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Jain P, Binder A, Chen B, Parada H, Gallo L, Alcaraz J, Horvath S, Bhatti P, Whitsel E, Jordahl K, Baccarelli A, Hou L, Stewart J, Li Y, LaMonte M, Manson J, LaCroix A. The Association of Epigenetic Age Acceleration and Multimorbidity at Age 90 in the Women's Health Initiative. J Gerontol A Biol Sci Med Sci 2023; 78:2274-2281. [PMID: 36107798 PMCID: PMC10692424 DOI: 10.1093/gerona/glac190] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Epigenetic age acceleration (EAA), a measure of accelerated biological aging, has been associated with an increased risk of several age-related chronic conditions. This is the first study to prospectively examine the relationship between EAA and both multimorbidity count and a weighted multimorbidity score among long-lived postmenopausal women. METHODS We included 1 951 women from the Women's Health Initiative who could have survived to age 90. EAA was estimated using the Horvath pan-tissue, Hannum, PhenoAge, and GrimAge "clocks." Twelve chronic conditions were included in the multimorbidity count. The multimorbidity score was weighted for each morbidity's relationship with mortality in the study population. Using mixed-effects Poisson and linear regression models that included baseline covariates associated with both EAA and multimorbidity, we estimated relative risks (RRs) and 95% confidence intervals (CIs) for the relationships between each EAA measure at the study baseline with both multimorbidity count and weighted multimorbidity score at age 90, respectively. RESULTS For every one standard deviation increase in AgeAccelPheno, the rate of multimorbidity accumulation increased 6% (RR = 1.06; 95% CI = 1.01-1.12; p = .025) and the multimorbidity score by 7% (RR = 1.07; 95% CI = 1.01-1.13; p = .014) for women who survived to age 90. The results for a one standard deviation increase in AgeAccelHorvath, AgeAccelHannum, and AgeAccelGrim with multimorbidity accumulation and score were weaker compared to AgeAccelPheno, and the latter 2 did not reach statistical significance. CONCLUSION AgeAccelPheno and AgeAccelHannum may predict multimorbidity count and score at age 90 in older women and, thus, may be useful as a biomarker predictor of multimorbidity burden in the last decades of life.
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Affiliation(s)
- Purva Jain
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Alexandra Binder
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California,USA
| | - Brian Chen
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Humberto Parada
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California, USA
- San Diego Moores Cancer Center, University of California, San Diego, California, La Jolla, California, USA
| | - Linda C Gallo
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California, USA
| | - John Alcaraz
- San Diego Moores Cancer Center, University of California, San Diego, California, La Jolla, California, USA
| | - Steve Horvath
- Department of Human Genetics, David Geffen School of Medicine, UCLA, Los Angeles, California,USA
- Department of Biostatistics, School of Public Health, University of California, Los Angeles, California,USA
| | - Parveen Bhatti
- Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada
| | - Eric A Whitsel
- Department of Epidemiology, Gillings School of Public Health and Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kristina Jordahl
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Andrea A Baccarelli
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
| | - Lifang Hou
- Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois,USA
| | - James D Stewart
- Department of Epidemiology, Gillings School of Public Health and Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Yun Li
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Computer Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo―SUNY, Buffalo, New York, USA
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrea Z LaCroix
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
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Rostant OS, Poggi A. Depressive Profiles among Older Puerto Rican Adults. P R Health Sci J 2023; 42:175-179. [PMID: 37352542] [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] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
OBJECTIVE This study examines the heterogeneity of depressive symptoms among older adults residing on the Island of Puerto Rico and their association with risk and protective health factors. METHODS Data from the Puerto Rican Elderly: Health Conditions study (PREHCO) to identify risk and protective factors associated with profiles of depressive symptoms. The sample was comprised of 3,114 Puerto Rican older adults ages 60 to 102 (71 ± 8.2 SD). The Geriatric Depression Scale 15-item short form (GDS-15) was used to assess the presence of depressive symptoms. Latent class analysis (LCA) was used to categorize depressive symptom classes. The association between depressive symptom classes and health status, lifestyle, health behavior and demographic characteristics were evaluated. RESULTS A three-class model was identified, they were defined as "low depressive symptoms" (56%), "medium depressive symptoms" (31%), and "high depressive symptoms" (13%). Having chronic illnesses, mainly diabetes, heart disease and high blood pressure as well as a history of smoking, and poor self-rated vision were all associated with being in a higher depressive class. Exercising regularly and participating in volunteer activities were protective to being in a high depressive class. CONCLUSION Chronic illnesses and poor self-rated vision were associated with being in a higher depressive classification. These findings can inform targeted interventions for sub-groups of community dwelling older adults impacted by depression.
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Affiliation(s)
- Ola S Rostant
- Institute for Social Research, University of Michigan
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Davis A, Van Eck K, Copeland-Linder N, Phuong K, Belcher HME. Hospitalization and Mortality for Insured Patients in the United States with COVID-19 with and without Autism Spectrum Disorder. J Autism Dev Disord 2023:10.1007/s10803-023-05971-2. [PMID: 37022580 PMCID: PMC10077315 DOI: 10.1007/s10803-023-05971-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 04/07/2023]
Abstract
Autism spectrum disorder (ASD) is a neuropsychiatric condition that may be associated with negative health outcomes. This retrospective cohort study reveals the odds of hospitalization and mortality based on ASD for a population of insured patients with COVID-19. The odds of hospitalization and mortality for people with ASD were found to be greater than individuals without ASD when adjusted for sociodemographic characteristics. Hospitalization and mortality was associated with a dose-response increase to comorbidity counts (1 to 5+). Odds of mortality remained greater for those with ASD when adjusting for comorbid health conditions. ASD is a risk factor for COVID-19 mortality. Comorbid health conditions play a particular role in increasing the odds of COVID-19 related hospitalization and death for ASD patients.
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Affiliation(s)
- Amber Davis
- Department of Pediatrics, Johns Hopkins University, School of Medicine, Baltimore, USA
- Office for Health, Equity, Inclusion, and Diversity, Kennedy Krieger Institute, Baltimore, USA
| | - Kathryn Van Eck
- Office for Health, Equity, Inclusion, and Diversity, Kennedy Krieger Institute, Baltimore, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, USA
- Kennedy Krieger Institute, Center for Diversity in Public Health Leadership Training, 716 North Broadway, Baltimore, MD, 21205, USA
| | - Nikeea Copeland-Linder
- Office for Health, Equity, Inclusion, and Diversity, Kennedy Krieger Institute, Baltimore, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, USA
- Kennedy Krieger Institute, Center for Diversity in Public Health Leadership Training, 716 North Broadway, Baltimore, MD, 21205, USA
| | | | - Harolyn M E Belcher
- Department of Pediatrics, Johns Hopkins University, School of Medicine, Baltimore, USA.
- Office for Health, Equity, Inclusion, and Diversity, Kennedy Krieger Institute, Baltimore, USA.
- Kennedy Krieger Institute, Center for Diversity in Public Health Leadership Training, 716 North Broadway, Baltimore, MD, 21205, USA.
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Wennberg AM, Ebeling M, Ek S, Meyer A, Ding M, Talbäck M, Modig K. Trends in Frailty Between 1990 and 2020 in Sweden Among 75-, 85-, and 95-Year-Old Women and Men: A Nationwide Study from Sweden. J Gerontol A Biol Sci Med Sci 2022; 78:342-348. [PMID: 36190806 PMCID: PMC9951059 DOI: 10.1093/gerona/glac210] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Aging is the primary risk factor for frailty, which is defined as an inability to respond to acute or chronic stressors. Individuals are living longer with greater multimorbidity, but there is a paucity of evidence examining frailty across birth cohorts and ages. METHODS We investigated frailty prevalence and its association with mortality at ages 75, 85, and 95 in the 1895-1945 birth cohorts in Sweden with data from population registries. Frailty was assessed with the Hospital Frailty Risk Score (HFRS). RESULTS We observed that frailty increased with increasing age and that it has become more common in more recent birth cohorts. At age 75, the percent frail in the Total Population Register increased from 1.1% to 4.6% from birth cohorts 1915-1945, corresponding to calendar years 1990-2020. At age 85, the percentage of frail increased from 3.5% to 11.5% from birth cohorts 1905-1935, and at age 95 from birth cohorts 1895-1925, from 4.7% to 18.7%. Our results show that the increase was primarily driven by an increase in the distribution of individuals with scores in the highest quartile of HFRS, while the bottom 3 quartiles remained relatively stable across birth cohorts. Women accounted for a greater distribution of the overall population and frail population, though these disparities decreased over time. Despite increasing levels of frailty, the relationship between frailty and mortality did not change over time, nor did it differ by sex. CONCLUSION Increased frailty with improved survival points to a chronic condition that could be intervened upon.
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Affiliation(s)
- Alexandra M Wennberg
- Address correspondence to: Alexandra M. Wennberg, PhD, Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, 171 77 Stockholm, Sweden. E-mail:
| | - Marcus Ebeling
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Stina Ek
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Meyer
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mozhu Ding
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mats Talbäck
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Karin Modig
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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de Araújo NC, Silveira EA, Mota BG, Guimarães RA, Modesto ACF, Pagotto V. Risk factors for potentially inappropriate medication use in older adults: a cohort study. Int J Clin Pharm 2022; 44:1132-1139. [PMID: 35896907 DOI: 10.1007/s11096-022-01433-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/17/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Much of the knowledge on the use of potentially inappropriate medications (PIM) in older adults is derived from cross-sectional studies, with little known about the risk factors over time. AIM Longitudinal analysis was applied to estimate the occurrence and risk factors of PIM use among older adults in a 10-year follow-up. METHOD Longitudinal study with 418 older adult residents of a capital city of Central-West Brazil. The PIM were classified according to the Beers criteria 2019. The usage rate was calculated at baseline (2008) and at the 10-year follow-up moment (2018). Analysis of predictors (sociodemographic, self-rated health, hospitalization, number of comorbidities, polypharmacy, diabetes, hypertension, hypercholesterolemia and nutritional status) was performed using Generalized Estimating Equation (GEE) models. RESULTS Mean age at baseline was 70.6 years (SD 7.1) and 76% were women; 221 older adults took part in the follow up. The rate of PIM use was 50.4% at baseline and 57.5% at the 10-year follow-up. Multiple analysis showed that PIM use in the cohort was statistically higher in the older adults with a history of hospitalization (RRadj 1.20; 95% CI 1.01-1.40), with three or more diseases (RRadj 1.41; 95% CI 1.14-1.74), with polypharmacy (RRadj 1.81; 95% CI 1.47-2.24) and with diabetes mellitus (RRadj 1.24; 95% CI 1.05-1.47). CONCLUSION A high level of potentially inappropriate medication use was observed, reaching 50% of the older adults, with a 7% increase in the prevalence over the 10-year follow-up period. Hospitalization, multimorbidities, polypharmacy and diabetes mellitus were associated with the use of these medications. Interventions for surveillance of the deprescribing process need to be encouraged to avoid potential harm caused by the use of medications.
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Affiliation(s)
- Natacha Christina de Araújo
- Postgraduate Program in Nursing, Faculty of Nursing, Federal University of Goiás, PPGENF/FEN/UFG, Rua 227 Qd. 68 s/n - Setor Universitário, Goiânia, Goiás, CEP 74605-080, Brazil
| | - Erika Aparecida Silveira
- Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Brenda Godoi Mota
- Faculty of Nursing, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Rafael Alves Guimarães
- Postgraduate Program in Nursing, Faculty of Nursing, Federal University of Goiás, PPGENF/FEN/UFG, Rua 227 Qd. 68 s/n - Setor Universitário, Goiânia, Goiás, CEP 74605-080, Brazil
| | | | - Valéria Pagotto
- Postgraduate Program in Nursing, Faculty of Nursing, Federal University of Goiás, PPGENF/FEN/UFG, Rua 227 Qd. 68 s/n - Setor Universitário, Goiânia, Goiás, CEP 74605-080, Brazil.
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Yoon J, Billings H, Wi CI, Hall E, Sohn S, Kwon JH, Ryu E, Shrestha P, Liu H, Juhn YJ. Establishing an expert consensus for the operational definitions of asthma-associated infectious and inflammatory multimorbidities for computational algorithms through a modified Delphi technique. BMC Med Inform Decis Mak 2021; 21:310. [PMID: 34749701 PMCID: PMC8573872 DOI: 10.1186/s12911-021-01663-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/13/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND A subgroup of patients with asthma has been reported to have an increased risk for asthma-associated infectious and inflammatory multimorbidities (AIMs). To systematically investigate the association of asthma with AIMs using a large patient cohort, it is desired to leverage a broad range of electronic health record (EHR) data sources to automatically identify AIMs accurately and efficiently. METHODS We established an expert consensus for an operational definition for each AIM from EHR through a modified Delphi technique. A series of questions about the operational definition of 19 AIMS (11 infectious diseases and 8 inflammatory diseases) was generated by a core team of experts who considered feasibility, balance between sensitivity and specificity, and generalizability. Eight internal and 5 external expert panelists were invited to individually complete a series of online questionnaires and provide judgement and feedback throughout three sequential internal rounds and two external rounds. Panelists' responses were collected, descriptive statistics tabulated, and results reported back to the entire group. Following each round the core team of experts made iterative edits to the operational definitions until a moderate (≥ 60%) or strong (≥ 80%) level of consensus among the panel was achieved. RESULTS Response rates for each Delphi round were 100% in all 5 rounds with the achievement of the following consensus levels: (1) Internal panel consensus: 100% for 8 definitions, 88% for 10 definitions, and 75% for 1 definition, (2) External panel consensus: 100% for 12 definitions and 80% for 7 definitions. CONCLUSIONS The final operational definitions of AIMs established through a modified Delphi technique can serve as a foundation for developing computational algorithms to automatically identify AIMs from EHRs to enable large scale research studies on patient's multimorbidities associated with asthma.
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Affiliation(s)
- Jungwon Yoon
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
- Precision Population Science Lab, Mayo Clinic, Rochester, MN, USA
- Department of Pediatrics, Myongji Hospital, Goyang-si, South Korea
| | - Heather Billings
- Office of Applied Scholarship and Education Science, Mayo Clinic, Rochester, MN, USA
| | - Chung-Il Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
- Precision Population Science Lab, Mayo Clinic, Rochester, MN, USA
| | - Elissa Hall
- Office of Applied Scholarship and Education Science, Mayo Clinic, Rochester, MN, USA
| | - Sunghwan Sohn
- Division of Digital Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Jung Hyun Kwon
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Pediatrics, Korea University College of Medicine, Seoul, South Korea
| | - Euijung Ryu
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Pragya Shrestha
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
- Precision Population Science Lab, Mayo Clinic, Rochester, MN, USA
| | - Hongfang Liu
- Division of Digital Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Young J Juhn
- Precision Population Science Lab, Mayo Clinic, Rochester, MN, USA.
- Department of Pediatric and Adolescent Medicine and Internal Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
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Soraci L, Corica F, Corsonello A, Remelli F, Abete P, Bellelli G, Bo M, Cherubini A, Di Bari M, Maggio M, Martone AM, Rizzo MR, Manca GM, Rossi AP, Zambon A, Volpato S, Landi F. Prognostic interplay of kidney function with sarcopenia, anemia, disability and cognitive impairment. The GLISTEN study. Eur J Intern Med 2021; 93:57-63. [PMID: 34253448 DOI: 10.1016/j.ejim.2021.06.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/01/2021] [Accepted: 06/29/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Interactions between chronic kidney disease (CKD) and several comorbidities may potentially affect prognosis of older hospitalized patients. This study aims at evaluating the prognostic interactions between estimated glomerular filtration rate (eGFR), anemia, sarcopenia, functional and cognitive dysfunction, and 3-year mortality among older patients discharged from acute care hospitals. METHODS Our series consisted of 504 older adults enrolled in a multicenter observational study carried out in twelve Acute Geriatric and Internal Medicine wards throughout Italy. CKD was defined as an eGFR< 60 ml/min/1.73 m2. Anemia, Short Portable Status Mental Questionnaire (SPMSQ), Basic Activities of Daily Living (BADL), sarcopenia, and Charlson index were considered in the analysis. 3-year survival was investigated by Cox regression and prognostic interactions among study variables were assessed by survival tree analysis. Accuracy of different survival models was investigated by C-index. RESULTS eGFR < 30 mL/min/1.73 m2, anemia, sarcopenia, SPMSQ ≥ 5, and impairment in 1 or more BADL were significantly associated with mortality. Survival tree analysis showed that patients with eGFR < 35.32 ml/min/1.73 m2 and SPMSQ ≥ 5 had the highest risk of mortality [hazard ratio (HR): 5.49, 95%CI: 3.04-9.94] followed by those with eGFR < 35.32 ml/min/1.73 m2, hemoglobin < 11.95 g/dL and SPMSQ < 5 (HR:3.65; 95%CI: 2.21-6.02) and those with eGFR 35.32-47.99 ml/min/1.73 m2 and sarcopenia (HR:3.65; 95%CI: 1.99-6.69). Survival tree leaf node membership had good accuracy in predicting the study outcome (C-index: 0.73, 95%CI:0.70-0.76). CONCLUSIONS Interactions among study risk factors designed distinct risk profiles in older patients discharged from acute care hospitals, that may help identify patients needing targeted interventions and appropriate follow-up after discharge.
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Affiliation(s)
- Luca Soraci
- Unit of Geriatric Medicine, IRCCS INRCA, Cosenza, Italy
| | - Francesco Corica
- Department of Clinical and Experimental Medicine, University of Messina, University of Messina, Messina, Italy.
| | - Andrea Corsonello
- Unit of Geriatric Medicine, IRCCS INRCA, Cosenza, Italy; Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, Ancona and Cosenza, Italy
| | - Francesca Remelli
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy; Center for Clinical Epidemiology, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Pasquale Abete
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy; Acute Geriatric Unit, S. Gerardo Hospital, Monza, Italy
| | - Mario Bo
- Section of Geriatrics, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Molinette, Turin, Italy
| | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Mauro Di Bari
- Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Geriatric Intensive Care Unit, Department of Geriatrics and Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Marcello Maggio
- Department of Medicine and Surgery, Geriatric Rehabilitation Department, University of Parma, Parma, Italy
| | - Anna Maria Martone
- Department of Geriatrics, Neurosciences and Orthopaedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Maria Rosaria Rizzo
- Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy
| | | | - Andrea P Rossi
- Department of Medicine, Geriatric Division, University of Verona, Verona, Italy
| | - Antonella Zambon
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology and Public Health, University of Milan-Bicocca, Milan, Italy; IRCCS Istituto Auxologico Italiano, Biostatistics Unit, Milan, Italy
| | - Stefano Volpato
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy; Center for Clinical Epidemiology, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Francesco Landi
- Department of Geriatrics, Neurosciences and Orthopaedics, Catholic University of the Sacred Heart, Rome, Italy
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Ward RE, Orkaby AR, Dumontier C, Charest B, Hawley CE, Yaksic E, Quach L, Kim DH, Gagnon DR, Gaziano JM, Cho K, Djousse L, Driver JA. Trajectories of Frailty in the 5 Years Prior to Death Among U.S. Veterans Born 1927-1934. J Gerontol A Biol Sci Med Sci 2021; 76:e347-e353. [PMID: 34244759 PMCID: PMC8825219 DOI: 10.1093/gerona/glab196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Electronic frailty indices (eFIs) are increasingly used to identify patients at risk for morbidity and mortality. Whether eFIs capture the spectrum of frailty change, including decline, stability, and improvement, is unknown. METHODS In a nationwide retrospective birth cohort of U.S. Veterans, a validated eFI, including 31 health deficits, was calculated annually using medical record and insurance claims data (2002-2012). K-means clustering was used to assign patients into frailty trajectories measured 5 years prior to death. RESULTS There were 214 250 veterans born between 1927 and 1934 (mean [SD] age at death = 79.4 [2.8] years, 99.2% male, 90.3% White) with an annual eFI in the 5 years before death. Nine frailty trajectories were identified. Those starting at nonfrail or prefrail had 2 stable trajectories (nonfrail to prefrail, n = 29 786 and stable prefrail, n = 28 499) and 2 rapidly increasing trajectories (prefrail to moderately frail, n = 28 244 and prefrail to severely frail, n = 22 596). Those who were mildly frail at baseline included 1 gradually increasing trajectory (mildly to moderately frail, n = 33 806) and 1 rapidly increasing trajectory (mildly to severely frail, n = 15 253). Trajectories that started at moderately or severely frail included 2 gradually increasing trajectories (moderately to severely frail, n = 27 662 and progressing severely frail, n = 14 478) and 1 recovering trajectory (moderately frail to mildly frail, n = 13 926). CONCLUSIONS Nine frailty trajectories, including 1 recovering trajectory, were identified in this cohort of older U.S. Veterans. Future work is needed to understand whether prevention and treatment strategies can improve frailty trajectories and contribute to compression of morbidity toward the end of life.
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Affiliation(s)
- Rachel E Ward
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston HealthCare System, USA
- New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston HealthCare System, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - Ariela R Orkaby
- New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston HealthCare System, Massachusetts, USA
| | - Clark Dumontier
- New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston HealthCare System, Massachusetts, USA
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Brian Charest
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston HealthCare System, USA
| | - Chelsea E Hawley
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston HealthCare System, USA
| | - Enzo Yaksic
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston HealthCare System, USA
| | - Lien Quach
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston HealthCare System, USA
- Department of Gerontology, University of Massachusetts Boston, USA
| | - Dae H Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - David R Gagnon
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston HealthCare System, USA
- Boston University School of Public Health Department of Biostatistics, Massachusetts, USA
| | - J Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston HealthCare System, USA
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kelly Cho
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston HealthCare System, USA
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Luc Djousse
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston HealthCare System, USA
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jane A Driver
- New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston HealthCare System, Massachusetts, USA
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston HealthCare System, USA
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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9
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Polenick CA, Birditt KS, Turkelson A, Bugajski BC, Kales HC. Discordant Chronic Conditions and Depressive Symptoms: Longitudinal Associations Among Middle-Aged and Older Couples. J Gerontol B Psychol Sci Soc Sci 2021; 76:451-460. [PMID: 31792532 DOI: 10.1093/geronb/gbz137] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Individuals often manage chronic conditions in middle and later life that may diminish well-being. Little is known, however, about discordant conditions (i.e., two or more conditions with competing self-management requirements) among older couples and their links to depressive symptoms. We considered discordant conditions at both the individual level and the couple level (i.e., between spouses), along with their long-term implications for depressive symptoms. METHODS The U.S. sample included 1,116 middle-aged and older couples drawn from five waves (2006-2014) of the Health and Retirement Study. Longitudinal actor-partner interdependence models evaluated whether individual-level and couple-level discordant chronic health conditions were concurrently linked to depressive symptoms, and whether these associations became stronger over time. Models controlled for age, minority status, education, prior wave depressive symptoms, and each partner's baseline report of negative marital quality and number of chronic conditions in each wave. RESULTS Wives and husbands reported significantly greater depressive symptoms when they had individual-level discordant conditions about 2 years after baseline, and these links intensified over time. Beyond this association, husbands had significantly greater depressive symptoms when there were couple-level discordant conditions. DISCUSSION Individual-level and couple-level discordant conditions may have lasting implications for depressive symptoms during midlife and older adulthood.
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Affiliation(s)
- Courtney A Polenick
- Department of Psychiatry, University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.,Institute for Social Research, University of Michigan, Ann Arbor
| | - Kira S Birditt
- Institute for Social Research, University of Michigan, Ann Arbor
| | - Angela Turkelson
- Institute for Social Research, University of Michigan, Ann Arbor
| | | | - Helen C Kales
- Department of Psychiatry, University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.,Department of Veterans Affairs, HSR&D Center for Clinical Management Research (CCMR), Ann Arbor, Michigan
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10
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Mullol J, Del Cuvillo A, Lockey RF. Rhinitis Phenotypes. J Allergy Clin Immunol Pract 2020; 8:1492-503. [PMID: 32389274 DOI: 10.1016/j.jaip.2020.02.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/11/2020] [Accepted: 02/11/2020] [Indexed: 02/08/2023]
Abstract
Rhinitis is an umbrella term of a group of upper airway diseases with nasal symptoms and signs with different etiologies and various clinical features or traits. It can be classified into different "phenotypes," based on these observable traits. A proper differential diagnosis is necessary to adequately manage the disease. The objective of this review is to clarify the concept of rhinitis phenotypes while analyzing the clinical features and/or traits of each in order to determine a proper differential diagnosis and appropriate treatment.
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11
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Bernabeu-Wittel M, Ternero-Vega JE, Nieto-Martín MD, Moreno-Gaviño L, Conde-Guzmán C, Delgado-Cuesta J, Rincón-Gómez M, Díaz-Jiménez P, Giménez-Miranda L, Lomas-Cabezas JM, Muñoz-García MM, Calzón-Fernández S, Ollero-Baturone M. Effectiveness of a On-site Medicalization Program for Nursing Homes With COVID-19 Outbreaks. J Gerontol A Biol Sci Med Sci 2021; 76:e19-e27. [PMID: 32738140 PMCID: PMC7454360 DOI: 10.1093/gerona/glaa192] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Nursing homes are highly vulnerable to the occurrence of COVID-19 outbreaks, which result in high lethality rates. Most of them are not prepared to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. METHOD A coordinated on-site medicalization program (MP) in response to a sizeable COVID-19 outbreak in 4 nursing homes was organized, with the objectives of improving survival, offering humanistic palliative care to residents in their natural environment, and reducing hospital referrals. Ten key processes and interventions were established (provision of informatics infrastructure, medical equipment, and human resources, universal testing, separation of "clean" and "contaminated" areas, epidemiological surveys, and unified protocols stratifying for active or palliative care approach, among others). Main outcomes were a composite endpoint of survival or optimal palliative care (SOPC), survival, and referral to hospital. RESULTS Two hundred and seventy-two of 457 (59.5%) residents and 85 of 320 (26.5%) staff members were affected. The SOPC, survival, and referrals to hospital occurred in 77%, 72.5%, and 29% of patients diagnosed before the start of MP, with respect to 97%, 83.7%, and 17% of those diagnosed during the program, respectively. The SOPC was independently associated to MP (OR = 15 [3-81]); and survival in patients stratified to active approach, to the use of any antiviral treatment (OR = 28 [5-160]). All outbreaks were controlled in 39 [37-42] days. CONCLUSIONS A coordinated on-site MP of nursing homes with COVID-19 outbreaks achieved a higher SOPC rate, and a reduction in referrals to hospital, thus ensuring rigorous but also humanistic and gentle care to residents.
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Affiliation(s)
- M Bernabeu-Wittel
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain.,Department of Medicine, University of Seville, Spain
| | - J E Ternero-Vega
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
| | - M D Nieto-Martín
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
| | - L Moreno-Gaviño
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
| | - C Conde-Guzmán
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
| | - J Delgado-Cuesta
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
| | - M Rincón-Gómez
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
| | - P Díaz-Jiménez
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
| | - L Giménez-Miranda
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
| | - J M Lomas-Cabezas
- Infectious Diseases Department, University Hospital Virgen del Rocío, Seville, Spain
| | - M M Muñoz-García
- Bermejales Primary Care Center, Primary Care District of Seville, Spain
| | - S Calzón-Fernández
- Epidemiology and Public Health Department, Primary Care District of Seville, Spain
| | - M Ollero-Baturone
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
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12
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Aoun M, Khalil R, Mahfoud W, Fatfat H, Bou Khalil L, Alameddine R, Afiouni N, Ibrahim I, Hassan M, Zarzour H, Jebai A, Khalil NM, Tawil L, Mechref Z, El Imad Z, Chamma F, Khalil A, Zeidan S, El Ghoul B, Dahdah G, Mouawad S, Azar H, Chahine KA, Kallab S, Moawad B, Fawaz A, Homsi J, Tabaja C, Delbani M, Kallab R, Hoballah H, Haykal W, Fares N, Rahal W, Mroueh W, Youssef M, Rizkallah J, Sebaaly Z, Dfouni A, Ghosn N, Nawfal N, Jaoude WA, Bassil N, Maroun T, Bassil N, Beaini C, Haddad B, Moubarak E, Rabah H, Attieh A, Finianos S, Chelala D. Age and multimorbidities as poor prognostic factors for COVID-19 in hemodialysis: a Lebanese national study. BMC Nephrol 2021; 22:73. [PMID: 33639881 PMCID: PMC7912967 DOI: 10.1186/s12882-021-02270-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/16/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Hemodialysis patients with COVID-19 have been reported to be at higher risk for death than the general population. Several prognostic factors have been identified in the studies from Asian, European or American countries. This is the first national Lebanese study assessing the factors associated with SARS-CoV-2 mortality in hemodialysis patients. METHODS This is an observational study that included all chronic hemodialysis patients in Lebanon who were tested positive for SARS-CoV-2 from 31st March to 1st November 2020. Data on demographics, comorbidities, admission to hospital and outcome were collected retrospectively from the patients' medical records. A binary logistic regression analysis was performed to assess risk factors for mortality. RESULTS A total of 231 patients were included. Mean age was 61.46 ± 13.99 years with a sex ratio of 128 males to 103 females. Around half of the patients were diabetics, 79.2% presented with fever. A total of 115 patients were admitted to the hospital, 59% of them within the first day of diagnosis. Hypoxia was the major reason for hospitalization. Death rate was 23.8% after a median duration of 6 (IQR, 2 to 10) days. Adjusted regression analysis showed a higher risk for death among older patients (odds ratio = 1.038; 95% confidence interval: 1.013, 1.065), patients with heart failure (odds ratio = 4.42; 95% confidence interval: 2.06, 9.49), coronary artery disease (odds ratio = 3.27; 95% confidence interval: 1.69, 6.30), multimorbidities (odds ratio = 1.593; 95% confidence interval: 1.247, 2.036), fever (odds ratio = 6.66; 95% confidence interval: 1.94, 27.81), CRP above 100 mg/L (odds ratio = 4.76; 95% confidence interval: 1.48, 15.30), and pneumonia (odds ratio = 19.18; 95% confidence interval: 6.47, 56.83). CONCLUSIONS This national study identified older age, coronary artery disease, heart failure, multimorbidities, fever and pneumonia as risk factors for death in patients with COVID-19 on chronic hemodialysis. The death rate was comparable to other countries and estimated at 23.8%.
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Affiliation(s)
- Mabel Aoun
- Department of Nephrology, Saint-George Hospital Ajaltoun, Ajaltoun, Lebanon
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | | | | | | | | | | | | | | | | | | | | | | | - Luay Tawil
- Siblin Governmental Hospital, Sebline, Lebanon
| | | | | | | | | | | | | | | | - Sarah Mouawad
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
- Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Hiba Azar
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
- Hotel-Dieu de France Hospital, Beirut, Lebanon
| | | | | | | | | | | | - Carmen Tabaja
- Hammoud Hospital University Medical Center, Sidon, Lebanon
| | - Maya Delbani
- Hammoud Hospital University Medical Center, Sidon, Lebanon
| | | | | | | | - Najat Fares
- Saint-Georges Orthodoxe Hospital, Beirut, Lebanon
| | | | | | | | | | | | - Antoine Dfouni
- Centre Hospitalier Universitaire Notre Dame de Secours Hospital, Byblos, Lebanon
| | - Norma Ghosn
- Centre Hospitalier Universitaire Notre Dame de Secours Hospital, Byblos, Lebanon
| | | | | | - Nadine Bassil
- Middle-East Institute of Health, Bsalim, Lebanon
- Saint-Joseph Hospital, Dora, Lebanon
| | - Therese Maroun
- Middle-East Institute of Health, Bsalim, Lebanon
- Saint-Joseph Hospital, Dora, Lebanon
| | - Nabil Bassil
- Middle-East Institute of Health, Bsalim, Lebanon
- Saint-Joseph Hospital, Dora, Lebanon
| | | | | | | | | | | | - Serge Finianos
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
- Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Dania Chelala
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
- Hotel-Dieu de France Hospital, Beirut, Lebanon
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13
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Soltan MA, Crowley LE, Melville CR, Varney J, Cassidy S, Mahida R, Grudzinska FS, Parekh D, Dosanjh DP, Thickett DR. To What Extent do Social Determinants of Health Modulate Presentation, ITU Admission and Outcomes among Patients with SARS-COV-2 Infection? An Exploration of Household Overcrowding, Air Pollution, Housing Quality, Ethnicity, Comorbidities and Frailty. J Infect Dis Ther 2021; 9:1000002. [PMID: 37034137 PMCID: PMC7614405] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Background Internationally, researchers have called for evidence to support tackling health inequalities during the severe acute respiratory syndrome coronavirus 2 (COVID19) pandemic. Despite the 2020 Marmot review highlighting growing health gaps between wealthy and deprived areas, studies have not explored social determinants of health (ethnicity, frailty, comorbidities, household overcrowding, housing quality, air pollution) as modulators of presentation, intensive care unit (ITU) admissions and outcomes among COVID19 patients. There is an urgent need for studies examining social determinants of health including socioenvironmental risk factors in urban areas to inform the national and international landscape. Methods An in-depth retrospective cohort study of 408 hospitalized COVID19 patients admitted to the Queen Elizabeth Hospital, Birmingham was conducted. Quantitative data analyses including a two-step cluster analysis were applied to explore the role of social determinants of health as modulators of presentation, ITU admission and outcomes. Results Patients admitted from highest Living Environment deprivation indices were at increased risk of presenting with multi-lobar pneumonia and, in turn, ITU admission whilst patients admitted from highest Barriers to Housing and Services (BHS) deprivation Indies were at increased risk of ITU admission. Black, Asian and Minority Ethnic (BAME) patients were more likely, than Caucasians, to be admitted from regions of highest Living Environment and BHS deprivation, present with multi-lobar pneumonia and require ITU admission. Conclusion Household overcrowding deprivation and presentation with multi-lobar pneumonia are potential modulators of ITU admission. Air pollution and housing quality deprivation are potential modulators of presentation with multi-lobar pneumonia. BAME patients are demographically at increased risk of exposure to household overcrowding, air pollution and housing quality deprivation, are more likely to present with multi-lobar pneumonia and require ITU admission. Irrespective of deprivation, consideration of the Charlson Comorbidity Score and the Clinical Frailty Score supports clinicians in stratifying high risk patients.
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Affiliation(s)
- MA Soltan
- University Hospitals Birmingham Foundation NHS trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Birmingham Acute Care Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - LE Crowley
- University Hospitals Birmingham Foundation NHS trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Birmingham Acute Care Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - CR Melville
- Department of Medical Sciences, University of Manchester, Manchester, UK
| | - J Varney
- Department of Public Health, Birmingham City Council, Birmingham, UK
| | - S Cassidy
- University Hospitals Birmingham Foundation NHS trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - R Mahida
- University Hospitals Birmingham Foundation NHS trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Birmingham Acute Care Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - FS Grudzinska
- University Hospitals Birmingham Foundation NHS trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Birmingham Acute Care Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - D Parekh
- University Hospitals Birmingham Foundation NHS trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Birmingham Acute Care Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - DP Dosanjh
- University Hospitals Birmingham Foundation NHS trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Birmingham Acute Care Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - DR Thickett
- Birmingham Acute Care Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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14
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Yao SS, Cao GY, Han L, Chen ZS, Huang ZT, Gong P, Hu Y, Xu B. Prevalence and Patterns of Multimorbidity in a Nationally Representative Sample of Older Chinese: Results From the China Health and Retirement Longitudinal Study. J Gerontol A Biol Sci Med Sci 2021; 75:1974-1980. [PMID: 31406983 DOI: 10.1093/gerona/glz185] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Multimorbidity has become a prominent problem worldwide; however, few population-based studies have been conducted among older Chinese with multimorbidity. This study aimed to examine the prevalence of multimorbidity and explore its common patterns among a nationally representative sample of older Chinese. METHODS This study used data from the China Health and Retirement Longitudinal Study and included 19,841 participants aged at least 50 years. The prevalence of individual chronic diseases and multimorbidity during 2011-2015 were evaluated among the entire cohort and according to residential regions and gender. The relationships between participants' demographic characteristics and multimorbidity were examined using logistic regression model. Patterns of multimorbidity were explored using hierarchical cluster analysis and association rule mining. RESULTS Multimorbidity occurred in 42.4% of the participants. The prevalence of multimorbidity was higher among women (odds ratio [OR] = 1.31, 95% confidence interval [CI]: 1.13-1.51) and urban residents (OR = 1.14, 95% CI: 1.02-1.27) than their respective counterparts after accounting for potential confounders of age, education, smoking, and alcohol consumption. Hierarchical cluster analysis revealed four common multimorbidity patterns: the vascular-metabolic cluster, the stomach-arthritis cluster, the cognitive-emotional cluster, and the hepatorenal cluster. Regional differences were found in the distributions of stroke and memory-related disease. Most combinations of conditions and urban-rural difference in multimorbidity patterns from hierarchical cluster analysis were also observed in association rule mining. CONCLUSION The prevalence and patterns of multimorbidity vary by gender and residential regions among older Chinese. Women and urban residents are more vulnerable to multimorbidity. Future studies are needed to understand the mechanisms underlying the identified multimorbidity patterns and their policy and interventional implications.
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Affiliation(s)
- Shan-Shan Yao
- Department of Epidemiology and Biostatistics, School of Public Health, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Gui-Ying Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Ling Han
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Zi-Shuo Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Zi-Ting Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Ping Gong
- Department of Geriatric Medicine, Peking University Third Hospital, Beijing, China
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Beibei Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
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15
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Lange-Maia BS, Karvonen-Gutierrez CA, Kazlauskaite R, Strotmeyer ES, Karavolos K, Appelhans BM, Janssen I, Avery EF, Dugan SA, Kravitz HM. Impact of Chronic Medical Condition Development on Longitudinal Physical Function from Mid- to Early Late-Life: The Study of Women's Health Across the Nation. J Gerontol A Biol Sci Med Sci 2021; 75:1411-1417. [PMID: 31732730 DOI: 10.1093/gerona/glz243] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 06/19/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chronic medical conditions (CMCs) often emerge and accumulate during the transition from mid- to late-life, and the resulting multimorbidity can greatly impact physical function. We assessed the association of CMC presence and incidence on trajectories of physical function from mid- to early late-life in the Study of Women's Health Across the Nation. METHODS Physical function was assessed at eight clinic visits (average 14 years follow-up) using the physical function subscale of the Short Form-36. CMCs included osteoarthritis, diabetes, stroke, hypertension, heart disease, cancer, osteoporosis, and depressive symptomatology, and were considered cumulatively. Repeated-measures Poisson models estimated longitudinal change (expressed as percent difference) in physical function by chronic CMCs. Change-points assessed physical function change coincident with the development of a new condition. RESULTS Women (N = 2,283) followed from age 50.0 ± 2.7 to 64.0 ± 3.7 years; 7.3% had zero CMCs through follow-up, 22.5% (N = 513) had no baseline CMCs but developed ≥1, 22.7% women had ≥1 baseline CMC but never developed another, and 47.6% had ≥1 baseline CMC and developed ≥1 more. Each additional baseline CMC was associated with 4.0% worse baseline physical function and annual decline of 0.20%/year. Women with more baseline CMCs had greater decline in physical function with a new CMC (-1.90% per condition); and annual decline when developing a new condition accelerated by -0.33%/year per condition. CONCLUSIONS Self-reported physical function changes are evident from mid- to early late-life with the development of CMCs. Preventing or delaying CMCs may delay declines in physical function, and these potential pathways to disability warrant further research.
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Affiliation(s)
- Brittney S Lange-Maia
- Department of Preventive Medicine, Chicago, Illinois.,Center for Community Health Equity, Rush University Medical Center, Chicago, Illinois
| | | | - Rasa Kazlauskaite
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Elsa S Strotmeyer
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh
| | | | | | - Imke Janssen
- Department of Preventive Medicine, Chicago, Illinois
| | - Elizabeth F Avery
- Department of Preventive Medicine, Chicago, Illinois.,Center for Community Health Equity, Rush University Medical Center, Chicago, Illinois
| | - Sheila A Dugan
- Department of Physical Medicine and Rehabilitation, Chicago, Illinois
| | - Howard M Kravitz
- Department of Preventive Medicine, Chicago, Illinois.,Department of Psychiatry, Rush University Medical Center, Chicago, Illinois
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16
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Karlsson LK, Jakobsen LH, Hollensberg L, Ryg J, Midttun M, Frederiksen H, Glenthøj A, Kodahl AR, Secher-Johnsen J, Nielsen LK, Bofill NG, Knudtzen FC, Lund CM. Clinical presentation and mortality in hospitalized patients aged 80+ years with COVID-19-A retrospective cohort study. Arch Gerontol Geriatr 2020; 94:104335. [PMID: 33476754 PMCID: PMC7836891 DOI: 10.1016/j.archger.2020.104335] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/22/2020] [Accepted: 12/29/2020] [Indexed: 12/14/2022]
Abstract
Background COVID-19, caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has great health implications in older patients, including high mortality. In general, older patients often have atypical symptom presentations during acute illness due to a high level of comorbidity. The purpose of this study was to investigate the presentation of symptoms at hospital admissions in older patients with COVID-19 and evaluate its impact on disease outcome. Methods This retrospective study included patients ≥80 years of age with a positive test for SARS-CoV-2, who were admitted to one of three medical departments in Denmark from March 1st to June 1st, 2020. Results A total of 102 patients (47% male) with a mean age of 85 years were included. The most common symptoms at admission were fever (74%), cough (62%), and shortness of breath (54%). Furthermore, atypical symptoms like confusion (29%), difficulty walking (13%), and falls (8%) were also present. In-hospital and 30-day mortality were 31% (n = 32) and 41% (n = 42), respectively. Mortality was highest in patients with confusion (50% vs 38%) or falls (63% vs 39%), and nursing home residency prior to hospital admission was associated with higher mortality (OR 2.7, 95% CI 1.1–6.7). Conclusions Older patients with SARS-Cov-2 displayed classical symptoms of COVID-19 but also geriatric frailty symptoms such as confusion and walking impairments. Additionally, both in-hospital and 30-day mortality was very high. Our study highlights the need for preventive efforts to keep older people from getting COVID-19 and increased awareness of frailty among those with COVID-19.
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Affiliation(s)
| | - Lasse Hjort Jakobsen
- Department of Haematology, Aalborg University, Denmark; Department of Clinical Medicine, Aalborg University Hospital, Denmark
| | - Louise Hollensberg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark
| | - Mette Midttun
- Department of Medicine, Copenhagen University Hospital, Herlev & Gentofte, Denmark
| | - Henrik Frederiksen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark; Department of Haematology, Odense University Hospital, Odense, Denmark; Open Patient data Explorative Network (OPEN), Odense University Hospital, Denmark
| | - Andreas Glenthøj
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Anette Raskov Kodahl
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark; Open Patient data Explorative Network (OPEN), Odense University Hospital, Denmark; Department of Oncology, Odense University Hospital, Odense, Denmark
| | | | - Lene Kongsgaard Nielsen
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Internal Medicine, Viborg Regional Hospital, Denmark
| | | | - Fredrikke Christie Knudtzen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Infectious diseases, Odense University Hospital, Odense, Denmark
| | - Cecilia Margareta Lund
- Department of Medicine, Copenhagen University Hospital, Herlev & Gentofte, Denmark; Copenhagen Center for Clinical Age Research (CopenAge), University of Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark.
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17
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Pajewski NM, Lenoir K, Wells BJ, Williamson JD, Callahan KE. Frailty Screening Using the Electronic Health Record Within a Medicare Accountable Care Organization. J Gerontol A Biol Sci Med Sci 2020; 74:1771-1777. [PMID: 30668637 DOI: 10.1093/gerona/glz017] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [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: 03/27/2018] [Accepted: 01/14/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The accumulation of deficits model for frailty has been used to develop an electronic health record (EHR) frailty index (eFI) that has been incorporated into British guidelines for frailty management. However, there have been limited applications of EHR-based approaches in the United States. METHODS We constructed an adapted eFI for patients in our Medicare Accountable Care Organization (ACO, N = 12,798) using encounter, diagnosis code, laboratory, medication, and Medicare Annual Wellness Visit (AWV) data from the EHR. We examined the association of the eFI with mortality, health care utilization, and injurious falls. RESULTS The overall cohort was 55.7% female, 85.7% white, with a mean age of 74.9 (SD = 7.3) years. In the prior 2 years, 32.1% had AWV data. The eFI could be calculated for 9,013 (70.4%) ACO patients. Of these, 46.5% were classified as prefrail (0.10 < eFI ≤ 0.21) and 40.1% frail (eFI > 0.21). Accounting for age, comorbidity, and prior health care utilization, the eFI independently predicted all-cause mortality, inpatient hospitalizations, emergency department visits, and injurious falls (all p < .001). Having at least one functional deficit captured from the AWV was independently associated with an increased risk of hospitalizations and injurious falls, controlling for other components of the eFI. CONCLUSIONS Construction of an eFI from the EHR, within the context of a managed care population, is feasible and can help to identify vulnerable older adults. Future work is needed to integrate the eFI with claims-based approaches and test whether it can be used to effectively target interventions tailored to the health needs of frail patients.
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Affiliation(s)
- Nicholas M Pajewski
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Winston-Salem, North Carolina.,Center for Health Care Innovation, Winston-Salem, North Carolina
| | - Kristin Lenoir
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Winston-Salem, North Carolina.,Center for Health Care Innovation, Winston-Salem, North Carolina.,Clinical and Translational Science Institute, Winston-Salem, North Carolina
| | - Brian J Wells
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Winston-Salem, North Carolina.,Clinical and Translational Science Institute, Winston-Salem, North Carolina
| | - Jeff D Williamson
- Center for Health Care Innovation, Winston-Salem, North Carolina.,Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kathryn E Callahan
- Center for Health Care Innovation, Winston-Salem, North Carolina.,Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
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18
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Wei MY, Levine DA, Zahodne LB, Kabeto MU, Langa KM. Multimorbidity and Cognitive Decline Over 14 Years in Older Americans. J Gerontol A Biol Sci Med Sci 2020; 75:1206-1213. [PMID: 31173065 PMCID: PMC7243582 DOI: 10.1093/gerona/glz147] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Multimorbidity is associated with greater disability and accelerated declines in physical functioning over time in older adults. However, less is known about its effect on cognitive decline. METHODS Participants without dementia from the Health and Retirement Study were interviewed about physician-diagnosed conditions, from which their multimorbidity-weighted index (MWI) that weights diseases to physical functioning was computed. We used linear mixed-effects models to examine the predictor MWI with the modified Telephone Interview for Cognitive Status (TICSm, global cognition), 10-word immediate recall and delayed recall, and serial 7s outcomes biennially after adjusting for baseline cognition and covariates. RESULTS Fourteen thousand two hundred sixty-five participants, 60% female, contributed 73,700 observations. Participants had a mean ± SD age 67 ± 9.3 years and MWI 4.4 ± 3.9 at baseline. Each point increase in MWI was associated with declines in global cognition (0.04, 95% CI: 0.03-0.04 TICSm), immediate recall (0.01, 95% CI: 0.01-0.02 words), delayed recall (0.01, 95% CI: 0.01-0.02 words), and working memory (0.01, 95% CI: 0.01-0.02 serial 7s; all p < .001). Multimorbidity was associated with faster declines in global cognition (0.003 points/year faster, 95% CI: 0.002-0.004), immediate recall (0.001 words/year faster, 95% CI: 0.001-0.002), and working memory (0.006 incorrect serial 7s/year faster, 95% CI: 0.004-0.009; all p < .001), but not delayed recall compared with premorbid slopes. CONCLUSIONS Multimorbidity using a validated index weighted to physical functioning was associated with acute decline in cognition and accelerated and persistent cognitive decline over 14 years. This study supports an ongoing geriatric syndrome of coexisting physical and cognitive impairment in adults with multimorbidity. Clinicians should monitor and address both domains in older multimorbid adults.
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Affiliation(s)
- Melissa Y Wei
- Division of General Medicine, University of Michigan, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Deborah A Levine
- Division of General Medicine, University of Michigan, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Laura B Zahodne
- Department of Psychology, University of Michigan, Ann Arbor, Michigan
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Mohammed U Kabeto
- Division of General Medicine, University of Michigan, Ann Arbor, Michigan
| | - Kenneth M Langa
- Division of General Medicine, University of Michigan, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
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19
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McDaid LM, Flowers P, Ferlatte O, McAloney-Kocaman K, Gilbert M, Frankis J. Informing theoretical development of salutogenic, asset-based health improvement to reduce syndemics among gay, bisexual and other men who have sex with men: Empirical evidence from secondary analysis of multi-national, online cross-sectional surveys. SSM Popul Health 2019; 10:100519. [PMID: 31853476 PMCID: PMC6911981 DOI: 10.1016/j.ssmph.2019.100519] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/16/2019] [Accepted: 11/18/2019] [Indexed: 12/21/2022] Open
Abstract
Globally, gay, bisexual and other men who have sex with men (GBMSM) experience an increased burden of poor sexual, mental and physical health. Syndemics theory provides a framework to understand comorbidities and health among marginalised populations. Syndemics theory attempts to account for the social, environmental, and other structural contexts that are driving and/or sustaining simultaneous multiple negative health outcomes, but has been widely critiqued. In this paper, we conceptualise a new framework to counter syndemics by assessing the key theoretical mechanisms by which pathogenic social context variables relate to ill-health. Subsequently, we examine how salutogenic, assets-based approaches to health improvement could function among GBMSM across diverse national contexts. Comparative quantitative secondary analysis of data on syndemics and community assets are presented from two international, online, cross-sectional surveys of GBMSM (SMMASH2 in Scotland, Wales, Northern Ireland and the Republic of Ireland and Sex Now in Canada). Negative sexual, mental and physical health outcomes were clustered as hypothesised, providing evidence of the syndemic. We found that syndemic ill-health was associated with social isolation and the experience of stigma and discrimination, but this varied across national contexts. Moreover, while some of our measures of community assets appeared to have a protective effect on syndemic ill-health, others did not. These results present an important step forward in our understanding of syndemic ill-health and provide new insights into how to intervene to reduce it. They point to a theoretical mechanism through which salutogenic approaches to health improvement could function and provide new strategies for working with communities to understand the proposed processes of change that are required. To move forward, we suggest conceptualising syndemics within a complex adaptive systems model, which enables consideration of the development, sustainment and resilience to syndemics both within individuals and at the population-level. Gay and other men who have sex with men experience syndemics in varied contexts. Some salutogenic community assets have a protective effect on syndemic ill-health. Conceptualising syndemics within a complex adaptive systems model is required.
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Affiliation(s)
- Lisa M McDaid
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB, UK
| | - Paul Flowers
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB, UK
| | - Olivier Ferlatte
- Department of Social and Preventative Medicine, School of Public Health, University of Montreal, 7101 Avenue du Parc (3rd Floor), Montreal, Quebec, H3N 1X9, Canada.,Community Based Research Centre for Gay Men's Health, 1007-808 Nelson Street, Vancouver, British Columbia, V6Z 2H2, Canada
| | | | - Mark Gilbert
- Community Based Research Centre for Gay Men's Health, 1007-808 Nelson Street, Vancouver, British Columbia, V6Z 2H2, Canada.,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Jamie Frankis
- Department of Health & Community Sciences, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK
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20
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Abstract
Chronic diseases and conditions are the leading cause of death and disability in the United States. The number of people living with two or more chronic conditions has increased in the last decades and is expected to continue to rise over the upcoming years. Yet, traditional chronic disease surveillance practices have been specialized for a specific symptom or a single health condition. To better understand the complication and complexity of multimorbidity in chronic diseases, this paper suggests the use of network science for multimorbidity network surveillance (MNS). We discuss why the relational perspective in surveillance is critical and how network science can help and be integrated into surveillance and public health practice.
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Affiliation(s)
- Eun Kyong Shin
- The University of Tennessee Health Science Center - Oak-Ridge National Laboratory (UTHSC-ORNL), Center for Biomedical Informatics, Department of Pediatrics, Memphis, TN 38103 USA
| | - Arash Shaban-Nejad
- The University of Tennessee Health Science Center - Oak-Ridge National Laboratory (UTHSC-ORNL), Center for Biomedical Informatics, Department of Pediatrics, Memphis, TN 38103 USA
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21
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Niedzwiedz CL, Katikireddi SV, Pell JP, Smith DJ. Sex differences in the association between salivary telomere length and multimorbidity within the US Health & Retirement Study. Age Ageing 2019; 48:703-710. [PMID: 31165156 PMCID: PMC6984958 DOI: 10.1093/ageing/afz071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 04/08/2019] [Accepted: 05/21/2019] [Indexed: 02/06/2023] Open
Abstract
Background Telomere length is associated with several physical and mental health conditions, but whether it is a marker of multimorbidity is unclear. We investigated associations between telomere length and multimorbidity by sex. Methods Data from adults (N = 5,495) aged ≥50 years were taken from the US Health and Retirement Study (2008–14). Telomere length was measured in 2008 from salivary samples. The cross-sectional associations between telomere length and eight chronic health conditions were explored using logistic regression, adjusting for confounders and stratified by sex. Logistic, ordinal and multinomial regression models were calculated to explore relationships between telomere length and multimorbidity (using a binary variable and a sum of the number of health conditions) and the type of multimorbidity (no multimorbidity, physical multimorbidity, or multimorbidity including psychiatric problems). Using multilevel logistic regression, prospective relationships between telomere length and incident multimorbidity were also explored. Results In cross-sectional analyses, longer telomeres were associated with reduced likelihood of lung disease and psychiatric problems among men, but not women. Longer telomeres were associated with lower risk of multimorbidity that included psychiatric problems among men (OR=0.521, 95% CI: 0.284 to 0.957), but not women (OR=1.188, 95% CI: 0.771 to 1.831). Prospective analyses suggested little association between telomere length and the onset of multimorbidity in men (OR=1.378, 95% CI: 0.931 to 2.038) nor women (OR=1.224, 95% CI: 0.825 to 1.815). Conclusions Although telomere length does not appear to be a biomarker of overall multimorbidity, further exploration of the relationships is merited particularly for multimorbidity including psychiatric conditions among men.
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Affiliation(s)
- Claire L Niedzwiedz
- Institute of Health & Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow
| | - Srinivasa Vittal Katikireddi
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health & Wellbeing, University of Glasgow
| | - Jill P Pell
- Institute of Health & Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow
| | - Daniel J Smith
- Institute of Health & Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow
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22
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Humbert M, Bousquet J, Bachert C, Palomares O, Pfister P, Kottakis I, Jaumont X, Thomsen SF, Papadopoulos NG. IgE-Mediated Multimorbidities in Allergic Asthma and the Potential for Omalizumab Therapy. J Allergy Clin Immunol Pract 2019; 7:1418-1429. [PMID: 30928481 DOI: 10.1016/j.jaip.2019.02.030] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/27/2019] [Accepted: 02/28/2019] [Indexed: 12/15/2022]
Abstract
Allergic asthma often coexists with different pathological conditions, called multimorbidities, that are mostly of allergic nature and share a common underlying inflammatory pathophysiological mechanism. Multimorbidities of allergic asthma may influence asthma control, its severity, and patients' response to treatment, and contribute to the overall socioeconomic burden of the disease. Immunoglobulin E (IgE) is known to play a central role in the pathogenesis of various allergic diseases, including asthma. Thus, IgE-mediated immunologic pathways present an attractive target for intervention in asthma and multimorbidities. In this review, we discuss the most frequently reported IgE-mediated multimorbidities in allergic asthma, including allergic rhinitis, rhinoconjunctivitis, atopic dermatitis, vernal keratoconjunctivitis, chronic rhinosinusitis with nasal polyps, food allergies, and allergic bronchopulmonary aspergillosis. Omalizumab is a recombinant humanized monoclonal antibody against IgE and has been in use to treat allergic asthma for more than a decade. We comprehensively review the clinical evidence for omalizumab in the treatment of the aforementioned multimorbidities in allergic asthma.
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Affiliation(s)
- Marc Humbert
- Service de Pneumologie, Hôpital Bicêtre, Le Kremlin Bicêtre, France.
| | - Jean Bousquet
- MACVIA-France, Contre les Maladies Chroniques pour un Vieillissement Actif en France, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
| | - Claus Bachert
- Upper Airways Research Laboratory and Department of Oto-Rhino-Laryngology, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Oscar Palomares
- Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University of Madrid, Madrid, Spain
| | | | | | | | - Simon Francis Thomsen
- Department of Dermatology, Bispebjerg University Hospital, Copenhagen, Denmark; Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nikolaos G Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, United Kingdom; Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
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23
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Abstract
The prevalence of non-communicable chronic diseases has been on the rise and the co-occurrence of morbidities is becoming more common. Multimorbidities are found more frequently among women, those with a history of mental disorders, lower level of schooling, and unfavorable socioeconomic condition. Physical inactivity, smoking and obesity are also associated with multimorbidities. Its occurrence is directly related to the age, affecting the majority of the individuals with more than 50 years old. It is important to consider the possibility of comorbid conditions that aggravate, complicate or simulate the symptoms of the disease in the face of a patient with asthma and poor response to treatment. Among subjects with asthma, some conditions stand out as the most frequent: chronic rhinitis or rhinosinusitis, gastroesophageal reflux disease, obstructive sleep apnea syndrome, obesity, and cardiovascular disorders. Comorbidities reduce the chances of optimal asthma control. It is essential to assess and manage properly these complex situations, choosing wisely preventive strategies and treatment options to avoid adverse events and optimize outcomes. Medications for asthma have the potential to worsen cardiovascular conditions, while beta-adrenergic receptor blockers and angiotensin conversion enzyme inhibitors used for cardiovascular conditions, can worsen asthma. Handling properly these cases will save lives and resources. However, there are multiple gaps in knowledge requiring investigation in this field to inform integrated care pathways and policies. It is likely information may be obtained from real life studies and electronic medical databases. Communications between the providers and patients may be facilitated by electronic technology, opening a large window for guided self-management.
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Affiliation(s)
| | - Álvaro A Cruz
- ProAR - Federal University of Bahia School of Medicine, Brazil
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24
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Tisminetzky M, Gurwitz J, McManus DD, Saczynski JS, Erskine N, Waring ME, Anatchkova M, Awad H, Parish DC, Lessard D, Kiefe C, Goldberg R. Multiple Chronic Conditions and Psychosocial Limitations in Patients Hospitalized with an Acute Coronary Syndrome. Am J Med 2016; 129:608-14. [PMID: 26714211 PMCID: PMC4879087 DOI: 10.1016/j.amjmed.2015.11.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 09/14/2015] [Revised: 11/19/2015] [Accepted: 11/19/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND As adults live longer, multiple chronic conditions have become more prevalent over the past several decades. We describe the prevalence of, and patient characteristics associated with, cardiac- and non-cardiac-related multimorbidities in patients discharged from the hospital after an acute coronary syndrome. METHODS We studied 2174 patients discharged from the hospital after an acute coronary syndrome at 6 medical centers in Massachusetts and Georgia between April 2011 and May 2013. Hospital medical records yielded clinical information including presence of eight cardiac-related and eight non-cardiac-related morbidities on admission. We assessed multiple psychosocial characteristics during the index hospitalization using standardized in-person instruments. RESULTS The mean age of the study sample was 61 years, 67% were men, and 81% were non-Hispanic whites. The most common cardiac-related morbidities were hypertension, hyperlipidemia, and diabetes (76%, 69%, and 31%, respectively). Arthritis, chronic pulmonary disease, and depression (20%, 18%, and 13%, respectively) were the most common noncardiac morbidities. Patients with ≥4 morbidities (37% of the population) were slightly older and more frequently female than those with 0-1 morbidity; they were also heavier and more likely to be cognitively impaired (26% vs 12%), have symptoms of moderate/severe depression (31% vs 15%), high perceived stress (48% vs 32%), a limited social network (22% vs 15%), low health literacy (42% vs 31%), and low health numeracy (54% vs 42%). CONCLUSION Multimorbidity, highly prevalent in patients hospitalized with an acute coronary syndrome, is strongly associated with indices of psychosocial deprivation. This emphasizes the challenge of caring for these patients, which extends well beyond acute coronary syndrome management.
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Affiliation(s)
- Mayra Tisminetzky
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester; Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Jerry Gurwitz
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester; Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester
| | - David D McManus
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Jane S Saczynski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester; Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Nathaniel Erskine
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Molly E Waring
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Milena Anatchkova
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Hamza Awad
- Department of Community Medicine, Mercer University School of Medicine, Macon, Ga
| | - David C Parish
- Department of Community Medicine, Mercer University School of Medicine, Macon, Ga
| | - Darleen Lessard
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Catarina Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Robert Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester.
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25
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Rillamas-Sun E, LaCroix AZ, Bell CL, Ryckman K, Ockene JK, Wallace RB. The Impact of Multimorbidity and Coronary Disease Comorbidity on Physical Function in Women Aged 80 Years and Older: The Women's Health Initiative. J Gerontol A Biol Sci Med Sci 2016; 71 Suppl 1:S54-61. [PMID: 26858325 PMCID: PMC5865533 DOI: 10.1093/gerona/glv059] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 04/08/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A better understanding of medically centered outcomes, such as physical function, for older women with multiple chronic conditions is a national public health priority. METHODS The prevalence of multimorbidity (defined as having 2 chronic conditions from a list of 12) and comorbidity with coronary disease (CHD) were calculated for 33,386 women who were enrolled in the Women's Health Initiative since 1993-1998 and were ≥ 80 years old by mid-September 2012. Associations between multimorbidity and CHD comorbidity on RAND-36 physical function scores were estimated using linear regression models. RESULTS The prevalence of multimorbidity in this sample was 59%. Women with 0-1 chronic condition had a mean physical function score of 74 (95% confidence interval [CI]: 73, 74). Relative decrements in physical function scores were -8 (95% CI: -8, -7), -13 (95% CI: -14, -12) and -19 (95% CI: -20, -18) in women with 2, 3, and ≥ 4 chronic conditions, respectively. Women with CHD in combination with hip fractures or cognitive impairment had the largest adjusted decreases in physical function scores compared to the scores for women with CHD only. The impact of select characteristics on physical function scores between multimorbid and non-multimorbid women were similar; however, overall mean physical functions scores were lower for women with multmorbidity. CONCLUSIONS Multimorbidity profoundly impacted physical functioning in women aged more than 80 years. Modifiable risk factors, such as obesity and physical activity, were similar in older women regardless of multimorbidity status and provide targets for health interventions aimed at preventing loss of late-age physical functioning.
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Affiliation(s)
- Eileen Rillamas-Sun
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Andrea Z LaCroix
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla
| | - Christina L Bell
- Department of Geriatric Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu
| | - Kelli Ryckman
- Department of Epidemiology, University of Iowa College of Public Health
| | - Judith K Ockene
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester
| | - Robert B Wallace
- Department of Epidemiology, University of Iowa College of Public Health
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26
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Pajewski NM, Williamson JD, Applegate WB, Berlowitz DR, Bolin LP, Chertow GM, Krousel-Wood MA, Lopez-Barrera N, Powell JR, Roumie CL, Still C, Sink KM, Tang R, Wright CB, Supiano MA. Characterizing Frailty Status in the Systolic Blood Pressure Intervention Trial. J Gerontol A Biol Sci Med Sci 2016; 71:649-55. [PMID: 26755682 DOI: 10.1093/gerona/glv228] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [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: 09/28/2015] [Accepted: 11/30/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The Systolic Blood Pressure Intervention Trial (SPRINT) is testing whether a lower systolic blood pressure (BP) target of 120 mm Hg leads to a reduction in cardiovascular morbidity and mortality among hypertensive, nondiabetic adults. Because there may be detrimental effects of intensive BP control, particularly in older, frail adults, we sought to characterize frailty within SPRINT to address ongoing questions about the ability of large-scale trials to enroll representative samples of noninstitutionalized, community-dwelling, older adults. METHODS We constructed a 36-item frailty index (FI) in 9,306 SPRINT participants, classifying participants as fit (FI ≤ 0.10), less fit (0.10 < FI ≤ 0.21), or frail (FI > 0.21). Recurrent event models were used to evaluate the association of the FI with the incidence of self-reported falls, injurious falls, and all-cause hospitalizations. RESULTS The distribution of the FI was comparable with what has been observed in population studies, with 2,570 (27.6%) participants classified as frail. The median FI was 0.18 (interquartile range = 0.14 to 0.24) in participants aged 80 years and older (N = 1,159), similar to the median FI of 0.17 reported for participants in the Hypertension in the Very Elderly Trial. In multivariable analyses, a 1% increase in the FI was associated with increased risk for self-reported falls (hazard ratio [HR] = 1.030), injurious falls (HR = 1.035), and all-cause hospitalizations (HR = 1.038) (all p values < .0001). CONCLUSIONS Large clinical trials assessing treatments to reduce cardiovascular disease risk, such as SPRINT, can enroll heterogeneous populations of older adults, including the frail elderly, comparable with general population cohorts.
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Affiliation(s)
- Nicholas M Pajewski
- Department of Biostatistical Sciences, Division of Public Health Sciences and
| | - Jeff D Williamson
- Department of Internal Medicine, Section on Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - William B Applegate
- Department of Internal Medicine, Section on Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Dan R Berlowitz
- Bedford Veterans Affairs Hospital, Massachusetts. School of Public Health, Boston University, Massachusetts
| | - Linda P Bolin
- College of Nursing, East Carolina University, Greenville, North Carolina
| | - Glenn M Chertow
- Department of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | - Marie A Krousel-Wood
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana. Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana. Research Division, Ochsner Clinic Foundation, New Orleans, Louisiana
| | | | - James R Powell
- Department of Internal Medicine, Division of General Internal Medicine, East Carolina University, Greenville, North Carolina
| | - Christianne L Roumie
- Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, Nashville. Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Carolyn Still
- Division of Nephrology and Hypertension, University Hospitals Case Medical Center, Cleveland, Ohio. Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
| | - Kaycee M Sink
- Department of Internal Medicine, Section on Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Rocky Tang
- Department of Surgery, Columbia University, New York
| | - Clinton B Wright
- Evelyn F. McKnight Brain Institute, Departments of Neurology and Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Florida
| | - Mark A Supiano
- Division of Geriatrics, School of Medicine, University of Utah, Salt Lake City. Veterans Affairs Salt Lake City, Geriatric Research, Education, and Clinical Center, Utah
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27
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Garin N, Koyanagi A, Chatterji S, Tyrovolas S, Olaya B, Leonardi M, Lara E, Koskinen S, Tobiasz-Adamczyk B, Ayuso-Mateos JL, Haro JM. Global Multimorbidity Patterns: A Cross-Sectional, Population-Based, Multi-Country Study. J Gerontol A Biol Sci Med Sci 2015; 71:205-14. [PMID: 26419978 DOI: 10.1093/gerona/glv128] [Citation(s) in RCA: 365] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 06/22/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Population ageing challenges health care systems due to the high prevalence and impact of multimorbidity in older adults. However, little is known about how chronic conditions present in certain multimorbidity patterns, which could have great impact on public health at several levels. The aim of our study was to identify and describe multimorbidity patterns in low-, middle-, and high-income countries. METHODS We analyzed data from the Collaborative Research on Ageing in Europe project (Finland, Poland, and Spain) and the World Health Organization's Study on Global Ageing and Adult Health (China, Ghana, India, Mexico, Russia, and South Africa). These cross-sectional studies obtained data from 41,909 noninstitutionalized adults older than 50 years. Exploratory factor analysis was performed to detect multimorbidity patterns. Additional adjusted binary logistic regressions were performed to identify associations between sociodemographic factors and multimorbidity. RESULTS Overall multimorbidity prevalence was high across countries. Hypertension, cataract, and arthritis were the most prevalent comorbid conditions. Two or three multimorbidity patterns were found per country. Several patterns were identified across several countries: "cardio-respiratory" (angina, asthma, and chronic obstructive pulmonary disease), "metabolic" (diabetes, obesity, and hypertension), and "mental-articular" (arthritis and depression). CONCLUSIONS A high prevalence of multimorbidity occurs in older adults across countries, with low- and middle-income countries gradually approaching the figures of richer countries. Certain multimorbidity patterns are present in several countries, which suggest that common underlying etiopathogenic factors may play a role. Deeper understanding of these patterns may lead to the development of preventive actions to diminish their prevalence and also give rise to new, comprehensive approaches for the management of these co-occurring conditions.
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Affiliation(s)
- Noe Garin
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Institut d'Investigacions Biomèdiques Sant Pau (IIB Sant Pau), Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain. Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Spain. Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Spain. Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Somnath Chatterji
- Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland
| | - Stefanos Tyrovolas
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Spain. Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Beatriz Olaya
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Spain. Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Neurological Institute Carlo Besta IRCCS Foundation, Milan, Italy
| | - Elvira Lara
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Spain. Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Seppo Koskinen
- National Institute for Health and Welfare, Helsinki, Finland
| | | | - Jose Luis Ayuso-Mateos
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain. Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain. Department of Psychiatry, Universidad Autónoma de Madrid, Spain
| | - Josep Maria Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Spain. Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
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Lahousse L, Ziere G, Verlinden VJA, Zillikens MC, Uitterlinden AG, Rivadeneira F, Tiemeier H, Joos GF, Hofman A, Ikram MA, Franco OH, Brusselle GG, Stricker BH. Risk of Frailty in Elderly With COPD: A Population-Based Study. J Gerontol A Biol Sci Med Sci 2015; 71:689-95. [PMID: 26355016 DOI: 10.1093/gerona/glv154] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 08/12/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Despite frailty being an important geriatric syndrome, its prevalence and associated mortality risk in older patients with chronic obstructive pulmonary disease (COPD) are unknown. METHODS We examined the relationship between COPD confirmed by spirometry, COPD severity, and frailty defined by the Fried criteria within 2,142 participants (aged 74.7 ± 5.6 years) of the Rotterdam Study, a prospective population-based cohort study. RESULTS The frailty prevalence was significantly higher (p < .001) in participants with COPD (10.2%, 95% CI: 7.6%-13.5%) compared with participants without COPD (3.4%, 95% CI: 2.6%-4.4%). Adjusted for age, sex, smoking, corticosteroids, and other confounders, participants with COPD had a more than twofold increased prevalence of frailty (odds ratio 2.2, 95% CI: 1.34-3.54, p = .002). The prevalence was highest when severe airflow limitation, dyspnea, and frequent exacerbations were present. Participants with mild airflow limitation were more frequently prefrail. COPD elderly who were frail had significant worse survival. CONCLUSIONS This population-based cohort study in elderly demonstrates that COPD is associated with frailty even after adjusting for shared risk factors. Our findings suggest that frailty-in addition to COPD severity and comorbidities-identifies those COPD participants at high risk of mortality.
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Affiliation(s)
- Lies Lahousse
- Department of Respiratory Medicine, Ghent University and Ghent University Hospital, De Pintelaan, Belgium. Departments of Epidemiology
| | | | | | - M Carola Zillikens
- Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands. Netherlands Consortium on Healthy Aging (NCHA), Leiden, The Netherlands
| | - André G Uitterlinden
- Departments of Epidemiology, Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands. Netherlands Consortium on Healthy Aging (NCHA), Leiden, The Netherlands
| | - Fernando Rivadeneira
- Departments of Epidemiology, Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands. Netherlands Consortium on Healthy Aging (NCHA), Leiden, The Netherlands
| | - Henning Tiemeier
- Departments of Epidemiology, Netherlands Consortium on Healthy Aging (NCHA), Leiden, The Netherlands
| | - Guy F Joos
- Department of Respiratory Medicine, Ghent University and Ghent University Hospital, De Pintelaan, Belgium
| | - Albert Hofman
- Departments of Epidemiology, Netherlands Consortium on Healthy Aging (NCHA), Leiden, The Netherlands
| | - M Arfan Ikram
- Departments of Epidemiology, Radiology, and Netherlands Consortium on Healthy Aging (NCHA), Leiden, The Netherlands. Departments of Neurology and
| | - Oscar H Franco
- Departments of Epidemiology, Netherlands Consortium on Healthy Aging (NCHA), Leiden, The Netherlands
| | - Guy G Brusselle
- Department of Respiratory Medicine, Ghent University and Ghent University Hospital, De Pintelaan, Belgium. Departments of Epidemiology, Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bruno H Stricker
- Departments of Epidemiology, Netherlands Consortium on Healthy Aging (NCHA), Leiden, The Netherlands. Inspectorate of Healthcare, The Hague, The Netherlands.
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Sampalli T, Desy M, Dhir M, Edwards L, Dickson R, Blackmore G. Improving wait times to care for individuals with multimorbidities and complex conditions using value stream mapping. Int J Health Policy Manag 2015; 4:459-66. [PMID: 26188810 DOI: 10.15171/ijhpm.2015.76] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/31/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Recognizing the significant impact of wait times for care for individuals with complex chronic conditions, we applied a LEAN methodology, namely - an adaptation of Value Stream Mapping (VSM) to meet the needs of people with multiple chronic conditions and to improve wait times without additional resources or funding. METHODS Over an 18-month time period, staff applied a patient-centric approach that included LEAN methodology of VSM to improve wait times to care. Our framework of evaluation was grounded in the needs and perspectives of patients and individuals waiting to receive care. Patient centric views were obtained through surveys such as Patient Assessment of Chronic Illness Care (PACIC) and process engineering based questions. In addition, LEAN methodology, VSM was added to identify non-value added processes contributing to wait times. RESULTS The care team successfully reduced wait times to 2 months in 2014 with no wait times for care anticipated in 2015. Increased patient engagement and satisfaction are also outcomes of this innovative initiative. In addition, successful transformations and implementation have resulted in resource efficiencies without increase in costs. Patients have shown significant improvements in functional health following Integrated Chronic Care Service (ICCS) intervention. The methodology will be applied to other chronic disease management areas in Capital Health and the province. CONCLUSION Wait times to care in the management of multimoribidities and other complex conditions can add a significant burden not only on the affected individuals but also on the healthcare system. In this study, a novel and modified LEAN methodology has been applied to embed the voice of the patient in care delivery processes and to reduce wait times to care in the management of complex chronic conditions.
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Affiliation(s)
- Tara Sampalli
- Integrated Chronic Care Service, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada.,Dalhousie University, Halifax, NS, Canada.,Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Michel Desy
- Performance Excellence, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Minakshi Dhir
- Integrated Chronic Care Service, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada.,Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Lynn Edwards
- Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Robert Dickson
- Integrated Chronic Care Service, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Gail Blackmore
- Performance Excellence, Nova Scotia Health Authority, Halifax, NS, Canada
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Schöttker B, Saum KU, Jansen EHJM, Boffetta P, Trichopoulou A, Holleczek B, Dieffenbach AK, Brenner H. Oxidative stress markers and all-cause mortality at older age: a population-based cohort study. J Gerontol A Biol Sci Med Sci 2014; 70:518-24. [PMID: 25070660 DOI: 10.1093/gerona/glu111] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The free radical/oxidative stress theory of aging has recently received much attention but the association of oxidative stress markers with all-cause mortality was not yet assessed in humans. METHODS We measured derivatives of reactive oxygen metabolites (d-ROM) as a proxy for the reactive oxygen species concentration and total thiol levels (TTL) as a proxy for the redox control status in 2,932 participants of a population-based cohort study from Germany. RESULTS The median age of the population was 70 years and 120 (4.1%) study participants died during a mean follow-up of 3.3 years. Compared with the bottom tertiles, the top tertiles of d-ROM and TTL concentrations were both associated with all-cause mortality in models adjusted for age, sex, education, smoking, physical activity, and alcohol consumption (hazard ratios and 95% confidence intervals: 1.63 [1.01; 2.63] and 0.68 [0.53; 0.87], respectively). Adding diseases, the inflammatory marker C-reactive protein or a cumulative somatic morbidity index did not alter the results for TTL. However, the association of d-ROM and mortality was attenuated and no longer statistically significant after adding C-reactive protein and the somatic morbidity index to the model. CONCLUSIONS This study adds epidemiological evidence to the free radical/oxidative stress theory of aging. Both d-ROM and TTL were associated with mortality at older age. For TTL, this association was independent of baseline health status. Inflammation and higher general morbidity could be intermediate states on the pathway from high d-ROM levels to mortality. This hypothesis should to be explored by future studies with repeated measurements.
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Affiliation(s)
- Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
| | - Kai-Uwe Saum
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Eugène H J M Jansen
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Paolo Boffetta
- International Prevention Research Institute, Lyon, France. Institute for Translational Epidemiology and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York
| | | | | | - Aida Karina Dieffenbach
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
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Emmons KM, Puleo E, Greaney ML, Gillman MW, Bennett GG, Haines J, Sprunck-Harrild K, Viswanath K. A randomized comparative effectiveness study of Healthy Directions 2--a multiple risk behavior intervention for primary care. Prev Med 2014; 64:96-102. [PMID: 24642140 PMCID: PMC4204110 DOI: 10.1016/j.ypmed.2014.03.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 04/25/2013] [Revised: 03/04/2014] [Accepted: 03/10/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of the Healthy Directions 2 (HD2) intervention in the primary care setting. METHODS HD2 was a cluster randomized trial (conducted 3/09-11/11). The primary sampling unit was provider (n=33), with secondary sampling of patients within provider (n=2440). Study arms included: 1) usual care (UC); 2) HD2--a patient self-guided intervention targeting 5 risk behaviors; and 3) HD2 plus 2 brief telephone coaching calls (HD2+CC). The outcome measure was the proportion of participants with a lower multiple risk behavior (MRB) score by follow-up. RESULTS At baseline, only 4% of the participants met all behavioral recommendations. Both HD2 and HD2+CC led to improvements in MRB score, relative to UC, with no differences between the two HD2 conditions. Twenty-eight percent of the UC participants had improved MRB scores at 6 months, vs. 39% and 43% in HD2 and HD2+CC, respectively (ps≤.001); results were similar at 18 months (p≤.05). The incremental cost of one risk factor reduction in MRB score was $310 for HD2 and $450 for HD2+CC. CONCLUSIONS Self-guided and coached intervention conditions had equivalent levels of effect in reducing multiple chronic disease risk factors, were relatively low cost, and thus are potentially useful for routine implementation in similar health settings.
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Affiliation(s)
- Karen M Emmons
- Kaiser Foundation Research Institute, 1800 Harrison Avenue, Oakland, CA 94612, USA.
| | - Elaine Puleo
- University of Massachusetts Amherst, Amherst, MA, USA
| | | | - Matthew W Gillman
- Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Gary G Bennett
- Duke University, Department of Psychology and Neuroscience, Box 90086, 417 Chapel Drive, Durham NC 27708-0086
| | - Jess Haines
- University of Guelph, Guelph, Ontario, Canada
| | | | - K Viswanath
- Dana-Farber Cancer Institute, Boston, MA, USA
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Cheung KL, Montez-Rath ME, Chertow GM, Winkelmayer WC, Periyakoil VS, Kurella Tamura M. Prognostic stratification in older adults commencing dialysis. J Gerontol A Biol Sci Med Sci 2014; 69:1033-9. [PMID: 24482541 DOI: 10.1093/gerona/glt289] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Accurate prognostic models could inform treatment decisions for older adults with end-stage renal disease who are considering dialysis and might identify patients more appropriate for conservative care or hospice. METHODS In a cohort of patients aged ≥ 67 years commencing dialysis in the United States between January 1, 2008 and June 30, 2009, we compared the discrimination of three existing instruments (the Liu index; the French Renal Epidemiology and Information Network score; and hospice eligibility criteria) for the prediction of 6-month mortality. We estimated the odds of death associated with each prognostic index using logistic regression with and without adjustment for age. Predictive indices were compared using the concordance ("c")-statistic. RESULTS Of 44,109 eligible patients, 10,289 (23.3%) died within 6 months of dialysis initiation. The c-statistic for the Liu, Renal Epidemiology and Information Network, hospice eligibility criteria, and combined Liu/hospice eligibility criteria scores without and with age were 0.62/0.65, 0.63/0.66, 0.65/0.68, and 0.68/0.70, respectively. Discrimination was poorer at older ages, especially for the Liu and Renal Epidemiology and Information Network scores. Although sensitivity was poor, a Renal Epidemiology and Information Network score ≥ 9 or an hospice eligibility criteria ≥ 3 had relatively high specificity. CONCLUSIONS Existing prognostic indices based on administrative data perform poorly with respect to prediction of 6-month mortality in older patients with end-stage renal disease commencing dialysis.
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Affiliation(s)
- Katharine L Cheung
- Division of Nephrology, University of Vermont College of Medicine, Burlington.
| | - Maria E Montez-Rath
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | - Glenn M Chertow
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | | | - Vyjeyanthi S Periyakoil
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, California. Division of General Medical Disciplines, Stanford University School of Medicine, Palo Alto, California
| | - Manjula Kurella Tamura
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California. Geriatric Research and Education Clinical Center, Veterans Affairs Palo Alto Health Care System, California
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Lagro J, Schoon Y, Heerts I, Meel-van den Abeelen ASS, Schalk B, Wieling W, Olde Rikkert MGM, Claassen JAHR. Impaired systolic blood pressure recovery directly after standing predicts mortality in older falls clinic patients. J Gerontol A Biol Sci Med Sci 2013; 69:471-8. [PMID: 23873962 DOI: 10.1093/gerona/glt111] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Normally, standing up causes a blood pressure (BP) drop within 15 seconds, followed by recovery to baseline driven by BP control mechanisms. The prognostic value of this initial BP drop, but also of the recovery hereafter, is unknown. The aim of this study was to examine the prognostic value of these BP characteristics in response to standing. METHODS In a retrospective cohort study of 238 consecutive patients visiting our falls outpatient clinic, we examined the relation between all-cause mortality and BP decline and recovery directly after active standing up with Cox proportional hazards analyses. RESULTS Of 238 patients (mean age 78.4 ± 7.8 years), during a median follow-up of 21.0 months, 36 (15%) patients died. Neither absolute nor relative (%) initial BP drop after standing predicted mortality. In contrast, the magnitude of BP recovery 40-60 seconds after standing was associated with mortality, even after adjustment for age, comorbidity, and other baseline characteristics. When systolic BP had recovered to less than 80% of prestanding baseline after 60 seconds of standing, this was a powerful independent predictor of mortality (hazard ratio: 3.00; 95% confidence interval 1.17-7.68). CONCLUSIONS Failure to recover from BP decline in the first minute after active standing up is associated with excess mortality in falls clinic patients. A recovery of systolic BP to less than 80% of baseline after 60 seconds may be used as an easily available cardiovascular marker for increased mortality risk in older falls clinic patients.
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Affiliation(s)
- Joep Lagro
- Department of Geriatric Medicine, Radboud University Nijmegen Medical Centre, University mail code 925, PO Box 9100, 6500 HB Nijmegen, The Netherlands.
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Mazzola P, Bellelli G, Perego S, Zambon A, Mazzone A, Bruni AA, Annoni G. The sequential organ failure assessment score predicts 30-day mortality in a geriatric acute care setting. J Gerontol A Biol Sci Med Sci 2013; 68:1291-5. [PMID: 23580741 DOI: 10.1093/gerona/glt020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Several tools to predict patients' survival have been proposed in medical wards, though they are often time consuming and difficult to apply. The Sequential Organ Failure Assessment (SOFA) is a promising tool that has been validated in intensive care units but never in acute medical wards. The aim of this study was to assess whether the SOFA score predicts short-term (30 days) mortality in a population of elderly patients admitted to a geriatric ward. METHODS This prospective observational cohort study was carried out in a Geriatric Clinic of an Italian teaching hospital. Among 359 patients consecutively and firstly admitted between January and April 2012, we considered eligible those (n = 314) directly admitted from the emergency department. Demographic, functional, and clinical variables were collected. The SOFA score was measured on admission (SOFA-admission) and 48 hours later (SOFA-48h). The vital status of participants was assessed over the 30 days following discharge. RESULTS Patients who died at 1-month follow-up were prevalently men, more comorbid, disabled, and undernourished and had higher SOFA scores on admission and at 48 hours than their counterparts. Among all potential predictors of 1-month mortality, the SOFA-48h score was the best, with a score greater than 4 significantly increasing the risk to die during hospitalization or in the 30 days following discharge (odds ratio = 7.030; 95% confidence interval = 3.982-12.409). CONCLUSIONS The SOFA score, a user-friendly tool used in intensive care units to estimate prognosis, is able to predict 1-month mortality also in patients admitted to an acute geriatric setting.
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Affiliation(s)
- Paolo Mazzola
- Department of Health Sciences, University of Milano-Bicocca, Milan, Italy.
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