Yearly Archives: 2018

When Do Age-Related Problems with Memory and Decision-Making Begin to Affect Older Adults’ Ability to Drive?

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Journal of the American Geriatrics Society Research Summary

For older adults, driving can mean living a more independent, satisfying life. Therefore, it’s no surprise that about 86 percent of adults age 65 and older hold active driver’s licenses, and many of us expect to drive for longer as we age.

Car crashes can be devastating or even deadly for anyone, including older adults and other road users. However, the fatal crash rate based on the distance someone travels in a vehicle begins to rise at age 65. At the same time, when older adults stop driving due to health issues or other concerns, they may experience isolation and depression. They also may be more likely to enter long-term care facilities earlier than they otherwise would.

Researchers have a history of studying driver safety in older adults after they’ve been diagnosed with dementia, a decline in memory and other mental abilities that make daily living difficult. However, we have limited knowledge about the effects on older drivers whose problems with mental abilities are less severe than those associated with dementia.

Recently, a team of researchers designed a study to learn more about cognitive health and older drivers’ crash risks. The study was published in the Journal of the American Geriatrics Society. In this study, the researchers focused on links between levels of cognitive function and crash risk among older drivers without dementia over a 14-year study period. They also assessed the link between changes in cognitive function over time and later risks of crashes. Continue reading →

Caregivers Can Help Assess Whether Older Adults are Dealing with Delirium

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Journal of the American Geriatrics Society Research Summary

Delirium is a sudden change in mental status that often occurs when older adults are in the hospital or after they have surgery. More than 20 percent of older adults may experience delirium.  The condition can lead to longer hospital stays, the need to be placed on a respirator (a machine that helps you breathe), long-term changes in your cognitive (mental) health, physical disability, and even death.

Acute illness (illnesses that happen suddenly, as opposed to chronic conditions that you live with over a longer period of time), surgery, and medications can contribute to delirium. In addition, disrupting regular routines may trigger sudden confusion or changes in behavior for certain people.

When healthcare professionals don’t recognize or diagnose delirium, it can delay an older person’s recovery.  Prolonged delirium can have a lasting impact on health and well-being. What’s more, delirium is distressing for caregivers—the family or friends involved in caring for an older adult. In hospitals, healthcare professionals screen (“test”) for delirium. However, despite routine screening, more than 60 percent of older adults with delirium are not diagnosed in hospitals. Continue reading →

High-Quality Nursing Homes Lower Risks for Long-Term Care Placement for Older Adults

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Journal of the American Geriatrics Society Research Summary

After being discharged from the hospital, an older person often is admitted directly to a skilled nursing facility (SNF). SNFs specialize in the skilled care we need to recover properly.  These facilities also provide the additional rehabilitation we may need before returning home. However, experts have raised concerns about the uneven quality of SNF services, the substantial differences among them, and how they are used in different parts of the country. A transfer from an SNF to a long-term care facility, for example, is considered a failure to achieve the goals of SNF care.  Most older people view a move to a long-term care facility as a step in the wrong direction.

In a new study, researchers decided to examine the role that SNFs play with regard to older adults’ placements in long-term care facilities. Their study was published in the Journal of the American Geriatric Society.

The researchers studied the role of SNF quality and how it affected older adults’ risks of transitioning to long-term care facilities. They also looked at whether any aspects of skilled nursing were linked with an older adult’s risk of entering long-term care facilities. The research team focused specifically on whether the quality ratings of SNFs (available to the public, free of charge, here) helped predict long-term care placements. Continue reading →

Should Older Adults with Diabetes Maintain Tight Blood Sugar Control?

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Journal of the American Geriatrics Society Research Summary

More than 25 percent of adults aged 65 or older have diabetes. Diabetes develops when the amount of sugar (or glucose) in your blood becomes too high. This happens either because your body doesn’t make enough insulin (type 1 diabetes), or because your body doesn’t respond to the insulin it makes (type 2 diabetes).

Older adults are especially likely to develop type 2 diabetes, because as we age, our bodies are less able to process sugars. What’s more, being overweight can increase our chances of developing the condition.

If you’re an older adult with type 2 diabetes, it’s likely that your healthcare provider has recommended that you carefully maintain your blood sugar levels with diet, exercise, and perhaps even medication. Blood sugar levels are typically monitored with a simple blood test that gives you a result called your “A1c level.” This is the percentage measurement of glucose levels in your blood over about three months.

But what should your target blood sugar level (A1c) be? If it’s too low, you could be at risk for hypoglycemia, or low blood sugar. When this occurs, you can fall or lose consciousness.

In a new study published in the Journal of the American Geriatrics Society, researchers say the evidence against “tightly” controlling blood sugar levels for older adults—the practice of targeting a more specific A1c level, often through the use of medications—hasn’t filtered down to clinics and primary care practices, where there may be value in pursuing looser target levels for blood sugar.

In their study, researchers examined records from the Diabetes Collaborative Registry for more than 30,000 adults aged 75 or older. In the study, 26 percent of older adults with diabetes had A1c levels less than 7 percent. They were treated with medications that have a high risk for lowering blood sugar to the point that someone could be at increased risk for a fall or losing consciousness.

Contrary to what researchers thought, these factors were each linked to having tight blood sugar control using a “high-risk” medication: older age, being male, or having heart failure, chronic kidney disease, and coronary artery disease. According to the researchers, people with these characteristics or conditions have the most potential to be harmed if they experience hypoglycemia and their A1c goals should be more relaxed.

The researchers concluded that we need more specific guidance about how to safely treat older adults with diabetes, and that we need to translate that guidance to help busy clinicians and their patients.

 This summary is from “Use of Intensive Glycemic Management in Older Adults with Diabetes.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Suzanne V. Arnold, MD, MHA; Kasia J. Lipska MD; Jingyan Wang MS; Leo Seman, MD PhD; Sanjeev N. Mehta MD, MPH; and Mikhail Kosiborod MD.

Can a Neighborhood Affect an Older Adult’s Health?

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Journal of the American Geriatrics Society Research Summary

According to a new study published in the Journal of the American Geriatrics Society, living in socially and economically disadvantaged neighborhoods can have a negative influence on older adults’ health and well-being.

Older adults who live in disadvantaged neighborhoods report having poorer health and have more difficulty getting around and performing daily tasks. What’s more, older adults living in disadvantaged neighborhoods tend to have more chronic illnesses and higher rates of death than do older adults who live in less disadvantaged neighborhoods.

Many issues affect the relationship between neighborhoods and health. One may be that disadvantaged neighborhoods have lower levels of social support for older adults and their caregivers. These neighborhoods also tend to have fewer physical resources, such as access to health care, retail stores, and recreational facilities.

Social and other resources are important for older adults. Therefore, older adults living in disadvantaged neighborhoods may find it harder to maintain well-being while aging. This can make it challenging for our society as a whole to benefit from our increased longevity.

The research team who conducted the study used the 2013 Medicare Health Outcome Survey (HOS) survey. This is a telephone and mail survey that was given to older adults enrolled in Medicare Advantage (MA) health plans (MA plans are insurance plans offered by private companies approved by Medicare). Around 17.6 million people are enrolled in MA plans. This is 31 percent of the population eligible for Medicare (the government program that provides health insurance to people 65-years-old and older). Information about 187,434 older adults was included in the study.

The researchers concluded that disadvantaged neighborhoods are an important predictor of mobility and other limitations among MA beneficiaries, particularly for those with multiple chronic conditions. Compared to those living in less disadvantaged neighborhoods, MA beneficiaries who have multiple chronic conditions and who live in the most disadvantaged neighborhoods are 12 percent more likely to report difficulty performing at least one daily task, such as bathing, dressing, or keeping house.

The researchers suggested that increasing resources in disadvantaged neighborhoods to support health programs for older adults could improve their health outcomes.

This summary is from “Linking Neighborhood Context and Health in Community-Dwelling Older Adults in the Medicare Advantage Program.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Daniel Jung, BS; Amy Kind, MD, PhD; Stephanie Robert, MSW, PhD; William Buckingham, PhD; and Eva DuGoff, PhD, MPP.