Category: JAGS Research Summaries

Does Having Alzheimer’s Disease and Dementia Affect Severity of Delirium?

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Journal of the American Geriatrics Society Research Summary

Forms of dementia, including Alzheimer’s disease, gradually affect your cognitive function by harming your memory and your ability to think and make decisions. By 2050, experts project that 13.8 million older adults in the United States will develop Alzheimer’s disease and related Dementias (ADRD). Although Alzheimer’s disease is the most common form of dementia, other forms include Lewy Body dementia, frontotemporal dementia, and vascular dementia—all of which have upsetting consequences for people with dementia and their families.

Since no cure or treatment yet exists for ADRD, healthcare providers currently focus on preventing the treatable risk factors that can lead to dementia. This strategy could potentially slow the onset and progression of ADRD.

Hospitalization poses risks to people with ADRD and can have life-threatening consequences, including predisposing us to delirium (the medical term for a rapid change in mental state, often marked by confusion), a decline in mental or physical function, being admitted to long-term care facilities, and even death.

In particular, delirium can worsen the course of an illness, quicken physical and mental decline, lengthen hospital stays, and cause higher rates of hospital re-admission and death. One in 8 hospitalized people with ADRD who develops delirium will have at least one serious problem, including cognitive decline, possibly leading to admission to long-term care or death.

Here’s the good news: Experts say 30 to 40 percent of delirium cases are preventable. But until now, we have not studied how delirium and its severity affect hospitalized older adults with and without ADRD. Continue reading →

When You’re 84…What Should Life Look Like as We Age?

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Journal of the American Geriatrics Society Research Summary

Have you thought about what you’d like your life to look like when you’re 84?

 When a leading health system leader put that question to Lewis A. Lipsitz, MD, Director, Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife and Professor of Medicine at Harvard Medical School, Dr. Lipsitz published an essay in the Journal of the American Geriatrics Society that outlined his thoughts. What follows is a summary of his essay, titled “When I’m 84: What Should Life Look Like in Old Age.” 

Knowing that I am a geriatrician, an esteemed health system leader once asked me: “What would you like your life to look like in old age?” I immediately listed the top contributors to a healthy longevity: Regular exercise, a well-balanced diet, a sense of purpose, social and family connections, intellectual stimulation and preventive health care.

However, many of us have trouble meeting these goals for various reasons. While we all hope to live long, productive lives, the field of geriatrics is more focused on achieving a long “health span,” in which we’re free of disease and disability, cognitively intact, and socially engaged. Since social factors account for most poor health outcomes, we need to help older adults address healthy longevity in our environment, our homes, communities, and lifestyles.

Here’s what I envision: Continue reading →

Don’t Let Social Isolation Keep You from Being Active

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Journal of the American Geriatrics Society Research Summary

By now, we’re all aware that COVID-19 is especially dangerous for older adults—the older you are, the higher your risk for serious illness and even death if you contract the virus. Because there is no treatment or a vaccine yet, it’s vitally important that we practice social distancing and wear masks to protect ourselves from disease.

But as we work to keep ourselves safe, we also need to be sure we’re not falling into physical inactivity. When we cut ourselves off from shopping, walking in malls, and going to the gym and other places where we can exercise, we can become sedentary. Older adults who don’t get regular exercise may become prone to chronic diseases, weakened muscles, and frailty.

Researchers from the University of Sao Paulo in Brazil recently reported on the dangers of physical inactivity for older adults during COVID-19. Their paper was published in the Journal of the American Geriatrics Society. Continue reading →

Should Nursing Home Residents Nearing the End of Life Continue Taking Statins?

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Journal of the American Geriatrics Society Research Summary

Cardiovascular disease (also called heart disease) is one of the most common medical conditions older adults face. In nursing homes, almost half of all older adult residents have been diagnosed with problems affecting the heart and/or blood vessels.

In spite of this, we know very little about how effective a class of popular heart disease medications may be for those 75 and older. Known as statins, these medications are prescribed to reduce the amount of cholesterol in your blood. High blood levels of cholesterol can damage your heart’s blood vessels and lead to the formation of blood clots, which can cause stroke and heart attacks.

The reason we have a knowledge gap as to how well statins work in older adults is because early medical studies that examined statin therapy for heart disease prevention included few adults age 75 and older. More recent trials that did include older adults often found that statin therapy did not help prevent these individuals from developing heart disease.

Why? It’s possible that, as we age, our sensitivity to medications may change. For instance, myopathy (muscle pain and weakness) is a commonly reported side effect of statins. This side effect may have a heightened effect on older adults who are already frail, which could speed up physical decline.

A team of researchers conducted a study to learn more about statin use among older adults, especially those nearing the end of their lives. Their study stemmed from concern about unclear statin prescribing guidelines for people over age 75, and a lack of information on the medications’ uses in nursing homes. The study, published in the Journal of the American Geriatrics Society, evaluated statin use by people with life-limiting conditions across nearly all U.S. nursing homes. The researchers hoped to identify statin use among nursing home residents who were unlikely to benefit from treatment. Continue reading →

Should Diabetes Treatment Lessen for Older Adults Approaching the End of Life?

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Journal of the American Geriatrics Society Research Summary

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One in four people aged 65 or older has diabetes. The disease is the seventh leading cause of death in the United States and a major contributor to heart disease. Experts have recommended that the best way to slow the progression of diabetes—and help prevent its many complications—is to maintain strict control of blood sugar levels. For healthy younger people, this means keeping the target blood sugar level (known as A1c or HbA1c) lower than 6.5 percent to 7.0 percent.

For older adults who have a limited life expectancy or who have advanced dementia, however, maintaining that target blood sugar level may cause more harm than good. For example, these older adults may not live long enough to experience potential benefits. What’s more, maintaining these strict blood sugar levels can raise the risk of potentially harmful events such as low blood sugar (also known as hypoglycemia). This can cause falls or loss of consciousness.

For these reasons, many guidelines now suggest targeting higher HbA1c targets—such as between 8.0 percent and 9.0 percent—for older adults who have multiple chronic conditions or limited life expectancy, or who live in nursing homes.

There is not much existing research to guide health care practitioners as to what the appropriate levels of diabetes medications are for this group of older adults. There is also little information about the effects for these individuals of taking fewer or lower dose of diabetes medications.

Experts suspect that lessening diabetes treatment in these older adults has the potential to prevent unnecessary hospitalizations due to lowering the risk for harmful drug events and increasing the patients’ comfort.

In order to investigate the issue, a team of researchers conducted a study—one of the first national studies to examine potential overtreatment and deintensification of diabetes management in nursing home residents with limited life expectancy or dementia. The researchers chose nursing home residents to study because admission to a nursing home could give healthcare practitioners a chance to learn more about patient goals and preferences and to review and adjust medications accordingly. The researchers published their results in the Journal of the American Geriatrics Society. Continue reading →