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Chen S, Nagel CL, Liu R, Botoseneanu A, Allore HG, Newsom JT, Thielke S, Kaye J, Quiñones AR. Mental-somatic multimorbidity in trajectories of cognitive function for middle-aged and older adults. PLoS One 2024; 19:e0303599. [PMID: 38743678 PMCID: PMC11093294 DOI: 10.1371/journal.pone.0303599] [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] [Received: 12/07/2023] [Accepted: 04/26/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION Multimorbidity may confer higher risk for cognitive decline than any single constituent disease. This study aims to identify distinct trajectories of cognitive impairment probability among middle-aged and older adults, and to assess the effect of changes in mental-somatic multimorbidity on these distinct trajectories. METHODS Data from the Health and Retirement Study (1998-2016) were employed to estimate group-based trajectory models identifying distinct trajectories of cognitive impairment probability. Four time-varying mental-somatic multimorbidity combinations (somatic, stroke, depressive, stroke and depressive) were examined for their association with observed trajectories of cognitive impairment probability with age. Multinomial logistic regression analysis was conducted to quantify the association of sociodemographic and health-related factors with trajectory group membership. RESULTS Respondents (N = 20,070) had a mean age of 61.0 years (SD = 8.7) at baseline. Three distinct cognitive trajectories were identified using group-based trajectory modelling: (1) Low risk with late-life increase (62.6%), (2) Low initial risk with rapid increase (25.7%), and (3) High risk (11.7%). For adults following along Low risk with late-life increase, the odds of cognitive impairment for stroke and depressive multimorbidity (OR:3.92, 95%CI:2.91,5.28) were nearly two times higher than either stroke multimorbidity (OR:2.06, 95%CI:1.75,2.43) or depressive multimorbidity (OR:2.03, 95%CI:1.71,2.41). The odds of cognitive impairment for stroke and depressive multimorbidity in Low initial risk with rapid increase or High risk (OR:4.31, 95%CI:3.50,5.31; OR:3.43, 95%CI:2.07,5.66, respectively) were moderately higher than stroke multimorbidity (OR:2.71, 95%CI:2.35, 3.13; OR: 3.23, 95%CI:2.16, 4.81, respectively). In the multinomial logistic regression model, non-Hispanic Black and Hispanic respondents had higher odds of being in Low initial risk with rapid increase and High risk relative to non-Hispanic White adults. CONCLUSIONS These findings show that depressive and stroke multimorbidity combinations have the greatest association with rapid cognitive declines and their prevention may postpone these declines, especially in socially disadvantaged and minoritized groups.
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Affiliation(s)
- Siting Chen
- OHSU-PSU School of Public Health, Portland, Oregon, United States of America
| | - Corey L. Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Ruotong Liu
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Anda Botoseneanu
- Department of Health & Human Services, University of Michigan, Dearborn, Michigan, United States of America
- Institute of Gerontology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Heather G. Allore
- Department of Internal Medicine, Yale University, New Haven, Connecticut, United States of America
- Department of Biostatistics, Yale University, New Haven, Connecticut, United States of America
| | - Jason T. Newsom
- Department of Psychology, Portland State University, Portland, Oregon, United States of America
| | - Stephen Thielke
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, United States of America
| | - Jeffrey Kaye
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Ana R. Quiñones
- OHSU-PSU School of Public Health, Portland, Oregon, United States of America
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
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Bartz-Overman C, Albanese AM, Fan V, Locke ER, Parikh T, Thielke S. Potential Explanatory Factors for the Concurrent Experience of Dyspnea and Pain in Patients with COPD. COPD 2022; 19:282-289. [PMID: 35666540 DOI: 10.1080/15412555.2022.2081540] [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] [Indexed: 10/18/2022]
Abstract
Previous research has identified unexpectedly strong associations between dyspnea and pain, but the reasons remain unclear. Ascertaining the underlying biological and psychological mechanisms might enhance the understanding of the experience of both conditions, and suggest novel treatments. We sought to elucidate whether demographic factors, disease severity, psychological symptoms and biomarkers might account for the association between pain and dyspnea in individuals with COPD. We analyzed data from 301 patients with COPD who were followed in a prospective longitudinal observational study over 2 years. Measures included self-reported dyspnea and pain, pulmonary function tests, serum levels of inflammatory cytokines, measures of physical deconditioning, and scales for depression and anxiety. Analyses involved cross-sectional and longitudinal linear regression models. Pain and dyspnea were strongly correlated cross-sectionally (r = 0.77, 95% CI 0.72-0.82) and simultaneously across time (r = 0.42, 95% CI 0.28-0.56). Accounting for any of the other health factors only slightly mitigated the associations. Symptoms of pain and dyspnea thus may be fundamentally linked in COPD, rather than being mediated by common biological, psychological, or functional factors. From the patient's perspective, pain and dyspnea may be part of the same essential experience. It is possible that treatments for one condition would improve the other.
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Affiliation(s)
| | - Anita M Albanese
- University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada, USA
| | - Vincent Fan
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Emily R Locke
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Toral Parikh
- Seattle-Denver Center of Innovation for Veteran-Centered & Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington, USA.,Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Stephen Thielke
- Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Psychiatry, University of Washington, Seattle, Washington, USA
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Nagel C, Allore H, Newsom J, Botoseneanu A, Dorr D, Thielke S, Kaye J, Quiñones A. Joint Trajectories of Multimorbidity, Function, Cognition, and Depression in the HRS (1998-2016). Innov Aging 2021. [PMCID: PMC8680577 DOI: 10.1093/geroni/igab046.2345] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
There is substantial heterogeneity in the impact of multimorbidity on functional, cognitive, and emotional health. Few studies, however, have examined this simultaneously across these multiple domains. We used finite mixture modeling to identify latent clusters of individuals following similar joint trajectories of multimorbidity, functional ability, cognitive performance, and depressive symptoms among 11,841 HRS respondents aged 65+ from 1998 to 2014. We identified four distinct clusters of joint trajectories: (1) 32.5% of the sample were characterized by low multimorbidity (mean = 0.60 conditions at age 65; 2.2 conditions at age 90), minimal deterioration in functional or cognitive ability, and low depressive symptoms; (2) 33.5%, had increased multimorbidity compared with the first group (mean = 2.3 at age 65; 4.0 at age 90) but minimal functional or cognitive impairment and low depressive symptoms; (3) 19.9%, had relatively low multimorbidity (mean = 1.3 at age 65 increasing to 2.8 at age 90), but exhibited worsening cognitive performance, increasing functional limitations, and moderate depressive symptoms ; and (4) 14.1%, had higher multimorbidity (mean = 3.3 at age 65 increasing to 4.6 at age 90), worsening cognitive performance, substantial functional limitation, and high depressive symptoms. Black and Hispanic race/ethnicity, lower levels of income and education, male gender, and smoking history were significantly associated with membership in classes characterized by higher multimorbidity, cognitive and functional impairment, and greater depressive symptoms. This study provides insight into the heterogenous trajectories of aging and helps identify older individuals at higher risk for poor aging outcomes across multiple health domains.
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Affiliation(s)
- Corey Nagel
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Heather Allore
- Yale School of Medicine, New Haven, Connecticut, United States
| | - Jason Newsom
- Portland State University, Portland, Oregon, United States
| | - Anda Botoseneanu
- University of Michigan - Dearborn, Dearborn, Michigan, United States
| | - David Dorr
- Oregon Health & Science University, Portland, Oregon, United States
| | - Stephen Thielke
- University of Washington, University of Washington, Washington, United States
| | - Jeffrey Kaye
- Oregon Health & Science University, Portland, Oregon, United States
| | - Ana Quiñones
- Oregon Health & Science University, Portland, Oregon, United States
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4
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Hwang PH, Longstreth W, Thielke S, Francis CE, Carone M, Kuller LH, Fitzpatrick AL. Longitudinal changes in hearing and visual impairments associated with risk of dementia in older adults: The Cardiovascular Health Study. Alzheimers Dement 2021. [DOI: 10.1002/alz.049110] [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] [Indexed: 11/10/2022]
Affiliation(s)
| | | | - Stephen Thielke
- University of Washington Seattle WA USA
- VAPSHCS/GRECC Seattle WA USA
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5
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Sale JEM, Gignac M, Frankel L, Thielke S, Bogoch E, Elliot-Gibson V, Hawker G, Funnell L. Perspectives of patients with depression and chronic pain about bone health after a fragility fracture: A qualitative study. Health Expect 2021; 25:177-190. [PMID: 34580957 PMCID: PMC8849261 DOI: 10.1111/hex.13361] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 08/11/2021] [Accepted: 08/31/2021] [Indexed: 11/05/2022] Open
Abstract
Background Compromised bone health is often associated with depression and chronic pain. Objective To examine: (1) the experience of existing depression and chronic nonfracture pain in patients with a fragility fracture; and (2) the effects of the fracture on depression and pain. Design A phenomenological study guided by Giorgi's analytical procedures. Setting and Participants Fracture patients who reported taking prescription medication for one or more comorbidities, excluding compromised bone health. Main Variables Studied Patients were interviewed within 6 weeks of their fracture, and 1 year later. Interview questions addressed the recent fracture and patients' experience with bone health and their other health conditions, such as depression and chronic pain, including the medications taken for these conditions. Results Twenty‐six patients (5 men, 21 women) aged 45–84 years old with hip (n = 5) and nonhip (n = 21) fractures were recruited. Twenty‐one participants reported depression and/or chronic nonfracture pain, of which seven reported having both depression and chronic pain. Two themes were consistent, based on our analysis: (1) depression and chronic pain overshadowed attention to bone health; and (2) the fracture exacerbated reported experiences of existing depression and chronic pain. Conclusion Experiences with depression and pain take priority over bone health and may worsen as a result of the fracture. Health care providers treating fragility fractures might ask patients about depression and pain and take appropriate steps to address patients' more general emotional and physical state. Patient Contribution A patient representative was involved in the study conception, data interpretation and manuscript writing.
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Affiliation(s)
- Joanna E M Sale
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Lucy Frankel
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Stephen Thielke
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Earl Bogoch
- Department of Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada.,Brookfield Chair, Toronto, Ontario, Canada
| | - Victoria Elliot-Gibson
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Gillian Hawker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Abstract
OBJECTIVE This study investigated the associations between various financial hardship and debt indicators and mental health status among older adults. METHODS Using data from the Health and Retirement Study (HRS), we considered the association between different forms of financial hardship and debt of those who were identified as having high levels of depressive symptoms (N = 7678) and anxiety (N = 8079). Financial hardship indicators: difficulty paying bills, food insecurity, and medication need; debt indicators: credit card and medical debt. Associations were tested using multiple logistic regression analyses and are reported as relative risk (RR) ratios and 95% confidence intervals (CIs). RESULTS Participants who had difficulty paying bills were more likely to have high levels of depressive symptoms (RR = 2.06, CI = 1.75-2.42, p < 0.001) and anxiety (RR = 1.46, CI = 1.02-2.05, p < 0.001) compared to those who did not have financial difficulty. Similarly, medical debt was associated with depressive symptoms (RR = 1.43, CI = 1.14-1.74, p < 0.01) and anxiety (RR = 1.20, CI = 0.96-1.50, p < 0.01). Credit card debt was not significantly associated with either mental health outcome. CONCLUSION Indicators of financial hardship and medical debt were associated with depressive symptoms and anxiety in a cohort of older adults. In contrast, the influence of credit card debt appeared to be more complex and vary by individual. These findings indicate that doing without meeting personal salient needs has a particularly adverse effect on psychological well-being.
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Affiliation(s)
| | - Eva Kahana
- Department of Sociology, Case Western Reserve University, Cleveland, OH, USA
| | - William T Gallo
- Department of Health Policy and Management, City University of New York, New York, NY, USA
| | - Kim L Stansbury
- Department of Social Work, North Carolina State University, Raleigh, NC, USA
| | - Stephen Thielke
- Department of Psychiatry and Behavioral Sciences, University of Washington, Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, Seattle, WA, USA
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7
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Andersen SL, Sweigart B, Glynn NW, Wojczynski MK, Thyagarajan B, Mengel-From J, Thielke S, Perls TT, Libon DJ, Au R, Cosentino S, Sebastiani P. Digital Technology Differentiates Graphomotor and Information Processing Speed Patterns of Behavior. J Alzheimers Dis 2021; 82:17-32. [PMID: 34219735 DOI: 10.3233/jad-201119] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Coupling digital technology with traditional neuropsychological test performance allows collection of high-precision metrics that can clarify and/or define underlying constructs related to brain and cognition. OBJECTIVE To identify graphomotor and information processing trajectories using a digitally administered version of the Digit Symbol Substitution Test (DSST). METHODS A subset of Long Life Family Study participants (n = 1,594) completed the DSST. Total time to draw each symbol was divided into 'writing' and non-writing or 'thinking' time. Bayesian clustering grouped participants by change in median time over intervals of eight consecutively drawn symbols across the 90 s test. Clusters were characterized based on sociodemographic characteristics, health and physical function data, APOE genotype, and neuropsychological test scores. RESULTS Clustering revealed four 'thinking' time trajectories, with two clusters showing significant changes within the test. Participants in these clusters obtained lower episodic memory scores but were similar in other health and functional characteristics. Clustering of 'writing' time also revealed four performance trajectories where one cluster of participants showed progressively slower writing time. These participants had weaker grip strength, slower gait speed, and greater perceived physical fatigability, but no differences in cognitive test scores. CONCLUSION Digital data identified previously unrecognized patterns of 'writing' and 'thinking' time that cannot be detected without digital technology. These patterns of performance were differentially associated with measures of cognitive and physical function and may constitute specific neurocognitive biomarkers signaling the presence of subtle to mild dysfunction. Such information could inform the selection and timing of in-depth neuropsychological assessments and help target interventions.
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Affiliation(s)
- Stacy L Andersen
- Geriatrics Section, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Benjamin Sweigart
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Nancy W Glynn
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary K Wojczynski
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Jonas Mengel-From
- Institute of Public Health, Epidemiology, Biostatistics and Biodemography Unit, University of Southern Denmark, Odense, Denmark
| | - Stephen Thielke
- Geriatric Research, Education, and Clinical Center, Puget Sound VA Medical Center, Seattle, WA, USA
| | - Thomas T Perls
- Geriatrics Section, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - David J Libon
- New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Stratford, NJ, USA
| | - Rhoda Au
- Department of Anatomy and Neurobiology and Neurology, Boston University School of Medicine, Boston, MA, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Stephanie Cosentino
- Cognitive Neuroscience Division of the Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA.,Gertrude H. Sergievsky Center, Columbia University, New York, NY, USA
| | - Paola Sebastiani
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
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Bryson WC, Piel J, Thielke S. Associations Between Parole, Probation, Arrest, and Self-reported Suicide Attempts. Community Ment Health J 2021; 57:727-735. [PMID: 32860595 DOI: 10.1007/s10597-020-00704-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/21/2020] [Indexed: 11/30/2022]
Abstract
This study estimated the associations between three categories of recent community criminal justice (CJ) involvement (arrest, parole, and probation) and suicide attempts, while accounting for how the categories overlap. Participants included adults aged ≥ 18 who completed the 2008-2014 National Surveys on Drug Use and Health. The outcome was self-reported suicide attempt(s) in the past 12 months (in the community or while incarcerated). Community CJ involvement included parole, probation, and/or arrest(s) during the past 12 months. Controls with no recent CJ involvement were matched to those with any recent involvement on demographics and education. We calculated the 12-month prevalence of suicide attempts for those reporting recent parole, probation, and arrest, including their overlaps. Logistic regression models estimated the associations between each category of recent CJ involvement and suicide attempts, controlling for their overlapping and covariates. There were 15,462 participants with recent community CJ involvement and 248,520 matched controls. The 12-month prevalence of suicide attempts was 3.2% for those with recent parole, 2.7% for probation, and 3.3% for arrest, which were all greater than the matched controls (1.0%, p < 0.001 for each). After controlling for overlapping and covariates, arrest was associated with suicide attempts (RR = 1.80, 99% CI 1.47-2.19), but neither parole (RR = 1.00, 99% CI 0.64-1.56) nor probation (RR = 0.81, 99% CI 0.61-1.08) were. Adults with recent arrest had higher risk of suicide attempts than those with parole, probation, or matched controls with no CJ involvement. Recent arrest may signify elevated risk and warrant increased screening and intervention.
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Affiliation(s)
- William C Bryson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA. .,Mental Health Service, VA Puget Sound Health Care System, Seattle, WA, USA.
| | - Jennifer Piel
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.,Mental Health Service, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Stephen Thielke
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.,Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA
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Abstract
Little research has characterized the natural history of weight change in older adults. Different changes may occur during aging and dying. We analyzed 18 years of weight measures from a cohort of 736,361 Veterans, all of whom had died at age 70 or older. We produced summary measures that accounted for both chronological age and number of years before death. Several clear population-level trends appeared. (1) The average weight of the sample declined across all ages at a rate of about 0.18 BMI points per year. (2) Starting about seven years before death, the amount of loss began to accelerate, reaching a decline of 0.75 BMI points in the year before death. (3) Changes in weight relative to years of remaining life were independent of chronologic age. People who died at age 70 experienced, on average, the same type and duration of terminal decline as did those who died at age 95. (4) The dying process involved a cumulative loss of about 1.3 BMI points. (5) The distribution of weights during advancing age both declined and narrowed. (6) Disproportionate deaths occurred at the lower BMI ranges (below a BMI of 24), and especially below 18, regardless of age. (7) The finding in #5 is explained by the entire cohort losing weight, with death of the thinnest members. These findings argue for examining survival time in studies of weight change. They indicate that weight loss may be a natural part of dying, rather than a risk factor for it.
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Affiliation(s)
- Stephen Thielke
- University of Washington, Seattle, Washington, United States
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10
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Barczi S, Gately M, Welch L, Nearing K, Thielke S, Pimentel C, Previll L, Dryden E. Spreading Telehealth for Older Adults in Rural Areas Through Network of Geriatric Interprofessional Teams. Innov Aging 2020. [PMCID: PMC7743215 DOI: 10.1093/geroni/igaa057.2885] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Older adults living in rural areas have limited access to geriatrics interprofessional team care. In the Veteran healthcare system, geriatric teams such as geriatricians, nursing professionals, social workers, pharmacists and psychologists, located in urban areas link up with rural clinics to provide geriatric consultation remotely through clinical video telehealth and other means in the project GRECC Connect. Since its inception in 2014, the service has now grown to 16 geriatric teams offering consultation to over 100 clinic sites serving older rural Veterans. GRECC Connect delivered over 2,000 consultations in 2019, meeting complex care needs by identifying and linking geriatric services and management to patients with geriatric syndromes. The network of established geriatric teams, local champions and a shared Electronic Health Record facilitated the spread, while ongoing effort to build and maintain relationships between consultants and local rural provider teams and other community based services are important for ongoing success.
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Affiliation(s)
- Steven Barczi
- University of Wisconsin, Madison; William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, United States
| | - Megan Gately
- Bedford VA Medical Center, Bedford, Massachusetts, United States
| | - Lauren Welch
- William S Middleton VAMC GRECC, Madison, Wisconsin, United States
| | - Kathryn Nearing
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Stephen Thielke
- VA Puget Sound Health Care System, Seattle, Washington, United States
| | - Camilla Pimentel
- Edith Nourse Rogers Memorial Veterans Hospital, Center for Heallthcare Organization and Implementation research, Bedford, Massachusetts, United States
| | - Laura Previll
- Duke University School of Medicine, Durham, North Carolina, United States
| | - Eileen Dryden
- Center for Health Care Implementation Research (CHOIR), Bedford, Maryland, United States
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11
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Quinones A, Chen S, Botoseneanu A, Allore H, Newsom J, Thielke S, Kaye J. Change in Cognitive Performance by Race or Ethnicity and Multimorbidity Among Older Americans. Innov Aging 2020. [PMCID: PMC7740553 DOI: 10.1093/geroni/igaa057.1054] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Understanding factors that influence cognitive performance remain critical priorities, particularly among racial/ethnic groups that have higher prevalence of dementia. This study assesses race/ethnic (non-Hispanic white, non-Hispanic black, Hispanic) differences in cognitive performance in adjusted models accounting for co-existing self-reported chronic conditions (arthritis, diabetes, cancer, depressive symptoms, cardiovascular disease, hypertension, lung disease, osteoporosis, stroke), age, sex, education, and income. Data from the 2011-2017 National Health and Aging Trends Study (NHATS), a nationally-representative sample of Medicare beneficiaries (N=7,041, mean age=77.5), were used to estimate a series of cross-sectional multivariable linear regressions to evaluate race/ethnic differences in cognitive performance scores on the NHATS cognitive composite test of memory, orientation, and executive function domains (range 0-33) over seven years. In adjusted models, black participants had lower cognitive scores relative to white participants in 2011 (b=-2.25, 95% CI[-2.52, -1.98]) and by the end of the observation period in 2017 (b=-3.24, 95% CI[-3.72, -2.76]). Similarly, Hispanic participants experienced lower cognitive scores relative to white participants in 2011 (b=-2.31, 95% CI[-2.77, -1.84]) which persisted to the end of the observation window (b=-2.77, 95% CI[-3.66, -1.89]). Racial/ethnic groups had significantly lower cognitive scores relative to white Medicare beneficiaries over seven years of assessment. These analyses build toward longitudinal analyses of repeated observations of cognitive performance. Given the broad clinical and policy implications involved in caring for persons with dementia, it will be important to intervene earlier on modifiable risk factors to postpone cognitive declines among older minority ethnic adults.
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Affiliation(s)
- Ana Quinones
- Oregon Health & Science University, Portland, Oregon, United States
| | - Siting Chen
- OHSU-PSU School of Public Health, Portland, Oregon, United States
| | | | | | - Jason Newsom
- Portland State University, Portland, Oregon, United States
| | - Stephen Thielke
- University of Washington, Seattle, Washington, United States
| | - Jeffrey Kaye
- Layton Alzheimer's Disease Center, Portland, Oregon, United States
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12
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Thielke S, Fredrickson K. Telegroup Visits for Caregivers and Patients With Dementia. Innov Aging 2020. [PMCID: PMC7743288 DOI: 10.1093/geroni/igaa057.2284] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Group visits have shown promise for caregiver support and medical management of patients with dementia. In-person visits can be challenging to schedule and complete, particularly in rural areas where there are few specialists. We describe our experience with using telehealth modalities to hold group dementia visits. For the last four years, we have held telegroup appointments with Veterans with dementia and their caregivers. A geriatric psychiatrist and geriatric social worker appear from the main facility, and the Veterans and caregivers are at remote sites. Participants have actively engaged. They have expressed that the structure allows them to support and be supported by peers, and to have frequent contact with care providers. This has led to improved care metrics. The technology requirements are minimal. We discuss the advantages of this approach, including flexibility and maximizing use of specialist resources. We address challenges to scaling up such programs.
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Affiliation(s)
- Stephen Thielke
- VA Puget Sound Health Care System, Seattle, Washington, United States
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13
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Hwang PH, Longstreth WT, Thielke S, Francis CE, Carone M, Fitzpatrick AL. Associations between ophthalmic conditions and risk of dementia in older adults. Alzheimers Dement 2020. [DOI: 10.1002/alz.040775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Black M, LaCroix R, Ritchey K, Herring D, Thielke S. How to Ensure That Teaching Kitchens Are Age-Friendly. J Nutr Educ Behav 2020; 52:187-194. [PMID: 32036997 DOI: 10.1016/j.jneb.2019.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 11/01/2019] [Accepted: 11/05/2019] [Indexed: 06/10/2023]
Abstract
Health systems and community organizations have increasingly offered nutrition education through teaching kitchens. With an increasing number of older adults (>65 years) accessing these programs, teaching kitchens may consider age-friendly adaptations to their standard curriculum. Based on experiences with implementing Healthy Teaching Kitchens Across Veteran Affairs Health Care System, and by applying the 5M Geriatric Care Framework (Mind, Multicomplexity, Medications, Mobility, What Matters Most), several steps are proposed for teaching kitchens to be able to better accommodate older adults.
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Affiliation(s)
- Marissa Black
- Division of Gerontology and Geriatric Medicine, Geriatric Research Education and Clinical Center, Puget Sound Veterans Affairs Medical Center and University of Washington, Seattle, WA.
| | - Robin LaCroix
- White River Junction Veterans Affairs Medical Center, White River Junction, VT
| | - Katherine Ritchey
- Division of Gerontology and Geriatric Medicine, Geriatric Research Education and Clinical Center, Puget Sound Veterans Affairs Medical Center and University of Washington, Seattle, WA; Division of Gerontology and Geriatric Medicine, Puget Sound Veteran Affairs, Seattle, WA
| | - Dana Herring
- Phoenix Veteran Affairs Health Care System, Phoenix, AZ
| | - Stephen Thielke
- Division of Gerontology and Geriatric Medicine, Geriatric Research Education and Clinical Center, Puget Sound Veterans Affairs Medical Center and University of Washington, Seattle, WA; Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
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Black M, LaCroix R, Hoerster K, Chen S, Ritchey K, Souza M, Utech A, Thielke S. Healthy Teaching Kitchen Programs: Experiential Nutrition Education Across Veterans Health Administration, 2018. Am J Public Health 2019; 109:1718-1721. [PMID: 31622156 DOI: 10.2105/ajph.2019.305358] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Traditional clinical interventions yield few positive effects on diet. The Healthy Teaching Kitchen (HTK) program implemented by the Veterans Health Administration at sites across the United States delivers interactive nutrition and culinary education, guided instruction, and social opportunities for patients and caregivers. We report HTK outcomes of veterans' self-reported acceptability, self-efficacy for dietary change, and dietary and cooking habits. The HTK program is acceptable and feasible and may empower participants to improve health.
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Affiliation(s)
- Marissa Black
- Marissa Black, Sunny Chen, Katherine Ritchey, and Stephen Thielke are with the Geriatric Research Education and Clinical Center, Puget Sound Veterans Affairs Medical Center, Seattle, WA. Katherine Hoerster is with the Research and Development Service, Puget Sound Veterans Affairs Medical Center, Seattle, WA. Robin LaCroix, Melanya Souza, and Anne Utech are with Nutrition and Food Service, Veterans Health Administration, Department of Veterans Affairs, Washington, DC
| | - Robin LaCroix
- Marissa Black, Sunny Chen, Katherine Ritchey, and Stephen Thielke are with the Geriatric Research Education and Clinical Center, Puget Sound Veterans Affairs Medical Center, Seattle, WA. Katherine Hoerster is with the Research and Development Service, Puget Sound Veterans Affairs Medical Center, Seattle, WA. Robin LaCroix, Melanya Souza, and Anne Utech are with Nutrition and Food Service, Veterans Health Administration, Department of Veterans Affairs, Washington, DC
| | - Katherine Hoerster
- Marissa Black, Sunny Chen, Katherine Ritchey, and Stephen Thielke are with the Geriatric Research Education and Clinical Center, Puget Sound Veterans Affairs Medical Center, Seattle, WA. Katherine Hoerster is with the Research and Development Service, Puget Sound Veterans Affairs Medical Center, Seattle, WA. Robin LaCroix, Melanya Souza, and Anne Utech are with Nutrition and Food Service, Veterans Health Administration, Department of Veterans Affairs, Washington, DC
| | - Sunny Chen
- Marissa Black, Sunny Chen, Katherine Ritchey, and Stephen Thielke are with the Geriatric Research Education and Clinical Center, Puget Sound Veterans Affairs Medical Center, Seattle, WA. Katherine Hoerster is with the Research and Development Service, Puget Sound Veterans Affairs Medical Center, Seattle, WA. Robin LaCroix, Melanya Souza, and Anne Utech are with Nutrition and Food Service, Veterans Health Administration, Department of Veterans Affairs, Washington, DC
| | - Katherine Ritchey
- Marissa Black, Sunny Chen, Katherine Ritchey, and Stephen Thielke are with the Geriatric Research Education and Clinical Center, Puget Sound Veterans Affairs Medical Center, Seattle, WA. Katherine Hoerster is with the Research and Development Service, Puget Sound Veterans Affairs Medical Center, Seattle, WA. Robin LaCroix, Melanya Souza, and Anne Utech are with Nutrition and Food Service, Veterans Health Administration, Department of Veterans Affairs, Washington, DC
| | - Melanya Souza
- Marissa Black, Sunny Chen, Katherine Ritchey, and Stephen Thielke are with the Geriatric Research Education and Clinical Center, Puget Sound Veterans Affairs Medical Center, Seattle, WA. Katherine Hoerster is with the Research and Development Service, Puget Sound Veterans Affairs Medical Center, Seattle, WA. Robin LaCroix, Melanya Souza, and Anne Utech are with Nutrition and Food Service, Veterans Health Administration, Department of Veterans Affairs, Washington, DC
| | - Anne Utech
- Marissa Black, Sunny Chen, Katherine Ritchey, and Stephen Thielke are with the Geriatric Research Education and Clinical Center, Puget Sound Veterans Affairs Medical Center, Seattle, WA. Katherine Hoerster is with the Research and Development Service, Puget Sound Veterans Affairs Medical Center, Seattle, WA. Robin LaCroix, Melanya Souza, and Anne Utech are with Nutrition and Food Service, Veterans Health Administration, Department of Veterans Affairs, Washington, DC
| | - Stephen Thielke
- Marissa Black, Sunny Chen, Katherine Ritchey, and Stephen Thielke are with the Geriatric Research Education and Clinical Center, Puget Sound Veterans Affairs Medical Center, Seattle, WA. Katherine Hoerster is with the Research and Development Service, Puget Sound Veterans Affairs Medical Center, Seattle, WA. Robin LaCroix, Melanya Souza, and Anne Utech are with Nutrition and Food Service, Veterans Health Administration, Department of Veterans Affairs, Washington, DC
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16
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Andersen SL, Sweigart B, Cosentino S, Wojczynski MK, Glynn NW, Thyagarajan B, Mengel-From J, Thielke S, Perls TT, Sebastiani P. P4-602: DIGITAL TECHNOLOGY IDENTIFIES DISTINCT PERFORMANCE PATTERNS ON THE DIGIT SYMBOL SUBSTITUTION TEST AMONG COGNITIVELY HEALTHY ADULTS. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.08.150] [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] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Thomas T. Perls
- Boston University School of Medicine; Boston MA USA
- Boston Medical Center; Boston MA USA
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17
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Hwang PH, Longstreth WT, Francis CE, Thielke S, Fitzpatrick AL. DUAL SENSORY IMPAIRMENT IN OLDER ADULTS AND RISK OF DEMENTIA AND ALZHEIMER'S DISEASE. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.4527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Quiñones AR, Markwardt S, Thielke S, Rostant O, Vásquez E, Botoseneanu A. Prospective Disability in Different Combinations of Somatic and Mental Multimorbidity. J Gerontol A Biol Sci Med Sci 2019; 73:204-210. [PMID: 28541396 DOI: 10.1093/gerona/glx100] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [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: 01/27/2017] [Accepted: 05/23/2017] [Indexed: 11/14/2022] Open
Abstract
Background Multimorbidity (multiple co-occurring chronic conditions) may be an important contributor to disability and poor health-related quality of life. The functional consequences of specific combinations of somatic and mental health conditions are unclear. Methods Nationally representative prospective cohort study using the National Health and Aging Trends Study data of Medicare beneficiaries. We included 4,017 participants aged 65 years or older interviewed in 2013 and 2014. The primary outcome was prospective activities of daily living (ADL)-instrumental ADL (IADL) index (range = 0-11) assessed in 2014. All other measures were assessed in 2013. Chronic conditions included heart disease, hypertension, stroke, diabetes, arthritis, lung disease, osteoporosis, cancer, depression, and cognitive impairment. Analyses were adjusted for age, sex, education, race/ethnicity, body mass index, and baseline ADL-IADL. Results Thirty-four percent of multimorbidity combinations included depression, cognitive impairment, or both. Relative to multimorbidity combinations of exclusively somatic conditions, combinations that included both depression and cognitive impairment were associated with 1.34 times greater ADL-IADL in adjusted models (95% confidence interval [CI]: 1.09, 1.64). Relative to combinations of both depression and cognitive impairment, combinations of cognitive impairment and somatic conditions were associated with 0.84 times lower ADL-IADL in adjusted models (95% CI: 0.74, 0.96); combinations of depression and somatic conditions were associated with 0.72 times lower ADL-IADL in adjusted models (95% CI: 0.62, 0.85). Conclusions Depression and/or cognitive impairment was identified in one-third of older adults with multimorbidity, and these combinations were associated with substantially greater prospective disability than combinations comprised exclusively of somatic conditions. This argues for identifying and managing mental health conditions that co-occur with somatic conditions.
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Affiliation(s)
- Ana R Quiñones
- Oregon Health & Science University, OHSU-PSU School of Public Health, Portland
- VA Portland Health Care System, Oregon
| | - Sheila Markwardt
- Oregon Health & Science University, OHSU-PSU School of Public Health, Portland
| | - Stephen Thielke
- VA Puget Sound Health Care System, Geriatric Research, Education, and Clinical Center, Seattle, Washington
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Ola Rostant
- National Institute on Aging, Intramural Research Program, Baltimore, Maryland
| | | | - Anda Botoseneanu
- University of Michigan-Dearborn, Health Policy Studies
- Institute of Gerontology, University of Michigan
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Stuart RB, Thielke S. Conditional Permission to Not Resuscitate: A Middle Ground for Resuscitation. J Am Med Dir Assoc 2019; 20:679-682. [PMID: 30826272 DOI: 10.1016/j.jamda.2019.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 09/27/2018] [Revised: 01/02/2019] [Accepted: 01/03/2019] [Indexed: 11/25/2022]
Abstract
Every decision to perform or withhold cardiopulmonary resuscitation (CPR) has ethical implications that are not always well understood. Value-based decisions with far-reaching consequences are made rapidly, based on incomplete or possibly inaccurate information. For some patients, skilled, timely CPR can restore spontaneous circulation, but for others, success may either be unobtainable or bring serious iatrogenic consequences. Because CPR is an aggressive process yielding mixed results, patients must be informed about the likelihood of its positive and adverse outcomes. In considering whether to accept or refuse it, patients should also be given a realistic set of alternatives. Current protocols limit patients' options by restricting them to a choice between accepting or refusing CPR. Adding a "middle" code, DNAR-X (Do Not Attempt Resuscitation-Except), significantly expands patients' right to control what happens to their bodies by allowing them to stipulate CPR in some circumstances but not in others.
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Affiliation(s)
- Richard B Stuart
- Swedish Edmonds Hospital, Samish Island Volunteer Fire Department, Bow, WA; Department of Psychiatry, University of Washington, Seattle, WA.
| | - Stephen Thielke
- Department of Psychiatry, University of Washington, Seattle, WA; Geriatric Research, Education, and Clinical Center, Puget Sound VA Medical Center, Seattle, WA
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20
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Thielke S. Scientific Autobiography. Am J Geriatr Psychiatry 2019; 27:175-177. [PMID: 30581141 DOI: 10.1016/j.jagp.2018.12.008] [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] [Received: 12/06/2018] [Accepted: 12/06/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Stephen Thielke
- Department of Psychiatry and Behavioral Sciences, University of Washington; Geriatric Research, Education, and Clinical Center, Puget Sound VA Medical Center.
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21
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Wiechers I, Epstein-Lubow G, Thielke S. Engage for Change: The Imperative to Increase Our Efforts in Geriatric Mental Health Policy. Am J Geriatr Psychiatry 2019; 27:97-99. [PMID: 30558850 DOI: 10.1016/j.jagp.2018.12.006] [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] [Received: 12/06/2018] [Accepted: 12/06/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Ilse Wiechers
- Department of Psychiatry, Yale University School of Medicine; Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs.
| | - Gary Epstein-Lubow
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University; Department of Health Services, Policy and Practice, Brown University School of Public Health; Department of Psychiatry, Harvard Medical School; Center for Memory Health at Hebrew SeniorLife
| | - Stephen Thielke
- Department of Psychiatry and Behavioral Sciences, University of Washington; Geriatric Research, Education, and Clinical Center, Puget Sound VA Medical Center
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22
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Trittschuh EH, Tyrrell CJ, Shofer JB, Thielke S. MEMORY SKILLS GROUP FOR OLDER VETERANS WITH COGNITIVE CONCERNS AND PTSD. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1431] [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] [Indexed: 11/12/2022] Open
Affiliation(s)
- E H Trittschuh
- University of Washington/ GRECC VA Puget Sound HCS, Seattle, Washington, United States
| | - C J Tyrrell
- VA Puget Sound Health Care System, Seattle, WA, USA
| | - J B Shofer
- VA Puget Sound Health Care System, Seattle, WA, USA
| | - S Thielke
- VA Puget Sound Health Care System, Seattle, WA, USA
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23
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Yashin AI, Arbeev KG, Wu D, Arbeeva LS, Bagley O, Stallard E, Kulminski AM, Akushevich I, Fang F, Wojczynski MK, Christensen K, Newman AB, Boudreau RM, Province MA, Thielke S, Perls TT, An P, Elo I, Ukraintseva SV. Genetics of Human Longevity From Incomplete Data: New Findings From the Long Life Family Study. J Gerontol A Biol Sci Med Sci 2018; 73:1472-1481. [PMID: 30299504 PMCID: PMC6175028 DOI: 10.1093/gerona/gly057] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 08/18/2017] [Indexed: 02/04/2023] Open
Abstract
The special design of the Long Life Family Study provides a unique opportunity to investigate the genetics of human longevity by analyzing data on exceptional lifespans in families. In this article, we performed two series of genome wide association studies of human longevity which differed with respect to whether missing lifespan data were predicted or not predicted. We showed that the use of predicted lifespan is most beneficial when the follow-up period is relatively short. In addition to detection of strong associations of SNPs in APOE, TOMM40, NECTIN2, and APOC1 genes with longevity, we also detected a strong new association with longevity of rs1927465, located between the CYP26A1 and MYOF genes on chromosome 10. The association was confirmed using data from the Health and Retirement Study. We discuss the biological relevance of the detected SNPs to human longevity.
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Affiliation(s)
- Anatoliy I Yashin
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, North Carolina,Address correspondence to: Anatoliy I. Yashin, PhD, Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, North Carolina. E-mail:
| | - Konstantin G Arbeev
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, North Carolina
| | - Deqing Wu
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, North Carolina
| | - Liubov S Arbeeva
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Olivia Bagley
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, North Carolina
| | - Eric Stallard
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, North Carolina
| | - Alexander M Kulminski
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, North Carolina
| | - Igor Akushevich
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, North Carolina
| | - Fang Fang
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, North Carolina
| | - Mary K Wojczynski
- Department of Genetics, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Kaare Christensen
- Department of Epidemiology, University of Southern Denmark, Odense, Denmark
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert M Boudreau
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael A Province
- Department of Genetics, Washington University in St Louis, St Louis, Missouri
| | | | - Thomas T Perls
- Medical Center, Boston University, Boston, Massachusetts
| | - Ping An
- Department of Genetics, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Irma Elo
- Department of Sociology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Svetlana V Ukraintseva
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, North Carolina
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24
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Sale JE, Thielke S. Qualitative research is a fundamental scientific process. J Clin Epidemiol 2018; 102:129-133. [DOI: 10.1016/j.jclinepi.2018.04.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 03/19/2018] [Accepted: 04/02/2018] [Indexed: 11/26/2022]
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Abstract
UNLABELLED Little is known about long-term pain after a fragility fracture. In this secondary analysis, we determined that pain continues to influence many patients' lives more than 1 year after a fracture and that health care providers do not seem to adequately recognize or manage these long-term consequences. INTRODUCTION We characterized perspectives on long-term pain among men and women who had sustained a fragility fracture. METHODS We conducted a secondary analysis of qualitative data from 67 individuals recruited in three primary studies (47-89 years old; 55 women, 12 men). Eligible individuals from the primary studies were those who had reported pain related to their fracture beyond 6 months. Data about reported pain were re-analyzed using qualitative description as articulated by Sandelowski. RESULTS Thirty-four individuals (47-89 years old; 4 men; 8 had sustained a vertebral fracture) reported pain related to their fracture in the primary studies. Thirty-one (91%) participants had sustained a fragility fracture at least 1 year previously (range 1-13 years). Patients described long-term pain beyond typical fracture healing times, generally unrelieved by analgesics, which affected their mobility, functional activity, independence, sleep, and energy. Health care providers were perceived to under-estimate timelines regarding the decrease of post-fracture pain and to not manage that pain. Participants reported that pain management was inadequate and that they developed their own strategies to respond to it. CONCLUSIONS Pain continues to influence many patients' lives more than 1 year after a fragility fracture. Patient narratives could be useful to help health care providers to better recognize and manage this long-term consequence of fractures.
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Affiliation(s)
- A Gheorghita
- Institute of Health Policy, Management & Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada
| | - F Webster
- Institute of Health Policy, Management & Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada
| | - S Thielke
- Geriatric Research Education and Clinical Center, Puget Sound VA Medical Center, Seattle, WA, 98108, USA
| | - J E M Sale
- Institute of Health Policy, Management & Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada.
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
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Stuart RB, Thielke S. Protocol for the Assessment of Patient Capacity to Make End-of-Life Treatment Decisions. J Am Med Dir Assoc 2018; 19:106-109. [DOI: 10.1016/j.jamda.2017.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/06/2017] [Accepted: 11/09/2017] [Indexed: 11/30/2022]
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27
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Renn BN, Asghar-Ali AA, Thielke S, Catic A, Martini SR, Mitchell BG, Kunik ME. A Systematic Review of Practice Guidelines and Recommendations for Discontinuation of Cholinesterase Inhibitors in Dementia. Am J Geriatr Psychiatry 2018; 26:134-147. [PMID: 29167065 PMCID: PMC5817050 DOI: 10.1016/j.jagp.2017.09.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 06/08/2017] [Revised: 09/08/2017] [Accepted: 09/29/2017] [Indexed: 01/08/2023]
Abstract
Cholinesterase inhibitors (ChEIs) are the primary pharmacological treatment for symptom management of Alzheimer disease (AD), but they carry known risks during long-term use, and do not guarantee clinical effects over time. The balance of risks and benefits may warrant discontinuation at different points during the disease course. Indeed, although there is limited scientific study of deprescribing ChEIs, clinicians routinely face practical decisions about whether to continue or stop medications. This review examined published practice recommendations for discontinuation of ChEIs in AD. To characterize the scientific basis for recommendations, we first summarized randomized controlled trials of ChEI discontinuation. We then identified practice guidelines by professional societies and in textbooks and classified them according to 1) whether they made a recommendation about discontinuation, 2) what the recommendation was, and 3) the proposed grounds for discontinuation. There was no consensus in guidelines and textbooks about discontinuation. Most recommended individualized discontinuation decisions, but there was essentially no agreement about what findings or situations would warrant discontinuation, or even about what domains to consider in this process. The only relevant domain identified by most guidelines and textbooks was a lack of response or a loss of effectiveness, both of which can be difficult to ascertain in the course of a progressive condition. Well-designed, long-term studies of discontinuation have not been conducted; such evidence is needed to provide a scientific basis for practice guidelines. It seems reasonable to apply an individualized approach to discontinuation while engaging patients and families in treatment decisions. .
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Affiliation(s)
- Brenna N Renn
- Veterans Affairs HSR&D Houston Center of Innovation, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Ali Abbas Asghar-Ali
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX; Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Houston, TX
| | - Stephen Thielke
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA; Veterans Affairs Puget Sound Health Care System, Seattle, WA
| | - Angela Catic
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Department of Medicine-Section of Geriatrics, Baylor College of Medicine, Houston, TX; Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Houston, TX
| | - Sharyl R Martini
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Department of Neurology, Baylor College of Medicine, Houston, TX
| | - Brian G Mitchell
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
| | - Mark E Kunik
- Veterans Affairs HSR&D Houston Center of Innovation, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX; Department of Medicine-Section of Health Services Research, Baylor College of Medicine, Houston, TX; Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Houston, TX.
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28
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Stuart RB, Thielke S. Ethical and Practical Ways in Which MOELI (Medical Orders for End-of-Life Intervention) Advance the Physician Orders for Life-Sustaining Treatment (POLST) Program. J Am Med Dir Assoc 2018; 19:270-272. [PMID: 29325923 DOI: 10.1016/j.jamda.2017.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 12/07/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Richard B Stuart
- Department of Psychiatry, University of Washington, Seattle, WA; Swedish/Edmonds Hospital, Edmonds, WA
| | - Stephen Thielke
- Department of Psychiatry, University of Washington, Seattle, WA
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29
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Thielke S. Screening Is Not Benign: Comment on "Olfactory Dysfunction Predicts Subsequent Dementia in Older US Adults". J Am Geriatr Soc 2017; 66:13-14. [PMID: 28944464 DOI: 10.1111/jgs.15122] [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] [Indexed: 11/30/2022]
Affiliation(s)
- Stephen Thielke
- Geriatric Research, Education and Clinical Center, Puget Sound Veterans Affairs Medical Center, Seattle, WA.,Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
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30
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Magwene EM, Quiñones AR, Marshall GL, Makaroun LK, Thielke S. Older adults rate their mental health better than their general health. J Public Health Res 2017; 6:967. [PMID: 29071258 PMCID: PMC5641665 DOI: 10.4081/jphr.2017.967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 08/11/2017] [Indexed: 11/28/2022] Open
Abstract
Background. Self-rated health (SRH) shows strong associations with measures of health and well-being. Increasingly, studies have used self-rated mental health (SRMH) as a predictor of various outcomes, independently or together with SRH. Research has not firmly established if and how these two constructs differ. We sought to characterize the relationship between SRH and SRMH, and to determine how this relationship differed across subgroups defined by sociodemographic and health-related characteristics. Design and methods. We analyzed data from the 2012 CAHPS Medicare Advantage Survey. SRH and SRMH ratings were crosstabulated to determine the distribution of responses across response categories. The expected joint probability distribution was computed and compared to the observed distribution. A constructed variable indicated whether SRMH was better, the same, or worse than SRH. We analyzed the distribution of this variable across various subgroups defined by sociodemographic and health-related factors. Results. A total of 114,905 Medicare Advantage beneficiaries responded to both the SRH and SRMH questions. Both in general and within all subgroups, SRMH was usually rated as better than SRH, and rarely as worse. Conclusions. Within a large group of Medicare recipients, the overwhelming trend was for recipients to rate their mental health as at least as good as their overall health, regardless of any sociodemographic and health-related factors. This finding of a shifted distribution encourages caution in the analytic use of selfrated mental health, particularly the use of both SRH and SRMH for adjustment. Additional research is needed to help clarify the complex relationship between these variables. Significance for public health Self-rated health (SRH) has become established as a general measure of health status, but less is known about self-rated mental health (SRMH). Recent epidemiological studies have included self-rated mental health (SRMH) without scrutinizing its properties and in particular its relationship with SRH. In a large dataset of Medicare recipients, we found that self-rated mental health was consistently rated better than self-rated health, across all patient groups. None of the sociodemographic or health factors we examined accounted for this discrepancy. Self-rated mental health seemed to be more resistant to the effects of medical illnesses and functional impairments than was self-rated health. This points to a likely difference in how people formulate and differentiate between their mental and general health, with mental health being seen as more separate from other health factors. These findings encourage caution in the use of SRMH in analytic models, especially if included simultaneously with SRH.
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Affiliation(s)
- Elena M Magwene
- Mental Health Service, VA Puget Sound Health Care System, Seattle, WA
| | | | | | - Lena K Makaroun
- University of Washington, Seattle, WA.,VA Health Services Research and Development, VA Puget Sound Healthcare System, Seattle, WA
| | - Stephen Thielke
- University of Washington, Seattle, WA.,Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA
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Stuart RB, Thielke S. Standardizing Protection of Patients' Rights From POLST to MOELI (Medical Orders for End-of-Life Intervention). J Am Med Dir Assoc 2017. [DOI: 10.1016/j.jamda.2017.04.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lee CWS, Lin CL, Lin PY, Thielke S, Su KP, Kao CH. Antidepressants and risk of dementia in migraine patients: A population-based case-control study. Prog Neuropsychopharmacol Biol Psychiatry 2017; 77:83-89. [PMID: 28392483 DOI: 10.1016/j.pnpbp.2017.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/28/2017] [Accepted: 04/06/2017] [Indexed: 01/23/2023]
Abstract
To ascertain the relationship between receipt of antidepressant agents and the risk of subsequent dementia in migraine patients. A population-based case-control analysis, using the Taiwan National Health Insurance Research Database. We identified 1774 patients with dementia and 1774 matched nondementia controls from migraine patients enrolled in the Taiwan National Health Insurance program between 2005 and 2011. The proportional distributions of exposure to three classes of antidepressant were compared between dementia and nondementia groups. Univariable and multivariable logistic regression analyses were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the risk of dementia based on antidepressant exposure. The proportions of subjects taking tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and new-generation antidepressants (NGAs) in dementia versus nondementia groups are 52.3 vs 51.2%, 25.5 vs 30.7%, and 18.8 vs 6.26%, respectively. The adjusted ORs of dementia were 1.02 (95% CI=0.89, 1.17; P=0.56) for TCAs, 0.58 (95% CI=0.50, 0.69; P<0.001) for SSRIs, and 4.23 (95% CI=3.34, 5.37; P<0.001) for NGAs. Treatment with SSRIs was associated with a decreased risk of dementia in migraine patients. TCAs showed no association with dementia risk, and NGAs showed increased risk. Given the possibility of confounding by indication, additional prospective trials and basic research are needed before drawing conclusions about the population-level risks for dementia onset conferred by antidepressant medications.
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Affiliation(s)
- Cynthia Wei-Sheng Lee
- Center for Drug Abuse and Addiction, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, China Medical University, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Pan-Yen Lin
- Department of Psychiatry and Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Neural and Cognitive Sciences, College of Medicine, China Medical University, Taichung, Taiwan
| | - Stephen Thielke
- Geriatric Research, Education, and Clinical Center, Puget Sound VA Medical Center, Seattle, WA, USA
| | - Kuan-Pin Su
- Department of Psychiatry and Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Neural and Cognitive Sciences, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan; Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.
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Thakral M, Saunders K, Shortreed S, Von Korff M, LeResche L, Thielke S, Rosenberg D, Turner J. SEX AND GENDER DIFFERENCES IN PAIN-RELATED DISABILITY AMONG PERSONS INITIATING CHRONIC OPIOID THERAPY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.5130] [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] [Indexed: 11/14/2022] Open
Affiliation(s)
- M. Thakral
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington,
| | - K. Saunders
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington,
| | - S. Shortreed
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington,
- Department of Statistics, University of Washington, Seattle, Washington,
| | - M. Von Korff
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington,
| | - L. LeResche
- Department of Oral Medicine, University of Washington, Seattle, Washington,
| | - S. Thielke
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington,
- Geriatric Research, Education, and Clinical Center, Pugent Sound Veterans Affairs Medical Center, Seattle, Washington,
| | - D. Rosenberg
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington,
| | - J. Turner
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington,
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington,
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
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Horvath KJ, Burns T, Fernandez C, Huh JWT, Moorer J, Thielke S, Trittschuh E, Cooley S. Reevaluation of a clinical resource for assessment of delirium, dementia, and depression. Gerontol Geriatr Educ 2017; 38:245-256. [PMID: 25386797 DOI: 10.1080/02701960.2014.966905] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
There is a perennial need to extend geriatrics knowledge and expertise to primary care providers to meet the unique needs of older patients. Reaching the target population of providers in an effective manner presents challenges for educators and evaluation of education programs. Gaps in a previous dissemination of an Assessment Guide for delirium, dementia, and depression were addressed through a multimodal strategy to reach a greater proportion of the intended audience, primary care clinicians, and to further evaluate the clinical impact of this learning resource. Sixty-five health care providers completed a forced choice online questionnaire. The majority of respondents were primary care providers (62.5%) who used the Assessment Guide in clinical activities such as patient assessment and patient education. Semistructured interviews with selected key informants (N = 16) provided examples of clinical impact such as improved diagnosis and changes in medication.
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Affiliation(s)
- Kathy J Horvath
- a New England Geriatric Research, Education, & Clinical Center (GRECC), Bedford VA Medical Center , Bedford , Massachusetts , USA
| | - Theressa Burns
- b Minneapolis Geriatric Research, Education, & Clinical Center (GRECC) , Minneapolis , Minnesota , USA
| | - Carmen Fernandez
- c Gainesville Geriatric Research Education, & Clinical Center (GRECC) , Gainesville , Florida , USA
| | - J W Terri Huh
- d Palo Alto Geriatric Research, Education, & Clinical Center (GRECC) , Palo Alto , California , USA
| | - Julie Moorer
- e Puget Sound Geriatric Research, Education, & Clinical Center (GRECC) , Seattle , Washington , USA
| | - Stephen Thielke
- e Puget Sound Geriatric Research, Education, & Clinical Center (GRECC) , Seattle , Washington , USA
| | - Emily Trittschuh
- e Puget Sound Geriatric Research, Education, & Clinical Center (GRECC) , Seattle , Washington , USA
| | - Susan Cooley
- f VA Geriatrics and Extended Care Services , Washington , DC , USA
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Affiliation(s)
- Stephen Thielke
- Geriatric Research, Education, and Clinical Center, Puget Sound VA Medical Center, Seattle, Washington
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Von Korff M, Shortreed SM, LeResche L, Saunders K, Thielke S, Thakral M, Rosenberg D, Turner JA. A longitudinal study of depression among middle-aged and senior patients initiating chronic opioid therapy. J Affect Disord 2017; 211:136-143. [PMID: 28113120 DOI: 10.1016/j.jad.2016.12.052] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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] [Received: 06/28/2016] [Revised: 12/23/2016] [Accepted: 12/31/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Improved understanding how depressive symptoms change with sustained opioid use is needed. METHODS We prospectively assessed patients 45 years or older initiating chronic opioid therapy (COT) at baseline and at 4 and 12 months, differentiating recent COT initiators (n=748) and continuing users (n=468). Level of opioid use before 12-month follow-up was classified as regular/higher-dose, intermittent/lower-dose, or minimal/no use. Depressive symptoms were assessed using the Patient Health Questionnaire-8 (PHQ-8). RESULTS Depressive symptoms decreased, on average, from baseline to 12 months regardless of level of opioid use. COT patients with regular/higher-dose compared to those with intermittent/lower-dose opioid use (who had similar pain outcomes) did not differ in PHQ-8 scores at 12 months (adjusted mean difference -0.14, 95% CI, -1.07, 0.78 for COT initiators). At 12 months, COT patients with intermittent/lower-dose use had higher adjusted PHQ-8 scores than did those with minimal/no opioid use (adjusted mean difference 0.77, 95% CI, 0.03-1.52 for COT initiators). However, 77% of patients who discontinued opioids cited improved pain as a reason for discontinuation, while 21% cited negative emotional effects of opioids as a reason for discontinuation. Discontinuation was more common among persons who, at baseline, attributed 3 or more depressive symptoms to opioid use. LIMITATIONS Results are relevant to older COT patients receiving low to moderate opioid doses. CONCLUSIONS Depressive symptoms did not increase with sustained opioid use. Depressive symptoms were not higher with regular/higher-dose compared to intermittent/lower-dose use. Persons who perceived negative effects of opioids on emotions more often discontinued their use.
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Affiliation(s)
| | - Susan M Shortreed
- Group Health Research Institute, Seattle, WA, USA; Department of Biostatistics, University of Washington, USA
| | - Linda LeResche
- Department of Oral Medicine, University of Washington, Seattle, WA, USA
| | | | - Stephen Thielke
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA; Geriatric Research, Education, and Clinical Center, Puget Sound Veterans Affairs Medical Center, Seattle, WA, USA
| | - Manu Thakral
- Group Health Research Institute, Seattle, WA, USA
| | | | - Judith A Turner
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA; Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
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DiNapoli EA, Craine M, Dougherty P, Gentili A, Kochersberger G, Morone NE, Murphy JL, Rodakowski J, Rodriguez E, Thielke S, Weiner DK. Deconstructing Chronic Low Back Pain in the Older Adult--Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment. Part V: Maladaptive Coping. Pain Med 2016; 17:64-73. [PMID: 26768183 DOI: 10.1093/pm/pnv055] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE As part of a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults, this article focuses on maladaptive coping--a significant contributor of psychological distress, increased pain, and heightened disability in older adults with CLBP. METHODS A modified Delphi technique was used to develop a maladaptive coping algorithm and table providing the rationale for the various components of the algorithm. A seven-member content expert panel and a nine-member primary care panel were involved in the iterative development of the materials. While the algorithm was developed keeping in mind resources available within the Veterans Health Administration (VHA) facilities, panelists were not exclusive to the VHA, and therefore, materials can be applied in both VHA and civilian settings. The illustrative clinical case was taken from one of the contributors' clinical practice. RESULTS We present a treatment algorithm and supporting table to be used by providers treating older adults who have CLBP and engage in maladaptive coping strategies. A case of an older adult with CLBP and maladaptive coping is provided to illustrate the approach to management. CONCLUSIONS To promote early engagement in skill-focused treatments, providers can routinely evaluate pain coping strategies in older adults with CLBP using a treatment algorithm.
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Affiliation(s)
- Elizabeth A DiNapoli
- *Mental Illness Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Michael Craine
- VA Eastern Colorado Healthcare System, Denver, Colorado Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Denver, Colorado
| | - Paul Dougherty
- Canandaigua VA Medical Center, Canandaigua, New York New York Chiropractic College, Seneca Falls, New York
| | - Angela Gentili
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia Virginia Commonwealth University Health System, Richmond, Virginia
| | - Gary Kochersberger
- Canandaigua VA Medical Center, Canandaigua, New York Division of Geriatrics, University of Rochester, Rochester, New York
| | - Natalia E Morone
- Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jennifer L Murphy
- James A. Haley Veterans' Hospital, Tampa, Florida University of South Florida, Tampa, Florida
| | - Juleen Rodakowski
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eric Rodriguez
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stephen Thielke
- Geriatric Research, Education, and Clinical Center, Puget Sound VA Medical Center, Seattle, Washington Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Debra K Weiner
- Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Trittschuh E, Thielke S. Memory Skills Classes to Address Cognitive Concerns in Older Veterans With a History of Posttraumatic Stress Disorder. Fed Pract 2016; 33:30-33. [PMID: 30766154 PMCID: PMC6373721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Classes adapting existing clinical and educational tools offered veterans with a history of PTSD an opportunity to enhance memory skills and self-management.
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Affiliation(s)
- Emily Trittschuh
- is a psychologist and is a physician at the Geriatric Research Education and Clinical Center for the VA Puget Sound Health Care System in Seattle, Washington
| | - Stephen Thielke
- is a psychologist and is a physician at the Geriatric Research Education and Clinical Center for the VA Puget Sound Health Care System in Seattle, Washington
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Thielke S, Slatore CG, Banks WA. Quantifying altitude of human habitation in studies of human health using geographical name server data. Geospat Health 2016; 11:463. [PMID: 27903068 DOI: 10.4081/gh.2016.463] [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] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 08/05/2016] [Accepted: 08/10/2016] [Indexed: 06/06/2023]
Abstract
Almost all studies examining the effects of altitude on human health have estimated the geographical altitude of defined regions, yet the primary interest lies in where people live, not the land around them. Populations are not homogenously distributed across altitudes. We propose a straightforward and computationally simple method for estimating the average altitude of habitation within the regional units for which health statistics are typically reported (such as counties). The United States Board on Geographical Names database contains records for over 2.7 million places, which can be processed to select places that are associated with human habitation. These points can easily be averaged by region yielding a representative altitude of human habitation within city, county, state regions, or by longitude and latitude zones. We provide an example of using this approach in a study of human health, and compare it with three other previously used methods of estimating altitude for counties.
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Affiliation(s)
- Stephen Thielke
- Puget Sound VA Medical Center, Geriatric Research, Education, and Clinical Centers, Seattle, WA.
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Abstract
OBJECTIVES Loneliness and social isolation are two important health outcomes among older adults. Current assessment of these outcomes relies on self-report which is susceptible to bias. This paper reports on the relationship between loneliness and objective measures of isolation using a phone monitoring device. METHOD Phone monitors were installed in the homes of 26 independent elderly individuals from the ORCATECH Life Laboratory cohort (age 86 ± 4.5, 88% female) and used to monitor the daily phone usage for an average of 174 days. Loneliness was assessed using the 20-item University of California Los Angeles (UCLA) Loneliness scale. A mixed effects negative binomial regression was used to model the relationship between loneliness and social isolation, as assessed using the total number of calls, controlling for cognitive function, pain, age, gender, and weekday. A secondary analysis examined the differential effect of loneliness on incoming and outgoing calls. RESULTS The average UCLA Loneliness score was 35.3 ± 7.6, and the median daily number of calls was 4. Loneliness was negatively associated with telephone use (IRR = 0.99, p < 0.05). Daily phone use was also associated with gender (IRR = 2.03, p < 0.001) and cognitive status (IRR = 1.51, p < 0.001). The secondary analysis revealed that loneliness was significantly related to incoming (IRR = 0.98, p < 0.01) but not outgoing calls. CONCLUSIONS These results demonstrate the close relationship between loneliness and social isolation, showing that phone behaviour is associated with emotional state and cognitive function. Because phone behaviour can be monitored unobtrusively, it may be possible to sense loneliness levels in older adults using objective assessments of key aspects of behaviour.
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Affiliation(s)
- Johanna Petersen
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA,Corresponding author.
| | - Stephen Thielke
- Department of Psychiatry and Behavioural Sciences, University of Washington, Seattle, WA, USA
| | - Daniel Austin
- Department of Neurology and the Oregon Center for Aging and Technology, Oregon Health & Science University, Portland, OR, USA
| | - Jeffrey Kaye
- Department of Neurology and the Oregon Center for Aging and Technology, Oregon Health & Science University, Portland, OR, USA
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Tsuang D, Shao E, Chen K, Thielke S, Zeng Q. P4‐326: Automated Machine Learning Methods to Dectect Undiagnosed Cognitive Impairment Using Electronic Medical Records. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.07.070] [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] [Indexed: 10/20/2022]
Affiliation(s)
- Debby Tsuang
- VAPSHCS/GRECCSeattleWA USA
- University of WashingtonSeattleWA USA
| | - Eugene Shao
- George Washington UniversityWashingtonDC USA
| | | | - Stephen Thielke
- VAPSHCS/GRECCSeattleWA USA
- University of WashingtonSeattleWA USA
| | - Qing Zeng
- George Washington UniversityWashingtonDC USA
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Austin J, Dodge HH, Riley T, Jacobs PG, Thielke S, Kaye J. A Smart-Home System to Unobtrusively and Continuously Assess Loneliness in Older Adults. IEEE J Transl Eng Health Med 2016; 4:2800311. [PMID: 27574577 PMCID: PMC4993148 DOI: 10.1109/jtehm.2016.2579638] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/15/2016] [Accepted: 05/20/2016] [Indexed: 01/29/2023]
Abstract
Loneliness is a common condition in older adults and is associated with increased morbidity and mortality, decreased sleep quality, and increased risk of cognitive decline. Assessing loneliness in older adults is challenging due to the negative desirability biases associated with being lonely. Thus, it is necessary to develop more objective techniques to assess loneliness in older adults. In this paper, we describe a system to measure loneliness by assessing in-home behavior using wireless motion and contact sensors, phone monitors, and computer software as well as algorithms developed to assess key behaviors of interest. We then present results showing the accuracy of the system in detecting loneliness in a longitudinal study of 16 older adults who agreed to have the sensor platform installed in their own homes for up to 8 months. We show that loneliness is significantly associated with both time out-of-home (\documentclass[12pt]{minimal}
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\end{document} for the model was 0.35. We also show the model’s ability to predict out-of-sample loneliness, demonstrating that the correlation between true loneliness and predicted out-of-sample loneliness is 0.48. When compared with the University of California at Los Angeles loneliness score, the normalized mean absolute error of the predicted loneliness scores was 0.81 and the normalized root mean squared error was 0.91. These results represent first steps toward an unobtrusive, objective method for the prediction of loneliness among older adults, and mark the first time multiple objective behavioral measures that have been related to this key health outcome.
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Affiliation(s)
- Johanna Austin
- Oregon Center for Aging and Technology Department of Neurology Oregon Health & Science University Portland OR 97239 USA
| | - Hiroko H Dodge
- Oregon Center for Aging and Technology Department of Neurology Oregon Health & Science University Portland OR 97239 USA
| | - Thomas Riley
- Oregon Center for Aging and Technology Department of Neurology Oregon Health & Science University Portland OR 97239 USA
| | - Peter G Jacobs
- Department of Biomedical Engineering Oregon Health & Science University Portland OR 97239 USA
| | - Stephen Thielke
- Department of Psychiatry and Behavioral SciencesUniversity of WashingtonSeattleWA98102USA; Geriatric Research, Education, and Clinical CenterSeattle VA Medical CenterSeattleWA98108USA
| | - Jeffrey Kaye
- Oregon Center for Aging and Technology Department of Neurology Oregon Health & Science University Portland OR 97239 USA
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Wallace ER, Siscovick DS, Sitlani CM, Dublin S, Mitchell PH, Odden MC, Hirsch CH, Thielke S, Heckbert SR. Incident Atrial Fibrillation and Disability-Free Survival in the Cardiovascular Health Study. J Am Geriatr Soc 2016; 64:838-43. [PMID: 26926559 DOI: 10.1111/jgs.14037] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To assess the associations between incident atrial fibrillation (AF) and disability-free survival and risk of disability. DESIGN Prospective cohort study. SETTING Cardiovascular Health Study. PARTICIPANTS Individuals aged 65 and older and enrolled in fee-for-service Medicare followed between 1991 and 2009 (MN = 4,046). Individuals with prevalent AF, activity of daily living (ADL) disability, or a history of stroke or heart failure at baseline were excluded. MEASUREMENTS Incident AF was identified according to annual study electrocardiogram, hospital discharge diagnosis, or Medicare claims. Disability-free survival was defined as survival free of ADL disability (any difficulty or inability in bathing, dressing, eating, using the toilet, walking around the home, or getting out of a bed or chair). ADLs were assessed at annual study visits or in a telephone interview. Association between incident AF and disability-free survival or risk of disability was estimated using Cox proportional hazards models. RESULTS Over an average of 7.0 years of follow-up, 660 individuals (16.3%) developed incident AF, and 3,112 (77%) became disabled or died. Incident AF was associated with shorter disability-free survival (hazard ratio (HR) for death or ADL disability = 1.71, 95% confidence interval (CI) = 1.55-1.90) and a higher risk of ADL disability (HR = 1.36, 95% CI = 1.18-1.58) than in individuals with no history of AF. This association persisted after adjustment for interim stroke and heart failure. CONCLUSION These results suggest that AF is a risk factor for shorter functional longevity in older adults, independent of other risk factors and comorbid conditions.
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Affiliation(s)
- Erin R Wallace
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington
| | | | - Colleen M Sitlani
- Department of Medicine, University of Washington, Seattle, Washington
| | - Sascha Dublin
- Department of Epidemiology, University of Washington, Seattle, Washington.,Group Health Research Institute, Group Health Cooperative, Seattle, Washington
| | | | - Michelle C Odden
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon
| | - Calvin H Hirsch
- University of California at Davis Health System, Davis, California
| | - Stephen Thielke
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, Washington.,Group Health Research Institute, Group Health Cooperative, Seattle, Washington
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Von Korff M, Turner JA, Shortreed SM, Saunders K, Rosenberg D, Thielke S, LeResche L. Timeliness of Care Planning upon Initiation of Chronic Opioid Therapy for Chronic Pain. Pain Med 2016; 17:511-520. [PMID: 26814284 PMCID: PMC6281132 DOI: 10.1093/pm/pnv054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Received: 06/02/2015] [Revised: 09/23/2015] [Accepted: 10/17/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND Chronic opioid therapy (COT) guidelines recommend developing a COT care plan at the initiation of COT. OBJECTIVE Assess the timeliness of care planning upon initiation of COT. DESIGN Observational cohort study in a setting incentivizing and tracking documentation of COT care plans in electronic health records (EHRs). PARTICIPANTS Study participants (N = 896) were aged 45 years or older, had initiated an episode of opioid use within the prior 6 months, and reported regular use of prescription analgesics when screened for a baseline interview about 3 months after an index opioid prescription MEASURES: A timely care plan was defined by an EHR documented care plan prior to or within 4 months after the index opioid prescription. RESULTS Among COT initiators, 30% had a timely COT care plan documented in the EHR within 4 months following index prescription, while 51% had a documented COT care plan within 12 months following index prescription. Among those interviewed at 1 year follow-up (N = 735), 252 (34.2%) reported opioid use on 7 or more days in the prior 2 weeks. Less than half (45.6%) of the 252 individuals who sustained regular opioid use at 1 year had predicted at baseline that it was somewhat, very, or extremely likely they would be using opioids regularly in 1 year. CONCLUSIONS Patients initiating COT were unlikely to have timely COT care plans. Many who sustained regular opioid use at 1 year had not anticipated using opioids long term.
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Affiliation(s)
| | - Judith A Turner
- Departments of Psychiatry and Behavioral Sciences
- Rehabilitation Medicine
- Anesthesiology and Pain Medicine
| | - Susan M Shortreed
- *Group Health Research Institute, Seattle, Washington, USA
- Biostatistics, and
| | | | - Dori Rosenberg
- *Group Health Research Institute, Seattle, Washington, USA
| | - Stephen Thielke
- Departments of Psychiatry and Behavioral Sciences
- Geriatric Research, Education, and Clinical Center, Puget Sound Veterans Affairs Medical Center, Seattle, Washington, USA
| | - Linda LeResche
- Oral Medicine, University of Washington, Seattle, Washington, USA
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Shortreed SM, Von Korff M, Thielke S, LeResche L, Saunders K, Rosenberg D, Turner JA. Electronic Health Records to Evaluate and Account for Non-response Bias: A Survey of Patients Using Chronic Opioid Therapy. Obs Stud 2016; 2:24-38. [PMID: 28042621 PMCID: PMC5193131] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND In observational studies concerning drug use and misuse, persons misusing drugs may be less likely to respond to surveys. However, little is known about differences in drug use and drug misuse risk factors between survey respondents and nonrespondents. METHODS Using electronic health record (EHR) data, we compared respondents and non-respondents in a telephone survey of middle-aged and older chronic opioid therapy patients to assess predictors of interview nonresponse. We compared general patient characteristics, specific opioid misuse risk factors, and patterns of opioid use associated with increased risk of opioid misuse. Inverse probability weights were calculated to account for nonresponse bias by EHR-measured covariates. EHR-measured covariate distributions for the full sample (nonrespondents and respondents), the unweighted respondent sample, and the inverse probability weighted respondent sample are reported. We present weighted and unweighted prevalence of self-reported opioid misuse risk factors. RESULTS Among 2489 potentially eligible patients, 1477 (59.3%) completed interviews. Response rates differed with age (45-54 years, 51.8%; 55-64 years, 58.7%; 65-74 years, 67.9%; and 75 years or older, 59.9%). Tobacco users had lower response rates than did nonusers (53.5% versus 60.9%). Charlson comorbidity score was also related to response rates. Individuals with a Charlson score of 2 had the highest response rate at 65.6%; response rates were lower amoung patients with the lowest (the patients with the fewest health conditions had response rates of 56.7-60.0%) and the highest Charlson scores (patients with the most health conditions had response rates of 52.2-56.0%). These bivariate relationships persisted in adjusted multivariable logistic regression models predicting survey response. Response rates of persons with and without specific opioid misuse risk factors were similar (e.g., 58.7% for persons with substance abuse diagnoses, 59.4% for those without). Opioid use patterns associated with opioid misuse did not predict response rates (e.g., 60.6% versus 59.2% for those receiving versus not receiving opioids from 3 or more physicians outside their primary care clinic). Very few patient characteristics predicted non-response; thus, inverse probability weights accounting for nonresponse had little impact on the distributions of EHR-measured covariates or self-reported measures related to opioid use and misuse. CONCLUSIONS Response rates differed by characteristics that predict nonresponse in general health surveys (age, tobacco use), but did not appear to differ by specific patient or drug use risk factors for prescription opioid misuse among middle- and older-aged chronic opioid therapy patients. When observational studies are conducted in health plan populations, electronic health records may be used to evaluate nonresponse bias and to adjust for variables predicting interview nonresponse, complementing other research uses of EHR data in observational studies.
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Affiliation(s)
- Susan M Shortreed
- Group Health Research Institute, Seattle, WA, USA., Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - Stephen Thielke
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA., Geriatric Research, Education, and Clinical Center, Puget Sound Veterans Affairs Medical Center, Seattle, WA, USA
| | - Linda LeResche
- Department of Oral Medicine, University of Washington, Seattle, WA, USA
| | | | | | - Judith A Turner
- Department of Psychiatry and Behavioral Sciences; Department of Rehabilitation Medicine; Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
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47
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Shortreed SM, Von Korff M, Thielke S, LeResche L, Saunders K, Rosenberg D, Turner JA. Electronic Health Records to Evaluate and Account for Non-response Bias: A Survey of Patients Using Chronic Opioid Therapy. ACTA ACUST UNITED AC 2016. [DOI: 10.1353/obs.2016.0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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48
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Lea C, Quiñones A, Whitson H, Bynum J, Thielke S. Changes in Self-Rated Health During the Transition to Retiring Living Among Medicare Managed-Care Recipients. J Hous Elderly 2016. [PMID: 29527088 DOI: 10.1080/02763893.2015.1129383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives Moving into a retirement community may be precipitated by or bring about changes in health status. We hypothesized that moving into a retirement community would be associated with a decline in self-rated health (SRH), but that health-related factors would mitigate this association. Methods We analyzed data from 58,272 participants in Cohort 3 of the Medicare Health Outcome Survey. Individuals answered questions regarding living status in 2000 and 2002. Those who moved into a retirement community were compared with those who did not. The primary outcome was change in SRH. We created adjusted and unadjusted models. Results 2,520 (4.4%) individuals moved into retirement communities between 2000 and 2002. There were no substantial differences in the mean change in SRH between those who moved and those who did not. In adjusted and unadjusted models, moving was not significantly associated with changes in SRH. In an analysis stratified by SRH, only those with the best SRH had a significant decline in SRH during the move. Discussion SRH mainly remained stable for most people regardless of moving into a retirement community. These findings argue against environmental context being a main determinant of self-perceived health status among older adults.
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Affiliation(s)
| | - Ana Quiñones
- Department of Medicine (Geriatrics) and the Aging Center, Duke University Medical Center, Durham, North Carolina
| | - Heather Whitson
- Geriatric Research, Education, and Clinical Center, Durham VA Medical Center, Durham, North Carolina.,Public Health & Preventive Medicine, Oregon Health & Science University
| | - Julie Bynum
- The Dartmouth Institute for Health Policy and Clinical Practice
| | - Stephen Thielke
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.,Geriatric Research, Education, and Clinical Center, Puget Sound VA Medical Center, Seattle, Washington
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49
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Affiliation(s)
- Stephen Thielke
- Geriatric Research, Education, and Clinical Center, Puget Sound VA Medical Center, Seattle, Washington
| | | | - William A Banks
- Geriatric Research, Education, and Clinical Center, Puget Sound VA Medical Center, Seattle, Washington
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50
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Carley JA, Karp JF, Gentili A, Marcum ZA, Reid MC, Rodriguez E, Rossi MI, Shega J, Thielke S, Weiner DK. Deconstructing Chronic Low Back Pain in the Older Adult: Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment: Part IV: Depression. Pain Med 2015; 16:2098-108. [PMID: 26539754 DOI: 10.1111/pme.12935] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To present the fourth in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. The series presents CLBP as a syndrome, a final common pathway for the expression of multiple contributors rather than a disease localized exclusively to the lumbosacral spine. Each article addresses one of twelve important contributors to pain and disability in older adults with CLBP. This article focuses on depression. METHODS The evaluation and treatment algorithm, a table articulating the rationale for the individual algorithm components, and stepped-care drug recommendations were developed using a modified Delphi approach. The Principal Investigator, a three-member content expert panel, and a nine-member primary care panel were involved in the iterative development of these materials. The algorithm was developed keeping in mind medications and other resources available within Veterans Health Administration (VHA) facilities. As panelists were not exclusive to the VHA, the materials can be applied in both VHA and civilian settings. The illustrative clinical case was taken from one of the contributor's clinical practice. RESULTS We present an algorithm and supportive materials to help guide the care of older adults with depression, an important contributor to CLBP. The case illustrates an example of a complex clinical presentation in which depression was an important contributor to symptoms and disability in an older adult with CLBP. CONCLUSIONS Depression is common and should be evaluated routinely in the older adult with CLBP so that appropriately targeted treatments can be planned and implemented.
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Affiliation(s)
- Joseph A Carley
- Departments of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jordan F Karp
- Departments of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.,Anesthesiology, University of Pittsburgh, Pittsburgh, PA, USA.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Angela Gentili
- Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA.,Virginia Commonwealth University Health System, Richmond, VA, USA
| | | | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Eric Rodriguez
- Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Michelle I Rossi
- Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,VA Pittsburgh Healthcare System, GRECC, Pittsburgh, PA, USA.,Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Stephen Thielke
- Geriatric Research, Education, and Clinical Center, Puget Sound VA Medical Center, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Debra K Weiner
- Departments of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.,Anesthesiology, University of Pittsburgh, Pittsburgh, PA, USA.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA.,Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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