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 →

COVID-19: My City is Reopening. How Can I Protect Myself?

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You may be living in an area where local officials have decided it’s time to begin loosening restrictions that were put in place to slow the spread of COVID-19. While we can’t reduce our chances of becoming infected with the virus to zero, we can lower our risks and help reduce the coronavirus’ spread as restrictions are lifted.

If you’ve been diagnosed with COVID-19, have symptoms, or have been in close contact with someone who has COVID-19, it is important to stay home and away from other people. When can you leave home and be around other people? That depends on different factors for different situations. Follow the Centers for Disease Control and Prevention (CDC)’s recommendations for your circumstances.

As your area starts to reopen, your risk for contracting COVID-19 will be tied to several different factors. In general, the closer and longer you interact with others, the higher your risk of catching or spreading COVID-19. Ask yourself these questions: Continue reading →

A Creative Way to Expand the Geriatrics Workforce

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Journal of the American Geriatrics Society Research Summary

Geriatrics is the field of health care focused on care for older adults. Experts suggest that our current geriatrics workforce needs better preparation to care for the 5.7 million people living with dementia in this country. To help meet this challenge, the Institute of Medicine has called for enhancing educational and training programs for improving the competence of the workforce, and to ensure that our workforce reaches the level needed to serve the growing population of older adults with dementia.

Despite these ongoing efforts, the shortage of geriatricians makes it difficult to meet these urgent educational needs. For this study, a team of researchers looked “outside the box” to learn more about whether creative solutions could offer valuable opportunities for addressing these issues. In this new study, the researchers outlined the results and outcomes of an undergraduate service-learning course that used music and filmmaking to teach person-centered approaches to dementia.

The course, which included music, filmmaking, and reflective writing components, focused on service at local dementia care settings and was conducted in collaboration with Music & Memory, a non-profit organization dedicated to bringing personalized music playlists to people living with dementia or other serious medical challenges.

The three-credit undergraduate service-learning course was developed and taught by a music professor over three consecutive semesters with 16 to 18 students each term.

The students worked in pairs at one of two dementia care settings. Students received initial classroom training on dementia, ethnomusicology (music anthropology), ethnographic fieldwork methods (the technical term for expert research based on studying people and culture), filmmaking basics, and creative aging. Continue reading →

Regular Physical Activity Can Maintain or Improve Frailty

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Journal of the American Geriatrics Society Research Summary

Frailty is the medical term for becoming weaker or experiencing lower levels of activity or energy. Becoming frail as we age increases our risk for poor health, falls, disability, and other serious concerns.

Aging increases the risks for becoming frail. As more of us live longer, it’s likely that frailty will pose a larger public health problem in the near future. Experts in geriatrics (the field of health care focused on care for older adults) suggest that maintaining a healthy lifestyle may reduce your chances of becoming frail.

One aspect of a healthy lifestyle is getting regular physical activity. However, studies on the association between physical activity and frailty among older adults show different results. Some studies suggest that regular physical activity could delay frailty and reduce its severity, but other studies do not. And most of the studies have examined people aged 50 to 70, so the information we have for people over age 70 is limited.

To address this gap, researchers conducted a new study as part of a European project that promotes healthy aging in older adults. They examined the benefits of assistance that helps older adults follow their prescribed medications and prevent falls, frailty, and loneliness. The participants received care at study sites in five European countries (Spain, Greece, Croatia, the Netherlands, and the United Kingdom). The study results were published in the Journal of the American Geriatrics Society. Continue reading →