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2. Effect of the STRIDE fall injury prevention intervention on falls, fall injuries, and health‐related quality of life

Author

Ganz, David A, Yuan, Anita H, Greene, Erich J, Latham, Nancy K, Araujo, Katy, Siu, Albert L, Magaziner, Jay, Gurwitz, Jerry H, Wu, Albert W, Alexander, Neil B, Wallace, Robert B, Greenspan, Susan L, Rich, Jeremy, Volpi, Elena, Waring, Stephen C, Dykes, Patricia C, Ko, Fred, Resnick, Neil M, McMahon, Siobhan K, Basaria, Shehzad, Wang, Rixin, Lu, Charles, Esserman, Denise, Dziura, James, Miller, Michael E, Travison, Thomas G, Peduzzi, Peter, Bhasin, Shalender, Reuben, David B, and Gill, Thomas M

Subjects
Health Services and Systems, Public Health, Health Sciences, Clinical Research, Rehabilitation, Patient Safety, Prevention, Clinical Trials and Supportive Activities, Aging, Physical Injury - Accidents and Adverse Effects, Injuries and accidents, Good Health and Well Being, Humans, Aged, Quality of Life, Independent Living, Fractures, Bone, Hospitalization, care management, health-related quality of life, older persons, pragmatic trials, falls, Medical and Health Sciences, Geriatrics, Biomedical and clinical sciences, Health sciences, Psychology
Abstract

BackgroundFalls are common in older adults and can lead to severe injuries. The Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) trial cluster-randomized 86 primary care practices across 10 health systems to a multifactorial intervention to prevent fall injuries, delivered by registered nurses trained as falls care managers, or enhanced usual care. STRIDE enrolled 5451 community-dwelling older adults age ≥70 at increased fall injury risk.MethodsWe assessed fall-related outcomes via telephone interviews of participants (or proxies) every 4 months. At baseline, 12 and 24 months, we assessed health-related quality of life (HRQOL) using the EQ-5D-5L and EQ-VAS. We used Poisson models to assess intervention effects on falls, fall-related fractures, fall injuries leading to hospital admission, and fall injuries leading to medical attention. We used hierarchical longitudinal linear models to assess HRQOL.ResultsFor recurrent event models, intervention versus control incidence rate ratios were 0.97 (95% confidence interval [CI], 0.93-1.00; p = 0.048) for falls, 0.93 (95% CI, 0.80-1.08; p = 0.337) for self-reported fractures, 0.89 (95% CI, 0.73-1.07; p = 0.205) for adjudicated fractures, 0.91 (95% CI, 0.77-1.07; p = 0.263) for falls leading to hospital admission, and 0.97 (95% CI, 0.89-1.06; p = 0.477) for falls leading to medical attention. Similar effect sizes (non-significant) were obtained for dichotomous outcomes (e.g., participants with ≥1 events). The difference in least square mean change over time in EQ-5D-5L (intervention minus control) was 0.009 (95% CI, -0.002 to 0.019; p = 0.106) at 12 months and 0.005 (95% CI, -0.006 to 0.015; p = 0.384) at 24 months.ConclusionsAcross a standard set of outcomes typically reported in fall prevention studies, we observed modest improvements, one of which was statistically significant. Future work should focus on patient-, practice-, and organization-level operational strategies to increase the real-world effectiveness of interventions, and improving the ability to detect small but potentially meaningful clinical effects.Clinicaltrialsgov identifier: NCT02475850.

Published
2022

3. Long-term Outcomes with Spinal versus General Anesthesia for Hip Fracture Surgery: A Randomized Trial

Author

Vail, Emily A., Feng, Rui, Sieber, Frederick, Carson, Jeffrey L., Ellenberg, Susan S., Magaziner, Jay, Dillane, Derek, Marcantonio, Edward R., Sessler, Daniel I., Ayad, Sabry, Stone, Trevor, Papp, Steven, Donegan, Derek, Mehta, Samir, Schwenk, Eric S., Marshall, Mitchell, Jaffe, J. Douglas, Luke, Charles, Sharma, Balram, Azim, Syed, Hymes, Robert, Chin, Ki-Jinn, Sheppard, Richard, Perlman, Barry, Sappenfield, Joshua, Hauck, Ellen, Tierney, Ann, Horan, Annamarie D., Neuman, Mark D., Looke, Thomas, Bent, Sandra, Franco-Mora, Ariana, Hedrick, Pamela, Newbern, Matthew, Tadros, Rafik, Pealer, Karen, Vlassakov, Kamen, Buckley, Carolyn, Gavin, Lauren, Gorbatov, Svetlana, Gosnell, James, Steen, Talora, Vafai, Avery, Zeballos, Jose, Hruslinski, Jennifer, Cardenas, Louis, Berry, Ashley, Getchell, John, Quercetti, Nicholas, Hassan, Manal, Bajracharya, Gauasan, Billow, Damien, Bloomfield, Michael, Cuko, Evis, Elyaderani, Mehrun K., Hampton, Robert, Honar, Hooman, Khoshknabi, Dilara, Kim, Daniel, Krahe, David, Lew, Michael M., Maheshwer, Conjeevram B., Niazi, Azfar, Saha, Partha, Salih, Ahmed, de Swart, Robert J., Volio, Andrew, Bolkus, Kelly, DeAngelis, Matthew, Dodson, Gregory, Gerritsen, Jeffrey, McEniry, Brian, Mitrev, Ludmil, Kwofie, M. Kwesi, Belliveau, Anne, Bonazza, Flynn, Lloyd, Vera, Panek, Izabela, Dabiri, Jared, Chavez, Chris, Craig, Jason, Davidson, Todd, Dietrichs, Chad, Fleetwood, Cheryl, Foley, Mike, Getto, Chris, Hailes, Susie, Hermes, Sarah, Hooper, Andy, Koener, Greg, Kohls, Kate, Law, Leslie, Lipp, Adam, Losey, Allison, Nelson, William, Nieto, Mario, Rogers, Pam, Rutman, Steve, Scales, Garrett, Sebastian, Barbara, Stanciu, Tom, Lobel, Gregg, Giampiccolo, Michelle, Herman, Dara, Kaufman, Margit, Murphy, Bryan, Pau, Clara, Puzio, Thomas, Veselsky, Marlene, Apostle, Kelly, Boyer, Dory, Chen Fan, Brenda, Lee, Susan, Lemke, Mike, Merchant, Richard, Moola, Farhad, Payne, Kyrsten, Perey, Bertrand, Viskontas, Darius, Poler, Mark, D’Antonio, Patricia, O’Neill, Greg, Abdullah, Amer, Fish-Fuhrmann, Jamie, Giska, Mark, Fidkowski, Christina, Guthrie, Stuart Trent, Hakeos, William, Hayes, Lillian, Hoegler, Joseph, Nowak, Katherine, Beck, Jeffery, Cuff, Jaslynn, Gaski, Greg, Haaser, Sharon, Holzman, Michael, Malekzadeh, A. Stephen, Ramsey, Lolita, Schulman, Jeff, Schwartzbach, Cary, Azefor, Tangwan, Davani, Arman, Jaberi, Mahmood, Masear, Courtney, Haider, Syed Basit, Chungu, Carolyn, Ebrahimi, Ali, Fikry, Karim, Marcantonio, Andrew, Shelvan, Anitha, Sanders, David, Clarke, Collin, Lawendy, Abdel, Schwartz, Gary, Garg, Mohit, Kim, Joseph, Caruci, Juan, Commeh, Ekow, Cuevas, Randy, Cuff, Germaine, Franco, Lola, Furgiuele, David, Giuca, Matthew, Allman, Melissa, Barzideh, Omid, Cossaro, James, D’Arduini, Armando, Farhi, Anita, Gould, Jason, Kafel, John, Patel, Anuj, Peller, Abraham, Reshef, Hadas, Safur, Mohammed, Toscano, Fiore, Tedore, Tiffany, Akerman, Michael, Brumberger, Eric, Clark, Sunday, Friedlander, Rachel, Jegarl, Anita, Lane, Joseph, Lyden, John P., Mehta, Nili, Murrell, Matthew T., Painter, Nathan, Ricci, William, Sbrollini, Kaitlyn, Sharma, Rahul, Steel, Peter A.D., Steinkamp, Michele, Weinberg, Roniel, Stephenson Wellman, David, Nader, Antoun, Fitzgerald, Paul, Ritz, Michaela, Bryson, Greg, Craig, Alexandra, Farhat, Cassandra, Gammon, Braden, Gofton, Wade, Harris, Nicole, Lalonde, Karl, Liew, Allan, Meulenkamp, Bradley, Sonnenburg, Kendra, Wai, Eugene, Wilkin, Geoffrey, Troxell, Karen, Alderfer, Mary Ellen, Brannen, Jason, Cupitt, Christopher, Gerhart, Stacy, McLin, Renee, Sheidy, Julie, Yurick, Katherine, Chen, Fei, Dragert, Karen, Kiss, Geza, Malveaux, Halina, McCloskey, Deborah, Mellender, Scott, Mungekar, Sagar S., Noveck, Helaine, Sagebien, Carlos, Biby, Luat, McKelvy, Gail, Richards, Anna, Abola, Ramon, Ayala, Brittney, Halper, Darcy, Mavarez, Ana, Rizwan, Sabeen, Choi, Stephen, Awad, Imad, Flynn, Brendan, Henry, Patrick, Jenkinson, Richard, Kaustov, Lilia, Lappin, Elizabeth, McHardy, Paul, Singh, Amara, Donnelly, Joanne, Gonzalez, Meera, Haydel, Christopher, Livelsberger, Jon, Pazionis, Theresa, Slattery, Bridget, Vazquez-Trejo, Maritza, Baratta, Jaime, Cirullo, Michael, Deiling, Brittany, Deschamps, Laura, Glick, Michael, Katz, Daniel, Krieg, James, Lessin, Jennifer, Mojica, Jeffrey, Torjman, Marc, Jin, Rongyu, Salpeter, Mary Jane, Powell, Mark, Simmons, Jeffrey, Lawson, Prentiss, Kukreja, Promil, Graves, Shanna, Sturdivant, Adam, Bryant, Ayesha, Crump, Sandra Joyce, Verrier, Michelle, Green, James, Menon, Matthew, Applegate, Richard, Arias, Ana, Pineiro, Natasha, Uppington, Jeffrey, Wolinsky, Phillip, Gunnett, Amy, Hagen, Jennifer, Harris, Sara, Hollen, Kevin, Holloway, Brian, Horodyski, Mary Beth, Pogue, Trevor, Ramani, Ramachandran, Smith, Cameron, Woods, Anna, Warrick, Matthew, Flynn, Kelly, Mongan, Paul, Ranganath, Yatish, Fernholz, Sean, Ingersoll-Weng, Esperanza, Marian, Anil, Seering, Melinda, Sibenaller, Zita, Stout, Lori, Wagner, Allison, Walter, Alicia, Wong, Cynthia, Orwig, Denise, Goud, Maithri, Helker, Chris, Mezenghie, Lydia, Montgomery, Brittany, Preston, Peter, Schwartz, J. Sanford, Weber, Ramona, Fleisher, Lee A., Mehta, Samir, Stephens-Shields, Alisa J., Dinh, Cassandra, Schwartz, Aron, Chelly, Jacques E., Goel, Shiv, Goncz, Wende, Kawabe, Touichi, Khetarpal, Sharad, Monroe, Amy, Shick, Vladislav, Breidenstein, Max, Dominick, Timothy, Friend, Alexander, Mathews, Donald, Lennertz, Richard, Sanders, Robert, Akere, Helen, Balweg, Tyler, Bo, Amber, Doro, Christopher, Goodspeed, David, Lang, Gerald, Parker, Maggie, Rettammel, Amy, Roth, Mary, White, Marissa, Whiting, Paul, Allen, Brian F.S., Baker, Tracie, Craven, Debra, McEvoy, Matt, Turnbo, Teresa, Kates, Stephen, Morgan, Melanie, Willoughby, Teresa, Weigel, Wade, Auyong, David, Fox, Ellie, Welsh, Tina, Cusson, Bruce, Dobson, Sean, Edwards, Christopher, Harris, Lynette, Henshaw, Daryl, Johnson, Kathleen, McKinney, Glen, Miller, Scott, Reynolds, Jon, Segal, B. Scott, Turner, Jimmy, VanEenenaam, David, Weller, Robert, Lei, Jineli, Treggiari, Miriam, Akhtar, Shamsuddin, Blessing, Marcelle, Johnson, Chanel, Kampp, Michael, Kunze, Kimberly, OʼConnor, Mary, Gaskins, Lakisha J., Looke, Thomas, Tadros, Rafik, Vlassakov, Kamen, Cardenas, Louis, Hassan, Manal, Bolkus, Kelly, Mitrev, Ludmil, Kwofie, M. Kwesi, Dabiri, Jared, Lobel, Gregg, Poler, Mark, Giska, Mark, Sanders, David, Schwartz, Gary, Giuca, Matthew, Tedore, Tiffany, Nader, Antoun, Papp, Stephen, Bryson, Greg, Troxell, Karen, Kiss, Geza, Choi, Stephen, Powell, Mark, Applegate, Richard, Warrick, Matthew, Ranganath, Yatish, Elkassabany, Nabil, Chelly, Jacques E., Hoeft, Mark A., Lennertz, Richard, Sanders, Robert, Allen, Brian F.S., Kates, Stephen, Weigel, Wade, Li, Jinlei, Wijeysundera, Duminda N., Kheterpal, Sachin, Moore, Reneé H., Smith, Alexander K., Tosi, Laura L., Elkassabany, Nabil, Looke, Thomas, Menio, Diane, Mehta, Samir, Fleisher, Lee, Menio, Diane, Hruslinski, Jennifer, Ramsey, Lolita, Gaskins, Lakisha J., Langlois, Christine, Gaskins, Lakisha J., Mezenghie, Lydia, Montgomery, Brittany, Oduwole, Samuel, and Rose, Thomas

Published
2024
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4. What Cut-Point in Gait Speed Best Discriminates Community-Dwelling Older Adults With Mobility Complaints From Those Without? A Pooled Analysis From the Sarcopenia Definitions and Outcomes Consortium

Author

Cawthon, Peggy M, Patel, Sheena M, Kritchevsky, Stephen B, Newman, Anne B, Santanasto, Adam, Kiel, Douglas P, Travison, Thomas G, Lane, Nancy, Cummings, Steven R, Orwoll, Eric S, Duchowny, Kate A, Kwok, Timothy, Hirani, Vasant, Schousboe, John, Karlsson, Magnus K, Mellström, Dan, Ohlsson, Claes, Ljunggren, Östen, Xue, Qian-Li, Shardell, Michelle, Jordan, Joanne M, Pencina, Karol M, Fielding, Roger A, Magaziner, Jay, Correa-de-Araujo, Rosaly, Bhasin, Shalender, and Manini, Todd M

Subjects
Clinical Research, Aging, Aged, Female, Gait, Humans, Independent Living, Male, Mobility Limitation, Sarcopenia, Walking, Walking Speed, Classification and regression trees, Gait speed, Mobility limitation, Clinical Sciences, Gerontology
Abstract

BackgroundCut-points to define slow walking speed have largely been derived from expert opinion.MethodsStudy participants (13 589 men and 5043 women aged ≥65years) had walking speed (m/s) measured over 4-6 m (mean ± SD: 1.20 ± 0.27 m/s in men and 0.94 ± 0.24 m/s in women.) Mobility limitation was defined as any self-reported difficulty with walking approximately 1/4 mile (prevalence: 12.6% men, 26.4% women). Sex-stratified classification and regression tree (CART) models with 10-fold cross-validation identified walking speed cut-points that optimally discriminated those who reported mobility limitation from those who did not.ResultsAmong 5043 women, CART analysis identified 2 cut-points, classifying 4144 (82.2%) with walking speed ≥0.75 m/s, which we labeled as "fast"; 478 (9.5%) as "intermediate" (walking speed ≥0.62 m/s but

Published
2021

6. Frequency, duration, and type of physiotherapy in the week after hip fracture surgery – analysis of implications for discharge home, readmission, survival, and recovery of mobility

Author

Almilaji, Orouba, Ayis, Salma, Goubar, Aicha, Beaupre, Lauren, Cameron, Ian D., Milton-Cole, Rhian, Gregson, Celia L., Johansen, Antony, Kristensen, Morten Tange, Magaziner, Jay, Martin, Finbarr C., Sackley, Catherine, Sadler, Euan, Smith, Toby O., Sobolev, Boris, and Sheehan, Katie J.

Published
2023
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7. Effect of a Multifactorial Fall Injury Prevention Intervention on Patient Well-Being: The STRIDE Study.

Author

Gill, Thomas M, Bhasin, Shalender, Reuben, David B, Latham, Nancy K, Araujo, Katy, Ganz, David A, Boult, Chad, Wu, Albert W, Magaziner, Jay, Alexander, Neil, Wallace, Robert B, Miller, Michael E, Travison, Thomas G, Greenspan, Susan L, Gurwitz, Jerry H, Rich, Jeremy, Volpi, Elena, Waring, Stephen C, Manini, Todd M, Min, Lillian C, Teresi, Jeanne, Dykes, Patricia C, McMahon, Siobhan, McGloin, Joanne M, Skokos, Eleni A, Charpentier, Peter, Basaria, Shehzad, Duncan, Pamela W, Storer, Thomas W, Gazarian, Priscilla, Allore, Heather G, Dziura, James, Esserman, Denise, Carnie, Martha B, Hanson, Catherine, Ko, Fred, Resnick, Neil M, Wiggins, Jocelyn, Lu, Charles, Meng, Can, Goehring, Lori, Fagan, Maureen, Correa-de-Araujo, Rosaly, Casteel, Carri, Peduzzi, Peter, and Greene, Erich J

Subjects
fall injury prevention, older persons, pragmatic trials, well-being, Medical and Health Sciences, Geriatrics
Abstract

Background/objectivesIn the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) study, a multifactorial intervention was associated with a nonsignificant 8% reduction in time to first serious fall injury but a significant 10% reduction in time to first self-reported fall injury relative to enhanced usual care. The effect of the intervention on other outcomes important to patients has not yet been reported. We aimed to evaluate the effect of the intervention on patient well-being including concern about falling, anxiety, depression, physical function, and disability.DesignPragmatic cluster-randomized trial of 5,451 community-living persons at high risk for serious fall injuries.SettingA total of 86 primary care practices within 10 U.S. healthcare systems.ParticipantsA random subsample of 743 persons aged 75 and older.MeasurementsThe well-being measures, assessed at baseline, 12 months, and 24 months, included a modified version of the Fall Efficacy Scale, Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety and depression scales, and Late-Life Function and Disability Instrument.ResultsParticipants in the intervention (n = 384) and control groups (n = 359) were comparable in age: mean (standard deviation) of 81.9 (4.7) versus 81.8 (5.0) years. Mean scores were similar between groups at 12 and 24 months for concern about falling, physical function, and disability, whereas the intervention group's mean scores on anxiety and depression were .7 points lower (i.e., better) at 12 months and .6 to .8 points lower at 24 months. For each of these outcomes, differences between the groups' adjusted least square mean changes from baseline to 12 and 24 months, respectively, were quantitatively small. The overall difference in means between groups over 2 years was statistically significant only for depression, favoring the intervention: -1.19 (99% confidence interval, -2.36 to -.02), with 3.5 points representing a minimally important difference.ConclusionsSTRIDE's multifactorial intervention to reduce fall injuries was not associated with clinically meaningful improvements in patient well-being.

Published
2021

8. A Randomized Trial of a Multifactorial Strategy to Prevent Serious Fall Injuries

Author

Bhasin, Shalender, Gill, Thomas M, Reuben, David B, Latham, Nancy K, Ganz, David A, Greene, Erich J, Dziura, James, Basaria, Shehzad, Gurwitz, Jerry H, Dykes, Patricia C, McMahon, Siobhan, Storer, Thomas W, Gazarian, Priscilla, Miller, Michael E, Travison, Thomas G, Esserman, Denise, Carnie, Martha B, Goehring, Lori, Fagan, Maureen, Greenspan, Susan L, Alexander, Neil, Wiggins, Jocelyn, Ko, Fred, Siu, Albert L, Volpi, Elena, Wu, Albert W, Rich, Jeremy, Waring, Stephen C, Wallace, Robert B, Casteel, Carri, Resnick, Neil M, Magaziner, Jay, Charpentier, Peter, Lu, Charles, Araujo, Katy, Rajeevan, Haseena, Meng, Can, Allore, Heather, Brawley, Brooke F, Eder, Rich, McGloin, Joanne M, Skokos, Eleni A, Duncan, Pamela W, Baker, Dorothy, Boult, Chad, Correa-de-Araujo, Rosaly, and Peduzzi, Peter

Subjects
Health Services, Aging, Clinical Trials and Supportive Activities, Comparative Effectiveness Research, Physical Injury - Accidents and Adverse Effects, Patient Safety, Prevention, Clinical Research, Injuries and accidents, Good Health and Well Being, Accidental Falls, Accidental Injuries, Aged, Aged, 80 and over, Female, Hospitalization, Humans, Incidence, Independent Living, Male, Patient Care Management, Precision Medicine, Risk Assessment, Risk Factors, STRIDE Trial Investigators, Medical and Health Sciences, General & Internal Medicine
Abstract

BackgroundInjuries from falls are major contributors to complications and death in older adults. Despite evidence from efficacy trials that many falls can be prevented, rates of falls resulting in injury have not declined.MethodsWe conducted a pragmatic, cluster-randomized trial to evaluate the effectiveness of a multifactorial intervention that included risk assessment and individualized plans, administered by specially trained nurses, to prevent fall injuries. A total of 86 primary care practices across 10 health care systems were randomly assigned to the intervention or to enhanced usual care (the control) (43 practices each). The participants were community-dwelling adults, 70 years of age or older, who were at increased risk for fall injuries. The primary outcome, assessed in a time-to-event analysis, was the first serious fall injury, adjudicated with the use of participant report, electronic health records, and claims data. We hypothesized that the event rate would be lower by 20% in the intervention group than in the control group.ResultsThe demographic and baseline characteristics of the participants were similar in the intervention group (2802 participants) and the control group (2649 participants); the mean age was 80 years, and 62.0% of the participants were women. The rate of a first adjudicated serious fall injury did not differ significantly between the groups, as assessed in a time-to-first-event analysis (events per 100 person-years of follow-up, 4.9 in the intervention group and 5.3 in the control group; hazard ratio, 0.92; 95% confidence interval [CI], 0.80 to 1.06; P = 0.25). The rate of a first participant-reported fall injury was 25.6 events per 100 person-years of follow-up in the intervention group and 28.6 events per 100 person-years of follow-up in the control group (hazard ratio, 0.90; 95% CI, 0.83 to 0.99; P = 0.004). The rates of hospitalization or death were similar in the two groups.ConclusionsA multifactorial intervention, administered by nurses, did not result in a significantly lower rate of a first adjudicated serious fall injury than enhanced usual care. (Funded by the Patient-Centered Outcomes Research Institute and others; STRIDE ClinicalTrials.gov number, NCT02475850.).

Published
2020

9. Protocol for serious fall injury adjudication in the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) study

Author

Ganz, David A, Siu, Albert L, Magaziner, Jay, Latham, Nancy K, Travison, Thomas G, Lorenze, Nancy P, Lu, Charles, Wang, Rixin, Greene, Erich J, Stowe, Cynthia L, Harvin, Lea N, Araujo, Katy LB, Gurwitz, Jerry H, Agrawal, Yuri, Correa-De-Araujo, Rosaly, Peduzzi, Peter, and Gill, Thomas M

Subjects
Health Services, Clinical Research, Patient Safety, Clinical Trials and Supportive Activities, Physical Injury - Accidents and Adverse Effects, Injuries and accidents, Good Health and Well Being, Falls, Injuries, Adjudication, STRIDE Investigators, Public Health and Health Services
Abstract

BackgroundThis paper describes a protocol for determining the incidence of serious fall injuries for Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE), a large, multicenter pragmatic clinical trial with limited resources for event adjudication. We describe how administrative data (from participating health systems and Medicare claims) can be used to confirm participant-reported events, with more time- and resource-intensive full-text medical record data used only on an "as-needed" basis.MethodsSTRIDE is a pragmatic cluster-randomized controlled trial involving 5451 participants age ≥ 70 and at increased risk for falls, served by 86 primary care practices in 10 US health systems. The STRIDE intervention involves a nurse falls care manager who assesses a participant's underlying risks for falls, suggests interventions using motivational interviewing, and then creates, implements and longitudinally follows up on an individualized care plan with the participant (and caregiver when appropriate), in partnership with the participant's primary care provider. STRIDE's primary outcome is serious fall injuries, defined as a fall resulting in: (1) medical attention billable according to Medicare guidelines with a) fracture (excluding isolated thoracic vertebral and/or lumbar vertebral fracture), b) joint dislocation, or c) cut requiring closure; OR (2) overnight hospitalization with a) head injury, b) sprain or strain, c) bruising or swelling, or d) other injury determined to be "serious" (i.e., burn, rhabdomyolysis, or internal injury). Two sources of data are required to confirm a serious fall injury. The primary data source is the participant's self-report of a fall leading to medical attention, identified during telephone interview every 4 months, with the confirmatory source being (1) administrative data capturing encounters at the participating health systems or Medicare claims and/or (2) the full text of medical records requested only as needed.DiscussionAdjudication is ongoing, with over 1000 potentially qualifying events adjudicated to date. Administrative data can be successfully used for adjudication, as part of a hybrid approach that retrieves full-text medical records only when needed. With the continued refinement and availability of administrative data sources, future studies may be able to use administrative data completely in lieu of medical record review to maximize the quality of adjudication with finite resources.Trial registrationClinicalTrials.gov (NCT02475850).

Published
2019

10. Functional Recovery After Hip Fracture

Author

Auais, Mohammad, Sheehan, Katie, Magaziner, Jay, Beaupre, Lauren, Pape, Hans-Christoph, editor, Kates, Stephen L., editor, Hierholzer, Christian, editor, and Bischoff-Ferrari, Heike A., editor

Published
2022
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11. Sustained IL‐6 and sTNF‐αR1 levels after hip fracture predict 5‐year mortality: A prospective cohort study from the Baltimore Hip Studies

Author

Câmara, Saionara M. A., primary, Hochberg, Marc C., additional, Miller, Ram, additional, Ryan, Alice S., additional, Orwig, Denise, additional, Gruber‐Baldini, Ann L., additional, Guralnik, Jack, additional, Magder, Laurence S., additional, Feng, Zhaoyong, additional, Falvey, Jason R., additional, Beamer, Brock A., additional, and Magaziner, Jay, additional

Published
2024
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12. Advancing clinical trials in nursing homes: A proposed roadmap to success

Author

Gurwitz, Jerry H., Quinn, Charlene C., Abi-Elias, Ivan H., Adams, Alyce S., Bartel, Rosie, Bonner, Alice, Boxer, Rebecca, Delude, Christopher, Gifford, David, Hanson, Bruce, Ito, Kouta, Jain, Paavani, Magaziner, Jay S., Mazor, Kathleen M., Mitchell, Susan L., Mody, Lona, Nace, David, Ouslander, Joseph, Reifsnyder, JoAnne, Resnick, Barbara, and Zimmerman, Sheryl

Published
2022
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13. Experience of a systematic approach to care and prevention of fragility fractures in New Zealand

Author

Gill, Christine Ellen, Mitchell, Paul James, Clark, Jan, Cornish, Jillian, Fergusson, Peter, Gilchrist, Nigel, Hayman, Lynne, Hornblow, Sue, Kim, David, Mackenzie, Denise, Milsom, Stella, von Tunzelmann, Adrienne, Binns, Elizabeth, Fergusson, Kim, Fleming, Stewart, Hurring, Sarah, Lilley, Rebbecca, Miller, Caroline, Navarre, Pierre, Pettett, Andrea, Sankaran, Shankar, Seow, Min Yee, Sincock, Jenny, Ward, Nicola, Wright, Mark, Close, Jacqueline Clare Therese, Harris, Ian Andrew, Armstrong, Elizabeth, Hallen, Jamie, Hikaka, Joanna, Kerse, Ngaire, Vujnovich, Andrea, Ganda, Kirtan, Seibel, Markus Joachim, Jackson, Thomas, Kennedy, Paul, Malpas, Kirsten, Dann, Leona, Shuker, Carl, Dunne, Colleen, Wood, Philip, Magaziner, Jay, Marsh, David, Tabu, Irewin, Cooper, Cyrus, Halbout, Philippe, Javaid, Muhammad Kassim, Åkesson, Kristina, Mlotek, Anastasia Soulié, Brûlé-Champagne, Eric, and Harris, Roger

Published
2022
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15. Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE): A Cluster-Randomized Pragmatic Trial of a Multifactorial Fall Injury Prevention Strategy: Design and Methods

Author

Bhasin, Shalender, Gill, Thomas M, Reuben, David B, Latham, Nancy K, Gurwitz, Jerry H, Dykes, Patricia, McMahon, Siobhan, Storer, Thomas W, Duncan, Pamela W, Ganz, David A, Basaria, Shehzad, Miller, Michael E, Travison, Thomas G, Greene, Erich J, Dziura, James, Esserman, Denise, Allore, Heather, Carnie, Martha B, Fagan, Maureen, Hanson, Catherine, Baker, Dorothy, Greenspan, Susan L, Alexander, Neil, Ko, Fred, Siu, Albert L, Volpi, Elena, Wu, Albert W, Rich, Jeremy, Waring, Stephen C, Wallace, Robert, Casteel, Carri, Magaziner, Jay, Charpentier, Peter, Lu, Charles, Araujo, Katy, Rajeevan, Haseena, Margolis, Scott, Eder, Richard, McGloin, Joanne M, Skokos, Eleni, Wiggins, Jocelyn, Garber, Lawrence, Clauser, Steven B, Correa-De-Araujo, Rosaly, and Peduzzi, Peter

Subjects
Health Services, Rehabilitation, Clinical Research, Comparative Effectiveness Research, Patient Safety, Aging, Prevention, Physical Injury - Accidents and Adverse Effects, Clinical Trials and Supportive Activities, Prevention of disease and conditions, and promotion of well-being, 3.1 Primary prevention interventions to modify behaviours or promote wellbeing, Injuries and accidents, Good Health and Well Being, Accidental Falls, Aged, Aged, 80 and over, Female, Humans, Male, Motivational Interviewing, Risk Assessment, Wounds and Injuries, Fall prevention, Clinical effectiveness, Patient and stakeholders in fall injury prevention research, Nurse falls care managers, Clinical Sciences, Gerontology
Abstract

BackgroundFall injuries are a major cause of morbidity and mortality among older adults. We describe the design of a pragmatic trial to compare the effectiveness of an evidence-based, patient-centered multifactorial fall injury prevention strategy to an enhanced usual care.MethodsStrategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) is a 40-month cluster-randomized, parallel-group, superiority, pragmatic trial being conducted at 86 primary care practices in 10 health care systems across United States. The 86 practices were randomized to intervention or control group using covariate-based constrained randomization, stratified by health care system. Participants are community-living persons, ≥70 years, at increased risk for serious fall injuries. The intervention is a comanagement model in which a nurse Falls Care Manager performs multifactorial risk assessments, develops individualized care plans, which include surveillance, follow-up evaluation, and intervention strategies. Control group receives enhanced usual care, with clinicians and patients receiving evidence-based information on falls prevention. Primary outcome is serious fall injuries, operationalized as those leading to medical attention (nonvertebral fractures, joint dislocation, head injury, lacerations, and other major sequelae). Secondary outcomes include all fall injuries, all falls, and well-being (concern for falling; anxiety and depressive symptoms; physical function and disability). Target sample size was 5,322 participants to provide 90% power to detect 20% reduction in primary outcome rate relative to control.ResultsTrial enrolled 5,451 subjects in 20 months. Intervention and follow-up are ongoing.ConclusionsThe findings of the STRIDE study will have important clinical and policy implications for the prevention of fall injuries in older adults.

Published
2018

17. Engaging patients as partners in a multicentre trial of spinal versus general anaesthesia for older adults

Author

Looke, Thomas, Bent, Sandra, Franco-Mora, Ariana, Hedrick, Pamela, Newbern, Matthew, Tadros, Rafik, Pealer, Karen, Marcantonio, Edward, Vlassakov, Kamen, Buckley, Carolyn, Gorbatov, Svetlana, Gosnell, James, Steen, Talora, Vafai, Avery, Zeballos, Jose, Cardenas, Louis, Berry, Ashley, Getchell, John, Quercetti, Nicholas, Sessler, Daniel I., Ayad, Sabry, Hassan, Manal, Ali, Assad, Bajracharya, Gauasan, Billow, Damien, Bloomfield, Michael, Elliott, Kavita, Hampton, Robert, He, Linda, Honar, Hooman, Khoshknabi, Dilara, Kim, Daniel, Minko, Paul, Morris, Adam, Niazi, Azfar, Nutcharoen, Tara, Roberts, Jeffrey, Saha, Partha, Salih, Ahmed, Skolaris, Alexis, Stang, Taylor, Strimbu, Victor, Templeton, Jesse, Volio, Andrew, Wang, Jiayi, Bolkus, Kelly, DeAngelis, Matthew, Dodson, Gregory, Gerritsen, Jeffrey, McEniry, Brian, Mitrev, Ludmil, Kwofie, Kwesi, Bonazza, Flynn, Lloyd, Vera, Panek, Izabela, Dabiri, Jared, Chavez, Chris, Craig, Jason, Davidson, Todd, Dietrichs, Chad, Fleetwood, Cheryl, Foley, Mike, Getto, Chris, Hailes, Susie, Hermes, Sarah, Hooper, Andy, Koener, Greg, Kohls, Kate, Law, Leslie, Lipp, Adam, Losey, Allison, Nelson, William, Nieto, Mario, Rogers, Pam, Rutman, Steve, Scales, Garrett, Sebastian, Barbara, Stanciu, Tom, Lobel, Gregg, Giampiccolo, Michelle, Herman, Dara, Kaufman, Margit, Murphy, Bryan, Pau, Clara, Puzio, Thomas, Veselsky, Marlene, Stone, Trevor, Apostle, Kelly, Boyer, Dory, Fan, Brenda Chen, Lee, Susan, Lemke, Mike, Merchant, Richard, Moola, Farhad, Payne, Kyrsten, Perey, Bertrand, Viskontas, Darius, Poler, Mark, D'Antonio, Patricia, Sheppard, Richard, Abdullah, Amer, Fish-Fuhrmann, Jamie, Giska, Mark, Fidkowski, Christina, Guthrie, Trent, Hakeos, William, Hayes, Lillian, Hoegler, Joseph, Nowak, Katherine, Hymes, Robert, Beck, Jeffery, Cuff, Jaslynn, Gaski, Greg, Haaser, Sharon, Holzman, Michael, Malekzadeh, A. Stephen, Ramsey, Lolita, Schulman, Jeff, Schwartzbach, Cary, Sieber, Frederick, Azefor, Tangwan, Brown, Charles, Davani, Arman, Jaberi, Mahmood, Masear, Courtney, Sharma, Balram, Haider, Syed Basit, Chungu, Carolyn, Ebrahimi, Ali, Fikry, Karim, Gannon, Kerri, Marcantonio, Andrew, Pace, Meredith, Sanders, David, Clarke, Collin, Lawendy, Abdel, Schwartz, Gary, Garg, Mohit, Kim, Joseph, Marshall, Mitchell, Caurci, Juan, Commeh, Ekow, Cuevas, Randy, Cuff, Germaine, Franco, Lola, Furguiele, David, Giuca, Matthew, Allman, Melissa, Barzideh, Omid, Cossaro, James, D'Arduini, Armando, Farhi, Anita, Gould, Jason, Kafel, John, Patel, Anuj, Peller, Abraham, Reshef, Hadas, Safur, Mohammed, Toscano, Fiore, Tedore, Tiffany, Akerman, Michael, Brumberger, Eric, Clark, Sunday, Friedlander, Rachel, Jegarl, Anita, Lane, Joseph, Lyden, John P., Mehta, Nili, Murrell, Matthew T., Painter, Nathan, Ricci, William, Sbrollini, Kaitlyn, Sharma, Rahul, Steel, Peter A.D., Steinkamp, Michele, Weinberg, Roniel, Wellman, David Stephenson, Nader, Antoun, Fitzgerald, Paul, Ritz, Michaela, Papp, Steven, Bryson, Greg, Craig, Alexandra, Farhat, Cassandra, Gammon, Braden, Gofton, Wade, Harris, Nicole, Lalonde, Karl, Liew, Allan, Meulenkamp, Bradley, Sonnenburg, Kendra, Wai, Eugene, Wilkin, Geoffrey, Donegan, Derek, Dinh, Cassandra, Elkassabany, Nabil, Horan, Annamarie, Mehta, Samir, Troxell, Karen, Alderfer, Mary Ellen, Brannen, Jason, Cupitt, Christopher, Gerhart, Stacy, McLin, Renee, Sheidy, Julie, Yurick, Katherine, Carson, Jeffrey, Chen, Fei, Dragert, Karen, Kiss, Geza, Malveaux, Halina, McCloskey, Deborah, Mellender, Scott, Mungekar, Sagar S., Noveck, Helaine, Sagebien, Carlos, Perlman, Barry, Biby, Luat, McKelvy, Gail, Richards, Anna, Azim, Syed, Abola, Ramon, Ayala, Brittney, Halper, Darcy, Mavarez, Ana, Choi, Stephen, Awad, Imad, Flynn, Brendan, Henry, Patrick, Jenkinson, Richard, Kaustov, Lilia, Lappin, Elizabeth, McHardy, Paul, Singh, Amara, Hauck, Ellen, Donnelly, Joanne, Gonzalez, Meera, Haydel, Christopher, Livelsberger, Jon, Pazionis, Theresa, Slattery, Bridget, Vazquez-Trejo, Maritza, Schwenk, Eric, Baratta, Jaime, Deiling, Brittany, Deschamps, Laura, Glick, Michael, Katz, Daniel, Krieg, James, Lessin, Jennifer, Torjman, Marc, Chin, Ki Jinn, Jin, Rongyu, Salpeter, Mary Jane, Powell, Mark, Simmons, Jeffrey, Lawson, Prentiss, Kukreja, Promil, Graves, Shanna, Sturdivant, Adam, Bryant, Ayesha, Crump, Sandra Joyce, Dillane, Derek, Taylor, Michael, Verrier, Michelle, Applegate, Richard, Arias, Ana, Pineiro, Natasha, Uppington, Jeffrey, Wolinsky, Phillip, Sappenfield, Joshua, Gunnett, Amy, Hagen, Jennifer, Harris, Sara, Hollen, Kevin, Holloway, Brian, Horodyski, Mary Beth, Pogue, Trevor, Ramani, Ramachandran, Smith, Cameron, Woods, Anna, Warrick, Matthew, Flynn, Kelly, Mongan, Paul, Ranganath, Yatish, Fernholz, Sean, Ingersoll-Weng, Esperanza, Marian, Anil, Seering, Melinda, Sibenaller, Zita, Stout, Lori, Wagner, Allison, Walter, Alicia, Wong, Cynthia, Magaziner, Jay, Orwig, Denise, Brown, Trina, Dattilo, Jim, Ellenberg, Susan, Feng, Rui, Fleisher, Lee, Gaskins, Lakisha, Goud, Maithri, Helker, Chris, Mezenghie, Lydia, Montgomery, Brittany, Preston, Peter, Stephens, Alisa, Schwartz, J. Sanford, Tierney, Ann, Weber, Ramona, Chelly, Jacques, Goel, Shiv, Goncz, Wende, Kawabe, Touichi, Khetarpal, Sharad, King, Kevin, Kunkel, Frank, Luke, Charles, Monroe, Amy, Shick, Vladislav, Silipo, Anthony, Stehle, Caroline, Szabo, Katherine, Yennam, Sudhakar, Hoeft, Mark, Breidenstein, Max, Dominick, Timothy, Friend, Alexander, Mathews, Donald, Lennertz, Richard, Akere, Helen, Balweg, Tyler, Bo, Amber, Doro, Christopher, Goodspeed, David, Lang, Gerald, Parker, Maggie, Rettammel, Amy, Roth, Mary, Sanders, Robert, White, Marissa, Whiting, Paul, Allen, Brian, Baker, Tracie, Craven, Debra, McEvoy, Matt, Turnbo, Teresa, Kates, Stephen, Morgan, Melanie, Willoughby, Teresa, Weigel, Wade, Auyong, David, Fox, Ellie, Welsh, Tina, Jaffe, J. Douglas, Cusson, Bruce, Dobson, Sean, Edwards, Christopher, Harris, Lynette, Henshaw, Daryl, Johnson, Kathleen, McKinney, Glen, Miller, Scott, Reynolds, Jon, Turner, Jimmy, VanEenenaam, David, Weller, Robert, Akhtar, Shamsuddin, Blessing, Marcelle, Johnson, Chanel, Kampp, Michael, Kunze, Kimberly, Li, Jinlei, O'Connor, Mary, Treggiari, Miriam, Hruslinski, Jennifer, Menio, Diane A., Hymes, Robert A., Langlois, Christine, Gaskins, Lakisha J., and Neuman, Mark D.

Published
2021
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18. Using Treatment Fidelity Measures to Understand Walking Recovery: A Secondary Analysis From the Community Ambulation Project

Author

Mangione, Kathleen K., Posner, Michael A., Craik, Rebecca L., Wolff, Edward F., Fortinsky, Richard H., Beamer, Brock A., Binder, Ellen F., Orwig, Denise L., Magaziner, Jay, and Resnick, Barbara

Subjects
Exercise therapy -- Testing, Outcome and process assessment (Health Care) -- Methods, Hip joint -- Fractures
Abstract

Objectives. Physical therapist intervention studies can be deemed ineffective when, in fact, they may not have been delivered as intended. Measurement of treatment fidelity (TF) can address this issue. The purpose of this study was to describe TF of a home-based intervention, identify factors associated with TF, and examine whether components of TF were associated with the outcome of change in 6-minute walk distance (A6MWD). Methods. This is a secondary analysis of community-dwelling hip fracture participants who completed standard therapy and were randomly assigned to the active intervention (Push). Push was 16 weeks of lower extremity strengthening, function, and endurance training. TF was defined as delivery (attendance rate, exercise duration) and receipt (progression in training load, heart rate reserve [HRR] during endurance training, and exercise position [exercise on floor]). The outcome was A6MWD. Independent variables included baseline (demographic and clinical) measures. Descriptive statistics were calculated; linear and logistic regressions were performed. Results. Eighty-nine participants were included in this analysis; 59 (66%) had attendance of 75% or greater. Participants walked for 20 minutes or more for 78% of sessions. The average training load increased by 22%; the mean HRR was 35%; and 61 (69%) participants exercised on the floor for at least 75% of sessions. Regression analyses showed that a higher body mass index and greater baseline 6MWD were related to components of TF; 4 out of 5 components of TF were significantly related to A6MWD. The strongest TF relationship showed that those who exercised on the floor improved by 62 m (95% CI = 31-93 m) more than those who did not get on the floor. Conclusions. Measures of TF should extend beyond attendance rate. This analysis demonstrates how measures of TF, including program attendance, progression in training load, endurance duration, and exercising on the floor were significantly related to improvement in 6MWD in participants post hip fracture. Impact. This careful analysis of treatment fidelity assured that the intervention was delivered and received as intended. Analysis of data from a large trial with participants after hip fracture showed that regular attendance, frequent endurance training for 20 minutes, increases in lower extremity training loads, and exercising on the floor were associated with improvements in the outcome of 6-minute-walk distance. The strongest association with improvement was exercising on the floor. Keywords: Exercise, Hip Fractures, Physical Therapists, Treatment Fidelity, Introduction Older adults demonstrate great heterogeneity in functional recovery following hip fracture. (1) Physical therapist interventions associated with hip fracture rehabilitation are complex behaviors that take time, physical effort, and [...]

Published
2021
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23. Low-Magnitude Mechanical Stimulation to Improve Bone Density in Persons of Advanced Age: A Randomized, Placebo-Controlled Trial.

Author

Kiel, Douglas, Hannan, Marian, Barton, Bruce, Bouxsein, Mary, Sisson, Emily, Allaire, Brett, Dewkett, Dawn, Carroll, Danette, Magaziner, Jay, Shane, Elizabeth, Leary, Elizabeth, Zimmerman, Sheryl, Rubin, Clinton, and Lang, Thomas

Subjects
BONE MINERAL DENSITY, BONE TURNOVER, ELDERLY, RANDOMIZED CONTROLLED TRIAL, WHOLE-BODY VIBRATION, Aged, Bone Density, Collagen Type I, Female, Femur, Humans, Male, Peptide Fragments, Peptides, Placebos, Procollagen, Spine, Vibration
Abstract

Nonpharmacologic approaches to preserve or increase bone mineral density (BMD) include whole-body vibration (WBV), but its efficacy in elderly persons is not clear. Therefore, we conducted the Vibration to Improve Bone in Elderly Subjects (VIBES) trial, a randomized, placebo-controlled trial of 10 minutes of daily WBV (0.3g at 37 Hz) in seniors recruited from 16 independent living communities. The primary outcomes were volumetric BMD of the hip and spine measured by quantitative computed tomography (QCT) and biochemical markers of bone turnover. We randomized 174 men and women (89 active, 85 placebo) with T-scores -1 to -2.5 who were not taking bone active drugs and had no diseases affecting the skeleton (mean age 82 ± 7 years, range 65 to 102). Participants received daily calcium (1000 mg) and vitamin D (800 IU). Study platforms were activated using radio frequency ID cards providing electronic adherence monitoring; placebo platforms resembled the active platforms. In total, 61% of participants in the active arm and 73% in the placebo arm completed 24 months. The primary outcomes, median percent changes (interquartile range [IQR]) in total volumetric femoral trabecular BMD (active group (2.2% [-0.8%, 5.2%]) versus placebo 0.4% [-4.8%, 5.0%]) and in mid-vertebral trabecular BMD of L1 and L2 (active group (5.3% [-6.9%, 13.3%]) versus placebo (2.4% [-4.4%, 11.1%]), did not differ between groups (all p values > 0.1). Changes in biochemical markers of bone turnover (P1NP and sCTX) also were not different between groups (p = 0.19 and p = 0.97, respectively). In conclusion, this placebo-controlled randomized trial of daily WBV in older adults did not demonstrate evidence of significant beneficial effects on volumetric BMD or bone biomarkers; however, the high variability in vBMD changes limited our power to detect small treatment effects. The beneficial effects of WBV observed in previous studies of younger women may not occur to the same extent in elderly individuals.

Published
2015

25. PROGNOSTIC BIOMARKERS OF DISEASE SEVERITY FOR PATIENTS INFECTED WITH CORONAVIRUS COVID-19

Author

MA, BING, primary, RYAN, ALICE, additional, VARGHESE, ANU, additional, SONG, YANG, additional, ZHANG, YUJI, additional, SINGH-BASRA, DALWINDER, additional, SIMPSON, MATTHEW, additional, SHABANI, JAWAD, additional, MANN, DEAN, additional, GEBRU, ETSE, additional, NANAVATY, UDAY, additional, MAGAZINER, JAY, additional, TERRIN, MICHAEL L, additional, and TIMOFTE, IRINA L, additional

Published
2023
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29. NIA Research Centers Collaborative Network.

Author

Kritchevsky, Stephen, van der Willik, Odette, Magaziner, Jay, Pritchett‐Montavon, Elizabeth, and Lederman, Stephanie

Subjects
INTERPROFESSIONAL relations, MEDICAL research, ADULT education workshops, HEALTH care teams, VOCATIONAL guidance
Abstract

The article discusses the support of the National Institute on Aging (NIA) to the establishment of the Research Centers Collaborative Network (RCCN) in 2018, led by the Wake Forest University School of Medicine and the American Federation for Aging Research. Topics include goals of the RCCN, NIA-supported center programs, and an interdisciplinary workshop series sponsored by the RCCN.

Published
2024
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32. Longitudinal characteristics of physical frailty and its components in men and women post hip fracture.

Author

Huang, Yi, Orwig, Denise, Hayssen, Hilary, Lu, Wenxin, Gruber‐Baldini, Ann L., Chiles Shaffer, Nancy, Magaziner, Jay, and Guralnik, Jack M.

Subjects
GRIP strength, ENERGY metabolism, FRAIL elderly, BODY weight, GAIT in humans, HIP fractures, MEN, WOMEN, COGNITION, SEX distribution, POSTOPERATIVE period, DESCRIPTIVE statistics, RESEARCH funding, LONGITUDINAL method
Abstract

Background: Frailty is an important geriatric syndrome predicting adverse health outcomes in older adults. However, the longitudinal characteristics of frailty components in post‐hip fracture patients are less understood. Adopting the Fried frailty definition, we examined the longitudinal trends and sex trajectory differences in frailty and its components over 1 year post‐fracture. Methods: Three hundred and twenty‐seven hip fracture patients (162 men and 165 women with mean age 80.1 and 81.5) from Baltimore Hip Studies 7th cohort with measurements at 22 days after admission, and months 2, 6, and 12 post‐fracture were analyzed. Frailty components included: grip strength, gait speed, weight, total energy expenditure, and exhaustion. Longitudinal analysis used mixed effect models. Results: At baseline, men were sicker with worse cognitive status, and had higher weight and grip strength, but lower total energy expenditure than women (p < 0.001). The prevalence of frailty was 31.5%, 30.2%, and 28.2% at months 2, 6, and 12 respectively, showing no longitudinal trends or sex differences. However, its components showed substantial recovery trends over the post‐fracture year after confounding adjustments, including increasing gait speed, reducing risk of exhaustion, and stabilized weight loss and energy expenditure over time. Particularly, while men's grip strength tended to remain stable over first year post surgery within patients, women's grip strength reduced significantly over time within patients. On average over time within patients, women were more active with higher energy expenditures but lower grip strength and weight than men. Conclusion: Significant recovery trends and sex differences were observed in frailty components during first year post‐fracture. Overall frailty status did not show those trends over months 2–12 since a summary measure might obscure changes in components. Therefore, frailty components provided important multi‐dimensional information on the complex recovery process of patients, indicating targets for intervention beyond the global binary measure of frailty. [ABSTRACT FROM AUTHOR]

Published
2024
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36. Conceptual Framework for an Episode of Rehabilitative Care After Surgical Repair of Hip Fracture

Author

Sheehan, Katie J., Smith, Toby O., Martin, Finbarr C., Johansen, Antony, Drummond, Avril, Beaupre, Lauren, Magaziner, Jay, Whitney, Julie, Hommel, Ami, Cameron, Ian D., Price, Lona, and Sackley, Catherine

Subjects
Continuum of care -- Methods, Hip fracture repair -- Patient outcomes, Physical therapy -- Patient outcomes, Outcome and process assessment (Medical care) -- Methods, Activities of daily living, Surgery, Fractures (Injuries), Fracture repair, Health
Abstract

Researchers face a challenge when evaluating the effectiveness of rehabilitation after a surgical procedure for hip fracture. Reported outcomes of rehabilitation will vary depending on the end point of the episode of care. Evaluation at an inappropriate end point might suggest a lack of effectiveness leading to the underuse of rehabilitation that could improve outcomes. The purpose of this article is to describe a conceptual framework for a continuum-care episode of rehabilitation after a surgical procedure for hip fracture. Definitions are proposed for the index event, end point, and service scope of the episode. Challenges in defining the episode of care and operationalizing the episode, and next steps for researchers are discussed. The episode described is intended to apply to all patients eligible for entry to rehabilitation after hip fracture and includes most functional recovery end points. This framework will provide a guide for rehabilitation researchers when designing and interpreting evaluations of the effectiveness of rehabilitation after hip fracture. Evaluation of all potential care episodes facilitates transparency in reporting of outcomes, enabling researchers to determine the true effectiveness of rehabilitation after a surgical procedure for hip fracture., Background Hip Fracture and Rehabilitation A projected 4.5 million people will fracture their hip in 2050. (1) The injury has been dubbed the 'hip attack' due to its clinical severity [...]

Published
2019
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38. Effect of Multicomponent Home-Based Training on Gait and Muscle Strength in Older Adults After Hip Fracture Surgery: A Single Site Randomized Trial

Author

Huang, Mei Zhen, primary, Rogers, Mark W., additional, Pizac, Douglas, additional, Gruber-Baldini, Ann L., additional, Orwig, Denise, additional, Hochberg, Marc C., additional, Beamer, Brock A., additional, Creath, Robert A., additional, Savin, Douglas N., additional, Conroy, Vincent M., additional, Mangione, Kathleen K, additional, Craik, Rebecca, additional, Zhang, Li-Qun, additional, and Magaziner, Jay, additional

Published
2023
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42. Associations of sex, Alzheimer's disease and related dementias, and days alive and at home among older Medicare beneficiaries recovering from hip fracture.

Author

Mutchie, Heather L., Orwig, Denise L., Gruber‐Baldini, Ann L., Johnson, Abree, Magaziner, Jay, and Falvey, Jason R.

Subjects
COGNITION disorders, FEE for service (Medical fees), ALZHEIMER'S disease, CONFIDENCE intervals, CONVALESCENCE, HOME care services, HIP fractures, RETROSPECTIVE studies, SEX distribution, TREATMENT effectiveness, SEVERITY of illness index, DEMENTIA, RESEARCH funding, MEDICARE, POISSON distribution, COMORBIDITY, LONGITUDINAL method, DISEASE complications
Abstract

Background: Males constitute 25% of older adults who experience hip fractures in the United States; a concerning upward trend given poorer health and outcomes among male survivors. Male sex is associated with worse cognitive performance after hip fracture, impacting participation in rehabilitation and long‐term outcomes especially for those with Alzheimer's disease or related dementias (ADRD). However, little research has evaluated whether sex differences in post‐fracture recovery are greater among those living with ADRD. Methods: Data were drawn from 2010 to 2017 Medicare fee‐for‐service beneficiaries aged 65 years and older who survived hospitalization for hip fracture (n = 69,581). The primary outcome was days alive and at home (DAAH), a validated patient‐centered claims‐based outcome calculated as 365 days from fracture minus days in hospital, nursing home, rehabilitation facility, emergency department, or time after death. Multivariable Poisson regressions with an interaction term between sex and ADRD status were to model the association between DAAH and ADRD in the 12 months post hip fracture, adjusting for demographics, injury severity, chronic disease burden, and hospital‐level fixed effects. Results: Compared to females, males were younger and had more comorbidities at the time of fracture. Among survivors, males with ADRD spent a mean of 160.7 DAAH compared to 228.4 for males without ADRD, 177.8 for females with ADRD, and 248.0 for females without ADRD. In adjusted analyses, males without ADRD spent 8.2% fewer DAAH compared to females (rate ratio [RR] = 0.92, 95% CI 0.92–0.92). This relative sex difference increased significantly when comparing those living with ADRD, with males spending an additional 3.3% fewer DAAH (interaction RR = 0.96, 95% CI 0.96–0.97). Conclusions: Males spend fewer DAAH after hip fracture than females, and this difference increases modestly for males living with ADRD compared to females. This suggests that cognitive impairment may be a small but significant contributor to sex‐based differences observed during hip fracture recovery. [ABSTRACT FROM AUTHOR]

Published
2023
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43. Outcomes with spinal versus general anesthesia for patients with and without preoperative cognitive impairment: Secondary analysis of a randomized clinical trial.

Author

O'Brien, Kyra, Feng, Rui, Sieber, Frederick, Marcantonio, Edward R., Tierney, Ann, Magaziner, Jay, Carson, Jeffrey L., Dillane, Derek, Sessler, Daniel I., Menio, Diane, Ayad, Sabry, Stone, Trevor, Papp, Steven, Schwenk, Eric S., Marshall, Mitchell, Jaffe, J. Douglas, Luke, Charles, Sharma, Balram, Azim, Syed, and Hymes, Robert

Abstract

INTRODUCTION: The effect of spinal versus general anesthesia on the risk of postoperative delirium or other outcomes for patients with or without cognitive impairment (including dementia) is unknown. METHODS: Post hoc secondary analysis of a multicenter pragmatic trial comparing spinal versus general anesthesia for adults aged 50 years or older undergoing hip fracture surgery. RESULTS: Among patients randomized to spinal versus general anesthesia, new or worsened delirium occurred in 100/295 (33.9%) versus 107/283 (37.8%; odds ratio [OR] 0.85; 95% confidence interval [CI] 0.60 to 1.19) among persons with cognitive impairment and 70/432 (16.2%) versus 71/445 (16.0%) among persons without cognitive impairment (OR 1.02; 95% CI 0.71 to 1.47, p = 0.46 for interaction). Delirium severity, in‐hospital complications, and 60‐day functional recovery did not differ by anesthesia type in patients with or without cognitive impairment. DISCUSSION: Anesthesia type is not associated with differences in delirium and functional outcomes among persons with or without cognitive impairment. [ABSTRACT FROM AUTHOR]

Published
2023
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44. Limited physician knowledge of sarcopenia: A survey

Author

Guralnik, Jack M., primary, Cawthon, Peggy M., additional, Bhasin, Shalender, additional, Fielding, Roger, additional, Magaziner, Jay, additional, Cruz‐Jentoft, Alfonso J., additional, Vellas, Bruno, additional, Clarke, Lindsay, additional, Lattimer, Laura, additional, and Evans, William, additional

Published
2023
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49. Impact of psychological resilience on walking capacity in older adults following hip fracture

Author

Soliman, Germine, primary, Fortinsky, Richard H., additional, Mangione, Kathleen, additional, Beamer, Brock A., additional, Magder, Larry, additional, Binder, Ellen F., additional, Craik, Rebecca, additional, Gruber‐Baldini, Ann, additional, Orwig, Denise, additional, Resnick, Barbara, additional, Wakefield, Dorothy B., additional, and Magaziner, Jay, additional

Published
2022
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