Association of the COVID-19 Pandemic With the Prevalence of Homebound Older Adults in the United States, 2011-2020.
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ABSTRACT:
SUBMITTER: Ankuda CK
PROVIDER: S-EPMC8383159 | biostudies-literature | 2021 Dec
REPOSITORIES: biostudies-literature
Publications
Association of the COVID-19 Pandemic With the Prevalence of Homebound Older Adults in the United States, 2011-2020.
Ankuda Claire K CK Leff Bruce B Ritchie Christine S CS Siu Albert L AL Ornstein Katherine A KA
JAMA internal medicine 20211201 12
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Project description:Study objectiveThe aim of this study was to examine the epidemiology of alcohol-associated fall injuries among older adults aged ≥65 years in the United States.MethodsWe included emergency department (ED) visits for unintentional fall injuries by adults from the National Electronic Injury Surveillance System-All Injury Program during 2011 to 2020. We estimated the annual national rate of ED visits for alcohol-associated falls and the proportion of these falls among older adults' fall-related ED visits using demographic and clinical characteristics. Joinpoint regression was performed to examine trends in alcohol-associated ED fall visits between 2011 and 2019 among older adult age subgroups and to compare these trends with those of younger adults.ResultsThere were 9,657 (weighted national estimate: 618,099) ED visits for alcohol-associated falls, representing 2.2% of ED fall visits during 2011 to 2020 among older adults. The proportion of fall-related ED visits that were alcohol-associated was higher among men than among women (adjusted prevalence ratio [aPR]=3.6, 95% confidence interval [CI] 2.9 to 4.5). The head and face were the most commonly injured body parts, and internal injury was the most common diagnosis for alcohol-associated falls. From 2011 to 2019, the annual rate of ED visits for alcohol-associated falls increased (annual percent change 7.5, 95% CI 6.1 to 8.9) among older adults. Adults aged 55 to 64 years had a similar increase; a sustained increase was not detected in younger age groups.ConclusionOur findings highlight the rising rates of ED visits for alcohol-associated falls among older adults during the study period. Health care providers in the ED can screen older adults for fall risk and assess for modifiable risk factors such as alcohol use to help identify those who could benefit from interventions to reduce their risk.
| S-EPMC10950308 | biostudies-literature
Project description:ObjectivesTo characterize antibiotics prescribed to older adults to guide efforts to improve antibiotic use.DesignDescriptive analysis.SettingAmbulatory.ParticipantsAdults aged 65 and older in the United States.MeasurementsInformation on outpatient antibiotic prescriptions dispensed for older adults from 2011 to 2014 was extracted from the IQVIA Xponent database. A chi-square trend analysis was conducted to assess annual changes in antibiotic prescribing rates. A descriptive analysis of prescribing rates by antibiotic, age group, sex, state, Census region, and provider specialty was conducted.ResultsFrom 2011 to 2014, outpatient antibiotic prescribing rates remained stable in older U.S. adults (P = .89). In 2014, older adults were dispensed 51.6 million prescriptions (1,115 prescriptions/1,000 persons). Persons aged 75 and older had a higher prescribing rate (1,157 prescriptions/1,000 persons) than those aged 65 to 74 (1,084 prescriptions/1,000 persons). Prescribing rates were highest in the South 1228 prescriptions/1,000 persons) and lowest in the West (854 prescriptions/1,000 persons). The most commonly prescribed class was quinolones, followed by penicillins and macrolides. Azithromycin was the most commonly prescribed drug, followed by amoxicillin and ciprofloxacin. Internists and family physicians prescribed 43% of antibiotic courses.ConclusionOn average, in 2014, U.S. adults aged 65 and older received enough outpatient antibiotic courses for every older adult to receive at least 1. Quinolones and azithromycin are potential targets for assessing the appropriateness of antibiotic prescribing in this population. Interventions to improve use targeting internists and family physicians in the South Census region might have the potential to have the greatest effect.
| S-EPMC7909599 | biostudies-literature
Project description:BackgroundOrganophosphate esters (OPEs) are widely used as an alternative to the brominated flame retardant polybrominated diphenyl ethers. The effects of OPEs on the cognitive abilities of older adults remain unclear.MethodsA cross-sectional study was conducted using data from the National Health and Nutrition Examination Survey 2011-2014. Cognitive function was assessed using the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) word learning test, the CERAD word recall test, the Animal Fluency Test (AFT), and the Digit Symbol Substitution Test (DSST). OPE metabolites with detection rates above 50% were included in the study. Weighted multiple linear regression, weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR) models were used to examine the effects of individual and mixed exposures to OPE metabolites on cognitive function.ResultsA total of 762 older adults were included. The weighted linear regression model revealed a positive association between Ln DPHP, Ln BDCPP, and Ln BCPP and the DSST score, while a negative association was observed between Ln DBUP and the DSST score. In the positive WQS model, the index was correlated with DSST score (β = 2.65, 95% CI: 0.40 ~ 4.90, P = 0.02), with DPHP having the highest weight. The results of BKMR analysis indicated a borderline statistical significance in the increase of DSST score when the mixture of OPEs is set to a specific 90th percentile compared to all mixture concentrations set to the median.ConclusionsOverall exposure to OPE metabolites are associated with improved cognitive function in older adults in the United States. Further prospective studies with large sample sizes are needed to confirm these results.
| S-EPMC11921510 | biostudies-literature
Project description:BackgroundHomebound older adults have heightened risks for isolation and negative health consequences, but it is unclear how COVID-19 has impacted them. We examine social contact and mood symptoms among previously homebound older adults during the COVID-19 pandemic.Design/settingCross-sectional analysis using data from the National Health and Aging Trends Study (NHATS), a nationally-representative longitudinal study of aging in the USA.ParticipantsA total of 3,112 community-dwelling older adults in 2019 who completed the COVID-19 survey in the summer/fall of 2020.MeasurementsHomebound status was defined via self-report as rarely/never leaving home or leaving the house with difficulty or help in the prior month. We measured limited social contact during COVID-19 (in-person, telephone, video or email contacts <once/week), as well as loneliness, anxiety, and depression.ResultsAmong homebound older adults, 13.2% experienced limited social contact during COVID-19 vs. 6.5% of the non-homebound. Differences in social contact were greatest for contacts via email/text/social media: 54.9% of the homebound used this <once/week vs. 28.4% of the non-homebound. In adjusted analyses of those without limited social contact prior to the pandemic, the homebound had higher but not significantly different odds (OR 1.83; 95% CI 0.95-3.52) of limited social contact during COVID-19, with increased risk among the older individuals, those with dementia, and those in assisted living facilities. Of the homebound, 13.2% felt lonely every/most days during the pandemic vs. 7.7% of non-homebound older adults. Homebound and non-homebound older adults reported similar rates of increased loneliness, anxiety, or depression during COVID-19. Fewer homebound older adults learned a new technology during the pandemic (16.3%) vs. non-homebound older adults (30.4%).DiscussionIsolation among homebound older adults increased during COVID-19, partially due to differences in technology use. We must ensure that homebound persons have the connection and care they need including new technologies for communication during and beyond COVID-19.
| S-EPMC8853401 | biostudies-literature
Project description: Not available
| S-EPMC10873719 | biostudies-literature
Project description:RationaleChronic obstructive pulmonary disease (COPD) is a common comorbidity among patients with lung cancer, and an important determinant of their outcomes, however, it is commonly underdiagnosed.ObjectiveOur objective was to estimate the prevalence of COPD among a cohort of U.S. lung cancer patients, the timing of a COPD diagnosis relative to their lung cancer diagnosis, and the association between an earlier diagnosis of COPD and stage of lung cancer, with consideration of patient sociodemographic modifying factors.MethodsWe conducted an analysis of the Medicare-linked Surveillance, Epidemiology, and End Results database including patients aged 68+ years who were diagnosed with lung cancer between 2008 to 2017. Exposure: Prevalence of COPD was identified using claims and subclassified based on the timing of its diagnosis relative to the lung cancer diagnostic episode-"preexisting" if diagnosed > 3 months before lung cancer, and "concurrent" if diagnosed around the same time as the lung cancer (+/-3 months). Outcome: The stage of cancer at diagnosis (early versus late) was the outcome.ResultsAmong 159,542 patients with lung cancer, 73.5% had COPD. Among those with COPD, 34.4% were diagnosed within 3 months of their lung cancer diagnosis and considered to have "concurrent COPD." We observed a positive association between preexisting COPD diagnosis and early-stage lung cancer (prevalence ratio= 1.27; 95% confidence interval= 1.23-1.30), in adjusted models which were stronger for male, non-Hispanic Black, and Hispanic patients.ConclusionsSeven out of 10 patients with lung cancer have COPD, however, many do not receive their COPD diagnosis until around the time of their lung cancer diagnosis. Among these patients, an early COPD diagnosis may improve early detection of lung cancer.
| S-EPMC11363966 | biostudies-literature
Project description:Background and aimsThe National Health and Nutrition Examination Survey (NHANES) underestimates the true prevalence of HCV infection. By accounting for populations inadequately represented in NHANES, we created 2 models to estimate the national hepatitis C prevalence among US adults during 2017-2020.Approach and resultsThe first approach (NHANES+) replicated previous methodology by supplementing hepatitis C prevalence estimates among the US noninstitutionalized civilian population with a literature review and meta-analysis of hepatitis C prevalence among populations not included in the NHANES sampling frame. In the second approach (persons who injected drugs [PWID] adjustment), we developed a model to account for the underrepresentation of PWID in NHANES by incorporating the estimated number of adult PWID in the United States and applying PWID-specific hepatitis C prevalence estimates. Using the NHANES+ model, we estimated HCV RNA prevalence of 1.0% (95% CI: 0.5%-1.4%) among US adults in 2017-2020, corresponding to 2,463,700 (95% CI: 1,321,700-3,629,400) current HCV infections. Using the PWID adjustment model, we estimated HCV RNA prevalence of 1.6% (95% CI: 0.9%-2.2%), corresponding to 4,043,200 (95% CI: 2,401,800-5,607,100) current HCV infections.ConclusionsDespite years of an effective cure, the estimated prevalence of hepatitis C in 2017-2020 remains unchanged from 2013 to 2016 when using a comparable methodology. When accounting for increased injection drug use, the estimated prevalence of hepatitis C is substantially higher than previously reported. National action is urgently needed to expand testing, increase access to treatment, and improve surveillance, especially among medically underserved populations, to support hepatitis C elimination goals.
| S-EPMC11557732 | biostudies-literature
Project description:Background/objectivesWith an aging population suffering from increased prevalence of chronic conditions in the United States (U.S.), a large portion of these patients are on multiple medications. High-risk medications can increase the risk for drug-drug interactions and medication nonadherence. This study aims to describe the prevalence of polypharmacy and high-risk medication prescribing in U.S. physician offices.MethodsThis was a cross-sectional study of the Centers for Disease Control and Prevention's National Ambulatory Medical Care Survey from 2009 to 2016. All patients over 65 years old were included. Polypharmacy was categorized as no polypharmacy (< 2 medications), minor polypharmacy (2-3 medications), moderate polypharmacy (4-5 medications), and major polypharmacy (>5 medications). Medications were further categorized into high-risk medication categories (anticholinergics, cardiovascular agents, central nervous system (CNS) medications, pain medications, and other). Comparisons between the degrees of polypharmacy were performed utilizing chi-square or Wilcoxon rank-sum tests with JMP Pro 14® (SAS Institute, Cary, NC).ResultsOver 2 billion patient visits were included. Overall, Polypharmacy was common (65.1%): minor polypharmacy (16.2%), moderate polypharmacy (12.1%), and major polypharmacy (36.8%). Patients with major polypharmacy were older compared to those with moderate or minor polypharmacy (75 vs. 73 years, respectively) and were most frequently prescribed pain medications (477.3 per 1,000 total visits). NSAIDs were the most frequently prescribed, with 232.4 per 1,000 total visits resulting in one high-risk NSAID prescription, while 21.9 per 1,000 total visits resulted in two or more high-risk NSAIDs.ConclusionMost patients over 65 years experienced some degree of polypharmacy, with many experiencing major polypharmacy. This indicates an increased need for expanded pharmacist roles through medication therapy management and safety monitoring in this patient population.
| S-EPMC8330900 | biostudies-literature
Project description:ImportanceMore than one-third of adults and 17% of youth in the United States are obese, although the prevalence remained stable between 2003-2004 and 2009-2010.ObjectiveTo provide the most recent national estimates of childhood obesity, analyze trends in childhood obesity between 2003 and 2012, and provide detailed obesity trend analyses among adults.Design, setting, and participantsWeight and height or recumbent length were measured in 9120 participants in the 2011-2012 nationally representative National Health and Nutrition Examination Survey.Main outcomes and measuresIn infants and toddlers from birth to 2 years, high weight for recumbent length was defined as weight for length at or above the 95th percentile of the sex-specific Centers for Disease Control and Prevention (CDC) growth charts. In children and adolescents aged 2 to 19 years, obesity was defined as a body mass index (BMI) at or above the 95th percentile of the sex-specific CDC BMI-for-age growth charts. In adults, obesity was defined as a BMI greater than or equal to 30. Analyses of trends in high weight for recumbent length or obesity prevalence were conducted overall and separately by age across 5 periods (2003-2004, 2005-2006, 2007-2008, 2009-2010, and 2011-2012).ResultsIn 2011-2012, 8.1% (95% CI, 5.8%-11.1%) of infants and toddlers had high weight for recumbent length, and 16.9% (95% CI, 14.9%-19.2%) of 2- to 19-year-olds and 34.9% (95% CI, 32.0%-37.9%) of adults (age-adjusted) aged 20 years or older were obese. Overall, there was no significant change from 2003-2004 through 2011-2012 in high weight for recumbent length among infants and toddlers, obesity in 2- to 19-year-olds, or obesity in adults. Tests for an interaction between survey period and age found an interaction in children (P = .03) and women (P = .02). There was a significant decrease in obesity among 2- to 5-year-old children (from 13.9% to 8.4%; P = .03) and a significant increase in obesity among women aged 60 years and older (from 31.5% to 38.1%; P = .006).Conclusions and relevanceOverall, there have been no significant changes in obesity prevalence in youth or adults between 2003-2004 and 2011-2012. Obesity prevalence remains high and thus it is important to continue surveillance.
| S-EPMC4770258 | biostudies-literature
Project description:Background/objectivesTo identify major barriers to video-based telehealth use among homebound older adults.DesignCross-sectional survey.SettingA large home-based primary care (HBPC) program in New York City (NYC) serving 873 homebound patients living in the community.ParticipantsSixteen primary care physicians.MeasurementsAn 11-item assessment of provider perceptions of patients' experience with and barriers to telehealth.ResultsAccording to physicians in the HBPC program, more than one-third (35%) of homebound patients (mean age of 82.7; 46.6% with dementia; mean of 4 comorbidities/patient) engaged in first-time video-based telehealth encounters between April and June 2020 during the first COVID-19 surge in NYC. The majority (82%) required assistance from a family member and/or paid caregiver to complete the visit. Among patients who had not used telehealth, providers deemed 27% (n = 153) "unable to interact over video" for reasons including cognitive or sensory impairment and 14% lacked access to a caregiver to assist them with technology. Physicians were not knowledgeable of their patients' internet connectivity, ability to pay for cellular plans, or video-capable device access.ConclusionThe COVID-19 pandemic resulted in a large and dramatic shift to video-based telehealth use in home-based primary care. However, 4 months into the pandemic a majority of patients had not participated in a video-based telehealth encounter due to a number of barriers. Patients lacking caregiver support to assist with technology may benefit from novel approaches such as the deployment of community health workers to assist with device setup. Physicians may not be able to identify potentially modifiable barriers to telehealth use among their patients, highlighting the need for better systematic data collection before targeted interventions to increase video-based telehealth use.
| S-EPMC8250614 | biostudies-literature