Hasil untuk "Geriatrics"

W. Chow, R. Rosenthal, R. Merkow et al.

Hatice Tuğba Yazır, Zehra Sarıkaya Demirbaş, Candeniz Avcı et al.

Carbon monoxide (CO) poisoning can cause delayed neurological sequelae (DNS), a condition with no effective treatment. We report a 66-year-old male patient who recovered from acute CO poisoning but developed DNS and delirium one week later. He showed akinetic mutism, parkinsonism, rigidity, and cognitive impairment. Non-pharmacological approaches and donepezil were tried, but due to side effects, memantine (20 mg/day) was started. Over the course of one year, the patient showed significant improvement in neurological and functional status, with improvements in cognitive function (Mini-Mental State Examination: 26) and brain magnetic resonance imaging findings. This case suggests memantine may contribute to DNS recovery.

Chen Li, Yang Lu, Yihao Liu et al.

Background Sialic acid-binding immunoglobulin-like lectins (SIGLECs) are widely expressed on immune cell surfaces, play an important role in maintaining immune homeostasis and regulating inflammatory responses, and are increasingly emerging as potential targets for tumor immunotherapy. However, the expression profile and crucial role of SIGLEC11 in gastric cancer (GC) remain unclear. This study aimed to elucidate the prognostic relevance of SIGLEC11 expression and its role in the immune microenvironment in patients with GC.Methods SIGLEC11 expression profile was analyzed using bioinformatics, immunohistochemistry, and immunofluorescence staining. Flow cytometry, mouse tumor models, patient-derived tumor organoid models, and RNA sequencing were used to explore the potential functions with the underlying mechanisms of SIGLEC11 in a coculture system of macrophages and GC cells.Results We demonstrated that SIGLEC11 was predominantly expressed in normal tissues. However, tumor-infiltrating SIGLEC11+ cells in the high SIGLEC11 expression subgroups showed poor overall survival, which was associated with the expression of an immunosuppressive regulator. Our results showed that SIGLEC11 was predominantly expressed in monocytes and macrophages and selectively upregulated in tumor-associated macrophages. Furthermore, SIGLEC11 promoted macrophage M2 polarization via AKT–mTOR signaling. In addition, SIGLEC11+ macrophages accelerate GC progression.Conclusions The abundance of SIGLEC11+ M2-like macrophage-infiltrating tumors may serve as a biomarker for identifying immunosuppressive subtypes of GC. Thus, the potential role of SIGLEC11+ M2 macrophages as therapeutic targets warrants further investigation.

Jenny Thain, Jennifer Arnold, Amit X Garg et al.

Objective Patients receiving haemodialysis are at very high risk of fragility fracture, yet there are no proven treatments for fracture prevention. We will advance a pilot study on the feasibility of a large, pragmatic, randomised controlled trial (RCT) of denosumab for fragility fracture prevention in haemodialysis.Trial design PRevEnting FracturEs in REnal Disease-1 is a pragmatic, open-label, pilot study of an RCT of a denosumab care pathway embedded in routine care haemodialysis centres.Methods We will recruit at least 60 participants at high risk of fracture from at least 6 haemodialysis centres in Ontario, Canada. They must be aged 40 years or older, have access to provincial drug coverage, have appropriate baseline calcium and parathyroid hormone levels and be deemed suitable for denosumab by their kidney care provider. Participants will be randomised 1:1 to denosumab (with supports to mitigate hypocalcaemia) versus usual care using block randomisation by a central statistician (computer-generated sequence). Primary outcomes include recruitment feasibility and adherence. Secondary outcomes include safety (hypocalcaemia) and participant satisfaction with our protocol and processes. Study investigators and data analysts will be blind to treatment allocation.We will present results descriptively. The trial was approved by Clinical Trials Ontario and local research ethics boards across study sites.Results Primary and secondary outcomes will be published on trial completion.Conclusions This pilot will inform the feasibility of conducting a large-scale, efficiently run, pragmatic RCT to test whether a denosumab care pathway safely reduces the risk of fragility fracture in patients receiving haemodialysis. Results have the potential to transform fracture care in real-world patients with kidney and metabolic bone disease.Trial registration number NCT05096195.

S Pirbay, MD, S Abou Kassm, MD, MPH, C Di-Maggio, MD et al.

Objectives: Despite the benefits of geriatric telepsychiatry, the lack of support from the staff remains one of the major challenges it faces. We wanted to explore whether negative opinions towards telepsychiatry in nursing home (NH) stakeholders were affected by prior experience with this modality and by the level of geriatric psychiatric care provided in NH. Methods: We conducted an opinion survey towards telepsychiatry among NH stakeholders (executive managers and care providers) from 10 NH, divided into 5 groups of differing levels of geriatric psychiatric care: Group A used telepsychiatry, Group B had the smallest level of psychiatry care (i.e. without any mental health professional visit), Group C had visiting nurses of general psychiatry, Group D had visiting geriatric psychiatry nurses, Group E had mobile teams including nurses and geriatric psychiatrists. Results: 216 (78.5 %) questionnaires were returned We found significant differences among the groups (Mean Group A (meanA)=63.5, standard error of the mean Group A (SEMA)=1.6); meanB=67.9, SEMB=2.2; meanC=75.6, SEMC=1.6; meanD=69.6, SEMD=2.1; meanE=73.1, SEME=1.9; F(4208)=6.6333, p = 4.824 × 10–5). All groups except group B were significantly different from group A, even after adjusting for age, gender, professional category and knowledge of telepsychiatry. Discussion: Negative opinions towards telepsychiatry were negatively associated with telepsychiatry use in the NH and positively associated with a high level of geriatric psychiatric care, specifically the presence of mobile geriatric psychiatry teams. Conclusions: Our findings suggest that telepsychiatry and face-to-face geriatric psychiatry are in competition. Telepsychiatry acceptance program should aim at describing its complementarity to usual geriatric psychiatry care.

Congqi Liu, Congqi Liu, Congqi Liu et al.

BackgroundMental health challenges are encountered by frail older adults as the population ages. The extant literature is scant regarding the correlation between depressive symptoms and social participation among frail older adults.MethodsThis study is based on an analysis of data from China Health and Retirement Longitudinal Study (CHARLS) participants aged 60 and older who are frail. A frailty index (FI) was developed for the purpose of assessing the frailty level of the participants. Additionally, latent class analysis (LCA) was employed to classify the participants’ social engagement patterns in 2015 and 2018. The study used ordered logistic regression to examine the relationship between social participation type and depressive symptoms. We also used Latent Transition Analysis (LTA) methods to explore the impact of changes in social activity types on depressive symptoms after three years of follow-up in 2018. In addition, the response surface analysis (RSM) investigation explored the relationship among FI, depression, and social participation.ResultsA total of 4,384 participants completed the baseline survey; three years later, 3,483 were included in the follow-up cohort. The baseline survey indicates that female older adults in rural areas who are single, have lower incomes, shorter sleep durations, and lighter weights exhibited more severe depressive symptoms. Social participation patterns were categorized into five subgroups by LCA. The findings indicate that individuals classified as “board game enthusiasts” (OR, 0.62; 95% CI, 0.47-0.82) and those as “extensive social interaction” (OR,0.67; 95% CI, 0.49-0.90) have a significantly lower likelihood of developing depressive symptoms compared to the “socially isolated” group. We also discovered that “socially isolated” baseline participants who transitioned to the “helpful individual” group after three years had significantly greater depressed symptoms (OR, 1.56; 95% CI, 1.00-2.44). More social activity types and less FI are linked to lower depression in our study.ConclusionThe results of the study emphasize the importance of social participation patterns and the number of social participation types in relation to the severity of depression among frail older adults individuals. This study’s findings may provide important insights for addressing depressive symptoms in frail older adults person.

Alinny R. Isaac, Mariana G. Chauvet, Ricardo Lima-Filho et al.

Abstract Major depressive disorder (MDD) is a significant cause of disability in adults worldwide. However, the underlying causes and mechanisms of MDD are not fully understood, and many patients are refractory to available therapeutic options. Impaired control of brain mRNA translation underlies several neurodevelopmental and neurodegenerative conditions, including autism spectrum disorders and Alzheimer’s disease (AD). Nonetheless, a potential role for mechanisms associated with impaired translational control in depressive-like behavior remains elusive. A key pathway controlling translation initiation relies on the phosphorylation of the α subunit of eukaryotic initiation factor 2 (eIF2α-P) which, in turn, blocks the guanine exchange factor activity of eIF2B, thereby reducing global translation rates. Here we report that the expression of EIF2B5 (which codes for eIF2Bε, the catalytic subunit of eIF2B) is reduced in postmortem MDD prefrontal cortex from two distinct human cohorts and in the frontal cortex of social isolation-induced depressive-like behavior model mice. Further, pharmacological treatment with anisomycin or with salubrinal, an inhibitor of the eIF2α phosphatase GADD34, induces depressive-like behavior in adult C57BL/6J mice. Salubrinal-induced depressive-like behavior is blocked by ISRIB, a compound that directly activates eIF2B regardless of the phosphorylation status of eIF2α, suggesting that increased eIF2α-P promotes depressive-like states. Taken together, our results suggest that impaired eIF2-associated translational control may participate in the pathophysiology of MDD, and underscore eIF2-eIF2B translational axis as a potential target for the development of novel approaches for MDD and related mood disorders.

Yuta Doshida, Shinichi Hashimoto, Sadahiro Iwabuchi et al.

Abstract Senescent cells are predicted to occur and increase in animal tissues with aging. However, senescent cells in the tissues of aged animals remain to be identified. We refer to the marker genes to identify senescent cells in tissues as “age-associated genes”. In this study, we searched for age-associated genes to identify senescent cells in the livers of aged animals. We performed single-cell RNA sequencing (scRNA-seq) to screen candidates for age-associated genes using young and aged rat primary hepatocytes. To remove animal species specificity, gene expression analyses in mouse livers were performed, confirming age-associated increases in the mRNA expression levels of Glipr1, Clec12a, and Phlda3. Moreover, the mRNA expression levels of Glipr1 and Phlda3 were increased by stress-induced premature senescence using doxorubicin in primary hepatocytes and livers of young mice. Transcriptome data of aged rat hepatocytes suggested that Glipr1, Clec12a, and Phlda3 were expressed in almost identical cells. Fluorescence in situ hybridization (FISH) confirmed the presence of cells with abundant Glipr1, Clec12a, and Phlda3 mRNA in 27-month-old mouse primary hepatocytes, which are considered to be senescent cells. This study is the first to identify Glipr1, Clec12a, and Phlda3 as age-associated genes in the mouse liver.

Satoru Kobayashi, Younghee Hahn, Brett Silverstein et al.

Diabetes is a major risk factor for a variety of cardiovascular complications, while diabetic cardiomyopathy, a disease specific to the myocardium independent of vascular lesions, is an important causative factor for increased risk of heart failure and mortality in diabetic populations. Lysosomes have long been recognized as intracellular trash bags and recycling facilities. However, recent studies have revealed that lysosomes are sophisticated signaling hubs that play remarkably diverse roles in adapting cell metabolism to an ever-changing environment. Despite advances in our understanding of the physiological roles of lysosomes, the events leading to lysosomal dysfunction and how they relate to the overall pathophysiology of the diabetic heart remain unclear and are under intense investigation. In this review, we summarize recent advances regarding lysosomal injury and its roles in diabetic cardiomyopathy.

David Brücken, Jenny Unterkofler, Sophie Pauge et al.

Abstract Background Increasing life expectancy is associated with a growing number of people living in nursing homes, while the availability of outpatient medical care, especially from family doctors, is stagnating in this sector. Consequently, numerous and often avoidable, low-threshold hospitalizations of nursing home residents are observed. This results in unnecessary use of resources such as emergency services and emergency rooms as well as in potential health risks to the nursing home residents related to hospitalization. This study aims to improve this healthcare gap by implementing an intersectoral telemedicine approach. Methods Twenty-five nursing homes are participating and provided with telemedical equipment to perform teleconsultations. Additionally, an early warning system and a digital patient record system are implemented. Telephysicians based at RWTH Aachen University Hospital are ready to support the nursing homes around the clock if the family doctor or an emergency service practice is not available in time. Mobile non-physician practice assistants from the telemedicine centre can be dispatched to perform delegable medical activities. General practitioners and the medical emergency practices also have access to the telemedical infrastructure and the non-physician practice assistants. Discussion Optimal@NRW adds a telemedicine component to standard care — combining elements of outpatient and inpatient health care as well as emergency service practices — to enable timely medical consultation for nursing home residents in case of the development of an acute medical condition. In addition to optimized medical care, the goal is to reduce unnecessary hospital admissions. The intersectoral approach allows for the appropriate use of resources to match the individually needed medical treatment. Trial registration ClinicalTrials.gov NCT04879537 . Registered on May 10, 2021

Joanna E. Klopotowska, Paul F. M. Kuks, Peter C. Wierenga et al.

Abstract Background The effectiveness of interventions to improve medication safety in older inpatients is unclear, given a paucity of properly designed intervention studies applying clinically relevant endpoints such as hospital-acquired preventable Adverse Drug Events (pADEs) and unrecognized Adverse Drug Events (uADEs). Therefore, we conducted a quality improvement study and used hospital-acquired pADEs and uADEs as main outcomes to assess the effect of an intervention aimed to improve medication safety in older inpatients. Method The study followed an interrupted time series design and consisted of three equally spaced sampling points during baseline and during intervention measurements. Each sampling point included between 80 to 90 patients. A total of 500 inpatients ≥65 years and admitted to internal medicine wards of three Dutch hospitals were included. An expert team retrospectively identified and assessed ADEs via a structured patient chart review. The findings from baseline measurement and meetings with the internal medicine and hospital pharmacy staff were used to design the intervention. The intervention consisted of a structured medication review by hospital pharmacists, followed by face-to-face feedback to prescribers, on average 3 days per week. Results The rate of hospital-acquired pADEs per 100 hospitalizations was reduced by 50.6% (difference 16.8, 95% confidence interval (CI): 9.0 to 24.6, P <  0.001), serious hospital-acquired pADEs by 62.7% (difference 12.8, 95% CI: 6.4 to 19.2, P <  0.001), and uADEs by 51.8% (difference 11.2, 95% CI: 4.4 to 18.0, P <  0.001). Additional analyses confirmed the robustness of the intervention effect, but residual bias cannot be excluded. Conclusions The intervention significantly decreased the overall and serious hospital-acquired pADE occurrence in older inpatients, and significantly improved overall ADE recognition by prescribers. Trial registration International Standard Randomized Controlled Trial Number Register, trial registration number: ISRCTN64974377 , registration date (date assigned): 07/02/2011.

Qian Zeng, Hongxu Pan, Yuwen Zhao et al.

Increasing evidence reveals sex as an important factor in the development of Parkinson’s disease (PD), but associations between genes on the sex chromosomes and PD remain unknown. TAF1 is a gene located on the X chromosome which is known to cause X-linked syndromic mental retardation-33 (MRXS33) and X-linked Dystonia-Parkinsonism (XDP). In this study, we conducted whole-exome sequencing (WES) among 1,917 patients with early-onset or familial PD and 1,652 controls in a Chinese population. We detected a hemizygous frameshift variant c.29_53dupGGA(CAG)2CTACCATCA(CTG)2C (p.A19Dfs*50) in two unrelated male patients. Further segregation analysis showed an unaffected family member carried this variant, which suggested the penetrance of the variant may be age-related and incomplete. To verify the effects of TAF1 on PD, genetic analyses were carried separately by gender. Analysis of rare variants by optimal sequence kernel association (SKAT-O) test showed a nominally significant difference in variant burden between the male PD patients and controls (2.01 vs. 1.38%, p = 0.027). In the female group, none of the variant types showed significant association with PD in this study. In conclusion, we found rare variants in TAF1 may be implicated in PD, but further genetic and functional analyses were needed.

Erik Dahlén, Linda Björkhem-Bergman

The aim of this study was to compare estimated glomerular filtration rate (eGFR) with creatinine (eGFR_crea) and cystatin C (eGFR_cys) in geriatric and frail patients. A retrospective, cross-sectional study was performed at a geriatric clinic in Stockholm (<i>n</i> = 95). The revised Lund–Malmö equation was used to calculate eGFR_crea and the Caucasian-Asian-Pediatric-Adult (CAPA) equation was used for eGFR_cys. The absolute mean percentage difference between eGFR_crea and eGFR_cys was used as a surrogate measure for accuracy in eGFR. Other outcome measures were consistency expressed in Lin’s concordance correlation coefficient and the proportion of consistent staging of renal failure. Subgroup analyses were performed with regard to frailty (according to Clinical Frailty Scale) and age. eGFR_cys estimated lower GFR than eGFR_crea across the entire study population as well as in all subgroups (<i>p</i> < 0.05). Difference between the estimates increased with increasing frailty (<i>r</i>² = 0.15, <i>p</i> < 0.01), but was not significantly affected by age (<i>r</i>² = 0.004, <i>p</i> = 0.55). In conclusion, eGFR_cys was significantly lower compared to eGFR_crea in geriatric and frail patients. Moreover, frailty had greater impact than age on the accuracy of eGFR. However, this study cannot determine if any of the estimates are preferable over the other in this patient group.

Punyabhorn Rattanacheeworn, Stephen J Kerr, Wonngarm Kittanamongkolchai et al.

Background: Ageing and chronic kidney disease (CKD) affect pharmacokinetic (PK) parameters. Since mechanisms are related and remain unclear, cytochrome P450 (CYP) 3A and drug transporter activities were investigated in the elderly with or without CKD and compared to healthy adults using a microdose cocktail.Methods: Healthy young participants (n = 20), healthy elderly participants (n = 16) and elderly patients with CKD (n = 17) received, in study period 1, a single dose of microdose cocktail probe containing 30 µg midazolam, 750 µg dabigatran etexilate, 100 µg atorvastatin, 10 µg pitavastatin, and 50 µg rosuvastatin. After a 14-day wash-out period, healthy young participants continued to study period 2 with the microdose cocktail plus rifampicin. PK parameters including area under the plasma concentration-time curve (AUC), maximum plasma drug concentration (Cmax), and half-life were estimated before making pairwise comparisons of geometric mean ratios (GMR) between groups.Results: AUC and Cmax GMR (95% confidence interval; CI) of midazolam, a CYP3A probe substrate, were increased 2.30 (1.70–3.09) and 2.90 (2.16–3.88) fold in healthy elderly and elderly patients with CKD, respectively, together with a prolonged half-life. AUC and Cmax GMR (95%CI) of atorvastatin, another CYP3A substrate, was increased 2.14 (1.52–3.02) fold in healthy elderly and 4.15 (2.98–5.79) fold in elderly patients with CKD, indicating decreased CYP3A activity related to ageing. Associated AUC changes in the probe drug whose activity could be modified by intestinal P-glycoprotein (P-gp) activity, dabigatran etexilate, were observed in patients with CKD. However, whether the activity of pitavastatin and rosuvastatin is modified by organic anion transporting polypeptide 1B (OATP1B) and of breast cancer resistance protein (BCRP), respectively, in elderly participants with or without CKD was inconclusive.Conclusions: CYP3A activity is reduced in ageing. Intestinal P-gp function might be affected by CKD, but further confirmation appears warranted.Clinical Trial Registration:http://www.thaiclinicaltrials.org/ (TCTR 20180312002 registered on March 07, 2018)

In Hye Park, Yustika Sya’bandari, Yang Liu

Abstract Background Although some previous studies have reported the impact of cultural factors on individuals’ cognition and decision making, a shortage of research has led to this comparison study for Chinese and Korean elderly, a growing population with depression. This study aimed to explore depression levels in Chinese and South Korean elderly individuals by focusing on testing the generalizability of the Geriatric Depression Scale (GDS). Methods The data of 493 community-dwelling Chinese and Korean elderly individuals over the age of 60 years were used to examine GDS. To test the dimensionality, item quality, and reliability of the GDS, the item response theory, Rasch analysis was performed. The detection of differential item functioning (DIF) of the GDS between the two countries was determined by performing a hybrid ordinal logistic regression. Results The four-dimensional framework of the GDS, categorized into agitation, cognitive concerns, dysphoria, and vigor/withdrawal was fit for measuring depression levels in Chinese and Korean elderly individuals. In addition, good item quality and reliability of the GDS indicate that almost all items in this scale contribute to measuring the intended trait. Meanwhile, 18 out of 28 items of the GDS were detected as country-related DIF with five items having a large effect size. Conclusions Although China and Korea are close geographically and culturally, the item bias shown by severe country-related DIF implies that different cultural backgrounds impact how the elderly interpret GDS items. The cultural issues related to the specific DIF items, the implication to accuracy of individual scores estimation, and the optimal decision to treat individuals were discussed.

Jafar Yahyavi Dizaj, Maryam Tajvar, Yousef Mohammadzadeh

Objectives Over the past few decades, Iran has faced rapid demographic changes, including a sharp decline in birth rates and increased life expectancy. This has led to an increase in the average age of the population and an increase in the percentage of the elderly people which is called “the phenomena of aging”. The occurrence of this phenomenon in Iran is rapidly increasing, and therefore the Iranian community has limited opportunity to prepare for the aging challenges. One of the major challenges for the aging population is the rising health care costs due to the elderly's need for a variety of health services, which causes many households with elderly members to face significant economic problems. This study aims to evaluate the effect of the presence and age of elderly members on health care costs of the households in Iran.  Methods & Materials This study is a secondary analysis using 2016 national household, expenditure and income survey data . Sample size was 19337 households in rural areas and 18809 households in urban areas (total= 38146) in Iran. Linear regression analysis in STATA V. 14 was used to test the effect of variables on health care costs of households with and without elderly members.  Results There was a significant association between the presence of an elderly member in the household and increase in total health care expenditure and medical expenses, such that for one increase in the number of elderly members, total health care expenditure increased by 390,000 Tomans, and medical expenses increased by 195,000 Tomans. In terms of age, families with an elderly member aged 75-79 years had the highest care costs, while those with an elderly member aged 80 and more had the least cost increase. Moreover, household income, having a smoker member, having an income-earner member, living in urban areas, household head education, and health development rate of the province of residence had significant association with total health care expenditure and medical expenses of households. However, no association was found between having health insurance and medical expenses.  Conclusion Since the presence of an elderly member significantly increase the household health costs, future policies should be planned to support the families with elderly members. The health care system of Iran should also be prepared to meet to the health and medical needs of future ageing population.

Ulf Guenther, Falk Hoffmann, Oliver Dewald et al.

Cardiac surgery and subsequent treatment in the intensive care unit (ICU) has been shown to be associated with functional decline, especially in elderly patients. Due to the different assessment tools and assessment periods, it remains yet unclear what parameters determine unfavorable outcomes. This study sought to identify risk factors during the entire perioperative period and focused on the decline in activity of daily living (ADL) half a year after cardiac surgery. Follow-ups of 125 patients were available. It was found that in the majority of patients (60%), the mean ADL declined by 4.9 points (95% CI, −6.4 to −3.5; <i>p</i> < 0.000). In the “No decline” -group, the ADL rose by 3.3 points (2.0 to 4.6; <i>p</i> < 0.001). A multiple regression analysis revealed that preoperative cognitive impairment (MMSE ≤ 26; Exp(B) 2.862 (95%CI, 1.192–6.872); <i>p</i> = 0.019) and duration of postoperative delirium ≥ 2 days (Exp(B) 3.534 (1.094–11.411); <i>p</i> = 0.035) was independently associated with ADL decline half a year after the operation and ICU. Of note, preoperative ADL per se was neither associated with baseline cognitive function nor a risk factor for functional decline. We conclude that the preoperative assessment of cognitive function, rather than functional assessments, should be part of risk stratification when planning complex cardiosurgical procedures.

Jacob B. Pierce, Kiarri N. Kershaw, Catarina I. Kiefe et al.

Background Childhood adversity and trauma have been shown to be associated with poorer cardiovascular disease (CVD) outcomes in adulthood. However, longitudinal studies of this association are rare. Methods and Results Our study used the CARDIA (Coronary Artery Risk Development in Young Adults) Study, a longitudinal cohort that has followed participants from recruitment in 1985–1986 through 2018, to determine how childhood psychosocial environment relates to CVD incidence and all‐cause mortality in middle age. Participants (n=3646) completed the Childhood Family Environment (CFE) questionnaire at the year 15 (2000–2001) CARDIA examination and were grouped by high, moderate, or low relative CFE adversity scores. We used sequential multivariable regression models to estimate hazard ratios of incident (CVD) and all‐cause mortality. Participants were 25.1±3.6 years old, 47% black, and 56% female at baseline and 198 participants developed CVD (17.9 per 10 000 person‐years) during follow‐up. CVD incidence was >50% higher for those in the high CFE adversity group compared with those in the low CFE adversity group. In fully adjusted models, CVD hazard ratios (95% CI) for participants who reported high and moderate CFE adversity versus those reporting low CFE adversity were 1.40 (0.98–2.11) and 1.25 (0.89–1.75), respectively. The adjusted hazard ratios for all‐cause mortality was 1.68 (1.17–2.41) for those with high CFE adversity scores and 1.55 (1.11–2.17) for those with moderate CFE adversity scores. Conclusions Adverse CFE was associated with CVD incidence and all‐cause mortality later in life, even after controlling for CVD risk factors in young adulthood.

Adelson Luiz Araújo Tinoco, Larissa Froede Brito, Mônica de Souza Lima Sant’Anna et al.

Resumo Este trabalho teve como objetivo caracterizar o estado nutricional dos idosos cadastrados no Programa Municipal da Terceira Idade (PMTI) situado em Viçosa, Minas Gerais. A população estudada constituiu-se de 183 idosos com idade entre 60 e 90 anos, assistidos pelo PMTI de Viçosa. Os idosos foram avaliados pelo método antropométrico, utilizando-se peso, altura, circunferências da cintura e do quadril para calcular a relação cintura/quadril (RCQ) e o índice de massa corporal (IMC). O perfil nutricional do grupo apresentou uma bipolarização, com alta prevalência de sobrepeso (40,8%) e baixo-peso (15,1%). A freqüência de CC (circunferência da cintura) aumentada e de RCQ inadequada foi alta em ambos os sexos (61,4%), sendo significativamente maior nas mulheres. Os resultados encontrados apresentam uma situação preocupante dessa população, sendo necessário adotar medidas de controle e prevenção do sobrepeso, destacando-se o baixo-peso como importante fator de risco de mortalidade entre idosos.

P. Hollmann, R. Zorowitz, N. Lundebjerg et al.

This article examines the work and leadership of the American Geriatrics Society in making payment for services provided under new, innovative payment codes a reality for geriatrics healthcare professionals. We examine more than a decade of work spanning from a proposal to pay for comprehensive geriatric assessments in 2003 to the multiyear effort that led to Medicare coverage for transitional care management (2013), chronic care management (2015, 2017), and assessment and care planning for cognitive impairment (2017). We review the forces that created an environment for change and the concurrent work of the American Medical Association and the Centers for Medicare and Medicaid Services that made this possible. We highlight opportunities seized that led to seats on crucial panels and legislative victories that helped us make our case for improved payment for geriatrics care. Finally, we address lessons learned and address opportunities where we are currently active. J Am Geriatr Soc 66:2059–2064, 2018.