The cross-sectional association of frailty with chronic past and current use of benzodiazepine drugs.

BACKGROUND: Frailty, a clinical syndrome characterized by vulnerability to stressors resulting from multisystemic loss of physiological reserve. The use of benzodiazepines in older adults has been associated with confusion, sedation, and cognitive impairment, which in turn may lead to frailty. AIMS: The purpose of this study was to determine the cross-sectional association between frailty and chronic past or current use of benzodiazepine drugs among older US Veterans. METHODS/DESIGN: This is a cross-sectional study of community-dwelling older Veterans who had determinations of frailty. Benzodiazepine prescription data were obtained via EHR. A 31-item VA Frailty Index (VA-FI) was generated at the time of the assessment. We categorized Veterans into robust (FI ≤ 0.10), pre-frail (FI 0.10-0.21), and Frail (FI ≥ 0.21). After adjusting for sociodemographic characteristics, we calculated ORs and 95% CIs using a binomial logistic regression (BLR) model to assess the cross-sectional association between benzodiazepine use and frailty. RESULTS: Population sample consisted of 17,423 Veterans, mean age 75.53 (SD = 8.03) years, 70.80% Caucasian, 97.34% male, 14,545 (83.50%) patients were non-users of benzodiazepine drugs, 2408 (13.80%) had a past use, and 470 (2.70%) were current users. In BLR, individuals with past (OR 2.51, 95% CI 2.30-2.74, p < .001) or current (OR 2.36, 95% CI 1.96-2.83, p < .001) use showed a higher association with frailty as compared to individuals who were non-users. CONCLUSIONS: The use of benzodiazepine was cross-sectionally associated with frailty in older Veterans. These results suggest that screening for frailty in patients with past or current exposure to benzodiazepine medications may be necessary for proper management.

The cross-sectional association of frailty with past and current exposure to strong anticholinergic drugs.

BACKGROUND: Anticholinergic drugs may contribute to frailty by impairing cognitive and physical functions. Strong anticholinergic drugs in particular may have adverse effects among older adults. OBJECTIVES: Determine the association between frailty and the use of strong anticholinergic drugs among older US Veterans. METHODS: This is a cross-sectional study of community-dwelling Veterans 65 years and older who had determinations of frailty status. Prescription data for patients using strong anticholinergic medications (never/past/current) was obtained via electronic health records. A 31-item VA Frailty Index (VA-FI) was generated at the time of the assessment. We dichotomized the groups into non-frail (FI = < 0.21) and frail (FI ≥ 0.21) patients. We used binomial logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Frailty was the dependent variable and use of strong anticholinergic drugs was the independent variable. Multivariate adjustment was conducted for age, gender, race, ethnicity, marital status, and BMI. RESULTS: Population sample consisted of 17,084 Veterans who were 71.05% Caucasian, 97.34% male, and with a mean age 75.60 (SD = 8.04) years. Among the population, 9940 (58.18%) patients had no previous use of strong anticholinergic drugs, whereas 5182 (30.33%) had past exposure and 1962 (11.49%) had current exposure. In binomial logistic regression, individuals with past (OR 3.27, 95% CI 3.03-3.54, p < 0.0005) or current (OR 4.78, 95% CI 4.30-5.31, p < 0.0005) exposure showed a higher association with frailty as compared to individuals who were never exposed. CONCLUSIONS: Past and current use of strong anticholinergic drugs were associated with frailty in older Veterans. These results suggest that screening for frailty in patients with past or current exposure to strong anticholinergic medications may be necessary for proper management.

Pseudocirrhosis in Chronic Budd Chiari Syndrome With Janus Tyrosine Kinase 2 (JAK2) Mutation.

Budd-Chiari syndrome (BCS) occurs when there is hepatic venous outflow obstruction. Chronic BCS may result in liver cirrhosis due to long-standing obstruction and tend to present late. We present the first case of BCS secondary to Janus tyrosine kinase 2 (JAK2) mutation resulting in "pseudocirrhosis" rather than cirrhosis of the liver. Pseudocirrhosis clinically and radiologically mimics cirrhosis without the classical histopathological changes, and it is usually associated with metastatic cancers.

Is There an Association Between Metformin Exposure and Frailty?

Frailty is a state of vulnerability to stressors resulting in higher morbidity, mortality, and utilization in older adults. Frailty and type 2 diabetes mellitus share similar pathophysiological mechanisms which metformin may target. The purpose of this study was to determine whether exposure to metformin is associated with frailty in veterans. This is a cross-sectional study of veterans 65 years and older with type 2 diabetes who were screened for frailty between January 2016 and August 2017. We constructed a 44-item Frailty Index including multiple variables using a deficit accumulation framework. After adjustment for covariates, the association was calculated using binomial logistic regression models with frailty status as the outcome variable, and metformin exposure as the independent variable. Patients were 98.3% male and 56.7% White with a mean age of 72.9 (SD = 6.8) years. The proportion of robust, prefrail and frail patients was 2.9% (n = 22), 46.7 % (n = 356) and 50.5% (n = 385), respectively. In binomial logistic regression, exposure to metformin was associated with lower risk for frailty, adjusted odds ratio (OR) = .55 (95% confidence interval [CI] = .39-.77), p ≤ .001. This study shows that exposure to metformin was associated with lower risk for frailty in community-dwelling veterans.

The association of health literacy domains with hospitalizations and mortality.

OBJECTIVES: To determine whether health literacy, numeracy, and graph literacy are associated with all-cause hospitalizations or mortality in community-dwelling veterans. STUDY DESIGN: Retrospective cohort study. METHODS: A total of 470 community-dwelling veterans underwent evaluations of health literacy, numeracy, and graph literacy with validated instruments in 2012 and were followed until 2018. At the end of follow-up, the associations with all-cause hospitalizations and mortality were determined with the Andersen-Gill model and Cox regression multivariate analysis, respectively. RESULTS: There were no associations of health literacy, numeracy, or graph literacy with all-cause hospitalization or mortality after multivariate adjustment. In subgroup analysis, subjective numeracy was associated with hospitalizations in African Americans. Higher objective and subjective numeracy were associated with future hospitalizations only for those with a history of hospitalization. Higher graph literacy was associated with lower mortality in those with a history of hospitalization. CONCLUSIONS: This study did not show associations of health literacy, numeracy, or graph literacy scores with lower risk of all-cause hospitalization or mortality. Further research is needed with random sampling in a broader spectrum of healthcare settings to better understand what roles health literacy, numeracy, and graph literacy might play in healthcare utilization and clinical outcomes.

Is vitamin D deficiency related to a higher risk of hospitalization and mortality in veterans with heart failure?

OBJECTIVES: 25-hydroxyvitamin D [25(OH)D] deficiency is related to an increase in cardiovascular risk but the association between low 25(OH)D and hospitalization and mortality in heart failure (HF) patients remains unclear. The objective of this study was therefore to determine whether 25(OH)D deficiency is associated with a higher risk of all-cause hospitalizations and mortality in veterans with HF, as well as the differential effect of frailty. STUDY DESIGN: A retrospective cohort study of veterans with HF. MAIN OUTCOME: Association between 25(OH)D deficiency and risk of hospitalization and mortality. MEASURES: 25(OH)D status was dichotomized as deficiency (<30 ng/mL) and non-deficiency (≥30 ng/mL). A 44-item Frailty Index (FI) was constructed and used to categorize patients as non-frail (FI < .21) or frail (FI ≥ .21). The association of 25(OH)D deficiency with recurrent hospitalization was analyzed through an Andersen-Gill model and the association with mortality using Cox regression. RESULTS: We identified 284 patients, of whom 141 (50 %) exhibited 25(OH)D deficiency (67.3 ±â€¯10.5 years of age). The mean 25(OH)D levels in the deficiency and non-deficiency groups were 21.3±5.9 ng/mL and 40.9 ±â€¯10.9 ng/mL, respectively. Over a median follow-up of 1136 days (IQR = 691), there were 617 hospitalizations (68 % in those with 25(OH)D deficiency) and 131 deaths (40 % in those with 25(OH)D deficiency). A significantly higher risk of hospitalization was found in patients with 25(OH)D deficiency: hazard ratio (HR) = 1.8 (95 % CI:1.3-2.5),p < 0.001. Frail veterans had a greater risk of hospitalization than non-frail veterans: HR = 1.7 (95 % CI:1.2-2.7),p < 0.05. Mortality did not show any significant association with 25(OH)D deficiency. CONCLUSIONS: 25(OH)D deficiency was an independent risk factor for hospitalization in patients with HF and the effect persisted in those with frailty.

The Association of Ageist Attitudes With All-Cause Hospitalizations and Mortality.

Background: Ageism is the systematic stereotyping and discrimination against older adults. Explicit ageism involves conscious control and implicit ageism involves unconscious processes. Studies have shown that ageist attitudes may be associated with poor clinical outcomes like hospitalizations and mortality. Objective: Determine the association of explicit and implicit ageism with all-cause hospitalizations and mortality in a sample of Veterans. Method: Retrospective cohort study of community-dwelling Veterans 50 years and older who underwent evaluations of explicit ageism using Kogan's Attitudes Toward Old People Scale and implicit ageism assessed with Implicit Association Test (IAT) during July 2014 to April 2015 and were followed until 2018. Data on all-cause hospitalizations and mortality following the initial assessment of ageism was aggregated. Results: The study included 381 participants, 89.8% male, 48.0% White, and mean age was 60.5 (SD = 7.2) years. A total of 339 completed the IAT. Over a mean follow-up of 3.2 years (SD = 0.3), 581 hospitalizations, and 35 deaths occurred. Neither explicit nor implicit ageism was associated with an increased risk for all-cause hospitalization or mortality on follow-up. Discussion: Future research may benefit from investigating whether ageist attitudes may predict all-cause hospitalizations and mortality in longitudinal studies including more diverse samples.

Is there an association between ageist attitudes and frailty?

BACKGROUND: Frailty is defined as a state of vulnerability to stressors that is associated with higher morbidity, mortality and healthcare utilization in older adults. Ageism is "a process of systematic stereotyping and discrimination against people because they are old." Explicit biases involve deliberate or conscious controls, while implicit bias involve unconscious processes. Multiple studies show that self-directed ageism is a risk factor for increased morbidity and mortality. The purpose of this study was to determine whether explicit ageist attitudes are associated with frailty in Veterans. METHODS: This is a cross-sectional study of Veterans 50 years and older who completed the Kogan's Attitudes towards Older People Scale (KAOP) scale to assess explicit ageist attitudes and the Implicit Association Test (IAT) to evaluate implicit ageist attitudes from July 2014 through April 2015. We constructed a frailty index (FI) of 44 variables (demographics, comorbidities, number of medications, laboratory tests, and activities of daily living) that was retrospectively applied to the time of completion of the KAOP and IAT. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by multinomial logistic regression models with frailty status (robust, prefrail and frail) as the outcome variable, and with KAOP and IAT scores as the independent variables. Age, race, ethnicity, median household income and comorbidities were considered as covariates. RESULTS: Patients were 89.76% male, 48.03% White, 87.93% non-Hispanic and the mean age was 60.51 (SD = 7.16) years. The proportion of robust, pre-frail and frail patients was 11.02% (n = 42), 59.58% (n = 227) and 29.40% (n = 112) respectively. The KAOP was completed by 381 and the IAT by 339 participants. In multinomial logistic regression, neither explicit ageist attitudes (KAOP scale score) nor implicit ageist attitudes (IAT) were associated with frailty in community dwelling Veterans after adjusting for covariates: OR = .98 (95% CI = .95-1.01), p = .221, and OR:=.97 (95% CI = .37-2.53), p = .950 respectively. CONCLUSIONS: This study shows that neither explicit nor implicit ageist attitudes were associated with frailty in community dwelling Veterans. Further longitudinal and larger studies with more diverse samples and measured with other ageism scales should evaluate the independent contribution of ageist attitudes to frailty in older adults.