Assessment of mobility in geriatric hospital units relies primarily on subjective observation or patient self-reports. We objectively examined the gait speed of hospitalized older patients.
...Prospective study of 322 patients 65 years or older admitted from the community to a geriatric hospital unit between March 2008 and October 2009. Associations of gait speed (in meters per second) and activities of daily living with length of stay and home discharge were examined in multivariable logistic and generalized linear regression models.
In total, 206 of 322 patients completed the gait speed walk, with a mean gait speed of 0.53 m/s. A strong association was found between faster gait speed and shorter length of stay. Patients unable to complete the walk and patients having gait speeds of less than 0.40 m/s had significantly longer lengths of stay by 1.9 and 1.4 days, respectively, compared with patients having gait speeds of at least 0.60 m/s. Similarly, patients unable to complete the walk (odds ratio, 0.03; 95% CI, 0.003-0.21) and patients having gait speeds of less than 0.40 m/s (odds ratio, 0.07; 95% CI, 0.001-0.63) had significantly decreased odds of home discharge compared with patients having gait speeds of at least 0.60 m/s. Activities of daily living were less robust than gait speed in discriminating the risk of length of stay or home discharge.
Gait speed is a clinically relevant indicator of functional status and is associated with important geriatric health outcomes, including length of stay and home discharge. Gait speed could be used to complement information obtained by self-reported activities of daily living.
Abstract
Background
Osteoporotic fractures are a leading cause of disability and premature death in the elderly. Patients with Alzheimer’s and related dementia (ADRD) have high rates of osteoporosis ...(OP) and substantial risk of osteoporotic fractures. Yet research is sparse on trends and predictors of OP medication use in ADRD.
Methods
Medicare beneficiaries with OP aged ≥67 years with Medicare parts A/B/D without HMO from 2016–2018. Outcome was receipt of OP medications in 2018. A multivariable logistic regression assessed association between ADRD and OP drug prescribing, adjusted for age, sex, race, region, Medicare entitlement, dual Medicaid eligibility, chronic conditions, number of provider visits/hospitalizations, and nursing home (NH) resident status. Age/ADRD and NH residency/ADRD interactions were tested.
Results
Sample consisted of 47,871 people with OP and ADRD and 201,840 with OP without ADRD. OP drug use was 38.6% in ADRD patients vs. 52.7% in non-ADRD. After adjustment for demographics, chronic conditions, previous hospitalizations/physician visits, the OR for OP drug in ADRD vs. Non-ADRD was 0.85 (95% CI: 0.83–0.87). NH residents had lower odds for OP medication (OR: 0.61, 95% CI: 0.58–0.64). There were significant interactions between ADRD/age and between ADRD/NH residency. The OR for OP drug use associated with ADRD was 0.88 (95% CI: 0.86–0.90) among community-dwelling elders and 0.66 (95% CI: 0.64–0.69) among NH residents. Conclusions: ADRD patients received OP drugs at lower rates than non-ADRD counterparts. More research is needed on prescribing or deprescribing OP drugs in context of ADRD severity, patient preferences, remaining life expectancy and time-to-benefit from OP drugs.
Abstract
Disparities in late-stage breast or colorectal cancer diagnosis in younger populations are associated with Social Determinants of Health-SDOH (education, poverty, housing, employment). We ...hypothesized that—in older Medicare beneficiaries—disparities in late-stage cancer diagnosis between Hispanics, non-Hispanic Blacks (NHB) and non-Hispanic white (NHW) would be associated with SDOH, comorbidities and primary care-PCP access. We thus used 2005–2017 Texas Cancer Registry data linked with Medicare data for patients aged ≥66 (Nf86,501). Variables included were age at diagnosis, sex, comorbidities, poverty level, education, primary care provider, and breast/colorectal cancer screening within 1 year. For breast cancer in women (Hispanic n=6380, NHW n=39, 225, non-Hispanic Black n=4055), fully adjusted model showed significantly higher odds of late-stage cancer diagnosis only in NH Black patients (OR= 1.11 95% CI= 1.01–1.22) compared with NHW; adjustment for comorbidities and SDOH partially decreased the odds of late-stage diagnosis relative to NWH. Interaction terms between race-ethnicity and poverty were not significant. For colorectal cancer, fully adjusted multivariate model showed significantly higher odds of late-stage diagnosis among Hispanics (n=6053, OR=1.07;95% CI= 1.00–1.15) and NH-Black patients (n=3318, OR=1.29 95% CI= 1.19–1.40) relative to NHW (n=27,470); adjustment for SDOH was associated with a partial decrease in the high odds of late-stage diagnosis in Hispanic and NH Black patients. Interaction terms between race-ethnicity and poverty were not significant. Racial disparities in late-stage breast and colorectal cancer diagnoses remained after adjusting for SDOH and other clinically-relevant factors, underscoring needs for studies on optimizing access to screening and timely cancer treatments in racial/ethnic minorities.
This article reports a pilot study of the effect of tai chi (TC), a pharmacological adjunct and mild aerobic exercise, on osteoarthritic knee pain in elders with cognitive impairment (CI). The TC ...program included a warm-up, 12-form Sun-style TC, and a cool-down period, for a total of 20-40
minutes per session, twice a week for 15 weeks. The results showed no significant differences in knee pain after the TC intervention in 7 elders with CI. However, more minutes of TC attendance were related to improved pain scores (Spearman's rho
=
.78,
P < .05). Greater accuracy in TC performance was also correlated with improvements in pain scores (Spearman's rho = .70,
P
=
.08). Of 4 elders who participated in TC practice regularly (more than 20 sessions), 3 showed clinically important improvements, but 3 elders who participated in no sessions or only a few sessions showed no improvement.
To examine the reliability of a 6-domain psychological well-being instrument in older patients admitted to an acute care hospital unit.
A prospective reliability study was conducted using a ...convenience sample of 40 hospitalized patients aged 65 or older. The main measure was a 6-domain psychological well-being instrument including self-acceptance, positive relations with others, autonomy, environmental mastery, purpose of life, and personal growth.
The mean age was 76.3 years standard deviation (SD)=6.1, 72.5% were white and 57.5% were men. The mean length of stay was 4.9 days (SD=3.1). Test-retest (admission and discharge) intraclass correlation (ICC) values for the six domains were self-acceptance (0.79), positive relations with others (0.72), autonomy (0.79), environmental mastery (0.66), purpose in life (0.79), and personal growth (0.78).
The 6-domain psychological well-being instrument demonstrated good reliability among a sample of hospitalized older patients. This instrument may be useful in a clinical setting to predict outcomes related to patient health and recovery.
A timely response to patient-initiated telephone calls can affect many aspects of patient health, including quality of care and health equity. Historically, at a family medicine residency clinic, at ...least 1 out of 4 patient calls remained unresolved three days after the call was placed. We sought to explore whether there were differential delays in resolution of patient concerns for certain groups and how these were affected by quality improvement interventions to increase responsiveness to patient calls. A multidisciplinary team at a primary care residency clinic applied Lean education and tools to improve the timeliness of addressing telephone encounters. Telephone encounter data were obtained for one year before and nine months after the intervention. Data were stratified by race, ethnicity, preferred language, sex, online portal activation status, age category, zip code, patient risk category, and reason for call. Stratified data revealed consistently worse performance on telephone encounter closure by 72 hours for Black/African American patients compared to Hispanic and non-Hispanic White patients pre-intervention. Interventions resulted in statistically significant overall improvement, with an OR of 2.9 (95% CI: 2.62 to 3.21). Though interventions did not target a specific population, pre-intervention differences based on race and ethnicity resolved post-intervention. Telephone calls serve as an important means of patient communication with care teams. General interventions to improve the timeliness of addressing telephone encounters can lead to sustainable improvement in a primary care academic clinic and may also alleviate disparities.
Objective
Little is known about long-term cognitive side effects of adjuvant chemotherapy for breast cancer. We thus examined incidence of dementia diagnoses in older women diagnosed with breast ...cancer, stratified by types of chemotherapy regimen.
Methods
We identified patients with incident dementia diagnoses through Medicare claims linked to the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) tumor registry data. The study population (
n
= 6,932) consisted of women at least 68 years of age, who were diagnosed with early-stage breast cancer from 1994 through 2002 in one of the SEER areas and received chemotherapy as part of their cancer treatment. Excluded were women with a diagnosis of dementia within the 3 years prior to their cancer diagnosis.
Results
Our sample comprised mostly white women. The mean age was 74. Fifty-seven percent were estrogen receptor positive. Over 70% had no comorbidity. The use of taxol and anthracycline-based treatments increased from mid-1990s to early 2000. Increasing age at cancer diagnosis, Black ethnicity, living in a census tract with lower level of education, and increasing number of comorbidities were associated with new claims of dementia diagnoses after chemotherapy. There was no significant association between types of chemotherapy agents and risk of subsequent dementia diagnoses.
Conclusion
No association was found between types of adjuvant chemotherapy agents for breast cancer and risk of new dementia diagnoses. Our findings suggest that concerns about post-chemotherapy dementia should not be a major factor in determining type of adjuvant chemotherapy regimen to prescribe for older women with breast cancer.
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