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Background: Given the rapid growth of the global aging population, pain has become an unneglectable concern amongst the elderly. The quantity of scientific research outputs on pain in the elderly has increased over time, but only a small number of studies have used bibliometric methods to analyze scientific research in this field. This paper aimed to analyze scientific research on pain in the elderly published from 2000 to 2019 in a systematic manner using bibliometric methods. Methods: Articles on pain in the elderly published from 2000 to 2019 were retrieved from the Web of Science (WoS). Abstracts were coded on the basis of predetermined items (eg, type of article, topic, type of subjects, pain characteristics), and relevant information on the first author, citation scores, and article keywords were collected. Results: A total of 2105 articles were included in this study. Statistical analysis revealed that the publication of articles on pain in the elderly increased in frequency over time (P< 0.001). Most of the publications were original articles. Amongst the countries identified, the United States published the largest number of papers on this topic. Pain characteristics (50.21%), pain intervention (35.68%), and pain assessment (9.69%) were the main topics of research on geriatric pain. Back pain (12.30%) appeared to be the most popular pain type described in the included papers. Conclusion: This work provides researchers with an in-depth understanding of pain in the elderly by evaluating relevant publications in the past two decades. Researchers in this field are warranted to explore future directions on geriatric pain such as the transition from acute pain to chronic pain and the underlying mechanisms of pain in the elderly. [ABSTRACT FROM AUTHOR]

The evidence presented in this paper shows that differential mortality by economic status is strongly present in the United States today, and that this relationship is monotonic, with men's death rates being lower among the wealthier. Also, the greater the number of spells of poverty, the higher the death rate. These data suggest that differential mortality rates by economic status are being confused with the well-known ethnic differences in mortality. An implication of this paper, therefore, is that ethnic differences in mortality are, in large part, a consequence of poverty or permanent low income, as opposed to genotype. Consequently, it may be just as valid, or even more so, to publish mortality tables by income as by race. A policy implication of this paper is that the redistributive effects of longevity-based transfer systems, such as social security (public pensions), may be less 'progressive' than has been assumed, since would-be poorer recipients are either less likely to live long enough to collect any benefits in the first place, or will not live to collect them for as long as more affluent recipients. In addition, I have failed to find a direct effect of schooling on probability of survival. Hence, the beneficial effect of schooling on longevity must work through its effect upon income, with only the latter directly influencing mortality risks. [ABSTRACT FROM AUTHOR]

Older adults often experience functional decline following acute medical care. This functional decline may lead to permanent disability, which will increase the burden on the medical and long-term care systems, families, and society as a whole. Post-acute care aims to promote the functional recovery of older adults, prevent unnecessary hospital readmission, and avoid premature admission to a long-term care facility. Research has shown that post-acute care is a cost-effective service model, with both the hospital-athome and community hospital post-acute care models being highly effective. This paper describes the post-acute care models of the United States and the United Kingdom and uses the example of Taiwan's highly effective post-acute care system to explain the benefits and importance of post-acute care. In the face of rapid demographic aging and smaller household size, a post-acute care system can lower medical costs and improve the health of older adults after hospitalization. [ABSTRACT FROM AUTHOR]

Purpose This paper aims to study the specific factors causing suburban-dwelling elderly American women to patronize different soup kitchens in Pennsylvania and investigate how non-profit and government agencies could better meet the needs of this food-insecure population, to fill a significant gap in the growing literature on food insecurity in high-income countries.Design/methodology/approach The authors conducted observational visits and structured interviews with over 200 patrons and staff of soup kitchens in two counties in the US state of Pennsylvania over visits spanning two years.Findings Elderly American women have very distinct soup kitchen needs and usage patters that differ from other patrons in eight key ways the authors identify. From these, the authors identify four central themes that food assistance reform in the US must address to improve the wellbeing of this subpopulation.Research limitations/implications The authors find that significant structural changes of the US food relief system must be made to better meet the needs of food-insecure elderly American women.Practical implications Soup kitchens should begin to offer information about federal programs, group transportation and other resources tailored to elderly women at soup kitchens to significantly improve their wellbeing, and help relieve the burden born by US non-profit food assistance organizations.Originality/value No studies to date have focused on the soup kitchen use of this specific population, whose needs, living circumstances, attitudes toward charity and socioeconomic realities differ significantly from other subpopulations of soup kitchen patrons. [ABSTRACT FROM AUTHOR]

Simple Summary: Although women 70 years of age and older represent a large percentage of newly diagnosed breast cancer cases, older individuals are drastically underrepresented in clinical trials. Most women diagnosed with breast cancer at 70 years of age and older present with hormone receptor-positive (HR+) breast cancer. Cyclin-dependent kinase (CDK) 4/6 inhibitor-based therapy has become the standard of care for metastatic HR+ breast cancer. This study reports that metastatic breast cancer patients ≥70 years of age receiving CDK4/6 inhibitor-based treatment, particularly when combined with an aromatase inhibitor, experience prolonged progression-free survival but display no such prolongation in overall survival and report more frequent adverse effects to treatment. The reported findings can aid in the development of optimized treatments based on age and help older patients weigh treatment options. The largest portion of breast cancer patients diagnosed after 70 years of age present with hormone receptor-positive (HR+) breast cancer subtypes. Cyclin-dependent kinase (CDK) 4/6 inhibitor treatment, in conjunction with endocrine therapy, has become standard-of-care for metastatic HR+ breast cancer. In total, 320 patients with metastatic breast cancer receiving CDK4/6 inhibitor combined with fulvestrant or an aromatase inhibitor were enrolled in an ongoing observational study or were included in an IRB-approved retrospective study. All patients receiving CDK4/6 inhibitor-based therapy that were ≥70 years of age (n = 111) displayed prolonged progression-free survival (27.6 months) as compared to patients <70 years of age (n = 209, 21.1 months, HR = 1.38, p < 0.05). Specifically, patients receiving a CDK4/6 inhibitor with an aromatase inhibitor who were ≥70 years of age (n = 79) displayed exceptionally prolonged progression-free survival (46.0 months) as compared to patients receiving the same treatment who were <70 years of age (n = 161, 21.8 months, HR = 1.71, p < 0.01). However, patients ≥70 years of age also experienced more frequent adverse responses to CDK4/6 inhibitor-based treatment leading to dose reduction, hold, or discontinuation than the younger cohort (69% and 53%, respectively). Treatment strategies that may decrease toxicity without affecting efficacy (such as dose titration) are worth further exploration. [ABSTRACT FROM AUTHOR]

Background: It has been shown that inflammation may be associated with cognitive impairment (CI). Diet modulates inflammation. However, there is currently a scarcity of epidemiological studies exploring the connection between the inflammatory potential of diet and CI. The objective was to investigate the correlation between the dietary inflammatory index (DII) and cognitive impairment in older adults in the United States. Methods: The present investigation utilized a cross-sectional dataset obtained from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2014. Dietary intake data was used to calculate DII scores, which were then used to categorize participants into quartiles. Participants' cognitive function was assessed using the Consortium to Establish a Registry for Alzheimer's Disease (CERAD), Animal Fluency Test (AFT), and Digit Symbol Substitution Test (DSST). Individuals who scored in the lowest quartile on any of these tests were classified as exhibiting low cognitive performance. The association between DII and cognitive impairment was investigated by multivariate logistic regression, smooth curve fitting, and subgroup analysis. Results: A total of 947 older adults were enrolled in the study. Following the adjustment of confounding variables, DII scores exhibited a significant and positive correlation with low cognitive performance, as measured by AFT (OR 1.15, 95% CI 1.02-1.28, p = 0.02) and the DSST (OR 1.38, 95% CI 1.13-1.68, p = 0.004). Compared with the lowest quartile of DII, the highest weighted odds ratio of cognitive impairment based on AFT was observed in the fourth quartile group (OR 1.89, 95% CI 1.05-3.38, p = 0.03). Similarly, a comparable pattern was evident in DSST (OR 4.30, 95% CI 1.85-9.98, p = 0.003). Additionally, the smooth curve fitting results showed a nonlinear relationship between DII and cognitive decline evaluated by DSST (p for nonlinearity = 0.016). No interaction effects between cognitive impairment and age or gender were observed in relation to all cognitive test scores. Conclusion: This research reveals a positive link between diet with higher inflammatory potential and cognitive decline among elderly individuals in America. However, additional studies on dietary interventions are necessary to explore the cause-and-effect relationship. [ABSTRACT FROM AUTHOR]

Joint geriatric/psychiatric wards are a potential solution to improving care of older patients with both psychiatric and medical illnesses in acute hospitals. A literature search using Medline, PsycINFO, Embase and CINAHL between 1980 and 2010 was carried out for information about joint wards for older people. Thirteen relevant papers were identified. These wards share common characteristics and there is evidence that they may reduce length of stay and be cost-effective, but there are no high-quality randomised controlled trials. Further research is needed, particularly regarding cost-effectiveness. [ABSTRACT FROM AUTHOR]

The United States is in the midst of profound demographic changes. The proportion of the elderly population (65+) in the country is projected to increase from a current 13% of the population to just over 20% of the population by 2030. Considering that the decision regarding living arrangements is of great consequence to the well-being of the elderly and their families, understanding the factors that influence this decision is of great value. In this paper, we exploit the changes in state income tax preferences over time to examine the impact of such tax policies on the living arrangements of the elderly population. [ABSTRACT FROM AUTHOR]

Little is known about whether differences in help‐seeking behaviours for urinary incontinence (UI) between the general population and Korean immigrant women are associated with differences in meaning of having UI from a cultural perspective. The purpose of this paper is to examine the similarities and uniqueness associated with these two perspectives from both the US and Korean standpoints. Similar to the USA, UI in Korea has been constructed from a biological perspective. The cultural construction of UI in both the USA and Korea is grounded in sexism. Subtle differences exist in each country regarding ageism and shame. In this cultural construction of UI on sexism, ageism and shame, managing the signs and symptoms of UI necessitates an approach different from that used in countries such as the USA. Findings from this study will contribute to understanding the health in Korean immigrant women who have poor health care access and utilization owing to cultural constraints. Health policy for minorities and policy makers should consider the cultural variances and meaning of UI. [ABSTRACT FROM AUTHOR]

Background: Elderly patients are generally underrepresented in oncology clinical trials; therefore, real-world data are needed to inform clinical management of elderly patients with hormone receptor--positive/human epidermal growth factor receptor 2--negative (HR+/HER2-) metastatic breast cancer (mBC). This subanalysis of the P-REALITY X study (NCT05361655) evaluated palbociclib treatment patterns and comparative effectiveness of palbociclib plus an aromatase inhibitor (AI) versus an AI alone among patients with HR+/HER2-mBC aged ≥ 75 years treated in routine clinical practice in the United States. Methods: This retrospective observational cohort study used electronic health records from the Flatiron Health Analytic Database. Palbociclib treatment patterns, overall survival (OS), real-world progression-free survival (rwPFS), and time to chemotherapy (TTC) were evaluated. Three methods were used for comparative analyses: (1) an unadjusted analysis, (2) stabilized inverse probability treatment weighting (sIPTW; primary analysis), and (3) propensity score matching (PSM; sensitivity analysis). Results: A total of 961 patients aged ≥ 75 years with HR+/HER2- mBC were identified who started palbociclib plus an AI (n = 313) or an AI alone (n = 648) as first-line (1L) therapy between February 2015 and March 2020 (data cut-off: September 30, 2020). Among patients in the palbociclib plus an AI group with a documented palbociclib starting dose (n = 306), approximately 75% started palbociclib at 125 mg/day, and approximately 40% experienced dose adjustment. After sIPTW, patients treated with palbociclib plus an AI versus an AI alone had significantly improved OS (median of 43.0 vs. 32.4 months; hazard ratio [HR], 0.66 [95% confidence interval (CI), 0.51--0.84]; P = 0.0007), rwPFS (median of 20.0 vs. 15.0 months; HR, 0.72 (0.59--0.89); P = 0.0021), and TTC (median of 40.2 vs. 27.4 months; HR, 0.69 [0.55--0.87]; P = 0.0014). These significant improvements in OS, rwPFS, and TTC remained consistent in the unadjusted analysis and after PSM. Conclusion: This real-world comparative analysis demonstrated that 1L palbociclib plus an AI is associated with improved effectiveness compared with an AI alone among patients with HR+/HER2 -mBC aged ≥ 75 years. These findings support palbociclib plus an AI as a standard-of-care 1L treatment for elderly patients with HR+/HER2- mBC. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is the most common cancer in women, and older patients comprise an increasing proportion of patients with this disease. The older breast cancer population is heterogenous with unique factors affecting clinical decision making. While many models have been developed and tested for breast cancer patients of all ages, tools specifically developed for older patients with breast cancer have not been recently reviewed. We systematically reviewed prognostic models developed and/or validated for older patients with breast cancer. Methods: We conducted a systematic search in 3 electronic databases. We identified original studies that were published prior to 8 November 2022 and presented the development and/or validation of models based mainly on clinico-pathological factors to predict response to treatment, recurrence, and/or mortality in older patients with breast cancer. The PROBAST was used to assess the ROB and applicability of each included tool. Results: We screened titles and abstracts of 7316 records. This generated 126 studies for a full text review. We identified 17 eligible articles, all of which presented tool development. The models were developed between 1996 and 2022, mostly using national registry data. The prognostic models were mainly developed in the United States (n = 7; 41%). For the derivation cohorts, the median sample size was 213 (interquartile range, 81–845). For the 17 included modes, the median number of predictive factors was 7 (4.5–10). Conclusions: There have been several studies focused on developing prognostic tools specifically for older patients with breast cancer, and the predictions made by these tools vary widely to include response to treatment, recurrence, and mortality. While external validation was rare, we found that it was typically concordant with interval validation results. Studies that were not validated or only internally validated still require external validation. However, most of the models presented in this review represent promising tools for clinical application in the care of older patients with breast cancer. [ABSTRACT FROM AUTHOR]

While there has been an increasing awareness among policy makers and the public about the potential risks of financial exploitation faced by the elderly, there have been few national assessments of this problem due largely to methodological challenges-such as underreporting, small and nonrepresentative samples, inconsistent offense definitions, and infrequent or unsystematic data collection. This paper illustrates the extent to which the National Incident-Based Reporting System (NIBRS) data can address some of these methodological limitations in order to contribute to a baseline picture of the prevalence and characteristics of elderly financial exploitation in the United States. [ABSTRACT FROM AUTHOR]

This article considers the relationship between ethnicity within the elderly population and education spending. Extensive literature analyzes the relationship between demographics and education spending. This article contributes to this literature by examining the dynamics between the elderly population and ethnicity and its impact on education finance. Using a national panel public school district data set, it is found that increased ethnic fragmentation within the elderly population is negatively related to perpupil spending and to per-pupil local revenues, but this effect depends on whether the state has a court-ordered reform. [ABSTRACT FROM AUTHOR]

Despite the growth of the Internet, one area that has not really been discussed is the elderly's use of the Internet. Given the rapid growth of this population as well as the potential the Internet holds for them, it is a subject worth consideration. However, seniors cannot be defined simply by their chronological age, but by their cognitive age. This paper discusses the impact of cognitive age of a national random sample of American elderly consumers on their Internet use. The results suggest that those seniors with a younger cognitive age use the Internet more than those seniors with an older cognitive age. Additionally, seniors with a younger cognitive age have more social contact off-line (but not online) than those seniors with an older cognitive age. Finally, in terms of demographic variables, chronological age is positively associated with cognitive age and women report a younger cognitive age than men. These results suggest that for policy makers interested in increasing the participation of seniors, they can utilize the Internet to reach those who are younger in terms of cognitive age; however, they will not be able to reach all seniors in this manner and they need to utilize the Internet as a complementing media to their traditional communication sources. [ABSTRACT FROM AUTHOR]

This paper documents a descriptive pilot study utilizing a "point-in-time" or "point prevalence" method to determine the characteristics of those older adults living in homeless shelters in the city of El Paso. Of the 227 individuals who agreed to be involved in the survey, 53 (23% of the total sample) were 50 years and older. The characteristics of those 53 individuals ranging in age from 50-80 are presented. The profile is that of a poorly educated, Hispanic, Catholic male born in Mexico, who identifies Spanish as a first language, and who attributes his homeless state to joblessness or poverty. Key issues with regard to homelessness are employment and retraining. The article discusses the policies relevant to homelessness and employment retraining options as well as local initiatives. Implications for research, policy, and for social work intervention are also suggested in an effort to address needs of these homeless older adults. [ABSTRACT FROM AUTHOR]

Among American evangelicals, the command to honor one's parents (Exod 20:12; Deut 5:16) has usually been interpreted as a command for young children to obey their parents. However, close study of this command reveals that it was primarily a command for adult children to care for their elderly parents. First, adult land- and slave-owning males were the implied audience of the Decalogue rather than children. Second, honoring and fearing parents in the ancient Near East was most commonly associated with adults and consisted primarily of physical support of elderly parents. Third, the other texts in the OT that describe the parentchild relationship clearly show the importance of honoring parents by caring for them. Fourth, NT texts and mainstream church tradition support this interpretation. The paper ends by looking at implications of this interpretation for today and some practical ways for adult children to care for parents in the modern world. [ABSTRACT FROM AUTHOR]

Uncontrolled asthma in the elderly is a public health issue recognized in developed countries such as the United States and among the European Union, both from patient safety and economic perspectives. Variations in the cutoff, which defines elderly age, contribute to epidemiological study difficulties. Nonetheless, the relevance of elderly asthma from a socioeconomic perspective is inarguable. The projected growth of the enlarging geriatric population in the United States portends an impending national health burden that may or may not be preventable with pharmacologic and non-pharmacologic treatments. Asthma in the elderly might be a consequence of uncontrolled disease that is carried throughout a lifetime. Or elderly asthmatics could suffer from uncontrolled asthma, which overlaps with other ailments common with advancing ages that merit consideration, eg, COPD, heart disease, OSA, diabetes mellitus, and other comorbidities. Because of the heterogeneity of asthma phenotypes and other conditions that could mimic the symptoms of elderly asthma, further cohort studies are needed to elucidate the elderly asthmatic pathophysiology and management. More studies to characterize elderly asthma can help address these patients' unmet need for evidence-based guidelines. We introduce the 5 "Ps" (phenotypes, partnership, pharmacology, practice in acute exacerbations, and problems or barriers for the elderly asthmatics) that establish a framework approach for clinical practice. [ABSTRACT FROM AUTHOR]

Background: Eggs are an affordable food providing many shortfall nutrients with the potential to improve cognitive health. We assessed the relationship between whole egg consumption and cognitive functioning among a US nationally representative sample of older adults. Methods: Individual‐level data (2816 adults, aged ≥ 60 years) were obtained from the National Health and Nutrition Examination Survey (NHANES) 2011–2012 and 2013–2014 waves. Cognitive assessments included the Consortium to Establish a Registry for Alzheimer's Disease Word List Learning Test (CERAD‐WL), Word List Recall Test (CERAD‐DR), Animal Fluency Test (AF) and Digit Symbol Substitution Test (DSST). A composite cognitive z‐score was constructed based on the individual tests to represent one's overall cognitive functioning. Multiple linear and logistic regressions were performed to examine the effect of whole egg consumption on cognitive functioning, adjusting for individual characteristics and survey design. Results: Approximately 57% of older adults consumed whole eggs, with an average daily intake of 34 g of whole egg equivalent among consumers. The average z‐scores of the CERAD‐WL, CERAD‐DR, AF and DSST tests were −0.08, 0.23, 0.37 and 0.42, respectively, and the overall composite cognitive z‐score was 0.24 among older adults. Regression analyses found that neither whole egg consumption status, nor daily intake quantity was associated with cognitive test scores. Conclusions: No association was found between whole egg consumption and cognitive functioning among US older adults. Study limitations included cross‐sectional study design and measurement errors. Future studies with longitudinal or experimental design are warranted to examine the possible link between egg consumption and cognition in older adults. Key points: In a large sample of 2816 adults aged ≥ 60 years in the 2011–2014 US National Health and Nutrition Examination Survey (NHANES), we report that no statistically significant association was found between whole egg consumption and cognitive function.Neither whole egg consumption status, nor daily intake quantity measured by the NHANES 24‐h dietary recall was found to be associated with the multidomain cognitive performance nor the overall cognitive score.Although egg consumption contributes to the intake of nutrients potentially beneficial to cognitive health, the quantity consumed remains modest and may not be sufficient to lead to measurable changes in cognitive functioning.Future studies should adopt longitudinal or experimental study designs to further examine the relationship between egg consumption and cognition in older adults. [ABSTRACT FROM AUTHOR]

Abstract: Social media sites have become immensely popular. In 2010 it was estimated that Americans spent a quarter of their online time using social networking sites (SNSs) and blogs. Prior studies have shown how people spend more time socializing through digital communication services such as SNSs reducing face-to-face interaction. Individuals limited offline interactions cause a sense of self-perception of being less socially involved. In this paper we explore how the use of an ubiquitous system we developed, Tlatoque, is able to adapt and move the SNS's social capital outside the desktop into a domestic setting to support older adults' offline interactions with their family. The findings of a 21 week deployment study uncovered the offline practices surrounding the use of Tlatoque and its social implications toward the existing family ties (n=30). Results qualitatively indicate that the content shared in SNSs strengthens older adults' social network by enriching and complementing traditional social engagements such as those conducted over the phone or in-person. [Copyright &y& Elsevier]

This paper examines intertemporal changes in racial disparity among mature Americans during the post-Jim Crow era, that is, 1965-2006. For a large nationally representative sample of American households, we pay special attention to differences between the South and other national regions, as the majority of African Americans do now and always have resided in the South. Historically, periods of progress in African American wellbeing have been followed by periods of regress that are often initiated by some combination of social change, government policy, and macroeconomic instability. Accordingly, we construct an overlapping series of five synthetic intertemporal cohorts of new seniors (ages 50-64). Cohorts are separated by the troughs of recessions. Finally, we note that regardless of race, men and women experience dissimilar opportunities in the market and in society; hence, gender dissimilarity is incorporated into our analysis. We find 1) large reductions in Post-Jim Crow contemporary disparity; 2) we also find large continuing disparity among the most recent cohorts; and, 3) changes in Southern racial weekly wage inequality (especially among men) have been especially important for determining the national pattern. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: There are many factors that influence older adults'' travel choices. This paper explores the associations between mode of travel choice for a short trip and older adults'' personal characteristics. Methods: This study included 406 drivers over the age of 64 who were enrolled in a large integrated health plan in the United States between 1991 and 2001. Bivariate analyses and generalized linear modeling were used to examine associations between choosing to walk or drive and respondents'' self-reported general health, physical and functional abilities, and confidence in walking and driving. Results: Having more confidence in their ability to walk versus drive increased an older adult''s likelihood of walking to make a short trip by about 20% (PR=1.22; 95% CI: 1.06-1.40), and walking for exercise increased the likelihood by about 50% (PR=1.53; 95% CI=1.22-1.91). Reporting fair or poor health decreased the likelihood of walking, as did cutting down on the amount of driving due to a physical problem. Discussion: Factors affecting a person''s decision to walk for exercise may not be the same as those that influence their decision to walk as a mode of travel. It is important to understand the barriers to walking for exercise and walking for travel to develop strategies to help older adults meet both their exercise and mobility needs. Impact on Industry: Increasing walking over driving among older adults may require programs that increase confidence in walking and encourage walking for exercise. [Copyright &y& Elsevier]

Background. Late life depression is an increasingly acute public health concern due to the quickly expanding population of elderly in the US. The last few years has witnessed an explosion in the research literature changing our understanding of this disease. Methods. Published studies over the past decade focusing on the epidemiology, phenomenology, comorbidity, and treatment of depression in the elderly were reviewed. Results. The prevalence and phenomenology of depression in late-life varies with age. It remains highly prevalent in the elderly population, and certain vulnerable populations of older adults are at special risk. Further, the morbidity of late-life depression on physical health, social support systems, and overall functioning is considerable, making depression a leading cause of disability in elderly adults and a risk factor for mortality and suicide as well. Findings suggest a heterogeneity in etiology and in treatment response among older adults with depression, and differences from younger adults as well. Conclusions. This paper reviews our current understanding of late life depression and the implications for treatment and prevention. In addition, we review current research questions and future considerations in this field. [ABSTRACT FROM AUTHOR]

Although malignant tumors occur at all ages, cancer dispro- portionately strikes individuals in the age group 65 years and older. Data from the National Cancer Institute Surveil- lance, Epidemiology, and End Results Program for the most recent five-year period, 1998-2002, reveal that 56% of all newly diagnosed cancer patients and 71% of cancer deaths are in this age group. Median ages of cancer patients at death for the major tumors common to both males and fe- males, all races (lung, colorectal, lymphoma, leukemia, pan- creas, stomach, urinary bladder) range from 71 to 77 years. The median age for prostate cancer is 79 years; for ovarian and female breast cancer, the median age is 71 for each tumor. These cancer statistics when cast against the demo- graphic changes occurring in the U.S. population take on ur- gency and importance for cancer treatment and care in our nation's health care system. The U.S. Census Bureau dem- ographic projections indicate that the number of persons 65 years and older in the United States will double from the cur- rent estimate of 35 million persons to a projected 70 million by 2030. Barring any cancer prevention breakthroughs, the expansion of the aged population will likely increase the ab- solute number of older individuals diagnosed and treated for cancer in coming decades. The United States is not unique as an aging developed industrial nation with a high proportion of the cancer burden in the elderly. Other developed industrial countries have a potentiality for increased cancer incidence and mortality as their populations grow older. This paper, using U.S. Bureau of Census demographic projections and current age stan- dardized death rates per 100,000 population (from World- wide Cancer Mortality Statistics, Cancer Mondial, WHO, and the International Association for Research on Cancer) com- pares cancer in the elderly in Italy and the United States. Italy is demographically ranked as the oldest nation in the world. Dimensions of the cancer burden challenge ahead are inferred in the context of two countries with aging popu- lations to underscore the possible increase that demo- graphic factors may have on the magnitude of the cancer problem for older persons in the next 25 years. (Cancer J [ABSTRACT FROM AUTHOR]

We examined dietary intake of creatine in U.S. men and women aged 65 years and over, and evaluated the association between creatine intake and risk of self‐reported medical conditions, and physical functioning/disability variables using data from the 2017–2018 National Health and Nutrition Examination Survey (NHANES). The NHANES 2017–2018 target population included the noninstitutionalized civilian resident population of the United States aged 65 years and over. Detailed dietary intake data from NHANES elderly were obtained by dietary interview component through a 24‐h dietary recall interview, with estimated individual values for total grams of creatine consumed per day for each respondent. A threshold for dietary intake of creatine used to calculate risk between creatine intake and medical conditions was set at 1.00 g/day. The sample population included 1500 participants aged 65 years and older, of which 1221 individuals (627 men and 594 women) provided detailed dietary data via a dietary interview. Creatine intake across all participants was 0.76 ± 0.79 g/day (95% CI from 0.72 to 0.81). As much as 70% of U.S. elderly consume <1.00 g of creatine per day, with about 1 in 5 individuals (19.8%) consume no creatine at all. Elderly with the suboptimal intake of creatine were found to have 2.62 times higher risk of angina pectoris (adjusted OR = 2.62, 95% CI from 1.14 to 6.01, p =.023) and 2.59 times higher risk of liver conditions (adjusted OR = 2.59, 95% CI from 1.23 to 5.48, p =.013), compared with older counterparts who consume ≥1.00 g of creatine per day after controlling for demographic and nutritional variables. The considerable shortage of dietary creatine is associated with an increased risk of heart and liver conditions, which calls for public measures that foster diets rich in creatine‐containing foods, and additional research to investigate the role of creatine in age‐related diseases. [ABSTRACT FROM AUTHOR]

Introduction: The main objective of this paper is to highlight travel patterns of older adults living in the United States as depicted in the 2001 National Household Travel Survey (NHTS). The NHTS is a national data collection program sponsored by the Bureau of Transportation Statistics and the Federal Highway Administration. It is the first national comprehensive household survey of both daily and long-distance travel, allowing for analysis of the full continuum of personal travel by Americans. To better understand the transportation needs of older Americans, it is useful to examine how travel patterns differ across age groups. The intent is to present basic travel characteristics of older adults (age 65+) and allow for comparisons with younger adults (ages 19–64). Travel-related characteristics of older adults in the United States: Results of the 2001 survey showed that older Americans travel extensively and rely on personal vehicles as heavily as their younger counterparts. Older Americans conduct 89% of their travel in personal vehicles. Characteristics of daily trips taken by older adults: Older adults tend to be less mobile in that they take fewer trips, travel shorter distances, and have shorter travel times. This pattern is even more pronounced among older women. They are also more likely to suffer from self-reported medical conditions that further limit their travel. Characteristics of long-distance travel by older adults: Older men and women take long-distance trips at about the same rates and show a strong preference for using personal vehicles. And, while men and women take an equal percentage of their trips by air, older women show a strong preference for bus travel. Conclusions: Although older Americans travel extensively, they are less mobile than their younger counterparts. This pattern is more pronounced among older women and among those with self-reported medical conditions that affect their ability to travel outside their home. Older women consistently take the least number of trips per day, have the lowest driving rates, travel the shortest distances, and are more likely to report medical conditions that limit their travel. For men and women who have to give up driving, alternative means of transportation becomes a necessity. Yet, use of alternative transportation is relatively low; excluding personal vehicle and walking, all other means of transportation account for about 2% of daily travel. Further, of those with medical conditions that affect their travel, only about 12% use special transportation services such as dial-a-ride. [Copyright &y& Elsevier]

This paper studies the role of health insurance in the retirement decisions of older workers. As policymakers consider mechanisms for how to increase access to affordable health insurance for the near elderly, considerations of the potential labor force implications of such policies will be important to consider--potentially inducing retirements just at a time when the labor force is shrinking. Using data from the 1992 and 1996 waves of the Health and Retirement Survey, this study demonstrates that access to post-retirement health insurance has a large effect on retirement. Among older male workers, those with retiree health benefit offers are 68% more likely to retire (and those with non-employment based insurance are 44% more likely to retire) than their counterparts who would lose employment-based health insurance upon retirement. In addition, the study demonstrated that in retirement models, when retiree health benefits are controlled for, the effects of pension coverage are reduced, suggesting that these effects may have been overestimated in the prior literature. [ABSTRACT FROM AUTHOR]

BACKGROUND Despite readily available treatments, control of blood pressure (BP) with population aging remains suboptimal. Further, there are gaps in the understanding of the management of high BP in the aged. We explored antihypertensive treatment and control among elderly hypertensive participants free from overt cardiovascular disease (CVD), and identified factors related to both "untreated" and "treated but uncontrolled" high BP. METHODS We analyzed baseline data from 19,114 individuals aged ≥65 years enrolled from Australia and United States (US) in the ASPirin in Reducing Events in the Elderly study. Hypertension was defined as an average systolic/diastolic BP ≥140/90 mm Hg and/or the use of any BP lowering medication. "Controlled hypertension" was defined if participants were receiving antihypertensive medication and BP <140 and 90 mm Hg. Descriptive analyses were used to summarize hypertension control rates; logistic regression was used to investigate relationships with treatment and BP control. RESULTS Overall, 74% (14,213/19,114) of participants were hypertensive; and of these 29% (4,151/14,213) were untreated. Among those treated participants, 53% (5,330/10,062) had BP ≥140/90 mm Hg. Participants who were untreated were more likely to be men, have higher educational status, and be in good physical health, and less likely to have significant comorbidities. The factors related to "treated but uncontrolled" BP included older age, male, Black race (vs. White), using antihypertensive monotherapy (vs. multiple) and residing in Australia (vs. US). CONCLUSIONS High levels of "untreated" and "treated but uncontrolled" BP occur in healthy elderly people without CVD, suggesting there are opportunities for better BP control in the primary prevention of CVD in this population. CLINICAL TRIALS REGISTRATION NCT01038583. [ABSTRACT FROM AUTHOR]

Background: Older adults with cognitive impairment may have difficulty understanding and complying with medical or medication instructions provided during hospitalization which may adversely impact patient outcomes. Objective: To evaluate the prevalence of cognitive impairment among patients aged 65 years and older within 24 hours of hospital admission using Mini-Cog™ assessments performed by advanced pharmacy practice experience (APPE) students. Methods: Students on APPE rotations were trained to perform Mini-Cog™ assessments during routine medication education sessions from February 2017 to April 2017. The primary end point was the prevalence of cognitive impairment indicated by a Mini-Cog™ score of ≤3. Secondary end points were the average number of observed Mini-Cog™ practice assessments required for APPE students to meet competency requirements, caregiver identification, and 30-day hospital readmissions. Results: Twelve APPE students completed the training program after an average of 4.4 (standard deviation [SD] = 1.0) graded Mini-Cog™ assessments. Of the 1159 admissions screened, 273 were included in the analysis. The prevalence of cognitive impairment was 55% (n = 149, 95% confidence interval [CI]: 48%-61%). A caregiver was identified for 41% (n = 113, 95% CI: 35%-47%) of patients, and 79 patients had a caregiver present at bedside during the visit. Hospital readmission within 30 days of discharge was 15% (n = 41, 95% CI: 11%-20%). Conclusion: Cognitive impairment could substantially impair a patient's ability to comprehend education provided during hospitalization. Pharmacy students can feasibly perform Mini-Cog™ assessments to evaluate cognitive function, thereby allowing them to tailor education content and involve caregivers when necessary. [ABSTRACT FROM AUTHOR]

Background: Choice of vascular access for older hemodialysis patients presents a special challenge since the rate of arteriovenous fistula (AVF) primary failure is high. The Lok's risk equation predicting AVF primary failure has achieved good prediction accuracy and holds great potential for clinical use, but it has not been validated in the United States older hemodialysis patients.Methods: We assembled a validation data set of 14,892 patients aged 67 years and older who initiated hemodialysis with a central venous catheter between July 1, 2010, and June 30, 2012, and had a subsequent, incident AVF placement from the United States Renal Data System. We examined the external validity of Lok's model by applying it to this validation data set. The discriminatory accuracy and calibration were evaluated by the concordance index (C-statistics) and calibration plot, respectively.Results: The observed frequency of AVF primary failure varied from 0.45 to 0.53 in hemodialysis patients in the validation data set. The predicted probabilities of AVF primary failure calculated by using the Lok's risk equation ranged from 0.08 to 0.61, and 77.8, 40.5, and 51.7% of patients were categorized as having high, intermediate, and low risk of AVF primary failure, respectively. The C-statistics of the Lok's risk equation in the validation data set was 0.53 (95% CI 0.52-0.54). The predicted probabilities of AVF primary failure corresponded poorly with the observed proportions in the calibration plot.Conclusions: When externally applied to a cohort of U.S. older hemodialysis patients, the Lok's risk equation exhibited poor discrimination and calibration accuracy. It is invalid to use it to predict AVF primary failure. A more complex model with strong predictors is expected to better serve clinical determination for AVF placement in this population. [ABSTRACT FROM AUTHOR]

To test applicability of an environmental assessment instrument in new settings, the ratings and reliability of the SOS Tool were compared in diverse settings with a similar climate: Milan, Italy; and Bryan/College Station, Texas, USA. This instrument evaluates physical environment support for outdoor usage by residents at senior facilities. Two trained raters assigned ratings (using a 1–7 scale) to the 60 instrument items at each setting (Italy: 94 outdoor spaces, 67 facilities; US: 22 outdoor spaces, 12 facilities). Overall mean ratings were similar across both sites (6% difference), and three of the five domains had comparable mean ratings. Mean inter-rater reliability was good in both settings but higher in Italy (ICC =.97 versus.82). Despite geographic/cultural differences, mean ratings for most items and domains were surprisingly similar between Italy and the US. This finding, and the high inter-rater reliability found in both settings, suggest this instrument may be useful in a wide range of settings. [ABSTRACT FROM AUTHOR]

The article discusses a study which examined the long-term consequences of traumatic military experiences on later-life functional impairment trajectories among older U.S. male veterans. Topics covered include method used for estimating functional impairment trajectories, findings to demonstrate the importance of psychological resilience in later-life, and implications of the study for current military training programs.

Both academic and popular literatures have repeatedly contended that emerging adults are the most narcissistic and entitled age-group in modern times. Although this contention is fiercely debated, the message that emerging adults are narcissistic and entitled has saturated popular culture. Despite this saturation, relatively little empirical work has examined how emerging adults might react to such labels. Across three studies in five samples in the U.S., the present work sought to address this deficit in research. Results from cross-sectional samples of university students at two universities, as well as an online convenience sample of web-using adults (Study 1), indicated that emerging adults believe their age-group and the one following them (e.g., adolescents) to be the most narcissistic and entitled age-groups, that they have generally negative opinions of narcissism and entitlement, and that they respond negatively to being labeled as narcissistic and entitled. Additionally, results from adult web-users revealed that, while all age groups tend to view adolescents and emerging adults as more narcissistic and entitled than older age-groups, these opinions are more exaggerated among members of older age-groups. Finally, across two experimental studies (Studies 2 & 3), results indicated that emerging adults react negatively to labeling of their age-group as narcissistic and entitled, but no more negatively than they do to potentially related undesirable labels (e.g., oversensitive). Collectively, these results indicate that emerging adults are aware of and somewhat distressed by messaging that casts their age-group as the most narcissistic and entitled age-group ever. [ABSTRACT FROM AUTHOR]

Objective: To assess advance care planning (ACP) preferences, experiences, and comfort in discussing end-of-life (EOL) care among elderly Latinos. Methods: Patients aged 60 and older from the Los Angeles County and University of Southern California (LAC+USC) Medical Center Geriatrics Clinic (n = 41) participated in this intervention. Trained staff conducted ACP counseling with participants in their preferred language, which included: (a) pre-counseling survey about demographics and EOL care attitudes, (b) discussion of ACP and optional completion of an advance directive (AD), and (c) post-session survey. Results: Patients were primarily Spanish speaking with an average of 2.7 chronic medical conditions. Most had not previously documented (95%) or discussed (76%) EOL wishes. Most were unaware they had control over their EOL treatment (61%), but valued learning about EOL options (83%). Post-counseling, 85% reported comfort discussing EOL goals compared to 66% pre-session, and 88% elected to complete an AD. Nearly half of patients reported a desire to discuss EOL wishes sooner. Conclusions: Elderly Latino patients are interested in ACP, given individualized, culturally competent counseling in their preferred language. Clinical Implications: Patients should be offered the opportunity to discuss and document EOL wishes at all primary care appointments, regardless of health status. Counseling should be completed in the patient's preferred language, using culturally competent materials, and with family members present if this is the patient's preference. Cultural-competency training for providers could enhance the impact of EOL discussions and improve ACP completion rates for Latino patients. [ABSTRACT FROM AUTHOR]

Introduction: The American College of Sports Medicine and American Heart Association recommends resistance training involving 60-70% of 1-repetition maximum (1RM) for 8-12 repetitions on 2 or 3 nonconsecutive days per week for the elderly. The Borg 6-20 scale, Borg category ratio (CR-10) scale, and OMNI scale are used to determine the rating of perceived exertion (RPE) for resistance training. Areas covered: RPE scales for resistance training performed by elderly individuals are described. The RPE has been related to resistance training intensity, and the RPE scale was used to determine the resistance training intensity of elderly or ill individuals. Expert commentary: RPE scales can determine the resistance training intensity of elderly individuals and may be used at home or in nursing homes, if they do not have specific resistance training machines. RPE is simple and useful, and may improve skeletal muscle strength or other health-related issues. [ABSTRACT FROM AUTHOR]

Objective: Arthritis and depressive symptoms often interact and negatively influence one another to worsen mental and physical health outcomes. Better characterization of arthritis rates among older adults with different levels of depressive symptoms is an important step toward informing mental health professionals of the need to detect and respond to arthritis and related mental health complications. The primary objective is to determine arthritis rates among US older adults with varying degrees of depression.Methods: Using National Health and Nutrition Examination Survey 2011 to 2014 data (N = 4792), we first identified participants aged ≥50 years. Measures screened for depressive symptoms and self-reported doctor-diagnosed arthritis. Weighted logistic regression models were conducted.Results: Prevalence of arthritis was 55.0%, 62.9%, and 67.8% in participants with minor, moderate, and severe depression, respectively. In both unadjusted and adjusted regression models, a significant association between moderate depression and arthritis persisted. There were also significant associations between minor and severe depression with arthritis.Conclusions: Arthritis is commonly reported in participants with varying degrees of depression. This study highlights the importance of screening for and treating arthritis-related pain in older adults with depressive symptoms and the need for future geriatric psychiatry research on developing integrated biopsychosocial interventions for these common conditions. [ABSTRACT FROM AUTHOR]

Objectives: Limited studies have investigated geographic accessibility to a nearby community pharmacy for elderly which is an essential determinant of the access to medications and pharmacy services. This research identified pharmacy deserts and investigated availability of different types of community pharmacies and their services for elderly enrolled in a State Pharmaceutical Assistance Program (SPAP). Methods: The state of Pennsylvania in the US was used as a case to demonstrate the geographic accessibility to community pharmacy and services for elderly enrolled in SPAP. The locations of community pharmacies and households of elderly enrolled in SPAP were derived from Pharmaceutical Assistance Contract for the Elderly programs’ database. The street addresses were geocoded and the distance to a nearby community pharmacy was calculated for study sample using the haversine formula. The demographic and geographic data were aggregated to Census Tracts and pharmacy deserts were identified using the predefined criteria. Descriptive statistical analysis was used to determine whether there are statistical differences in the socio-demographic profiles and distribution of different types of community pharmacies and their services in pharmacy deserts and non-deserts. This research used hot spot analyses at county level to identify clusters of pharmacy deserts, areas with high concentration of different racial/ethnic groups and clusters of high densities of chain and independent pharmacies. Results: The Spatial analysis revealed that 39% and 61% Census Tracts in Pennsylvania were pharmacy deserts and non-deserts respectively (p < 0.001). Pharmacy deserts were found to have significantly more females, married and white elderly and fewer blacks and Hispanics compared to pharmacy non-deserts. Pharmacy deserts had significantly fewer chain and independent pharmacies and less delivery and 24-hour services in pharmacies than pharmacy non-deserts. Hot spot analyses showed that clusters of pharmacy deserts were more concentrated in southcentral, northwest and northeast regions of the state which represent rural areas and overlapped with clusters of high concentration of white individuals. Conclusions: The findings suggest that urban-rural inequality, racial/ethnic disparity and differences in availability of pharmacies and their services exist between pharmacy deserts and non-deserts. The methodological approach and analyses used in this study can also be applied to other public health programs to evaluate the coverage and breadth of public health services. [ABSTRACT FROM AUTHOR]

Objective: To examine changes in cause-specific Years of Life Lost (YLL) by age, race, and sex group in the USA from 1990 to 2014. Methods: 60 million death reports from the National Center for Health Statistics (NCHS) were categorized by age group, sex, race, and cause of death. YLL were calculated using age-specific life expectancies. Age groups were: infants <1, children 1–19, adults 20–64, and older adults 65+. Results: Blacks have historically experienced more years of life lost than whites or other racial groups in the USA. In the year 1990 the YLL per 100,000 population was 21,103 for blacks, 14,160 for whites, and 7,417 for others. Between 1990 and 2014 overall YLL in the USA improved by 10%, but with marked variations in the rate of change across age, race, and sex groups. Blacks (all ages, both sexes) showed substantial improvement with a 28% reduction in YLL, compared to whites (all ages, both sexes) who showed a 4% reduction. Among blacks, improvements were seen in all age groups: reductions of 43%, 48%, 28%, and 25% among infants, children, adults, and older adults, respectively. Among whites, reductions of 33%, 44%, and 18% were seen in infants, children, and older adults, but there was a 6% increase in YLL among white adults. YLL increased by 18% in white adult females and declined 1% in white adult males. American Indian/Alaska Native women also had worsening in YLL, with an 8% increase. Asian Pacific Islanders consistently had the lowest YLL across all ages. Whites had a higher proportion of YLL due to overdose; blacks had a higher proportion due to homicide at younger ages and to heart disease at older ages. Conclusions: Race-based disparities in YLL in the USA since 1990 have narrowed considerably, largely as a result of improvements among blacks compared to whites. Adult white and American Indian / Alaskan Native females have experienced worsening YLL, while white males have experienced essentially no change. If recent trajectories continue, adult black/white disparities in YLL will continue to narrow. [ABSTRACT FROM AUTHOR]

Introduction: As atrial fibrillation (AF) is often asymptomatic, it may remain undiagnosed until or even after development of complications, such as stroke. Consequently the observed prevalence of AF may underestimate total disease burden. Methods: To estimate the prevalence of undiagnosed AF in the United States, we performed a retrospective cohort modeling study in working age (18–64) and elderly (≥65) people using commercial and Medicare administrative claims databases. We identified patients in years 2004–2010 with incident AF following an ischemic stroke. Using a back-calculation methodology, we estimated the prevalence of undiagnosed AF as the ratio of the number of post-stroke AF patients and the CHADS2-specific stroke probability for each patient, adjusting for age and gender composition based on United States census data. Results: The estimated prevalence of AF (diagnosed and undiagnosed) was 3,873,900 (95%CI: 3,675,200–4,702,600) elderly and 1,457,100 (95%CI: 1,218,500–1,695,800) working age adults, representing 10.0% and 0.92% of the respective populations. Of these, 698,900 were undiagnosed: 535,400 (95%CI: 331,900–804,400) elderly and 163,500 (95%CI: 17,700–400,000) working age adults, representing 1.3% and 0.09% of the respective populations. Among all undiagnosed cases, 77% had a CHADS2 score ≥1, and 56% had CHADS2 score ≥2. Conclusions: Using a back-calculation approach, we estimate that the total AF prevalence in 2009 was 5.3 million of which 0.7 million (13.1% of AF cases) were undiagnosed. Over half of the modeled population with undiagnosed AF was at moderate to high risk of stroke. [ABSTRACT FROM AUTHOR]

Introduction: Studies indicate similar survival and toxicity between pazopanib and sunitinib, but few have examined real-world outcomes among elderly patients with advanced renal cell carcinoma (RCC). The purpose of this retrospective claims analysis was to assess real-world overall survival (OS), healthcare resource utilization (HRU), and healthcare costs (both all-cause and associated with RCC diagnosis) among elderly advanced RCC patients starting pazopanib or sunitinib treatment.Methods: Advanced RCC patients aged 65 years or older who started first-line treatment with pazopanib or sunitinib (index drug; the initiation date was the index date) were identified from the 100% Medicare database plus Part D linkage (January 1, 2006 to December 31, 2014). Patients were stratified by index drug and matched 1:1 with use of propensity scores based on baseline characteristics. OS was assessed from the index date to death and compared by Kaplan-Meier analyses and univariable Cox models; patients were censored at the end of eligibility/data. Monthly HRU and costs from an intent-to-treat perspective were compared by Wilcoxon signed-rank tests.Results: Baseline characteristics were balanced after matching (both N = 522). Treatment with pazopanib was associated with significantly longer median OS compared with treatment with sunitinib (18.2 months vs 14.6 months, respectively; log-rank p = 0.015). Pazopanib was associated with significantly lower monthly all-cause costs compared with sunitinib ($8845 vs $10,416, respectively), as well as lower inpatient costs associated with RCC diagnosis ($1542 vs $2522), fewer monthly inpatient admissions (0.179 vs 0.262), and shorter length of inpatient stay (1.375 days vs 1.883 days; all p ≤ 0.004).Conclusions: Among elderly Medicare patients with advanced RCC, first-line pazopanib tretament was associated with significantly longer OS, as well as lower healthcare costs and HRU, compared with first-line sunitinib treatment. [ABSTRACT FROM AUTHOR]