1
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Utzschneider KM, Younes N, Butera NM, Balasubramanyam A, Bergenstal RM, Barzilay J, DeSouza C, DeFronzo RA, Elasy T, Krakoff J, Kahn SE, Rasouli N, Valencia WM, Sivitz WI. Impact of Insulin Sensitivity and β-Cell Function Over Time on Glycemic Outcomes in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE): Differential Treatment Effects of Dual Therapy. Diabetes Care 2024; 47:571-579. [PMID: 38190619 PMCID: PMC10973903 DOI: 10.2337/dc23-1059] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/10/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE To compare the effects of insulin sensitivity and β-cell function over time on HbA1c and durability of glycemic control in response to dual therapy. RESEARCH DESIGN AND METHODS GRADE participants were randomized to glimepiride (n = 1,254), liraglutide (n = 1,262), or sitagliptin (n = 1,268) added to baseline metformin and followed for mean ± SD 5.0 ± 1.3 years, with HbA1c assessed quarterly and oral glucose tolerance tests at baseline, 1, 3, and 5 years. We related time-varying insulin sensitivity (HOMA 2 of insulin sensitivity [HOMA2-%S]) and early (0-30 min) and total (0-120 min) C-peptide (CP) responses to changes in HbA1c and glycemic failure (primary outcome HbA1c ≥7% [53 mmol/mol] and secondary outcome HbA1c >7.5% [58 mmol/mol]) and examined differential treatment responses. RESULTS Higher HOMA2-%S was associated with greater initial HbA1c lowering (3 months) but not subsequent HbA1c rise. Greater CP responses were associated with a greater initial treatment response and slower subsequent HbA1c rise. Higher HOMA2-%S and CP responses were each associated with lower risk of primary and secondary outcomes. These associations differed by treatment. In the sitagliptin group, HOMA2-%S and CP responses had greater impact on initial HbA1c reduction (test of heterogeneity, P = 0.009 HOMA2-%S, P = 0.018 early CP, P = 0.001 total CP) and risk of primary outcome (P = 0.005 HOMA2-%S, P = 0.11 early CP, P = 0.025 total CP) but lesser impact on HbA1c rise (P = 0.175 HOMA2-%S, P = 0.006 early CP, P < 0.001 total CP) in comparisons with the glimepiride and liraglutide groups. There were no differential treatment effects on secondary outcome. CONCLUSIONS Insulin sensitivity and β-cell function affected treatment outcomes irrespective of drug assignment, with greater impact in the sitagliptin group on initial (short-term) HbA1c response in comparison with the glimepiride and liraglutide groups.
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Affiliation(s)
- Kristina M. Utzschneider
- VA Puget Sound Health Care System and Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, WA
| | - Naji Younes
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Nicole M. Butera
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Ashok Balasubramanyam
- Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX
| | | | - Joshua Barzilay
- Department of Endocrinology, Kaiser Permanente of Georgia, Duluth, GA
| | - Cyrus DeSouza
- Division of Diabetes, Endocrinology and Metabolism, University of Nebraska and Omaha VA Medical Center, Omaha, NE
| | - Ralph A. DeFronzo
- Diabetes Division, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Tom Elasy
- Vanderbilt University Medical Center, Nashville, TN
| | - Jonathan Krakoff
- Division of General Internal Medicine and Public Health, Southwestern American Indian Center, Phoenix, AZ
| | - Steven E. Kahn
- VA Puget Sound Health Care System and Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, WA
| | - Neda Rasouli
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, and VA Eastern Colorado Health Care System, Aurora, CO
| | - Willy M. Valencia
- Geriatric Research Education and Clinical Center, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL
- Department of Public Health Sciences, University of Miami, Miami, FL
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL
- Endocrinology & Metabolism Institute, Cleveland Clinic, Cleveland, OH
| | - William I. Sivitz
- Department of Internal Medicine, Endocrinology and Metabolism, University of Iowa, Iowa City, IA
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2
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Wilkins SS, Melrose RJ, Hall KS, Blanchard E, Castle SC, Kopp T, Katzel LI, Holder A, Alexander N, McDonald MKS, Tayade A, Forman DE, Abbate LM, Harris R, Valencia WM, Morey MC, Lee CC. PTSD Improvement Associated with Social Connectedness in Gerofit Veterans Exercise Program. J Am Geriatr Soc 2020; 69:1045-1050. [PMID: 33368144 DOI: 10.1111/jgs.16973] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/05/2020] [Accepted: 11/08/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Post-traumatic stress disorder (PTSD) is common in Veterans. Symptoms can perpetuate into late life, negatively impacting physical and mental health. Exercise and social support are beneficial in treating anxiety disorders such as PTSD in the general population, although less is known about the impact on Veterans who have lived with PTSD for decades. This study assessed associations between social connectedness, physical function and self-reported change in PTSD symptoms among older Veterans specifically participating in Gerofit. DESIGN Prospective clinical intervention. SETTING Twelve sites of Veterans Affairs (VA) Gerofit exercise program across the United States. PARTICIPANTS Three hundred and twenty one older Veteran Gerofit participants (mean age = 74) completed physical assessments and questionnaires regarding physical and emotional symptoms and their experience. MEASUREMENTS Measures of physical function, including 30-second chair stands, 10-m and 6-min walk were assessed at baseline and 3 months; change in PTSD symptoms based on the Diagnostic Statistical Manual-5 (DSM-5) assessed by a self-report questionnaire; and social connection measured by the Relatedness Subscale of the Psychological Need Satisfaction in Exercise scale (PNSE) were evaluated after 3 months of participation in Gerofit. RESULTS Ninety five (29.6%) Veterans reported PTSD. Significant improvement was noted in self-rated PTSD symptoms at 3 months (P < .05). Moderate correlation (r = .44) was found between social connectedness with other participants in Gerofit and PTSD symptom improvement for those Veterans who endorsed improvement (n = 59). All participants improved on measures of physical function. In Veterans who endorsed PTSD there were no significant associations between physical function improvement and PTSD symptoms. CONCLUSION Veterans with PTSD that participated in Gerofit group exercise reported symptom improvement, and social connectedness was significantly associated with this improvement. In addition to physical health benefits, the social context of Gerofit may offer a potential resource for improving PTSD symptoms in older Veterans that warrants further study.
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Affiliation(s)
- Stacy Schantz Wilkins
- VA Greater Los Angeles Healthcare System; Geriatric Research, Education, and Clinical Center and Mental Health, Los Angeles, California, USA.,Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Rebecca J Melrose
- VA Greater Los Angeles Healthcare System; Geriatric Research, Education, and Clinical Center and Mental Health, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Katherine S Hall
- Geriatric Research, Education, and Clinical Center, VA Health Care System, Durham, North Carolina, USA.,Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Erin Blanchard
- VA Greater Los Angeles Healthcare System; Geriatric Research, Education, and Clinical Center and Mental Health, Los Angeles, California, USA
| | - Steven C Castle
- VA Greater Los Angeles Healthcare System; Geriatric Research, Education, and Clinical Center and Mental Health, Los Angeles, California, USA.,Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Teresa Kopp
- Department of Physical Medicine and Rehabilitation, VA Medical Center, Canandaigua, New York, USA
| | - Leslie I Katzel
- Geriatric Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, Maryland, USA.,Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Alice Holder
- Department of Physical Therapy, VA Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Neil Alexander
- Geriatric Research, Education, and Clinical Center, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Michelle K S McDonald
- Geriatric Rehabilitation and Clinical Center, VA Pacific Health Care System, Honolulu, Hawaii, USA
| | - Arti Tayade
- Geriatrics and Extended Care, VA Puget Sound Health Care System, Seattle, Washington, USA.,Division of Gerontology & Geriatric Medicine, University of Washington, Seattle, Washington, USA
| | - Daniel E Forman
- Pittsburgh Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.,Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Lauren M Abbate
- Geriatric Research, Education, and Clinical Center, Eastern Colorado Health Care System, Aurora, Colorado, USA.,Department of Emergency Medicine, University of Colorado, Aurora, Colorado, USA
| | - Rebekah Harris
- Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Willy M Valencia
- Geriatric Research, Education, and Clinical Center, Miami Healthcare System, Florida, USA.,University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Miriam C Morey
- Geriatric Research, Education, and Clinical Center, VA Health Care System, Durham, North Carolina, USA.,Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Cathy C Lee
- VA Greater Los Angeles Healthcare System; Geriatric Research, Education, and Clinical Center and Mental Health, Los Angeles, California, USA.,Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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3
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Jennings SC, Manning KM, Bettger JP, Hall KM, Pearson M, Mateas C, Briggs BC, Oursler KK, Blanchard E, Lee CC, Castle S, Valencia WM, Katzel LI, Giffuni J, Kopp T, McDonald M, Harris R, Bean JF, Althuis K, Alexander NB, Padala KP, Abbate LM, Wellington T, Kostra J, Allsup K, Forman DE, Tayade AS, Wesley AD, Holder A, Morey MC. Rapid Transition to Telehealth Group Exercise and Functional Assessments in Response to COVID-19. Gerontol Geriatr Med 2020; 6:2333721420980313. [PMID: 33403222 PMCID: PMC7739082 DOI: 10.1177/2333721420980313] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 09/04/2020] [Revised: 10/08/2020] [Accepted: 11/12/2020] [Indexed: 12/25/2022] Open
Abstract
Exercise is critical for health maintenance in late life. The COVID-19 shelter in place and social distancing orders resulted in wide-scale interruptions of exercise therapies, placing older adults at risk for the consequences of decreased mobilization. The purpose of this paper is to describe rapid transition of the Gerofit facility-based group exercise program to telehealth delivery. This Gerofit-to-Home (GTH) program continued with group-based synchronous exercise classes that ranged from 1 to 24 Veterans per class and 1 to 9 classes offered per week in the different locations. Three hundred and eight of 1149 (27%) Veterans active in the Gerofit facility-based programs made the transition to the telehealth delivered classes. Participants’ physical performance testing continued remotely as scheduled with comparisons between most recent facility-based and remote testing suggesting that participants retained physical function. Detailed protocols for remote physical performance testing and sample exercise routines are described. Translation to remote delivery of exercise programs for older adults could mitigate negative health effects.
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Affiliation(s)
| | | | - Janet Prvu Bettger
- VA Health Care System, Durham, NC, USA.,Duke University Medical Center, Durham, NC, USA.,Duke University, Durham, NC, USA
| | - Katherine M Hall
- VA Health Care System, Durham, NC, USA.,Duke University Medical Center, Durham, NC, USA.,Duke University, Durham, NC, USA
| | | | | | | | - Krisann K Oursler
- Salem VA Medical Center, VA, USA.,Virginia Tech Carilion School of Medicine, Roanoke, USA
| | | | - Cathy C Lee
- VA Greater Los Angeles Healthcare System, CA, USA.,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Steven Castle
- VA Greater Los Angeles Healthcare System, CA, USA.,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Willy M Valencia
- Miami Healthcare System, FL, USA.,University of Miami, Miller School of Medicine, FL, USA
| | - Leslie I Katzel
- VA Maryland Health Care System, Baltimore, USA.,University of Maryland School of Medicine, Baltimore, USA
| | - Jamie Giffuni
- VA Maryland Health Care System, Baltimore, USA.,University of Maryland School of Medicine, Baltimore, USA
| | | | | | | | - Jonathan F Bean
- VA Boston Healthcare System, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Katherine Althuis
- VA Ann Arbor Healthcare System, MI, USA.,University of Michigan, Ann Arbor, USA
| | - Neil B Alexander
- VA Ann Arbor Healthcare System, MI, USA.,University of Michigan, Ann Arbor, USA
| | - Kalpana P Padala
- Central Arkansas Veterans Healthcare System, Little Rock, USA.,University of Arkansas for Medical Sciences, Little Rock, USA
| | - Lauren M Abbate
- Eastern Colorado Health Care System, Aurora, USA.,Unverisity of Colorado, Aurora, USA
| | | | - James Kostra
- VA Pittsburgh Healthcare System, PA, USA.,University of Pittsburgh, PA, USA
| | | | - Daniel E Forman
- VA Pittsburgh Healthcare System, PA, USA.,University of Pittsburgh, PA, USA.,University of Pittsburgh Medical Center, PA, USA
| | - Arti S Tayade
- VA Puget Sound Health Care System, Seattle, WA, USA.,University of Washington, Seattle, USA
| | | | | | - Miriam C Morey
- VA Health Care System, Durham, NC, USA.,Duke University Medical Center, Durham, NC, USA
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4
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Pepin MJ, Valencia WM, Bettger JP, Pearson M, Manning KM, Sloane R, Schmader KE, Morey MC. Impact of Supervised Exercise on One-Year Medication Use in Older Veterans with Multiple Morbidities. Gerontol Geriatr Med 2020; 6:2333721420956751. [PMID: 32995368 PMCID: PMC7503003 DOI: 10.1177/2333721420956751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/14/2020] [Indexed: 11/16/2022] Open
Abstract
Exercise is touted as the ideal prescription to treat and prevent many chronic diseases. We examined changes in utilization and cost of medication classes commonly prescribed in the management of chronic conditions following participation in 12-months of supervised exercise within the Veterans Affairs Gerofit program. Gerofit enrolled 480 veterans between 1999 and 2017 with 12-months participation, with 453 having one or more active prescriptions on enrollment. Active prescriptions overall and for five classes of medications were examined. Changes from enrollment to 12 months were calculated, and cost associated with prescriptions filled were used to estimate net cost changes. Active prescriptions were reduced for opioids (77 of 164, 47%), mental health (93 of 221, 42%), cardiac (175 of 391, 45%), diabetes (41 of 166, 25%), and lipid lowering (56 of 253, 22%) agents. Cost estimates resulted in a net savings of $38,400. These findings support the role of supervised exercise as a favorable therapeutic intervention that has impact across chronic conditions.
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Affiliation(s)
| | - Willy M Valencia
- Miami Healthcare System, FL, USA.,University of Miami, Miami, FL, USA
| | | | | | | | - Richard Sloane
- Duke University Medical Center, Durham, NC, USA.,Center for Aging/ OAIC, Duke University, NC USA
| | - Kenneth E Schmader
- VA Health Care System, Durham, NC, USA.,Duke University Medical Center, Durham, NC, USA.,Center for Aging/ OAIC, Duke University, NC USA
| | - Miriam C Morey
- VA Health Care System, Durham, NC, USA.,Duke University Medical Center, Durham, NC, USA.,Center for Aging/ OAIC, Duke University, NC USA
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5
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Valencia WM, Florez HJ, Palacio AM. Suitable Use of Injectable Agents to Overcome Hypoglycemia Risk, Barriers, and Clinical Inertia in Community-Dwelling Older Adults with Type 2 Diabetes Mellitus. Drugs Aging 2020; 36:1083-1096. [PMID: 31565780 PMCID: PMC7481154 DOI: 10.1007/s40266-019-00706-4] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The management of type 2 diabetes mellitus in older adults requires a comprehensive understanding of the relationship between the disease (medical) and the functional, psychological/cognitive, and social geriatric domains, to individualize both glycemic targets and therapeutic approaches. Prevention of hypoglycemia is a major priority that should be addressed as soon as its presence or risk is detected, adjusting the target and therapeutics accordingly. Nonetheless, treatment intensification should not be neglected when applicable, consistent with recommendations from organizations such as the American Geriatrics Society and the American Diabetes Association, to reduce not only long-term macrovascular and microvascular complications (individualization), but also short-term complications from hyperglycemia (polyuria, volume depletion, urinary incontinence). Such complications can negatively impact the physical and cognitive function of older adults, worsen their quality of life, and additionally affect their families and society. We emphasize individualization, utilizing the multiple classes of antihyperglycemic agents available. Metformin remains as first-line therapy, and additional agents offer advantages and disadvantages that ought to be considered when developing a patient-centric plan of care. For selected cases, injectable therapies such as long-acting basal insulin analogs and glucagon-like peptide-1 receptor agonists can offer advantages to counter hypoglycemia risk, patient-related barriers, and clinical inertia. Furthermore, some injectable agents could potentially simplify regimens while providing safe and effective glycemic control. In this review, we discuss the use of injectable therapies for selected community-dwelling older adults, barriers to transition to injectable therapy, and measures aimed at removing these barriers and assisting physicians and their teams to transition older patients to injectable therapies when appropriate.
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Affiliation(s)
- Willy M Valencia
- Geriatrics Research, Education and Clinical Center (GRECC), Miami VA Healthcare System, 1201 NW 16th St., 11 GRC, CLC 207 A2, Miami, FL, 33125, USA. .,Department of Humanities, Health and Society, Florida International University Herbert Wertheim College of Medicine, Miami, FL, 33199, USA. .,Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, 33136, USA.
| | - Hermes J Florez
- Geriatrics Research, Education and Clinical Center (GRECC), Miami VA Healthcare System, 1201 NW 16th St., 11 GRC, CLC 207 A2, Miami, FL, 33125, USA.,Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, 33136, USA.,Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Ana M Palacio
- Geriatrics Research, Education and Clinical Center (GRECC), Miami VA Healthcare System, 1201 NW 16th St., 11 GRC, CLC 207 A2, Miami, FL, 33125, USA.,Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, 33136, USA.,Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
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6
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Manning KM, McNeill DL, Pinheiro SO, Heflin MT, Valencia WM, Lee CC, Castle SC, Katzel L, Giffuni J, Morey MC. An innovative educational clinical experience promoting geriatric exercise. Gerontol Geriatr Educ 2020; 41:20-31. [PMID: 29028419 DOI: 10.1080/02701960.2017.1391802] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Formal educational training in physical activity promotion is relatively sparse throughout the medical education system. The authors describe an innovative clinical experience in physical activity directed at medical clinicians on a geriatrics rotation. The experience consists of a single 2 1/2 hour session, in which learners are partnered with geriatric patients engaged in a formal supervised exercise program. The learners are guided through an evidence-based exercise regimen tailored to functional status. This experience provides learners with an opportunity to interact with geriatric patients outside the hospital environment to counterbalance the typical geriatric rotation in which geriatric patients are often seen in clinics or hospitals. In this experience, learners are exposed to fit and engaged geriatric patients successfully living in the community despite chronic or disabling conditions. A survey of 105 learners highlighted positive responses to the experience, with 96% of survey respondents indicating that the experience increased their confidence in their ability to serve as advocates for physical activity for older adults, and 89.5% of responders to a follow-up survey indicating that the experience changed their perception of geriatric patients. Modifications to the experience, implemented at partnering facilities are described. The positive feedback from this experience warrants consideration for implementation in other settings.
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Affiliation(s)
- Kenneth M Manning
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, North Carolina USA
| | - Darien L McNeill
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, North Carolina USA
- University of North Carolina School of Medicine, Chapel Hill, North Carolina USA
| | - Sandro O Pinheiro
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, North Carolina USA
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, North Carolina USA
- Department of Medicine, Duke University Medical Center, Durham, North Carolina USA
| | - Mitchell T Heflin
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, North Carolina USA
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, North Carolina USA
- Department of Medicine, Duke University Medical Center, Durham, North Carolina USA
| | - Willy M Valencia
- Geriatric Research, Education, and Clinical Center, VA Healthcare System, Miami, Florida USA
- Division of Epidemiology, Division of Geriatric Medicine, University of Miami Miller School of Medicine, Miami, Florida USA
| | - Cathy C Lee
- Geriatric Research, Education, and Clinical Center, Greater Los Angeles VA Healthcare System, Los Angeles, California USA
- David Geffen School of Medicine at the University of California, Los Angeles, California USA
| | - Steven C Castle
- Geriatric Research, Education, and Clinical Center, Greater Los Angeles VA Healthcare System, Los Angeles, California USA
- David Geffen School of Medicine at the University of California, Los Angeles, California USA
| | - Leslie Katzel
- Geriatric Research and Education Clinical Center, Baltimore VA Medical Center, Baltimore, Maryland
- Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine and Geriatric Research and Education Clinical Center, Baltimore, Maryland USA
| | | | - Miriam C Morey
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, North Carolina USA
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, North Carolina USA
- Department of Medicine, Duke University Medical Center, Durham, North Carolina USA
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7
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Addison O, Serra MC, Katzel L, Giffuni J, Lee CC, Castle S, Valencia WM, Kopp T, Cammarata H, McDonald M, Oursler KA, Jain C, Bettger JP, Pearson M, Manning KM, Intrator O, Veazie P, Sloane R, Li J, Morey MC. Mobility Improvements are Found in Older Veterans After 6-Months of Gerofit Regardless of BMI Classification. J Aging Phys Act 2019; 27:848-854. [PMID: 31170861 PMCID: PMC7184640 DOI: 10.1123/japa.2018-0317] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Veterans represent a unique population of older adults as they are more likely to self-report disability and be overweight or obese compared to the general population. We sought to compare changes in mobility function across the obesity spectrum in older Veterans participating in six-months of Gerofit, a clinical exercise program. 270 Veterans completed baseline, three, and six-month functional assessment and were divided post-hoc into groups: normal weight, overweight, and obese. Physical function assessment included: ten-meter walk time, six-minute walk distance, 30-second chair stands, and eight-foot up-and-go time. No significant weight x time interactions were found for any measure. However, significant (P<0.02) improvements were found for all mobility measures from baseline to three-months and maintained at six-months. Six-months of participation in Gerofit, if enacted nationwide, appears to be one way to improve mobility and function in older Veterans at high risk for disability regardless of weight status.
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Affiliation(s)
- Odessa Addison
- 1 Geriatric Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, MD
- 2 School of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Monica C Serra
- 3 Atlanta VA Medical Center, Atlanta, GA
- 4 School of Medicine, Emory University, Atlanta, GA
| | - Leslie Katzel
- 1 Geriatric Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, MD
- 2 School of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Jamie Giffuni
- 1 Geriatric Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, MD
| | - Cathy C Lee
- 5 Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, CA
- 6 David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Steven Castle
- 5 Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, CA
- 6 David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Willy M Valencia
- 7 Geriatric Research, Education, and Clinical Center, Miami Healthcare System, FL
- 8 University of Miami, Miller School of Medicine, Miami, FL
| | | | | | - Michelle McDonald
- 10 Geritaric Rehabilitation and Clinical Center, VA Pacific Health Care System, Honolulu, HI
| | - Kris A Oursler
- 11 Geriatric Research and Education, VA Medical Center, Salem, VA
| | - Chani Jain
- 11 Geriatric Research and Education, VA Medical Center, Salem, VA
| | - Janet Prvu Bettger
- 12 Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC
| | - Megan Pearson
- 13 Geriatric Research, Education, and Clinical Center, VA Health Care System, Durham, NC
| | - Kenneth M Manning
- 13 Geriatric Research, Education, and Clinical Center, VA Health Care System, Durham, NC
| | - Orna Intrator
- 14 Geriatrics and Extended Care Data and Analyses Center, VA Medical Center, Canandaigua, University of Rochester, Medical Center, Rochester, NY
- 15 Center for the Study of Aging / Claude D. Pepper Older Americans Independence Center
| | - Peter Veazie
- 14 Geriatrics and Extended Care Data and Analyses Center, VA Medical Center, Canandaigua, University of Rochester, Medical Center, Rochester, NY
- 15 Center for the Study of Aging / Claude D. Pepper Older Americans Independence Center
| | - Richard Sloane
- 16 Department of Medicine, Duke University Medical Center, Durham, NC
| | - Jiejin Li
- 14 Geriatrics and Extended Care Data and Analyses Center, VA Medical Center, Canandaigua, University of Rochester, Medical Center, Rochester, NY
- 15 Center for the Study of Aging / Claude D. Pepper Older Americans Independence Center
| | - Miriam C Morey
- 13 Geriatric Research, Education, and Clinical Center, VA Health Care System, Durham, NC
- 16 Department of Medicine, Duke University Medical Center, Durham, NC
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8
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Briggs BC, Jain C, Morey MC, Blanchard EH, Lee CC, Valencia WM, Oursler KK. Providing Rural Veterans With Access to Exercise Through Gerofit. Fed Pract 2018; 35:16-23. [PMID: 30766328 PMCID: PMC6366594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Clinical video telehealth can be used to deliver functional circuit exercise training to older veterans in remote locations.
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Affiliation(s)
- Brandon C Briggs
- is an Exercise Physiologist, is a Biostatistician, and is a Physician and the Director of Geriatric Research and Education at the Salem VAMC in Virginia. is Associate Director of Research in the Geriatric Research, Education, and Clinical Center (GRECC) at Durham VAMC in North Carolina. is an Exercise Physiologist and is a Physician in the GRECC at the Greater Los Angeles VAHS in California. is a physician in the GRECC at the Miami VAHS in Florida. Dr. Morey is a Professor at Duke University Medical Center in Durham. Dr. Lee is an Associate Professor at the David Geffen School of Medicine at University of California Los Angeles. Dr. Valencia is an Assistant Professor at University of Miami Miller School of Medicine and Florida International University in Miami, Florida. Dr. Oursler is an Associate Professor at Virginia Tech Carilion School of Medicine in Roanoke, Virginia
| | - Chani Jain
- is an Exercise Physiologist, is a Biostatistician, and is a Physician and the Director of Geriatric Research and Education at the Salem VAMC in Virginia. is Associate Director of Research in the Geriatric Research, Education, and Clinical Center (GRECC) at Durham VAMC in North Carolina. is an Exercise Physiologist and is a Physician in the GRECC at the Greater Los Angeles VAHS in California. is a physician in the GRECC at the Miami VAHS in Florida. Dr. Morey is a Professor at Duke University Medical Center in Durham. Dr. Lee is an Associate Professor at the David Geffen School of Medicine at University of California Los Angeles. Dr. Valencia is an Assistant Professor at University of Miami Miller School of Medicine and Florida International University in Miami, Florida. Dr. Oursler is an Associate Professor at Virginia Tech Carilion School of Medicine in Roanoke, Virginia
| | - Miriam C Morey
- is an Exercise Physiologist, is a Biostatistician, and is a Physician and the Director of Geriatric Research and Education at the Salem VAMC in Virginia. is Associate Director of Research in the Geriatric Research, Education, and Clinical Center (GRECC) at Durham VAMC in North Carolina. is an Exercise Physiologist and is a Physician in the GRECC at the Greater Los Angeles VAHS in California. is a physician in the GRECC at the Miami VAHS in Florida. Dr. Morey is a Professor at Duke University Medical Center in Durham. Dr. Lee is an Associate Professor at the David Geffen School of Medicine at University of California Los Angeles. Dr. Valencia is an Assistant Professor at University of Miami Miller School of Medicine and Florida International University in Miami, Florida. Dr. Oursler is an Associate Professor at Virginia Tech Carilion School of Medicine in Roanoke, Virginia
| | - Erin H Blanchard
- is an Exercise Physiologist, is a Biostatistician, and is a Physician and the Director of Geriatric Research and Education at the Salem VAMC in Virginia. is Associate Director of Research in the Geriatric Research, Education, and Clinical Center (GRECC) at Durham VAMC in North Carolina. is an Exercise Physiologist and is a Physician in the GRECC at the Greater Los Angeles VAHS in California. is a physician in the GRECC at the Miami VAHS in Florida. Dr. Morey is a Professor at Duke University Medical Center in Durham. Dr. Lee is an Associate Professor at the David Geffen School of Medicine at University of California Los Angeles. Dr. Valencia is an Assistant Professor at University of Miami Miller School of Medicine and Florida International University in Miami, Florida. Dr. Oursler is an Associate Professor at Virginia Tech Carilion School of Medicine in Roanoke, Virginia
| | - Cathy C Lee
- is an Exercise Physiologist, is a Biostatistician, and is a Physician and the Director of Geriatric Research and Education at the Salem VAMC in Virginia. is Associate Director of Research in the Geriatric Research, Education, and Clinical Center (GRECC) at Durham VAMC in North Carolina. is an Exercise Physiologist and is a Physician in the GRECC at the Greater Los Angeles VAHS in California. is a physician in the GRECC at the Miami VAHS in Florida. Dr. Morey is a Professor at Duke University Medical Center in Durham. Dr. Lee is an Associate Professor at the David Geffen School of Medicine at University of California Los Angeles. Dr. Valencia is an Assistant Professor at University of Miami Miller School of Medicine and Florida International University in Miami, Florida. Dr. Oursler is an Associate Professor at Virginia Tech Carilion School of Medicine in Roanoke, Virginia
| | - Willy M Valencia
- is an Exercise Physiologist, is a Biostatistician, and is a Physician and the Director of Geriatric Research and Education at the Salem VAMC in Virginia. is Associate Director of Research in the Geriatric Research, Education, and Clinical Center (GRECC) at Durham VAMC in North Carolina. is an Exercise Physiologist and is a Physician in the GRECC at the Greater Los Angeles VAHS in California. is a physician in the GRECC at the Miami VAHS in Florida. Dr. Morey is a Professor at Duke University Medical Center in Durham. Dr. Lee is an Associate Professor at the David Geffen School of Medicine at University of California Los Angeles. Dr. Valencia is an Assistant Professor at University of Miami Miller School of Medicine and Florida International University in Miami, Florida. Dr. Oursler is an Associate Professor at Virginia Tech Carilion School of Medicine in Roanoke, Virginia
| | - Krisann K Oursler
- is an Exercise Physiologist, is a Biostatistician, and is a Physician and the Director of Geriatric Research and Education at the Salem VAMC in Virginia. is Associate Director of Research in the Geriatric Research, Education, and Clinical Center (GRECC) at Durham VAMC in North Carolina. is an Exercise Physiologist and is a Physician in the GRECC at the Greater Los Angeles VAHS in California. is a physician in the GRECC at the Miami VAHS in Florida. Dr. Morey is a Professor at Duke University Medical Center in Durham. Dr. Lee is an Associate Professor at the David Geffen School of Medicine at University of California Los Angeles. Dr. Valencia is an Assistant Professor at University of Miami Miller School of Medicine and Florida International University in Miami, Florida. Dr. Oursler is an Associate Professor at Virginia Tech Carilion School of Medicine in Roanoke, Virginia
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Ruiz JG, Rahaman Z, Dang S, Anam R, Valencia WM, Mintzer MJ. Association of the CAN score with the FRAIL scale in community dwelling older adults. Aging Clin Exp Res 2018; 30:1241-1245. [PMID: 29468614 DOI: 10.1007/s40520-018-0910-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 02/08/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Frailty is a state of vulnerability to stressors which results in higher morbidity, mortality and healthcare utilization. The FRAIL scale is used as a validated screening for frailty. The Care Assessment Need (CAN) score is automatically generated from electronic health record data using a statistical model that includes data elements similar to the deficit accumulation model for frailty and predicts risk for hospitalization and/or mortality. AIM To determine the correlation of the CAN score with the FRAIL scale. METHODS A cross-sectional study of 503 community-dwelling older adults. We compared the FRAIL scale with the CAN score. RESULTS The CAN score was significantly different between robust, prefrail and frail. Post hoc analysis revealed significant increases in scores from robust to prefrail and frail groups, in that order. The CAN score and FRAIL scale showed a correlation. CONCLUSIONS The CAN score show a moderate positive association with the FRAIL scale.
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Affiliation(s)
- Jorge G Ruiz
- Veterans' Successful Aging for Frail Elders (VSAFE) Program, Miami VA Healthcare System Geriatric Research Education and Clinical Center (GRECC), Bruce W. Carter Miami VAMC, 1201 NW 16th Street, Miami, FL, 33125, USA.
- University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Zubair Rahaman
- Veterans' Successful Aging for Frail Elders (VSAFE) Program, Miami VA Healthcare System Geriatric Research Education and Clinical Center (GRECC), Bruce W. Carter Miami VAMC, 1201 NW 16th Street, Miami, FL, 33125, USA
| | - Stuti Dang
- Veterans' Successful Aging for Frail Elders (VSAFE) Program, Miami VA Healthcare System Geriatric Research Education and Clinical Center (GRECC), Bruce W. Carter Miami VAMC, 1201 NW 16th Street, Miami, FL, 33125, USA
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ramanakumar Anam
- Veterans' Successful Aging for Frail Elders (VSAFE) Program, Miami VA Healthcare System Geriatric Research Education and Clinical Center (GRECC), Bruce W. Carter Miami VAMC, 1201 NW 16th Street, Miami, FL, 33125, USA
| | - Willy M Valencia
- Veterans' Successful Aging for Frail Elders (VSAFE) Program, Miami VA Healthcare System Geriatric Research Education and Clinical Center (GRECC), Bruce W. Carter Miami VAMC, 1201 NW 16th Street, Miami, FL, 33125, USA
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael J Mintzer
- Veterans' Successful Aging for Frail Elders (VSAFE) Program, Miami VA Healthcare System Geriatric Research Education and Clinical Center (GRECC), Bruce W. Carter Miami VAMC, 1201 NW 16th Street, Miami, FL, 33125, USA
- FIU Herbert Wertheim College of Medicine, Miami, FL, USA
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10
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Ruiz JG, Priyadarshni S, Rahaman Z, Cabrera K, Dang S, Valencia WM, Mintzer MJ. Validation of an automatically generated screening score for frailty: the care assessment need (CAN) score. BMC Geriatr 2018; 18:106. [PMID: 29728064 PMCID: PMC5935952 DOI: 10.1186/s12877-018-0802-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 04/30/2018] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Frailty is a state of vulnerability to stressors that is prevalent in older adults and is associated with higher morbidity, mortality and healthcare utilization. Multiple instruments are used to measure frailty; most are time-consuming. The Care Assessment Need (CAN) score is automatically generated from electronic health record data using a statistical model. The methodology for calculation of the CAN score is consistent with the deficit accumulation model of frailty. At a 95 percentile, the CAN score is a predictor of hospitalization and mortality in Veteran populations. The purpose of this study was to validate the CAN score as a screening tool for frailty in primary care. METHODS This is a cross-sectional, validation study compared the CAN score with a 40-item Frailty Index reference standard based on a comprehensive geriatric assessment. We included community-dwelling male patients over age 65 from an outpatient geriatric medicine clinic. We calculated the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of the CAN score. RESULTS 184 patients over age 65 were included in the study: 97.3% male, 64.2% White, 80.9% non-Hispanic. The CGA-based Frailty Index defined 14.1% as robust, 53.3% as prefrail and 32.6% as frail. For the frail, statistical analysis demonstrated that a CAN score of 55 provides sensitivity, specificity, PPV and NPV of 91.67, 40.32, 42.64 and 90.91% respectively whereas at a score of 95 the sensitivity, specificity, PPV and NPV were 43.33, 88.81, 63.41, 77.78% respectively. Area under the receiver operating characteristics curve was 0.736 (95% CI = .661-.811). CONCLUSION CAN score is a potential screening tool for frailty among older adults; it is generated automatically and provides acceptable diagnostic accuracy. Hence, the CAN score may be a useful tool to primary care providers for detection of frailty in their patient panels.
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Affiliation(s)
- Jorge G. Ruiz
- Veterans’ Successful Aging for Frail Elders (VSAFE) Program, Miami VA Healthcare System Geriatric Research Education and Clinical Center (GRECC), Bruce W. Carter Miami VAMC, 11 GRC, 1201 NW 16th Street, Miami, Florida, 33125 USA
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Shivani Priyadarshni
- Veterans’ Successful Aging for Frail Elders (VSAFE) Program, Miami VA Healthcare System Geriatric Research Education and Clinical Center (GRECC), Bruce W. Carter Miami VAMC, 11 GRC, 1201 NW 16th Street, Miami, Florida, 33125 USA
| | - Zubair Rahaman
- Veterans’ Successful Aging for Frail Elders (VSAFE) Program, Miami VA Healthcare System Geriatric Research Education and Clinical Center (GRECC), Bruce W. Carter Miami VAMC, 11 GRC, 1201 NW 16th Street, Miami, Florida, 33125 USA
| | - Kimberly Cabrera
- Veterans’ Successful Aging for Frail Elders (VSAFE) Program, Miami VA Healthcare System Geriatric Research Education and Clinical Center (GRECC), Bruce W. Carter Miami VAMC, 11 GRC, 1201 NW 16th Street, Miami, Florida, 33125 USA
| | - Stuti Dang
- Veterans’ Successful Aging for Frail Elders (VSAFE) Program, Miami VA Healthcare System Geriatric Research Education and Clinical Center (GRECC), Bruce W. Carter Miami VAMC, 11 GRC, 1201 NW 16th Street, Miami, Florida, 33125 USA
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Willy M. Valencia
- Veterans’ Successful Aging for Frail Elders (VSAFE) Program, Miami VA Healthcare System Geriatric Research Education and Clinical Center (GRECC), Bruce W. Carter Miami VAMC, 11 GRC, 1201 NW 16th Street, Miami, Florida, 33125 USA
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael J. Mintzer
- Veterans’ Successful Aging for Frail Elders (VSAFE) Program, Miami VA Healthcare System Geriatric Research Education and Clinical Center (GRECC), Bruce W. Carter Miami VAMC, 11 GRC, 1201 NW 16th Street, Miami, Florida, 33125 USA
- Florida International University, Herbert Wertheim College of Medicine, Miami, USA
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11
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Morey MC, Lee CC, Castle S, Valencia WM, Katzel L, Giffuni J, Kopp T, Cammarata H, McDonald M, Oursler KA, Wamsley T, Jain C, Bettger JP, Pearson M, Manning KM, Intrator O, Veazie P, Sloane R, Li J, Parker DC. Should Structured Exercise Be Promoted As a Model of Care? Dissemination of the Department of Veterans Affairs Gerofit Program. J Am Geriatr Soc 2018; 66:1009-1016. [PMID: 29430642 DOI: 10.1111/jgs.15276] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 01/05/2023]
Abstract
Exercise provides a wide range of health-promoting benefits, but support is limited for clinical programs that use exercise as a means of health promotion. This stands in contrast to restorative or rehabilitative exercise, which is considered an essential medical service. We propose that there is a place for ongoing, structured wellness and health promotion programs, with exercise as the primary therapeutic focus. Such programs have long-lasting health benefits, are easily implementable, and are associated with high levels of participant satisfaction. We describe the dissemination and implementation of a long-standing exercise and health promotion program, Gerofit, for which significant gains in physical function that have been maintained over 5 years of follow-up, improvements in well-being, and a 10-year 25% survival benefit among program adherents have been documented. The program has been replicated at 6 Veterans Affairs Medical Centers. The pooled characteristics of enrolled participants (n = 691) demonstrate substantial baseline functional impairment (usual gait speed 1.05 ± 0.3 m/s, 8-foot up and go 8.7 ± 6.7 seconds, 30-second chair stands 10.7 ± 5.1, 6-minute walk distance 404.31 ± 141.9 m), highlighting the need for such programs. Change scores over baseline for 3, 6, and 12 months of follow-up are clinically and statistically significant (P < .05 all measures) and replicate findings from the parent program. Patient satisfaction ratings of high ranged from 88% to 94%. We describe the implementation process and present 1-year outcomes. We suggest that such programs be considered essential elements of healthcare systems.
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Affiliation(s)
- Miriam C Morey
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Health Care System, Durham, North Carolina.,Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Cathy C Lee
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.,David Geffen School of Medicine, University of California, Los Angeles, California
| | - Steven Castle
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.,David Geffen School of Medicine, University of California, Los Angeles, California
| | - Willy M Valencia
- Geriatric Research, Education, and Clinical Center, Miami Healthcare System, Miami, Florida.,University of Miami, Miller School of Medicine, Miami, Florida
| | - Leslie Katzel
- Geriatric Research, Education and Clinical Center, Veterans Affairs Maryland Health Care System, Baltimore, Maryland.,School of Medicine, University of Maryland, Baltimore, Maryland
| | - Jamie Giffuni
- Geriatric Research, Education and Clinical Center, Veterans Affairs Maryland Health Care System, Baltimore, Maryland
| | - Teresa Kopp
- Veterans Affairs Medical Center, Canandaigua, New York
| | | | - Michelle McDonald
- Geriatric Rehabilitation and Clinical Center, Veterans Affairs Pacific Health Care System, Honolulu, Hawaii
| | - Kris A Oursler
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Salem, Virginia
| | - Timothy Wamsley
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Salem, Virginia
| | - Chani Jain
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Salem, Virginia
| | - Janet P Bettger
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Megan Pearson
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Health Care System, Durham, North Carolina
| | - Kenneth M Manning
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Health Care System, Durham, North Carolina
| | - Orna Intrator
- Geriatrics and Extended Care Data and Analysis Center, Veterans Affairs Medical Center, Canandaigua, New York.,University of Rochester Medical Center, Rochester, New York
| | - Peter Veazie
- Geriatrics and Extended Care Data and Analysis Center, Veterans Affairs Medical Center, Canandaigua, New York.,University of Rochester Medical Center, Rochester, New York
| | - Richard Sloane
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Jiejin Li
- Geriatrics and Extended Care Data and Analysis Center, Veterans Affairs Medical Center, Canandaigua, New York.,University of Rochester Medical Center, Rochester, New York
| | - Daniel C Parker
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Health Care System, Durham, North Carolina
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Abstract
KEY POINTS Falls are a major health issue for older adults, leading to adverse events and even death. Older persons with type 2 diabetes are at increased risk of falling compared to healthy adults of a similar age. Over 400 factors are associated with falls risk, making identification and targeting of key factors to prevent falls problematic. However, the major risk factors include hypertension, diabetes, pain, and polypharmacy. In addition to age and polypharmacy, diabetes-related loss of strength, sensory perception, and balance secondary to peripheral neuropathy along with decline in cognitive function lead to increased risk of falling. Designing specific interventions to target strength and balance training, reducing polypharmacy to improve cognitive function, relaxation of diabetes management to avoid hypoglycemia and hypotension, and relief of pain will produce the greatest benefit for reducing falls in older persons with diabetes. Abbreviation: DPN = diabetic polyneuropathy.
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Abstract
The pharmacological management of diabetes in older people is complex and challenging. It requires a comprehensive understanding of the individual beyond the diabetes itself. Through the ageing years, the older individual presents with diabetes-related and non-related comorbidities and complications, develops functional limitations and psychological issues, and may lack social support and access to care. A disturbance in these categories, known as the four geriatric domains, will negatively affect diabetes self-management and self-efficacy, leading to poor outcomes and complications. Furthermore, older people with diabetes may be more interested in the management of other chronic conditions such as pain or impaired mobility, and diabetes may be lower in their list of priorities. Proper education must be provided to the older individual and caregivers, with continuous monitoring and counselling, especially when pharmacological interventions offer risks of side effects, adverse reactions and interactions with other medications. Informed shared medical decisions will help to improve adherence to the regimen; however, such discussions ought to be based on the best evidence available, which is unfortunately limited in this age group. We performed a review focused on pharmacological agents and summarize current evidence on their use for the treatment of diabetes in older people. We encourage clinicians to investigate and incorporate the four geriatrics domains in the selection and monitoring of these agents.
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Affiliation(s)
- W M Valencia
- Geriatrics Research, Education and Clinical Center, Miami Bruce W. Carter VA Medical Center, Miami, FL, USA; Department of Public Health Sciences, Division of Epidemiology, University of Miami Miller School of Medicine, Miami, FL, USA
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