Medicine and Health Sciences Commons^™

Characteristics, Treatment Practices, And In-Hospital Outcomes Of Older Adults Hospitalized With Acute Myocardial Infarction, Han-Yang Chen, David Mcmanus, Jane Saczynski, Jerry Gurwitz, Joel Gore, Jorge Yarzebski, Robert Goldberg

Jorge L. Yarzebski

OBJECTIVES: To examine overall and decade-long trends (1999-2009), characteristics, treatment practices, and hospital outcomes in individuals aged 65 and older hospitalized for acute myocardial infarction (AMI) and to describe how these factors varied in the youngest, middle, and oldest-old individuals.

DESIGN: Retrospective cohort study.

SETTING: Population-based Worcester Heart Attack Study.

MEASUREMENTS: Analyses were conducted to examine the sociodemographic and clinical characteristics, cardiac treatments, and hospital outcomes of older adults in three age strata (65-74, 75-84, > /=85).

PARTICIPANTS: The study sample consisted of 3,851 individuals aged 65 and older hospitalized with AMI every other year between 1999 and 2009; 32% were …

Scramble Or Script: Responding To New Medicare Billing For Medications In Hospice, Jennifer Tjia, Shaida Talebreza, Maija Reblin, Anna Beck, Lee Ellington

Jennifer Tjia

No abstract provided.

Use Of Medications Of Questionable Benefit In Advanced Dementia, Jennifer Tjia, Becky Briesacher, Daniel Peterson, Qin Liu, Susan Andrade, Susan Mitchell

Jennifer Tjia

IMPORTANCE: Advanced dementia is characterized by severe cognitive impairment and complete functional dependence. Patients' goals of care should guide the prescribing of medication during such terminal illness. Medications that do not promote the primary goal of care should be minimized. OBJECTIVES: To estimate the prevalence of medications with questionable benefit used by nursing home residents with advanced dementia, identify resident- and facility-level characteristics associated with such use, and estimate associated medication expenditures. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of medication use by nursing home residents with advanced dementia using a nationwide long-term care pharmacy database linked to the Minimum Data …

Possible Molecular Mechanisms Underlying Age-Related Cardiomyocyte Apoptosis In The F344xbn Rat Heart, Sunil Kakarla, Kevin Rice, Anjaiah Katta, Satyanarayana Paturi, Miaozong Wu, Madhukar Kolli, Saba Keshavarzian, Kamran Manzoor, Paulette Wehner, Eric Blough

Paulette S. Wehner

Despite advances in treatment, age-related cardiac dysfunction still remains a leading cause of cardiovascular death. Recent data have suggested that increases in cardiomyocyte apoptosis may be involved in the pathological remodeling of heart. Here, we examine the effects of aging on cardiomyocyte apoptosis in 6-, 30-, and 36-month-old Fischer344xBrown Norway F1 hybrid rats (F344XBN). Compared with 6-month hearts, aged hearts exhibited increased TdT-mediated dUTP nick end labeling–positive nuclei, caspase-3 activation, caspase-dependent cleavage of α-fodrin and diminished phosphorylation of protein kinase B/Akt (Thr 308). These age-dependent increases in cardiomyocyte apoptosis were associated with alterations in the composition of the cardiac dystrophin …

Possible Molecular Mechanisms Underlying Age-Related Cardiomyocyte Apoptosis In The F344xbn Rat Heart, Sunil Kakarla, Kevin Rice, Anjaiah Katta, Satyanarayana Paturi, Miaozong Wu, Madhukar Kolli, Saba Keshavarzian, Kamran Manzoor, Paulette Wehner, Eric Blough

Kevin M Rice

Despite advances in treatment, age-related cardiac dysfunction still remains a leading cause of cardiovascular death. Recent data have suggested that increases in cardiomyocyte apoptosis may be involved in the pathological remodeling of heart. Here, we examine the effects of aging on cardiomyocyte apoptosis in 6-, 30-, and 36-month-old Fischer344xBrown Norway F1 hybrid rats (F344XBN). Compared with 6-month hearts, aged hearts exhibited increased TdT-mediated dUTP nick end labeling–positive nuclei, caspase-3 activation, caspase-dependent cleavage of α-fodrin and diminished phosphorylation of protein kinase B/Akt (Thr 308). These age-dependent increases in cardiomyocyte apoptosis were associated with alterations in the composition of the cardiac dystrophin …

Physical Activity And Cognitive-Health Content In Top-Circulating Magazines, 2006–2008, Anna Greer, Sara Corwin, Daniela Friedman

Anna E. Greer

Physical activity may promote cognitive health in older adults. Popular media play an important role in preventive health communication. This study examined articles discussing associations between physical activity and cognitive health in top-circulating magazines targeting older adults. 42,753 pages of magazines published from 2006 to 2008 were reviewed; 26 articles met inclusion criteria. Explanations regarding the link between physical activity and cognitive health were provided in 57.7% of articles. These explanations were generally consistent with empirical evidence; however, few articles included empirical evidence. Physical activity recommendations were presented in 80.8% of articles; a wide range was recommended (90–300 min of …

Possible Molecular Mechanisms Underlying Age-Related Cardiomyocyte Apoptosis In The F344xbn Rat Heart, Sunil Kakarla, Kevin Rice, Anjaiah Katta, Satyanarayana Paturi, Miaozong Wu, Madhukar Kolli, Saba Keshavarzian, Kamran Manzoor, Paulette Wehner, Eric Blough

Eric Blough

Despite advances in treatment, age-related cardiac dysfunction still remains a leading cause of cardiovascular death. Recent data have suggested that increases in cardiomyocyte apoptosis may be involved in the pathological remodeling of heart. Here, we examine the effects of aging on cardiomyocyte apoptosis in 6-, 30-, and 36-month-old Fischer344xBrown Norway F1 hybrid rats (F344XBN). Compared with 6-month hearts, aged hearts exhibited increased TdT-mediated dUTP nick end labeling–positive nuclei, caspase-3 activation, caspase-dependent cleavage of α-fodrin and diminished phosphorylation of protein kinase B/Akt (Thr 308). These age-dependent increases in cardiomyocyte apoptosis were associated with alterations in the composition of the cardiac dystrophin …

Use Of Atypical Antipsychotics In Nursing Homes And Pharmaceutical Marketing, Camilla Pimentel, Jennifer Donovan, Terry Field, Jerry Gurwitz, Leslie Harrold, Abir Kanaan, Celeste Lemay, Kathleen Mazor, Jennifer Tjia, Becky Briesacher

Jennifer Tjia

OBJECTIVES: To describe the current extent and type of pharmaceutical marketing in nursing homes (NHs) in one state and to provide preliminary evidence for the potential influence of pharmaceutical marketing on the use of atypical antipsychotics in NHs.

DESIGN: Nested mixed-methods, cross-sectional study of NHs in a cluster randomized trial.

SETTING: Forty-one NHs in Connecticut.

PARTICIPANTS: NH administrators, directors of nursing, and medical directors (n = 93, response rate 75.6%).

MEASUREMENTS: Quantitative data, including prescription drug dispensing data (September 2009-August 2010) linked with Nursing Home Compare data (April 2011), were used to determine facility-level prevalence of atypical antipsychotic use, facility-level …

Rationales That Providers And Family Members Cited For The Use Of Antipsychotic Medications In Nursing Home Residents With Dementia, Alice Bonner, Terry Field, Celeste Lemay, Kathleen Mazor, Daniel Andersen, Christina Compher, Jennifer Tjia, Jerry Gurwitz

Jennifer Tjia

OBJECTIVES: To describe the rationales that providers and family members cite for the use of antipsychotic medications in people with dementia living in nursing homes (NHs). DESIGN: Qualitative, descriptive study. SETTING: Twenty-six medium-sized and large facilities in five Centers for Medicare and Medicaid Services regions. PARTICIPANTS: Individuals diagnosed with dementia who received an antipsychotic medication. MEASUREMENTS: Data were collected from medical record abstraction and interviews with prescribers, administrators, direct care providers, and family members. Textual data from medical record abstraction and responses to open-ended interview questions were analyzed using directed content analysis techniques. A coding scheme was developed, and coded …

Statin Discontinuation In Nursing Home Residents With Advanced Dementia, Jennifer Tjia, Sarah Cutrona, Daniel Peterson, George Reed, Susan Andrade, Susan Mitchell

Jennifer Tjia

OBJECTIVES: To describe patterns of, and factors associated with, statin use and discontinuation in nursing home (NH) residents progressing to advanced dementia and followed for at least 90 days.

DESIGN: Retrospective inception cohort using a dataset linking 2007 to 2008 Minimum Data Set (MDS) to Medicare denominator and Part D files.

SETTING: All NHs in five states (Minnesota, Massachusetts, Pennsylvania, California, Florida).

PARTICIPANTS: NH residents with dementia.

MEASUREMENTS: Residents who developed advanced dementia were observed from baseline (date of progression to very severe cognitive impairment with eating problems) and followed for at least 90 days to statin discontinuation or death. …

Appropriateness Of Psychopharmaco-Logical Medication, Kate Lapane, Jacob Hunnicutt, Jennifer Tjia

Jennifer Tjia

No abstract provided.

Systematic Review Of The Use Of Online Questionnaires Of Older Adults, Meegan Remillard, Kathleen Mazor, Sarah Cutrona, Jerry Gurwitz, Jennifer Tjia

Jennifer Tjia

OBJECTIVES: To describe methodological approaches to population targeting and sampling and to summarize limitations of Internet-based questionnaires in older adults.

DESIGN: Systematic literature review.

SETTING: Studies using online questionnaires in older adult populations.

PARTICIPANTS: English-language articles using search terms for geriatric, age 65 and over, Internet survey, online survey, Internet questionnaire, and online questionnaire in PubMed and EBSCO host between 1984 and July 2012. Inclusion criteria were study population mean age 65 and older and use of an online questionnaire for research. Review of 336 abstracts yielded 14 articles for full review by two investigators; 11 articles met inclusion criteria. …

Antipsychotic Use In Nursing Homes Varies By Psychiatric Consultant, Jennifer Tjia, Terry Field, Celeste Lemay, Kathleen Mazor, Michelle Pandolfi, Ann Spenard, Shih-Yieh Ho, Abir Kanaan, Jennifer Donovan, Jerry Gurwitz, Becky Briesacher

Jennifer Tjia

BACKGROUND: The relationship between psychiatric consultation and antipsychotic prescribing in nursing homes (NH) is unknown. OBJECTIVE: To identify the association between psychiatric consultant groups and NH-level antipsychotic prescribing after adjustment for resident case-mix and facility characteristics. RESEARCH DESIGN AND SUBJECTS: Nested cross-sectional study of 60 NHs in a cluster randomized trial. We linked facility leadership surveys to October 2009-September 2010 Minimum Data Set, Nursing Home Compare, the US Census, and pharmacy dispensing data. MEASURES: The main exposure is the psychiatric consultant group and the main outcome is NH-level prevalence of atypical antipsychotic use. We calculated annual means and interquartile ranges …

Use Of Mechanical Ventilation By Patients With And Without Dementia, 2001 Through 2011, Tara Lagu, Marya Zilberberg, Jennifer Tjia, Penelope Pekow, Peter Lindenauer

Jennifer Tjia

Increasing demand for US critical care resources, including beds, intensivists, and invasive mechanical ventilation (IMV),has placed substantial strain on the critical care system. Since 2000, elderly patients treated in the intensive care unit have received higher intensity care (and have experienced lower mortality rates) than historical cohorts. Yet certain populations of elderly patients exposed to intensive care experience substantial long-term adverse effects, including functional decline and excess mortality. Patients with dementia receiving IMV, for example, are at high risk for delirium, which confers a 3.2-fold increased risk of 6-month mortality. The increasing use of aggressive therapies suggests that demand for …

An Electronic Health Record-Based Intervention To Increase Follow-Up Office Visits And Decrease Rehospitalization In Older Adults, Jerry Gurwitz, Terry Field, Jessica Ogarek, Jennifer Tjia, Sarah Cutrona, Leslie Harrold, Shawn Gagne, Peggy Preusse, Jennifer Donovan, Abir Kanaan, George Reed, Lawrence Garber

Jennifer Tjia

OBJECTIVES: To assess the effect of an electronic health record-based transitional care intervention involving automated alerts to primary care providers and staff when older adults were discharged from the hospital.

DESIGN: Randomized controlled trial.

SETTING: Large multispecialty group practice.

PARTICIPANTS: Individuals aged 65 and older discharged from hospital to home.

INTERVENTION: In addition to notifying primary care providers about the individual's recent discharge, the system provided information about new drugs added during the inpatient stay, warnings about drug-drug interactions, recommendations for dose changes and laboratory monitoring of high-risk medications, and alerts to the primary care provider's support staff to schedule …

Knowledge Of And Perceived Need For Evidence-Based Education About Antipsychotic Medications Among Nursing Home Leadership And Staff, Celeste Lemay, Kathleen Mazor, Terry Field, Jennifer Donovan, Abir Kanaan, Becky Briesacher, Sarah Foy, Leslie Harrold, Jerry Gurwitz, Jennifer Tjia

Jennifer Tjia

BACKGROUND/OBJECTIVES: Antipsychotic use is common in US nursing homes, despite evidence of increased risk of morbidity and mortality, and limited efficacy in older adults with dementia. Knowledge, attitudes, and beliefs regarding antipsychotic use among nursing home staff are unclear. The study aim was to describe nursing home leadership and direct care staff members' knowledge of antipsychotic risks, beliefs and attitudes about the effectiveness of antipsychotics and nonpharmacologic management of dementia-related behaviors, and perceived need for evidence-based training about antipsychotic medication safety. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: Survey of leadership and direct care staff of nursing homes in Connecticut was conducted …

Healthy Aging In Massachusetts: Reporting Indicators, Identifying Resources & Activating Allies, Elizabeth Dugan, Frank Porell, Nina Silverstein, Ruth Palombo, Chae Lee, Kristina Turk

Nina Silverstein

In Massachusetts, a Healthy Aging Collaborative comprised of a diverse group of stakeholders has been formed for multiple purposes: information sharing around healthy aging, idea generation, partnership building and activity mapping.

The Driving Dilemma: The Complete Resource Guide For Older Drivers And Their Families, Elizabeth Dugan

Elizabeth Dugan

Publisher's Description: The Driving Dilemma is a comprehensive resource for older drivers and their families facing questions about driving safety. Dr. Dugan provides clear, useful information about the effects of age, medical conditions, and medications on driving. She offers practical advice on how to discuss this issue with loved ones. The book provides not only the facts, but also a research-based approach to communication, with useful sample dialogue scripts that will help you discuss driving with your loved ones. Also included are state-by-state listings of available resources, making this book a total information source for families. Citation: Dugan E. The …

Adverse Drug Events After Hospital Discharge In Older Adults: Types, Severity, And Involvement Of Beers Criteria Medications, Abir Kanaan, Jennifer Donovan, Nerissa Duchin, Terry Field, Jennifer Tjia, Sarah Cutrona, Shawn Gagne, Lawrence Garber, Peggy Preusse, Leslie Harrold, Jerry Gurwitz

Jennifer Tjia

OBJECTIVES: To characterize adverse drug events (ADEs) occurring within the high-risk 45-day period after hospitalization in older adults.

DESIGN: Clinical pharmacists reviewed the ambulatory records of 1,000 consecutive discharges.

SETTING: A large multispecialty group practice closely aligned with a Massachusetts-based health plan.

PARTICIPANTS: Hospitalized individuals aged 65 and older discharged home.

MEASUREMENTS: Possible drug-related incidents occurring during the 45-day period after hospitalization were identified and presented to a pair of physician-reviewers who classified incidents as to whether an ADE was present, whether the event was preventable, and the severity of the event. Medications implicated in ADEs were further characterized according …

Antipsychotic Use Among Nursing Home Residents, Becky Briesacher, Jennifer Tjia, Terry Field, Daniel Peterson, Jerry Gurwitz

Jennifer Tjia

The prescribing of antipsychotic medications persists at high levels in US nursing homes (NHs) despite extensive data demonstrating marginal clinical benefits and serious adverse effects, including death.1- 2 However, imprecise and outdated data have limited the understanding of the current state of antipsychotic medication prescribing in NHs.3 We analyzed recent and detailed NH prescription data to address: (1) What is the current level of antipsychotic use? (2) Does antipsychotic use in NHs display geographic variation? and (3) Which antipsychotics are most commonly prescribed?

Potentially Inappropriate Use Of Antipsychotics In Community-Dwelling Adults With Dementia More Common In Those With Low Income, Jennifer Tjia

Jennifer Tjia

Comment on: The essential and potentially inappropriate use of antipsychotics across income groups: an analysis of linked administrative data. [Can J Psychiatry. 2012]

Studies To Reduce Unnecessary Medication Use In Frail Older Adults: A Systematic Review, Jennifer Tjia, Sarah Velten, Carole Parsons, Sruthi Valluri, Becky Briesacher

Jennifer Tjia

BACKGROUND: Overuse of unnecessary medications in frail older adults with limited life expectancy remains an understudied challenge.

OBJECTIVE: To identify intervention studies that reduced use of unnecessary medications in frail older adults. A secondary goal was to identify and review studies focusing on patients approaching end of life. We examined criteria for identifying unnecessary medications, intervention processes for medication reduction, and intervention effectiveness.

METHODS: A systematic review of English articles using MEDLINE, EMBASE, and International Pharmaceutical Abstracts from January 1966 to September 2012. Additional studies were identified by searching bibliographies. Search terms included prescription drugs, drug utilization, hospice or palliative …

Standing Orders In An Ambulatory Setting Increases Influenza Vaccine Usage In Older People, Lynne Goebel, Shirley Neitch, Maurice Mufson

Maurice A. Mufson

Objectives: To determine whether standing orders for influenza vaccine increase its usage in an ambulatory setting in elderly patients. Design: Retrospective analysis of influenza vaccine usage over 4 years (1999–2002). Setting: University ambulatory setting. Participants: Overall, 912 elderly patients of two physicians who issued standing orders and 884 elderly patients of two physicians who did not do so constituted the study group. Measurements: Physicians were categorized as to whether they issued a verbal or written standing order to their nurses to administer the influenza vaccine to patients aged 65 and older. Rates of influenza vaccination of patients whose physicians used …

Standing Orders In An Ambulatory Setting Increases Influenza Vaccine Usage In Older People, Lynne Goebel, Shirley Neitch, Maurice Mufson

Shirley M. Neitch

Objectives: To determine whether standing orders for influenza vaccine increase its usage in an ambulatory setting in elderly patients. Design: Retrospective analysis of influenza vaccine usage over 4 years (1999–2002). Setting: University ambulatory setting. Participants: Overall, 912 elderly patients of two physicians who issued standing orders and 884 elderly patients of two physicians who did not do so constituted the study group. Measurements: Physicians were categorized as to whether they issued a verbal or written standing order to their nurses to administer the influenza vaccine to patients aged 65 and older. Rates of influenza vaccination of patients whose physicians used …

Standing Orders In An Ambulatory Setting Increases Influenza Vaccine Usage In Older People, Lynne Goebel, Shirley Neitch, Maurice Mufson

Lynne J. Goebel

Objectives: To determine whether standing orders for influenza vaccine increase its usage in an ambulatory setting in elderly patients. Design: Retrospective analysis of influenza vaccine usage over 4 years (1999–2002). Setting: University ambulatory setting. Participants: Overall, 912 elderly patients of two physicians who issued standing orders and 884 elderly patients of two physicians who did not do so constituted the study group. Measurements: Physicians were categorized as to whether they issued a verbal or written standing order to their nurses to administer the influenza vaccine to patients aged 65 and older. Rates of influenza vaccination of patients whose physicians used …

Dementia And Risk Of Adverse Warfarin-Related Events In The Nursing Home Setting, Jennifer Tjia, Terry Field, Kathleen Mazor, Jennifer Donovan, Abir Kanaan, George Reed, Peter Doherty, Leslie Harrold, Jerry Gurwitz

Jennifer Tjia

BACKGROUND: Little attention has been focused on the safety of medications administered to treat non illnesses in nursing home residents with dementia. It is unclear whether this population is at increased risk of adverse drug events. OBJECTIVES: To test the hypotheses that in nursing home residents with dementia prescribed warfarin have less time in therapeutic range and a higher incidence of nonpreventable and preventable adverse warfarin events compared to nursing home residents without dementia after controlling for facility and patient characteristics. METHODS: A prospective cohort embedded in a clinical trial of nursing home residents prescribed warfarin in 26 nursing homes …

Driving Assessment Results In Patients With A Diagnosis Of Dementia, Shirley Neitch, Guillermo Madero, Shawn Maynard

Shirley M. Neitch

Primary care physicians are frequently involved in cases in which they must decide if a patient with dementia should stop driving. The decision is complex, and there are no firm clinical guidelines available. We examined the results of a number of patients who have undergone assessment in our Driving Assessment Clinic, to determine if any of our findings correlated with the diagnosis of dementia. If any associations exist, recommendations may be possible to assist PCPs in making the decision to have patients stop driving, even if full formal testing cannot be done.

Predicting Nursing Home Adherence To A Clinical Trial Intervention: Lessons For The Conduct Of Cluster Randomized Trials, Jennifer Tjia, Kathleen Mazor, Terry Field, Peter Doherty, Ann Spenard, Jerry Gurwitz

Jennifer Tjia

OBJECTIVES: To describe factors predictive of nursing home (NH) adherence to a clinical trial intervention. DESIGN: Post hoc analysis of a cluster randomized trial (CRT) evaluating a structured communication intervention to improve nurse-physician telephone communication in NHs. SETTING: NH. PARTICIPANTS: All eligible licensed nursing staff in all participating NHs. MEASUREMENTS: Adherence was defined as active participation for at least 3 months of the 12-month trial. NH characteristics hypothesized to affect trial outcomes (profit status, bed size, nursing staff time, NH quality, and leadership turnover) were measured a priori. The association between intervention adherence, NH characteristics and preintervention questionnaire response rate …

Growth In Dementia-Associated Hospitalizations Among The Oldest Old In The United States: Implications For Ethical Health Services Planning, Marya Zilberberg, Jennifer Tjia

Jennifer Tjia

As the world population ages, an epidemic of neurologic diseases, such as Alzheimer-type dementia and Parkinson disease, is predicted. The most rapid population growth has been observed in the 85 years and older group ... Concurrent with this population growth, we have witnessed a vast expansion of health care utilization and expenditures, with the consequent close scrutiny and attempts to rein in this supply-driven juggernaut. ... We conducted this analysis to gain a better understanding of the current trends in dementia-associated hospitalizations among the 85 years and older population in the United States and its implications for future health care …

Challenge Of Changing Nursing Home Prescribing Culture, Jennifer Tjia, Jerry Gurwitz, Becky Briesacher

Jennifer Tjia

This article described a framework for improving prescribing in nursing homes (NH) by focusing on the whole facility as a system that has created a "prescribing culture." We offered this paradigm as an alternative to focused interventions that target prescribers only. We used the example of atypical antipsychotics to illustrate the approach. We also highlighted elements of the NH culture change movement that are germane to medication prescribing, and illustrated which elements of NH culture were shown to be associated with suboptimal quality of care. We concluded by describing current models, including our study funded by the Agency for Healthcare …