Impact of firearm injury in children and adolescents on health care costs and use within a family.

In 2020, firearm injury became the leading cause of death in U.S. children and adolescents.

Functional Decline Over Time and Change in Family and Other Unpaid Care Provided to Community-Dwelling Older Adults Living With and Without Dementia.

Objectives: To provide a longitudinal analysis of how functional decline over time among older adults affects provision of family and unpaid care, overall and stratified by dementia status.

Methods: Longitudinal cohorts of community-dwelling adults ≥65 years between 2015 and 2017 from the National Health and Aging Trends Study (NHATS; n = 5,103) and their caregivers from the National Study of Caregiving (n = 862 caregivers for 595 NHATS care recipients). A panel data fixed-effects model was used to examine how increases in mobility, self-care, and household activity-related impairment between 2015 and 2017 affected family and unpaid care (care recipient reported: total number of family and unpaid caregivers, total hours of care received; caregiver reported: hours of care provided, caregiving-related emotional, and physical difficulties).

A national profile of sandwich generation caregivers providing care to both older adults and children.

Background: Many U.S. caregivers provide care to the generation above and below simultaneously, described as "sandwich" generation caregivers.

Characteristics and Predictors of Sleep Among Spousal Care Dyads Living With Chronic Conditions.

Objectives: Poor sleep is common among older adults with chronic health conditions and their spousal caregivers. However, dyadic sleep patterns among spouses are underexplored within the literature. This study examines dyadic sleep characteristics and associated contextual factors among spousal care dyads.

Communication About Fall Risk in Community Oncology Practice: The Role of Geriatric Assessment.

Purpose: Falls are a modifiable source of morbidity for older adults with cancer, yet are underassessed in oncology practice. In this secondary analysis of a nationwide cluster-randomized controlled trial, we examined characteristics associated with patient-oncologist conversations about falls, and whether oncologist knowledge of geriatric assessment (GA) resulted in more conversations.

Methods: Eligible patients (ClinicalTrials.

Association of Oncologist-Patient Communication With Functional Status and Physical Performance in Older Adults: A Secondary Analysis of a Cluster Randomized Clinical Trial.

Importance: The functional status and physical performance of older adults with cancer are underassessed and undertreated despite the high prevalence of impaired functional status and physical performance in this population and their associations with chemotherapy-induced toxic effects and mortality.

Objective: To examine the association between providing oncologists with a geriatric assessment (GA) summary with recommendations and having oncologist-patient conversations about functional and physical performance.

Design, Setting, And Participants: Data for this secondary analysis were collected from October 29, 2014, to April 28, 2017, for a national cluster randomized clinical trial conducted by the University of Rochester Cancer Center National Cancer Institute Community Oncology Research Program evaluating the effect of a GA intervention on patient satisfaction with communication about aging-related concerns.

Inflammation, Attention, and Processing Speed in Patients With Breast Cancer Before and After Chemotherapy.

Background: Inflammation may contribute to cognitive difficulties in patients with breast cancer. We tested 2 hypotheses: inflammation is elevated in patients with breast cancer vs noncancer control participants and inflammation in patients is associated with worse attention and processing speed over the course of chemotherapy.

Methods: Serum cytokines (interleukin [IL]-4, 6, 8, 10; tumor necrosis factor [TNF]-α) and soluble receptors [sTNFRI, II]) were measured in 519 females with breast cancer before and after chemotherapy and 338 females without cancer serving as control participants.

Medication Costs and Use of Older Americans in Assisted Living Settings: a Nationally Representative Cross-Sectional Study.

Background: Assisted-living (AL) settings are an important residential care option for old and disabled Americans, but there are no national data characterizing medication use in AL.

Objective: To investigate medication costs and use of older adults living in the AL settings compared to those in the community, independent living, and nursing home settings.

Design: 2015 National Health and Aging Trends Study; nationally representative cross-sectional study.

Impact of Spousal Death on Healthcare Costs and Use Among Medicare Beneficiaries: NHATS 2011-2017.

Background: Spousal death is associated with elevated mortality in the surviving partner; less is known about how healthcare costs and use change following spousal death.

Objectives: To examine the causal impact of spousal death on Medicare costs and use over time.

Design: Longitudinal cohort study with an event study design.

Relationships between cytokines and cognitive function from pre- to post-chemotherapy in patients with breast cancer.

Cancer-related cognitive decline (CRCD) is a clinically important problem and negatively affects daily functioning and quality of life. We conducted a pilot longitudinal study from pre- to post-chemotherapy in patients with breast cancer to assess changes in inflammation and cognition over time, as well as the impact of baseline cytokine level on post-chemotherapy cognitive scores. We found that concentrations of IL-6, MCP-1, sTNFRI, and sTNFRII significantly increased in patients, while IL-1β significantly decreased (p < 0.

Evaluating the association of frailty with communication about aging-related concerns between older patients with advanced cancer and their oncologists.

Background: A geriatric assessment (GA) intervention improves communication about aging-related concerns, but its effect on communication in patients with various levels of frailty is unknown.

Methods: This was a secondary analysis of a nationwide trial of patients aged ≥70 years with incurable cancer and impairment on 1 or more GA domains (ClinicalTrials.gov Identifier NCT02107443; principal investigator Supriya G.

Continuity of Care and Successful Hospital Discharge of Older Veterans With Dementia.

Background: Care transitions are frequent among patients with dementia. This study aimed to estimate the impact of continuity of care (COC) on successful community discharge after hospitalization.

Methods: National Veterans Health Administration data linked to Medicare claims in fiscal years 2014-2015.

Opioid and CNS-Depressant Medication Prescribing among Older Adults Enrolled in Medicare Advantage Versus Fee-for-Service Medicare.

Objective: To examine whether prescription fills of opioids and central nervous system (CNS) depressants are lower in Medicare Advantage (MA) plans, which aim to provide more coordinated and integrated care, than fee-for-service (FFS) Medicare.

Methods: Data from the 2015 National Health and Aging Trends Study linked with Medicare claims. Community-dwelling adults ≥65 enrolled in Medicare Part D were included (n = 5,652).

The Relationship Between Frailty and Emotional Health in Older Patients with Advanced Cancer.

Background: Aging-related deficits that eventually manifest as frailty may be associated with poor emotional health in older patients with advanced cancer. This study aimed to examine the relationship between frailty and emotional health in this population.

Methods: This was a secondary analysis of baseline data from a nationwide cluster randomized trial.

Life expectancy in older adults with advanced cancer: Evaluation of a geriatric assessment-based prognostic model.

Objectives: Oncologists estimate patients' prognosis to guide care. Evidence suggests oncologists tend to overestimate life expectancy, which can lead to care with questionable benefits. Information obtained from geriatric assessment may improve prognostication for older adults.

Benzodiazepine Prescribing from VA and Medicare to Dually Enrolled Older Veterans: A Retrospective Cohort Study.

Background: There has been a reduction in BZD prescribing in the Veterans Affairs (VA) health care system since 2013. It is unknown whether the decline in VA-dispensed BZDs has been offset by Medicare Part D prescriptions.

Objectives: To examine (1) whether, accounting for Part D, declines in BZD prescribing to older Veterans remain; (2) patient characteristics associated with obtaining BZDs outside VA and facility variation in BZD source (VA only, VA and Part D, Part D only).

Caregiver status and illness self-efficacy during the COVID-19 pandemic among older adults with chronic conditions.

Objectives: Older adults providing unpaid care to a relative or friend during the COVID-19 pandemic may have diminished self-efficacy in managing their own chronic illness, especially in the context of more complex self-management. We evaluated whether adults aged 50 and older with caregiving roles are more likely to report reduced illness self-efficacy since the pandemic, and whether this link is exacerbated by a higher number of conditions.

Methods: Participants (105 caregivers and 590 noncaregivers) residing in Michigan (82.

Caregiver support and place of death among older adults.

Background/objectives: As home becomes the most common place of death in the United States, information about caregiver support and place of death is critical to improve patient and caregiver experiences at end of life. We seek to examine (1) the association between family care availability and place of death; and (2) caregiving intensity associated with place of death.

Design: 2017 National Health and Aging Trends Study and National Study of Caregiving; nationally representative cross-sectional study of deceased older adults and last-month-of-life (LML) caregivers.

The longitudinal relationship between immune cell profiles and frailty in patients with breast cancer receiving chemotherapy.

Background: Frailty is associated with an increased risk of chemotherapy toxicity. Cellular markers of inflammation can help identify patients with frailty characteristics. However, the role of cellular markers of inflammation in identifying patients at risk of developing chemotherapy-induced frailty and their clinical utility are not fully understood.

Assessment of Financial Toxicity Among Older Adults With Advanced Cancer.

Importance: Financial toxicity (FT), unintended and unanticipated financial burden experienced by cancer patients undergoing cancer care, is associated with negative consequences and increased risk of mortality. Older patients (≥70 years) with cancer are at risk for FT, yet data are limited on FT and whether oncologists discuss FT with their patients.

Objective: To examine the prevalence of FT in older adults with advanced cancer, its association with health-related quality of life (HRQoL), and cost conversations between oncologists and patients.

Medicaid coverage and use of nicotine replacement treatment.

Smoking prevalence is disproportionately high among low-income populations. To help smokers who are socioeconomically disadvantaged quit smoking, some states offer coverage of tobacco-dependence treatments, such as nicotine replacement therapy (NRT), to Medicaid beneficiaries. We used US nationally representative data (2003 and 2010/2011 Current Population Survey-Tobacco Use Supplements) and employed a difference-in-difference-in-difference approach to investigate the effects of Medicaid coverage of NRT on the usage of NRT products among Medicaid smokers.

Can Continuity of Care Reduce Hospitalization Among Community-dwelling Older Adult Veterans Living With Dementia?

Background: Hospitalization is a difficult experience, especially for patients with dementia. Understanding whether better continuity of care (COC) reduces hospitalizations can indicate interventions that might help curb hospitalizations.

Objective: To estimate the causal impact of COC on hospitalizations and different reasons for hospitalization among community-dwelling older veterans with dementia.