What matters when it comes to measuring Age‐Friendly Health System transformation

Journal of the American Geriatrics Society, Год журнала: 2022, Номер 70(10), С. 2775 - 2785

Опубликована: Авг. 22, 2022

Abstract Thousands of health systems are now recognized as “Age‐Friendly Health Systems,” making this model one the most widely disseminated – and promising‐ models to redesign care delivery for older adults. Sustaining these gains will require demonstrating impact on outcomes We propose a new measurement more tightly link Age‐Friendly System transformation within each “M” (What Matters, Medications, Mobility, Mentation). evaluated measures based following characteristics: (1) conceptual responsiveness changes brought about by practicing “4Ms” care; (2) degree which they represent that matter adults; (3) how can be feasibly, reliably, validly measured. offer specific examples novel currently being used where available. Finally, we present could capture system‐level effects across “M”s. tie suggestions together into AFHS transformation, with intent spur discussion, debate, iterative improvement in over time.

Язык: Английский

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Association between recently raised anticholinergic burden and risk of acute cardiovascular events: nationwide case-case-time-control study

BMJ, Год журнала: 2023, Номер unknown, С. e076045 - e076045

Опубликована: Сен. 27, 2023

To evaluate the association between recently raised anticholinergic burden and risk of acute cardiovascular events in older adults.Case-case-time-control study (ie, incorporating a case crossover design control consisting future cases).Taiwan's National Health Insurance Research Database.317 446 adults aged ≥65 who were admitted to hospital because an incident event 2011 2018. Acute included myocardial infarction, strokes, arrhythmias, conduction disorders, death.The was measured for each participant by adding up scores individual drugs using Anticholinergic Cognitive Burden Scale. Scores classified into three levels (0 points, 1-2 ≥3 points). For participant, during hazard periods (day -1 -30 before event) compared with randomly selected 30 day reference days -61 -180). Conditional logistic regression determined odds ratios 95% confidence intervals burden.The analyses 248 579 current cases. Participants' average age on index date 78.4 years (standard deviation 0.01), 53.4% men. The most frequently prescribed activity antihistamines (68.9%), gastrointestinal antispasmodics (40.9%), diuretics (33.8%). Among patients varying different periods, more carried higher than periods. example, 17 603 cases had points period 0 period, while 8507 period. In comparison versus burden, ratio 1.86 (95% interval 1.83 1.90) analysis 1.35 (1.33 1.38) analysis, which yielded case-case-time-control 1.38 (1.34 1.42). Similar results found (2.03, 1.98 2.09) (1.48, 1.44 1.52). findings remained consistent throughout series sensitivity (eg, cut-off categories redefined scales used measure burden).An increased events. Furthermore, greater increase associated

Язык: Английский

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Cognitive Loss

Cambridge University Press eBooks, Год журнала: 2025, Номер unknown, С. 218 - 245

Опубликована: Янв. 10, 2025

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DOTA: Deep Learning Optimal Transport Approach to Advance Drug Repositioning for Alzheimer’s Disease

Biomolecules, Год журнала: 2022, Номер 12(2), С. 196 - 196

Опубликована: Янв. 24, 2022

Alzheimer's disease (AD) is the leading cause of age-related dementia, affecting over 5 million people in United States and incurring a substantial global healthcare cost. Unfortunately, current treatments are only palliative do not cure AD. There an urgent need to develop novel anti-AD therapies; however, drug discovery time-consuming, expensive, high-risk process. Drug repositioning, on other hand, attractive approach identify drugs for AD treatment. Thus, we developed deep learning method called DOTA (Drug repositioning using Optimal Transport disease) repurpose effective FDA-approved Specifically, consists two major autoencoders: (1) multi-modal autoencoder integrate heterogeneous information (2) Wasserstein variational drugs. Using our approach, predict that antipsychotic with circadian effects, such as quetiapine, aripiprazole, risperidone, suvorexant, brexpiprazole, olanzapine, trazadone, will have efficacious effects patients. These target important brain receptors involved memory, learning, cognition, including serotonin 5-HT2A, dopamine D2, orexin receptors. In summary, repositions promising biological pathways predicted improve patient rhythms, pathogenesis.

Язык: Английский

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The Prognostic Utility of Anticholinergic Burden Scales: An Integrative Review and Gap Analysis

Drugs & Aging, Год журнала: 2023, Номер 40(9), С. 763 - 783

Опубликована: Июль 18, 2023

Язык: Английский

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Development of a pharmacological evidence‐based anticholinergic burden scale for medications commonly used in older adults

Geriatrics and gerontology international/Geriatrics & gerontology international, Год журнала: 2023, Номер 23(7), С. 558 - 564

Опубликована: Июнь 14, 2023

The present study aimed to develop a pharmacological evidence-based anticholinergic burden scale (ABS) through direct assessment of muscarinic receptor-binding activities 260 medications commonly used in older adults.

Язык: Английский

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Medication burden and anticholinergic use are associated with overt HE in individuals with cirrhosis

Hepatology Communications, Год журнала: 2024, Номер 8(8)

Опубликована: Июль 22, 2024

Background: Polypharmacy and anticholinergic medications are associated with cognitive decline in elderly populations. Although several have been HE, associations between medication burden, anticholinergics, HE not explored. We examined burden anticholinergics patients cirrhosis their HE-related hospitalization. Methods: conducted a retrospective cohort study of aged 18–80 seen hepatology clinics during 2019. The number chronic (medication burden) use were recorded. primary outcome was Results: A total 1039 followed for median 840 days. Thirty-seven percent had history 9.8% an hospitalization follow-up. mean 6.1 ± 4.3. Increasing hospitalizations univariable (HR: 1.09, 95% CI: 1.05–1.12) multivariable 1.07, 1.03–1.11) models. This relationship maintained those baseline but without HE. Twenty-one taking medication. Anticholinergic exposure increased both 1.68, 1.09–2.57) 1.71, 1.11–2.63) Conclusions: hospitalizations, particularly Special considerations to limit minimize overall should be tested potential benefit this population.

Язык: Английский

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Barriers and Facilitators of Communication in the Medication Reconciliation Process during Hospital Discharge: Primary Healthcare Professionals’ Perspectives

Healthcare, Год журнала: 2023, Номер 11(10), С. 1495 - 1495

Опубликована: Май 21, 2023

The WHO established that medication errors are the most common and preventable represent an expenditure of 42 billion U.S. dollars annually. risk increases in transitions between levels care, mainly from hospital care to primary healthcare after discharge. In this context, communication is a key element safety reconciliation process. aim paper was describe barriers to, facilitators of, effective during process at discharge people over 65 years age, perspective professionals. A qualitative descriptive study designed, in-depth interviews were conducted with 21 individuals, whom 13 nurses 8 physicians. This carried out professionals belonging centres Huelva (Spain). Following content analysis discourses we identified 19 categories, grouped into three areas: interlevel communication, professionals, patients/caregivers. found relate adequacy use technological tools, time available, workload level collaboration Facilitating elements for included technologies, such as computerized medical history, protocolization clinical sessions, presence case management nurse interdisciplinary teamwork.

Язык: Английский

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Pharmcokinetic and pharmacodynamic considerations for the anticholinergic burden scale of drugs

Geriatrics and gerontology international/Geriatrics & gerontology international, Год журнала: 2023, Номер 24(S1), С. 81 - 87

Опубликована: Окт. 23, 2023

Older adults frequently have many systemic diseases that require treatment with multiple drugs, and thus anticholinergic adverse effect by polypharmacy is a significant concern in the management of older adults. The accuracy burden rating may be increased considering pharmacokinetic pharmacodynamic factors such as biophase drug concentrations, pharmacologically active metabolites formed after administration, muscarinic receptor‐mediated effects. Therefore, pharmacological evidence‐based scale considers expected to more optimal tool for precisely assessing burden, specifically risk reductions events poly‐medicated elderly. Geriatr Gerontol Int 2024; 24: 81–87 .

Язык: Английский

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Anticholinergic burden in middle and older age is associated with lower cognitive function, but not with brain atrophy

British Journal of Clinical Pharmacology, Год журнала: 2023, Номер 89(7), С. 2224 - 2235

Опубликована: Фев. 23, 2023

The aim of this study is to estimate the association between anticholinergic burden, general cognitive ability and various measures brain structural MRI in relatively healthy middle-aged older individuals.

Язык: Английский

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