Summary of Articles from the Journal of the American Geriatrics Society: October 2010, Volume 58
Reviewed, prepared, and submitted by Joseph G. Ouslander, MD, Executive Editor, Journal of the American Geriatrics Society Title: Physician Consultation, Multidisciplinary Care, and 1-Year Mortality in Medicare Recipients Hospitalized with Hip and Lower Extremity Injuries Authors: Adams AL, Schiff M, Koepsell TD, et al Summary: The authors conducted a retrospective cohort study in to determine whether routine surgeon consultation with medicine specialists and multidisciplinary care conferences are associated with lower 1-year mortality in older adults with hip and lower extremity injuries among 2538 Medicare recipients aged 67 and older hospitalized in Oregon hospitals in 2002. All Oregon hospitals with a qualifying case were surveyed using a structured telephone interview to collect information about routine surgeon consultations and multidisciplinary care conferences for older adult orthopedic patients. After adjusting for age, injury severity, comorbid conditions, trauma center status, and hospital annual volume of patients with hip fracture, the relative odds of dying in the year after injury for inpatients treated in settings with routine surgeon consultation with medical staff was 0.69 (95% CI, 0.57–0.83) compared with patients not treated in such settings. Inpatient treatment in settings with routine multidisciplinary care conferences did not significantly affect the relative odds of dying in the year after injury (OR=1.06; 95% CI, 0.89–1.26). The authors conclude that routine consultation by attending orthopedic surgeons with medicine or primary care specialists for Medicare inpatients is associated with better survival 1 year after injury. Comment: This observational study reinforces other studies in the literature that demonstrate the value of medical co-management of elderly hip fracture patients. Many hospitals in the U.S. as well as in other countries have developed services that involve close collaboration between geriatricians and orthopedic surgeons. Such interdisciplinary collaboration will hopefully become more widespread and contribute to improving the outcomes of geriatric orthopedic patients while reducing in-hospital complications that interfere with functional recovery, reduce quality of life, and result in excess healthcare costs. The opinions expressed are solely those of the reviewer and do not necessarily reflect those of the American Geriatrics Society or the Journal of the American Geriatrics Society. ______________________________________________________________________ Title: Sisters in Motion: A Randomized Controlled Trial of a Faith-Based Physical Activity Intervention Authors: Duru OK, Sarkisian CA, Leng M, and Mangione CM Summary: This randomized controlled trial evaluated a faith-based intervention (Sisters in Motion) designed to increase walking in older, sedentary African-American women. The study was carried out in three Los Angeles churches using within-church randomization. Sixty-two African-American women aged 60 and older who reported being active less than 30 minutes three times per week and walked less than 35,000 steps per week as measured using a baseline pedometer reading were enrolled in the trial. Intervention participants received a multi-component curriculum including scripture readings, prayer, goal-setting, a community resource guide, and walking competitions. Intervention and control participants both participated in physical activity sessions. Outcomes, assessed at baseline and 6 months after the intervention, included change in weekly steps walked as measured using the pedometer; and change in systolic blood pressure (SBP). Eighty-five percent of participants attended at least six of eight sessions. Intervention participants averaged 12,727 steps per week at baseline, compared with 13,089 steps in controls. Mean baseline SBP was 156 mm Hg for intervention participants and 147 mm Hg for controls (P=.10). At 6 months, intervention participants had increased their weekly steps by 9883 on average, compared with an increase of 2426 for controls (P=.02); SBP decreased on average by 12.5 mm Hg in intervention participants and only 1.5 mm Hg in controls (P=.007). Comment: This relatively small randomized trial of an innovative church-based lifestyle intervention program yielded remarkable results. Intervention participants overall increased their walking by approximately 75%, and had an approximately 8% reduction in SBP. Both of these improvements were statistically significant compared with the control group. This intervention should be further studied to determine its longer-term impact on overall health, function, and quality of life. If positive impacts are demonstrated, Sisters in Motion could easily be replicated in churches as well as senior centers across the United States and yield major health benefits to sedentary African-American women. The opinions expressed are solely those of the reviewer and do not necessarily reflect those of the American Geriatrics Society or the Journal of the American Geriatrics Society. ______________________________________________________________________ Title: Sleep Disturbances and Adverse Driving Events in a Predominantly Male Cohort of Active Older Drivers Authors: Vaz Fragoso CA, Araujo KLB, Van Ness PL, and Marottoli RA Summary: The authors conducted a longitudinal study to evaluate the association between sleep disturbances and adverse driving events among 430 older persons (mean age, 78.5; 84.9% male) who drove at least once a week recruited from clinic and community sites in New Haven, Connecticut. Baseline measures included self-reported driving patterns and sleep questionnaires (Insomnia Severity Index [ISI], Epworth Sleepiness Scale [ESS], and Sleep Apnea Clinical Score [SACS]). The primary outcome was an adverse driving event based on self-report and driving records and categorized as a crash or traffic infraction (composite I) or as a crash, traffic infraction, near crash, or getting lost (composite II). Participants reported driving a median of 17.0 miles per day, with 96.7% driving daily or every other day. Although 26.0% had insomnia (ISI ≥ 8), 19.3% had daytime drowsiness (ESS ≥ 10), and 19.9% had high sleep apnea risk (SACS > 15), the median scores for the ISI, ESS, and SACS were normal at 3.0, 6.0, and 8.0, respectively, and only 5.1% reported drowsy driving. Over a period of up to 2 years, 24.9% and 51.4% of participants had a composite I and II driving event, respectively. In unadjusted and adjusted multivariable models, insomnia, daytime drowsiness, and high sleep apnea risk were not associated with a composite I or II driving event. The authors conclude that in this predominantly male cohort of active older drivers, sleep disturbances were mild and not associated with adverse driving events, and recommend that future studies evaluate whether sleep disturbances are more important as a mechanism that underlies driving cessation rather than compromising driving safety. Comment: This is one of two papers in the October 2010 issue of the Journal of the American Geriatrics Society that offer somewhat surprising results. The study reviewed above failed to show a relationship between sleep disturbances and adverse driving events—a relationship that, based on other literature as well as common sense, one would think exists. The authors suggest that poor sleep may in fact cause older drivers to cease driving—a hypothesis that requires testing given the huge public health and safety implications of impaired older drivers. A second paper in the October issue reports that longer self-reported sleep duration (> 7 hours) was associated with higher mortality in a large cohort of people age 60 and older followed over 7 years, and that sleeping only 6 hours per night was not associated with higher mortality than sleeping 7 hours. This finding runs counter to the commonly cited belief that more sleep results in better health outcomes. Further research to confirm these findings and examine mechanisms underlying them will be of great interest. The opinions expressed are solely those of the reviewer and do not necessarily reflect those of the American Geriatrics Society or the Journal of the American Geriatrics Society.