Browsing by Subject "Geriatrics"
Now showing 1 - 5 of 5
Results Per Page
Sort Options
Item Open Access Age patterns of incidence of geriatric disease in the U.S. elderly population: Medicare-based analysis.(J Am Geriatr Soc, 2012-02) Akushevich, Igor; Kravchenko, Julia; Ukraintseva, Svetlana; Arbeev, Konstantin; Yashin, Anatoliy IOBJECTIVES: To use the Medicare Files of Service Use (MFSU) to evaluate patterns in the incidence of aging-related diseases in the U.S. elderly population. DESIGN: Age-specific incidence rates of 19 aging-related diseases were evaluated using the National Long Term Care Survey (NLTCS) and the Surveillance, Epidemiology, and End Results (SEER) Registry data, both linked to MFSU (NLTCS-M and SEER-M, respectively), using an algorithm developed for individual date at onset evaluation. SETTING: A random sample from the entire U.S. elderly population (Medicare beneficiaries) was used in NLTCS, and the SEER Registry data covers 26% of the U.S. population. PARTICIPANTS: Thirty-four thousand seventy-seven individuals from NLTCS-M and 2,154,598 from SEER-M. MEASUREMENTS: Individual medical histories were reconstructed using information on diagnoses coded in MFSU, dates of medical services and procedures, and Medicare enrollment and disenrollment. RESULTS: The majority of diseases (e.g., prostate cancer, asthma, and diabetes mellitus) had a monotonic decline (or decline after a short period of increase) in incidence with age. A monotonic increase in incidence with age with a subsequent leveling off and decline was observed for myocardial infarction, stroke, heart failure, ulcer, and Alzheimer's disease. An inverted U-shaped age pattern was detected for lung and colon carcinomas, Parkinson's disease, and renal failure. The results obtained from the NLTCS-M and SEER-M were in agreement (excluding an excess for circulatory diseases in the NLTCS-M). A sensitivity analysis proved the stability of the incidence rates evaluated. CONCLUSION: The developed computational approaches applied to the nationally representative Medicare-based data sets allow reconstruction of age patterns of disease incidence in the U.S. elderly population at the national level with unprecedented statistical accuracy and stability with respect to systematic biases.Item Open Access Evaluation of a geriatrics primary care model using prospective matching to guide enrollment.(BMC medical research methodology, 2021-08) Smith, Valerie A; Van Houtven, Courtney Harold; Lindquist, Jennifer H; Hastings, Susan NBackground
Few definitive guidelines exist for rigorous large-scale prospective evaluation of nonrandomized programs and policies that require longitudinal primary data collection. In Veterans Affairs (VA) we identified a need to understand the impact of a geriatrics primary care model (referred to as GeriPACT); however, randomization of patients to GeriPACT vs. a traditional PACT was not feasible because GeriPACT has been rolled out nationally, and the decision to transition from PACT to GeriPACT is made jointly by a patient and provider. We describe our study design used to evaluate the comparative effectiveness of GeriPACT compared to a traditional primary care model (referred to as PACT) on patient experience and quality of care metrics.Methods
We used prospective matching to guide enrollment of GeriPACT-PACT patient dyads across 57 VA Medical Centers. First, we identified matches based an array of administratively derived characteristics using a combination of coarsened exact and distance function matching on 11 identified key variables that may function as confounders. Once a GeriPACT patient was enrolled, matched PACT patients were then contacted for recruitment using pre-assigned priority categories based on the distance function; if eligible and consented, patients were enrolled and followed with telephone surveys for 18 months.Results
We successfully enrolled 275 matched dyads in near real-time, with a median time of 7 days between enrolling a GeriPACT patient and a closely matched PACT patient. Standardized mean differences of < 0.2 among nearly all baseline variables indicates excellent baseline covariate balance. Exceptional balance on survey-collected baseline covariates not available at the time of matching suggests our procedure successfully controlled many known, but administratively unobserved, drivers of entrance to GeriPACT.Conclusions
We present an important process to prospectively evaluate the effects of different treatments when randomization is infeasible and provide guidance to researchers who may be interested in implementing a similar approach. Rich matching variables from the pre-treatment period that reflect treatment assignment mechanisms create a high quality comparison group from which to recruit. This design harnesses the power of national administrative data coupled with collection of patient reported outcomes, enabling rigorous evaluation of non-randomized programs or policies.Item Open Access The changing face of general internal medicine and lessons learned from geriatric medicine.(Journal of general internal medicine, 2014-06) Bosworth, Hayden BItem Open Access The second international conference "genetics of aging and longevity".(Aging (Albany NY), 2012-05) Anisimov, Vladimir N; Bartke, Andrzej; Barzilai, Nir; Batin, Mikhail A; Blagosklonny, Mikhail V; Brown-Borg, Holly; Budovskaya, Yelena; Campisi, Judith; Friguet, Bertrand; Fraifeld, Vadim; Franceschi, Claudio; Gems, David; Gladyshev, Vadim; Gorbunova, Vera; Gudkov, Andrei V; Kennedy, Brian; Konovalenko, Maria; Kraemer, Brian; Moskalev, Alexey; Petropoulos, Isabelle; Pasyukova, Elena; Rattan, Suresh; Rogina, Blanka; Seluanov, Andrei; Shaposhnikov, Mikhail; Shmookler Reis, Robert; Tavernarakis, Nektarios; Vijg, Jan; Yashin, Anatoli; Zimniak, PiotrItem Open Access The Sickle Cell Disease Functional Assessment (SCD-FA) tool: a feasibility pilot study.(Pilot and feasibility studies, 2022-03) Oyedeji, Charity I; Hall, Katherine; Luciano, Alison; Morey, Miriam C; Strouse, John JBackground
The life expectancy for individuals with sickle cell disease (SCD) has greatly increased over the last 50 years. Adults with SCD experience multiple complications such as cardiopulmonary disease, strokes, and avascular necrosis that lead to limitations that geriatric populations often experience. There are no dedicated instruments to measure functional decline and functional age to determine risk of future adverse outcomes in older adults with SCD. The objective of this study was to assess the feasibility of performing the Sickle Cell Disease Functional Assessment (SCD-FA).Methods
We enrolled 40 adults with SCD (20 younger adults aged 18-49 years as a comparison group and 20 older adults aged 50 years and older) in a single-center prospective cohort study. Participants were recruited from a comprehensive sickle cell clinic in an academic center in the southeastern United States. We included measures validated in an oncology geriatric assessment enriched with additional physical performance measures: usual gait speed, seated grip strength, Timed Up and Go, six-minute walk test, and 30-second chair stand. We also included an additional cognitive measure, which was the Montreal Cognitive Assessment, and additional patient-reported measures at the intersection of sickle cell disease and geriatrics. The primary outcome was the proportion completing the assessment. Secondary outcomes were the proportion consenting, duration of the assessment, acceptability, and adverse events.Results
Eighty percent (44/55) of individuals approached consented, 91% (40/44) completed the SCD-FA in its entirety, and the median duration was 89 min (IQR 80-98). There were no identified adverse events. On the acceptability survey, 95% (38/40) reported the length as appropriate, 2.5% (1/40) reported a question as upsetting, and 5% (2/40) reported portions as difficult. Exploratory analyses of physical function showed 63% (25/40) had a slow usual gait speed (< 1.2 m/s).Conclusion
The SCD-FA is feasible, acceptable, and safe and physical performance tests identified functional impairments in adults with SCD. These findings will inform the next phase of the study where we will assess the validity of the SCD-FA to predict patient-important outcomes in a larger sample of adults with SCD.