@article {11117, title = {Geriatric Syndromes and Atrial Fibrillation: Prevalence and Association with Anticoagulant Use in a National Cohort of Older Americans.}, journal = {Journal of the American Geriatrics Society}, volume = {69}, year = {2021}, pages = {349-356}, abstract = {

BACKGROUND: Although guidelines recommend focusing primarily on stroke risk to recommend anticoagulants in atrial fibrillation (AF), physicians report that geriatric syndromes (e.g., falls and disability) are important when considering anticoagulants. Little is known about the prevalence of geriatric syndromes in older adults with AF or the association with anticoagulant use.

METHODS: We performed a cross-sectional analysis of the 2014 Health and Retirement Study, a nationally representative study of older Americans. Participants were asked questions to assess domains of aging, including function, cognition, and medical conditions. We included participants 65 years and older with 2 years of continuous Medicare enrollment who met AF diagnosis criteria by claims codes. We examined five geriatric syndromes: one or more falls within the last 2 years, receiving help with activities of daily living (ADLs) or instrumental ADLs (IADL), experienced incontinence, and cognitive impairment. We determined the prevalence of geriatric syndromes and their association with anticoagulant use, adjusting for ischemic stroke risk (i.e., CHA DS -VASc score [congestive heart failure, hypertension, age, diabetes mellitus, stroke, vascular disease, and sex]).

RESULTS: In this study of 779 participants with AF (median age = 80 years; median CHA DS -VASc score = 4), 82\% had one or more geriatric syndromes. Geriatric syndromes were common: 49\% reported falls, 38\% had ADL impairments, 42\% had IADL impairments, 37\% had cognitive impairments, and 43\% reported incontinence. Overall, 65\% reported anticoagulant use; guidelines recommend anticoagulant use for 97\% of participants. Anticoagulant use rate decreased for each additional geriatric syndrome (average marginal effect = -3.7\%; 95\% confidence interval = -1.4\% to -5.9\%). Lower rates of anticoagulant use were reported in participants with ADL dependency, IADL dependency, and dementia.

CONCLUSION: Most older adults with AF had at least one geriatric syndrome, and geriatric syndromes were associated with reduced anticoagulant use. The high prevalence of geriatric syndromes may explain the lower than expected anticoagulant use in older adults.

}, keywords = {anticoagulants, Atrial Fibrillation, Epidemiology, geriatric syndromes}, issn = {1532-5415}, doi = {10.1111/jgs.16822}, author = {Sachin J Shah and Margaret C Fang and Sun Y Jeon and Gregorich, Steven E and Kenneth E Covinsky} } @article {8487, title = {Coping With Chronic Stress by Unhealthy Behaviors: A Re-Evaluation Among Older Adults by Race/Ethnicity.}, journal = {Journal of Aging and Health}, volume = {29}, year = {2017}, pages = {805-825}, abstract = {

OBJECTIVE: To assess the role of unhealthy behaviors in the relationship between chronic stress and significant depressive symptoms by race/ethnicity among older adults.

METHOD: Participant data from the 2006 to 2008 Health and Retirement Study were analyzed. Unhealthy behaviors included current smoking, excessive/binge drinking, and obesity. Chronic stress was defined by nine previously used factors. The eight-item Center for Epidemiologic Studies Depression (CES-D) Scale measured depressive symptoms, where >=4 symptoms defined significant. Multivariable logistic regression assessed the effects of chronic stress and unhealthy behaviors in 2006 on depressive symptoms in 2008.

RESULTS: A higher chronic stress index score predicted depressive symptoms in 2008 among African Americans, Latinos, and Whites (adjusted odds ratio [aOR] = 1.78, 95\% confidence interval [CI] = [1.48, 2.15]; aOR = 1.54, 95\% CI = [1.15, 2.05]; and aOR = 1.40, 95\% CI = [1.26, 1.56], respectively). Unhealthy behaviors moderated this relationship among Latinos (aOR = 1.54, 95\% CI = [1.02, 2.33]).

DISCUSSION: Unhealthy behaviors were not effective coping mechanisms for chronic stress in terms of preventing significant depressive symptoms. Instead, they strengthened the relationship between chronic stress and significant depressive symptoms among Latinos.

}, keywords = {Adaptation, Psychological, Aged, California, Chronic disease, Continental Population Groups, depression, Ethnic Groups, Female, Humans, Logistic Models, Longitudinal Studies, Male, Middle Aged, Minority Groups, Risk-Taking, Stress, Psychological, Surveys and Questionnaires}, issn = {1552-6887}, doi = {10.1177/0898264316645548}, author = {Rodriquez, Erik J and Gregorich, Steven E and Livaudais-Toman, Jennifer and Eliseo J Perez-Stable} }