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29. Health Profile Transitions and the Association With Cognitive Impairment in Older Nursing Home Residents With Suicidal Ideation.

Author

Yuan, Yiyang, Barooah, Adrita, Lapane, Kate L., Mack, Deborah, Rothschild, Anthony J., and Ulbricht, Christine M.

Subjects
COGNITION disorder risk factors, RISK assessment, PAIN measurement, SUICIDAL ideation, PATIENTS, HEALTH status indicators, DATABASE management, MILD cognitive impairment, RESEARCH funding, HOSPITAL admission & discharge, QUESTIONNAIRES, FRAIL elderly, SEVERITY of illness index, DESCRIPTIVE statistics, TRANSITIONAL care, NURSING care facilities, PAIN, TIME, MENTAL depression, OLD age
Abstract

Objectives: In older U.S. nursing home residents with suicidal ideation (SI), limited studies have longitudinally investigated their health changes as related to cognitive function. This study aimed to identify the health profiles and the transitions between profiles at admission and 90‐days and examine the associations with cognitive impairment. Methods: Using Minimum Data Set 3.0 (2011–15), we identified 10,079 older residents without severe cognitive impairment who reported SI on Patient Health Questionnaire‐9. Health profile indicators included at‐admission and 90‐day post‐admission depressive symptoms, frailty, and pain frequency and intensity. Using latent transition analysis, we identified distinct health profiles, examined the transitions between profiles over time, and estimated their associations with cognitive impairment. Results: One third of residents continued to report SI at 90 days. The five health profiles identified at admission were distinctive with varying levels of frailty, depressive symptoms, and pain, from the most severe Profile 1 characterized by frailty, all depressive symptoms, and horrible or frequent pain, to the least severe Profile 5 characterized by pre‐frailty, depressed mood, and no pain. The 90‐day profiles were mostly consistent. Most residents remained in a similar profile over time. Relative to residents with intact cognition/mild cognitive impairment, those with moderate impairment were less likely to belong to profiles characterized by more depressive symptoms and pain. Conclusions: Residents with SI had heterogeneous health profiles, which varied by cognitive impairment levels, but showed minimal changes despite being in a medically supervised setting. Findings highlighted the critical need for adequate recognition and management of SI in nursing homes. [ABSTRACT FROM AUTHOR]

Published
2024
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37. Exploratory analysis of osteoarthritis progression among medication users: data from the Osteoarthritis Initiative

Author

Driban, Jeffrey B, Lo, Grace H, Eaton, Charles B, Lapane, Kate L, Nevitt, Michael, Harvey, William F, McCulloch, Charles E, and McAlindon, Timothy E

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Clinical Research, Pain Research, Aging, Arthritis, Chronic Pain, 6.1 Pharmaceuticals, Evaluation of treatments and therapeutic interventions, Musculoskeletal, knee, pain, radiographs, Clinical sciences
Abstract

BackgroundWe conducted an exploratory analysis of osteoarthritis progression among medication users in the Osteoarthritis Initiative to identify interventions or pathways that may be associated with disease modification and therefore of interest for future clinical trials.MethodsWe used participants from the Osteoarthritis Initiative with annual medication inventory data between the baseline and 36-month follow-up visit (n = 2938). Consistent medication users were defined for each medication classification as a participant reporting at all four annual visits that they were regularly using an oral prescription medication at the time of the visit. The exploratory analysis focused on medication classes with 40 or more users. The primary outcome measures were medial tibiofemoral joint space width change and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) knee pain score change (12-36-month visits). Within each knee, we explored eight comparisons between users and matched or unmatched nonusers (defined two ways). An effect size of each comparison was calculated. Medication classes had potential signals if (a) both knees had less progression among users compared with nonusers, or (b) there was less progression based on structure and symptoms in one knee.ResultsWe screened 28 medication classes. Six medication classes had signals for fewer structural changes and better knee pain changes: alpha-adrenergic blockers, antilipemic (excluding statins and fibric acid), anticoagulants, selective serotonin reuptake inhibitors, antihistamines, and antineoplastic agents. Four medication classes had signals for structural changes alone: anti-estrogen (median effect size = 0.28; range = -0.41-0.64), angiotensin-converting enzyme inhibitors (median effect size = 0.13; range = -0.08-0.28), beta-adrenergic blockers (median effect size = 0.09; range = 0.01-0.30), and thyroid agents (median effect size = 0.04; range = -0.05-0.14). Thiazide diuretics had evidence for symptom modification (median effect size = -0.12; range = -0.24-0.04).ConclusionsUsers of neurovascular, antilipemic, or hormonal interventions may have less disease progression compared with nonusers.

Published
2016

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