Geriatrics Commons^™

Alzheimer's And Patient Caregiver Burnout: A Review Of The Literature, Madeline Hekeler

James Madison Undergraduate Research Journal (JMURJ)

The term “silent epidemic” is fitting for Alzheimer’s disease (AD), as its negative impact is widely felt but rarely discussed. Burnout among AD caregivers has become an epidemic of its own as caregivers experience an increase in health risks, stress, and financial burden. This literature review focuses on caregiver burnout and how imperative it is that caregivers are better supported in their role. Researchers have developed instruments to assess and intervene in caregiver burnout that have shown effectiveness among caregivers and their families.Nevertheless, further longitudinal research is warranted regarding more effective interventions, including stress management and social support mechanisms.

Underutilization Of Endovascular Therapy In Black Patients With Ischemic Stroke: An Analysis Of State And Nationwide Cohorts, Youngran Kim, Anjail Sharrief, Min Ji Kwak, Swapnil Khose, Rania Abdelkhaleq, Sergio Salazar-Marioni, Guo-Qiang Zhang, Sunil A Sheth

Faculty, Staff and Student Publications

BACKGROUND AND PURPOSE: Endovascular therapy (EVT) is a very effective treatment but relies on specialized capabilities that are not available in every hospital where acute ischemic stroke is treated. Here, we assess whether access to and utilization of this therapy has extended uniformly across racial and ethnic groups.

METHODS: We conducted a retrospective, population-based study using the 2019 Texas Inpatient Public Use Data File. Acute ischemic stroke cases and EVT use were identified using the

RESULTS: Among 40 814 acute ischemic stroke cases in Texas in 2019, 54% were White, 17% Black, and 21% Hispanic. Black patients had similar admissions …

Age-Associated Gut Dysbiosis, Marked By Loss Of Butyrogenic Potential, Correlates With Altered Plasma Tryptophan Metabolites In Older People Living With Hiv., Smita Ghare, Richa Singhal, Vaughn Bryant, Sabina Gautam, Chanakya Charan Tirumala, Praneet Kumar Srisailam, Andrea Reyes-Vega, Dushan Ghooray, Craig J. Mcclain, Kristi Hoffman, Joseph Petrosino, Kendall Bryant, Varand Govind, Ronald Cohen, Robert L. Cook, Shirish Barve

Faculty and Staff Scholarship

Background:

Imbalance in tryptophan (TRP) metabolism and its neuroactive metabolites, serotonin and kynurenine (KYN), is a known pathogenic mechanism underlying neurocognitive impairment. Gut microbiota plays an important role in TRP metabolism, and the production of these neuroactive molecules affects neurocognitive function. Although both HIV infection and normal aging independently induce gut dysbiosis and influence TRP metabolism, their interactive effects on compositional/functional changes in gut microbiota and consequent alterations in TRP metabolites remain largely undetermined.

Methods:

Older people living with HIV infection (PLWH, aged 50–70 years, n = 22) were enrolled in this cross-sectional pilot study. Metagenomic analysis of fecal microbiome …

Comorbidities, Health-Related Quality Of Life, Health-Care Utilization In Older Persons With Hemophilia-Hematology Utilization Group Study Part Vii (Hugs Vii), Randall Curtis, Marilyn Manco-Johnson, Barbara A Konkle, Roshni Kulkarni, Joanne Wu, Judith R Baker, Megan Ullman, Duc Quang Tran, Michael B Nichol

Faculty, Staff and Student Publications

PURPOSE: We compare the impact of hemophilia on comorbidities, joint problems, health-related quality of life (HRQoL) and health-care utilization between two age groups: 40-49 years and ≥50 years.

PATIENTS AND METHODS: The HUGS VII study recruited persons with hemophilia A or B age ≥40 years. Participants completed surveys to collect data on sociodemographic and clinical characteristics, hemophilia treatment regimen, pain, joint problems, comorbidities, HRQoL, depression and anxiety, at baseline and 6-months later. Clinical chart reviews documented hemophilic severity and treatment.

RESULTS: The sample includes 69 males, 65.2% aged ≥50 years, 75.4% with hemophilia A. Individuals ≥50 years were more likely …

Effect Of Auricular Acupressure On Acute Pain In Nursing Home Residents With Mild Dementia: A Single-Blind, Randomized, Sham-Controlled Study, Jun Jun Zhang, Li Yu, Jun Hui Mei, Hong Xin Wang, Hai Xiang Gao, Ju Fang Fu, Ye Cheng, Lu Lu Gao, Lei Bu, Jian Qiang Yu, Carol Chunfeng Wang, Yu Xiang Li

Research outputs 2022 to 2026

Introduction. Acute pain is a prevalent problem for dementia residents in nursing homes. A variety of intervention strategies have been applied to address this problem. However, there remains an issue of inadequate pain control. This study aims to explore the analgesic efficacy of auricular acupressure (AA) for dementia residents with acute pain in nursing homes. Methods. A multicenter, single-blind, randomized, and sham-controlled clinical trial was performed in three nursing homes in Yinchuan, China. All of the 206 eligible patients with acute pain were randomly divided into two groups for real AA therapy or sham AA (at sham point stimulation) therapy. …

An Asian Case Of Combined 17Α-Hydroxylase/17,20-Lyase Deficiency Due To Homozygous Pr96q Mutation: A Case Report And Review Of The Literature, Qian Liao, Rufei Shen, Mingyu Liao, Chenxi Ran, Ling Zhou, Yuling Zhang, Guiliang Peng, Zheng Sun, Hongting Zheng, Min Long

Center on Aging Staff Publications

Background: Combined 17α-hydroxylase/17,20-lyase deficiency (17-OHD) is a very rare form of congenital adrenal hyperplasia (CAH) caused by mutations in the CYP17A1 gene. Almost 100 different mutations of the CYP17A1 gene have been reported, including p.R96Q mutation, but no case of p.R96Q mutation has been described in Asian populations.

Case presentation: We describe a 22-year-old female patient of 46,XY karyotype, who presented with pseudohermaphrodism, primary amenorrhea, underdeveloped secondary sexual characteristics, delayed epiphyseal healing, hypertension, and hypokalemia. The diagnosis of 17-OHD was reached by measurement of steroid hormones and abdominal CT scan and confirmed by genetic sequencing, which revealed a homozygous p.R96Q …

Geriatric Emergency Medicine Fellowship Journal Club: Frailty, Sarah Keene, Rebecca Fisher, Lauren Cameron-Comasco

Journal of Geriatric Emergency Medicine

No abstract provided.

Feasibility Of A Sensor-Controlled Digital Game For Heart Failure Self-Management: Randomized Controlled Trial, Kavita Radhakrishnan, Christine Julien, Tom Baranowski, Matthew O'Hair, Grace Lee, Atami Sagna De Main, Catherine Allen, Bindu Viswanathan, Edison Thomaz, Miyong Kim

Faculty, Staff and Students Publications

BACKGROUND: Poor self-management of heart failure (HF) contributes to devastating health consequences. Our innovative sensor-controlled digital game (SCDG) integrates data from sensors to trigger game rewards, progress, and feedback based on the real-time behaviors of individuals with HF.

OBJECTIVE: The aim of this study is to compare daily weight monitoring and physical activity behavior adherence by older adults using an SCDG intervention versus a sensors-only intervention in a feasibility randomized controlled trial.

METHODS: English-speaking adults with HF aged 55 years or older who owned a smartphone and could walk unassisted were recruited from Texas and Oklahoma from November 2019 to …

Delirium In Frail Older Adults, Min Ji Kwak

Faculty, Staff and Student Publications

Delirium and frailty are prevalent geriatric syndromes and important public health issues among older adults. The prevalence of delirium among hospitalized older adults ranges from 15% to 75%, while that of frailty ranges from 12% to 24%. The exact pathophysiology of these two conditions has not been clearly identified, although several hypotheses have been proposed. However, these conditions are considered to be multifactorial in etiology and are associated with inflammation related to aging, alterations in vascular systems, genetics, and nutritional deficiency. Furthermore, clinically, they are significantly associated with frailty, which increases the risk of delirium by almost two- to three-fold …

The Detrimental Association Between Fear Of Falling And Motor Performance In Older Cancer Patients With Chemotherapy-Induced Peripheral Neuropathy, Gu Eon Kang, Tamiko K Murphy, Mark E Kunik, Hoda J Badr, Biruh T Workeneh, Sarvari V Yellapragada, Yvonne H Sada, Bijan Najafi

Faculty, Staff and Students Publications

BACKGROUND: Cancer patients with chemotherapy-induced peripheral neuropathy (CIPN) are at increased risk of falls and developing fear of falling (FoF). Although FoF may continue to impair motor performance and increase the risk of falling even further, this association remains unexplored in CIPN.

RESEARCH QUESTION: Does high FoF in patients with CIPN further deteriorate motor performance beyond the impairment from CIPN-related sensory deficits?

METHODS: In this secondary analysis of data collected from two clinical trials, gait parameters during habitual walking condition and postural sway parameters during 30-second quiet standing (eye-open and eyes-closed) were compared among older participants (≥ 65 years) with …

Understanding Older Adults Living In Medically Underserved Areas Perspectives Regarding Type 2 Diabetes Care Received, Christopher Rogers

Seton Hall University Dissertations and Theses (ETDs)

Older adults with type 2 diabetes living in medically underserved areas (MUAs) have unique health and social needs that must be taken into consideration when supporting their type 2 diabetes treatment and management care. Effective treatment and management of type 2 diabetes for older adults living in MUAs requires incorporating the preferences, desires, needs, values, and goals of the person at the center of the care into his/her care plan. Shifting care to be conducive to the treatment and management goals and plans co-created with older adults living in MUAs based on their individual physical, psychological, social, and spiritual preferences, …

Alzheimer's Patients’ Mental Health During The Covid 19 Pandemic, Maryanna Schweininger, Yvonne Maduka, Ajh'shana Collins

Rowan-Virtua Research Day

Alzheimer’s disease (AD) is a degenerative brain disease caused by β Amyloid plaques and neurofibrillary tangles, which results in memory loss and cognitive decline. It is the sixth leading cause of death in the United States. Approximately 50% of those with AD experience some degree of depression during the course of the disease, which has been shown to accelerate functional decline, institutionalization, and even mortality.

Many who cannot care for themselves live in an assisted living facility or retirement home. Since the beginning of the COVID 19 pandemic, people have been urged to social distance in order to decrease the …

Bilateral Lower Extremity Ischemia Following Cardiac Catheterization, Moses Avedikian, Alan Lucerna, Trent Malcolm

Rowan-Virtua Research Day

Acute limb ischemia is a rare yet limb-threatening presentation where rapid diagnosis and intervention is warranted. Bilateral lower extremity ischemia can be a rare complication following procedures, such as a cardiac catheterization with access obtained in the groin. We describe a case of a 79-year-old female who presented with bilateral lower extremity ischemia following a cardiac catheterization 2 weeks prior. The patient underwent CT angiography, which demonstrated occlusion with no contrast present in the bilateral femoral arteries.

Decade-Long Nationwide Trends And Disparities In Use Of Comfort Care Interventions For Patients With Ischemic Stroke, Kristie M Chu, Erica M Jones, Jennifer R Meeks, Alan P Pan, Kathryn L Agarwal, George E Taffet, Farhaan S Vahidy

Faculty, Staff and Students Publications

Background Stroke remains one of the leading causes of disability and death in the United States. We characterized 10-year nationwide trends in use of comfort care interventions (CCIs) among patients with ischemic stroke, particularly pertaining to acute thrombolytic therapy with intravenous tissue-type plasminogen activator and endovascular thrombectomy, and describe in-hospital outcomes and costs. Methods and Results We analyzed the National Inpatient Sample from 2006 to 2015 and identified adult patients with ischemic stroke with or without thrombolytic therapy and CCIs using validated

Characterization Of Age-Associated Gut Microbial Dysbiosis And Plasma Metabolite Alterations In People Living With Hiv (Plwh)., R. Sighal, Smita Ghare, Vaughn Bryant, Sabina Gautam, Chanakya Charan Tirumala, Andrea Reyes-Vega, Craig J. Mcclain, Ronald Cohen, Varand Govind, R L. Cook, Shirish Barve

Faculty and Staff Scholarship

Background: HIV-1 infection and aging are independently associated with gut microbial dysbiosis and neurocognitive impairment. However, the interactive effects of HIV-infection and aging on the development of specific pathogenic features of gut microbial dysbiosis and consequent metabolic abnormalities associated with neurocognitive dysfunction remain largely undetermined and were examined in the present study

Beyond The Skin: A Case Report Of Vaginal Melanoma, Brittany Gilbert, Wm Tanner Gilbert, Ardeshir Hakam, Lynne J. Goebel

Marshall Journal of Medicine

Mucosal melanomas are rare, accounting for only 1.4% of all melanomas. Only 18% of mucosal melanomas are vulvovaginal in origin, making it exceedingly rare. Mucosal melanomas typically carry a worse prognosis than those arising from cutaneous sites with a higher risk of recurrence and disseminated disease. We report a rare case of vaginal melanoma presenting as postmenopausal bleeding and discuss management of this disease.

Conference Proceedings: Aurora Scientific Day 2020

Journal of Patient-Centered Research and Reviews

Abstracts published in this supplement were among those presented at the 46th annual Aurora Scientific Day research symposium, held virtually on May 20, 2020. The symposium provides a forum for describing research studies conducted by faculty, fellows, residents, and allied health professionals affiliated with Wisconsin-based Aurora Health Care, a part of the Advocate Aurora Health health system, which publishes the Journal of Patient-Centered Research and Reviews.

Sexually Transmitted Infections And The 65 And Older Population: Knowledge And Perceived Risk, Alexus Miranda

UNLV Theses, Dissertations, Professional Papers, and Capstones

Sexually transmitted infections (STI) can impact all persons. Since 2000, the number of STIs has steadily increased among persons aged 50 years and older in the United States (Purpora, 2012). Persons over the age of 60 accounted for the biggest increase of in-office treatments of STIs between 2014 and 2017 (Howley, 2018). The purpose of this study was to use the Sexual Health Model to examine the relationship between various predictors and these persons’ perceived risk of STIs, their STI knowledge, and other barriers that impact the sexual health of persons 65 years of age and older. This study used …

Geriatrics In Clinical Practice And Beyond: Brain Health, The Sixth Vital Sign?, Nannette Hoffman

HCA Healthcare Journal of Medicine

Brain health in middle age and geriatric patients will take on greater importance for health care practitioners in our aging society. This article discusses various approaches clinicians can use for their patients to promote and improve brain health. These are generally the same lifestyle adoptions for cerebrovascular disease and cardiovascular disease prevention: weight management, exercise, and blood pressure and cholesterol lowering. Social stimulation and cognitive activities may also be important for the elderly.

Investigating The Impact Of The Nursing Practice Environment (Npe) On Central Line-Associated Bloodstream Infections (Clabsi) Among Older Adults In The Intensive Care Unit (Icu), Kristen A. Cribbs

Dissertations and Theses

Background: Health care–associated infections, resulting from treatment received for medical or surgical conditions in a health care setting, represent a critical public health and patient safety issue, exacting substantial medical, social, and economic costs. The costliest among the leading causes of preventable health care-associated infections is central-line associated bloodstream infections (CLABSI), to which older adults (age 65 years and older) are particularly susceptible, especially during intensive care unit (ICU) stays. A rich body of research has empirically linked the quality of the nursing practice environment (NPE) in hospitals to both positive and negative patient outcomes; yet, surprisingly few studies have …

Integrating Geriatric Assessment And Genetic Profiling To Personalize Therapy Selection In Older Adults With Acute Myeloid, Vijaya R. Bhatt

Theses & Dissertations

Integrating geriatric assessment for patient profiling and genetic profiling of leukemic cells represents an innovative approach to personalize therapy selection in older adults with acute myeloid leukemia (AML). We report results of a pre-planned interim analysis of a pragmatic phase II trial that utilized this strategy to personalize therapy. Patients ≥60 years with a new diagnosis of AML underwent geriatric assessment prior to initiation of treatment. Geriatric assessment of physical function, cognitive function and comorbidity burden were used to determine fitness for chemotherapy. Patients with good or intermediate-risk AML received intensive chemotherapy such as anthracycline and cytarabine (7+3) if determined …

A Retrospective Matched-Cohort Study Of 3994 Lower Extremity Wounds Of Multiple Etiologies Across 644 Institutions Comparing A Bioactive Human Skin Allograft, Theraskin, Plus Standard Of Care, To Standard Of Care Alone, Geoff C Gurtner, Aimee D Garcia, Katie Bakewell, Jason B Alarcon

Faculty, Staff and Students Publications

Most chronic wounds are related to comorbidities, for which no clinical trials are performed. This retrospective propensity matched-cohort study examined data from 2 074 000 lower extremity wounds across 644 institutions to determine the effectiveness of TheraSkin plus standard of care (SOC; n = 1997) versus SOC alone (n = 1997). Multivariate modelling comparing outcomes such as healing rates, percent area reductions (PARs), amputations, recidivism, treatment completion, and medical transfers were evaluated. A higher proportion of wounds in the treatment group compared with the controls were more likely to close (68.3% versus 60.3%), particularly wounds with exposed structures (64% versus …

Older Adults Hospitalized For Pneumonia In The United States: Incidence, Epidemiology, And Outcomes., Forest W. Arnold, Andrea Reyes-Vega, Vidyulata Salunkhe, Stephen P. Furmanek, Christian Furman, Laura Morton, Anna Johan Faul, Pam Yankeelov, Julio A. Ramirez

Faculty and Staff Scholarship

OBJECTIVES: To define the current incidence, epidemiology, and mortality of older adult patients hospitalized with community-acquired pneumonia (CAP) in Louisville, KY and thus estimate the burden of CAP in the older adult population of the United States. To define risk factors associated with early and late outcomes. DESIGN: This was a secondary analysis of older adults (aged ≥65 years) from the University of Louisville Pneumonia Study, a prospective population-based cohort study of all hospitalized adults with CAP between June 1, 2014, and May 31, 2016. SETTING: The study took place in all nine acute care hospitals for adults in Louisville, …

Age And Functional Outcomes Post-Neurologic Insult In Patients Attending Inpatient Rehabilitation, Jonathan Bowman Spt, Elena Crooks Pt, Dpt, Phd, Doug Weeks Phd, Kimberly Honn Phd

2020 Symposium Posters

Introduction

Neurologic insults such as strokes and traumatic brain injuries (TBI) affect over 1 million Americans every year. The lack of current knowledge informing accurate prognoses causes victims and their loved ones distress, and is a focus of much research. The purpose of this study was to determine whether patient age at time of insult could predict change in functional outcomes during inpatient rehabilitation.

Methods

Subjects were patients of an inpatient rehabilitation facility (IRF) post-stroke or TBI. The Functional Independence Measure (FIM) assessed functional independence and cognitive status at admission and discharge from the IRF. The Montebello Rehabilitation Factor Score …

Pain Management In Dementia Patients In Nursing Homes, Tiffany Kneuss, Kelsey Weisenburger, Hannah Stewart, Kelly Reilly Kroustos

Pharmacy and Wellness Review

Pain in the elderly, especially those with dementia, is often undertreated and misdiagnosed by health care professionals in the long-term care setting. Communication barriers in patients with cognitive impairment force pain assessment to rely heavily on subjective interpretation of behavioral factors due to the inability of patients to self-report pain symptoms. It is important for clinicians to develop a standard method of identifying and assessing signs of pain in patients with dementia in order to appropriately treat those experiencing discomfort. Patients with dementia who present with a sudden onset of behavioral changes should receive a comprehensive evaluation that includes a …

Delirium In Long Term Care Rehabilitation Residents: A Correlational Retrospective Study, Rebecca Lerma-Kjonegaard

Dissertations

Abstract Background: Delirium is associated with devastating outcomes, cognitive loss,

decreased function and an increase risk of mortality which affects patients and places a heavy burden on family and the healthcare system. The purpose of this study was to describe the relationship between select demographics, clinical characteristics, CHART- DEL-derived delirium diagnosis and ICD-10 coded discharge delirium diagnoses among Long Term Care (LTC) rehabilitation residents.

Method: A retrospective correlational design from174 LTC rehabilitation residents age 65 years or older using EMR and hard copy charts. The setting was a Southern California community hospital-based 100-bed LTC. Abstracted data included demographic characteristics (age, …

Visual And Verbal Serial List Learning In Patients With Statistically-Determined Mild Cognitive Impairment., Victor Wasserman, Sheina Emrani, Emily F Matusz, David Miller, Kelly Davis Garrett, Katherine A Gifford, Timothy J Hohman, Angela L Jefferson, Rhoda Au, Rod Swenson, David J Libon, Consortium For Clinical And Epidemiological Neuropsychological Data Analysis (Cenda).

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Background and Objective: Prior research with patients with mild cognitive impairment (MCI) suggests that visual versus verbal episodic memory test performance may be more sensitive to emergent illness. However, little research has examined visual versus verbal episodic memory performance as related to MCI subtypes.

Research Design and Methods: Patients were diagnosed with non-MCI, amnestic MCI (aMCI), and combined mixed/dysexecutive MCI (mixed/dys MCI). Visual and verbal episodic memory were assessed with the Brief Visuospatial Memory Test-Revised (BVMT-R) and the 12-word Philadelphia (repeatable) Verbal Learning Test (P[r]VLT), respectively.

Results: BVMT-R and P(r)VLT scores yielded similar between-group patterns of performance. Non-MCI patients scored …

The Relationship Of Cardiovascular Disease To 30-Day Hospital Readmission Among Older Adults With Type 2 Diabetes Mellitus, Meet Shah, Shmilah Choudhary, Sanath Shetty, Terrie Ginsberg, Matthew H. Mclaughlin

Rowan-Virtua Research Day

Reducing thirty-day hospital readmissions is a top healthcare priority. However, there is little research describing the risk factors of readmission among patients with diabetes, especially for older adults. Understanding what the risk factors are for 30-day hospital readmission for older adults with type 2 diabetes (T2DM) would help identify patients at risk of rehospitalization. The aim of this study was to identify factors associated with 30-day unplanned hospital readmissions among older adults with T2DM.Factors to be investigated are: patient demographics and whether the patient was hospitalized for cardiovascular disease. Participants were older adults>65 years old with T2DM, admitted to …

The Relationship Of Risk Of Falls And Activities Of Daily Living To 30-Day Hospital Readmission Among Older Adults With Type 2 Diabetes, Sanath Shetty, Shmilah Choudhary, Meet Shah, Terrie Ginsberg, Matthew H. Mclaughlin

Rowan-Virtua Research Day

Introduction: Reducing thirty-day hospital readmissions is a top healthcare priority. However, there is little research describing the risk factors of readmission among patients with diabetes, especially for older adults. Understanding what the risk factors are for 30-day hospital readmission for older adults with type 2 diabetes (T2DM) would help identify patients at risk of rehospitalization.

Objective: The aim of this study was to identify factors associated with 30-day unplanned hospital readmissions among older adults with T2DM. Factors to be investigated are: patient demographics, whether patients were at risk for falling, and patients’ activities of daily living (ADL) at discharge.

Methods: …

Toxic Environmental Risk Factors For Alzheimer's Disease: A Systematic Review, Oluwaseyi Olayinka, Olaniyi O. Olayinka, Brook T. Alemu, Muge Akpinar-Elci, George T. Grossberg

Community & Environmental Health Faculty Publications

There is growing evidence of a possible association between toxic environmental factors and Alzheimer’s disease (AD), a disabling neurodegenerative condition with no known cause. Previous reviews of toxic environmental factors for AD either focused on occupational exposures or used a non-systematic methodology. The objective of this systematic review is to assess the evidence on the link between AD and exposure to a variety of toxic environmental risk factors beyond the work environment. Structured database search was used to identify relevant studies. Twenty-nine eligible studies examining the effect of various toxic environmental agents including electromagnetic fields, solvents, pesticides, toxic metals, and …