Weight Loss Is a Strong Predictor of Memory Disorder Independent of Genetic Influences.

BACKGROUND: Past studies identified a link between weight loss and dementia, but lacked consistent conclusions. We sought to establish this link by examining the weight change profiles before and after dementia diagnosis. METHODS: Using data from the Health and Retirement Study (1996-2020), we examined 13,123 participants. We conducted a nested case-control analysis to assess differences in biennial weight change profile while controlling for BMI, longevity polygenic risk scores, and APOE gene variants. RESULTS: Participants with a memory disorder lost weight (-0.63%) biennially, whereas those without a diagnosis did not (+0.013%, p-value < 0.0001). Our case-control study shows a significant difference (p-value < 0.01) in pre-dementia % weight changes between the cases (-0.29%) and controls (0.19%), but not in post-dementia weight changes. The weight loss group have the highest risk (OR = 2.01; p-value < 0.0001) of developing a memory disorder compared to the stable weight and weight gain groups. The observations hold true after adjusting for BMI, longevity polygenic risk scores, and APOE variant in a multivariable model. CONCLUSIONS: We observe that weight loss in dementia is a physiological process independent of genetic factors associated with BMI and longevity. Pre-dementia weight loss may be an important prognostic criterion to assess a person's risk of developing a memory disorder.

Multidimensional trajectories of multimorbidity, functional status, cognitive performance, and depressive symptoms among diverse groups of older adults.

Background: Inter-relationships between multimorbidity and geriatric syndromes are poorly understood. This study assesses heterogeneity in joint trajectories of somatic disease, functional status, cognitive performance, and depressive symptomatology. Methods: We analyzed 16 years of longitudinal data from the Health and Retirement Study (HRS, 1998-2016) for n = 11,565 older adults (≥65 years) in the United States. Group-based mixture modeling identified latent clusters of older adults following similar joint trajectories across domains. Results: We identified four distinct multidimensional trajectory groups: (1) Minimal Impairment with Low Multimorbidity (32.7% of the sample; mean = 0.60 conditions at age 65, 2.1 conditions at age 90) had limited deterioration; (2) Minimal Impairment with High Multimorbidity (32.9%; mean = 2.3 conditions at age 65, 4.0 at age 90) had minimal deterioration; (3) Multidomain Impairment with Intermediate Multimorbidity (19.9%; mean = 1.3 conditions at age 65, 2.7 at age 90) had moderate depressive symptomatology and functional impariments with worsening cognitive performance; (4) Multidomain Impairment with High Multimorbidity (14.1%; mean = 3.3 conditions at age 65; 4.7 at age 90) had substantial functional limitation and high depressive symptomatology with worsening cognitive performance. Black and Hispanic race/ethnicity, lower wealth, lower education, male sex, and smoking history were significantly associated with membership in the two Multidomain Impairment classes. Conclusions: There is substantial heterogeneity in combined trajectories of interrelated health domains in late life. Membership in the two most impaired classes was more likely for minoritized older adults.

TOMM40 genetic variants associated with healthy aging and longevity: a systematic review.

INTRODUCTION: Healthy aging relies on mitochondrial functioning because this organelle provides energy and diminishes oxidative stress. Single nucleotide polymorphisms (SNPs) in TOMM40, a critical gene that produces the outer membrane protein TOM40 of mitochondria, have been associated with mitochondrial dysfunction and neurodegenerative processes. Yet it is not clear whether or how the mitochondria may impact human longevity. We conducted this review to ascertain which SNPs have been associated with markers of healthy aging. METHODS: Using the PRISMA methodology, we conducted a systematic review on PubMed and Embase databases to identify associations between TOMM40 SNPs and measures of longevity and healthy aging. RESULTS: Twenty-four articles were selected. The TOMM40 SNPs rs2075650 and rs10524523 were the two most commonly identified and studied SNPs associated with longevity. The outcomes associated with the TOMM40 SNPs were changes in BMI, brain integrity, cognitive functions, altered inflammatory network, vulnerability to vascular risk factors, and longevity. DISCUSSIONS: Our systematic review identified multiple TOMM40 SNPs potentially associated with healthy aging. Additional research can help to understand mechanisms in aging, including resilience, prevention of disease, and adaptation to the environment.

Longitudinal Changes in Hearing and Visual Impairments and Risk of Dementia in Older Adults in the United States.

Importance: Hearing and vision problems are individually associated with increased dementia risk, but the impact of having concurrent hearing and vision deficits, ie, dual sensory impairment (DSI), on risk of dementia, including its major subtypes Alzheimer disease (AD) and vascular dementia (VaD), is not well known. Objective: To evaluate whether DSI is associated with incident dementia in older adults. Design, Setting, and Participants: This prospective cohort study from the Cardiovascular Health Study (CHS) was conducted between 1992 and 1999, with as many as 8 years of follow-up. The multicenter, population-based sample was recruited from Medicare eligibility files in 4 US communities with academic medical centers. Of 5888 participants aged 65 years and older in CHS, 3602 underwent cranial magnetic resonance imaging and completed the modified Mini-Mental State Examination in 1992 to 1994 as part of the CHS Cognition Study. A total of 227 participants were excluded due to prevalent dementia, leaving a total of 3375 participants without dementia at study baseline. The study hypothesis was that DSI would be associated with increased risk of dementia compared with no sensory impairment. The association between the duration of DSI with risk of dementia was also evaluated. Data analysis was conducted from November 2019 to February 2020. Exposures: Hearing and vision impairments were collected via self-report at baseline and as many as 5 follow-up visits. Main Outcomes and Measures: All-cause dementia, AD, and VaD, classified by a multidisciplinary committee using standardized criteria. Results: A total of 2927 participants with information on hearing and vision at all available study visits were included in the analysis (mean [SD] age, 74.6 [4.8] years; 1704 [58.2%] women; 455 [15.5%] African American or Black; 2472 [85.5%] White). Compared with no sensory impairment, DSI was associated with increased risk of all-cause dementia (hazard ratio [HR], 2.60; 95% CI, 1.66-2.06; P < .001), AD (HR, 3.67; 95% CI, 2.04-6.60; P < .001) but not VaD (HR, 2.03; 95% CI, 1.00-4.09; P = .05). Conclusions and Relevance: In this cohort study, DSI was associated with increased risk of dementia, particularly AD. Evaluation of hearing and vision in older adults may help to identify those at high risk of developing dementia.

Arrest and non-fatal suicide attempts among men: analysis of survey data from the National Survey on Drug Use and Health.

BACKGROUND: Studies have found an association between recent arrest and suicide attempts, but the population-level significance of this link has not been reported. We estimated the population attributable risk percent (PAR%) of self-reported non-fatal suicide attempts based on recent arrest in a national sample of adult men. METHODS: This study included men aged ≥18 who completed the 2008-2019 National Surveys on Drug Use and Health. The outcome measure was any non-fatal suicide attempts in the past year. The primary independent variable was any arrest in the past year. Major depression and substance use disorders were also included as independent variables for comparison. Descriptive statistics and multivariate logistic regression with postestimation marginal effects ascertained the PAR% of non-fatal suicide attempts for arrest, major depression, and substance use disorders, while controlling for sociodemographic covariates. All analyses applied survey weights. We disaggregated analyses by race/ethnicity. RESULTS: In the sample of 220,261 men, arrest accounted for 8.9% (99% CI 5.1 to 12.6%, p < 0.001) of non-fatal suicide attempts, while major depression accounted for 40.3% (99% CI 35.0 to 45.1%. p < 0.001) and substance use disorders for 24.1% (99% CI 17.6 to 30.2%, p < 0.001). After disaggregating by race/ethnicity, arrest accounted for 9.5% (99% CI 4.5 to 14.3%, p < 0.001) of suicide attempts among Non-Hispanic White men and fell short of statistical significance for Non-Hispanic Black men (10.2, 99% CI - 3.0 to 21.6%, p = 0.043) and Hispanic men (8.1, 99% CI - 0.5 to 15.9%, p = 0.016). CONCLUSIONS: Arrest accounted for nearly one in eleven non-fatal suicide attempts in a national sample of American men, which is by extension about 50,000 suicide attempts per year. Results were similar for Non-Hispanic White, Non-Hispanic Black, and Hispanic men, although there were differences in prevalence of arrest and suicide attempts. Unlike major depression, arrest is an easily identifiable event, and the period after arrest might provide an opportunity to support mental health and coping.

Unexpected Findings During Double-blind Discontinuation of Acetylcholinesterase Inhibitor Medications.

PURPOSE: The long-term effects of acetylcholinesterase inhibitors (AChEIs) used in the treatment of patients with various types of dementia remain unclear, largely due to challenges in the study of their discontinuation. We present several unexpected results from a discontinuation trial that might merit further investigation. METHODS: This double-blind, placebo-controlled study of the discontinuation of AChEI medications was conducted in 62 US veterans. Participants were randomized to receive continued treatment with their medication (sham-taper group) or to treatment discontinuation via tapering (real-taper group), over a period of 6 weeks. The primary end point was the patient's/family caregiver's decision to discontinue the study medication. FINDINGS: The study was underpowered to detect a significant between-group difference in the primary end point, but examination of the discontinuation process generated several unexpected results: (1) recruitment proved extremely challenging for a variety of reasons, with <5% of potentially eligible participants enrolled; (2) all 3 patients with Parkinson disease-associated dementia showed a worsening of symptoms when they discontinued their AChEI medication, but they showed improvement after they restarted it; (3) changes in symptom-scale scores varied quite broadly across participants, regardless of treatment arm; (4) unusual effects were noted in the sham-taper arm; and (5) the only significant predictor of the decision to discontinue the study medication was a worsening in the caregiver's mood. IMPLICATIONS: These findings argue for the use of caution in discontinuing AChEIs in patients with Parkinson disease-associated dementia, although there may be potential benefits of a "drug holiday." The findings also urge the consideration of distress on the part of the caregiver while making medication treatment decisions in dementia. Future research must address challenges with recruitment and symptom fluctuations.

Cannabis Use and Nonfatal Opioid Overdose among Patients Enrolled in Methadone Maintenance Treatment.

BACKGROUND: Some ecological studies found lower rates of opioid overdose in states with liberalized cannabis legislation, but results are mixed, and the association has not been analyzed in individuals. We quantified the association between cannabis use and nonfatal opioid overdose among individuals enrolled in methadone maintenance treatment (MMT) for opioid use disorder (OUD). METHODS: We recruited a convenience sample of individuals enrolled in four MMT clinics in Washington State and southern New England who completed a one-time survey.Descriptive statistics and multivariate logistic regression compared the prevalence and risk of nonfatal opioid overdose in the past 12 months between participants reporting frequent (at least weekly) or infrequent (once or none) cannabis use in the past month. RESULTS: Of 446 participants, 35% (n = 156) reported frequent cannabis use and 7% (n = 32) reported nonfatal opioid overdose in the past year. The prevalence of nonfatal opioid overdose was 3% among reporters of frequent cannabis use, and 9% among reporters of infrequent/no use (p = 0.02). After imputing missing data and controlling for demographic and clinical factors, the likelihood of self-reported nonfatal opioid overdose in the past year was 71% lower among reporters of frequent cannabis use in the past month (adjusted RR = 0.29, 95% CI 0.10-0.80, p = 0.02). CONCLUSIONS: Among individuals enrolled in MMT, frequent cannabis use in the past month was associated with fewer self-reported nonfatal opioid overdoses in the past year. Methodological limitations caution against causal interpretation of this relationship. Additional studies are needed to understand the prospective impact of co-occurring cannabis on opioid-related outcomes.

Ophthalmic conditions associated with dementia risk: The Cardiovascular Health Study.

INTRODUCTION: Ophthalmic conditions and dementia appear to overlap and may share common pathways, but research has not differentiated dementia subtypes. METHODS: Diagnoses of cataracts, age-related macular degeneration (AMD), diabetic retinopathy (DR), and glaucoma were based on medical histories and International Classification of Diseases, Ninth Revision (ICD-9) codes for 3375 participants from the Cardiovascular Health Study. Dementia, including Alzheimer's disease (AD) and vascular dementia (VaD), was classified using standardized research criteria. RESULTS: Cataracts were associated with AD (hazard ratio [HR] = 1.34; 95% confidence interval [CI] = 1.01-1.80) and VaD/mixed dementia (HR = 1.41; 95% CI = 1.02-1.95). AMD was associated with AD only (HR = 1.87; 95% CI = 1.13-3.09), whereas DR was associated with VaD/mixed dementia only (HR = 2.63; 95% CI = 1.10-6.27). DISCUSSION: Differential associations between specific ophthalmic conditions and dementia subtypes may elucidate pathophysiologic pathways. Lack of association between glaucoma and dementia was most surprising from these analyses.

An Agenda for Addressing Multimorbidity and Racial and Ethnic Disparities in Alzheimer's Disease and Related Dementia.

Advancements in Alzheimer's disease and related dementias (ADRD) research on the U.S. population acknowledge the importance of the high burden of ADRD on segments of the population and yet-to-be characterized risks attributable to the burden of multiple chronic diseases (multimorbidity). These realizations suggest successful strategies in caring for people with ADRD and their caregivers will rely not only on clinical treatments but also on more refined and comprehensive models of ADRD that take its broad effects on the whole-person and the whole of society into consideration. To this end, it is critical to characterize and address the relationship between ADRD and multimorbidity combinations that complicate care and lead to poor outcomes, particularly with regard to racial and ethnic disparities in the occurrence, course, and effects of ADRD. Several research and policy recommendations are presented to address the intersection of ADRD, multimorbidity, and underrepresented populations most at risk for adverse outcomes.

Dual sensory impairment in older adults and risk of dementia from the GEM Study.

INTRODUCTION: Hearing and vision loss are independently associated with dementia, but the impact of dual sensory impairment (DSI) on dementia risk is not well understood. METHODS: Self-reported measures of hearing and vision were taken from 2051 participants at baseline from the Gingko Evaluation of Memory Study. Dementia status was ascertained using standardized criteria. Cox models were used to estimate risk of dementia associated with number of sensory impairments (none, one, or two). RESULTS: DSI was significantly associated with higher risk of all-cause dementia (hazard ratio [HR] = 1.86; 95% confidence interval [CI] = 1.25-2.76) and Alzheimer's disease (HR = 2.12; 95% CI = 1.34-3.36). Individually only visual impairment was independently associated with an increased risk of all-cause dementia (HR = 1.32; 95% CI = 1.02-1.71). DISCUSSION: Older adults with DSI are at a significantly increased risk for dementia. Further studies are needed to evaluate whether treatments can modify this risk.

Associations Between Activities of Daily Living Independence and Mental Health Status Among Medicare Managed Care Patients.

BACKGROUND/OBJECTIVES: Although there is a strong cross-sectional association between dependence in activities of daily living (ADLs) and decreased mental health, it is largely unknown how the loss of specific ADLs, or the combination of ADLs, influences mental health outcomes. We examined the effect of ADL independence on mental health among participants in a large survey of Medicare managed care recipients. DESIGN/SETTING: Retrospective cohort study. PARTICIPANTS: A total of 104,716 participants in cohort 17 of the Medicare Health Outcomes Survey, who completed the baseline and follow-up surveys in 2014 and 2016. MEASUREMENTS: Linear regression models estimated the effects of loss of ADL independence on change in Mental Component Summary (MCS) score. RESULTS: In an adjusted model, loss of independence in eating, bathing, dressing, and toileting were associated with three- to four-point declines in MCS, suggesting meaningful worsening. In a model that also included all six ADLs, loss of independence in each ADL was associated with declines in MCS, with the largest effects for eating and bathing. MCS decreased by 1.3 per each additional summative loss of ADL independence (P < .001). CONCLUSION: Loss of ADL independence was associated with large declines in mental health, with personal care activities showing the largest effects. Additional research can help to characterize the causes of ADL loss, to explore how older adults cope with it, and to identify ways of maximizing resilience. J Am Geriatr Soc 68:1301-1306, 2020.

GRECC Connect: Geriatrics Telehealth to Empower Health Care Providers and Improve Management of Older Veterans in Rural Communities.

A telehealth program supports meaningful partnerships between urban geriatric specialists and rural health care providers to facilitate increased access to specialty care.

Cost-related delay in filling prescriptions and health care ratings among medicare advantage recipients.

Despite higher health care needs, older adults often have limited and fixed income. Approximately a quarter of them report not filling or delaying prescription medications due to cost (cost-related prescription delay, CRPD). To ascertain the association between CRPD and satisfaction with health care, secondary analysis of the 2012 Consumer Assessment of Healthcare Providers and Systems (CAHPS) Medicare Advantage Survey was performed.Regression models quantified the association between CRPD and rating of personal doctor, specialist, and overall health care. Models were adjusted for demographic, health-related, and socioeconomic characteristics. 274,996 Medicare Advantage enrollees were mailed the CAHPS survey, of which 101,910 (36.8%) returned a survey that had responses to all the items we analyzed. CRPD was assessed by self-report of delay in filling prescriptions due to cost. Health care ratings were on a 0-10 scale. A score ≤ 5 was considered a poor rating of care.In unadjusted models, CRPD more than doubled the relative risk (RR) for poor ratings of personal doctor (RR 2.34), specialist (RR 2.14), and overall health care (RR 2.40). Adjusting for demographics and health status slightly reduced the RRs to 1.9, but adjusting for low-income subsidy and lack of insurance for medications did not make a difference.CRPD is independently associated with poor ratings of medical care, regardless of health, financial or insurance status. Providers might reduce patients' financial stress and improve patient satisfaction by explicitly discussing prescription cost and incorporating patient priorities when recommending treatments.

Detection of probable dementia cases in undiagnosed patients using structured and unstructured electronic health records.

BACKGROUND: Dementia is underdiagnosed in both the general population and among Veterans. This underdiagnosis decreases quality of life, reduces opportunities for interventions, and increases health-care costs. New approaches are therefore necessary to facilitate the timely detection of dementia. This study seeks to identify cases of undiagnosed dementia by developing and validating a weakly supervised machine-learning approach that incorporates the analysis of both structured and unstructured electronic health record (EHR) data. METHODS: A topic modeling approach that included latent Dirichlet allocation, stable topic extraction, and random sampling was applied to VHA EHRs. Topic features from unstructured data and features from structured data were compared between Veterans with (n = 1861) and without (n = 9305) ICD-9 dementia codes. A logistic regression model was used to develop dementia prediction scores, and manual reviews were conducted to validate the machine-learning results. RESULTS: A total of 853 features were identified (290 topics, 174 non-dementia ICD codes, 159 CPT codes, 59 medications, and 171 note types) for the development of logistic regression prediction scores. These scores were validated in a subset of Veterans without ICD-9 dementia codes (n = 120) by experts in dementia who performed manual record reviews and achieved a high level of inter-rater agreement. The manual reviews were used to develop a receiver of characteristic (ROC) curve with different thresholds for case detection, including a threshold of 0.061, which produced an optimal sensitivity (0.825) and specificity (0.832). CONCLUSIONS: Dementia is underdiagnosed, and thus, ICD codes alone cannot serve as a gold standard for diagnosis. However, this study suggests that imperfect data (e.g., ICD codes in combination with other EHR features) can serve as a silver standard to develop a risk model, apply that model to patients without dementia codes, and then select a case-detection threshold. The study is one of the first to utilize both structured and unstructured EHRs to develop risk scores for the diagnosis of dementia.

Mental health treatment among older adults with mental illness on parole or probation.

BACKGROUND: The number of older adults on parole and probation is growing at an unprecedented rate, yet little is known about the mental health needs and treatment utilization patterns among this group. The objective of this study is to compare the prevalence of serious or moderate mental illness (SMMI), and the proportion of those with SMMI who receive mental health treatment, among community-dwelling older adults on correctional supervision (parole or probation) vs. not on correctional supervision. METHODS: Design: Cross-sectional analysis of data from the 2008-2014 National Surveys for Drug Use and Health (NSDUH). SETTING: Population-based national survey data. PARTICIPANTS: Older adults (age ≥ 50) who participated in the NSDUH between 2008 and 2014 (n = 44,624). Participants were categorized according to whether they were on parole or probation during the 12 months prior to survey completion (n = 379) vs. not (n = 44,245). MEASUREMENTS: Probable SMMI was defined using a validated measure in the NSDUH. Mental health treatment included any outpatient mental health services or prescriptions over the 12 months prior to survey completion. We compared the prevalence of SMMI, and the proportion of those with SMMI who received any treatment, by correctional status. RESULTS: Overall, 7% (N = 3266) of participants had SMMI; the prevalence was disproportionately higher among those on parole or probation (21% vs. 7%, p <  0.001). Sixty-two percent of those with SMMI received any mental health treatment, including 81% of those on parole or probation and 61% of those who were not (p <  0.001). This result remained statistically significant after logistic regression accounted for differences in sociodemographics and health. CONCLUSIONS: SMMI is disproportionally prevalent among older adults on parole or probation, and community correctional supervision programs may be facilitating linkages to needed community-based mental health treatment.

Long-Term Cognitive Decline After Newly Diagnosed Heart Failure: Longitudinal Analysis in the CHS (Cardiovascular Health Study).

BACKGROUND: Heart failure (HF) is associated with cognitive impairment. However, we know little about the time course of cognitive change after HF diagnosis, the importance of comorbid atrial fibrillation, or the role of ejection fraction. We sought to determine the associations of incident HF with rates of cognitive decline and whether these differed by atrial fibrillation status or reduced versus preserved ejection fraction. METHODS AND RESULTS: Participants were 4864 men and women aged ≥65 years without a history of HF and free of clinical stroke in the CHS (Cardiovascular Health Study)-a community-based prospective cohort study in the United States, with cognition assessed annually from 1989/1990 through 1998/1999. We identified 496 participants with incident HF by review of hospital discharge summaries and Medicare claims data, with adjudication according to standard criteria. Global cognitive ability was measured by the Modified Mini-Mental State Examination. In adjusted models, 5-year decline in model-predicted mean Modified Mini-Mental State Examination score was 10.2 points (95% confidence interval, 8.6-11.8) after incident HF diagnosed at 80 years of age, compared with a mean 5-year decline of 5.8 points (95% confidence interval, 5.3-6.2) from 80 to 85 years of age without HF. The association was stronger at older ages than at younger ages, did not vary significantly in the presence versus absence of atrial fibrillation (P=0.084), and did not vary significantly by reduced versus preserved ejection fraction (P=0.734). CONCLUSIONS: Decline in global cognitive ability tends to be faster after HF diagnosis than without HF. Clinical and public health implications of this finding warrant further attention.

Identifying and categorizing spurious weight data in electronic medical records.

Background: Spurious weights compromise the validity of summary measures, such as averages and trends. Even rare errors in weight records can undermine the utility of electronic medical record (EMR) data. Objective: We sought to estimate the prevalence of spurious weight values in a large EMR, to ascertain the likely causes, and to develop and test straightforward algorithms for identifying spurious weight data. Design: Using EMR data from 10,000 randomly selected patients aged ≥65 y in the VA system, we examined the percentage of weight change across various time intervals, from 1 to 3000 d. We examined descriptive results and developed 3 algorithms to categorize degree of weight change over time. On the basis of distributions, we identified cases that were most likely spurious. We manually reviewed these and categorized the type of error. Results: The data followed the expected distributions. The algorithms reliably identified spurious weight. Approximately 0.8% of all weights in the record appeared to be spurious and ∼1 in 5 patient charts included ≥1 spurious weight value. The most common type of error involved the misentry of a single digit (e.g., 148 for 178). Conclusions: Spurious weights are common in EMRs. Straightforward algorithms can identify and remove them, and thus enhance the reliability of EMR data.

Association Between Mental Health Staffing Level and Primary Care-Mental Health Integration Level on Provision of Depression Care in Veteran's Affairs Medical Facilities.

We examined the association of mental health staffing and the utilization of primary care/mental health integration (PCMHI) with facility-level variations in adequacy of psychotherapy and antidepressants received by Veterans with new, recurrent, and chronic depression. Greater likelihood of adequate psychotherapy was associated with increased (1) PCMHI utilization by recurrent depression patients (AOR 1.02; 95% CI 1.00, 1.03); and (2) staffing for recurrent (AOR 1.03; 95% CI 1.01, 1.06) and chronic (AOR 1.02; 95% CI 1.00, 1.03) depression patients (p < 0.05). No effects were found for antidepressants. Mental health staffing and PCMHI utilization explained only a small amount of the variance in the adequacy of depression care.

Racial and ethnic differences in smoking changes after chronic disease diagnosis among middle-aged and older adults in the United States.

BACKGROUND: Middle-aged and older Americans from underrepresented racial and ethnic backgrounds are at risk for greater chronic disease morbidity than their white counterparts. Cigarette smoking increases the severity of chronic illness, worsens physical functioning, and impairs the successful management of symptoms. As a result, it is important to understand whether smoking behaviors change after the onset of a chronic condition. We assessed the racial/ethnic differences in smoking behavior change after onset of chronic diseases among middle-aged and older adults in the US. METHODS: We use longitudinal data from the Health and Retirement Study (HRS 1992-2010) to examine changes in smoking status and quantity of cigarettes smoked after a new heart disease, diabetes, cancer, stroke, or lung disease diagnosis among smokers. RESULTS: The percentage of middle-aged and older smokers who quit after a new diagnosis varied by racial/ethnic group and disease: for white smokers, the percentage ranged from 14% after diabetes diagnosis to 32% after cancer diagnosis; for black smokers, the percentage ranged from 15% after lung disease diagnosis to 40% after heart disease diagnosis; the percentage of Latino smokers who quit was only statistically significant after stoke, where 38% quit. In logistic models, black (OR = 0.43, 95% CI: 0.19-0.99) and Latino (OR = 0.26, 95% CI: 0.11-0.65) older adults were less likely to continue smoking relative to white older adults after a stroke, and Latinos were more likely to continue smoking relative to black older adults after heart disease onset (OR = 2.69, 95% CI [1.05-6.95]). In models evaluating changes in the number of cigarettes smoked after a new diagnosis, black older adults smoked significantly fewer cigarettes than whites after a new diagnosis of diabetes, heart disease, stroke or cancer, and Latino older adults smoked significantly fewer cigarettes compared to white older adults after newly diagnosed diabetes and heart disease. Relative to black older adults, Latinos smoked significantly fewer cigarettes after newly diagnosed diabetes. CONCLUSIONS: A large majority of middle-aged and older smokers continued to smoke after diagnosis with a major chronic disease. Black participants demonstrated the largest reductions in smoking behavior. These findings have important implications for tailoring secondary prevention efforts for older adults.

Methods Employed to Assess Weight Loss in Older Adults by Means of Electronic Medical Records: A Systematic Review.

Electronic medical records (EMRs) can be used to identify and categorize weight loss in older adults, but research has not scrutinized methods for doing so. Through a modified PRISMA protocol, we systematically reviewed published methods for quantifying weight change from EMRs. Articles (all available through July 2016) were identified through PubMed and SCOPUS searches, screened, and evaluated. We abstracted relevant data and tabulated the methods to assess weight change. The 13 selected articles showed little consistency in the approach to key methodological issues: 1) time ranges assessed; 2) removal of spurious values; 3) metrics to quantify weight change; 4) number of measures needed to estimate change; 5) threshold for significant weight change; and 6) relation to ideal weight. There was essentially no consensus around how to identify and categorize weight loss. Further investigation is needed to establish scientifically validated and clinically useful algorithms, accounting for the six issues above.