Search

Background and Objectives The coronavirus disease 2019 pandemic placed unprecedented stress on older adults. Resiliency could mitigate deleterious effects of pandemic stressors. We described trends in resilience among U.S. adults aged 50–80 years approximately one and a half years after the onset of the pandemic, compared with before the pandemic, and evaluated associations between relationships and resilience. Research Design and Methods Data were from the National Poll on Healthy Aging (N = 2,100) in August 2021. Respondents rated their resiliency as compared with before the pandemic (more, about the same, or less) and different types of relationships (spouse/partner, friends, and neighbors) as sources of joy and/or stress during the pandemic (a lot, some, very little, and not at all). Multinomial logistic regressions (complete-case analysis) estimated the relationships between each joyful and stressful relationships and resiliency. Results Most participants reported feeling as resilient as before the pandemic (70.6%) with 14.5% feeling less resilient. More women than men felt less resilient than before the pandemic (16.7% vs 12.8%, p =.006). Feeling a lot of stress from one's spouse or neighbors was associated with increased likelihood of feeling less resilient than before the pandemic (odds ratio [OR] = 3.7; 95% confidence interval [CI]: 1.8, 7.7 and OR = 4.5; 95% CI: 1.5, 13.9, respectively), which was stronger among women (OR = 15.1; 95% CI: 4.8, 45.6) than men (OR = 1.03; 95% CI: 0.4, 2.7). Discussion and Implications Social relationships may have been more important for women than for men in supporting resiliency during the pandemic. Understanding patterns of resiliency can help to inform policymaking and support the well-being of older adults. [ABSTRACT FROM AUTHOR]

Objectives: Older adults regularly encounter age-based discrimination and stereotyping in their day-to-day lives. Whether this type of routine ageism negatively affects their health and well-being is unclear, in part due to the absence of validated scales that comprehensively measure this phenomenon and distinguish it from other sources of everyday discrimination. Methods: This study describes the development of a novel scale, the Everyday Ageism Scale, and its psychometric evaluation using a nationally representative sample of US adults age 50–80 from the December 2019 National Poll on Healthy Aging (N = 2012). Results: Exploratory factor analysis indicated a 3-factor structure comprised of ageist messages, ageism in interpersonal interactions, and internalized ageism. The ten-item scale was psychometrically sound and demonstrated good internal reliability. Discussion: Everyday ageism is a multidimensional construct. Preliminary evaluation of the Everyday Ageism Scale suggests its utility in future studies examining the prevalence of everyday ageism and its relationships with health. [ABSTRACT FROM AUTHOR]

Background: Physical function worsens with older age, particularly for sedentary and socially isolated individuals, and this often leads to injuries. Through reductions in physical activity, the COVID‐19 pandemic may have worsened physical function and led to higher fall‐related risks. Methods: A nationally representative online survey of 2006 U.S. adults aged 50–80 was conducted in January 2021 to assess changes in health behaviors (worsened physical activity and less daily time spent on feet), social isolation (lack of companionship and perceived isolation), physical function (mobility and physical conditioning), and falls (falls and fear of falling) since March 2020. Multivariable logistic regression was used to assess relationships among physical activity, social isolation, physical function, falls, and fear of falling. Results: Among respondents, 740 (36.9%) reported reduced physical activity levels, 704 (35.1%) reported reduced daily time spent on their feet since March 2020, 712 (37.1%) reported lack of companionship, and 914 (45.9%) social isolation. In multivariable models, decreased physical activity (adjusted risk ratio, ARR: 2.92, 95% CI: 2.38, 3.61), less time spent on one's feet (ARR: 1.95, 95% CI: 1.62, 2.34), and social isolation (ARR: 1.51, 95% CI: 1.30, 1.74) were associated with greater risks of worsened physical conditioning. Decreased physical activity, time spent daily on one's feet, and social isolation were similarly associated with worsened mobility. Worsened mobility was associated with both greater risk of falling (ARR: 1.70, 95% CI: 1.35, 2.15) and worsened fear of falling (ARR: 2.02, 95% CI: 1.30, 3.13). Worsened physical conditioning and social isolation were also associated with greater risk of worsened fear of falling. Conclusion: The COVID‐19 pandemic was associated with worsened physical functioning and fall outcomes, with the greatest effect on individuals with reduced physical activity and social isolation. Public health actions to address reduced physical activity and social isolation among older adults are needed. [ABSTRACT FROM AUTHOR]

Background and Objectives The coronavirus disease 2019 (COVID-19) pandemic poses new challenges for caregivers of adults with chronic or disabling conditions. This study uses nationally representative data to examine the prevalence of pandemic care challenges and supports and their associations with caregiver mental health and interpersonal well-being. Research Design and Methods Participants include 311 caregivers aged 50–80 in the United States who were providing care for an adult with a chronic or disabling condition from the June 2020 National Poll on Healthy Aging. Five care challenges (e.g. confusion on public health guidelines) and 2 supports (e.g. physician offered information on care during COVID-19) are treated as predictors of caregiver mental health (care-related stress, self-reported mental health, and depressive symptoms) and interpersonal well-being (interpersonal conflicts, lack of companionship, and isolation). Results Each care challenge/support was endorsed by 13%–23% of caregivers. In adjusted models, difficulty getting needed medical care was associated with greater caregiver stress, depressive symptoms, and lower interpersonal well-being. All care challenges universally predicted greater caregiver stress. Caregiving supports were not independently associated with caregiver' mental health and interpersonal well-being. Discussion and Implications Care challenges were associated with caregivers' mental health and interpersonal well-being during the early months of the pandemic. Some of these challenges may be attributed to changing public health guidelines and practices as the pandemic unfolded, whereas others are relevant to all care contexts (e.g. less support from family). Tools and supports for caregivers must consider both changing policies and care needs. [ABSTRACT FROM AUTHOR]

Objectives: Sexual health is an important component of overall health and well-being for older adults. Despite this, little is known about the importance of sex to quality of life, as part of romantic relationships for older adults, and potential drivers of interactions between healthcare providers and older adults about sexual health. In this study using a nationally representative population, we describe perceptions and experiences of sex among older adults. Methods: A nationally representative, cross-sectional sample of community-dwelling U.S. adults aged 65–80 was surveyed about their sexual health and interaction with their health care providers about sexual health. Results: The survey completion rate was 75% (N = 1,002). Overall, 50.9% of men and 30.8% of women reported being sexually active. In all, 17.3% of adults aged 65–80 reported speaking to their health care provider about sexual health in the past two years and of those, 60.5% of patients initiated the conversation. Multivariable logistic regression demonstrated that sexual activity (yes/no), interest in sex, and satisfaction with sex life are major drivers of sexual health conversations between patients and healthcare providers. Conclusions: Many adults aged 65–80 are interested in and engage in sexual activity. While the majority of older adults reported a willingness to discuss their sexual health with their health care providers, few had done so, and most conversations were initiated by patients. Iterest in sex and satisfaction with sex life may be targets for intervention and offer a segue for providers as they begin the conversation to engage with older adults about their sexual health. Clinical Implications: Providers may have conversations with older adults about sexual health and may need sexual health training to have effective discussions; age nor chronic conditions should preclude this essential conversation. Clinical gerontologists may be helpful in this training and in encouraging patients to bring up sexual health concerns during their medical appointments. [ABSTRACT FROM AUTHOR]

Total joint arthroplasty (TJA) is commonly performed on older adults. Prosthetic joint infection (PJI) is a serious complication of TJA that can significantly impact quality of life and physical function. In this review, we discuss the epidemiology and risk factors for PJIs among older adults. We also offer an overview of current diagnostic, treatment and management strategies for PJI. Given the serious nature of PJI, prevention efforts remain essential. Several approaches to infection prevention exist, including antimicrobial prophylaxis and decolonization. Although there are standardized recommendations for antimicrobial prophylaxis, the specific regimens must be individualized based on the patient's drug allergies, potential for drug interactions, renal function and bodyweight. The best approach to preoperative screening and decolonization programmes remains unclear. Each of these issues is reviewed in detail with a focus on adverse effects and current debates regarding best practice. Given the increased numbers of TJAs performed, additional research on prevention and management is critical. [ABSTRACT FROM AUTHOR]

The article discusses research which examined the mortality trends for major infectious diseases including lower respiratory infection, diarrheal disease and hepatitis, from 1980 to 2014. Topics discussed include statistics of deaths due to infectious diseases, lower respiratory infections as the most common cause of infectious diseases mortality, socioeconomic factors contributing to risk of pneumonia, geographic variations in HIV mortality and the role of climate change.

The authors comment on the move by more hospitals in the U.S. to offer palliative care programs. They attribute the expansion to evidence that supports the early involvement of palliative care specialists in the care of people with serious illness. However, they observe limited access to palliative care specialists for this group of patients. The authors also discuss some studies on the integration of palliative care specialists throughout the duration of treatments.

IMPORTANCE: Estimating the US burden of methicillin-resistant Staphylococcus aureus (MRSA) infections is important for planning and tracking success of prevention strategies. OBJECTIVE: TO describe updated national estimates and characteristics of health care- and community-associated invasive methicillin-resistant Staphylococcus aureus (MRSA) infections in 2011. DESIGN, SETTING, AND PARTICIPANTS: Active laboratory-based case finding identified MRSA cultures in 9 US metropolitan areas from 2005 through 2Oll. Invasive infections (MRSA cultured from normally sterile body sites) were classified as health care-associated community-onset (HACO) infections (cultured ≤3 days after admission and/or prior year dialysis, hospitalization, surgery, long-term care residence, or central vascular catheter presence ≤2 days before culture); hospital-onset infections (cultured >3 clays after admission); or community-associated infections if no other criteria were met. National estimates were adjusted using US census and US Renal Data System data. MAIN OUTCOMES AND MEASURES: National estimates of invasive HACO, hospital-onset, and community-associated MRSA infections using US census and US Renal Data System data as the denominator. RESULTS: An estimated 80 461 (95% CI, 69 515-93 914) invasive MRSA infections occurred nationally in 2011. Of these, 48 353 (95% CI, 40 195-58 642) were HACO infections; 14 156 (95% CI, 10 096-20 440) were hospital-onset infections; and 16 560 (95% CI, 12 806-21 811) were community-associated infections. Since 2005, adjusted national estimated incidence rates decreased among HACO infections by 27.7% and hospital-onset infections decreased by 54.2%; community-associated infections decreased by only 5.0%. Among recently hospitalized community-onset (nondialysis) infections, 64% occurred 3 months or less after discharge, and 32% of these were admitted from long-term care facilities. CONCLUSIONS AND RELEVANCE: An estimated 30 800 fewer invasive MRSA infections occurred in the United States in 2011 compared with 2005; in 2011 fewer infections occurred among patients during hospitalization than among persons in the community without recent health care exposures. Effective strategies for preventing infections outside acute care settings will have the greatest impact on further reducing invasive MRSA infections nationally. [ABSTRACT FROM AUTHOR]

The article reports on the U.S. Congress' approval of the HIV Organ Policy Equity (HOPE) Act which ends the federal ban on transplantation of organs deceased HIV-infected donors to HIV-infected recipients. The law aims to address the reality that more people with HIV infection will benefit from transplantation. The number of organs available for transplantation into patients with HIV is expected to expand following the approval of the HOPE Act.

OBJECTIVES: COVID-19 has strained the household finances of many Americans who are already experiencing increasing health care expenses. Concerns about the cost of care may deter patients from seeking even urgent care from the emergency department (ED). This study examines predictors of older Americans' concerns about ED visit costs and how cost concerns may have influenced their ED use in the early stages of the pandemic. STUDY DESIGN: This was a cross-sectional survey study using a nationally representative sample of US adults aged 50 to 80 years (N = 2074) in June 2020. METHODS: Multivariate logistic regressions assessed the relationships of sociodemographic, insurance, and health factors with cost concerns for ED care. RESULTS: Of the respondents, 80% were concerned (45% very, 35% somewhat) about costs of an ED visit and 18% were not confident in their ability to afford an ED visit. Of the entire sample, 7% had avoided ED care because of cost concerns in the past 2 years. Of those who may have needed ED care, 22% had avoided care. Predictors of cost-related ED avoidance included being aged 50 to 54 years (adjusted odds ratio [AOR], 4.57; 95% CI, 1.44-14.54), being uninsured (AOR, 2.93; 95% CI, 1.35-6.52), having poor or fair mental health (AOR, 2.82; 95% CI, 1.62-4.89), and having an annual household income of less than $30,000 (AOR, 2.30; 95% CI, 1.19-4.46). CONCLUSIONS: During the early COVID-19 pandemic, most older US adults expressed concerns about the financial impact of ED use. Further research should examine how insurance design could alleviate the perceived financial burden of ED use and prevent cost-related care avoidance, especially for those at higher risk in future pandemic surges. [ABSTRACT FROM AUTHOR]

Introduction: COVID-19 necessitated a shift from in-person to virtual care for all patients, particularly older adults. It is unknown how older individuals' views of telehealth changed during this time and how this may affect their future use of telehealth services., Methods: We used data from a cross-sectional online survey of a nationally representative sample of 2074 U.S. adults ages 50-80 who were participants in the National Poll on Healthy Aging. We performed a descriptive and multivariable analysis of individuals' perspectives on past and future telehealth visits, sociodemographics, and health status., Results: Before March 2020, 5.8% of respondents had used telehealth, compared to 32.0% by June 2020. Of telehealth users, 36.1% indicated their most recent telehealth visit used audio-only (i.e., without video) technology. In multivariable analysis, those who never used video technology compared to those who were "very comfortable" (average marginal effect (AME) 49%, 95% CI: 36-63), identified as Hispanic (AME 19% vs White, non-Hispanic, 95% CI: 5-32), or were female (AME 9%, 95% CI: 1-17) were more likely to report audio-only use. Concerns remained about the inability to conduct physical exams (75%) and telehealth quality of care (67%), though most (64%) older adults indicated an interest in future telehealth visits., Discussion: Telehealth use increased substantially among older U.S. adults during the early months of the COVID-19 pandemic; however, many reported using audio-only telehealth, an important consideration for policymakers and providers. Addressing older adults' concerns about and barriers to telehealth visits is needed to ensure telehealth does not exacerbate disparities in their care., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Kullgren has received grant funding from the US National Institutes of Health, US Department of Veterans Affairs, Robert Wood Johnson Foundation, Donaghue Foundation, Healthwell Foundation, and State of Michigan Department of Military and Veterans Affairs; consulting fees from SeeChange Health, HealthMine, Kaiser Permanente Washington Health Research Institute, and Washington State Office of the Attorney General; and honoraria from the Robert Wood Johnson Foundation, AbilTo, Inc., Kansas City Area Life Sciences Institute, American Diabetes Association, Luxembourg National Research Fund, and Donaghue Foundation. All other authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Appearance is an indicator of age and life stage, which are linked to socially salient stereotypes and prejudices. Older adults' appearance-related perceptions and behaviors may affect their experiences of aging within broader society, which may in turn influence health. This study examined associations between two measures related to aging appearance-assessment of one's aging appearance relative to same-age peers and investing time or effort to look younger-positive and negative experiences of aging, and health using multivariable regression. Cross-sectional data were from a nationally representative sample of 2006 U.S. adults ages 50-80 ( M age = 63, 52% women, 71% White) who completed Wave 6 of the National Poll on Healthy Aging in 2019. The majority (59%) reported appearing relatively younger than peers, while fewer reported appearing the same age (35%) or older (6%). About a third (35%) reported investing in looking younger. Appearing relatively younger was associated with more positive ( p < .001) and less negative experiences of aging ( p = .019). Appearing relatively older showed the opposite relationships ( p values < .001). Investing in looking younger was associated with more positive and more negative experiences of aging ( p values < .001). Few sociodemographic variations were detected. More positive and less negative experiences of aging were associated with better physical and mental health ( p values < .001). While aging appearance is often the basis for jokes, it may affect the quality of older adults' experiences of aging and associated health outcomes. Nuanced findings caution against framing youthful biases in aging appearance and investments in looking younger as solely negative (or positive). (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: Legal access to and attitudes toward cannabis are changing rapidly. Most of the United States and territories allow adults to use medical and/or recreational cannabis. Recent trends demonstrate increasing cannabis use among older U.S. adults. However, little research has examined cannabis use among older adults since 2019, when the COVID-19 pandemic caused major changes in patterns of substance use. Methods: The National Poll on Healthy Aging is a nationally cross-sectional survey that asked U.S. adults ages 50-80 in January 2021 about their cannabis use in the past year. Multivariable logistic regression was used to identify demographic and health characteristics associated with cannabis use. Results: Among 2023 participants aged 50-80 (52.7% female), 12.1% reported cannabis use in the past year. Among those who reported cannabis use, 34.2% reported using cannabis products 4 or more days per week. In multivariable logistic regression, cannabis use was less likely among people who identified as Hispanic ethnicity or as "other" races compared with non-Hispanic white respondents. Cannabis use was more likely among unmarried/unpartnered and unemployed respondents. Those who consumed alcohol were more likely to use cannabis. Conclusions: More than one in 10 U.S. adults aged 50-80 used cannabis in the 1st year of the COVID-19 pandemic, and many used cannabis frequently. As access to and use of cannabis continue to increase nationally, clinicians and policymakers should monitor and address the potential risks among older adults.

The availability of direct-to-consumer, at-home medical tests has grown over the last decade, but it is unknown how frequently older adults purchase at-home tests, how they perceive such tests, and how interested they are in using at-home tests in the future. We conducted a cross-sectional, nationally representative survey of non-institutionalized US adults aged 50 to 80 about their previous use of, perceptions of, and future intentions to use at-home medical tests. We found that nearly half of older adults (48.1%) have purchased an at-home medical test (95% CI 45.2%-51.0%), including 32.0% (95% CI 29.3%-34.8%) who purchased a COVID-19 test, 16.6% (95% CI 14.7%-18.7%) who purchased an at-home DNA or genetic test, 5.6% (95% CI 4.5%-7.0%) who purchased a screening test for cancer, and 4.4% (95% CI 3.4%-5.6%) who purchased a test for an infection other than COVID-19. Compared with White, non-Hispanic adults, Black, non-Hispanic adults were less likely to have purchased an at-home test (35.5% vs 49.6%, P  < .01). Those with a college degree and those with an annual household income greater than $100K were more likely than others to have purchased at-home tests (55.5% vs 42.0%, P  < .01; 60.6% vs 39.0%, P  < .001, respectively). Most older adults had positive perceptions about at-home tests and expressed interest in using at-home tests in the future. At-home medical testing is now common among older adults. Clinicians should be familiar with different tests that patients can purchase and be prepared to discuss the potential advantages and disadvantages of at-home testing., Competing Interests: Data Availability StatementThe National Poll on Healthy Aging regularly releases data from each survey wave for public use at https://www.healthyagingpoll.org/reports-more/data. Those interested in using this dataset should contact the National Poll on Healthy Aging. Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Kullgren reports grant funding from the US National Institutes of Health, the US Department of Veterans Affairs, the Healthwell Foundation, and the State of Michigan Department of Military and Veterans Affairs; receiving consulting fees from the Washington State Office of the Attorney General; receiving honoraria from the American Diabetes Association, the Luxembourg National Research Fund, the Donaghue Foundation, the National Science Foundation, the University of California-Los Angeles, and the University of Pennsylvania. Dr. Kullgren is also supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service and the views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

Objectives: To investigate the preparations made by adults to age in place and identify disparities., Methods: A cross-sectional survey was conducted among U.S. adults ages 50-80 years old (n = 2277). Individual, environmental, social, and community factors influencing readiness for aging in place were examined using chi-square tests and logistic regression., Results: Income, disability status, and household composition, emerged as influential factors, often negatively affecting minority aging. Participants' consideration of aging in place was related to their disability status (OR 1.80 [1.32, 2.45]) and age (OR age 60-69 2.06 [1.54, 2.74], age 70-80 (OR 1.98 [1.46,2.67]), compared with age 50-59). Indigenous and Black older adults reported significantly higher levels of consideration for aging in place than White older adults (Indigenous OR 7.89 [2.35, 26.42], Black OR 1.71 [1.11, 2.64])., Conclusion: Aging in place is best facilitated by inclusive communities that prioritize adaptive homes and accessible community services., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Polypharmacy is highly prevalent among older adults. This study's purpose was to provide nationally representative estimates of self-reported comprehensive medication review (CMR) receipt among older adults and describe factors associated with their receipt, as CMRs are available through the Medicare Part D program., Methods: This cross-sectional study used data from the National Poll on Healthy Aging (NPHA), a nationally representative online survey of community-dwelling adults aged 50-80, administered in December 2019. Participants included older adults aged 65-80 with any health insurance (n = 960). Outcomes were self-reported CMR receipt, awareness of CMR insurance coverage, and interest in a future CMR with a pharmacist. Sociodemographic and health-related variables were included. Descriptive statistics and multivariable logistic regression with NPHA population sampling weights were used., Results: Among older adults on 2 or more prescription medications, only 20.8% had received a CMR while 34.3% were interested in a future CMR. Among individuals who had not received a CMR, most (83.4%) were unaware their insurance might cover a CMR. Factors associated with higher odds of receiving a CMR included taking 5 or more prescription medications (adjusted odds ratio [AOR] = 2.6, 95% CI: 1.59-4.38) and reporting food insecurity (AOR = 2.9, 95% CI: 1.07-7.93). Having fair or poor self-reported physical health was associated with lower odds of receiving a CMR (AOR = 0.49, 95% CI: 0.25-0.97)., Conclusions: Most older adults on 2 or more prescription medications with health insurance had not received a CMR and many were interested in one. Targeted strategies to increase older adults' awareness and receipt of CMRs are warranted., (© The Author(s) 2022. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: To examine whether fragmentation of care is associated with worse in-hospital and 90-day outcomes following durable ventricular assist device (VAD) implant., Study Design: Cohort study., Methods: This study was conducted using Medicare claims linked to the Society of Thoracic Surgeons (STS) Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) among patients undergoing VAD implant between July 2009 and April 2017. Medicare data were used to measure fragmentation of the multidisciplinary care delivery network for the treating hospital, based on providers' history of shared patients within the previous year. STS Intermacs data were used for risk adjustment and outcomes ascertainment. Hospitals were sorted into terciles based on the degree of network fragmentation, measured as the mean number of links separating providers in the network. Multivariable regression was used to associate network fragmentation with 90-day death or infection risk., Results: The cohort included 5159 patients who underwent VAD implant, with 11.2% dying and 27.6% experiencing an infection within 90 days after implant. After adjustment, a 1-unit increase in network fragmentation was associated with an increase of 0.179 in the probability of in-hospital infection and an increase of 0.183 in the probability of 90-day infection (both P < .05). Similar results were observed in models of the numbers of in-hospital and 90-day infections. Network fragmentation was predictive of the probability of 90-day mortality, although this relationship was not significant after adjustment., Conclusions: Care delivery network fragmentation is associated with higher in-hospital and 90-day infection rates following durable VAD implant. These networks may serve as novel targets for enhancing outcomes for patients undergoing VAD implant.

Objective: The objective of this study was to investigate variations across hospitals in infection rates and associated costs, the latter reflected in 90-day Medicare payments. Despite high rates and expenditures of health care--associated infections associated with durable ventricular assist device implantation, few studies have examined interhospital variation and associated costs., Methods: Clinical data on 8688 patients who received primary durable ventricular assist devices from July 2008 to July 2017 from the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) hospitals (n = 120) were merged with postimplantation 90-day Medicare claims. Terciles of hospital-specific, risk-adjusted infection rates per 100 patient-months were estimated using Intermacs and associated with Medicare payments (among 5440 Medicare beneficiaries). Primary outcomes included infections within 90 days of implantation and Medicare payments., Results: There were 3982 infections identified among 27.8% (2417/8688) of patients developing an infection. The median (25th, 75th percentile) adjusted incidence of infections (per 100 patient-months) across hospitals was 14.3 (9.3, 19.5) and varied according to hospital (range, 0.0-35.6). Total Medicare payments from implantation to 90 days were 9.0% (absolute difference: $13,652) greater in high versus low infection tercile hospitals (P < .0001). The period between implantation to discharge accounted for 73.1% of the difference in payments during the implantation to 90-day period across terciles., Conclusions: Health care--associated infection rates post durable ventricular assist device implantation varied according to hospital and were associated with increased 90-day Medicare expenditures. Interventions targeting preventing infections could improve the value of durable ventricular assist device support from the societal and hospital perspectives., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Infectious complications remain a major source of morbidity and mortality for patients with end-stage renal disease on dialysis. The majority of these complications are related to dialysis access devices, and as such represent a potentially modifiable risk factor. This article reviews the important infectious complications associated with dialysis access, including both hemodialysis and peritoneal dialysis. The discussion highlights the epidemiology, management, and prevention of dialysis access infections.

Objectives: Cigarette smoking has been shown to be related to inflammatory bowel disease. We investigated whether smoking affected the probability of developing Clostridium difficile infection (CDI)., Methods: We conducted a longitudinal study of 16,781 older individuals from the nationally representative Health and Retirement Study. Data were linked to files from the Centers for Medicare and Medicaid Services., Results: Overall, the rate of CDI in older individuals was 220.6 per 100,000 person-years (95% CI 193.3, 248.0). Rates of CDI were 281.6/100,000 person-years in current smokers, 229.0/100,000 in former smokers and 189.1/100,000 person-years in never smokers. The odds of CDI were 33% greater in former smokers (95% CI: 8%, 65%) and 80% greater in current smokers (95% CI: 33%, 145%) when compared to never smokers. When the number of CDI-related visits was evaluated, current smokers had a 75% increased rate of CDI compared to never smokers (95% CI: 15%, 167%)., Conclusions: Smoking is associated with developing a Clostridium difficile infection. Current smokers have the highest risk, followed by former smokers, when compared to rates of infection in never smokers.

Background: Serious gram-positive bacterial infections are an important cause of morbidity and mortality among older adults and can present significant challenges to clinicians. Data evaluating the safety and effectiveness of newer agents in this population are limited., Objective: Daptomycin is a lipopeptide with activity against resistant gram-positive organisms. To better understand the overall safety and effectiveness of daptomycin in older adults (≥66 years of age), the authors reviewed the data that were collected as part of an ongoing registry maintained by Cubist Pharmaceuticals, Inc. (Lexington, Massachusetts), the manufacturer of daptomycin., Methods: The Cubicin Outcomes Registry and Experience (CORE) is a multicenter, retrospective registry designed to collect postmarketing clinical data on patients who received daptomycin. The CORE data collected from 58 institutions across the United States between January 1, 2005, and December 31, 2007, were analyzed to better understand the overall safety profile of daptomycin and the clinical outcomes of older adults who were treated with this agent. Patients were considered to be nonevaluable if the medical record did not contain sufficient information to determine response at the end of therapy. Nonevaluable patients were excluded from the clinical outcome analysis but included in the safety analysis., Results: The registry contained 1073 patients aged ≥66 years who received daptomycin; 23.8% (255/1073) were ≥81 years of age. Overall, 18.1% (194/1073) of patients experienced 324 adverse events, and 6.2% (67/1073) of patients experienced 97 adverse events that were considered possibly related to treatment with daptomycin. The most frequently reported adverse events that were considered possibly treatment related included creatine phosphokinase (CPK) elevations, gastrointestinal disorders, and skin rashes. Among the 67 patients who experienced ≥1 adverse event that was possibly related to daptomycin, 30 discontinued therapy due to the adverse event (13 due to CPK elevation). Overall, 78.7% (844/1073) of patients were considered evaluable for clinical outcomes. The clinical success rate for all evaluable patients was 90.2% (761/844). The success rate for evaluable patients ≥81 years of age (88.6% [171/193]) was comparable to that of the overall population., Conclusion: Experience with daptomycin in this group of older adults suggests good tolerability and clinical outcomes that are consistent with the results of other studies published to date., (Copyright © 2010. Published by EM Inc USA.)

Attention to the improvement of safety in healthcare lately has focused on healthcare-associated infections, including many that occur in the intensive care unit, such as catheter-related bloodstream infections and ventilator-associated pneumonias. Great strides have been made in decreasing the rates of intensive care unit hospital-acquired infections in the past decade. This is attributable to a number of factors, including standardization of care, technological advances, provider payment reform, and consumer activism. Teamwork and communication remain the most important facets in patient safety. The papers in this supplement examine the roles of human factors and process engineering, survey a spectrum of infection control and safety challenges encountered by critical care practitioners, and assess the future challenges for continued improvement in our systems of care.

Objective: To assess the response of long-term care facilities (LTCFs) to the 2004-2005 influenza vaccine shortage and the impact on resident and healthcare worker (HCW) immunization rates., Methods: A 12-item questionnaire was sent to 824 randomly selected LTCFs in December 2004. The following 2 open-ended questions were also asked: "How did you cope with the vaccine shortage?" and "Who helped you get your supply?" Immunization rates reported by LTCF administrators for 2003-2003 and 2003-2004 were compared with those for 2004-2005. Immunization rates were defined as the proportion of all eligible residents and HCWs who received influenza vaccine., Results: Responses were received from 380 LTCFs (46.3%), which had a total of 38,447 beds. Resident mean influenza immunization rates (+/-SD) decreased from 85%+/-15.3% in 2002-2003 and 85.1%+/-15.3% in 2003-2004 to 81.9%+/-19.4% in the 2004-2005 influenza season (P=.025). The immunization rates among HCWs also decreased from 51% in 2002-2003 and 2003-2004 to 38.4% in 2004-2005 (P<.001). In response to one of the open-ended questions, 96 facilities (25.3%) reported that they obtained vaccine from 2 or more sources. Eight percent commented on specific intensified infection control efforts, and only 2.3% commented on emergency preparedness., Conclusions: The influenza vaccine shortage in 2004-2005 impacted immunization practices of LTCFs across the United States, leading to decreases in both resident and HCW vaccination rates. The significant decrease in vaccination rates in LTCFs is of concern and has broad implications for policy makers working on emergency preparedness for a possible pandemic of influenza.