Lung cancer in older adults: Treatment experience through the patient’s lens (Lens Study)
This multisite prospective cohort study will characterize changes in patient-centered outcomes including function, cognition, and quality of life among older adults with advanced non-small cell lung cancer receiving chemotherapy, immunotherapy, and/or targeted therapy.
Improving decision making for older adults with cancer: A feasibility pilot study
This is a pilot cluster randomized controlled trial to determine the feasibility and acceptability of training medical oncologists to use the Best Case/Worst Case-Geriatric Oncology communication tool in clinical practice with older adults with cancer (NCT05374304).
The Effect of Electronic Nudges on Influenza Vaccination Rate in Older Adults With Cardiovascular Disease: a Prespecified Analysis of the NUDGE-FLU Trial
Influenza vaccines have been demonstrated to effectively reduce the incidence of influenza infection and potentially associated risks of cardiovascular events in patients with cardiovascular disease (CVD). Despite strong guideline and public health endorsements, global influenza vaccination rates in patients with…
Gilsanz, Paola
Cholesterol Lowering via Bempedoic Acid, an ACL-Inhibiting Regimen in Acute Coronary Syndrome (CLEAR ACS) Study
The overall objective of the Cholesterol Lowering via Bempedoic Acid/Ezetimibe, an ACL-Inhibiting Regimen in Acute Coronary Syndrome ACS (CLEAR ACS) study is to determine the efficacy, safety, and tolerability of bempedoic acid/ezetimibe (BA/E) in a contemporary and real-world population, enriched…
Early to Midlife Smoking Trajectories and Cognitive Function in Middle-Aged US Adults: the CARDIA Study
Smoking starts in early adulthood and persists throughout the life course, but the association between these trajectories and midlife cognition remains unclear. Determine the association between early to midlife smoking trajectories and midlife cognition. Prospective cohort study. Participants were 3364…
Measuring cognitive health in ethnically diverse older adults
Understanding racial/ethnic disparities in late-life cognitive health is a public health imperative. We used baseline data from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study to examine how age, education, gender, and clinical diagnosis, a proxy for brain…
Lifecourse health, cerebral pathology and ethnic disparities in dementia (KHANDLE Study)
The Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study, a collaborative study between DOR and UC Davis, follows a diverse cohort of Kaiser Permanente Northern California members who participated in at least one optional check-up (Multiphasic Health Checkups) during…
Skeletal Health Outcomes among US Asian Women
The burden of osteoporosis has increased as the US population over age 65 years has increased. Ethnic diversity in the U.S. has also increased. This is the first large scale US study of fracture outcomes among Asians and ethnic subgroups…
A Pragmatic Randomized Controlled Trial of a Bundled, Pharmacist-Led Hyperpolypharmacy Deprescribing Intervention
This randomized controlled trial study is testing an intervention to reduce unsafe medication use in patients aged 75 years and older. The intervention uses collaborative drug therapy management between physicians and pharmacists, standard-of-care treatment protocols, shared decision-making, and the CEASE deprescribing protocol.…
Progression of atypical femur stress fracture after discontinuation of bisphosphonate therapy
Atypical femur fracture (AFF) is an uncommon complication of long-term bisphosphonate use, but the risk declines substantially after treatment cessation. We report a case of a 70-year-old woman with osteopenia treated with alendronate for 9 years who presented with right…
Associations between longitudinal trajectories of insomnia symptoms and sleep duration with objective physical function in postmenopausal women: the Study of Women’s Health Across the Nation
Examine the association between trajectories of self-reported insomnia symptoms and sleep duration over 13 years with objective physical function. We utilized data from 1,627 Study of Women's Health Across the Nation participants, aged 61.9 ± 2.7 years at the end…
Bipolar Disease and Parkinson’s Disease – DUPLICATED DO NOT ACTIVATE
This study, being done with a parallel effort at UCSF, will focus on how bipolar disease is related to Parkinson's disease. We will look within the KPNC membership data, as well as focusing on a specific KP study population of…
Evaluating Acceptance and Screening Yield for Early Colorectal Cancer Screening: (EASY Early CRC)
Three national guideline groups now recommend that all adults start colorectal cancer (CRC) screening at age 45. Before 2018, some guideline groups only recommended African Americans begin CRC screening at age 45. There is currently no empirical evidence of the…
Mediation analysis of racial disparities in triple-negative breast cancer incidence among postmenopausal women
Triple-negative breast cancer (TNBC) is disproportionately higher in Black women relative to White women. The objective of this study was to examine to what extent the association between race/ethnicity and risk of TNBC is mediated by potentially modifiable factors. A…
Does the Hispanic Mortality Advantage Vary by Marital Status Among Postmenopausal Women in the Women’s Health Initiative?
Literature assessing the effect of marital status on mortality has underrepresented, or altogether omitted Hispanics and the potential moderating effect of Hispanic ethnicity on these relationships. Given cultural and network dynamics, marital advantages in older Hispanic women may be greater…
A large multiethnic GWAS meta-analysis of cataract identifies new risk loci and sex-specific effects
Cataract is the leading cause of blindness among the elderly worldwide and cataract surgery is one of the most common operations performed in the United States. As the genetic etiology of cataract formation remains unclear, we conducted a multiethnic genome-wide…
Metabolic syndrome risk components and mortality after triple-negative breast cancer diagnosis in postmenopausal women in the Women’s Health Initiative
Triple-negative breast cancer (TNBC) has a high recurrence risk and poor clinical outcomes. Associations between metabolic syndrome (MetS) risk components and mortality in postmenopausal women with TNBC were examined in the Women's Health Initiative. Five hundred forty-four postmenopausal women were…
The Study of Women’s Health Across the Nation (SWAN)
SWAN VI aims to elucidate menopause transition characteristics and trajectories of midlife health markers (inflammation, metabolic and cardiovascular risk factors, body composition, and bone, genitourinary, and vascular health) that are related to the preservation of physical and cognitive functioning, avoidance…
GUARD-AF: reducinG stroke by screening for UndiAgnosed atRial fibrillation in elderly inDividuals
To determine if one-time screening for atrial fibrillation using the 14-day Zio XT patch leads to a reduced risk of stroke compared with usual care among adults aged 70 years or older without prior known atrial fibrillation or atrial flutter.
Predictive Value of DXA Appendicular Lean Mass for Incident Fractures, Falls, and Mortality, Independent of Prior Falls, FRAX, and BMD: Findings from the Women’s Health Initiative (WHI)
In the Women's Health Initiative (WHI), we investigated associations between baseline dual-energy X-ray absorptiometry (DXA) appendicular lean mass (ALM) and risk of incident fractures, falls, and mortality (separately for each outcome) among older postmenopausal women, accounting for bone mineral density…
Variation in fracture risk estimation among East Asian women
Bone mineral density (BMD) testing and fracture risk calculation help clinicians assess fracture risk and counsel patients. However, predicted fracture risks and outcomes for US East Asian individuals remain understudied. Retrospective cohort study. Using standardized clinical profiles for East Asian…
Are adverse childhood experiences associated with late-life cognitive performance across racial/ethnic groups: results from the Kaiser Healthy Aging and Diverse Life Experiences study baseline
Evidence on adverse childhood experiences (ACEs) and late-life cognitive outcomes is inconsistent, with little research among diverse racial/ethnic groups. We investigated whether ACE exposures were associated with worse late-life cognition for all racial/ethnic groups and at different ages of exposure.…
Sex Differences in Cognitive Decline Among US Adults
Sex differences in dementia risk are unclear, but some studies have found greater risk for women. To determine associations between sex and cognitive decline in order to better understand sex differences in dementia risk. This cohort study used pooled analysis…
Association of Major Dietary Protein Sources With All-Cause and Cause-Specific Mortality: Prospective Cohort Study
Background Dietary recommendations regarding protein intake have been focused on the amount of protein. However, such recommendations without considering specific protein sources may be simplistic and insufficient. Methods and Results We included 102 521 postmenopausal women enrolled in the Women's Health…
Fitting a shared frailty illness-death model to left-truncated semi-competing risks data to examine the impact of education level on incident dementia
Semi-competing risks arise when interest lies in the time-to-event for some non-terminal event, the observation of which is subject to some terminal event. One approach to assessing the impact of covariates on semi-competing risks data is through the illness-death model…
Physical Performance and Cognition in a Diverse Cohort: Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study
The authors assessed the cross-sectional association of physical function measures with cognition in the Kaiser Healthy Aging and Diverse Life Experiences Cohort. Analyses included 1369 participants (24% Asian, 26% Black, 18% Latino, 32% White). Grip strength was measured using a…
Physical Performance and Cognition in a Diverse Cohort: Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study
The authors assessed the cross-sectional association of physical function measures with cognition in the Kaiser Healthy Aging and Diverse Life Experiences Cohort. Analyses included 1369 participants (24% Asian, 26% Black, 18% Latino, 32% White). Grip strength was measured using a…
Sex, diabetes status and cognition: findings from the study of longevity in diabetes
Women comprise two-thirds of people with dementia, making female sex a significant dementia risk factor. Both type 1 diabetes (T1D) and type 2 diabetes (T2D) are known dementia risk factors with an increasing global incidence. Understanding whether subtle sex differences…
Relationships of Inflammation Trajectories with White Matter Volume and Integrity in Midlife
Elevated inflammation is associated with worse late-life cognitive functioning and brain health. Our goal was to examine the relationship between inflammation trajectories and white matter integrity in midlife. Participants were 508 adults from the Coronary Artery Risk Development in Young…
Bone Mineral Density in Older U.S. Filipino, Chinese, Japanese, and White Women
Bone mineral density (BMD) reference data exist for U.S. White, Black, and Hispanic (Mexican American) populations but not for U.S. Asians. Few studies have compared BMD findings among different U.S. Asian ethnicities. Retrospective observational study. Large northern California healthcare system.…
Elevated Depressive Symptoms and the Risk of Stroke among the Mexican Older Population
Several longitudinal studies in high-income countries suggest that depression increases stroke risk. However, few prior studies have evaluated this association in low- and middle-income countries (LMICs), where rapidly aging populations may have markedly different vascular risk profiles. Prospective cohort study.…
Decline in kidney function over the course of adulthood and cognitive function in midlife
To test the hypothesis that end-stage renal disease (ESRD) risk exposure during young adulthood is related to worse cognitive performance in midlife. We included 2,604 participants from the population-based Coronary Artery Risk Development in Young Adults (CARDIA) Study (mean age…
Statin Treatment and Incident Alzheimer’s Disease and Related Dementias in a Large, Multi-ethnic Health Plan
The study will assess the effects of statin treatment on risk of Alzheimer's disease and related dementias, controlling for potential confounding and examining potential mediating factors among Kaiser Permanente Northern California members during the years 1996 to 2020. A second…
Clinical Trial of Expanded Advance Care Planning to Address Regimen Intensity in Older Patients at High Risk for Treatment-Induced Hypoglycemia
The goal of this study is to apply the patient-centered advance care planning paradigm of values elicitation and decision-making and communication preparation to hypoglycemia-related adverse outcomes in vulnerable older patients with type 2 diabetes. This will involve a randomized clinical…
Understanding Racial/Ethnic Disparities in Physical Performance in Mid-Life Women: Findings from SWAN (Study of Women’s Health Across the Nation)
Evaluate degree to which racial/ethnic differences in physical performance are mediated by sociodemographic, health, behavioral, and psychosocial factors. Physical performance was evaluated using a decile score derived from grip strength, timed 4 m walk, and timed repeat chair stand in…
Informatics approaches to assessing patient frailty in surgical care
Patient frailty increases the risk for surgical complications, which are common, costly, and deadly, especially for older Americans. To improve surgical care for older adults, we will investigate whether electronic measures of frailty can help reduce complications by identifying which…
Association of Prediagnostic Frailty, Change in Frailty Status, and Mortality After Cancer Diagnosis in the Women’s Health Initiative
Understanding changes in frailty in relation to cancer diagnosis can inform optimal selection of cancer treatments and survivorship care. To investigate associations of prediagnostic frailty and change in frailty status with mortality after a cancer diagnosis. This multicenter, prospective cohort…
Dietary Intakes of Women’s Health Initiative Long Life Study Participants Falls Short of the Dietary Reference Intakes
Understanding how nutrient intake in older women compares with recommendations is important. The Academy of Nutrition and Dietetics position statement summarizes the nutrient needs of older adults (aged ≥60 years) based on a systematic review. The objective of this study…
Sustained weight loss and risk of breast cancer in women ≥50 years: a pooled analysis of prospective data
Excess body weight is an established cause of postmenopausal breast cancer, but it is unknown if weight loss reduces risk. Associations between weight change and risk of breast cancer were examined among women aged 50 years and older in the Pooling…
Body mass index versus bioelectrical impedance analysis for classifying physical function impairment in a racially diverse cohort of midlife women: the Study of Women’s Health Across the Nation (SWAN)
Body composition strongly influences physical function in older adults. Bioelectrical impedance analysis (BIA) differentiates fat mass from skeletal muscle mass, and may be more useful than body mass index (BMI) for classifying women on their likelihood of physical function impairment.…
Association of blood pressure with cognitive function at midlife: a Mendelian randomization study
Whether high blood pressure has a causal effect on cognitive function as early as middle age is unclear. We investigated whether high blood pressure (BP) causally impairs cognitive function at midlife using Mendelian Randomization (MR). We applied a two-sample MR…
Social Relationships and Risk of Type 2 Diabetes Among Postmenopausal Women
We examined whether social relationship variables (social support, social strain, social network size, and stressful life events) were associated with risk of developing type 2 diabetes among postmenopausal women. 139,924 postmenopausal women aged 50-79 years without prevalent diabetes at baseline…
Postmenopausal Hormone Therapy and Colorectal Cancer Risk by Molecularly Defined Subtypes and Tumor Location
Postmenopausal hormone therapy (HT) is associated with a decreased colorectal cancer (CRC) risk. As CRC is a heterogeneous disease, we evaluated whether the association of HT and CRC differs across etiologically relevant, molecularly defined tumor subtypes and tumor location. We…
Association of Racial Residential Segregation Throughout Young Adulthood and Cognitive Performance in Middle-aged Participants in the CARDIA Study
Neighborhood-level residential segregation is implicated as a determinant for poor health outcomes in black individuals, but it is unclear whether this association extends to cognitive aging, especially in midlife. To examine the association between cumulative exposure to residential segregation during…
Associations between Prediagnostic Concentrations of Circulating Sex Steroid Hormones and Liver Cancer Among Post-Menopausal Women
In almost all countries, incidence rates of liver cancer (LC) are 100%-200% higher in males than in females. However, this difference is predominantly driven by hepatocellular carcinoma (HCC), which accounts for 75% of LC cases. Intrahepatic cholangiocarcinoma (ICC) accounts for…
Reducing Treatment Risk in Older Patients with Diabetes: Comparative Effectiveness of Academic Detailing with and without Pre-Visit Patient Preparation
This pragmatic, randomized clinical trial will compare the effect of primary care physician academic detailing with or without patient pre-visit preparation on insulin de-prescribing rates among older patients with type 2 diabetes at high risk for insulin-related hypoglycemia. We will…
Identifying metabolomic profiles of inflammatory diets in postmenopausal women
We previously showed that a food-based empirical dietary inflammatory pattern (EDIP) score is associated with circulating inflammatory biomarkers. Metabolomic profiling of inflammatory diets may therefore provide insights on mechanisms contributing to disease etiology and prognosis. We aimed to elucidate metabolites…
Associations between nutritional factors and chemotherapy toxicity in older adults with solid tumors
Nutritional status can directly affect morbidity and mortality in older adults with cancer. This study evaluated the association between pretreatment body mass index (BMI), albumin level, and unintentional weight loss (UWL) in the prior 6 months and chemotherapy toxicity among older…
Association Between Blood Pressure and Later-Life Cognition Among Black and White Individuals
Black individuals are more likely than white individuals to develop dementia. Whether higher blood pressure (BP) levels in black individuals explain differences between black and white individuals in dementia risk is uncertain. To determine whether cumulative BP levels explain racial…
Lights on MsFLASH: a review of contributions
The Menopause Strategies: Finding Lasting Answers for Symptoms and Health clinical trials network was funded by the National Institutes of Health to find new ways to alleviate the most common, bothersome menopausal symptoms by designing and conducting multiple concurrent clinical…
The impact of breast cancer on physical activity from midlife to early older adulthood and predictors of change post-diagnosis
To examine physical activity (PA) patterns from pre- to post-diagnosis, and compare these changes to women without breast cancer. To determine pre-diagnosis predictors of PA change, post-diagnosis, in breast cancer survivors (BCS). Data were from 2314 Study of Women's Health…
Severe Hypoglycemia and Cognitive Function in Older Adults With Type 1 Diabetes: The Study of Longevity in Diabetes (SOLID)
In children with type 1 diabetes (T1D), severe hypoglycemia (SH) is associated with poorer cognition, but the association of SH with cognitive function in late life is unknown. Given the increasing life expectancy in people with T1D, understanding the role…
Sexual function, menopausal symptoms, depression and cancer worry in women with BRCA mutations
Assess sexual function, menopausal symptoms, and depression in women with BRCA mutations associated with oophorectomy and menopause status. Women age 40 and older with BRCA mutations completed a questionnaire with validated measures of sexual activity, menopausal symptoms, depression, and cancer…
Lifecourse CVD Risk and Midlife Cognitive Trajectories and Brain Aging: Implications for Alzheimer’s and Dementia Prevention
Determinants of cognitive aging may begin decades prior to the development of pathological brain changes, but it is unknown whether risk factors such as hypertension and diabetes exert their influence as early as young adulthood. In this CARDIA Year 35…
Pragmatic Trial of Acupuncture for Chronic Low Back Pain in Older Adults
The goal of this project is to conduct a three-arm parallel-group randomized clinical trial of two acupuncture interventions vs. a usual-care control group for change in low back pain symptoms among adults at least 65 years of age.
Smoking mediates the relationship between SES and brain volume: The CARDIA study
Investigate whether socioeconomic status (SES) was related to brain volume in aging related regions, and if so, determine whether this relationship was mediated by lifestyle factors that are known to associate with risk of dementia in a population-based sample of…
Racial/Ethnic Differences in Sleep Quality among Older Adults: Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study
We assessed cross-sectional differences in sleep quality and risk factors among Asian, Black, Latino, and White participants in the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study. KHANDLE enrolled community-dwelling adults aged ≥65 years living in northern California. Participants…
Chronicity of Uncorrected Hyponatremia and Clinical Outcomes in Older Patients Undergoing Hip Fracture Repair
Background: Chronic hyponatremia is a risk factor for hip fracture but remains uncorrected in most patients. This study evaluated if preoperative chronicity of uncorrected hyponatremia influences outcomes after hip fracture repair. Materials and Methods: Evaluated were older patients hospitalized for…
Don’t Fall for That: A Residency Curricular Innovation about Fall Prevention
Amid a growing geriatric population and rise in frailty-related morbidity, fall prevention represents an opportunity to improve patient outcomes and reduce health care costs. Traditional lectures on geriatric content have had limited impact on physician behaviors; however, use of multimodal…
Interpersonal Trauma as a Marker of Risk for Urinary Tract Dysfunction in Midlife and Older Women
To examine relationships between interpersonal trauma exposures and urinary symptoms in community-dwelling midlife and older women. We analyzed cross-sectional data from a multiethnic cohort of women aged 40-80 years enrolled in an integrated health care system in California. Lifetime history…
It’s Absolutely Relative: The Effect of Age on the BMI-Mortality Relationship in Postmenopausal Women
The use of relative and absolute effect estimates has important implications for the interpretation of study findings. Likewise, examining additive and multiplicative interaction can lead to differing conclusions about the joint effects of two exposure variables. The aim of this…
Sleep Quality and Cognitive Function in Type 1 Diabetes: Findings From the Study of Longevity in Diabetes (SOLID)
The objective was to examine the association between sleep quality and global and domain-specific cognitive function among older individuals with type 1 diabetes (T1D). We evaluated 695 individuals with T1D aged 60 years or above who participated in the baseline…
Association Between Aging of the US Population and Heart Disease Mortality From 2011 to 2017
A deceleration in the rate of decrease of heart disease (HD) mortality between 2011 and 2014 has been reported. In the context of the rapid increase in the population of adults aged 65 years and older, extending the examination of…
Atypical femur fracture incidence in women increases with duration of bisphosphonate exposure
In a northern California population of older women who were treated with oral bisphosphonate drugs, the incidence of atypical femur fracture, a rare complication of treatment, increased with longer duration of bisphosphonate exposure. These findings align with those previously reported…
Use and Discontinuation of Insulin Treatment Among Adults Aged 75 to 79 Years With Type 2 Diabetes
Among older individuals with type 2 diabetes, those with poor health have greater risk and derive less benefit from tight glycemic control with insulin. To examine whether insulin treatment is used less frequently and discontinued more often among older individuals…
Aggregation of Asian-American subgroups masks meaningful differences in health and health risks among Asian ethnicities: an electronic health record based cohort study
Few large cohort studies have examined the prevalence of diabetes mellitus (DM), hypertension (HTN), coronary artery disease (CAD), obesity, and smoking among middle-aged and older adults in the major Asian-American ethnic groups and Native Hawaiian/Pacific Islanders (PIs). The aim of…
Locus of Control and Cognition in Older Adults With Type I Diabetes: Evidence For Sex Differences From the Study of Longevity in Diabetes (SOLID)
Life expectancy for individuals with type 1 diabetes mellitus (T1DM) has increased recently; however, it is unknown how diabetes care attitudes affect late-life brain health. The Study of Longevity in Diabetes (SOLID) consists of 734 older adults with T1DM, reporting…
The Effect of Reverse Causality and Selective Attrition on the Relationship Between Body Mass Index and Mortality in Postmenopausal Women
Concerns about reverse causality and selection bias complicate the interpretation of studies of body mass index (BMI, calculated as weight (kg)/height (m)2) and mortality in older adults. The objective of this study was to investigate methodological explanations for the apparent…
Incident Anemia in Older Adults with Heart Failure Rate, Etiology, and Association with Outcomes
Limited data exist on the epidemiology, evaluation, and prognosis of otherwise unexplained anaemia of the elderly in heart failure (HF). Thus, we aimed to determine the incidence of anaemia, to characterize diagnostic testing patterns for potentially reversible causes of anaemia,…
Multisite Pain Is Associated with Long-term Patient-Reported Outcomes in Older Adults with Persistent Back Pain
To estimate the prevalence of co-occurring pain sites among older adults with persistent back pain and associations of multisite pain with longitudinal outcomes. Secondary analysis of a cohort study. Three integrated health systems in the United States. Eight hundred ninety-nine…
Optimizing Medical Decision-Making for Older Patients with Type 2 Diabetes
Medicare-age patients with type 2 diabetes are projected to double in the next 25 years and have high rates of complications and adverse drug events. However, older patients are largely excluded from the major clinical trials of diabetes care. This…
Contributions of Educational Quality and Occupational Complexity on Racial and Ethnic Inequities in Brain Health and Alzheimer’s Disease and Related Dementia
This study utilizes a lifecourse approach to evaluate the roles of education quality and occupational complexity on dementia risk and cognitive decline and to examine if patterns of educational quality and occupational complexity across the lifecourse drive racial and ethnic…
Characteristics of New Opioid Use Among Medicare Beneficiaries: Identifying High-Risk Patterns
Opioid prescription patterns, including long-term use, multiple prescribers, and high opioid doses, increase the risk for adverse outcomes; however, previous research in older adult populations has primarily described opioid dose patterns using average daily dose measures or using very high…
Identifying Common Predictors of Multiple Adverse Outcomes Among Elderly Adults With Type-2 Diabetes
As part of a multidisciplinary team managing patients with type-2 diabetes, pharmacists need a consistent approach of identifying and prioritizing patients at highest risk of adverse outcomes. Our objective was to identify which predictors of adverse outcomes among type-2 diabetes…
Bidirectional 10-year associations of accelerometer-measured sedentary behavior and activity categories with weight among middle-aged adults
Although higher sedentary behavior (SB) with low light intensity (LPA) and moderate-to-vigorous intensity physical activity (MVPA) are thought to increase risk for obesity, other data suggest excess weight may precede these behaviors in the causal pathway. We aimed to investigate…
Association of Normal-Weight Central Obesity With All-Cause and Cause-Specific Mortality Among Postmenopausal Women
Current public health guidelines for obesity prevention and control focus on promoting a normal body mass index (BMI), rarely addressing central obesity, which is reflected by high waist circumference (WC) and common in the general population. Studies of the association…
Comparison of Universal Versus Age-Restricted Screening of Colorectal Tumors for Lynch Syndrome Using Mismatch Repair Immunohistochemistry: A Cohort Study
Guidelines recommend screening all patients with newly diagnosed colorectal cancer (CRC) for Lynch syndrome (LS). However, the efficiency of universal LS screening in elderly populations has not been well studied. To compare the performance of age-restricted and universal LS screening…
Telomere length and socioeconomic status at neighborhood and individual levels among 80,000 adults in the Genetic Epidemiology Research on Adult Health and Aging cohort
Telomere length (TL) may serve as a biologic marker of aging. We examined neighborhood and individual-level socioeconomic status (SES) in relation to TL. The study included 84,996 non-Hispanic white subjects from the Genetic Epidemiology Research on Adult Health and Aging…
Coronary Artery Calcium From Early Adulthood to Middle Age and Left Ventricular Structure and Function
Background The relationship of coronary artery calcium (CAC) with adverse cardiac remodeling is not well established. We aimed to study the association of CAC in middle age and change in CAC from early adulthood to middle age with left ventricular…
Serum Sex Hormones and the Risk of Fracture across the Menopausal Transition: Study of Women’s Health Across the Nation
Sex steroid hormones have been linked to fractures in older women. To test the hypothesis that hormones measured over the menopausal transition predict fractures. Seven US clinical centers. Two thousand nine hundred sixty women (average age, 46.4 ± 2.7 years)…
Dietary patterns during adulthood and cognitive performance in midlife: The CARDIA study
To investigate whether dietary patterns (Mediterranean diet [MedDiet], Dietary Approaches to Stop Hypertension [DASH], and A Priori Diet Quality Score [APDQS]) during adulthood are associated with midlife cognitive performance. We studied 2,621 Coronary Artery Risk Development in Young Adults (CARDIA)…
Urinary N-Telopeptide as Predictor of Onset of Menopause-Related Bone Loss in Pre- and Perimenopausal Women
The menopause transition (MT) is a period of rapid bone loss and has been proposed to be a time-limited window for early intervention to prevent permanent microarchitectural damage and reduce the risk of subsequent fracture. To intervene early, however, we…
Incidence of dementia after age 90 in a multiracial cohort
Little is known about dementia incidence in diverse populations of oldest-old, the age group with highest dementia incidence. Incident dementia diagnoses from 1/1/2010 to 9/30/2015 were abstracted from medical records for 2350 members of an integrated health care system in…
Prevalence and Factors Influencing Use of Internet and Electronic Health Resources by Middle-Aged and Older Adults in a US Health Plan Population: Cross-Sectional Survey Study
Health care organizations are increasingly using electronic health (eHealth) platforms to provide and exchange health information and advice (HIA). There is limited information about how factors beyond internet access affect use of eHealth resources by middle-aged and older adults. We…
Study of Healthy Aging in African Americans (STAR)
Rates of dementia and Alzheimer’s disease are 40% to 100% higher among African Americans compared to non-Hispanic whites. STAR is a longitudinal cohort study of lifecourse vascular risk and brain aging in 700 African Americans ages 50 and older. The goals…
Study of Longevity in Diabetes (SOLID)
Type 1 diabetes is a complicated disease requiring constant adherence to glycemic targets and meticulous attention and vigilance of blood sugar. Individuals with type 1 diabetes are living longer than ever before, yet very little is known about how this…
Kaiser Healthy Aging and Diverse Life Experiences Study (KHANDLE)
Although there are marked ethnic disparities in rates of dementia, almost nothing is known about early-life contributors to dementia in ethnic minority groups, nor if the trajectory of cognitive decline or transition to cognitive impairment varies across ethnic groups. We…
Life After 90
Alzheimer’s disease and other dementias affect 15 percent of those aged 65 and older, by age 90 and older this number increases to a startling 40 to 50 percent. The oldest-old, people aged 90 and older, are the fastest growing…
Changes in body composition and weight during the menopause transition
The relation between the menopause transition (MT) and changes in body composition or weight remains uncertain. We hypothesized that, independent of chronological aging, the MT would have a detrimental influence on body composition. Participants were from the longitudinal Study of…
Racial Differences in Maintaining Optimal Health Behaviors Into Middle Age
Earlier development of cardiovascular disease risk factors in blacks versus whites may result from differences in maintaining health behaviors. Age-specific racial differences in maintaining health behaviors from ages 18 to 50 years were determined. In 1985-1986, the population-based Coronary Artery…
The Legacy Effect in Type 2 Diabetes: Impact of Early Glycemic Control on Future Complications (the Diabetes & Aging Study)
To examine for a legacy effect of early glycemic control on diabetic complications and death. This cohort study of managed care patients with newly diagnosed type 2 diabetes and 10 years of survival (1997-2013, average follow-up 13.0 years, N =…
Lifecourse Health, Cerebral Pathology, and Ethnic Disparities in Dementia
Although there are marked ethnic disparities in rates of dementia, almost nothing is known about early-life contributors to dementia in ethnic minority groups, nor if the trajectory of cognitive decline or transition to cognitive impairment varies across ethnic groups. This…
Changes in physical and mental health are associated with cardiovascular disease incidence in postmenopausal women
physical and mental health are important risk factors for cardiovascular disease (CVD) incidence and death among postmenopausal women. The objective of this study was to assess whether changes in physical and mental health were associated with CVD incidence and death.…
Closing the Gap Between Observational Research and Randomized Trials for Prevention of Alzheimer‘s Disease and Dementia
Observational studies should have a core role in justifying and guiding the development of randomized controlled trials, but to date observational research and trials on Alzheimer’s disease prevention are not closely aligned. Observational and randomized studies nearly always answer different…
Association of Body Fat and Risk of Breast Cancer in Postmenopausal Women With Normal Body Mass Index: A Secondary Analysis of a Randomized Clinical Trial and Observational Study
Obesity is associated with an increased risk of breast cancer, including the estrogen receptor (ER)-positive subtype in postmenopausal women. Whether excess adiposity is associated with increased risk in women with a normal body mass index (BMI; calculated as weight in…
Pregnancy-Associated Cancer: A U.S. Population-Based Study
The incidence of pregnancy-associated cancer (PAC) is expected to increase as more women delay childbearing until later ages. However, information on frequency and incidence of PAC is scarce in the United States. We identified pregnancies among women aged 10-54 years…
Genome-wide association study of 23,500 individuals identifies 7 loci associated with brain ventricular volume
The volume of the lateral ventricles (LV) increases with age and their abnormal enlargement is a key feature of several neurological and psychiatric diseases. Although lateral ventricular volume is heritable, a comprehensive investigation of its genetic determinants is lacking. In…
Associations of Intimate Partner Violence, Sexual Assault, and Posttraumatic Stress Disorder With Menopause Symptoms Among Midlife and Older Women
Little is known about the prevalence of traumatic exposures among midlife and older women and the association of these traumatic exposures with health issues. To examine the associations of intimate partner violence (IPV), sexual assault, and posttraumatic stress with menopause…
Birth in High Infant Mortality States and Dementia Risk in a Cohort of Elderly African American and White Health Care Members
Birth in areas with high infant mortality rates (IMRs) has been linked to worse long-term health outcomes, yet it is completely unknown if it impacts dementia risk. In total 6268 health care members were followed for dementia diagnosis from 1996…
Healthy Lifestyle During the Midlife Is Prospectively Associated With Less Subclinical Carotid Atherosclerosis: The Study of Women’s Health Across the Nation
Background Measures of subclinical atherosclerosis are predictors of future cardiovascular outcomes as well as of physical and cognitive functioning. The menopausal transition is associated with accelerated progression of atherosclerosis in women. The prospective association between a healthy lifestyle during the…
Statins for Primary Prevention in Older Adults-Moving Toward Evidence-Based Decision-Making
To determine the efficacy and safety of statins for primary prevention of atherosclerotic cardiovascular disease (ASCVD) events in older adults, especially those aged 80 and older and with multimorbidity. The National Institute on Aging and the National Heart, Lung and…
Long-term postmenopausal estrogen therapy may be associated with increased risk of breast cancer: a cohort study
Reports of a role of postmenopausal estrogen replacement therapy in the development of breast cancer have been inconsistent. Although many epidemiologic studies have failed to show an association between short-term use of estrogen and breast cancer, there are indications that…
Continuation of postmenopausal hormone replacement therapy: comparison of cyclic versus continuous combined schedules
Discontinuation of hormone replacement therapy (HRT) is much more common than what is reported in randomized, double-blind clinical trials. Our purpose in this retrospective study, using a prescription database, was to compare the continuation rate among women who took cyclic…
Advancing Geriatrics Infrastructure and Network Growth (AGING) Initiative
The Advancing Geriatrics Infrastructure and Network Growth (AGING) Initiative was initiated in 2014 to bridge the Health Care Systems Research Network (HCSRN) with the Older Americans Independence Centers (OAICs, also known as “Pepper Centers”) in order to advance an interdisciplinary…
Understanding functional and social risk characteristics of frail older adults: a cross-sectional survey study
Frailty is a condition of increasing importance, given the aging adult population. With an anticipated shortage of geriatricians, primary care physicians will increasingly need to manage care for frail adults with complex functional risks and social-economic circumstances. We used cross-sectional…
Genetic variation in the SIM1 locus is associated with erectile dysfunction
Erectile dysfunction affects millions of men worldwide. Twin studies support the role of genetic risk factors underlying erectile dysfunction, but no specific genetic variants have been identified. We conducted a large-scale genome-wide association study of erectile dysfunction in 36,649 men…
Differences in molecular features of triple-negative breast cancers based on the age at diagnosis
Although the proportion of triple-negative breast cancers (TNBCs) diagnosed among older women is low, the number of TNBC cases is substantial because of the high incidence of breast cancer after the age of 65 years. The molecular features of TNBC…
Traumatic brain injury associated with dementia risk among people with type 1 diabetes
To examine the association between traumatic brain injury (TBI) and dementia risk among a cohort of middle-aged and elderly individuals with type 1 diabetes (T1D). We evaluated 4,049 members of an integrated health care system with T1D ≥50 years old…
Long-term Glycemic Control and Dementia Risk in Type 1 Diabetes
Individuals with type 1 diabetes have experienced an increase in life expectancy; yet, it is unknown what level of glycemic control is ideal for maintaining late-life brain health. We investigated the association of long-term glycemic control with dementia in older…
Stratified probabilistic bias analysis for BMI-related exposure misclassification in postmenopausal women
There is widespread concern about the use of body mass index (BMI) to define obesity status in postmenopausal women because it may not accurately represent an individual's true obesity status. The objective of the present study is to examine and…
Long-term outcomes of a large, prospective observational cohort of older adults with back pain
Although back pain is common among older adults, there is relatively little research on the course of back pain in this age group. Our primary goals were to report 2-year outcomes of older adults initiating primary care for back pain…
Exome Chip Analysis Identifies Low-Frequency and Rare Variants in MRPL38 for White Matter Hyperintensities on Brain Magnetic Resonance Imaging
Background and Purpose- White matter hyperintensities (WMH) on brain magnetic resonance imaging are typical signs of cerebral small vessel disease and may indicate various preclinical, age-related neurological disorders, such as stroke. Though WMH are highly heritable, known common variants explain…
Cumulative Incidence of Hypertension by 55 Years of Age in Blacks and Whites: The CARDIA Study
Blacks have higher blood pressure levels compared with whites beginning in childhood. Few data are available on racial differences in the incidence of hypertension from young adulthood through middle age. We calculated the cumulative incidence of hypertension from age 18…
Occupational cognitive complexity in earlier adulthood is associated with brain structure and cognitive health in midlife: The CARDIA study
In line with cognitive reserve theory, higher occupational cognitive complexity is associated with reduced cognitive decline in older adulthood. How and when occupational cognitive complexity first exerts protective effects during the life span remains unclear. We investigated associations between occupational…
Manuscript title: Can survival bias explain the age attenuation of racial inequalities in stroke incidence? A simulation study
In middle age, stroke incidence is higher among black than white Americans. For unknown reasons, this inequality decreases and reverses with age. We conducted simulations to evaluate whether selective survival could account for observed age patterning of black-white stroke inequalities.…
Cumulative blood pressure from early adulthood to middle age is associated with left atrial remodelling and subclinical dysfunction assessed by three-dimensional echocardiography: a prospective post hoc analysis from the coronary artery risk development in young adults study
To evaluate the association of cumulative blood pressure (BP) from young adulthood to middle age with left atrial (LA) structure/function as assessed by three-dimensional echocardiography (3DE) in a large longitudinal bi-racial population study. We conducted a prospective post hoc analysis…
10-year changes in accelerometer-based physical activity and sedentary time during midlife: CARDIA Study
To describe 10-year changes in accelerometer-determined physical activity (PA) and sedentary time in a midlife cohort, within and by race/sex groups. Coronary Artery Risk Development in Young Adults participants (n = 962) who wore the accelerometer with valid wear (≥4…
Mendelian randomisation study of age at menarche and age at menopause and the risk of colorectal cancer
Substantial evidence supports an association between use of menopausal hormone therapy and decreased colorectal cancer (CRC) risk, indicating a role of exogenous sex hormones in CRC development. However, findings on endogenous oestrogen exposure and CRC are inconsistent. We used a Mendelian…
Depression in type 1 diabetes and risk of dementia
Depression afflicts 14% of individuals with type 1 diabetes (T1D). Depression is a robust risk factor for dementia but it is unknown if this holds true for individuals with T1D, who recently started living to an age conferring dementia risk.…
Diabetic Retinopathy and Dementia in Type 1 Diabetes
Retinopathy impacts over one-third of those with diabetes mellitus and is associated with impaired cognitive performance and cerebrovascular lesions in middle-aged adults with type 1 diabetes. However, the association between diabetic retinopathy (DR) and risk of dementia in type 1…
The relationship between non-steroidal anti-inflammatory drug use and age-related macular degeneration
To describe the relationship between the incidence of age-related macular degeneration (AMD) and nonsteroidal anti-inflammatory drug (NSAIDs) use. Prospective cohort study. This study consisted of participants in the California Men's Health Study. Those who completed surveys in 2002-2003 and 2006…
Older adults’ readiness to engage with eHealth patient education and self-care resources: a cross-sectional survey
This study examined access to digital technologies, skills and experience, and preferences for using web-based and other digital technologies to obtain health information and advice among older adults in a large health plan. A primary aim was to assess the…
Network and Infrastructure Support for Development of Interdisciplinary Aging Research
For adults aged 40 to 75 years, randomized trials provide conclusive evidence that statins reduce the risk of initial and secondary cardiovascular disease (CVD) events. However, there is limited evidence that statins reduce CVD events in individuals over the age…
Prevalence of Parkinson’s disease across North America
Estimates of the prevalence of Parkinson's disease in North America have varied widely and many estimates are based on small numbers of cases and from small regional subpopulations. We sought to estimate the prevalence of Parkinson's disease in North America…
Associations between ACE-Inhibitors, Angiotensin Receptor Blockers, and Lean Body Mass in Community Dwelling Older Women
Studies suggest that ACE-inhibitors (ACE-I) and angiotensin receptor blockers (ARBs) may preserve skeletal muscle with aging. We evaluated longitudinal differences in lean body mass (LBM) among women diagnosed with hypertension and classified as ACE-I/ARB users and nonusers among Women's Health…
MultIethNic Study of BrEast ARterial Calcium Gradation and CardioVAscular Disease: cohort recruitment and baseline characteristics
MultIethNic Study of BrEast ARterial Calcium Gradation and CardioVAscular Disease (MINERVA) was designed to answer the question of whether a novel continuous breast arterial calcification (BAC) mass score improves cardiovascular risk stratification among asymptomatic postmenopausal women. This article describes recruitment…
Associations of plasma clusterin and Alzheimer’s disease-related MRI markers in adults at mid-life: The CARDIA Brain MRI sub-study
Clinical and epidemiological studies of older persons have implicated clusterin in Alzheimer's disease (AD) pathogenesis. In the context of identifying early biomarkers of risk, we examined associations of plasma clusterin and characteristics of AD in middle-aged individuals from the community.…
Associations between cellular aging markers and metabolic syndrome: findings from the CARDIA study
Metabolic syndrome (MetS) is thought to promote biological aging, which might lead to cardiovascular and aging-related complications. This large-scale study investigated longitudinal relationships between MetS, its components, and cellular aging markers: leukocyte mitochondrial DNA copy number (mtDNAcn) and telomere length…
A large multi-ethnic genome-wide association study identifies novel genetic loci for intraocular pressure
Elevated intraocular pressure (IOP) is a major risk factor for glaucoma, a leading cause of blindness. IOP heritability has been estimated to up to 67%, and to date only 11 IOP loci have been reported, accounting for 1.5% of IOP variability.…
Epidemiology of Age-related Dementia, Mild Cognitive Impairment, and Brain Pathology in a Multiethnic Cohort of Oldest-Old
Alzheimer's disease and other dementias affect 15 percent of those aged 65 and up; by age 90 and up, this number increases to a startling 40 to 50 percent. The oldest-old, people aged 90 and -older, are the fastest-growing segment…
Visit-to-Visit Blood Pressure Variability in Young Adulthood and Hippocampal Volume and Integrity at Middle Age: The CARDIA Study (Coronary Artery Risk Development in Young Adults)
The aims of this study are to assess the relationships of visit-to-visit blood pressure (BP) variability in young adulthood to hippocampal volume and integrity at middle age. We used data over 8 examinations spanning 25 years collected in the CARDIA…
Physical activity trajectories during midlife and subsequent risk of physical functioning decline in late mid-life: The Study of Women’s Health Across the Nation (SWAN)
The purpose of this study was to examine the importance of midlife physical activity on physical functioning in later life. Data are from 1771 Study of Women's Health Across the Nation (SWAN) participants, aged 42-52 (46.4±2.7) years at baseline (1996-97).…
Associations of Race and Ethnicity with Patient-Reported Outcomes and Health Care Utilization among Older Adults Initiating a New Episode of Care for Back Pain
Secondary analysis of the Back Pain Outcomes using Longitudinal Data (BOLD) cohort study. To characterize associations of self-reported race/ethnicity with back pain (BP) patient-reported outcomes (PROs) and health care utilization among older adults with a new episode of care for…
Female sex, early-onset hypertension, and risk of dementia
To evaluate the association of early-adulthood and mid-adulthood hypertension with dementia in men and women. We evaluated 5,646 members of a diverse integrated health care delivery system who had clinical examinations and health survey data from 1964 to 1973 (mean…
Sex hormones and brain volumes in a longitudinal study of middle-aged men in the CARDIA study
Several findings suggest that testosterone (T) is neuroprotective and that declining T levels during aging are associated with cognitive and brain pathologies; however, little is known on T and brain health in middle-age. We examined the relationships of total T,…
Association Between Birth in a High Stroke Mortality State, Race, and Risk of Dementia
Birth in a group of predominantly southern US states is robustly linked to increased stroke risk. Given the role of cerebrovascular disease in dementia risk, geographic patterning may also occur for dementia incidence. To determine whether birth in 9 high…
Alzheimer’s disease genetic risk variants beyondAPOEε4 predict mortality
INTRODUCTION: We hypothesized that, like apolipoprotein E (APOE), other late-onset Alzheimer's disease (LOAD) genetic susceptibility loci predict mortality.METHODS: We used a weighted genetic risk score (GRS) from 21 non-APOELOAD risk variants to predict survival in the Adult Changes in Thought…
Research Priorities to Advance the Health and Health Care of Older Adults with Multiple Chronic Conditions
To prioritize research topics relevant to the care of the growing population of older adults with multiple chronic conditions (MCCs). Survey of experts in MCC practice, research, and policy. Topics were derived from white papers, funding announcements, or funded research…
Posttraumatic stress disorder and accelerated aging: PTSD and leukocyte telomere length in a sample of civilian women
BACKGROUND: Studies in male combat veterans have suggested posttraumatic stress disorder (PTSD) is associated with shorter telomere length (TL). We examined the cross-sectional association of PTSD with TL in women exposed to traumas common in civilian life.METHODS: Data are from…
Racial-Ethnic Differences in Fall Prevalence among Older Women: A Cross-Sectional Survey Study
Falls are the leading cause of hip fracture in older women, with important public health implications. Fall risk increases with age and other clinical factors, and varies by race/ethnicity. International studies suggest that fall risk is lower in Asians, although…
Multiple Chronic Conditions and Adverse Outcomes in Older Adults with Heart Failure
This ancillary pilot study to the Cardiovascular Research Network Heart Failure Consortium will evaluate the frequency and association of multiple chronic condition burden with clinical outcomes in adults who have diagnosed heart failure.
Early Vascular Contributions to Dementia Risk in African-Americans
This is a lifecourse study of vascular risk and brain aging in a well-characterized population of 1,200 elderly African-Americans that will close the gap in knowledge regarding midlife risk and protective factors for cognitive decline. The data collected, in conjunction…
Preferences, Management and Outcomes in the Oldest Patients with Diabetes
The aim of this study is to develop, pilot and conduct a survey among older diabetes patients (75 years of age or older) or their caregiver surrogates to collect data on: 1) self-management barriers (e.g., poor functional status, financial barriers,…
Partnership for Anemia: Clinical and Translational Trials in the Elderly (PACTTE)
Within the CVRN-HF Network, and in collaboration with NIA-sponsored PACTTE consortium investigators, we will examine the following among a large, multi-center cohort of elderly patients with heart failure with reduced or preserved left ventricular systolic function: 1) to characterize the…
Lifecourse Health, Cerebral Pathology and Ethnic Disparities in Dementia
Although there are marked ethnic disparities in rates of dementia, almost nothing is known about early life contributors to dementia in ethnic minority groups, nor if the trajectory of cognitive decline or transition to cognitive impairment varies across ethnic groups.…
Genome-Wide Study of Hearing Impairment
More than 25% of individuals over age 65 and 50% of individuals over age 80 suffer from varying levels of age-related hearing impairment (AHRI), and adults are losing hearing at earlier ages than in the past. There is strong evidence…
Early Vascular Contributions to Dementia Risk in African-Americans – DUPLICATED DO NOT ACTIVATE
This is a life-course study of vascular risk and brain aging in a well-characterized population of 1,200 elderly African-Americans that will close the gap in knowledge regarding midlife risk and protective factors for cognitive decline. We will conduct cognitive testing…
The Safety and Effectiveness of Diabetes Quality Metrics in Elderly Patients
Improving health care quality for seniors with complex chronic conditions is a critical issue for health services and health policy research. Widely-used quality metrics for patients with chronic illness put forth by agencies such as HEDIS and CMS are often…
A Methodology Study to Assess the Logistics of Stool Collection and Shipment in an Elderly Population
The study is non-interventional and consists of data collection on patients receiving treatment as part of their standard medical care for C.Diff.
Predictors of Late-Life Cognitive Health in Type 1 Diabetes
There is evidence that middle aged-adults with Type 1 diabetes have deficits in cognitive function and are more likely to be diagnosed with depression . Although it is well established that elderly individuals with type 2 diabetes are at double…
Advancing Geriatrics Infrastructure and Network Growth
This pilot development grant proposes to: 1) evaluate the available information in existing data resources related to multiple morbidity and aging-related variables through collaborations among HCSRN network collaboratives (e.g., CVRN, CRN, SUPREME-DM); 2) pursue up to 3 pilot analyses using…
Gravidity is not associated with telomere length in a biracial cohort of middle-aged women: The Coronary Artery Risk Development in Young Adults (CARDIA) study
Having experienced 2-3 births is associated with reduced mortality versus women with
Validation of a theoretically motivated approach to measuring childhood socioeconomic circumstances in the Health and Retirement Study
Childhood socioeconomic status (cSES) is a powerful predictor of adult health, but its operationalization and measurement varies across studies. Using Health and Retirement Study data (HRS, which is nationally representative of community-residing United States adults aged 50+ years), we specified…
Changes in Medication Use After Dementia Diagnosis in an Observational Cohort of Individuals with Diabetes Mellitus
To assess changes in medication use after a diagnosis of dementia in individuals with type 2 diabetes mellitus. Difference-in-differences analysis of changes in the number of dispensed chronic medications between individuals with and without newly diagnosed dementia. Integrated healthcare delivery…
A call for comparative effectiveness research to learn whether routine clinical care decisions can protect from dementia and cognitive decline
Common diseases like diabetes, hypertension, and atrial fibrillation are probable risk factors for dementia, suggesting that their treatments may influence the risk and rate of cognitive and functional decline. Moreover, specific therapies and medications may affect long-term brain health through…
Populations and Interventions for Palliative and End-of-Life Care: A Systematic Review
Evidence supports palliative care effectiveness. Given workforce constraints and the costs of new services, payers and providers need help to prioritize their investments. They need to know which patients to target, which personnel to hire, and which services best improve…
Comparison of continuation of postmenopausal hormone replacement therapy: transdermal versus oral estrogen
OBJECTIVE: To determine possible differences in the rate at which hormone replacement therapy (HRT) is continued among postmenopausal women treated initially with transdermal estradiol versus those treated initially with oral conjugated estrogens. DESIGN: A retrospective database search for prescription use.…
Effect of age on reasons for initiation and discontinuation of hormone replacement therapy
OBJECTIVE: The purpose of this study was to examine age-related differences in reasons that postmenopausal women began and stopped hormone replacement therapy (HRT). DESIGN: Two identical telephone surveys were conducted of women members of Kaiser Foundation Health Plan who had…
Initiation of osteoporosis treatment after bone mineral density testing
The aim of the study was to describe initiation of osteoporosis drug therapy after bone mineral density (BMD) testing and to determine any association with BMD test results obtained, physician factors, or both. The setting was the Kaiser Foundation Health…
Outcomes of a disease-management program for patients with recent osteoporotic fracture
INTRODUCTION: The purpose of this study was to evaluate outcomes of a disease-management program designed to increase rates of bone-mineral-density (BMD) testing and initiation of osteoporosis medication among patients with a recent osteoporotic fracture. STUDY DESIGN: We identified 744 consecutive…
Aging Population and Future Burden of Pneumococcal Pneumonia in the United States
Pneumococcal pneumonia is concentrated among the elderly. Using a decision analytic model, we projected the future incidence of pneumococcal pneumonia and associated healthcare utilization and costs accounting for an aging U.S. population. Between 2004 and 2040, as the population increases…
Is heart rate variability associated with frequency and intensity of vasomotor symptoms among healthy perimenopausal and postmenopausal women?
Research has suggested that the autonomic nervous system (ANS) is involved in the experience of vasomotor symptoms (VMS) during menopause. We examined the relationship of VMS intensity and heart rate variability (HRV), a measure of ANS function. Women (n =…
Differences in Access to and Preferences for Using Patient Portals and Other eHealth Technologies Based on Race, Ethnicity, and Age: A Database and Survey Study of Seniors in a Large Health Plan
Patients are being encouraged to go online to obtain health information and interact with their health care systems. However, a 2014 survey found that less than 60% of American adults aged 65 and older use the Internet, with much lower…
Predictors of impact of vaginal symptoms in postmenopausal women
This study aims to identify factors associated with greater impact of vaginal symptoms on the functioning and well-being of postmenopausal women. Postmenopausal women who reported vaginal dryness, itching, irritation, or pain with sexual activity completed the multidimensional Day-to-day Impact of…
Genotyping Informatics and Quality Control for 100,000 Subjects in the Genetic Epidemiology Research on Adult Health and Aging (GERA) Cohort
The Kaiser Permanente (KP) Research Program on Genes, Environment and Health (RPGEH), in collaboration with the University of California-San Francisco, undertook genome-wide genotyping of >100,000 subjects that constitute the Genetic Epidemiology Research on Adult Health and Aging (GERA) cohort. The…
Pooled Analysis of Six Pharmacologic and Nonpharmacologic Interventions for Vasomotor Symptoms
To describe the effects of six interventions for menopausal vasomotor symptoms relative to control in a pooled analysis, facilitating translation of the results for clinicians and symptomatic women. The Menopause Strategies: Finding Lasting Answers for Symptoms and Health network tested…
Ethnic Differences in Geriatric Conditions and Diabetes Complications Among Older, Insured Adults With Diabetes: The Diabetes and Aging Study
The aim of this study was to evaluate ethnic differences in burden of prevalent geriatric conditions and diabetic complications among older, insured adults with diabetes. An observational study was conducted among 115,538 diabetes patients, aged ³60, in an integrated health…
Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations
Degenerative changes are commonly found in spine imaging but often occur in pain-free individuals as well as those with back pain. We sought to estimate the prevalence, by age, of common degenerative spine conditions by performing a systematic review studying…
Association of early imaging for back pain with clinical outcomes in older adults
In contrast to the recommendations for younger adults, many guidelines allow for older adults with back pain to undergo imaging without waiting 4 to 6 weeks. However, early imaging may precipitate interventions that do not improve outcomes. To compare function…
Trends in mortality following hip fracture in older women
To examine contemporary trends in mortality following hip fracture among older postmenopausal women in an integrated healthcare delivery system. Retrospective cohort study of 13,550 women aged ?65 years with hip fracture during 2000 to 2010. Demographic factors, comorbidity index score,…
Day-to-Day Impact of Vaginal Aging questionnaire: a multidimensional measure of the impact of vaginal symptoms on functioning and well-being in postmenopausal women
This study aims to develop a self-report questionnaire assessing the impact of vaginal dryness, soreness, itching, irritation, and pain on functioning and well-being in postmenopausal women. Structured self-report items were developed to address the impact of vaginal symptoms on functioning…
Caregiving Frequency and Physical Function: The Women’s Health Initiative
Informal caregiving is common for older women and can negatively affect health, but its impact on physical function remains unclear. Using inverse probability weighting methods, we quantified the association of caregiving with physical function over 6 years. Study participants were…
Recent evidence exploring the associations between physical activity and menopausal symptoms in midlife women: perceived risks and possible health benefits
Although the health benefits of physical activity are well established, the prevalence of midlife women accumulating sufficient physical activity to meet current physical activity guidelines is strikingly low, as shown in United States (U.S.) based surveillance systems that utilize either…
Functional Limitations, Medication Support, and Responses to Drug Costs among Medicare Beneficiaries
Standard Medicare Part D prescription drug benefits include substantial and complex cost-sharing. Many beneficiaries also have functional limitations that could affect self-care capabilities, including managing medications, but also have varying levels of social support to help with these activities. We…
The burden of nocturia among middle-aged and older women
To examine the prevalence, predictors, and effects of nocturia in women and evaluate overlaps with established urinary tract disorders. This was a cross-sectional analysis of 2,016 women, aged 40 years and older, recruited from Kaiser Permanente Northern California from 2008…
Incidence of Remission in Adults With Type 2 Diabetes: The Diabetes & Aging Study
To estimate the incidence of remission in adults with type 2 diabetes not treated with bariatric surgery and to identify variables associated with remission. We quantified the incidence of diabetes remission and examined its correlates among 122,781 adults with type…
The Impact of Multimorbidity on Sexual Function in Middle-Aged and Older Women: Beyond the Single Disease Perspective
Little is known about sexual activity and function in women with multiple chronic health conditions. To examine the impact of multimorbidity on sexual activity and function in middle-aged and older women. Multiethnic cross-sectional cohort of 1,997 community-dwelling women (mean age…
Associations Between Antidepressant Adherence and Shared Decision-Making, Patient-Provider Trust, and Communication Among Adults with Diabetes: Diabetes Study of Northern California (DISTANCE)
Depression and adherence to antidepressant treatment are important clinical concerns in diabetes care. While patient-provider communication patterns have been associated with adherence for cardiometabolic medications, it is unknown whether interpersonal aspects of care impact antidepressant medication adherence. To determine whether…
Minilaparotomy vs. laparoscopic hysterectomy: comparison of length of hospital stay
To compare length of hospital stay for minilaparotomy vs laparoscopic hysterectomy. Retrospective cohort study (Canadian Task Force classification II-2). Kaiser Permanente Northern California, a large integrated health care delivery system. Women >18 years of age undergoing laparoscopic or minilaparotomy hysterectomy…
National Trends in US Hospital Admissions for Hyperglycemia and Hypoglycemia Among Medicare Beneficiaries, 1999 to 2011
The increasing intensity of diabetes mellitus management over the past decade may have resulted in lower rates of hyperglycemic emergencies but higher rates of hospital admissions for hypoglycemia among older adults. Trends in these hospitalizations and subsequent outcomes are not…
Depression and All-Cause Mortality in Persons with Diabetes Mellitus: Are Older Adults at Higher Risk? Results from the Translating Research Into Action for Diabetes Study
To compare the strength of the association between depression and mortality between elderly and younger individuals with diabetes mellitus. A survival analysis conducted in a longitudinal cohort study of persons with diabetes mellitus to test the association between depression and…
Racial/ethnic differences in dementia risk among older type 2 diabetes patients: The Diabetes and Aging Study
OBJECTIVE Although patients with type 2 diabetes have double the risk of dementia, potential racial/ethnic differences in dementia risk have not been explored in this population. We evaluated racial/ethnic differences in dementia and potential explanatory factors among older diabetic patients.…
A Novel Telemonitoring Device for Improving Diabetes Control: Protocol and Results from a Randomized Clinical Trial
Telemedicine is one approach to managing patients with chronic illness. Several telephone-based monitoring studies of diabetes patients have shown improved glycosylated hemoglobin (HbA1c), blood pressure (BP), and low-density lipoprotein (LDL) levels. The purpose of this study was to evaluate an…
Rates of Complications and Mortality in Older Patients With Diabetes Mellitus: The Diabetes and Aging Study
In the coming decades, the population of older adults with type 2 diabetes mellitus is expected to grow substantially. Understanding the clinical course of diabetes in this population is critical for establishing evidence-based clinical practice recommendations, identifying research priorities, allocating…
Medicare star excludes diabetes patients with poor CVD risk factor control
CMS recently added medication adherence to antihypertensives, antihyperlipidemics, and oral antihyperglycemics to its Medicare Star quality measures. These CMS metrics exclude patients with
Severe Diabetic Retinal Disease and Dementia Risk in Type 2 Diabetes
Persons with type 2 diabetes are at an increased risk of dementia compared to those without, but the etiology of this increased risk is unclear. Cerebral microvascular disease may mediate the link between diabetes and dementia. Given the anatomical and…
Obesity and Late-Age Survival Without Major Disease or Disability in Older Women
The effect of obesity on late-age survival in women without disease or disability is unknown. To investigate whether higher baseline body mass index and waist circumference affect women's survival to 85 years of age without major chronic disease (coronary disease,…
HbA1c and Risk of Severe Hypoglycemia in Type 2 Diabetes: The Diabetes and Aging Study
We examined the association between HbA1c level and self-reported severe hypoglycemia in patients with type 2 diabetes. Type 2 diabetic patients in a large, integrated healthcare system, who were 30-77 years of age and treated with glucose-lowering therapy, were asked…
Patient-provider communication and trust in relation to use of an online patient portal among diabetes patients: The Diabetes and Aging Study
Patient-provider relationships influence diabetes care; less is known about their impact on online patient portal use. Diabetes patients rated provider communication and trust. In this study, we linked responses to electronic medical record data on being a registered portal user…
Relation of serum magnesium levels and postdischarge outcomes in patients hospitalized for heart failure (from the EVEREST Trial).
Serum magnesium levels may be impacted by neurohormonal activation, renal function, and diuretics. The clinical profile and prognostic significance of serum magnesium level concentration in patients hospitalized for heart failure (HF) with reduced ejection fraction is unclear. In this retrospective…
Association Between Estimated GFR, Health-Related Quality of Life, and Depression Among Older Adults With Diabetes: The Diabetes and Aging Study
BACKGROUND: Although chronic kidney disease (CKD) is a highly prevalent condition among older adults with diabetes, the associations between health-related quality of life (HRQoL) and severity of CKD in this population are not well understood. The objective of this study…
Adverse Clinical Events Among Medicare Beneficiaries Using Antipsychotic Drugs: Linking Health Insurance Benefits and Clinical Needs
OBJECTIVE: Medicare Part D provides formulary protections for antipsychotics but does not exempt these drugs from cost-sharing. We investigated the impact of Part D coverage on antipsychotic drug spending, adherence, and clinical outcomes among beneficiaries with varying indications for use.…
Health Literacy and Antidepressant Medication Adherence Among Adults with Diabetes; The Diabetes Study of Northern California (DISTANCE)
Previous studies have reported that health literacy limitations are associated with poorer disease control for chronic conditions, but have not evaluated potential associations with medication adherence. To determine whether health literacy limitations are associated with poorer antidepressant medication adherence. Observational…
Does the Diagnosis of Breast or Ovarian Cancer Trigger Referral to Genetic Counseling?
OBJECTIVE: Kaiser Permanente Northern California is a large integrated health care delivery system in the United States that has guidelines for referring women with newly diagnosed BRCA1-and BRCA2-associated cancers for genetic counseling. This study assesses adherence to genetic counseling referral…
Accelerated Cell Aging in Female APOE-epsilon4 Carriers: Implications for Hormone Therapy Use
Apolipoprotein-epsilon4 (APOE-epsilon4) is a major genetic risk factor for cognitive decline, Alzheimer's disease (AD) and early mortality. An accelerated rate of biological aging could contribute to this increased risk. Here, we determined whether APOE-epsilon4 status impacts leukocyte telomere length (TL)…
Symptom Burden of Adults with Type 2 Diabetes Across the Disease Course: Diabetes & Aging Study
BACKGROUND: Reducing symptom burden is paramount at the end-of-life, but typically considered secondary to risk factor control in chronic disease, such as diabetes. Little is known about the symptom burden experienced by adults with type 2 diabetes and the need…
Psychological stress and reproductive aging among pre-menopausal women
BACKGROUND: Life history models suggest that biological preparation for current versus longer term reproduction is favored in environments of adversity. In this context, we present a model of reproductive aging in which environmental adversity is proposed to increase the number…
Plasma signaling proteins in persons at genetic risk for Alzheimer disease: influence of APOE genotype.
OBJECTIVE:To study the effect of familial Alzheimer disease (FAD) mutations and APOE genotype on plasma signaling protein levels.DESIGN:Cross-sectional comparison of plasma levels of 77 proteins measured using multiplex immune assays.SETTING:A tertiary referral dementia research center.PARTICIPANTS:Thirty-three persons from families harboring PSEN1…
Estimating sample sizes for predementia Alzheimer’s trials based on the Alzheimer’s Disease Neuroimaging Initiative
This study modeled predementia Alzheimer's disease clinical trials. Longitudinal data from cognitively normal (CN) and mild cognitive impairment (MCI) participants in the Alzheimer's Disease Neuroimaging Initiative were used to calculate sample size requirements for trials using outcome measures, including the…
Age-related somatic structural changes in the nuclear genome of human blood cells
Structural variations are among the most frequent interindividual genetic differences in the human genome. The frequency and distribution of de novo somatic structural variants in normal cells is, however, poorly explored. Using age-stratified cohorts of 318 monozygotic (MZ) twins and…
Central Obesity, Leptin and Cognitive Decline: The Sacramento Area Latino Study on Aging
BACKGROUND/AIMS: Central obesity is a risk factor for cognitive decline. Leptin is secreted by adipose tissue and has been associated with better cognitive function. Aging Mexican Americans have higher levels of obesity than non-Hispanic Whites, but no investigations examined the…
A characterization of the relationship of ovarian reserve markers with age
OBJECTIVE: To identify markers of ovarian age that best match the pattern of oocyte loss seen in histology specimens. DESIGN: Cross-sectional study. SETTING: University. PATIENT(S): Caucasian women (n = 252) aged 25-45 years. INTERVENTION(S): none. MAIN OUTCOME MEASURE(S): The relationship…
Study Protocol- Lumbar Epidural Steroid Injections for Spinal Stenosis (LESS): a double-blind randomized controlled trial of epidural steroid injections for lumbar spinal stenosis among older adults
BACKGROUND: Lumbar spinal stenosis is one of the most common causes of low back pain among older adults and can cause significant disability. Despite its prevalence, treatment of spinal stenosis symptoms remains controversial. Epidural steroid injections are used with increasing…
Aging and living with HIV/AIDS
With individuals either living longer with the disease or contracting it at a later stage in life, HIV/AIDS can no longer be regarded as just a young person's disease. In fact, people older than 50 will represent 50% of HIV/AIDS…
Parturition events and risk of urinary incontinence in later life
AIMS: To examine the association between specific events during vaginal deliveries and urinary incontinence later in life. METHODS: A retrospective cohort study of 1,521 middle-aged and older women with at least one vaginal delivery who were long-term members of an…
Medicare part d and changes in prescription drug use and cost burden: national estimates for the medicare population, 2000 to 2007
CONTEXT: The full effect of Medicare Part D, after the initial policy transition period and across the United States Medicare population, remains unclear. OBJECTIVE: To estimate nationally representative changes in prescription drug use and out-of-pocket drug costs 2 years after…
Correlates of quality of life in older adults with diabetes: the diabetes & aging study
OBJECTIVE: To evaluate associations between health-related quality of life (HRQL) and geriatric syndromes, diabetes complications, and hypoglycemia in older adults with diabetes. RESEARCH DESIGN AND METHODS: A race-stratified random sample of 6,317 adults with type 2 or type 1 diabetes,…
Patterns of alcohol and drug use among depressed older adults seeking outpatient psychiatric services
OBJECTIVE: Alcohol and drug use and related problems may compromise depression treatment, and older adults may be especially at risk for poor outcomes. However, alcohol and drug use among older adults have not been studied in settings in which depression…
Glycemic control, complications, and death in older diabetic patients: the diabetes and aging study
OBJECTIVE: To identify the range of glycemic levels associated with the lowest rates of complications and mortality in older diabetic patients. RESEARCH DESIGN AND METHODS: We conducted a retrospective cohort study (2004-2008) of 71,092 patients with type 2 diabetes, aged…
Heterogeneity of diabetes outcomes among asians and pacific islanders in the US; the diabetes study of northern california (DISTANCE)
OBJECTIVE: Ethnic minorities with diabetes typically have lower rates of cardiovascular outcomes and higher rates of end-stage renal disease (ESRD) compared with whites. Diabetes outcomes among Asian and Pacific Islander subgroups have not been disaggregated. RESEARCH DESIGN AND METHODS: We…
Association between prior authorization for medications and health service use by Medicaid patients with bipolar disorder
OBJECTIVE: This study examined the association between a Medicaid prior-authorization policy for second-generation antipsychotic and anticonvulsant agents and medication discontinuation and health service use by patients with bipolar disorder. METHODS: A pre-post design with a historical comparison group was used…
Impact of prior authorization on the use and costs of lipid-lowering medications among Michigan and Indiana dual enrollees in Medicaid and Medicare: results of a longitudinal, population-based study
BACKGROUND: Some Medicaid programs have adopted prior-authorization (PA) policies that require prescribers to request approval from Medicaid before prescribing drugs not included on a preferred drug list. OBJECTIVE: This study examined the association between PA policies for lipid-lowering agents in…
Incidence of and risk factors for change in urinary incontinence status in a prospective cohort of middle-aged and older women: the reproductive risk of incontinence study in Kaiser
PURPOSE: Urinary incontinence is a dynamic condition that can progress and regress but few groups have examined risk factors for change in incontinence status. MATERIAL AND METHODS: We used stratified random sampling to construct a racially and ethnically diverse, population…
Relationship of opioid use and dosage levels to fractures in older chronic pain patients
BACKGROUND: Opioids have been linked to increased risk of fractures, but little is known about how opioid dose affects fracture risk. OBJECTIVE: To assess whether risk of fracture increases with opioid dose among older patients initiating sustained use of opioids…
The association between the number of prescription medications and incident falls in a multi-ethnic population of adult type-2 diabetes patients: the diabetes and aging study
BACKGROUND: Use of four or more prescription medications is considered a risk factor for falls in older people. It is unclear whether this polypharmacy-fall relationship differs for adults with diabetes. OBJECTIVE: We evaluated the association between number of prescription medications…
Unintended impacts of a Medicaid prior authorization policy on access to medications for bipolar illness
OBJECTIVES: Prior authorization policies (PA) are widely used to control psychotropic medication costs by state Medicaid programs and Medicare Part D plans. The objective of this study was to examine the impact of a Maine Medicaid PA policy on initiation…
Cognitive functioning is related to physical functioning in a longitudinal study of women at midlife
BACKGROUND: Studies have reported declines with age in cognitive or physical functioning, but rarely identify whether these are parallel or linked events in the same study. Furthermore, most research in this area has focused on persons in late life rather…
Clinical features in early Parkinson disease and survival
OBJECTIVE: To examine the association between demographic and clinical features in early Parkinson disease (PD) and length of survival in a multiethnic population. DESIGN: Clinical features within 2 years of diagnosis were determined for an inception cohort established during 1994-1995.…
Sexual function and aging in racially and ethnically diverse women
OBJECTIVES: To examine factors influencing sexual activity and functioning in racially and ethnically diverse middle-aged and older women. DESIGN: Cross-sectional cohort study. SETTING: Integrated healthcare delivery system. PARTICIPANTS: One thousand nine hundred seventy-seven women aged 45 to 80. MEASUREMENTS: Self-administered…
Predicting risk of dementia in older adults: The late-life dementia risk index
OBJECTIVE: To develop a late-life dementia risk index that can accurately stratify older adults into those with a low, moderate, or high risk of developing dementia within 6 years. METHODS: Subjects were 3,375 participants in the Cardiovascular Health Cognition Study…
Lipid changes during the menopause transition in relation to age and weight: the Study of Women’s Health Across the Nation
Few studies have prospectively examined lipid changes across the menopause transition or in relation to menopausal changes in endogenous hormones. The relative independent contributions of menopause and age to lipid changes are unclear. Lipid changes were examined in relation to…
Meeting report: consensus statement-Parkinson’s disease and the environment: collaborative on health and the environment and Parkinson’s Action Network (CHE PAN) conference 26-28 June 2007
BACKGROUND: Parkinson's disease (PD) is the second most common neurodegenerative disorder. People with PD, their families, scientists, health care providers, and the general public are increasingly interested in identifying environmental contributors to PD risk. METHODS: In June 2007, a multidisciplinary…
Chronic conditions and mortality among the oldest old
OBJECTIVES: We sought to determine whether chronic conditions and functional limitations are equally predictive of mortality among older adults. METHODS: Participants in the 1998 wave of the Health and Retirement Study (N=19430) were divided into groups by decades of age,…
Factors associated with worsening and improving urinary incontinence across the menopausal transition
OBJECTIVE: To evaluate whether the menopausal transition is associated with worsening of urinary incontinence symptoms over 6 years in midlife women. METHODS: We analyzed data from 2,415 women who reported monthly or more incontinence in self-administered questionnaires at baseline and…
Adiposity and reporting of vasomotor symptoms among midlife women: the study of women’s health across the nation
It has long been hypothesized that increased adiposity would be associated with decreased vasomotor symptoms during menopause because of conversion of androgens to estrogens in body fat. However, recent thermoregulatory models have postulated that increased adipose tissue would be associated…
Use of complementary and alternative medicine during the menopause transition: longitudinal results from the Study of Women’s Health Across the Nation
OBJECTIVE: This study examined whether use of complementary and alternative (CAM) therapies during the menopause transition varied by ethnicity. DESIGN: The Study of Women's Health Across the Nation is a prospective cohort study following a group of 3,302 women from…
Calcium plus vitamin D supplementation and the risk of postmenopausal weight gain
BACKGROUND: Obesity in the United States has increased significantly during the past several decades. The role of calcium in the maintenance of a healthy body weight remains controversial. METHODS: A randomized, double-blinded, placebo-controlled trial was performed with 36 282 postmenopausal…
Metabolic syndrome and cognitive decline in elderly Latinos: findings from the Sacramento Area Latino Study of Aging study
OBJECTIVES: To investigate the effect of metabolic syndrome on cognitive function in an elderly Latino population and to determine whether inflammation modifies this association. DESIGN: A longitudinal cohort study. SETTING: Sacramento area and the surrounding California counties from 1998 to…
Older age and the response to and tolerability of antiretroviral therapy
BACKGROUND: The unique health needs of a growing older adult population infected with human immunodeficiency virus (HIV) require study, especially in terms of the response to and tolerability of highly active antiretroviral therapy (HAART). METHODS: Changes in HIV clinical markers…
Menopause transition stage and endogenous estradiol and follicle-stimulating hormone levels are not related to cognitive performance: cross-sectional results from the study of women’s health across the nation (SWAN)
BACKGROUND: By one estimate, 60% of women experiencing the menopause transition perceive that they have memory problems, but most studies that have used cognitive function tests have not substantiated a relation between menopause stage and cognitive performance. We sought to…
Reducing suicidal ideation in depressed older primary care patients
OBJECTIVES: To determine the effect of a primary care-based collaborative care program for depression on suicidal ideation in older adults. DESIGN: Randomized, controlled trial. SETTING: Eighteen diverse primary care clinics. PARTICIPANTS: One thousand eight hundred one adults aged 60 and…
Midlife obesity and long-term risk of nursing home admission
OBJECTIVE: Obesity is a growing problem among middle-aged individuals. We investigated whether obesity in middle-aged individuals influences the need for future nursing home care and whether the risk of nursing home admission associated with obesity is greater in whites than…
Outdoor falls among middle-aged and older adults: a neglected public health problem
OBJECTIVES: Although risk factors for indoor falls among older individuals have been well studied, little is known about the etiology of outdoor falls. We examined risk factors for outdoor falls among middle-aged and older adults. METHODS: We analyzed data on…
Fecal incontinence in females older than aged 40 years: who is at risk?
PURPOSE: This study was designed to estimate the prevalence of, and identify risk factors associated with, fecal incontinence in racially diverse females older than aged 40 years. METHODS: The Reproductive Risks for Incontinence Study at Kaiser is a population-based study…
Sexual activity and function in middle-aged and older women
OBJECTIVE: Data on the sexual activity of middle-aged and older women are scant and vary widely. This analysis estimates the prevalence and predictors of sexual activity and function in a diverse group of women aged 40-69 years. METHODS: The Reproductive…
Long term outcomes from the IMPACT randomised trial for depressed elderly patients in primary care
OBJECTIVE: To determine the long term effectiveness of collaborative care management for depression in late life. DESIGN: Two arm, randomised, clinical trial; intervention one year and follow-up two years. SETTING: 18 primary care clinics in eight US healthcare organisations. Patients…
Depression treatment preferences in older primary care patients
PURPOSE: For depressed older primary care patients, this study aimed to examine (a) characteristics associated with depression treatment preferences; (b) predictors of receiving preferred treatment; and (c) whether receiving preferred treatment predicted satisfaction and depression outcomes. DESIGN AND METHODS: Data…
Cost-effectiveness and net benefit of enhanced treatment of depression for older adults with diabetes and depression
OBJECTIVE: To determine the incremental cost-effectiveness and net benefit of a depression collaborative care program compared with usual care for patients with diabetes and depression. RESEARCH DESIGN AND METHODS: This article describes a preplanned subgroup analysis of patients with diabetes…
Effect of reproductive factors and postmenopausal hormone use on the risk of amyotrophic lateral sclerosis
OBJECTIVE: To examine the associations of reproductive factors and postmenopausal hormone use with the risk of amyotrophic lateral sclerosis (ALS) among women. METHODS: This case-control study was conducted within the Kaiser Permanente Medical Care Program (KPMCP) of Northern California during…
Risk factors for pelvis fracture in older persons
From 1996 to 2001, the authors undertook a case-control study of 192 pelvis fracture cases (men and women) and 2,402 controls aged > or = 45 years at five Kaiser Permanente medical centers in Northern California. Most information on potential…
Pioglitazone initiation and subsequent hospitalization for congestive heart failure
AIMS: Thiazolidinediones (TZD) have been associated with an expansion in plasma volume and the development of peripheral oedema. A recent study reported an association between the use of TZDs and development of congestive heart failure (CHF). The objective of this…
Health information technology and physician-patient interactions: impact of computers on communication during outpatient primary care visits
OBJECTIVE: The aim of this study was to evaluate the impact of introducing health information technology (HIT) on physician-patient interactions during outpatient visits. DESIGN: This was a longitudinal pre-post study: two months before and one and seven months after introduction…
Improving depression care for older, minority patients in primary care
OBJECTIVE: Few older minorities receive adequate treatment of depression in primary care. This study examines whether a collaborative care model for depression in primary care is as effective in older minorities as it is in nonminority elderly patients in improving…
Treatment of depression improves physical functioning in older adults
OBJECTIVES: To determine the effect of collaborative care management for depression on physical functioning in older adults. DESIGN: Multisite randomized clinical trial. SETTING: Eighteen primary care clinics from eight healthcare organizations. PARTICIPANTS: One thousand eight hundred one patients aged 60…
Simple computer model for calculating and reporting 5-year osteoporotic fracture risk in postmenopausal women
PURPOSE: To devise, validate, and test a software model that improves how clinicians calculate individual risk for osteoporotic fracture and expected treatment benefit. METHODS: We developed a simple model of seven easily ascertained items plus bone mineral density (BMD) that…
The epidemiology of atrial fibrillation in elderly persons: the tip of the iceberg
Atrial fibrillation is the most common clinically relevant arrhythmia and preferentially afflicts elderly persons, especially persons aged >/=75 years, with associated complications of ischemic stroke and other adverse outcomes. More than 2.2 million Americans currently have atrial fibrillation, and this…
Use of dietary supplements by female seniors in a large Northern California health plan
BACKGROUND: Women aged >or= 65 years are high utilizers of prescription and over-the-counter medications, and many of these women are also taking dietary supplements. Dietary supplement use by older women is a concern because of possible side effects and drug-supplement…
Depression and comorbid illness in elderly primary care patients: impact on multiple domains of health status and well-being
PURPOSE: Our objective was to examine the relative association of depression severity and chronicity, other comorbid psychiatric conditions, and coexisting medical illnesses with multiple domains of health status among primary care patients with clinical depression. METHODS: We collected cross-sectional data…
The effectiveness of depression care management on diabetes-related outcomes in older patients
BACKGROUND: Depression frequently occurs in combination with diabetes mellitus, adversely affecting the course of illness. OBJECTIVE: To determine whether enhancing care for depression improves affective and diabetic outcomes in older adults with diabetes and depression. DESIGN: Preplanned subgroup analysis of…
Limb fractures in elderly men as indicators of subsequent fracture risk
BACKGROUND: Whether limb fracture in elderly men predicts future fracture is unknown. METHODS: Electronic health records were examined to determine fracture incidence among men 60 years or older who were members of a large health maintenance organization, experienced no fracture…
Effect of the Women’s Health Initiative on women’s decisions to discontinue postmenopausal hormone therapy
OBJECTIVE: To examine whether women who were using postmenopausal hormone therapy (HT) before publication of Women's Health Initiative findings about risks associated with HT had been informed about the findings once published; and to estimate how knowledge of these findings…
Predictors of difficulty when discontinuing postmenopausal hormone therapy
OBJECTIVE: To describe the experiences of postmenopausal women who try to stop hormone therapy and to identify characteristics associated with inability to stop. METHODS: We conducted telephone interviews with 377 randomly selected female members of the Kaiser Foundation Health Plan,…
Effect of improving depression care on pain and functional outcomes among older adults with arthritis: a randomized controlled trial
CONTEXT: Depression and arthritis are disabling and common health problems in late life. Depression is also a risk factor for poor health outcomes among arthritis patients. OBJECTIVE: To determine whether enhancing care for depression improves pain and functional outcomes in…
Early discontinuation of treatment for osteoporosis
PURPOSE: To identify factors associated with early treatment discontinuation of three agents commonly prescribed for women with low bone density. METHODS: A telephone survey was conducted in 2000 to 2001 in a random sample of women aged 45 years or…
Incidence of Parkinson’s disease: variation by age, gender, and race/ethnicity
The goal of this study was to estimate the incidence of Parkinson's disease by age, gender, and ethnicity. Newly diagnosed Parkinson's disease cases in 1994-1995 were identified among members of the Kaiser Permanente Medical Care Program of Northern California, a…
Depression treatment in a sample of 1,801 depressed older adults in primary care
OBJECTIVES: To examine rates and predictors of lifetime and recent depression treatment in a sample of 1,801 depressed older primary care patients DESIGN: Cross sectional survey data collected from 1999 to 2001 as part of a treatment effectiveness trial. SETTING:…
Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial
CONTEXT: Few depressed older adults receive effective treatment in primary care settings. OBJECTIVE: To determine the effectiveness of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) collaborative care management program for late-life depression. DESIGN: Randomized controlled trial with recruitment from…
Postmenopausal hormonal support: discontinuation of raloxifene versus estrogen
OBJECTIVE: To determine possible differences in continuation among women initiating treatment with the selective estrogen receptor modulator raloxifene, versus those initiating treatment with estrogen-containing regimens. DESIGN: A pharmacy prescription database search for refill patterns. The study subjects were members of…
Low-dosage esterified estrogens opposed by progestin at 6-month intervals
OBJECTIVE: To estimate incidence of endometrial hyperplasia, vaginal bleeding, and menopausal symptoms in women who changed from standard monthly cyclic hormone replacement therapy (HRT) to half-strength estrogen opposed by medroxyprogesterone acetate (MPA) at 6-month intervals. METHODS: We identified 138 women…
Improving primary care for depression in late life: the design of a multicenter randomized trial
BACKGROUND: Late life depression can be successfully treated with antidepressant medications or psychotherapy, but few depressed older adults receive effective treatment. RESEARCH DESIGN: A randomized controlled trial of a disease management program for late life depression. SUBJECTS: Approximately 1,750 older…
Who bears responsibility for glucocorticoid-exposed patients in a large health maintenance organization?
OBJECTIVE: High exposure to glucocorticoid drugs is associated with an increased risk of osteoporosis and fracture. To define the degree to which individual prescribers needed to adjust their prescribing practices and thus to prevent glucocorticoid-induced osteoporosis among their patients, this…
Risk for fracture in women with low serum levels of thyroid-stimulating hormone
BACKGROUND: Biochemical evidence of hyperthyroidism may be associated with low bone mass, particularly in older postmenopausal women, but no prospective studies of thyroid function and subsequent fracture risk have been done. OBJECTIVE: To examine the association between low levels of…
Hormone replacement therapy and the risk of myocardial infarction in women with coronary risk factors
To assess the risk of myocardial infarction in users of post-menopausal hormone replacement therapy who are at high risk of coronary disease because of hypertension, diabetes mellitus, or smoking, we used data from a previously published case-control study of women…
The North American Menopause Society 1998 menopause survey: Part II. Counseling about hormone replacement therapy: association with socioeconomic status and access to medical care
OBJECTIVE: The purpose of this study was to examine two predictors of women's obtaining hormone replacement therapy (HRT) counseling: socioeconomic status and access to health care. DESIGN: During May-July 1998, by means of random-digit telephone dialing, 749 postmenopausal women who…
Diagnosis of symptomatic postmenopausal women by traditional Chinese medicine practitioners
OBJECTIVE: To learn more about the way that practitioners of traditional Chinese medicine (TCM) diagnose women who have menopausal symptoms. DESIGN: We assembled a cohort of 23 postmenopausal women who had hot flushes and were otherwise healthy. Each woman was…
Continuation of postmenopausal hormone replacement therapy in a large health maintenance organization: transdermal matrix patch versus oral estrogen therapy
OBJECTIVE: To determine possible differences in continuation of postmenopausal estrogen replacement therapy among women initiating treatment with transdermal estradiol versus those initiating treatment with oral estrogen. STUDY DESIGN: A retrospective database search. PATIENTS AND METHODS: We analyzed estrogen use among…
Habitual physical activity and menopausal symptoms: a case-control study
A case-control study design was used to examine whether habitual physical activity prior to the final menstrual period (FMP) was associated with reduced risk of vasomotor and other symptoms during the perimenopausal period. Both cases and controls were identified through…
Clinic visits and hospital admissions for care of acid-related upper gastrointestinal disorders in women using alendronate for osteoporosis
CONTEXT: About 1 in 3 women taking alendronate for osteoporosis report gastrointestinal symptoms, a rate much higher than that found during clinical trials. OBJECTIVE: To establish the frequency of outpatient visits and hospital admissions for acid-related upper gastrointestinal disorder (ARD)…
