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Background Care partners are key members of patients’ health care teams, yet little is known about their experiences accessing patient information via electronic portals. Objective To better understand the characteristics and perceptions of care partners who read patients’ electronic visit notes. Patient involvement Focus groups with diverse patients from a community health center provided input into survey development. Methods We contacted patient portal users at 3 geographically distinct sites in the US via email in 2017 for an online survey including open ended questions which we qualitatively analyzed. Results Respondents chose whether to answer as care partners (N = 874) or patients (N = 28,782). Among care partner respondents, 44% were spouses, 43% children/other family members, and 14% friends/neighbors/other. Both care partners and patients reported that access to electronic notes was very important for promoting positive health behaviors, but care partners’ perceptions of importance were consistently more positive than patients’ perceptions of engagement behaviors. Open-ended comments included positive benefits such as: help with remembering the plan for care, coordinating care with other doctors, decreasing stress of care giving, improving efficiency of visits, and supporting patients from a geographical distance. They also offered suggestions for improving electronic portal and note experience for care partners such as having a separate log on for care partners; having doctors avoid judgmental language in their notes; and the ability to prompt needed medical care for patients. Discussion Care partners value electronic access to patients’ health information even more than patients. The majority of care partners were family members, whose feedback is important for improving portal design that effectively engages these care team members. Practical value Patient care in the time of COVID-19 increasingly requires social distancing which may place additional burden on care partners supporting vulnerable patients. Access to patient notes may promote quality of care by keeping care partners informed, and care partner’s input should be used to optimize portal design and electronic access to patient information.

The study aim was to evaluate the associations among the presence of wisdom teeth (third molars, M3), periodontal disease, and serum C-reactive protein (CRP) in the US adult population, thus to generate population-based evidence to inform heart disease prevention and dental care.We performed secondary data analysis of the 2009-2010 National Health and Nutrition Examination Survey (NHANES), and included 3752 people aged 30 years and older who participated in the periodontal examination.Descriptive analyses were performed to determine the prevalence of M3 presence, periodontal disease, and elevated CRP. Multivariate logistic regression modeling was used to determine the association between M3 presence, periodontal disease, and elevated CRP.The prevalence of M3 presence, periodontal disease (probing periodontal pockets depth (PPD)≥ 4 mm), and elevated serum C-reactive protein level (≥5 mg/L) was 39%, 41%, and 19% respectively. M3 presence was highest among men, younger adults, Blacks and Hispanics compared to Non-Hispanic Whites, those who did not attend college, and people with low incomes (P 0.001). M3 presence, adjusted for sociodemographic and health characteristics, was independently associated with periodontal disease (adjusted [Adj.] odds ratio [OR] 1.61, 95% confidence interval [CI] 1.31, 1.97), and periodontal disease was independently associated with elevated serum CRP (Adj. OR 1.35, 95% CI 1.06, 1.73), but we did not find M3 presence associated with elevated serum CRP (Adj. OR 1.02, 95% CI 0.79, 1.31).We observed expected associations between M3 presence and periodontal disease, and periodontal disease and elevated CRP. However, M3 presence alone is not associated with elevated CRP. Further research into cardiovascular health hazards related to the retention of wisdom teeth is needed, including examining possible relationships with other inflammatory factors.

OBJECTIVES: To examine associations between mild cognitive impairment (MCI) and falls among primary care patients, and to investigate whether social engagement (SE) modifies these associations.DESIGN: Cross sectional analysis using baseline data from an observational cohort study.SETTING: Primary care.PARTICIPANTS: Community-dwelling older adults (N=430) at risk of mobility decline with a mean age of 76.6 years (range 65-96y).MAIN OUTCOME MEASURES: The number of falls in the past year was reported at the baseline interview. MCI was identified using a cutoff of 1.5 SD below the age-adjusted mean on at least 2 of the standardized cognitive performance tests. SE (eg, keeping in touch with friends and family, volunteering, participating social activities…) was assessed with the Late Life Function and Disability Instrument, and required a score above the median value 49.5 out of 100.RESULTS: MCI was present among 42% of participants and 42% reported at least 1 fall in the preceding year. Using generalized estimating equations, MCI was associated with a 77% greater rate of falls (PCONCLUSIONS: While MCI is associated with a greater risk for falls, higher levels of SE may play a protective role.

Falls are a complex problem and play a leading role in the development of disabilities in the older population. While fall detection systems are important, it is also essential to work on fall preventive strategies, which will have the most significant impact in reducing disability in the elderly. In this work, we explore a prospective cohort study, specifically designed for examining novel risk factors for falls in community-living older adults. Various types of data were acquired that are common for real-world applications. Learning from multiple data sources often leads to more valuable findings than any of the data sources can provide alone. However, simply merging features from disparate datasets usually will not produce a synergy effect. Hence, it becomes crucial to properly manage the synergy, complementarity, and conflicts that arise in multi-source learning. In this work, we propose a multi-source learning approach called the Synergy LSTM model, which exploits complementarity among textual fall descriptions together with people's physical characteristics. We further use the learned complementarities to evaluate fall risk factors present in the data. Experiment results show that our Synergy LSTM model can significantly improve classification performance and capture meaningful relations between data from multiple sources.

Objective To identify neuromuscular impairments most predictive of unfavorable mobility outcomes in late life. Design Longitudinal cohort study. Setting Research clinic. Participants Community-dwelling primary care patients aged ≥65 years (N=391) with self-reported mobility modifications, randomly selected from a research registry. Interventions Not applicable. Main Outcome Measures Categories of decline in and persistently poor mobility across baseline, 1 and 2 years of follow-up in the Lower-Extremity Function scales of the Late-Life Function and Disability Instrument. The following categories of impairment were assessed as potential predictors of mobility change: strength (leg strength), speed of movement (leg velocity, reaction time, rapid leg coordination), range of motion (ROM) (knee flexion/knee extension/ankle ROM), asymmetry (asymmetry of leg strength and knee flexion/extension ROM measures), and trunk stability (trunk extensor endurance, kyphosis). Results The largest effect sizes were found for baseline weaker leg strength (odds ratio [95% confidence interval]: 3.45 [1.72–6.95]), trunk extensor endurance (2.98 [1.56–5.70]), and slower leg velocity (2.35 [1.21–4.58]) predicting a greater likelihood of persistently poor function over 2 years. Baseline weaker leg strength, trunk extensor endurance, and restricted knee flexion motion also predicted a greater likelihood of decline in function (1.72 [1.10–2.70], 1.83 [1.13–2.95], and 2.03 [1.24–3.35], respectively). Conclusions Older adults exhibiting poor mobility may be prime candidates for rehabilitation focused on improving these impairments. These findings lay the groundwork for developing interventions aimed at optimizing rehabilitative care and disability prevention, and highlight the importance of both well-recognized (leg strength) and novel impairments (leg velocity, trunk extensor muscle endurance).

Independent control of the right and left ankles (differentiation) may be a motor control mechanism linking impaired coordination and mobility limitations. We tested the hypotheses that motor control differentiation of the ankles, as measured using Cross-Sample Entropy, during antiphase coordination at two movement frequencies, is associated with impaired coordination (high ankle coordination variability) and mobility limitations (Short Physical Performance Battery score ≤9). We conducted a cross-sectional study of community-dwelling older adults (N = 133) aged 80.04 (±4.67) years. In linear regression modeling, low ankle Cross-Sample Entropy (low motor control differentiation) was associated with poor (i.e., high) coordination variability at the slower (P = 0.026), but not the faster (P = 0.447), ankle movement frequency. In logistic regression modeling, low Cross-Sample Entropy at the slower (OR = 1.67; 95 % CI: 1.07–2.59) and faster (OR = 2.38; 95 % CI: 1.43–3.94) ankle movement frequencies were associated with increased odds for mobility limitations. Our findings support the hypothesis that ankle differentiation may be a motor control mechanism that links impaired coordination with mobility limitations.

Objectives To describe the methods of a longitudinal cohort study among older adults with preclinical disability. The study aims to address the lack of evidence guiding mobility rehabilitation for older adults by identifying those impairments and impairment combinations that are most responsible for mobility decline and disability progression over 2 years of follow-up. Design Longitudinal cohort study. Setting Metropolitan-based health care system. Participants Community-dwelling primary care patients aged ≥65 years (N=430), with self-reported modification of mobility tasks because of underlying health conditions. Interventions Not applicable. Main Outcome Measures Late Life Function and Disability Instrument (LLFDI) (primary outcome); Short Physical Performance Battery and 400-m walk test (secondary outcomes). Results Among 7403 primary care patients identified as being potentially eligible for participation, 430 were enrolled. Participants have a mean age of 76.5 years, are 68% women, and have on average 4.2 chronic conditions. Mean LLFDI scores are 55.5 for Function and 68.9 and 52.3 for the Disability Limitation and Frequency domains, respectively. Conclusions Completion of our study aims will inform development of primary care–based rehabilitative strategies to prevent disability. Additionally, data generated in this investigation can also serve as a vital resource for ancillary studies addressing important questions in rehabilitative science relevant to geriatric care.

Prevalence of tender points (TP), and widespread pain and fibromyalgia, as well as the relationship between TP and widespread pain and mobility, was examined in 585 community-dwelling older adults (mean age 78.2 years, 63.4% female). Pain was based on location (none, single site, multisite, widespread). Mobility was measured by the Short Physical Performance Battery (SPPB), gait speed, and self-reported (S-R) mobility difficulty. Tender-point count and health characteristics (ie, BMI, chronic conditions, analgesic use, number of medications, depression, and blocks walked per week) were assessed. Several participants had 3 or more TP (22.1%) although prevalence of criteria-based fibromyalgia was low (.3%). Mobility was more limited in persons with higher tender-point counts. After adjustment for pain and other risk factors, higher tender-point count was associated with poorer SPPB performance (score10, aOR = 1.09 per TP, 95%CI, 1.01-1.17), and slow gait speed (.784m/sec, aOR = 1.14 per TP, 95%CI, 1.05-1.24), but not with S-R mobility difficulty. S-R mobility difficulty was associated with more disseminated pain (multisite pain, aOR = 2.01, 95%CI, 1.21-3.34; widespread pain, aOR = 2.47, 95%CI, 1.09-5.62). These findings portray a significant mobility burden related to tender-point count and multisite and widespread pain in the older population. Future studies using longitudinal methods are warranted.Higher tender-point count, multisite pain, and widespread pain are common in community-dwelling older adults and associated with mobility problems. Both the manual tender-point exam and the McGill Pain Map may provide important yet different information about risks for mobility disability in older individuals.

For research purposes, there are few alternatives to costly surveillance for ascertaining infections in community populations. We propose a new approach based on antibiotic prescription fills in automated pharmacy records of the Group Health Cooperative of Puget Sound, in Seattle, Washington, to identify treated infections in postmenopausal women. After excluding probable antimicrobial prophylaxis and chronic antibiotic use, four intervals between antibiotic fills (30, 45, 60, and 90 days) were tested for their ability to detect new infections. Concordance with outpatient medical record reviews was evaluated in 150 women. The sensitivity of the automated pharmacy records using the four cutpoints for detecting new infections ranged from 88 to 80%, from 30 to 90 days, respectively. Of the 81 women with no infection in the chart reviews, 75% also had no infection using the pharmacy method. Good agreement was found between the two methods for counts of infections per person over the 2-year follow-up, with the 60-day cutpoint showing the greatest overall agreement with chart reviews (kappa = 0.55). The pharmacy method presented here offers a useful new approach for infection ascertainment for epidemiologic research.

Introduction The purpose of this article is to examine the effectiveness of recruitment strategies used to recruit African-American older adults for a senior center–based health promotion trial with a 6-month exercise component. Methods We compared multiple strategies for recruiting participants from senior center members and other older adults residing in the surrounding predominantly African-American community. The phonathon, direct telephone recruitment by senior center leadership, is compared with traditional approaches. Results All recruiting strategies combined yielded a total of 120 participants. Phonathons involving five or six senior center board members in two half-day sessions yielded 40 participants or 33% of all participants. Strategies categorized as printed media yielded 39 participants or 33% of all participants. Strategies categorized as word-of-mouth yielded 31 participants or 26% of all participants. Remaining approaches accounted for an additional 10 participants or 8% of all participants. Conclusions Our results support employing a multifaceted recruitment approach and demonstrate the importance of strong linkages between the research team and community leaders in conducting health promotion research in minority communities. An innovative approach, the phonathon, may be a potentially important recruitment strategy.

The role of dietary antioxidants in osteoporosis has not been well explored. The objective of this study was to examine the relationship between the dietary antioxidants, vitamin E and beta-carotene, and hip bone mineral density (BMD) in postmenopausal women. Subjects were 1892 screenees, aged 55–80 years, who were volunteers for a clinical trial. Bone densitometry and osteoporosis risk factor information was obtained during screening. Dietary and supplement information was obtained by mailed food frequency and vitamin supplement questionnaires. We found no evidence of an association between dietary and/or supplemental vitamin E and bone density of the femoral neck. Dietary beta-carotene, adjusted for age and weight was positively associated with hip BMD (β=1.5×10 −6 gm/cm 2 , p=0.05). Further adjustment for osteoporosis risk factors diminished the association (β=0.7×10 −6 gm/cm 2 , p=0.38). Neither total nor supplemental beta-carotene intake was found to be associated with BMD. We did not find that vitamin E or beta-carotene was associated with femoral neck bone density in postmenopausal women, however, the potential role of antioxidants and other nutrients in postmenopausal bone loss warrants further study, including research of other bone sites.