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Article ; Online: Time-Varying Effect Models for Examining Age-Dynamic Associations in Gerontological Research.

Costello, Darcé M / Murphy, Terrence E

2022 Volume 49, Issue 3, Page(s) 289–305

Abstract: Objectives: Dynamic processes unfolding over later adulthood are of prime interest to gerontological researchers. Time-varying effect modeling (TVEM) accommodates dynamic change trajectories, but its use in gerontological research is limited. We ... ...

Abstract	Objectives: Dynamic processes unfolding over later adulthood are of prime interest to gerontological researchers. Time-varying effect modeling (TVEM) accommodates dynamic change trajectories, but its use in gerontological research is limited. We introduce and demonstrate TVEM with an empirical example based on the National Health and Aging Trends Study (NHATS). Methods: We examined (a) age-varying prevalence of past month elevated symptoms of depression and anxiety and (b) age-varying associations between older adults' elevated symptoms of depression and anxiety and needing help with basic activities of daily living and educational attainment. Results: The proportion of participants reporting elevated symptoms of depression and anxiety in the past month increased gradually from 23-29% across the ages 70-92. Individuals needing help with ADLs had higher odds of reporting elevated symptoms of depression and anxiety, however the association was strongest for those in their 60s versus 80s. Across all ages, adults with lower education levels had higher odds of reporting elevated symptoms of depression and anxiety, an association that also varied by age. Conclusion: We demonstrated TVEM's value for studying dynamic associations that vary across chronological age. With the recent availability of free, user-friendly software for implementing TVEM, gerontological researchers have a new tool for exploring complex change processes that characterize older adults' development.
MeSH term(s)	Humans ; Aged ; Adult ; Aging ; Activities of Daily Living ; Anxiety/epidemiology ; Depression/epidemiology
Language	English
Publishing date	2022-07-03
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	753202-7
ISSN	1096-4657 ; 0361-073X
ISSN (online)	1096-4657
ISSN	0361-073X
DOI	10.1080/0361073X.2022.2095606
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Article ; Online: Association Between Daily Average of Mobility Achieved During Physical Therapy Sessions and Hospital-Acquired or Ventilator-Associated Pneumonia among Critically Ill Patients.

Qi, Wei / Murphy, Terrence E / Doyle, Margaret M / Ferrante, Lauren E

Journal of intensive care medicine

2022 Volume 38, Issue 5, Page(s) 418–424

Abstract: Purpose: Hospital-acquired and ventilator-associated pneumonias (HAP and VAP) are associated with increased morbidity and mortality. Immobility is a risk factor for developing ICU-acquired weakness (ICUAW). Early mobilization is associated with improved ...

Abstract	Purpose: Hospital-acquired and ventilator-associated pneumonias (HAP and VAP) are associated with increased morbidity and mortality. Immobility is a risk factor for developing ICU-acquired weakness (ICUAW). Early mobilization is associated with improved physical function, but its association with hospital-acquired (HAP) and ventilator-associated pneumonias (VAP) is unknown. The purpose of this study is to evaluate the association between daily average of highest level of mobility achieved during physical therapy (PT) and incidence of HAP or VAP among critically ill patients. Materials and methods: In a retrospective cohort study of progressive mobility program participants in the medical ICU, we used a validated method to abstract new diagnoses of HAP and VAP. We captured scores on a mobility scale achieved during each inpatient physical therapy session and used a Bayesian, discrete time-to-event model to evaluate the association between daily average of highest level of mobility achieved and occurrence of HAP or VAP. Results: The primary outcome of HAP/VAP occurred in 55 (26.8%) of the 205 participants. Each increase in the daily average of highest level of mobility achieved during PT (0-6 mobility scale) exhibited a protective association with occurrence of HAP or VAP (adjusted hazard ratio [HR] 0.61; 95% CI 0.44, 0.85). Age, baseline ambulatory status, Acute Physiology and Chronic Health Evaluation (APACHE) II, and previous day's mechanical ventilation (MV) status were not significantly associated with the occurrence of HAP/VAP. Conclusions: Among critically ill patients in a progressive mobility program, a higher daily average of highest level of mobility achieved during PT was associated with a decreased risk of HAP or VAP.
MeSH term(s)	Humans ; Pneumonia, Ventilator-Associated/epidemiology ; Pneumonia, Ventilator-Associated/etiology ; Pneumonia, Ventilator-Associated/prevention & control ; Retrospective Studies ; Critical Illness/therapy ; Bayes Theorem ; Intensive Care Units ; Physical Therapy Modalities ; Hospitals
Language	English
Publishing date	2022-10-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	632828-3
ISSN	1525-1489 ; 0885-0666
ISSN (online)	1525-1489
ISSN	0885-0666
DOI	10.1177/08850666221133318
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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: A multivariate joint model to adjust for random measurement error while handling skewness and correlation in dietary data in an epidemiologic study of mortality.

Agogo, George O / Muchene, Leacky / Orindi, Benedict / Murphy, Terrence E / Mwambi, Henry / Allore, Heather G

Annals of epidemiology

2023 Volume 82, Page(s) 8–15

Abstract: Purpose: A substantial proportion of global deaths is attributed to unhealthy diets, which can be assessed at baseline or longitudinally. We demonstrated how to simultaneously correct for random measurement error, correlations, and skewness in the ... ...

Abstract	Purpose: A substantial proportion of global deaths is attributed to unhealthy diets, which can be assessed at baseline or longitudinally. We demonstrated how to simultaneously correct for random measurement error, correlations, and skewness in the estimation of associations between dietary intake and all-cause mortality. Methods: We applied a multivariate joint model (MJM) that simultaneously corrected for random measurement error, skewness, and correlation among longitudinally measured intake levels of cholesterol, total fat, dietary fiber, and energy with all-cause mortality using US National Health and Nutrition Examination Survey linked to the National Death Index mortality data. We compared MJM with the mean method that assessed intake levels as the mean of a person's intake. Results: The estimates from MJM were larger than those from the mean method. For instance, the logarithm of hazard ratio for dietary fiber intake increased by 14 times (from -0.04 to -0.60) with the MJM method. This translated into a relative hazard of death of 0.55 (95% credible interval: 0.45, 0.65) with the MJM and 0.96 (95% credible interval: 0.95, 0.97) with the mean method. Conclusions: MJM adjusts for random measurement error and flexibly addresses correlations and skewness among longitudinal measures of dietary intake when estimating their associations with death.
MeSH term(s)	Humans ; Nutrition Surveys ; Diet/adverse effects ; Eating ; Proportional Hazards Models ; Epidemiologic Studies
Language	English
Publishing date	2023-03-25
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1074355-8
ISSN	1873-2585 ; 1047-2797
ISSN (online)	1873-2585
ISSN	1047-2797
DOI	10.1016/j.annepidem.2023.03.007
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Article ; Online: Association Between Socioeconomic Disadvantage and Decline in Function, Cognition, and Mental Health After Critical Illness Among Older Adults : A Cohort Study.

Jain, Snigdha / Murphy, Terrence E / O'Leary, John R / Leo-Summers, Linda / Ferrante, Lauren E

Annals of internal medicine

2022 Volume 175, Issue 5, Page(s) 644–655

Abstract: Background: Older adults admitted to an intensive care unit (ICU) are at risk for developing impairments in function, cognition, and mental health. It is not known whether socioeconomically disadvantaged older persons are at greater risk for these ... ...

Abstract	Background: Older adults admitted to an intensive care unit (ICU) are at risk for developing impairments in function, cognition, and mental health. It is not known whether socioeconomically disadvantaged older persons are at greater risk for these impairments than their less vulnerable counterparts. Objective: To evaluate the association between socioeconomic disadvantage and decline in function, cognition, and mental health among older survivors of an ICU hospitalization. Design: Retrospective analysis of a longitudinal cohort study. Setting: Community-dwelling older adults in the National Health and Aging Trends Study (NHATS). Participants: Participants with ICU hospitalizations between 2011 and 2017. Measurements: Socioeconomic disadvantage was assessed as dual-eligible Medicare-Medicaid status. The outcome of function was defined as the count of disabilities in 7 activities of daily living and mobility tasks, the cognitive outcome as the transition from no or possible to probable dementia, and the mental health outcome as the Patient Health Questionnaire-4 score in the NHATS interview after ICU hospitalization. The analytic sample included 641 ICU hospitalizations for function, 458 for cognition, and 519 for mental health. Results: After accounting for sociodemographic and clinical characteristics, dual eligibility was associated with a 28% increase in disability after ICU hospitalization (incidence rate ratio, 1.28; 95% CI, 1.00 to 1.64); and nearly 10-fold greater odds of transitioning to probable dementia (odds ratio, 9.79; 95% CI, 3.46 to 27.65). Dual eligibility was not associated with symptoms of depression and anxiety after ICU hospitalization (incidence rate ratio, 1.33; 95% CI, 0.99 to 1.79). Limitation: Administrative data, variability in timing of baseline and outcome assessments, proxy selection. Conclusion: Dual-eligible older persons are at greater risk for decline in function and cognition after an ICU hospitalization than their more advantaged counterparts. This finding highlights the need to prioritize low-income seniors in rehabilitation and recovery efforts after critical illness and warrants investigation into factors leading to this disparity. Primary funding source: National Institute on Aging.
MeSH term(s)	Activities of Daily Living ; Aged ; Aged, 80 and over ; Cognition ; Cohort Studies ; Critical Illness/psychology ; Dementia ; Humans ; Longitudinal Studies ; Medicare ; Mental Health ; Retrospective Studies ; Socioeconomic Factors ; United States/epidemiology
Language	English
Publishing date	2022-03-08
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	336-0
ISSN	1539-3704 ; 0003-4819
ISSN (online)	1539-3704
ISSN	0003-4819
DOI	10.7326/M21-3086
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Article ; Online: Reaction time asymmetries provide insight into mechanisms underlying dominant and non-dominant hand selection.

Dexheimer, Brooke / Przybyla, Andrzej / Murphy, Terrence E / Akpinar, Selcuk / Sainburg, Robert

Experimental brain research

2022 Volume 240, Issue 10, Page(s) 2791–2802

Abstract: Handedness is often thought of as a hand "preference" for specific tasks or components of bimanual tasks. Nevertheless, hand selection decisions depend on many factors beyond hand dominance. While these decisions are likely influenced by which hand might ...

Abstract	Handedness is often thought of as a hand "preference" for specific tasks or components of bimanual tasks. Nevertheless, hand selection decisions depend on many factors beyond hand dominance. While these decisions are likely influenced by which hand might show performance advantages for the particular task and conditions, there also appears to be a bias toward the dominant hand, regardless of performance advantage. This study examined the impact of hand selection decisions and workspace location on reaction time and movement quality. Twenty-six neurologically intact participants performed targeted reaching across the horizontal workspace in a 2D virtual reality environment, and we compared reaction time across two groups: those selecting which hand to use on a trial-by-trial basis (termed the choice group) and those performing the task with a preassigned hand (the no-choice group). Along with reaction time, we also compared reach performance for each group across two ipsilateral workspaces: medial and lateral. We observed a significant difference in reaction time between the hands in the choice group, regardless of workspace. In contrast, both hands showed shorter but similar reaction times and differences between the lateral and medial workspaces in the no-choice group. We conclude that the shorter reaction times of the dominant hand under choice conditions may be due to dominant hand bias in the selection process that is not dependent upon interlimb performance differences.
MeSH term(s)	Functional Laterality ; Hand ; Humans ; Movement ; Psychomotor Performance ; Reaction Time
Language	English
Publishing date	2022-09-06
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1201-4
ISSN	1432-1106 ; 0014-4819
ISSN (online)	1432-1106
ISSN	0014-4819
DOI	10.1007/s00221-022-06451-2
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Article ; Online: Population-Based Estimates of 1-Year Mortality After Major Surgery Among Community-Living Older US Adults.

Gill, Thomas M / Vander Wyk, Brent / Leo-Summers, Linda / Murphy, Terrence E / Becher, Robert D

JAMA surgery

2022 Volume 157, Issue 12, Page(s) e225155

Abstract: Importance: Despite their importance to guiding public health decision-making and policies and to establishing programs aimed at improving surgical care, contemporary nationally representative mortality data for geriatric surgery are lacking.: ... ...

Abstract	Importance: Despite their importance to guiding public health decision-making and policies and to establishing programs aimed at improving surgical care, contemporary nationally representative mortality data for geriatric surgery are lacking. Objective: To calculate population-based estimates of mortality after major surgery in community-living older US adults and to determine how these estimates differ according to key demographic, surgical, and geriatric characteristics. Design, setting, and participants: Prospective longitudinal cohort study with 1 year of follow-up in the continental US from 2011 to 2018. Participants included 5590 community-living fee-for-service Medicare beneficiaries, aged 65 years or older, from the National Health and Aging Trends Study (NHATS). Data analysis was conducted from February 22, 2021, to March 16, 2022. Main outcomes and measures: Major surgeries and mortality over 1 year were identified through linkages with data from the Centers for Medicare & Medicaid Services. Data on frailty and dementia were obtained from the annual NHATS assessments. Results: From 2011 to 2017, of the 1193 major surgeries (from 992 community-living participants), the mean (SD) age was 79.2 (7.1) years; 665 were women (55.7%), and 30 were Hispanic (2.5%), 198 non-Hispanic Black (16.6%), and 915 non-Hispanic White (76.7%). Over the 1-year follow-up period, there were 206 deaths representing 872 096 survey-weighted deaths and 13.4% (95% CI, 10.9%-15.9%) mortality. Mortality rates were 7.4% (95% CI, 4.9%-9.9%) for elective surgeries and 22.3% (95% CI, 17.4%-27.1%) for nonelective surgeries. For geriatric subgroups, 1-year mortality was 6.0% (95% CI, 2.6%-9.4%) for persons who were nonfrail, 27.8% (95% CI, 21.2%-34.3%) for those who were frail, 11.6% (95% CI, 8.8%-14.4%) for persons without dementia, and 32.7% (95% CI, 24.3%-41.0%) for those with probable dementia. The age- and sex-adjusted hazard ratios for 1-year mortality were 4.41 (95% CI, 2.53-7.69) for frailty with a reduction in restricted mean survival time of 48.8 days and 2.18 (95% CI, 1.40-3.40) for probable dementia with a reduction in restricted mean survival time of 44.9 days. Conclusions and relevance: In this study, the population-based estimate of 1-year mortality after major surgery among community-living older adults in the US was 13.4% but was 3-fold higher for nonelective than elective procedures. Mortality was considerably elevated among older persons who were frail or who had probable dementia, highlighting the potential prognostic value of geriatric conditions after major surgery.
MeSH term(s)	Aged ; Humans ; Female ; United States/epidemiology ; Adult ; Middle Aged ; Aged, 80 and over ; Male ; Frailty/mortality ; Longitudinal Studies ; Medicare ; Prospective Studies ; Dementia ; Patient Outcome Assessment ; Treatment Outcome
Language	English
Publishing date	2022-12-14
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2701841-6
ISSN	2168-6262 ; 2168-6254
ISSN (online)	2168-6262
ISSN	2168-6254
DOI	10.1001/jamasurg.2022.5155
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Article ; Online: Modeling success: How to work effectively with your biostatistician.

Lee, Jiha / Kamdar, Biren B / Bergstrom, Jaclyn / Murphy, Terrence E / Gill, Thomas M

Journal of the American Geriatrics Society

2022 Volume 70, Issue 8, Page(s) 2449–2454

MeSH term(s)	Humans ; Research Personnel
Language	English
Publishing date	2022-05-24
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.17888
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Article ; Online: Geriatric vulnerability and the burden of disability after major surgery.

Gill, Thomas M / Murphy, Terrence E / Gahbauer, Evelyne A / Leo-Summers, Linda / Becher, Robert D

Journal of the American Geriatrics Society

2022 Volume 70, Issue 5, Page(s) 1471–1480

Abstract: Background: Strong epidemiologic evidence linking indicators of geriatric vulnerability to long-term functional outcomes after major surgery is lacking. The objective of this study was to evaluate the association between geriatric vulnerability and the ... ...

Abstract	Background: Strong epidemiologic evidence linking indicators of geriatric vulnerability to long-term functional outcomes after major surgery is lacking. The objective of this study was to evaluate the association between geriatric vulnerability and the burden of disability after hospital discharge for major surgery. Methods: From a prospective longitudinal study of 754 nondisabled community-living persons, aged 70 years or older, 327 admissions for major surgery were identified from 247 participants who were discharged from the hospital from March 1997 to December 2017. The indicators of geriatric vulnerability were ascertained immediately prior to the major surgery or during the prior comprehensive assessment, which was completed every 18 months. Disability in 13 essential, instrumental and mobility activities was assessed each month. Results: The burden of disability over the 6 months after major surgery was considerably greater for non-elective than elective surgery. In multivariable analysis, 10 factors were independently associated with disability burden: age 85 years or older, female sex, Black race or Hispanic ethnicity, neighborhood disadvantage, multimorbidity, frailty, one or more disabilities, low functional self-efficacy, smoking, and obesity. The burden of disability increased with each additional vulnerability factor, with mean values (credible intervals) increasing from 1.6 (1.4-1.9) disabilities for 0-1 vulnerability factors to 6.6 (6.0-7.2) disabilities for 7 or more vulnerability factors. The corresponding values were 1.2 (0.9-1.5) and 5.9 (5.0-6.7) disabilities for elective surgery and 2.6 (2.1-3.1) and 8.2 (7.3-9.2) disabilities for non-elective surgery. Conclusions: The burden of disability after hospital discharge for major surgery increases progressively as the number of geriatric vulnerability factors increases. These factors can be used to identify older persons who are particularly susceptible to poor functional outcomes after major surgery, and a subset may be amenable to intervention, including frailty, low functional self-efficacy, smoking, and obesity.
MeSH term(s)	Activities of Daily Living ; Aged ; Aged, 80 and over ; Disability Evaluation ; Disabled Persons ; Female ; Frailty ; Geriatric Assessment ; Humans ; Longitudinal Studies ; Obesity ; Prospective Studies
Language	English
Publishing date	2022-02-24
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.17693
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Article ; Online: Acute hospital use in older adults following the 2015 Dutch reform of long-term care: an interrupted time series analysis.

Wammes, Joost D / Bakx, Pieter / Wouterse, Bram / Buurman, Bianca M / Murphy, Terrence E / MacNeil Vroomen, Janet L

The lancet. Healthy longevity

2023 Volume 4, Issue 6, Page(s) e257–e264

Abstract: Background: In 2015, the Dutch government implemented a long-term care (LTC) reform primarily designed to promote older adults to age-in-place. Increased proportions of older adults living in the community might have resulted in more and longer acute ... ...

Abstract	Background: In 2015, the Dutch government implemented a long-term care (LTC) reform primarily designed to promote older adults to age-in-place. Increased proportions of older adults living in the community might have resulted in more and longer acute hospitalisations. The aims of this study were to evaluate whether the Dutch 2015 LTC reform was associated with immediate and longitudinal increases in the monthly rate of acute clinical hospitalisation and monthly average hospital length of stay (LOS) in adults aged 65 years or older. Methods: In this interrupted time series analysis of national hospital data (2009-18), we evaluated the association of the Dutch 2015 LTC reform with the monthly rate of acute clinical hospitalisation and monthly average LOS for older adults (aged ≥65 years). Patient-level episodic hospital data were provided by Dutch Hospital Data. Records were included that were defined as an acute clinical hospital admission for which a medical specialist decided treatment was necessary within 24 h. The analysis controlled for population growth (Dutch population data was provided by Statistics Netherlands) and seasonality, and calculated adjusted incident rate ratios (IRR). Findings: Before the 2015 LTC reform, the rate of acute monthly hospitalisation was increasing (IRR 1·002 [95% CI 1·001-1·002]). A positive average reform effect was observed (1·116 [1·070-1·165]), accompanied by a negative change in trend (0·997 [0·996-0·998]) that resulted in a decreasing trend over the post-reform period (0·998 [0·998-0·999]). The pre-reform trend of LOS was decreasing (0·998 [0·997-0·998]), and the 2015 reform exhibited a positive change in trend (1·002 [1·002-1·003]) that resulted in a stabilisation of LOS in the post-reform period (0·999 [0·999-1·000]). Interpretation: Our findings suggest that the increase in the rate of acute hospitalisation after the reform implementation was temporary, whereas the increase in LOS post-reform appeared to last longer than expected. These results have the potential to inform policy makers about effects of ageing-in-place LTC strategies on health and curative care. Funding: The Netherlands Organization for Health Research and Development, the Yale Claude Pepper Center, and the National Center for Advancing Translational Sciences, National Institutes of Health. Translation: For the Dutch translation of the abstract see Supplementary Materials section.
MeSH term(s)	United States ; Humans ; Aged ; Long-Term Care ; Interrupted Time Series Analysis ; Hospitalization ; Aging ; Hospitals
Language	English
Publishing date	2023-06-01
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ISSN	2666-7568
ISSN (online)	2666-7568
DOI	10.1016/S2666-7568(23)00064-8
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In stock of ZB MED Cologne/Königswinter

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Inter-library loan at ZB MED