Dynamic changes in medication burden leading to fall and hospital readmissions in older adults: Toward a strategy for improving risk and managing costs.

The majority of a health plan's performance and designated Star Rating is related to medication-related behavior, eg, medication adherence, medication review, and reconciliation, that are intricately related to adverse drug events (ADEs). Altered pharmacodynamics and pharmacokinetics owing to aging make older adults more vulnerable to ADEs like falls, fractures, hospitalizations, and mortality. Prevention of avoidable risk factors such as medication burden can help maintain quality of life.

Mentoring for the Diverse Range of Family Physicians' Engagement in Research.

Primary care researchers are increasingly at the forefront of developing innovations and new research methods to address complex issues in health care, including multi-morbidity, social determinants of health, health equity, managing population health in clinical practice, patient satisfaction, and provider burnout. Research demonstrates that "primary care is the only health care component where an increased supply is associated with better population health and more equitable outcomes." As a primary care specialty, family medicine has evolved beyond its initial focus on clinical practice and education to realizing the imperative for the discipline to robustly engage in research and embrace the responsibility to generate the evidence that drives changes in primary care practice and policy.

Protective Effects of β-Blockers on Bone in Older Adults with Dementia.

Increased β-adrenergic receptor activity has been hypothesized to cause bone loss in those with dementia. We investigated the effect of long-term β-blocker use on rate of bone loss in older adults with dementia. We used a linear mixed-effects model to estimate the relationship between long-term β-blocker use and rate of bone loss in participants from the Health Aging and Body Composition study.

Improving patient safety through mandatory quality improvement (QI) education in a family medicine residency programme.

Although the American College of Graduate Medical Education (ACGME) requires that medical trainees acquire competencies in patient safety and quality improvement (QI), no standard curriculum exists. We envisaged that a sustainable QI curriculum would be a pragmatic way to improve residents' skills and competence in patient safety. Our aim was to develop and evaluate a patient safety-oriented QI curriculum in an established family medicine residency programme.

Effect of Quarantine on Body Weight Among Residents of Assisted Living Facilities During the COVID-19 Pandemic.

Assisted living facility (ALF) residents are at greater risk of declining health and death from coronavirus disease 2019 (COVID-19) due to advanced age, frailty, chronic conditions, and transmission prevention methods. One method, room quarantine, can lead to isolation and potential weight changes. Continuous room quarantine was mandated by the state for all nursing home and ALF residents.

Diuretic use and risk of falls in older women with urinary incontinence.

Objective: To determine the association between diuretic use and falls in community-dwelling older women with urinary incontinence (UI).

Methods: We conducted an analytic cross-sectional study using patients' electronic medical records. Patients were women with UI, 65 years or older seen at a urogynecology clinic between January 1, 2018 and September 30, 2019.

A Randomized Clinical Trial of Transgender Women Switching to B/F/TAF: The (mo)BETTA Trial.

Background: Cardiometabolic disease in transgender women (TW) is affected by gender-affirming hormonal therapies (GAHTs), HIV, and antiretroviral therapy (ART). We evaluated the 48-week safety/tolerability of switching to bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) vs continued ART in TW on GAHT.

Methods: TW on GAHT and suppressive ART were randomized 1:1 to switch to B/F/TAF (Arm A) or continue current ART (Arm B).

Risk of Depression in a Suburban Primary Care Setting Before and During the COVID-19 Pandemic.

Introduction: Major depression is a common disorder affecting millions of adults each year. Many population-based surveys showed an increase in the number people with symptoms of depression at the onset of the COVID-19 pandemic. Our aim was to determine and compare the prevalence of depression risk in a primary care setting before and during the COVID-19 pandemic.

Negotiating a new chair package: context and considerations.

Negotiating a resource package as a potential new department chair is common practice in academic medicine. The foundations for this negotiation include the historical presence of the department in relation to the broader institution, projections for future growth, accounting for mission/vision, resource needs (space, personnel, finances, etc), faculty and staff development, and external partnerships within and outside the institution. Despite similarities in this process across departments, many nuances influence the development of a specific new chair package, such as, department size; desires, perspectives and talents of the incoming chair, the department faculty, the medical school and dean; prevailing agendas and mission imperatives; and the overall priorities of the institution.

Chronic inflammatory back pain commencing late in life: a neglected concept.

Chronic inflammatory back pain (CIBP) occurs in up to one-third of those with chronic back pain. Criteria for diagnosis of inflammatory back pain include an onset below 50 years. Using the US National Health and Nutrition Examination Survey data for 2009-2010, we showed that 3% of adults aged 50-69 years have features of CIBP with onset on or after 50 years.

Elevated parathyroid hormone levels in older women treated for osteoporosis using denosumab.

Purpose: Primary care physicians (PCPs) often struggle with elevated serum intact parathyroid hormone (iPTH) in osteoporotic patients on antiresorptive treatment, specifically, denosumab. As iPTH and calcium levels need to be within normal ranges to receive the next dose of denosumab, continuously high serum iPTH may necessitate additional tests to rule out pathological causes. We aimed to determine factors associated with iPTH elevation in a cohort of postmenopausal women receiving osteoporosis treatment.

Osteoporosis management: Use a goal-oriented, individualized approach.

Recommendations for care are evolving, with increasingly sophisticated screening and diagnostic tools and a broadening array of treatment options.

Thirty-day hospital readmission rate, reasons, and risk factors after acute inpatient cancer rehabilitation.

Objectives: To evaluate the 30-day hospital readmission rate, reasons, and risk factors for patients with cancer who were discharged to home setting after acute inpatient rehabilitation.

Design, Setting, And Participants: This was a secondary retrospective analysis of participants in a completed prospective survey study that assessed the continuity of care and functional safety concerns upon discharge and 30 days after discharge in adults. Patients were enrolled from September 5, 2018, to February 7, 2020, at a large academic quaternary cancer center with National Cancer Institute Comprehensive Cancer Center designation.

Impact of Fall Risk and Direct Oral Anticoagulant Treatment on Quality-Adjusted Life-Years in Older Adults with Atrial Fibrillation: A Markov Decision Analysis.

Background And Objective: The decision to initiate anticoagulation in older adults with atrial fibrillation is complicated by the benefit of ischemic stroke prevention vs the risk of falls resulting in major bleeds. The objective of this study was to assess the impact of different treatments including direct oral anticoagulants on quality-adjusted life-years (QALYs) in patients aged 75 years and older with atrial fibrillation in the context of falls.

Methods: A Markov decision process was constructed for older patients with atrial fibrillation taking no anti-thrombotic, aspirin, warfarin, rivaroxaban, and apixaban.

Quality of Life Assessment in Older Adults with Dementia: A Systematic Review.

Introduction: In the absence of a cure, dementia is often managed by minimizing risk factors contributing to quality of life (QOL). Attitudes to dementia in older adults may differ from those in relatively younger adults. The aim was to conduct a systematic review of the literature to determine how QOL was assessed in adults, 65 years and older with dementia, and identify factors that influence the reported scores.

Patient-Reported Continuity of Care and Functional Safety Concerns After Inpatient Cancer Rehabilitation.

Background: Patients with cancer have been noted to have inadequate continuity of care after discharge from hospital. We sought to assess patient-reported continuity of care and functional safety concerns after acute inpatient rehabilitation.

Methods: This was a prospective study that used cross-sectional surveys at a National Cancer Institute Comprehensive Cancer Center.

A Postural Assessment Utilizing Machine Learning Prospectively Identifies Older Adults at a High Risk of Falling.

Falls are the leading cause of accidental death in older adults. Each year, 28.7% of US adults over 65 years experience a fall resulting in over 300,000 hip fractures and $50 billion in medical costs.

Delirium Among Hospitalized Older Adults With Acute Heart Failure Exacerbation.

Background: Delirium among older adults hospitalized with acute heart failure is associated with increased mortality. However, studies concomitantly assessing the association of delirium with both clinical and economic outcomes in this population, such as mortality, hospital cost, or length of stay, are lacking.

Methods And Results: We conducted a retrospective observational study using National Inpatient Sample data from 2011 to 2014.

Shorter length of hospital stay for hip fracture in those with dementia and without a known diagnosis of osteoporosis in the USA.

Background: About 50% of all hospitalized fragility fracture cases in older Americans are hip fractures. Approximately 3/4 of fracture-related costs in the USA are attributable to hip fractures, and these are mostly covered by Medicare. Hip fracture patients with dementia, including Alzheimer's disease, have worse health outcomes including longer hospital length of stay (LOS) and charges.

The Association of Economic Outcome and Geriatric Syndromes among Older Adults with Transcatheter Aortic Valve Replacement (TAVR).

Background: The association of geriatric syndromes and economic outcomes among patients who are undergoing transcatheter aortic valve replacement (TAVR) remains unknown.

Methods And Results: A retrospective observational study using the National Inpatient Sample (NIS) from 2011 to 2014 was conducted with 7078 patients who were 65 years or older and underwent TAVR. The average hospital cost was US$58 703 (± SD 29 777) and length of stay (LOS) was 8.

Association of Visceral Adipose Tissue and Subclinical Atherosclerosis in US-Born Mexican Americans but not First Generation Immigrants.

Background Excess visceral adipose tissue (VAT) is a primary driver for the cardiometabolic complications of obesity; VAT-associated cardiovascular disease risk varies by race, but most studies have been done on Non-Hispanics. This study aimed to evaluate the clinical and metabolic correlates of VAT, its association with subclinical atherosclerosis, and the factors affecting this association in Mexican Americans. Methods and Results Participants (n=527) were drawn from the Cameron County Hispanic Cohort (CCHC), on whom a carotid ultrasound to assess carotid intima media thickness and a dual-energy X-ray absorptiometry scan to assess for VAT were obtained.

Paget Disease of Bone for Primary Care.

Paget disease of bone is a benign disorder characterized by focal areas of increased bone turnover in one or more skeletal sites. It usually affects older adults, and men are at a higher risk than women. Any bone may be affected, but the disease has a high preference for the pelvis, spine, skull, and long bones.

Greater Changes in Drug Burden Index (DBI) during Hospitalization and Increased 30-Day Readmission Rates among Older In-Hospital Fallers.

A higher drug burden index (DBI) is known to be associated with pre-admission falls leading to hospitalization. We investigated whether a mean difference in DBI (ΔDBI) between the events of in-hospital falls and hospital admission was associated with 30-day readmission in 113 patients ≥50 years who fell during their hospital stays between 2007 and 2014. A greater ΔDBI (≥0.

Factors Considered by Interprofessional Team for Treatment Decision in Hip Fracture with Dementia.

Objectives: Patients with dementia are at high risk for hip fractures and often have poor outcomes when a fracture is sustained. Despite this poor prognosis, little data are available on what factors should be prioritized to guide surgical decision making in these cases. We aimed to understand the decision-making process for older dementia patients hospitalized after hip fractures.

Lower femoral neck bone mineral density (BMD) in elderly women not on statins.

Coronary artery disease (CAD) and osteoporosis, the two most frequently occurring chronic diseases of aging populations, share many risk factors including lack of estrogen, smoking, and low physical activity. CAD and low bone mineral density (BMD) are strongly associated. Statins, (3-hydroxy-3-methylglutaryl coenzyme A [HMG-CoA] reductase inhibitors), are used to prevent and treat CAD and have been associated with high BMD.