Moderating effect of age on the relationship between physical health loss and emotional distress post-acute care in Japanese older hospitalized patients.

BACKGROUND: At present, there are no consistent findings regarding the association between physical health loss and mental health in older adults. Some studies have shown that physical health loss is a risk factor for worsening of mental health. Other studies revealed that declining physical health does not worsen mental health. This study aimed to clarify whether the relationship between physical health loss and emotional distress varies with age in older inpatients post receiving acute care. METHODS: Data for this study were collected from 590 hospitalized patients aged ≥ 65 years immediately after their transfer from an acute care ward to a community-based integrated care ward. Emotional distress, post-acute care physical function, and cognitive function were assessed using established questionnaires and observations, whereas preadmission physical function was assessed by the family members of the patients. After conducting a one-way analysis of variance (ANOVA) and correlation analysis by age group for the main variables, a hierarchical multiple regression analysis was conducted with emotional distress as the dependent variable, physical function as the independent variable, age as the moderator variable, and cognitive and preadmission physical function as control variables. RESULTS: The mean GDS-15 score was found to be 6.7 ± 3.8. Emotional distress showed a significant negative correlation with physical function in younger age groups (65-79 and 80-84 years); however, no such association was found in older age groups (85-89, and ≥ 90 years). Age moderated the association between physical function and emotional distress. Poor physical function was associated with higher emotional distress in the younger patients; however, no such association was observed in the older patients. CONCLUSIONS: Age has a moderating effect on the relationship between physical health loss and increased emotional distress in older inpatients after acute care. It was suggested that even with the same degree of physical health loss, mental damage differed depending on age, with older patients experiencing less damage.

Exploring the associations between structural and functional aspects of social relationships and cognition in very old age.

OBJECTIVES: Few studies have examined the associations between social relationships and cognition in very old adults (80+ years). Moreover, limited research has considered structural and functional aspects of social relationships together when exploring their associations with cognition. Therefore, the present study aimed to investigate the associations between structural and functional social aspects and cognition in very old age. METHOD: The sample comprised 518 two-wave participants of the NRW80+ Study, who showed no indication of dementia and an average age of 85 years at baseline (range: 80-97 years). They were assessed twice over an approximate 2-year interval. Multilevel linear growth curve analysis was employed to model cognitive development over very old age and to examine the associations between structural and functional aspects of social relationships and cognitive development. It was controlled for demographic and health characteristics. RESULTS: A larger social network size (ß = 0.05, 95% CI [0.02, 0.08], p = 0.002) and frequent compared with occasional, seldom, and no contact with others (ß = 0.16, 95% CI [0.03, 0.28], p = 0.013) were associated with higher global cognition in the fully-controlled model. Model comparisons further revealed that structural aspects better predicted global cognition in very old age compared to functional aspects (χ2(2) = 16.17, p < 0.001). CONCLUSION: The findings underline the positive association between structural aspects of social relationships and global cognition in very old age. They also highlight the need for interventions promoting a socially active lifestyle to prevent cognitive decline in this vulnerable age group.

Prescribing and deprescribing in very old age: perceptions of very old adults, caregivers and health professionals.

BACKGROUND: although they are major consumers of medications, there is little evidence-based data to guide prescribing and deprescribing of medications for very old adults (80+ years). OBJECTIVES: to discover the perceptions of very old adults, caregivers and health professionals in order to further examine the clinical and ethical issues raised by prescribing and deprescribing in very old age. METHODS: individual interviews were conducted with very old adults (n = 10) and caregivers (n = 6), whereas group interviews were conducted with health professionals (n = 11). The themes covered included perceptions of medication use, polypharmacy, deprescribing and patient-health professional relationships. Thematic analysis was used to identify areas of convergence and divergence. RESULTS: very old adults are satisfied with the medications they are taking, do not see the need to reduce their medication use and consider their doctor as the expert who should make the decisions regarding treatment. The perceptions of caregivers are similar to those of older adults, whereas health professionals believe that very old adults take a lot of inappropriate medications and list multiple barriers to deprescribing. All participants describe a normalisation of medication use with ageing. CONCLUSION: there is a dichotomy between the perception of the very old adults/caregivers and that of health professionals regarding the safety of medication in very old age. A cultural change regarding medication use seems essential to optimise therapy and support deprescribing in clinical practice since the potential issues raised by researchers do not resonate with the main stakeholders.

Social relationships, living arrangements and loneliness.

BACKGROUND: Oldest-old people are expected to be particularly likely to experience loneliness due to the loss of their intimate partner or of same-aged social network members. It is assumed that individuals in different living arrangements maintain different kinds of social networks because they adjust their networks to their specific needs. However, not much is known about the variation in the social networks of the oldest-old depending on their living arrangements and how this variation is related to loneliness. This is the first study that seeks to fill this research gap by examining how the composition and the size of a social network varies among the oldest-old depending on their living arrangements with a partner (coresidential partnership, living apart together (LAT) partnership, no partnership), and how this variation contributes to explain loneliness among the oldest-old. METHODS: We used cross-sectional data from the representative survey NRW80+ (Quality of Life and Well-Being of the Very Old in North-Rhine Westphalia). The sample of analysis used in this study consists of 1860 respondents from the German state of North-Rhine Westphalia aged 80 years and older. Associations between social network characteristics and living arrangements were tested using χ2-tests and one-way ANOVA. Ordered logit models were used to explain loneliness. RESULTS: Respondents in a coresidential partnership maintained larger social networks than those in an LAT partnership and those with no intimate partner. Furthermore, the respondents with no partner maintained more diverse social networks. Compared to those in the other living arrangements, the respondents in an LAT partnership maintained the smallest and least diverse social networks. Being in a coresidential partnership and the social network size were found to be negatively associated with loneliness. CONCLUSION: First, the results indicate that respondents who do not have a partner adjusted their social networks to meet their needs in the absence of this relationship. Second, we conclude that being in a coresidential partnership and having a large social network protects the oldest-old against loneliness.

The NRW80+ study: conceptual background and study groups.

BACKGROUND: The study "Quality of life and well-being of the very old in North Rhine-Westphalia NRW80+" aims at giving a representative picture of the quality of life (QoL) in this population. Conceptually, QoL research has rarely considered the values of older individuals themselves and societal values, and their relevance for successful life conduct. Empirically, comparisons of different age groups over the age of 80 years are rare and hampered by quickly decreasing numbers of individuals in oldest age groups in the population of very old individuals. STUDY DESIGN AND THEORETICAL FRAMEWORK: This paper describes the population of the NRW80+ study and different age groups of very old individuals with respect to biographical background. Furthermore, using the challenges and potentials model of QoL in very old age (CHAPO), key aspects of QoL in late life are discussed and the importance of normative stipulations of what constitutes a successful life conduct are highlighted. In the NRW80+ study older age groups (i.e., 85-89 years, 90+ years) were deliberately overrepresented in the survey sample to enable robust cross-group comparison. Individuals willing to participate in the study but unable to participate in the interview themselves for health reasons were included by means of proxy interviews. The total sample included 1863 individuals and 176 individuals were represented by proxy interviews. Pronounced differences were observed between age groups 80-84 years (born 1933-1937, N = 1012), 85-89 years (born 1928-1932, N = 573), and 90 years or older (*born before 1927, N = 278) with respect to education, employment and the timing of major life events (e.g., childbirth). CONCLUSION: Different life courses and resulting living conditions should be considered when discussing QoL disparities in very old age.

Correlates of hospitalization among the oldest old: results of the AgeCoDe-AgeQualiDe prospective cohort study.

BACKGROUND: Hospitalization is a key driver of health care costs. Thus far, there are only a few longitudinal studies investigating whether changes in explanatory variables lead to hospitalization. Moreover, these longitudinal studies did not focus on individuals in highest age. AIM: The purpose of the current study was to examine the correlates of hospitalization among the oldest old in Germany longitudinally. METHODS: A multicenter prospective cohort study ["Study on Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)", AgeQualiDe]. Primary care patients ≥ 85 years took part [n = 861 at follow-up (FU) 7, average age of 89.0 years; 85-100 years]. Two waves were used. Hospitalization in the last 6 months was used as outcome measure. Well-established scales were used to quantify the independent variables such as Instrumental Activities of Daily Living Scale, Global Deterioration Scale or Geriatric Depression Scale. RESULTS: Logistic random effects regressions showed that the probability of hospitalization in the preceding 6 months significantly increased with increases in the social network, more depressive symptoms, functional decline, and increase in chronic conditions, whereas it was not significantly associated with age, sex, marital status, education, and cognitive impairment. Social networks moderate the relationship between functional decline and hospitalization. DISCUSSION: The results of the present longitudinal study emphasize the association of depressive symptoms, functional decline, more social networks, and chronic conditions with hospitalization among the oldest old. CONCLUSIONS: Treatments with the aim to reduce or postpone these factors might also help to reduce hospitalization.

Quality of life of the very old : Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+).

BACKGROUND: In Germany, the very old are the most rapidly growing proportion of the population. A comprehensive investigation of the conditions for a good quality of life in this group is relevant for both society and politics. OBJECTIVE: The project "Quality of life and subjective well-being of the very old in North Rhine-Westphalia" (NRW80+) at the University of Cologne surveys quality of life of the very old. Taking into account many specific methodological and theoretical challenges, it aims at setting up a specific theoretical framework and methodological approach. METHODS: Existing studies on quality of life in old age in Germany and abroad as well as models on quality of life are reviewed with respect to their relevance for the very old and their specific living conditions, needs and interests. A theoretical framework of quality of life in very old age is developed. The NRW80+ study combines three levels: the empirical level of description of life situations and conditions, the explanative level of evaluating models of quality of life and the normative level of societal and ethical standards and norms. RESULTS: Considering results of recently conducted studies with the very old, an integrative conceptual model for studying quality of life of very old persons is introduced. In the model of challenges and potentials (CHAPO), environmental and individual factors as well as life chances and life results are thereby taken into consideration from a subjective as well as an objective point of view, supplemented by the concept of successful life conduct. CONCLUSION: Starting from the CHAPO model of quality of life, the representative study NRW80+ aims at challenging methodological standards for the inclusion of the very old in social research thus providing the basis for further research as well as for sustainable social politics especially for the very old.

Measuring attachment to life in old age: the Portuguese version of the Positive Valuation of Life Scale (Positive VOL).

PURPOSE: This study aims to present the psychometric properties of the Portuguese version of the Positive Valuation of Life Scale (Lawton et al. in J Aging Ment Healt 13:3-31, 2001). METHOD: Sample included 207 community-dwelling elders (129 women; M Age = 77.2 years, SD = 7.5). The data collection included the translated and adapted Portuguese version of Positive Valuation of Life Scale, Life Satisfaction Index Z, Meaning in Life Questionnaire and Geriatric Depression Scale. RESULTS: From exploratory factor analysis, two factors emerged, existential beliefs and perceived control, explaining 49 % of the total variance. Both factors were positively related with meaning in life and life satisfaction and negatively related with depression (p < 0.05). The values obtained for internal consistency for the total scale and for each subscale were good (α > 0.75). CONCLUSION: The Portuguese version of Positive VOL Scale represents a reliable and valid measure to capture the subjective experience of attachment to one's life. The two-factor structure is an update to Lawton's previous work and in line with findings obtained in the USA (Dennis et al. in What is valuation of life for frail community-dwelling older adults: factor structure and criterion validity of the VOL, Thomas Jefferson University, Center for Applied Research on Aging and Health Research, 2005) and Japan (Nakagawa et al. in Shinrigaku Kenkyu 84:37-46, 2013). Future research is required to investigate VOL predictors and the potential changes toward the end of the life span.

Prescribing statins for cardiovascular disease prevention in the old: an absence of evidence and an absence of guidelines.

Australia's oldest old are potentially being harmed by the under- and over- use of statins. Variations in prescription of statins are in part due to the vacuum of clinical research trial evidence and paucity of contemporary guidelines that are needed to address the use of lipid lowering therapy in the oldest old. There are a few randomised placebo-controlled trials that recruited an older population. Therefore evidence of statins efficacy in the oldest old is based on an extrapolation of results from those studies. The extensive exclusion criteria of those studies, the relative youth of the study participants, the low levels of comorbidity and functional impairment limit the external validity and the generalisability of the findings. Current guidelines are silent or generally non-specific about statin therapy for the oldest old deferring decisions to individual medical practitioners. Life expectancy, time to benefit, functional status and medication related adverse events, polypharmacy, adherence to treatment are factors that need to be considered when forming appropriate guidelines for statin prescription in the very old. Well-designed clinical trials that account for the heterogeneity of this population are needed. While waiting for this research evidence better clinical guidelines are needed to address this issue.

Differential Item Functioning Along the Old Age Continuum: Contrasting Chronological Age With Contextual Variables in the Assessment of Gains and Losses Across Advanced Old Age.

OBJECTIVES: The fourth age is considered a life stage with a high likelihood of age-related losses. However, very old age extends over decades, and little is known about how transitions that may happen during this age period (e.g., developing support needs or adopting caregiving roles) or lack thereof might change perceptions of age-related gains or losses. Many subjective age scales assume implicitly that they work across advanced old age, but data to support this assumption are scarce. This study reports findings on (1) diverging, age-specific understandings of age-related change and (2) whether very old adults' functional health, received social support, and caregiving roles, rather than chronological age, account for such differences. METHODS: Data came from the nationally representative survey "Old Age in Germany D80+" conducted in 2020/2021, comprising 10,578 individuals aged 80-106 years. RESULTS: At equivalent levels of perceived gains and losses, adults in the early fourth age reported more "freedom in daily life," less "dependency on others," and fewer "needs to reduce activities," whereas adults in the late fourth age reported more "appreciation of others." Chronological age, as such, was not the primary source of this response shift. Rather, functional health, social support, and caregiving responsibilities accounted for the differences in how older adults interpreted and reported specific age-related gains and losses. DISCUSSION: Findings underscore that across the multiple decades of the fourth age, interpretations of aging experiences vary and depend on a person's own late-life health and functioning and on that of significant others.

Cognition in People Aged 80 Years and Older: Determinants and Predictors of Change from a Population-Based Representative Study in Germany.

BACKGROUND: The number of people aged 80 years and older (80+) will increase drastically in the upcoming decades. The preservation of cognitive functions will contribute to their quality of life and independence. OBJECTIVES: To identify determinants of cognition and predictors of change in cognitive performance in the population 80+. DESIGN: Cross-sectional and longitudinal population-based on the representative NRW80+ survey. SETTING: Randomly drawn cases of people aged 80+ from the municipal registration offices, including people living in private homes and institutional settings. PARTICIPANTS: The participants in the cross-sectional sample (N=1503, 65.5%female) were 84.7 years old (95%CI[84.5,85.0]) and had 12.3 years of education (95%CI[12.1,12.4]). The participants in the longitudinal sample (N=840, 62.5%female) were 84.9 years old (95%CI[84.6,85.2]) and had 12.3 years of education (95%CI[12.0,12.5]). MEASUREMENTS: The cognitive screening DemTect, age, sex, education, and social, physical, and cognitive lifestyle activities, as well as subjective general health status and depressive symptoms, were assessed at baseline and 24-month follow-up. RESULTS: Younger age, more years of education, and more cognitive lifestyle activities were identified as the most consistent determinants of both better cognitive performance and preservation of cognitive performance for both global cognition as well as the DemTect subtests on memory and executive functions. CONCLUSIONS: Our findings reveal that commonly investigated determinants of, and change in, cognitive performance are valid for the people 80+ and highlight the importance of cognitive lifestyle activities for cognitive health. The maintenance of cognitive functions is a key aspect of healthy aging in terms of preserving independence in people 80+.

Bidirectional Links of Daily Sleep Quality and Duration With Pain and Self-rated Health in Older Adults' Daily Lives.

BACKGROUND: Sleep and health perceptions, such as self-ratings of pain and health are closely linked. However, the temporal ordering of such associations is not well understood, and it remains unclear whether sleep quality and sleep duration show similar or differential associations with health perceptions. METHODS: We used ecological momentary assessment data from 123 young-old (66-69 years, 47% women) and 47 old-old adults (84-90 years, 60% women). Across 7 consecutive days, participants reported their sleep quality and sleep duration each morning and rated their momentary pain and health 6 times per day. We applied dynamic structural equation models to examine bidirectional links of morning reports of sleep quality and duration with daily levels of self-rated pain and health. RESULTS: In line with the hypotheses, results showed that when participants reported better sleep quality than what is typical for them, they reported less pain and better self-rated health on the day that followed. Longer sleep duration was not linked with subsequent pain or self-rated health. On days when people rated their health as better than usual, they reported better sleep quality but not longer sleep duration the following night. These associations were not moderated by age, gender, or chronic pain. CONCLUSION: Findings suggest that in old age, sleep quality is more relevant for health perceptions than sleep duration. Associations between sleep quality and self-rated health seem to be bidirectional; daily pain was linked to prior but not subsequent sleep quality.

Awareness of Age-Related Gains and Losses in a National Sample of Adults Aged 80 Years and Older: Cross-Sectional Associations With Health Correlates.

Background and Objectives: Advanced old age is a life stage with a high likelihood of age-related loss experiences. However, little is known about remaining gain experiences and their relation with perceived losses and health correlates in community-dwelling very old adults. Moreover, virtually nothing is known in this regard about the experiences of individuals in long-term care settings. First, we strived to establish the normative course of age-related gains and losses in advanced old age. Second, we examined whether such gain/loss perceptions in advanced aging moderated health correlates. Research Design and Methods: Data came from the nationally representative survey "Old Age in Germany D80+" conducted in 2020/2021. The sample comprised 10 578 individuals aged 80-106 years, including 587 individuals in long-term care. We used the multidimensional Awareness of Age-Related Change (AARC) questionnaire and moderated regression to analyze associations with late-life health and functioning correlates. Results: Levels of AARC-Gains were higher than those of AARC-Losses across most of the age range. Long-term care residents showed more AARC-Losses and fewer AARC-Gains compared with community-dwelling adults and contributed significantly to an overall negative balance of more losses than gains in those aged 90 years or older. Regarding functional health and autonomy, negative age effects were amplified by AARC-Losses, but buffered by AARC-Gains. A more positive ratio of gains-to-losses predicted better health and functioning. Discussion and Implications: Findings suggest that the loss aspect of development in very late life might have been overstated in the existing literature. Perceived gains and losses are of critical importance for the understanding of health correlates in very old age.

Osteosarcopenia in Very Old Age Adults After Hip Fracture: A Real-World Therapeutic Standpoint.

Loss of bone and muscle mass and strength (i. e., osteosarcopenia) is a highly prevalent clinical condition in older adults, associated with an increased risk of fragility fractures and unfavorable clinical outcomes. Although sarcopenia is a potential risk factor for osteoporosis and subsequent fracture, and the management of this hazardous duet is the key to preventing osteoporotic fracture, evidence pertaining to the treatment of sarcopenia for the purpose of preventing fragile fractures remains insufficient. Given this scenario we aimed at prospectively compare the long-term effectiveness of bisphosphonates vs. denosumab, on bone and muscle, in a cohort of old age hip fractured patients by virtue of a timely osteo-metabolic and sarcopenic assessment. Ninety-eight patients consecutively enrolled at the IRCCS Hospital San martino, Genoa, Italy, received at baseline comprehensive geriatric assessment and Bone Densitometry (DXA) with the quantitative and quantitative bone analysis and evaluation of relative skeletal muscle index (RSMI) and longitudinally after 1 year form hip surgery. The results showed a slightly and non-significant osteo-metabolic improvement in the Alendronate group compared to the Denosumab group, and a positive trend of RSMI measurements in the Denosumab group. Although preliminary in nature, this is the first report to longitudinally analyze osteosarcopenia in a real-world cohort of very old age patients after hip fracture and moved a step forward in the understanding of the best osteo-metabolic therapy for long- term treatment, exploring as well the potential dual role of denousumab as antiresorptive and muscle strength specific drug for osteosarcopenia in this vulnerable population.

Associations of Wellbeing Levels, Changes, and Within-Person Variability With Late-Life All-Cause Mortality Across 12 Years: Contrasting Hedonic vs. Eudaimonic Wellbeing Among Very Old Adults.

Advanced old age has been characterized as a biologically highly vulnerable life phase. Biological, morbidity-, and cognitive impairment-related factors play an important role as mortality predictors among very old adults. However, it is largely unknown whether previous findings confirming the role of different wellbeing domains for mortality translate to survival among the oldest-old individuals. Moreover, the distinction established in the wellbeing literature between hedonic and eudaimonic wellbeing as well as the consideration of within-person variability of potentially relevant mortality predictors has not sufficiently been addressed in prior mortality research. In this study, we examined a broad set of hedonic and eudaimonic wellbeing indicators, including their levels, their changes, as well as their within-person variability, as predictors of all-cause mortality in a sample of very old individuals. We used data from the LateLine study, a 7-year longitudinal study based on a sample of n = 124 individuals who were living alone and who were aged 87-97 years (M = 90.6, SD = 2.9) at baseline. Study participants provided up to 16 measurement occasions (mean number of measurement occasions per individual = 5.50, SD = 4.79) between 2009 and 2016. Dates of death were available for 118 individuals (95.2%) who had deceased between 2009 and 2021. We ran longitudinal multilevel structural equation models and specified between-person level differences, within-person long-term linear change trends, as well as the "detrended" within-person variability in three indicators of hedonic (i.e., life satisfaction and positive and negative affect) and four indicators of eudaimonic wellbeing (i.e., purpose in life, autonomy, environmental mastery, and self-acceptance) as all-cause mortality predictors. Controlling for age, gender, education, and physical condition and testing our sets of hedonic and eudaimonic indictors separately in terms of their mortality impact, solely one eudaimonic wellbeing indicator, namely, autonomy, showed significant effects on survival. Surprisingly, autonomy appeared "paradoxically" related with mortality, with high individual levels and intraindividual highly stable perceptions of autonomy being associated with a shorter residual lifetime. Thus, it seems plausible that accepting dependency and changing perceptions of autonomy over time in accordance with objectively remaining capabilities might become adaptive for survival in very old age.

Immune Thrombocytopenia in a Very Elderly Patient With Covid-19.

Immune thrombocytopenia (ITP) is an autoimmune disorder characterized by a decreased number of platelets and mucocutaneous bleeding. Many viruses have been identified as triggers of the autoimmune process, including human immunodeficiency virus (HIV), hepatitis C virus (HCV), Epstein-Barr virus (EBV), cytomegalovirus (CMV), parvovirus, rubella, and measles. Association with the new severe acute respiratory syndrome coronavirus, SARS-CoV-2 infection (Covid-19 infection) has been rarely reported. Here, we report the oldest case of ITP patient triggered by the novel coronavirus infection. He showed inadequate response to IVIG but responded to corticosteroids with no severe adverse events. Further studies are warranted to determine the optimal therapeutic strategies for ITP with the Covid-19 infection.

Risk factors for uroseptic shock in hospitalized patients aged over 80 years with urinary tract infection.

BACKGROUND: The purpose of this study was to compare clinical characteristics and outcomes in individuals of different age groups with urinary tract infection (UTI), and to identify the relationships among advanced age and uroseptic shock. METHODS: This retrospective study compared clinical characteristics and outcomes in patients in different age groups with UTI and identified relationships between advanced age and uroseptic shock among hospitalized patients with UTI in an acute hospital care setting from January 2006 to October 2018. Patients were divided into young (age below 65 years), old (65-80 years), and very old (above 80 years) groups. RESULTS: Of 1,043 participants, 269 (25.8%) were very old and 200 (19.2%) developed uroseptic shock. Very old age [odds ratio (OR) 1.99, 95% confidence interval (CI): 1.25-3.19, P=0.004], male (OR 1.54, 95% CI: 1.07-2.24, P=0.022), presented flank pain (OR 1.54, 95% CI: 1.05-2.24, P=0.025), congestive heart failure (CHF) (OR 2.54, 95% CI: 1.27-5.06, P=0.008), acute kidney injury (AKI) (OR 4.19, 95% CI: 2.78-6.30, P<0.001), bacteremia (OR 1.78, 95% CI: 1.25-2.53, P=0.001), and multiple drug-resistant (MDR) bacteria (OR 1.43, 95% CI: 1.02-2.00, P=0.039) were associated with an increased risk of uroseptic shock in patients with UTI. In very old patients with UTI, bacteremia (OR 2.54, 95% CI: 1.38-4.69, P=0.003) and AKI (OR 4.37, 95% CI: 2.15-8.90, P<0.001) were independently associated with uroseptic shock. CONCLUSIONS: Very old patients with UTI had a higher risk of developing uroseptic shock than younger patients. Bacteremia was an independent risk factor for uroseptic shock in very old patients with UTI.

Factors associated with length of stay in hospital for men and women aged 85 and over: A quantile regression approach.

OBJECTIVES: Explore characteristics of hospital use for adults aged 85 and over in their last year of life and examine factors associated with cumulative overnight length of stay (LOS). DATA SOURCE/STUDY SETTING: NSW 45 and Up Study linked with hospital data. STUDY DESIGN: Longitudinal cohort study. METHODS: Quantile regression models were performed for men and women (N = 3145) to examine heterogeneity in predictors of overnight hospital admissions. Coefficients were estimated at the 25th, 50th, 75th and 90th percentiles of the LOS distribution. PRINCIPAL FINDINGS: 86% had at least one hospitalisation in their last year of life, with 60% dying in hospital. For men, first admission for organ failure was associated with a 26 day increase at the 90th LOS percentile, and a 0.22 day increase at the 10th percentile compared to men with cancer. Women admitted with influenza had decreased LOS of 20.5 days at the 75th percentile and 6 to 8 fewer days at the lower percentiles compared to those women with cancer. CONCLUSIONS: Poor health behaviours were a major driver of highest LOS among older men, pointing to opportunities to achieve health care savings through prevention. For older women, influenza was associated with shorter LOS, which could be an indicator of the high and rapid mortality rates at older ages, and may be easily prevented. Other factors associated with LOS among women, included where they lived before they were admitted, and discharge destination.

Non-response in surveys of very old people.

Very old people are known to participate less often in social surveys than younger age-groups. However, survey participation among very old people in institutional settings is understudied. Additionally, the focus of the literature is on response rates, which neglects the complexity of the process of survey participation. The present study uses standard definitions of the American Association for Public Opinion Research to give a detailed description of survey participation among very old people, including those in institutional settings. Data come from a German survey on quality of life and subjective well-being of persons aged 80-84, 85-89, and 90+ (N = 1800). The present study (a) estimates contact, cooperation, response, and refusal rates and (b) identifies associations of age, sex, and type of residence with each of these rates. Weighted outcome rates for the survey were: contact = 66.0%, cooperation = 39.6%, response = 26.1%, and refusal = 26.9%. Age, sex, and type of residence were not associated with the contact, cooperation, and response rate. Lower refusal rates were found for people aged 90+, men, and institutionalized people. Additional analyses showed higher rates of non-interviews due to health-related reasons for institutionalized people and those aged 90+. Overall, results indicate that institutionalized and non-institutionalized people showed similar levels of survey participation. Willingness to participate is a key factor for women and people in private households, while the ability to participate is more important for institutionalized people.

Coronary angiography in the very old: impact of diabetes on long-term revascularization and mortality.

BACKGROUND: Diabetes is often associated with coronary artery disease, leading to adverse clinical outcomes. Real-world data is limited regarding the impact of diabetes in very old patients undergoing coronary angiography on the risk for late or repeated coronary revascularization and mortality. METHODS: Retrospective analysis of 1,353 consecutive patients ≥ 80 years who were admitted to the cardiac unit and further underwent coronary angiography. Subsequent revascularization procedures and all-cause mortality were recorded over a median follow-up of 47 months and their relation to diabetic status and presentation with acute coronary syndrome (ACS) was studied. RESULTS: Diabetes was present in 31% of the patients undergoing coronary angiography, and was associated with higher rates of obesity, hypertension, hyperlipidemia, chronic kidney disease and female gender. ACS was the presenting diagnosis in 71% of the patients and was associated with worse survival (1-year mortality 20% in ACS vs. 6.2% in non-ACS patients, P < 0.0001). Increase in long-term mortality rates was seen in diabetic subjects compared to non-diabetic subjects presenting with ACS (log-rank P = 0.005), but not in the non-ACS setting (P = 0.199). In a multivariable model, additionally adjusting for acuity of presentation, the presence of diabetes was associated with an adjusted hazard ratio of 1.60 (95% confidence interval: 1.12-2.28), P = 0.011, for the need of late or repeat coronary revascularization and 1.48 (1.26-1.74), P < 0.0001 for all-cause mortality, during long-term follow-up. CONCLUSIONS: In very old patients undergoing coronary angiography, presentation with ACS was associated with worse survival. Diabetes was an independent predictor of late or repeated revascularization and long-term mortality.