Comprehensive Center for Healthy Aging

Sun City Center, United States

Comprehensive Center for Healthy Aging

Sun City Center, United States
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Patel K.,University of California at San Francisco | Fonarow G.C.,University of California at Los Angeles | Ahmed M.,Comprehensive Center for Healthy Aging | Ahmed M.,University of Alabama at Birmingham | And 7 more authors.
Circulation: Heart Failure | Year: 2014

Background-Little is known about associations of calcium channel blockers (CCBs) with outcomes in patients with heart failure and preserved ejection fraction (EF). Methods and Results-Of the 10 570 hospitalized patients with heart failure and preserved EF, ≥65 years, EF ≥40%, in the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF; 2003- 2004), linked to Medicare data (through December 31, 2008), 7514 had no prior history of CCB use. Of these, 815 (11%) patients received new discharge prescriptions for CCBs. Propensity scores for CCB initiation, calculated for each of the 7514 patients, were used to assemble a matched cohort of 1620 (810 pairs) patients (mean age, 80 years; mean EF, 56%; 65% women; 10% black) receiving and not receiving CCBs, balanced on 114 baseline characteristics. The primary composite end point of all-cause mortality or heart failure hospitalization occurred in 82% and 81% of patients receiving and not receiving CCBs (hazard ratio for CCBs, 1.03; 95% confidence interval, 0.92-1.14). Hazard ratios (95% confidence intervals) for allcause mortality, heart failure hospitalization, and all-cause hospitalization were 1.05 (0.94-1.18), 1.05 (0.91-1.21), and 1.03 (0.93-1.14), respectively. Similar associations were observed when we categorized patients into those receiving amlodipine and nonamlodipine CCBs. Among 7514 prematch patients, multivariable-adjusted and propensity-adjusted hazard ratios (95% confidence interval) for primary composite end point were 1.03 (0.95-1.12) and 1.02 (0.94-1.11), respectively. Conclusions-In hospitalized older patients with heart failure, new discharge prescriptions for CCBs had no associations with composite or individual end points of mortality or heart failure hospitalization, regardless of the class of CCBs. © 2014 American Heart Association, Inc.

Buys D.R.,Geriatrics and Palliative Care | Buys D.R.,Comprehensive Center for Healthy Aging | Buys D.R.,University of Alabama at Birmingham | Roth D.L.,Johns Hopkins University | And 9 more authors.
Journals of Gerontology - Series A Biological Sciences and Medical Sciences | Year: 2014

Background. Nutritional risk and low BMI are common among community-dwelling older adults, but it is unclear what associations these factors have with health services utilization and mortality over long-term follow-up. The aim of this study was to assess prospective associations of nutritional risk and BMI with all-cause, nonsurgical, and surgical hospitalization; nursing home admission; and mortality over 8.5 years. Methods. Data are from 1,000 participants in the University of Alabama at Birmingham Study of Aging, a longitudinal, observational study of older black and white residents of Alabama aged 65 and older. Nutritional risk was assessed using questions associated with the DETERMINE checklist. BMI was categorized as underweight (<18.5), normal weight (18.5-24.9), overweight (25.0-29.9), class I obese (30.0-34.9), and classes II and III obese (≥35.0). Cox proportional hazards models were fit to assess risk of all-cause, nonsurgical, and surgical hospitalization; nursing home admission; and mortality. Covariates included social support, social isolation, comorbidities, and demographic measures. Results. In adjusted models, persons with high nutritional risk had 51% greater risk of all-cause hospitalization (95% confidence interval: 1.14-2.00) and 50% greater risk of nonsurgical hospitalizations (95% confidence interval: 1.11-2.01; referent: low nutritional risk). Persons with moderate nutritional risk had 54% greater risk of death (95% confidence interval: 1.19-1.99). BMI was not associated with any outcomes in adjusted models. Conclusions. Nutritional risk was associated with all-cause hospitalizations, nonsurgical hospitalizations, and mortality. Nutritional risk may affect the disablement process that leads to health services utilization and death. These findings point to the need for more attention on nutritional assessment, interventions, and services for community-dwelling older adults. © The Author 2014.

Lo A.X.,University of Alabama at Birmingham | Brown C.J.,University of Birmingham | Brown C.J.,Birmingham Atlanta Veterans Affairs Geriatric Research | Brown C.J.,Comprehensive Center for Healthy Aging | And 5 more authors.
Journal of the American Geriatrics Society | Year: 2014

Objectives: To determine the effect of falls and fractures on life-space mobility in a cohort of community-dwelling older adults. Design: Prospective, observational study with a baseline in-home assessment and 6-month telephone follow-up interviews over 4 years. Setting: Central Alabama. Participants: Community-dwelling adults aged 65 and older recruited from a random sample of Medicare beneficiaries stratified according to sex, race, and urban versus rural residence (N = 970). Measurements: Sociodemographic factors, medical history, depressive symptoms (Geriatric Depression Scale), cognitive function (Mini-Mental State Examination), mobility-related symptoms, transportation difficulty, and healthcare use were assessed during a baseline in-home interview of participants. Life-space mobility and falls or injuries (including fractures) were assessed at the baseline interview and at 6-month intervals in follow-up telephone calls. Results: Four hundred fifty-four (47%) participants reported at least one fall during the 4-year follow-up. The life-space score fell 3.2 points from the beginning to the end of the 6-month interval during which a fall occurred, adjusting for other known predictors of decline in life-space mobility. The decrease in interval life-space score was progressively greater for a fall and an injury (-4.7 points), a fall and a fracture (-14.2 points), and a fall and a hip fracture (-23.6 points). Conclusion: Falls, whether associated with an injury or not, were independently associated with a decrease in life-space mobility in the ensuing 6 months. Further studies are needed to determine reasons for life-space mobility decline in community-dwelling older adults with incident falls without any injuries. © 2014, The American Geriatrics Society.

Garrett S.L.,Morehouse School of Medicine | Sawyer P.,Comprehensive Center for Healthy Aging | Sawyer P.,University of Alabama at Birmingham | Kennedy R.E.,University of Alabama at Birmingham | And 5 more authors.
Journal of the American Geriatrics Society | Year: 2013

Objectives: To examine the association between function measured according to activities of daily living (ADLs), instrumental activ1ities of daily living (IADLs), and cognition assessed according to Mini-Mental State Examination (MMSE) scores of older African-American and non-Hispanic white community-dwelling men and women. Design: Cross-sectional study assessing associations between self-reported ADL and IADL difficulty and MMSE scores for race- and sex-specific groups. Setting: Homes of community-dwelling older adults. Participants: A random sample of 974 African-American and non-Hispanic white Medicare beneficiaries aged 65 and older living in west-central Alabama and participating in the University of Alabama at Birmingham Study of Aging, excluding those with reported diagnoses of dementia or with missing data. Measurements: Function, based on self-reported difficulty in performing ADLs and IADLs, and cognition, using the MMSE. Multivariable linear regression models were used to test the association between function and cognition in race- and sex-specific groups after adjusting for covariates. Results: Mini-Mental State Examination scores were modestly correlated with ADL and IADL difficulty in all four race- and sex-specific groups, with Pearson correlation coefficients ranging from -0.189 for non-Hispanic white women to -0.429 for African-American men. Correlations between MMSE and ADL or IADL difficulty in any of the race- and sex-specific groups were no longer significant after controlling for sociodemographic factors and comorbidities. Conclusion: Mini-Mental State Examination was not significantly associated with functional difficulty in older African-American and non-Hispanic white men and women after adjusting for sociodemographic factors and comorbidities, suggesting a mediating role in the relationship between cognition and function.

Lo A.X.,University of Alabama at Birmingham | Lo A.X.,Comprehensive Center for Healthy Aging | Donnelly J.P.,University of Alabama at Birmingham | McGwin G.,University of Alabama at Birmingham | And 5 more authors.
American Journal of Cardiology | Year: 2015

Mobility and function are important predictors of survival. However, their combined impact on mortality in adults ≤65 years with heart failure (HF) is not well understood. This study examined the role of gait speed and instrumental activities of daily living (IADL) in all-cause mortality in a cohort of 1,119 community-dwelling Cardiovascular Health Study participants ≤65 years with incident HF. Data on HF and mortality were collected through annual examinations or contact during the 10-year follow-up period. Slower gait speed (<0.8 m/s vs ≤0.8 m/s) and IADL impairment (≤1 vs 0 areas of dependence) were determined from baseline and follow-up assessments. A total of 740 (66%) of the 1,119 participants died during the follow-up period. Multivariate Cox proportional hazards models showed that impairments in either gait speed (hazard ratio 1.37, 95% confidence interval 1.10 to 1.70; p = 0.004) or IADL (hazard ratio 1.56, 95% confidence interval 1.29-1.89; p <0.001), measured within 1 year before the diagnosis of incident HF, were independently associated with mortality, adjusting for sociodemographic and clinical characteristics. The combined presence of slower gait speed and IADL impairment was associated with a greater risk of mortality and suggested an additive relation between gait speed and IADL. In conclusion, gait speed and IADL are important risk factors for mortality in adults ≤65 years with HF, but the combined impairments of both gait speed and IADL can have an especially important impact on mortality. © 2015 Elsevier Inc.

PubMed | Comprehensive Center for Healthy Aging and, Comprehensive Center for Healthy Aging, Veterans Health Administration and University of Alabama at Birmingham
Type: Journal Article | Journal: The journals of gerontology. Series A, Biological sciences and medical sciences | Year: 2015

Life-space is associated with adverse health outcomes in older adults, but its role in health care utilization among individuals with heart failure is not well understood. We examined the relationship between life-space and both emergency department (ED) utilization and hospitalization.Participants were community-dwelling older adults with a verified diagnosis of heart failure who completed a baseline in-home assessment and at least one follow-up telephone interview. Life-space was measured at baseline and at follow-up every 6 months for 8.5 years. Poisson models were used to determine the association between life-space, measured at the beginning of each 6-month interval, and health care utilization, defined as ED utilization or hospitalization in the immediate ensuing 6 months, adjusting for sociodemographic and clinical confounders.A total of 147 participants contributed 259 total health care utilization events involving an ED visit or a hospital admission. Multivariate analysis demonstrated an inverse association between life-space and health care utilization, where a clinically significant 10-point difference in life-space was independently associated with a 14% higher rate of ED utilization or hospitalization (incidence rate ratio 1.14, 95% CI 1.04-1.26, p = .004).Life-space may be a useful identifier of community-dwelling older adults with heart failure at increased risk of ED visits or hospital admissions in the ensuing 6 months. Life-space may therefore be a potentially important component of intervention programs to reduce health care utilization.

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