Antipsychotic Use in Older Adults After Heart Surgery

Journal of the American Geriatrics Society Research Summary

Delirium is the medical term for an abrupt, rapid change in mental function that goes well beyond the typical forgetfulness of aging. Delirium can cause you to become confused, potentially aggressive, agitated, sleepy, and/or inactive. Post-operative delirium can occur after you’ve had an operation, and is the most common complication older adults experience after they have surgery. Older adults are at high risk for post-operative delirium after they have heart surgery.

When older adults have post-operative delirium, they are often given antipsychotic medications (APMs).  However, these drugs are not proven to be effective for treating delirium and may be harmful. Experts suggest that these drugs do not reduce how often or for how long older adults may experience delirium, or how serious the effects of delirium may be.

Additionally, some studies in older adults with dementia have found that APMs may cause heart rhythm problems and other drug-related side effects. Taking these drugs can increase the effects of anesthesia, and can cause stroke, pneumonia, and even death. Older adults who have had heart surgery are more likely to experience these dangerous events.

In a new study published in the Journal of the American Geriatrics Society, researchers looked into the use of APMs in older adults following heart surgery. Continue reading

Recognizing and Diagnosing Obstructive Sleep Apnea in Older Adults

Journal of the American Geriatrics Society Research Summary

Obstructive sleep apnea (OSA) is a common condition that causes brief, repeated pauses in breathing throughout the night as you sleep. OSA is linked to several serious health problems, including heart disease, difficulties with thinking and memory, depression, car crashes, heart disease, stroke, and diabetes. Having OSA can also cause a decline in quality of life, and increase the risk of motor vehicle crashes.

Until now, researchers have not explored on a national scale how many older adults may be at risk for OSA, or how often healthcare providers evaluate and treat the condition in older people. Recently, a team of researchers from the University of Michigan designed a first-of-its-kind study to answer those questions. Their work was published in the Journal of the American Geriatrics Society.

The researchers studied information from the National Health and Aging Trends Study (NHATS), a survey of Medicare beneficiaries that assesses the impact of aging on health and well-being. Funded by the National Institute on Aging, NHATS has conducted five annual face-to-face interviews in older adults’ homes since 2011. The NHATS research team has collected detailed information about participants’ health, physical and mental capabilities, living conditions, daily activities, and social support. In 2013, NHATS interviews also asked beneficiaries questions about sleep disturbances and symptoms of sleep apnea. Many of the NHATS sleep questions resembled questions from a common sleep apnea screening questionnaire known as the “STOP-Bang” questionnaire, which got its name from the symptoms it assesses: snoring, tiredness, observed apneas (pauses in breathing), high blood pressure, body mass index (BMI, a ratio of weight to height that assesses levels of under/overweight and obesity), age, neck circumference, and gender. Continue reading

Avoiding Dangerous Side Effects of Medications in Nursing Homes

Journal of the American Geriatrics Society Research Summary

Experts from the University of Iowa recently published a study in the Journal of the American Geriatrics Society examining the kind of medication errors and side effects that nursing home residents experience. They also looked at staffing and work systems in nursing homes that could affect medication errors and side effects. This is important because more than 1.4 million older adults lived in nursing home facilities as of 2015. Of these, 85 percent were 65-years-old and older and 41 percent were 85-years-of-age or older. In 2014, there were 15,600 nursing homes in the United States.

Older adults who live in nursing homes are at greater risk for injuries related to the medications we might take as we age (these injuries are also known as “adverse drug events”). There is a greater risk for adverse drug events for this population due to age, frailty, disability, and the multiple chronic illnesses we may be managing at any given time. For these illnesses, nursing home residents usually need several medicines, sometimes including riskier medicines like antipsychotics, antidepressants, and antiepileptics.

Some adverse drug events are due to preventable errors. Others are considered “non-preventable” because they can occur even when the medications are correctly given at normal doses. Continue reading

How Severe is Insomnia in People 80-Years-Old and Older?

Journal of the American Geriatrics Society Research Summary

Insomnia means having difficulty falling or staying asleep at night. It tends to worsen as we age, and insomnia is a common problem among older adults. As many as 50 percent of people report having trouble sleeping. However, when researchers study insomnia, they may not include older adults in their studies. This means we don’t fully understand insomnia among older people.

A team of researchers from the Yale School of Medicine and the Yale School of Nursing decided to fill the knowledge gap by studying insomnia and its severity in older adults. The researchers’ theory was that insomnia would be more common and severe as people aged and would be linked to other health problems. Their study was published in the Journal of the American Geriatrics Society.

The researchers reviewed information from the Yale Precipitating Events Project (PEP), an ongoing study that began around 20 years ago. The study population consists of 754 non-disabled older adults between the ages of 78 and 102 (with an average age of about 84). Over the years, the study’s participants have regularly completed tests at home and interviews to determine their health.

The participants answered questions about sleep disorders, such as restless leg syndrome, daytime sleepiness, and sleep apnea (the medical term for when your breathing pauses during sleep). They also answered questions to determine whether they had insomnia, and if so, how severe it was.

The researchers reported that 43 percent of the older adults in the study had insomnia, and that restless leg syndrome and symptoms of depression were linked to insomnia. However, the researchers were surprised to discover that the participants’ insomnia was mild.

They also reported another surprising finding. The researchers looked at risk factors for insomnia in younger adults. These risk factors included chronic heart and breathing problems, sleep apnea, taking multiple medications, and cognitive impairment (trouble with thinking abilities). These risk factors were not linked with insomnia in the older study participants.

The researchers concluded that the high rate but mild severity of insomnia highlights the need for healthcare providers to use appropriate tests to confirm sleep problems among older adults. They also suggested that healthcare providers should take depression and restless leg syndrome into account when they treat older adults who have insomnia.

This summary is from “Insomnia in Community-Living Persons with Advanced Age.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Brienne Miner, MD, MHS; Thomas M. Gill, MD; H. Klar Yaggi, MD, MPH; Nancy S. Redeker, PhD, RN; Peter H. Van Ness, PhD, MPH; Ling Han, MD, PhD; and Carlos A. Vaz Fragoso, MD.

The Link Between Handgrip Strength and Healthy Lungs in Older Women

Journal of the American Geriatrics Society Research Summary

As we age, we may become weaker as our muscles tend to lose their mass and strength. This condition of losing muscle mass is called sarcopenia. Sarcopenia can lead to problems performing your daily activities, such as shopping, socializing, and taking care of yourself and your home. Having sarcopenia can lessen your quality of life—and your independence.

A simple, fast way to test your overall muscle strength is by measuring the strength of your handgrip. In the test, you grip a small device as hard as you can, and it measures the strength of your grip. Studies have shown that handgrip strength is closely linked to muscle mass and other signs of your general health, including nutrition and walking ability. What’s more, handgrip strength is considered an important test for diagnosing sarcopenia. Weak handgrip strength can predict low muscle mass and poor physical performance.

Research has linked handgrip strength to other health problems in older adults. Losing muscle strength as you age also means losing muscle strength in your respiratory system. (The respiratory system is the part of your body responsible for breathing.) This can lead to poor lung function. When your lungs don’t function properly, you are at higher risk for respiratory issues like bronchitis and pneumonia, as well as heart disease and even death. Continue reading