Browsing by Subject "age"

Now showing 1 - 6 of 6
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    Age-specific rates of hospital transfers in long-stay nursing home residents
    (Oxford Academic, 2022-01) Tu, Wanzhu; Li, Ruohong; Stump, Timothy E.; Fowler, Nicole R.; Carnahan, Jennifer L.; Blackburn, Justin; Sachs, Greg A.; Hickman, Susan E.; Unroe, Kathleen T.; Biostatistics, School of Public Health
    Introduction hospital transfers and admissions are critical events in the care of nursing home residents. We sought to determine hospital transfer rates at different ages. Methods a cohort of 1,187 long-stay nursing home residents who had participated in a Centers for Medicare and Medicaid demonstration project. We analysed the number of hospital transfers of the study participants recorded by the Minimum Data Set. Using a modern regression technique, we depicted the annual rate of hospital transfers as a smooth function of age. Results transfer rates declined with age in a nonlinear fashion. Rates were the highest among residents younger than 60 years of age (1.30-2.15 transfers per year), relatively stable between 60 and 80 (1.17-1.30 transfers per year) and lower in those older than 80 (0.77-1.17 transfers per year). Factors associated with increased risk of transfers included prior diagnoses of hip fracture (annual incidence rate ratio or IRR: 2.057, 95% confidence interval (CI): [1.240, 3.412]), dialysis (IRR: 1.717, 95% CI: [1.313, 2.246]), urinary tract infection (IRR: 1.755, 95% CI: [1.361, 2.264]), pneumonia (IRR: 1.501, 95% CI: [1.072, 2.104]), daily pain (IRR: 1.297, 95% CI: [1.055,1.594]), anaemia (IRR: 1.229, 95% CI [1.068, 1.414]) and chronic obstructive pulmonary disease (IRR: 1.168, 95% CI: [1.010,1.352]). Transfer rates were lower in residents who had orders reflecting preferences for comfort care (IRR: 0.79, 95% CI: [0.665, 0.936]). Discussion younger nursing home residents may require specialised interventions to reduce hospital transfers; declining transfer rates with the oldest age groups may reflect preferences for comfort-focused care.
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    Developmental Considerations for Assessment and Treatment of Impulsivity in Older Adults
    (Springer, 2020) Liu, Melissa; Argyriou, Eva; Cyders, Melissa A.; Psychology, School of Science
    Impulsivity is an important factor in many clinical disorders, especially alcohol and substance use disorders. Most of the research on impulsivity in this domain has focused on adolescence and young adulthood, as this developmental period is characterized by onset of and escalation in alcohol and substance use, likely driven in part by brain development patterns. Although many individuals eventually “mature out” of these behaviors in middle adulthood, a critical subset of people do not. The role of impulsivity in middle-to-older adulthood, when certain individuals transition from normative to disordered substance use, has not been carefully examined. The goal of this paper is to review the literature on measuring and modifying impulsivity from adolescence through older adulthood, with a special focus on middle-to-older adulthood. We propose that impulsivity research should include data on middle-to-older adulthood as an important time of transition to disordered use. We consider how impulsivity might have unique meaning at different stages of the adult lifespan and suggest modifications for assessing and treating impulsivity in older adults.
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    The Effect of Age on the Progression and Severity of Type 1 Diabetes: Potential Effects on Disease Mechanisms
    (Springer, 2018-11) Leete, Pia; Mallone, Roberto; Richardson, Sarah J.; Sosenko, Jay M.; Redondo, Maria J.; Evans-Molina, Carmella; Medicine, School of Medicine
    Purpose of Review To explore the impact of age on type 1 diabetes (T1D) pathogenesis. Recent Findings Children progress more rapidly from autoantibody positivity to T1D and have lower C-peptide levels compared to adults. In histological analysis of post-mortem pancreata, younger age of diagnosis is associated with reduced numbers of insulin containing islets and a hyper-immune CD20hi infiltrate. Moreover compared to adults, children exhibit decreased immune regulatory function and increased engagement and trafficking of autoreactive CD8+ T cells, and age-related differences in β cell vulnerability may also contribute to the more aggressive immune phenotype observed in children. To account for some of these differences, HLA and non-HLA genetic loci that influence multiple disease characteristics, including age of onset, are being increasingly characterized. Summary The exception of T1D as an autoimmune disease more prevalent in children than adults results from a combination of immune, metabolic, and genetic factors. Age-related differences in T1D pathology have important implications for better tailoring of immunotherapies.
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    Individualized approach to primary prevention of substance use disorder: age-related risks
    (Springer, 2020-08-14) Afuseh, Eric; Pike, Caitlin; Oruche, Ukamaka M.; University Library
    Background The misuse of legal and illegal substances has led to an increase in substance use disorder (SUD) in the United States. Although primary prevention strategies have been successfully used to target chronic physical diseases, these strategies have been less effective with SUD, given misconceptions of SUD, shortages in behavioral health professionals, and the population-based focus on specific substances. A developmental approach to the identification and primary prevention of SUD that does not fully rely upon behavioral health workers is needed. The purpose of this paper was to examine age related risk factors for developing SUD and present a novel individualized approach to SUD prevention. Methods A literature search was conducted to identify risk factors for SUD among children, young adults, adults, and older adults. We searched CINAHL, PsycINFO, and PubMed between the years 1989–2019, and extracted data, analyzing similarities and differences in risk factors across life stages. Broader categories emerged that were used to group the risk factors. Results More than 370 articles were found. Across all age groups, risk factors included adverse childhood experiences, trauma, chronic health diseases, environmental factors, family history, social determinants, and grief and loss. Despite the similarities, the contextual factors and life challenges associated with these risks varied according to the various life stages. We proposed an approach to primary prevention of SUD based on risk factors for developing the disease according to different age groups. This approach emphasizes screening, education, and empowerment (SEE), wherein individuals are screened for risk factors according to their age group, and screening results are used to customize interventions in the form of education and empowerment. Given that trained persons, including non-healthcare providers, close to the at-risk individual could conduct the screening and then educate and mentor the individual according to the risk level, the number of people who develop SUD could decrease. Conclusions The risk factors for developing SUD vary across the various life stages, which suggests that individualized approaches that do not overtax behavioral healthcare workers are needed. Using SEE may foster early identification and individualized prevention of SUD.
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    Influence of Age on Warfarin Dose, Anticoagulation Control, and Risk of Hemorrhage
    (Wiley, 2018) Shendre, Aditi; Parmar, Gaurav M.; Dillon, Chrisly; Beasley, T. Mark; Limdi, Nita A.; Epidemiology, School of Public Health
    Objective We assessed the influence of age on warfarin dose, percentage time in target range (PTTR), and risk of major hemorrhage. Design Warfarin users recruited into a large prospective inception cohort study were categorized into three age groups: young (younger than 50 yrs), middle aged (50–70 yrs), and elderly (older than 70 yrs). The influence of age on warfarin dose and PTTR was assessed using regression analysis; risk of major hemorrhage was assessed using proportional hazards analysis. Models were adjusted for demographic, clinical, and genetic factors. Setting Two outpatient anticoagulation clinics. Participants A total of 1498 anticoagulated patients. Outcomes Warfarin dose (mg/day), PTTR, major hemorrhage. Results Of the 1498 patients, 22.8% were young, 44.1% were middle aged, and 33.1% were elderly. After accounting for clinical and genetic factors, compared with young warfarin users, warfarin dose requirements were 10.6% lower among the middle aged and an additional 10.6% lower for the elderly. Compared with young patients, middle-aged and elderly patients spent more time in target international normalized ratio (INR) range (p<0.0001), despite having fewer INR assessments (p<0.0001). Compared with young warfarin users, absolute risk of hemorrhage was marginally higher among the middle aged (p=0.08) and significantly higher among the elderly (p=0.016). Compared with young warfarin users, after adjustment, the relative risk of hemorrhage increased by 31% for each age category (p=0.026). Conclusions In a real-world setting, despite achieving better anticoagulation control, elderly patients had a higher risk of major hemorrhagic events. As the population ages and the candidacy for oral anticoagulation increases, strategies that mitigate the elevated risk of hemorrhage need to be identified.
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    Quality of Life in Younger versus Older Breast Cancer Survivors
    (Office of the Vice Chancellor for Research, 2011-04-08) Ziner, Kim; Champion, Victoria; Sledge, George; Monahan, Patrick; Zho, Qian Qian
    Background: Breast cancer is one of the most frequently occurring cancers in the developing world, but with earlier detection and better treatment, the majority of breast cancer survivors will live many years after diagnosis. Breast cancer survivors may experience many symptoms that impact their quality of life, and these symptoms may vary by age. The purpose of this study is to compare breast cancer survivors who were diagnosed at 45 and under (n=469) with survivors diagnosed at 55 to 70 (n=584) years of age. Materials and methods: Participants were identified through a large cooperative group (Eastern Cancer Cooperative Group). Eligibility criteria included use of chemotherapy at initial diagnosis, being 3 to 8 years from diagnosis, and not having a recurrence of breast cancer. The mean current age of younger survivors was 45.2 and for older survivors was 66.7. Women who agreed to participate were sent a survey and informed consent which was completed and returned via mail. Overall, 80% of eligible women contacted by researchers agreed to participate. Measures included physical, psychological, social, spiritual, and overall quality of life constructs. All measurements had good reported validity and reliability. A total of 469 younger and 584 older breast cancer survivors are included. Linear regression was used to compare the two groups on continuous outcomes while adjusting for the following potentially confounding covariates: marital status (married versus not), years of education, and total household income, and years since diagnosis. Results: Younger survivors scored significantly worse than older survivors on gynecological problems, sexual enjoyment, attention function, and overall reported symptoms. Psychologically, younger survivors demonstrated greater symptom distress, greater depression, and greater state and trait anxiety than older survivors. Younger survivors had lower marital satisfaction scores. Younger survivors reported greater fear of recurrence and less favorable body image. Younger survivors reported lower perceived social support from their partners and greater social constraint. Older survivors held higher spiritual beliefs and behaviors as compared to younger survivors. Perceived self efficacy for dealing with problems related to cancer survivorship was lower in younger survivors as compared to older survivors. For overall quality of life measures, younger survivors reported lower index of well being scores than older survivors and reported that breast cancer had a greater impact on their life. Health care service use was greater for younger as opposed to older survivors both during and after treatment. Conclusions: Younger survivors reported significantly more problems on several, physical, psychological, social and generic quality of life issues as compared to older survivors. Results indicate a need to proactively assess quality of life issues in younger women at time of diagnosis.