper Older Americans Independence Center, Yale University, New Haven, Connecticut, USA
| | - Peter Charpentier
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA
| | - Shehzad Basaria
- Boston Claude D. Pepper Older Americans Independence Center, Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Pamela W Duncan
- School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Thomas W Storer
- Boston Claude D. Pepper Older Americans Independence Center, Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Priscilla Gazarian
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of Massachusetts, Boston, Massachusetts, USA
| | - Heather G Allore
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA
| | - James Dziura
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA
| | - Denise Esserman
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA
| | | | | | - Fred Ko
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Neil M Resnick
- Pittsburgh Claude D. Pepper Older Americans Independence Center, Division of Geriatrics and Gerontology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Charles Lu
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA
| | - Can Meng
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA
| | - Lori Goehring
- Boston Claude D. Pepper Older Americans Independence Center, Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Maureen Fagan
- University of Miami Health System, Miami, Florida, USA
| | | | | | - Peter Peduzzi
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA
| | - Erich J Greene
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA
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Quiñones AR, Allore HG, Botoseneanu A, Newsom JT, Nagel CL, Dorr DA. Tracking Multimorbidity Changes in Diverse Racial/Ethnic Populations Over Time: Issues and Considerations. J Gerontol A Biol Sci Med Sci 2020; 75:297-300. [PMID: 30721991 DOI: 10.1093/gerona/glz028] [Citation(s) in RCA: 8] [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: 11/28/2018] [Indexed: 11/13/2022] Open
Abstract
Multimorbidity is widely recognized as having adverse effects on health and wellbeing and may threaten the ability of older adults to live independently. Much of what is known about multimorbidity rests on research that has largely focused on one point in time, or from a static perspective. Given that there remains a lack of agreement in the field on how to standardize multimorbidity definitions and measurement, it is not surprising that analyzing and predicting multimorbidity development, progression over time, and its impact are still largely unaddressed. As a result, there are important gaps and challenges to measuring and studying multimorbidity in a longitudinal context. This Research Practice perspective summarizes pressing challenges and offers practical steps to move the field forward.
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Affiliation(s)
- Ana R Quiñones
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.,OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon
| | - Heather G Allore
- Department of Internal Medicine, Yale University, New Haven, Connecticut.,Department of Biostatistics, Yale University, New Haven, Connecticut
| | - Anda Botoseneanu
- Department of Health & Human Services, University of Michigan, Dearborn, Michigan.,Institute of Gerontology, University of Michigan, Ann Arbor, Michigan
| | - Jason T Newsom
- Department of Psychology, Portland State University, Portland, Oregon
| | - Corey L Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - David A Dorr
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon
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32
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MacNeil-Vroomen JL, Thompson M, Leo-Summers L, Marottoli RA, Tai-Seale M, Allore HG. Health-care use and cost for multimorbid persons with dementia in the National Health and Aging Trends Study. Alzheimers Dement 2020; 16:1224-1233. [PMID: 32729984 PMCID: PMC9238348 DOI: 10.1002/alz.12094] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 02/18/2019] [Revised: 01/06/2020] [Accepted: 01/17/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Most persons with dementia have multiple chronic conditions; however, it is unclear whether co-existing chronic conditions contribute to health-care use and cost. METHODS Persons with dementia and ≥2 chronic conditions using the National Health and Aging Trends Study and Medicare claims data, 2011 to 2014. RESULTS Chronic kidney disease and ischemic heart disease were significantly associated with increased adjusted risk ratios of annual hospitalizations, hospitalization costs, and direct medical costs. Depression, hypertension, and stroke or transient ischemic attack were associated with direct medical and societal costs, while atrial fibrillation was associated with increased hospital and direct medical costs. No chronic condition was associated with informal care costs. CONCLUSIONS Among older adults with dementia, proactive and ambulatory care that includes informal caregivers along with primary and specialty providers, may offer promise to decrease use and costs for chronic kidney disease, ischemic heart disease, atrial fibrillation, depression, and hypertension.
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Affiliation(s)
- Janet L. MacNeil-Vroomen
- Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut, USA,Section of Geriatric Medicine, Department of Internal Medicine, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Mary Thompson
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Canada
| | - Linda Leo-Summers
- Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Richard A. Marottoli
- Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut, USA,Geriatrics and Extended Care, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Ming Tai-Seale
- Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, San Diego, California, USA
| | - Heather G. Allore
- Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut, USA,Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
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Affiliation(s)
- Makoto Mori
- Section of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Heather G Allore
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
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Allore HG, Goldfeld KS, Gutman R, Li F, Monin JK, Taljaard M, Travison TG. Statistical Considerations for Embedded Pragmatic Clinical Trials in People Living with Dementia. J Am Geriatr Soc 2020; 68 Suppl 2:S68-S73. [PMID: 32589276 DOI: 10.1111/jgs.16616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 12/17/2022]
Abstract
There is overwhelming need for nonpharmacological interventions to improve the health and well-being of people living with dementia (PLWD). The National Institute on Aging Imbedded Pragmatic Alzheimer's Disease (AD) and AD-Related Dementias Clinical Trials (IMPACT) Collaboratory supports clinical trials of such interventions embedded in healthcare systems. The embedded pragmatic clinical trial (ePCT) is ideally suited to testing the effectiveness of complex interventions in vulnerable populations at the point of care. These trials, however, are complex to conduct and interpret, and face challenges in efficiency (i.e., statistical power) and reproducibility. In addition, trials conducted among PLWD present specific statistical challenges, including difficulty in outcomes ascertainment from PLWD, necessitating reliance on reports by caregivers, and heterogeneity in measurements across different settings or populations. These and other challenges undercut the reliability of measurement, the feasibility of capturing outcomes using pragmatic designs, and the ability to validly estimate interventions' effectiveness in real-world settings. To address these challenges, the IMPACT Collaboratory has convened a Design and Statistics Core, the goals of which are: to support the design and conduct of ePCTs directed toward PLWD and their caregivers; to develop guidance for conducting embedded trials in this population; and to educate quantitative and clinical scientists in the design, conduct, and analysis of these trials. In this article, we discuss some of the contemporary methodological challenges in this area and develop a set of research priorities the Design and Statistics Core will undertake to meet these goals. J Am Geriatr Soc 68:S68-S73, 2020.
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Affiliation(s)
- Heather G Allore
- Department of Biostatistics, School of Public Health, Yale University, New Haven, Connecticut, USA.,Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Keith S Goldfeld
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Roee Gutman
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Fan Li
- Department of Biostatistics, School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Joan K Monin
- Department of Social and Behavioral Sciences, School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Thomas G Travison
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.,Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
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Affiliation(s)
- Tone M Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway .,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Heather G Allore
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, USA.,Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
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36
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Zapata HJ, Van Ness PH, Avey S, Siconolfi B, Allore HG, Tsang S, Wilson J, Barakat L, Mohanty S, Shaw AC. Impact of Aging and HIV Infection on the Function of the C-Type Lectin Receptor MINCLE in Monocytes. J Gerontol A Biol Sci Med Sci 2020; 74:794-801. [PMID: 30239628 DOI: 10.1093/gerona/gly209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Indexed: 12/11/2022] Open
Abstract
Both aging and HIV infection are associated with an enhanced pro-inflammatory environment that contributes to impaired immune responses and is mediated in part by innate immune pattern-recognition receptors. MINCLE is a C-type lectin receptor that recognizes trehalose-6,6'-dimycolate or "cord factor," the most abundant glycolipid in Mycobacterium tuberculosis. Here, we evaluated MINCLE function in monocytes in a cohort of HIV-infected and uninfected young (21-35 years) and older adults (≥60 years) via stimulation of peripheral blood mononuclear cells with trehalose-6,6-dibehenate, a synthetic analog of trehalose-6,6'-dimycolate and measurement of cytokine production (interleukin [IL]-10, IL-12, IL-6, tumor necrosis factor-α) by multicolor flow cytometry. Our studies show an age- and HIV-associated increase in cytokine multifunctionality of monocytes both at the population and single cell level that was dominated by IL-12, IL-10, and IL-6. These findings provide insight into the host response to M. tuberculosis and possible sources for the pro-inflammatory environment seen in aging and HIV infection.
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Affiliation(s)
- Heidi J Zapata
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Peter H Van Ness
- Yale University Program on Aging, Yale University, New Haven, Connecticut
| | - Stefan Avey
- Interdepartmental Program in Computational Biology and Bioinformatics, Yale University, New Haven, Connecticut
| | - Barbara Siconolfi
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Heather G Allore
- Yale University Program on Aging, Yale University, New Haven, Connecticut
| | - Sui Tsang
- Yale University Program on Aging, Yale University, New Haven, Connecticut
| | - Jean Wilson
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Lydia Barakat
- Yale AIDS Care Program, Yale University, New Haven, Connecticut
| | - Subhasis Mohanty
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Albert C Shaw
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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Norekvål TM, Allore HG, Bendz B, Bjorvatn C, Borregaard B, Brørs G, Deaton C, Fålun N, Hadjistavropoulos H, Hansen TB, Igland S, Larsen AI, Palm P, Pettersen TR, Rasmussen TB, Schjøtt J, Søgaard R, Valaker I, Zwisler AD, Rotevatn S. Rethinking rehabilitation after percutaneous coronary intervention: a protocol of a multicentre cohort study on continuity of care, health literacy, adherence and costs at all care levels (the CONCARD PCI). BMJ Open 2020; 10:e031995. [PMID: 32054625 PMCID: PMC7045256 DOI: 10.1136/bmjopen-2019-031995] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Percutaneous coronary intervention (PCI) aims to provide instant relief of symptoms, and improve functional capacity and prognosis in patients with coronary artery disease. Although patients may experience a quick recovery, continuity of care from hospital to home can be challenging. Within a short time span, patients must adjust their lifestyle, incorporate medications and acquire new support. Thus, CONCARDPCI will identify bottlenecks in the patient journey from a patient perspective to lay the groundwork for integrated, coherent pathways with innovative modes of healthcare delivery. The main objective of the CONCARDPCI is to investigate (1) continuity of care, (2) health literacy and self-management, (3) adherence to treatment, and (4) healthcare utilisation and costs, and to determine associations with future short and long-term health outcomes in patients after PCI. METHODS AND ANALYSIS This prospective multicentre cohort study organised in four thematic projects plans to include 3000 patients. All patients undergoing PCI at seven large PCI centres based in two Nordic countries are prospectively screened for eligibility and included in a cohort with a 1-year follow-up period including data collection of patient-reported outcomes (PRO) and a further 10-year follow-up for adverse events. In addition to PROs, data are collected from patient medical records and national compulsory registries. ETHICS AND DISSEMINATION Approval has been granted by the Norwegian Regional Committee for Ethics in Medical Research in Western Norway (REK 2015/57), and the Data Protection Agency in the Zealand region (REG-145-2017). Findings will be disseminated widely through peer-reviewed publications and to patients through patient organisations. TRIAL REGISTRATION NUMBER NCT03810612.
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Affiliation(s)
- Tone M Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Heather G Allore
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Bjørn Bendz
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Cathrine Bjorvatn
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Centre on Learning and Mastery, Haukeland University Hospital, Bergen, Norway
| | - Britt Borregaard
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Gunhild Brørs
- Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway
| | - Christi Deaton
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Nina Fålun
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Tina Birgitte Hansen
- Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Stig Igland
- Medical Clinic, Førde Hospital Trust, Førde, Norway
| | - Alf Inge Larsen
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Pernille Palm
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Trond Røed Pettersen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Jan Schjøtt
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
| | - Rikke Søgaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Irene Valaker
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway
| | - Ann Dorthe Zwisler
- The Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA), Odense University Hospital, Odense, Denmark
| | - Svein Rotevatn
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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38
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MacNeil-Vroomen JL, Nagurney JM, Allore HG. Comorbid conditions and emergency department treat and release utilization in multimorbid persons with cognitive impairment. Am J Emerg Med 2020; 38:127-131. [PMID: 31337598 PMCID: PMC6917961 DOI: 10.1016/j.ajem.2019.07.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 05/23/2019] [Revised: 07/02/2019] [Accepted: 07/16/2019] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND There is an increasing focus in the emergency department (ED) on addressing the needs of persons with cognitive impairment, most of whom have multiple chronic conditions. We investigated which common comorbidities among multimorbid persons with cognitive impairment conferred increased risk for ED treat and release utilization. METHODS We examined the association of 16 chronic conditions on use of ED treat and release visit utilization among 1006 adults with cognitive impairment and ≥ 2 comorbidities using the nationally-representative National Health and Aging Trends Study merged with Fee-For-Service Medicare claims data, 2011-2015. RESULTS At baseline, 28.5% had ≥6 conditions and 35.4% were ≥ 85 years old. After controlling for sex, age, race, education, urban-living, number of disabled activities of daily living, and sampling strata, we found significantly increased adjusted risk ratios (aRR) of ED treat and release visits for persons with depression (aRR 1.38 95% CI 1.15-1.65) representing 78/100 person-years, and osteoarthritis or rheumatoid arthritis (aRR 1.32 95% CI 1.12-1.57) representing 71/100 person-years. At baseline 93.9% had ≥1 informal caregiver and 69.7% had a caregiver that helped with medications or attended physician visits. CONCLUSION These results show that multimorbid cognitively impaired older adults with depression or osteoarthritis or rheumatoid arthritis are at higher risk of ED treat and release visits. Future ED research with multimorbid cognitively impaired persons may explore behavioral aspects of depression and/or pain and flairs associated with osteoarthritis or rheumatoid arthritis, as well as the role of informal caregivers in the care of these conditions.
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Affiliation(s)
- Janet L MacNeil-Vroomen
- Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven 06511, CT, United States of America; Section of Geriatric Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam 110Z AZ, the Netherlands.
| | - Justine M Nagurney
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston 02215-5321, MA, United States of America
| | - Heather G Allore
- Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven 06511, CT, United States of America; Department of Biostatistics, Yale School of Public Health, New Haven 06511, CT, United States of America
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39
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Quiñones AR, Kaye J, Allore HG, Botoseneanu A, Thielke SM. An Agenda for Addressing Multimorbidity and Racial and Ethnic Disparities in Alzheimer's Disease and Related Dementia. Am J Alzheimers Dis Other Demen 2020; 35:1533317520960874. [PMID: 32969234 PMCID: PMC7984095 DOI: 10.1177/1533317520960874] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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] [Indexed: 02/01/2023]
Abstract
Advancements in Alzheimer's disease and related dementias (ADRD) research on the U.S. population acknowledge the importance of the high burden of ADRD on segments of the population and yet-to-be characterized risks attributable to the burden of multiple chronic diseases (multimorbidity). These realizations suggest successful strategies in caring for people with ADRD and their caregivers will rely not only on clinical treatments but also on more refined and comprehensive models of ADRD that take its broad effects on the whole-person and the whole of society into consideration. To this end, it is critical to characterize and address the relationship between ADRD and multimorbidity combinations that complicate care and lead to poor outcomes, particularly with regard to racial and ethnic disparities in the occurrence, course, and effects of ADRD. Several research and policy recommendations are presented to address the intersection of ADRD, multimorbidity, and underrepresented populations most at risk for adverse outcomes.
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Affiliation(s)
- Ana R. Quiñones
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
- OHSU-PSU School of Public Health, Portland, OR, USA
| | - Jeffrey Kaye
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Heather G. Allore
- Department of Internal Medicine, Yale University, New Haven, CT, USA
- Department of Biostatistics, Yale University, New Haven, CT, USA
| | - Anda Botoseneanu
- Department of Health & Human Services, University of Michigan, Dearborn, MI, USA
- Institute of Gerontology, University of Michigan, Ann Arbor, MI, USA
| | - Stephen M. Thielke
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA
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40
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Quiñones AR, Botoseneanu A, Markwardt S, Nagel C, Newsom JT, Dorr DA, Allore HG. TRACKING CHANGES IN MULTIMORBIDITY AMONG RACIALLY AND ETHNICALLY DIVERSE POPULATIONS. Innov Aging 2019. [PMCID: PMC6840299 DOI: 10.1093/geroni/igz038.1285] [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: 11/17/2022] Open
Abstract
Multimorbidity is widely recognized as having adverse effects on health and wellbeing above and beyond the risk attributable to individual chronic disease. Much of what is known about multimorbidity rests on research that has largely focused on one point-in-time, or from a static perspective, with little consideration to issues involved in assessing longitudinal changes in multimorbidity. In addition, less focus has been placed on assessing racial and ethnic variations in longitudinal changes of multimorbidity. Addressing this knowledge gap, we highlight important issues and considerations in addressing multimorbidity research from a longitudinal perspective and present findings from longitudinal models that examine differences in the rate of chronic disease accumulation and multimorbidity onset between non-Hispanic white (white), non-Hispanic black (black), and Hispanic study participants in the Health and Retirement Study starting in middle-age and followed for up to 16 years.
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Affiliation(s)
- Ana R Quiñones
- Family Medicine, Oregon Health & Science University, Portland, Oregon, United States
| | | | - Sheila Markwardt
- Oregon Health & Science University, Portland, Oregon, United States
| | - Corey Nagel
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Jason T Newsom
- Portland State University, Portland, Oregon, United States
| | - David A Dorr
- Oregon Health & Science University, Portland, Oregon, United States
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41
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Murphy TE, McAvay GJ, Agogo GO, Allore HG. Personalized and typical concurrent risk of limitations in social activity and mobility in older persons with multiple chronic conditions and polypharmacy. Ann Epidemiol 2019; 37:24-30. [PMID: 31473124 DOI: 10.1016/j.annepidem.2019.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 03/26/2019] [Revised: 07/17/2019] [Accepted: 08/05/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE We define personalized concurrent risk (PCR) as the subject-specific probability of an index outcome within a defined interval of time, while currently at risk for a separate outcome, where the outcomes are not mutually exclusive and can be jointly modeled with a shared random intercept. We further define typical concurrent risk as the risk obtained by setting the random intercept to null. METHODS Drawing data from the Medical Expenditure Panel Survey (cohorts 2008-2013), we jointly model limitations in social activity and mobility over two years among older community-dwelling persons with both hypertension and chronic obstructive pulmonary disease. The joint model uses inverse probability of treatment weighting based on each participant's baseline propensity of polypharmacy (≥5 classes of medication). RESULTS Even among participants with the same covariates, older persons with multiple chronic conditions exhibit wide-ranging heterogeneity of the treatment effect from polypharmacy, a risk factor for negative health outcomes among older persons. The magnitude of the PCRs is dominated by the value of the subject-specific random effect. CONCLUSIONS Estimates of PCR and typical concurrent risk can be calculated from national or institutional data sets and may facilitate the practice of personalized care for older patients with multiple chronic conditions.
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Affiliation(s)
- Terrence E Murphy
- Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT; Department of Biostatistics, Yale School of Public Health, New Haven, CT
| | - Gail J McAvay
- Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT
| | - George O Agogo
- Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT
| | - Heather G Allore
- Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT; Department of Biostatistics, Yale School of Public Health, New Haven, CT.
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42
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Quiñones AR, Botoseneanu A, Markwardt S, Nagel CL, Newsom JT, Dorr DA, Allore HG. Racial/ethnic differences in multimorbidity development and chronic disease accumulation for middle-aged adults. PLoS One 2019; 14:e0218462. [PMID: 31206556 PMCID: PMC6576751 DOI: 10.1371/journal.pone.0218462] [Citation(s) in RCA: 158] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 06/03/2019] [Indexed: 11/21/2022] Open
Abstract
Background Multimorbidity–having two or more coexisting chronic conditions–is highly prevalent, costly, and disabling to older adults. Questions remain regarding chronic diseases accumulation over time and whether this differs by racial and ethnic background. Answering this knowledge gap, this study identifies differences in rates of chronic disease accumulation and multimorbidity development among non-Hispanic white, non-Hispanic black, and Hispanic study participants starting in middle-age and followed up to 16 years. Methods and findings We analyzed data from the Health and Retirement Study (HRS), a biennial, ongoing, publicly-available, longitudinal nationally-representative study of middle-aged and older adults in the United States. We assessed the change in chronic disease burden among 8,872 non-Hispanic black, non-Hispanic white, and Hispanic participants who were 51–55 years of age at their first interview any time during the study period (1998–2014) and all subsequent follow-up observations until 2014. Multimorbidity was defined as having two or more of seven somatic chronic diseases: arthritis, cancer, heart disease (myocardial infarction, coronary heart disease, angina, congestive heart failure, or other heart problems), diabetes, hypertension, lung disease, and stroke. We used negative binomial generalized estimating equation models to assess the trajectories of multimorbidity burden over time for non-Hispanic black, non-Hispanic white, and Hispanic participants. In covariate-adjusted models non-Hispanic black respondents had initial chronic disease counts that were 28% higher than non-Hispanic white respondents (IRR 1.279, 95% CI 1.201, 1.361), while Hispanic respondents had initial chronic disease counts that were 15% lower than non-Hispanic white respondents (IRR 0.852, 95% CI 0.775, 0.938). Non-Hispanic black respondents had rates of chronic disease accumulation that were 1.1% slower than non-Hispanic whites (IRR 0.989, 95% CI 0.981, 0.998) and Hispanic respondents had rates of chronic disease accumulation that were 1.5% faster than non-Hispanic white respondents (IRR 1.015, 95% CI 1.002, 1.028). Using marginal effects commands, this translates to predicted values of chronic disease for white respondents who begin the study period with 0.98 chronic diseases and end with 2.8 chronic diseases; black respondents who begin the study period with 1.3 chronic diseases and end with 3.3 chronic diseases; and Hispanic respondents who begin the study period with 0.84 chronic diseases and end with 2.7 chronic diseases. Conclusions Middle-aged non-Hispanic black adults start at a higher level of chronic disease burden and develop multimorbidity at an earlier age, on average, than their non-Hispanic white counterparts. Hispanics, on the other hand, accumulate chronic disease at a faster rate relative to non-Hispanic white adults. Our findings have important implications for improving primary and secondary chronic disease prevention efforts among non-Hispanic black and Hispanic Americans to stave off greater multimorbidity-related health impacts.
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Affiliation(s)
- Ana R. Quiñones
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
- School of Public Health, Oregon Health & Science University, Portland, Oregon, United States of America
- * E-mail:
| | - Anda Botoseneanu
- Department of Health & Human Services, University of Michigan, Dearborn, Michigan, United States of America
- Institute of Gerontology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Sheila Markwardt
- School of Public Health, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Corey L. Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Jason T. Newsom
- Department of Psychology, Portland State University, Portland, Oregon, United States of America
| | - David A. Dorr
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Heather G. Allore
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut, United States of America
- Department of Biostatistics School of Public Health, Yale University, New Haven, Connecticut, United States of America
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43
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Agogo GO, Murphy TE, McAvay GJ, Allore HG. Joint modeling of concurrent binary outcomes in a longitudinal observational study using inverse probability of treatment weighting for treatment effect estimation. Ann Epidemiol 2019; 35:53-58. [PMID: 31085069 DOI: 10.1016/j.annepidem.2019.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 10/14/2018] [Revised: 02/05/2019] [Accepted: 04/23/2019] [Indexed: 01/18/2023]
Abstract
PURPOSE Correlated healthcare utilization outcomes may be encoded as binary outcomes in epidemiologic studies. We demonstrate how to account for correlation between concurrent binary outcomes and confounding by person characteristics when estimating a treatment effect in observational studies. METHODS We present a joint shared-parameter model, weighted by inverse probability of treatment weights (IPTW) to account for confounding. The model is evaluated in a simulation study that emulates the Medical Expenditure Panel Survey data and compared with a covariate-adjusted joint model and with separate outcome models (IPTW weighted and covariate adjusted). RESULTS For the IPTW-weighted joint model, relative bias in the estimated treatment effect on outcome 1 ranged from -0.057 to -0.033 and outcome 2 from -0.077 to -0.043. For the covariate-adjusted joint model, relative bias ranged from -0.010 to -0.083 for outcome 1 and from -0.087 to -0.110 for outcome 2. The covariate-adjusted joint model estimated the effect more closely than the covariate-adjusted separate model. The IPTW-weighted joint model estimated the effect more closely for outcome 1. CONCLUSIONS The IPTW-weighted joint model handles correlation between binary outcomes, adjusts for confounding, and estimates the treatment effect accurately in observational studies. We illustrate the contribution of person-specific effects in estimating personalized risk.
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Affiliation(s)
- George O Agogo
- Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT
| | - Terrence E Murphy
- Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT; Department of Biostatistics, Yale School of Public Health, New Haven, CT
| | - Gail J McAvay
- Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT
| | - Heather G Allore
- Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT; Department of Biostatistics, Yale School of Public Health, New Haven, CT.
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Van Ness PH, MacNeil Vroomen J, Leo-Summers L, Vander Wyk B, Allore HG. Chronic Conditions, Medically Supportive Care Partners, And Functional Disability Among Cognitively Impaired Adults. Innov Aging 2019; 3:igz018. [PMID: 31286072 PMCID: PMC6604743 DOI: 10.1093/geroni/igz018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To assess whether medically supportive care partners modify the associations of symptomatic chronic conditions with the number of functional disabilities in a cohort of multimorbid older adults with cognitive impairment. RESEARCH DESIGN AND METHODS The research design is a prospective study of a nationally representative cohort of Medicare beneficiaries. National Health and Aging Trends Study (NHATS) data were linked with Medicare claims for years 2011-2015. Participants were aged 65 or older and had cognitive impairment with at least 2 chronic conditions (N = 1,003). Annual in-person interviews obtained sociodemographic information at baseline and time-varying variables for caregiving, hospitalization, and 6 activities of daily living (ADL); these variables were merged with Center for Medicare and Medicaid Services data to ascertain 16 time-varying chronic conditions. A care partner was defined as a person who sat with their care recipient during doctor visits in the past year and/or who helped them with prescribed medications in the last month. Chronic condition associations and their potential effect modifications by care partner status were assessed using weighted generalized estimating equations accounting for the complex survey design of the longitudinal analytical sample. RESULTS Chronic kidney disease, depression, and heart failure were associated with an increased number of functional disabilities. Among these, only the association of chronic kidney disease with the number of functional disabilities (interaction p value = .001) was weakened by the presence of a care partner. DISCUSSION AND IMPLICATIONS The presence of care partners showed limited modification of the associations of symptomatic chronic conditions with functional disability.
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Affiliation(s)
- Peter H Van Ness
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Janet MacNeil Vroomen
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Internal Medicine, Section of Geriatric Medicine, Academic University Medical Center, Amsterdam, The Netherlands
| | - Linda Leo-Summers
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Brent Vander Wyk
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Heather G Allore
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
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45
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Murphy TE, Tsang SW, Leo-Summers LS, Geda M, Kim DH, Oh E, Allore HG, Dodson J, Hajduk AM, Gill TM, Chaudhry SI. Bayesian Model Averaging for Selection of a Risk Prediction Model for Death within Thirty Days of Discharge: The SILVER-AMI Study. ACTA ACUST UNITED AC 2019; 8:1-7. [PMID: 31178945 PMCID: PMC6553647 DOI: 10.6000/1929-6029.2019.08.01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We describe a selection process for a multivariable risk prediction model of death within 30 days of hospital discharge in the SILVER-AMI study. This large, multi-site observational study included observational data from 2000 persons 75 years and older hospitalized for acute myocardial infarction (AMI) from 94 community and academic hospitals across the United States and featured a large number of candidate variables from demographic, cardiac, and geriatric domains, whose missing values were multiply imputed prior to model selection. Our objective was to demonstrate that Bayesian Model Averaging (BMA) represents a viable model selection approach in this context. BMA was compared to three other backward-selection approaches: Akaike information criterion, Bayesian information criterion, and traditional p-value. Traditional backward-selection was used to choose 20 candidate variables from the initial, larger pool of five imputations. Models were subsequently chosen from those candidates using the four approaches on each of 10 imputations. With average posterior effect probability ≥ 50% as the selection criterion, BMA chose the most parsimonious model with four variables, with average C statistic of 78%, good calibration, optimism of 1.3%, and heuristic shrinkage of 0.93. These findings illustrate the utility and flexibility of using BMA for selecting a multivariable risk prediction model from many candidates over multiply imputed datasets.
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Affiliation(s)
| | - Sui W Tsang
- Yale University School of Medicine, New Haven, CT, USA
| | | | - Mary Geda
- Yale University School of Medicine, New Haven, CT, USA
| | - Dae H Kim
- Harvard University School of Medicine, Boston, MA, USA
| | - Esther Oh
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - John Dodson
- New York University School of Medicine, New York, NY, USA
| | | | - Thomas M Gill
- Yale University School of Medicine, New Haven, CT, USA
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46
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Juthani-Mehta M, Allore HG. Design and analysis of longitudinal trials of antimicrobial use at the end of life: to give or not to give? Ther Adv Drug Saf 2019; 10:2042098618820210. [PMID: 30800269 PMCID: PMC6378640 DOI: 10.1177/2042098618820210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 11/28/2018] [Indexed: 01/22/2023] Open
Abstract
This perspective review considers analytic features of the design of a longitudinal trial regarding antimicrobial therapy in older terminal cancer patients receiving palliative care. We first overview antimicrobial use at the end of life; both the potential hazards and benefits. Antimicrobial prescribing should consider both initiation as well as cessation of medications when analyzing the burden of medications. Approaches to decision making regarding antimicrobial use are presented and the importance of health literacy in these decision processes. We next present aspects of both feasibility and comparative trial design with a health literacy intervention to reduce antimicrobial use in older terminal cancer patients receiving palliative care. Considerations to clustered randomization and given that infections can reoccur over a trial period, we share suggestions of longitudinal modeling of clustered randomized trial data.
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Affiliation(s)
| | - Heather G Allore
- Yale University School of Medicine, 300 George St, Suite 775, New Haven, CT 06511, USA
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47
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Liu Z, Han L, Feng Q, Dupre ME, Gu D, Allore HG, Gill TM, Payne CF. Are China's oldest-old living longer with less disability? A longitudinal modeling analysis of birth cohorts born 10 years apart. BMC Med 2019; 17:23. [PMID: 30704529 PMCID: PMC6357399 DOI: 10.1186/s12916-019-1259-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/14/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND China has transitioned from being one of the fastest-growing populations to among the most rapidly aging countries worldwide. In particular, the population of oldest-old individuals, those aged 80+, is projected to quadruple by 2050. The oldest-old represent a uniquely important group-they have high demand for personal assistance and the highest healthcare costs of any age group. Understanding trends in disability and longevity among the oldest-old-that is, whether successive generations are living longer and with less disability-is of great importance for policy and planning purposes. METHODS We utilized data from successive birth cohorts (n = 20,520) of the Chinese oldest-old born 10 years apart (the earlier cohort was interviewed in 1998 and the later cohort in 2008). Disability was defined as needing personal assistance in performing one or more of five essential activities (bathing, transferring, dressing, eating, and toileting) or being incontinent. Participants were followed for age-specific disability transitions and mortality (in 2000 and 2002 for the earlier cohort and 2011 and 2014 for the later cohort), which were then used to generate microsimulation-based multistate life tables to estimate partial life expectancy (LE) and disability-free LE (DFLE), stratified by sex and age groups (octogenarians, nonagenarians, and centenarians). We additionally explored sociodemographic heterogeneity in LE and DFLE by urban/rural residence and educational attainment. RESULTS More recently born Chinese octogenarians (born 1919-1928) had a longer partial LE between ages 80 and 89 than octogenarians born 1909-1918, and octogenarian women experienced an increase in partial DFLE of 0.32 years (P = 0.004) across the two birth cohorts. Although no increases in partial LE were observed among nonagenarians or centenarians, partial DFLE increased across birth cohorts, with a gain of 0.41 years (P < 0.001) among nonagenarians and 0.07 years (P = 0.050) among centenarians. Subgroup analyses revealed that gains in partial LE and DFLE primarily occurred among the urban resident population. CONCLUSIONS Successive generations of China's oldest-old are living with less disability as a whole, and LE is expanding among octogenarians. However, we found a widening urban-rural disparity in longevity and disability, highlighting the need to improve policies to alleviate health inequality throughout the population.
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Affiliation(s)
- Zuyun Liu
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Ling Han
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Qiushi Feng
- Department of Sociology, National University of Singapore, Singapore, Singapore
| | - Matthew E Dupre
- Department of Population Health Sciences, Duke University, Durham, NC, USA.,Department of Sociology, Duke University, Durham, NC, USA
| | - Danan Gu
- Independent Researcher, New York, NY, USA
| | - Heather G Allore
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Thomas M Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Collin F Payne
- School of Demography, Research School of Social Sciences, Australian National University, 9 Fellows Road, Acton, ACT, Canberra, 2601, Australia.
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48
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Vaughan CP, Dale W, Allore HG, Binder EF, Boyd CM, Bynum JPW, Gurwitz JH, Lundebjerg NE, Trucil DE, Supiano MA, Colón-Emeric C. AGS Report on Engagement Related to the NIH Inclusion Across the Lifespan Policy. J Am Geriatr Soc 2019; 67:211-217. [PMID: 30693956 DOI: 10.1111/jgs.15784] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 12/13/2018] [Accepted: 12/16/2018] [Indexed: 11/28/2022]
Abstract
After passage of the 21st Century Cures Act, the National Institutes of Health held a workshop in 2017 to consider expanding its inclusion policy to encompass individuals of all ages. American Geriatrics Society (AGS) leaders and members participated in the workshop and formal feedback period. AGS advocacy clearly impacted the resulting workshop report and Inclusion Across the Lifespan policy that eliminates upper-age limits for research participation unless risk justified and changes the language used to describe older adults and other vulnerable groups. AGS recommendations that were not specifically stated in the updated policy were to encourage active recruitment of older adults, add standard measures of function and/or frailty, and change review criteria to ensure the health status of a study population mirrors typical clinical populations. The updated inclusion policy ultimately offers academic geriatrics programs the opportunities to expand knowledge about health in aging and to continue to provide leadership for research and advocacy efforts on behalf of older adults. J Am Geriatr Soc 67:211-217, 2019.
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Affiliation(s)
- Camille P Vaughan
- Department of Veterans Affairs Birmingham/Atlanta, Geriatric Research, Education, and Clinical Center, Atlanta, Georgia.,Division of General Medicine and Geriatrics, Department of Medicine, Emory University, Atlanta, Georgia
| | - William Dale
- Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, California
| | - Heather G Allore
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Ellen F Binder
- Division of Geriatrics and Nutritional Science, Department of Internal Medicine, School of Medicine, Washington University, St. Louis, Missouri
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Julie P W Bynum
- Division of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan.,Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, Michigan
| | - Jerry H Gurwitz
- Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Health, and Reliant Medical Group, Worcester, Massachusetts
| | | | | | - Mark A Supiano
- Division of Geriatrics, School of Medicine, University of Utah, Salt Lake City, Utah.,Department of Veterans Affairs Salt Lake City, Geriatric Research, Education, and Clinical Center, Salt Lake City, Utah
| | - Cathleen Colón-Emeric
- Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs, Durham, North Carolina.,Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Health Services Research and Development, Durham Veterans Affairs, Durham, North Carolina
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49
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Gill TM, Allore HG, Gahbauer EA, Murphy TE. Burden of Restricted Activity and Associated Symptoms and Problems in Late Life and at the End of Life. J Am Geriatr Soc 2018; 66:2282-2288. [PMID: 30277571 PMCID: PMC6607906 DOI: 10.1111/jgs.15566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 01/01/2018] [Accepted: 01/01/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To compare rates of restricted activity and associated symptoms and problems in the last 6 months of life with those in the period before the last 6 months of life. DESIGN Prospective cohort study. SETTING Greater New Haven, Connecticut. PARTICIPANTS Community-living persons aged 70 and older (N=754). MEASUREMENTS The occurrence of restricted activity (staying in bed for at least half the day or cutting down on usual activities) and 24 prespecified symptoms and problems leading to restricted activity was ascertained monthly for nearly 19 years. RESULTS Rates of restricted activity per 100 person-months were 36.5 in the last 6 months of life versus 16.1 in the period before the last 6 months of life (P<.001). Of 737 participants with 1 month or more of restricted activity, rates of restricting symptoms per 100 person-months of restricted activity ranged from 8.0 for frequent or painful urination to 65.6 for been fatigued, and rates of restricting problems ranged from 0.1 for problem with alcohol to 23.4 for been afraid of falling. Rates were significantly higher in the last 6 months of life than in the prior period for 13 of the 24 restricting symptoms and problems (P<.05), most notably for shortness of breath (38.6 vs 21.8), weakness (37.3 vs 18.9), and confusion (31.2 vs 9.8). Mean (standard error) number of restricting symptoms and problems was significantly higher in the last 6 months of life (6.1 (0.1)) than in the prior period (4.7 (0.03)) (P<.001). CONCLUSION Rates of restricted activity and associated symptoms and problems are substantially greater in the last 6 months of life than in the period before the last 6 months of life. Enhanced palliative care strategies may be needed to diminish the burden of distressing symptoms and problems at the end of life. J Am Geriatr Soc 66:2282-2288, 2018.
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Affiliation(s)
- Thomas M Gill
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Heather G Allore
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Evelyne A Gahbauer
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Terrence E Murphy
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
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50
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Liu Z, Han L, Gahbauer EA, Allore HG, Gill TM. JOINT TRAJECTORIES OF COGNITION AND FRAILTY, AND ASSOCIATED BURDEN OF PATIENT-REPORTED OUTCOMES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.085] [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)
- Z Liu
- Yale University, New Haven, Connecticut, United States
| | - L Han
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - E A Gahbauer
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - H G Allore
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - T M Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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