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Peterson M.D.,University of Michigan | McGrath R.,University of Michigan | Zhang P.,University of Michigan | Markides K.S.,University of Texas Medical Branch | And 2 more authors.
Journal of the American Medical Directors Association | Year: 2016

Background: The risk of cardiovascular problems due to diabetes mellitus is highest among older Mexicans, and yet what remains to be determined is the association between muscle weakness and diabetes in this population. Therefore, the purpose of this study was to determine the association between muscle strength and diabetes among Mexican adults greater than 50 years of age. Design: Cross-sectional. Setting: National sample of households in both urban and rural areas. Participants: A subsample of 1841 individuals aged 50 years and older was included from the 2012 Mexican Health and Aging Study. Measurements: Strength was assessed using a hand-held dynamometer, and the single largest reading from either hand was normalized to body mass (normalized grip strength [NGS]). Conditional inference tree analyses were used to identify sex-specific NGS weakness thresholds. Linear regression was used to examine the association between NGS and HbA1c, and logistic regression was used to assess the association between weakness and risk of diabetes (HbA1c ≥ 6.5% [≥48 mmol/mol]), after controlling for age, sex, and waist circumference. Results: NGS was inversely associated with HbA1c (β = -1.56; . P < .001). Optimal sex-specific NGS weakness thresholds to detect diabetes were ≤0.46 and ≤0.30 for men and women, respectively. Weakness was associated with significantly increased odds of diabetes (odds ratio, 1.69; 95% confidence interval, 1.37-2.10), even after adjusting for age, sex, and waist circumference. Conclusions: NGS was robustly associated with diabetes and other cardiometabolic risk factors in older Mexicans. This simple screen may serve as a valuable tool to identify adults that are at risk for negative health consequences or early mortality and who might benefit from lifestyle interventions to reduce risk. © 2016 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

Kuo Y.-F.,University of Texas Medical Branch | Raji M.A.,Sealy Center on Aging | Goodwin J.S.,University of Texas Medical Branch
American Journal of Medicine | Year: 2015

Background: There is growing concern about potential overuse of, and toxicity from, opioid analgesics. No nationally representative study has examined inter-state variations in opioid use and impact of policy on opioid use among older adults. Methods: We used national Medicare data from 2007-2012 to assess temporal and geographic trends in rates of opioid prescription and relationship to opioid toxicity and different state regulations in Part D Medicare recipients. We excluded those with a cancer diagnosis. Multilevel, multivariable regression analyses evaluated rates of prolonged prescriptions for schedule II, schedule III, and combination II/III opioid for each state, adjusting for patient characteristics. Results: The percent of Part D recipients receiving prescriptions for combined schedule II/III opioid more than 90 days in a year increased from 4.62% in 2007 to 7.35% in 2012. Large variations existed among states in rates of opioid prescriptions: from 2.84% in New York to 10.93% in Utah, in 2012 data. The state variation was larger for schedule III than schedule II. Individual characteristics independently associated with prolonged use included older age, female gender, white race, low income, living in a lower-education area, and comorbidity of drug abuse, rheumatoid arthritis, and depression. Only state law regulating pain clinic was associated with reduction of schedule II opioid prescriptions. Prolonged opioid prescription use increased the odds of opioid overdose-related emergency room visits or hospitalization by 60%. Conclusions: Analyses of Medicare Part D data demonstrated a substantial growth in opioid prescriptions from 2007 to 2011 and large variation in opioid prescriptions across states. © 2015 Elsevier Inc.

Dickinson J.M.,Arizona State University | Volpi E.,Sealy Center on Aging | Rasmussen B.B.,Sealy Center on Aging | Rasmussen B.B.,University of Texas Medical Branch
Exercise and Sport Sciences Reviews | Year: 2013

The loss of skeletal muscle size and function with aging and sarcopenia may be related, in part, to an age-related muscle protein synthesis impairment. In this review, we discuss to what extent aging affects skeletal muscle protein synthesis and how nutrition and exercise can be used strategically to overcome age-related protein synthesis impairments and slow the progression of sarcopenia. © 2013 by the American College of Sports Medicine.

Raji M.A.,University of Texas Medical Branch | Lowery M.,Sealy Center on Aging | Lin Y.-L.,Sealy Center on Aging | Kuo Y.-F.,Sealy Center on Aging | And 2 more authors.
Annals of Pharmacotherapy | Year: 2013

BACKGROUND: Although warfarin therapy reduces stroke incidence in patients with atrial fibrillation (AF), the rate of warfarin use in this population remains low. In 2008, the Medicare Part D program was expanded to pay for medications for Medicare enrollees. OBJECTIVE: To examine rates and predictors of warfarin use in Medicare Part D beneficiaries with AF. METHODS: This population-based retrospective cohort study used claims data from 41,447 Medicare beneficiaries aged 66 and older with at least 2 AF diagnoses in 2007 and at least 1 diagnosis in 2008. All subjects had continuous Medicare Part D prescription coverage in 2008. Statistical analysis using χ2 was used to examine differences in warfarin use by patient characteristics (age, ethnicity, sex, Medicaid eligibility, comorbidities, contraindications to warfarin, and whether they visited a cardiologist or a primary care physician [PCP]), CHADS2 score (congestive heart failure, hypertension, age, diabetes, and stroke or transient ischemic attack; higher scores indicate higher risks of stroke), and geographic regions. Using hierarchical generalized linear models restricted to subjects without warfarin contraindications (n = 34,947), we examined the effect of patient characteristics and geographic regions on warfarin use. RESULTS: The overall warfarin use rate was 66.8%. The warfarin use rates varied between hospital referral regions, with highest rates in the Midwestern states and lowest rates in the South. The regional variation persisted even after adjustment for patient characteristics. Multivariable analysis showed that the odds of being on warfarin decreased significantly with age and increasing comorbidity, in blacks, and among those with low income. Seeing a cardiologist (OR 1.10; 95% CI 1.05-1.16), having a PCP (OR 1.23; 95% CI 1.17-1.29), and CHADS2 score of 2 or greater (OR 1.09; 95% CI 1.01-1.17) were associated with increased odds of warfarin use. CONCLUSIONS: Warfarin use rates vary by patient characteristics and region, with higher rates among residents of the Midwest and among patients seen by cardiologists and PCPs. Preventing stroke-related disability in AF requires implementation of evidence-based initiatives to increase warfarin use. © 1967-2013 Harvey Whitney Books Co. All rights reserved.

Howrey B.T.,Sealy Center on Aging | Kuo Y.-F.,Sealy Center on Aging | Kuo Y.-F.,University of Texas Medical Branch | Lin Y.-L.,Sealy Center on Aging | And 2 more authors.
Journals of Gerontology - Series A Biological Sciences and Medical Sciences | Year: 2013

Background.The study assessed the impact of prostate-specific antigen (PSA) testing in the United States by comparing the rates of PSA testing in U.S. counties to the rates of prostate biopsies and newly treated prostate cancer and to deaths from prostate cancer.Methods.We examined the association between the percentage of men aged 66-74 from a nationally representative 5% Medicare sample who received PSA testing in each U.S. county in 1997 and the percent of men who received prostate biopsies or treatment for newly diagnosed prostate cancer in 1997 as well as mortality from prostate cancer and from all other causes from 1998 to 2007.Results.Analyses of 1,067 U.S. counties showed a significant relationship between the rate of PSA testing and both the rate of men undergoing treatment for prostate cancer and prostate cancer mortality (both p <. 001) but no relationship with mortality from other causes. For every 100,000 men receiving a PSA test in 1997, an additional 4,894 men underwent prostate biopsy and 1,597 additional men underwent prostate cancer treatment in 1997, and 61 fewer men died from prostate cancer during 1998-2006. Analyses stratified by age and race produced similar results.Conclusions.PSA testing was associated with modest reductions in prostate cancer mortality and large increases in the number of men overdiagnosed with and overtreated for prostate cancer. The results are similar to those obtained by the large European randomized prospective trial of PSA testing. © 2012 The Author.

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