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Malani AN, Malani PN. Harnessing the Electronic Health Record to Improve Empiric Antibiotic Prescribing. JAMA 2024:2817977. [PMID: 38639731 DOI: 10.1001/jama.2024.6554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Affiliation(s)
- Anurag N Malani
- Section of Infectious Diseases, Trinity Health Michigan, Ann Arbor
| | - Preeti N Malani
- Department of Medicine, University of Michigan, Ann Arbor
- Deputy Editor, JAMA
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Bibbins-Domingo K, Flanagin A, Sietmann C, Bonow RO, Navar AM, Shinkai K, Roberson ML, Ayanian JZ, Ponce N, Inouye SK, Durant RW, Simon MA, Rivara FP, Vela M, Josephson SA, Rawls A, Disis MLN, Florez N, Bressler NM, Scott AW, Piccirillo JF, Osazuwa-Peters N, Christakis DA, Duncan AF, Öngür D, Bagot KS, Kibbe MR, Backhus LM, Malani PN. Advancing Equity at the JAMA Network-Self-Reported Demographics of Editors and Editorial Board Members. JAMA 2024; 331:837-839. [PMID: 38334991 DOI: 10.1001/jama.2024.1709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Affiliation(s)
| | | | | | | | - Ann Marie Navar
- Deputy Editor, Diversity, Equity, and Inclusion, JAMA Cardiology
| | | | - Mya L Roberson
- Associate Editor for Diversity, Equity, and Inclusion, JAMA Dermatology
| | | | - Ninez Ponce
- Associate Editor for Diversity, Equity, and Inclusion, JAMA Health Forum
| | | | - Raegan W Durant
- Associate Editor and Diversity, Equity, and Inclusion Associate Editor, JAMA Internal Medicine
| | - Melissa A Simon
- Associate Editor and Equity, Diversity, and Inclusion Editor, JAMA
| | | | - Monica Vela
- Diversity, Equity, and Inclusion Associate Editor, JAMA Network Open
| | | | - Ashley Rawls
- Associate Editor, Diversity, Equity, and Inclusion, JAMA Neurology
| | | | - Narjust Florez
- Associate Editor for Diversity, Equity, and Inclusion, JAMA Oncology
| | | | | | | | | | | | - Andrea F Duncan
- Associate Editor and Diversity, Equity, and Inclusion Editor, JAMA Pediatrics
| | | | - Kara S Bagot
- Diversity, Equity, and Inclusion Editor, JAMA Psychiatry
| | | | | | - Preeti N Malani
- Deputy Editor, JAMA , and Equity, Diversity, and Inclusion Editor, JAMA and the JAMA Network
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Allen JO, Moïse V, Solway E, Cheney MK, Larson DJ, Malani PN, Singer D, Kullgren JT. How old do I look? Aging appearance and experiences of aging among U.S. adults ages 50-80. Psychol Aging 2024:2024-58254-001. [PMID: 38421758 DOI: 10.1037/pag0000800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
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 (Mage = 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).
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Affiliation(s)
- Julie Ober Allen
- Department of Health and Exercise Science, University of Oklahoma
| | - Valerie Moïse
- Department of Health and Exercise Science, University of Oklahoma
| | - Erica Solway
- Institute for Healthcare Policy and Innovation, University of Michigan
| | | | | | - Preeti N Malani
- Institute for Healthcare Policy and Innovation, University of Michigan
| | - Dianne Singer
- Institute for Healthcare Policy and Innovation, University of Michigan
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Fernandez AC, Coughlin L, Solway ES, Singer DC, Kullgren JT, Kirch M, Malani PN. Prevalence and Frequency of Cannabis Use Among Adults Ages 50-80 in the United States. Cannabis Cannabinoid Res 2024; 9:59-64. [PMID: 38010715 PMCID: PMC10874828 DOI: 10.1089/can.2023.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
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.
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Affiliation(s)
- Anne C. Fernandez
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Lara Coughlin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Erica S. Solway
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Dianne C. Singer
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Jeffrey T. Kullgren
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Matthias Kirch
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Preeti N. Malani
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Berlin NL, Kirch M, Singer DC, Solway E, Malani PN, Kullgren JT. Preoperative Concerns of Older US Adults and Decisions About Elective Surgery. JAMA Netw Open 2024; 7:e2353857. [PMID: 38289606 PMCID: PMC10828908 DOI: 10.1001/jamanetworkopen.2023.53857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/07/2023] [Indexed: 02/01/2024] Open
Abstract
This cross-sectional study examines the preoperative concerns among US adults aged 50 to 80 years who considered elective surgery.
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Affiliation(s)
| | - Matthias Kirch
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Dianne C. Singer
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor
| | - Erica Solway
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Preeti N. Malani
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Jeffrey T. Kullgren
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- School of Public Health, University of Michigan, Ann Arbor
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Desai AN, Malani PN. Mpox and the importance of clinical history and physical examination. Clin Microbiol Infect 2023; 29:1480-1481. [PMID: 37678510 DOI: 10.1016/j.cmi.2023.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Angel N Desai
- Division of Infectious Diseases, University of California Davis, Sacramento, CA, USA
| | - Preeti N Malani
- Division of Infectious Diseases, University of Michigan, Ann Arbor, MI, USA.
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Robinson-Lane SG, Johnson FU, Tuyisenge MJ, Kirch M, Christensen LL, Malani PN, Solway E, Singer DC, Kullgren JT, Koumpias AM. Racial and ethnic variances in preparedness for aging in place among US adults ages 50-80. Geriatr Nurs 2023; 54:357-364. [PMID: 37802755 DOI: 10.1016/j.gerinurse.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 10/08/2023]
Abstract
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.
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Affiliation(s)
- Sheria G Robinson-Lane
- Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, USA.
| | - Florence U Johnson
- Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Marie Jeanne Tuyisenge
- Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Matthias Kirch
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Loretta L Christensen
- Indian Health Services, U.S. Department of Health and Human Services, Rockville, MD, USA
| | - Preeti N Malani
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Department of Internal Medicine, Division of Infectious Diseases, University of Michigan, Ann Arbor, MI, USA
| | - Erica Solway
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Dianne C Singer
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Jeffrey T Kullgren
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Departments of Internal Medicine and Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Antonios M Koumpias
- Department of Social Sciences, University of Michigan - Dearborn, Dearborn, MI, USA
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Westrick AC, Kobayashi LC, Kirch M, Singer D, Malani PN, Kullgren JT, Solway E, Finlay JM. The Joys and Stresses of Social Relationships and the Effect on Resiliency During the Covid-19 Pandemic: A National Survey of US Older Adults. Gerontologist 2023:gnad141. [PMID: 37875132 DOI: 10.1093/geront/gnad141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The COVID-19 pandemic placed unprecedented stress on older adults. Resiliency could mitigate deleterious effects of pandemic stressors. We described trends in resilience among US adults aged 50-80 years approximately one and 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, 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=0.006). Feeling a lot of stress from one's spouse or neighbors was associated with increased likelihood of feeling less resilient than before the pandemic (OR=3.7; 95% 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.
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Affiliation(s)
- Ashly C Westrick
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Lindsay C Kobayashi
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Matthias Kirch
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Dianne Singer
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Preeti N Malani
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Jeffrey T Kullgren
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Erica Solway
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Jessica M Finlay
- Social Environment and Health Program, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
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Abstract
This Viewpoint addresses the state of COVID-19 as of fall 2023 in the US and summarizes key clinical information for health care professionals and patients.
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Affiliation(s)
- Carlos Del Rio
- Division of Infectious Diseases, Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Preeti N Malani
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor
- Deputy Editor, JAMA
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Chew KW, Malani PN, Gandhi RT. COVID-19 Therapeutics for Nonhospitalized Patients-Updates and Future Directions. JAMA 2023; 330:1519-1520. [PMID: 37773595 DOI: 10.1001/jama.2023.19542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
In this Viewpoint, the authors summarize the therapeutic landscape for COVID-19, discuss who is most likely to benefit from treatment, provide an update on managing illness in immunocompromised individuals, and highlight how to improve COVID-19 treatment.
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Affiliation(s)
- Kara W Chew
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at University of California Los Angeles, Los Angeles
| | - Preeti N Malani
- Department of Internal Medicine, Division of Infectious Diseases, University of Michigan, Ann Arbor
- Deputy Editor, JAMA
| | - Rajesh T Gandhi
- Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston
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Abstract
This JAMA Patient Page describes current medications available for outpatient treatment of COVID-19 (nirmatrelvir-ritonavir, remdesivir, and molnupiravir), their effectiveness, and how to obtain them.
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Affiliation(s)
- Zoe Raglow
- Division of Infectious Diseases, University of Michigan, Ann Arbor
| | | | - Lindsay A Petty
- Division of Infectious Diseases, University of Michigan, Ann Arbor
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Abstract
This JAMA Patient Page describes respiratory syncytial virus (RSV) and its symptoms, risk factors, and preventive measures.
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Zhou S, Yang G, Hou H, Zhang M, Grady KL, Chenoweth CE, Aaronson KD, Pienta M, Fetters MD, Paul Chandanabhumma P, Stewart JW, Cabrera L, Malani PN, Pagani FD, Likosky DS. Infections following left ventricular assist device implantation and 1-year health-related quality of life. J Heart Lung Transplant 2023; 42:1307-1315. [PMID: 37187319 PMCID: PMC10527882 DOI: 10.1016/j.healun.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 05/02/2023] [Accepted: 05/10/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Left ventricular assist device (LVAD) implantation leads to substantial and sustained improvement in health-related quality of life (HRQOL) among patients. Infection following device implantation remains an important and frequent complication and adversely affects patient-reported HRQOL. METHODS Patients in The Society of Thoracic Surgeons' Interagency Registry for Mechanically Assisted Circulatory Support receiving a primary LVAD between April 2012 to October 2016 were included. The primary exposure was one-year post-implant infection, characterized by: (1) any infection; (2) total number of infections and (3) type (LVAD-specific, LVAD-related, non-LVAD). The association between infection and the primary composite adverse outcome (defined as EuroQoL Visual Analog Scale< 65, too sick to complete the survey, or death at 1-year) was estimated using inverse probability weighting and Cox regression. RESULTS The study cohort included 11,618 patients from 161 medical centers with 4,768 (41.0%) patients developing an infection, and 2,282 (19.6%) patients having> 1 infection during the follow up period. The adjusted odds ratio for the primary composite adverse outcome was 1.22 (95% CI, 1.19-1.24, p < 0.001) for each additional infection. Each additional infection was associated with a 3.49% greater probability of the primary composite outcome and was associated with worse performance across multiple dimensions of HRQOL as assessed by the EQ-5D for patients who survived to 1 year. CONCLUSIONS For patients undergoing LVAD implantation, each additional infection within the first post-implantation year was associated with an incremental negative effect on survival free of impaired HRQOL.
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Affiliation(s)
- Shiwei Zhou
- Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine, Ann Arbor, MI.
| | - Guangyu Yang
- Institute of Statistics and Big Data, Renmin University of China, People's Republic of China
| | - Hechuan Hou
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, MI
| | - Min Zhang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Kathleen L Grady
- Division of Cardiac Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Carol E Chenoweth
- Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine, Ann Arbor, MI
| | - Keith D Aaronson
- Department of Internal Medicine, Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor, MI
| | - Michael Pienta
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, MI
| | | | | | - James W Stewart
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT
| | - Lourdes Cabrera
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, MI
| | - Preeti N Malani
- Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine, Ann Arbor, MI
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Abstract
This JAMA Patient Page describes the problem of polypharmacy and its consequences, and how deprescribing can reduce polypharmacy.
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Zhou S, Yang G, Zhang M, Pienta M, Chenoweth CE, Pagani FD, Aaronson KD, Fetters MD, Chandanabhumma PP, Cabrera L, Hou H, Malani PN, Likosky DS. Mortality following durable left ventricular assist device implantation by timing and type of first infection. J Thorac Cardiovasc Surg 2023; 166:570-579.e4. [PMID: 34895722 PMCID: PMC9094062 DOI: 10.1016/j.jtcvs.2021.10.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/24/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Although infections are common after left ventricular assist device implantation, the relationship between timing and type of first infection with regard to mortality is less well understood. METHODS The Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support patients receiving a primary left ventricular assist device from April 2012 to May 2017 were included. The primary exposure was defined 3 ways: any infection, timing of first infection (early: ≤90 days; intermediate: 91-180 days; late: >180 days), and type (ventricular assist device specific, ventricular assist device related, non-ventricular assist device). The association between first infection and all-cause mortality was estimated using Cox regression. RESULTS The cohort included 12,957 patients at 166 centers (destination therapy: 47.4%, bridge-to-transplant: 41.2%). First infections were most often non-ventricular assist device (54.2%). Rates of first infection were highest in the early interval (10.7/100 person-months). Patients with any infection had a significantly higher adjusted hazard of death (hazard ratio, 2.63; 2.46-2.86). First infection in the intermediate interval was associated with the largest increase in adjusted hazard of death (hazard ratio, 3.26; 2.82-3.78), followed by late (hazard ratio, 3.13; 2.77-3.53) and early intervals (hazard ratio, 2.37; 2.16-2.60). Ventricular assist device-related infections were associated with the largest increase in hazard of death (hazard ratio, 3.02; 2.69-3.40), followed by ventricular assist device specific (hazard ratio, 2.92; 2.57-3.32) and non-ventricular assist device (hazard ratio, 2.42; 2.20-2.65). CONCLUSIONS Relative to those without infection, patients with any postimplantation infection had an increased risk of death. Ventricular assist device-related infections and infections occurring in the intermediate interval were associated with the largest increase in risk of death. After left ventricular assist device implantation, infection prevention strategies should target non-ventricular assist device infections in the first 90 days, then shift to surveillance/prevention of driveline infections after 90 days.
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Affiliation(s)
- Shiwei Zhou
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Mich.
| | - Guangyu Yang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Mich
| | - Min Zhang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Mich
| | - Michael Pienta
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Carol E Chenoweth
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Mich
| | - Francis D Pagani
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Keith D Aaronson
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Mich
| | | | | | - Lourdes Cabrera
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Hechuan Hou
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Preeti N Malani
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Mich
| | - Donald S Likosky
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
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Abstract
This JAMA Patient Page describes the eligibility, safety and effectiveness, and administration procedure for the JYNNEOS vaccine for mpox infection.
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Malani PN. Public Health Experts Advise Clinicians to Be on the Lookout for New Mpox Cases. JAMA 2023:2806021. [PMID: 37285139 DOI: 10.1001/jama.2023.9500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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19
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Johnson KE, Malani PN, Kirch M, Solway E, Singer DC, Kullgren JT. Attitudes toward policies to encourage influenza vaccination in long-term care facilities: A national survey of US adults aged 50-80 years. Infect Control Hosp Epidemiol 2023; 44:830-833. [PMID: 35603805 PMCID: PMC10714674 DOI: 10.1017/ice.2022.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In October 2017, the National Poll on Healthy Aging surveyed a nationally representative sample of 2,007 adults aged 50-80 years to assess attitudes toward influenza (flu) vaccination policies in long-term care facilities. Support for requiring vaccinations was lowest for visitors. Policy makers can use these findings to develop sustainable vaccination strategies.
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Affiliation(s)
- Kimson E. Johnson
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, United States
- Department of Sociology, University of Michigan, Ann Arbor, MI, United States
| | - Preeti N. Malani
- Department of Internal Medicine, Division of Infectious Diseases, University of Michigan, Ann Arbor, MI, United States
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Matthias Kirch
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Erica Solway
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Dianne C. Singer
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Jeffrey T. Kullgren
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, United States
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, University of Michigan, Ann Arbor, MI, United States
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
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20
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Charles A, Malani PN. Informing a Rational Approach to Antimicrobial Prophylaxis in Open Pancreatoduodenectomy. JAMA 2023; 329:1556-1557. [PMID: 37078778 DOI: 10.1001/jama.2023.6275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Affiliation(s)
- Anthony Charles
- Department of Surgery, School of Medicine, University of North Carolina, Chapel Hill
- Associate Editor, JAMA
| | - Preeti N Malani
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor
- Deputy Editor, JAMA
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21
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Li KY, Marquis LB, Malani PN, Solway E, Kirch M, Singer D, Kullgren JT, Plegue MA, Buis LR. Perceptions of telehealth among older U.S. adults during the COVID-19 pandemic: A national survey. J Telemed Telecare 2023:1357633X231166031. [PMID: 37021477 PMCID: PMC10080170 DOI: 10.1177/1357633x231166031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
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.
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Affiliation(s)
- Kathleen Y Li
- Institute for Healthcare Policy and Innovation, 1259University of Michigan, Ann Arbor, United States
- 21614Department of Emergency Medicine, 1259University of Michigan, Ann Arbor, United States
- Department of Emergency Medicine, Icahn School of Medicine, Mount Sinai, New York, United States
- Department of Emergency Medicine, 12353University of Washington, Seattle, United States
| | - Liz B Marquis
- School of Information, 1259University of Michigan, Ann Arbor, United States
| | - Preeti N Malani
- Institute for Healthcare Policy and Innovation, 1259University of Michigan, Ann Arbor, United States
- Department of Internal Medicine, Division of Infectious Diseases, 1259University of Michigan, Ann Arbor, United States
| | - Erica Solway
- Institute for Healthcare Policy and Innovation, 1259University of Michigan, Ann Arbor, United States
| | - Matthias Kirch
- Institute for Healthcare Policy and Innovation, 1259University of Michigan, Ann Arbor, United States
| | - Dianne Singer
- Child Health Evaluation and Research Center, 1259University of Michigan, Ann Arbor, United States
| | - Jeffrey T Kullgren
- Institute for Healthcare Policy and Innovation, 1259University of Michigan, Ann Arbor, United States
- Center for Clinical Management Research, 20034VA Ann Arbor Healthcare System, Ann Arbor, United States
- Departments of Internal Medicine and Health Management and Policy, 1259University of Michigan, Ann Arbor, United States
| | - Melissa A Plegue
- Department of Family Medicine, 1259University of Michigan, Ann Arbor, United States
| | - Lorraine R Buis
- Institute for Healthcare Policy and Innovation, 1259University of Michigan, Ann Arbor, United States
- Department of Family Medicine, 1259University of Michigan, Ann Arbor, United States
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22
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Bibbins-Domingo K, Malani PN. At a Higher Dose and Longer Duration, Ivermectin Still Not Effective Against COVID-19. JAMA 2023; 329:897-898. [PMID: 36805613 DOI: 10.1001/jama.2023.1922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Abstract
This Viewpoint discusses the growth of diagnostic stewardship beyond infectious disease to reduce diagnostic errors in other fields.
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Affiliation(s)
- Daniel J Morgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
- VA Maryland Healthcare System, Baltimore
| | - Preeti N Malani
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, Ann Arbor
- Deputy Editor, JAMA
| | - Daniel J Diekema
- Department of Internal Medicine, University of Iowa, Iowa City
- Department of Medicine, Maine Medical Center, Portland
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24
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Coe AB, Farris KB, Solway E, Singer DC, Kirch M, Kullgren JT, Malani PN, Bynum JPW. Predictors of Receipt of Comprehensive Medication Reviews in Older Adults. J Gerontol A Biol Sci Med Sci 2023; 78:463-469. [PMID: 35446953 PMCID: PMC9977218 DOI: 10.1093/gerona/glac096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Indexed: 01/18/2023] Open
Abstract
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.
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Affiliation(s)
- Antoinette B Coe
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Karen B Farris
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Erica Solway
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Dianne C Singer
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthias Kirch
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Jeffrey T Kullgren
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA.,Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan, USA
| | - Preeti N Malani
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Julie P W Bynum
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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25
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26
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Abstract
This JAMA Patient Page describes measles infection, including prevention, symptoms of infection, contagiousness, and treatment.
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27
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Funk RJ, Pagani FD, Hou H, Zhang M, Yang G, Malani PN, Chandanabhumma PP, Cabrera L, Kim KD, Likosky DS. Care fragmentation predicts 90-day durable ventricular assist device outcomes. Am J Manag Care 2022; 28:e444-e451. [PMID: 36525664 PMCID: PMC10405264 DOI: 10.37765/ajmc.2022.89280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
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.
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Affiliation(s)
- Russell J Funk
- Carlson School of Management, University of Minnesota, 321 19th Ave S, #3-354, Minneapolis, MN 55455.
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28
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Abstract
This JAMA Patient Page discusses polio, including its epidemiology, prevention, and symptoms.
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29
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Yang G, Zhang M, Zhou S, Hou H, Grady KL, Stewart JW, Chenoweth CE, Aaronson KD, Fetters MD, Chandanabhumma PP, Pienta MJ, Malani PN, Hider AM, Cabrera L, Pagani FD, Likosky DS. Incompleteness of health-related quality of life assessments before left ventricular assist device implant: A novel quality metric. J Heart Lung Transplant 2022; 41:1520-1528. [PMID: 35961829 PMCID: PMC10405265 DOI: 10.1016/j.healun.2022.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/16/2022] [Accepted: 07/01/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Improved health-related quality of life (HRQOL) is an important outcome following durable left ventricular assist device (LVAD) implant. However, half of pre-implant HRQOL data are incomplete in The Society of Thoracic Surgeons' Intermacs registry. Pre-implant HRQOL incompleteness may reflect patient status or hospital resources to capture HRQOL data. We hypothesized that pre-implant HRQOL incompleteness predicts 90 day outcomes and serves as a novel quality metric. METHODS Risk factors for pre-implant HRQOL (EQ-5D-5L visual analog scale; 12-item Kansas City Cardiomyopathy Questionnaire "KCCQ") incompleteness were examined by stepwise logistic modeling. Direct standardization method was used to calculate adjusted incompleteness rates using a mixed effects logistic model. Hospitals were dichotomized as low or high based on median adjusted incompleteness rates. Andersen-Gill models were used to associate pre-implant HRQOL adjusted incompleteness rate with adverse events within 90 day post-implant. RESULTS The study cohort included 14,063 patients receiving a primary LVAD (4/2012-8/2017). HRQOL incompleteness at high-rate hospitals was more often due to administrative reasons (risk difference, EQ-5D: 10.1%; KCCQ-12: 11.6%) and less likely due to patient reasons (risk difference, EQ-5D: -8.9%; KCCQ-12: -11.4%). A 10% increase in the adjusted pre-implant EQ-5D incompleteness rate was significantly associated with higher risk of infection-related mortality (HR: 1.09), infection (HR: 1.05), and renal dysfunction (HR: 1.03). A 10% increase in the adjusted pre-implant KCCQ-12 incompleteness rate was significantly associated with higher risk of infection (HR: 1.04). CONCLUSIONS Hospital adjusted pre-implant HRQOL incompleteness was predictive of 90-day post-implant outcomes and may serve as a novel quality metric.
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Affiliation(s)
- Guangyu Yang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Min Zhang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Shiwei Zhou
- Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Hechuan Hou
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Kathleen L Grady
- Division of Cardiac Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - James W Stewart
- Division of Cardiac Surgery, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Carol E Chenoweth
- Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Keith D Aaronson
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Michael D Fetters
- Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - P Paul Chandanabhumma
- Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Michael J Pienta
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Preeti N Malani
- Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ahmad M Hider
- Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Lourdes Cabrera
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Francis D Pagani
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Donald S Likosky
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.
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Affiliation(s)
- Carlos Del Rio
- Division of Infectious Diseases, Department of Internal Medicine, Grady Health System, Emory University School of Medicine, Atlanta, Georgia
| | - Preeti N Malani
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor
- Associate Editor, JAMA
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31
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Affiliation(s)
| | - Preeti N Malani
- Associate Editor, JAMA
- Division of Infectious Diseases, University of Michigan Health System, Ann Arbor
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32
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Affiliation(s)
- Jeannette Guarner
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Carlos Del Rio
- Division of Infectious Diseases, Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Georgia Grady Health System, Atlanta
| | - Preeti N Malani
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor
- Associate Editor, JAMA
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33
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Affiliation(s)
- Carlos Del Rio
- Division of Infectious Diseases, Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Georgia Grady Health System, Atlanta
| | - Preeti N Malani
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor
- Associate Editor, JAMA
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34
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Affiliation(s)
- Lindsay A Petty
- Division of Infectious Diseases, University of Michigan, Ann Arbor
| | - Preeti N Malani
- Division of Infectious Diseases, University of Michigan, Ann Arbor
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35
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Gandhi RT, Malani PN, Del Rio C. COVID-19 Treatments for Nonhospitalized Patients-Reply. JAMA 2022; 327:2248. [PMID: 35699707 DOI: 10.1001/jama.2022.6173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Rajesh T Gandhi
- Massachusetts General Hospital, Harvard Medical School, Boston
| | - Preeti N Malani
- Division of Infectious Diseases, University of Michigan Health System, Ann Arbor
| | - Carlos Del Rio
- Emory School of Medicine, Georgia Grady Health System, Atlanta
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36
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Allen JO, Solway E, Kirch M, Singer D, Kullgren JT, Moïse V, Malani PN. Experiences of Everyday Ageism and the Health of Older US Adults. JAMA Netw Open 2022; 5:e2217240. [PMID: 35704314 PMCID: PMC9201677 DOI: 10.1001/jamanetworkopen.2022.17240] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/28/2022] [Indexed: 12/15/2022] Open
Abstract
Importance Major incidents of ageism have been shown to be associated with poorer health and well-being among older adults. Less is known about routine types of age-based discrimination, prejudice, and stereotyping that older adults encounter in their day-to-day lives, known as everyday ageism. Objective To examine the prevalence of everyday ageism, group differences and disparities, and associations of everyday ageism with indicators of poor physical and mental health. Design, Setting, and Participants This cross-sectional study was conducted using survey data from the December 2019 National Poll on Healthy Aging among a nationally representative household sample of US adults ages 50 to 80 years. Data were analyzed from November 2021 through April 2022. Exposures Experiences of everyday ageism were measured using the newly developed multidimensional Everyday Ageism Scale. Main Outcomes and Measures Fair or poor physical health, number of chronic health conditions, fair or poor mental health, and depressive symptoms. Results Among 2035 adults ages 50 to 80 years (1047 [54.2%] women; 192 Black [10.9%], 178 Hispanic [11.4%], and 1546 White [71.1%]; mean [SD] age, 62.6 [8.0] years [weighted statistics]), most participants (1915 adults [93.4%]) reported regularly experiencing 1 or more forms of everyday ageism. Internalized ageism was reported by 1664 adults (81.2%), ageist messages by 1394 adults (65.2%), and interpersonal ageism by 941 adults (44.9%). Mean Everyday Ageism Scale scores were higher for several sociodemographic groups, including adults ages 65 to 80 years vs those ages 50 to 64 years (11.23 [95% CI, 10.80-11.66] vs 9.55 [95% CI, 9.26-9.84]) and White (10.43 [95% CI, 10.20-10.67]; P < .001) and Hispanic (10.09 [95% CI, 9.31-10.86]; P = .04) adults vs Black adults (9.23 [95% CI, 8.42-10.03]). Higher levels of everyday ageism were associated with increased risk of all 4 negative physical and mental health outcomes examined in regression analyses (with odds ratios [ORs] per additional scale point as high as 1.20 [95% CI, 1.17-1.23] for depressive symptoms and b = 0.039 [95% CI, 0.029-0.048] for chronic health conditions; P values < .001). Internalized ageism was the category associated with the greatest increase in risk of poor outcomes for all health measures (with ORs per additional scale point as high as 1.62 [95% CI, 1.49-1.76] for depressive symptoms and b = 0.063 [95% CI, 0.034-0.092] for chronic health conditions; P values < .001). Conclusions and Relevance This study found everyday ageism to be prevalent among US adults ages 50 to 80 years. These findings suggest that commonplace ageist messages, interactions, and beliefs may be harmful to health and that multilevel and multisector efforts may be required to reduce everyday ageism and promote positive beliefs, practices, and policies related to aging and older adults.
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Affiliation(s)
- Julie Ober Allen
- Department of Health and Exercise Science, University of Oklahoma, Norman
- Research Center for Group Dynamics, Institute for Social Research, University of Michigan, Ann Arbor
| | - Erica Solway
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Matthias Kirch
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Dianne Singer
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor
| | - Jeffrey T. Kullgren
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Department of Health Management and Policy, University of Michigan, Ann Arbor
| | - Valerie Moïse
- Department of Health and Exercise Science, University of Oklahoma, Norman
| | - Preeti N. Malani
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Internal Medicine, University of Michigan, Ann Arbor
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37
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Chandanabhumma PP, Fetters MD, Pagani FD, Malani PN, Hollingsworth JM, Funk RJ, Aaronson KD, Zhang M, Kormos RL, Chenoweth CE, Shore S, Watt TMF, Cabrera L, Likosky DS. Correction: Understanding and Addressing Variation in Health Care–Associated Infections After Durable Ventricular Assist Device Therapy: Protocol for a Mixed Methods Study (Preprint). JMIR Res Protoc 2022; 11:e39663. [PMID: 35737967 PMCID: PMC9264132 DOI: 10.2196/39663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- P Paul Chandanabhumma
- Mixed Methods ProgramDepartment of Family MedicineUniversity of MichiganAnn Arbor, MIUnited States
| | - Michael D Fetters
- Mixed Methods ProgramDepartment of Family MedicineUniversity of MichiganAnn Arbor, MIUnited States
| | - Francis D Pagani
- Department of Cardiac SurgeryUniversity of MichiganAnn Arbor, MIUnited States
| | - Preeti N Malani
- Division of Infectious DiseasesDepartment of Internal MedicineUniversity of MichiganAnn Arbor, MIUnited States
| | | | - Russell J Funk
- Department of Strategic Management and EntrepreneurshipCarlson School of ManagementUniversity of MinnesotaMinneapolis, MNUnited States
| | - Keith D Aaronson
- Division of Cardiovascular MedicineDepartment of Internal MedicineUniversity of MichiganAnn Arbor, MIUnited States
| | - Min Zhang
- Department of BiostatisticsSchool of Public HealthUniversity of MichiganAnn Arbor, MIUnited States
| | - Robert L Kormos
- Department of Cardiothoracic SurgeryUniversity of Pittsburgh Medical CenterPittsburgh, PAUnited States
| | - Carol E Chenoweth
- Division of Infectious DiseasesDepartment of Internal MedicineUniversity of MichiganAnn Arbor, MIUnited States
| | - Supriya Shore
- Division of Cardiovascular MedicineDepartment of Internal MedicineUniversity of MichiganAnn Arbor, MIUnited States
| | - Tessa M F Watt
- Department of Cardiac SurgeryUniversity of MichiganAnn Arbor, MIUnited States
| | - Lourdes Cabrera
- Department of Cardiac SurgeryUniversity of MichiganAnn Arbor, MIUnited States
| | - Donald S Likosky
- Department of Cardiac SurgeryUniversity of MichiganAnn Arbor, MIUnited States
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Gerlach LB, Maust DT, Solway E, Kirch M, Kullgren JT, Singer DC, Malani PN. Perceptions of Overall Mental Health and Barriers to Mental Health Treatment Among US Older Adults. Am J Geriatr Psychiatry 2022; 30:521-526. [PMID: 34649786 PMCID: PMC8938292 DOI: 10.1016/j.jagp.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES We surveyed older adults about their perceived mental health and their comfort discussing and engaging in mental health treatment. METHODS A nationally representative survey of community-dwelling older adults aged 50-80 (N = 2,021), with respondents asked to rate their current mental health as compared to 20 years ago, comfort discussing their mental health, and potential hesitations to seeking treatment in the future. RESULTS About 79.6% reported their mental health as the same or better than 20 years ago; 18.6% reported their mental health to be worse. Most respondents reported that they were comfortable (87.3%) discussing their mental health, preferring to discuss such concerns with their primary care provider (30.6%). About 28.5% of respondents did endorse some hesitation seeking mental health care in the future. CONCLUSIONS Most older adults reported that their mental health was as good if not better than it was 20 years ago and felt comfortable discussing mental health concerns.
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Affiliation(s)
- Lauren B Gerlach
- Department of Psychiatry, University of Michigan (LBG, DTM), Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan (LBG, DTM, ES, MK, JTK, DCS, PNM), Ann Arbor, MI.
| | - Donovan T Maust
- Department of Psychiatry, University of Michigan (LBG, DTM), Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan (LBG, DTM, ES, MK, JTK, DCS, PNM), Ann Arbor, MI; Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System (DTM, JTK), Ann Arbor, MI
| | - Erica Solway
- Institute for Healthcare Policy and Innovation, University of Michigan (LBG, DTM, ES, MK, JTK, DCS, PNM), Ann Arbor, MI
| | - Matthias Kirch
- Institute for Healthcare Policy and Innovation, University of Michigan (LBG, DTM, ES, MK, JTK, DCS, PNM), Ann Arbor, MI
| | - Jeffrey T Kullgren
- Institute for Healthcare Policy and Innovation, University of Michigan (LBG, DTM, ES, MK, JTK, DCS, PNM), Ann Arbor, MI; Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System (DTM, JTK), Ann Arbor, MI; Department of Internal Medicine, University of Michigan (JTK, PNM), Ann Arbor, MI
| | - Dianne C Singer
- Institute for Healthcare Policy and Innovation, University of Michigan (LBG, DTM, ES, MK, JTK, DCS, PNM), Ann Arbor, MI; Child Health Evaluation and Research Center, University of Michigan (DCS), Ann Arbor, MI
| | - Preeti N Malani
- Institute for Healthcare Policy and Innovation, University of Michigan (LBG, DTM, ES, MK, JTK, DCS, PNM), Ann Arbor, MI; Department of Internal Medicine, University of Michigan (JTK, PNM), Ann Arbor, MI
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Abstract
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.
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Affiliation(s)
- Julie Ober Allen
- Department of Health and Exercise Science, University of Oklahoma, Norman
- Research Center for Group Dynamics, Institute for Social Research, University of Michigan, Ann Arbor
| | - Erica Solway
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Matthias Kirch
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Dianne Singer
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor
| | - Jeffrey T. Kullgren
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Preeti N. Malani
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Internal Medicine, University of Michigan, Ann Arbor
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40
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Carter PM, Losman E, Roche JS, Malani PN, Kullgren JT, Solway E, Kirch M, Singer D, Walton MA, Zeoli AM, Cunningham RM. Firearm ownership, attitudes, and safe storage practices among a nationally representative sample of older U.S. adults age 50 to 80. Prev Med 2022; 156:106955. [PMID: 35065980 DOI: 10.1016/j.ypmed.2022.106955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 01/07/2022] [Accepted: 01/15/2022] [Indexed: 11/19/2022]
Abstract
Firearms are a leading cause of injury mortality across the lifespan, with elevated risks for older adult populations. To inform prevention efforts, we conducted a probability-based web survey (12/1/2019-12/23/2019) of 2048 older adults (age 50-80) to characterize national estimates of firearm ownership, safety practices, and attitudes about health screening, counseling, and policy initiatives. Among older U.S. adults, 26.7% [95%CI = 24.8%-28.8%] report owning one or more firearms. The primary motivation for ownership was protection (69.5%), with 90.4% highlighting a fear of criminal assault. 39.4% of firearm owners reported regularly storing firearm(s) unloaded and locked, with 24.2% regularly storing at least one loaded and unlocked. While most firearm owners found healthcare screening (69.2% [95%CI: 64.9-73.1]) and safety counseling (63.2% [95%CI = 58.8-67.3]) acceptable, only 3.7% of older adults reported being asked about firearm safety by a healthcare provider in the past year. Among firearm owners, there was support for state-level policy interventions, including allowing family/police to petition courts to restrict access when someone is a danger to self/others (78.9% [95%CI = 75.1-82.3]), comprehensive background checks (85.0% [95%CI = 81.5-87.9]), restricting access/ownership under domestic violence restraining orders (88.1%; 95%CI = 84.9-90.7], and removing firearms from older adults with dementia/confusion (80.6%; 95%CI = 76.8-84.0]. Healthcare and policy-level interventions maintained higher support among non-owners than owners (p's < 0.001). Overall, data highlights opportunities exist for more robust firearm safety prevention efforts among older adults, particularly healthcare-based counseling and state/federal policies that focus on addressing lethal means access among at-risk individuals.
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Affiliation(s)
- Patrick M Carter
- Univ of Michigan Injury Prevention Center, 2800 Plymouth Rd, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Health Behavior/Health Education, Univ. of Michigan School of Public Health, 1415 Washington Heights 3790A SPH I, Ann Arbor, MI 48109, United States of America; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd, NCRC 16, Ann Arbor, MI 48109, United States of America.
| | - Eve Losman
- Univ of Michigan Injury Prevention Center, 2800 Plymouth Rd, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America.
| | - Jessica S Roche
- Univ of Michigan Injury Prevention Center, 2800 Plymouth Rd, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America.
| | - Preeti N Malani
- Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd, NCRC 16, Ann Arbor, MI 48109, United States of America; Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States of America.
| | - Jeffrey T Kullgren
- Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd, NCRC 16, Ann Arbor, MI 48109, United States of America; Department of Internal Medicine, University of Michigan, 2800 Plymouth Rd., NCRC 16-330W, Ann Arbor, MI 48019, United States of America; Dept of Health Management/Policy, Univ. of Michigan School of Public Health, 1415 Washington Heights 3790A, SPH I, Ann Arbor, MI 48109, United States of America; Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Rd., Ann Arbor, MI 48105, United States of America.
| | - Erica Solway
- Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd, NCRC 16, Ann Arbor, MI 48109, United States of America.
| | - Matthias Kirch
- Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd, NCRC 16, Ann Arbor, MI 48109, United States of America.
| | - Dianne Singer
- Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd, NCRC 16, Ann Arbor, MI 48109, United States of America; Child Health Evaluation and Research Center, University of Michigan, North Ingalls Building, 300N. Ingalls St., 6th Floor, Ann Arbor, MI 48109, United States of America.
| | - Maureen A Walton
- Univ of Michigan Injury Prevention Center, 2800 Plymouth Rd, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Addiction Center, Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Road, Ann Arbor, MI 48109, United States of America.
| | - April M Zeoli
- School of Criminal Justice, Michigan State University, 655 Auditorium Rd., East Lansing, MI 48824, United States of America.
| | - Rebecca M Cunningham
- Univ of Michigan Injury Prevention Center, 2800 Plymouth Rd, NCRC 10-G080, Ann Arbor, MI 48109, United States of America; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America; Dept of Health Behavior/Health Education, Univ. of Michigan School of Public Health, 1415 Washington Heights 3790A SPH I, Ann Arbor, MI 48109, United States of America; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd, NCRC 16, Ann Arbor, MI 48109, United States of America.
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Affiliation(s)
- Saad B Omer
- Yale Institute for Global Health, New Haven, Connecticut
| | - Preeti N Malani
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, Ann Arbor
- Associate Editor, JAMA
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Affiliation(s)
- Rajesh T Gandhi
- Massachusetts General Hospital, Harvard Medical School, Boston
| | - Preeti N Malani
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, Ann Arbor
- Associate Editor, JAMA
| | - Carlos Del Rio
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Georgia Grady Health System, Atlanta, Georgia
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Affiliation(s)
- Carlos Del Rio
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Saad B Omer
- Yale Institute for Global Health, New Haven, Connecticut
| | - Preeti N Malani
- Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Health System, Ann Arbor
- Associate Editor, JAMA
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44
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Kurlander JE, Kullgren JT, Adams MA, Malani PN, Kirch M, Solway E, Singer DC, Steppe E, Saini SD. Interest in and concerns about telehealth among adults aged 50 to 80 years. Am J Manag Care 2021; 27:415-422. [PMID: 34668670 DOI: 10.37765/ajmc.2021.88759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To describe associations between patient factors and interest in and concerns about telehealth video visits among adults in midlife and older. STUDY DESIGN A cross-sectional, nationally representative panel survey of US adults aged 50 to 80 years (N = 2256) in May 2019. METHODS Multivariable logistic regression was used to estimate the adjusted prevalence of interest in different types of video telehealth visits and concerns about telehealth for individuals with different characteristics. RESULTS Individuals aged 65 to 80 (vs 50-64) years were more likely to be interested in a first-time telehealth visit (37.3% vs 31.5%; P < .05) and to be concerned about not feeling personally connected to their provider (52.8% vs 46.5%; P < .05). Women (vs men) were less likely to be interested in a first-time visit (29.3% vs 38.2%; P < .001) and more likely to be concerned about technical difficulties (52.3% vs 42.1%; P < .001). Black, non-Hispanic individuals (vs White, non-Hispanic individuals) were more likely to be interested in first-time (45.2% vs 29.8%; P < .001) and return (67.7% vs 56.2%; P < .01) visits. Individuals comfortable using video chat (vs never users) were more likely to be interested in a telehealth visit for any reason (all P < .001) and less likely to have concerns about privacy, difficulty seeing/hearing, technical difficulties, not feeling personally connected, and lower quality of care (all P < .01). CONCLUSIONS Interest in and concerns about telehealth vary along the lines of sociodemographic factors and experience using the internet for video communication. These findings have implications for the design of interventions and policies to promote equitable access to health care as it increasingly moves online.
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Affiliation(s)
- Jacob E Kurlander
- University of Michigan, 3912 Taubman Center, 1500 E Medical Center Dr, SPC 5352, Ann Arbor, MI 48109-5362.
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Leggett AN, Carmichael A, Leonard N, Jackson J, Kirch M, Solway E, Kullgren JT, Singer D, Malani PN, Gonzalez R. Care Challenges Due to COVID-19 and Mental Health Among Caregivers of U.S. Adults With a Chronic or Disabling Condition. Innov Aging 2021; 5:igab031. [PMID: 34632106 PMCID: PMC8493889 DOI: 10.1093/geroni/igab031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Indexed: 01/21/2023] Open
Abstract
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.
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Affiliation(s)
- Amanda N Leggett
- Department of Psychiatry, School of Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Alicia Carmichael
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Natalie Leonard
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Jeannette Jackson
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthias Kirch
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Erica Solway
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Jeffrey T Kullgren
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Dianne Singer
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Preeti N Malani
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Richard Gonzalez
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
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Affiliation(s)
- Carlos Del Rio
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
- Hubert Department of Global Health, Rollins School of Public Health of Emory University, Atlanta, Georgia
| | - Preeti N Malani
- Department of Internal Medicine, Division of Infectious Diseases, University of Michigan, Ann Arbor
- Associate Editor, JAMA
| | - Saad B Omer
- Yale Institute for Global Health, New Haven, Connecticut
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Hoffman GJ, Malani PN, Solway E, Kirch M, Singer DC, Kullgren JT. Changes in activity levels, physical functioning, and fall risk during the COVID-19 pandemic. J Am Geriatr Soc 2021; 70:49-59. [PMID: 34536288 DOI: 10.1111/jgs.17477] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 01/21/2023]
Abstract
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.
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Affiliation(s)
- Geoffrey J Hoffman
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Preeti N Malani
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA.,Department of Internal Medicine, Division of Infectious Diseases, University of Michigan, Ann Arbor, Michigan, USA
| | - Erica Solway
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthias Kirch
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Dianne C Singer
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Jeffrey T Kullgren
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA.,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan, USA
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48
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Affiliation(s)
- Shiwei Zhou
- Department of Internal Medicine, Division of Infectious Diseases, University of Michigan, Ann Arbor
| | - Preeti N Malani
- Department of Internal Medicine, Division of Infectious Diseases, University of Michigan, Ann Arbor
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49
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Affiliation(s)
- Adam S Lauring
- Division of Infectious Diseases, University of Michigan, Ann Arbor
| | - Preeti N Malani
- Division of Infectious Diseases, University of Michigan, Ann Arbor
- Associate Editor, JAMA
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Kullgren JT, Malani PN, Kirch M, Singer D, Solway E, Hanauer DA. Use of Online Physician Ratings and Reviews by Older U.S. Adults: Results of a National Survey. Ann Intern Med 2021; 174:1180-1182. [PMID: 33844573 DOI: 10.7326/m20-7600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jeffrey T Kullgren
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, University of Michigan Medical School, University of Michigan School of Public Health, and University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan
| | - Preeti N Malani
- University of Michigan Medical School and University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan
| | - Matthias Kirch
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan
| | - Dianne Singer
- University of Michigan Institute for Healthcare Policy and Innovation and Child Health Evaluation and Research Center at the University of Michigan Medical School, Ann Arbor, Michigan
| | - Erica Solway
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan
| | - David A Hanauer
- University of Michigan Institute for Healthcare Policy and Innovation and University of Michigan Medical School, Ann Arbor, Michigan
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