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Abadir P, Whitson H. Geriatric research through the lens of AGS/NIA U13: Two decades of interdisciplinary dialogues that have propelled the field. J Am Geriatr Soc 2024. [PMID: 38363144 DOI: 10.1111/jgs.18810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/09/2024] [Accepted: 01/14/2024] [Indexed: 02/17/2024]
Affiliation(s)
- Peter Abadir
- Department of Medicine, Division of Geriatrics Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Heather Whitson
- Department of Medicine, Duke University, Durham, North Carolina, USA
- Durham VA GRECC, Durham VA Geriatrics Research, Education, and Clinical Center, Durham, North Carolina, USA
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Ukraintseva S, Duan H, Holmes R, Bagley O, Wu D, Yashkin A, Kulminski A, Akushevich I, Whitson H, Stallard E, Yashin A, Arbeev K. Patterns of Aging Changes in Bodyweight May Predict Alzheimer's Disease. J Alzheimers Dis 2024; 97:163-170. [PMID: 38108347 PMCID: PMC10789330 DOI: 10.3233/jad-220998] [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] [Accepted: 10/10/2023] [Indexed: 12/19/2023]
Abstract
Relationships between patterns of aging-changes in bodyweight and AD are not fully understood. We compared mean age-trajectories of weight between those who did and did not develop late-onset-AD, and evaluated impact of age at maximum weight (AgeMax), and slope of decline in weight, on AD risk. Women with late-onset-AD had lower weight three or more decades before AD onset, and ∼10 years younger AgeMax, compared to AD-free women. APOE4 carriers had younger AgeMax and steeper slope. Older AgeMax and flatter slope predicted lower AD risk. Premature decline in weight could be a sign of accelerated physical aging contributing to AD.
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Affiliation(s)
- Svetlana Ukraintseva
- Biodemography of Aging Research Unit (BARU), Social Science Research Institute, Duke University, Durham, NC, USA
| | - Hongzhe Duan
- Biodemography of Aging Research Unit (BARU), Social Science Research Institute, Duke University, Durham, NC, USA
| | - Rachel Holmes
- Biodemography of Aging Research Unit (BARU), Social Science Research Institute, Duke University, Durham, NC, USA
| | - Olivia Bagley
- Biodemography of Aging Research Unit (BARU), Social Science Research Institute, Duke University, Durham, NC, USA
| | - Deqing Wu
- Biodemography of Aging Research Unit (BARU), Social Science Research Institute, Duke University, Durham, NC, USA
| | - Arseniy Yashkin
- Biodemography of Aging Research Unit (BARU), Social Science Research Institute, Duke University, Durham, NC, USA
| | - Alexander Kulminski
- Biodemography of Aging Research Unit (BARU), Social Science Research Institute, Duke University, Durham, NC, USA
| | - Igor Akushevich
- Biodemography of Aging Research Unit (BARU), Social Science Research Institute, Duke University, Durham, NC, USA
| | - Heather Whitson
- Center for Aging and Human Development, Duke University, Durham, NC, USA
- Geriatrics Research, Education, and Clinical Center (GRECC), Durham VA Medical Center, Durham, NC, USA
| | - Eric Stallard
- Biodemography of Aging Research Unit (BARU), Social Science Research Institute, Duke University, Durham, NC, USA
| | - Anatoliy Yashin
- Biodemography of Aging Research Unit (BARU), Social Science Research Institute, Duke University, Durham, NC, USA
| | - Konstantin Arbeev
- Biodemography of Aging Research Unit (BARU), Social Science Research Institute, Duke University, Durham, NC, USA
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Nader MM, Cosarderelioglu C, Miao E, Whitson H, Xue QL, Grodstein F, Oh E, Ferrucci L, Bennett DA, Walston JD, George C, Abadir PM. Navigating and diagnosing cognitive frailty in research and clinical domains. Nat Aging 2023; 3:1325-1333. [PMID: 37845509 DOI: 10.1038/s43587-023-00504-z] [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] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 09/13/2023] [Indexed: 10/18/2023]
Abstract
While physical frailty has been recognized as a clinical entity for some time, the concept of cognitive frailty (CF) is now gaining increasing attention in the geriatrics research community. CF refers to the co-occurrence of physical frailty and cognitive impairment in older adults, which has been suggested as a potential precursor to both dementia and adverse physical outcomes. However, this condition represents a challenge for researchers and clinicians, as there remains a lack of consensus regarding the definition and diagnostic criteria for CF, which has limited its utility. Here, using insights from both the physical frailty literature and cognitive science research, we describe emerging research on CF. We highlight areas of agreement as well as areas of confusion and remaining knowledge gaps, and provide our perspective on fine-tuning the current construct, aiming to stimulate further discussion in this developing field.
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Affiliation(s)
- Monica M Nader
- Johns Hopkins University School of Medicine, Division of Geriatric Medicine and Gerontology, Baltimore, MD, USA
| | - Caglar Cosarderelioglu
- Johns Hopkins University School of Medicine, Division of Geriatric Medicine and Gerontology, Baltimore, MD, USA
- Ankara University School of Medicine, Department of Internal Medicine, Division of Geriatrics, Ankara, Turkey
| | - Emily Miao
- Albert Einstein College of Medicine/Montefiore Medical Center, Department of Medicine, Division of Geriatrics, New York, NY, USA
| | - Heather Whitson
- Duke University School of Medicine, Center for the Study of Aging, Durham, NC, USA
| | - Qian-Li Xue
- Johns Hopkins University School of Medicine, Division of Geriatric Medicine and Gerontology, Baltimore, MD, USA
- Johns Hopkins University Center on Aging and Health, Baltimore, MD, USA
| | - Francine Grodstein
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Esther Oh
- Johns Hopkins University School of Medicine, Division of Geriatric Medicine and Gerontology, Baltimore, MD, USA
| | | | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Jeremy D Walston
- Johns Hopkins University School of Medicine, Division of Geriatric Medicine and Gerontology, Baltimore, MD, USA
| | - Claudene George
- Albert Einstein College of Medicine/Montefiore Medical Center, Department of Medicine, Division of Geriatrics, New York, NY, USA
| | - Peter M Abadir
- Johns Hopkins University School of Medicine, Division of Geriatric Medicine and Gerontology, Baltimore, MD, USA.
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Colon-Emeric C, Schmader K, Cohen HJ, Morey M, Whitson H. Ageing and physical resilience after health stressors. Stress Health 2023; 39:48-54. [PMID: 36879359 PMCID: PMC10480330 DOI: 10.1002/smi.3241] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/15/2023] [Accepted: 02/23/2023] [Indexed: 03/08/2023]
Abstract
The objectives of this article are to introduce a conceptual framework for physical resilience in the context of ageing and to discuss key elements and challenges in the design of studies of physical resilience after health stressors. Advancing age is associated with increasing exposure to multiple stressors and declining capacity to respond to health stressors. Resilience is defined broadly as the ability to resist or recover well from the adverse effects of a health stressor. In ageing-related study designs of physical resilience after a health stressor, this dynamic resilience response can be observed as changes in repeated measures of function or health status in various domains important to older adults. Methodologic issues in selecting the study population, defining the stressor, covariates, outcomes, and analytic strategies are highlighted in the context of an ongoing prospective cohort study of physical resilience after total knee replacement surgery. The article concludes with approaches to intervention development to optimize resilience.
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Affiliation(s)
- Cathleen Colon-Emeric
- Department of Medicine, Duke University Claude D. Pepper Older Americans Independence Center, Center for Aging, Duke University, Durham, North Carolina, USA
- Geriatric Research Education Clinical Center, Durham Veteran Affairs Health Care System, Durham, North Carolina, USA
| | - Kenneth Schmader
- Department of Medicine, Duke University Claude D. Pepper Older Americans Independence Center, Center for Aging, Duke University, Durham, North Carolina, USA
- Geriatric Research Education Clinical Center, Durham Veteran Affairs Health Care System, Durham, North Carolina, USA
| | - Harvey Jay Cohen
- Department of Medicine, Duke University Claude D. Pepper Older Americans Independence Center, Center for Aging, Duke University, Durham, North Carolina, USA
| | - Miriam Morey
- Department of Medicine, Duke University Claude D. Pepper Older Americans Independence Center, Center for Aging, Duke University, Durham, North Carolina, USA
- Geriatric Research Education Clinical Center, Durham Veteran Affairs Health Care System, Durham, North Carolina, USA
| | - Heather Whitson
- Department of Medicine, Duke University Claude D. Pepper Older Americans Independence Center, Center for Aging, Duke University, Durham, North Carolina, USA
- Geriatric Research Education Clinical Center, Durham Veteran Affairs Health Care System, Durham, North Carolina, USA
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Arbeev KG, Ukraintseva S, Bagley O, Duan H, Wu D, Akushevich I, Stallard E, Kulminski A, Christensen K, Feitosa MF, O’Connell JR, Parker D, Whitson H, Yashin AI. Interactions between genes involved in physiological dysregulation and axon guidance: role in Alzheimer's disease. Front Genet 2023; 14:1236509. [PMID: 37719713 PMCID: PMC10500346 DOI: 10.3389/fgene.2023.1236509] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/17/2023] [Indexed: 09/19/2023] Open
Abstract
Dysregulation of physiological processes may contribute to Alzheimer's disease (AD) development. We previously found that an increase in the level of physiological dysregulation (PD) in the aging body is associated with declining resilience and robustness to major diseases. Also, our genome-wide association study found that genes associated with the age-related increase in PD frequently represented pathways implicated in axon guidance and synaptic function, which in turn were linked to AD and related traits (e.g., amyloid, tau, neurodegeneration) in the literature. Here, we tested the hypothesis that genes involved in PD and axon guidance/synapse function may jointly influence onset of AD. We assessed the impact of interactions between SNPs in such genes on AD onset in the Long Life Family Study and sought to replicate the findings in the Health and Retirement Study. We found significant interactions between SNPs in the UNC5C and CNTN6, and PLXNA4 and EPHB2 genes that influenced AD onset in both datasets. Associations with individual SNPs were not statistically significant. Our findings, thus, support a major role of genetic interactions in the heterogeneity of AD and suggest the joint contribution of genes involved in PD and axon guidance/synapse function (essential for the maintenance of complex neural networks) to AD development.
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Affiliation(s)
- Konstantin G. Arbeev
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, United States
| | - Svetlana Ukraintseva
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, United States
| | - Olivia Bagley
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, United States
| | - Hongzhe Duan
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, United States
| | - Deqing Wu
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, United States
| | - Igor Akushevich
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, United States
| | - Eric Stallard
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, United States
| | - Alexander Kulminski
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, United States
| | - Kaare Christensen
- Danish Aging Research Center, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Mary F. Feitosa
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St. Louis, MO, United States
| | - Jeffrey R. O’Connell
- Division of Endocrinology, Diabetes and Nutrition and Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Daniel Parker
- Duke Center for the Study of Aging and Human Development, Duke University, Durham, NC, United States
| | - Heather Whitson
- Duke Center for the Study of Aging and Human Development, Duke University, Durham, NC, United States
- Durham VA Geriatrics Research Education and Clinical Center, Durham, NC, United States
| | - Anatoliy I. Yashin
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, United States
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Ukraintseva S, Duan M, Simanek AM, Holmes R, Bagley O, Rajendrakumar AL, Yashkin AP, Akushevich I, Tropsha A, Whitson H, Yashin A, Arbeev K. Vaccination Against Pneumonia May Provide Genotype-Specific Protection Against Alzheimer's Disease. J Alzheimers Dis 2023; 96:499-505. [PMID: 37807778 PMCID: PMC10657669 DOI: 10.3233/jad-230088] [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] [Accepted: 08/29/2023] [Indexed: 10/10/2023]
Abstract
Vaccine repurposing that considers individual genotype may aid personalized prevention of Alzheimer's disease (AD). In this retrospective cohort study, we used Cardiovascular Health Study data to estimate associations of pneumococcal polysaccharide vaccine and flu shots received between ages 65-75 with AD onset at age 75 or older, taking into account rs6859 polymorphism in NECTIN2 gene (AD risk factor). Pneumococcal vaccine, and total count of vaccinations against pneumonia and flu, were associated with lower odds of AD in carriers of rs6859 A allele, but not in non-carriers. We conclude that pneumococcal polysaccharide vaccine is a promising candidate for genotype-tailored AD prevention.
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Affiliation(s)
- Svetlana Ukraintseva
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, USA
| | - Matt Duan
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, USA
| | - Amanda M. Simanek
- Department of Foundational Sciences and Humanities, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Rachel Holmes
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, USA
| | - Olivia Bagley
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, USA
| | - Aravind L. Rajendrakumar
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, USA
| | - Arseniy P. Yashkin
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, USA
| | - Igor Akushevich
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, USA
| | - Alexander Tropsha
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Heather Whitson
- Center for Aging and Human Development, Duke University Medical Center, Durham, NC, USA
| | - Anatoliy Yashin
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, USA
| | - Konstantin Arbeev
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, USA
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Ukraintseva S, Arbeev K, Duan H, Holmes R, Akushevich I, Yashkin A, Whitson H, Yashin A. PATTERNS OF AGING CHANGES IN BODY WEIGHT AND BMI MAY PREDICT CHANCES OF ALZHEIMER'S DISEASE AND LONGEVITY. Innov Aging 2022. [PMCID: PMC9770681 DOI: 10.1093/geroni/igac059.1287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Lower bodyweight/BMI was previously linked to AD and frailty; however, the role of long-term changes in the bodyweight/BMI in both AD and longevity is not well understood, as is the role of APOE polymorphism in such changes. Methods Using longitudinal data from the Framingham Heart Study (FHS) and the Health and Retirement Study (HRS), we estimated trajectories of the weight and BMI at ages 40 to 75, and compared them between individuals who did and who did not develop AD at ages 75+. We also evaluated associations between APOE4 carrier status and key characteristics of the age-trajectories of weight/BMI, including the age at peak value of the bodyweight/BMI (AgeMax), and slope of the decline in bodyweight/BMI after reaching the maximum. Results Women with late-onset-AD had lower bodyweight/BMI values up to three decades before AD diagnosis. They reached the peak of bodyweight in their 50s, about 10 years earlier than AD-free women. Younger AgeMax was associated with lower survival chances after age 80 in women. APOE4 carriers showed earlier/faster declines in weight and BMI than non-carriers; however, relevance of this to AD was unclear. Conclusion Younger age at peak value of the bodyweight/BMI indicates higher chances of late-onset-AD, while older age can predict better survival later in life and may favor longevity in women. The earlier start of the decline in bodyweight/BMI values could be sign of accelerated aging, which may contribute to AD. Relevance of APOE4 effects on age-trajectories of weight/BMI to AD warrants further investigation.
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Affiliation(s)
| | | | - Hongzhe Duan
- Duke University, Durham, North Carolina, United States
| | - Rachel Holmes
- Duke University, Durham, North Carolina, United States
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Ehrlich J, Goldstein J, Swenor B, Whitson H, Langa K, Veliz P. VISION IMPAIRMENT IN A GLOBAL LIFE COURSE MODEL OF POTENTIALLY MODIFIABLE DEMENTIA RISK FACTORS. Innov Aging 2022. [PMCID: PMC9766602 DOI: 10.1093/geroni/igac059.1498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Vision impairment (VI) is a risk factor for accelerated cognitive decline and incident dementia. An estimated 90% of VI is preventable. Nonetheless, VI has not been included in the dominant life-course models of dementia risk factors. We sought to strengthen existing models of potentially modifiable dementia risk factors through the inclusion of VI using cross-sectional survey data from the Gateway to Global Aging project (G2Aging) from 31 countries. Prevalence rates and communalities from the G2Aging will be used to estimate the population attributable fraction (PAF) of dementia due to VI. It is expected that the PAF for VI will range from 1.0%-2.0%, suggesting that >10,000,000 prevalent dementia cases globally may potentially have been prevented through healthy vision. Since a large majority of VI can be treated with cost-effective but underutilized interventions, this may represent a viable target for future interventional research that aims to slow cognitive decline and prevent dementia.
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Affiliation(s)
- Joshua Ehrlich
- University of Michigan, Ann Arbor, Michigan, United States
| | | | | | | | - Kenneth Langa
- University of Michigan, Ann Arbor, Michigan, United States
| | - Phillip Veliz
- University of Michigan, Ann Arbor, Michigan, United States
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Deal J, Whitson H. SENSORY LOSS AND BRAIN HEALTH: SPOTLIGHTING JUNIOR INVESTIGATORS IN THE SENSORY HEALTH INTEREST GROUP. Innov Aging 2022. [DOI: 10.1093/geroni/igac059.602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Sensory loss (hearing, vision, touch, smell, taste) is common in older adults, with over 2/3 of adults over age 55 experiencing loss in multiple senses. Sensory loss has been consistently linked to dementia and cognitive decline in epidemiologic studies. However, research gaps exist, with some senses having been studied more widely than others. Given differing underlying anatomy and physiology of the senses, the nature of the pathways linking sensory loss to dementia may vary and some have yet to be elucidated. For some, it may be that they are both caused by a common underlying biology (e.g., neurodegeneration). Alternatively, potential causal mechanisms include increased cognitive load, changes brain structure/function, social isolation and/or reduced activity. Additionally, gaps exist in how sensory loss may impact the lived experience of people with dementia. This session will address these research gaps by highlighting the work of outstanding junior investigators in the GSA Sensory Health Interest Group. The association between touch and dementia will be reported, a relationship which hitherto has not been well described. We will present on the relationship between olfaction and white matter integrity in the brain and describe how sensory function predicts levels of Alzheimer’s disease biomarkers over 10 years. We will present evidence for associations between audiometric hearing, structural brain volumes, white matter integrity, and cognitive test performance on speech-in-noise processing and will conclude by describing how hearing loss may impact patient-provider communication among older adults with dementia.
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Ehrlich JR, Goldstein J, Swenor BK, Whitson H, Langa KM, Veliz P. Addition of Vision Impairment to a Life-Course Model of Potentially Modifiable Dementia Risk Factors in the US. JAMA Neurol 2022; 79:623-626. [PMID: 35467745 PMCID: PMC9039828 DOI: 10.1001/jamaneurol.2022.0723] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [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]
Abstract
Importance Dementia prevention is a high priority, given the large impact of dementia on the well-being of individuals and society. The number of older adults with dementia in the US and globally is projected to increase as a result of population aging and growth. Thus, it is vital to identify potentially modifiable dementia risk factors. Vision impairment has been identified as a risk factor for accelerated cognitive decline and incident dementia. An estimated 90% of vision impairment is preventable or has yet to be treated. Nevertheless, vision impairment has not been included in the dominant life-course model of dementia risk factors, developed by the Lancet Commission, used to shape public health policy and research priorities. Objective To strengthen an existing model of potentially modifiable dementia risk factors through the inclusion of vision impairment and to estimate the contributions of those risk factors in the US population. Design, Setting, and Participants Population-based, cross-sectional study using data from the 2018 round of the Health and Retirement Study. Analyses were conducted from March 11 through September 24, 2021. The study population was a probability sample of US adults aged 50 years and older. Exposures Potentially modifiable dementia risk factors, including vision impairment. Main Outcomes and Measures The estimated population attributable fractions (PAFs) of dementia associated with vision impairment and other dementia risk factors (11 of those included in the Lancet Commission's life-course model) were calculated. The PAF represents the number of cases of dementia that would potentially be prevented if a risk factor were eliminated. Results The probability sample from the Health and Retirement Study included 16 690 participants (weighted demographic characteristics: 54.0% female, 52.0% age ≥65, 10.6% Black, 80% White, and 9.2% identified as other [including American Indian or Alaska Native, Asian, and Hawiian Native or Pacific Islander, although specific data were not available]). The 12 dementia risk factors in the PAF model were associated with an estimated 62.4% of dementia cases in the US. The risk factor with the highest weighted PAF for dementia was hypertension (12.4%). The PAF of vision impairment was 1.8%, suggesting that more than 100 000 prevalent dementia cases in the US could potentially have been prevented through healthy vision. Conclusions and Relevance Existing life-course models of potentially modifiable dementia risk factors, such as the Lancet Commission's, may consider including vision impairment. Since a large majority of vision impairment can be treated with cost-effective but underused interventions, this may represent a viable target for future interventional research that aims to slow cognitive decline and prevent incident dementia.
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Affiliation(s)
- Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor.,Institute for Social Research, University of Michigan, Ann Arbor
| | | | - Bonnie K Swenor
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland.,Disability Health Research Center, Johns Hopkins University, Baltimore, Maryland
| | - Heather Whitson
- Geriatric Medicine Division, Duke University School of Medicine, Durham, North Carolina.,Geriatric Research Education and Clinical Center, Durham VA Health Care System, Durham, North Carolina
| | - Kenneth M Langa
- Institute for Social Research, University of Michigan, Ann Arbor.,Department of Internal Medicine, University of Michigan, Ann Arbor.,Department of Health Management and Policy, University of Michigan, Ann Arbor.,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Phillip Veliz
- Institute for Social Research, University of Michigan, Ann Arbor.,University of Michigan School of Nursing, Ann Arbor
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11
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Ma JP, Robbins CB, Lee JM, Soundararajan S, Stinnett SS, Agrawal R, Plassman BL, Lad EM, Whitson H, Grewal DS, Fekrat S. Longitudinal analysis of the retina and choroid in cognitively normal individuals at higher genetic risk for Alzheimer disease. Ophthalmol Retina 2022; 6:607-619. [PMID: 35283324 DOI: 10.1016/j.oret.2022.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/18/2022] [Accepted: 03/03/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess baseline differences and longitudinal rate of change in retinal and choroidal imaging parameters between APOE ε4 carriers and non-carriers with normal cognition. DESIGN Prospective study. SUBJECTS 413 eyes of 218 individuals with normal cognition aged ≥55 years with known APOE status (98 ε4 carriers, 120 non-carriers). Exclusion criteria included diabetes mellitus, uncontrolled hypertension, glaucoma, and vitreoretinal or neurodegenerative disease. METHODS Optical coherence tomography (OCT) and OCT angiography (OCTA) was performed at baseline and at 2 years [Zeiss Cirrus HD-OCT 5000 with AngioPlex (Zeiss Meditec, Dublin, CA)]. Groups were compared using sex- and age-adjusted generalized estimating equations. MAIN OUTCOME MEASURES OCT: retinal nerve fiber layer thickness, macular ganglion cell-inner plexiform layer thickness, central subfield thickness (CST), choroidal vascularity index. OCTA: foveal avascular zone area, perfusion density (PD), vessel density, peripapillary capillary perfusion density and capillary flux index (CFI). Rate of change per year was calculated. RESULTS At baseline, ε4 carriers demonstrated decreased CST (p=0.018), PD in the 6mm Early Treatment Diabetic Retinopathy Study (ETDRS) circle (p=0.049), and temporal CFI (p=0.047). Seventy-one ε4 carriers and 78 non-carriers returned at 2 years; at follow-up, the 6mm ETDRS circle (p=0.05) and outer ring (p=0.049) showed decreased PD in ε4 carriers, with no differences in rates of change between groups (all p>0.05). CONCLUSIONS There were measured differences in CST, PD, and peripapillary CFI between APOE ε4 carriers and non-carriers with normal cognition. Larger and longer-term studies may further elucidate the potential prognostic value of these findings.
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Affiliation(s)
- Justin P Ma
- iMIND Research Group, Duke University School of Medicine, Durham, NC, USA; Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Cason B Robbins
- iMIND Research Group, Duke University School of Medicine, Durham, NC, USA; Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Jia Min Lee
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Srinath Soundararajan
- iMIND Research Group, Duke University School of Medicine, Durham, NC, USA; Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Sandra S Stinnett
- iMIND Research Group, Duke University School of Medicine, Durham, NC, USA; Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Singapore Eye Research Institute, Singapore; Duke NUS Medical School, Singapore
| | - Brenda L Plassman
- iMIND Research Group, Duke University School of Medicine, Durham, NC, USA; Departments of Psychiatry and Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Eleonora M Lad
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Heather Whitson
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Dilraj S Grewal
- iMIND Research Group, Duke University School of Medicine, Durham, NC, USA; Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Sharon Fekrat
- iMIND Research Group, Duke University School of Medicine, Durham, NC, USA; Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA.
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12
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Nagarajan N, Assi L, Varadaraj V, Motaghi M, Sun Y, Couser E, Ehrlich JR, Whitson H, Swenor BK. Vision impairment and cognitive decline among older adults: a systematic review. BMJ Open 2022; 12:e047929. [PMID: 34992100 PMCID: PMC8739068 DOI: 10.1136/bmjopen-2020-047929] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 08/03/2021] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES There has been increasing epidemiological research examining the association between vision impairment (VI) and cognitive impairment and how poor vision may be a modifiable risk factor for cognitive decline. The objective of this systematic review is to synthesise the published literature on the association of VI with cognitive decline, cognitive impairment or dementia, to aid the development of interventions and guide public policies pertaining to the relationship between vision and cognition. METHODS A literature search was performed with Embase, Medline and Cochrane library databases from inception to March 2020, and included abstracts and articles published in peer-reviewed journals in English. Our inclusion criteria included publications that contained subjective/objective measures of vision and cognition, or a diagnosis of VI, cognitive impairment or dementia. Longitudinal or cross-sectional studies with ≥100 participants aged >50 years were included. The search identified 11 805 articles whose abstracts underwent screening by three teams of study authors. Data abstraction and quality assessment using the Effective Public Health Practice Project Quality Assessment Tool were performed by one author (NN). 10% of the articles underwent abstraction and appraisal by a second author (LA/VV), results were compared between both and were in agreement. RESULTS 110 full-text articles were selected for data extraction, of which 53 were cross-sectional, 43 longitudinal and 14 were case-control studies. The mean age of participants was 73.0 years (range 50-93.1). Ninety-one (83%) of these studies reported that VI was associated with cognitive impairment. CONCLUSION Our systematic review indicates that a majority of studies examining the vision-cognition relationship report that VI is associated with more cognitive decline, cognitive impairment or dementia among older adults. This synthesis supports the need for additional research to understand the mechanisms underlying the association between VI and cognitive impairment and to test interventions that mitigate the cognitive consequences of VI.
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Affiliation(s)
- Niranjani Nagarajan
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lama Assi
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - V Varadaraj
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mina Motaghi
- Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Yi Sun
- Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Elizabeth Couser
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joshua R Ehrlich
- Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
- Institute for healthcare policy and innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Heather Whitson
- Department of Medicine, Geriatrics, Duke University, Durham, North Carolina, USA
| | - Bonnielin K Swenor
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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13
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Cesari M, Azzolino D, LeBrasseur NK, Whitson H, Rooks D, Sourdet S, Angioni D, Fielding RA, Vellas B, Rolland Y, Andrieu S, Leheudre MA, Barcons N, Beliën A, de Souto Barreto P, Delannoy C, John G, Robledo LMG, Hwee D, Mariani J, Reshma M, Morley J, Pereira S, Erin Q, Michelle R, Rueda R, Tarasenko L, Tourette C, Van Maanen R, Waters DL. Resilience: Biological Basis and Clinical Significance - A Perspective Report from the International Conference on Frailty and Sarcopenia Research (ICFSR) Task Force. J Frailty Aging 2022; 11:342-347. [PMID: 36346720 PMCID: PMC9589704 DOI: 10.14283/jfa.2022.62] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Resilience is a construct receiving growing attention from the scientific community in geriatrics and gerontology. Older adults show extremely heterogeneous (and often unpredictable) responses to stressors. Such heterogeneity can (at least partly) be explained by differences in resilience (i.e., the capacity of the organism to cope with stressors). The International Conference on Frailty and Sarcopenia Research (ICFSR) Task Force met in Boston (MA,USA) on April 20, 2022 to discuss the biological and clinical significance of resilience in older adults. The identification of persons with low resilience and the prompt intervention in this at-risk population may be critical to develop and implement preventive strategies against adverse events. Unfortunately, to date, it is still challenging to capture resilience, especially due to its dynamic nature encompassing biological, clinical, subjective, and socioeconomic factors. Opportunities to dynamically measure resilience were discussed during the ICFSR Task Force meeting, emphasizing potential biomarkers and areas of intervention. This article reports the results of the meeting and may serve to support future actions in the field.
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Affiliation(s)
- Matteo Cesari
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, University of Milan, Via Camaldoli 64, 20138 Milano, Italy
| | - D. Azzolino
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, University of Milan, Via Camaldoli 64, 20138 Milano, Italy
| | - N. K. LeBrasseur
- Robert and Arlene Kodod Center on Aging, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, USA
| | - H. Whitson
- Duke University School of Medicine & Durham VA Medical Center, Durham, USA
| | - D. Rooks
- Translational Medicine, Novartis Institutes for Biomedical Research Inc., Cambridge, USA
| | - S. Sourdet
- Gérontopôle de Toulouse, Centre Hospitalier-Universitaire de Toulouse, Inserm 1295, Université de Toulouse, Toulouse, France
| | - D. Angioni
- Gérontopôle de Toulouse, Centre Hospitalier-Universitaire de Toulouse, Inserm 1295, Université de Toulouse, Toulouse, France
| | - R. A. Fielding
- Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA, Human Nutrition Research Center on Aging at Tufts University, Boston, MA USA
| | - B. Vellas
- Gérontopôle de Toulouse, Centre Hospitalier-Universitaire de Toulouse, Inserm 1295, Université de Toulouse, Toulouse, France
| | - Y. Rolland
- Gérontopôle de Toulouse, Centre Hospitalier-Universitaire de Toulouse, Inserm 1295, Université de Toulouse, Toulouse, France
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14
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Wright MC, Bunning T, Eleswarpu SS, Heflin MT, McDonald S, Lagoo-Deenadalayan S, Whitson H, Martinez-Camblor P, Deiner SG, Berger M. A Processed Electroencephalogram-Based Brain Anesthetic Resistance Index Is Associated With Postoperative Delirium in Older Adults: A Dual Center Study. Anesth Analg 2022; 134:149-158. [PMID: 34252066 PMCID: PMC8678136 DOI: 10.1213/ane.0000000000005660] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Some older adults show exaggerated responses to drugs that act on the brain. The brain's response to anesthetic drugs is often measured clinically by processed electroencephalogram (EEG) indices. Thus, we developed a processed EEG-based measure of the brain's resistance to volatile anesthetics and hypothesized that low scores on it would be associated with postoperative delirium risk. METHODS We defined the Duke Anesthesia Resistance Scale (DARS) as the average bispectral index (BIS) divided by the quantity (2.5 minus the average age-adjusted end-tidal minimum alveolar concentration [aaMAC] inhaled anesthetic fraction). The relationship between DARS and postoperative delirium was analyzed in 139 older surgical patients (age ≥65) from Duke University Medical Center (n = 69) and Mt Sinai Medical Center (n = 70). Delirium was assessed by geriatrician interview at Duke, and by research staff utilizing the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) instrument at Mt Sinai. We examined the relationship between DARS and delirium and used the Youden index to identify an optimal low DARS threshold (for delirium risk), and its associated 95% bootstrap confidence bounds. We used multivariable logistic regression to examine the relationship between low DARS and delirium risk. RESULTS The relationship between DARS and delirium risk was nonlinear, with higher delirium risk at low DARS scores. A DARS threshold of 28.755 maximized the Youden index for the association between low DARS and delirium, with bootstrap 95% confidence bounds of 26.18 and 29.80. A low DARS (<28.755) was associated with increased delirium risk in multivariable models adjusting for site (odds ratio [OR] [95% confidence interval {CI}] = 4.30 [1.89-10.01]; P = .001), or site-plus-patient risk factors (OR [95% CI] = 3.79 [1.63-9.10]; P = .003). These associations with postoperative delirium risk remained significant when using the 95% bootstrap confidence bounds for the low DARS threshold (P < .05 for all). Further, a low DARS (<28.755) was associated with delirium risk after accounting for opioid, midazolam, propofol, phenylephrine, and ketamine dosage as well as site (OR [95% CI] = 4.21 [1.80-10.16]; P = .002). This association between low DARS and postoperative delirium risk after controlling for these other medications remained significant (P < .05) when using either the lower or the upper 95% bootstrap confidence bounds for the low DARS threshold. CONCLUSIONS These results demonstrate that an intraoperative processed EEG-based measure of lower brain anesthetic resistance (ie, low DARS) is independently associated with increased postoperative delirium risk in older surgical patients.
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Affiliation(s)
| | - Thomas Bunning
- Anesthesiology Department, Duke University Medical Center, Durham NC
| | | | - Mitchell T. Heflin
- Geriatrics Division, Department of Medicine, Duke University Medical Center, Durham NC
| | - Shelley McDonald
- Geriatrics Division, Department of Medicine, Duke University Medical Center, Durham NC
| | | | - Heather Whitson
- Geriatrics Division, Department of Medicine, Duke University Medical Center, Durham NC,Center for the Study of Aging and Human Development, Duke University Medical Center, Durham NC
| | | | - Stacie G Deiner
- Geriatrics and Palliative Care Medicine, Department of Medicine, Mount Sinai Medical Center, New York, NY,Anesthesiology Department, Mount Sinai Medical Center, New York, NY,Neurosurgery Department, Mount Sinai Medical Center, New York, NY,Geisel School of Medicine, Dartmouth College, New Hanover, New Hampshire
| | - Miles Berger
- Anesthesiology Department, Duke University Medical Center, Durham NC,Center for the Study of Aging and Human Development, Duke University Medical Center, Durham NC,Center for Cognitive Neuroscience, Duke University, Durham NC
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15
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Whitson H, Badea A, Stout J, Davis S, Zhuang J, Madden D. Age-Related Macular Degeneration and the Aging Brain. Innov Aging 2021. [PMCID: PMC8969668 DOI: 10.1093/geroni/igab046.598] [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: 11/21/2022] Open
Abstract
Age-related macular degeneration (AMD), a leading cause of vision loss in older Americans, is associated with cognitive decline and, particularly, worse performance on verbal fluency tasks. To determine whether AMD is associated with changes in brain structure that may underlie decline in cognition, we conducted a longitudinal, observational study of 39 visually impaired AMD patients and 33 age-matched peers with healthy eyes. Participants (mean age 74.3) underwent cognitive assessments and 3T magnetic resonance imaging (MRI) at baseline and two years. At baseline, AMD patients exhibited lower cortical volume and worse white matter tract integrity, especially in inter-hemispheric connections (FDR <0.05). Principal components analyses revealed faster white matter decline in the AMD group, especially in visual cortex and left hemisphere, which is implicated in language tasks. Understanding patterns of regional brain atrophy in AMD sheds light on mechanisms for the AMD-cognition link and opens windows of opportunity for intervention.
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Affiliation(s)
- Heather Whitson
- Duke University School of Medicine, Durham, North Carolina, United States
| | | | - Jacques Stout
- DUKE UNIVERSITY, Durham, North Carolina, United States
| | - Simon Davis
- DUKE UNIVERSITY, Durham, North Carolina, United States
| | - Jie Zhuang
- Shanghai University of Sport, Durham, North Carolina, United States
| | - David Madden
- DUKE UNIVERSITY, Durham, North Carolina, United States
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16
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Hreha K, Samper-Ternent R, Downer B, Ehrlich J, Downer P, Reistetter T, Whitson H. Impact of Vision and Hearing Impairment on Cognition and Loneliness: Evidence From the Mexican Health and Aging Study. Innov Aging 2021. [PMCID: PMC8682722 DOI: 10.1093/geroni/igab046.653] [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: 11/14/2022] Open
Abstract
Abstract
Poor vision and hearing have been associated with lower cognitive function and greater social isolation (i.e., loneliness) among older adults. However, this evidence is based largely on data from non-Hispanic populations. Therefore, we investigated whether self-reported vision and hearing was associated with cognitive function and loneliness in a nationally-representative study of Mexican adults aged 50 and older in Wave 3 of the Mexican Health and Aging Study. The final sample included 12,426 participants. The majority were female (58%), and the mean age was 67. Self-reported vision and hearing status were categorized as excellent-very good [ref], good, and fair-poor. Measures for global cognition, memory, and non-memory cognition were calculated using z-scores based on nine cognitive tests. Participants who reported frequently feeling a lack of companionship, left out, or isolated were categorized as feeling lonely. All analyses controlled for age, sex, and years of education. Participants with fair-poor vision had lower global (β= -0.06, p <.01), memory (β= -0.07, p <.01), and non-memory cognition (β= -0.06, p <.01) than participants with excellent-very good vision. In addition, participants with fair-poor hearing had higher non-memory cognition (β= 0.03, p <.05) but not global cognition (β=0.02) or memory (β=0.001). Fair-poor vision (OR=1.53, 95% CI=1.25-1.87) but not fair-poor hearing (OR=1.16, 95% CI=0.97-1.38) was associated with higher odds of being lonely. Poor vision may be a potentially modifiable risk factor for lower cognition and loneliness among Mexican adults. Future research should incorporate robust measures of sensory health and investigate the longitudinal association between vision, cognition, and loneliness.
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Affiliation(s)
| | | | - Brian Downer
- University of Texas Medical Branch, Galveston, Texas, United States
| | - Joshua Ehrlich
- University of Michigan, University of Michigan, Michigan, United States
| | - Paige Downer
- University of Texas Medical Branch, Galveston, Texas, United States
| | - Timothy Reistetter
- University of Texas Health Science Center at San Antonio, Dickinson, Texas, United States
| | - Heather Whitson
- Duke University School of Medicine, Durham, North Carolina, United States
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17
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Abstract
Epidemiological evidence indicates that 3-4% of community-dwelling adults over age 65 years old have functionally limiting deficits in both vision and cognition. The comorbidity prevalence is higher in older age strata and in long-term care. Seniors with co-occurrence of vision impairment and dementia have six times higher odds of disability and higher average annual Medicare fee for service costs ($13,655 [95% confidence interval: $9,931-$18,798], compared to peers with dementia alone ($8,867 [95% confidence interval: $7,360-10,683]) or neither condition ($4,518 [95% confidence interval: $4,360-$4,682]). This talk will review evidence that people with early dementia and vision problems can experience improved function through appropriately tailored vision rehabilitation interventions. The talk will provide recommendations for unbiased cognitive assessment in visually impaired people. The session will outline research opportunities regarding the question of whether preventing or treating vision impairment may improve cognitive trajectories and neuropsychiatric symptoms in people with dementia.
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Affiliation(s)
- Heather Whitson
- Duke University School of Medicine, Durham, North Carolina, United States
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18
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Sloane PD, Whitson H, Williams SW. Addressing Hearing and Vision Impairment in Long-Term Care: An Important and Often-Neglected Care Priority. J Am Med Dir Assoc 2021; 22:1151-1155. [PMID: 34088504 DOI: 10.1016/j.jamda.2021.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 01/01/2023]
Affiliation(s)
- Philip D Sloane
- Cecil G. Sheps Center for Health Services Research and Departments of Family Medicine and Internal Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
| | - Heather Whitson
- Departments of Medicine and Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Sharon Wallace Williams
- Division of Speech and Hearing Sciences, Department of Allied Health Sciences, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
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19
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Abstract
In 2019, the World Health Organization World Report on Vision estimated that that 2.2 billion people have a vision impairment, of which almost half could have been prevented or is yet to be addressed. As the global population ages and the prevalence of visual impairment increases, inequities in eye care and the downstream health and aging consequences of vision loss will become magnified. This session will: (1) provide key information regarding the burden of eye disease and visual impairment among older adults worldwide; (2) outline a framework created to conceptualize the aging and long-term health implications of vision loss, and (3) discuss the global public health challenges to eye care and to maximizing health for older adults with visual impairments.
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Affiliation(s)
| | | | - Moon Jeong Lee
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | | | - Pradeep Ramulu
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States
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20
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Nagarajan N, Swenor B, Assi L, Ehrlich J, Whitson H. A Systematic Review of Visual Impairment and Cognitive Decline Among Older Adults. Innov Aging 2020. [PMCID: PMC7743184 DOI: 10.1093/geroni/igaa057.1707] [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: 11/14/2022] Open
Abstract
Abstract
Cognitive and visual impairments frequently coexist. With the aging of populations worldwide, the prevalence of these conditions are projected to increase substantially over time. A number of studies suggest that cognitive function and vision impairment are associated, and it is hypothesized to be due to a (1) common cause etiology, where both share common risk factors, and/or (2) causal association, where visual impairment causes cognitive decline. Sensory loss can lead to increased cognitive load, structural and functional changes in the brain, and/or decreased emotional, social, and physical well-being, all of which could potentially increase the risk of cognitive impairment. We conducted a systematic review of the existing literature, examining the association between cognitive and visual impairment among older adults. A total of 80 observational studies that reported a measure of association between visual and cognitive function and met the following criteria were included: (1) cross-sectional or longitudinal study design, (2) baseline mean age of participants ≥50 years, and (3) sample size of ≥100 participants. Of these 80 studies, 56 found a positive, significant association between visual function and cognitive decline. Forty-nine of the 56 studies used objective measures to test for visual acuity, contrast sensitivity, or visual fields. The sample included participants from 14 countries, including the US, UK, China, and Australia among others. Converging evidence of an association between vision impairment and subsequent cognitive decline suggests that visual impairment is a possible modifiable risk factor for cognitive decline and dementia. This hypothesis should be tested in prospective, controlled studies.
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Affiliation(s)
- Niranjani Nagarajan
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | | | - Lama Assi
- Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, United States
| | - Joshua Ehrlich
- University of Michigan, Ann Arbor, Michigan, United States
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21
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Hreha K, Ottenbacher K, Ehrlich J, Whitson H. Use of the New ICD-10 Vision Codes Among Medicare Beneficiaries With Stroke. Innov Aging 2020. [PMCID: PMC7740384 DOI: 10.1093/geroni/igaa057.721] [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: 11/14/2022] Open
Abstract
Older adults can experience vision impairment following stroke in combination with pre-existing ophthalmologic disease. The new ICD-10 coding system for identifying vision related health conditions provides a much higher level of detail for coding these complex scenarios than the previous ICD-9 system. While this new coding system has advantages for clinical care and billing, the degree to which providers are utilizing the expanded code structure is unknown. The study objective was to describe the use of ICD-10 vision codes in a large cohort of stroke survivors. We used a retrospective cohort design to study national 100% Medicare claims files from 2015 through 2017. Data were analyzed using all available ICD-10 vision codes for beneficiaries who had an acute care stay because of a stroke and who also had an ICD-10 visual code recorded at least once in their claims chart. The cohort (n= 269,314) was mostly female (57.1%) with ischemic stroke (87.8%). Approximately 15% were coded as having one or more vision impairments. Unspecified glaucoma was the most frequently used code among men (2.83%), beneficiaries over 85+ (4.80%) and non-Hispanic blacks (4.12%). But multiple vision codes were used in few patients, overall (0.6%). Less than 3% of those in the oldest group (85+ years) had two vision codes noted in their claims. Despite more available codes, the coding used to describe the vision impairments in this population of stroke survivors was not specific or diverse. Hospital providers should pay attention to specificity in order to improve coding practices.
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Affiliation(s)
- Kimberly Hreha
- The University of Texas Medical Branch at Galveston, Galveston, Texas, United States
| | - Kenneth Ottenbacher
- The University of Texas Medical Branch at Galveston, Galveston, Texas, United States
| | - Joshua Ehrlich
- University of Michigan, Ann Arbor, Michigan, United States
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22
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Carpenter CR, McFarland F, Avidan M, Berger M, Inouye SK, Karlawish J, Lin FR, Marcantonio E, Morris J, Reuben D, Shah R, Whitson H, Asthana S, Verghese J. Impact of Cognitive Impairment Across Specialties: Summary of a Report From the U13 Conference Series. J Am Geriatr Soc 2019; 67:2011-2017. [PMID: 31436318 PMCID: PMC6800784 DOI: 10.1111/jgs.16093] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 05/30/2019] [Revised: 06/27/2019] [Accepted: 06/30/2019] [Indexed: 11/28/2022]
Abstract
Although declines in cognitive capacity are assumed to be a characteristic of aging, increasing evidence shows that it is age-related disease, rather than age itself, that causes cognitive impairment. Even so, older age is a primary risk factor for cognitive decline, and with individuals living longer as a result of medical advances, cognitive impairment and dementia are increasing in prevalence. On March 26 to 27, 2018, the American Geriatrics Society convened a conference in Bethesda, MD, to explore cognitive impairment across the subspecialties. Bringing together representatives from several subspecialties, this was the third of three conferences, supported by a U13 grant from the National Institute on Aging, to aid recipients of Grants for Early Medical/Surgical Specialists' Transition to Aging Research (GEMSSTAR) in integrating geriatrics into their subspecialties. Scientific sessions focused on the impact of cognitive impairment, sensory contributors, comorbidities, links between delirium and dementia, and issues of informed consent in cognitively impaired populations. Discussions highlighted the complexity not only of cognitive health itself, but also of the bidirectional relationship between cognitive health and the health of other organ systems. Thus, conference participants noted the importance of multidisciplinary team science in future aging research. This article summarizes the full conference report, "The Impact of Cognitive Impairment Across Specialties," and notes areas where GEMSSTAR scholars can contribute to progress as they embark on their careers in aging research. J Am Geriatr Soc 67:2011-2017, 2019.
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Affiliation(s)
| | | | | | | | | | | | | | | | - John Morris
- Washington University School of Medicine, St. Louis, MO
| | | | - Raj Shah
- Rush University Medical Center, Chicago, IL
| | - Heather Whitson
- Duke University School of Medicine, Durham, NC and Geriatrics Research Education and Clinical Center, Durham VA, Durham, NC
| | - Sanjay Asthana
- University of Wisconsin, Madison, WI
- Albert Einstein College of Medicine, Bronx, NY
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23
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High KP, Zieman S, Gurwitz J, Hill C, Lai J, Robinson T, Schonberg M, Whitson H. Use of Functional Assessment to Define Therapeutic Goals and Treatment. J Am Geriatr Soc 2019; 67:1782-1790. [PMID: 31081938 DOI: 10.1111/jgs.15975] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 09/20/2018] [Revised: 04/10/2019] [Accepted: 04/16/2019] [Indexed: 12/13/2022]
Abstract
This article summarizes the presentations and discussions from a workshop, "Using Functional Assessment to Define Therapeutic Goals and Treatment," which took place on November 30 to December 1, 2017. This workshop brought together transdisciplinary leaders in the fields of function and disability and clinical investigators engaged in research on geriatric populations to outline opportunities and challenges for incorporating measures of function in clinical research. Topics addressed included reliable and clinically feasible measures of function and key domains of health (eg, musculoskeletal, cognitive, and sensory) that are most strongly associated with patients' perceptions of well-being, independence, and quality of life across a wide array of diseases and interventions. The workshop also focused on the importance of function in medical decision making to inform communications between specialty physicians and patients about prognosis and goals of care. Workshop participants called for more research on the role of function as a predictor of an intervention's effectiveness and an important treatment outcome. Such research would be facilitated by development of a core set of simple, short, functional measures that can be used by all specialties in the clinical setting to allow "big data" analytics and a pragmatic research. J Am Geriatr Soc 67:1782-1790, 2019.
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Affiliation(s)
- Kevin P High
- Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | | | - Jerry Gurwitz
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Carl Hill
- National Institute on Aging, Bethesda, Maryland
| | - Jennifer Lai
- University of California, San Francisco, San Francisco, California
| | - Thomas Robinson
- Denver VA Medical Center, Veterans Affairs, Denver, Colorado
| | - Mara Schonberg
- Beth Israel Deaconess Medical Center, Brookline, Massachusetts
| | - Heather Whitson
- Duke University School of Medicine and Durham VA Geriatrics Research, Education, and Clinical Center, Durham, North Carolina
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24
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Whitson H, Potter G, Davis S, Plassman B, Sloane R, Reynolds K, Schmader K, Welsh-Bohmer K. DIFFERENCE IN BRAIN ACTIVATION WITH HIGHER TASK DEMAND IN ASYMPTOMATIC ADULTS WITH AND WITHOUT AN APOE E4 ALLELE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - S Davis
- Duke University Medical Center
| | - B Plassman
- Duke University - Joseph and Kathleen Bryan Alzheimer’s Disease Research Center
| | - R Sloane
- Center for the Study of Aging, Duke University Medical Center
| | | | - K Schmader
- Duke University and GRECC-Durham VA Medical Centers
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Whitson H, Woolson S, Olsen M, Muir K, McConnell E, Dziadul J, Stelmack J. PREVALENCE AND CONSEQUENCES OF COGNITIVE IMPAIRMENT AMONG VETERANS RECEIVING VISION REHABILITATION: A PILOT STUDY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.3182] [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)
| | | | | | - K Muir
- Duke University School of Medicine
| | | | - J Dziadul
- Durham Veterans Administration Medical Center
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Lipsitz L, Whitson H, Berger M, Giattino C, Zhou J, Woldorff M. DYNAMIC PHYSIOLOGICAL OUTPUT DURING SURGERY AS A PREDICTOR OF POST-OPERATIVE RESILIENCE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.873] [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: 11/13/2022] Open
Affiliation(s)
- L Lipsitz
- Harvard Medical School, Boston, Massachusetts, United States
| | - H Whitson
- Duke University School of Medicine, Durham, NC,USA; Durham VA GRECC, Durham, NC, USA
| | - M Berger
- Duke University School of Medicine, Durham, NC, USA
| | | | - J Zhou
- Harvard Medical School, Boston, MA, USA
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Deardorff W, Liu P, Sloane R, Van Houtven C, Hastings S, Cohen H, Whitson H. ASSOCIATION OF SENSORY IMPAIRMENT WITH HEALTHCARE UTILIZATION AND COSTS IN ADULTS WITH AND WITHOUT DEMENTIA. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.495] [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: 11/13/2022] Open
Affiliation(s)
| | | | - R Sloane
- Center for the Study of Aging, Duke University Medical Center
| | | | | | - H Cohen
- Duke Center for the Study of Aging and Human Development
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Zuo X, Zhuang J, Chen N, Cousins S, Lad E, Madden D, Potter G, Whitson H. DEFAULT MODE NETWORK CONNECTIVITY, EPISODIC MEMORY AND HEARING AND VISION LOSS IN OLDER ADULTS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3120] [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)
- X. Zuo
- Duke-NUS Medical School, Singapore, Singapore, Singapore,
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina,
| | - J. Zhuang
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina,
| | - N. Chen
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina,
| | - S. Cousins
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina,
| | - E. Lad
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina,
| | - D.J. Madden
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina,
| | - G. Potter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina,
| | - H. Whitson
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina,
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina,
- Department of Ophthalmology and Department of Medicine, Duke University Medical Center, Durham, North Carolina
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Colon-Emeric C, Whitson H, Bandeen-Roche K. MEASURING PHYSICAL RESILIENCE IN OLDER ADULTS: TRAJECTORY, PHENOTYPE, AND AGE DISCREPANCY APPROACHES. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.5061] [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: 11/15/2022] Open
Affiliation(s)
| | - H. Whitson
- Duke University Medical Center & Durham VA
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Guo Y, Whitson H, Ostbye T, Luciano A, Malhotra R. CARE COMPLEXITY AND MEDICATION USE AMONG OLDER SINGAPOREANS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3227] [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: 11/13/2022] Open
Affiliation(s)
- Y. Guo
- Duke University, Durham, North Carolina,
- Duke-NUS Medical School, Singapore, Singapore
| | - H. Whitson
- Duke University, Durham, North Carolina,
| | - T. Ostbye
- Duke University, Durham, North Carolina,
| | - A. Luciano
- Duke University, Durham, North Carolina,
| | - R. Malhotra
- Duke-NUS Medical School, Singapore, Singapore
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Lea C, Quiñones A, Whitson H, Bynum J, Thielke S. Changes in Self-Rated Health During the Transition to Retiring Living Among Medicare Managed-Care Recipients. J Hous Elderly 2016. [PMID: 29527088 DOI: 10.1080/02763893.2015.1129383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives Moving into a retirement community may be precipitated by or bring about changes in health status. We hypothesized that moving into a retirement community would be associated with a decline in self-rated health (SRH), but that health-related factors would mitigate this association. Methods We analyzed data from 58,272 participants in Cohort 3 of the Medicare Health Outcome Survey. Individuals answered questions regarding living status in 2000 and 2002. Those who moved into a retirement community were compared with those who did not. The primary outcome was change in SRH. We created adjusted and unadjusted models. Results 2,520 (4.4%) individuals moved into retirement communities between 2000 and 2002. There were no substantial differences in the mean change in SRH between those who moved and those who did not. In adjusted and unadjusted models, moving was not significantly associated with changes in SRH. In an analysis stratified by SRH, only those with the best SRH had a significant decline in SRH during the move. Discussion SRH mainly remained stable for most people regardless of moving into a retirement community. These findings argue against environmental context being a main determinant of self-perceived health status among older adults.
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Affiliation(s)
| | - Ana Quiñones
- Department of Medicine (Geriatrics) and the Aging Center, Duke University Medical Center, Durham, North Carolina
| | - Heather Whitson
- Geriatric Research, Education, and Clinical Center, Durham VA Medical Center, Durham, North Carolina.,Public Health & Preventive Medicine, Oregon Health & Science University
| | - Julie Bynum
- The Dartmouth Institute for Health Policy and Clinical Practice
| | - Stephen Thielke
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.,Geriatric Research, Education, and Clinical Center, Puget Sound VA Medical Center, Seattle, Washington
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Chaudhry SI, McAvay G, Chen S, Whitson H, Newman AB, Krumholz HM, Gill TM. Risk factors for hospital admission among older persons with newly diagnosed heart failure: findings from the Cardiovascular Health Study. J Am Coll Cardiol 2013; 61:635-42. [PMID: 23391194 DOI: 10.1016/j.jacc.2012.11.027] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 10/12/2012] [Accepted: 11/12/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study sought to identify risk factors for the occurrence of all-cause hospital admissions among older persons after heart failure diagnosis, and to determine whether geriatric conditions would emerge as independent risk factors for admission when evaluated in the context of other relevant clinical data. BACKGROUND Efforts to reduce costs in heart failure have focused on hospital utilization, yet few studies have examined how geriatric conditions affect the long-term risk for hospital admission after heart failure diagnosis. With the aging of the population with heart failure, geriatric conditions such as slow gait and muscle weakness are becoming increasingly common. METHODS The study population included participants with a new diagnosis of heart failure in the Cardiovascular Health Study, a longitudinal study of community-living older persons. Data were collected through annual examinations and medical-record reviews. Geriatric conditions assessed were slow gait, muscle weakness (defined as weak grip), cognitive impairment, and depressive symptoms. Anderson-Gill regression modeling was used to determine the predictors of hospital admission after heart failure diagnosis. RESULTS Of the 758 participants with a new diagnosis of heart failure, the mean rate of hospital admission was 7.9 per 10 person-years (95% CI: 7.4 to 8.4). Independent risk factors for hospital admission included diabetes mellitus (HR: 1.36; 95% CI: 1.13 to 1.64), New York Heart Association functional class III or IV (HR: 1.32; 95% CI: 1.11 to 1.57), chronic kidney disease (HR: 1.32; 95% CI: 1.14 to 1.53), slow gait (HR: 1.28; 95% CI: 1.06 to 1.55), depressed ejection fraction (HR: 1.25; 95% CI: 1.04 to 1.51), depression (HR: 1.23; 95% CI: 1.05 to 1.45), and muscle weakness (HR: 1.19; 95% CI: 1.00 to 1.42). CONCLUSIONS Geriatric conditions are important, and potentially modifiable, risk factors for hospital admission in heart failure that should be routinely assessed at the time of heart failure diagnosis.
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Affiliation(s)
- Sarwat I Chaudhry
- Section of General Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
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Thielke SM, Whitson H, Diehr P, O'Hare A, Kearney PM, Chaudhry SI, Zakai NA, Kim D, Sekaran N, Sale JEM, Arnold AM, Chaves P, Newman A. Persistence and remission of musculoskeletal pain in community-dwelling older adults: results from the cardiovascular health study. J Am Geriatr Soc 2012; 60:1393-400. [PMID: 22861385 DOI: 10.1111/j.1532-5415.2012.04082.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To characterize longitudinal patterns of musculoskeletal pain in a community sample of older adults over a 6-year period and to identify factors associated with persistence of pain. DESIGN Secondary analysis of the Cardiovascular Health Study. SETTING Community-based cohort drawn from four U.S. counties. PARTICIPANTS Five thousand ninety-three men and women aged 65 and older. MEASUREMENTS Over a 6-year period, pain was assessed each year using a single question about the presence of pain in any bones or joints during the last year. If affirmative, participants were queried about pain in seven locations (hands, shoulders, neck, back, hips, knees, feet). Participants were categorized according to the percentage of time that pain was present and according to the intermittent or chronic pattern of pain. Factors associated with persistent pain during five remaining years of the study were identified. RESULTS Over 6 years, 32% of participants reported pain for three or more consecutive years, and 32% reported pain intermittently. Of those who reported pain the first year, 54% were pain free at least once during the follow-up period. Most of the pain at specific body locations was intermittent. Factors associated with remission of pain over 5 years included older age, male sex, better self-rated health, not being obese, taking fewer medications, and having fewer depressive symptoms. Approximately half of those with pain reported fewer pain locations the following year. CONCLUSION Musculoskeletal pain in older adults, despite high prevalence, is often intermittent. The findings refute the notion that pain is an inevitable, unremitting, or progressive consequence of aging.
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Affiliation(s)
- Stephen M Thielke
- Department of Psychiatry, University of Washington, Seattle, Washington 98195, USA.
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Whitson H, DeMarco D, Reilly D, Murphy S, Yett HS, Mattingly D, Greenspan SL. Uncoupling of bone turnover following hip replacement. Calcif Tissue Int 2002; 71:14-9. [PMID: 12200656 DOI: 10.1007/s00223-001-1096-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2001] [Accepted: 01/17/2002] [Indexed: 10/27/2022]
Abstract
Studies using total hip replacement surgery as a model for acute hip injury have shown that bone mineral density of the proximal femur decreases 6-18% in the 6 months following surgery. To examine the acute biochemical mechanism associated with bone loss, we measured two indicators of bone formation [serum osteocalcin (OC), serum bone-specific alkaline phosphatase (BSAP)], as well as two markers for bone resorption [urine and serum N-telopeptide cross-linked collagen type 1 (NTx)], in 20 patients (10 men, 10 women, mean age 59.4 years) prior to hip replacement and 1-2 days postsurgery. The average OC value (ng/ml) decreased by 57.3% following surgery (7.5 +/- 4.3 to 3.2 +/- 1.1, P <0.001), and the average BSAP level (U/L) decreased by 27.6% (19.9 +/- 5.6 to 14.4 +/- 3.7, P <0.001). In contrast, levels of urine NTx (nmol BCE/mmol Cr) did not change significantly after the surgery (73.9 +/- 47.2 to 70.1 +/- 29.7). In addition, there was no change in serum NTx (nmol BCE) after surgery (11.8 +/- 2.3 to 11.8 +/- 3.0). Six months after surgery, bone mass had not changed significantly from baseline. These findings suggest that there is an uncoupling of bone turnover following hip replacement surgery which is characterized by significant reductions in bone formation without compensatory decreases in bone resorption, potentially leading to bone loss. Longer periods of follow-up are needed to assess long-term bone mass changes.
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Affiliation(s)
- H Whitson
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
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David Y, Cheng S, Natale D, Whitson H, Keller J, Larkin B. New approaches to technology assessment: opportunities and trends. Biomed Instrum Technol 1993; 27:371-6. [PMID: 8220630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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