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Article ; Online: A risk model for decline in health status after acute myocardial infarction among older adults.

Hajduk, Alexandra M / Dodson, John A / Murphy, Terrence E / Chaudhry, Sarwat I

Journal of the American Geriatrics Society

2022 Volume 71, Issue 4, Page(s) 1228–1235

Abstract: Background: Health status is increasingly recognized as an important patient-centered outcome after acute myocardial infarction (AMI). Yet drivers of decline in health status after AMI remain largely unknown in older adults. We sought to develop and ... ...

Abstract	Background: Health status is increasingly recognized as an important patient-centered outcome after acute myocardial infarction (AMI). Yet drivers of decline in health status after AMI remain largely unknown in older adults. We sought to develop and validate a predictive risk model for health status decline among older adult survivors of AMI. Methods: Using data from a prospective cohort study conducted from 2013 to 2017 of 3041 patients age ≥75 years hospitalized with acute myocardial infarction at 94 U.S. hospitals, we examined a broad array of demographic, clinical, functional, and psychosocial variables for their association with health status decline, defined as a decrease of ≥5 points in the Short Form-12 (SF-12) physical component score from hospitalization to 6 months post-discharge. Model selection was performed in logistic regression models of 20 imputed datasets to yield a parsimonious risk prediction model. Model discrimination and calibration were evaluated using c-statistics and calibration plots, respectively. Results: Of the 2571 participants included in the main analyses, 30% of patients experienced health status decline from hospitalization to 6 months post-discharge. The risk model contained 14 factors, 10 associated with higher risk of health status decline (age, pre-existing AMI, pre-existing cancer, pre-existing COPD, pre-existing diabetes, history of falls, presenting Killip class, acute kidney injury, baseline health status, and mobility impairment) and four associated with lower risk of health status decline (male sex, higher hemoglobin, receipt of revascularization, and arrhythmia during hospitalization). The model displayed good discrimination (c-statistic = 0.74 in validation cohort) and calibration (p > 0.05) in both development and validation cohorts. Conclusions: We used split sampling to develop and validate a risk model for health status decline in older adults after hospitalization for AMI and identified several risk factors that may be modifiable to mitigate the threat of this important patient-centered outcome. External validation of this risk model is warranted.
MeSH term(s)	Humans ; Male ; Aged ; Prospective Studies ; Aftercare ; Patient Discharge ; Myocardial Infarction/complications ; Health Status
Language	English
Publishing date	2022-12-15
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	80363-7
ISSN	1532-5415 ; 0002-8614
ISSN (online)	1532-5415
ISSN	0002-8614
DOI	10.1111/jgs.18162
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Article ; Online: Association of Financial Strain With Mortality Among Older US Adults Recovering From an Acute Myocardial Infarction.

Falvey, Jason R / Hajduk, Alexandra M / Keys, Christopher R / Chaudhry, Sarwat I

JAMA internal medicine

2022 Volume 182, Issue 4, Page(s) 445–448

MeSH term(s)	Adult ; Aged ; Humans ; Middle Aged ; Myocardial Infarction ; Risk Factors
Language	English
Publishing date	2022-02-21
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2699338-7
ISSN	2168-6114 ; 2168-6106
ISSN (online)	2168-6114
ISSN	2168-6106
DOI	10.1001/jamainternmed.2021.8569
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Article ; Online: Racial disparities among older adults with acute myocardial infarction: The SILVER-AMI study.

Demkowicz, Patrick C / Hajduk, Alexandra M / Dodson, John A / Oladele, Carol R / Chaudhry, Sarwat I

Journal of the American Geriatrics Society

2022 Volume 71, Issue 2, Page(s) 474–483

Abstract: Background: Despite an aging population, little is known about racial disparities in aging-specific functional impairments and mortality among older adults hospitalized for acute myocardial infarction (AMI).: Methods: We analyzed data from patients ... ...

Abstract	Background: Despite an aging population, little is known about racial disparities in aging-specific functional impairments and mortality among older adults hospitalized for acute myocardial infarction (AMI). Methods: We analyzed data from patients aged 75 years or older who were hospitalized for AMI at 94 US hospitals from 2013 to 2016. Functional impairments and geriatric conditions were assessed in-person during the AMI hospitalization. The association between race and risk of mortality (primary outcome) was evaluated with logistic regression adjusted sequentially for age, clinical characteristics, and measures of functional impairment and other conditions associated with aging. Results: Among 2918 participants, 2668 (91.4%) self-identified as White and 250 (8.6%) as Black. Black participants were younger (80.8 vs 81.7 years; p = 0.010) and more likely to be female (64.8% vs 42.5%; p < 0.001). Black participants were more likely to present with impairments in cognition (37.6% vs 14.5%; p < 0.001), mobility (66.0% vs 54.6%; p < 0.001) and vision (50.1% vs 35.7%; p < 0.001). Black participants were also more likely to report a disability in one or more activities of daily living (22.4% vs 13.0%; p < 0.001) and an unintentional loss of more than 10 lbs in the year prior to hospitalization (37.2% vs 13.0%; p < 0.001). The unadjusted odds of 6-month mortality among Black participants (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.4-2.8) attenuated to non-significance after adjustment for age, clinical characteristics (OR 1.70, 95% CI 1.7, 1.2-2.5), and functional/geriatric conditions (OR 1.5, 95% CI 1.0-2.2). Conclusions: Black participants had a more geriatric phenotype despite a younger average age, with more functional impairments. Controlling for functional impairments and geriatric conditions attenuated disparities in 6-month mortality somewhat. These findings highlight the importance of systematically assessing functional impairment during hospitalization and also ensuring equitable access to community programs to support post-AMI recovery among Black older adults.
MeSH term(s)	Female ; Humans ; Male ; Activities of Daily Living ; Hospitalization ; Hospitals ; Myocardial Infarction/ethnology ; United States/epidemiology ; Black or African American ; White ; Health Status Disparities
Language	English
Publishing date	2022-11-23
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	80363-7
ISSN	1532-5415 ; 0002-8614
ISSN (online)	1532-5415
ISSN	0002-8614
DOI	10.1111/jgs.18084
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Article ; Online: Comparisons Between GPS-based and Self-reported Life-space Mobility in Older Adults.

Bai, Chen / Zapata, Ruben / Karnati, Yashaswi / Smail, Emily / Hajduk, Alexandra M / Gill, Thomas M / Ranka, Sanjay / Manini, Todd M / Mardini, Mamoun T

AMIA ... Annual Symposium proceedings. AMIA Symposium

2023 Volume 2022, Page(s) 212–220

Abstract: Assessments of Life-space Mobility (LSM) evaluate the locations of movement and their frequency over a period of time to understand mobility patterns. Advancements in and miniaturization of GPS sensors in mobile devices like smartwatches could facilitate ...

Abstract	Assessments of Life-space Mobility (LSM) evaluate the locations of movement and their frequency over a period of time to understand mobility patterns. Advancements in and miniaturization of GPS sensors in mobile devices like smartwatches could facilitate objective and high-resolution assessment of life-space mobility. The purpose of this study was to compare self-reported measures to GPS-based LSM extracted from 27 participants (44.4% female, aged 65+ years) who wore a smartwatch for 1-2 weeks at two different site locations (Connecticut and Florida). GPS features (e.g., excursion size/span) were compared to self-reported LSM with and without an indicator for needing assistance. Although correlations between self-reported measures and GPS-based LSM were positive, none were statistically significant. The correlations improved slightly when needing assistance was included, but statistical significance was achieved only for excursion size (r=0.40, P=0.04). The poor correlations between GPS-based and self-reported indicators suggest that they capture different dimensions of life-space mobility.
MeSH term(s)	Humans ; Female ; Aged ; Male ; Self Report ; Activities of Daily Living ; Computers, Handheld ; Movement
Language	English
Publishing date	2023-04-29
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ISSN	1942-597X
ISSN (online)	1942-597X
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Article ; Online: Sex Differences in Symptom Complexity and Door-to-Balloon Time in Patients With ST-Elevation Myocardial Infarction.

Brush, John E / Chaudhry, Sarwat I / Dreyer, Rachel P / D'Onofrio, Gail / Greene, Erich J / Hajduk, Alexandra M / Lu, Yuan / Krumholz, Harlan M

The American journal of cardiology

2023 Volume 197, Page(s) 101–107

Abstract: Greater symptom complexity in women than in men could slow acute ST-elevation myocardial infarction (STEMI) recognition and delay door-to-balloon (D2B) times. We sought to determine the sex differences in symptom complexity and their relation to D2B ... ...

Abstract	Greater symptom complexity in women than in men could slow acute ST-elevation myocardial infarction (STEMI) recognition and delay door-to-balloon (D2B) times. We sought to determine the sex differences in symptom complexity and their relation to D2B times in 1,677 young and older patients with STEMI using data from the VIRGO and SILVER-AMI studies. Symptom complexity was defined by the number of symptom patterns or phenotypes and average number of symptoms. The numbers of symptom phenotypes were compared in women and men using the Monte Carlo permutation testing. Groups were also compared using the generalized linear regression and logistic regression. The number of symptom phenotypes (244 vs 171, p = 0.02), mean number of symptoms (4.7 vs 4.2, p <0.001), and mean D2B time (114.6 vs 97.8 minutes, p = 0.004) were greater in young women than in young men but were not significantly different in older women compared with older men. The regression analysis did not show a relation between symptom complexity and D2B time overall; although, chest pain was a significant predictor of D2B times, and young women were more likely to report symptoms other than chest pain. Among patients with STEMI, 36% did not receive percutaneous coronary intervention (PCI), which was associated with presentation delay >6 hours. In patients with STEMI with either D2B time ≥90 minutes or no PCI, women had significantly more symptom phenotypes overall and in VIRGO but not in SILVER-AMI. In conclusion, the markers of symptom complexity were not associated with D2B time overall, but more symptom phenotypes in young women were associated with prolonged D2B time or no PCI. In addition, greater frequency of nonchest pain symptoms in young women may have also slowed the recognition of STEMI and D2B times in young women. Further research on symptoms clusters is needed to improve the recognition of STEMIs to improve the D2B times in young women.
MeSH term(s)	Humans ; Male ; Female ; ST Elevation Myocardial Infarction/surgery ; ST Elevation Myocardial Infarction/diagnosis ; Myocardial Infarction/diagnosis ; Sex Characteristics ; Time Factors ; Percutaneous Coronary Intervention
Language	English
Publishing date	2023-04-14
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	80014-4
ISSN	1879-1913 ; 0002-9149
ISSN (online)	1879-1913
ISSN	0002-9149
DOI	10.1016/j.amjcard.2023.03.009
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Article ; Online: Associations of Social Support With Physical and Mental Health Symptom Burden After COVID-19 Hospitalization Among Older Adults.

Lee, Seohyuk / McAvay, Gail J / Geda, Mary / Chattopadhyay, Sumon / Acampora, Denise / Araujo, Katy / Charpentier, Peter / Gill, Thomas M / Hajduk, Alexandra M / Cohen, Andrew B / Ferrante, Lauren E

The journals of gerontology. Series A, Biological sciences and medical sciences

2024 Volume 79, Issue 5

Abstract: Background: Despite significant support system disruptions during the coronavirus 2019 (COVID-19) pandemic, little is known about the relationship between social support and symptom burden among older adults following COVID-19 hospitalization.: ... ...

Abstract	Background: Despite significant support system disruptions during the coronavirus 2019 (COVID-19) pandemic, little is known about the relationship between social support and symptom burden among older adults following COVID-19 hospitalization. Methods: From a prospective cohort of 341 community-living persons aged ≥60 years hospitalized with COVID-19 between June 2020 and June 2021 who underwent follow-up at 1, 3, and 6 months after discharge, we identified 311 participants with ≥1 follow-up assessment. Social support prehospitalization was ascertained using a 5-item version of the Medical Outcomes Study Social Support Survey (range, 5-25), with low social support defined as a score ≤15. At hospitalization and each follow-up assessment, 14 physical symptoms were assessed using a modified Edmonton Symptom Assessment System inclusive of COVID-19-relevant symptoms. Mental health symptoms were assessed using Patient Health Questionnaire-4. Longitudinal associations between social support and physical and mental health symptoms, respectively, were evaluated through multivariable regression. Results: Participants' mean age was 71.3 years (standard deviation, 8.5), 52.4% were female, and 34.2% were of Black race or Hispanic ethnicity. 11.8% reported low social support. Over the 6-month follow-up period, low social support was independently associated with higher burden of physical symptoms (adjusted rate ratio [aRR], 1.26; 95% confidence interval [CI], 1.05-1.52), but not mental health symptoms (aRR, 1.14; 95% CI, 0.85-1.53). Conclusions: Low social support is associated with greater physical, but not mental health, symptom burden among older survivors of COVID-19 hospitalization. Our findings suggest a potential need for social support screening and interventions to improve post-COVID-19 symptom management in this vulnerable group.
MeSH term(s)	Humans ; COVID-19/psychology ; COVID-19/epidemiology ; Aged ; Female ; Male ; Social Support ; Hospitalization/statistics & numerical data ; Prospective Studies ; SARS-CoV-2 ; Mental Health ; Middle Aged ; Aged, 80 and over ; Symptom Burden
Language	English
Publishing date	2024-04-01
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	1223643-3
ISSN	1758-535X ; 1079-5006
ISSN (online)	1758-535X
ISSN	1079-5006
DOI	10.1093/gerona/glae092
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Article: Sedentary Behavior and Cardiovascular Risk in Older Adults: a Scoping Review.

Hajduk, Alexandra M / Chaudhry, Sarwat I

Current cardiovascular risk reports

2016 Volume 10, Issue 1

Abstract: Sedentary behavior is an emerging risk factor for cardiovascular disease (CVD) and may be particularly relevant to the cardiovascular health of older adults. This scoping review describes the existing literature examining the prevalence of sedentary time ...

Abstract	Sedentary behavior is an emerging risk factor for cardiovascular disease (CVD) and may be particularly relevant to the cardiovascular health of older adults. This scoping review describes the existing literature examining the prevalence of sedentary time in older adults with CVD and the association of sedentary behavior with cardiovascular risk in older adults. We found that older adults with CVD spend >75 % of their waking day sedentary, and that sedentary time is higher among older adults with CVD than among older adults without CVD. High sedentary behavior is consistently associated with worse cardiac lipid profiles and increased cardiac risk scores in older adults; the associations of sedentary behavior with blood pressure, CVD incidence, and CVD-related mortality among older adults are less clear. Future research with larger sample sizes using validated methods to measure sedentary behavior are needed to clarify the association between sedentary behavior and cardiovascular outcomes in older adults.
Language	English
Publishing date	2016-01-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	2489103-4
ISSN	1932-9563 ; 1932-9520
ISSN (online)	1932-9563
ISSN	1932-9520
DOI	10.1007/s12170-016-0485-6
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Article ; Online: Rates of Medical Student Placement Into Graduate Medical Education by Sex, Race and Ethnicity, and Socioeconomic Status, 2018-2021.

Nguyen, Mytien / Chaudhry, Sarwat I / Desai, Mayur M / Hajduk, Alexandra M / McDade, William A / Fancher, Tonya L / Boatright, Dowin

JAMA network open

2022 Volume 5, Issue 8, Page(s) e2229243

MeSH term(s)	Education, Medical, Graduate ; Ethnicity ; Humans ; Social Class ; Socioeconomic Factors ; Students, Medical
Language	English
Publishing date	2022-08-01
Publishing country	United States
Document type	Journal Article
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2022.29243
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Article ; Online: Emergency department clinician satisfaction with an APRN-led geriatric emergency medicine service consult team.

Moreines, Laura T / Gettel, Cameron J / Hajduk, Alexandra M / Kukulka, Shannon / Lai, James M / Ouellet, Jennifer A

Journal of the American Geriatrics Society

2022 Volume 71, Issue 3, Page(s) 991–994

MeSH term(s)	Humans ; Aged ; Advanced Practice Nursing ; Emergency Medical Services ; Emergency Service, Hospital ; Personal Satisfaction ; Emergency Medicine
Language	English
Publishing date	2022-11-24
Publishing country	United States
Document type	Letter ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	80363-7
ISSN	1532-5415 ; 0002-8614
ISSN (online)	1532-5415
ISSN	0002-8614
DOI	10.1111/jgs.18133
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Article ; Online: Perceived dementia risk and advance care planning among older adults.

Lee, Yu Kyung / Fried, Terri R / Costello, Darcé M / Hajduk, Alexandra M / O'Leary, John R / Cohen, Andrew B

Journal of the American Geriatrics Society

2022 Volume 70, Issue 5, Page(s) 1481–1486

Abstract: Background: Although advance care planning (ACP) is beneficial if dementia develops, and virtually all older adults are at risk for this disease, older adults do not consistently engage in ACP. Health behavior models have highlighted the importance of ... ...

Abstract	Background: Although advance care planning (ACP) is beneficial if dementia develops, and virtually all older adults are at risk for this disease, older adults do not consistently engage in ACP. Health behavior models have highlighted the importance of perceived susceptibility to medical conditions in motivating behavior. Following these models, we sought to determine how often older adults believe they are not at risk of developing dementia and to examine the association between perceived dementia risk and ACP participation. Methods: We performed a cross-sectional study of community-dwelling adults without cognitive impairment, aged ≥65 years, who were interviewed for the Health and Retirement Study in 2016 and asked about their perceived dementia risk (n = 711). Perceived dementia risk was ascertained with this question: "on a scale of 0 to 100, what is the percent chance that you will develop dementia sometime in the future?" We used multivariable-adjusted logistic regression to evaluate the association between perceived risk (0% versus >0%) and completion of a living will, appointment of a durable power of attorney for healthcare decisions, and discussion of treatment preferences. Results: Among respondents, 10.5% reported a perceived dementia risk of 0%. Perceived risk of 0% was associated with lower odds of completing a living will (OR 0.53; 95% CI, 0.30-0.93) and discussing treatment preferences (OR 0.51; 95% CI, 0.28-0.93) but not appointment of a durable power of attorney (OR 0.77; 95% CI, 0.42-1.39). Many respondents with perceived dementia risk >0% had not completed ACP activities, including a substantial minority of those with perceived risk >50%. Conclusions: Older adults with no perceived dementia risk are less likely to participate in several forms of ACP, but the fact that many older adults with high levels of perceived risk had not completed ACP activities suggests that efforts beyond raising risk awareness are needed to increase engagement.
MeSH term(s)	Advance Care Planning ; Aged ; Cross-Sectional Studies ; Dementia/epidemiology ; Humans ; Independent Living ; Living Wills
Language	English
Publishing date	2022-03-11
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	80363-7
ISSN	1532-5415 ; 0002-8614
ISSN (online)	1532-5415
ISSN	0002-8614
DOI	10.1111/jgs.17721
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