Machine learning to predict notes for chart review in the oncology setting: a proof of concept strategy for improving clinician note-writing.

OBJECTIVE: Leverage electronic health record (EHR) audit logs to develop a machine learning (ML) model that predicts which notes a clinician wants to review when seeing oncology patients. MATERIALS AND METHODS: We trained logistic regression models using note metadata and a Term Frequency Inverse Document Frequency (TF-IDF) text representation. We evaluated performance with precision, recall, F1, AUC, and a clinical qualitative assessment. RESULTS: The metadata only model achieved an AUC 0.930 and the metadata and TF-IDF model an AUC 0.937. Qualitative assessment revealed a need for better text representation and to further customize predictions for the user. DISCUSSION: Our model effectively surfaces the top 10 notes a clinician wants to review when seeing an oncology patient. Further studies can characterize different types of clinician users and better tailor the task for different care settings. CONCLUSION: EHR audit logs can provide important relevance data for training ML models that assist with note-writing in the oncology setting.

Is Sex Good for Your Brain? A National Longitudinal Study on Sexuality and Cognitive Function among Older Adults in the United States.

Using a life course approach, we examined how sexuality is related to cognitive function for partnered older adults. We utilized longitudinal data from two rounds of the National Social Life, Health, and Aging Project (NSHAP) to analyze 1,683 respondents. Cognitive function was measured using a continuous Montreal Cognitive Assessment (MoCA) score. We considered both sexual frequency and sexual quality (i.e., physical pleasure, emotional satisfaction). We estimated cross-lagged models to consider the potential reciprocal relationship between sexuality and cognitive function. Results indicated that sexuality was not related to later cognitive function in the total sample, but the pattern varied by age and gender. For adults aged 62-74, better sexual quality (i.e., feelings of physical pleasure and emotional satisfaction) was related to better cognitive functioning, while for those aged 75-90, more frequent sex was related to better cognitive functioning. Feelings of physical pleasure were related to better cognitive functioning for men but not women. There was no evidence of cognitive functioning being related to later sexuality. The findings highlight the importance of age and gender in modifying the link between sexuality and cognition in later life.

Cognitive Impairment Leads to Increased Feelings of Sexual Obligation Among a National Longitudinal Sample of Sexually Active Adults Aged 62 and Older.

BACKGROUND AND OBJECTIVES: We work from a gendered life-course perspective to examine the relationship between cognitive impairment and feelings of sexual obligation among U.S. older adults. RESEARCH DESIGN AND METHODS: Data are drawn from 2 rounds of the National Social Life, Health, and Aging Project (2010/2011 and 2015/2016). The analytic sample includes 575 sexually active respondents aged 62-86 at baseline. Cognitive impairment is measured using a survey-adapted version of the Montreal Cognitive Assessment, with categories of normal, mild cognitive impairment, and dementia. We estimate cross-lagged models to test the potential reciprocal relationships between cognitive impairment and feelings of sexual obligation. RESULTS: Older adults with dementia at baseline had significantly higher odds of sexual obligation 5 years later than their peers with normal cognition at baseline, after adjusting for gender, race/ethnicity, education, income, age, marital status, self-rated health, depression, comorbidities, and sexual obligation at baseline. We find no evidence of a reciprocal relationship, as sexual obligation at baseline did not predict later cognitive status. DISCUSSION AND IMPLICATIONS: Older adults with dementia often remain sexually active after their 60s, and many of them feel obligated to have sex with their partner. Our study highlights the importance of understanding the context of their sexual lives. The quality of their sexual relationship, such as whether they feel a duty to maintain their earlier sexual activity or please their partner, and the health implications of sexual obligation should be considered alongside the increase of older adults with dementia.

"Went Along With": Acquiescence During First Sexual Experience and Late-Life Health.

Working from a life course perspective, we examined how acquiescence (i.e., "lack of resistance") to an unwanted (i.e., "without experiencing a concomitant desire") first sexual experience was related to health and well-being in late life. Data were drawn from the second wave of the National Social Life, Health, and Aging Project (2010/11). The sample included 2558 older adults ages 62-99 (1182 men and 1376 women). Results from regression models suggested those respondents whose first sex was acquiesced reported higher levels of psychological distress and poorer physical health during late life than respondents whose first sex was wanted. Results from generalized structural equation modeling analysis further suggested that the association between acquiesced first sex and late-life health operated through adulthood socioeconomic status but not through marital relationships. We did not find gender differences in these processes.

Sexual Obligation and Perceived Stress: A National Longitudinal Study of Older Adults.

Objectives: This study examines the relationship between sexual obligation and perceived stress among older adults in the United States.Methods: Using longitudinal data from three waves of the National Social Life, Health, and Aging Project (NSHAP), our sample included 1,477 partnered, sexually-active respondents aged 57 to 85 at the baseline survey. We estimated mixed-effects models to test how feelings of sexual obligation are related to changes in perceived stress score.Results: Sexual obligation was positively associated with perceived stress score. The positive relationship between sexual obligation and perceived stress score became stronger over the study period among older men, although it remained relatively stable among older women. Relationship quality only partially explains this relationship.Conclusions: Feeling more obligated to have sex had a significantly greater effect on older men's perceived level of stress over time than older women's. This association became marginally significant after relationship quality was controlled for, suggesting that relationship quality was a key explanatory factor for the gendered patterns in sexual obligation's linkage to stress. These results highlight the importance of understanding gendered sexuality among aging older adults within the context of their relationship.Clinical Implications: Older adults' feelings of sexual obligation can manifest in their daily stress experience. Clinicians seeking to lower older adults', in particular older men's, stress levels should address the context of their sexual life and if they feel obligated to have sex, along with the positive and negative aspects of their relationship, as these could elevate their stress levels over time.

Chronic Disease Burden, Sexual Frequency, and Sexual Dysfunction in Partnered Older Adults.

This research evaluates the relationship between chronic disease burden and partnered sexuality of older adults by using data from the National Social Life, Health, and Aging Project. Ordinary least squares and logistic regressions identify how chronic disease burden is associated with sexual frequency and sexual dysfunction for men (N = 893) and women (N = 641). Results indicate that an increasing chronic disease burden is negatively associated with men's sexual frequency, while a greater burden of chronic disease is related to a greater risk of lubrication problems for women and orgasm problems for men. The findings reveal gender differences in how disease is linked to older adults' sexual lives.

A National Dyadic Study of Oral Sex, Relationship Quality, and Well-Being among Older Couples.

Objectives: We examine how giving versus receiving oral sex, 2 processes that are linked to relationship quality, are associated with older men's and women's well-being. Method: We analyzed 884 heterosexual couples from the National Social Life, Health, and Aging Project (2010-2011). We estimate Actor-Partner Interdependence Models using the SEM approach to assess three well-being outcomes: general happiness, psychological distress, and self-reported mental health. Results: Older adults with better relationship quality gave oral sex to their partner more often than those with worse relationship quality; this association was stronger for men than for women. While receiving oral sex was positively related to both men's, and women's perceptions of relationship quality, women's relationship quality was more strongly linked to their partners' well-being than men's. Correspondingly, men's giving of oral sex (and thus their female partner's receiving of oral sex) was positively related to their own well-being through increasing their female partner's perceived relationship quality. Discussion: Given the high prevalence of sexual dysfunctions among older adults, oral sex may play an important but overlooked role in maintaining an active sexual life, a high-quality relationship, and psychological vibrancy in late life.

Is Sex Good for Your Health? A National Study on Partnered Sexuality and Cardiovascular Risk among Older Men and Women.

Working from a social relationship and life course perspective, we provide generalizable population-based evidence on partnered sexuality linked to cardiovascular risk in later life using national longitudinal data from the National Social Life, Health and Aging Project (NSHAP) (N = 2,204). We consider characteristics of partnered sexuality of older men and women, particularly sexual activity and sexual quality, as they affect cardiovascular risk. Cardiovascular risk is defined as hypertension, rapid heart rate, elevated C-reactive protein (CRP), and general cardiovascular events. We find that older men are more likely to report being sexually active, having sex more often, and more enjoyably than are older women. Results from cross-lagged models suggest that high frequency of sex is positively related to later risk of cardiovascular events for men but not women, whereas good sexual quality seems to protect women but not men from cardiovascular risk in later life. We find no evidence that poor cardiovascular health interferes with later sexuality for either gender.

Diabetes Risk and Disease Management in Later Life: A National Longitudinal Study of the Role of Marital Quality.

OBJECTIVES: We assess the association between marital quality and both the risk of developing diabetes and the management of diabetes after its onset in later life. METHOD: We use data from the first two waves of the National Social Life, Health, and Aging Project to estimate regression models with lagged dependent variables. The sample includes 1,228 married respondents, among whom 389 were diabetic. Those with either a reported diagnosis or with HbA1c ≥ 6.5% are identified diabetic. We categorize diabetic respondents into three groups: controlled, undiagnosed, and uncontrolled diabetes. We conduct factor analysis to construct positive and negative marital quality scales. RESULTS: For women, an increase in positive marital quality between Waves 1 and 2 is related to a lower risk of being diabetic at Wave 2, net of diabetes status at Wave 1; surprisingly, for men, an increase in negative marital quality between Waves 1 and 2 is related to both a lower risk of being diabetic at Wave 2 and a higher chance of controlling diabetes at Wave 2 after its onset. DISCUSSION: Our results challenge the traditional assumption that negative marital quality is always detrimental to health and encourage family scholars to distinguish different sources and types of negative marital quality.