Health In Aging Blog

Older Adults Want Telemedicine to Remain an Option Alongside In-person Care

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Journal of the American Geriatrics Society Research Summary

Today the Journal of the American Geriatrics Society published a study about older adults’ views on receiving their primary care through telemedicine. Researchers asked adults over the age of 65 what they thought about the telemedicine care they received during the COVID-19 pandemic. The researchers wanted to understand if telemedicine should remain an option for patients on a permanent basis.

Why does this matter?

We all want to have access to good quality care that helps us stay healthy as we age. Policy makers are making big decisions about what kind of care older adults should receive and whether insurance will cover it. A current law, the Coronavirus Aid, Relief, and Economic Security (CARES) Act, allows telemedicine to be covered by insurance. However, it will expire on October 13, 2022. Researchers wanted to find out if people were happy with receiving primary care through telemedicine. They also identified barriers that make receiving care through telemedicine difficult for some people, so changes can be made to improve the patient experience.

What Was Learned from thisStudy?

Most adults over the age of 65 who participated in the study reported being satisfied with the primary care telemedicine they received during the pandemic. Participating older adults also expressed their hopes that telemedicine would remain available as an option, even as social distance orders begin to lift. Study participants reported that telemedicine was easier:

  • In bad weather.
  • During pandemics.
  • When they weren’t feeling well.
  • When they had mobility issues.

They also liked that it was easy to include family and caregivers during telemedicine visits.

Even though older adults clearly appreciate the benefits of telemedicine, most respondents still preferred in-person care because:

  • They want to have a physical examination.
  • It is easier to have a good relationship with their healthcare provider.
  • They had technical difficulties using video.

How Researchers Conducted this Study

The study participants included 208 adults over the age of 65 who had completed a phone-only and/or video telemedicine primary care visit with their primary care provider (PCP) since March 2020. The survey took place by phone and through an online questionnaire with multiple choice and open-ended questions.

Researchers asked participants to compare telemedicine to in-person visits and to rate their experience on a scale from 1-7. Open-ended questions gave participants an opportunity to share more detailed thoughts on their preference and what might improve telemedicine.

What are the Study’s Limitations?

The researchers concluded that having a choice between telemedicine and in-person care was preferred by the study participants. However, the findings were limited to one health system in Massachusetts and included mostly non-Hispanic white, highly educated participants. These people may be more likely to choose telemedicine than people from other backgrounds. Some participants reported that telemedicine was their only option, so they were not given a choice.

What this Study Means for You

The researchers found that adults over 65 want to continue to have a choice of seeing their PCP in person or through a telemedicine visit. Their findings will support efforts to have insurance companies cover telemedicine for older adults after the October deadline.

This summary is from “Older Adults’ Perspectives on Primary Care Telemedicine during the COVID-19 Pandemic.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study’s authors are Roma Bhatia, MD, MPH; Elizabeth Gilliam, MA; Gianna Aliberti, MD; Adlin Pinheiro, MS; Maria Karamourtopoulos, BA; Roger B. Davis, ScD; Laura DesRochers, MD, MPH; and Mara A. Schonberg, MD, MPH.

Psychological Resilience May Increase Healthy Aging for Older Adults with Type 2 Diabetes

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Journal of the American Geriatrics Society Research Summary

The Journal of the American Geriatrics Society recently published a study about healthy aging for older adults with type 2 diabetes. The researchers looked into the role of psychological resilience in helping people with diabetes stay healthy as they get older. Psychological resilience is the attitudes and behaviors that help us adapt to stress and avoid its negative impact. In general, researchers are eager to find ways to support people in healthy aging, instead of focusing only on problems that can occur as people get older. This study highlights opportunities to promote ways for older adults with type 2 diabetes to age better.

Why Does this Matter?

We all hope to have a positive and healthy experience as we age. Researchers and clinicians are evaluating different ways we can enhance people’s later years of life. Existing research suggests that among older adults, higher psychological resilience has been linked to better well-being, a healthier lifestyle, and a reduced risk of death.

People with type 2 diabetes face many challenges, including the risk of developing other chronic conditions and declines in cognitive and physical function. Because of these challenges, this study looks at how psychological resilience impacts these older adults specifically.

How is Psychological Resilience Measured?

Participants in the study were evaluated using the Brief Resilience Scale (BRS). The BRS is a 6-question survey that asks people to report how well they think they adapt to or avoid the negative outcomes of stress. A higher score means the person has greater resilience.

What Was Learned from this Study?

The study found that older people with a history of type 2 diabetes who had higher scores of psychological resilience experience better health as they age compared to those who had lower scores.

Those with higher resilience had many positive health outcomes compared to people with lower resilience. The researchers found that the study participants with higher resilience had the following positive outcomes:

  • They were hospitalized less frequently over the past year
  • They had better physical functioning
  • They reported having fewer disabilities
  • They showed fewer depressive symptoms
  • They had a better mental and physical quality of life
  • They were less likely to have frailty (feeling weak, having less energy, and difficulty performing daily activities)

These results suggest that resilience may help an individual do better during a medical challenge, or that individuals may view themselves as more resilient when they face a medical challenge. Understanding how resilience provides helpful health benefits will help researchers find out what interventions can help improve aging.

How the Researchers Conducted the Study

The study included 3,199 older adults with type 2 diabetes who were enrolled in a program called Look AHEAD. Look AHEAD was a clinical trial that took place at multiple sites and assigned participants to random study groups. The study compared lifestyle interventions with education and whether those changes helped a patient to lose weight. After the Look AHEAD trial finished, the researchers continued to follow the participants for ten years. An assessment was carried out after approximately 14 years.

Researchers analyzed the participants’ information such as basic demographics, diabetes status, number of overnight hospitalizations, BRS score, quality of life, depressive symptoms, disability, physical function, and frailty.

What are the Study’s Limitations?

It is possible that some connections between resilience and health may be different, depending on a person’s race or ethnicity. Because these differences have not been fully studied yet, the authors stress that it is important to conduct additional research.

Previously published research also suggests that greater psychological resilience also may protect against the onset of diabetes and help improve management of the disease. However, further studies are needed to fully understand this connection.

What the Study Means for You

The researchers believe that being psychologically resilient may provide many benefits to older adults with type 2 diabetes. With further research, they believe interventions and support to promote better aging could be developed.

This summary is from “Psychological resilience in older adults with type 2 diabetes from the Look AHEAD Trial.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study’s authors are KayLoni L. Olson, PhD; Marjorie Howard, MS; Jeanne M. McCaffery, PhD; Gareth R. Dutton, PhD; Mark A. Espeland, PhD; Felicia R. Simpson, PhD; Karen C. Johnson, MD, MPH; Medha Munshi, MD; Thomas A. Wadden, PhD; Rena R. Wing, PhD; and the Look AHEAD Research Group.

Cognitive Behavior Therapy Conducted by Telephone May Ease Arthritis-Related Insomnia

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Journal of the American Geriatrics Society Research Summary

A new study revealed that a talk therapy practice conducted by telephone could help older adults who have arthritis-related insomnia sleep better. The study was published in the Journal of the American Geriatrics Society.

Why does this matter?

Insomnia is a difficulty in falling or staying asleep. It affects more than 14 million Americans aged 65 and older. It may lead to daytime problems such as tiredness or fatigue, poor concentration, and daytime sleepiness.

Osteoarthritis (OA) is the most common form of arthritis. It can cause or worsen sleep problems. Older adults may develop arthritis after years of wear and tear on their joints, often due to normal physical activity or past injuries. About half of Americans over the age of 65 have been told they have arthritis by their healthcare provider.

What is Cognitive Behavior Therapy?

Cognitive behavioral therapy (CBT) is a type of talk therapy. It can be a fast-acting, long-lasting treatment for insomnia in older adults. In fact, studies suggest that CBT is one of the most effective therapies for insomnia. During CBT sessions, you learn to develop new sleep habits and to identify and change any unhelpful sleep habits.

What the Researchers Learned from this Study

The researchers’ interest in this study was inspired by earlier studies that showed strong evidence that  cognitive behavioral therapy is an effective treatment for insomnia. A growing body of evidence suggests that CBT is an especially successful treatment for insomnia that is related to arthritis discomfort.

However, CBT treatment typically requires weekly visits to a therapist’s office, often over several months. For older adults who have insomnia and arthritis, attending therapy sessions in person can be difficult or even impossible.

In this new study, researchers showed that having brief CBT sessions over the telephone was effective for improving arthritis-related insomnia and fatigue over 12 months. They said that the results of their trial showed that telephone CBT reduced the clinical and financial burdens of in-person, arthritis-related CBT insomnia treatment.

Research has shown that telephone CBT can also successfully treat smoking cessation and depression. These results have prompted some health insurance providers to cover CBT phone treatment for certain conditions.

How the Researchers Conducted this Study

The researchers recruited 325 adults aged 60 and over who had moderate to severe insomnia and arthritis pain. The participants were randomly selected to receive one of two treatments. One group received six CBT telephone sessions each week for eight weeks. These participants received coaching on sleep restriction, sleep hygiene, and learned how to restructure their sleep behavior. Participants also got homework assignments to perform.

Participants in the second treatment group received information about sleep and arthritis but did not receive any CBT sleep coaching. Both groups kept sleep diaries.

The researchers collected information on how the participants rated their general health and quality of life according to standard questionnaires. The participants ranked their insomnia status as well as their arthritis pain, stiffness, and ability to function.

After the sessions ended, the researchers said that the people in the CBT group showed improvements in sleeplessness and pain compared to those in the education-only group. They estimated that the cost for the CBT sessions was about $200 per person.

Study Limitations

According to the researchers, no studies exist to show whether CBT for arthritis-related insomnia is a cost-effective treatment. Experts say that there is a strong need for further study in this area. The researchers suggest that further study will help insurers and health care providers decide upon the best treatment decisions and evaluate the cost-effectiveness of CBT telephone treatment for arthritis-related insomnia.

What this Study Means for You

The researchers concluded that phone-delivered CBT significantly improved sleeplessness and pain without increasing total healthcare costs. The researchers said that their findings should encourage healthcare practitioners to consider telephone CBT treatment of insomnia for older adults who also have arthritis.

This summary is from “Cost-Effectiveness of Telephone Cognitive Behavioral Therapy for Osteoarthritis-Related Insomnia.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Kai Yeung, PharmD, PhD; Weiwei Zhu, MS; Susan M. McCurry, PhD; Michael Von Korff, ScD; Robert Wellman, MS; Charles M. Morin, PhD; and Michael V. Vitiello, PhD.

What’s the Best Way to Prevent Falls in Older Adults?

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Journal of the American Geriatrics Society Research Summary

An international team of experts compared practices that research has shown to help older adults prevent falls. Their new study, published in the Journal of the American Geriatrics Society, suggests that:

  • Exercise is the most effective method for decreasing the rate of falls in adults aged 65 and older who live independently. It is especially effective in adults aged 75 and older.
  • Exercise and a basic falls risk assessment by your healthcare provider can reduce your risk of breaking bones in a fall. In a falls assessment, your healthcare provider asks you about whether you’ve fallen, the details of the fall, and whether your home environment contributed to the fall. They also evaluate how well you walk and move around, along with your balance and other walking-related issues.

These strategies can also help prevent falls:

  • Using assistive technology and devices. These can include canes, walkers, and devices that can call for help at the touch of a button.
  • Making homes safer by:
    • removing clutter, throw rugs, and other falling hazards
    • improving lighting
    • installing grab bars
    • making other home improvements.

Falls: A Serious Health Problem for Older Adults

Falling, or accidentally and unexpectedly landing on the ground, usually happens in familiar environments while you are doing your normal, daily activities. You may fall when something pushes you, you trip, you lose consciousness (from a seizure, stroke, or other health problem), or you are experiencing the symptoms of a new illness.

Falls have serious consequences. One out of five falls does causes a serious injury, such as a broken bone or a head injury.[1] In older adults, they are the number one cause of hospital admissions for injuries. The older you are, the more likely falls are to threaten your ability to live at home and increase your risk of an early death.

Falls are very common among older adults, especially those who have multiple chronic conditions. An older person falls every second of the day, and one out of three older adults living at home falls every year.

Why the Researchers Studied Fall Prevention Strategies

Falls are such a big problem for older adults that many researchers have studied ways of preventing them. In order to get the big picture of what works best to prevent falls, the researchers of this study did what is called a systematic review and meta-analysis. This means that the researchers looked at the results of multiple studies all at once.

Most of the studies they looked at evaluated programs that used more than one strategy at the same time to prevent falls. Researchers say this study is the first to look at how effective the individual falls prevention strategies are when they are examined separately, instead of together. Understanding and comparing the effects of each strategy can make it easier for healthcare professionals to offer older adults personalized help.

Earlier studies have also failed to include people over the age of 75 and older adults with multiple chronic conditions. Because people in these groups have an especially high risk of falling, it is important to learn more about which falls prevention methods are most effective for them.

What the Researchers Learned

The researchers examined 192 studies that included nearly 100,000 older adults who live independently. Of those studies, 128 included adults between the ages of 75 and 84 years old.  Eleven of the studies included people 85 or older. The studies compared the effects of 63 fall prevention strategies—some individual strategies and some combinations of strategies—to the effects of the care the participants usually received.

Researchers found that that exercise is the most effective individual strategy for decreasing the rate of falls and number of falls in adults aged 65 and older who live independently. It seems to be especially effective in adults aged 75 and older. Strategies that work in combination include exercise, falls risk assessments, the use of assistive devices, and making changes to your home that make it safer.

Study findings also suggest that older adults who exercise and have had falls risk assessments may be less likely to break bones if they fall.

Study Limitations

Over half the studies that the researchers looked at used methods that may have caused biased results.

What This Study Means for You

If you do only one thing to prevent falls and fall-related broken bones, make it exercise.

This summary is from “Interventions for preventing falls and fall-related fractures in community-dwelling older adults: a systematic review and network meta-analysis.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Lauren Dautzenberg, MD, MSc; Shanthi Beglinger, MD, MBiolSci; Sofia Tsokanid, MSc; Stella Zevgitid, PhD; Renee CMA Raijmanna, MD, MSc; Nicolas Rodondib, MD, PhD; Rob JPM Scholtene, MD, PhD; Anne WS Rutjesc, PhD; Marcello Di Nisiog, MD, PhD; Marielle Emmelot-Vonka, MD, PhD; Andrea C Tricco, PhD; Sharon E Straush, MD, MSc; Sonia Thomash, MSc; Lisa Bretagneb, MD, MSc; Wilma Knola, MD, PhD; Dimitris Mavridis, PhD; and Huiberdina L Koeka, MD, PhD.

[1] https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html

Heart Transplants: Age is No Barrier to Successful Surgery

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Journal of the American Geriatrics Society Research Summary

A new study published in the Journal of the American Geriatrics Society suggests that survival rates after heart transplant surgery are similar in adults ages 18 to 69 and adults ages 70 and older.

Researchers examined a large U.S. database of patients who were listed as candidates for surgery to replace their failing hearts with healthier donor hearts. The researchers found that:

  • Only 1 in 50 people who are considered for heart transplant surgery and 1 in 50 people who receive a heart transplant are ages 70 or older.
  • For older adults in the study, the likelihood of surviving one or five years after a heart transplant was about the same as for younger adults.
  • Having a stroke after heart transplant surgery was more common in older adults, but the risk in both age groups was low.
  • Older patients were more likely to receive hearts from higher-risk donors, who are older and more likely to have diabetes and high blood pressure.
  • Advanced age alone should not prevent people from being considered as candidates for heart transplants.

Why We May Need Heart Transplants as We Age Continue reading →