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  • 1
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    Patterns of Association between Depressive Symptoms and Chronic Medical Morbidities in Older Adults
    Wiley ; 2020
    In:  Journal of the American Geriatrics Society Vol. 68, No. 8 ( 2020-08), p. 1834-1841
    Details
    In: Journal of the American Geriatrics Society, Wiley, Vol. 68, No. 8 ( 2020-08), p. 1834-1841
    Abstract: To investigate the association between depressive symptoms and several medical morbidities, and their combination, in a large older population. DESIGN Cross‐sectional study of baseline data from the ASPirin in Reducing Events in the Elderly (ASPREE) trial. SETTING Multicentric study conducted in Australia and the United States. PARTICIPANTS A total of 19,110 older adults (mean age = 75 years [standard deviation = ±4.5]). MEASUREMENTS Depressive symptoms were measured using the Center for Epidemiological Studies Depression (CES‐D 10) scale. Medical morbidities were defined according to condition‐specific methods. Logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) to test associations before and after accounting for possible confounders. RESULTS Depressive symptoms were significantly associated with obesity (OR = 1.19; 95% CI = 1.07‐1.32), diabetes (OR = 1.22; 95% CI = 1.05‐1.42), gastroesophageal reflux disease (GERD) (OR = 1.41; 95% CI = 1.28‐1.57), metabolic syndrome (OR = 1.16; 95% CI = 1.03‐1.29), osteoarthritis (OR = 1.41; 95% CI = 1.27‐1.57), respiratory conditions (OR = 1.25; 95% CI = 1.10‐1.42), history of cancer (OR = 1.19; 95% CI = 1.05‐1.34), Parkinson’s disease (OR = 2.56; 95% CI = 1.83‐3.56), polypharmacy (OR = 1.60; 95% CI = 1.44‐1.79), and multimorbidity (OR = 1.29; 95% CI = 1.12‐1.49). No significant association was observed between depressive symptoms and hypertension, chronic kidney disease, dyslipidemia, and gout ( P 〉  .05). A significant dose‐response relationship was evident between the number of medical comorbidities and the prevalence of depression (OR = 1.18; 95% CI = 1.13‐1.22). CONCLUSION Late‐life depressive symptoms are significantly associated with several medical morbidities, and there appears to be a cumulative effect of the number of somatic diseases on the prevalence of depression. These findings augment the evidence for a complex relationship between mental and physical health in an otherwise healthy older population and might guide clinicians toward early recognition of high‐risk individuals. J Am Geriatr Soc 68:1834‐1841, 2020.
    Type of Medium: Online Resource
    ISSN: 0002-8614 , 1532-5415
    URL: Issue
    URL: Article
    DOI: 10.1111/jgs.v68.8
    DOI: 10.1111/jgs.16468
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2040494-3
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  • 2
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    Spirometry and regular follow‐up do not improve quality of life in children or adolescents with asthma: Cluster randomized controlled trials
    Wiley ; 2015
    In:  Pediatric Pulmonology Vol. 50, No. 10 ( 2015-10), p. 947-954
    Details
    In: Pediatric Pulmonology, Wiley, Vol. 50, No. 10 ( 2015-10), p. 947-954
    Abstract: To determine whether spirometry and regular medical review improved quality of life or other outcomes in children and adolescents with asthma. Methods We conducted two cluster randomized controlled trials. We recruited 238 asthma patients aged between 7 and 17 years from 56 general practices in South Eastern Australia. Participants were randomized to receive an intervention that included spirometry or usual care. The main outcome measure was asthma related quality of life. Results Baseline characteristics were well matched between the intervention and control groups. Neither trial found any difference in asthma related quality of life between groups. However because of measurement properties, a formal meta‐analysis could not be performed. Nor were there any significant effects of the intervention upon asthma attacks, limitation to usual activities, nocturnal cough, bother during physical activity, worry about asthma, or written asthma action plans. Conclusions The findings do not support more widespread use of spirometry for the management of childhood asthma in general practice, unless it is integrated into a complete management model. Pediatr Pulmonol. 2015; 50:947–954. © 2014 Wiley Periodicals, Inc.
    Type of Medium: Online Resource
    ISSN: 8755-6863 , 1099-0496
    URL: Issue
    URL: Article
    DOI: 10.1002/ppul.v50.10
    DOI: 10.1002/ppul.23096
    Language: English
    Publisher: Wiley
    Publication Date: 2015
    detail.hit.zdb_id: 1491904-7
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  • 3
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    The association of allopurinol with persistent physical disability and frailty in a large community based older cohort
    Wiley ; 2023
    In:  Journal of the American Geriatrics Society Vol. 71, No. 9 ( 2023-09), p. 2798-2809
    Details
    In: Journal of the American Geriatrics Society, Wiley, Vol. 71, No. 9 ( 2023-09), p. 2798-2809
    Abstract: The protective effects of allopurinol on physical function in older adults are not well understood, despite its potential to improve functional gains and reduce sarcopenia. This study aims to determine the association between allopurinol, persistent physical disability, and frailty in older gout patients. Methods This analysis used data from a randomized trial in an older cohort, ASPirin in Reducing Events in the Elderly (ASPREE). ASPREE recruited 19,114 participants aged ≥65 years without prior cardiovascular events, dementia, or independence‐limiting physical disability at trial enrolment. This analysis examined the association of baseline and time‐varying allopurinol use with persistent physical disability and new‐onset frailty in participants with gout at baseline (self‐report or use of any anti‐gout medications). Frailty was measured using the Fried frailty phenotype (score ≥3/5) and a deficit accumulation frailty index (FI) (score  〉 0.21/1.0). Multivariable Cox proportional‐hazards models were used for main analyses. Results This analysis included 1155 gout participants, with 630 taking allopurinol at baseline and 525 not. During a median follow‐up of 5.7 years, 113 new allopurinol users were identified. Compared with nonusers, baseline allopurinol use was associated with a significant risk reduction of persistent physical disability (Adjusted HR 0.46, 95% CI 0.23–0.92, p  = 0.03). The strength of the association was modestly attenuated in the time‐varying analysis (Adjusted HR 0.56, 0.29–1.08, p  = 0.08). No significant associations with frailty measures were observed for either baseline allopurinol use (Fried frailty: Adjusted HR 0.83, 0.62–1.12; FI: Adjusted HR 0.96, 0.74–1.24) or time‐varying allopurinol use (Fried frailty: Adjusted HR 0.92, 0.69–1.24; FI: Adjusted HR 1.02, 0.78–1.33). Conclusions Allopurinol use in older adults with gout is associated with a reduced risk of persistent physical disability but not associated with risk of frailty.
    Type of Medium: Online Resource
    ISSN: 0002-8614 , 1532-5415
    URL: Issue
    URL: Article
    DOI: 10.1111/jgs.v71.9
    DOI: 10.1111/jgs.18395
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2040494-3
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  • 4
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    Prescription Medication Use in Older Adults Without Major Cardiovascular Disease Enrolled in the Aspirin in Reducing Events in the Elderly (ASPREE) Clinical Trial
    Wiley ; 2020
    In:  Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy Vol. 40, No. 10 ( 2020-10), p. 1042-1053
    Details
    In: Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, Wiley, Vol. 40, No. 10 ( 2020-10), p. 1042-1053
    Abstract: Efforts to minimize medication risks among older adults include avoidance of potentially inappropriate medications. Contemporary analysis of medication use in community‐dwelling older people compared with the general population is lacking. Participants A total of 19,114 community‐dwelling adults in Australia and the United States aged 70 years or older (65 years or older for U.S. minorities) without histories of major cardiovascular disease, cognitive impairment, or disability participated in a randomized, placebo‐controlled trial of aspirin: ASPirin in Reducing Events in the Elderly study. Measurements Prescribed baseline medications obtained by self‐report and medical record review were grouped by World Health Organization Anatomic and Therapeutic Chemical category. Potentially inappropriate medications were defined using a modified American Geriatrics Society Beers Criteria. Polypharmacy was defined as 5 or more medications, and hyperpolypharmacy defined as 10 or more medications. Cross‐sectional descriptive statistics and adjusted odds ratios were computed. Results The median number of prescription medications per participant was three, regardless of age. Women had a higher medication prevalence. Cardiovascular drugs (primarily antihypertensives) were the most commonly reported (64%). Overall, 39% of the cohort reported taking at least one potentially inappropriate medication, with proton‐pump inhibitors being the most commonly reported (21.2% of cohort). Of the cohort, 27% had polypharmacy, and 2% hyperpolypharmacy. Age 75 years or older, less than 12 years of education, hypertension, diabetes mellitus, chronic kidney disease, frailty, gastrointestinal complaint, and depressive symptoms were associated with an increased likelihood of potentially inappropriate medications and polypharmacy. For almost all medication classes, prevalence was equivalent or lower than the general older population. Conclusion Overall medication burden and polypharmacy are low in older adults free of major cardiovascular disease, disability, and cognitive impairment. The prevalence of potentially inappropriate medications is higher than previously reported and similar to more vulnerable populations as a result of the introduction of proton‐pump inhibitors to the American Geriatrics Society Beers Criteria. Longitudinal follow‐up is required to further understand the balance of benefits and risks for potentially inappropriate medications and polypharmacy in community‐dwelling older people.
    Type of Medium: Online Resource
    ISSN: 0277-0008 , 1875-9114
    URL: Issue
    URL: Article
    DOI: 10.1002/phar.v40.10
    DOI: 10.1002/phar.2461
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2061167-5
    SSG: 15,3
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  • 5
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    Safety, Pharmacokinetics, and Antiretroviral Activity of the Potent, Specific Human Immunodeficiency Virus Protease Inhibitor Nelfinavir: Results of a Phase I/II Trial and Extended Follow-up in Patients Infected with Human Immunodeficiency Virus
    Wiley ; 1998
    In:  The Journal of Clinical Pharmacology Vol. 38, No. 8 ( 1998-08), p. 736-743
    Details
    In: The Journal of Clinical Pharmacology, Wiley, Vol. 38, No. 8 ( 1998-08), p. 736-743
    Type of Medium: Online Resource
    ISSN: 0091-2700
    URL: Issue
    URL: Article
    DOI: 10.1002/jcph.1998.38.issue-8
    DOI: 10.1002/j.1552-4604.1998.tb04814.x
    RVK:
    XA 52835
    Language: English
    Publisher: Wiley
    Publication Date: 1998
    detail.hit.zdb_id: 2010253-7
    SSG: 15,3
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  • 6
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    Evaluation of the Pain Impact Index for Community‐Dwelling Older Adults Through the Application of Rasch Modelling
    Wiley ; 2021
    In:  Pain Practice Vol. 21, No. 5 ( 2021-06), p. 501-512
    Details
    In: Pain Practice, Wiley, Vol. 21, No. 5 ( 2021-06), p. 501-512
    Abstract: Evaluate the Pain Impact Index, a simple, brief, easy‐to‐use, and novel tool to assess the impact of chronic pain in community‐dwelling older adults. Methods A Rasch modelling analysis was undertaken in Stata using a partial credit model suited to the Likert‐type items that comprised the Index. The Index was evaluated for ordering of category thresholds, unidimensionality, overall fit to the Rasch model, measurement bias (Differential Item Functioning, DIF), targeting, and construct validity. Results The four‐item Pain Impact Index was self‐completed by 6454 community‐dwelling Australians who were aged at least 70 years and experienced pain on most days. Two items showed evidence of threshold disordering, and this was resolved by collapsing response categories (from 5 to 3) for all items. The rescored Index conformed to the unidimensionality assumption and had satisfactory fit with the Rasch model (analyses conducted on a reduced sample size to mitigate the potential for overpowering: n  = 377, P   〉  0.0125, power  〉  77%). When considering uniform DIF, the most frequent sources of measurement bias were age, knee pain, and upper back pain. When considering nonuniform DIF, the most frequent source of measurement bias was knee pain. The Index had good ability to differentiate between respondents with different levels of pain impact and had highest measurement precision for respondents located around the average level of pain impact in the study sample. Both convergent and discriminant validity of the Index were supported. Conclusion The Pain Impact Index showed evidence of unidimensionality, was able to successfully differentiate between levels of pain impact, and had good evidence of construct validity.
    Type of Medium: Online Resource
    ISSN: 1530-7085 , 1533-2500
    URL: Issue
    URL: Article
    DOI: 10.1111/papr.v21.5
    DOI: 10.1111/papr.12980
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2046672-9
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  • 7
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    Potentially inappropriate medication use is associated with increased risk of incident disability in healthy older adults
    Wiley ; 2023
    In:  Journal of the American Geriatrics Society Vol. 71, No. 8 ( 2023-08), p. 2495-2505
    Details
    In: Journal of the American Geriatrics Society, Wiley, Vol. 71, No. 8 ( 2023-08), p. 2495-2505
    Abstract: Efforts to minimize medication risks among older adults include avoidance of potentially inappropriate medications (PIMs). However, most PIMs research has focused on older people in aged or inpatient care, creating an evidence gap for community‐dwelling older adults. To address this gap, we investigated the impact of PIMs use in the ASPirin in Reducing Events in the Elderly (ASPREE) clinical trial cohort. Methods Analysis included 19,114 community‐dwelling ASPREE participants aged 70+ years (65+ if US minorities) without major cardiovascular disease, cognitive impairment, or significant physical disability. PIMs were defined according to a modified 2019 AGS Beers Criteria. Cox proportional‐hazards regression models were used to estimate the association between baseline PIMs exposure and disability‐free survival, death, incident dementia, disability, and hospitalization, with adjustment for sex, age, country, years of education, frailty, average gait speed, and comorbidities. Results At baseline, 7396 (39% of the total) participants were prescribed at least one PIM. Compared with those unexposed, participants on a PIM at baseline were at an increased risk of persistent physical disability (adjusted hazard ratio [HR] 1.47, 95% confidence interval [CI] 1.21, 1.80) and hospitalization (adjusted HR 1.26, 95% CI 1.20, 1.32), but had similar rates of disability‐free survival (adjusted HR 1.02; 95% CI 0.93, 1.13) and death (adjusted HR 0.92, 95% CI 0.81, 1.05). These effects did not vary by polypharmacy status in interaction analyses. PIMs exposure was associated with higher risk of disability followed by hospitalization (adjusted HR 1.92, 95% CI 1.25, 2.96) as well as vice versa (adjusted HR 1.54, 95% CI 1.15, 2.05). PPIs, anti‐psychotics and benzodiazepines, were associated with increased risk of disability. Conclusions PIMs exposure is associated with subsequent increased risk of both incident disability and hospitalization. Increased risk of disability prior to hospitalization suggests that PIMs use may start the disability cascade in healthy older adults. Our findings emphasize the importance of caution when prescribing PIMs to older adults in otherwise good health.
    Type of Medium: Online Resource
    ISSN: 0002-8614 , 1532-5415
    URL: Issue
    URL: Article
    DOI: 10.1111/jgs.v71.8
    DOI: 10.1111/jgs.18353
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2040494-3
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  • 8
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    Prevalence of depressive symptoms and its associated factors among healthy community‐dwelling older adults living in Australia and the United States
    Wiley ; 2019
    In:  International Journal of Geriatric Psychiatry Vol. 34, No. 8 ( 2019-08), p. 1208-1216
    Details
    In: International Journal of Geriatric Psychiatry, Wiley, Vol. 34, No. 8 ( 2019-08), p. 1208-1216
    Abstract: This study was conducted to estimate prevalence rates and factors associated with depressive symptoms indexed by the Centre for Epidemiological Studies‐Depression (CES‐D‐10) score in a large sample of community‐dwelling healthy older adults from Australia and the United States. Convergent and divergent validity of the CES‐D‐10 were also examined. Methods A total of 19 114 individuals aged greater than or equal to 65 years old were enrolled from a primary prevention clinical trial. Depressive symptoms were classified using the CES‐D‐10 score greater than or equal to 8 and greater than or equal to 10. Gender‐specific prevalence for subgroups according to sociodemographic characteristics were reported, and factors associated with depressive symptoms were estimated. Results The overall prevalence rates of depressive symptoms were 9.8%, 95% CI, 8.5‐11.2 and 5.0%, 95% CI, 4.0‐6.0, according to the CES‐D‐10 score greater than or equal to 8 and greater than or equal to 10, respectively. Depressive symptoms were more common in women, individuals with less than 12 years of education, those living alone or in a residential care, ethnic minorities, current smokers, and former alcohol users. Convergent and divergent validities of the CES‐D‐10 were confirmed by observing strong negative association with the SF‐12 mental health component and a modest negative association with SF‐12 physical component, respectively. Conclusions This study reports the prevalence of depressive symptoms in Australian and US community‐dwelling healthy older populations. These findings emphasize the high burden of the condition and factors associated with depressive symptoms, to better inform clinicians and help with early detection and treatment of depression in this age group.
    Type of Medium: Online Resource
    ISSN: 0885-6230 , 1099-1166
    URL: Issue
    URL: Article
    DOI: 10.1002/gps.v34.8
    DOI: 10.1002/gps.5119
    RVK:
    XA 10000
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 1500455-7
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  • 9
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    Antihypertensive medication use and blood pressure control among treated older adults
    Wiley ; 2020
    In:  The Journal of Clinical Hypertension Vol. 22, No. 8 ( 2020-08), p. 1406-1414
    Details
    In: The Journal of Clinical Hypertension, Wiley, Vol. 22, No. 8 ( 2020-08), p. 1406-1414
    Abstract: The association of different antihypertensive regimens with blood pressure (BP) control is not well‐described among community‐dwelling older adults with low comorbidity. We examined antihypertensive use and BP control in 10 062 treated hypertensives from Australia and the United States (US) using baseline data from the ASPirin in Reducing Events in the Elderly (ASPREE) trial. Renin‐angiotensin system (RAS) drugs were the most prevalently used antihypertensive in both countries (Australia: 81.7% of all regimens; US: 62.9% of all regimens; P   〈  .001). Diuretics were the next most commonly used antihypertensive in both countries, but were more often included in regimens of US participants (48.9%, vs 33.3% of regimens in Australia; P   〈  .001). Among all antihypertensive classes and possible combinations, monotherapy with a RAS drug was the most common regimen in both countries, but with higher prevalence in Australian than US participants (35.9% vs 20.9%; P   〈  .001). For both monotherapy and combination users, BP control rates across age, ethnicity, and sex were consistently lower in Australian than US participants. After adjustment for age, sex, ethnicity, and BMI, significantly lower BP control rates remained in Australian compared to US participants for the most commonly used classes and regimens (RAS blocker monotherapy: BP control = 45.5% vs 54.2%; P  = .002; diuretic monotherapy: BP control = 45.2% vs 64.5%; P  = .001; and RAS blocker/diuretic combo: BP control = 50.2% vs 65.6%; P  = .001). Our findings highlight variation in antihypertensive use in older adults treated for hypertension, with implications for BP control. Differences in BP control that were observed may be influenced, in part, by reasons other than choice of specific regimens.
    Type of Medium: Online Resource
    ISSN: 1524-6175 , 1751-7176
    URL: Issue
    URL: Article
    DOI: 10.1111/jch.v22.8
    DOI: 10.1111/jch.13934
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2058690-5
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  • 10
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    The effect of depressive symptoms on disability‐free survival in healthy older adults: A prospective cohort study
    Wiley ; 2023
    In:  Acta Psychiatrica Scandinavica Vol. 147, No. 1 ( 2023-01), p. 92-104
    Details
    In: Acta Psychiatrica Scandinavica, Wiley, Vol. 147, No. 1 ( 2023-01), p. 92-104
    Abstract: Gerontology and ageing research are increasingly focussing on healthy life span (healthspan), the period of life lived free of serious disease and disability. Late‐life depression (LLD) is believed to impact adversely on physical health. However, no studies have examined its effect on healthspan. This study investigated the effect of LLD and subthreshold depression on disability‐free survival, a widely accepted measure of healthspan. Methods This prospective cohort study used data from the ASPirin in Reducing Events in the Elderly study. Participants were aged ≥70 years (or ≥65 years for African‐American and Hispanic participants) and free of dementia, physical disability and cardiovascular disease. Depressive symptoms were measured using the 10‐item Centre for Epidemiological Studies Depression Scale (CES‐D‐10). LLD and subthreshold depression were defined as CES‐D‐10 scores ≥8 and 3–7, respectively. Disability‐free survival was defined as survival free of dementia and persistent physical disability. Results A total of 19,110 participants were followed up for a maximum of 7.3 years. In female participants, LLD was associated with lower disability‐free survival adjusting for sociodemographic and lifestyle factors, medical comorbidities, polypharmacy, physical function and antidepressant use (HR, 1.50; 95% CI, 1.23–1.82). In male participants, LLD was associated with lower disability‐free survival adjusting for sociodemographic and lifestyle factors (HR, 1.30; 95% CI, 1.03–1.64). Subthreshold depression was also associated with lower disability‐free survival in both sexes. Conclusions LLD may be a common and important risk factor for shortened healthspan.
    Type of Medium: Online Resource
    ISSN: 0001-690X , 1600-0447
    URL: Issue
    URL: Article
    DOI: 10.1111/acps.v147.1
    DOI: 10.1111/acps.13513
    RVK:
    XA 10000
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2378389-8
    detail.hit.zdb_id: 2005703-9
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